Public health experts fear global trade agreements and powerful transnational food companies are creating a boom industry in death and disease. This week the medical journal The Lancet published a paper arguing alcohol and food multinationals were employing the same tactics as Big Tobacco in seeking to further their profits at the expense of people's lives. "Fundamentally obesity is a commercial success," says the lead author of the paper, Rob Moodie. The professor of public health and the University of Melbourne says developing countries in particular are the targets of aggressive marketing and lobbying. He found packaged food sales are growing at nearly five times the rate each year in low- and middle-income countries than they are in high income countries.

Tobacco is growing at 20 times the rate, alcohol more than double. At least four countries, Lesotho, Malawi, Uganda and Botswana, have had their national alcohol policies written by, or strongly influenced by, the industry-funded and established group the International Center for Alcohol Policies, and the brewing company SAB Miller. The problem is not confined to the developing world. The day before Moodie's paper was released, Fairfax Media revealed a V8 racing website was selling Jim Beam-branded clothing for children as young as four. The day it came out, the news broke from New Zealand a coroner had found a mother of eight, Natasha Harris, had died from drinking too much Coca-Cola.

She had been drinking about 10 litres a day, her teeth rotted away from the sugar. At least one of her children was born with no enamel on their teeth, her family said. Yet they had not realised how dangerous her habit was. Moodie says the problem, essentially, is that people are not playing on a level field when it comes to making healthy choices. They are saturated by advertising, covert marketing and sponsorships, and shopping in an environment increasingly dominated by cheaper, so-called ultraprocessed foods. While the case of Harris is extreme, in the same year she died another 18 million people lost their lives from complications relating to high blood pressure and blood sugar, cholesterol and obesity.

''Much of [this] could be attributed to the consumption of ultraprocessed foods and drinks,'' Moodie wrote in The Lancet. Three-quarters of world food sales are of processed foods, and the largest manufacturers control more than a third of the market, his paper found. It also documented huge political donations paid by food and alcohol companies, and the extensive connections between the alcohol, tobacco and food companies. Many share common executives, and, in some cases, ownership. And the links go further. A study published in PLOS Medicinelast year found countries with high consumption of tobacco and alcohol generally have high levels of unhealthy food consumption.

It found a free-trade agreement with the US is linked to a country's citizens having a 63 per cent higher level of soft drink consumption. Moodie says these companies should no longer be given a place at the table when it comes to negotiating a public health response to the growing obesity crisis. "When you survey parents they want something done about it, but the problem is they are not really the people who have the power," he said. He is unmoved by criticisms he is promoting a "nanny state", a term he says is widely credited to a Scottish MP, Iain Macleod, who was a "furious smoker". He died from a heart attack at the age of 56. In the Pacific Islands the threat of non-communicable, or lifestyle, diseases has reached crisis point. In some countries, more than 90 per cent of the population is overweight or obese.

Australia could have a crucial role in increasing the reach of multinational food companies in the Pacific. It is negotiating an update on an agreement known as PACER Plus. Health groups worry that its commitment to trade liberalisation will stop Pacific Island nations from implementing policies that could prevent the expansion of unhealthy industries. Submissions to the negotiations include one from Phillip Morris Australia, calling for the removal of barriers it says are preventing it from expanding its market. "Trade is definitely associated with a shift from non-traditional diets in these countries," said Anne Marie Thow, a lecturer at the Menzies centre for health policy at the University of Sydney. Australia has also played an active role in the development of the Trans-Pacific Partnership Agreement, which she says could take trade liberalisation to previously unseen levels.

"It's been conducted in complete secrecy, it's impossible to actually find out what's going on," she said. "But the concern is that particularly in low- and middle-income countries the cheap processed foods are going to become even cheaper and more heavily marketed." But Thow, who has spent the week in Fiji attending the first workshop on trade and non-communicable diseases with representatives from nine Pacific Island countries, is hopeful the worst health outcomes can be avoided. In conference rooms in Nadi she has seen trade and health officials working together on strategies that will improve trade outcomes, but not at the cost of human health. She believes there is strong public knowledge of the importance of doing something about lifestyle diseases. "It's difficult to understand in Australia, what having something like diabetes means if you are in a low-resource setting. In Australia you might have to do things like give up sugar in your tea. Here perhaps your leg is amputated or you go blind," she said. "It's quite obvious to everyone that something has to be done."