Leadership is one of the building blocks of health systems and commercial determinants of health (CDoH) shape decisions for health through a range of incentives and opportunities. “Revolving doors”, where those in public office move into the private sector (and vice versa), referring to those with decision-making authority, is a practice that can shape policies that may be more favourable to industry and harmful to health, for example, when regulators go to work in industry. Commercial forces not only shape current leadership, but also the talent pipeline of early and mid-career professionals and future leadership in the health sector. The “hidden curriculum”, which refers to the informal norms and values that are learned outside of the official curriculum, is particularly relevant in educating the generation of medical professionals. Higher pay and opportunities in the private sector naturally attract talent and hiring health professionals trained in the public sector risks eroding institutional knowledge and experience. It may also increase reliance on external advisors to design strategies for ministries of health. Formal and informal networks of influence shape the way information is shared, advice is given and decisions are made.

To examine these issues further, this session puts the spotlight an underexplored actor and pathway in the CDoH literature, that of leadership and talent pipelines. Existing CDoH scholarship outlines how commercial actors shape health through practices to influence decision-making such as lobbying, revolving doors), scientific and knowledge through funding research and education, and increasingly, agenda-setting and legitimacy-building through multi-stakeholder platforms (see Figure 1 below). This session seeks to apply these principles to the health workforce: who is recruited, trained, retained, and positioned to lead in public health institutions, and how commercial actors shape each of these stages. During the session, issues of mobility and influence around “revolving doors” as well as “hidden curriculum” will be of focus, and other topics raised will be addressed through accompanying activities.

The session is anchored in the megatrends identified by the Prince Mahidol Award Conference (PMAC) as shaping the health landscape, which are also impacting leadership and talent pipelines: climate change is demonstrating the need for a multi-sectoral approach to health; geopolitical realities are highlighting power imbalances and the need to redefine narratives for health that perpetuate inequities; Artificial Intelligence (AI) and technology is heralding another industrial revolution, defining what education and skills are needed in this era,  changing the way health professional interact with their work as well as the job market, and defining the talent pipeline and leadership in health; and demographics shifts mean that in an ageing population, intergenerational transmission of knowledge, experience and skills to tackle health challenges of the twenty-first century.

Mechanisms for transparently and effectively managing conflict of interests, building a dynamic cadre of health professionals and harnessing external capacity (such as through consultants), while increasing awareness and skills to engage with commercial actors, are needed. Low-and-middle income countries (LMICs) as well as underrepresented groups across countries will need to play a more active role in shaping the dialogue.