Asa Cristina Laurell: Commercial determinants of health, a WHO concept

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The WHO is under severe pressure following the withdrawal of the US and Argentina from the organization due to a unilateral decision by its ultra-liberal president, Javier Milei. However, these events also seem to give the organization greater leeway to address politically sensitive issues more easily. This is the case with the concept of commercial determinants of health, launched in June by the intergovernmental organization. This is a novelty because funding for this organization was already in the hands of the World Bank and private organizations such as the Bill and Melinda Gates Foundation.

This greater freedom is reflected in the concept of commercial determinants of health, which goes beyond the concept of social determinants of the health-disease process. Social physicians and those involved in public health can attest to the resistance to this concept, which was persistently defended and promoted in Brazil by Margaret Chan, who was Director-General of the WHO from 2006 to 2017. The notion of commercial determinants is defined as: the activities of the private sector that directly or indirectly affect, either positively or negatively, the health of the population, but particularly young people, as explained in an analysis published by CEE-FIOCRUZ.

Harmful goods also exacerbate existing economic, social, and racial inequalities. Pre-existing power relations also play a role, as small developing countries have greater difficulty resisting the pressures of large transnational corporations. The text also emphasizes that effective public health measures exist to respond to these determinants and that they must be implemented for a more just and healthy reconstruction after the COVID-19 pandemic.

It is revealing that the WHO revived the concept of determinants after this epidemic, as it allows us to locate the causes beyond society in a natural biological phenomenon. It is also significant that this organization reiterates the definition of social determinants as the conditions under which people are born, grow, work, live, and age, and are influenced by economic, political, and social forces . It is worth remembering that this statement was subject to intense discussion, so as not to sound untimely in the context of the recent fall of the Berlin Wall.

The notion of commercial determinants can be understood as a key element, as it represents the impact of market logic on public health. In this context, activities modulate the physical and social environments with effects that can be both positive and negative. The private sector directly affects the social, physical, and cultural environments through its business actions and also through its social commitments, whether through working conditions, product design and packaging, lobbying legislators, shaping behaviors, and so on.

The best-known examples include the promotion of smoking and, indirectly, the use of other addictive drugs, including alcohol; the consumption of foods that cause obesity, along with physical inactivity that leads to chronic degenerative diseases; accidents of all kinds, and so on.

The novelty is not that these trade determinants exist, but that they are listed in a WHO document. This is probably positive, but it can also promote Trump-Milei-style ultra-liberalism. Its advance is observed in the countries of the South, but it is also making inroads in Europe, for example, in Italy, the Netherlands, Hungary, and Greece; countries that are also abandoning doctrines of social justice and equality.

Commercial determinants have certainly been studied previously, but in the context of specific problems, such as the impact of the so-called medical-industrial complex . What's new, then, would be the new approach to commercial determinants, which includes everything that has an impact on health, whether direct or indirect, but created by economic agents for profit.