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The Lancet Series on the commercial determinants of health

- Wits University

The 3-paper Series launching at Wits today is a ground-breaking exposé of the products and practices collectively called the commercial determinants of health.

Just four industries account for at least one-third of global preventable deaths. These industries are: unhealthy processed food and drinks, fossil fuels, alcohol, and tobacco. Collectively they cause 19 million deaths annually.

These are amongst the findings of a series of reports published by The Lancet and to be launched in South Africa in hybrid format at Wits University in Johannesburg on Wednesday, 29 March, at 1pm SAST.

The launch features an eminent panel of local and international public health, civil society, government, scientific, and academic representatives whose discussion will be moderated by Mr Mark Heywood, Founding co-editor of Maverick Citizen.

The Lancet Series on commercial determinants of health is a ground-breaking exposé of the products and practices that are collectively called the commercial determinants of health.

The commercial determinants of health are “the systems, practices, and pathways through which commercial actors drive health and equity.”

The Lancet Series comprises three papers of which academics at the SAMRC/Wits Centre for Health Economics and Decision Science – PRICELESS SA, in the School of Public Health at Wits, are co-authors.

PRICELESS SA Director Professor Karen Hofman and Senior Researcher Dr Agnes Erzse are co-authors of the first report of the Series, titled Defining and conceptualising the commercial determinants of health.

Prof Karen Hofman 2022 ASSAf Science for Society Gold Medal winner

“Policy inertia”

This paper explains how the shift towards market fundamentalism and increasingly powerful transnational corporations has created a pathological system in which commercial actors are increasingly enabled to cause harm and externalise the costs of doing so.

Consequently, as harms to human and planetary health increase, commercial sector wealth and power increase, whereas the countervailing forces having to meet these costs (notably individuals, governments, and civil society organisations) become correspondingly impoverished and disempowered or captured by commercial interests.

This power imbalance leads to policy inertia and although many policy solutions are available, they are not being implemented. Health harms are escalating, leaving healthcare systems increasingly unable to cope. Governments can and must act to improve, rather than continue to threaten, the wellbeing of future generations, development, and economic growth.

Extent of commercial influence on health outcomes

Paper 2 in the Series, titled Conceptualising commercial entities in public health: beyond unhealthy commodities and transnational corporations.

In this paper, the authors develop a framework that enables meaningful distinctions among diverse commercial entities through consideration of their practices, portfolios, resources, organisation, and transparency.

The framework that the authors develop permits fuller consideration of whether, how, and to what extent a commercial actor might influence health outcomes.

Prioritise public interest, challenge contemporary capitalism

Paper 3, titled Commercial determinants of health: future directions is about the future role of the commercial sector in global health and health equity.

The discussion is not about the overthrow of capitalism nor a full-throated embrace of corporate partnerships.

No single solution can eradicate the harms from the commercial determinants of health – the business models, practices, and products of market actors that damage health equity and human and planetary health and wellbeing.

But evidence shows that progressive economic models, international frameworks, government regulation, compliance mechanisms for commercial entities, regenerative business types and models that incorporate health, social, and environmental goals, and strategic civil society mobilisation together offer possibilities of systemic, transformative change, reduce those harms arising from commercial forces, and foster human and planetary wellbeing.

Can humanity survive?

Health and the commercial sector don’t have to be in opposition – in fact, the former are essential to economic development.

But what is needed, stress the Series’ authors, is a global re-balancing of power that prioritises public interests and challenges contemporary capitalism. The energy and innovation of the commercial sector are powerful and could be better harnessed into profitable enterprises that advance health, wellbeing, equity, and society.

The authors leave readers with this statement, “The question is not whether the world has the resources or will to take such actions, but whether humanity can survive if we fail to make this effort.”