The U.S. is terrible at keeping businesses from worsening public health, experts say

WASHINGTON — Here in the U.S., it’s “in” to study the social determinants of health.

There are programs at Columbia and Emory dedicated to the field. Papers on the topic garner thousands of citations.The federal health department has even crafted an entire plan for addressing this topic, which is broadly defined as the ways a person’s environment impacts their health.

The opposite is true for the commercial determinants of health, which studies the ways businesses impact public health. As one researcher bluntly put it, the field is all about “when companies profit from making us sick.”


There’s only one university in the U.S. with a program dedicated to it. You can literally count the number of U.S.-based experts on one hand. And there isn’t a single mention of the commercial determinants of health on the federal health department’s website, according to Google.

That’s a shame, because experts in the field agree: The U.S. is doing a terrible job of addressing this very topic.


STAT asked 10 global experts to grade the U.S. approach to grappling with all the ways that businesses drive sickness and death in the country. No one gave the U.S. higher than a C+, and several gave the nation an F.

The list of offenders is numerous. First there are the industries themselves that directly (and relatively obviously) profit from poor health: food makers behind ultra-processed foods. Tobacco companies. The alcohol industry. And of course, there are the lawmakers and regulators who fail to rein them in, and the industry of lobbyists who help maintain the status quo.

Alex Hogan/STAT

Several also dinged the energy sector, arguing that the country’s reliance on fossil fuels, and its role in climate change, has and continues to make people sicker, around the globe.

One of the U.S.-based experts, CUNY’s Nick Freudenberg, even spotlighted the financial industry.

“Their demand for regular quarterly profits and their predilection for moving capital with high speed leads many other industries (food, fossil fuel, housing, etc.) to sacrifice long term investment or balancing public and private needs with an insistence on short-term profits.”

The United States’ relationship to the commercial determinants of health is all the more interesting — and deserving of study — because the nation, by and large, has stood up programs to try to tackle these issues. They’re just not very good, the experts told STAT.

Freudenberg gave the U.S. a C because, he said, the United States has attempted to “regulate the financial, environmental, occupational and consumer practices of many businesses.” But those same business interests have become a “dominant voice in shaping these regulatory policies.”

May Van Schalkwyk, a researcher at the London School of Hygiene & Tropical Medicine, gave the United States an F overall for its broad failures to regulate a whole host of industries.

But she also noted that “some past efforts concerning tobacco control and ongoing efforts to research the ‘commercial determinants of health’ or to litigate against harmful industry practices are a definite A grade.”

STAT also asked the experts to recommend a single policy proposal that could be a first step toward reining in the health harms caused by businesses. Their answers included higher taxes on unhealthy products like tobacco, alcohol and sugary drinks, increasing restrictions around corporate lobbying and the “revolving door,” and tightening antitrust enforcement.

But two of the four U.S.-based experts had an even simpler answer: More study of the field stateside.

“The first step would be to acknowledge [commercial determinants of health] as a field and make it a priority to invest in research and programs,” said Nino Paichadze, the associate director of George Washington University’s Center on Commercial Determinants of Health.

STAT’s coverage of the commercial determinants of health is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.

Source: STAT