Mapping the commercial determinants of health in countries of the WHO South-East Asia Region: conceptualizations, impacts and actions
About the report
This is the first regional mapping of the commercial determinants of health (CDoH) in the WHO South-East Asia Region. It was produced through a collaboration between the WHO Regional Office for South-East Asia and WHO headquarters, with substantive inputs from Member States, academia, civil society organisations and United Nations partners gathered through a regional consultation convened by the Regional Office.
Based on a systematic review of secondary sources and interviews with key informants, the report documents the commercial products, activities and market systems that shape people’s choices and health outcomes in the Region, and derives recommendations from points of consensus reached in the multisectoral regional consultation.
Summary
Framing the commercial determinants of health
The report frames commercial determinants of health as industry-driven commercial activities — including products and services that affect public health, health-care delivery systems and costs, working conditions, and the broader political economy — which influence healthy and unhealthy lifestyle choices and contribute to global health inequities. It situates the production and consumption of “unhealthy” commodities such as tobacco, alcohol, ultra-processed foods and sugar-sweetened beverages alongside environmental degradation and occupational health as central concerns.
Commercial landscape and burden in South-East Asia
The report sets out the regional commercial landscape and reviews how commercial practices contribute to the region’s noncommunicable disease (NCD) burden. NCDs account for around nine million deaths in South-East Asia Region countries in 2019 — 22% of global NCD mortality. Drivers include the region’s nutrition transition from home-grown to mass-produced ultra-processed foods; rising sales of sugar-sweetened beverages; availability of cheap unhealthy products such as loose cigarettes, inexpensive liquor and uncertified food; and increasing industrial pollution. Commercial systems in pharmaceuticals, medical technologies, vaccines and health supplements can reinforce health inequities by widening out-of-pocket costs and differentiating access between rich and poor.
Commercial sector practices
A central chapter maps seven sets of commercial sector practices observed in the Region and their health implications:
- Political practices — including lobbying, strategic litigation and influence over regulatory processes.
- Labour and employment practices — including occupational health risks and precarious work.
- Reputational management practices — including corporate social responsibility and sponsorship.
- Marketing practices — including targeting of children and vulnerable groups, digital marketing and cross-border marketing.
- Practices impacting health-enabling legal environments — including use of trade, investment and intellectual property frameworks.
- Supply chain, waste practices and environmental degradation.
- Scientific practices — including industry-funded research, casting doubt on evidence and strategic use of academia.
Action on the commercial determinants of health
The report documents action across three loci:
- Action by governments — including policies, regulation and legislation. Illustrative examples include the use of compulsory licensing to secure affordable access to HIV, cancer and cardiovascular medicines (Indonesia, Thailand, India); anti-corruption frameworks; restrictions on the gaming industry in Thailand and Viet Nam; national wellness and well-being initiatives (Bhutan’s Gross National Happiness, Thailand’s Sufficiency Economy Philosophy, India’s Ministry of Ayush); and NCD-related measures such as health taxes, plain packaging and bans on industrial trans-fats in Thailand, and early adoption of the International Code of Marketing of Breast-milk Substitutes in Sri Lanka, Myanmar and Thailand.
- Action by commercial actors — including both negative practices and positive contributions, and the limits of voluntary corporate initiatives.
- Action by civil society organisations, academics and non-profit organisations — including advocacy, watchdog roles, evidence generation and coalition-building.
Conclusions and recommendations
The report concludes with a set of recommendations directed primarily at governments in the Region, alongside recommendations for commercial actors, civil society and academia. Core directions include strengthening whole-of-government approaches to regulate commercial products and marketing systems; reinforcing consumer protection and the right to health; acting on the imbalance of power between transnational commercial actors and national decision-makers; using regional solidarity and multilateral mechanisms to reduce negative commercial impacts and amplify positive ones; and supporting public participation and health literacy so that commercial determinants are visible, debated and governed.