The Ethics of Marketing Alcohol, Sugar & Ill Health
Modern health policy faces an uncomfortable ethical question: what happens when industries profit from products associated with chronic disease, while other industries profit from treating the consequences?
Alcohol, sugar-sweetened drinks and hyper-palatable, ultra-processed foods are widely marketed, highly accessible and often cheaper and more convenient than healthier alternatives. Simultaneously, rates of obesity, type 2 diabetes, metabolic syndrome and related conditions have risen across many regions of the world in adults and children. I am not suggesting anyone is out to intentionally make everyone sick, but it’s a perverse reflection to observe the current landscape. Billions of people are eating and drinking empty calories designed to act on the hedonic pathways of our brains in the most addictive way, while another industry tidies up the mess with blood pressure-lowering drugs, sugar-lowering drugs and weight-loss medicines for those who can afford them. Those who can’t often rely on formulary medicines to manage symptoms and hopefully prevent a stroke or two.
This creates an ethical tension between economic success and public health.
Hyper-palatable foods, engineered to be highly rewarding through combinations of refined carbohydrates, fats, salt, artificial flavourings and texture, have become increasingly dominant in global diets. It’s no accident that the acronym for the Standard American Diet is SAD. Research examining food-system trends across dozens of countries has documented substantial worldwide growth in ultra-processed foods, particularly as countries become wealthier and food markets become more industrialised. Traditional diets are increasingly displaced by packaged snacks, sweetened beverages and ready-to-eat meals.
The public health implications are substantial. A 2024 umbrella review found that higher consumption of ultra-processed foods was associated with increased risk of obesity, cardiometabolic disease and poorer mental health outcomes. Although many studies are observational and cannot prove causation alone, the consistency of findings has strengthened calls for preventive policy.
The relationship between ultra-processed food and childhood obesity is particularly troubling. Children are exposed to food marketing not only through television, but also through social media, gaming, influencers, schools, retail displays and sponsorship. The World Health Organization has recommended comprehensive mandatory policies to protect children from marketing food and drinks high in saturated fat, trans fats, salt and free sugars. I was disappointed when my Checkers Sixty60 bags arrived with free bottles of a concentrated sugary orange drink to potentially hook my children on a daily dose of probable diabetes. Many people might welcome the free gift, but reading the ingredient list reveals a product made up almost entirely of chemicals.
At the centre of many debates about sugar is high-fructose corn syrup, a low-cost industrial sweetener widely used in processed foods. It’s important to be precise: high-fructose corn syrup is not uniquely toxic, and when it replaces sucrose calorie for calorie, differences in many metabolic markers may be modest. However, high intake of free sugars, particularly in sugar-sweetened beverages, has consistently been linked to weight gain, type 2 diabetes and metabolic syndrome.
Alcohol marketing raises similar ethical concerns. Alcohol is a legal consumer product, but it is also associated with preventable disease, injury and social harm. Research shows greater exposure to alcohol marketing is associated with earlier drinking and higher alcohol consumption among young people. This matters because adolescence is a period when habits, identity and social norms are still forming. The adolescent brain is highly neuroplastic, making young people far more vulnerable to addictive behaviours than adults exposed to the same substances.
The overlap between food, alcohol and pharmaceutical industries is best understood not as a conspiracy, but as a shared commercial ecosystem in which chronic disease can generate revenue at multiple stages. Food and beverage companies profit from selling products, alcohol companies from increased consumption, and pharmaceutical companies develop medicines that treat diabetes, hypertension, obesity and related conditions. The ethical concern arises when prevention receives less investment and policy support than treatment.
This does not require an anti-industry or anti-medicine response. Pharmaceuticals save lives and remain essential. The question is whether societies are willing to invest as seriously in preventing illness as they are in treating it.
That means stronger safeguards around marketing to children, clearer front-of-pack labelling, healthier school food environments, transparent conflict-of-interest declarations, limits on misleading health claims and policies that make minimally processed foods more affordable and accessible.
The deeper ethical issue is simple: public health should not depend solely on individual willpower in an environment engineered for overconsumption. Lead us not into temptation.
ABOUT THE AUTHOR
Dr Melinda Whitfield is a family GP, and co-owner of Health with Heart - a holistic wellness solution that includes a warm-hearted practice in Sandton; bespoke corporate wellness programmes; an educational podcast and portal; and a community outreach initiative. For more information or to get in touch, follow @health_w_heart on Instagram, @HealthwithHeartDoctors on Facebook, or visit www.healthwithheart.co.za.
