The rationale for the work rests on the recognition that commercial actors shape health far beyond the sale of harmful products. Industry influence can permeate policymaking processes themselves, from lobbying and partnership arrangements to sponsorship and the framing of evidence. The Lancet series identified preventing undue influence on policymaking as one of the key mechanisms for interrupting commercial harm. In the United Kingdom, local authorities are considered natural agents of change in this landscape because they hold varied powers, statutory duties, assets and resources that shape the determinants of health, from licensing and planning to procurement and public estate management. Yet until now, there has been a gap between the growing academic literature on the commercial determinants of health and the pragmatic, day-to-day decisions that council officers and elected members must make about engaging with the private sector.

The developers set out to produce what they call a Research-Derived Actionable Tool, or RDAT: a resource distilled from academic knowledge into clear, actionable and pragmatic guidance that local authorities can align with their own values. Four principles guided the entire development process. The first, concise sufficiency, dictated that only material directly useful to local authority colleagues tackling local issues should be included. The second, getting started over perfection, prioritised a timely, actionable output that could be iterated and improved through practice and evaluative research rather than waiting for a flawless product. The third principle, guidance rather than direction, reflected the fact that local authorities are independent, varied and democratically accountable bodies, meaning the toolkit should help each organisation develop the right policy for its own population rather than imposing a single template. The fourth, evidence-informed, required drawing from existing evidence on harms and on how to address them in different contexts.

The methodology behind the toolkit combined document searching and analysis, expert workshops, individual stakeholder input, iterative drafting and structured dissemination. The document search was purposive, built on the research team’s existing knowledge, stakeholder recommendations, internet and key website searches, and snowballing techniques to identify examples of existing policies, comparable toolkits, and research on governance and conflicts of interest. In November 2022, a 90-minute online workshop brought together sixteen stakeholders, four from local authorities, seven from non-governmental, regional or national policy organisations and five from academia, to explore three questions that the published evidence base could not answer: what organisations need in place to introduce policy, what challenges implementation might pose, and how organisations should determine the scope of their policy. Crucially, the workshop aimed to map the breadth, divergence and convergence of views rather than force a consensus. Twelve further stakeholders contributed individually by video call or email, sometimes offering off-the-record insight that would not have surfaced in a group setting.

Editorial decision-making rested with the two authors, both of whom had extensive experience working within local authorities and had been engaged in academic work on the commercial determinants of health. Their approach to weighing conflicting input was systematic: practitioners’ expertise was prioritised for questions of accessibility, ease of use and pragmatic concerns; academics’ expertise carried the greatest weight for research evidence; and NGO and national or regional colleagues’ expertise informed questions of coherence and cross-contextual variation. Data analysis and synthesis were carried out throughout using reflective writing and discussion, and the process was explicitly non-linear, with expert input sought at the planning stage, again during analysis where gaps in the evidence demanded judgement calls, and finally during feedback on content and format.

The drafting process unfolded across three versions between December 2022 and October 2023, with the toolkit finalised in January 2024 and launched in April 2024. The first draft set out the structure and expected content; the second put key content in place while highlighting gaps; and the third was circulated for red-line comments from four key peer reviewers charged with guarding against major errors or harm. The resulting toolkit is modular, comprising seven sections, a foreword and an accompanying set of flow-charts to inform policy and decision-making. Its sections cover how to use the toolkit, the case for using good governance to protect health, issues to consider and evidence for managing private-sector engagement in governance policy development, benefits and key issues, principles and content considerations for policy and process, frequently asked questions, and a glossary. Separating the guidance from the supporting evidence was a deliberate design choice, allowing time-pressed readers to grasp key points quickly while retaining a transparent evidence base behind each recommendation. The launch event attracted 128 online attendees, with 160 registrants receiving follow-up information, and the design was funded by the University of Stirling and the SPECTRUM consortium.

One of the most instructive episodes in the development process involved a fundamental disagreement about scope. Some stakeholders recommended starting narrowly, with a set of specific health-harming industries where the evidence of harm related to conflicting interests is strongest, particularly tobacco and alcohol. Academic evidence, however, highlighted the risks that so-called tobacco exceptionalism, the practice of singling out one industry for restrictions, may paradoxically slow progress in other policy areas by implying that other commercial actors are benign. Rather than choosing between these positions mechanically, the team used the workshop format to explore the reasoning underpinning each perspective and then resolved the conflict through their guiding principles and expertise weightings. They opted for a broad approach covering commercial interactions in general, reasoning that this prioritised research evidence, added value over existing approaches that had focused on single industries, and respected the democratic accountability of local authorities by giving them tools to suit their own contexts.

Recognising that a broad approach might feel overwhelming to some councils and lead to less progress rather than more, the developers built in mitigations. The modular structure allows readers to pick and choose which parts of the toolkit to use depending on context and need, and the dissemination strategy explicitly states that people may use the toolkit in different ways, suggesting starting points that could include choosing a limited number of industries or policy processes. Whether these mitigations work as intended is now an open empirical question: an evaluation of the process and impact of implementation is underway, led by the Local Health and Global Profits research consortium, part of Population Health Improvement UK. That evaluation is expected to feed lessons, including resource implications, into future iterations of the toolkit.

The authors are candid about the central limitation of their work: at the time of publication, the toolkit had not been fully implemented, meaning its feasibility had not been tested in the real world and testimonies from direct application could not be incorporated. Nevertheless, an expert panel judged that the toolkit meets many criteria considered highly relevant for planning system-level health promotion, including a clearly described target audience, adaptability to context, prioritisation of action, an adequate range of supporting evidence, and alignment with existing structures and systems. The authors argue that toolkits for public health practice are subject to a different set of standards and priorities than academic work, and that the methods for producing them must therefore differ as well. By publishing their methods, they hope to encourage timely, evidence-informed action in emerging fields of public health where more rigorous evaluation approaches inevitably lag behind practice needs, and to contribute to broader debate about the methods and standards appropriate for research-derived actionable tools. For local authorities, the toolkit is positioned not only as a policy-development instrument but also as material for learning and education, for building a case for change, and for supporting ad-hoc decisions, with wider use potentially opening the policy window for full policy adoption in councils that are not yet ready to act on the commercial determinants of health.

The arms industry operates through a complex web of corporate strategies that profoundly influence public policy and shape societal narratives around violence and security. Its arsenal extends well beyond weaponry, encompassing lobbying efforts, sponsorship of research institutions, and the cultivation of intimate ties with governmental agencies. These tactics, strikingly similar to those employed by the tobacco, alcohol, and fossil fuel sectors, effectively obscure the detrimental societal and health impacts intrinsic to the production and proliferation of arms. Consequently, this industry’s influence disrupts public health agendas and perpetuates cycles of conflict, injury, and mortality on a global scale.

Health professionals now find themselves at a pivotal crossroads. As the United Kingdom prepares to host the world’s largest arms fair, the urgency to counterbalance the pervasive reach of the arms industry on governmental priorities has never been greater. Researchers such as Mark Bellis of Liverpool John Moores University and his international collaborators have illuminated the direct and systemic harms arising from arms manufacturing and trade. Their analyses advocate for a paradigm shift that recognizes the arms industry’s corporate behavior—its marketing, lobbying, and institutional influence—as equally responsible for public health consequences as the weapons it produces.

The reallocation of resources toward defense spending increasingly strains budgets traditionally dedicated to health care and foreign aid, undermining efforts to improve population well-being domestically and internationally. Such fiscal shifts threaten to erode the already fragile social determinants of health, especially in vulnerable communities dependent on welfare systems and international assistance. The health costs associated with this militarization extend beyond battlefield casualties and encompass broader societal repercussions, including psychological trauma, displacement, and the degradation of health infrastructure in conflict zones.

Critically, while Europe seeks to diminish its security dependence on the United States, experts warn that this strategic autonomy must not come at the expense of sustaining essential health and welfare programs. The imperative to protect humanitarian interests and uphold global health commitments must guide defense policy decisions, rather than allowing commercial and militaristic imperatives to dominate. This approach aligns with a renewed advocacy for a “peace dividend,” a concept urging the reinvestment of military funds into social sectors that bolster health equity and human rights.

The academic and medical research communities currently exhibit a conspicuous gap in addressing the arms industry as a commercial determinant of health. By applying a critical lens to this nexus of commerce, policy, and health outcomes, scholars can unravel the intricate mechanisms through which the industry perpetuates health harms. This investigative framework not only enriches scientific understanding but also equips health practitioners and policymakers with evidence to challenge industry narratives and advocate for reforms grounded in ethical imperatives and health priorities.

The conceptual transition toward recognizing the arms industry within the health determinants paradigm demands robust interdisciplinary collaboration. Public health experts, researchers, and civil society must coalesce to champion a reorientation away from profit-driven arms development and deployment. Instead, global agendas must prioritize health preservation, human rights, and peacebuilding as foundational goals. This realignment necessitates confronting entrenched industry influence embedded in political and economic systems, a task requiring vigilance, transparency, and unwavering commitment from the health community.

Health practitioners wield unique moral authority and credibility, representing a formidable counterbalance to the arms industry’s framing of security issues. Their expertise in exposing the human cost of violence and conflict positions them as vital actors in reframing public discourse and influencing policy. Historical precedents underscore the efficacy of health sector engagement in challenging powerful industries—most notably the successful campaigns against tobacco corporations and fossil fuel lobbyists. This legacy provides a blueprint for confronting the arms industry’s entrenched position and advocating for health-centered security paradigms.

Moreover, medical journals and editorial institutions hold a critical role in this endeavor, serving as platforms for disseminating research, amplifying ethical concerns, and mobilizing professional communities. The collective action of journal editors, physicians, and anti-arms trade activists previously compelled corporate divestment from defense sectors, exemplified by Reed-Elsevier’s exit in 2007. However, despite these advances, current scrutiny of arms industry practices remains insufficient. A reinvigorated focus is essential to dismantle obfuscation tactics and hold corporations accountable for their contributions to global health crises.

Beyond direct health consequences, the arms industry’s influence undermines the structural determinants of peace and security, which are intrinsically linked to population health outcomes. Conflict-driven displacement, injury burden, and mental health disorders constitute only the visible manifestations of deeper systemic issues fueled by the continuous production and distribution of weapons for profit. Addressing these challenges requires integrating health considerations into security analyses, thereby promoting policies that mitigate harm and foster resilience.

A proactive stance necessitates that health professionals not only critique the arms industry’s impacts but also advocate for political and social reforms aligned with peace and health imperatives. This advocacy includes supporting disarmament initiatives, promoting transparency in defense spending, and demanding accountability mechanisms that address corporate complicity in perpetuating violence. By positioning the arms industry as a commercial determinant of health, the health sector can leverage its expertise to influence policy debates and prioritize human well-being over militaristic interests.

Ultimately, bridging the divide between public health and security sectors unveils an urgent imperative: reimagining global security through the lens of health and human rights. This vision challenges entrenched orthodoxies that conflate security solely with military might and instead advocates for comprehensive approaches that address the root causes of conflict and harm. The pursuit of such a transformative agenda requires solidarity among health professionals, researchers, policymakers, and civil society to confront the arms industry’s pervasive influence and champion a sustainable, peaceful future.

The mounting evidence and renewed advocacy underscore a critical juncture in the global discourse on security and health. Recognizing the arms industry as a commercial determinant of health elevates the conversation beyond traditional defense narratives, exposing the profound human and planetary costs of unchecked arms proliferation. As the world watches London host the largest arms fair, the call to action grows louder: health professionals must harness their collective power to advocate for peace dividends, safeguard welfare programs, and realign societal priorities to place health and human dignity at the forefront of security policies.

Subject of Research: The arms industry as a commercial determinant of health and its broader implications on global health, policy, and welfare.

Article Title: Weapons, wealth and health: the arms industry as a commercial determinant of health

News Publication Date: 2-Sep-2025

Web References: 10.1136/bmj-2025-086166

Keywords: Warfare, Government, International relations, Health care industry

Maternal health occupies a unique position within public health due to its intrinsic connections with generational well-being and social progress. Despite significant advances in maternal care and policy, disparities remain stubbornly persistent, often reflecting underlying societal inequities. Historic gender inequities have systematically marginalized mothers, limiting their agency and amplifying their vulnerability to harmful commercial practices. These range from aggressive marketing of formula milk circumventing breastfeeding norms to commodification of reproductive health services, all of which contribute to poorer health outcomes. This intersection of commerce and gender inequity lays bare the structural challenges that impede mothers from accessing and exercising autonomy in health-related decisions.

Understanding the commercial determinants of maternal health requires a multilayered analysis of the economic forces, industry practices, and regulatory environments that combine to influence maternal well-being globally. Commercial determinants encompass not only the direct products and services marketed to expectant and new mothers but extend to the broader economic ecosystem that includes employment conditions, access to social protections, and environmental exposures shaped by commercial enterprise. These determinants often shape risks in insidious ways, embedding themselves into cultural norms and healthcare infrastructure, making their identification and mitigation a daunting yet necessary task.

One of the critical dimensions addressed in the recent research is how multinational corporations exploit gaps in regulation and societal vulnerabilities to promote products that undermine maternal health. For instance, the marketing strategies of formula companies in low- and middle-income countries often disregard international codes that safeguard breastfeeding practices, exacerbating risks such as infections and malnutrition in infants. Beyond infant formula, the commercialization of fertility treatments or prenatal supplements raises ethical questions around profiteering versus genuine health promotion, with disparities evident in access and information dissemination.

Moreover, labor market dynamics influenced by commercial interests pose significant health risks to mothers. Precarious employment, low wages, and lack of maternity protections are direct consequences of economic models valuing profit maximization over worker well-being. These conditions limit mothers’ ability to seek timely prenatal care, maintain nutrition, and avoid stressors detrimental to pregnancy outcomes. In many regions, commercial pressures on healthcare delivery systems push services towards privatization and cost-cutting, diminishing quality and accessibility, disproportionately affecting the most vulnerable populations.

Environmental risks—another domain driven by commercial activities—add an additional layer of complexity. Mothers are uniquely susceptible to exposures such as air and water pollution, toxic substances, and chemical contaminants linked to industrial and agricultural operations. These exposures are often compounded by poverty and inadequate healthcare, intensifying adverse maternal and fetal health outcomes. The commercial imperative driving environmental degradation thus intersects with gender and socio-economic inequities, crafting a potent threat matrix to maternal health.

Addressing these commercial determinants necessitates integrated, cross-sectoral approaches. Isolated public health interventions risk futility if systemic commercial drivers remain intact. Regulatory reforms targeting marketing, labor rights, environmental standards, and healthcare access must be harmonized with gender-equitable policies and community empowerment frameworks. Recognizing commercial determinants as a priority issue transforms maternal health advocacy into a broader movement aligned with social justice, economic policy reform, and sustainable development goals.

A moral dimension underpins the imperative to tackle commercial determinants in maternal health. Ethical stewardship demands that society does not tolerate forces compromising the fundamental rights of mothers to health, dignity, and informed choice. These rights must be foregrounded in global policy dialogue, transcending national boundaries and economic agendas. The study underscores that prioritizing mothers’ health in the face of commercial pressures is not merely a health sector concern but a fundamental reflection of societal values and commitments.

The implications extend far beyond individual health. Maternal health is a cornerstone of human potential, influencing childhood development, educational attainment, and economic productivity. When commercial determinants degrade maternal well-being, they set off a cascade of negative outcomes across communities and generations. Conversely, mitigating these harms fosters resilient, equitable societies where social, economic, and environmental potentials can flourish. Therefore, public health interventions must embrace systemic change, involving stakeholders from government, civil society, healthcare providers, and affected communities.

Technological innovations and data analytics offer promising tools for identifying and monitoring commercial influences on maternal health. Real-time data on product marketing, labor conditions, and environmental exposures can facilitate targeted interventions and accountability mechanisms. However, technology alone cannot supplant the need for political will, advocacy, and grassroots mobilization to confront entrenched commercial interests and structural inequities.

International frameworks, such as the World Health Organization’s code on marketing breastmilk substitutes, represent critical benchmarks but face enforcement challenges. Strengthening global governance and cooperation can amplify these instruments’ effectiveness. Simultaneously, empowering mothers through education, legal protections, and economic support strengthens their agency, enabling informed decisions resistant to harmful commercial pressures.

The COVID-19 pandemic has further highlighted the vulnerabilities of maternal health systems under commercial strain, as economic disruptions and service constraints magnified exposure to adverse determinants. Recovering from the pandemic provides an impetus to reimagine maternal health within a framework that fully integrates commercial determinants into health planning and policy, ensuring resilience against future shocks.

In conclusion, the burgeoning recognition of commercial determinants as fundamental drivers in maternal health marks a paradigm shift in public health thinking. It calls for comprehensive, ethically grounded, and multisectoral responses to safeguard mothers from the harms hidden within the vast expanse of global commerce. As the study articulates, prioritizing this agenda is not only necessary but urgent to unlock the full spectrum of human social, economic, and environmental potential. This transformative perspective reaffirms maternal health as a linchpin in achieving a just, sustainable future.

Subject of Research:
The study investigates the adverse impact of commercial determinants on maternal health, emphasizing historic gender inequities and the necessity for integrated policy and social action.

Article Title:
The commercial determinants of maternal health.

Article References:

Hanson, M., Bustreo, F., Di Renzo, G.C. et al. The commercial determinants of maternal health.
npj Womens Health 3, 44 (2025). https://doi.org/10.1038/s44294-025-00090-y

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