Defining the commercial determinants of health after COVID-19

Abstract

Abstract Background Commercial Determinants of Health (CDoH) and related terms such as ‘Corporate Determinants of Health' have in recent years been applied to the tactics and strategies of corporations that may lead to morbidity and mortality due to non-communicable diseases (NCDs). But the field is at an inflection point. COVID-19 is an infectious disease, and commercial actions that increase COVID-19-related morbidity would typically fall outside CDoH definitions. We therefore felt it was timely to review and analyse the heterogeneity present in this field, and recommend a unified definition of CDoH. Methods We conducted a rapid literature review. We catalogued and analysed the current terms and industries in the academic literature related to CDoH. We mapped the field using a Sankey diagram, which shows the connections between pre-defined nodes. In this case, the nodes are: the terms (e.g. CDoH) and associated sectors (e.g. tobacco, alcohol, or unhealthy foods). We then analysed the definitions using a conceptual framework we developed. Results We screened and included 122 full text articles. Our Sankey diagram demonstrated that ‘commercial determinants of health' is superseding ‘corporate determinants of health' and all other terms as the most common terminology in this field over time. Furthermore, our conceptual framework and analysis demonstrated that the choice of definition has significance for which industries and activities fall within the scope of CDoH research. Conclusions Narrow definitions of CDoH pose a challenge to equity. As the field of CDoH develops, definitions - and the research that flows from them - need to more consistently consider a wider range of both NCDs and IDs, not least to avoid the existing structural inequities in research. A narrow focus on NCDs may skew policy solutions toward those which are most relevant to NCDs and higher income populations. Key messages Researchers in commercial determinants of health(CDoH) have previously called for clarity on the appropriate definition of CDoH in this nascent field, which we provide in our research. We used mixed analytical methods (including literature review, Sankey diagrams, and conceptual frameworks) to develop the field of CDoH research for a post-COVID-19 world.