Better understanding the commercial determinants of health to reduce the influence of harmful industries

In an interview with The Johns Hopkins University News-Letter, Anna Gilmore, professor of public health, director of the Tobacco Control Research Group and co-director of the Center for 21st Century Public Health at the University of Bath in England, discussed her work to define the influence of commercial actors on public health, known as the commercial determinants of health (CDOH).[1].

Commercial determinants of health refer to the way in which actors in the commercial sector, their products and their practices influence health. Some of these industries: tobacco, alcohol, agri-food or even fossil fuels deploy numerous strategies to hinder the implementation of policies relating to the fight against non-communicable diseases (cancers, respiratory and cardiovascular diseases, diabetes, etc.) caused by the products of these industries.

However, defining and addressing the commercial determinants of health remains complex due to the difficulty of obtaining reliable data and the pervasive influence of these industries on public perception.

Industries responsible for the increase in non-communicable diseases

These industries are estimated to be responsible for approximately 19 million deaths per year, or about 34.1% of all deaths. A recent WHO report on the commercial determinants of health estimated that tobacco, fossil fuels, ultra-processed foods (UPFs) and alcohol are responsible for more than 7,400 deaths each day in the 53 countries of the WHO European Region. Together, these four industries cause approximately 2.7 million preventable premature deaths annually in the region, or about a quarter (24.5% ) of all mortality.[2].

Between 1990 and 2019, the share of noncommunicable diseases (NCDs) increased from 43 % to 54 % of the global burden of disease. NCDs now account for 71 % of total deaths worldwide, of which 81 % are due to four types of diseases (cardiovascular diseases, diabetes, cancers and chronic respiratory diseases). This proportion is expected to increase to more than 85 % by 2030.[3].

Similar influence practices within these industries

In her research, Gilmore studied internal documents from the British American Tobacco Company (BATCo) and its parent company, BAT Industries, that were made public following litigation between the state of Minnesota and Minnesota Blue Cross Blue Shield and several tobacco companies. Gilmore also looked at other industries and found similarities in how tobacco companies and other companies influenced public policy and shaped the narrative about the health risks of the products they sell. These strategies included intimidation or legal action to block access to evidence about the harms of the products they sell; funding industry-friendly papers and studies; engaging third parties to echo the same “science message” that is favorable to the industry (such as “echo chambers”); and maximizing industry-friendly media coverage.

These companies continue to exert considerable influence over scientific research. While there are guidelines in place to ensure research transparency, some of these companies have become adept at finding loopholes in these guidelines, Gilmore says, citing the tobacco industry as an example. Some journals, for example, have a policy of not publishing research funded by the tobacco industry, but manufacturers circumvent these rules by conducting research funded by external third-party organizations. This form of indirect funding allows companies to influence scientific narratives while appearing neutral and disconnected from the scientific research process.

The ability to influence public opinion

Gilmore also highlighted the fact that corporations position themselves as impartial actors in society. By positioning themselves as the consumer's "friend," corporations are able to subtly influence public opinion and present health problems as matters of individual action rather than as systemic problems constructed and perpetuated by their very activities. In this way, the responsibility for solving health and other problems caused by these products is shifted to individuals. This absolves corporations of any responsibility for the negative effects of their products, particularly on health. Corporations are thus able to evade public scrutiny and continue to sell and produce harmful products without being questioned.

A concrete example of the transfer of responsibility towards the consumer put forward by anti-smoking associations are the awareness campaigns on cigarette butt pollution, orchestrated by tobacco manufacturers.[4]. In France, the eco-organization Alcome (managed by the main tobacco manufacturers), in charge of collecting cigarette butts, recently launched a national campaign entitled "I throw my cigarette butt where it should be" with the aim of raising awareness among smokers about the wild throwing of cigarette butts in nature. This discourse thus places the responsibility for cigarette butt pollution on the incivility of its consumers who should be educated, while failing to specify that this waste is primarily produced by tobacco manufacturers and that its toxicity results in particular from the ingredients of these products and the plastic filters which in no way protect the smoker.

The problem of shifting responsibility is further compounded by the powerful influence of corporations on the media landscape. According to GiImore, the shift in media ownership toward wealthy players with vested commercial interests is skewing media coverage. Narratives are developing that align with the interests of industries that are portrayed in a more favorable light. They are presented as responsible actors, involved in research and development of less toxic products, concerned about their consumers and their freedom of choice in the face of a nanny state.

Stronger legal frameworks to limit corporate influence

To combat corporate influence, Gilmore advocates for stronger legal frameworks, drawing on lessons learned from tobacco control. Article 5.3 of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC), for example, aims to prevent the tobacco industry from interfering in public health policy. The FCTC could thus serve as a framework for protecting public policy from interference by other harmful industries. This includes implementing conflict of interest policies and appropriate governance.

As the United Nations negotiations for an international treaty to reduce plastic pollution continue, anti-smoking activists are calling for a consideration of conflicts of interest in the treaty articles and for the FCTC to be explicitly referred to alongside other relevant treaties in the preamble to the plastics treaty and in certain key articles or annexes.  According to them, the established rules would protect future environmental policies from the commercial interests of the tobacco industry (in particular concerning the ban on cigarette filters requested by the associations) but also from other problematic industries with interests that go against this treaty.

Gilmore also said there is a need for stricter rules on media ownership to reduce corporate influence over the media and ensure the public receives unbiased health information.

©Tobacco Free Generation

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[1] Understanding commercial determinants of health: insights from professor Anna Gilmore, The John Hopkins Newsletter, published November 12, 2024, accessed November 15, 2024 [2] Tobacco-free generation, Europe: Tobacco, alcohol, processed foods and fossil fuels cause 2.7 million preventable premature deaths per year, published June 14, 2024, accessed November 15, 2024 [3] Lee K, Freudenberg N, Zenone M, Smith J, Mialon M, Marten R, Lima JM, Friel S, Klein DE, Crosbie E, Buse K. Measuring the Commercial Determinants of Health and Disease: A Proposed Framework. Int J Health Serv. 2022 Jan;52(1):115-128. doi:10.1177/00207314211044992. Epub 2021 Nov 1. PMID: 34723675; PMCID: PMC8592108. [4] Communicated, The eco-organization ALCOME, a greenwashing tool for the tobacco industry in France, CNCT, 2022 National Committee Against Smoking |