It’s now more commonly known that alcohol and tobacco use make us ill. Less known is that just four industries account for at least one-third of global preventable deaths. These industries are: unhealthy processed food and drinks, fossil fuels, alcohol and tobacco. Collectively they cause 19 million deaths every year, according to a recent series of reports published in The Lancet.
These deaths happen because of accepted business practices that prioritise profit over health – and not only through the companies’ products. This include cigarettes that cause cancer, sugary drinks that result in obesity or coal that drives carbon dioxide emissions, for example. The world’s largest commercial companies routinely operate in a way that masks their practices and allows them to continue and expand in the name of neoliberal economic freedoms.
These transnational corporations drive rapidly rising sickness and death levels, disability, environmental damage, and widening social inequities. The Lancet series describes a “pathological system” in which a substantial group of commercial actors are increasingly enabled to cause harm and to make others pay the costs of doing so. They profit without bearing any of the costs of the harmful products marketed to an unsuspecting public.
Commercial actors must meet the actual costs of the harm they cause if further damage is to be prevented. Governments will need to hold commercial actors to account. And norms need to be reshaped in the public interest, drawing attention to the right to health and the governmental obligation to protect health, not just corporate freedoms.
The commercial sector exists to make a profit. In the logic of the private sector, this outweighs public health and well-being considerations. Commercial activity’s health impacts can be positive, such as employing people in communities. But most are harmful. In public health, we call these “commercial determinants of health”.
The commercial practices that lead to these impacts range from legal to illegal, evident to subtle. They often overlap. At the same time, several types of practices used by commercial actors harm us. The most obvious are marketing, reputation management, questioning scientific evidence, and financial manipulation.
This matters because it is the unsuspecting public that pay. They bear the suffering and the costs of the global epidemic of noncommunicable diseases, and the rapidly accelerating climate emergency.
Marketing: making people consume more
The commercial sector uses various “dark marketing” strategies to create demand for brands and increase product consumption. Advertising for fast food and other ultra-processed food (high in fat, sugar and salt) dominates many countries’ advertising space. Nearly half of the advertisements viewed during child or family time in South Africa are for ultra-processed food and drink products.
A case study from South Africa that features in the Lancet series, on Coca-Cola’s marketing of sugar-sweetened drinks, illustrates how seemingly “normal” business practices can have devastating health impacts.
Coca-Cola and other beverage companies operate in South Africa in the context of alarming rates of obesity. Of the obese population, 68% are women, 31% are men and 13% are children. School children aged 10-13 consume at least two servings of sugary drinks daily. This makes South Africa one of the top 10 global consumers of Coca-Cola products.
The company’s marketing practices target mostly poor South Africans, seen as its growth market. Its products are available everywhere, from supermarkets to street vendors and remote rural areas. Branding is pervasive, from school and shop signs to billboards, TV advertisements and social media presence. One under-discussed aspect of this practice is how marketing reshapes cultural norms. It makes a deadly product aspirational – much as the tobacco industry did decades ago.
Reputation management: covering their tracks
Creating brand loyalty can fall into the realm of reputation management, sometimes in the guise of “corporate social responsibility”.
For example, some big food companies distributed unhealthy products with no nutritional value during the COVID-19 pandemic. Coca-Cola donated sugary drinks in Ghana. Krispy Kreme donated doughnuts to frontline emergency workers in the US. South African Breweries claimed to have recycled beer crates to make face shields for health workers.
The commercial sector seeks to influence policies so that they support the trade of harmful products or services. For example, the sugar industry in South Africa successfully lobbied to halve the proposed tax on sugary drinks.
The world’s largest tobacco company, Philip Morris International, has been