Everyone’s business: Understanding the commercial determinants of mental ill health

The impact that our social and physical environments have on mental health is increasingly being recognised. A powerful but relatively understudied contributor to those environments are corporate actors, sometimes termed the commercial determinants of health. To date, there has been little research into how our mental health is shaped by such forces, compared to the wider social determinants.

In this blog, Alice Tompson, Kate Dun-Campbell, Nason Maani and Mark Petticrew introduce the background to a new NIHR three schools funded project that investigates the commercial determinants of mental ill health. It hopes to identify overlooked interventions to help address the growing burden of mental ill health and inequality in the UK.

The importance of prevention in mental health

The COVID-19 pandemic has seen an increase in mental ill health and already overstretched mental health services struggling to cope. This mismatch between the number of people needing help and the minority with access to mental healthcare represents an implementation gap. One contributor to this gap is a deficit of mental health treatment services. However, just as importantly, we must consider the role of wider, upstream forces that generate mental ill health.

There are large inequalities in who experiences mental ill health and how they recover that are caused by the social, economic, and physical environments in which we live. Social inequalities are associated with increased risk of many common mental disorders. Improving mental health therefore, must not just focus on improving access to treatment, but also adopt a preventative approach to reduce the differences in our wider living conditions that cause mental ill health. Some of these wider conditions are directly shaped by commercial activity. For example, through promotion of unhealthy products altering social norms and affecting when and how much is consumed. Alcohol and tobacco use have been shown, for example, to harm our mental health.

Taking a public mental health approach by recognising the influence of the wider environment in which people live and work has been proposed as a means to help address the implementation gap in the longer term. It opens up the possibility of a broader portfolio of interventions - beyond provision of clinical services - to foster good mental health and reduce inequalities. In order do this, we must first understand the forces that shape our environments in ways lead to mental ill health.

Commercial determinants of health

As part of the public health interest in our social and physical environment, the role of commercial interests in determining health outcomes has been studied. Initial efforts focused on industry activities seeking to directly increase use of unhealthy products such as tobacco and alcohol. Recently a broader focus has been adopted considering other industries and the diffuse ways powerful corporate actors shape both our living and working conditions. For example, by lobbying against emissions regulations, political campaigns donations, and influencing research agendas. This diversification in interests is reflected in a recent definition of the commercial determinants of health as, “the social, political, and economic structures, norms, rules, and practices by which business activities designed to generate profits and increase market share influence patterns of health, disease, injury, disability, and death within and across populations”. Despite proving to be a fruitful approach in understanding - and addressing - other non-communicable diseases, a commercial determinants lens is yet to be fully applied to mental ill health. 

Bridging gaps in our understanding

In an ongoing study funded by the NIHR, researchers in the Commercial Determinants Research Group at LSHTM are beginning to address this knowledge gap by i) mapping the commercial determinants of mental ill health and ii) identifying evidence-based interventions and potential leverage points. Through adopting a complex system approach combined with systematic reviewing techniques, we are robustly synthesizing a diverse evidence base across six key industries (alcohol, tobacco, ultra-processed foods, gambling, social media and fossil fuels). Our approach enables the identification of upstream leverage points for intervention that may be currently missed. The project’s ultimate goal is to inform effective mental health programmes that reduce the pressure on health and social care services, reduce inequalities and lessen the burden on individuals, their families and communities. Findings will be available towards the end of the year.

Further information

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