Adverse commercial determinants of health in low- and middle-income countries: a public health challenge

Research on the Commercial Determinants of Health (CDoH) has primarily focused on high-income countries and large commercial entities, with limited scholarly literature addressing the practices of smaller commercial entities in low- and middle-income countries (LMICs). However, LMICs face the greatest public health challenges resulting from harmful commercial activities, and most commercial entities in these countries are small and medium-sized enterprises (SMEs). This perspective article examines harmful practices commonly adopted by SMEs in LMICs, drawing on a published framework of commercial sector practices and portfolio. By sharing examples of these practices, the paper highlights harmful actions of SMEs in LMICs, illustrates the significant public health burden they create, and calls for more research and policy focus on these issues. There is an urgent need for CDoH research in LMIC contexts, which should include documenting and monitoring the activities of commercial actors, including SMEs. It is essential for researchers from LMICs to be involved in this research, and efforts should focus on building capacity in this area. To minimize the harms associated with these commercial practices, local regulatory action is required, alongside support from intergovernmental organizations such as the World Health Organization.