Abstract
BACKGROUND: In recent decades, the Big Three asset managers (BlackRock, Vanguard, State Street) have emerged to be among the top shareholders in thousands of listed companies worldwide. Accordingly, they have considerable influence on corporate decision-making. This paper aimed to examine the influence of the Big Three on the governance of leading corporations in key health-harming commodity industries responsible for a large burden of preventable death and disease worldwide (i.e., industrial epidemics). METHODS: We used an innovative combination of methods and data sources. We analysed share-ownership in 40 selected corporations across 10 major health-harming commodity industries. We then examined the voting behaviour of the Big Three with respect to 61 proposals put to vote at the 2024 shareholder meetings of these corporations (28/40). These proposals related to public health, social and environmental issues, as well as shareholder payouts and political lobbying and expenditure. Following this, we explored key characteristics of the ‘environmental, social, and governance’ (ESG) funds marketed by the Big Three. RESULTS: The Big Three were the most prominent shareholders across the selected corporations. In 2024, the Big Three overwhelmingly voted against proposals calling for the incorporation of social and environmental objectives into the policies and strategies of these corporations, and invariably voted in favour of proposals seeking to boost shareholder payouts and authorise political activities. The majority (54/73) of the Big Three’s identified ESG funds included one or more of the identified corporations, despite their well-documented health-harming products and practices. CONCLUSIONS: The Big Three appear to be reinforcing shareholder primacy in health-harming commodity industries, including by undermining many shareholder-led social and environmental initiatives, which risks perpetuating widespread health inequities. States need to take greater action to address industrial epidemics, including through regulating private finance in ways that prioritise health, equity, and sustainability. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12992-026-01194-z.