Charting a Healthier Future: A Comprehensive Analysis of Economic and Commercial Determinants of Health in Small Island Developing States
A newly released technical paper by the World Health Organization (WHO) marks a pivotal advancement in the global response to noncommunicable diseases (NCDs), mental health conditions, injuries, and violence in Small Island Developing States (SIDS). Titled “Economic and Commercial Determinants of Health in Small Island Developing States: Noncommunicable Diseases, Mental Health Conditions, Injuries and Violence,” the document provides the first comprehensive, evidence-based analysis of how commercial and economic forces are shaping public health in these unique and often vulnerable nations.
The paper was unveiled during a key side event at the 78th World Health Assembly, aligning its release with global discussions on the upcoming United Nations High-Level Meeting on NCDs and Mental Health. It builds upon the momentum generated by the 2023 Bridgetown Declaration, which was endorsed by leaders from SIDS at the Ministerial Conference on NCDs and Mental Health held in Barbados. This declaration set forth an ambitious roadmap for action, one that now finds its technical underpinnings in this detailed WHO analysis.
A Focus on Vulnerability and Opportunity
Small Island Developing States are a group of 58 countries and territories characterized by their small population sizes, geographic isolation, limited natural resources, and economic dependence on a few key sectors such as tourism, agriculture, and fishing. While these states boast unique cultural and ecological diversity, they also face profound structural challenges, many of which directly influence the health of their populations.
This technical paper zeroes in on the economic and commercial factors that contribute to the growing burden of NCDs—such as heart disease, cancer, diabetes, and chronic respiratory conditions—as well as rising mental health disorders, injuries, and instances of violence. These health threats are often compounded by systemic inequities, climate vulnerability, and inadequate regulatory frameworks, which allow harmful commercial practices to flourish.
Crucially, the paper recognizes that SIDS are not merely passive victims of external pressures but are also actively seeking pathways to resilience and reform. By identifying shared vulnerabilities and strategic opportunity areas, the WHO aims to empower governments, civil society, and development partners to create sustainable, health-promoting policy environments.
Core Findings: Shared Challenges Across SIDS
The report outlines several interconnected economic and commercial factors that disproportionately affect SIDS. These include:
- Power Imbalances with Multinational Corporations:
Due to their limited political and economic leverage, SIDS often find themselves at a disadvantage when dealing with powerful multinational companies. These corporations, frequently driven by profit motives, may engage in aggressive marketing of unhealthy products such as ultra-processed foods, sugary beverages, and tobacco—contributing to the rising tide of NCDs. - Economic Reliance on Harmful Industries:
Many SIDS economies depend on sectors such as alcohol production, processed food imports, and tourism-related industries, which may inadvertently promote harmful consumption patterns. The lack of economic diversification limits the ability of these states to pivot toward health-positive industries. - Dependence on External Imports:
High levels of import dependency, especially for food and pharmaceuticals, make SIDS susceptible to price volatility, supply chain disruptions, and unfavorable trade conditions. These vulnerabilities can restrict access to affordable, nutritious food and essential medicines. - Compound Risks from Climate Change and Globalization:
Climate change exacerbates food insecurity, water scarcity, and the spread of vector-borne diseases, while also undermining infrastructure critical to healthcare delivery. Simultaneously, globalization exposes local populations to a barrage of unhealthy products and influences through unregulated marketing and trade. - Fragmented Health Governance Systems:
With limited capacity and resources, many SIDS struggle to establish cohesive public health governance mechanisms that can regulate commercial actors, monitor health outcomes, and implement evidence-based policies.
Strategic Opportunities for Transformative Action
In response to these challenges, the paper outlines five key opportunity areas that SIDS can leverage to safeguard and improve the health of their populations:
- Enabling Health-Promoting Policy Environments:
Governments are urged to implement fiscal and regulatory measures such as taxing sugary drinks, alcohol, and tobacco; restricting marketing of harmful products, particularly to children; and mandating transparent labeling and reformulation of unhealthy food items. - Managing Conflicts of Interest:
Stronger institutional mechanisms are needed to prevent conflicts of interest in health policymaking. This includes establishing guidelines for engagement with private sector actors and ensuring that public health goals are not compromised by corporate influence. - Community Empowerment and Participatory Governance:
A key element of effective health governance is ensuring that communities—particularly Indigenous populations, youth, and other marginalized groups—have a voice in shaping policies that affect them. The paper emphasizes the importance of bottom-up approaches that integrate local knowledge and values. - Integrated Development Planning:
Commercial determinants of health should be considered within the broader context of national development strategies. This calls for cross-sectoral collaboration between ministries of health, trade, finance, agriculture, and education to ensure that economic development does not come at the expense of public health. - South-South and Triangular Cooperation:
The paper highlights the value of enhanced collaboration among SIDS themselves, as well as with development partners and multilateral organizations. Sharing best practices, technical expertise, and policy innovations can help accelerate progress across the region.
A Turning Point in the Global NCD and Mental Health Response
The release of this paper comes at a critical juncture. The 2023 Bridgetown Declaration has already signaled a new era of political commitment within SIDS, and this technical analysis provides the evidence base needed to translate that commitment into action. By drawing clear links between economic systems and health outcomes, the paper challenges traditional silos and encourages a whole-of-government, whole-of-society approach.
Dr. Etienne Krug, Director of WHO’s Department for the Social Determinants of Health, underscores this point in the foreword:
“Tackling the commercial determinants of health in SIDS includes action to support shifting businesses from health-harming to health-promoting practices, addressing power imbalances between public sectors and commercial actors, regulating harmful commercial practices, and improving underlying systems.”
The comparisons drawn between the Bridgetown Declaration and the historic 2007 Port-of-Spain Declaration are also notable. The latter played a crucial role in galvanizing the first-ever UN High-Level Meeting on NCDs in 2011 and reframing NCDs as a global development priority. There is now hope that the Bridgetown Declaration—and by extension, this technical paper—will help reignite global momentum toward addressing the dual burden of NCDs and mental health, particularly in regions at the frontlines of these crises.
A Call for Global Solidarity and Local Innovation
The technical paper ends with a powerful call to action: “The time for action is now.” It urges governments of SIDS, regional organizations, international donors, and community stakeholders to collaborate on holistic, inclusive, and context-specific health strategies. These efforts must prioritize Indigenous wisdom, promote health-aligned local businesses, and ensure that development goals align with the well-being of populations.
WHO has committed to continuing its support through technical assistance, capacity-building, and the development of a global community of practice on the commercial determinants of health. Through this collective effort, the aim is to shift paradigms—transforming harmful market dynamics into engines of health, equity, and sustainability.
In the face of escalating NCDs, climate challenges, and economic pressure, this paper represents not only a diagnostic tool but a roadmap for transformation. For Small Island Developing States—and perhaps for the world—it is a reminder that health is not merely the absence of disease but a product of equitable economic systems, resilient governance, and empowered communities.
