How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention

Document Type : Perspective


1 School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada

2 Menzies Centre for Health Policy, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia


Alcohol, tobacco, and unhealthy foods contribute greatly to the global burden of non-communicable disease (NCD). Member states of the World Health Organization (WHO) have recognized the critical need to address these three key risk factors through global action plans and policy recommendations. The 2013-2020 WHO action plan identifies the need to engage economic, agricultural and other relevant sectors to establish comprehensive and coherent policy. To date one of the biggest barriers to action is not so much identifying affective policies, but rather how a comprehensive policy approach to NCD prevention can be established across sectors. Much of the research on policy incoherence across sectors has focused on exposing the strategies used by commercial interests to shape public policy in their favor. Although the influence of commercial interests on government decisions remains an important issue for policy coherence, we argue, that the dominant neoliberal policy paradigm continues to enable the ability of these interests to influence public policy. In this paper, we examine how this dominant paradigm and the way it has been enshrined in institutional mechanisms has given rise to existing systems of governance of product environments, and how these systems create structural barriers to the introduction of meaningful policy action to prevent NCDs by fostering healthy product environments. Work to establish policy coherence across sectors, particularly to ensure a healthy product environment, will require systematic engagement with the assumptions that continue to structure institutions that perpetuate unhealthy product environments.


Commentaries Published on this Paper


  • Neo-Liberalism, Policy Incoherence and Discourse Coalitions Influencing Non-Communicable Disease Strategy; Comment on “How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention”

          Abstract | PDF


  • Towards Critical Analysis of the Political Determinants of Health; Comment on “How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention”

          Abstract | PDF


  • Paradigm Shift: New Ideas for a Structural Approach to NCD Prevention; Comment on “How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention”

          Abstract | PDF


  • Neoliberalism 4.0: The Rise of Illiberal Capitalism; Comment on “How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention”

          Abstract | PDF


  • On the Perils of Universal and Product-Led Thinking; Comment on “How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention”

          Abstract | PDF


  • A Systems Thinking Approach to Inform Coherent Policy Action for NCD Prevention; Comment on “How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention”

          Abstract | PDF


  • Next Steps for Elevating Health on Trade and Investment Policy Agendas; Comment on “How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention”

          Abstract | PDF


  • Understanding Structure and Agency as Commercial Determinants of Health; Comment on “How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention”

          Abstract | PDF


 Authors' Response to the Commentaries


  • Developing a Research Agenda for the Analysis of Product Supply: A Response to the Recent Commentaries

           Abstract | PDF


Main Subjects

  1. Lencucha R, Drope J, Labonte R, Zulu R, Goma F. Investment incentives and the implementation of the Framework Convention on Tobacco Control: evidence from Zambia. Tob Control. 2016;25(4):483-487. doi:10.1136/tobaccocontrol-2015-052250
  2. Labonte R, Lencucha R, Drope J, Packer C, Goma FM, Zulu R. The institutional context of tobacco production in Zambia. Global Health. 2018;14(1):5. doi:10.1186/s12992-018-0328-y
  3. Labonte R, Lencucha R, Goma F, Zulu R, Drope J. Consequences of policy incoherence: how Zambia's post-FCTC investment policy stimulated tobacco production. J Public Health Policy. 2019. doi:10.1057/s41271-019-00171-8
  4. Knai C, Petticrew M, Mays N, et al. Systems Thinking as a Framework for Analyzing Commercial Determinants of Health. Milbank Q. 2018;96(3):472-498. doi:10.1111/1468-0009.12339
  5. 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
  6. Blouin C. Trade policy and health: from conflicting interests to policy coherence. Bull World Health Organ. 2007;85(3):169-173. doi:10.2471/blt.06.037413
  7. Solow RM. Rethinking fiscal policy. Oxf Rev Econ Policy. 2005;21(4):509-514.  
  8. 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
  9. Brownell KD, Warner KE. The perils of ignoring history: Big Tobacco played dirty and millions died. How similar is Big Food? Milbank Q. 2009;87(1):259-294. doi:10.1111/j.1468-0009.2009.00555.x
  10. Stuckler D, Nestle M. Big food, food systems, and global health. PLoS Med. 2012;9(6):e1001242. doi:10.1371/journal.pmed.1001242
  11. 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
  12. Kickbusch I, Allen L, Franz C. The commercial determinants of health. Lancet Glob Health. 2016;4(12):e895-e896. doi:10.1016/s2214-109x(16)30217-0
  13. Thorn M. Addressing power and politics through action on the commercial determinants of health. Health Promot J Austr. 2018;29(3):225-227. doi:10.1002/hpja.216
  14. Harvey D. Neoliberalism as creative destruction. Ann Am Acad Pol Soc Sci. 2007;610(1):21-44. doi:10.1177/0002716206296780
  15. Gill S. Globalisation, market civilisation, and disciplinary neoliberalism. Millennium. 1995;24(3):399-423. doi:10.1177/03058298950240030801
  16. Friedman M. Why government is the problem (Essays in Public Policy). USA: Hoover Institution Press; 1993.
  17. Peck J, Theodore N, Brenner N. Postneoliberalism and its Malcontents. Antipode. 2010;41:94-116.
  18. Harvey D. A brief history of neoliberalism. Oxford University Press; 2007:256.
  19. Rodrik D. Populism and the economics of globalization. Journal of International Business Policy. 2018;1(1-2):12-33. doi:10.1057/s42214-018-0001-4
  20. Baker P, Friel S, Schram A, Labonte R. Trade and investment liberalization, food systems change and highly processed food consumption: a natural experiment contrasting the soft-drink markets of Peru and Bolivia. Global Health. 2016;12(1):24. doi:10.1186/s12992-016-0161-0
  21. 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
  22. Hall PA. Policy paradigms, social learning, and the state: the case of economic policymaking in Britain. Comp Polit. 1993;25(3):275-296. doi:10.2307/422246
  23. Jernigan DH. The global alcohol industry: an overview. Addiction. 2009;104(Suppl 1):6-12. doi:10.1111/j.1360-0443.2008.02430.x
  24. Appau A, Drope J, Labonte R, Stoklosa M, Lencucha R. Disentangling regional trade agreements, trade flows and tobacco affordability in sub-Saharan Africa. Global Health. 2017;13(1):81. doi:10.1186/s12992-017-0305-x
  25. Chan A. Racing to the bottom: international trade without a social clause. Third World Q. 2003;24(6):1011-1028. doi:10.1080/01436590310001630044
  26. Otero G. The neoliberal food regime in Latin America: state, agribusiness transnational corporations and biotechnology. Rev Can Etudes Dev. 2012;33(3):282-294. doi:10.1080/02255189.2012.711747
  27. Key N, Runsten D. Contract farming, smallholders, and rural development in Latin America: the organization of agroprocessing firms and the scale of outgrower production. World Dev. 1999;27(2):381-401. doi:10.1016/S0305-750X(98)00144-2
  28. Moyer-Lee J, Prowse M. How traceability is restructuring Malawi's tobacco industry. Dev Policy Rev. 2015;33(2):159-174.
  29. Nino HP. Class dynamics in contract farming: the case of tobacco production in Mozambique. Third World Q. 2016;37(10):1787-1808. doi:10.1080/01436597.2016.1180956
  30. Labonte R, Lencucha R, Drope J, Packer C, Goma FM, Zulu R. The institutional context of tobacco production in Zambia. Global Health. 2018;14(1):5. doi:10.1186/s12992-018-0328-y
  31. Magati P, Lencucha R, Li Q, et al. Costs, contracts and the narrative of prosperity: an economic analysis of smallholder tobacco farming livelihoods in Kenya. Tob Control. 2019;28(3):268-273. doi:10.1136/tobaccocontrol-2017-054213
  32. Makoka D, Drope J, Appau A, et al. Costs, revenues and profits: an economic analysis of smallholder tobacco farmer livelihoods in Malawi. Tob Control. 2017;26(6):634-640. doi:10.1136/tobaccocontrol-2016-053022
  33. Makoka D, Drope J, Appau A, Lencucha R. Farm-level economics of tobacco production in Malawi. Lilongwe, Malawi: Centre for Agricultural Research and Development, American Cancer Society; 2016.
  34. Goma F, Drope J, Zulu R, et al. The economics of tobacco farming in Zambia. Lusaka, Zambia and Atlanta, USA: University of Zambia, American Cancer Society; 2016.
  35. Magati P, Li Q, Drope J, Lencucha R, Labonte R. The economics of tobacco farming in Kenya. Nairobi, Kenya: Institute for Legislative Affairs, American Cancer Society; 2016.
  36. Thow AM, Verma G, Soni D, et al. How can health, agriculture and economic policy actors work together to enhance the external food environment for fruit and vegetables? A qualitative policy analysis in India. Food Policy. 2018;77:143-151. doi:10.1016/j.foodpol.2018.04.012
  37. Jordan A, Wurzel RKW, Zito A. The rise of 'new'policy instruments in comparative perspective: has governance eclipsed government? Polit Stud. 2005;53(3):477-496. doi:10.1111/j.1467-9248.2005.00540.x
  38. Smith J, Lee K. From colonisation to globalisation: a history of state capture by the tobacco industry in Malawi. Rev Afr Polit Econ. 2018;45(156):186-202. doi:10.1080/03056244.2018.1431213
  39. Ostrom E. An agenda for the study of institutions. Public Choice. 1986;48(1):3-25. doi:10.1007/BF00239556
  40. Crawford SES, Ostrom E. A grammar of institutions. Am Polit Sci Rev. 1995;89(3):582-600. doi:10.2307/2082975
  41. Magnusson R, Reeve B. “Steering” private regulation? A new strategy for reducing population salt intake in Australia. Syd Law Rev. 2014;36(2):255-289.
  42. Webster JL, Dunford EK, Hawkes C, Neal BC. Salt reduction initiatives around the world. J Hypertens. 2011;29(6):1043-1050. doi:10.1097/HJH.0b013e328345ed83
  43. Harvey D. The new imperialism. New York, USA: Oxford University Press; 2003.
  44. McCarthy J. Privatizing conditions of production: trade agreements as neoliberal environmental governance. Geoforum. 2004;35(3):327-341. doi:10.1016/j.geoforum.2003.07.002
  45. Yeates N. Globalization and social policy: from global neoliberal hegemony to global political pluralism. Glob Soc Policy. 2002;2(1):69-91. doi:10.1177/1468018102002001095
  46. Immergut EM. The Theoretical Core of the New Institutionalism. Polit Soc. 1998;26(1):5-34. doi:10.1177/0032329298026001002
  47. Wendt A. Social theory and international politics. New York, USA: Cambridge University Press; 1999.
  48. Bakke O, Endal D. Vested interests in addiction research and policy alcohol policies out of context: drinks industry supplanting government role in alcohol policies in sub-Saharan Africa. Addiction. 2010;105(1):22-28. doi:10.1111/j.1360-0443.2009.02695.x
  49. Lencucha R, Drope J, Labonte R. Rhetoric and the law, or the law of rhetoric: How countries oppose novel tobacco control measures at the World Trade Organization. Soc Sci Med. 2016;164:100-107. doi:10.1016/j.socscimed.2016.07.026
  50. Lencucha R, Reddy SK, Labonte R, et al. Global tobacco control and economic norms: an analysis of normative commitments in Kenya, Malawi and Zambia. Health Policy Plan. 2018;33(3):420-428. doi:10.1093/heapol/czy005
  51. Thow AM, Greenberg S, Hara M, Friel S, duToit A, Sanders D. Improving policy coherence for food security and nutrition in South Africa: a qualitative policy analysis. Food Secur. 2018;10(4):1105-1130. doi:10.1007/s12571-018-0813-4
  52. Schmidt VA. Taking ideas and discourse seriously: explaining change through discursive institutionalism as the fourth ‘new institutionalism’. Eur Political Sci Rev. 2010;2(1):1-25. doi:10.1017/S175577390999021X
  53. Schmidt VA. Discursive institutionalism: The explanatory power of ideas and discourse. Annu Rev Polit Sci. 2008;11(1):303-326.
  54. Gopinathan U, Watts N, Lefebvre A, Cheung A, Hoffman SJ, Rottingen JA. Global governance and the broader determinants of health: A comparative case study of UNDP's and WTO's engagement with global health. Glob Public Health. 2018:1-15. doi:10.1080/17441692.2018.1476567
  55. Drope J, Lencucha R. Evolving norms at the intersection of health and trade. J Health Polit Policy Law. 2014;39(3):591-631. doi:10.1215/03616878-2682621
  56. Snowdon W, Thow AM. Trade policy and obesity prevention: challenges and innovation in the Pacific Islands. Obes Rev. 2013;14 Suppl 2:150-158. doi:10.1111/obr.12090
  57. Eckhardt J, Holden C, Callard CD. Tobacco control and the World Trade Organization: mapping member states' positions after the framework convention on tobacco control. Tob Control. 2016;25(6):692-698. doi:10.1136/tobaccocontrol-2015-052486
  58. Thow AM, Reeve E, Naseri T, Martyn T, Bollars C. Food supply, nutrition and trade policy: reversal of an import ban on turkey tails. Bull World Health Organ. 2017;95(10):723-725. doi:10.2471/blt.17.192468
  59. Drope J, Lencucha R. Tobacco control and trade policy: proactive strategies for integrating policy norms. J Public Health Policy. 2013;34(1):153-164. doi:10.1057/jphp.2012.36
  60. World Health Organization (WHO). Guidelines for implementation of Article 5.3 of the WHO Framework Convention on Tobacco Control. Geneva: WHO FCTC Convention Secretariat; 2008.
  61. Malone RE, Bialous SA. WHO FCTC article 5.3: promise but little progress. Tob Control. 2014;23(4):279-280. doi:10.1136/tobaccocontrol-2014-051817
  62. Battams S, Townsend B. Power asymmetries, policy incoherence and noncommunicable disease control-a qualitative study of policy actor views. Crit Public Health. 2018:1-14. doi:10.1080/09581596.2018.1492093
  63. Schram A. When evidence isn’t enough: Ideological, institutional, and interest-based constraints on achieving trade and health policy coherence. Glob Soc Policy. 2018;18(1):62-80. doi:10.1177/1468018117744153
  64. Lencucha R, Drope J, Chavez JJ. Whole-of-government approaches to NCDs: the case of the Philippines Interagency Committee-Tobacco. Health Policy Plan. 2015;30(7):844-852. doi:10.1093/heapol/czu085
  65. Lang A. World Trade Law After Neoliberalism: Reimagining the Global Economic Order. Oxford University Press; 2011:416.
  66. Dube L, Addy NA, Blouin C, Drager N. From policy coherence to 21st century convergence: a whole-of-society paradigm of human and economic development. Ann N Y Acad Sci. 2014;1331:201-215. doi:10.1111/nyas.12511
  67. Lencucha R, Dube L, Blouin C, Hennis A, Pardon M, Drager N. Fostering the catalyst role of government in advancing healthy food environments. Int J Health Policy Manag. 2018;7(6):485-490. doi:10.15171/ijhpm.2018.10
Volume 8, Issue 9
September 2019
Pages 514-520
  • Receive Date: 05 May 2019
  • Revise Date: 18 June 2019
  • Accept Date: 25 June 2019
  • First Publish Date: 01 September 2019