Mental health equity has often been defined through the lens of the social determinants of health (SDOH), which are the conditions in which people are born, grow, work, live, and age, such as housing, food security, education, social support and health care access(1). Emerging research on the commercial determinants of health has explored how commercial forces, like private corporations, can affect health, configure risk, and normalize inequity. The commercial determinants of health amplify social determinants, as commercial actors seek to influence political, marketing, supply chain, waste, labor, employment, and scientific sectors(2). The implications for mental health are evident as the commercial determinants of health shape the environments, labor conditions, and digital spaces that influence psychological well-being. These include not only the products people consume but also the power structures that govern policy and promote certain cultural values.

While for-profit entities can positively contribute to health, growing evidence demonstrates the detrimental impact that multinational and transnational corporations have on human health and well-being. Four products: tobacco, alcohol, ultra-processed food and fossil fuels are responsible for an estimated 19 million global deaths annually(3).

Corporate decisions across design, production, pricing, and marketing may create and exacerbate structural conditions that heighten vulnerability to chronic disease, climate-related health impacts, and mental health harms. Youth and disadvantaged communities are particularly vulnerable(4). For example, tobacco, e-cigarettes and alcohol can be addictive and can increase the risk of developing depression and suicidal behavior. Tobacco companies target advertising to youth, lobby to avoid taxation, fund public health campaigns and research to frame consumption as individual responsibility and create evidence that favors their products(2).

A 2023 Lancet series on the commercial determinants of health deconstructs the key practices through which commercial actors advance their interests, often in ways that harm mental and physical health(2). Supply chain, labor, financial, marketing, scientific and political practices shape the economic, environmental, cultural/normative, informational, and policy contexts that perpetuate mental health and social inequities for at-risk communities. For example, labor and supply chain practices can contribute to income and employment instability, which in turn contribute to anxiety, depression and burnout for workers(6). Commercial activity can also be associated with unsafe housing, pollution and climate change-related displacement, which can lead to stress, trauma and eco-anxiety(7). Cultural determinants such as social inclusion, stigma, and intersectionality are continually shaped by advertising, mass media, and entertainment. Gender-targeted marketing, for example, can intensify inequities as women and girls are framed as emerging markets for tobacco and alcohol, with companies employing empowerment or rights-based language(8).

Digital business models may encourage addictive behavior, expose users to harmful content and raise privacy concerns. Facebook’s own research uncovered the negative effects of Instagram on body image among young girls but subsequently downplayed the risks to the general public(9). Additionally, the targeting tools used by social media platforms allow companies to promote their products or messaging with precision, reaching specific groups based on location, demographics, consumer behaviors, interests and more(10).

Through various practices, commercial forces shape the conditions in which people live, work, and seek care, potentially embedding inequities directly into the structures that influence mental health. Recognizing this interconnected system is essential for developing policies that protect public well-being.

While social determinants like income, housing, and access to care remain central to mental-health equity, they are often the downstream expressions of commercial practices that structure the realities patients experience. Bringing the commercial determinants of health into a mental health equity framework helps us see how economic systems are drivers of the inequities psychiatry seeks to address. This perspective also widens our sense of what prevention looks like, such that regulating harmful industries, improving labor conditions, promoting transparency in research and strengthening environmental protections become mental health strategies, and not just economic or policy reforms.

For psychiatry, this means looking beyond symptoms and asking how commercial pressures shape the lives of people seeking care. Psychiatrists can also lend their clinical authority to policies that regulate harmful commercial practices, particularly those impacting youth and marginalized communities. Clinicians can also support research beyond individual pathology and advocate for training the mental health workforce to understand and respond to commercial determinants(11).

By
Fátima Reynolds, M.P.H.
Senior Program Manager, Division of Diversity and Health Equity
American Psychiatric Association