Abstract
BackgroundThe term ‘commercial determinants of health’ (CDOH) is increasingly focussing attention upon the role of tobacco, alcohol and food and beverage companies and others—as important drivers of non-communicable diseases (NCDs). However, the CDOH do not seem to be clearly represented in the most common social determinants of health (SDOH) frameworks. We review a wide range of existing frameworks of the determinants of health to determine whether and how commercial determinants are incorporated into current SDOH thinking.MethodsWe searched for papers and non-academic reports published in English since 2000 describing influences on population health outcomes. We included documents with a formal conceptual framework or diagram, showing the integration of the different determinants.ResultsForty-eight framework documents were identified. Only one explicitly included the CDOH in a conceptual diagram. Ten papers discussed the commercial determinants in some form in the text only and fourteen described negative impacts of commercial determinants in the text. Twelve discussed positive roles for the private sector in producing harmful commodities. Overall, descriptions of commercial determinants are frequently understated, not made explicit, or simply missing. The role of commercial actors as vectors of NCDs is largely absent or invisible in many of the most influential conceptual diagrams.ConclusionsOur current public health models may risk framing public health problems and solutions in ways that obscure the role that the private sector, in particular large transnational companies, play in shaping the broader environment and individual behaviours, and thus population health outcomes.
Highlights
Over the last few decades, the complex interactions between individuals, communities and their environments have been a focus of public health practice and research, and to a lesser extent policymaking. These interactions are conceptualized through frameworks, often prominently involving graphical schematic diagrams illustrating the different determinants of health and how they inter-relate
We identified 48 of the most common conceptual frameworks for the social determinants
It is clear that consideration of commercial actors is frequently understated, not made explicit, or missing in many of the most influential conceptual frameworks addressing the social determinants of health (SDOH), with few exceptions (e.g. Libman et al.[9] include reference to the food industry in the context of diet-related noncommunicable diseases (NCDs))
Summary
Over the last few decades, the complex interactions between individuals, communities and their environments have been a focus of public health practice and research, and to a lesser extent policymaking. These interactions are conceptualized through frameworks, often prominently involving graphical schematic diagrams illustrating the different determinants of health and how they inter-relate. Conclusions: Our current public health models may risk framing public health problems and solutions in ways that obscure the role that the private sector, in particular large transnational companies, play in shaping the broader environment and individual behaviours, and population health outcomes
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