Healthcare is evolving. We used to focus purely on addressing specific symptoms and treating specific diseases. Our understanding of medicine and medical care was shaped by biology and what goes on inside the body.
But we now know that our health outcomes are also significantly shaped by external factors – everything from our ZIP code to what we eat.
What Are Commercial Determinants of Health (CDOH)?
You’re probably familiar with Social Determinants of Health (SDOH): the social and economic conditions that influence health, such as housing, education level and access to transportation. But did you know that Commercial Determinants of Health (CDOH) can also impact health outcomes?
These are the ways business practices, marketing strategies, lobbying efforts and pricing models influence the care we receive – and therefore, our health outcomes.
CDOH encompasses everything from the ads we see and the insurance policies we’re offered. Understanding the impact of commercial activities on health is crucial for anyone trying to improve care.
Why the Traditional Patient Journey Falls Short
The Myth of the Linear Patient Journey
It’s easier to fall into the trap of picturing the patient journey as a neat linear path. Symptoms appear, a diagnosis is made, treatment begins, and finally, recovery follows.
But the reality is much messier. Access to medications can be blocked by insurance hurdles. Physicians may not be aware of the latest guidelines. Drug prices and marketing campaigns can impact treatment decision-making, both for patients and providers.
All of these commercial factors affect the real-life patient experience. And until recently, most of them went untracked and unmeasured.
The Impact of Commercial Influence on Patient Care
Let’s break down some of the key ways CDOH factors into healthcare:
Market Forces and Access Barriers
Even if a patient is correctly diagnosed and prescribed the right medication, things like prior authorization rules and high out-of-pocket costs can delay or block timely treatment. These policies are often shaped by payer strategies – which may, in turn, be influenced by rebate agreements or marketing pressures from pharmaceutical companies.
How Physician Behavior is Shaped
Physicians are busy. They rely on a mix of clinical evidence, peer recommendations, and sometimes, promotional materials. Medical information and guidelines are constantly evolving, so even well-meaning doctors may miss newer treatments or be unknowingly influenced by inaccurate industry narratives. That can lead to outdated or suboptimal choices for patients.
Biosimilars, Rare Diseases, and Payer Resistance
Biosimilars offer a promising path to more affordable medications. But uptake is slow – partly due to payer formulary decisions, partly because of physician comfort levels, and partly due to patient awareness. Commercial strategies heavily influence all three.
For rare conditions, commercial dynamics are magnified. High-cost drugs may be effective, but still face resistance from payers. And without strong real-world evidence to demonstrate value, manufacturers may struggle to justify coverage — leaving patients without access to needed therapies.
Health-Related Social Needs with Commercial Roots
Things like food insecurity, transportation gaps or social isolation (also known as Health-Related Social Needs, or HRSNs) are now widely recognized as key health factors. But dig deeper and you’ll often find a commercial element. For example, the availability of healthy food options in a community can be influenced by zoning regulations, which in turn can be influenced by lobbying efforts from the food industry.
The Business of Health: How Commercial Forces Operate
Several mechanisms drive how CDOH shows up in our lives:
- Marketing and Advertising: From fast food to pharmaceuticals, advertising shapes behavior – especially among vulnerable populations like children and teens.
- Product Design: Ultra-processed snacks, addictive social media platforms or vape pens aren’t popular by accident. They are specifically designed to maximize usage, often at the expense of wellbeing.
- Policy Influence: Lobbying is a powerful tool. Industries can influence legislation that affects drug pricing, product labeling or healthcare access.
- Shifting Social Norms: Advertising has the power to shape what we consider normal. Over time, this can influence diet, exercise and health behaviors at scale.
- Environment and Access: Commercial decisions help shape our neighborhoods – whether that’s through pollution, lack of healthy retail, or unsafe working conditions.
How Real-World Data Makes Invisible Forces Visible
The good news? Real-world data is finally giving us the tools to see these connections more clearly – and to act on them.
RWD pulls together information from across the healthcare system: claims data, electronic health records, prescription patterns, demographics, and more. When analyzed thoughtfully, it reveals where commercial pressures are impacting care, and how we can intervene more effectively.
Some key ways RWD helps close the gap between commercial influence and better health:
Identifying CDOH Hotspots
Analyzing geographic data, consumer data and commercial data can reveal areas or populations disproportionately affected by specific CDOH. For example, this approach might identify areas with limited access to healthy food options.
Measuring the Impact of Commercial Influence
RWD lets us quantify the health effects of CDOH. Want to understand how limited access to healthy food correlates with diabetes rates in a given ZIP code? Now we can.
Seeing the Whole Picture
CDOH overlaps with social factors, clinical history, and more, in highly complex – and often poorly understood – ways. The right data platform can uncover unexpected patterns and connections across all these domains.
Designing and Testing Targeted Interventions
Once we understand what specific commercial factors are affecting someone’s health, we can craft more effective solutions – whether that’s connecting them with local services or advocating for systemic changes.
Tracking What Works
RWD gives us a way to evaluate whether interventions are actually improving outcomes. This makes it easier to refine and scale what works.
Meet your Trusted RWD Partner
As healthcare shifts toward holistic whole-person care, understanding the commercial layer of influence is becoming just as important as understanding clinical or social factors.
That’s where platforms like PurpleLab® come in. We provide the data, tools and expertise needed to surface these insights. As such, we help healthcare organizations move from reactive care to proactive strategy – from designing targeted programs and improving care coordination, to informing policy change.
Want to learn how we can help you? Book a demo today!