Context

The Transparency and Truth initiative is rooted in the theoretical framework of the commercial determinants of health. By mobilizing this concept, we critically analyze the systemic logic through which the tobacco and nicotine industry influences public health.

Commercial determinants of health (CDH) refer to a set of economic and structural factors through which private actors—particularly multinational companies—directly or indirectly influence the health of populations. This influence can be positive (e.g., the development of a vaccine to combat a pandemic) or negative (e.g., the tobacco industry opposes advertising bans, even though its products kill half of the people who consume them).

Commercial determinants harmful to health

Beyond the products themselves, CDH encompass market logic, social norms, and regulatory frameworks that impact lifestyles, noncommunicable diseases, infectious diseases, pandemics, and climate change. It is widely recognized that CDH related to the tobacco industry are exclusively negative. Thus, the UN General Assembly has recognized that “there is a fundamental conflict of interest between the tobacco industry and public health.” This is why our review is limited to HTDs that negatively influence public health. These SDGs are very similar in various sectors that produce goods harmful to health or the environment (in addition to tobacco, alcohol, ultra-processed foods, sugary soft drinks, fossil fuels, etc.). The study of DCS makes it possible to move beyond approaches focused on individual behavior to highlight marketing strategies, working conditions, production externalities, and political activities that affect the health of the population.

The consequences of DCS exacerbate inequalities within and between populations

Reflecting a structural failure linked to the concentration of economic power and the intertwining of private interests and public policy, DCS raise major issues of regulation, accountability, and protection of the common good, particularly by exacerbating inequalities within and between populations. The following paragraphs highlight six main areas of influence through which DCSs affect public health.

Political influence

Companies exert influence on the development of health policies, particularly through lobbying, participation in legislative processes, and strategic institutional partnerships. They deliberately use economic and legal arguments to delay, weaken, or block regulatory initiatives. The use of international legal instruments can significantly restrict political maneuvering and lead to a more cautious regulatory approach. As a result, states’ health sovereignty is structurally weakened.

Behavioral influence

Marketing (including advertising, storytelling, and public relations) shapes behaviors, identities, and social norms. By associating their products with values such as freedom or well-being, companies normalize the consumption of harmful products. Digital targeting amplifies this influence, often in ways that are impossible to trace, reducing individuals’ capacity to act. Marketing thus becomes a powerful lever for cultural legitimization and for obscuring the true determinants of health.

Control of knowledge production and dissemination

By funding research, companies shape scientific priorities and create doubt. This influence ranges from problematization to the (non-)publication of results. By perpetuating artificial controversies, they undermine the legitimacy of evidence and block political action. Science thus becomes a strategic arena of influence.

Corporate social responsibility (CSR)

CSR allows companies to build a responsible image, regardless of the health effects of their activities. Charitable actions, partnerships, and communication campaigns reinforce their social legitimacy, while diverting attention from harmful practices. CSR thus acts as a symbolic alternative to legal regulation, consolidating a status quo favorable to economic interests.

Structural Market Power

Market power is the central lever behind all other mechanisms of influence. By concentrating capital and influence, large corporations control supply, shape collective preferences, and actively limit access to healthier alternatives. They externalize health and environmental costs onto society, while privatizing profits and individualizing responsibilities. This deliberate strategy of confusion obscures the true causes of health inequalities and hinders the establishment of fair and effective governance.