It is almost impossible nowadays to listen to the radio, watch TV or scroll through social media without being exposed to an advertisement telling us that all we need for a little happiness and love is a sugary drink or a fast-food snack. There’s nothing that a tasty, affordable, ready-made meal cannot fix, we are asked to believe.
Over many decades our food environments have relentlessly been encouraging us to make choices that are harmful to our health, through pricing, marketing and availability. This rise in advertising has contributed to a growing global obesity crisis as well as nutrition deficiencies as more and more people opt to eat unhealthy food.
We each have the right to buy whatever we can afford. But commercial forces limit our freedom of choice more than we think. New evidence published in The Lancet shows that key causes of ill health – such as obesity and related noncommunicable diseases – are linked to commercial entities with deep pockets and the power to shape the choices people make. They do this by influencing the political and economic system, and its underlying regulatory approaches and policies.
The ways that commercial entities shape our food environments to maximise their profits are known as the “commercial determinants of health”. They create an environment that drives us towards unhealthy choices.
There are three main ways they do this:
We are socialised to believe that, as adults, our food choices are a direct result of free will, and of freedom of choice. Yet for people with a limited amount of money, that “freedom” is exercised in a context largely shaped – and limited – by what food and drink manufacturers and retailers choose to produce, market and sell.
Marketing creates demand. Supermarkets are filled with ultra-processed foods with lots of added sugars, unhealthy fats and harmful additives. These food products are designed to activate your taste “bliss point” and make you crave more. Food and beverage manufacturers use unethical tactics to market them. They target children with manipulative imagery and stressed-out parents with “easy” solutions for feeding and satisfying their family.
Food and beverage companies’ profits strengthen their political influence. This is especially true in under-regulated markets in low- and middle-income countries. They use their economic power (employment, tax revenues) to support corporate lobbying that weakens government policy.
What can be done
The Lancet series maps out four ways through which governments, businesses and citizens can reduce the harms caused by big corporations and curb the power of commercial entities.
1. Rethink the political and economic systems.
Developing countries, including Bhutan, Ecuador and Brazil, as well as developed countries such as New Zealand and Norway, are beginning to pave the way for new frameworks that put people’s well-being first. In the UK, Scotland and Wales have also taken significant steps.
These frameworks measure commercial effects on health and the environment, and encourage commercial practices that promote health. Ways to do this include enforcing policies – such as the tax on sugar-sweetened beverages – that ensure commercial entities pay their fair share of taxes, and are obliged to account for the full costs of the health, social and environmental harms caused by the production, consumption and disposal of their products.
2. Develop an “international convention” on commercial determinants of health.
In practice, this would mean replicating and expanding global regulatory frameworks that work. The World Health Organization’s (WHO) Framework Convention on Tobacco Control has shown that public health policies can be protected from commercial interests. Since its adoption in 2003, the convention has had significant impact on public policy changes related to tobacco control around the world. It’s provided a framework for countries to develop and implement evidence-based measures to reduce tobacco use and the harms associated with it. Some examples include smoke-free laws; graphic health warnings on tobacco products; prohibition of tobacco advertising, promotion and sponsorship; and tobacco tax increases.
The Lancet suggests that, with support from the WHO and its member states, an “international convention” on commercial determinants of health should be developed. It is proposed that public health policy leaders and politicians replicate the tobacco control convention by making it legally binding for countries to comply with a set of principles or rules. The framework would have to be broad enough to cover the full range of commercial influences on health. These include mining, fossil fuels, gambling, automobile industries, pharmaceuticals, technology and social media (beyond the better-known alcohol and food industries).
3. Comprehensive food-environment policies.
One type of government policy proven to help protect and improve health is public procurement – how governments purchase goods and services. Governments can use their purchasing power to influence the food industry by encouraging the production and distribution of healthy food and limiting the availability of unhealthy food products.
In 2008, the mayor of New York City ordered city agencies to meet public food procurement standards for over 260 million annual meals and snacks. The standards apply to food from over 3,000 programmes at 12 agencies, including schools, hospitals and shelters. Nutritional requirements cover dairy, cereals, meat, fruit and vegetables, and set meal nutrient thresholds.
The Brazilian School Food Programme is another example of a national public-procurement policy with direct health benefits. The programme provides healthy meals to millions of students in public schools across Brazil.
It’s required to purchase 30% of its supply from family farmers. The programme has improved the health and well-being of students, and promoted sustainable and ethical food production practices. It has also successfully regulated the sale and marketing of food within and outside school premises.
Countries across the globe could benefit from adopting this model, including South Africa, where despite industry pledges not to sell to schools, unhealthy foods and beverages remain easily accessible and available in schools.
4. Social mobilisation.
Citizens, civil society groups, activists, public health practitioners and academics can demand their right to health by calling for government action on commercial determinants of health. This can be done using a variety of strategies. They can raise their collective voice in support of evidence-based health measures; expose and oppose the harmful effects of commercial determinants on health and equity; and insist that commercial actors and governments are held accountable.
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.