Background Non-communicable diseases are the leading cause of mortality across the Caribbean and similar Low and Middle Income Country regions. Structural determinants include a marked increase in the dependency on food imports and the proliferation of processed and fast foods, including sugar-sweetened beverages. In this project, we emphasised the importance of a historical approach. We asked what role the past and more recent history of the local and global sugar economy play in shaping contemporary Jamaica’s consumption of sugar-sweetened beverages, and in the public health efforts to reduce this health crisis. We also asked how those invested in the food system, health and the sugar economy make sense of these issues, and in what way they historicise contemporary challenges of commercial determinants of health.

Methods We conducted a quasi-ethnographic study with remote data collection in online or phone semi-structured interviews and online workshops with 22 stakeholders. This included agricultural extension workers, restauranteurs, tertiary level students of public health, and NGO and health sector advisors and managers. We also undertook a ‘netnography’ of discourses around sugar-sweetened beverages in newspaper archives and contemporary articles of national daily Jamaican newspapers, and reviewed historical accounts of Caribbean food economies. Jamaican and UK based researchers collected and ethnographically analysed the data jointly, and in iterative discussion as a transdisciplinary team.

Results Historical understandings mattered in three ways in our analysis. First, using the past to examine contemporary sugar consumption highlighted how the dynamics of power during periods of agrarian economies in former colonies are expressed in modern day powerful lobbies and industries, which ultimately exert pressures on governmental trade and industry regulation decisions. Second, we identified the lived experiences of sugar histories, in particular the change from, often home-made, sugary drinks as special treats to regularly consuming branded and marketed sugary drinks, as these were shaped by the proliferation of advertisement and the availability of branded sugary drinks. Third, the making of ‘new histories’ was an important role of public health stakeholders in public action (against advertising, or for taxation or labelling) and disputes with industry, and the shaping of counter-narratives around health and cultural meanings of drinks.

Conclusion Our project emphasises the importance of understanding temporal complexities of commercial determinants of health.Our findings show that complex historical factors included the changing nature of the sugar industry over time, the increasing affordability and availability of sugar-sweetened beverages, and the poor regulation of industry.