Addressing the Commercial Determinants of Health in Sub-Saharan Africa

Background: The global health, social and economic burdens arising from non-communicable diseases (NCDs) and the climate crisis are characterised by inequalities within and between countries, and by shared determinants. These crises are shaped by the commercial determinants of health (CDoH), or the systems, practices and pathways through which commercial actors impact on health and equity.

CDoH research has centred on high-income countries and there is a dearth of policy relevant evidence to inform effective responses in Sub-Saharan Africa (SSA).

Aims and objectives: Our overall aim is to explore how three unhealthy commodity industries (UCIs), alcohol, ultra-processed food and fossil fuels, influence population health in SSA, and to inform the development of coherent policies to promote health and sustainable development. Across four interrelated work programmes we will address the following objectives:

- To map the health impacts of key CDoH in SSA and strategic links in corporate political activity across alcohol, UPF and fossil fuel industries - To use economic modelling and evaluation to inform policies to effectively regulate unhealthy commodity industries - To examine how health governance can be enhanced by managing conflict of interest and promoting policy coherence

- To explore how CDoH research can inform efforts to promote health equity and tackle power imbalances, in co-production with communities and civil society partners

This proposed research in South Africa, Ghana and Kenya will address national priorities, develop a sustainable research agenda, and promote South-South learning. It will enable innovative comparative studies across industries, policy spheres and country contexts, extending the scope of CDoH research geographically, empirically, and analytically.

Approach and Methods: This is a partnership of four leading research centres: PRICELESS, University of Witwatersrand; Kwame Nkrumah University of Science and Technology (KNUST, Ghana); African Population Health Research Center, Kenya; Global Health Policy Unit, U. of Edinburgh. The project entails co-production throughout, including via partnerships with leading NGOs in South Africa, Ghana and Kenya.

Our interdisciplinary approach draws on public health methods, systems thinking and network analysis to map health impacts and links across industry sectors; economic evaluation methods to asses trends in prices and sales, analyse market concentration and examine impacts of corporate practices; political science and legal analysis of governance challenges in regulating conflict of interest with UCIs; and participatory research methods to examine stakeholder support and prioritise interventions to address CDoH.

Outputs and Impact: Our research design will enable us to rapidly build an evidence base to inform effective interventions. We will generate over 20 research papers across health and social science journals, with a minimum of 3 papers per WP; analyses of barriers and opportunities for strengthening governance for health equity in each country; papers on the alcohol, UPF and fossil fuel industries as CDoH in SSA; methodology papers on conducting mixed methods cross-industry research on CDoH in SSA; and a project synthesis paper.

We will generate editorials, commentaries, and analysis pieces in journals and other media to help inform emerging research and policy debates, and leverage our collaborations to shape changes in policy and practice.