Most of us go online every day to read the news, interact with others via social media, gather information, and make household purchases. Global technology giants like Google, Facebook, Apple, Amazon, Microsoft, and others influence what we see online, the sites we visit, and how we interact with content. They can also impact how we make decisions about our health.
Global technology and social media companies represent a gap in what public health experts call the commercial determinants of health. Companies in agriculture, energy and other fields market their products, lobby governments, make displays of social responsibility, and maintain a massive global presence. Through these avenues, they have the power to impact health-related decision-making at the individual, household, community, national, and international levels.
Unlike other organizations, tech companies employ complex algorithms, cross-platform advertising, and hosted content that shape what users’ see online based on their behavior and engagement patterns. Of course, not all of the information online is factual;it may be true, partially true, or false. Tech tools create echo chambers that reinforce and bolster users’ existing beliefs and biases and foster continued online engagement. Tech companies profit by holding users’ attention, using ads to sponsor websites that spread misinformation, which can involve, in some cases, hosting content from "anti-vaxx" and other conspiracy theory groups.
Our health is affected by where we live, the food we eat, how much money we have, access to health services, and who is part of our social networks. However, these social determinants of health fail to holistically include the online ‘infosphere’, as I shared in a blog post in April.
Research has shown that online content can influence decision-making, local cultures, body image, lifestyle choices, and health habits, especially for individuals with low levels of health literacy. And when we consider how the quality, accuracy, accessibility, and availability of information can impact our health, we must also acknowledge that commercial influencers shape the information we see and how we receive it. Commercial entities wield a tremendous amount of power over how we make health-related decisions.
Commercial determinants of health are commonly defined as "factors that influence health which stem from the profit motive." Historically, public health work and research in this space has focused on how companies sell products (including highly-processed foods, beverages, alcohol, and tobacco) that contribute to early mortality and diseases including obesity, cancer, and type-2 diabetes.
Additional studies have explored commercial interests that negatively impact health through contributions to environmental pollution, pesticide and chemical exposure, poor access to safe living conditions, and unequal access to medications and health services.
While there are efforts to foster corporate accountability and engagement in health promotion activities, there is a longstanding tension between the public health community and private sector players. The commercial determinants of health present a considerable challenge that requires cross-sectoral collaboration and innovative partnerships. While companies often favor personal responsibility over regulatory or policy interventions, multisectoral engagement across economics, finance, policy, research, healthcare, social sciences, public health, and others is vital.
In the tech sector, broad, coordinated policy actions have not been taken to improve the quality of health content, though some companies are actively working to improve health content on their individual platforms by implementing their own policies, strengthening content moderation and fact-checking practices, and redeveloping algorithms. For example, in an industry first, on July 1, 2021, Pinterest banned ads containing weight loss-related products, images, or language in response to a rise in disordered eating habits and conditions over the past year.
Unfortunately, there is not a singular response or "quick fix" solution to addressing the commercial determinants of health across sectors, and additional research is needed to further define and understand how these factors impact health. Furthermore, we must acknowledge tech companies as unique entities in commercial determinants of health models since search engines, social media companies, messaging platforms, and online advertising engines do and will continue to influence the health infosphere.
