The global health community is operating in a period of profound and accelerating change. Geopolitical tensions, economic fragmentation, climate disruption, and the rapid expansion of artificial intelligence are reshaping markets, institutions, and public trust — and with them, the conditions that determine population health. At the centre of this transformation is a fundamental tension: economic systems designed to maximise growth and profit have created substantial wealth, but have also deepened inequities, accelerated environmental degradation, and driven the rising burden of non-communicable diseases.

The commercial determinants of health (CDoH) — defined as the systems, practices, and pathways through which commercial actors drive health and equity — are not inherently harmful or beneficial. Their direction depends on how incentives are structured, how markets are governed, and how power is regulated and distributed. Under weak governance, commercial practices externalise health and environmental costs onto populations and public systems. Under strong and accountable governance, commercial actors and financial systems can be aligned with prevention, innovation, equity, and public value.

PL0 serves as the strategic overture of PMAC 2027. It opens the conference by translating the urgency of the current moment into the CDoH lens, making the system visible, and asking what it would take to redesign it toward health-enabling outcomes. It establishes the intellectual framework and the three questions that carry through PL1, PL2, and PL3.