Commercial Determinants of Health
Gambling-related harm
Obesity
Smoking prevalence
Non-communicable diseases
Alcohol misuse
Climate change
Adult healthy weight
Healthy places
Healthy people
Deaths
Diabetes
Ethnicity
Wider determinants
Population
Commercial Determinants of Health
Introduction
Health outcomes are determined by the influence of corporate activities on the environment in which people live, work, and socialise. The Commercial Determinants of Health (CDoH) are defined as the “strategies and approaches used by the private sector to promote products and choices that are detrimental to health”.1
Although commercial entities can contribute positively to health and society, there is growing evidence that the products and practices of some commercial actors - notably the largest transnational corporations - are responsible for escalating rates of avoidable ill health, planetary damage, and social and health inequity; these problems are increasingly referred to as the CDoH.
Adopting a CDoH lens in public health, cross-departmentally, and across wider health systems, is crucial to reduce health inequalities and ensure that residents are spending less time living in ill-health, thereby improving healthy life expectancy. Local authorities and public health teams have a part to play in ensuring that sources of information used are politically and commercially impartial. Furthermore, local authorities can support with promoting and raising awareness of tactics used by corporations, with the aim of reducing inequalities and fostering improved health outcomes for residents.
Industry tactics manifest in lots of different ways to create a playbook of mechanisms that can be deployed to maximise the use of harmful products, with profit prioritised over health and society.
These include:
- Political
- Scientific
- Marketing
- Supply chain & waste
- Labour & employment
- Financial
- Reputation management
Corporate influence extends beyond aggressive marketing, to industry-funded research and social responsibility messages, designed by those who increase exposure of harms in the first instance. Across the health system, this has become apparent when looking at food insecurity, alcohol and substance misuse, climate change, tobacco, Best Start in Life initiatives, and (online) gambling-related harm.
This brief overview exemplifies how the CDoH is interwoven with other public health topics, and can contribute towards some of the main drivers of what makes us healthy, such as the food that we eat, and our surroundings: ‘the building blocks for good health’.
Consequently, this key topic summary encourages partners and wider system networks to critically evaluate how commercial forces directly and indirectly shape service delivery, and key organisational policies. Moving forward, this key topic summary will illustrate how a framework for action can be used as part of a ‘health in all policies approach’ to provide the best opportunity for staff, residents, and service users to thrive and live healthily.
Why is it important to Population Health?
Healthy people and healthy lives
There is a significant link between the CDoH, harmful exposure to unhealthy products and subsequent consumption, and the rapid rise in non-communicable diseases (NCDs) amongst residents. It is estimated that the CDoH contribute to at least 78% of NCDs globally.2 Additonally, just under a quarter of all deaths in Great Britain were considered avoidable.3
The CDoH can have a damaging effect on indicators such as smoking prevalence, percentage of those overweight in adults and children, breastfeeding prevalence at 6 to 8 weeks, admission episodes for alcohol-related conditions, and the prevalence and severity of gambling-related harm. These can therefore exacerbate NCDs such as cancer, diabetes, hypertension, cardiovascular and heart disease, and strokes.
The rise in NCDs requires more urgent, clinical care, ‘at the point of need’. Thus, this poses serious risks to accessible and equitable access to healthcare, increasing the demand on health systems. As such, adopting a population health lens is crucial in order to prevent the harmful exposure of unhealthy commodities in the first instance, and promote ways to maximise healthy choices, underpinning department-wide work which seeks to create thriving communities.
Healthy places
There is a social gradient attached to the CDoH. The places where we live, work and socialise are instrumental to health outcomes. Those broader socioeconomic dimensions - referred to as the wider determinants of health - contextualise why health inequalities exist in society, as a result of the level of deprivation, quality of home, neighbourhood opportunities, and disposable income.
For example, corporate actors target junk food advertising in low-income areas, promoting cheap meal deals on billboards, old telephone boxes, and through other means such as social media campaigns. In turn, this has an impact on the foods that we consume. Ultra-processed foods contain higher levels of fat and sugar, and can lead to less people adopting a balanced diet.
Commercial entities may also position themselves within deprived communities. Gambling outlets are often found clustered on high streets, in central locations, next to public transport networks or drinking establishments, strategically positioned to entice customers. Therefore, public health continues to play a much-needed role in minimising the risk in the areas where we live and enjoy spending time with friends and family, by working with licensing and planning colleagues.
Examples of national policy changes includes the minimum unit pricing for alcohol, and the restrictions on smoking in certain public spaces.
At a local level, Councils can exercise their responsibility to protect local residents through sponsorship and advertising policies on local authority owned premises, and impose stringent measures through local area plans (LAPs) and statement of licensing policies.
The Derbyshire Population Health Approach
The Derbyshire Population Health Approach focuses on prevention, population health, evidence-informed practices, causes, and collaboration. It emphasises proactive measures to prevent health issues, tailors interventions to specific populations, incorporates evidence-informed practices, addresses underlying causes, and promotes collaboration for effective action.
When considering the topic of CDoH within The Derbyshire Population Health Approach:
• Prevention
In Derbyshire, a number of preventive strategies are in place to reduce the influence of harmful commercial products and environments on residents’ health. These include measures designed to restrict exposure to unhealthy commodities, raise awareness of risks, and create healthier environments.
Examples include:
- The Sponsorship and Advertising Policy developed by Derbyshire County Council, which restricts the promotion of harmful products such as fast food, alcohol, and gambling across council-owned spaces. This helps reduce exposure and normalisation of unhealthy behaviours.
- Local planning policies, including the use of Supplementary Planning Documents, enable borough and district councils to implement exclusion zones, preventing fast food outlets or betting shops from opening within 200 metres of schools.
- Trading Standards teams enforce regulations around the packaging, labelling, and in-store positioning of harmful products to ensure retailers are not misleading or disproportionately targeting vulnerable populations.
- Nationally, interventions such as the standardised packaging of tobacco products have set a precedent for de-marketing health-harming goods.
Together, these measures contribute to the creation of healthier, safer and more thriving neighbourhoods, where informed decision making is supported by a less harmful commercial environment.
• Population
Commercial determinants of health affect all communities in Derbyshire, but the burden is not shared equally.
People living in areas of higher deprivation are more likely to be exposed to advertising for unhealthy products and to live near clusters of fast food outlets, betting shops and other harmful commercial services. This disproportionately affects already vulnerable communities, compounding poor health outcomes. In Cotmanhay in Erewash, for example, local deprivation scores place it within the most deprived one percent of areas nationally.
Young people are particularly at risk. A study from Scotland found that children in deprived areas encountered seven times more exposure to harmful shops or advertising on their school commute than their more affluent peers. These early exposures shape future behaviours and health risks, highlighting the importance of shielding younger populations.
Commercial exposures are deeply patterned by social and economic factors, contributing to enduring health inequalities and higher prevalence of non-communicable diseases in disadvantaged groups.
• Evidence
Public health in Derbyshire is taking a proactive role in building and sharing the evidence base around commercial determinants of health:
- Staff from the council’s public health team have participated in action research programmes to pilot and shape the CDOH Essentials training toolkit, which has been endorsed by the Association of Directors of Public Health.
- The training programme is being rolled out locally to help public health teams and wider stakeholders build a shared understanding of commercial influences and their impact on residents.
- National models and local pilots such as Sheffield’s work on a sugar tax and their cost benefit evaluation of advertising restrictions are being reviewed to inform strategy in Derbyshire.
- Derbyshire has also explored adopting the AdFree Cities model, advocating for healthier public spaces by reducing harmful advertising.
This evidence informed approach helps identify what works, strengthens the case for system wide interventions, and supports more consistent and strategic action.
• Causes
At the root of the commercial determinants of health is a model that prioritises profit over population health.
Corporate entities operate across multiple domains including political, financial, scientific, labour and employment, supply chain and waste, reputation management, and marketing. These mechanisms influence consumer behaviour and shape environments that normalise the consumption of harmful products.
This business model drives widespread availability and exposure to:
- Tobacco
- Alcohol
- Ultra-processed foods high in fat, sugar and salt
- Gambling
- Fossil fuels
These exposures are major contributors to preventable non-communicable diseases including cardiovascular disease, type 2 diabetes, cancers, respiratory illness, and liver disease. All of these reduce healthy life expectancy and disproportionately affect disadvantaged populations.
Adapted from Simplified version of image from Gilmore et al 2023.
By recognising and addressing these upstream causes, we can create healthier conditions and more equitable health outcomes for all.
• Collaboration
Responding to the commercial determinants of health requires coordinated system wide action. In Derbyshire, this has included:
- Presenting to the Health and Wellbeing Board on the implications of commercial determinants and identifying opportunities to engage anchor institutions in system wide efforts.
- Collaborating with regional Directors of Public Health, including development of a position statement across the East Midlands to align understanding and priorities.
- Working with city and county counterparts to build a consistent and strategic approach to commercial health challenges.
- Delivering training across localities to ensure that key stakeholders from planning teams to commissioning partners are equipped to understand and act on commercial influences.
Embedding this work within broader health and wellbeing strategies is essential for long term change and for supporting residents to live in environments that enable, rather than undermine, good health.
Latest Derbyshire Data
Trend Data
Derbyshire Quilt
Prevalence Maps of Derbyshire
The maps below illustrate Lower Super Output Areas (LSOAs) and Middle Super Output Areas (MSOAs) for Derbyshire. LSOAs and MSOAs are geographical divisions used for statistical purposes, allowing for more detailed analysis of local data. In these maps, you can explore various health indicators and data for Derbyshire, providing valuable insights into the area’s health and wellbeing.