Author: Dr. Jason Attard, Consultant in Public Health Medicine
01 April 2026
Health is often thought of as a matter of personal choice: eating well, exercising and avoiding harmful habits. But behind many of the choices people make are powerful commercial forces shaping what is available, affordable and desirable. Public health experts call these forces the commercial determinants of health; the ways in which business practices, marketing strategies and corporate influence affect people’s health.
At their core, commercial determinants are about how companies promote products and behaviours that can harm health while seeking profit and market growth.[i] This does not mean that all businesses are harmful. Many industries contribute positively to society. However, some sectors profit from products that increase the risk of disease, such as tobacco, alcohol and highly processed foods high in salt, sugar and unhealthy fats.
These products are closely linked to the growing global burden of non-communicable diseases, including heart disease, cancer, diabetes and chronic respiratory illnesses. Diet-related risks and harmful alcohol consumption are now among the leading contributors to ill health worldwide, alongside tobacco use.[ii]
Among these, the tobacco industry remains one of the clearest and most studied examples.
Tobacco use continues to be a major cause of preventable illness and death worldwide. According to the World Health Organization, tobacco kills more than seven million people each year. These deaths are linked to diseases such as lung cancer, heart disease and chronic respiratory illnesses.[iii] But the scale of tobacco-related harm is not simply the result of individual decisions to smoke. It is also the outcome of decades of deliberate corporate strategies.
For much of the 20th century, tobacco companies worked aggressively to promote smoking and protect their markets. Advertising campaigns portrayed cigarettes as symbols of glamour, freedom and sophistication. Smoking appeared in films, magazines and sports sponsorships, often targeting young people.[iv] More recently, however, smoking imagery has begun to make a noticeable comeback, with its portrayal increasingly normalised again in a number of contemporary television series.[v]
At the same time, internal industry documents later revealed that companies were aware of the addictive and harmful nature of their products long before the public was fully informed. Yet they funded research designed to create doubt about the health risks and lobbied governments to delay stronger regulation.[vi] Today, similar strategic narratives persist, with the tobacco industry increasingly promoting so-called “harm reduction” products as healthier alternatives, often positioning them as part of the solution while continuing to protect and expand their markets. Examples include heated tobacco products, electronic cigarettes and nicotine pouches.[vii]
Similar patterns can be observed in other industries linked to health risks. The alcohol industry, for example, markets its products through lifestyle branding that associates drinking with celebration, success and social belonging. Promotions, sponsorship of cultural and sporting events and digital marketing campaigns help normalise consumption, particularly among young people.[viii] While moderate drinking may be socially accepted, harmful alcohol use contributes to liver disease, certain cancers, injuries, road traffic accidents and violence.[ix]
The global food environment has also changed dramatically in recent decades. Highly processed foods, often engineered to be hyper-palatable and heavily marketed, are now widely available and relatively inexpensive.[x] Aggressive advertising, especially to children, promotes snacks, sugary drinks and fast food while healthier options are often less visible or more expensive.[xi] As a result, many populations are consuming diets high in calories, sugar, salt and unhealthy fats, contributing to rising rates of obesity and diet-related diseases.[xii]
This pattern of promoting harmful products while shaping the environment around them illustrates how commercial determinants operate. Marketing is one key pathway. Constant exposure to advertising can normalize risky behaviours, especially among adolescents. Pricing strategies also matter: cheaper products are more accessible to young people and lower-income groups. Product placement in shops, online promotions and sponsorship of entertainment or sporting events can further reinforce consumption. Political influence is another factor. Industries often lobby policymakers to weaken health regulations, delay warning labels or oppose taxation measures that could reduce consumption.[xiii]
“…health is shaped not only by personal choices but also by the environments in which those choices are made”
Public health policies have made important progress in reducing tobacco use. Measures such as smoke-free laws, advertising bans, plain packaging and higher taxes have helped drive down smoking rates in many countries. These efforts are strongly supported by the World Health Organization’s global treaty on tobacco control, the WHO Framework Convention on Tobacco Control. Increasingly, governments are applying similar approaches to other health risks. Policies such as taxes on sugary drinks, restrictions on alcohol marketing, clearer food labelling and limits on advertising to children aim to reshape environments so that healthier choices become easier.
Understanding the commercial determinants of health reminds us that health is shaped not only by personal choices but also by the environments in which those choices are made. When unhealthy products are aggressively marketed, widely available and politically protected, the odds are stacked against individuals.
Addressing these influences requires strong public policies, transparency in decision-making and a clear recognition that protecting health sometimes means regulating powerful commercial interests.
Ultimately, healthier societies are built not just on individual responsibility, but on systems that make the healthy choice the easier choice.
Do you think Malta is doing enough to make the healthy choice the easy choice?
[i] Commercial determinants of health (2023) World Health Organization. Available at: https://www.who.int/news-room/fact-sheets/detail/commercial-determinants-of-health (Accessed: 30 March 2026).
[ii] Noncommunicable Diseases (2025) World Health Organization. Available at: https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases (Accessed: 30 March 2026).
[iii] Tobacco (2025) World Health Organization. Available at: https://www.who.int/news-room/fact-sheets/detail/tobacco (Accessed: 30 March 2026).
[iv] National Cancer Institute. (2008). The role of the media in promoting and reducing tobacco use (NIH Publication No. 07-6242). U.S. Department of Health and Human Services, National Institutes of Health.
[v] New report details alarming surge in tobacco imagery in on-screen entertainment most popular among youth (2024) Truth Initiative. Available at: https://truthinitiative.org/press/press-release/new-report-details-alarming-surge-tobacco-imagery-screen-entertainment-most (Accessed: 30 March 2026).
[vi] Influencing science case studies (2024) Tobacco Tactics. Available at: https://www.tobaccotactics.org/article/influencing-science-case-studies/ (Accessed: 30 March 2026).
[vii] Harm reduction (2022) Tobacco Tactics. Available at: https://www.tobaccotactics.org/article/harm-reduction/ (Accessed: 30 March 2026).
[viii] Reducing the harm from alcohol by regulating cross-border alcohol marketing, advertising and promotion: a technical report. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO.
[ix] Alcohol (2024) World Health Organization. Available at: https://www.who.int/news-room/fact-sheets/detail/alcohol (Accessed: 30 March 2026).
[x] Scrinis, G., Monteiro, C. From ultra-processed foods to ultra-processed dietary patterns. Nat Food 3, 671–673 (2022). https://doi.org/10.1038/s43016-022-00599-4
[xi] Policies to protect children from the harmful impact of food marketing: WHO guideline.
Geneva: World Health Organization; 2023. Licence: CC BY-NC-SA 3.0 IGO.
[xii] Healthy diet (2026) World Health Organization. Available at: https://www.who.int/news-room/fact-sheets/detail/healthy-diet (Accessed: 30 March 2026).
[xiii] Commercial determinants of noncommunicable diseases in the WHO European Region. Copenhagen: WHO Regional Office for Europe; 2024. Licence: CC BY-NC-SA 3.0 IGO.
Featured Image: Wooden Blocks Spelling Influenced on Beige Background (Anne H on Pexels.com).
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