Health Inc. Corporations, capitalism, and the commercial determinants of health | Fiona Miller

  • Oct 26

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Profile of Fiona Miller

Climate change, sustainable care, and the medically-related industry

Featuring Dr. Fiona Miller

October 26, 2023 | 12 PM – 1 PM | Online via Zoom – link will be sent to registrants

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Climate change poses a growing threat to global health due to extreme weather events, loss of biodiversity, risk of zoonotic disease outbreaks, heat stress, and poor air quality. Such threats also pose challenges for safe and effective healthcare, including through risks to reliable supply, safe infrastructure and accessible and high quality health services. Paradoxically, healthcare is a surprisingly significant contributor to climate change and other environmental harms, estimated at more than 5% of global greenhouse gas emissions. Yet pollution from the health sector is not primarily a function of buildings. Instead, it arises from the ways in which care is organized and delivered and the products that are used, including from the manufacturing, transportation, delivery, use and disposal of the drugs, devices, and other products that healthcare organizations consume. Manufacturers of medical products and services, termed the ‘medically-related industry,’ thus have an outsized role in healthcare pollution and climate adaptation, given their role in the design, manufacture, transportation, and promotion of medical products within health systems. As health systems move to reduce these challenges, through innovations in the ways that medical products can be reused or repurposed, changes to intellectual property to support distributed and locally responsive refurbishment and manufacturing, and efforts to reduce consumption, commercial interests may be challenged. In this seminar, we will discuss the roles and accountabilities of the medically-related industry given global, World Health Organization-supported  efforts to deliver climate resilient, low carbon and sustainable health systems.

Dr. Fiona A. Miller is a Professor of health policy in the Institute of Health Policy, Management and Evaluation in the Dalla Lana School of Public Health at the University of Toronto. She holds the Chair in Health Management Strategies and is a Connaught Scholar. Dr. Miller is the Founding Director of the Centre for Sustainable Health Systems at the University of Toronto, and leads a national initiative for climate action and awareness in healthcare: CASCADES. She is a Commissioner and Executive member of the Lancet Commission on Sustainable Healthcare, and a Canadian designate to the WHO Alliance for Transformative Action on Climate and Health. As a policy scholar, Dr. Miller brings a critical political economy perspective to the analysis of technological innovation and sustainability transitions. Her work aims at sustainable ‘demand driven’ innovation.

Suggested readings:

Miller FA, & Xie E. Toward a sustainable health system: A call to action. Healthcare Papers.

2020, 19(3):9-25. DOI: 10.12927/hcpap.2020.26377

Miller FA, Young SB, Dobrow M & Shojania KG. Vulnerability of the medical product supply chain: the wake-up call of COVID-19. BMJ Quality and Safety, 30:331-335. DOI: 10.1136/bmjqs-2020-012133

World Health Organization. Alliance for Transformative Action on Climate and Health (ATACH; “the Alliance”). Available at:

The Health Inc Seminar Series: Corporations, Capitalism and Commercial Determinants of Health

The corporation is arguably the most powerful social and economic institution globally, with unprecedented power to shape scientific evidence, public policy, and lifestyles. Corporations share practices including advertising, public relations, and lobbying that are common across industries and which impact population health and health equity. For example, non-communicable diseases (NCDs) are currently the leading cause of mortality globally and account for 71% of all deaths according to the World Health Organization (WHO).1 The main risk factors for developing NCDs as identified by the WHO include harmful alcohol drinking, tobacco use, physical inactivity, and the consumption of unhealthy diets rich in overly processed foods.2 The United Nations has addressed NCDs in their Sustainable Development Goal target 3.4, which is to reduce premature mortality from NCDs by a third by 2030.3 At the same time, the medically-related industry, including pharmaceutical, medical device, infant formula, and health technology companies have pervasive influence over the production of health evidence, the dissemination of health innovations, and the development of clinical practice and health policy. Critical public health analysis of the power of the corporate sector in influencing public health outcomes informed the field referred to as the commercial determinants of health. The Lancet Global Health defines the commercial determinants of health as “strategies and approaches used by the private sector to promote products and choices that are detrimental to health”.4 Corporate practices can thus be critically examined and strategically challenged in order to contribute to healthy, evidence-based public policy solutions.5 In 2021, The Dalla Lana School of Public Health’s Centre for Global Health in partnership with the Lawrence S. Bloomberg Faculty of Nursing at the University of Toronto launched a seminar series entitled, “Health Inc.: Corporations, Capitalism, and the Commercial Determinants of Health.” The objective of this seminar series is to create a forum to promote conversations, research training and collaboration across sectors and disciplines regarding the impact of corporations and other commercial determinants of health.

  1. World Health Organization. Non communicable diseases. World Health Organization; 2021.
  2. World Health Organization. Noncommunicable diseases country profiles 2018. Geneva, Switzerland: World Health Organization; 2018.
  3. NCD Countdown 2030 collaborators. (2020). NCD Countdown 2030: pathways to achieving Sustainable Development Goal target 3.4. Lancet Public Health. 396(10255): 918-934
  4. Kickbusch, I., Allen, L., Franz, C. (2016). The commercial determinants of health. Lancet. 4(12): 895-896,
  5. S, et al. (2023). Commercial determinants of health: future directions. Lancet. 401(10383): 1229-1240.