Abstract for: What are the Systemic Drivers of Commercial Health Harms? Identifying Systems Archetypes in the Commercial Determinants of Health

Systems archetypes, recurring combinations of system structures and behaviors, offer a system dynamics lens to diagnosing drivers of undesirable system outcomes. We applied archetype theory to The Lancet 2023 Commercial Determinants of Health paper series, which offered qualitative explanations for the empirical observation that over a third of global mortality is linked to commerce. We identified six archetypes mapped to governmental, civic and market structures (drifting goals & fixes that fail), system goals (shifting the burden & success to the successful), and paradigms (accidental adversaries & tragedy of the commons). These archetypes suggest a sequenced approach: first, the narrative must be established that private entrepreneurship can benefit public health if it does not externalize costs, and that this requires robust public and civic institutions. Competition and regulatory policies are needed to curb concentrated, harmful commercial power, enabling business models less likely to externalize costs and upstream public health approaches. By focusing on dynamics, our analysis helps reallocate blame away from individual players in the ‘pathological’ system that currently causes commercial health harms and onto deeper-seated, structural drivers.