A structuralist perspective on the commercial determinants of health: Corporate survival strategies in competitive landscapes

Commercial determinants of health (CDoH) are now widely recognized as major drivers of global morbidity and mortality. The existing literature describes the practices of health-harming industries in detail, but less attention has been paid to how capitalism systematically generates these harms. In other words, the “systems” dimension of CDoH remains under-theorized and under-researched. We propose a structuralist perspective that situates the CDoH within the dynamics of capitalism. Drawing on Marx, Weber, Briefs, Smith and contemporary literature on financial capitalism and financialization, we argue that the harmful practices of tobacco, alcohol, ultra-processed foods, fossil fuels, and other industries are best understood not as isolated actions of individual firms but as predictable corporate survival strategies resulting from capitalist competition and financial obligations. We provide an account of these strategies, which invariably lead to externalizing social and ecological costs to society. We conclude that health-harming implications of financialization, corporate concentration and externalization can be broken if health were recognized as a key factor in productivity and thus macro-economic policy making, and that this requires addressing the institutional and ideological underpinnings of capitalism itself. If the CDoH are structurally produced, relying on individual corporate responsibility and regulating individual products and corporations is a category mistake. The objective must be to level the playing field and change the normative, legal and financial rules of the game, so that corporate survival no longer harms health.