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 critical analytical 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
Established health equity theories provide substantial untapped potential for expanding CDOH scholarship. Using these frameworks as a conceptual map clarifies the mechanisms of inequality most commonly addressed in current CDOH research and highlights gaps. CDOH are embedded within and actively shape the social, economic, and political structures that produce and sustain health inequities. Moving beyond exposure-centred analyses to examine how corporate power drives social stratification, differential vulnerability, and unequal consequences across the life course will strengthen not only CDOH scholarship but public health more broadly, enhancing its capacity to address the structural reproduction of health inequities over time.