Predators in the park: multinational corporates versus population health
Authors: Nasheeta Peer, Andre Pascal Kengne
Journal: The Lancet Global Health (2021)

In The Lancet Global Health, Luke N Allen and colleagues1Allen LN Holmer H Wigley S Implementation of non-communicable disease policies from 2015 to 2020: a geopolitical analysis of 194 countries.Lancet Glob Health. 2021; 9: e1528-e1538Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar address an important and topical issue. They describe the worldwide uptake of legislation and implementation of 19 policies for non-communicable diseases (NCD) recommended by WHO from 2015 to 2020. Despite the inability to establish the effectiveness of such policy implementations, which is the ultimate benchmark of policy success, their study provides some valuable insights on determinants of policy implementation. That policies relating to alcohol, tobacco, and unhealthy foods were least likely to be implemented was unsurprising.1Allen LN Holmer H Wigley S Implementation of non-communicable disease policies from 2015 to 2020: a geopolitical analysis of 194 countries.Lancet Glob Health. 2021; 9: e1528-e1538Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar The undue influence of tobacco, alcohol, and food multinational corporates on governments’ attempts to fulfil their mandate to implement these NCD policies are clearly visible. Their frequent attempts to oppose, subvert, and undermine NCD-policy implementation inhibit the implementation of NCD policies.1Allen LN Holmer H Wigley S Implementation of non-communicable disease policies from 2015 to 2020: a geopolitical analysis of 194 countries.Lancet Glob Health. 2021; 9: e1528-e1538Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar These multinational corporates, particularly in the tobacco industry, have unlimited financial resources and extensive experience in promoting false information and coercing governments to formulate poor and ineffective policies.2Peer N Current strategies are inadequate to curb the rise of tobacco use in Africa.S Afr Med J. 2018; 108: 551-556Crossref PubMed Scopus (9) Google Scholar The extent of the power and influence wielded by multinational corporates is underscored by the fact that the positive effect of democracy was nullified in countries with average or above-average corporate infiltration.1Allen LN Holmer H Wigley S Implementation of non-communicable disease policies from 2015 to 2020: a geopolitical analysis of 194 countries.Lancet Glob Health. 2021; 9: e1528-e1538Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar Incredibly, such behaviours extend to litigation initiated by these multinational corporations. They easily overcome any resistance from governments in low-income and middle-income countries (LMICs) who do not have the capacity and expertise to validly and successfully make their case in court.2Peer N Current strategies are inadequate to curb the rise of tobacco use in Africa.S Afr Med J. 2018; 108: 551-556Crossref PubMed Scopus (9) Google Scholar For example, the tobacco industry challenged the Tobacco Control Act in Kenya, which resulted in the ban on smoking in public being suspended.3Tumwine J Implementation of the framework convention on tobacco control in Africa: current status of legislation.Int J Environ Res Pub Health. 2011; 8: 4312-4331Crossref PubMed Scopus (59) Google Scholar LMICs are constantly being intimidated with litigation by the tobacco industry to prevent the implementation of effective tobacco control policies.2Peer N Current strategies are inadequate to curb the rise of tobacco use in Africa.S Afr Med J. 2018; 108: 551-556Crossref PubMed Scopus (9) Google Scholar Nevertheless, the mean implementation for all tobacco policies has increased,1Allen LN Holmer H Wigley S Implementation of non-communicable disease policies from 2015 to 2020: a geopolitical analysis of 194 countries.Lancet Glob Health. 2021; 9: e1528-e1538Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar which is likely a reflection of the influence of the WHO Framework Convention on Tobacco Control (FCTC). The WHO FCTC clearly delineates approaches to address tobacco-related issues, such as tobacco promotion and sponsorship, illicit trade of tobacco products, tobacco taxation, and agricultural diversification, which member states are expected to implement.4WHODiet, nutrition and the prevention of chronic diseases. Report of a joint WHO/FAO expert consultation. World Health Organization, Geneva2003Google Scholar By contrast to the gains shown for tobacco policies, mean implementation decreased for all alcohol policies.1Allen LN Holmer H Wigley S Implementation of non-communicable disease policies from 2015 to 2020: a geopolitical analysis of 194 countries.Lancet Glob Health. 2021; 9: e1528-e1538Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar In view of the large health and social burden attributable to risky alcohol use, together with its adverse effects on sustainable development, this decrease in alcohol policies is unfortunate. Despite the strong parallels between tobacco and alcohol, and that risky alcohol use is a pervasive global issue with potentially devastating consequences, there has been disproportionally inadequate attention paid to this matter.5Peer N There has been little progress in implementing comprehensive alcohol control strategies in Africa.Am J Drug Alcohol Abuse. 2017; 43: 631-635Crossref PubMed Scopus (10) Google Scholar There is extensive evidence on the effectiveness of different policies in reducing alcohol-related harm6Anderson P Chisholm D Fuhr DC Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol.Lancet. 2009; 373: 2234-2246Summary Full Text Full Text PDF PubMed Scopus (743) Google Scholar and a longstanding call for a Framework Convention on Alcohol Control (FCAC).7Casswell S Thamarangsi T Reducing harm from alcohol: call to action.Lancet. 2009; 373: 2247-2257Summary Full Text Full Text PDF PubMed Scopus (222) Google Scholar However, the WHO or member states are unlikely to support this process.7Casswell S Thamarangsi T Reducing harm from alcohol: call to action.Lancet. 2009; 373: 2247-2257Summary Full Text Full Text PDF PubMed Scopus (222) Google Scholar In the absence of a FCAC, alcohol conglomerates, similar to their tobacco counterparts, are able to infiltrate high-abstinence populations, mainly in vulnerable LMICs. Traditionally low-alcohol-consuming populations such as non-western youth and women are then transformed into high-alcohol-consuming populations.7Casswell S Thamarangsi T Reducing harm from alcohol: call to action.Lancet. 2009; 373: 2247-2257Summary Full Text Full Text PDF PubMed Scopus (222) Google Scholar An urgent call to action is needed to pressurise stakeholders to introduce alcohol-control measures to counterbalance the influence of alcohol corporates. With greater attention directed to the food industry, it is likely that these corporates will escalate their resistance to reformulate healthier products and prevent the marketing of unhealthy foods. This is already evident in that policies targeting the advertising of junk foods and foods high in salt were among the least-widely implemented.1Allen LN Holmer H Wigley S Implementation of non-communicable disease policies from 2015 to 2020: a geopolitical analysis of 194 countries.Lancet Glob Health. 2021; 9: e1528-e1538Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar There are key lessons to be learned from tobacco control, especially those pertaining to advertising and taxation, among others, to curb the influence of the obesogenic environment and to promote healthy diets. The increase in paper-based policies that probably affect guidelines and health-service delivery1Allen LN Holmer H Wigley S Implementation of non-communicable disease policies from 2015 to 2020: a geopolitical analysis of 194 countries.Lancet Glob Health. 2021; 9: e1528-e1538Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar is encouraging, given that these policies have been scarce, particularly in many LMICs.8Peer N Baatiema L Kengne AP Ischaemic heart disease, stroke, and their cardiometabolic risk factors in Africa: current challenges and outlook for the future.Exp Rev Cardio Ther. 2021; 19: 129-140Crossref PubMed Scopus (2) Google Scholar, 9Ibrahim MM Damasceno A Hypertension in developing countries.Lancet. 2012; 380: 611-619Summary Full Text Full Text PDF PubMed Scopus (420) Google Scholar These advances probably reveal the achievements that are possible when unhindered by the outside influences of multinational corporates. Designing and implementing national policies for NCD management or health-service provision, particularly important in LMICs,8Peer N Baatiema L Kengne AP Ischaemic heart disease, stroke, and their cardiometabolic risk factors in Africa: current challenges and outlook for the future.Exp Rev Cardio Ther. 2021; 19: 129-140Crossref PubMed Scopus (2) Google Scholar are unlikely to affect multinational corporates, hence their non-interference in such processes. This fact is reiterated by Allen and colleagues1Allen LN Holmer H Wigley S Implementation of non-communicable disease policies from 2015 to 2020: a geopolitical analysis of 194 countries.Lancet Glob Health. 2021; 9: e1528-e1538Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar who state that paper-based policies do not threaten powerful vested interests. Corporate lobbying is widespread across the globe and probably an extremely influential motivation for policy-maker decisions regarding NCD policies. Unfortunately, the inability to accurately measure such activities1Allen LN Holmer H Wigley S Implementation of non-communicable disease policies from 2015 to 2020: a geopolitical analysis of 194 countries.Lancet Glob Health. 2021; 9: e1528-e1538Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar prevents their harmful effects from being quantified. Corporate lobbying is generally shrouded in secrecy but has far-reaching consequences; greater transparency is required if the tide against the rising global NCD burden is to be tackled. Allen and colleagues’1Allen LN Holmer H Wigley S Implementation of non-communicable disease policies from 2015 to 2020: a geopolitical analysis of 194 countries.Lancet Glob Health. 2021; 9: e1528-e1538Summary Full Text Full Text PDF PubMed Scopus (7) Google Scholar findings highlight the importance of curbing the insidious influence of multinational corporates on the implementation of effective NCD policies. We declare no competing interests. Implementation of non-communicable disease policies from 2015 to 2020: a geopolitical analysis of 194 countriesImplementation of NCD policies is uneven, but broadly improving over time. Urgent action is needed to boost implementation of policies targeting corporate vectors of NCDs, and to support countries facing high corporate permeation. Full-Text PDF Open Access