PLoS Medicine on Manufacturing Epidemics

In a new report in the PLoS Medicine series on Big Food, David Stuckler, Martin McKee, Shah Ebrahim and Sanjay Basu describe the role of the alcohol, tobacco, and food and beverage industries in rising rates of consumption of unhealthy commodities, especially in low- and middle income countries.  They write:


Unhealthy commodities are highly profitable because of their low production cost, long shelf-life, and high retail value. These market characteristics create perverse incentives for industries to market and sell more of these commodities. Coca-Cola’s net profit margins, for example, are about one-quarter of the retail price, making soft drink production, alongside tobacco production, among the most profitable industrial activities in the world. Indeed, transnational corporations that manufacture and market unhealthy food and beverage commodities, including Coca-Cola, PepsiCo, and Cadbury Schweppes, are among the leading vectors for the global spread of NCD risks. Increasingly, they target developing countries’ markets as a major area for expansion.


Unweighted Trends in Unhealthy Commodities, by Geographic Region,

2000-2010 and 2010-2015.  Source: PLoS Medicine

Their article examines two main questions:

(1) Where is the consumption of unhealthy commodities rising most rapidly?
(2) What determines the pace and scale of these increases?


Based on analysis of market data on commodity sales in 80 countries, they offer five observations:

Observation 1.  Growth of snacks, soft drinks and processed foods is fastest in LMICs (i.e. GDP≤USD12,500). Little or no growth is expected in HICs in the next 5 years.

Observation 2.  The pace of increase in consumption of unhealthy commodities in several LMIC is projected to occur at a faster rate than historically in HICs.

Observation 3. Multinational companies have already entered food systems of middle-income countries to a similar degree observed in HICs.

Observation 4. Tobacco and alcohol are joint risks with unhealthy food commodities.

Observation 5. Substantial increases in consumption of unhealthy commodities are not an inevitable consequence of economic growth.

Observation 6. Foreign direct investment increases risks of rising unhealthy commodities among LMICs.


Trends in Tobacco and Alcohol Commodities, 1997-2010 and projected to 2016

Source: PLoS Medicine

The authors conclude that:

NCDs are the current and future leading causes of global ill health; unhealthy commodities, their producers, and the markets that power them, are their leading risk factors. Until health practitioners, researchers, and politicians are able to understand and identify feasible ways to address the social, economic, and political conditions that lead to the spread of unhealthy food, beverage, and tobacco commodities, progress in areas of prevention and control of NCDs will remain elusive.


For related posts on the role of the alcohol, tobacco and food industries in the production of  NCDs , see here and here and here.