ArticleBMJ global health2022
Asserting public health interest in acting on commercial determinants of health in sub-Saharan Africa: insights from a discourse analysis.
Article in BMJ global health, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- Understanding Global Health Inequality and Inequity: Causes, Consequences, and the Path Toward Justice in Healthcare.Public health challenges · 2025Review
- Toward Monitoring and Addressing the Commercial Determinants of Health: Where Can We Go From Here?The Milbank quarterly · 2025Article
- Health systems as human systems: reflexivity, relationships, and resilience in the pursuit of the SDGs.Frontiers in public health · 2025Article
- Can health impact assessment help tackle commercial determinants of health and support a wellbeing economy?Health promotion international · 2024Review
- Children, young people and the Commercial Determinants of Health.Health promotion international · 2024Article
- Recovering lost tax to meet the health financing gap for universal public sector health systems in East and Southern Africa.BMJ global health · 2023Article
- Equity dimensions in initiatives promoting urban health and wellbeing in east and southern Africa.Frontiers in public health · 2023Review
- Beyond political will: unpacking the drivers of (non) health reforms in sub-Saharan Africa.BMJ global health · 2022Review
- Asserting public health interest in acting on commercial determinants of health in sub-Saharan Africa: insights from a discourse analysis.BMJ global health · 2022Article
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Authors and funding
3 authors.
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Abstract
The actors influencing the commercial determinants of health (CDOH) in sub-Saharan Africa (SSA) have different interests and lenses around the costs and benefits of market influences in health. We analysed the views and priorities on CDOH in the discourse of global and regional agencies, SSA governments, private investors and companies, civil society and academia through a desk review of online publications post-2010, validated by purposively selected key informant interviews.The most polarised views were between civil society and academia on one hand, focused more on harms, and private business/investors on the other, almost exclusively focused on benefits. Others had mixed messaging, encouraging partnerships with commercial actors for health benefits and also voicing cautions over negative health impacts. Views also differed between transnational and domestic business and investors.Three areas of discourse stood out, demonstrating also tensions between commercial and public health objectives. These were the role of human rights as fundamental for or obstacle to engaging commercial practice in health; the development paradigm and role of a neoliberal political economy generating harms or opportunities for health; and the implications of commercial activity in health services. COVID-19 has amplified debate, generating demand for public sectors to incentivise commercial activity to 'modernise' and digitise health services and meet funding gaps and generating new thinking and engagement on domestic production of key health inputs.Power plays a critical role in CDOH. Commercial actors in SSA increase their influence through discursive and agential forms of power and take advantage of the structural power gained from a dominant view of free markets and for-profit commerce as essential for well-being. As a counterfactual, we found and present options for using these same three forms of narrative, agential and structural power to proactively advance public health objectives and leadership on CDOH in SSA.
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