The commercial determinants of mental health

Ed Davie and Zainab Shafan-Azhar with input from Action on Smoking and Health

Summary

Commercial determinants of mental health describe how the actions of private companies affect people’s mental health.

In this briefing we focus more on risk factors (to promote understanding and work towards mitigating them) but it is important to state that properly regulated, responsible commerce can also be protective of mental health by producing good jobs, tax revenue and vital products including vaccines and medicines.

Business practices influence everyone’s economic, social, environmental, and cultural surroundings, meaning the effects of commercial determinants on mental health are extremely widespread.

This includes how private sector workers are paid and treated to produce, advertise and sell products that may directly harm the health of consumers. Those products include tobacco, alcohol, (high fat, salt, sugar, ultra-processed) foods and drinks, gambling and those that create pollution, like petrol and diesel cars, and online harms.   

Commercial determinants also include the private sector lobbying against taxes, laws and regulations, shaping consumer preferences, and more.

As mental ill health is now one of the most prevalent and expensive health challenges facing the UK (Cardoso and McHayle, 2024), it is vital we identify these harms and act to prevent them whilst boosting the positive contributions commerce can make to people’s mental health.

Commerce can make people more vulnerable to mental health harm

Commercial employment practices like low pay can leave people without sufficient means to protect their mental wellbeing and create stresses that make them more vulnerable to harmful, unhealthy products:

• Most UK households living in poverty – a very significant determinant of mental ill health (Davie, 2022) – have at least one adult working in the private sector (Health Foundation, 2024), indicating that pay and hours for many are too low to maintain healthy lives
• Average house prices are more than eight times typical annual earnings, meaning that buying a home (and renting privately) is less affordable than ever (ONS, 2023). Secure, decent housing is fundamental to mental wellbeing. With 84% of people reliant on the private sector for housing, this market’s (and government’s) failure to provide enough genuinely affordable homes harms mental health (Singh et al., 2019)
• Poverty, caused and worsened by low private sector pay and an unaffordable private housing market, leads to stress which drives demand for products (tobacco, alcohol, high in fat, salt, sugar, ultra-processed foods and drinks, gambling) that harm mental health (Mullainathan and Shafir, 2014)
• There is a bidirectional relationship between the products covered by this briefing and mental health: they can cause direct harm to mental health and people with mental ill health are more likely to use them, worsening their mental and physical health further
• People with severe mental illness are three times more likely to smoke, and more likely to use food or alcohol to cope with distress. The physical health problems caused by consumption of these products is the biggest contributor to a difference in life expectancy of up to 20 years between people with severe mental illness and the rest of the population (Chan et al., 2023)  
• Tobacco, alcohol, high in fat, salt, sugar, ultra-processed foods and drinks, gambling and polluting products such as cars are all associated with worse mental health outcomes (Dun-Campbell et al., 2024)
• Industries that produce, advertise and sell these products further damage mental health by framing the product-related harm as the responsibility of individuals who, they suggest, should be counting and controlling their calories, alcoholic units, carbon etc. and not ‘misusing’ their products (Maani, Petticrew and Galea, 2023).

Commercial industry tactics exploit people with fewer resources and poor mental health, widening health inequalities:

• Companies exploit people on low incomes by targeting deprived areas (which have higher rates of poor mental health) with six times more adverts and outlets selling unhealthy products than wealthy areas (Scott et al., 2023).
• This means that those who are short on time, money and mental energy (Mullainathan and Shafir, 2014) are primed to turn to commercial products such as fast food which are cheap, quick, easily available and initially gratifying. When combined with the addictiveness of many of these commercial products, this keeps people using them despite harms to their mental and physical health.

Recommendations

Create a mental health plan, policy test and commissioner

• The Government should develop a ten-year, cross-government mental health plan that addresses commercial (as well as social and economic) determinants
• The Government should establish a new ‘mental health policy test’ to ensure explicit consideration of mental health before introducing new policies and regulations, including those concerning commercial products and practices
• A Mental Health Commissioner role, along the lines of the Children’s Commissioner, should be established to support the delivery of the above, among other duties.

Regulate the sale, advertisement and promotion of commercial products that harm mental health

• Increase the price of harmful products to reduce use, encourage product reformulation, and raise funds for preventative measures and subsidies of healthier alternatives. This could include:
  • Minimum unit pricing for alcohol and equivalents to the Soft Drinks Industry Levy (‘sugary drinks tax’) for high in fat, salt, sugar, ultra-processed foods
  • ‘Polluter pays’ taxes on the tobacco industry and on environmentally damaging industries.
• Use additional revenues to fund smoking cessation, substance use, diet and exercise programmes, and subsidise healthier food, active travel, green spaces and water fountains, especially in the most deprived areas
• Reduce the influence of unhealthy product manufacturers, advertisers and retailers by restricting their role in government and scientific reviews and in policy making; banning their materials in educational settings; and better regulating research and the media communication of public health risks
• Restrict promotion – curtail advertising of unhealthy products (including sponsorship) and produce a more effective and mandatory food, drink, and gambling product labelling scheme with strong warnings regarding the harm of alcohol, certain food products, gambling and pollutants.

Ensure a cross-government commitment to providing the means to live a mentally healthy life

• Continue to increase the minimum wage in line with inflation to ensure a healthy life is affordable and improve working conditions
• Ensure more people with mental health difficulties are supported to gain and sustain good jobs by continuing to expand the coverage of models like Individual Placement and Support
• Increase the supply of genuinely affordable housing, especially social homes and supported housing for people with mental health difficulties, and better regulate the social and private rental sector to improve standards.

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Introduction

Levels of mental illness in the UK are rising, causing misery, premature death and significant service demand with over one million people waiting for NHS treatment (Darzi, 2024), and costs over £300 billion a year in England alone (Cardoso and McHayle, 2024).

Health outcomes, including mental health outcomes, are driven by:

• Social determinants (such as income and working conditions)
• Environmental factors (such as housing and air pollution)
• Activities related to commercial products (such as smoking tobacco, drinking alcohol, diet, and gambling – WHO, 2017).

Commercial entities (i.e. businesses), have a clear influence on the factors above as most or all people:

• Are employed in the private sector (80%)
• Rent or buy housing commercially (84%)
• Breathe air polluted by transport, industry and agriculture  
• Are exposed to the advertising, placement and promotion of alcohol, ultra-processed food, gambling and other products that can harm their health.  

While the role of businesses in these health risks has recently gained more attention (see Maani, Petticrew and Galea, 2023, for example) their influence on mental health has been less well explored. This policy briefing brings together some of the evidence that links commercial determinants to mental and physical health outcomes, and how those intersect, and makes suggestions to tackle them.

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Employment, pay and work conditions

Decently paid work with good conditions are protective factors for mental health (WHO, 2022) and a (slim) majority of UK workers are satisfied in their job – though the lower the pay, the lower the satisfaction rate (Resolution Foundation, 2021). 

As more than 80% of the UK workforce is employed in the private sector, commercial entities have the most influence on pay and conditions. Living Wage Foundation research (2021) finds that 46% of people working full-time but being paid less than the real living wage felt their pay negatively affected their levels of anxiety. 34% of respondents said that their low pay damaged relationships with family and friends – a key driver of mental health and illness.

Research from the Health Foundation (2024) also found that:

• 63% of children and working-age adults living in poverty in 2022/23 were in families where at least one adult was working part-time or more, up from 56% in 2012/13 and 44% in 1996/97
• 17% of children and working-age adults living in poverty in 2022/23 were in families where all adults were working and at least one adult was working full-time, which is up from 13% in 2012/13 and 9% in 1996/97.

Poverty is associated with a range of much poorer mental health outcomes (Davie, 2022) – the most deprived children, for example, are four times more likely to have severe mental health problems than the least deprived (Gutman et al., 2015).

The workplace can be a source of protective and risk factors for people’s mental health, and guidance from the World Health Organisation (2022a) sets out the actions that all employers can take to support the mental health and wellbeing of their workers. These range from organisation-wide policies (like paying at least Living Wage Foundation rates) to training programmes and individual interventions. Included within them are tools to support employees at work, and to help people return to work after a period of absence.

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Housing

Housing can have a significant effect on mental health, with homelessness and insecure, unaffordable, poor-quality housing harming both mental and physical health (Singh et al., 2019). Only 16% of people in England are housed by the social housing sector, meaning the vast majority are vulnerable to housing-related commercial determinants, including the cost of private purchases and rents driven by the private market.

In 2023, full-time employees in England could expect to spend more than eight times their annual earnings buying a home, the highest (or least affordable) level ever recorded (ONS, 2023). This also pushes up mortgage payments (especially as interest rates have increased) and private rents. With affordable housing supply outstripped by demand, there is clear market failure in housing leading to homelessness, inadequate housing, and poverty related to housing costs. A significant proportion of the social rent homes that used to fill this gap were sold as part of the ‘right to buy’ scheme and not replaced. This is part of what the Joseph Rowntree Foundation says is an increasing problem – housing in the UK is increasingly being seen as an investment opportunity rather than a means to provide homes for all, distorting the market and driving prices beyond what many people on low incomes can afford (Baxter, 2022). 

The private rented sector makes up 19% of all UK households, and these households tend to be younger, more ethnically and nationally diverse, and more likely to house dependent children than other tenures (ONS, 2023).

About 823,000 (18%) private renting households and approximately 2.2 million (14%) owner-occupying households were also in the lowest income quintile (ONS, 2023), with housing costs a substantial contributor to their impoverishment, again leading increased mental health risk. 

A third of people with mental health difficulties are not in stable accommodation (Mental Health Foundation, n.d.) and compared with the general population, they are:

• One and a half times more likely to live in rented housing
• Twice as likely to be unhappy with their home
• Four times as likely to say that poor housing makes their health worse.

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Tobacco

Prevalence

In 2024, 11.6% of the general population over the age of 18 in England smoked but this is very unequally distributed, with 24% of the most deprived 10th of the population smoking tobacco compared to 7% of the least deprived.

Among people with mental health difficulties, this was found to be significantly higher:

• 70% of those with substance use issues used tobacco
• 41% of those with a severe mental illness used tobacco
• 26% of those with depression and anxiety used tobacco.

Given that smoking kills two out of three long-term users, high levels of smoking among people with mental health difficulties are a leading cause of premature death and disease. Smoking accounts for two-thirds of the reduced life expectancy of people with a severe mental illness (ASH, 2022).

Tobacco, mental health and disparities

There is a bi-directional relationship between smoking tobacco and poor mental health: smoking increases the risk of developing mental illness (Firth et al., 2020) and people with mental health difficulties are much more likely to smoke, smoke more heavily and find it harder to quit. This increases dependency and worsens physical health, which can worsen mental health, trapping people in a stress cycle of dependence (ASH and PHMIC, 2022).

Smoking also compounds other economic and health disadvantages. The average person who smokes in the UK spends £2,500 a year on tobacco, a spend which pushes 31% of all smoking households below the poverty line after smoking expenses (ASH, 2023). This clear economic burden stands in stark contrast to tobacco industry profits: in the UK alone, the industry revenue from tobacco sales was £7.3 billion in 2022/3 (ASH, OHA, AHA, 2023). Quitting smoking puts money back in people’s pockets and improves physical health, all of which reverses the cycle of poor mental health and tobacco use.

Mental health impacts of quitting

Increasing the rates of people quitting can improve population level mental health, reduce the burden on the NHS and improve the wealth and employment prospects of people with mental health problems. There is now good evidence that stopping smoking improves mental health (Taylor et al., 2014), but without targeted action, people with mental health difficulties will be left behind. People with mental health difficulties are similarly motivated to quit compared to people without, and with the right support can be equally successful – but higher levels of addiction and multiple other barriers undermine quit success (Sinclair, 2020).

Vaping may have particular importance for people who smoke and have mental health problems (who tend to be more addicted to smoking) and has been shown to work for this population. Vapes have proven to be an effective aid for supporting the implementation of smokefree policies in mental health hospitals. It is therefore important that measures introduced by the government to tackle youth vaping do not make vapes inaccessible to people using them as quitting aids. There is already a lack of public understanding of the relevant risks of vaping verses smoking, with ASH finding that 50% of the public believe that vapes are equally or more harmful than smoking despite evidence that vaping is significantly less harmful than smoking (RCOP, 2024).

Industry tactics

Despite the harmful impacts and economic burden that tobacco products cause, the tobacco industry has repeatedly challenged legislative attempts to regulate tobacco and reduce smoking. They have argued that regulations are an attack on personal freedom (despite smoking being a life-threatening addiction), impossible to police and enforce (despite widespread public support), and likely to increase the black market sales (despite no evidence of this) (ASH, OHA, AHA, 2024).

The tobacco industry has given financial gifts and sponsored political events despite the UK’s commitments under the Framework Convention on Tobacco Control, an international treaty which aims to limit the impact of the tobacco industry on public health. 

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Alcohol

Prevalence

There is a high prevalence of alcohol-related issues among people with mental health difficulties:

• People with common mental health difficulties (depression, anxiety, phobia) are twice as likely to report an alcohol use disorder than people without common mental health problems (Puddephatt et al., 2022)
• In England, 55% of people in alcohol treatment expressed a need for help with their mental health and 79% were already receiving support (O’Connor, 2020)
• Alcohol dependence for people in inpatient mental health settings is over five times that of the general population (8% compared to 1.4%) (ibid)
• Mental health and behavioural problems were also identified as the second most common reason for alcohol-specific deaths in 2021 (Stiebahl, 2024). 

Mental health impacts of alcohol

Alcohol is a depressant that disrupts brain neurotransmitters, affecting mood, thoughts and behaviour. It also slows brain processing, and impairs emotional understanding and decision-making. Long-term use depletes neurotransmitters needed to manage anxiety and depression. This creates a cycle of dependence as people drink more to relieve these feelings, but are often left feeling lower. There are common risk factors for alcohol use disorders and mental health problems, including exposure to traumatic events (including in childhood) or genetic and environmental risks (Goodwin, 2022).

Alcohol and health disparities

Alcohol-specific mortality disproportionately impacts people living in greater socioeconomic deprivation. Rates of alcohol-specific deaths are more than twice as high for people in the most deprived groups versus those in the least deprived (Institute of Alcohol Studies, 2020). One study found that people with alcohol problems living in the most deprived areas in the north-west of England were most likely to report low life satisfaction (Bellis et al., 2012).

The affordability of alcohol is directly linked to alcohol harm, with heavier drinkers tending to consume products that are both cheaper and stronger on average (Griffith et al., 2017). Thousands of additional deaths have occurred due to cuts and freezes in alcohol duty in both England and Scotland between 2012 and 2019 (Angus and Henney, 2019).

Alcohol harm also has substantial costs to the economy, with the Institute of Alcohol Studies finding that alcohol harm costs England £27.4 billion a year, an increase of 37% since 2003 (Institute of Alcohol Studies, 2024). This huge cost to society compares to alcohol industry revenue of £11.2 billion in 2022/3.

Regulating alcohol can have a positive impact

Reducing alcohol consumption overall would have a large benefit to physical and mental health. There is a wealth of evidence on the most effective policies for reducing population-level alcohol consumption, including restrictions on marketing, pricing measures such as minimum unit pricing and alcohol duty reform, increased treatment funding and training for professionals, and restrictions on availability through stronger licensing powers (Public Health England, 2016). 

In Scotland, minimum unit pricing has been effective in reducing overall alcohol consumption by 3-3.5% (Giles et al., 2022). In the first year of implementation, Scotland saw a 10% reduction in alcohol-specific deaths within the first year, rising to 13.4% by the end of 2020. The largest reductions were found for those living in the 40% most deprived areas.

Industry tactics

Alcohol marketing normalises alcohol consumption and exposes people to alcohol products, which has been linked to people drinking more and at an earlier age (Jernigan et al., 2016). The Institute of Alcohol Studies found that alcohol marketing is causally linked to young people drinking at an earlier age, and that outdoor alcohol marketing is frequent in deprived areas, contributing to higher crime rates in these areas (Institute of Alcohol Studies, 2024). It suggests that reducing outdoor advertising of unhealthy commodities including alcohol could help reduce health and social problems that drive inequalities. The World Health Organisation recommends comprehensive marketing restrictions as a most effective ‘best buy’ to reduce alcohol harm and protect children and vulnerable people (World Health Organisation, 2022b).

Despite this, the alcohol industry has repeatedly argued that alcohol consumption is a matter of choice, and that problem drinking is an individual choice to misuse their products. 

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Food and drink

Prevalence

Consumption of junk foods that are high in fat, salt and sugar and of low nutritive value is associated with poorer mental health in adults (Ejtahed et al., 2024). Research shows that that people with mental health difficulties are more likely to have lower-quality diets (Teasdale et al., 2019).

The relationship between diet and mental health is complex, partly because of the bidirectional relationship. For example, stress can affect appetite and influence food cravings, with some psychiatric medications causing an increase in appetite. Emerging evidence suggests that low-quality diets may alter stress responses and could be associated with stress-related mental health problems (Bremner et al., 2020). In addition, poor diets over a long period of time increase the risk of obesity and type two diabetes, which are also associated with poorer mental health.

Over 700,000 people in the UK are estimated to have an eating disorder and while causes are complex, commercial idealisations about body shape are a factor (NICE, 2024). Eating disorders have some of the worst outcomes (including premature death) of all mental health difficulties. It is extremely important, therefore, to be mindful that some food-related interventions (calorie counting, for example) may exacerbate risks around eating disorders.    

Unhealthy food and drink and health disparities

We know there is a strong relationship between unhealthy food and drink, socioeconomic deprivation, and poor mental health, meaning that the mental health burden of unhealthy foods and drinks falls hardest on those with the fewest resources.

Companies place six times more adverts and outlets for unhealthy foods in deprived areas compared to wealthy areas (Adfree Cities, 2024). The Food Foundation also found that:

• Healthier foods are more than twice as expensive per calorie as less healthy foods, with healthier food increasing in price at twice the rate in the past two years 
• The most deprived fifth of the population would need to spend 45% of their disposable income on food to afford the government-recommended healthy diet, rising to 70% for households with children
• Over a third (37%) of supermarket promotions on food and non-alcoholic drinks are for unhealthy items  
• A quarter (26%) of places to buy food in England are fast-food outlets, rising to nearly one in three in the most deprived fifth of areas 
• Over a third (36%) of food and soft drink advertising spend is on confectionery, snacks, desserts and soft drinks, compared to just 2% for fruit and veg, and has increased from 33% in 2022. 

(The Food Foundation, 2025)

Low incomes are also associated with poorer-quality diets, including high proportions of ultra-processed foods high in salt, sugar and trans-fats and low in fibre, vitamins and other nutrients. There are a number of reasons for this. The stress of poverty can reduce ‘mental bandwidth’ for decision making surrounding food and diet (Mullainathan and Shafir, 2014). There is also a greater risk of ‘maladaptive coping mechanisms’ that drive short-term ‘comfort-seeking’, including eating highly calorific, ultra-processed products (Algorani and Gupta, 2023). This can leave people dependent on poor-quality food, which then negatively impacts their mental and physical health, making it harder to make changes to diet.

Food insecurity (whereby individuals have poorer access to food than others in society) is also a significant risk factor for several common mental health problems, particularly within the context of a less equal society (Pourmotabbed et al., 2020). When people are living in constant worry about not having enough food, skipping meals or facing chronic hunger, they are deprived of the material and social resources to support mental health and wellbeing. This is particularly pertinent in areas where food insecurity is less common and potentially more stigmatised (Elgar et al., 2021).

In contrast, research has demonstrated positive associations between healthy diets (particularly high intakes of vegetables, fruit, fish, water and fibre) and good mental health, while nutrient-poor diets – high in processed foods, refined sugars, and unhealthy fats – are linked to an increased risk of mental health problems. Furthermore, better mental health has also been associated with lower food expenditure for those on lower incomes, highlighting the benefits of making food more affordable (Waqas et al., 2024)

Industry tactics

The unhealthy food and drinks industry is poised to take advantage of lower access to healthy food in deprived areas. For example, Food Foundation found that there are 41% more fast-food outlets in England’s poorest communities compared to the most affluent (Food Foundation, 2025). This translates into both mental and physical health inequalities: neighbourhoods with a lower concentration of fast-food outlets have a higher life expectancy, leaving a gap of around two years between the areas with the lowest and highest concentration of fast-food outlets (The Health Foundation, 2024). The same study also found that people from racialised communities are more likely to live in neighbourhoods where fast-food outlets make up a higher proportion of all food outlets (ibid).

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Gambling

Prevalence

Gambling is an under-recognised cause and exacerbator of mental health difficulties, and those with mental health difficulties are also at increased risk of gambling-related harms. Problematic gambling can lead to psychological distress and is often comorbid with mood, anxiety and substance use disorders (Parhami et al., 2014). It is also associated with increased frequency of suicidal thoughts and self-harm (Lloyd et al., 2016) and risk of suicide (Karlsson and Håkansson, 2018).

An umbrella review (Dun-Campbell, 2024) found:

• Problem gambling was associated with double the odds of an incident of major depression and four times the odds of any mental health difficulty
• Those aged 20-74 who had a gambling disorder were 15 times more likely to die by suicide than the general population
• This was even higher for those aged 20-49, who were 19 times more likely to die by suicide.

Cycle of dependence

Depression, anxiety and substance use are consistently positively associated with the development of gambling problems (Dowling et al., 2021). Evidence reviews of gambling-related harms commissioned by the Department of Health and Social Care (DHSC) also identified that people who indicated that they had a mental health problem were 2.4 times more likely to experience gambling-related harms compared to gamblers without a mental health problem (Office for Health Improvement & Disparities and Public Health England, 2019). Among young people, mental health symptoms and problem behaviours are also related to an increase in gambling frequency and risk of gambling problems (Richard and Derevensky, 2017).

Gambling and health inequalities

The DHSC-commissioned review also found that risk of gambling harms is concentrated in areas of higher deprivation such as the north of England, indicating health inequalities in these areas (Office for Health Improvement & Disparities and Public Health England, 2019). More recent research has also identified health inequalities in gambling harms, with a systematic review of studies demonstrating that certain groups (including migrants and less affluent individuals) experience more harms even when gambling less (Raybould et al., 2021). The negative effects of gambling tend to be unequally distributed, with economically and socially disadvantaged groups often at greatest risk of harm (Rogers et al., 2019). 

Industry tactics

Much like unhealthy food and drink, the gambling industry has attempted to shift the blame onto consumers, labelling them as ‘problem’ users of their products who refuse to gamble ‘responsibly’. This narrative pushes the conversation away from regulation of the industry, downplaying the impact of advertisement and products designed to be addictive, allowing both the government and industry to shirk accountability for harms (Thomas et al., 2023).

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Air pollution and other machine-related mental health harm

Motorised vehicles, industry, agriculture and domestic solid fuel burning are the main sources of various kinds of air pollution (DEFRA, 2022). Commercial activity is responsible for the vast majority of pollution, and it is the widely acknowledged role of both governments and commercial actors to regulate this and protect health.

Imperial College London published an air pollution evidence review (Fuller et al., 2023) suggesting that the establishment of links between air pollution and brain health, including mental ill health and dementia, are among the most significant new findings over the last decade of research.

The review includes the following studies:

• After adjusting for external factors such as smoking and socioeconomic status, people exposed at age 10 to higher levels of Nitrogen Oxides (NOx) and Particulate Matter 2.5 (PM2.5) air pollutants were at higher risk of a mental health difficulty including conduct disorders and depression (Latham et al., 2021)
• Another 2021 study found that increased NOx exposure was linked to increased rates of mental illness among participants (Reuben et al., 2021), and a 2017 review indicated that airborne pollutants were associated with higher risks of psychotic disorders (Attademo et al., 2017)
• Airborne pollutants also cause and worsen physical ailments including cardiovascular, respiratory and neurological diseases, which in turn increase risks of mental ill health (Dominici et al., 2006).

In addition to the direct effects of air pollution on mental and physical health, the most significant sources of air pollution are also associated with other mental health risks:

• Urban road traffic reduces social contact, increasing isolation which negatively impacts mental health (Hart and Parkhurst, 2011)
• Conversely, urban environments with better walking, cycling and public transport connectivity support social contact and reduce loneliness (Williams et al., 2021)
• Dependency on fossil fuels, subject to international inflationary pressure, increases poverty (Daley and Lawrie, 2022) which, in turn, worsens mental health
• The worsening effects of climate change increase the risks of anxiety and other mental health difficulties. Climate anxiety (or eco anxiety) is particularly present amongst young people (Palinkas and Wong, 2020; Hickman et al., 2021).

An evidence review (Dun-Campbell, 2024) identified associations linking air pollution with depression, anxiety and suicide; ambient temperature increases (caused by climate changing gases) with risk of suicide; and pesticides with depression and suicide.

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Online activity

Nearly everybody (97.8%) of the general population now regularly accesses the internet (Kemp, 2024). The rise in internet connectivity has correlated with worsening mental health, leading to speculation that it is a cause of mental health problems, though the evidence to date is inconclusive.

One mechanism of online mental harm is through its use to downplay the harms of some of the products discussed elsewhere in this paper. For example, research has indicated that the tobacco industry has sought to minimize and deny the health harms and addictiveness of combustible cigarettes using misinformation on social media. The industry has attempted to create doubt about scientific evidence showing the harms of cigarette smoking, as well as painting vaping as just as or more harmful than smoking to deter current cigarette smokers from quitting (Tan et al., 2020). Unevenly distributed exposure of such misinformation towards certain groups can also exacerbate existing disparities in tobacco use and health inequalities (ibid). Misinformation often exploits the algorithm process online (McLoughlin and Brady, 2024) with the algorithm increasing the amount of similar content shown to social media users who have engaged with the content previously.

Similar issues are observed in the alcohol industry. Research has shown that the alcohol industry uses ‘dark nudges’ which change consumer behaviour against their best interests, and ‘sludges’ which use cognitive biases to make behaviour change more difficult, in their corporate social responsibility materials (Petticrew et al., 2020). These are used to normalise and encourage alcohol consumption and undermine information on alcohol harms. One way that this occurs is by placing statements emphasising uncertainty about whether alcohol causes cancer first on a website where viewability is higher and placing factual statements about the risks further down in less legible fonts where there is lower viewability (ibid).

There are mixed opinions about whether social media has a positive or negative impact on mental health and the evidence suggests that the full picture is complex. The overall mental health effect of screen time (Tang et al., 2021) and social media use (Meier and Reinecke, 2021) is small, and highly dependent on the way that users interact with digital media – ‘active’ participation in online communities may be protective of mental health, while ‘passive’ viewing of posts or exposure to cyberbullying and trolling can have a profound adverse effect. There is also mounting evidence showing high rates of social media use among people with mental health difficulties. This can exacerbate existing challenges by increasing exposure to harm (such as cyberbullying) and misleading information. However, there are also benefits such as access to peer support networks and facilitating social interaction (Naslund et al., 2021).

Further, evidence from whistleblowers suggests that social media companies are aware of the negative mental health effects of their products and choose not to act to prevent harm (Gayle, 2021). The Online Safety Act 2024 is an attempt to regulate the online space and make it less harmful. The Act includes laws to protect children and adults online and places a range of new duties on social media companies and search services to make them more responsible for users’ safety. It also includes elements to tackle content that promotes suicide, self-harm and eating disorders, and bullying and hateful content (Department for Science, Innovation and Technology, 2024). While the Act includes good provision for tackling online harms, it does not go far enough to tackle online misinformation. The only reference to misinformation in the Act is to setting up a committee to advise Ofcom and changes to Ofcom’s media literacy policy (Full Fact, n.d.). Tackling misinformation online should be considered in any ongoing work with the Act. We are also calling for ongoing support for the Online Safety Act to protect children and young people, with adequate funding provided to support regulation by Ofcom and to enable regulators to adapt to new algorithms and social media platforms as they evolve.

More investment into independent research on online safety is needed, and social media companies should be compelled to share information about their algorithms for this purpose. Finally, commercial entities must be held accountable for the spread of misinformation to increase unhealthy behaviours through social media.

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Common techniques of health harming industries

Positioning themselves as the solution

Health-harming industries will often call for self-regulation and attempt to fund and steer research into the health impacts of their products. However, these are private companies which largely exist to maximise profits, sometimes at the expense of human and environmental health. When asked to voluntarily improve the healthiness of products or practices, through the 2011 ‘Public Health Responsibility Deal’, for example, these industries fail to deliver significant improvements (Durand et al., 2015).

Framing health harms as results of individual choice

Companies profiting from unhealthy products often try to reinforce the primacy of ‘individual responsibility’ over industry obligations by suggesting products are safe if used ‘responsibly’. By encouraging the counting of calories, alcoholic units, personal carbon output and gambling spend, companies attempt to frame discussion in the context of them ‘helping’ ‘problematic’ consumers regulate their behaviour – and in doing so, there should be less need to tax and regulate their products. This is especially pertinent when it comes to mental health, as those experiencing low mood can be sapped of energy and motivation if they are surrounded by unhealthy products being presented as easy, stress-relieving options (Maani, Petticrew and Galea, 2023).

Arguing that regulation will bring negative economic impacts

Companies that profit from products that harm health often seek to reduce governmental controls fearing they will harm their revenue, and therefore harm those that rely on these industries for income. Despite expensive efforts attempting to block, dilute and delay regulation, there is little evidence that effective health protection measures harm revenues – for example:

• No evidence of harm to the alcohol industry due to minimum unit pricing in Scotland (Scottish Government, 2023)
• No evidence of reduced profits to soft drinks industry following ‘sugary drinks tax’ (London School of Hygiene & Tropical Medicine, 2020)
• Advertising revenue for Transport for London increased after junk food advertising ban (Yau et al., 2022).

Downplaying evidence whilst lobbying the government

Companies can seek to influence legislators, media and the public to reduce the threat of taxation or pricing controls, restrictions on advertising, or warning labelling on packaging. This can take the form of donations and gifts to political parties and politicians; lobbying at political events and in consultation groups and processes; advertising revenues to media outlets which can make them less inclined to criticize the source of that funding; and even the funding of ‘educational’ programmes in schools.

Alongside this, they create uncertainty about the scientific evidence of harm by funding academics, ‘health’ charities and scientists to ‘water down’ and counter evidence that shows practices and products harm health. Often ultra-processed food products will make health claims about their products which are not supported by the evidence (Maani, Petticrew and Galea, 2023).

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Conclusion

Commerce is a tool that, with the right regulation, can be used to benefit mental health by creating good jobs, taxes for services and infrastructure, and useful products including healthy food, connectivity and medicines. But all too often, some companies (often very large multi-nationals) appear to have too much power over national governments. They expend a lot of effort to minimise regulation and taxes that could be used to protect people – especially those living in deprivation and with existing mental health difficulties – from the harm of their practices and products. Low wages, insecure hours, poor working conditions, market failure in the affordable housing sector, and shaming people by suggesting harms caused by products are due to individual irresponsibility, are all examples of commercial practices which can harm mental health. From tobacco, alcohol and unhealthy food to gambling and polluting vehicles, many commercial products, disproportionately marketed in the most deprived communities, directly harm mental and physical health.

Individual and corporate responsibility models are ineffective when companies, not unreasonably, are driven to maximise profits. Government therefore needs to use strong, evidence-based measures to give people the truly free choice of living a healthier life. Our recommendations therefore focus on efforts to minimise the influence of these companies.

Recommendations

Create a mental health plan, policy test and commissioner

• The Government should develop a ten-year, cross-government mental health plan that addresses commercial (as well as social and economic) determinants
• The Government should establish a new ‘mental health policy test’ to ensure explicit consideration of mental health before introducing new policies and regulations, including those concerning commercial products and practices
• A Mental Health Commissioner role, along the lines of the Children’s Commissioner, should be established to support the delivery of the above, among other duties.

Regulate the sale, advertisement and promotion of commercial products that harm mental health

• Increase the price of harmful products to reduce use, encourage product reformulation, and raise funds for preventative measures and subsidies of healthier alternatives. This could include:
  • Minimum unit pricing for alcohol and equivalents to the Soft Drinks Industry Levy (‘sugary drinks tax’) for high in fat, salt, sugar, ultra-processed foods
  • ‘Polluter pays’ taxes on the tobacco industry and on environmentally damaging industries.
• Use additional revenues to fund smoking cessation, substance use, diet and exercise programmes, and subsidise healthier food, active travel, green spaces and water fountains, especially in the most deprived areas
• Reduce the influence of unhealthy product manufacturers, advertisers and retailers by restricting their role in government and scientific reviews and in policy making; banning their materials in educational settings; and better regulating research and the media communication of public health risks
• Restrict promotion – curtail advertising of unhealthy products (including sponsorship) and produce a more effective and mandatory food, drink, and gambling product labelling scheme with strong warnings regarding the harm of alcohol, certain food products, gambling and pollutants.

Ensure a cross-government commitment to providing the means to live a mentally healthy life

• Continue to increase the minimum wage in line with inflation to ensure a healthy life is affordable and improve working conditions
• Ensure more people with mental health difficulties are supported to gain and sustain good jobs by continuing to expand the coverage of models like Individual Placement and Support
• Increase the supply of genuinely affordable housing, especially social homes and supported housing for people with mental health difficulties, and better regulate the social and private rental sector to improve standards.

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