Social determinants of health

Social determinants of health refer to the social, economic and political forces that influence people’s health and wellbeing (Lucyk and McLaren 2017). Influences such as education, employment, income, housing, social participation and gender can act to strengthen or undermine the health of individuals and communities.

The World Health Organization (WHO) describes social determinants as ‘the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, live, work and age, and the wider set of forces and systems shaping the conditions of daily life’ (WHO 2025b).

Generally, population health outcomes follow a predictable pattern, with evidence supporting a social gradient; the lower the socioeconomic position the worse the health outcomes (WHO 2025b). Every step up the socioeconomic ladder is accompanied by a benefit for health. The relationship is two-way – poor health can be both a product of, and contribute to, lower socioeconomic position (Kawachi et al. 2010). The advantages or disadvantages experienced throughout life can build over time, creating cycles that are difficult for individuals to disrupt. In adverse cycles, this can often further reduce access to resources while increasing need for support. The relationship between disadvantage and health is bidirectional.

The conditions that make up the social determinants of health contribute to both health inequalities and health inequities and are critical for understanding population health. As preventable health conditions are disproportionately concentrated among people experiencing social disadvantage, prevention policies identifying priority populations and interventions targeting determinants of health can improve health outcomes and reduce disparities. This recognises that health prevention requires action beyond the individual to the broader conditions in which people live, work and age (WHO 2024).

Social determinants form part of the wider determinants of health which also includes environmental, economic, structural, cultural, biomedical, commercial and digital factors in our lives. This report includes a description of commercial determinants of health. As evidence on determinants of health continues to grow, it is increasingly understood that these factors can interact and reinforce one another.

For more information on health determinants, see What are determinants of health?

Monitoring social determinants of health

Monitoring and measuring the social determinants of health presents several challenges. Isolating the effects of individual determinants is difficult because they are complex, cut across multiple domains, and are closely interconnected. Additionally, the health impacts often take time to emerge reflecting their cumulative nature. As well, social concepts such as participation and discrimination are difficult to capture using traditional indicators and require indirect measures like frequency of community involvement or reported experiences of unfair treatment.

It is important to be careful when considering the contributing influences on health outcomes. Data may show that a factor is related to or associated with positive or negative health outcomes, but it does not necessarily mean it is the cause. In statistics, this is known as the difference between correlation and causation. Additionally, there can be other factors (known as confounding variables) that also contribute. For example, people with lower levels of education often experience poorer health outcomes than those with higher levels of education. However, this pattern reflects an association rather than direct causation as other factors, such as where people live or whether they are experiencing poverty may also influence the outcome. The relationship can also work in the opposite direction, poorer health may limit opportunities to engage in or complete education, making it difficult to determine which factor is driving the other.

Despite the challenges in measuring social determinants of health, it is still necessary to examine them as they help us understand the broader conditions shaping people’s health, identify the root causes of inequities and illustrate how social disadvantage can compound over time. Children who grow up in low-income households are more likely to experience poorer educational outcomes, which can lead to limited employment opportunities and influence health outcomes. This accumulative disadvantage influences health across the life course and demonstrates the importance of understanding the social factors that shape health outcomes and highlights opportunities for targets interventions to improve health equity. 

One commonly used measure in health reporting is the Socio-Economic Indexes for Areas (SEIFA) that ranks areas in Australia according to relative socioeconomic advantage and disadvantage (ABS 2016). This index, compiled by the ABS, represents the socioeconomic conditions of Australian geographic areas by measuring aspects of relative advantage and disadvantage such as low income, education and high unemployment of the population of an area. As it is a widely used score, it provides a useful proxy for measuring some social determinants of health.

Another widely used indicator is the ABS Remoteness Areas classification, which groups regions from Major cities to Very remote areas based on physical distance to services. This classification helps assess how geographic location influences access to healthcare, education, and other essential services.

Other health outcomes and behaviours, such as life expectancy, mortality rates, chronic disease prevalence, and downstream determinants of health including some modifiable behavioural risk factors like smoking, physical activity and diet can be examined alongside upstream determinants to explore patterns and associations. This page presents selected Australian data on key social determinants and demonstrates, where available, how they relate to health outcomes. For other health determinants, see the Built environment and health and Natural environment and health.

Socioeconomic influences

Income, education, level and type of occupation are key determinants of health as they shape access to resources, living conditions and opportunities that influence health outcomes across the life course. Education also plays a critical role in shaping health literacy, as higher levels of education can improve a person’s ability to access, understand and use health information effectively. These variables are commonly used to determine an individual’s, or a household’s socioeconomic position.

Patterns of health outcomes in Australian data shows that for almost all health measures people from lower socioeconomic areas fare worse. For example (Figure 1):

• Overweight and obesity rates were highest (69%) within the third quintile for socioeconomic area (areas sitting in the middle of the national distribution). This generally decreased in higher socioeconomic areas (63%) for Australians aged 18 and over in 2022 (ABS 2023c).
• Daily tobacco smoking was 13.4% for those living in the lowest socioeconomic areas compared with 4.1% in highest socioeconomic areas in 2022–23 (AIHW 2025c).
• Life expectancy of people living in lower socioeconomic areas (78.7 years) was 7.6 years less than those in highest socioeconomic areas (86.3 years) (Rodda et al. 2025).
• In 2021–2023, the age-standardised death rate for potentially avoidable deaths increased with socioeconomic disadvantage. Potentially avoidable causes of death for those living in the lowest socioeconomic areas were 2.3 times as high than for those living in the highest socioeconomic areas (AIHW 2025a).

Almost 1 in 3 people living in the lowest socioeconomic areas have two or more chronic conditions, compared with 1 in 8 of those living in the highest socioeconomic areas (ABS 2023b). Data relating to chronic conditions show that (Figure 1):

• People in the lowest socioeconomic areas are more likely to be diagnosed with cancer, more likely to die from cancer, and have a lower 5-year relative survival rate compared to those living in the highest socioeconomic areas (AIHW 2021).
• People living in the lowest socioeconomic areas were more likely to delay seeking medical help for cancer symptoms, have lower overall engagement with healthcare services for reasons including costs, limited access to services, lower health literacy, and poorer cancer symptom knowledge (Cancer Australia 2023; Baccolini et al. 2022; McCutchan et al. 2015).
• In 2024, among people living in the lowest socioeconomic areas, there were around 6,100 deaths where diabetes was the underlying or associated cause (113 per 100,000 population). The diabetes death rate among this group was 2.4 times higher than people living in the highest socioeconomic areas, after adjusting for age (AIHW 2026b).
• Chronic obstructive pulmonary disease (COPD) prevalence in the lowest socioeconomic areas was over 3 times greater than in the highest socioeconomic areas in 2022 (ABS 2023c).
• In 2022–24, the death rate for cardiovascular disease (CVD) was 1.6 times higher for people living in the lowest socioeconomic areas compared with those in the highest socioeconomic areas and was slightly greater for males than females (1.6 and 1.5 times as high, respectively) (AIHW 2026d).

Note that in Figure 1, estimates for back pain in 2011–12 are not comparable to other years due to coding issues. Estimates prior to 2014–15 are also not comparable to earlier years due to changes in collection methodology.

Employment and work

Having stable and secure employment helps to protect health by providing income, social inclusion and access to essential resources. Conversely, being unemployed or having insecure work increases stress and limits opportunities for healthy living, contributing to poorer physical and mental health outcomes. The psychosocial stress caused by unemployment has a strong impact on physical and mental health and wellbeing (WHO 2008). It is important to note that, as with many social determinants of health, the relationship between employment and health is complex and bidirectional. Good health increases the likelihood of being employed, while employment itself can influence health.

In Australia:

• The proportion of the population aged 15–64 who are employed (employment-to-population ratio) has fluctuated over the last 15 years, from 72% in January 2007 to a low of 70% in May 2020 (reflecting the effects of COVID-19) to 77% in August 2025 (ABS 2025d).
• In August 2025, 5.9% of employed people aged 15–64 were underemployed (not working the hours they would like to, and available to work) – 5.1% and 6.6% of the male and female labour force, respectively (ABS 2025d).
• In June 2025, there were 1.4 million jobless families (18.5% of all families). Of the 1.1 million jobless families with children aged 0–14, there were 58,000 (2.7%) jobless couple families, with 139,000 (25%) jobless one parent families. This is a decline from 2024 where there were 68,000 (3.1%) jobless couple families, and153,000 (27%) jobless one parent families (ABS 2024a; ABS 2025c).
• During January 2022 to April 2023, about 2 in 5 (43%) unemployed Australians aged 15 and over had a mental or behavioural condition during the collection period (January 2022 to April 2023), compared to 26% of employed Australians (AIHW 2025).

Analysis from the Australian Council of Social Service (ACOSS) and the University of New South Wales (UNSW) on labour force groups and the National Health Survey 2017–18 found (de Leeuw 2021):

• People employed full-time or part-time were more likely to report good self‑assessed health (64.8% and 62.6% respectively) compared with those who were unemployed (49.7%).
• People employed full-time or part-time were less likely to have a mental health condition (15.6% and 23.2% respectively) compared with those who were unemployed (30.8%).
• Prevalence of heart, stroke or vascular disease was similar across labour force groups, 2.2% employed full-time, 2.6% employed part-time and 2.2% unemployed.

For more information, see Employment and unemployment.

Housing and homelessness

People experiencing homelessness and those at risk of homelessness are among Australia’s most socially and economically disadvantaged. Experiencing or being at risk of homelessness is associated with a higher risk of adverse health, social, and economic outcomes (AIHW 2026d; Fitzpatrick et al. 2013).

Health problems can arise as a consequence of experiencing homelessness, including malnutrition and dental problems (Goode et al. 2018; Huang et al. 2022). Homelessness can expose people to violence and victimisation, result in long-term unemployment and lead to the development of chronic ill health (Larney et al. 2009).

People experiencing homelessness have significantly higher rates of death and chronic illness when compared with the general population (AIHW 2026d; Morrison 2009). Those experiencing health issues while also experiencing homelessness may have difficulties managing their health conditions which can lead to the development and/or exacerbation of a chronic health issue. This, in turn, can reduce a person’s ability to sustain wellbeing, employment, housing, and personal networks, further impacting their ability to achieve stable housing.

Young people, First Nations people, people with long-term health conditions or disability, people living in low-income housing, or people who are unemployed or underemployed are at greater risk of living in poor-quality housing.

On 2021 census night (ABS 2023a) more than 122,000 people were estimated to be experiencing homelessness in Australia, up from 116,000 (an increase of 5.2%) since 2016.

In 2024–25, 35% of persons accessing specialist homelessness services identified accommodation as a main reason for support, with housing crisis (18%) the most commonly reported. For those who identified health-related reasons for seeking support, mental health issues (1.3%), medical issues (0.9%), problematic drug or substance use (0.4%) and problematic alcohol use (0.2%) were the commonly provided reasons for needing support (AIHW 2025f).

Australian studies have found the life expectancy of people who are homeless to be up to 33 years less than those who are housed (Knaus 2024; Zordan et al. 2023).

Around 14,000 people received specialist homelessness services (SHS) support in their last year of life between 2012–13 to 2022–23 (around 8,700 males and 5,300 females). Annually, the death rate of SHS clients was 1.4–1.7 times that of non-SHS clients; around 1.7–2.3 times for males and 1.0–1.4 times for females (controlling for the age profile in both groups) (AIHW 2025g).

The most common underlying cause of death among SHS clients was consistently accidental poisoning (14–20% of deaths), followed by suicide (10–15%) and coronary heart disease (6.2–8.8%) (AIHW 2025d).

For more information see Homelessness and homelessness services, Health of people experiencing homelessness, Housing affordability, Housing circumstances of First Nations people.

Remoteness and access to healthcare

Access to healthcare is a key social determinant of health because it directly affects whether people can receive timely, appropriate medical care. Limited access can lead to delayed diagnoses, untreated conditions, and poorer health outcomes, while good access supports prevention and management of illness. In Australia, remoteness area classification (ABS 2021) is often used as a proxy measure for healthcare access, as it measures how far people live from services by calculating road distance to the nearest urban centre. 

Data on remoteness areas in Australia show that risk factor prevalence is generally greater in Outer regional and Remote areas compared to Major cities (Figure 2):

• In 2022–23, daily tobacco use was highest for those living in Remote/Very remote areas (20%), and in Outer regional and Inner regional areas (11%) compared to Major cities (7.0%) (AIHW 2025c).
• In 2022–23, risky alcohol use was highest for those living in Remote and Very remote areas (40%), and in Outer regional areas (39%) compared to Major cities (29%) (AIHW 2025c).
• In 2022–23, daily e-cigarette use was highest for those living in Major cities (3.9%), Remote/Very remote areas (3.7%) compared Outer regional (2.5%) Inner Regional areas (2.2%) and generally increased for most areas of remoteness since 2019 (AIHW 2025c).
• In 2022, more adults were insufficiently physically active in Outer regional and Remote (80%) areas than in Major cities (75%) (ABS 2023c).
• In 2023–24 the hospitalisation rate for CVD rate was 1.3 times higher for people living in Remote and Very remote areas compared with those in Major cities (AIHW 2026d).
• The age-standardised death rate increased with increasing remoteness and was 1.6 times as high in Very remote areas compared with Major cities (779 and 499 deaths per 100,000 between 2021 and 2023, respectively) (AIHW 2024b).

People living in rural and remote areas have higher mortality rates and higher rates of potentially avoidable deaths and are more likely to die at a younger age than their counterparts in Major cities.

• Compared with the national average, mortality rates are 1.1 times higher in Inner and Outer regional areas, 1.2 times higher in Remote areas, and 1.5 times higher in Very remote areas (AIHW 2025e).
• People in Remote areas were 2.5 times as likely to present to an Emergency Department (ED) than people in Major cities for an injury in 2023–24 (AIHW 2025b).

Food insecurity

Food security and food insecurity describe whether people have reliable access to food that supports health and wellbeing. Food security exists when all people at all times, have physical and economic access to sufficient, safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life (FAO 2025).

In contrast, food insecurity exists ‘whenever the availability of nutritionally adequate and safe foods or the ability to acquire food in socially acceptable ways is limited or uncertain (Australian Institute of Family Studies 2020). Food insecurity is driven by a range of systemic factors, such as extreme weather events, economic shocks and policy impacts (FAO 2025).

While food insecurity is commonly considered a concern for developing nations in relation to poverty, agricultural capacity and sustainability, it is also an issue for high income countries like Australia where individuals, families and communities experience unequal levels of security in relation to food. Different contributing factors may differ across developed and developing nations, however, food insecurity can result in similar physical and emotional health outcomes (Myers 2020).

Data from the National Nutrition and Physical Activity Survey (NNPAS) found that in 2023 (ABS 2025b):

• About 1 in 8 (13%) Australian households experienced food insecurity.
• Households in lower socio-economic areas were more likely to experience food insecurity than those in higher socio-economic areas (21% compared to 6.8%).
• Lone parent family households with dependent children (34%) and group households (28%) were the most likely households to experience food insecurity.
• Almost 1 in 4 (23%) of the lowest income households experienced food insecurity, more than six times higher than that of the highest income households (3.6%).

In high income countries like Australia, food insecure households often rely more on energy dense and often ultra-processed foods that are high in calories, fat, sugar, and salt, but low in nutrients, fibre, and water, and eat fewer fruits and vegetables. Inadequate food with essential nutrients from a diverse diet contributes to development of chronic diseases, abdominal obesity, and an elevated risk of noncommunicable diseases via multiple pathways – nutritional, psychological and behavioural. Poor diet is also linked to gut microbiome disruption and implicated in liver inflammation, mental health disorders, and poor general health (Barb and Wallen 2025; Gallegos 2025; Leung et al. 2022; McKay et al. 2019).

Early childhood

The foundations of adult health are laid in-utero and develop during the early childhood period. Physical, social/emotional and language/cognition development in early childhood strongly influence school success, economic participation, social citizenship and health (Van Eyk et al. 2023).

In 2023, around 15% of women in lowest socioeconomic areas smoked during pregnancy compared with 2% of those in highest socioeconomic areas. The proportion of women who consumed alcohol in the first 20 weeks of pregnancy was 2.1% in lowest socioeconomic areas compared with 3.1% of those in highest socioeconomic areas (AIHW 2026a).

Low birthweight rates vary across some population groups. In 2017, babies born in (AIHW 2022):

• Very remote areas (11%) were more likely to be of low birthweight than those born in Major cities (6.5%).
• Areas of greatest socioeconomic disadvantage also saw more babies born with low birthweight (7.8%) than those born in areas of least disadvantage (5.7%).

In 2022, the proportion of infants aged 0–3 years exclusively breastfed for 6 months was greater in Remote areas (50%) compared with Major cities (38%) and Outer regional areas (30%) (AIHW 2024a).

The percentage of children in the first year of school developmentally on track across 5 domains was 54% for Major cities compared with 43% in Remote and Very remote areas (Department of Education 2024).

In 2024, the percentage of children developmentally on track across 5 domains was 41% for the lowest socioeconomic areas compared with 61% in the highest socioeconomic areas (Department of Education 2024).

For more information, see Early childhood and transition to school, 2024 AEDC National Report.

Sex and gender biases

Sex and gender are recognised by WHO as structural social determinants of health because they shape access to resources and opportunities (WHO 2025b). This includes discrimination, gender norms and availability of culturally appropriate services which can act as barriers to help-seeking behaviours and receiving timely and appropriate health care. Such barriers disproportionately affect some subpopulations including First Nations people, rural and remote communities, migrants and refugees, LGBTQI+ people and people with disabilities (Commonwealth of Australia 2024).

Growing evidence shows that systemic issues in healthcare delivery and medical research mean women often suffer poorer health outcomes, for example (Commonwealth of Australia 2024):

• Women disproportionately experience delayed diagnosis, overprescribing, and a failure to properly investigate symptoms.
• Women who experience family and intimate partner violence were more likely to report poor mental health, physical function and general health than other women.

In Australia, family, domestic and sexual violence mainly affects women and children and has health and behavioural outcomes through assault injury, sexually transmitted infection, and post–traumatic stress, depression, or suicide (AIHW 2026c).

According to the ABS Personal Safety Survey, in 2021–22 more than 1 in 4 (2.7 million) women had experienced family and domestic violence since the age of 15, compared with 1 in 8 (1.1 million) men (ABS 2023d).

In 2023–24 around 9 in 10 (88%) hospitalisations for injury by a spouse or domestic partner were for females (AIHW 2026b).

Social and community context

Social and community context refers to the extent to which individuals are connected, supported and able to participate in society. It encompasses social inclusion, isolation, discrimination, and opportunities for engagement. Strong social networks and inclusive communities are linked to better health outcomes, including lower morbidity and increased life expectancy (WHO 2025a). Social connection provides people with practical and emotional support to help cope with hardships. Conversely, social exclusion, often driven by disadvantage, discrimination, racism or stigma, can lead to psychological harm, chronic stress, and poorer health outcomes (WHO 2025b).

Social isolation is linked to mental illness, psychological distress, suicide and the development of dementia, premature death and poor health behaviours (Cacioppo et al. 2002; Holt-Lunstad et al. 2015). In 2018, 54% of people aged 15 and over who had a long-term health condition or disability experienced some level of social exclusion, with 16% experiencing deep social exclusion (Brotherhood of ^St Laurence 2020). In 2023 an estimated 15% of Australians aged 15 and over were experiencing social isolation (18% of males and 12% of females) (AIHW 2026e). In 2025 most people aged 15 and over (93%) reported being able to get support in times of crisis from people living outside their household, similar to 2020 (93%) and 2019 (94%) (ABS 2026).

Discrimination is associated with reduced social and emotional wellbeing, elevated psychological distress, poorer mental health, increased suicide risk and health compromising behaviours (Thurber et al. 2022; WHO 2025c).

• In 2020, 13% of people aged 18 years and over experienced some form of discrimination in the previous 12 months. This is a decrease from 18% in 2019 and 19% in 2014, possibly influenced by short-term changes in behaviour and experience due to the COVID-19 pandemic (ABS 2025a).
• In 2022–23, around 1in 4 (24%) First Nations people aged 15 years and over felt they had been treated unfairly at least once in the previous 12 months because they were of Aboriginal and/or Torres Strait Islander origin, about the same as in 2018–19 (23%) (ABS 2024b).
• The difference (gap) in life expectancy at birth between First Nations people and non-Indigenous Australians was 8.8 years for males and 8.1 years for females in (2020–2022) (AIHW 2025b).

For more information, see: Social isolation, loneliness and wellbeing, Family, domestic and sexual violence, Social isolation and loneliness, The role community relationships play in fostering resilience - Relationships Australia.

Health literacy

Health literacy relates to how people access, understand and use health information in ways that benefit their health. People with low health literacy are at higher risk of poorer health behaviours and worse health outcomes.

The idea of health literacy is dynamic and evolving. There are many definitions of health literacy, but they generally share these common elements; health literacy describes the literacy and numeracy skills that enable people to access, understand, assess, and use information to make decisions and take actions that will have an impact on health status (Nutbeam and Lloyd 2021).

Health literacy is needed to:

• Navigate health systems and understand information provided in a healthcare setting and is discussed below in Health literacy in healthcare services.
• Allow people to critically analyse and use information on health determinants from a range of sources such as health advocacy, promotion and consumer engagement (Nutbeam and Lloyd 2021). For more information, see Health promotion and health protection.
• Digital health literacy is becoming increasingly relevant; reflecting the manner in which more people are taking on health information.

Health literacy in healthcare services

Health literacy in the healthcare setting has 2 main components (Australian Commission on Safety and Quality in Health Care 2014):

• Individual health literacy – these are individual skills, such as the ability to find, understand and use information relevant to health; for example, to complete health care forms or understand and use the health care system.
• The health literacy environment – the infrastructure, policies, processes, materials, people and relationships that make up the healthcare system and affect the way that people gain access to, understand, appraise and apply health-related information and services.

People with low health literacy are more likely to have worse health outcomes overall (Berkman et al. 2011) and adverse health behaviours, such as:

• Lower engagement with health services, including preventive services such as cancer screening (Kobayashi et al. 2014).
• Higher hospital re-admission rates (Mitchell et al. 2012).
• Poorer understanding of medication instructions (for example, non–adherence, improper usage) (Marvanova et al. 2011; Miller 2016).
• Lower ability to self-manage care (Geboers et al. 2016).

In contrast, higher levels of health literacy are associated with increased patient involvement in shared decision making (de Oliveira et al. 2018; Seo et al. 2016), which is important in patient-centred care. Improving health literacy is therefore a key element in allowing people to partner with health professionals for better health.

Measuring health literacy

Data generated by measuring health literacy can inform policy decisions and assist health organisations to tailor services appropriately to particular groups of people. The Organisation for Economic Co-operation and Development identified that addressing gaps in health literacy measurement is an important way to remove barriers to health literacy (Moreira 2018). However, the ability to measure health literacy is hampered by the broad range of definitions, a lack of consensus on what to measure, and the multiple approaches to measuring it (Osborne et al. 2013; Poureslami et al. 2017). Data on health literacy in Australia is available from the Health Literacy Survey conducted by the Australian Bureau of Statistics (ABS 2019).

Digital health literacy

Digital health literacy refers to people’s ability to find, understand and use digital health information and tools, including navigating online services and assessing whether information is trustworthy. It can shape people’s ability to engage with healthcare, benefit from digital services and avoid harm from misinformation.

Social media is powerful in the context of health literacy, with the potential to offer accessible information but also spread misinformation. This creates a digital health literacy dilemma where many Australians may struggle to determine whether the content they are viewing is accurate and trustworthy, especially impacting youth and parents who rely heavily on platforms for health information. Upskilling in digital health literacy to navigate risks such as anxiety, body image issues, and potentially harmful advice, which are available on some digital platforms, along with appropriate research on the impact of digital platforms on health literacy is required.

An example of the potential large-scale impact of navigating health information on social media is the resurgence of vaccine preventable illnesses, which has led the WHO to identify vaccine hesitancy as a major threat to global health (WHO 2025a). There has been growing public health concern regarding the impact of anti-vaccination content on vaccine denial, threatening the uptake of vaccines (Puri et al. 2020).

The new National Immunisation Strategy 2025–2030 highlights building trust as a priority to increase vaccine uptake (Department of Health, Disability and Ageing 2025).

Commercial determinants of health

Commercial determinants of health are the conditions, actions and omissions undertaken by commercial organisations that affect people’s health, directly or indirectly, positively or negatively (WHO 2023). An example of a commercial organisation is tobacco companies. Commercial determinants include the systems, practices and pathways through which these organisations affect health and equity (Gilmore et al. 2023).

While private sector commercial organisations can have a positive effect on health (for example, green grocers and gyms), there is a large body of evidence of an increasingly negative effect, particularly linked to multi- and trans-national corporations (Gilmore et al. 2023). Problems can arise when the profit motive conflicts with good health outcomes (Department of Health 2021).

Most focus has been on specific unhealthy products with direct health effects – such as tobacco, alcohol, and discretionary foods – and the large commercial organisations behind them (Lacy-Nichols 2023). However, commercial organisations are diverse, and there is increasing attention being paid to the wider, and more indirect effects. Examples include social media’s effect on mental health and the fossil fuel industry’s contribution to pollution and climate change which in turn harms health (Gilmore et al. 2023).

The spectrum of activities commercial organisations are engaged in range from legal and healthy, legal and neutral, legal and harmful, to illegal (Friel et al. 2023).

How do commercial actions affect health?

Commercial organisations can influence health directly or through the broad features of society – by influencing the social, physical and cultural environments. Harms to health are often hidden and indirect, and the many pathways are inter-related.

Commercial determinants can influence health either positively or negatively. Some examples of the ways in which commercial determinants of health can be harmful include (Department of Health 2021; Gilmore et al. 2023; WHO 2023):

• Product design, packaging and marketing – for example, misleading packaging, inappropriate marketing to children.
• Supply chains – for example, harm to local communities and the environment during production.
• Labour and employment – such as low pay levels and dangerous work environments.
• Reputational management – such as enhancing credibility and corporate image through donating to charity, greenwashing.
• Research funding and shaping the knowledge environment – for example, influencing the direction and volume of research, spreading unjustified doubt, spreading misinformation and disinformation.
• Lobbying and donations to influence the political and economic environment – for example, to block or delay regulation that aims to limit harms.
• Financial practices – including investment in products harmful to health, or tax avoidance.

What do we know about the consequences?

The activities of commercial organisations affect many risk factors and health outcomes (Chung et al 2022; UNICEF 2019; WHO 2023). Risk factors include smoking and e-cigarette use, diet, alcohol use, obesity, physical inactivity and air pollution. Health outcomes include acute, chronic and infectious diseases as well as injuries.

All groups of society are affected; For example, access to health information, or mis-information, through social media such as vaccine denial (Puri et al. 2020), has been a growing public health concern as, on some social media platforms, falsehoods are 70% more likely to get shared than accurate news (WHO 2026). The WHO has several mechanisms to reduce the prevalence of health mis-information online (WHO 2026). Additionally, First Nations people may also be disproportionately affected by actions undertaken by commercial organisations. These actions include marketing, lobbying, corporate social responsibility activities and exploitation of Indigenous land and imagery. Such practices are harmful to the health and wellbeing of Indigenous populations (Crocetti et al. 2022).

Given the complexity in how commercial determinants can affect health, it is difficult to measure their impact. Using Global Burden of Disease data, it is estimated that 4 commercial products – tobacco, alcohol, ultra-processed food, and fossil fuels accounted for 19 million global deaths in 2019, which is 34% of all deaths and 41% of non-communicable disease deaths (Gilmore et al. 2023).

Where do I go for more information?

For more information on social determinants of health, see:

• Australia’s health 2020: data insights article, Social determinants of health in Australia
• Australia’s welfare topic summaries
• World Health Organization Social determinants of health
• World Health Organisation Commercial determinants of health

For more on this topic, see Social determinants.