Countering industry promotion of harmful products to protect public health

Abstract

The increasing prevalence of non-communicable diseases (NCDs), caused by the consumption and use of unhealthy products, cannot be attributed to individual behaviours alone. The way that our world has changed in recent decades shows that the problem needs to be addressed through changes in policy rather than focusing solely on behaviour change.

The efforts to reduce the harm caused by smoking over the past 50 years have given us a blueprint for how to reduce the harm caused by the tactics used by big industry to promote and sell harmful products. These commercial determinants of health (CDOH) can be countered by pre-exisitng powers at the local level, but we need national policy changes to help counter these CDOH more effectively.

Introduction

Non-communicable diseases (NCDs) account for nearly 90% of deaths in England¹ and 74% worldwide² and contribute significantly to disabilities and poor health, including heart disease, stroke, cancer, diabetes and a range of mental health issues. The increasing prevalence of NCDs is caused, in large part, by the consumption and use of harmful products such as tobacco, alcohol, unhealthy food and drink and gambling. The harm caused by use and consumption of these products not only impacts individuals and their families, but costs the UK economy over £30 billion and leads to nearly half a million people being out of work through ill health.³ They also drive inequality, with people living in the most disadvantaged areas experiencing greater levels of harm than those in the least deprived.

The alarming rise in NCDs – and the associated costs – cannot be attributed to individual behaviours alone. The way that our world has changed in recent decades shows that the problems go beyond behaviours being singled out as the sole attributable factor. The changes in tobacco control (with restrictions) have reduced smoking prevalence. In contrast, industry, political and market activities, including the changes in food availability, affordability and promotion, have led to a population change in weight. Similarly, change in affordability, availability and promotion of alcohol has led to increased consumption and a change in the pattern of drinking from on trade to off trade.

Image from the NCD Alliance https://ncdalliance.org/why-ncds

What we know works

The tactics used by industry to promote and sell harmful products largely follow the same playbook4, 5, 6, 7 and efforts to reduce the harm caused by smoking over the past 50 years have given us a blueprint for how to reduce the harm caused by all commercial determinants of health (CDOH).

The most recent data⁸ show that in 2019 smoking caused 74,600 deaths in England, a decrease of 9% from 2009. This happened through a powerful combination of policy and regulatory changes and public information. We must learn from history and the approach taken to tobacco control, and implement policies that address the availability, affordability and marketing of harmful products, and that restrict industry influence over the policy making process. Implemented in 2005, the Framework Convention on Tobacco Control⁹ reaffirmed the rights of people to the ‘highest standard of health’, stating ‘parties to this convention are determined to give priority to their right to protect public health’. The treaty represented a move from previous strategies, focused on supply, to a regulatory framework that also focused on prevention through evidence-based action to reduce demand.

If we can build a comprehensive approach to limiting all harmful products and services that doesn’t rely on changing individual behaviour, we will see a notable reduction in the number of people living with, and dying from, preventable illness. Children and young people and people from lower socioeconomic groups are priority groups to protect from industry tactics not only with tobacco, but also the harms driven by the food and alcohol industries.

At the local level

Directors of public health (DsPH) and their teams, working in partnership with the community and voluntary sector, and local and national governments, have shown that industry tactics can be countered not just successfully, but in a cost-effective way that benefits individuals’ health, and improves outcomes for the wider community.

By focusing on a narrative that ensures the local residents are aware of the public health issues around CDOH, local authorities (LAs) can take the emphasis away from personal responsibility. LAs can also resource and support campaigns that build public support for policies that are needed to prevent harm and raise awareness, using hard-hitting facts and evidence to reinforce public health messaging (as opposed to campaigns that aim to change individual behaviour) and develop education packages that are entirely free from industry influence.

There are also a number of pre-existing powers that LAs can use to tackle CDOH, and many that are already using them are seeing positive results.

For example, LAs have levers already at their disposal to influence planning and licensing decisions, as well as advertising and marketing activity, in their local area.

However, as we know from tobacco control policy, big industries have the funds and resources to strategically undermine and water down policy, and LAs are facing high-profile challenges to their planning decisions. Learning from our work to counter the tobacco industry over many years, we know that other industries use the same playbook. For example, the advertising industry is lobbying LAs to delay or scrap plans to ban junk food advertising on bus stops and billboards, using the well-rehearsed industry tactics of deny, dilute and delay, and the government is leaving LAs to push back alone against industry interests.¹⁰

It is also important to highlight the conflicts of interest, where industries that produce harmful products fund and partner organisations, including charities, recruit academics, doctors and influencers to dispute evidence that products are harmful, as well as lobbying government and committees, and funding research.

Despite these tactics, LAs are fighting back by using the powers available to them. Hounslow council is one of a growing number of councils to introduce a policy¹¹ that restricts advertising of inappropriate and nutritionally poor food and drink across council-owned land. This type of action is happening across the country, with Cheshire East recently becoming the 20th English council to introduce such restrictions.¹²

Other councils, like Gateshead¹³ and Newcastle,¹⁴ have used planning law to restrict the opening of new takeaways. In a bid by the government to empower more local areas to act, the recently announced National Planning Policy Framework¹⁵ includes a recommendation that local planning authorities should refuse applications for fast-food outlets within walking distance of schools and other places where children and young people congregate.

Licensing is another powerful tool, and LAs should be empowered to consider the public health implications of licensing decisions. For example, Sheffield City Council¹⁶ has recently introduced a gambling harm prevention strategy to reduce the number of people experiencing gambling harm and to stop the promotion of gambling activities on LA-owned land.

Implementing interventions that use LA’s pre-existing powers are, however, dependent on a wide range of factors and influences. In order for LAs to properly enforce national regulations and implement locally tailored solutions, they need more powers and responsibilities alongside adequate resources and funding – and the training and tools to be able to keep industry-funded opposition at bay.

As well as using these pre-existing powers, it is also important that the public health community comes together to help explain the impact of commercial influence on our behaviour to our politicians and other decision makers, the public and the media so that everyone, including the wider public health workforce and stakeholders from across sectors, have the facts at their disposal. A deeper understanding will mean that as well as helping drive national policy action forward, industry influence can be minimised in other areas, including for example pension fund investments.

At the national level

National policy change, like we have seen with historical tobacco control legislation and are now seeing with the upcoming restrictions on food and drink advertising, and the National Planning Policy Framework, is vital – and very welcome – but enforcement and follow-up action is often the responsibility of LAs. A lack of time, money and legal resources can significantly hamper progress.

Instead of placing responsibility with individuals – the approach supported by industry – we should be tackling the issue at source, with robust national regulation. While this is already happening at a local level, thanks to a wide range of partnerships between DsPH and other organisations, it must be adequately resourced and funded, and backed by national policy. Public health teams must continue to review their own practices and support others to understand why this is harmful and how to transition away from such ways of working and the need to prevent conflicts of interest.

One example of a national initiative that has had a significant effect on reducing the harms caused by alcohol consumption is the introduction of minimum unit pricing (MUP) in Scotland. Since its introduction in 2018, there has been a reduction in deaths (13.4%) and hospital admissions (4.1%) solely attributed to alcohol consumption.¹⁷ Wales has also introduced MUP and Northern Ireland is currently consulting on its introduction. England must now follow suit and ensure that a consistent, evidence-based approach to reducing alcohol harm through pricing is in place across the UK.

Conclusion

Protecting children and young people needs to be front and centre so that they have the opportunity to grow up in healthier environments and live healthier, more productive lives – for themselves, their communities, and the wider economy. Only by protecting the next generation from harmful products will we be able to break the cycle of consumption and harm that we are currently in.

Meanwhile, the Association of Directors of Public Health¹⁸ is working to support public health teams to share good practice and learn from what works when tackling industry tactics, to help improve outcomes for the whole population and realise the ambition for everyone to live healthier lives for longer. Sustain (the alliance for better food and farming) has also produced a local government guide for putting children and young people’s health first and switching the spotlight away from advertising unhealthy food across council-owned land,¹⁹ and the Good Governance Toolkit,²⁰ which provides evidence-based guidance for LAs, focusing on strengthening the governance of engagement with commercial actors to maximise benefits and minimise the health risks for their populations.

Change is happening and the new UK government has given a commitment to supporting this agenda. However, in order to tackle CDOH effectively, we must replicate what we know works to create sustainable environments that make living healthier lives appealing, and accessible, to everyone. Without change, existing inequalities in health outcomes between rich and poor communities will continue to widen, and industry will continue to profit from people’s suffering.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

CRediT authorship contribution statement

Alice Wiseman: Writing – review & editing, Writing – original draft, Conceptualization.

Declaration of competing interests

Alice Wiseman reports that administrative support was provided by the Association of Directors of Public Health. Alice Wiseman reports a relationship with Association of Directors of Public Health that includes: board membership. Board member of the Institute of Alcohol Studies.