Can health impact assessment help tackle commercial determinants of health and support a wellbeing economy?

Commercial activity has positive and negative effects on health. Adverse commercial impacts on health are underpinned by corporate power and economic models and policy that prioritize economic growth, rather than a wellbeing economy that prioritizes health, equity and sustainability. Health in all policies (HiAP) aims to ensure that all policies promote health and health equity, using processes including health impact assessment (HIA). We aimed to explore the potential for HiAP and HIA to help address commercial determinants of health and promote a wellbeing economy. We completed a scoping review to identify how HiAP approaches, including HIA, could address commercial determinants, including challenges and implications for practice. This found synergy between the concepts of wellbeing economy and HiAP. However, corporate interests have sometimes co-opted HiAP to influence policy. We found some examples of HIAs of transnational corporations and international trade and investment agreements. We reviewed HIA frameworks for guidance to practitioners on managing corporate influence. This identified little guidance on identifying and managing corporate and other conflicts of interest or managing power differentials between stakeholders. We also mapped wellbeing economy outcomes against health determinants considered in selected HIA frameworks. This found that HIA frameworks with a comprehensive checklist of health determinants prompt consideration of most wellbeing economy outcomes. HIA could support the transition to a wellbeing economy if applied routinely to economic policies, but ideational change is also needed. HIA frameworks should provide guidance on corporate conflicts of interest and power differentials.