Safeguarding governance and advancing policy at the nexus of climate and health: a commercial determinants of health perspective

• Climate change is destabilizing systems of governance for health and health equity. • Commercial actors misaligned with health can cause or exploit this destabilization. • Destabilized governance is relevant to commercial determinants of health research. • Destabilized governance warrants more attention in health and climate policymaking. • Public policy responses should prioritize commercial and wider determinants of health. The impacts of climate change on physical and mental health and health equity are well-established. Intersectoral and multisectoral policy responses are emerging, yet current entry-points, to build decarbonised and climate-resilient health services or respond to health emergencies, risk trapping health in downstream and biomedical policy paradigms at the expense of wider determinants. However, climate change does not only undermine health and equity by worsening disease pathways and burdens. Drawing on a wide range of literature, this perspective deepens our understanding, exploring how climate change destabilizes key political, economic, social and technological systems necessary to govern for health and equity, and why this is a public health concern. Using a ‘commercial determinants of health’ lens, we then investigate how commercial activities misaligned with health can cause, worsen and exploit destabilized conditions of governance, and how climate change undermines health-enabling commercial ecosystems. Learning from examples across industries and sectors, four recommendations are made. First, governments should cooperate to mainstream determinants of health and health equity approaches in intersectoral and multisectoral health and climate policies, locally to globally. Second, governments should prioritize policies that explicitly address commercial activities as determinants of climate change and health. Third, governments and international finance institutions (IFIs) should acknowledge their past decisions have accelerated climate change as an existential threat to sustainable economic development, and urgently re-evaluate normative approaches to market externalities, climate financing and human and institutional capital development. Fourth, policymakers have opportunities to champion untapped co-benefits of resilient economies, sustainable development, human health and planetary flourishing.