A new review will assess whether "countermarketing"—campaigns that expose the dirty tricks of junk food, alcohol, tobacco, and gambling companies—can actually reduce demand for their products. This matters because these industries deliberately target marginalised communities, and current public health strategies have struggled to counter their influence. The researchers will conduct two systematic reviews: one measuring whether countermarketing changes consumption, awareness of industry tactics, and public perceptions; the other examining how these campaigns work, who finds them acceptable, and whether they backfire. They will also analyse findings through a health-equity lens, asking whether countermarketing helps or harms disadvantaged groups. If the evidence shows countermarketing is effective, public health agencies could deploy it as a low-cost, scalable tool to push back against industries that normalise harmful products through marketing and corporate social responsibility campaigns. The review may also reveal unintended harms—such as stigmatising consumers—that need to be avoided. The project is not fundamental science; it is a practical evidence synthesis designed to give policymakers and practitioners a clear answer on whether this strategy works, for whom, and under what conditions.
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Business activities and products can harm health and drive inequalities. For example, the UPF, alcohol, tobacco and gambling industries all target marginalised and minoritised communities. New strategies are urgently needed to address these commercial determinants of health (CDOH). Countermarketing (CM) is one such approach. Palmedo et al. (2017) define CM as, “health communications strategies to reduce the demand for unhealthy products by exposing the motives of their producers and portraying their marketing activities as outside the boundaries of civilized corporate behavior”. Since then, CDOH scholarship has expanded beyond marketing to include corporate social responsibility (CSR) strategies which normalise harmful products. Therefore an updated, comprehensive evidence synthesis analysing CM using a broader conceptual framework is warranted. Under such a framing, in addition to problematising product marketing, CM challenges how industries ‘market’ themselves as legitimate actors. To maximise the review’s utility evidence on mechanisms and implementation will also be collated. Aim: To synthesise the evidence on the effectiveness of CM as a way of reducing the demand for unhealthy products by exposing the motives of their producers and portraying their marketing and related activities as outside the boundaries of legitimate corporate behaviour. Objectives: To synthesise the evidence on: (i) Effectiveness of countermarketing interventions across a range of industries (ii) Mechanisms and acceptability of CM interventions (iii) Unintended and/or adverse outcomes; and (iv) To conduct these syntheses from a health-equity perspective. Methods, timeline: The project begins with stakeholder consultations in months 1-4 - including with PPI representatives, academics working in CDOH and related fields, and public health practitioners. We then conduct two systematic reviews in months 5-24. The first review considers CM effectiveness in terms of the consumption of unhealthy products. Secondary outcomes include awareness of industry tactics, and perceptions of products and industries. The second investigates the acceptability, feasibility and mechanisms relevant to CM interventions. This includes the processes by which CM interventions work and the mechanisms through which industry markets itself. We will follow the CODES guidance [36] for conducting CDOH reviews. Terms for interventions will be based on the framework produced by the Lancet Commission on CDOH. The methodological quality of eligible studies will be assessed using a modified version of the Newcastle-Ottawa Scale or relevant CASP tool, and relevant GRADE tools. We will also analyse our findings in relation to the PROGRESS-PLUS framework. Analysis will be undertaken from a systems perspective to help us look beyond narrow, linear pathways of effects. Anticipated impact and dissemination" A comprehensive cross-industry review of the effectiveness and equity of CM interventions is overdue and likely to be impactful, given that CDOH discussions frequently end with a plea for evidence on solutions. We will use a multi-stranded dissemination plan based on stakeholder input. Outputs include academic papers, blogs, a YouTube film, a webinar and training events (e.g. our CDOH short course).
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