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Corporate Profits Trumping Public Health

Elizabeth Whitman

UNITED NATIONS, Sep 21 2011 (IPS) - “There is a well-documented and shameful history of certain players in industry who… put public health at risk to protect their own profits,” U.N. Secretary-General Ban Ki-moon told world leaders Monday as they met to address the issue of non-communicable diseases at the 66th U.N. General Assembly.

The high-level meeting provided countries with a chance to share stories of success and innovation to combat NCDs, the most common of which are cancer, diabetes, chronic respiratory illness, and cardiovascular disease.

Responsible for 63 percent of deaths worldwide, or 36 million deaths per year, NCDs constitute a serious threat to global social and economic development.

Yet throughout events held on Monday and Tuesday, and in the political declaration agreed upon by member states outlining the steps they would take to address NCDs, a clear, persistent and pervasive challenge emerged: ensuring that profit-driven corporations and industry groups are not able to influence policies or other efforts aiming to improve public health.

Government and civil society leaders alike agreed that, as the political declaration stated, NCD prevention and control require “multisectoral approaches”. But many also expressed concern that no clear boundaries exist to distinguish appropriate involvement of the private sector from the inappropriate and potentially unethical, or to ensure that profits do not trump public health.

A demonstrated conflict of interest

The political declaration itself explicitly noted a “fundamental conflict of interest between the tobacco industry and public health,” but it did not do the same for the food and beverage or pharmaceutical industries. Rather, it called on the private sector to “consider producing and promoting more food products consistent with a healthy diet” and to “contribute to efforts to improve access and affordability for medicines.”

Tobacco, overconsumption of alcohol, an unhealthy diet, and lack of exercise are the four main causes of NCDs. Industry groups play a key role in the first three of these areas, though whether that role is advantageous or dangerous to public health can vary.

Bill Jeffery, national coordinator for Centre for Science in the Public Interest, Canada (CSPI-Canada), told IPS private sector engagement will “have no integrity” without a code of conduct. Nor was the “relationship between trade and health… squarely addressed in this political declaration,” Jeffery pointed out.

CSPI-Canada is part of the Conflict of Interest Coalition calling for the creation of such a code.

Douglas Bettcher, director of the World Health Organisation‘s (WHO) Tobacco Free Initiative – WHO is considered the world’s primary specialised health agency – told IPS that WHO had “very clear and strict guidelines vis-à-vis work with commercial enterprises to make sure that our… policy work is not deviated and not open to undue influence by the private sector.”

He insisted that the political declaration did protect against such undue influence. “It says very strictly, ‘where and as appropriate,'” he told IPS.

Nevertheless, there are “certain aspects of reducing risk factors where the cooperation of the industry can be beneficial,” Bettcher said. Actually implementing policies by cutting down on sodium in foods and engaging in responsible marketing can help improve public health, for example.

But when industry groups participate in discussions or are involved in policy making decisions, their influence can run the gamut from directly opposing public health interests to emphasising control of NCDs, a more profitable aspect from the pharmaceutical perspective, for instance, over prevention.

“Ensuring that the focus is… less on prevention and more on how to control NCDs” is one way the pharmaceutical industry can profit from the NCD crisis, Gigi Kellet, deputy campaign director for Corporate Accountability International, told IPS.

Prior to the start of the NCD summit, PepsiCo co-hosted, with two U.N. agencies, a breakfast panel discussion at the U.N. on Monday for government representatives.

When asked about the potential for a conflict of interest in such an event, Bettcher told IPS that side events were separate from the U.N. and WHO.

Dr. Mehmood Khan, CEO of PepsiCo’s Global Nutrition Group, spoke at a related event on Tuesday, where he emphasised the need for public- private partnerships. He stated explicitly that his job was to help the group grow to 30 billion dollars by 2020, and reminded the audience, “Processing (foods) equals preservation of important food groups.”

Resistance to hard targets

WHO recommended setting a goal of reducing NCD deaths by 25 percent by the year 2025, a target whose exclusion from the political declaration drew criticism from many leaders. Monitoring NCDs and setting reduction targets are the next crucial steps – and challenges – they said.

“Without clear targets there will be neither accountability nor a real incentive to deliver,” Princess Dina Mired of Jordan, director of the King Hussein Cancer Foundation in Jordan, told the General Assembly on Monday.

Joanna Ralston, CEO of the World Heart Forum, a member of the NCD Alliance, highlighted the disparity between NCD rates in developed versus developing countries, where 90 percent of NCD-related deaths occur.

Because “people are increasingly urbanised, living in huge dense cities in low and middle income countries,” their lifestyles and food options have changed, Ralston told IPS. They generally get less exercise and don’t have as many options for healthy food.

“There’s a host of factors that affect this,” she elaborated, ranging from urban planning to agricultural development to trade. These aspects are in some ways part of the problem, but they can also be part of the solution, she said. She also mentioned a need for stronger language surrounding specific targets.

Regulating the amount of sodium allowed in foods, for instance, has a clear impact on cardiovascular disease, Ralston said.

All over the world, evidence points to the feasibility of reducing NCD deaths. The challenge that remains for many countries is simply to take action.

After imposing advertising bans and anti-tobacco laws, Uruguay, for example, saw a 25 percent reduction in smoking over a three-year period. Meanwhile, Brazil has taken steps to increase the amount of physical activity children get at school and to better label foods while reducing sodium content and eliminating trans fats from foods.

WHO estimates that NCD-related deaths will increase by 17 percent in the next decade, but in Africa the increase will be 24 percent. According to the World Economic Forum, over the next 20 years, the global economic impact of the four major NCDs, plus mental ill- health, could total 47 trillion dollars.