Stop industry interference, save lives

Abstract

Japan, Jordan, Bangladesh, and Lebanon are lagging in implementing measures to protect their public health policy making efforts from tobacco industry interference, according to the first ever Global Tobacco Industry Interference Index. The report, published last month by global industry watchdog, Stopping Tobacco Organizations and Products (STOP), used publicly available information to rank 33 countries from all regions in their overall efforts to guard against industry meddling. As one of the four key risk factors for non-communicable diseases (NCDs), tobacco use is an enormous threat to people's health worldwide, responsible for 8 million deaths every year, including over 20% of global cancer deaths. The 2005 Framework Convention on Tobacco Control (FCTC), which now has 168 signatories and 181 parties, sets minimum standards to guide countries in adopting strong tobacco control policies and legislation. Article 5.3 of the Convention requires parties to protect health policies from commercial and other vested interests of the tobacco industry and target 3A of Sustainable Development Goal 3 aims to strengthen the FCTC in all countries. Last September at the third UN High Level Meeting on the prevention and control of non-communicable diseases (NCDs), parties reaffirmed their commitment to accelerate the implementation of the FCTC. Furthermore, WHOs latest report on the global tobacco epidemic recognises tobacco industry interference as “the greatest obstacle to reducing tobacco use”. Despite all of this, the Index shows that tobacco companies are succeeding in pressuring governments of many countries to subvert health laws and continue to sell harmful products, employing a range of tactics including undermining, blocking, or delaying government efforts to develop tobacco control policies, enlisting senior government officials in corporate social responsibility activities, taking advantage of tax breaks or incentives that support business expansion, and failing to disclose meetings with non-health departments. The industry's strong opposition to any tobacco control measures comes as no surprise when one considers the value of the global tobacco market—it was estimated to be worth approximately US$785 billion (excluding China) in 2017. Contrast this with the global cost of tobacco use, in terms of health care and lost productivity each year, which is estimated to be around $1·4 trillion. A similar economic perversity was illustrated in a Comment published in last month's issue. Luke Allen and colleagues contrast the cost of implementing WHO's Best Buys—the agency's menu of policy options and cost-effective interventions targeting the four key NCD risk factors—in low-income and middle-income countries, estimated at $11·4 billion, with profits for 33 publicly listed companies that sell tobacco, alcohol, and processed foods. They find that combined sales for the included companies totalled $829 billion in 2017, with profits of $99 billion. Sector profitability ranged from 7% for processed foods to 29% for tobacco. US tobacco firms are spending $1 million per hour on advertising. So, what can be done? The Index illuminates how tobacco industry interference in public health policies is an issue that transcends country income groupings, cultures, and political systems. High, upper-middle, lower-middle, and low-income countries feature in both the top and bottom groups of the ranking, with two high-income countries—the UK and Japan—faring best and worst overall, respectively. Any country can succeed (or fail) and there are lessons to be learned from governments that are successfully resisting tobacco industry interference: they are transparent in their dealings with industry, avoid conflicts of interest, refuse donations, and do not endorse the industry's activities. Yet perhaps Richard Horton summed it up best in his Offline column on NCDs published in May 2019: “Here is the alarming truth: our economies are incentivised to earn vast private wealth by increasing public risks for NCDs. Until that truth is accepted and addressed, NCDs will remain part of an unchecked planetary emergency.” It is up to governments to tackle industry interference head on as part of broader strategies to reduce the burden of NCDs and ultimately save lives. This will necessitate strong leadership, independent analysis of industry lobbying efforts (eg, those that claim that public health measures damage personal freedoms and jobs), and recognition of the damaging realities of the commercial determinants of health. The clock is ticking. While STOP and other organisations set out recommendations to help governments, the industry will continue to find new ways to subvert them.