Corporate Vectors of Chronic Disease – Using Internal Industry Documents to Craft Counterstrategies
Research paper
Background: The Commercial Determinants of Chronic Disease
Chronic or noncommunicable diseases – including cancers, diabetes, neurocognitive disorders, and chronic respiratory disease – account for 74% of global deaths. Transnational corporations that manufacture and market health-harming products are identified by the authors as a primary driver of this global burden, operating as vectors of disease by producing harmful products and influencing their consumption.
The authors make the scientific case that the medical and public health fields must prioritise research on corporate activity as a health risk, and that internal industry documents – obtained through litigation, whistleblowers, and freedom-of-information laws – provide uniquely direct evidence of what corporations knew, when they knew it, and what tactics they used to delay regulation and conceal harm.
Alcohol’s Role in the Global Death Toll
The study identifies five commercial products as key factors in 31% of all deaths globally each year. Alcohol is among them, responsible for 1.8 million deaths annually worldwide – the same number as manufactured chemicals and pesticides combined, and behind fossil fuels (8.1 million), tobacco (7.2 million) and ultra-processed foods (2.3 million).
- Fossil fuels contribute to 8.1 million deaths,
- Tobacco contributes to 7.2 million deaths,
- Ultra-processed foods contribute to 2.3 million deaths,
- Chemicals (manufactured chemicals used in commerce and pesticides) contribute to 1.8 million deaths, and
- Alcohol contributes to 1.8 million deaths.*
The study notes that sales of health-harming products, including alcohol, have grown substantially – particularly in low- and middle-income countries – driven by economic globalisation, which the authors describe as intensifying adverse health effects and exacerbating health inequities within and between countries.
*The death toll due to alcohol of 1.8 million in this study is substantially lower than the figure of 2.6 millions deaths due to alcohol from the WHO Global Alcohol Status Report 2024. The researchers are using data from the Global Burden of Disease study that is likely to substantially underestimate alcohol’s death toll.
Big Alcohol and Big Tobacco: A Documented Alliance
One of the study’s most significant alcohol-relevant findings concerns documented collaboration between the tobacco and alcohol industries to jointly undermine public health actions in the United States.
Internal documents show that the Tobacco Institute, seeking to oppose a cigarette tax increase, created a front group – the “Consumer Tax Alliance” – and proposed that the California Beer Association and other alcohol industry groups provide the majority of its funding. The purpose was to create the impression of a broad, independent coalition opposing the tax, obscuring its tobacco industry origins. While the alcohol industry did not ultimately provide majority funding, the tobacco industry successfully used similar front group tactics to fight federal excise taxes throughout the 1980s.
The collaboration extended further: the R.J. Reynolds tobacco brand worked directly with the National Liquor Store Association to oppose laws protecting the cleanliness of indoor air. This cross-industry alliance to resist regulation – despite the two industries being commercial competitors – illustrates a documented pattern of health-harming corporations collaborating to prevent government regulation that might reduce their combined power or market reach.
Tobacco Executives Running Alcohol Subsidiaries
The study also documents how between 1960 and 2010, America’s largest tobacco companies – R.J. Reynolds and Philip Morris – owned some of the world’s largest food companies, and also held alcohol subsidiaries. When Philip Morris acquired General Foods in 1985, it installed tobacco executives to maximise what it called technical and marketing “synergies” across its tobacco, food, and alcohol operations.
The authors present this as evidence of how harmful corporate strategies — developed in one industry — are deliberately transferred and applied across others.
Three Mechanisms Used Across Health-Harming Industries – Including Big Alcohol
The study identifies three key mechanisms used across all health-harming industries, which the existing literature confirms have also been deployed by the alcohol industry:
- Knowledge capture: influencing research questions, suppressing unfavourable findings, attacking independent science, and funding research that downplays harm.
- Regulatory and policy capture: direct lobbying, the use of front groups and trade associations, the “revolving door” between government and industry, and direct participation in regulatory agencies.
- Shaping the public narrative: sophisticated marketing and advertising campaigns, use of public relations companies, think tanks, and front groups to influence public perceptions of harm and personal responsibility.
The study cites existing research confirming that the alcohol industry has used all three mechanisms, particularly in attempts to influence marketing regulations.
What This Means for Alcohol Policy
The authors conclude that corporations across health-harming industries – including Big Alcohol – have systematically undermined science and policymaking to prioritise profit over health. They call for a suite of countermeasures, including mandatory transparency on corporate research funding, open-science requirements, prohibition of financial ties between industry and researchers, and – critically – the development of binding policy frameworks that insulate policymakers from industry influence.
The authors point to Article 5.3 of the WHO Framework Convention on Tobacco Control – which limits government engagement with the tobacco industry during health policy development – as a model that could and should be adapted for other health-harming industries, including alcohol. They note that governments need not wait for international treaties and can implement such safeguards at the national level now.
Study Summary
Chronic diseases including cancer, diabetes, neurocognitive disorders and infertility are rising globally, with health-harming products such as fossil fuels, tobacco, ultra‑processed foods, toxic chemicals, plastics and alcohol being major contributors, say the authors of a new paper published in New England Journal of Medicine (NEJM). The authors include proposed solutions, including policy safeguards and a stronger research focus on the risks to health connected with corporate activity.
This is the first time the NEJM has published a paper which recognises corporations that manufacture and market health-harming products as primary vectors of non-communicable disease.
Corporate drivers of chronic disease
The global increase in certain chronic diseases is startling,” said lead author Dr Nicholas Chartres, researcher from University of Sydney’s Faculty of Medicine and Health and scientific lead to the Center to End Corporate Harm at the UC San Francisco.
Increases in health-harming products mirror the rise in certain chronic diseases to a disturbing extent. Chronic diseases now account for 74 percent of deaths around the world.”
Dr Nicholas Chartres, researcher, Faculty of Medicine and Health, University of Sydney and scientific lead, Center to End Corporate Harm at UC San Francisco
Globally, five commercial products are key factors in 31 percent of all deaths each year:
- Fossil fuels contribute to 8.1 million deaths,
- Tobacco contributes to 7.2 million deaths,
- Ultra-processed foods contribute to 2.3 million deaths,
- Chemicals (manufactured chemicals used in commerce and pesticides) contribute to 1.8 million deaths, and
- Alcohol contributes to 1.8 million deaths.*
*The death toll due to alcohol of 1.8 million in this study is substantially lower than the figure of 2.6 millions deaths due to alcohol from the WHO Global Alcohol Status Report 2024. The researchers are using data from the Global Burden of Disease study that is likely to substantially underestimate alcohol’s death toll.
To protect our health, it is critical to analyse and understand these corporate drivers of disease and how to curb their influence,” Dr Chartres said, as per EurekAlert reporting.
Dr Nicholas Chartres, researcher, Faculty of Medicine and Health, University of Sydney and scientific lead, Center to End Corporate Harm at UC San Francisco
Lessons from tobacco industry reform
Industry documents have shown that tobacco company executives knew for decades that smoking caused cancer and that nicotine was addictive yet concealed this information from the public.
Research on the tobacco industry provides a blueprint for identifying and counteracting other corporate influences on health,” said Dr Chartres, according to EurekAlert.
In the United States, tobacco documents research led to sweeping policy changes including local tobacco bans, national and state tax increases, state and local smoke-free policies, and a federal investigation of the industry.
A significant drop in smoking occurred in high-income countries once the tobacco industry lies about the safety of their products were exposed alongside major anti-smoking campaigns. It is estimated that more than 37 million lives have been saved to date.
Clinicians, the public, media and policy makers need to understand that these health harming industries all apply the same set of tactics used by ‘Big Tobacco’ to create uncertainty about the harms of their products, delay regulation and therefore continue to profit from their sale – while we increasingly become sick from consuming them and ultimately pay the price with our health.
We must regulate these products like we have with tobacco,” he said.
Dr Nicholas Chartres, researcher, Faculty of Medicine and Health, University of Sydney and scientific lead, Center to End Corporate Harm at UC San Francisco
Co-author of the paper Tracey J. Woodruff, co-founder of the Center to End Corporate Harm, said:
A clear solution to corporate drivers of disease is to enact similar restrictions on policy influence for all health-harming industries.”
Tracey J. Woodruff, co-founder, Center to End Corporate Harm
Proposed solutions
Dr Chartres added:
In the paper we propose solutions to safeguard policy from corporate influence, such as rules that prohibit health-harming industries from engaging in policy via a global treaty – which would be similar to the tobacco treaty; databases that track and expose industry payments to scientists and policymakers; and governments prohibiting financial ties between industry and researchers.
We believe that the medical and health fields should prioritise research on, and communication about, risks to health associated with corporate activity.”
Dr Nicholas Chartres, researcher, Faculty of Medicine and Health, University of Sydney and scientific lead, Center to End Corporate Harm at UC San Francisco