Commercial Determinants of Health Case Scenario

Original Editor - Ewa Jaraczewska Top Contributors - Ewa Jaraczewska and Jess Bell  and Cornelia Barth

Introduction

Commercial determinants of health (CDoH) refer to the strategies and practices of private sector actors – including marketing, product development, pricing, and lobbying – that shape the conditions influencing population health. While some may support health, many contribute to harmful behaviours and health inequities.

Although rehabilitation professionals primarily focus on individual care, their close engagement with patients and communities positions them to identify and respond to the effects of commercial influences on health and recovery.

This fictional case scenario draws on common themes identified in the literature, exploring how commercial factors influence rehabilitation outcomes and the role of rehabilitation professionals in addressing these issues. It does not describe a real patient or physiotherapist.

Client Characteristics

Maya is a physiotherapist working at a community health centre in an urban neighbourhood with high rates of chronic diseases, limited green spaces, and a high concentration of fast-food outlets. Alcohol and tobacco products are heavily marketed throughout the neighbourhood. Residents have predominantly low socioeconomic status and limited health literacy.

Maya's patient, Carla, is a 45-year-old warehouse worker attending physiotherapy for a low back injury. Carla lives with type 2 diabetes and obesity. Despite initial progress in her rehabilitation programme, Carla finds it increasingly difficult to meet her exercise goals, maintain a healthy weight, and adhere to the nutritional plan the clinic's nutritionist developed.

Examination Findings

Maya identifies several commercial determinants affecting Carla's rehabilitation.

Carla is regularly exposed to the marketing of unhealthy products. Her daily commute takes her past numerous fast-food outlets with billboards advertising value meals. Her neighbourhood has three times more fast-food establishments than grocery stores.

Economic practices impact Carla; healthier food options cost significantly more than processed alternatives, especially since a major supermarket chain closed its local store.

Carla's workplace has vending machines filled with ultra-processed snacks and sugary drinks, but limited facilities for storing or preparing healthy meals.

Potential Interventions

Individual-Level Approach

Maya recognises that education on healthy eating and exercise is not enough when Carla is constantly exposed to advertisements for fast food and snacks at lower prices than healthier options.

In order to address this, Maya could work with Carla to enhance her health literacy, helping her recognise marketing tactics that food and beverage companies use. In collaboration with the nutritionist, they would work to identify affordable, healthier food options and create personalised strategies to navigate Carla's food environment. This includes planning daily routines and travel routes that reduce exposure to tempting advertisements and exploring simple, cost-effective meal preparation options at home that fit with Carla's budget and time constraints.

Population-Level Approach

Recognising that Carla’s experience reflects wider community patterns, Maya may be able to work with colleagues to co-develop a local programme fostering critical awareness of commercial influences on health. By partnering with a nearby community garden, they could aim to improve access to fresh produce while building social connections through group activities. Multilingual health literacy resources may be developed and distributed throughout the clinic, helping residents better understand how commercial strategies shape their choices and environments.

Policy-Level Approach

For long-term change, Maya would want to engage in policy advocacy. She could present practice-based findings at physiotherapy conferences to raise awareness of commercial determinants of health among peers. Within her clinic, she can campaign for policies that reject sponsorship from ultra-processed food companies. Collaborating with other health professionals, she could contribute evidence to city council hearings on the link between fast-food outlet density and rehabilitation outcomes. To further raise public awareness, Maya might write articles for local media on how commercial influences affect injury recovery and chronic disease management.

Potential Challenges

Maya may face multiple barriers in implementing these strategies. Limited appointment time can make it difficult to address broader commercial and social influences during clinical care, and some colleagues might view this work as outside the scope of rehabilitation. Resource constraints at the health centre may restrict the reach of community-level initiatives, and advocacy may provoke resistance from commercial interests. Measuring the impact of such interventions is challenging, and the emotional toll of tackling systemic issues can contribute to professional fatigue.

Carla, meanwhile, would continue to face daily exposure to marketing and financial limitations that restrict access to healthier options. She has little influence over her workplace environment, and changing behaviours may create tension within her social and cultural context. Sustaining motivation is difficult, especially with limited time for food preparation and physical activity.

Potential Outcomes

A multi-level approach has the potential to improve both individual and community outcomes. Carla may gain greater awareness of how marketing shapes her health choices and develop strategies to navigate her environment more effectively. This would support better adherence to her rehabilitation plan, improved management of co-morbidities, and increased confidence in making health-related decisions.

At the community level, increased awareness of commercial determinants of health can encourage collective action and support healthier lifestyles. Policy initiatives – such as zoning restrictions on fast-food outlets near health services and schools – may begin to gain traction. Within the rehabilitation field, Maya’s advocacy could contribute to greater recognition of commercial determinants in practice, as reflected in presentations, publications, and the integration of commercial determinants of health considerations into clinical assessments.

Conclusion

Rehabilitation professionals are well-placed to identify and address commercial determinants of health due to their ongoing relationships with patients and focus on function in real-world environments. They can contribute to meaningful improvements in health equity and rehabilitation outcomes by operating at individual, population, and policy levels.

Effective interventions must address individual behaviours while recognising the powerful commercial forces that shape those behaviours. Understanding commercial determinants of health can lead to improved, sustainable rehabilitation outcomes, particularly for vulnerable populations who face multiple barriers to health.