Just four industries –  tobacco, ultra-processed foods (UPFs), fossil fuels, and alcohol – cause over a third of all deaths globally each year, according to a new report from the World Health Organization’s (WHO) Regional Office for Europe.

Not only are these industries driving ill health and premature mortality across Europe and Central Asia, but they are “interfering in and influencing prevention and control efforts for non-communicable diseases (NCDs) such as cardiovascular diseases, cancers, diabetes and their risk factors including tobacco, alcohol, unhealthy diets and obesity,” according to a press release from WHO Europe. This translates to 19 million deaths globally each year. 

WHO Europe, a vast region of 53 countries including Russia, is disproportionately affected by these industries.

The region has the highest global levels of alcohol consumption and alcohol-related harms in the world, and the highest level of adolescent tobacco use.

Non-communicable diseases (NCD) – primarily cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases – are responsible for 90% of deaths in the region. By 2017, one out of five deaths from cardiovascular diseases and cancers in the European Union were attributable to unhealthy diets.

“Four industries kill an estimated 7,400 people in our region every day. The same large commercial entities block regulation that would protect the public from harmful products and marketing, and protect health policy from industry interference,” said Dr Hans Henri P. Kluge, WHO regional director for Europe.

“Industry tactics include exploitation of vulnerable people through targeted marketing strategies, misleading consumers, and making false claims about the benefits of their products or their environmental credentials,” added Kluge. 

“These tactics threaten public health gains of the past century and prevent countries from reaching their health targets. WHO Europe will work with policymakers to strengthen tactics to protect against and reduce harmful industry influence.

“Today, we provide indisputable evidence of harmful commercial practices and products and we say: people must take precedence before profit, always,” added Kluge.

The report provides a detailed estimate of each industry’s impact on health: tobacco leads as the highest proportion of all cause death at 10.37% (nearly 1.2 million deaths in 2021), followed by fossil fuels (5.21%), alcohol (3.84%), and unhealthy foods (3.52%). “Unhealthy foods” being diets of processed meats, high sodium, trans fats, and sugar-sweetened beverages.

Corporate social responsibility and image laundering 

The WHO Europe Region has the highest rates of adult tobacco use.

Through a series of unsettling case studies, the report documents the lengths to which companies go to protect their reputations, shift blame, and take advantage of crises for profit. 

Industry corporate social responsibility (CSR) programs that appear “inherently beneficial to society” yet undermine public health efforts, were singled out as image laundering. 

“Pinkwashing” is one example. The phrase was coined by Breast Cancer Action, and refers to  groups that claims to care about breast cancer by displaying a pink ribbon while selling or promoting products that contain chemicals linked to cancer.

For example, alcohol consumption is a known risk factor for breast cancer, yet some alcohol companies fund charities that have underplayed or denied the risk of alcohol, according to the report.

“They fund charities that raise awareness of breast cancer and other dangers, while selling alcohol which causes these harms,” said Kluge.

‘Wresting power back. from industries

“We really have to re-think,” said Belgian Deputy Prime Minister and Minister of Social Affairs and Public Health, Frank Vandenbroucke.  “For too long we have considered risk factors as being mostly linked to individual choices. We need to re-frame the problem as a systemic problem, where policy has to counter ‘hyper-consumption environments’, restrict marketing, and stop interference in policy making.

The report calls for an entire rethinking of current economic models – going beyond traditional metrics of “productivity and profit, emphasizing wellbeing over monetary return on investment.” 

It calls on member states to enforce stronger regulations on marketing of harmful products; monopolistic practices; transparency, lobbying, funding and conflicts of interest, and  taxation of multinational corporations.

It also wants vulnerable populations to be protected against exploitation during crises and funding and government support for civil society organizations to ensure their independence.

Not a new conflict

In 2023, the Lancet journal commissioned a series on the mechanisms and scope of commercial determinants of health, examining how the private sector influences health through activities like product design, packaging, supply chains, lobbying, research funding, and marketing. 

The Lancet series identified companies that “are escalating avoidable levels of ill health, planetary damage, and inequity.” These include formula milk companies’ extensive lobbying networks and “predatory” marketing tactics that derailed progress on breastfeeding education, and the palm oil industry fueling unsustainable deforestation, driving malaria risks in deforestation hotpots. 

Indeed, industry’s battles with public health can trace its roots to 1950s era tobacco press statements – the beginnings of a half-century charade to mislead Americans about the dangers of smoking.

Yet resistance from industry to change that could be health-promoting has grown more sophisticated over time, says the report. 

“Earlier efforts were exemplified by the tobacco industry denying that nicotine was addictive or that there was no evidence that tobacco was harmful to health.

More recently, in many European countries, industry efforts have challenged public health by promoting ‘harm reduction,’ where the concept does not apply across a bundle of industries taken together, thereby reducing the impact of strong regulation to promote health.” 

With these tactics in mind, “we have no illusion that one report will bring about a sea change, but we are firm in the belief that the reaction the report is getting is evidence of a groundswell of support, not just in public health practitioners, but in governments, civil society, and academia,” said Dr Gauden Galea, WHO Europe regional adviser on NCDs and Innovation.

“The report is a rallying cry in a generational struggle for health for all,” she added.

Image Credits: PAHO, The Lancet, WHO Europe, Standford School of Medicine .