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