How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention.

Raphael Lencucha,Anne Marie Thow

doi:10.15171/ijhpm.2019.56

Abstract

Alcohol, tobacco, and unhealthy foods contribute greatly to the global burden of non-communicable disease (NCD). Member states of the World Health Organization (WHO) have recognized the critical need to address these three key risk factors through global action plans and policy recommendations. The 2013-2020 WHO action plan identifies the need to engage economic, agricultural and other relevant sectors to establish comprehensive and coherent policy. To date one of the biggest barriers to action is not so much identifying affective policies, but rather how a comprehensive policy approach to NCD prevention can be established across sectors. Much of the research on policy incoherence across sectors has focused on exposing the strategies used by commercial interests to shape public policy in their favor. Although the influence of commercial interests on government decisions remains an important issue for policy coherence, we argue, that the dominant neoliberal policy paradigm continues to enable the ability of these interests to influence public policy. In this paper, we examine how this dominant paradigm and the way it has been enshrined in institutional mechanisms has given rise to existing systems of governance of product environments, and how these systems create structural barriers to the introduction of meaningful policy action to prevent NCDs by fostering healthy product environments. Work to establish policy coherence across sectors, particularly to ensure a healthy product environment, will require systematic engagement with the assumptions that continue to structure institutions that perpetuate unhealthy product environments.

Highlights

In 2015, the Zambian government established an incentive program to attract investment in a recently developed multifacility special economic zone.[1,2] This program was offered to any company interested in establishing their operations in this zone, including tobacco companies
The influence of private interests on government decisions remains an important issue for policy coherence, and scholarship in this area continues to grow under the new frame of the commercial determinants of health,[12] we argue, that policy paradigms are a critical but often invisible underpinning of policycoherence, including the ability of private interests to influence public policy
We examine how neoliberalism became the dominant paradigm, how it has been materialized in institutional mechanisms governing product supply, and how these ways of governing create structural barriers to whole-of-government policy action to prevent non-communicable disease (NCD)

Summary

Introduction

In 2015, the Zambian government established an incentive program to attract investment in a recently developed multifacility special economic zone.[1,2] This program was offered to any company interested in establishing their operations in this zone, including tobacco companies. Research into tobacco production suggests that farmers continue to grow tobacco largely because companies provide access to inputs such as seed and fertilizer as well as cash loans and access to markets.[33,34,35] supply chains for minimally processed healthy foods such as fruit and vegetables are often characterised by significant losses, due to a systemic lack of public investment in agriculture.[36] In contrast supply chains for highly processed vegetables, such as potato chips are highly developed due to downstream industry investment This dynamic is characteristic of the neoliberal paradigm representing a general “decline in central government’s ability to steer society.”[37] The force of law is used to protect private individual and corporate rights while ensuring that the international movement of goods, services and capital is freed, and that this freedom is protected. By engaging with decision-makers involved in supply side issues health advocates have an opportunity to create dialogue across paradigms and interrogate and debate the merits of these paradigmatic foundations with those who are operating to foster product supply

Conclusion

Improving policy coherence for food security and nutrition in South