Measuring the Commercial Determinants of Health and Disease: A Proposed Framework
Lee K. Freudenberg N. Zenone M. Smith J. Mialon M. Marten R. Lima J.M. Friel S. Klein D.E. Crosbie E. Buse K.
January 2022SAGE Publications Inc.
International Journal of Health Services
2022#52Issue 1115 - 128 pp.
The commercial determinants of health (CDoH) describe the adverse health effects associated with for-profit actors and their actions. Despite efforts to advance the definition, conceptualization, and empirical analyses of CDoH, the terms practical application to mitigate these effects requires the capacity to measure the influences of specific components of CDoH and the cumulative impacts of CDoH on the health and well-being of specific populations. Building on the Global Burden of Disease Study, we begin by conceptualizing CDoH as risk factor exposures that span agency and structural influences. We identify 6 components of these influences and propose an initial set of indicators and datasets to rank exposures as high, medium, or low. These are combined into a commercial determinants of health index (CDoHi) and illustrated by 3 countries. Although now a proof of concept, comparative analysis of CDoH exposures by population, over time and space, and their associated health outcomes will become possible with further development of indicators and datasets. Expansion of the CDoHi and application to varied populations groups will enable finer targeting of interventions to reduce health harms. The measurement of improvements to health and wellness from such interventions will, in turn, inform overall efforts to address the CDoH.
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Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
School of Public Health, City University New York, New York, United States
School of Hygiene & Tropical Medicine, London, London, United Kingdom
Trinity Business School, Trinity College Dublin, Dublin, Ireland
Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
WHO Regional Office for Europe, WHO Country Office in Kyrgyzstan, Kazakhstan
School of Regulation and Global Governance, Australian National University, Canberra, Australia
Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
School of Public Health, University of Nevada Reno, Reno, United States
George Institute for Global Health UK, Imperial College London, London, United Kingdom
Faculty of Health Sciences
School of Public Health
School of Hygiene & Tropical Medicine
Trinity Business School
Alliance for Health Policy and Systems Research
WHO Regional Office for Europe
School of Regulation and Global Governance
Dalla Lana School of Public Health
School of Public Health
George Institute for Global Health UK
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