Researchers at Emory University and partner institutions have developed a comprehensive systems model to map the complex forces driving the persistent and inequitable exposure to unhealthy commercial beverages in the United States. Published in Globalization and Health, the study utilizes a participatory group model building approach to visualize how the beverage industry maintains its market dominance and influences public health outcomes. The team aimed to move beyond linear analyses of specific products, such as sugar-sweetened beverages, to understand the broader commercial determinants of health that shape consumer behavior, policy environments, and industry power.
The study was conducted from August 2023 to July 2024 and involved a series of workshops and interviews with 28 national experts. These participants represented a diverse range of sectors, including government agencies, academia, advocacy organizations, funding bodies, and community-led groups. By leveraging the expertise of stakeholders who work at local, state, and federal levels, the researchers sought to capture a multistakeholder understanding of the system. The process involved identifying key factors, their relationships, and the feedback loops that drive the system’s function and adaptability over time.
The core methodological tool employed was the causal loop diagram, a visual representation of complex systems that illustrates how variables interact and reinforce one another. Unlike traditional statistical models that often isolate singular effects, this systems science approach allows for the visualization of feedback loops where a change in one variable eventually feeds back to influence that same variable. The final model included 31 variables and eight reinforcing feedback loops, all of which demonstrated cycles of reinforcing effects across multiple sectors. This structure highlights how the system resists change and maintains a status quo that favors industry interests.
One of the primary mechanisms identified in the model is the normalization of commercial beverages. The beverage industry utilizes extensive product formulation, vast product profiles, and ubiquitous media and retail marketing strategies to displace non-commercialized water sources. This persistent displacement over generations has led to the dominance of commercial beverage norms, shaping habitual purchasing behaviors that bypass conscious evaluation. As a result, consumers increasingly rely on commercial products for hydration, leading to industry profits that enable further investment in influential market strategies, thereby reinforcing the cycle.
The model also reveals how industry profits are leveraged to influence political and regulatory environments. Through lobbying tactics, political donations, and other approaches, the beverage industry contributes to a political system that often aligns with corporate interests. This dynamic weakens the political will to advance health promotion policies, such as taxation, which have shown effectiveness in reducing purchasing in other contexts. Instead, public policies at state and national levels often support industry priorities, including preemption laws that limit local jurisdictions’ ability to implement regulations or restrict lawsuits alleging health harms.
Another critical pathway involves the industry’s shaping of public opinion. The beverage industry deploys public relations campaigns, community investments, and strategic alliances with trusted institutions to maintain a positive public view. These reputational management strategies diminish public interest in beverage company regulation and reduce elected officials’ support for equitable health promotion policies. The model indicates that these tactics are intertwined with other industry strategies, allowing the industry to act nimbly in response to counteracting forces from advocates or government agencies.
The health consequences of commercial beverage consumption are also embedded within the system’s feedback loops. Purchasing patterns lead to the consumption of sugar, non-sugar sweeteners, and microplastics, all of which negatively affect health. These poor health outcomes require treatments offered by the healthcare and pharmaceutical industries, generating revenues that are used to influence policymakers to support the needs of the health sector. This creates a cycle where the focus remains on treating chronic diseases rather than preventing them, further undermining health promotion approaches to policymaking.
Environmental impacts from beverage manufacturing and the healthcare system are also significant components of the model. Participants identified increases in greenhouse gases, plastic pollution, and depletion of freshwater resources as key environmental consequences. These impacts can lead to water pollution and climate change, which in turn affect the reliability and safety of public water supplies. When public water is perceived as unsafe or unpalatable, it reinforces the public belief that commercial beverages are a better option, further driving demand for industry products.
The study highlights the constraints faced by government agencies in addressing these issues. While water departments and public health departments work to change norms and enact policies, their actions are often dampened by the influence of both the beverage and health sector industries. Budget constraints and confusion over policy advisement limits further restrict the capacity of government personnel to implement prevention-oriented actions. The model shows how these constraints limit the counteraction strength of government agencies, as their funding and autonomy depend on policymakers’ decision-making, which is highly influenced by industry pressure.
Advocates for corporate accountability face similar challenges, with limited resources and capacity restricting their ability to engage in long-term campaigns. Funders of advocacy work often lack support for corporate accountability strategies due to their own investments in the health, pharmaceutical, and beverage industries. Additionally, shifts in non-governmental organization leadership priorities away from obesity and diet concerns further reduce the momentum for corporate watchdog activities. The model suggests that building stronger cross-sector collaborations and networks is essential to counter industry influence and build a collective movement capable of addressing corporate power.
The researchers propose a transformative action agenda based on systems principles and the commercial determinants of health framework. This agenda includes enhancing systems thinking abilities among decision-makers, building power to counter industry influence through cross-sector collaborations, disrupting the connection between industry and political will, and insisting on new system goals that prioritize health promotion and equity over corporate power. By changing the relationships within the system and rewriting its goals, the study suggests that it is possible to transform the current system for population health and health equity.
The study acknowledges several limitations, including the dependency of model results on the specific contributors and the potential omission of key variables. The small group size may have limited the depth of insight into specific institutional or geographic contexts, and some domains of the system were not fully represented in the initial versions of the model. However, the iterative engagement with participants over a year allowed for deeper reflection and enhanced the depth of understanding of the system. The model provides a valuable visual tool for understanding the complex dynamics of the US beverage industry and offers a foundation for developing innovative strategies to address the commercial determinants of unhealthy beverage exposure.
The research was motivated by national beverage consumption patterns and public health trends documented across the United States. Although consumption of sugar-sweetened beverages declined following a peak in 2000, overall progress has largely plateaued in recent years, while commercial marketing remains elevated and disproportionately targets communities of color. Meanwhile, the scope of documented beverage harms has expanded beyond added sugars. Emerging evidence links low-calorie and non-sugar sweeteners to adverse metabolic outcomes, and plastic containers are increasingly recognized as sources of microplastic exposure. Concurrently, public water utilization has eroded, with approximately 20 percent of Americans avoiding municipal tap water altogether, pushing commercial non-alcoholic beverage sales and bottled water purchases to historic highs. Conventional policy interventions have faced substantial resistance; to date, only nine United States jurisdictions have enacted sugar-sweetened beverage taxes, with the most recent policy passed after a six-year gap and facing active legal challenges.
The underlying model development followed a structured, three-phase protocol approved by the Emory University Institutional Review Board under protocol STUDY00005972. During the first phase between August and December 2023, the researchers assembled twenty-four participants, comprising six government officials from local, state, and federal levels, seven academic scholars, seven national advocates, and four representatives from community organizations such as food policy councils. Working in breakout groups, these contributors produced four initial diagrammatic models that the core team synthesized by identifying overlaps and resolving conceptual discrepancies. The second phase, conducted from January through March 2024, utilized targeted interviews with six workshop members to refine underdeveloped mechanisms. In the third phase, between April and July 2024, the team incorporated four interviews with external key informants and analyzed published literature to integrate critical variables, such as manufacturing environmental burdens, that workshop participants identified but felt unqualified to map alone. The researchers noted that participants occasionally found the modeling challenging, particularly in tracking how variables interacted across indirect feedback pathways.
Rather than isolating structural inequities into an independent feedback loop, the final framework applies a comprehensive overlay labeled Neoliberalism and Colonial Racial Capitalism across all model components. This overlay reflects how systemic oppression shapes industry behavior, including targeted retail marketing and public messaging that brands soda taxes as regressive. It also captures the ongoing displacement of non-commercial hydration networks, such as Indigenous water practices. To disrupt these deeply entrenched feedback cycles, the authors outline specific strategic reforms informed by systems theory. These proposals include expanding systems science curricula across educational levels from kindergarten through graduate study, bridging administrative divisions between municipal water systems and nutritional departments, and supporting campaign finance regulations that restrict commercial influence over lawmakers. Additionally, the framework advocates implementing true-cost accounting mechanisms, such as graduated corporate taxes pegged directly to environmental contamination and chronic disease burdens, while elevating alternative, community-centered governance structures such as cooperative ownership models to replace commercial profit maximization.
Subject of Research: Systems analysis of commercial determinants of unhealthy beverage exposure in the United States
Article Title: Addressing the commercial determinants of unhealthy beverage exposure: a systems thinking approach
Article References: Winkler, M. R., Mui, Y., Smith, A., & Krieger, J. (2026). Addressing the commercial determinants of unhealthy beverage exposure: a systems thinking approach. Globalization and Health, 22(1), Article 60. https://doi.org/10.1186/s12992-026-01228-6
Image Credits: AI Generated
DOI: 10.1186/s12992-026-01228-6
Keywords: systems thinking, beverage industry, public health policy, commercial determinants of health, causal loop diagram, group model building, sugar-sweetened beverages, health equity, industry lobbying, microplastics, water infrastructure, chronic disease prevention, corporate accountability, US beverage market, systems science, public water safety, political will, advocacy strategies, environmental impacts, healthcare system
News Source: Phoebe Ingram. (November 13, 2026). Systems model maps beverage industry influence on US health. Scienmag.
