Identifying a hidden market within the supported housing system in England: The value of a commercial determinants of health lens

This article broadens understanding of the Commercial Determinants of Health (CDoH) by applying this lens to supported housing, specifically non-commissioned supported exempt accommodation in England. While this housing type is required to operate not-for-profit as part of the welfare system, we illustrate how a ‘hidden market’ has emerged, creating for-profit opportunities for private gain, with harmful consequences for public health. The article draws on documentary analysis of government and academic reports to make a novel contribution to the CDoH field. We identify three ‘profit lanes’ for commercial gain with ramifications for public health: 1) a leasing model that allows property owners to extract profit from Housing Benefit payments, creating opportunity costs for public spending on public health; 2) strategic selection of lucrative places to invest capital for profit rather than in response to welfare needs, which risks undermining housing quality and tenant wellbeing; and 3) overcharging for support and housing services beyond covering costs, which risks undermining tenants’ income security, voice and control as key determinants of health. A CDoH lens and the concepts of a hidden market and profit lanes could be applied to analyse other areas of the welfare system in England that provide social goods (e.g., education) and in other country contexts.