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The case for developing a cohesive systems approach to research across unhealthy commodity industries
  1. Cécile Knai1,2,
  2. Mark Petticrew1,2,
  3. Simon Capewell3,
  4. Rebecca Cassidy4,
  5. Jeff Collin2,5,
  6. Steven Cummins6,
  7. Elizabeth Eastmure1,
  8. Patrick Fafard7,
  9. Niamh Fitzgerald2,8,
  10. Anna B Gilmore2,9,
  11. Ben Hawkins1,
  12. Jørgen Dejgård Jensen10,
  13. Srinivasa Vittal Katikireddi11,
  14. Nason Maani1,2,12,
  15. Nicholas Mays1,
  16. Modi Mwatsama13,
  17. Rima Nakkash14,
  18. Jim F Orford15,16,
  19. Harry Rutter17,
  20. Natalie Savona1,
  21. May C I van Schalkwyk1,
  22. Heide Weishaar18
  1. 1Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
  2. 2SPECTRUM Consortium, UK
  3. 3Department of Public Health, Policy & Systems, University of Liverpool, Liverpool, UK
  4. 4Department of Anthropology, Goldsmiths University of London, London, UK
  5. 5Global Public Health Unit, University of Edinburgh, Edinburgh, UK
  6. 6Population Health Innovation Lab, Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, London, UK
  7. 7Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
  8. 8Institute for Social Marketing and Health, University of Stirling, Stirling, UK
  9. 9Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
  10. 10Institute of Food and Resource Economics, University of Copenhagen, Frederiksberg, Denmark
  11. 11MRC/CSO Social and Public Health Sciences Unit, University of Glasgow School of Life Sciences, Glasgow, UK
  12. 12School of Public Health, Boston University, Boston, Massachusetts, USA
  13. 13Our Planet Our Health, Wellcome Trust, London, UK
  14. 14Health Promotion and Community Health, American University of Beirut, Beirut, Lebanon
  15. 15School of Psychology, University of Birmingham, Birmingham, UK
  16. 16King's College London, London, UK
  17. 17Department of Social and Policy Sciences, University of Bath, Bath, Bath and North East Somer, UK
  18. 18Center for International Health Protection, Robert Koch Institute, Berlin, Germany
  1. Correspondence to Professor Cécile Knai; cecile.knai{at}


Objectives Most non-communicable diseases are preventable and largely driven by the consumption of harmful products, such as tobacco, alcohol, gambling and ultra-processed food and drink products, collectively termed unhealthy commodities. This paper explores the links between unhealthy commodity industries (UCIs), analyses the extent of alignment across their corporate political strategies, and proposes a cohesive systems approach to research across UCIs.

Methods We held an expert consultation on analysing the involvement of UCIs in public health policy, conducted an analysis of business links across UCIs, and employed taxonomies of corporate political activity to collate, compare and illustrate strategies employed by the alcohol, ultra-processed food and drink products, tobacco and gambling industries.

Results There are clear commonalities across UCIs’ strategies in shaping evidence, employing narratives and framing techniques, constituency building and policy substitution. There is also consistent evidence of business links between UCIs, as well as complex relationships with government agencies, often allowing UCIs to engage in policy-making forums. This knowledge indicates that the role of all UCIs in public health policy would benefit from a common approach to analysis. This enables the development of a theoretical framework for understanding how UCIs influence the policy process. It highlights the need for a deeper and broader understanding of conflicts of interests and how to avoid them; and a broader conception of what constitutes strong evidence generated by a wider range of research types.

Conclusion UCIs employ shared strategies to shape public health policy, protecting business interests, and thereby contributing to the perpetuation of non-communicable diseases. A cohesive systems approach to research across UCIs is required to deepen shared understanding of this complex and interconnected area and also to inform a more effective and coherent response.

  • public health
  • qualitative study

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  • Handling editor Eduardo Gómez

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  • Contributors CK developed and led the research concept, methods, analysis, writing and editing, with support from MP, SC, RC, SC, EE, PF, BH, JDJ, SVK, NM, MM, JFO and HW. JC, NMF, ABG, NMH, RN, HR, NS and MCIVS contributed to the writing and editing.

  • Funding The 2016 international meeting of researchers was funded by a Wellcome Trust Small Grant in Humanities and Social Sciences (PI CK). JC, ABG, CK, MP and NF are supported by the UK Prevention Research Partnership (MR/S037519/1), which is funded by the British Heart Foundation, Cancer Research UK, Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Health and Social Care Research and Development Division (Welsh Government), Medical Research Council, National Institute for Health Research, Natural Environment Research Council, Public Health Agency (Northern Ireland), The Health Foundation and Wellcome. NM is supported by a Harkness Fellowship from the Commonwealth Fund. SVK is funded by an NRS Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_12017/13) and Scottish Government Chief Scientist Office (SPHSU13). MCIVS is funded by an NIHR Doctoral Fellowship (Ref NIHR300156).

  • Disclaimer The views presented here are those of the authors and should not be attributed to the above funding organisations, their directors, officers or staff.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available. Not applicable.