Addressing commercial determinants of health at local level: insights from co-produced system maps

Background

The commercial determinants of health (CDoH) influence population health and equity in varied, complex and deeply interconnected ways, having both positive and negative, direct and indirect influence on human and planetary health. Systems mapping is a valuable method for exploring such complexity, offering a visual approach to understand interconnected factors and identify opportunities for coordinated action. This study aimed to synthesise eight co-produced systems maps to generate a comprehensive, multi-perspective overview of factors shaping the CDoH at the local government level.

Methods

As part of the Local Health and Global Profits (LHGP) research, eight local authorities in England participated in separate co-production workshops, involving stakeholders from public health, planning, corporate affairs and councillors, among others. Each site developed a systems map capturing locally relevant influences on the CDoH. Individual maps were then integrated through an iterative, thematic process, with factors categorised using a domains framework and reviewed collaboratively by LHGP researchers until consensus was reached.

Results

Based on initial findings, across the eight maps, 374 nodes (factors) were identified. While there was substantial overlap between sites for some factors, including availability and accessibility of unhealthy products, employment conditions and opportunities and social norms, the inclusion of, and emphasis on, other factors differed per local context. Variation in terminology was consolidated by the research team, resulting in a final integrated map comprising of 114 factors.

Conclusions

The integrated systems map highlights both the complexity, shared meaning, and contextual variation in the CDOH across local authorities in England. It provides a practical tool to support discussions and share understanding, providing a platform to conceptualise and further develop action areas to address CDoH at local government level.

Key messages

• Co-producing system maps are a useful approach to help local government identify the complex and interconnected ways in which the commercial determinants of health impact their local communities.

• The commercial determinants of health impact population health in a variety of direct and indirect ways, and action to address these will require coordinated action from across local government.