Industry influence: a barrier to progress in public health policy
SPECTRUM researchers Professor Mark Petticrew and Professor Jeff Collin discuss the influence of powerful unhealthy commodity industries as a significant barrier to progress in public health policy.
The consumption of health harming commodities such as tobacco, alcohol and foods high in fat, salt and sugar are causes of non-communicable diseases (NCDs) and drivers of health inequalities in the UK and worldwide. NCDs such as cancer, heart disease, diabetes, liver and lung disease and stroke are estimated to account for 89% of all deaths in the UK1.
There are clear, evidence-based policy options available to reduce the burden of harm from NCDs, including measures to reduce consumption of health harming commodities by increasing the price, controlling availability and restricting marketing.
While there is a clear evidence base on the most productive and cost-effective policy options to prevent and reduce harm from NCDs, there remain barriers and challenges to their implementation. One of the most significant barriers to progress is the influence of powerful corporate actors on the policy process.
Strategies designed to influence
The adverse influence of unhealthy commodity industries (UCI) in public health policy is well documented, with similar strategies and approaches employed across different commodities2.
These can include influencing the creation of evidence, questioning the effectiveness of statutory regulation, and forming alliances with other sectors or the public to give the impression of support for industry positions.
UCIs employ these strategies to obstruct the most effective interventions to improve public health out of a fear of lost revenue. Instead, they use their influence to undermine evidence, and obstruct, delay and weaken regulation, compromising public health goals2.
Misinformation and manufacturing doubt
Another common approach taken by UCIs is the dissemination of misinformation to the public and to schoolchildren3 about the harms of their products, often through Corporate Social Responsibility (CSR) organisations and industry-funded charities. This misinformation can come in the form of ‘dark nudges’ – which are used to promote mixed messages about harms and to undermine scientific evidence4.
Alternative causation arguments are used by UCIs to present alternative, misleading explanations for product harms in an effort to downplay their risk. The tobacco industry is well known for this strategy, promoting alternative causes for lung cancer in an effort to cast doubt about the link to smoking.
Recently published research5 from colleagues at the London School of Hygiene and Tropical Medicine and Imperial College London has shown that alternative causation arguments used by industry to dispute product-harm relationships are creating public uncertainty about health risks. Using real world statements, the study found that exposure to industry sponsored messages significantly increases uncertainty or false certainty about products links with harms.
Signalling virtue while promoting harm
Recent examples of UCI actions during the COVID-19 pandemic also illustrate the vulnerability of public health policies to corporate capture.
Published by SPECTRUM and the NCD Alliance6, the “Signalling virtue, promoting harm” report exposes UCI tactics during the global COVID-19 pandemic, with hundreds of examples from across the world. The report highlights the exploitation of the pandemic by UCIs to advance preferred policy positions, particularly as governments struggle to reconcile health objectives with economic and trade imperatives.
The examples contained in the report indicate an extraordinary range and scale of responses to COVID-19 from UCIs, reflecting extensive efforts on the part of these industries to be viewed as contributing to the pandemic response. These activities serve to promote these industries’ core interests by promoting products, enhancing reputations, and building political influence. They distract from the role of UCIs in harming population health, which made us more vulnerable to COVID-19.
Collectively, the actions outlined in the report raise concerns about the prospect of the involvement of UCIs in the pandemic response directing public policy efforts away from broader health and social goals and towards the entrenchment of industry interests.
Taking steps to limit future industry influence
It is vital that policy makers are made aware of attempts by UCIs to influence their decision-making and the need to actively manage conflicts of interest in public health policy.
As part of wider efforts to highlight the issue, SPECTRUM recently produced a briefing for MSPs ahead of a meeting of the Scottish Parliament’s Cross Party Group (CPG) on Improving Scotland's Health. The briefing brings together evidence on the strategies and approaches used by UCIs to influence policy and includes a set of recommendations for policy makers.
The CPG has a focus on preventing NCDs by reducing risk factors from health harming commodities, in particular tobacco, alcohol and unhealthy food. In recognition of the inherent conflict of interest which commercial operators who produce and sell these commodities have with the aims of the CPG, they are explicitly excluded from membership. The CPG explore evidence-based measures to prevent and reduce consumption and harm, with priority given to the World Health Organization recommendations of increasing price, controlling availability and restricting marketing.
The CPG has stimulated the establishment of an NCD Prevention coalition of ten Scottish charities who have developed priorities for the current Scottish Parliament7. The Coalition will produce regular assessments of progress in delivering these priorities, the first of which was published in January 20228. Such active coordination across related agendas constitutes an important step forward in approaches to tackling NCDs. An article in the 30th anniversary issue of the journal Tobacco Control highlights the CPG as an internationally significant “collaborative forum promot[ing] coherent action to address the impacts of industrial epidemics.”9
SPECTRUM is pleased to be contributing to this crucial discussion, to limit future industry influence and allow the development of public health policies to reduce the burden of harm from NCDs.
View the SPECTRUM briefing for MSPs
- Knai, C., Petticrew, M., Mays, N., et al. (2018) Systems Thinking as a Framework for Analyzing Commercial Determinants of Health. The Milbank Quarterly: A Multidisciplinary Journal of Population Health and Health Policy, Vol 96
- van Schalkwyk MCI, Petticrew M, Maani N, Hawkins B, Bonell C, Katikireddi SV, Knai C. Distilling the curriculum: An analysis of alcohol industry-funded school-based youth education programmes. PLoS One. 2022 Jan 12;17(1):e0259560. doi: 10.1371/journal.pone.0259560.
- Petticrew M, Maani N, Pettigrew L, Rutter H, van Schalkwyk MCI. Dark Nudges and Sludge in Big Alcohol: Behavioral Economics, Cognitive Biases, and Alcohol Industry Corporate Social Responsibility. Milbank Q. 2020 Dec;98(4):1290-1328. doi: 10.1111/1468-0009.12475.
- N. Maani, M.C.I. van Schalkwyk, F.T. Filippidis, C. Knai, M. Petticrew. Manufacturing doubt: Assessing the effects of independent vs industry-sponsored messaging about the harms of fossil fuels, smoking, alcohol, and sugar sweetened beverages, SSM - Population Health, Volume 17, 2022, 101009, ISSN 2352-8273. doi: 10.1016/j.ssmph.2021.101009.
- Collin J, Ralston R, Hill SE, Westerman L (2020) Signalling Virtue, Promoting Harm: Unhealthy commodity industries and COVID-19. NCD Alliance, SPECTRUM. https://ncdalliance.org/resources/signalling-virtue-promoting-harm
- Hill SE, Johns P, Nakkash RT, Collin J. From silos to policy coherence: tobacco control, unhealthy commodity industries and the commercial determinants of health. Tobacco Control 2022;31:322-327.