When I first heard the term Commercial Determinants of Health, I said, “YES!”
Finally, I had the right phrase to describe what I had been thinking: It’s fine and good to shift our focus from individual behaviors to Social Determinants of Health, but we STILL are not pulling back far enough.
The phrase Commercial Determinants of Health (CoDH) captures how commercial forces, meaning money and profit, shape our health. Just think about the health effects of tobacco, the climate crisis, air pollution, the marketing of guns and ultra-processed foods, the opioid crisis, and the housing crisis, and you’ll get the idea. The profits are going to industries, while the costs disproportionately burden historically marginalized communities, and the money extracted typically does not benefit these communities.
If you are ready for something hopeful and positive, and who could blame you, just skip directly to the successes at the end of this blog.
Community Power Vs. Commercial Forces
I once did some research on what communities were saying about land use and what city governments were saying about land use. Communities were asking for parks and affordable housing. City governments wanted more market rate housing so they could bring a larger tax base to the city. These are opposite goals. As you might guess, communities did not feel heard against the powerful forces of housing developers. Unfortunately, when decisions are made about land use, commercial forces are very well funded and therefore have great power and influence compared to community voices.
Housing as an Example
Lack of affordable housing and rent burden are experienced by about half of Americans, according to the Pew Charitable Trust. Lack of housing impacts physical and mental health, traps people in a cycle of poverty, increases health care and emergency services costs, and perpetuates systemic inequities. Housing is a topic of contention on social media and a platform for political campaigns.
Let’s look at housing solutions at the Individual Behavior Change Level, the Social Determinants of Health level (SoDH), and the Commercial Determinants of Health (CoDH) Level.
Housing Solutions: Individual Behavioral Change Level
When we focus our housing solutions at the individual level, we may advise people to update their resume, practice interviewing, or get a degree in order to afford housing. While there is some merit to this approach, solely focusing on individual behavior change puts all of the responsibility on the individual and can be seen as blaming the victim. It lacks the perspective that individuals are operating within larger forces. It diverts attention from systemic accountability.
Housing Solutions: Social Determinants of Health Level
Social Determinants of Health were once considered a cutting-edge approach because emphasis previously had been placed at the Individual Level, and clearly, social factors affect health. The lack of adequate housing, for example, is linked to asthma, and being unhoused is a set up for a myriad of negative experiences. Housing solutions focused on SoDH may look like administering a questionnaire that identifies the need for housing, offering them a housing voucher, creating a referral network, or hiring systems navigators. This can help, but it has its limits when the wait to use a housing voucher is 18 years long, or the referral is to a shelter that is already full. When it comes to housing, this approach may remove the “problem” from the doctor’s visit, but it is not likely to solve it.
Housing Solutions: Commercial Determinants of Health Level
When we add a focus on CoDH, we work to address market forces. We work to level the playing field between the needs of communities and the interests of those with greater resources. We enact policies and laws to protect human dignity. Historical wrongs like state-sanctioned theft of Indigenous lands and redlining combined with current practices like exclusionary zoning have already supported inequitable wealth building. Adding solutions that address CoDH can look like engaging those most affected by the lack of affordable housing and building community power to change laws and policies. It can look like funders supporting community-driven solutions, and government workers including communities’ input to land use decisions early in the process.
An Integrated Approach
When we focus more broadly and build community power to advocate, we can integrate the Individual Behavior Change, SoDH, and CoDH Levels to hold commercial forces accountable. It may seem like an uphill battle, but it can be done!
Success!
Some recent examples at the local, state, and national levels of what can happen when communities have power to influence market decisions are:
- The Sunshine Law was passed in Santa Ana, California.
- The movement toward social housing.
- California’s success in eliminating ultraprocessed foods from school lunches.
- Opioid settlement funds are returning some profits to affected communities.
- The PHaRE Model© for Systems Change: The PHaRE Model© is the only model I have seen that illustrates how community power building directly connects to Social and Commercial Determinants of Health. Download your copy here.
Let’s Go!
Now that we know, now that we have this broader, more integrated focus, let’s support community power building. Let’s eliminate the blaming narrative and harmful extraction from communities that have already paid the price many times over. Let’s have a tangible influence on the root causes of so many of our problems.
If you would like to discuss how we might work together to create a systems-focused, integrated component of your work, we’d love to hear from you. Email us so we can set up a time to talk: info@gingerleeglobal.com.
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