How Corporate Actions Shape Public Health

by Jon Scaccia January 20, 2025

Our health is not just shaped by genetics, personal choices, or access to care, but by corporate boardrooms and advertising agencies. The term for these forces is “Commercial Determinants of Health” (CDoH).

CDoH captures how business practices, from aggressive marketing to lobbying, influence behaviors, environments, and policies. The result? A staggering rise in non-communicable diseases (NCDs) like heart disease, diabetes, and cancer, now responsible for 71% of global deaths. How did we get here, and how can we shift this trajectory? Let’s dive into the research to unravel the story.

The Roots of the Problem: A Global Industrial Epidemic

The concept of CDoH gained traction in 2013, coined by Kickbusch et al., who defined it as strategies used by corporations to promote products and choices detrimental to health. Think ultra-processed foods, alcohol, and tobacco—the so-called “unhealthy commodities.” These products aren’t inherently appealing; they’re engineered, marketed, and positioned to dominate our choices.

In the 1990s, lawsuits against Big Tobacco unveiled internal documents exposing how these companies deliberately shaped public policy, undermined scientific evidence, and targeted vulnerable populations. Decades later, similar tactics are evident in industries like alcohol, fast food, and even automobiles.

The commercialization of health has evolved into what some call an “industrial epidemic.” Here, corporations are the vectors of disease, unhealthy commodities the agents, and consumers the hosts. But it’s not just the products themselves—it’s the ecosystems that corporations create to thrive, often at the expense of public health.

How Business Shapes Behavior: The Invisible Strings

Corporations wield power across three interconnected areas:

1. Unhealthy Commodities: Products like sugary drinks, cigarettes, and ultra-processed foods dominate markets because they’re cheap to produce and easy to distribute.
2. Business Practices: Tax avoidance, exploitative labor practices, and supply chain control allow companies to prioritize profits over community well-being.
3. Political Practices: Lobbying, coalition building, and funding favorable research influence policy and public opinion.

Take marketing to children as an example. Studies reveal that advertisements for junk food significantly increase consumption among kids, setting the stage for lifelong habits and health challenges. Efforts to regulate this have often been stymied by corporate lobbying, with industries claiming such restrictions infringe on free speech or consumer choice.

The Global Drivers: Beyond Borders

CDoH is amplified by globalization. As companies expand into emerging markets, they bring with them aggressive marketing campaigns, ultra-processed foods, and exploitative labor practices. Transnational corporations hold immense sway, sometimes eclipsing the regulatory power of national governments.

For example, trade agreements can prioritize corporate rights over public health by reducing tariffs on unhealthy products or restricting governments’ ability to regulate harmful practices. This dynamic often exacerbates health disparities, hitting low- and middle-income countries hardest.

A Case Study: The Double Burden of Malnutrition

One of the starkest examples of CDoH in action is the coexistence of undernutrition and obesity within the same communities—sometimes even the same households. This paradox, driven by corporate practices, underscores how food systems prioritize cheap, calorie-dense options over nutritious, whole foods.

Imagine a single mother in a low-income country. She can buy a bag of chips for a fraction of what fresh produce costs. Corporate lobbying has ensured minimal regulation on junk food, while subsidies on staple crops make processed foods artificially cheap. Her child, consuming these products, faces stunted growth and later, obesity-related illnesses.

Turning the Tide: What Can Be Done?

Despite the grim picture, there’s hope. Researchers and public health advocates have outlined several strategies to mitigate the harm caused by CDoH:

• Regulation: Countries like Chile have implemented front-of-package labeling to warn consumers about high sugar, salt, and fat content. This approach empowers consumers and pressures companies to reformulate products.
• Countering Corporate Power: Supporting communities and organizations that challenge harmful practices can shift the balance of power. For instance, grassroots movements against soda taxes being overturned by lobbying have gained traction in the U.S.
• Rethinking Systems: Some researchers propose moving beyond market-driven economies to models that prioritize health equity. Initiatives like the Lancet Commission’s work on the “Global Syndemic” highlight the interconnectedness of obesity, undernutrition, and climate change.

What’s Next?

The field of CDoH is still young but growing. Researchers are calling for:

• Unified Definitions: A consistent understanding of CDoH can strengthen advocacy and policymaking.
• Holistic Approaches: Tackling CDoH requires systemic interventions, from trade policy reform to stricter advertising regulations.
• Cross-Sector Collaboration: Governments, NGOs, and even corporations themselves need to work together to align profit motives with public health goals.

Public health practitioners also play a crucial role. By focusing on upstream solutions—addressing the systemic causes of ill health rather than individual behaviors—they can drive meaningful change.

Join the Conversation

How do you see the role of corporations in shaping health outcomes in your community? Are there local initiatives addressing CDoH that inspire you? What steps can public health advocates take to hold corporations accountable while fostering healthier systems?

Read More

de Lacy-Vawdon, C., Livingstone, C. Defining the commercial determinants of health: a systematic review. BMC Public Health 20, 1022 (2020). https://doi.org/10.1186/s12889-020-09126-1

Mialon, M. An overview of the commercial determinants of health. Global Health 16, 74 (2020). https://doi.org/10.1186/s12992-020-00607-x

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