Applying a Health Equity Lens to the Commercial Determinants of Health: A Critical Review

Background: Commercial determinants of health (CDOH) are increasingly recognised as central to health inequities, yet CDOH scholarship has not consistently engaged with established health equity theories. As a result, CDOH research often invokes equity without clearly articulating the mechanisms through which commercial power translates into unequal health outcomes. This review addresses this conceptual gap by examining how health equity theories can be used to interpret and organise CDOH scholarship and clarify where theoretical engagement is strongest and where key gaps remain.Methods: A theory-informed interpretive review was conducted using purposive sampling of influential conceptual papers and review literature in the CDOH field. Six established health equity explanations and theories were used as interpretive lenses: cultural-behavioural, materialist, and psychosocial perspectives; fundamental cause theory, the Diderichsen model, and life course theory. Included documents were analysed for explicit engagement with these frameworks, conceptual alignment, and unrealised opportunities for theorising mechanisms linking commercial practices to health inequities.Results: CDOH scholarship most clearly aligns with cultural-behavioural explanations through its emphasis on how corporate actors shape consumption patterns and risk environments. Engagement with materialist and psychosocial perspectives is growing but remains comparatively limited. Fundamental cause theory and the Diderichsen model offer underutilised tools for specifying how corporate power contributes not only to differential exposure but also to social stratification, differential vulnerability, and unequal social consequences of illness. Life course perspectives remain notably underdeveloped.Conclusion: By placing CDOH research in dialogue with established health equity theories, this analysis clarifies both where the field has developed explanatory strength and where deeper engagement with health equity theory is lacking. The analysis demonstrates that CDOH are embedded within and actively shape the social, economic, and political structures that produce and sustain health inequities. Future research should therefore move beyond exposure-centred analyses to examine how corporate power drives social stratification, differential vulnerability, and unequal consequences across the life course. In doing so, CDOH scholarship can more fully explain how commercial actors contribute not only to immediate harms, but to the enduring reproduction of structural health inequities over time.