How the Centre for 21^st Century Public Health is setting the global agenda for addressing the Commercial Determinants of Health  

The Centre for 21^st Century Public Health (C21PH) at the University of Bath takes a transdisciplinary approach to improving the health of communities and the environments in which they live across the globe. Led by Professors Anna Gilmore and Harry Rutter, the centre has achieved significant impact and policy influence through identifying the structural drivers, political, commercial and environmental factors of poor health in the 21st century.

Addressing the Commercial Determinants of Health (CDoH) - the ways in which commercial actors and practices influence health and health equity - represents one of the most significant challenges facing the world today.

Professors Gilmore and Rutter are academic leaders in a field which is steadily gaining international prominence in the political landscape. Both Co-directors recently gave keynote addresses on these structural drivers of health at the international Wellbeing Economy Forum in Iceland; a global platform where speakers such as Halla Tómasdóttir, President of Iceland, and Michele Cecchini, Head of Public Health at the Organisation for Economic Co-operation and Development (OECD) spoke in support of sustainable wellbeing in alignment with the United Nations’ Sustainable Development Goals (SDGs).

Professor Gilmore presented on the commercial determinants of health, sharing her research which examines how corporate interests shape economies, policies and environments, and the structural and policy changes needed to address the health and environmental harms of harmful corporate practices.

“Four products are responsible for a third of global deaths; tobacco, alcohol, unhealthy foods, and fossil fuel resulting in air pollution and 40% to 80% of Non-communicable Disease (NCD) deaths.” – Professor Anna Gilmore 

A seminal piece of work in this area is her model of the Commercial Determinants of Health, published in a three-part Lancet Series. Speaking about the model, Professor Gilmore said: “The model helps explain how commercial actors, products, and practices impact health and can also be used to identify solutions. The Lancet Series was also important in flagging the impact that commercial determinants of health have on inequality and the system nature of the problem.”

Her work is having impact on a global scale and Professor Gilmore contributed expert analysis on how commercial actors shape human and planetary health outcomes in the latest report of the Pan-European Commission on Climate and Health (PECCH), an independent advisory group convened by the World Health Organization (WHO).

Drawing on her research, she demonstrated how some commercial actors obstruct progress to addressing the global climate emergency and non-communicable diseases by shaping policy, regulatory, and information environments in their favour. She explains that governments need to adopt a health-in-all-policies approach that explicitly regulates commercial power, removes subsidies for health-harming industries, and aligns fiscal and trade policies with health and climate goals.

 As part of this work, the Centre for 21^st Century Public Health has developed a curated collection of practical tools, frameworks, and evidence to support public health action on the commercial determinants of health.

Applying tobacco control lessons to address the influence of other health-harming industries

The Group’s work on tobacco industry influence has provided a strong foundation for examining how other health harming sectors shape policy and public understanding. The Centre’s research has, for example, demonstrated how other industries, including food, gambling and alcohol, use similar tactics to make it harder to influence environmental and public health protections.

Some of this most-impactful research has come from Dr Tess Legg. Her research into industry-funded science led to the development of the Science-for-Profit model, which shows the myriad of ways some corporate sectors have used the manipulation of science to weaken regulation, prevent litigation, and maximise product sales.

Drawing on a synthesis of 68 studies across multiple sectors, including tobacco, chemical and pharmaceutical industries, the model identified a consistent pattern of strategies used to delay action on threats to human and planetary health. It showed how corporations intervene at every stage of the scientific process, manipulating methods, reshaping standards of evidence, exerting pressure on researchers, and promoting policy reforms that privilege industry-generated evidence.

Dr Legg said, “We provided an accessible way to understand how and why corporations influence science, demonstrating the need for collective solutions, and the changes needed to ensure science works in the public interest.”

The model has been employed  as an analytic framework in other researchers’ projects including those investigating tobacco industry involvement in science on heated tobacco products and livestock and meat industry influence in academia and public policy. Most recently, it has been used by the World Heart Federation as a framework to inform its new conflict of interest policy toolkit. 

These insights are now being applied to the fossil fuel sector.

Research Fellow Dr Rachel Barry, whose research focuses on the regulation and political influence of health-harming industries, is examining how political and institutional structures currently enable harmful industries to influence the policies meant to regulate them by providing them at seat at the policy table.

In a recent paper for the Future Healthcare Journal, she highlighted how industries with vested interests use partnerships, youth prevention programmes, funding of science, and voluntary regulation schemes to position themselves as responsible corporate citizens – while blocking effective public health action behind the scenes.

“The historic claim to fame is that doubt is their product, an argument long used by Big Tobacco to delay action on smoking,” Barry said, referencing the tobacco industry’s decades-long campaign to obscure evidence of harm. “This is a tactic mirrored by other industry sectors like fossil fuels and ultra-processed foods.”

Drawing on the work of Dr Tess Legg and other colleagues in the Centre, Dr Barry highlighted striking parallels between the tactics used by health-harming industries and those now deployed by the fossil fuel companies. These include promoting doubt about the harms of their products through highly publicised disinformation campaigns, funding and conducting science that produces industry favourable outcomes, and positioning themselves as legitimate partners and part of the solution to the problems they cause.

“There’s still a deeply embedded view that fossil fuel companies can be a partner in achieving climate goals,” she observed. “That norm of industry engagement remains a major barrier to addressing the global climate emergency.”

Dr Barry recently addressed the European Parliament to highlight lessons from tobacco control to curb fossil fuel influence on climate policy. The cross-party meeting, convened by the Fossil Free Politics, a campaign spearheaded by Friends of the Earth Europe, Corporate Europe Observatory and Food and Water Europe, focused on how fossil fuel industry influence can be effectively regulated in climate and energy policymaking.

Dr Barry emphasised that lack of consensus and understanding serves as a key barrier to the adoption of concrete safeguards to protect climate and energy policymaking, including clear conflict-of-interest rules and limits on fossil fuel industry access to decision-making spaces.

Reflecting on the meeting Dr Barry said, “There is still significant work to be done to raise awareness and build understanding of the risks that conflicts-of-interest pose to climate policymaking in the public interest.”