Non-communicable diseases (NCDs) are responsible for almost 70% of all deaths worldwide. Almost three quarters of all NCD deaths, and 82% of the 16 million premature deaths, occur in low- and middle-income countries. NCDs have devastating consequences for individuals, families, and communities; they threaten to overwhelm health systems; and they hinder development. The international community has acknowledged the scope of the problem and undertaken to act to reduce the availability, acceptability and affordability of tobacco products, alcoholic beverages and unhealthy food. However, state efforts to regulate the tobacco, alcohol and food industries to prevent NCDs and promote public health have given rise to expensive challenges anchored in international trade and investment law, as illustrated by recent claims challenging tobacco control legislation in Australia and Uruguay. The regulation of alcoholic beverages and unhealthy food could face similar challenges under international trade and investment law as the food and alcohol industries become more regulated. This raises important and timely questions about how international trade and investment law can affect state regulatory autonomy in designing and implementing measures for preventing NCDs