Commercial determinants of health revisited: Integrating business scholarship for greater public health impact

In her influential 2020 review in Globalization and Health, Mialon synthesizes the commercial determinants of health (CDOH) literature and underscores how commercial actors are connected to public health through the institutional environments in which they operate. Much of this research conceptualizes firms as institutionally embedded but relatively homogeneous actors, emphasizing external practices such as the production and promotion of harmful commodities, lobbying, and corporate social responsibility initiatives. While recent CDOH scholarship has begun to recognize the importance of organizational-level factors, few studies analyze the internal processes through which corporate conduct with public health consequences emerges. We argue that integrating insights from management scholarship can enrich CDOH research by opening the “black box” of the firm and clarifying how such conduct arises from interactions among institutional contexts, organizational arrangements, and individual-level dynamics. Drawing on management research, we conceptualize firms as multilevel systems in which institutional conditions inform conduct through organizational governance, resources, and practices, as well as through individual values, cognitions, sensemaking, and interaction among organizational members and stakeholders. These analytically distinct yet dynamically interconnected levels give rise to patterned forms of corporate conduct that affect public health. By foregrounding these multilevel connections, this paper advances a management-informed framework for CDOH research that moves beyond documenting harmful practices toward explaining how firms contribute to public health outcomes and identifying leverage points for intervention.