Key points
- Commercial determinants of health are the private-sector activities that affect people's health, positively or negatively — the WHO fact sheet definition, dated 21 March 2023.
- The Lancet Series (2023) defines them as the systems, practices and pathways through which commercial actors drive health and health inequity.
- Four industry sectors — tobacco, alcohol, unhealthy foods and fossil fuels — are linked to at least a third of deaths worldwide each year.
- In the WHO European Region, commercial products and practices contribute to about 25% of all deaths — nearly 7,500 deaths a day (WHO Europe, 2024 report).
- Commercial determinants are not the whole story: they sit inside the wider social determinants of health, and commercial activity can also help health.
Direct answer: Commercial determinants of health are the private-sector activities that affect people's health, positively or negatively. That is the World Health Organization's definition, in its fact sheet dated 21 March 2023. The activities arise when goods or services are provided for payment — what companies make and sell, how they price and market it, the conditions they set for workers, and the influence they exercise over laws and research. The Lancet Series on the Commercial Determinants of Health (2023) puts it more broadly: the systems, practices and pathways through which commercial actors drive health and health inequity. This guide explains the industries, the practices and the numbers — and where commercial influence helps health as well as harms it.
What the term covers
Commercial determinants arise in the context of the provision of goods or services for payment, and they include the commercial activities themselves and the environment in which commerce takes place. That is wider than “unhealthy products”. A company shapes health through its supply chain, its labour conditions, its product design and packaging, the research it funds, the lobbying it does and the preferences it shapes — as well as through the product on the shelf.
The influence runs in both directions. Commercial activity can harm health: tobacco, alcohol, ultra-processed food, sugar-sweetened beverages and fossil fuels are the examples most often named. It can also help health: companies make medicines, vaccines, food, housing, transport and protective equipment, and employ most of the world’s workers. The term describes the influence itself, not a verdict that every business is harmful.
The industries that matter most
Four industry sectors are linked to at least a third of deaths worldwide each year, according to The Lancet Series on the Commercial Determinants of Health (2023): tobacco, alcohol, unhealthy foods and fossil fuels. The WHO fact sheet names the same ground and adds breastmilk substitutes — whose marketing WHO has regulated since 1981 — and occupational practices, including work in mining and other hazardous industries.
Tobacco is the clearest case: it kills up to half of its users who do not quit, most of them in low- and middle-income countries. Alcohol, ultra-processed food and sugar-sweetened beverages drive noncommunicable diseases — heart disease, cancer, chronic respiratory disease, diabetes and obesity — through the products themselves and through marketing that increases exposure, especially to children and young people. Fossil fuels harm health through air pollution and through climate change, and through the industry’s influence on energy policy. These are population-level patterns: they describe what raises risk across whole populations, not what causes any one person’s illness.
Seven practices, not just products
The March 2023 Lancet series sets out seven categories of commercial-sector practice that affect health and equity. They are worth naming, because the public debate usually stops at products and misses the rest.
First, political practices: lobbying, donations, and participation in policy-making. Second, scientific practices: funding research, and casting doubt on evidence about harm. Third, marketing practices: advertising, sponsorship and promotion, including marketing to children. Fourth, supply chain and waste practices: how goods are produced, moved and disposed of. Fifth, labour and employment practices: wages, hours, safety and job security. Sixth, financial practices: tax arrangements, pricing and investment. Seventh, reputational management: corporate social responsibility programmes and partnerships that present a company as part of the solution.
No single practice explains the effect. A sugary drink harms health through the product, through the marketing that makes children want it, through the lobbying that resists a tax on it, and through the research funding that questions the evidence against it. The seven practices are the reason the field talks about systems and pathways rather than single products.
What the numbers say in Europe
The WHO Regional Office for Europe’s 2024 report, Commercial Determinants of Noncommunicable Diseases in the WHO European Region, puts numbers on the European picture. Nearly 7,500 deaths per day in the Region are attributed to commercial determinants such as tobacco, alcohol, processed food, fossil fuels and occupational practices. Those products and practices contribute to about 25% of all deaths in the Region — 2,723,211 deaths, or 24.5%, in the 2021 estimates the report uses. The report’s chapters describe how commercial interests worsen noncommunicable diseases and how the four industries — tobacco, alcohol, processed food and fossil fuels — have bought influence in science to cast doubt on the harm of their products and industries.
Commercial determinants vs social determinants
Commercial determinants sit inside the wider social determinants of health. Social determinants are the conditions in which people are born, grow, live, work and age — income, education, housing, neighbourhood, social support. Commercial determinants are one set of forces shaping those conditions: businesses influence what food costs and what is advertised, what jobs pay and how safe they are, what housing is built and where, and what laws get passed.
The distinction matters for action. Social-determinant responses are broad — education, housing, income support. Commercial-determinant responses are more targeted: tax a harmful product, restrict its marketing, require plain labelling, disclose lobbying and research funding, and keep commercial interests out of the rooms where health policy is written. The two overlap: young people are especially at risk from commercial determinants, and unhealthy commodities worsen pre-existing economic, social and racial inequities — a point the WHO fact sheet makes directly.
What can be done
There are effective public-health actions to respond to commercial determinants, and they are the same tools public health has used for decades. Tobacco control is the most developed example: taxation, comprehensive advertising bans, smoke-free laws and plain packaging are all commercial-determinant measures, and they work at population level. At least 68 countries have passed comprehensive tobacco advertising, promotion and sponsorship bans, according to the WHO Framework Convention on Tobacco Control fact sheet of March 2026 — up from 29 countries, covering 832 million people (12% of the world’s population), by the end of 2014. Alcohol and food policy follow the same pattern: taxes, marketing restrictions, labelling, and limits on marketing to children.
Transparency is the other half: disclosure of lobbying, of funding for research and for patient and professional groups, and of conflicts of interest in policy-making. None of this requires a view that business is the enemy. It requires treating commercial influence as a health issue to be managed in the open, like any other determinant — measured, disclosed and regulated where the evidence shows harm.
Frequently asked questions
Are commercial determinants of health always bad for health?
No. The WHO definition covers private-sector activities that affect health positively or negatively. Companies make medicines, food, housing and transport as well as tobacco and alcohol. The term describes the influence, not a verdict on every business.
How are commercial determinants different from social determinants?
Social determinants are the wider conditions in which people are born, grow, live, work and age — income, education, housing, neighbourhood. Commercial determinants are one driver inside that picture: the ways businesses shape those conditions, through what they sell, how they market it, and how they influence policy.
What can be done about harmful commercial determinants?
The public-health responses are regulation, taxation, marketing restrictions, labelling, and transparency about lobbying and research funding. Tobacco control is the most developed example: taxes, advertising bans and smoke-free laws are all commercial-determinant measures.