Corporate profits versus spending on non-communicable disease prevention: an unhealthy balance
Authors: Luke N Allen, Arian Hatefi, Andrea B Feigl
Journal: The Lancet Global Health (2019)

Tobacco, alcohol, and the overconsumption of unhealthy foods are responsible for approximately half of all premature non-communicable disease (NCD) deaths.1GBD 2015 Risk Factors CollaboratorsGlobal, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015.Lancet. 2016; 388: 1659-1724Summary Full Text Full Text PDF PubMed Scopus (2164) Google Scholar Transnational companies play an important role in driving increasing consumption of these unhealthy commodities in the global south.2Stuckler 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; 9e1001235Crossref PubMed Scopus (358) Google Scholar Fully implementing the NCD Best Buys, as described by WHO, in low-income and middle-income countries would cost an estimated US$11·4 billion.3WHOWorld Economic ForumFrom burden to “Best Buys”: reducing the economic impact of non-communicable disease in low-and middle-income countries.http://www.who.int/nmh/publications/best_buys_summary.pdfDate: Sept 18, 2011Date accessed: May 1, 2018Google Scholar How does this compare to industry profits? We used the 2017 Forbes Global 2000 report to extract financial data for publicly listed transnational companies that sell tobacco, alcohol, and processed food. We included the four largest fast-food retailers, two major soft drinks companies, and every company in the top ten of the tobacco, alcohol, and processed food sectors for which financial data were publicly available (nine of the top ten in each sector had data available). For a random 10% sample of the included companies we cross-checked the data with annual financial reports; the Forbes figures were accurate in all cases. Combined sales for the 33 included companies totalled US$829 billion in 2017. The companies are all based in high-income countries, with the exception of the Indonesian tobacco manufacturer Gudang. Total profits were $99 billion (which is twice the GDP of Ghana) and mean sector profitability ranged from 7% for processed foods to 29% for tobacco (figure). Although the market share and sector sales figures are illuminating, the most striking finding is that a handful of companies command resources that are orders of magnitude larger than those required for NCD prevention and control. Coca-Cola spends approximately $4 billion on marketing each year,4The Coca-Cola CompanyForm 10-K. Annual report pursuant to section 13 or 15(d) of the securities exchange act of 1934. 2018 annual report.https://www.coca-colacompany.com/content/dam/journey/us/en/private/fileassets/pdf/2018/2017-10K.pdfDate accessed: June 30, 2018Google Scholar which is more than the public health budget for many low-income and middle-income countries, and US tobacco firms spend $1 million per hour on advertising.5US Federal Trade CommissionCigarette report for 2015.https://www.ftc.gov/system/files/documents/reports/federal-trade-commission-cigarette-report-2015-federal-trade-commission-smokeless-tobacco-report/2015_cigarette_report.pdf?utm_source=govdelivery%20Date: 2017Date accessed: June 30, 2018Google Scholar In the vernacular of economics, the consumption of tobacco, alcohol, junk food, and sugar-sweetened beverages leads to negative externalities—ecological, economic, social, and health costs that are borne by third parties. These products also constitute so-called demerit goods, because their use also harms the user. Demerit goods tend to be overconsumed when left to market forces. Governments can (but often do not) respond by introducing taxes and other policy measures, such as the cheap and effective WHO Best Buys.3WHOWorld Economic ForumFrom burden to “Best Buys”: reducing the economic impact of non-communicable disease in low-and middle-income countries.http://www.who.int/nmh/publications/best_buys_summary.pdfDate: Sept 18, 2011Date accessed: May 1, 2018Google Scholar Our data highlight the fact that the sale of these products is extremely lucrative. These transnational companies have a substantial interest in maintaining the status quo. They design and advertise their products in ways that exploit biological, psychological, and social vulnerabilities,6Roberto CA Swinburn B Hawkes C et al.Patchy progress on obesity prevention: emerging examples, entrenched barriers, and new thinking.Lancet. 2015; 385: 2400-2409Summary Full Text Full Text PDF PubMed Scopus (462) Google Scholar and undermine policy implementation through lobbying and political financing.7Gilmore AB Fooks G Drope J Bialous SA Jackson RR Exposing and addressing tobacco industry conduct in low-income and middle-income countries.Lancet. 2015; 385: 1029-1043Summary Full Text Full Text PDF PubMed Scopus (164) Google Scholar, 8Miller D Harkins C Corporate strategy, corporate capture: food and alcohol industry lobbying and public health.Crit Soc Policy. 2010; 30: 564-589Crossref Scopus (83) Google Scholar, 9Hawkins B Holden C A corporate veto on health policy? Global constitutionalism and investor-state dispute settlement.J Health Polit Policy Law. 2016; 41: 969-995Crossref PubMed Scopus (19) Google Scholar Companies often frame public health policies as wasteful and ineffective assaults on personal freedoms that harm jobs and the national economy.10British Soft Drinks AssociationBSDA's response to the Soft Drinks Tax Consultation and the Childhood Obesity Strategy.https://www.britishsoftdrinks.com/Press-releases-/its-a-sad-irony-that-the-one-category-that-has-led-the-way-in-reducing-consumers-sugar-intake-is-being-targeted-for-a-punitive-taxDate: Aug 17, 2016Date accessed: May 1, 2018Google Scholar Policy makers should acknowledge that, although tighter state intervention constrains short-term preferences (commonly decried as government over-reach or nanny-statism), measures to reduce tobacco addiction, alcohol use, and consumption of unhealthy foods are widely popular; they align with people's longer-term preferences for long and healthy lives and increase net welfare through health gains. This online publication has been corrected. The corrected version first appeared at thelancet.com/lancetgh on October 22, 2019 This online publication has been corrected. The corrected version first appeared at thelancet.com/lancetgh on October 22, 2019 We declare no competing interests. We thank Joseph Dieleman from the Institute for Health Metrics and Evaluation (Seattle, WA, USA) for his contribution. Correction to Lancet Glob Health 2019; 7: e1482–83Allen LN, Hatefi A, Feigl AB. Corporate profits versus spending on non-communicable disease prevention: an unhealthy balance. Lancet Glob Health 2019; 7: e1482–83—In this Comment, the affiliation and email address of the corresponding author were incorrect. These corrections have been made as of Oct 22, 2019. Full-Text PDF Open Access