It’s time to focus on the commercial determinants of rural health

Imagine driving into a small rural town after a long journey. As you scan the main street, you notice a distinct lack of decent food options. No butcher or bakery remains in town. You wander into the only supermarket and see the eye-watering prices for second-rate fresh produce. The only meat and bread available are frozen; the only seafood is pre-packaged and pre-prepared to be oven-ready. This all-too-familiar scenario perfectly illustrates the Commercial Determinants of Rural Health—the profit-driven activities that significantly influence our health and everyday living conditions.

Often viewed as part of the broader Social Determinants of Health, the Commercial Determinants are most apparent to consumers through product design, packaging, and marketing strategies. For instance, consider how tobacco and alcohol outlets are strategically placed for maximum sales or how misleading labels can make unhealthy foods appear nutritious. The less apparent effects include the indirect consequences of fossil fuel industries on employment, housing, and climate change. Alarmingly, four major sectors—tobacco, alcohol, processed foods, and fossil fuels—were responsible for nearly half of non-communicable disease deaths worldwide in recent years. Rural areas face an even more significant burden from these diseases.

Consider Sarah, a young mother living in a remote farming community. With the nearest hospital and supermarket over two hours away and limited access to affordable, healthy food options, she struggles to provide her family with the nutrition they need. The local general store, one of the only options available, predominantly stocks ultra-highly processed and packaged foods. "It's tough," Sarah admits, "I want to feed my kids healthy meals, but it's just not always possible with what's available and affordable here. We cannot afford fresh fruit and vegetables here in town." Fortnightly, Sarah makes the four-hour round trip to shop, meaning she needs someone to look after the children, and has significant fuel costs.  Even ice is double metropolitan prices, for packing the eskies for the journey home. Stories like Sarah's highlight the real-life impact of commercial determinants on individuals in rural areas. 

The Commercial Determinants of Health, while widely recognised and understood, often overlook the unique challenges rural communities face. Unlike the general commercial determinants that apply broadly, those specific to rural health encompass a distinct set of influences shaped by geographic isolation, limited access to services, and economic disparities. These factors can significantly alter health outcomes in rural areas, highlighting the need for a tailored approach that considers the rural context in health research and policy development. By understanding these nuances, we can better address the inequities that persist in rural health.

Recently, the Curtin Medical School conducted a scoping review that revealed a significant gap in research regarding the Commercial Determinants of Rural Health in rural areas. Despite ongoing and unacceptable health inequities across rural Australia, existing studies tend to focus narrowly on specific industries (like pharmaceuticals) or products (such as alcohol), leaving a comprehensive investigation of rural-specific confounding factors sorely lacking. Our exploration of Australian federal and state grant opportunities also failed to uncover any initiatives to study Commercial Determinants' impact on Rural Health.

While interest in the Commercial Determinants of Health is growing internationally and within Australia, the insights gained from this research may not benefit rural communities if urban-centric studies overshadow them. It’s time to focus on the Commercial Determinants of Rural Health.