Incentivizing Corporate Accountability in Market-Driven Epidemics: Examining the Role of Corporate Strategy, Marketing, and Responsibility in Shaping Global Health Outcomes, Using Chronic Traumatic Encephalopathy as a Case Study

Abstract

INTRODUCTION: Chronic Traumatic Encephalopathy (CTE) has emerged as a public health concern among individuals exposed to repetitive head impacts (RHIs), with 97% of cases in those with known exposure, football players. CTE fits the definition of a market-driven epidemic (MDE), in which a profitable product causes widespread harm while corporate incentives delay recognition and mitigation. Similar patterns have been documented in tobacco, opioids, and sugar-sweetened beverages. While literature examines neuropathology, legal battles, and individual outcomes, no study has analyzed the mechanisms driving delayed mitigation or identified interventions that could have shortened that delay. This thesis asks: (1) how did the NFL respond to evidence linking football to neurological harm, and what factors shaped that response? and (2) what mechanisms could align corporate self-interest with public health to enable earlier, more substantive harm reduction? METHODS: Using thematic coding of peer-reviewed literature, investigative journalism, and legal filings, the NFL’s response was mapped across five MDE phases: market development, evidence of harm, corporate resistance, mitigation, and market adaptation. Key milestones included suspicion and confirmation of harm, internal awareness versus public acknowledgment, the mitigation tipping point, and intervals between each. Building on this case study, a part of the methodology involved developing a framework for earlier corporate responses to emerging harm. FINDINGS: CTE follows classic MDE patterns, including corporate resistance strategies such as denial, funded counter-research, and influence over harm-reduction policy. External legal, financial, and public pressures eventually drove mitigation, including rule and equipment changes. Concussions per game declined 35% between 2015 and 2024. However, 85 years elapsed between initial suspicion (1928) and the mitigation tipping point (2013), with nearly two decades between internal awareness and action. Delayed mitigation produced compounding harms: elevated neurodegenerative disease and disability among players, over $1 billion in litigation costs, loss of liability insurance, and declining youth participation. Leadership accountability remained limited, raising broader ethical concerns. CONCLUSIONS: CTE demonstrates how profit-driven systems delay harm mitigation through predictable strategies of denial and uncertainty. A structured framework for earlier response could have prevented substantial harm. Despite progress, gaps in diagnosis, monitoring, and cultural norms persist, emphasizing the need for systemic reform.