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
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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)
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Alcohol and ultra-processed food and drink industries use similar strategies to the tobacco industry to undermine effective public health policies and programmes
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Unhealthy commodity industries should have no role in the formation of national or international policy for non-communicable disease policy
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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
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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