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We can’t let companies get away with making consumers sick

The writer is a science commentator

A clown comes knocking on your door with a fun message for your kids. They can have a toy for free — if you buy them a meal from a fast-food restaurant. Would you invite him in?

Such is the power of advertising, that you don’t need to. The jester has the money and regulatory freedom to plaster his jolly corporate message across billboards, television screens and livestreamed content. Yet his products are associated with obesity and heart disease.

The clown symbolises what researchers call the “commercial determinants of health”, a budding concept that describes the influence of companies over the health of people and the planet. Researchers fighting globally to bring in plain cigarette packaging or minimum alcohol pricing have all found themselves up against the same adversary: commercial self-interest. Now, those same researchers have teamed up to define those determinants and quantify their reach.

Their analysis, published last week in The Lancet medical journal, offers little to smile at: just four sectors — tobacco, fossil fuels, ultra-processed food and alcohol — contribute to at least a third of all global deaths. “[The] shift towards market fundamentalism and increasingly powerful transnational corporations”, the researchers write, “has created a pathological system in which commercial actors are increasingly enabled to cause harm and externalise the costs of doing so.”

It is hard to overstate how radical the analysis is — it takes aim at free markets, neoliberalism, tax havens, feeble regulators, cowardly politicians, naive scientists and the corporate-driven mantra of personal responsibility. “This isn’t anti-corporate but pro-health and pro-planet,” insists co-author Anna Gilmore, professor of public health and director of the tobacco control research group at the UK’s University of Bath.

The researchers, drawn from countries including the UK, Australia, New Zealand, America and Brazil, are not demanding the overthrow of capitalism; rather, Gilmore says, “the scale of the damage caused to health and the planet is now really significant and we need to take action”. She denies being a killjoy, pointing out that most smokers regret starting and most obese people want to lose weight.

Health is influenced by medical factors, such as genes, and non-medical factors, usually called social determinants. The latter include income, social status, education and housing; the affluent enjoy better health and live longer than those on low incomes.

The World Health Organization has now added “commercial determinants” under its social determinants umbrella, describing them as “the conditions, actions and omissions by commercial actors that affect health”. These can be positive, as with seat belts, but also negative — the pricing and targeted marketing of tobacco, junk food, alcohol and formula milk (including in low-income countries); the siting of factories that cause air pollution; and the deforestation linked to the production of commodities such as timber, coffee and sugar.

It is unfair and unsustainable, the study’s authors argue, for companies to continue to profit from their products without paying for the harms. Restaurateur Henry Dimbleby may sympathise: this month, he resigned as the UK government’s food tsar, citing the delay in tightening rules on junk food advertising.

Dimbleby predicted that the reluctance of ministers to intervene would, in a decade, bring “huge problems to the NHS . . . and cause misery from diet-related disease”. Around a quarter of adults in England are obese. The Department of Health and Social Care said the government “will continue to work closely with industry to make it easier for people to make healthy choices”. That is music to corporate ears: many sectors have lobbied to delay, dilute or destroy policies that would curb commercial freedom. Industry, the Lancet researchers say, should never have a hand in shaping policy.

But industry has deep pockets and powerful allies, with compliant scientists, supportive “front” organisations and influential free-market think-tanks ready to fight its corner. The study’s authors are right to point out how deftly corporate irresponsibility has been recast as consumer weakness: the antisocial litter bug; the problem gambler, the fast-food consumer who exercises too little.

It is not asking too much, Gilmore says, for business to follow the rules, pay their taxes and not obstruct public-interest policymaking — and for governments to act for the many, not the few, in pursuit of a happier, healthier economy.

We can but hope. On with the circus.

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