Big Tobacco, Alcohol, and Food and NCDs in LMICs: An Inconvenient Truth and Call to Action; Comment on “Addressing NCDs: Challenges From Industry Market Promotion and Interferences”

Document Type: Commentary

Author

1 University of Western Cape, Cape Town, South Africa

2 Chronic Disease Initiative for Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

Abstract

In their editorial, Tangcharoensathien et al1 describe the challenges of industry market promotion and policy interference from Big Tobacco, Alcohol, and Food in addressing non-communicable diseases (NCDs). They provide an overview of the increasing influence of corporate interest in emerging economies and government attempts to implement the World Health Organization (WHO) ‘best buy’ interventions. The authors largely draw on examples from Asia and a few selected countries, but provide little detail as to how aggressive marketing and policy interference plays out in a context of poor legislation and regulation in many low- and middleincome countries (LMICs), where the burden of NCDs is increasing at an alarming rate and governments face a high burden of disease with a limited budget for countering industry interference. This commentary provides some poignant examples of the influence of Big Tobacco, Alcohol, and Food on market regulation and policy interference in LMICs and argues for more policy coherence and accountability in terms of multisectoral action and civil society activism. Securing funds for health promotion and establishing health promotion foundations could help achieve that goal.

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Main Subjects


  1. Tangcharoensathien V, Chandrasiri O, Kunpeuk W, Markchang K, Pangkariya N. Addressing NCDs: challenges from industry market promotion and interferences. Int J Health Policy Manag. 2019;8(5):256-260. doi:10.15171/ijhpm.2019.02
  2. Doku D. The tobacco industry tactics-a challenge for tobacco control in low and middle income countries. Afr Health Sci. 2010;10(2):201-203.
  3. Gilmore AB, Fooks G, Drope J, Bialous SA, Jackson RR. Exposing and addressing tobacco industry conduct in low-income and middle-income countries. Lancet. 2015;385(9972):1029-1043. doi:10.1016/s0140-6736(15)60312-9
  4. Lee S, Ling PM, Glantz SA. The vector of the tobacco epidemic: tobacco industry practices in low and middle-income countries. Cancer Causes Control. 2012;23 Suppl 1:117-129. doi:10.1007/s10552-012-9914-0
  5. Savell E, Gilmore AB, Sims M, et al. The environmental profile of a community's health: a cross-sectional study on tobacco marketing in 16 countries. Bull World Health Organ. 2015;93(12):851-861g. doi:10.2471/blt.15.155846
  6. ACT Brazil, Campaign for Tobacco-Free Kids, Corporate Accountability International, Framework Convention Alliance, InterAmerican Heart Foundation, Southeast Asia Tobacco Control Alliance. Maybe you're the target: New Global Marlboro Campaign Found to Target Teens. Published 2014.
  7. Philip Morris International Fined in Brazil for Targeting Youth with its “Be Marlboro” Ads. Campaign for Tobacco-Free Kids website. https://www.tobaccofreekids.org/blog/2014_08_28_pmi.  Accessed May 20, 2019. Published August 28, 2014.
  8. Kalra A, Bansal P, Lasseter T, Wilson D. The Philip Morris Files - Part 2: Marlboro Country. In: Hirschberg P, ed. Philip Morris takes aim at young people in India, and health officials are fuming. Reuters; 2017.
  9. Alechnowicz K, Chapman S. The Philippine tobacco industry: "the strongest tobacco lobby in Asia." Tob Control. 2004;13 Suppl 2:ii71-78. doi:10.1136/tc.2004.009324
  10. Borzekowski DL, Cohen JE. International reach of tobacco marketing among young children. Pediatrics. 2013;132(4):e825-831. doi:10.1542/peds.2013-1150
  11. Chow CK, Corsi DJ, Gilmore AB, et al. Tobacco control environment: cross-sectional survey of policy implementation, social unacceptability, knowledge of tobacco health harms and relationship to quit ratio in 17 low-income, middle-income and high-income countries. BMJ Open. 2017;7(3):e013817. doi:10.1136/bmjopen-2016-013817
  12. Chapman S. Vector control: Controlling the tobacco industry and its promotions. Public Health Advocacy and Tobacco Control: Making Smoking History. Oxford: Blackwell Publishing; 2007:172-197.
  13. Patel P, Okechukwu CA, Collin J, Hughes B. Bringing 'Light, Life and Happiness': British American Tobacco and musicsponsorship in sub-Saharan Africa. Third World Q. 2009;30(4):685-700. doi:10.1080/01436590902867110
  14. Ayo-Yusuf OA, Olutola BG, Agaku IT. Permissiveness toward tobacco sponsorship undermines tobacco control support in Africa. Health Promot Int. 2016;31(2):414-422. doi:10.1093/heapro/dau102
  15. Boseley S. Threats, bullying, lawsuits: Tobacco industry's dirty war for the African market. The Guardian. 2017. https://www.theguardian.com/world/2017/jul/12/big-tobacco-dirty-war-africa-market.
  16. Legresley E, Lee K, Muggli ME, Patel P, Collin J, Hurt RD. British American Tobacco and the "insidious impact of illicit trade" in cigarettes across Africa. Tob Control. 2008;17(5):339-346. doi:10.1136/tc.2008.025999
  17. Sullivan C. BAT investigated by Serious Fraud Office over bribery allegations. Financial Times. 2017. https://www.ft.com/content/fd6eb592-7682-11e7-90c0-90a9d1bc9691.
  18. Tax Justice Network. Ashes to ashes: How British American Tobacco avoids taxes in Low- and Middle-Income Countries. London: Tax Justsice Network; 2019.
  19. Rimmer L. BAT in its own words. London: Action on Smoking and Health, Christian Aid and Friends of the Earth; 2005.
  20. Lee K, Collin J. "Key to the future": British American tobacco and cigarette smuggling in China. PLoS Med. 2006;3(7):e228. doi:10.1371/journal.pmed.0030228
  21. Fooks GJ, Gilmore AB, Smith KE, Collin J, Holden C, Lee K. Corporate social responsibility and access to policy elites: an analysis of tobacco industry documents. PLoS Med. 2011;8(8):e1001076. doi:10.1371/journal.pmed.1001076
  22. Sebrié EM, Glantz SA. Attempts to undermine tobacco control: tobacco industry "youth smoking prevention" programs to undermine meaningful tobacco control in Latin America. Am J Public Health. 2007;97(8):1357-1367. doi:10.2105/ajph.2006.094128
  23. Collin J, Johnson E, Officer H, Hill S. Government support for alcohol industry: promoting exports, jeopardising global health? BMJ. 2014;348:g3648. doi:10.1136/bmj.g3648
  24. Anderson P, Chisholm D, Fuhr DC. Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol. Lancet. 2009;373(9682):2234-2246. doi:10.1016/s0140-6736(09)60744-3
  25. Cook WK, Bond J, Greenfield TK. Are alcohol policies associated with alcohol consumption in low- and middle-income countries? Addiction. 2014;109(7):1081-1090. doi:10.1111/add.12571
  26. Bakke Ø, Endal D. Vested interests in addiction research and policy alcohol policies out of context: drinks industry supplanting government role in alcohol policies in sub-Saharan Africa. Addiction. 2010;105(1):22-28. doi:10.1111/j.1360-0443.2009.02695.x
  27. Jernigan DH. Global alcohol producers, science, and policy: the case of the International Center for Alcohol Policies. Am J Public Health. 2012;102(1):80-89. doi:10.2105/ajph.2011.300269
  28. Esser MB, Jernigan DH. Multinational Alcohol Market Development and Public Health: Diageo in India. Am J Public Health. 2015;105(11):2220-2227. doi:10.2105/ajph.2015.302831
  29. van Beemen O. Heineken in Africa: A Multinational Unleashed. London: Hurst; 2019.
  30. The Global Fund. Global Fund Suspends Partnership with Heineken. Geneva: The Global Fund; 2018.
  31. Mialon M, McCambridge J. Alcohol industry corporate social responsibility initiatives and harmful drinking: a systematic review. Eur J Public Health. 2018;28(4):664-673. doi:10.1093/eurpub/cky065
  32. Yoon S, Lam TH. The illusion of righteousness: corporate social responsibility practices of the alcohol industry. BMC Public Health. 2013;13:630. doi:10.1186/1471-2458-13-630
  33. Collier AC, Van der Borght SF, Rinke de Wit T, Richards SC, Feeley FG. A successful workplace program for voluntary counseling and testing and treatment of HIV/AIDS at Heineken, Rwanda. Int J Occup Environ Health. 2007;13(1):99-106. doi:10.1179/107735207800244910
  34. Dumbili EW. Heightened hypocrisy: a critical analysis of how the alcohol industry-sponsored ‘‘Nigerian Beer Symposium’’ jeopardises public health. Drugs (Abingdon Engl). 2019;26(3):287-291. doi:10.1080/09687637.2017.1421144
  35. Molelekwa J. Calls mount to boycott SAB's campaign against hunger. IOL News. August 1, 2017. https://www.iol.co.za/news/south-africa/calls-mount-to-boycott-sabs-campaign-against-hunger-10579697.
  36. Matzopoulos R, Parry CD, Corrigall J, Myers J, Goldstein S, London L. Global Fund collusion with liquor giant is a clear conflict of interest. Bull World Health Organ. 2012;90(1):67-69; discussion 70. doi:10.2471/blt.11.091413
  37. Parry C. African experience supports view that the global alcohol industry should have no role in the formulation of public health policies. Addiction. 2014;109(7):1211-1212. doi:10.1111/add.12582
  38. Parry C, Burnhams NH, London L. A total ban on alcohol advertising: presenting the public health case. S Afr Med J. 2012;102(7):602-604.  
  39. Parry C, London L, Myers B. Delays in South Africa's plans to ban alcohol advertising. Lancet. 2014;383(9933):1972. doi:10.1016/s0140-6736(14)60954-5
  40. Greenhalgh S. Making China safe for Coke: how Coca-Cola shaped obesity science and policy in China. BMJ. 2019;364:k5050. doi:10.1136/bmj.k5050
  41. Greenhalgh S. Soda industry influence on obesity science and policy in China. J Public Health Policy. 2019;40(1):5-16. doi:10.1057/s41271-018-00158-x
  42. O'Connor A. Coca-Cola funds scientists who shift blame for obesity away from bad diets. The New York Times. August 9, 2015. https://well.blogs.nytimes.com/2015/08/09/coca-cola-funds-scientists-who-shift-blame-for-obesity-away-from-bad-diets/.
  43. Serôdio PM, McKee M, Stuckler D. Coca-Cola - a model of transparency in research partnerships? A network analysis of Coca-Cola's research funding (2008-2016). Public Health Nutr. 2018;21(9):1594-1607. doi:10.1017/s136898001700307x
  44. Colchero MA, Rivera-Dommarco J, Popkin BM, Ng SW. In Mexico, Evidence Of Sustained Consumer Response Two Years After Implementing A Sugar-Sweetened Beverage Tax. Health Aff (Millwood). 2017;36(3):564-571. doi:10.1377/hlthaff.2016.1231
  45. McHiza ZJ, Parker WA, Labadarios D. Mitigating the consumption of sugar-sweetened beverages: the developing country perspective. Public Health Nutr. 2016;19(13):2293-2295. doi:10.1017/s1368980016002202
  46. Kelly B, Vandevijvere S, Ng S, et al. Global benchmarking of children's exposure to television advertising of unhealthy foods and beverages across 22 countries. Obes Rev. 2019. doi:10.1111/obr.12840
  47. Stuckler D, Nestle M. Big food, food systems, and global health. PLoS Med. 2012;9(6):e1001242. doi:10.1371/journal.pmed.1001242
  48. Williams SN. The incursion of ‘Big Food’ in middle-income countries: a qualitative documentary case study analysis of the soft drinks industry in China and India. Crit Public Health. 2015;25(4):455-473. doi:10.1080/09581596.2015.1005056
  49. Mendez Lopez A, Loopstra R, McKee M, Stuckler D. Is trade liberalisation a vector for the spread of sugar-sweetened beverages? A cross-national longitudinal analysis of 44 low- and middle-income countries. Soc Sci Med. 2017;172:21-27. doi:10.1016/j.socscimed.2016.11.001
  50. Basu S, Stuckler D, McKee M, Galea G. Nutritional determinants of worldwide diabetes: an econometric study of food markets and diabetes prevalence in 173 countries. Public Health Nutr. 2013;16(1):179-186. doi:10.1017/s1368980012002881
  51. Igumbor EU, Sanders D, Puoane TR, et al. "Big food," the consumer food environment, health, and the policy response in South Africa. PLoS Med. 2012;9(7):e1001253. doi:10.1371/journal.pmed.1001253
  52. Hawkes C, Harris JL. An analysis of the content of food industry pledges on marketing to children. Public Health Nutr. 2011;14(8):1403-1414. doi:10.1017/s1368980011000607
  53. McHiza ZJ, Temple NJ, Steyn NP, Abrahams Z, Clayford M. Content analysis of television food advertisements aimed at adults and children in South Africa. Public Health Nutr. 2013;16(12):2213-2220. doi:10.1017/s136898001300205x
  54. Delobelle P, Sanders D, Puoane T, Freudenberg N. Reducing the Role of the Food, Tobacco, and Alcohol Industries in Noncommunicable Disease Risk in South Africa. Health Educ Behav. 2016;43(1 Suppl):70s-81s. doi:10.1177/1090198115610568
  55. Abrahams Z, McHiza Z, Steyn NP. Diet and mortality rates in Sub-Saharan Africa: stages in the nutrition transition. BMC Public Health. 2011;11:801. doi:10.1186/1471-2458-11-801
  56. Hamada A, Mori M, Mori H, et al. Deterioration of traditional dietary custom increases the risk of lifestyle-related diseases in young male Africans. J Biomed Sci. 2010;17 Suppl 1:S34. doi:10.1186/1423-0127-17-s1-s34
  57. Popkin BM. Nutrition, Agriculture and the Global Food System in Low and Middle Income Countries. Food Policy. 2014;47:91-96. doi:10.1016/j.foodpol.2014.05.001
  58. Gilmore AB, Savell E, Collin J. Public health, corporations and the new responsibility deal: promoting partnerships with vectors of disease? J Public Health (Oxf). 2011;33(1):2-4. doi:10.1093/pubmed/fdr008
  59. World Health Organization (WHO). Global Strategy on Diet, Physical Activity and Health. Geneva: WHO; 2004.
  60. World Health Organization (WHO). Global strategy to reduce the harmful use of alcohol. Geneva: WHO; 2010.
  61. World Health Organization (WHO). Global status report on alcohol and health 2018. Geneva: WHO; 2018.
  62. Buse K, Tanaka S, Hawkes S. Healthy people and healthy profits? Elaborating a conceptual framework for governing the commercial determinants of non-communicable diseases and identifying options for reducing risk exposure. Global Health. 2017;13(1):34. doi:10.1186/s12992-017-0255-3
  63. Hawkins B, Holden C, Eckhardt J, Lee K. Reassessing policy paradigms: A comparison of the global tobacco and alcohol industries. Glob Public Health. 2018;13(1):1-19. doi:10.1080/17441692.2016.1161815
  64. Magnusson RS. Framework legislation for non-communicable diseases: and for the Sustainable Development Goals? BMJ Glob Health. 2017;2(3):e000385. doi:10.1136/bmjgh-2017-000385
  65. Reeve B, Gostin LO. "Big" Food, Tobacco, and Alcohol: Reducing Industry Influence on Noncommunicable Disease Prevention Laws and Policies Comment on "Addressing NCDs: Challenges From Industry Market Promotion and Interferences". Int J Health Policy Manag. 2019;8(7):450-454. doi:10.15171/ijhpm.2019.30
  66. Anaf J, Baum F, Fisher M, Friel S. Civil society action against transnational corporations: implications for health promotion. Health Promot Int. 2019. doi:10.1093/heapro/daz088
  67. Schang LK, Czabanowska KM, Lin V. Securing funds for health promotion: lessons from health promotion foundations based on experiences from Austria, Australia, Germany, Hungary and Switzerland. Health Promot Int. 2012;27(2):295-305. doi:10.1093/heapro/dar023
  68. Tangcharoensathien V, Sopitarchasak S, Viriyathorn S, et al. Innovative Financing for Health Promotion: A Global Review and Thailand Case Study. In: Quah SR, ed. International Encyclopedia of Public Health. 2nd ed. Oxford: Academic Press; 2017:275-287.
  69. Perez AM, Ayo-Yusuf OA, Hofman K, et al. Establishing a health promotion and development foundation in South Africa. S Afr Med J. 2013;103(3):147-149. doi:10.7196/samj.6281
  70. Tangcharoensathien V, Srisookwatana O, Pinprateep P, Posayanonda T, Patcharanarumol W. Multisectoral Actions for Health: Challenges and Opportunities in Complex Policy Environments. Int J Health Policy Manag. 2017;6(7):359-363. doi:10.15171/ijhpm.2017.61