Elsevier

The Lancet

Volume 381, Issue 9867, 23 February–1 March 2013, Pages 670-679
The Lancet

Series
Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries

https://doi.org/10.1016/S0140-6736(12)62089-3Get rights and content

Summary

The 2011 UN high-level meeting on non-communicable diseases (NCDs) called for multisectoral action including with the private sector and industry. However, through the sale and promotion of tobacco, alcohol, and ultra-processed food and drink (unhealthy commodities), transnational corporations are major drivers of global epidemics of NCDs. What role then should these industries have in NCD prevention and control? We emphasise the rise in sales of these unhealthy commodities in low-income and middle-income countries, and consider the common strategies that the transnational corporations use to undermine NCD prevention and control. We assess the effectiveness of self-regulation, public–private partnerships, and public regulation models of interaction with these industries and conclude that unhealthy commodity industries should have no role in the formation of national or international NCD policy. Despite the common reliance on industry self-regulation and public–private partnerships, there is no evidence of their effectiveness or safety. Public regulation and market intervention are the only evidence-based mechanisms to prevent harm caused by the unhealthy commodity industries.

Introduction

At the 2011 UN high-level meeting on non-communicable diseases (NCDs), the political declaration presented the case for prevention of NCDs in low-income and middle-income countries.1 Participants agreed that no one factor could fully address the burden of NCDs and called for collaboration with “non-health actors and key stakeholders, where appropriate, including the private sector and civil society, in collaborative partnerships to promote health and to reduce non-communicable disease risk factors”.1 To achieve the agreed goal to reduce premature mortality due to NCDs of 25% by 20252 will need a massive scale-up of concerted action to reduce consumption of unhealthy commodities—mainly tobacco, alcohol, and ultra-processed food and drink products (panel 1). National governments, non-governmental organisations, academics, and civil society need to consider what the appropriate role of the private sector will be in NCD prevention and control. The debate is most contentious about the unhealthy commodities industries, which are major drivers of NCD epidemics worldwide. What role should these industries have in NCD prevention and control? What type of interaction—defined here as a reciprocal action or influence—with these industries promotes health and protects the public from conflicts of interest? The global health community has different views about how to proceed, which range from collaborative partnerships to outright criticism.

Although there is now consensus that the tobacco industry's conflict of interest with public health is irreconcilable, whether the competing interests of the alcohol, food, and drink industries are similarly irreconcilable is debated. This lack of clarity stems partly from the absence of a coherent and agreed upon framework for interaction; the normalisation of unhealthy commodities in many countries;10 the financial and institutional relations many public health researchers,11 non-governmental organisations, and national and international health agencies have with these companies; and little appreciation that the purpose of corporations is to maximise profits.12 These conflicts are largely unstudied in public health. The science of the effect of corporate behaviour on health is an emerging area of public health that needs to be developed substantially; it studies the health risks of transnational corporations and the distribution of the unhealthy commodities that they make and market. The term industrial epidemic13, 14 has been used to describe health harms associated with various goods including tobacco,9, 15 alcohol,16, 17 vinyl chloride,18 asbestos,19 cars,20 and the food and drink industries.14 In industrial epidemics, the vectors of spread are not biological agents, but transnational corporations. Unlike infectious disease epidemics, however, these corporate disease vectors implement sophisticated campaigns to undermine public health interventions. To minimise the harmful effects of unhealthy commodity industries on NCD prevention, we call for a substantially scaled up response from governments, public health organisations, and civil society to regulate the harmful activities of these industries.

Key messages

  • Transnational corporations are major drivers of non-communicable disease epidemics and profit from increased consumption of tobacco, alcohol, and ultra-processed food and drink (so-called unhealthy commodities)

  • Alcohol and ultra-processed food and drink industries use similar strategies to the tobacco industry to undermine effective public health policies and programmes

  • Unhealthy commodity industries should have no role in the formation of national or international policy for non-communicable disease policy

  • Despite the common reliance on industry self-regulation and public–private partnerships to improve public health, there is no evidence to support their effectiveness or safety

  • In view of the present and predicted scale of non-communicable disease epidemics, the only evidence-based mechanisms that can prevent harm caused by unhealthy commodity industries are public regulation and market intervention

Section snippets

Unhealthy commodities in low-income and middle-income countries

In 2010, tobacco was estimated to have been responsible for 6·3 million deaths and alcohol accounted for 4·9 million deaths. Together tobacco and alcohol—the second and third leading risk factors for the global disease burden, respectively—cause nearly 12% of global disability-adjusted life-years.21 The consumption of energy-dense ultra-processed foods, unlike low-energy foods such as fruits and vegetables, promotes obesity.22 Similarly, consumption of sugar-sweetened beverages is associated

Strategies by industry to undermine effective public health policies and programmes

Industry documents released because of tobacco46 and asbestos20 litigation show how these industries affect public health legislation and avoid regulation with both hard power (ie, building financial and institutional relations) and soft power (ie, influence of culture, ideas, and cognitions of people, advocates, and scientists). There is now evidence to show that the food, drink, and alcohol industries use similar tactics and strategies to the tobacco companies to undermine public health

Public health responses to unhealthy commodity industries

What is the most effective way to address the disease burden caused by unhealthy commodities: voluntary self-regulation, public–private partnerships, or regulation and market intervention?

Industry-operated, voluntary self-regulation is the default approach of many governments and the UN, and the preferred approach of industry. It is argued that market forces, driven by informed individual choice, correct for negative results caused by high consumption of unhealthy commodities. For example, the

The case for public regulation

On the basis of evidence and experience so far, the tobacco industry is ruled out of any interaction with public health policy makers, researchers, and practitioners, other than what is consistent with the Framework Convention on Tobacco Control. Guidelines for implementation of article 5·3 of the Convention state that the “parties should interact with the tobacco industry only when and to the extent strictly necessary to enable them to effectively regulate the tobacco industry and tobacco

References (106)

  • CA Monteiro et al.

    A new classification of foods based on the extent and purpose of food processing

    Cad Saude Publica

    (2010)
  • CA Monteiro et al.

    The impact of transnational “big food” companies on the South: a view from Brazil

    PLoS Med

    (2012)
  • D Stuckler et al.

    Big food, food systems, and global health

    PLoS Med

    (2012)
  • DS Ludwig

    Technology, dirt, and the burden of chronic disease

    JAMA

    (2011)
  • DA Kessler
  • L Dorfman et al.

    Soda and tobacco industry corporate social responsibility campaigns: how do they compare?

    PLoS Med

    (2012)
  • D Stuckler et al.

    Global health philanthropy and institutional relationships: How should conflicts of interest be addressed?

    PLoS Med

    (2011)
  • M Friedman

    The social responsibility of business is to increase its profits

    New York Times Magazine

    (Sept, 13, 1970)
  • B Majnoni d'Intignano

    Epidemies industrielles

    Commentaire

    (1995)
  • RI Jahiel et al.

    Industrial epidemics, public health advocacy and the alcohol industry: lessons from other fields

    Addiction

    (2007)
  • J Slade

    The tobacco epidemic: lessons from history

    J Psychoactive Drugs

    (1989)
  • T Babor et al.

    Alcohol: no ordinary commodity: research and public policy

    (2003)
  • DH Jernigan

    The global alcohol industry: an overview

    Addiction

    (2009)
  • G Markowitz et al.

    Denial and deceit: the deadly politics of industrial pollution

    (2003)
  • D Lilienfeld

    The silence: the asbestos industry and early occupational cancer research–a case study

    Am J Public Health

    (1991)
  • CA MacLennen

    From accident to crash: the auto industry and the politics of injury

    Med Anthropol Q

    (1988)
  • CD Parry et al.

    Alcohol consumption and non-communicable diseases: epidemiology and policy implications

    Addiction

    (2011)
  • Diet, nutrition and the prevention of chronic diseases. WHO Technical Report Series 916

    (2003)
  • S Basu et al.

    Nutritional determinants of worldwide diabetes: an econometric study of food markets and diabetes prevalence in 173 countries

    Public Health Nutr

    (2012)
  • LA Moreno et al.

    Dietary risk factors for development of childhood obesity

    Curr Opin Clin Nutr Metab Care

    (2007)
  • V Malik et al.

    Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk

    Circulation

    (2010)
  • C Hawkes

    Marketing activities of global soft drink and fast food companies in emerging markets: a review

    Globalization, diets and noncommunicable diseases

    (2003)
  • Global status report on noncommunicable diseases 2010. Description of the global burden of NCDs, their risk factors and determinants. April, 2011. Report

    (2011)
  • Basu SMM, Galea G, Stuckler D. The relationship of soft drink consumption to global overweight, obesity, and diabetes:...
  • Passport Global Market Information Database

  • CA Monteiro

    The big issue is ultra-processing. There is no such thing as a healthy ultra-processed product

    World Nutrition

    (2011)
  • T Lyson et al.

    Stalking the wily multinational: power and control in the US food system

    Agric Human Values

    (2000)
  • E Alexander et al.

    Major multinational food and beverage companies and informal sector contributions to global food consumption: Implications for nutrition policy

    Global Health

    (2011)
  • O Alfranca et al.

    Technological fields and concentration of innovation among food and beverage multinationals

    International Food and Agribusiness Management Review

    (2003)
  • The structure of the beverage alcohol industry

  • Diageo Annual Report 2011

  • “Responsib'ALL Day” – 24 hours of action worldwide

  • Annual Report 2011

  • Quarterly divisional seminar series; Africa 2012. Africa in context

  • D Stuckler et al.

    Manufacturing epidemics: the role of global producers in increased consumption of unhealthy commodities including processed foods, alcohol, and tobacco

    PLoS Med

    (2012)
  • G Rose

    The strategy of preventive medicine

    (2003)
  • A Regmi et al.

    Processed food trade pressured by evolving global supply chains

    Amber Waves

    (2005)
  • DA Kessler

    A question of intent: a great American battle with a deadly industry

    (2001)
  • G Hastings et al.

    Failure of self regulation of UK alcohol advertising

    BMJ

    (2010)
  • Alcohol: first report of session 2009–2010

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