Introduction
In recent decades, global health has been shaped not only by governments and health systems but also by powerful corporate actors whose influence extends across markets, policies, and everyday behaviors. While the private sector plays a critical role in innovation and economic development, there is increasing recognition that many corporate practices actively undermine population health. This dynamic is captured by the concept of the commercial determinants of health (CDoH)—defined as “the systems, practices, and pathways through which commercial actors drive health and equity outcomes” 1World Health Organization. (2023). Commercial determinants of health..
A growing body of evidence shows that industries such as tobacco, alcohol, ultra-processed food, and pharmaceuticals contribute significantly to the global burden of disease through the production and promotion of harmful products, as well as through political and economic influence2Kickbusch, I., Allen, L., & Franz, C. (2016). The commercial determinants of health. The Lancet Global Health, 4(12), e895–e896.. These influences extend beyond individual behavior, shaping structural conditions such as access to healthy environments, information, and healthcare. As a result, many of today’s leading health challenges are not simply biomedical or behavioral—they are deeply embedded in political and economic systems.
The Scale of the Problem: Profits Driving Disease
Non-communicable diseases (NCDs) account for approximately 41 million deaths annually, representing nearly 74% of all global deaths3World Health Organization. (2023). Commercial determinants of health.. A substantial proportion of these deaths is attributable to risk factors closely linked to commercial products, including tobacco use, unhealthy diets, and harmful alcohol consumption. These risk factors are systematically produced and reinforced through corporate strategies that prioritize market expansion and consumption.
Research suggests that a relatively small number of multinational corporations dominate global markets for health-harming commodities, shaping consumption patterns across diverse contexts4Moodie, R., Stuckler, D., Monteiro, C., et al. (2013). Profits and pandemics. The Lancet, 381(9867), 670–679.. These corporations rely on strategies such as aggressive marketing, price manipulation, and global supply chain expansion to sustain demand. Importantly, these strategies often target emerging markets in low- and middle-income countries, where regulatory environments may be weaker and consumption is still growing.
This creates a structural contradiction: while public health systems aim to reduce exposure to harmful products, corporate success often depends on increasing their consumption. As a result, the global burden of disease is not merely an unintended consequence of economic activity but is, in part, a predictable outcome of current market dynamics.
Case Study 1: Big Tobacco and the Blueprint for Harm
The tobacco industry provides one of the most extensively documented examples of corporate practices that prioritize profit over public health. Internal documents released through litigation in the United States revealed that major tobacco companies were aware of the harmful and addictive nature of their products as early as the mid-20th century, yet actively worked to obscure this knowledge5. The cigarette century. Basic Books..
A central strategy employed by tobacco companies was the deliberate creation of scientific uncertainty. By funding research designed to cast doubt on the link between smoking and disease, and by promoting alternative explanations for health outcomes, the industry was able to delay regulatory action for decades6Oreskes, N., & Conway, E. M. (2010). Merchants of doubt. Bloomsbury Press.. This approach not only misled the public but also influenced policymakers, slowing the implementation of effective tobacco control measures.
In parallel, tobacco companies invested heavily in marketing strategies that targeted vulnerable populations. Youth-oriented advertising, gender-specific campaigns, and the expansion into low- and middle-income countries allowed the industry to sustain and grow its consumer base despite declining smoking rates in high-income countries7Gilmore, A. B., Fabbri, A., Baum, F., et al. (2023). Defining and conceptualising the commercial determinants of health. The Lancet, 401(10383), 1194–1213.. These strategies were often facilitated by weak regulatory frameworks and limited public awareness.
Perhaps most significantly, the tobacco industry established a broader “corporate playbook” that has since been adopted by other industries. This includes lobbying against regulation, framing public health interventions as threats to personal freedom, and shifting responsibility onto individual behavior rather than corporate practices8Savell, E., Gilmore, A. B., & Fooks, G. (2014). Corporate political activity in public health. Globalization and Health, 10(1), 1–11.. As such, the tobacco industry is not only a case of harm but also a model for understanding how corporate power can shape health outcomes across sectors.
Case Study 2: Ultra-Processed Foods and the Global Nutrition Crisis
The rapid global expansion of ultra-processed foods has fundamentally transformed dietary patterns and contributed to rising rates of obesity and diet-related diseases. These products -characterized by high levels of sugar, salt, and unhealthy fats- are engineered for palatability, convenience, and profitability9Monteiro, C. A., Cannon, G., Levy, R., et al. (2019). Ultra-processed foods. Public Health Nutrition, 22(5), 936–941..
Multinational food and beverage corporations have played a central role in this transformation. Through sophisticated marketing strategies, including targeted advertising and digital engagement, these companies have normalized the consumption of ultra-processed foods across diverse populations. Children and adolescents are particularly vulnerable, as they are frequently exposed to marketing that associates these products with positive emotions and social success10Hastings, G., et al. (2020). Marketing of unhealthy foods to children. Public Health Nutrition, 23(1), 1–10..
Pricing and distribution strategies further reinforce these consumption patterns. In many settings, ultra-processed foods are more affordable and accessible than fresh, nutritious alternatives. This is particularly evident in urban areas of low- and middle-income countries, where rapid economic and social changes have increased demand for convenient food options11Popkin, B. M., Corvalan, C., & Grummer-Strawn, L. (2020). Dynamics of the nutrition transition. The Lancet, 395(10217), 65–74.. However, this demand is not purely organic; it is actively shaped by corporate strategies that influence both supply and preferences.
The result is a global “nutrition transition” characterized by declining consumption of traditional diets and increasing reliance on processed foods. This transition is associated with a growing burden of obesity, diabetes, and cardiovascular disease, particularly in contexts where health systems are not well-equipped to manage chronic conditions12Swinburn, B. A., et al. (2019). The global obesity pandemic. The Lancet, 393(10173), 791–846.. Importantly, these outcomes are not inevitable but are shaped by policy environments that either constrain or enable corporate practices.
Case Study 3: The Pharmaceutical Industry and the Cost of Care
The pharmaceutical industry presents a more complex case, as it produces essential medicines while also operating within a profit-driven framework. While pharmaceutical innovation has led to significant health gains, concerns have been raised about pricing, access, and the influence of commercial interests on healthcare systems13Light, D. W., & Lexchin, J. (2012). Pharmaceutical research and development. BMJ, 345, e4348..
One of the most pressing issues is the high cost of medicines. In many countries, essential drugs remain unaffordable for large segments of the population, limiting access to treatment and exacerbating health inequalities. While companies often justify high prices by citing research and development costs, studies have shown that these costs are frequently overstated and that pricing strategies are influenced by market considerations rather than public health needs14Kesselheim, A. S., Avorn, J., & Sarpatwari, A. (2016). The high cost of prescription drugs. JAMA, 316(8), 858–871..
The opioid crisis in the United States provides a stark example of how pharmaceutical practices can contribute to public health harm. Companies such as Purdue Pharma aggressively marketed opioid medications while minimizing their risks, leading to widespread misuse and addiction. This crisis highlights how profit-driven incentives, when combined with weak regulatory oversight, can result in devastating consequences.
In addition to pricing and marketing, pharmaceutical companies exert influence through their relationships with healthcare providers, researchers, and policymakers. Industry funding of clinical trials and medical education can create conflicts of interest that shape prescribing practices and treatment guidelines15. The truth about the drug companies. Random House. (Angell, 2004). While collaboration between industry and health systems is necessary for innovation, these relationships require careful regulation to ensure that patient welfare remains the primary priority.
Corporate Influence on Policy and Regulation
Corporate influence on public policy is a critical mechanism through which health outcomes are shaped. Through lobbying, political donations, and participation in policy processes, companies can shape regulatory environments in ways that protect their interests (Gilmore et al., 2023). This influence is often referred to as corporate political activity (CPA).
Evidence shows that industries producing harmful products frequently engage in strategies designed to delay, weaken, or prevent regulation. These strategies include framing public health policies as economically harmful, emphasizing individual responsibility, and promoting voluntary self-regulation as an alternative to government intervention16Savell, E., Gilmore, A. B., & Fooks, G. (2014). Corporate political activity in public health. Globalization and Health, 10(1), 1–11..
In low- and middle-income countries, these dynamics are often intensified by limited regulatory capacity and economic dependence on foreign investment. As a result, governments may face significant challenges in implementing effective public health policies, even when the evidence is clear.
Structural Inequalities and the Global South
The impacts of profit-driven corporate practices are not evenly distributed. Low- and middle-income countries often bear a disproportionate burden due to weaker regulatory systems, targeted marketing, and limited healthcare access17World Health Organization. (2023). Commercial determinants of health..
Corporate strategies frequently exploit these vulnerabilities, expanding markets for harmful products while minimizing accountability. At the same time, global economic structures enable profit extraction without corresponding investment in local health systems, reinforcing inequalities18Labonté, R., & Stuckler, D. (2016). The rise of neoliberalism and health inequalities. Globalization and Health, 12(1), 1–12..
Addressing these disparities requires coordinated global action, including stronger international regulations and greater accountability for multinational corporations.
Conclusion
The evidence is clear: corporate practices across multiple industries are contributing to a global burden of disease that is largely preventable. From tobacco and ultra-processed foods to pharmaceuticals, the pursuit of profit often comes at the expense of public health.
Addressing this challenge requires a fundamental rebalancing of power between public health and commercial interests. Stronger regulation, greater transparency, and more equitable economic systems are essential to ensure that corporate activities align with the goal of improving health outcomes. Ultimately, sustainable development depends on placing human well-being -not profit- at the center of decision-making.
Felix Rutayisire is a researcher and evaluation specialist focusing on the political economy of health systems and health equity. His work explores how socioeconomic and institutional factors shape the quality and fairness of care, with a commitment to advancing evidence-informed policy and development practice in Africa and beyond.
