Commercial Determinants of Health

For centuries, many of those seeking to make profit have done so at the expense of the health of individuals. The challenges in the 21st century have deep roots in history, but the commercial determinants of health (CDoH), defined by WHO as “private sector activities that affect people’s health, directly or indirectly, positively or negatively”, are increasingly expressed in new and complex ways. Public health is not in opposition of commercial activity, but there needs to be more nuance in addressing health-harming commercial activity and industries (like tobacco, alcohol, gambling) and find ways of engaging with health-promoting industries.A clear example of the new landscape is the proliferation of social media. Positively, social media provides people with opportunity for connection and socialisation, as well as increasing access to credible health information sources. However, it also brings risks to the health and wellbeing of young people through health-related mis- and dis-information, addictive platform attributes impairing mental health, and targeted marketing of health-harming products. Population health misinformation is prevalent on social media platforms and vaccine misinformation has driven a decline in vaccine uptake, leading to disease outbreaks. Online food advertisement is predominantly of ultra-processed foods, and social media marketing is influencing food choice for adolescents.Exposure to alcohol and smoking content across traditional media and digital media channels is associated with the initiation and use of tobacco and alcohol. Ready access to gambling platforms via the internet and mobile phones has brought gambling into people’s pockets and homes, and despite advertising regulations, gambling firms continue to sponsor major sporting tournaments and expose young people to potential harms through online advertising.The harmful commodities industries use tactics that often undermine science, reframe the discussion and debate, seek to influence the political process, and frequently hide behind corporate goodwill and social responsibility agendas. These tactics, including their promotion of ‘personal and individual responsibility’, make the CDoH an increasingly difficult challenge for public health practitioners.At this year’s festival we hear from researchers and practitioners examining the challenges and opportunities of CDoH, and explore solutions to the underlying tensions to promote the health and wellbeing of the public.