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 calling for relaxed regulations on advertising its “smoke-less” products in South Africa ahead of a new Control of Tobacco Products and Electronic Delivery Systems Bill .
The alcohol industry once formed an interest group , known as the Association for Responsible Alcohol Use, to influence government policies in South Africa.
Commercial influences on the scientific process can be subtle but pervasive. Funding research in non-transparent ways creates bias. Many commercial sectors attempt to manipulate scientific findings in their favour or to hide or falsify results. In 2017, for example, independent researchers uncovered how Exxon Mobil had intentionally misled the public about how extractive activities contributed to climate change .
Pharmaceutical companies use intellectual property rights to keep drugs at a high price. This limits access to medicines. Recently, COVID-19 vaccines were affordable for only the wealthiest countries. The same thing happened two decades earlier with antiretroviral drugs for HIV.
Financial manipulation: tax avoidance and more
Multinational mining companies continue to cheat Africa out of billions of dollars by under-reporting profits and paying lower taxes. In Zambia, for example, copper earns transnational copper mining companies billions annually. It's estimated that their corporate tax avoidance denies the country US$3 billion in taxes yearly. This is more than 12.5% of Zambia's entire GDP .
Some companies exploit labour (for instance, in the agricultural sector) and pollute the environment (for example, in the mining sector). These practices harm human and environmental health but were previously considered “normal” modes of doing business.
Many of these “routine” commercial methods overlap and support each other. Transnational corporations with deep pockets can use them particularly well in weakly regulated low- and middle-income countries.
Individuals and their families, civil society, and governments increasingly bear the costs of harm caused by corporations.
It will take concerted joint efforts, such as an international convention, to change the system. This change needs to be in the direction of prioritsing societal and environmental well-being and health impacts. Until this happens, health and equity will continue to be threatened, causing significant economic damage and declining social development.
This article is part of a media partnership between The Conversation Africa and PRICELESS SA, a research-to-policy unit based in the School of Public Health at the University of the Witwatersrand. Researchers from the SAMRC/ Wits Centre for Health Policy and Decision Science - also contributed to the Lancet Series on the commercial determinants of health.
Teurai Rwafa does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
By Teurai Rwafa, Senior Researcher, SAMRC/Wits Centre for Health Economics and Decision Science – PRICELESS SA, University of the Witwatersrand