Commercial Determinants of Health and The Future of Public Health

Abstract

Health is closely related to the conditions and environment in which individuals live. In particular, the commercial determinants of health have become a significant factor that directly and indirectly affects public health within the framework of globalized economies and free market dynamics. The commercial determinants of health refer to private sector activities that influence public health positively or negatively, as well as the political and economic systems that facilitate these activities. They also include the norms and practices shaped by these systems and widely accepted by society. While commercial organizations can contribute positively to health and society, there is growing evidence that the products and strategies of certain commercial actors are linked to rising rates of preventable diseases, environmental damage, and social and health inequalities. To counteract the commercial determinants that threaten public health, multidisciplinary approaches should be developed. Therefore, governments, international organizations, the commercial sector, civil society organizations, academics, volunteers, and various segments of society should contribute within their respective areas of responsibility.

Keywords

• Commercial determinants of health
• social determinants of health
• commercial sectors

Sağlığın Ticari Belirleyicileri ve Halk Sağlığının Geleceği

Abstract

Sağlık, bireylerin içinde yaşadıkları koşullar ve çevre ile yakından ilişkilidir. Özellikle sağlığın ticari belirleyicileri, küreselleşen ekonomiler ve serbest piyasa dinamikleri çerçevesinde halk sağlığını doğrudan ve dolaylı olarak etkileyen önemli bir alan haline gelmiştir. Sağlığın ticari belirleyicileri, halk sağlığını olumlu ya da olumsuz yönde etkileyen özel sektör faaliyetleri ile bu faaliyetlere olanak sağlayan politik ve ekonomik sistemlerdir; ayrıca bu sistemlerin etkisiyle şekillenen ve toplumun genel kabul ettiği normlar ve uygulamalardır. Ticari kuruluşlar sağlığa ve topluma olumlu katkıda bulunabilse de bazı ticari aktörlerin ürün ve stratejilerinin, önlenebilir hastalık oranlarının artmasından, gezegene verilen zarardan ve sosyal ve sağlık alanındaki eşitsizlikten sorumlu olduğu yönünde artan kanıtlar vardır. Halk sağlığını tehdit eden ticari belirleyicilere karşı multidisipliner yaklaşımlar geliştirilmelidir. Bu sebeple hükümetler, uluslararası kuruluşlar, ticari sektör, sivil toplum örgütleri, akademisyenler, gönüllüler ve toplumun farklı kesimleri kendi sorumlulukları çerçevesinde katkı sağlamalıdır.

Keywords

• Sağlığın ticari belirleyicileri
• sağlığın sosyal belirleyicileri
• ticari sektörler

References

1. World Health Organization. Determinants of health [Internet]. Erişim adresi: https://www.who.int/news-room/questions-and-answers/item/determinants-of-health
2. World Health Organization. Social determinants of health [Internet]. Erişim adresi: https://www. who.int/health-topics/social-determinants-of-health#tab=tab_1
3. Detels R, Abdool Karim Q, Baum F, Li L, Leyland AH, editors. Oxford Textbook of Global Public Health. 7th ed. Oxford: Oxford University Press; 2021 Nov 1.
4. World Health Organization. Commercial determinants of health [Internet]. Geneva: WHO; 2023. Erişim adresi: https://www.who.int/news-room/fact-sheets/detail/commercial-determinants-of-health
5. Gilmore AB, Fabbri A, Baum F, Bertscher A, Bondy K, Chang HJ, et al. Defining and conceptualising the commercial determinants of health. Lancet. 2023;401(10383):1194-213.
6. Lacy-Nichols J, Nandi S, Mialon M, McCambridge J, Lee K, Jones A, et al. Conceptualising commercial entities in public health: beyond unhealthy commodities and transnational corporations. The Lancet. 2023;401(10383):1214-28.
7. Dahlgren G, Whitehead M. Policies and strategies to promote social equity in health. Background document to WHO - Strategy paper for Europe. Institute for Futures Studies, Arbetsrapport. 1991;14.
8. Dönmez E, Kılıç B. Türkiye Sağlık Raporu 2020. In: Okyay P, Üner S, editors. Türkiye’de Sağlığın Sosyal Belirleyicileri. Ankara: Hipokrat Yayınevi; 2020. p. 1197-205.

9. Gençoğlu AY. Kapitalizme Teorik Yaklaşımlar: Kapitalist Ekonomik Sistemin Temel Nitelikleri Üzerinden Karşılaştırmalı Bir Analiz. Temaşa Erciyes Üniversitesi Felsefe Bölümü Dergisi. 2020(14):237-56.
10. Hoge A, Labeye M, Donneau AF, Nekoee HZ, Husson E, Guillaume M. Health Literacy and Its Associations with Understanding and Perception of Front-of-Package Nutrition Labels among Higher Education Students. Int J Environ Res Public Health. 2022;19(14):8751.
11. Bouguila Siham D. Marketing Mix - An Area of Unethical Practices? British Journal of Marketing Studies. 2013;1(4):20-8.
12. Ndebele P, Shaikh H, Paichadze N, Bari I, Michaels D, Santos Burgoa C, et al. Commercial determinants of health: an ethical exploration. Int J Public Health. 2020;65(7):1123-32.
13. Pitt H, McCarthy S, Arnot G. Children, young people and the Commercial Determinants of Health. Health Promotion International. 2024;39(1):1-10.
14. Commercial determinants of noncommunicable diseases in the WHO European Region. Copenhagen: WHO Regional Office for Europe; 2024.
15. Friel S, Collin J, Daube M, Depoux A, Freudenberg N, Gilmore AB, et al. Commercial determinants of health: future directions. The Lancet. 2023;401(10383):1229-40.
16. Carah N, Brodmerkel S. Alcohol Marketing in the Era of Digital Media Platforms. J Stud Alcohol Drugs. 2021;82(1):18-27.
17. Marmot M, Bell R. Fair society, healthy lives. Public Health. 2012;126(Suppl 1):4-10.
18. Office for Health Improvement and Disparities (OHID). Local Alcohol Profiles for England [Internet]. England: OHID; 2023 Erişim adresi: https://fingertips.phe.org.uk/profile/local-alcohol-profiles/data#page/1
19. Killer tactics. How tobacco, alcohol, and unhealthy food and drink industries hold back public health progress. London; 2024.
20. Venrick SJ, Kelley DE, O’Brien E, Margolis KA, Navarro MA, Alexander JP, et al. U.S. digital tobacco marketing and youth: A narrative review. Prev Med Rep. 2023;31:102094.
21. Jernigan D, Noel J, Landon J, Thornton N, Lobstein T. Alcohol marketing and youth alcohol consumption: a systematic review of longitudinal studies published since 2008. Addiction. 2017;112(Suppl 1):7-20.
22. Gannon J, Bach K, Cattaruzza MS, Bar-Zeev Y, Forberger S, Kilibarda B, et al. Big tobacco’s dirty tricks: Seven key tactics of the tobacco industry. Tob Prev Cessat. 2023;9:39.
23. van Schalkwyk MCI, Petticrew M, Maani N, Hawkins B, Bonell C, Katikireddi SV, et al. Distilling the curriculum: An analysis of alcohol industry-funded school-based youth education programmes. PLoS One. 2022;17(1):e0259560.
24. Malik VS, Popkin BM, Bray GA, Després JP, Willett WC, Hu FB. Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta-analysis. Diabetes Care. 2010;33(11):2477-83.
25. Te Morenga LA, Howatson AJ, Jones RM, Mann J. Dietary sugars and cardiometabolic risk: systematic review and meta-analyses of randomized controlled trials of the effects on blood pressure and lipids. Am J Clin Nutr. 2014;100(1):65-79.
26. Trius-Soler M, Bramming M, Jensen MK, Tolstrup JS, Guasch-Ferré M. Types of dietary sugars and carbohydrates, cardiometabolic risk factors, and risk of diabetes: a cohort study from the general Danish population. Nutr J. 2025;24(1):8.
27. Della Corte KA, Della Corte D, Camacho D, Horgan G, Palmeira AL, Stubbs J, et al. Association and substitution analyses of dietary sugars, starch and fiber for indices of body fat and cardiometabolic risk- a NoHoW sub-study. Eur J Nutr. 2025;64(2):68.
28. Isaksen IM, Dankel SN. Ultra-processed food consumption and cancer risk: A systematic review and meta-analysis. Clin Nutr. 2023;42(6):919-28.
29. BBC News. Dubai chocolate: Mucidi kim, neden popüler oldu? [Internet]. 2024. Erişim adresi: https://www.bbc.com/turkce/articles/cvg7lre9dmvo
30. Roberts M, Pettigrew S, Chapman K, Miller C, Quester P. Compliance with children’s television food advertising regulations in Australia. BMC Public Health. 2012;12(1):846.
31. O’Connor A. Coca-Cola Funds Scientists Who Shift Blame for Obesity Away From Bad Diets: New York Times; 2015. Erişim adresi: https://archive.nytimes. com/well.blogs.nytimes.com/2015/08/09/coca-cola-funds-scientists-who-shift-blame-for-obesity-away-from-bad-diets/
32. Borland S. McDonald’s triumphs over councils’ rejections of new branches—by claiming it promotes “healthier lifestyles”. BMJ. 2025;388:r163.
33. Yıldırım Öztürk EN, Uyar M. Sağliğin Sosyal Belirleyicilerinden Sonra Yeni Bir Konsept: Sağliğin Ticari Belirleyicileri. Eskişehir Türk Dünyası Uygulama ve Araştırma Merkezi Halk Sağlığı Dergisi. 2023;8(1):87-96.
34. Climate Change 2023 Synthesis Report Geneva, Switzerland: The Intergovernmental Panel on Climate Change; 2023.
35. Romanello M, Napoli CD, Green C, Kennard H, Lampard P, Scamman D, et al. The 2023 report of the Lancet Countdown on health and climate change: the imperative for a health-centred response in a world facing irreversible harms. Lancet. 2023;402(10419):2346-94.
36. Tannock S. The oil industry in our schools: from Petro Pete to science capital in the age of climate crisis. Environmental Education Research. 2020;26(4):474-90.
37. van Schalkwyk MCI, Hawkins B, Petticrew M. The politics and fantasy of the gambling education discourse: An analysis of gambling industry-funded youth education programmes in the United Kingdom. SSM - Population Health. 2022;18:101122.
38. Berman ML. Lethal but Legal: Corporations, Consumption, and Protecting Public Health. Journal of Legal Medicine. 2014;35(4):601-8.
39. Raworth K. A Safe and Just Space for Humanity: Can we live within the doughnut? : Oxfam International; 2012.
40. Rockström J, Steffen W, Noone K, Persson Å, Chapin FS, Lambin EF, et al. A safe operating space for humanity. Nature. 2009;461(7263):472-5.