Can BRICS chart new directions in public health?



Last week, the BRICS nations—Brazil, Russia, India, China and South Africa– met in Durban, South Africa, to create a new set of financial institutions designed to better meet their needs than the World Bank and the International Monetary Fund.  They took steps to create their own credit rating agency and a BRICS Development Bank designed to fund infrastructure and sustainable development projects.


These new developments highlight the rapid growth of BRICS and their growing global influence.  A recent report by the United Nations Development Program noted that “for the first time in 150 years, the combined output of the developing world’s three leading economies – Brazil, China and India – is about equal to the combined GDP of the long-standing industrial powers of the North”.


As BRICS nations develop, industrialize and urbanize, they are also becoming the world’s leading producers of chronic diseases and injuries – the by-products of the western model of consumption oriented economic growth.  And here the question is will BRICS nations take a different path in public health than the western nations that have increasingly allowed market forces to set public health policy?


Two recent policy debates in South Africa illustrate the tensions.  Last month, South Africa’s Department of Health announced new regulations designed to lower the salt (sodium) content of certain categories of food manufactured in South Africa.  Research studies had shown that South Africans had higher salt intake than other populations. South Africans also have one of the highest rates of hypertension worldwide. An estimated 6.3 million people are believed to be living with high blood pressure in SA, making them more susceptible to life-threatening diseases like stroke and heart disease. Lowering the salt content in the foods most associated with salt intake was described as a cost effective measure to lower health care costs associated with NCDs.  Initially, many major South African industries supported the new regulations, claiming it would create a more level playing field for all food companies.  The Department of Health consulted extensively with food industry representatives and modified the regulations in response to industry suggestions. 


Outside experts hailed South Africa for taking such concrete steps for reducing salt or sodium consumption. Professor Graham Macgregor, chairman of the World Action on Salt and Health (WASH) described South Africa as taking a “pioneering” role in salt reduction programmes. “Achieving a long and healthy life, free from disease,” he said, “is a right not just for South Africans but for everybody in the world. It is time that Western governments stopped being pressurised by their tobacco and food industry and follow South Africa’s example by setting specific targets for reducing non-communicable diseases (NCDs), including salt reduction to less than 5g a day, particularly in developing countries where the major burden of NCDs lies.”


But after the regulations were issued, the Consumer Goods Council, the trade association representing South African food manufacturers, changed its tune.  In a statement, it said the Council was:

shocked and disappointed by the article regarding the salt reduction regulations. Following the process of policy promulgation(salt reduction), the CGCSA on behalf of its food members wrote to the Minister of Health on alternative approaches to ensure effective implementation of this initiative. The industry fully supports the goal of reducing salt in order to enhance public health. However, we are concerned that should these alternative measures not be taken into consideration, the impact of these good intentions will not be effective due to a number of reasons such as unrealistic timelines; lack of consumer education and cost implications as per the proposed draft regulations.


Some knowledgeable observers attributed the change in industry position to lobbying by multinational food companies, who feared that the South African regulations might set a precedent other countries would follow.


In another example of industry involvement in public health policy in South Africa, last week the government of Western Cape Province abruptly withdrew proposed regulations to restrict Sunday sales of alcohol only a few days before they were to go into effect.  Western Cape Province is led by the Democratic Alliance, a political party that is regarded as more business friendly than the opposition African national Congress Party.  Commenting on the apparent about-turn by the DA‚ the opposition party the African National Congress (ANC)‚ said the decision was a “political ploy by the DA after in realized that big business‚ its key constituency  would be the hardest hit.” The ANC generally supported the by-law because alcohol abuse was a “serious problem in our communities”. South African Liquor Traders Association president Saint Madlala welcomed the decision on Thursday but said “they should not keep us in suspense‚ they should just scrap the whole idea” of restricting alcohol sales.


BRICS nations differ from each other politically and economically and face internal as well as external pressures to follow rather than guide market influences. But the Durban meeting showed the potential for emerging nations to chart new paths for sustainable development and human-oriented economic growth.  In this context, the continued vulnerability of South Africa –and other BRICS nations-   to corporate pressure to weaken public health protection shows that like Western nations, BRICS countries will need to find new ways to protect their people’s health from corporate interference.