Commercial Determinants of Noncommunicable Diseases in the WHO European Region: A Summary

Introduction

The burden of noncommunicable diseases (NCDs) in the WHO European Region is staggering. Accounting for 90% of all deaths and 85% of years lived with disability, NCDs such as cardiovascular disease, cancer, chronic respiratory conditions, and diabetes dominate the public health landscape. While behavioral and environmental risk factors play a well-known role, the underlying commercial determinants of health (CDoH)—systems, practices, and policies driven by profit-oriented industries—are now recognized as pivotal contributors to the NCD crisis.

A recent report from the WHO Regional Office for Europe offers a groundbreaking exploration of how commercial actors exacerbate NCD risks and undermine public health policies. This article provides a very compact summary of the report’s findings (the original report being over 130 pages), highlighting how industries manipulate environments, policies, and public perceptions to their advantage and offering strategies for addressing these challenges.

The Scope of the Problem

Every day, 7,500 people in Europe die from conditions directly linked to commercial determinants of health. These include:

• Tobacco: Linked to over 1.1 million annual deaths, tobacco products remain a leading cause of preventable mortality.
• Alcohol: Contributing to over 426,000 deaths annually, alcohol consumption exacerbates NCD risks and societal inequities.
• Processed Foods: Diets high in sugar, sodium, trans fats, and processed meats drive obesity, hypertension, and heart disease.
• Fossil Fuels: Air pollution from fossil fuel use causes respiratory and cardiovascular illnesses, leading to 579,000 deaths annually.
• Pharmaceutical Industry: Keeping long term, monopolistic holding of drugs and constant legal challenges to the creation of generic alternatives prevent lower cost, equally effective medicines from reaching the market. In turn, this directly harms those who would likely most benefit from pharmaceutical interventions and increase the mortality burdens of diseases.

Commercial practices like aggressive marketing, lobbying, and price manipulation amplify these health burdens, disproportionately impacting vulnerable populations such as children and low-income groups.

How Commercial Determinants Shape NCD Risks

Marketing and Consumption

Industries use sophisticated marketing techniques to normalize and glamorize harmful products. For example, digital advertising enables companies to target specific demographics, such as youth or low-income households, with precision. Evidence from the report highlights how sugary drink manufacturers and tobacco companies exploit these tactics to expand their consumer base, often circumventing regulatory oversight.

Policy Interference

Lobbying is another critical strategy employed by industries to delay or weaken public health measures. Case studies from the WHO report reveal how:

• The tobacco industry has used trade agreements to challenge plain packaging laws, slowing their implementation.
• Alcohol producers opposed France’s Loi Évin, a landmark law restricting alcohol advertising, under the guise of protecting economic interests.
• Food and beverage companies mounted campaigns against sugar-sweetened beverage (SSB) taxes in Estonia and other nations, delaying crucial fiscal health policies.

Scientific Manipulation

Industries also fund biased research to cast doubt on the harms of their products. The report documents how tobacco companies historically distorted evidence linking smoking to cancer, and how processed food manufacturers undermine dietary guidelines to protect their market share.

Case Studies: Real-World Examples of Industry Influence

1. Tobacco Control and Trade Agreements

Tobacco companies have leveraged international trade agreements to challenge regulations such as plain packaging and advertising restrictions. This tactic, known as regulatory chill, deters governments from implementing strong public health measures for fear of costly legal battles.

2. Alcohol Industry Opposition to Marketing Restrictions

In France, the Loi Évin faced significant resistance from the alcohol industry, which argued that the restrictions violated free trade principles. Advocacy from public health groups ensured the law’s survival, demonstrating the importance of civil society in countering industry influence.

3. Processed Food Taxes in Estonia

When Estonia proposed an SSB tax to combat rising obesity rates, the food and beverage industry launched a coordinated campaign to block the policy. Despite initial delays, Estonia implemented the tax, providing a model for other nations to follow.

4. Fossil Fuels and Air Pollution

The fossil fuel industry’s role in perpetuating air pollution and climate change is well-documented. In Europe, lax regulations on emissions from transportation and industrial activities contribute to chronic respiratory diseases and cardiovascular conditions, disproportionately affecting urban populations.

The Social Gradient: Who Is Most Affected?

Commercial determinants of health exacerbate inequities, with the most vulnerable populations bearing the brunt of the harm. For instance:

• Children: Targeted by junk food advertising, children face higher risks of obesity and related health issues.
• Low-Income Communities: The affordability and ubiquity of harmful products in poorer areas lead to disproportionate health impacts.
• Minority Groups: Discriminatory marketing practices target marginalized communities, compounding existing health disparities.

These inequities extend beyond health, affecting economic and social outcomes. For example, the high cost of treating NCDs often pushes families into poverty, creating a vicious cycle of disadvantage.

Urgent Actions and Policy Recommendations

To counter the influence of harmful industries and reduce the burden of NCDs, the WHO report calls for a comprehensive approach that includes:

1. Strengthening Regulations

• Implement stricter advertising restrictions on harmful products, especially those targeting children.
• Increase taxes on tobacco, alcohol, and sugary beverages to reduce consumption and generate revenue for health programs.
• Enforce transparent labeling requirements for processed foods, including warnings about sugar, salt, and fat content.

2. Enhancing Public Awareness

• Launch educational campaigns to inform the public about the risks associated with harmful products.
• Empower consumers to make healthier choices by promoting evidence-based dietary and lifestyle guidelines.

3. Building Multi-Sectoral Coalitions

• Encourage collaboration between governments, civil society, and public health organizations to counter industry lobbying.
• Support grassroots movements advocating for stronger health policies and corporate accountability.

4. Promoting Equity

• Ensure that public health measures prioritize vulnerable populations, such as low-income groups and children.
• Address systemic inequities by improving access to affordable, healthy food and clean air.

Conclusion

The commercial determinants of health are a significant yet underappreciated driver of the NCD epidemic in Europe. By addressing these determinants (as well as many others brought about by commercial interests) through robust regulation, transparency, and public engagement, the WHO European Region has an opportunity to reduce the burden of NCDs and promote a healthier, more equitable future. The time to act is now.

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