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Epidemiology is concerned with the distribution of disease and death and their determinants and consequences. Diseases can be divided into two broad categories: communicable and non- communicable. Communicable diseases spread from one person to another or from an animal to a person. This spread may happen via airborne viruses or bacteria, but also through blood or other bodily fluid. The terms ‘infectious’ and ‘contagious’ are used to describe communicable disease. Major examples are influenza, HIV infection, hepatitis, polio, malaria and tuberculosis. Non-communicable, or chronic, diseases are generally diseases of long duration and have a slow progression. Major examples are cardiovascular diseases (e.g., heart attacks and stroke), cancer, chronic respiratory diseases (e.g., chronic obstructed pulmonary disease and asthma) and diabetes. Non-communicable diseases (NCDs) are currently the leading cause of death in the world, representing 63% of all annual deaths (World Health Organization, 2014b). NCDs kill at least 36 million people each year, some 80% of which occur in low- and middle-income countries.

Omran (1971) described what he termed the ‘epidemiological transition’. This refers to a reduction in prevalence of communicable diseases and an increase in the prevalence of NCDs that occur as a country becomes economically stronger. NCDs are lifestyle-related chronic diseases that accompany increased usage of unhealthy commodities such as alcohol, tobacco and processed foods. During this transition, countries that have low or middle incomes face a heavy burden from both communicable and non-communicable diseases. In industrial countries such as the USA, Germany, the UK and Japan, the prevalence of communicable diseases is much lower compared to chronic NCDs. In India, and other low- and middle-income countries, while communicable diseases are still present, the rise of NCDs has been rapid (Anjana et al., 2011). Low- and middle-income countries like India, therefore, are currently facing an epidemiological transition with a ‘double burden’ of disease.

The major driver of the transition towards widespread prevalence of NCDs is corporate globalization. From the point of view of human health, globalization flies a banner of progress and freedom yet brings illness and an early death to millions of people. Transnational corporations are indeed the major drivers of NCD ‘pandemics’ as they scale up their promotion of, and huge profits from, tobacco, alcoholic and other beverages, ultra-processed food and other unhealthy commodities throughout low- and middle-income countries.

Stuckler et al. (2012) observed that the sales of unhealthy commodities across 80 low- and middle-income countries are strongly interrelated. They argue (see Figure 4.2) that:

in countries where there are high rates of tobacco and alcohol consumption, there is also a high intake of snacks, soft drinks, processed foods, and other unhealthy food commodities. The correlations of these products with unhealthy foods suggest they share underlying risks associated with the market and regulatory environment. (Stuckler et al., 2012: 3)

Referring to these data, Moodie et al. (2013: 670) argued in The Lancet that:

Alcohol and ultra-processed food and drink industries are using similar strategies to the tobacco industry to undermine effective public health policies and programmes.

Unhealthy commodity industries should have no role in the formation of national or international policy for non-communicable-disease policy.

Despite the common reliance on industry self-regulation and public–private partnerships to improve public health, there is no evidence to support their effectiveness or safety.

In view of the present and predicted scale of NCD epidemics, the only evidence- based mechanisms that can prevent harm caused by unhealthy commodity industries are public regulation and market intervention.

Figure 4.2 Associations of sales of tobacco, alcohol, soft drink and processed food markets, 80 countries, 2010

Source: Stuckler et al. (2012)