As a child, I was never awfully convinced by the strategy of turning the other cheek to assailants. The prospect of owning the moral high ground did little to allay the fear of further pain. There are times, however, when refusing to be drawn into confrontation is the pragmatically sensible course of action.
This may well be the case with the food industry’s relationship with the World Health Organization (WHO), represented most visibly by its combative director-general, Dr Margaret Chan.
In her opening speech to the 8th Global Conference on Health Promotion, held in Helsinki last month and co-hosted by the WHO and Finland’s Ministry of Social Affairs and Health, Dr Chan was as usual not pulling her punches, with the food industry and national governments in the firing line.
The food industry is always keen to stress the importance of engaging with governments, inter-governmental agencies and other civil society stakeholders in collaborative attempts to tackle diet-related health issues. Striving to be “part of the solution” has become something of a mantra. But there is little in Dr Chan’s rhetoric to suggest she has much time for industry engagement.
She spoke of the “daunting challenges” to the fight against non-communicable diseases (NCDs) represented by big business. “Efforts to prevent non-communicable diseases go against the business interests of powerful economic operators. In my view, this is one of the biggest challenges facing health promotion,” Dr Chan told the conference in her opening speech.
She accused the food industry of adopting the same approach towards the prospect of regulation that had been employed by the tobacco industry. “It is not just Big Tobacco anymore. Public health must also contend with Big Food, Big Soda, and Big Alcohol,” she said.
“All of these industries fear regulation, and protect themselves by using the same tactics.” Among these tactics, she added, was industry-funded research which “confuses the evidence and keeps the public in doubt”. Other tactics include “front groups, lobbies, promises of self-regulation and lawsuits”.
Acknowledging the political influence powerful commercial forces wield, Dr Chan also had criticism for governments that welcome industry involvement in finding solutions, characterising this as caving to the will of industry. “Market power readily translates into political power. Few governments prioritise health over big business. As we learned from experience with the tobacco industry, a powerful corporation can sell the public just about anything.”
The lack of progress on tackling the obesity epidemic was indicative of a “failure of political will to take on big business”.
She was particularly critical of governments which allow industry involvement in shaping policy. “When industry is involved in policy-making, rest assured that the most effective control measures will be downplayed or left out entirely. This, too, is well documented, and dangerous. In the view of WHO, the formulation of health policies must be protected from distortion by commercial or vested interests.”
So how does the food industry respond to such a haranguing? The International Food and Beverage Alliance (IFBA), a coalition of major food companies formed in 2008 to respond to and engage with the WHO’s 2004 Global Strategy on Diet, Physical Activity and Health, ignored the slights entirely and focused on the positive contribution it believes industry has made and can continue to make.
The IFBA said: “Since 2002, at the invitation of WHO, the food and non-alcoholic beverage industry has been engaging constructively with WHO, including on the development of the WHO 2004 Global Strategy on Diet, Physical Activity and Health and the recently-adopted WHO Global Action Plan on the Prevention and Control of Noncommunicable Diseases 2013-2020.”
It continued: “We all share a common interest in tackling the problem of noncommunicable diseases and, indeed, the UN, WHO and Member States recognise that the solution requires a whole of society approach and collaboration of multisectoral actions. IFBA and its members recognise the role we play in addressing public health challenges and have been leading the effort in reformulating products to reduce key nutrients of public health concern; providing nutrition information to consumers; restricting marketing of foods high in fat, sugar and salt to children and promoting healthier lifestyles to communities and in the workplace. We look forward to continuing our engagement with WHO on these issues.”
The industry perspective on engagement with the WHO certainly seems very different from Dr Chan’s. IFBA points out that it has participated in informal dialogues and consultations with the WHO on various issues and in the development of strategies. And there are certainly references to the importance of multisectoral actions within both the 2004 Global Strategy on Diet, Physical Activity and Health and the Global Action Plan on the Prevention and Control of Noncommunicable Diseases 2013-2020.
Even if the WHO does give greater prominence to direct action and regulation by government, it is hard to reconcile Dr Chan’s aggressive stance towards the industry with the fact that her organisation’s strategies call for a joined-up approach and collaboration with all stakeholders.
One wants the food industry to say: ‘Look, we have a legitimate role as a stakeholder here to engage constructively and are doing so and should not be publicly cast as the villain of the piece by the chief officer of a major inter-governmental organisation.’
The industry chooses to bite its lip and allow Dr Chan’s accusations to go largely unchallenged, and maybe that is the wisest course of action. Getting involved in a tit-for-tat exchange will ultimately be unproductive.
As the alcohol industry – which has a far more difficult relationship with WHO Secretariat than the food industry – has found, expecting the WHO Secretariat to act as an “honest broker” between different stakeholder groups is a forlorn task. The Secretariat is dominated and heavily influenced by the public health lobby which means it is often at odds with the views of national governments.
One cannot help thinking the UK government’s Public Health Responsibility Deal (PHRD) may have been at least in the back of Dr Chan’s mind when she referred to protecting policymaking from vested commercial interests.
When asked to comment on Dr Chan’s speech, the UK Department of Health chose not to address the suggestion that such approaches showed a lack of political will and that allowing the commercial sector involvement in policymaking was dangerous. Rather like the IFBA, the DH spokesperson accentuated the positive, noting in particular the recent breakthrough on front-of-pack labelling.
“By working voluntarily with UK business through the Responsibility Deal, we have led the world on salt reduction, artificial trans fats are virtually eliminated from our foods, calories are displayed on menus in 9,000 high street outlets, and a new consistent front of pack food labelling [has been launched] which all the major supermarkets and some of the big manufacturers signed up to,” the DH spokesperson told just-food. “But we are not complacent. As part of the Responsibility Deal we are continuing discussions with businesses so we can get even better results.”
The inclusive and open view towards industry engagement, taken for example by the UK, the EU and the US, may well be borne out of the political influence wielded by commercial operators, as Dr Chan asserts. However, others would argue that taking such an approach need not result in less effective public health measures. Regulation is costly and takes time. Self-regulation may be a dirty word to Margaret Chan but it has yielded results in Europe and the US on issues such as labelling and advertising, which are acknowledged by independent third parties.
Of course industry can always go further and it is no bad thing that NGOs, public health organisations and campaigners push companies hard and are fairly grudging in their acknowledgement of any progress. However, the WHO is not a public health pressure group. It is an inter-governmental agency comprising UN member states which often have a lot more faith in industry’s potential to be part of the solution than Dr Chan and her staff.