How are commercial determinants of health problematised in key health and climate policy guidance?

Background

Commercial forces impact health and climate outcomes. Given the need for coherent policy approaches, we critically examine the problematisation of commercial activities in documents guiding the development of multisectoral climate and health policies. This guidance matters: it informs how governments set their climate and health policies, and thus the health of their populations.

Methods

A qualitative content analysis of documents published by the World Health Organization, United Nations Environment Programme and the UK Government between 2014 and 2025 to guide multisectoral action for climate and health, to understand how they problematise commercial actors, products and practices in their a) policy background, b) proposed policy solutions and c) approaches to governance.

Results

Policy guidance documents (n = 25) were more likely to ‘passively’ problematise commercial products (mostly fossil fuels) as harmful to climate and health, than to ‘actively’ attribute these products to specific commercial actors, practices, or policy solutions. Policy solutions prioritised downstream interventions in the health care sector, interventions that emphasised behaviour change and product-shifting, or interventions that advocated a role for a largely undifferentiated ‘private sector’ to deliver and finance policy. Despite some upstream attention to fiscal measures, such as taxes and subsidies towards fossil fuels and carbon-intensive agriculture, several key commercial determinants of health and climate change were not problematised. These included policy solutions for commercial tax avoidance, fossil fuel advertising, and jointly state- and corporate-owned high-emitting enterprises.

Conclusions

Existing health and climate policy guidance is widely neglecting structural, consumptogenic and commercial drivers of harm. Instead, by prioritising interventions in the health care sector, guidance risks performing a narrow, biomedical policy paradigm for climate and health.

Key messages

• Existing guidance for developing health and climate policies widely fails to engage with structural, consumptogenic and commercial drivers of harm, except for partial attention to fiscal measures.

• Guidance prioritises policy solutions within the health care sector. No guidance problematises policy responses to commercial tax avoidance, fossil fuel advertising, or state-owned enterprises.