The commercial determinants of health operate through systems, practices, and pathways that shape health across populations. These dynamics are not confined to a narrow set of industries. They are embedded in how markets are structured, how incentives are set, and how governance is exercised, determining whose interests are prioritized, how resources flow, and what governance models are rewarded.

While the landscape of commercial actors and systems at national levels is itself complex, it faces increasing pressure from several mega-trends that are evolving globally. The Megatrends Hub defines megatrends as ‘long-term driving forces that are observable now and will most likely have significant influence on the future’. Several megatrends—and their predicted impact on health—have been identified and described by think-tanks, scholars, and conferences, including previous PMAC Conferences.

Megatrends are both the product and driver of a rapidly changing global political economy; rising geopolitical tension, strategic industrial policy, supply chain realignments, technological acceleration, and shifts in global health financing are reshaping state-market relations and regulatory capacity across regions. Despite growing scholarship on megatrends, what has received less attention is how megatrends interact with and amplify one another, and how those interrelations are themselves becoming a driver of commercial determinants. In global health, we are increasingly using terms like ‘syndemic’, ‘polycrisis’, and ‘metacrisis’ to refer to these interrelations, but it is time to unpack and critically discuss what these terms mean for the future of global and public health.

Parallel Session 2.1 examines the exacerbating effect of interrelated megatrends on the commercial determinants of health, with a focus on the disproportionate impacts on the health of the most vulnerable people, populations, and states worldwide. The Session puts a spotlight on the following megatrends and industries driving them;

• Megatrend: Aggravating resource scarcity; Industry: Extractives
• Megatrend: Climate change and environmental degradation; Industry: Extractives
• Megatrend: Changing security paradigm; Industry: Arms
• Megatrend: Accelerating technological change; Industry: Technology (including media)

Each of these megatrends carry significant health consequences independent of one another, but together the consequences compound. The result is a set of interlocking commercial dynamics and determinants that change our health risk and deepen health inequities within and between countries—not through any single industry’s actions, but through the structural interactions of competing markets, geopolitics, and planetary systems