Heather Wipfli, from the University of Southern California, highlights the lack of consensus regarding the role of private industry in efforts to control the burden of non-communicable diseases.
Non-communicable diseases (NCDs) were extensively discussed at the 66th World Health Assembly (WHA) in May. An ‘omnibus’ resolution was passed adopting the WHO Global NCD Action Plan 2013-2020, the Global NCD Monitoring Framework, and consensus was reached to move toward the formation of a coordinating partnership on NCDs. Each of these actions represented follow up on the commitments made during the 2011 United Nations High Level Meeting on NCDs.
At the WHA, there was widespread discussion about the role of the private sector in NCD control. In her opening address, WHO Director General Margaret Chan acknowledged the private sector contributes to epidemics of chronic disease and emphasized that WHO would never be on speaking terms with the tobacco industry. However, while acknowledging that health advocates will face well organized and well funded opposition when public health policies threaten the profits of industries that contribute to the rise of NCDs, she emphasized she would “not exclude cooperation with other industries that have a role to play in reducing the risks for NCDs.” She went on to argue that while there is no safe level of tobacco consumption, “there are healthier foods and beverages, and in some cultures, alcohol can be consumed at levels that do not harm health.”
While WHO’s position on the tobacco industry is definitive, the definition and parameters of partnerships with other industries driving NCD epidemics are not, despite recent efforts to put safeguards in place. The lack of clarity on when and how to engage with the private sector and the increasing push for public-private partnerships to address global health challenges provides industries with vested interests in policy outcomes direct access to, and greater influence on, decision makers. Throughout the WHA, for example, the alcohol industry, specifically AB INBEV (Budweiser), was present at multiple side events represented by its Vice President of Global Corporate Affairs, Scott Ratzen, a well-respected global health expert. The corporate social responsibility material distributed at these events echoed well-known tobacco industry arguments, touting the effectiveness of ‘self-regulation’ and that “population-based interventions, such as tax increases and restrictions on sales and marketing, in fact, often have unintended, harmful consequences in the long term.” References to supporting evidence were not provided.
Alcohol consumption is the third leading risk factor for disease and disability in the world and is a major driver of NCDs including cardiovascular diseases, cirrhosis of the liver and various cancers. Harmful alcohol use is also associated with several infectious diseases including HIV/AIDS, tuberculosis and sexually transmitted infections. Alcohol also causes harm far beyond diminishing the physical and psychological health of the drinker. An intoxicated person can harm others and put them at risk of traffic accidents. Alcohol costs more than 1% of the gross national product in high-income and middle-income countries and is linked to poverty. Apart from money spent on drinks, heavy alcohol consumers may suffer other economic problems such as lower wages, lost employment opportunities and increased medical and legal expenses. Evidence-based regulations can reduce the negative costs of alcohol use. An analysis of the strength of alcohol control policies, as estimated by the Alcohol Policy Index, among 30 countries located in Europe, Asia, North America, and Australia, revealed a clear inverse relationship between policy strength and alcohol consumption.
Given its global impact and effectiveness of regulation, Dr. Chan’s singular alcohol-related comment during her opening address to the WHA that alcohol can be consumed at safe levels in some cultures seems out of place. The argument that the alienation of the tobacco industry is uniquely justified because there is no safe level of tobacco consumption belies the fact that, although many seek to destroy the tobacco industry and end all tobacco use, the WHO Framework Convention on Tobacco Control (FCTC) is not an instrument of prohibition. It is a legally binding treaty committing countries to implement evidence-based regulations to control tobacco use and reduce costs. Similarly, an effective international regime can be established that addresses alcohol labeling, marketing, and pricing to reduce harm while still allowing legal consumption. Global legal agreements can also be put in place limiting transnational food and beverage industry behaviors that drive obesity.
Tobacco is unique, but the lessons we have learned about how industries act to protect their markets and resist regulation are not. The notion that the behavior of the tobacco industry is so exceptional that it is the only industry that needs to be isolated from public health policymaking must end. Instead, normative acceptance of the transnational food, beverage and alcohol industries within global health governance must continue to be challenged and global legal regimes that reduce their negative impacts on health should be developed. Otherwise, global efforts to prevent and control NCDs will be hampered.
Dr. Heather Wipfli is an Assistant Professor in the Department of Preventive Medicine at the USC/Keck School of Medicine and in the Department of International Relations at the USC Dana and David Dornsife College of Letters, Arts and Sciences. She is also the Associate Director of the USC Institute for Global Health. Her research focuses on global health politics and the development of innovative forms of global health governance.
H. Wipfli has no conflict of interests. All viewpoints are hers and not those of organizations with whom she is affiliated.