From evidence to action: lessons on tackling commercial determinants of health locally
K KimAbstract
While the need to address commercial determinants of health (CDOH) has become increasingly clear, few studies have evaluated potential actions targeting CDOH, especially at the local level. Existing evidence has primarily focused on interventions for reducing exposure and consumption of individual unhealthy commodities, rather than wider actions with a basis in local authorities such as procurement or planning. Using a review of reviews approach, we searched 7 scientific databases for systematic reviews reporting population-level, upstream actions. Drawing on existing conceptual CDOH models and frameworks of public health interventions, identified actions were categorised according to their level of action, targeted commercial practice(s) and/or underlying driver(s), mechanism, evidence of efficacy and local-level implementation. 87 reviews were included, with most focusing on tobacco, alcohol and/or high fat, salt and sugar products. Recorded actions tended to target sectoral public policies and environments, instead of more upstream reforms to political and economic systems or approaches to governance and policymaking. Actions typically had one of three objectives:
1) reduce exposure and consumption of unhealthy commodities via restrictions on accessibility, affordability and marketing; 2) challenge harmful corporate practices and norms; and 3) promote positive practices. While evidence for regulating unhealthy commodities was comparatively strong, less is known about the efficacy of actions targeting wider harmful commercial conduct. Locally implemented healthful practices included Health in All Polices approaches, investment in public and active transport and developing local, sustainable procurement policies. Our evidence synthesis not only highlights what works to address CDOH at the local level but also recognises potential policy levers for future action and provides a baseline for developing new tools to mitigate CDOH.