Commercial determinants of health (4). Counter tactics
Counter tactics
around the commercial determinants of health
This is the
fourth blog in a series and focused on strategies to counter and reduce the
impact of products that can be framed as CDOH
1 Policies on products into a broader
framework
A list of target
policies not enough. We DO need policies to address fast food, alcohol
consumption, tobacco for eg – broadly access, promotion and price AND to
explitly focus on the underpinning concept of the tactics of industry
(regardless of the nature of the product). Needs wrapping in a set of core
principles.
Should be focused
on industry influence (across many spaces research, treatment, policy and
regulation).
Whole system not
just focus on some aspects of system. Whole of govt and cross govt coordination
Framing towards
leverage points (see Donella
Meadows on leverage points for big changes in any system)
Focus on the unit
of intervention is the population or the system, not the individuals within
it (especially not just pointy end risk
or demand wise).
Specific tactics
3 Structurally excluding industry
influence
Commit to adopting
international best practice in managing and preventing conflicts of interest.
Take a model similar to the WHO Framework Convention on Tobacco Control
and audit adherence.
4 Conflicts of interest
Seek out and call
out conflicts of interest
Reduce conflicts of interest in policy making by
training policy makers
Seek for greater transparency about industry lobbying and funding
in policy making. Seek to establish statutory
registers of corporations lobbying governments to allow public scrutiny of the
nature and scale of their activities, including all donations
The scientific community must
renew its commitment to strict implementation of conflict-of-interest policies
and reject offers of paid placement in special journal editions
researchers must also embrace
policies to keep conferences free from industry participation and refuse to
participate in forums with industry personnel
5 Raising awareness
Raise awareness
of the models of practice and methods used (see blog 3). Seek to trigger public debates and the like on gambling
related harms.
Develop
different narratives to appeal to different ideologies – play industry at its
own game. Explicitly take on the “it’s a harmless leisure pursuit” line.
Awareness
raising in such a way we speak to multiple constituencies who will come at the
problem from different perspectives, thus broadening the alliance of people who
see this as an issue, own it and want action.
My guess is most
of the public whilst they might accept there is commercial influence in the
policy making process they may not be aware of the extent of it, or they feel
the direct link to their lives is not powerful enough to be angry
Openly acknowledging, documenting
and challenging the
hidden power of corporations. We know those corporations will seek
to reframe issues and shift attention away from the most impactful
interventions, and that industry funded studies tend to reach conclusions
favourable to their sponsors (see this Cochrane review). On this McKee and others describe the hidden and
invisible forms of power, whereby large corporations use various methods to
shape thinking about what are appropriate responses to the health consequences
of their products. Also Greenhalgh
demonstrates how some companies influence obesity policies in a way friendly to
their interests but obscured behind the public face of intermediaries.
6 Shape a different narrative
When commercial
partners suggest health policies, ask about the competence of that stakeholder
to develop those. Ask in whose interest is the suggestion.
When ideological
objections are raised, ask whether ideology is simply a front for a commercial
objection
“This is anti
business or anti economy”
You may get
framed “anti business” or “anti economy”. For what it is worth I am
definitively not “anti business”, nor “anti industry”. I am anti harms from
consumption of some products and services, especially where the harm outweighs
the benefit. I accept there are personal, political and ideological judgements
in this.
On this is “anti
economy”, it is probably important to get straight what we mean by “the
economy”. When you get all of the costs and all of the consequences on the table
(ie factor in the externalities) over a long time frame, it changes the nature
of the thinking. The polluter pays principle is enshrined in the Environment Act.
Why not this space?
Health and wealth are not mutually exclusive,
focus on arguments about unleashing economic potential not curtailing it,
minimising constraints on economic growth, the economic consequences of
insufficient regulation. Unhealthy and unproductive workforce e.g. alcohol use
leads to more years of working life lost than the 10 most common cancers
combined.
Significant additional costs to society due
their impact e.g. costs to health, social care, law enforcement, fires etc
Appropriate regulation drives more sustainable economic growth, reduces
inequalities in poor health, boosts productivity and reduces wider burdens on
society. Pandemic has powerfully illustrated that the economy benefits from
good health of the population and suffers when they are in poor health
Reframe from
individual to societal responsibility. But done in a way oriented around “traditional”
notions of “the economy”. Unhealthy populations are economically less
productive, less able to resist shocks, much more expensive to maintain through
welfare. Thinking back to
Victorian times,
the Boer war was reason we introduced free school meals as poor folk were under
nourished and too weak to fight
The nanny state
The “this is the
nanny state gone wild” or “swivel eyed loon” lines are never too far away. I
have blogged
on the nanny state in the past with some thought to responses to those type
of lines. Are
your choices “truly” “free” or are you also being manipulated by industries
that want to sell you their products. Some of the academic
papers can be found here.
People should
take “personal responsibility”
A focus on
individual responsibility is a failed policy in many policy areas over decades.
The policy says to individuals sort yourself out, and if you cant, you are
greedy and lazy (HT @Profpaulgately)
It is either a
callous policy or a deliberate policy of industry to frame problems in a way to
maintain status quo.
Yes of course I should
take responsibility, but I don’t make choices in a vacuum. My choices are shaped
by the environment I am in – with financial, marketing and other cues all the
time. A focus on personal responsibility and individualism simply locks on
ineffective and inequitable interventions, it will not help us level up.
The obvious counter
challenge is - If we ARENT people to take personal responsibly what ARE we
asking. We ARE asking for personal responsibility - It is necessary, but nowhere
near sufficient. Its more complex than simple binary.
7 Don’t allow industry funded education
Don’t use commercial sponsors
in the funding, design or delivery of education or treatment. See this
from van Shhalkwyk and others on the impact of industry sponsored education
programmes - reframing information,
avoiding coverage to some aspects, emphasising some aspects of an issue and
shaping the way a whole issue is seen in a way favourable to the industry
position.
Regulation
regulatory agencies must rely on
independent, rather than industry-sponsored, study findings in assessing the population-level
health impacts of novel tobacco products
Set up independent panels to advise on corporate
engagement in policy making
Use regulations, frameworks, and criminal law to
prevent corporations from misleading the public and causing environmental and
other harms, including destroying ecosystems
8 Focus
on and build public support
Public
support is high for many specific policy interventions to regulate industry
but support is highest for tobacco and gambling where public consumption is
lowest need to expand this in areas of food and alcohol via education and
raising awareness. Support for regulatory measures does not vary a great deal
by past voting preferences. Young people slightly less supportive of regulatory
controls than adults.
For some, but not all, regulatory interventions there is high political support,
cross party consensus, it is known to be popular. It is easy to increase
support through focusing the narrative on protecting children,
Consumers drive
industry and policy, so change consumer views. Citizens also have an important
role in demanding change from industry, through consumer choices and civil
society organisations, as well as demanding change from more cautious
governments through the ballot box and engagement in deliberative processes.
Selected references
Professor Chris
Whitty Gresham Lecture. The Role of the State in Public Health, and its Limits
https://www.gresham.ac.uk/lectures-and-events/state-health
Briggs on the
lessons from tobacco control - https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2021.306683?af=R
Industry
influence: a barrier to progress in public health policy
Systems Thinking
as a Framework for Analyzing Commercial Determinants of Health. https://pubmed.ncbi.nlm.nih.gov/30277610/
Measuring the
Commercial Determinants of Health and Disease: A Proposed Framework
https://journals.sagepub.com/doi/pdf/10.1177/00207314211044992
Marteau and
others on climate set out some thoughts on protecting protect policies
for net zero from corporate interference
Healthier and
Fairer Futures - Commercial Determinants of Health conference. https://www.yhphnetwork.co.uk/links-and-resources/healthier-and-fairer-futures-commercial-determinants-of-health/
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