Project Title
Defining and measuring the commercial determinants of health as risk factors for non-communicable diseases: Advancing a new framework for addressing the global epidemiological transition

Canadian Institutes of Health Research 

January 1 - December 31 2020

Project Team
Professors Kelley Lee & Nicholas Freudenberg (City University of New York)


The steady and continuing rise in the prevalence of non-communicable diseases (NCDs), notably since the 1990s, is profoundly challenging “the very foundations of public health” according to the World Health Organization. NCDs now cause 71% of deaths worldwide, affecting populations at every income level in every country. Given the prohibitive costs of treating NCDs, this trend is also worsening health inequities. There is thus an urgent need for more effective prevention strategies focused on reducing the risk factors associated with NCDs. Traditional approaches have focused on metabolic and modifiable behavioural risk factors, such as reducing tobacco use and increasing physical activity, but the need to also change the social conditions shaping these risk factors is now widely accepted. The concept of the commercial determinants of health (CDH) has been put forth in this context. One commonly used definition is “factors that influence health which stem from the profit motive.” Current definitions, however, remain difficult to measure and operationalize to inform public health action. The purpose of this project is to develop a clear definition and set of indicators to measure CDH as risk factors for NCDs. Following the completion of a scoping review, we will bring together leading experts, from both the research and policy communities, to develop a composite CDH Risk Factor Index and preliminary methodology for its application to selected populations. The index will seek to measure risk of NCDs in a given population associated with CDHs. The outputs produced by this project will include a CIHR project grant application to pilot this definition, index and methodology as a novel approach for understanding the relationship among three types of NCD risk factors (metabolic, modifiable behavioural and CDHs), how CDH risk factors contribute to patterns of NCDs in a selected population over time, and how these metrics can inform public health action to reduce NCDs.


a) develop a clear and opreational definition for CDH as risk factors associated witih changing patterns of morbidity and mortality from NCDS;

b) identify potential indicators for a composite index to measure CDH as risk factors, and their relative importance across different disease outcomes, populations and social contexts; and

c) collaborate on a CIHR project grant application for refining and piloting the draft CDH Risk Factor Index in selected populations to better understand changing patterns of NCDs over time and place, and inform NCD prevention strategies.