By Robert Pezzolesi
Addressing the Social, Economic, and Commercial Determinants of NCDs Through Fiscal Measures
In preparation for the Fourth High-Level Meeting of the UN General Assembly on NCDs and mental health in September 2025, Antigua and Barbuda, Belgium, Brazil, Ghana, Georgia, Japan, and Thailand along with the World Health Organization (WHO), and the UN Foundation are co-hosting a series of interactive dialogues.
The fourth discussion focused on the fundamental aspects, rationale, and methods of addressing the social, economic, and commercial determinants of noncommunicable diseases (NCDs), as well as the role of fiscal measures in NCDs prevention.
Movendi International participated as lead discussant. This interactive dialogue took place under Chatham House rule and considered the challenges posed by social, economic and commercial drivers of NCDs and mental health conditions, as well as the tools and record of best practices for addressing these challenges.
The dialogue was rooted in the WHO framework for achieving well-being, the final report of the WHO Council on the Economics of Health for All, and the Bridgetown Declaration on NCDs and mental health – that Movendi International contributed to. The dialogue brought together external experts, key stakeholders, and country representatives from UN Permanent Missions.
Confronting the Commercial Determinants of Health
Around the world, communities are grappling with an epidemic of preventable death and disease. Cancer, heart disease, mental ill-health, and other non-communicable diseases (NCDs) take a staggering toll on families, economies, and societies. But behind these health conditions lies a deeper, systemic cause that is too often ignored or downplayed: the commercial determinants of health.
We live in a world where greedy, multinational corporations profit from harm. Tobacco, alcohol, ultra-processed food, and polluting industries are collectively responsible for 19 million deaths every year.
These deaths are not random or inevitable – they are the outcome of intentional business models built on deception, sabotage, manipulation, saturation marketing, lobbying and political interference – the Dubious Five, as we call it in Movendi International.
To prevent these harms and build healthier, more just societies, we boldly need to confront these commercial drivers of disease – with ambition, urgency, and unwavering commitment to people’s health and societies’ development.
In Movendi International we focus on six priority actions for our governments, UN agencies, and civil society to take to promote health and social justice through tackling the commercial drivers of NCDs.
1. Do What Works: Evidence-Based, People-Centered Action
We already know what works to reduce the burden of NCDs and mental ill-health. The World Health Organization has outlined “Best Buys” – cost-effective, high-impact policy measures – and frameworks such as SAFER for alcohol policy. These tools are ready for use. What’s needed now is the political commitment to implement them fully and comprehensively.
Take alcohol taxation, for example. It is a proven to be the single most cost-effective alcohol policy solutions to lower population-level alcohol consumption, prevent harm, save lives, and generate revenue. Yet alcohol industry lobbying and pollution of the discourse with outdated and harmful myths still manages to derail alcohol taxation initiatives in too many countries.
But caving to Big Alcohol’s private profit interests goes against world class science as well as the people’s interest and public support for raising alcohol taxes. Global surveys show widespread backing for alcohol tax increases.
Best practices don’t need to be imported – they’re being developed locally. Communities around the world are innovating, adapting, and demonstrating success in preventing and reducing NCDs risk factors. These locally-rooted solutions should be recognized, resourced, and scaled up globally.
2. Stop Doing What Doesn’t Work
While we need to accelerate action on what works, such as promoting proven policies, we also need to stop doing what does not work, including to let go of myths, harmful frames and terms, and industry-friendly concepts that undermine real progress.
Industry self-regulation does not work. Self-regulation is no regulation. Years of broken promises, watered-down guidelines, and marketing to minors have proven this beyond doubt. Similarly, public-private partnerships with health-harming industries – often masquerading as corporate social responsibility – are nothing more than health-washing campaigns aimed at preempting and derailing real action on evidence-based solutions.
We also need to end subsidies for health harming industries and reject language in policy documents that legitimizes their involvement. The term “harmful use of alcohol” is a prime example of problematic framing – it obscures the inherent risks of alcohol itself and shifts the focus onto individuals, rather than the environments and systems that determine health outcomes.
Instead, we need clear, accurate, and unambiguous language that acknowledges the role of commercial actors in driving health harm.
3. Expose and Regulate Health-Harming Industries
Health-harming industries – especially Big Alcohol and Big Tobacco – need to be recognized for what they are: key commercial drivers of disease, destruction, and death.
These industries do not act alone. They collaborate to shape policies, undermine science, and delay public policy progress. Their strategies and tactics are well-documented: from lobbying against life-saving taxes, to funding misleading research, to infiltrating policy processes. Alcohol and tobacco companies are not just bad actors – they are strategic allies, working in tandem to maximize profit at the expense of people’s health and societies’ development.
World class, evidence-based regulatory standards are urgently needed. Governments have now an opportunity to:
- Establish clear boundaries that prevent industry interference in policymaking,
- Remove industry representation from health forums and decision-making bodies,
- Protect public institutions from conflicts of interest, and
- Build systems for technical assistance and accountability that shield public policy making from private profit motives.
4. Connect the Dots: Risk Factors, Equity, and the SDGs
The risk factors driving NCDs and mental ill-health – alcohol, tobacco, unhealthy diets, and more – don’t operate in isolation. They are interconnected, compounding one another’s harms.
For example:
- Alcohol consumption increases tobacco use, and vice versa.
- Alcohol contributes to obesity and undermines healthy eating habits.
- Alcohol fuels gender-based violence and impedes mental health recovery.
These issues cut across multiple global health and development priorities, including:
- Mental health and well-being,
- Women’s, children’s, and adolescents’ health and rights,
- Universal Health Coverage (UHC) and the resilience, sustainability, and capacity of health systems,
- Economic productivity and growth, and
- The Sustainable Development Goals (SDGs) beyond Goal 3, such as Goals 1, 2, and 4 (poverty eradication, hunger eradication, good education), 5 and 8 (gender equality and economic productivity), 10 (reduced inequalities), as well as 11 and 16 (reduced violence and proper functioning of public institutions).
Addressing commercial determinants through the NCDs best buys, such as raising alcohol and other pro-health taxes, means embracing a systems approach, one that integrates prevention, promotes equity, and builds resilience across sectors.
5. Put People and Communities First
Ultimately, the solutions we need are already emerging from the ground up. People and communities are not just victims of harmful products – they are powerful agents of change.
- People demand transparency and accountability.
- People organize for healthier environments and fairer economies.
- People support policies like taxation, advertising bans, and labeling regulations – because they are protective and help promote social goods people care about deeply.
Health systems must evolve to reflect this reality. We need systems that:
- Address multiple risk factors and co-morbidities, not just single diseases.
- Focus on prevention and health promotion at the population level, not “just” treatment.
- Empower people to live healthy, dignified lives across the lifespan.
6. Pro-Health Taxes: A Transformative Opportunity
If one policy captures the spirit of ambition, equity, and effectiveness, it is pro-health taxation – especially increased taxes on alcohol.
Alcohol taxes are:
- Evidence-based: They succeed in reducing population-level alcohol consumption and linked harms and costs.
- Popular: People support raising alcohol taxes, especially so when they understand the benefits.
- Equitable: They reduce health and social disparities and free up resources for public services that benefit the most vulnerable and marginalized communities the most.
- Sustainable: They generate revenue that can fund universal health coverage and social protection programs.
With these four points, what raising alcohol taxes does is help build a self-sufficient, sustainable, effective system geared towards health promotion, providing health and social services, and improving social justice.
In short, alcohol taxation is a win-win-win: Prevent harm. Raise revenue. Promote justice
A Path Forward: Clarity, Courage, and Commitment
To overcome the commercial determinants of health and make real – and much needed progress on NCDs prevention and control – we need to resolve to act with clarity of language, ambition in policy making, and commitment to justice. That means exposing health harming industries, rejecting failed approaches, scaling what works, and listening to communities.
People’s health and the future of our communities – either thriving or deteriorating- depends not just on treating disease, but on transforming the systems that determine health and social outcomes. And that begins with holding industry accountable and putting people first.
We know what works. Now let’s get to work.
