Tobacco, alcohol, highly processed foods and fossil fuel industries cause 19 million deaths per year globally. These shocking statistics, reported in Commercial Determinants of noncommunicable diseases in the WHO European Region, show how commercial activities are harming our health and increasing the global burden of non-communicable diseases (NCDs), including cancer (WCRF International contributed to two case studies to this report, one on civil society engagement and one on alcohol warning labels).
The commercial determinants of health (CDOH) assess how commercial industries and their products can influence and impact the overall health and health equity of people, and whole societies.
Impacts of CDOH are felt across society, from the individual consumer, their health behaviours and choices, extending to global levels of consumption, and the politics and economics of increasing globalisation.
Health-harming industries
Commercial determinants that negatively impact health involve products from unhealthy commodity industries, which produce and sell health-harming products such as:
- tobacco
- alcohol
- highly processed foods
- and fossil fuels
The recent WHO/Europe report shows how exposure to these health-harming products is driving up already exceptionally high rates of cancer and other NCDs globally.
In the European Region alone, almost two thirds (61.3%) of deaths caused by NCDs can be attributed directly to risk factors linked to unhealthy diets, physical inactivity, alcohol and tobacco consumption.
This equates to an estimated 2.7m deaths annually, or more than 7,400 deaths every day. Many of these deaths could be prevented with reduced exposure to these commercial products.
Corporate channels of influence
You will certainly have experienced commercial forces at play in the world in both visible and invisible ways. Industries influence and impact health, and undermine policymaking through the following corporate channels:
- marketing and advertising
- engaging in corporate social responsibility strategies and activities
- lobbying governments and policymakers; and
- deflecting attention away from their role and responsibilities in causing health harms
Marketing and advertising enhance the acceptability and desirability of health-harming products. Often selling a certain lifestyle, aesthetic or experience, it normalises these products as part of everyday life, as well as more aspirational ways of living.
Marketing and promotions have been found to disproportionately target low socioeconomic status or minority populations, with industry tactics ranging from timing marketing campaigns to coincide with the distribution of benefits from food assistance programmes, to aiming advertisements directly at children.
Corporate social responsibility activities serve to improve corporate brands and reputations. Coca-Cola or PepsiCo’s frequent sponsorship of sports teams, events, and funding children’s physical activity programmes seeks to shift focus away from how their own products contribute to the obesity epidemic, and instead reflect favourably on their support for physical activity promotion.
DrinkAware, an alcohol-industry funded health information organisation, promotes “responsible drinking” campaigns (despite alcohol being classified as a Group 1 carcinogen that is causally linked to 7 types of cancer), and engages in partnerships with government and public health agencies.
Lobbying governments and policymakers works to avoid or circumvent regulation. Examples include the food and beverage industry’s opposition to sugar-sweetened beverage taxes, or the alcohol industry’s use of legal threats to stop the implementation of health warning labels.
Public health experts are also targeted through less obvious channels, such as Coca-Cola’s emails to the US Centre for Disease Control (obtained through Freedom of Information Act requests) to advance corporate objectives over health, including trying to influence the WHO.
Other tactics include funding research and political parties to sway the evidence base and policymakers in their favour—influencing all levels of policy, from scientific evidence through to policy development and implementation.
Where does the buck stop?
Perhaps the most significant and insidious tactic used by health-harming industries is their deflection of responsibility. Industry uses the rhetoric of ‘personal responsibility’, ‘individual’ or ‘freedom of choice’ around the consumption of their products.
These messages shift the blame away from health-harming industries, and onto their customers. This argument is used not only to shape societal views around consuming tobacco, alcohol and unhealthy foods, but also in legal arguments to deny or downplay their responsibility and liability for the costs they impose on society.
Do not be mistaken: these efforts are intentionally well-crafted and funded. Health-harming industries seek to protect their own interests and offload their responsibility at the expense of public health. These narratives serve to manufacture doubt and increase uncertainty in the public, while simultaneously undermining trust in government agencies and scientific evidence to normalise the prevalence and use of their products.
Is addressing commercial determinants of health anti-business?
It’s also important to recognise what addressing CDOH is not. Addressing CDOH is not anti-business; but rather, it challenges the existing status quo and power imbalances. It also does not assume a solely negative impact: it accounts for industry actors to drive health and equity in either direction.
Profitable business and health promotion do not need to be mutually exclusive. For example, a coalition of Nestlé shareholders (co-ordinated by Share Action) has filed a resolution to challenge the company to increase their proportion of sales from healthier products.
Work to address CDOH is also not an attack on the free market, or personal liberties. It is about a consumer’s right to know about the risks involved with consuming a harmful product.
Say for instance you had a higher risk of developing breast cancer. Would knowing that drinking alcohol increases your risk of developing it, or 6 other types of cancer, impact whether you decide to consume alcohol? When buying products, would you want to be thoroughly informed about the risks you take?
Interestingly, critics of responses aimed to address CDOH often (knowingly or unknowingly) follow the same script taken straight from health-harming industries’ playbook.
This upholds the narrative that responsibility solely rests with the individual and does not hold corporations accountable for the health impacts of their products, or their influence through the four corporate channels.
Getting rid of the industry playbook; reframing the issues
But this criticism is misplaced: rather than effecting a ‘nanny-state’ or ‘prohibition’, addressing CDOH is an act to abolish and break free from the false-narratives and manipulation that industries employ for their own profit and gains.
Given the scale and size of transnational corporations, some with incomes higher than GDPs of whole countries, putting a focus on the CDOH and their impacts will have a global effect.
This is a movement to shift the focus and alignment of political will in a direction that better serves public health and health outcomes, including the reduction of health inequities, and incidence of cancer and other NCDs.
For more information on CDOH
> WHO Europe Report Commercial Determinants of noncommunicable diseases in the WHO European Region – the report also contains a number of case studies, which WCRF International has contributed to.
> Let’s Talk Cancer podcast (UICC): The obesity epidemic, shifting away from individual responsibility
