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The virus of capitalism: industry consultation through public health eyes

The exclusion of industry from public health campaigns is increasingly driven by the pathologisation of corporations as vectors of disease that must be controlled.

What role should industry play in the regulation and taxation of its products? How much should industry be consulted?

A few would argue governments should never consult with industry because it only dilutes the impact of regulation. Some in industry think the meaning of “consultation” is when governments do exactly what industry wants. Outside those extremes, the majority of policymakers and stakeholders accept that there’s benefit in governments consulting with industry on how it is regulated, in terms of more effective regulation and avoidance of unintended consequences, but without necessarily having to accept all or any of industry’s viewpoints. It also depends on where on the spectrum of regulation an industry sits. Aviation is regulated very differently to, say, a “co-regulated” industry like television.

When it comes to public health, however, there’s a very different dynamic at work, which not merely rejects a role for industry, but sees capitalism itself as a key public health enemy.

Crikey recently reported concerns from within the public health sector about the exclusion of industry from consultations on policy development in areas such as alcohol, on the basis that it should be treated like tobacco. In response, the doyen of Australian public health lobbyists, Professor Mike Daube, responded by quoting the head of the World Health Organisation that “the alcohol industry has no role in the formulation of alcohol policies”.

But the public health sector hostility to an industry role in regulation goes far beyond the alcohol industry. We’ll deal with specific instances in a later piece, but it’s important to understand the intellectual world that some public health lobbyists inhabit.

The cartography of that world is best laid out in a remarkable paper from February last year in The Lancet by a group of authors led by another high-profile public health lobby figure, Professor Rob Moody of Melbourne University’s School of Population Health, who among many other roles was also chairman of the Rudd-Gillard government’s National Preventative Health Taskforce.

This much-cited paper, Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries, ostensibly sought to resolve the issue of working with industry:

Although there is now consensus that the tobacco industry’s conflict of interest with public health is irreconcilable, whether the competing interests of the alcohol, food, and drink industries are similarly irreconcilable is debated.”

Moody et al then proceed to explain the basis for the profound antipathy of the public health sector not just toward specific industries like alcohol, food or drink, but against global capitalism itself.

The term industrial epidemic has been used to describe health harms associated with various goods including tobacco, alcohol, vinyl chloride, asbestos, cars, and the food and drink industries. In industrial epidemics, the vectors of spread are not biological agents, but transnational corporations. Unlike infectious disease epidemics, however, these corporate disease vectors implement sophisticated campaigns to undermine public health interventions.”

The paper seems to consider evidence about the best approach to the problem of corporate-driven epidemics. This being The Lancet, one would expect a rigorous consideration of the available evidence in health outcome about the success of self-regulation versus what the paper terms “public-private partnerships” versus full-scale regulation. But when the paper belatedly considers the evidence of the outcomes from different levels of industry involvement, it comes up short:

The precautionary principle argues against public–private partnership because there is no evidence that the partnership of alcohol and ultra-processed food and drink industries is safe or effective, unless driven by the threat of government regulation.”

While the logic of that statement might be a bit wanting — don’t work with industry because there’s no evidence involving industry “is safe or effective” — the footnote intended as evidence refers to two papers by prominent American obesity expert Kelly Brownell. One is a comparison of the US food industry’s response to proposed regulation with the “playbook” of tobacco companies. The other is best described as a rant at the food industry that concludes that while “respectful dialogue with industry is desirable”, the only thing that will work is “regulation with a purpose”.

That is — putting aside whether you like the food industry or not (and I’ve written repeatedly about the food industry’s efforts to stop labelling laws that would better inform consumers about their products) — a Lancet article purporting to analyse the case for including industry in developing regulation offers no data about whether better outcomes proceed from involving industry.

… consulting with industry on public health matters makes no more sense than consulting a virus about plans to eradicate it.”

Some other problems crop up in the paper. In making the case against large corporations, it claims that industries affected by public health regulation, including alcohol, are becoming increasingly oligopolistic, but one of the papers cited by the researchers actually explains that the global alcohol industry, while more concentrated than it used to be, remains highly fragmented in wine and that “most of the alcohol that is produced and consumed around the world continues to be non-commercial and largely unrecorded”. Moreover, that paper reports “leading beverage alcohol companies have over the years made efforts to promote responsible drinking. Their aim is to find ways to educate their consumers about responsible drinking and to target patterns of drinking that are harmful either to the drinkers or to others.” A feature of the organisations established to co-ordinate such efforts (an example is Drinkwise in Australia, target of much public health lobby criticism) are partnerships with other stakeholders, which are:

… a testament to how seriously these organizations and, indeed, the alcohol beverage industry more generally, have been taken. The activities of [these bodies] have developed considerably over the past decade, reaching out to more stakeholders in their efforts to prevent alcohol abuse. Many of their activities have focused on three core areas: young people and drinking, alcohol-impaired driving, and responsible hospitality and server training.”

And much of the paper is aimed at the impact of corporations in developing countries as incomes in those countries rise and diets change. But the paper fails to address the broader point that there is a case for linking economic growth created by market economies with longer life spans — the evidence is mixed about the extent to which higher standards of living lead to longer lives (rather than the obvious connection between longer lives and higher living standards), but there’s at least some evidence that higher incomes lead to better health outcomes. It also doesn’t address the fact that economic growth in an open liberal market economy like Australia’s has not prevented an increase in life expectancy by more than five years since the mid-1980s, despite the onslaught of multinational corporation influence on Australian diets.

Despite all that, the paper concludes “[r]egulation, or the threat of government regulation, is the only way to change transnational corporations; therefore, the audience for public health is government and not industry”.

As nutrition consultant and commentator Bill Shrapnel argues, this approach leaves the public health lobby politically aligned to the Left, and therefore exposed to attack from a Right-aligned government, and is thus ultimately counterproductive even within the narrow terms of the public health lobby.

But it also emphasises one of the key drivers of the paternalist impulse of the kind of middle-class progressives represented by many public health lobbyists.

Since the acceptance by parties of the Left in Anglophone economies of the victory of liberal market economics in the 1980s and 1990s, what used to be a philosophy of intervention in favour of large government and heavily regulated economies has been redirected into a philosophy of paternalist intervention to ameliorate the impacts of market economics on individuals. Having accepted, however reluctantly, the structural reform of the economy along liberal lines, progressive paternalists don’t believe individuals can navigate that economy without their guidance. Individuals are too easily gulled by the marketing campaigns of Big Food, Big Alcohol, Big Soft Drink, etc, and thus need to be saved from their own consumption choices through education, nudging, pricing mechanisms and regulation.

But part of that process inevitably manifests the original interventionist impulse: thus the pathologisation of large corporations as disease vectors, giant viruses that fight back against attempts to restrict them, in the same way that human behaviours like alcohol consumption — which humans have been doing for tens of thousands of years — are increasingly portrayed as medical problems.

From this point of view, consulting with industry on public health matters makes no more sense than consulting a virus about plans to eradicate it.

*Next: how industry gets excluded, and evidence hidden, in public health campaigns

21
  • 1
    Bo Gainsbourg
    Posted Thursday, 27 March 2014 at 2:50 pm | Permalink

    So in the public health debate you’re arguing that some of the worlds largest most powerful corporations need more say than they already have over policy? Can’t see that one passing the basic logic test. You may be uncomfortable with what you term paternalism, but to suggest that public health would be improved by more industry influence is a very very long bow to draw with I’d suggest zero evidence to support it. Some public health interventions may be less than effective, hard to see that giving ‘big junk’ less regulatory control and more influence will help though.

  • 2
    Liamj
    Posted Thursday, 27 March 2014 at 4:15 pm | Permalink

    Capitalist enterprises are pathologies on their own terms, amoral and uninterested in the externalised costs of consuming their products, and there are countless examples: smoking, seatbelts, asbestos, fossil fuels, CFCs, SSRIs, many many more. What the ‘Left’ (Right-lite) thinks is of no consequence, it has little to no effective power in this or any anglo country.

    I say govt should consult but only to get an idea on their tactics, then regulate to make suppliers bear the cost of misuse of their products, IOW force business to internalise the costs that they otherwise will dodge/externalise/shift onto taxpayers. Currently we have countless corporate ‘deadbeat dads’ who go to extreme lengths to dodge responsibility, eg. fossil fuel corps spending US$1billion a year on funding global warming denial.

  • 3
    rhwombat
    Posted Thursday, 27 March 2014 at 4:30 pm | Permalink

    Oh FFS BK. Put the bottle down and step away from the lobby.

  • 4
    CML
    Posted Thursday, 27 March 2014 at 5:22 pm | Permalink

    Surely it should be obvious to anyone, including you Bernard, that the public health lobbyists are concerned for the health of the population and the burgeoning costs of health care for the taxpayer.
    On the other hand, the alcohol, tobacco, food and drink lobbies are just protecting their own profits when they try to water down, or remove, any regulatory framework.
    It’s all about greed with large (particularly multinational) corporations, who don’t give a rat’s ar+s about what happens to the consumers of their products. Just so long as MORE and MORE money keeps rolling in!
    The law, as it stands, is an ass. It protects the shareholders of said corporations far better than their consumers!! After a long career in the health-care sector, I can vouch for that statement.

  • 5
    Andrew Cochrane
    Posted Thursday, 27 March 2014 at 8:13 pm | Permalink

    Bernard, your argument may have some academic logic but ignores what has happened time amd time again in the real world. The examples of tobacco and asbestos, to take just two clear cases, demonstrate that the companies were aware of cancer and death from their products for many years but continued to deny it, try to get around the evidence / restrictions, and continued to sell their products. I am sorry to say it but the companies have no morals / ethics. We continue to see the same thing with the huge campaign waged by fossil-fuel companies to cast doubt on climate change, with great success in Australia and the USA.
    While smoking has declined in many western countries, the same companies have taken their sales to the developing world, and continue to make even bigger profits. Over 50% of men in Indonesia smoke, and similarly in many other Asian and Middle-eastern countries, and the same companies again oppose legislation in those countries.

    Andrew Cochrane (Cardiothoracic surgeon)

  • 6
    BookishMisfit
    Posted Friday, 28 March 2014 at 8:53 am | Permalink

    Does Government have a responsibility for the wellbeing of its citizens?

    I think it does, at least in a civilized society like ours. How Government prioritises and manifests that responsibility is always up for discussion.

    Does Big Business have a responsibility for the wellbeing of its customers and the community it which it operates.

    Ethically it does but how this would manifest is quite unclear and many would argue that Big Business has a responsibility primarily to its shareholders. Of course, Big Business is responsible to the laws of the community in which it operates. This is where the key to questions raised by this article lies.

    Personally, I believe that Big Business has shown its inability and unwillingness to regulate itself. There is plenty of evidence about this in relation to Big Food, Big Alcohol, Big Gambling and Big Pharma.

    Yes - you left a few critical areas out, BK.

    When the wellbeing of an economy is tied to the success of the various Big Businesses the question of well being becomes more obscure.

    For example, does the fact that Big Gambling provides employment to tens of thousands of people offset the undoubted harm that problem gambling inflicts on the wider community?

    Same questions could be asked in relation to the other ‘problem’ industries.

    Has anyone made these kinds of economic and social analyses? Possibly in different forms but I doubt that Government, political and ideological as it is, really bases many of its decisions on this kind of material. We have seen this in all the industries nominated but especially, recently, with Big Gambling.

    What often really matters is when someone you know or love is harmed in some way. This is when you start to think and act. It is even better when influential figures in the Government, the community and Big Business are affected personally by particular issue. Look at the 1980’s NCADA campaign inspired by the fact that Bob Hawke’s daughter was a problematic drug user.

    This is when Governments may contemplate protective legislation and harm minimisation campaigns.

    Another motivation may be purely economic. When Government realises the future health costs of the harms, it may be inspired to regulate. I am cynical enough to believe that that most significant protective legislation occurs on this realisation.

    But we need a health and wellbeing industry to research, monitor and educate communities about possible and real harms. We need an industry to support and treat those damaged as well.

    That is how it works, folks. The scales may tip in various directions according to ideologies in Government and intent in Big Business.

  • 7
    AR
    Posted Friday, 28 March 2014 at 9:10 am | Permalink

    While the logic of that statement might be a bit wanting — don’t work with industry because there’s no evidence involving industry “is safe or effective”” - I see no lack of logic here BK except in your continuing jihad against public health advocacy.
    I used to think that your increasingly unhinged articles were job applications to mudorc’s news corpse but it seems that I was wrong.
    What you are really seeking is an IPA sinecure.

  • 8
    R. Ambrose Raven
    Posted Friday, 28 March 2014 at 10:04 am | Permalink

    No need to talk to them; their representatives will be constantly lobbying politicians.

    Regulation of Big Obesity (the fast food industry) is exactly as it would like it – nonexistent. Let us rejoice that this total lack of effective regulation is allowing Big Obesity’s advertising to do exactly what it wants - selling unhealthy food to children and adults alike.

    Naturally, Big Obesity will throw money at convincing our politicians and the voting public of the evils of another tax, in this case on the unhealthy (“fast”) food that earns Big Obesity so much profit. As a Parliamentary researcher noted, “to date, the Australian response to this issue has emphasised the value of a self regulatory regime. However, this approach may be modified in the future, as a result of a number of factors. These include growing public demand for intervention and a shift in health policy more towards preventive health than has been emphasised in the past.”

    In 2009, Kevin Rudd’s hand-picked Preventative Health Taskforce called for legal action against tobacco companies to recoup health costs. It also wanted junk food ads to be banned until after 9pm and new health labels required on packaged food under a blueprint to make Australia the world’s healthiest nation.

    Big Obesity is of course completely opposed to such a reasonable step as limits on junk food advertising. Australian Food and Grocery Council head lobbyist Kate Carnell criticised a 2011 plan as “nothing but censorship”. Ms Carnell cited a Productivity Commission finding that it was “difficult to discern a relationship between advertising and body weight”. Yet they had managed to overlook a 2006 U.S. National Bureau of Economic Research study that found that “… a ban on [fast-food restaurant advertising] advertisements would reduce the number of overweight children ages 3-11 in a fixed population by 18% and would reduce the number of overweight adolescents ages 12-18 by 14%.”

    In the 2010 Budget Labor took care to protect the powerful food and alcohol industries. Ms Roxon then described the preventative health policy as “a bold strategy”, causing anti-obesity campaigners to accuse the government of ignoring public support for such measures to favour the interests of the food and alcohol industries.

    Now, of course, given Abbott’s war on regulation, Big Obesity has even less need to protect its interests at our expense.

  • 9
    Anon
    Posted Friday, 28 March 2014 at 1:49 pm | Permalink

    CML, are you seriously saying that while big business has a motive based on self-interest, all public health lobbyists are concerned with, and only with, the well being of the population? You don’t think some public health lobbyists might not too have vested interests? For instance, couldn’t it be the case that some of these lobbyists may have jobs in the public health bureaucracy, and as that grows their job prospects, pay and influence grow. Could it not also be the case that they may have jobs in academia, with greater spending on public health campaigns providing greater opportunities for research funding and consultancies.

    Don’t get me wrong, I do believe that many public health advocates are doing what they do because they truly believe they are doing the right thing. Just as many people in big business (food, alcohol etc) are trying to make money. However, to paint one side as completely honest, and good, and wholesome, and the other as entirely compromised, is incredibly naive. Reality is almost always shades of grey.

  • 10
    rhwombat
    Posted Friday, 28 March 2014 at 3:10 pm | Permalink

    Anon @#9.

    Bullshit. CML is absolutely correct, and you (and BK - who at least has the honesty to sign his name to this tendentious crap) are desperately trying to divert from the obvious. The fact that you pathetically cite the salaries and influence of those of us who work in public health as moral equivalents to the obscene selfishness of your bleating about not really being evil scum who lie and distort for profit demonstrates your moral bankruptcy. Let’s see: Slavery, Tobacco, Alcohol, Drugs,

    We count lives and their quality: you count dollars and possession. Compared to you and your commercial fellow travellers (including the Shareholding, Financing, Management, Legal, Advertising, Media, Political,”Academic” (Professor of Marketing - really?), Retired and Trust-Funded members of Capitalist Society Inc.) we are completely honest, good and wholesome, and you are entirely compromised.

  • 11
    Anon
    Posted Friday, 28 March 2014 at 4:34 pm | Permalink

    rhwombat, I hope this was a joke email, because it really reads like the kind of immature response a 14 year old would make. If it is not, please let me know so I can provide a proper response (or at least, as good a response as this kind of rant deserves).

  • 12
    rhwombat
    Posted Friday, 28 March 2014 at 7:02 pm | Permalink

    Anon. I’m a 57 year old physician in public and academic medical practice. I meant every word. Your post @#9 says nothing except that you refuse to accept that everyone is as venal as you. You are beneath contempt.

  • 13
    Blair Martin
    Posted Saturday, 29 March 2014 at 8:44 am | Permalink

    Since the acceptance by parties of the Left in Anglophone economies of the victory of liberal market economics in the 1980s and 1990…” - yes, and to what cost? Liberal market economics are a vicious, selfish and failed set of ideas. We are paying for the fool’s ideal that everyone can be a share holder, everyone has oodles of cash to spend and will spend that on whichever corporate behemoth has the best marketing campaign. Sickening.

  • 14
    Anon
    Posted Saturday, 29 March 2014 at 8:56 am | Permalink

    Rhwombat, your work must be impressive, considering you somehow judged me without knowing anything about my character, except that I am unwilling to characterise all participants on one side of a public policy debate as good and pure, and the other side as evil and compromised. And your displays or hubris and naivety justify that assertion. Your view of the world is incredibly simplistic, and I think despite your age, you still have a but of growing up to do.

  • 15
    Anon
    Posted Saturday, 29 March 2014 at 8:58 am | Permalink

    Bit’ of growing up. iPad not so great for typing posts..

  • 16
    R. Ambrose Raven
    Posted Saturday, 29 March 2014 at 9:23 pm | Permalink

    One more thing. I do not pay a subscription to Crikey to receive Rightist propaganda. Citizen Murdock’s The Australian/Business Spectator has loads of transnational-serving opinion, plus lots of other news, and is cheaper.

  • 17
    R. Ambrose Raven
    Posted Saturday, 29 March 2014 at 9:28 pm | Permalink

    Rhwombat is far more likely to be correct than Anon. There is money in selling profit-seeking ill-health. There is no money in promoting good health. We are not talking of equals and opposites but, as with Big Tobacco, one side driven by greed and contemptuous of people and the public interest, against the other which is instantly accused of bias and of being anti-business if it so much as whispers.

  • 18
    Tyger Tyger
    Posted Sunday, 30 March 2014 at 2:58 am | Permalink

    It also doesn’t address the fact that economic growth in an open liberal market economy like Australia’s has not prevented an increase in life expectancy by more than five years since the mid-1980s, despite the onslaught of multinational corporation influence on Australian diets.”

    It’s important to recognise countervailing factors at work here: better medical treatment; declining infant mortality rates; fewer road and work-related deaths; far fewer smokers; and so on; versus overeating; more sedentary lifestyles; and an increase in the rate of related conditions like type 2 diabetes. In short, to put another slant on your own words, life expectancy probably has improved since the mid-1980s “despite the onslaught of multinational corporation influence on Australian diets”, and would almost certainly have improved more without it.

  • 19
    Altakoi
    Posted Monday, 31 March 2014 at 11:19 am | Permalink

    Apparantly makingt the decisions where to place outlets, what products to make available, and at what price as well as the assumed right to saturate the population with media promotion is not in any way seen as paternalistic when practised by corporations. Presumably this is because decisions taken in boardrooms are supposed through the magic of capitalism to represent the wishes of consumers despite them not being on these boards, not owning the company and not being asked. However, trying to influence where to place outlets, what products are available and what price and using very much more limited media campaigns to try and influence behaviour is outrageous nanny statism when practiced by health departments. Because, apparantly, people have no say in what Governments do by actually voting, writing to their politicians and lobbying for change.
    The criticism that people should be left to make their own decisions would actually be fine if they were currently being left to make their own decisions. Stop the advertising, the backing of sports figures, the promotion of big events, the push to make products available at all times of the day and night. Then we might not have a problem, and then public health officials could spend their time doing reacting to something else.

  • 20
    Altakoi
    Posted Monday, 31 March 2014 at 11:22 am | Permalink

    Apparantly makingt the decisions where to place outlets, what products to make available, and at what price as well as the assumed right to saturate the population with media promotion is not in any way seen as paternalistic when practised by corporations. Presumably this is because decisions taken in boardrooms are supposed through the magic of capitalism to represent the wishes of all consumers despite them not being on these boards, not owning the company and many not being asked. However, trying to influence where to place outlets, what products are available and what price and using very much more limited media campaigns to try and influence behaviour is outrageous nanny statism when practiced by health departments. Because, apparantly, people have no say in what Governments do by actually voting, writing to their politicians and lobbying for change.
    The criticism that people should be left to make their own decisions would actually be fine if they were currently being left to make their own decisions. Stop the advertising, the backing of sports figures, the promotion of big events, the push to make products available at all times of the day and night. Then we might not have a problem, and then public health officials could spend their time doing reacting to something else.

  • 21
    Observation
    Posted Monday, 31 March 2014 at 4:14 pm | Permalink

    Hmmm….big business sitting down with government to construct policy…like say…the mining tax?

    Unfortunately I think the spin doctors and high power solicitors big business would run rings around the public service sector in negotiations. No offence to the people in the government and PSS but lets face it, the corporations would have more people, more firepower and more money to win the day in their favor. And their favor is profits.

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