How to Spot — and Stop — a Market-Driven Epidemic

Companies that profit from unhealthy products such as cigarettes and sugar often follow a familiar playbook of denial and resistance to extend their sales. Their strategies are often so effective that public health awareness takes decades to catch up, fueling public health crises that seem almost impossible to control. 

But a new study led by Duke policy experts argues that understanding the phases of these market-driven epidemics may help science move more quickly to stop them, potentially saving millions of lives. 

“Experience over the last several decades has demonstrated that it is possible to make dramatic changes in the consumption of these products, thereby saving countless lives,” says Jonathan Quick, M.D., an adjunct professor with the Duke Global Health Institute who led the research, which was published this week in the open access journal PLOS Global Public Health. “Such achievements are possible through a combination of good science, public health action and public engagement.”

The research introduces the concept of a market-driven epidemic to explain the misuse and overconsumption of unhealthy, often addictive products. These include consumer products such as alcohol, cigarettes and ultra-processed foods, which are widely marketed and consumed despite significant evidence of harmful health effects, as well as products like prescription opioids or even social media, which can be dangerous when overused. Such market-driven epidemics contribute to nearly 23 million deaths worldwide each year and cost global health systems trillions of dollars, according to the study.

Quick and co-authors studied three such products – cigarettes, prescription opioids, and sugary foods and beverages. In each case, companies aggressively marketed products despite proven harms and actively resisted public health efforts to control them, the researchers note. 

Yet in each of those cases, a tipping point did come. From the peak of consumption, U.S. cigarette sales have fallen by 82 percent and use of prescription opioids has dropped by 62 percent. Even consumption of sugar has declined by 15 percent as consumers shift away from soft drinks and sugary beverages. 

Eventually, overwhelming evidence of harms and the consistent messaging of public health authorities are enough to overcome corporate marketing and resistance, the authors assert. 

“Progress in combatting market-driven epidemics is possible with concerted efforts by public health leaders, researchers, professional associations, civil society organizations, journalists and well-informed pop culture figures,” says Eszter Rimányi, a recent epidemiology graduate from the University of North Carolina-Chapel Hill who was the study’s first author. 

But that evolution can take time. Among the three cases the researchers studied, the gap between suspicion of harm and the consumption tipping point ranged from one to five decades. 

            Understanding the patterns of these market-driven epidemics can help public health officials recognize them more quickly, the authors note. The research describes five phases that these epidemics predictably follow: market development, evidence of harm, corporate resistance, mitigation and market adaptation. Companies also used similar tactics in resisting concerns about the safety of their products, including denying harm, discrediting critics, commissioning counter-science, and mounting legal and public relations challenges.

Thinking about the use of these products as an epidemic can give public health officials a new, action-oriented strategy to bend the consumption curve and reduce the social costs of harmful products, says Quick,, whose 2018 book, The End of Epidemics, outlined approaches for minimizing the effects of infectious disease epidemics. Co-authors on the study include DGHI policy professor Gavin Yamey, M.D., as well as public health scholars from Ghana, Canada and South Africa. 

“We can save lives by recognizing these market-driven epidemics earlier and acting more decisively to control them,” says Quick.