“Big” Food, Tobacco, and Alcohol: Reducing Industry Influence on Noncommunicable Disease Prevention Laws and Policies; Comment on “Addressing NCDs: Challenges From Industry Market Promotion and Interferences”

Document Type : Commentary


1 The University of Sydney Law School, Sydney, NSW, Australia

2 O’Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC, USA


The food, tobacco and alcohol industries have penetrated markets in low- and middle-income countries (LMICs), with a significant impact on these countries’ burden of noncommunicable diseases (NCDs). Tangcharoensathien and colleagues describe the aggressive marketing of unhealthy food, alcohol and tobacco in LMICs, as well as key tactics used by these industries to resist laws and policies designed to reduce behavioural risk factors for NCDs. This commentary expands on the recommendations made by Tangcharoensathien and colleagues for preventing or managing conflicts of interest and reducing undue industry influence on NCD prevention policies and laws, focusing on the needs of LMICs. A growing body of research proposes ways to design voluntary industry initiatives to make them more effective, transparent and accountable, but governments should also consider whether collaboration with health-harming industries is ever appropriate. More fundamentally, mechanisms for identifying, managing and mitigating conflicts of interest and reducing industry influence must be woven into – and supported by – broader governance and regulatory structures at both national and international levels.


Main Subjects

  1. Bollyky TJ, Templin T, Cohen M, Dieleman JL. Lower-income countries that face the most rapid shift in noncommunicable disease burden are also the least prepared. Health Aff (Millwood). 2017;36(11):1866-1875. doi:10.1377/hlthaff.2017.0708
  2. Moodie R, Stuckler D, Monteiro C, et al. Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries. Lancet. 2013;381(9867):670-679. doi:10.1016/s0140-6736(12)62089-3
  3. Stuckler D, McKee M, Ebrahim S, Basu S. Manufacturing epidemics: the role of global producers in increased consumption of unhealthy commodities including processed foods, alcohol, and tobacco. PLoS Med. 2012;9(6):e1001235. doi:10.1371/journal.pmed.1001235
  4. Tangcharoensathien V, Chandrasiri O, Kunpeuk W, Markchang K, Pangkariya N. Addressing NCDs: challenges from industry market promotion and interference. Int J Health Policy Manag. 2019;8(5):256-260. doi:10.15171/ijhpm.2019.02
  5. Sustainable development goal 3: Ensure healthy lives and promote well-being for all at all ages. United Nationswebsite. https://sustainabledevelopment.un.org/sdg3.  Accessed  May 6, 2019.
  6. World Cancer Research Fund. Building momentum: lessons on implementing a robust sugar sweetened beverage tax. https://www.wcrf.org/sites/default/files/PPA-Building-Momentum-Report-WEB.pdf. Published 2018.
  7. Gostin LO, Monahan JT, Kaldor J, et al. The legal determinants of health: harnessing the power of law for global health and sustainable development. Lancet. 2019;393(10183):1857-1910. doi:10.1016/s0140-6736(19)30233-8
  8. World Health Organisation (WHO). Advancing the right to health: the vital role of law. Geneva: WHO; 2017.
  9. Magnusson RS, McGrady B, Gostin L, Patterson D, Abou Taleb H. Legal capacities required for prevention and control of noncommunicable diseases. Bull World Health Organ. 2019;97(2):108-117. doi:10.2471/blt.18.213777
  10. Buse K, Tanaka S, Hawkes S. Healthy people and healthy profits? Elaborating a conceptual framework for governing the commercial determinants of non-communicable diseases and identifying options for reducing risk exposure. Global Health. 2017;13(1):34. doi:10.1186/s12992-017-0255-3
  11. McKee M, Stuckler D. Revisiting the corporate and commercial determinants of health. Am J Public Health. 2018;108(9):1167-1170. doi:10.2105/ajph.2018.304510
  12. Wiist W. The corporate playbook, health, and democracy. In: Stuckler D, Siegel K, eds. Sick Societies: Responding to the Global Challenge of Chronic Disease. New York: Oxford University Press; 2011:204-216.
  13. Delobelle P, Sanders D, Puoane T, Freudenberg N. Reducing the role of the food, tobacco, and alcohol industries in noncommunicable disease risk in South Africa. Health Educ Behav. 2016;43(1 Suppl):70s-81s. doi:10.1177/1090198115610568
  14. Greenhalgh S. Soda industry influence on obesity science and policy in China. J Public Health Policy. 2019;40(1):5-16. doi:10.1057/s41271-018-00158-x
  15. World Health Organisation (WHO). WHO Framework Convention on Tobacco Control. Geneva: WHO; 2003.
  16. Knai C, Petticrew M, Douglas N, et al. The public health responsibility deal: Using a systems-level analysis to understand the lack of impact on alcohol, food, physical activity, and workplace health sub-systems. Int J Environ Res Public Health. 2018;15(12). doi:10.3390/ijerph15122895
  17. Stuckler D, Nestle M. Big food, food systems, and global health. PLoS Med. 2012;9(6):e1001242. doi:10.1371/journal.pmed.1001242
  18. World Health Organisation (WHO). Draft approach on the prevention and management of conflicts of interest in the policy development and implementation of nutrition programmes at country level. Decision-Making Process and Tool. Geneva: WHO; 2017. https://www.who.int/nutrition/consultation-doi/comments/en/.
  19. Barbor TF, Caetano R, Casswell S, et al. Alcohol: No Ordinary Commodity: Research and Public Policy. 2nd ed. New York: Oxford University Press; 2010.
  20. Anderson P. Global alcohol policy and the alcohol industry. Curr Opin Psychiatry. 2009;22(3):253-257. doi:10.1097/YCO.0b013e328329ed75
  21. Kraak VI, Swinburn B, Lawrence M, Harrison P. An accountability framework to promote healthy food environments. Public Health Nutr. 2014;17(11):2467-2483. doi:10.1017/s1368980014000093
  22. Reeve B, Magnusson R. Reprint of: Food reformulation and the (neo)-liberal state: new strategies for strengthening voluntary salt reduction programs in the UK and USA. Public Health. 2015;129(8):1061-1073. doi:10.1016/j.puhe.2015.04.021
  23. Reeve B. Self-regulation of food advertising to children: an effective tool for improving the food marketing environment? Monash Univ Law Rev. 2016;42(2):419-457.
  24. Magnusson RS. Framework legislation for non-communicable diseases: and for the Sustainable Development Goals? BMJ Glob Health. 2017;2(3):e000385. doi:10.1136/bmjgh-2017-000385
  25. Ayres I, Braithwaite J. Responsive Regulation: Transcending the Deregulation Debate. New York: Oxford University Press; 1995.
  26. Baker P, Jones A, Thow AM. Accelerating the worldwide adoption of sugar-sweetened beverage taxes: strengthening commitment and capacity: Comment on "the untapped power of soda taxes: incentivizing consumers, generating revenue, and altering corporate behaviour." Int J Health Policy Manag. 2017;7(5):474-478. doi:10.15171/ijhpm.2017.127
  27. Statement by Michael R. Bloomberg on Philip Morris International v. Uruguay Decision. Mike Bloomberg website. https://www.mikebloomberg.com/news/statement-by-michael-r-bloomberg-on-philip-morris-international-v-uruguay-decision/.  Published  July 8, 2016. Accessed March 20, 2019.
  28. Garde A, Jefferey B, Rigby N. Implementing the WHO recommendations whilst avoiding real, perceived or potential conflicts of interest. Eur J Risk Regul. 2017;8(2):237-250.
  29. World Health Organisation (WHO). Global strategy on diet, physical activity and health. Geneva: WHO; 2004.
  30. World Health Organisation (WHO). Global strategy to reduce harmful use of alcohol. Geneva: WHO; 2011.
  31. World Health Organisation (WHO). Framework of engagement with non-State actors. Geneva: WHO; 2016.
  32. World Health Organisation (WHO). Global action plan for the prevention and control of noncommunicable diseases 2013-2020. Geneva: WHO; 2013.
  33. Thow AM, Snowdon W, Labonte R, et al. Will the next generation of preferential trade and investment agreements undermine prevention of noncommunicable diseases? A prospective policy analysis of the Trans Pacific Partnership Agreement. Health Policy. 2015;119(1):88-96. doi:10.1016/j.healthpol.2014.08.002
  34. Thow AM, McGrady B. Protecting policy space for public health nutrition in an era of international investment agreements. Bull World Health Organ. 2014;92(2):139-145. doi:10.2471/blt.13.120543