TRUTH, POWER AND PROFITDistorting truth and exploiting fear for profit

24 March 2021

COMMERCIAL DETERMINANTS OF HEALTH

24 March 2021

Social determinants of health

• The non-medical factors that influence health outcomes

• The conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.

• These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.

Sir Michael Marmot2008

Commercial determinants of health

Disclaimer

• Personal views and not necessarily those of La Cote church or WHO

• Not all companies and multi-nationals are the same

• Not intended to be personal

• Not intending to occupy the moral high ground – apologies if I end up doing so!

Tobacco• 1920s. German scientists noted association between smoking and cancer

• 1949. Sir Richard Doll, epidemiologist, started research• 1951. Wrote to 59,600 doctors and asked about their health• In a 4-year period, 200 heavy smokers dies, negligible mortality in non-smokers

• 1953. Survey of Cancer Research (confidential report by Claude Teague)• Written for upper management at RJ Reynolds, makers of Camel cigarettes, concluded that the parallel

rise in cigarette use and cancer had led to the suspicion that tobacco was ‘an important etiologic factor in the induction of primary cancer of the lung’.

• Teague observed that clinical data were confirming the relationship, and concluded that the large body of animal experimental work ‘would seem to indicate the presence of carcinogens’

Tobacco strategy (Merchants of Doubt. Naomi Oreskes & Erik Conway)

• 09 May 1979, Colin Stokes, former chair RJ Reynolds, convened meeting of Tobacco industry executives

• Frederick Saitz, President of American Academy of Science, Former advisor to NATO• RJ Reynolds Research scholarships – degenerative diseases ($ 45m over 6 years)

• ‘an obligation of corporate citizenship’• ‘Contribute to the prevention and cure of diseases for which tobacco products have been blamed’• To produce ‘an extensive body of scientifically, well-grounded data useful in defending the industry

against attacks’• ‘keep the controversy alive’• So long as there was doubt about the causal link, the tobacco industry woud be safe from litigation and

regulation.’• Bad science: A Resource Book – a how-to-handbook for fact fighters providing examples

of successful strategies for undermining science.

Tobacco strategy

• Use science to undermine science• Create doubt• Delay

Tobacco Control 2012

19 March 2021

The Guardian

19 March 2021

The Guardian

Mapping the web of influence: Conflict of interest and the corporate capture of science, civil society and policy David Miller. University of Bath, UK

• EU level - Social Network Analysis Mapping Exercise of the organisational structure of industry influence activities –Food, alcohol, tobacco, gambling.

• Compiled data from various public sources on memberships, interlocks and affiliations (trade association directory, expert group register, transparency register, organisational website)

• Supplemented by political economy, publication analysis, interviews, grey materials, leaked and FoI documents

http://pressclub.ch/health-governance-in-the-public-interest/?lang=en

The web of influence: Industry networks

• Industrial actors engage in a range of tactics and strategies in order to influence the policy process.

• Corporations and their proxies form complex networks across multiple levels of governance in order to develop and extend favourable trading conditions.

• Such strategies are not always successful, but they are comprehensively and consciously planned and relatively unexplored.

David Miller. Univ. Bath, UK

Multiple corporate voices

17 memberships

David Miller. Univ. Bath, UK

Multiple corporate voices (Coca Cola)

Coca colaLobby groups/think tanks Trade associationsCSR Europe - The European business network for CSR European Fruit Juice AssociationTransatlantic Policy Network European Brands AssociationAdvertising Education Forum Beverage Industry Environmental RoundtableFriends of Europe Better Sugarcane InitiativeEU Pledge Committee of Industrial Users of SugarEuropean Food & Drink Council European Food Law AssociationInternational Life Science Institute European Bioplastics

Lobby firmsEuropean Organization for Packaging and the Environment

Interel European Affairs (since 11/2013) European Technical Caramel AssociationEPPA SA European Water PartnershipEU Issue Tracker / Shungham Information FoodDrinkEuropeDods International Sweeteners Association

PET user alliancePeak business associations Regfrigerants, Naturally!American Chamber of Commerce to the EU SAI - Sustainable Agriculture InitiativeBritish Chamber of Commerce in Belgium Sustainability ConsortiumPolicy fora Union of European Beverages AssociationsEU Platform on Physical Activity, Diet and Health World Federation of Advertisers

David Miller. Univ. Bath, UK

Multiple corporate voices (Philip Morris)

Philip MorrisTrade Associations American Chamber of Commerce of LithuaniaAmCham EU AmCham SpainThe American European Community Association (AECA)

Confederacion Espanola de Organizaciones Empresariales

International Trademark Association Spanish Tobacco RoundtableBusinessEurope Ass. Industrial PortuguesaEuropean Smokeless Tobacco Council Centromarca

British Chamber of Commerce Unindustria (Confindustria)VBO-FBE EconomiesuisseAPRAM Lobby group/think tankLES France Tobacco Industry PlatformEuropean Communities Trade Mark Association Trans-Atlantic Business Council (TABC),MARQUES European Policy Centre (EPC), AmCham Germany Kangaroo Group,Bund fur Lebensmittelrecht & Lebensmittelkunde European Risk Forum (ERF),Europaischer Wirtschftssenat Public Affairs CouncilWirtschaftsbeirat der Union e.V.American Chamber of Commerce of Estonia Lobby firmAmerican Lithuanian Business Council CNC - Communications & Network Consulting AGLithuanian Confederation of Industrialists, FELULA SA Investors' Forum Pandic

David Miller. Univ. Bath, UK

Multiple corporate voices (Nestlé)

NestleLobby group/think tank Trade AssocationsAdvertising Education Forum European Brands AssociationCentre for European Policy Studies Association of chocolate, biscuit and confectionery

industries of the European UnionEuropean Policy Centre European Cereal Breakfast AssociationEuropean Roundtable of Industrialists Committee of Industrial Users of SugarEuropean Food Information Council Culinaria EuropeResponsible Advertising and Children European Coffee federationSAI Platform – Sustainable Agriculture Initiative European Dairy AssociationInternational Life Science Institute European Federation of Bottled Water

European Association of Dairy TradeLobby firm European Ice Cream AssociationWeber Shandwick European Organization for Packaging and the

EnvironmentPolicy fora Medical Nutrition InternationalHigh Level Forum for a Better Functioning Food Supply Chain

Specialised Nutrition Europe

EU Platform for Action on Diet, Physical Activity and Health

European Pet Food Industry

European Alliance for Apprenticeships FoodDrinkEuropeAdvisory Group on Food Waste Union of European Beverages AssociationsEuropean Food Sustainable Consumption and Production Round Table

World Federation of Advertisers

David Miller. Univ. Bath, UK

Science and civil society

• The purpose of ‘front groups’ and ‘astroturf’ is to give the erroneous impression that business views are held by a range of groups

• They require to be deceptive and secretive to work.

David Miller. Univ. Bath, UK

Think tanks and policy planning

• EPC – covert lobbyist for Big tobacco (and Food and Alcohol)

• Kangaroo Group – key avenue for Tobacco access to policy makers

• ICAP – collective think tank for big alcohol• ECPA and FoE – foster collective interests of big

business including addiction related business

David Miller. Univ. Bath, UK

Marketing and advertising industry as public health challenges

• Addictive industries closely aligned with the advertising/marketing/ sponsorship/ media and PR industries

• Close working relationships to defend commercial communications against regulation;

• Significant investment in academics to attack public health messages

David Miller. Univ. Bath, UK

Corporate influence of science

• Corporate funding of science related groupings: eg ILSI, EUFIC

• Contaminate the supply of expertise, undermine science-based assessments – egEFSA

• Lack of understanding and acceptance of conflict of interest rules among scientists and journals

• Inadequate monitoring of conflict of interest mechanisms

David Miller. Univ. Bath, UK

Policy capture: Partnership governance

• The advent of ‘partnership’ governance where public policy is not simply ‘influenced’ but is actually co-created and delivered by the private sector.

• This raises new questions about industrial actors and their relations with policy makers.

• Enshrines ‘voluntary’ approaches to compliance.

• Binding regulation, not co-regulation needed

David Miller. Univ. Bath, UK

Coca Cola CompanyMission• To refresh the world• To inspire moments of optimism and happiness

• Global Energy Balance Network• “independent research organisation mission”

• Reframe obesity as a problem of energy balance• Promote reduction strategies that are commensurate

with Coca Cola’s interests

• Coca Cola see GEBN as a “weapon” in the “growing war between the public health community and private industry” over obesity

Reframing truth / facts for corporate interests

And much, much more ….

Is there a problem with any of this?

• ?Reasonable and standard business practice• Auto industry• Tourism• Televisions / IT equipment

• Is it different because the respective commodities (so profoundly) affect health and survival?

Breastfeeding and Breastmilk Substitutes

• Breastfeeding is the single-most effective health intervention to improve survival, health and development of children

In 2016, improving breastfeeding practices would have saved about 820,000 U5 children

Breastfeeding practices over time

Population-weighted averages from 217 surveys

Many factors influence breastfeeding rates- Individual level

- Confidence- Past experiences- Family views- Medical conditions*

- Support available- Work environment- Societal perspectives

“If breastfeeding did not already exist, someone who invented it today would deserve a dual Nobel Prize in medicine and economics.”

Keith Hanson, Vice President for Human Development,

World Bank Group

Trends in sales of breastmilk substitutes (BMS)

18,699 19,323 19,691

20,486 21,006

21,94123,259 25,770 27,778 30,109 31,913

34,06637,407

41,06244,809 48,960 53,629 58,854 64,525

70,660

3.3%

1.9%

4.0%

2.5%

4.5% 6.0%

10.8%

7.8%8.4%

6.0%6.7%

9.8% 9.8%9.1%

9.3%9.5% 9.7% 9.6% 9.5%

0%

2%

4%

6%

8%

10%

12%

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

Year

-on-

Year

Gro

wth

%

Reta

il Sale

s (US

$ milli

on)

Total Milk Formula Market by Category Volume/Value

�In 2014, global sales of all baby milk formula were about US$ 44.8 billion �By 2019, the market value was projected to reach US$ 70.6 billion.

2000 20032001 20042002 2005 2007 20102008 201120092006 2012 20152013 20162014 2017 2018 2019

Commodity vs. marketing

6 things BMS MARKETING does to INFLUENCE mothers

1. Segment populations2. Normalise bottle feeding3. Get mothers early4. Build a relationship as partner in care5. Make bottle feeding aspirational6. Provide emotional reassurance

Promoting … lifestyle

Decisions being promoted on lifestyle rather than what is the healthy choice for the baby

The underlying (marketing) message

• “BMS is as good as breastmilk”

• Yet of the 7 studies cited• 5 published by only 3 research groups

between 1983-2013• 4 funded by Industry • Only refers to lipids• 3 papers not obviously relevant

Journal of Family Health, 2016

Words and aspirations

IQ refers to Intestinal Quality

NOTIntelligence Quotient

VITAFOODS 2017 (trade event)Infant nutrition: The business of ‘selling sleep’ and ‘peace of mind’

• Jens Bleiel remarked to an audience of fellow food professionals that infant nutrition wasn’t necessarily about the ingredients or innovation.

• “What we are selling is actually sleep,” he said. “If the baby doesn’t sleep for three nights and the mother is exhausted, the mother will change the infant formula. So that’s what we’re selling.”

• Fellow panellist Steve French, managing partner of Natural Marketing Institute (NMI) echoed these comments adding that infant food offerings were also selling peace of mind.

Vietnam• “WHO raises COVID-19 threat warning to its highest level”.• “The world is entering a decisive moment when coronavirus

disease is spreading more rapidly”

• “XXXXBaby Boost immune system” and “Prevent respiratory and digestive infections caused by viruses and bacteria”

Cows Milk Protein Allergy (CMPA)

United KingdomBetween 2010-2016• 500% increase in prescribing specialist formulas for CMPA• (105,029 Æ600,000+)• NHS spending increased by ~700% (£8.1 Æ £60m+ pa)• 2012 ESPGHAN guidelines: 10/12 authors funded by industry

• 2017 Milk Allergy in Primary Care (iMAP) guidelines: all 12 of 12 authors funded by industry

• No increase reported in Australia or US (NHANES)

NUTRA ingredients.com. News and analysis on supplements, health and nutrition - Europe

… banking on baby allergy rise to fuel demand• New Danone Facility• Opened March 2019• Euro 240 million• Focus on Specialised infant formula • Danone’s Specialised Nutrition arm

posted net sales growth of +5.9% in 2018 on a like-for-like New Danone basis

BMS digital marketing

Marketing has changed• Advertisements --> Digital presence • Focuses on building relationships

• Similac videos – ‘we’re all the same’• https://www.youtube.com/watch?v=4rXHuL2mbBs

• Aims to modify norms and values and exploit vulnerabilities• “Midnight mothers”

Proctor & Gamble “Thank You Mom” campaign

• Most successful campaign in P&G's 175 year history. • Delivered +$200 million incremental sales (USA) on the back of record-setting

P&G ROI results. • 17 Million views on YouTube.

Commodity vs. marketing

�By 2019, the BMS market value is projected to reach US$ 70.6 billion.

�Estimated that about US$ 6.3 bn spent per year on BMS marketing = about US$ 45 per every new baby born

18,699 19,323 19,691

20,486 21,006

21,94123,259 25,770 27,778 30,109 31,913

34,06637,407

41,06244,809 48,960 53,629 58,854 64,525

70,660

3.3%

1.9%

4.0%

2.5%

4.5% 6.0%

10.8%

7.8%8.4%

6.0%6.7%

9.8% 9.8%9.1%

9.3%9.5% 9.7% 9.6% 9.5%

0%

2%

4%

6%

8%

10%

12%

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

Year

-on-

Year

Gro

wth

%

Reta

il Sale

s (US

$ milli

on)

Total Milk Formula Market by Category Volume/Value

2000 20032001 20042002 2005 2007 20102008 201120092006 2012 20152013 20162014 2017 2018 2019

Industry needs to respond to the economic expectations of shareholders

…. a moral maze

BBC Radio 4

Industry and us

Conservative MPs at the 1922 Committee• "The reason we have the [COVID-19] vaccine

success is because of capitalism, because of greed, my friends.“

• Rephrased to “motivated by profit”

• OK when ‘greed’ results in beneficial outcomes in the context of a pandemic

• Exposes the tension between business, trading and health

• Outside of global crisis, which prevails –business/shareholder interests or health - in political circles and influence?

Can money from business be good?

• Is there a conflict if corporate and health outcomes are aligned?’

• Is it ok if someone makes money out of helping others improve their health?’

• Are funds from philanthropic foundations always ok?

• Are there always strings attached?

• Is it ok to use money from tobacco or arms to improve health, or is that money irrevocably ‘dirty’?

• Are there partnerships that are simply unacceptable – “incompatible partnerships”

Question …

• How do we reconcile our place in a world that is largely capitalist-based, withinherent good and bad consequences, with a world view that puts individual life and well-being ahead of commercial gain?

The world we want …• Business, policy, legislation, marketing …….. as if children matter

Impact of corporate power and marketing

• Industry has the financial resources (power) to influence normative beliefs and values • Short and long game (frogs in hot water)

• Money reinforces industry’s power• Power of marketing• Power to market

• Civil society and communities are not resourced and equipped to compete• Marketing can undermine objective and truthful information (a fundamental human

right) to make individual and collective informed decisions

How to respond• Democracy

• Swiss business initiative

• Citizen engagement• Consumer rights

• Action• Support to individuals

How to respond• Democracy• Citizen engagement• Action

He has shown you what is good; and what does the LORD require of youbut to do justice, and to love kindness, and to walk humbly with your God

‘The arc of history is long but it bends towards justice’

Thank you

Winners Take All: The Elite Charade of Changing the WorldGiridharadas' (2020)

‘how can there be anything wrong in trying to do good?... The answer may be when the good is an accomplice to even greater, if more invisible, harm.

In our era that harm is the concentration of money and power among a small few, who reap from that concentration a near monopoly on the benefits of change’