Incompatible? Public health vs tobacco, alcohol and fast food industries

Shobha Shukla, Citizen News Service - CNS
[Read presentation of Prof Jeff Collin] Governments of over 180 countries that have ratified the global tobacco treaty had met recently earlier this month and adopted and advanced strong measures to stop tobacco industry interference in health policy and also to hold tobacco industry liable.The meeting formally called the Seventh Conference of the Parties to the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) concluded with commendable progress on WHO FCTC Articles 5.3 and 19 (liability). In this context, I find it pertinent to share some of the learnings from the 47th Union World Conference on Lung Health that was held in Liverpool last month.

Reality check on policy coherence

Dr Jeff Collin, Professor of Global Health Policy at the University of Edinburgh, gave some interesting insights by exploring the dark nexus between industry and public health policies; and raised the issue of tackling conflict of interest and promoting policy coherence.

Public health policies have increasingly been conducted via partnerships with commercial sector actors in many national contexts and in global health. However, there seems to be limited policy coherence in dealing with global health and, for that matter, the Sustainable Development Goals (SDGs).

Non communicable diseases (NCDs) are now being seen as industrial epidemics that are shaped by unhealthy commodity producers and are substantially preventable by addressing risk factors like tobacco use, unhealthy diets, physical inactivity and harmful use of alcohol. However, there are stark contrast across NCD policy areas. While there is strong endorsement of statutory approaches to tobacco control in FCTC, there is emphasis on partnership and just voluntary approaches to limiting alcohol and unhealthy food.

Tobacco control policy has developed a distinctive model of health governance centred on recognition of a fundamental and irreconcilable conflict of interest and rejection of partnership approaches with tobacco companies. The Article 5.3 of the WHO FCTC states that “in setting and implementing their public health policies…. Parties (to FCTC) shall act to protect these policies from commercial and other vested interests of the tobacco industry”.

Analytically, this definition needs to be extended to the alcohol and food industries as well, in the broader strategies for addressing NCDs and public health.

Fox guarding chickens situation

[Read presentation of Prof Jeff Collin] Economic interests of key actors in the food and beverage industries are often at variance with global health objectives. Collin cited many contradictions that abound when it comes to protecting global health from industry interference. According to him, the WHO itself seems to be in a state of strategic confusion when it comes to talking about NCDs and global health. Not only is there participation of International Food and Beverage Alliance and alcohol industry in meetings of WHO Global Coordinating Mechanism on NCDs, but some of the public statements made by Dr Margaret Chan are conflicting too.

Just to refresh our memory, in a health promotion campaign in Helsinki, in June 2013, Dr Chan had said: "It is not just Big tobacco anymore. Public health must also contend with Big Food, Big Soda and Big Alcohol. All of these industries fear regulation and protect themselves by using the same tactics... In the view of WHO, the formulation of health policies must be protected from distortion by commercial or vested interests."

But a month earlier, at the World Health Assembly in May 2013, she had drawn a divide between the two, saying: ‘WHO will never be on speaking terms with the tobacco industry. At the same time I do not exclude cooperation from other industries that have a role to play in reducing the risks for NCDs. There are no safe tobacco products. There is no safe level of tobacco consumption. But there are healthier foods and beverages, and in some cultures alcohol can be consumed at levels that do not harm health.”

Institutional and structural links: Big Tobacco, Big Alcohol and Big Food

[Read presentation of Prof Jeff Collin] While delving upon interlocking directorates, Collin gave the example of SAB Miller, a multinational beer manufacturing company headquartered in London. SAB Miller has commercial ties with the tobacco industry through its shareholder Altria - the parent company of Philip Morris in USA. SAB Miller earlier used to be entirely owned by Philip Morris, and 22% of it is still owned by it. 3 of its Board members are also on the Board of Philip Morris International. It also appointed Jan du Plessis, former chairman of British American Tobacco (BAT), as its Chief Executive, explicitly because of his expertise in penetrating international markets, and also in managing regulatory environments in developing countries. Others sitting around the table include Trevor Manuel - two time head of World Bank Development Committee- and John Manzoni, the Head of UK Civil Service. John Manzoni ultimately had to step down from his brewery directorship. "He was charged with reducing tobacco price in England which was problematic. But his being on board of SAB was not seen as problematic until tobacco control activists said he was seen with tobacco industry folks", said Collin.

At the local level, Souza Cruz, the Brazilian subsidiary of BAT, has on its Board of Directors 2 former Presidents of the Brazilian Supreme Court, a former Ambassador to WTO, Directors of Latin America’s leading think tank as well as representatives of Hersheys and Coca Cola.

SAB Miller’s story is also a the narrative of mature markets in the global North being replaced by increasingly targeting the global South. It had negligible revenues from sales in Latin America in 2005. But less than a decade later in 2014, they rose to be one of the highest, with Brazil recording 42% of all beer sales in Latin America.

Merger of alcohol giants poses another big threat to global health. The recent merger between SAB Miller and Belgian brewing company AB InBev - the 3rd biggest merger in corporate history - was predicated on the prospects of the industry’s growth in African and new Latin American markets - touting it as a  critical driver of growth for the combined company. Is this not going to have serious consequences for global health?

Interestingly, this merger was driven by a group of Brazilian venture capitalists 3G, who had previously also led the merger between food giants Kraft and Heinz and the buy out of Burger King. One of the impediments in the process of merger SAB Miller and AB InBev was that both had rival distribution deals - AB InBev with Pepsi and SAB Miller is the biggest distributor of Coca Cola drinks in Southern Africa.

At the country level, Collin gave the example of contrasting attitudes of UK government towards tobacco and alcohol industry. Since the pre-FCTC era, UK has had guidelines for its overseas Embassies’ staff that restrict them from promoting the interests of tobacco companies overseas. At the same time UK uses strategies to support the alcohol industry by promoting the industry’s interests in trade negotiations, promoting alcohol exports and thus jeopardising global health. Its Department for International Development (DfID) provides development aid to SABMiller and Diageo, a British multinational alcoholic beverages company. Is this not lack of policy coherence?

What does all this mean for development of effective NCDs policies in the context of Global coordination mechanism and WHO reform? What are the implications that arise from multiple links across tobacco, alcohol and food industries? How can WHO “never be on speaking terms with the tobacco industry” if it does not exclude collaboration with such closely linked companies? These are some of the questions that beg candid answers.

Private sector and SDGs

Partnership with private sector has been emphasised as one of the keys to achieving SDGs. And yet, taking the conflict of interest seriously is essential to realising the potential of SDGs. SDG 3 ends with ‘a call to strengthen the capacity of all countries, in particular developing countries for (early warning, risk reduction) the management of national and global health risks’. While we are used to treating tobacco industry as a national and global health risk, it is high time to also treat the expansion of alcohol industry and most of processed food industry in similar terms. And while Goal 17 does call for partnerships, it also requires us to enhance policy coherence for sustainable development.

[Read presentation of Prof Jeff Collin] In the words of Collin “Tobacco control has a got lot to gain from breaking down silos across NCD risk factors and working more closely with anti alcohol and pro nutrition communities by exploring areas of common interest. In the context of the multiple challenges we will be confronting in terms of trade agreements, it is increasingly important that we explore common ground and try to work together more constructively.”

Shobha Shukla, Citizen News Service - CNS
13 November 2016

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