24 May 2023
By Kerry Cullinan, Health Policy Watch
GENEVA – There needs to be stronger global action to prevent interference in health policy by industries selling products that harm people – tobacco, alcohol, ultra-processed food and fossil fuel.
This is the call from advocates for non-communicable diseases (NCD) attending a side event at the World Health Assembly in Geneva, which is due to debate a political declaration on NCD prevention and control on Wednesday.
“The industries that produce and market these products are more interested in profit than in healthy people and healthy communities,” said José Luis Castro, President and CEO of Vital Strategies, at a WHA side event hosted by his organisation and the NCD Alliance.
“They use their considerable resources to influence governments to reject or suspend restrictions on these products,” added Castro, citing tactics such as “financial enticements, legal battles and other ways to limit the policies such as food, warning, labels, marketing restrictions, and taxes on harmful products”.
“These commercial interests are antithetical to the goals of public health policy. This alone should disqualify them from joining the table to share so-called solutions.”
Implementing NCD plan of action
NCDs, including diabetes, heart disease and strokes, are responsible for almost three-quarters of global deaths – a staggering 40 million deaths every year. Yet no country is on track to significantly reverse this trend by 2030, one of the key health goals of the global sustainable development goals.
To help countries navigate the complexities of addressing NCDs, the World Health Organization (WHO) has come up with “Best Buys” – evidence-based strategies for countries to use, including taxing unhealthy products (officially called Appendix 3 of the WHO Global NCD Action Plan).
WHO NCD Director Dr Bente Mikkelsen said that the “Best Buys” now consisted of 90 interventions, 28 of which are “considered to be the most cost-effective and feasible for implementation”, and that countries should select these based on “their own epidemiology”.
However, she acknowledged that the “commercial determinants” of health – industry influence – are so strong in many countries that they cannot implement some of the “Best Buys”, and that “it’s all about the country’s leadership”.
Castro believes that “Best Buys” should be modified to include “more explicit recommendations against corporate influence” because “corporate influence worldwide has been identified as the main reason why Best Buys’ implementation falls short”.
“For small island developing states like in the Caribbean, the best buys are the only buys,” said Dr Kenneth Connell, Vice President of the Healthy Caribbean Coalition. “The reason simply is we cannot afford treatment.”
But Connell said there were huge barriers to implementing the best buys – including that sugar and alcohol consumption had become an integral part of the Caribbean culture.
However, the Philippines is making inroads against NCDs, thanks to its system of universal health care (UHC) that is primary-care centric, and addresses prevention as well as treatment, according to Dr Razel Nikka Hao, the country’s Director of Disease Prevention and Control.
“The icing on the cake is that the tax we get from sin taxes [on tobacco, alcohol and ultra-processed food] is the one that is funding our UHC,” said Hao. “So we actually have around $2 billion a year from sin taxes, and that has triggered investments in health facilities and workforce expansions. We’re very lucky that we have very strong legislators who fight with industry leaders.”
Air pollution is the elephant in the NCD room
Nina Renshaw, Head of Health at the Clean Air Fund, described the influence of air pollution on NCDs as “the elephant in the room”.
“Seven million deaths per year attributable to air pollution is a really conservative estimate,” said Renshaw.
“We know that 40% of COPD deaths are due to air pollution, over a quarter of strokes, over 20% of cardiovascular deaths… 20% of diabetes and 19% of lung cancer deaths,” added Renshaw.
“There’s emerging evidence of causality in dementia and of course with mental health. If you live in an area of poor air quality, highly polluted or an area that’s at serious risk of climate change, this is clearly going to take a toll on your mental health.”
Media campaigns help shift the social narrative
Dr Nandita Murukutla, Vital Strategies’ Vice President for Global Policy and Research, acknowledged that social and political barriers prevented the implementation of the “best buys”.
Aside from political interference, because some NCDs take a while to manifest, this undermines “the sense of urgency and the belief that the risk is real” which could lead to “apathy around implementation”, she said.
However, media and communication play an essential role in shifting social narratives, galvanising public support and putting pressure on policy-makers.
“Media campaigns and communication efforts are vital for tax implementation,” said Murukutla, adding that in some places where there had been the absence of public support, tax proposals have failed.
“Message framing on how to describe the tax is significant. Linking the tax to social benefits is a very powerful way of building public support,” she added.
For Professor Anna Gilmore, Director of the Tobacco Control Research Group at the University of Bath, the problem is “not just a few unhealthy commodity industries and their products, its a system”.
The commercial sector undermines the Best Buys by influencing science, said Gilmore, who also pointed to how industry players manipulate impact assessments.
“There are some minimal things we need [from policy-makers] including conflict-of-interest policies and policies on non-engagement with industry,” said Gilmore. “We need to avoid partnerships with vectors of disease and ensure that science functions in the public interest.”