The Capital NCD-Nexus: The Commercial Determinants of Health and Global Capital Flows

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Cross-border Merger and Acquisitions  purchases in food, beverages, and tobacco. Source: World Investment Report 2018, Table 10 (Annex); calculations and illustrations by CPC Analytics. Note: The average M&A value in the sectors food, beverages, and tobacco between 2000 – 2009 is calculated by excluding the two crisis years. Credit

In the past, the role of global capital flows for health has not been considered in the debate about key risk factors of Noncommunicable Diseases (NCDs). This is a blind spot in public health. A significant share of the global food and beverage industry is owned by institutional investors. Cross-border mergers and acquisition volumes in the food, beverage, and tobacco industries have substantially increased. Progress on preventing and controlling NCDs requires the public health community to engage in a forward-looking discussion to address investors’ responsibility in relation to global health in general and the tsunami of NCDs in particular.

Citation: Franz C, Kickbusch I. The Capital NCD-Nexus: The Commercial Determinants of Health and Global Capital Flows  Eurohealth 2018;24(3): 21-25.

Reducing Harmful Corporate Influences on Diet-Related Non-Communicable Diseases

Cross-posted from CUNY Urban Food Policy Institute

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Seven years ago, the first United Nations High Level Meeting on Non-Communicable Diseases (NCDs — the public health term for chronic diseases) met to discuss the growing health, social and economic burdens NCDs were imposing on high, middle- and low-income countries around the world. A World Health Organization report prepared for the UN meeting concluded that four risk factors — tobacco use, unhealthy diets, alcohol use and physical inactivity accounted for the vast majority of the rising prevalence of premature deaths and preventable illnesses from conditions like cardiovascular disease, diabetes, stroke, hypertension and some forms of cancer. Later, the UN and WHO set the goal of reducing premature deaths — those before age 70 — by 25% by 2025, a goal that has proved elusive. Here in the United States and New York City and around the world, NCDs are a leading cause of persistent inequities in health between the better off and the poor and in the US between Blacks and other people of color and whites. 

In seeking to achieve these reductions, the public health community has launched three different — although sometimes intersecting — strategies. The first seeks to change individual behavior through education, counseling and support. These strategies encourage and support people to quit or not start smoking, eat healthier diets, stop or reduce alcohol consumption and become more physically active. This approach is an essential foundation for reducing NCDs but by itself it has shown disappointing results in bringing about population level change.

The second strategy is to change the behavior and practices of health care systems– provide more people with access, emphasize clinical and community prevention, and ensure that every health care worker applies what is known about prevention and early intervention for NCDs. This too is an essential foundation for reducing the burden of NCDs. But as public health researchers deepen our understanding of the profound influence of what are called social determinants of health and the challenge of transforming health care systems that have mostly focused on treatment rather than prevention, the limits of this strategy of changing health care to reduce NCDs have also been recognized.

The third strategy, the focus of the CUNY Urban Food Policy Institute’s Forum on Reducing Harmful Corporate Influences on Diet-Related Non-Communicable Diseases on September 26, 2018, seeks to change the behavior of the corporations that have played such a powerful role in promoting the behaviors that contribute to NCDs. This approach examines the business practices of food, alcohol, tobacco and pharmaceutical corporations — their marketing, product design, pricing and retail practices — to identify opportunities for changing practices that contribute to NCDs. It also puts the spotlight on corporation’s political practices such as lobbying, campaign contributions, sponsored science and philanthropy to illuminate their influence in weakening or strengthening public health protection. By limiting corporate political practices that undermine public health, we can prevent disease and perhaps strengthen democracy.

To explore these topics, three speakers summarized some of what we have learned in the last seven years.

Jeff Collin, Professor of Global Health Policy at the University of Edinburgh discussed Limiting Corporate Interference in Health Policy: Lessons from across Tobacco, Alcohol and FoodView his presentation here.

Paula Johns, General Director, ACT Health Promotion – Brazil spoke on The Role of Global and National Civil Society Groups in Reducing Harmful Corporate Influences on Food Policy.

Neena Prasad, Director of Obesity Prevention Program, Bloomberg Philanthropies, described  Lessons from the Obesity Prevention Program, a multi-year effort to support public health policies aimed at improving the food environment in Mexico, Brazil, Colombia, the Caribbean and South Africa.

Nicholas Freudenberg, Distinguished Professor of Public Health at the CUNY Graduate School of Public Health and Health Policy and Director of the CUNY Urban Food Policy Institute moderated the discussion.

To view the resources the speakers suggested for those who want more information, click here.

To view the video of the forum on September 26, 2018, click here.

People’s Health Movement: A Call to Action on Nutrition, Food Security and Food Sovereignty

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In a commentary, in World Nutrition,  David Sanders, Claudio Schuftan, and Vandana Prasad write, “There are common roots underlying both under and ‘over-nutrition’ in our globalized world. These pertain to the impact on food systems of current practices related to food production, processing, manufacture, distribution, trade and commerce, as well as to the power differentials between those who are most affected by and those who benefit most from the current food system.

The unregulated penetration of food and beverage companies and the aggressive marketing of processed and ultra-processed foods have been severely compounding the problem of malnutrition and the underlying food insecurity.  This process is driven by mega agribusiness conglomerates and transnational food and beverage corporations through the employment of technologies and practices that are energy intensive and ecologically unsustainable, and that are also implicated in environmental degradation and climate change… In sum, malnutrition in all its forms, food insecurity and the erosion of food sovereignty are all socially and politically determined.  It is inadequate to acknowledge the continuing crisis of malnutrition and the inequalities it engenders without addressing their political roots and the conditions that perpetuate this.”

Four Recent Books on the Political Economy of Global Health

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Four recent books dealing with the political economy of global health are reviewed in a recent issue of Critical Public Health.  Drawing on the material covered in these sources, the reviewer argues that the concepts of capitalism, imperialism and class (at the national and global levels) are fundamental to a critical public health in the present era of economic globalization.

Analysis of corporate political activity strategies of the food industry: evidence from France

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A new study in  Public Health Nutrition  analyzed the corporate political activity (CPA) of major food industry actors in France. The  analysis shows that the main practices used by Coca-Cola and McDonald’s were the framing of diet and public health issues in ways favorable to the company, and their involvement in the community. The French National Association of Agribusiness Industries primarily used the ‘information and messaging’ strategy (e.g. by promoting deregulation and shaping the evidence base on diet- and public health-related issues), as well as the ‘policy substitution’ strategy. Nestlé framed diet and public health issues and shaped the evidence based on diet- and public health-related issues. Carrefour particularly sought involvement in the community. The authors found that, in 2015, the food industry in France was using CPA practices that were also used by other industries in the past, such as the tobacco and alcohol industries. Because most, if not all, of these practices proved detrimental to public health when used by the tobacco industry, we propose that the precautionary principle should guide decisions when engaging or interacting with the food industry.

Public Procurement of Food in Canada

Unhealthy foods are widely available in public settings across Canada, contributing to diet-related chronic diseases, such as obesity and diet-related diseases especially among vulnerable groups, including children and seniors. Healthy food procurement policies, which support procuring, distributing, selling, and serving healthier foods, have recently emerged as a promising strategy to counter this public health issue by increasing access to healthier foods. Although numerous Canadian health and scientific organizations have recommended such policies, they have not yet been broadly implemented in Canada.  To inform further policy action on healthy food procurement in a Canadian context, the authors conducted an evidence synthesis to assess the impact of healthy food procurement policies on health outcomes and sales, intake, and availability of healthier food. Based on this review, they recommend policies and practices for governments, publicly funded institutions, decision-makers and professionals, citizens, and researchers. They conclude that implementation of healthy food procurement policies can increase Canadians’ access to healthier foods as part of a broader vision for food policy in Canada.

Citation: Raine KD, Atkey K, Olstad DL,  et al. Healthy food procurement and nutrition standards in public facilities: evidence synthesis and consensus policy recommendations. Health Promot Chronic Dis Prev Can. 2018 ;38(1):6-17.

Holding Food Companies Responsible for Unhealthy Food Marketing to Children: Can International Human Rights Instruments Provide a New Approach?

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Public health advocates argue that unhealthy food marketing to children infringes children’s rights, given its link to obesity, and that states have an obligation under the UN Convention on the Rights of the Child (‘UNCRC’) to protect children from such marketing. This article explains how international human rights concepts could be used to impose obligations directly on companies to modify their practices to protect children from unhealthy food marketing. We draw on the global governance framework that creates human rights obligations for businesses, and evaluate voluntary codes and initiatives on responsible marketing to children in Australia, to see whether they satisfy the obligations imposed under this framework and the UNCRC. Finding significant limitations in these measures, we set out recommendations for how the food industry could take an approach to food marketing that places children’s best interests as a primary consideration.

Citation: Handsley E, Reeve B. Holding Food Companies Responsible for Unhealthy Food Marketing to Children: Can International Human Rights Instruments Provide a New Approach?  University of New South Wales Law Journal, 2018 (41)2: 1-41.

90% of calories consumed by U.S. residents come from the commercial food sector

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Source:  USDA, 2018 from 2012-13 data.

This chart recently released by the USDA’s Economic Research Service shows that more than 90 percent of the calories consumed by U.S. residents come from the commercial food sector: supermarkets and other food stores, restaurants and other food service outlets.  Fewer than 10 percent of calories come from those sectors of the food system controlled by the public (e.g., school food), individuals or nonprofit organizations.  Since the composition of commercial sector food is highly controlled by giant food corporations, these products are more likely to be the high in fat, sugar and salt. The global food system is built on the more profitable highly processed products that are easier to store, ship and market, even though they are the primary causes of the global epidemics of diet-related diseases.

Nutrition and public health researchers and food advocates should be asking: what would it take to increase the less than 10 percent of calories that comes from sources other than Big Food to 15 or 20 percent?  And how can the non-commercial food sector—food systems controlled by public and civil society groups– serve as both a healthier alternative to and a competitive pressure on transnational corporate food producers?

In NAFTA Talks, U.S. Tries to Limit Junk Food Warning Labels

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Source: OECD Obesity Update 2017

Urged on by big American food and soft-drink companies, reports the New York Times,  the Trump administration is using the trade talks with Mexico and Canada to try to limit the ability of the pact’s three members — including the United States — to warn consumers about the dangers of junk food, according to confidential documents outlining the American position.

The Mexican government support for such restrictions “is one of the most invasive forms of industrial interference we have seen,” Alejandro Calvillo, the founder of El Poder del Consumidor, or Consumer Power, a health advocacy group in Mexico told the New York Times. Heading off pressure for more explicit warnings through the NAFTA negotiation is especially appealing to the food and beverage industry, writes the Times, because it could help limit domestic regulation in the United States as well as avert a broad global move to adopt mandatory health-labeling standards.  “It kind of kills a law before it can be written,” said Lora Verheecke, a researcher at the Corporate Europe Observatory, a group that tracks lobbying efforts. “And once you put it in one trade agreement, it can become the precedent for all future deals with future countries.”

Sustain, an alliance of advocates in the United Kingdom working for better food and agriculture policies and practices, summarizes some of the ‘”barriers to trade” that a 2017 report by the  US Office of the Trade Representative identified:

  • Additional nutritional labelling such as traffic light labels in the UK and Ireland. The US is arguing that these initiatives must remain voluntary.
  • South Africa’s plans to introduce a sugary drinks tax in 2016. The US raised concerns that the tax would effectively discriminate against sugary drinks. The move jeopardizes $5m of US sugary beverage exports
  • Proposals by six Gulf states to regulate energy drinks, including introducing labelling statements about recommended consumption. (One estimate puts this market at $2bn.)
  • Efforts by Chile to clearly label products high in sugar, salt and saturated fat and restrict junk food marketing on packaging to children. The US has referred the Chileans to the WTO saying delays and repackaging has cost the US firms ‘millions of dollars’ in lost sales
  • A food act in Peru introducing mandatory front of pack warnings for pre-packaged foods high in sugar, salt and fat and restrictions on junk food advertising to children and young people
  • Indonesia’s attempts to introduce nutritional labelling for pre-packaged and fast food along with and regulations to limit advertising and health claims aimed at children.