The commercial determinants of child health

In addition to interventions to strengthen the delivery of healthcare services for children, it is vital to address the commercial determinants of health – and the ways in which the food, alcohol and tobacco industries have a negative impact on child health.

Commercial formula milk industry 

For example, the International Code of Marketing of Breastmilk Substitutes (1981) and local Regulation R991 of the Foodstuffs and Cosmetics and Disinfectants Act (2012) aim to promote and protect breastfeeding by removing commercial pressures from the infant feeding arena. This includes strict guidelines around industry sponsorship of conferences and scientific meetings, to ensure that financial support for health professionals does not create conflicts of interest that may compromise patient care. 

Our ongoing efforts to address conflicts of interest have led to collaborations with local and international scholars, including an invitation to serve on the World Health Organization (WHO) Work Group of Physicians in Healthcare Against Sponsorship by Formula Industry, and the development of a WHO model policy to help healthcare professional associations implement WHO’s call to end sponsorship from the formula milk industry.

Ultra-processed foods

In addition, multinational food companies are targeting children as consumers, flooding local markets with cheap, ultra-processed foods that are high in sugar, salt, and fat, which are helping to fuel a dramatic increase in obesity.  We have supported civil society calls for the strengthening of regulatory frameworks, including draft Regulation R3337 of the Food, Cosmetics and Disinfectants Act 54 of 1972, which will introduce food labels and protect infants and children from the marketing of foods that are harmful to health.  

Alcohol

It has been established that the over-consumption of alcohol contributes to a wide array of harms in societies and families across the world, including health, social, and economic harms. 

In 2024, we concluded supporting a research project in Uganda and Malawi that investigated the policy processes involved in the removal of small alcohol sachets from the market and learnt how and why these policy processes were successful or not. The research consortium has presented findings to policy stakeholders in Uganda and Malawi to enable further conversation about alcohol regulation in these countries.

In 2025, in South Africa and Botswana, we are working with another research consortium that will generate new evidence to support the revitalisation of the policy and law reform aimed at reducing the harmful effects of alcohol in South Africa and Botswana. This includes, but is not limited to, examining the global political economy of alcohol policy, including political, commercial, cultural and regulatory influences on harmful alcohol use as well as mapping the local alcohol environment.