At the American Public Health Association conference in November 2025, Counter Tools presented on a panel to talk about Commercial Determinants of Health (CDoH). CDoH refers to the ways in which businesses and industries influence population health and the ways in which people work, live, and interact. It recognizes how upstream corporate actions and business practices shape health outcomes. These business activities include lobbying, marketing and promotion, pricing, supply chain decisions, and more.
This presentation explored the commercial determinants of health (CDoH) as they relate to the cannabis industries sector, examining how product availability and design, placement, pricing, promotion, lobbying, and cross-industry partnerships may influence community health.
Recognizing that cannabis commercialization is relatively young compared to other consumer product industries, and, given the distinct social and legal backdrop of cannabis, there remains diverse viewpoints around both profit-driven motives and public health responsibilities – even from within the industry. With the significant harms faced by many U.S. communities of color due to mass incarceration, institutionalized racism, and disproportionately applied enforcement practices, cannabis-related criminalization of communities deepened cycles of poverty. Cannabis occupies a unique regulatory and historical space. It is simultaneously: 1) A product with reported therapeutic benefit for those suffering from certain medical conditions; 2) A substance historically used to justify disproportionate criminal punishment; 3) Operating only in state-based marketplaces, and 4) A rapidly expanding commercial sector attracting global corporate interest.
The expansion of cannabis commercialization has resulted in massive growth of public relations and policy strategies. Globally, the cannabis market is estimated at $50 billion today, with projections reaching $250-$400 billion by 2030. Apart from cannabis producers, processors, retailers, and interest groups working at the state level, this presentation focused more broadly on the cross-sector, multi-national corporate involvement in cannabis. At the corporate level, there are patterns that can be seen in the approaches taken by cannabis sector actors to influence public policy in ways that reflect strategies used by other sectors, such as tobacco and alcohol companies.
Internal documents from major tobacco companies — published in the Legacy Tobacco Documents Library at UCSF — show that the industry’s interest in cannabis dates back at least to the 1970s. A paper published in 2014, which combed through the tobacco industry documents and the companies’ stated interest in cannabis as both a potential and a rival product, has seemed to be quite predictive, at least based on the tobacco industry’s current and growing interest and investment in cannabis. Altria Group invested $1.8 billion in the Canadian company Cronos Group (45% ownership), which Altria calls an “emerging global cannabinoid company.” On their own website, Altria states that they hold “diversified positions across tobacco and cannabis.” British American Tobacco invested $86.8 million in Organigram (Canada) in 2025, plus ~$70 million in CBD and hemp companies. These investments remain small relative to tobacco’s global footprint in tobacco, nicotine, food, and beverage products — but the trendline is unmistakable. Given cannabis remains Schedule 1 under the United States Uniform Controlled Substances Act, multinational companies are “learning the industry” abroad, gaining operational experience before expanding into the U.S. once legal or regulatory hurdles shift.
Falling cigarette sales in many so-called developed nations in combination with an easing of cannabis restrictions have been clear drivers prompting this shift of their portfolio and positioning. This shift to invest more in cannabis-related products comes with the ability to leverage the tobacco industry’s manufacturing and distribution networks and technological capital and devices; they already have significant experience in inhalation and oral delivery systems, through their growth in vaping devices, new heated tobacco products, and oral nicotine pouch products. There is also a continuing trend of executives from alcohol, tobacco, and pharmaceutical industries moving in roles within cannabis industries.
As cannabis becomes more profitable and corporatized – potentially both within and across state borders – we may expect certain behaviors to emerge or intensify. It is important to be vigilant and prepared for the ostensible commercial actions that will attempt to maximize profits and minimize costs, as that is an inherent goal to the business model. These patterns are already recognizable from other industries:
Pushing for regulations that disadvantage smaller operators
Efforts that quietly promote monopolization, reduce competition, and crowd out smaller businesses.
Funding research designed to produce favorable outcomes
Or suppressing findings that threaten profits.
Exploiting labor and growers
Both domestically and internationally, especially in regions lacking strong labor protections.
Prioritizing high-profit products at the expense of quality and safety
Particularly harmful for vulnerable populations of consumers.
Undermining education and social-equity aims
Including reducing cannabis taxes that fund health education and reinvestment in communities harmed by the War on Drugs.
Lobbying against evidence-supported public-health regulations
Even when such policies are designed to prevent consumer harm.
Using state-level preemption to block local protections
A well-documented tactic to weaken or delay stronger health regulations.
For policymakers, health leaders, consumers, and communities, it is important to be aware of these potential actions. Similar players that reshaped alcohol, pharmaceutical, food, and tobacco markets are already mapping out and leveraging strategies for cannabis. Understanding strategies that may threaten health – as well as anticipating commercial tactics – are both critical to supporting public health, equity, and safety.
References:
Barry RA, Hiilamo H, Glantz SA. Waiting for the opportune moment: the tobacco industry and marijuana legalization. Milbank Q. 2014 Jun;92(2):207-42. doi: 10.1111/1468-0009.12055. PMID: 24890245; PMCID: PMC4089369.
Ongenaert M, Decorte T. Like birds of a feather? A multi-case study on the connections between cannabis, tobacco, alcohol and pharmaceutical companies in legalized cannabis markets. Int J Drug Policy. 2025 Sep;143:104863. doi: 10.1016/j.drugpo.2025.104863. Epub 2025 Jun 5. PMID: 40479916.
University of Bath, Tobacco Tactics, Cannabis. 31 March 2023. https://www.tobaccotactics.org/article/cannabis/
Altria, About Altria, Corporate Factsheet. https://www.altria.com/about-altria/At_A_Glance/corporate-fact-sheet
