Industry Influence on UN Noncommunicable Disease Summit?

Jacquelyn K. Beals, PhD

August 25, 2011

August 25, 2011 — The United Nations (UN) High-Level Summit on Non-Communicable Diseases (NCDs) will convene in New York City from September 19 to 20. However, negotiations recently broke down in drafting an outcomes document that will contain commitments toward progress in 4 target NCD areas: cardiovascular disease, respiratory illnesses, cancer, and diabetes.

The risk factors for these often-preventable NCDs have attracted the attention of the alcohol, tobacco, and food industries. Combined with US and European Union reluctance to endorse firm goals and deadlines with their associated economic commitments, the influence of industry may undermine even more of the summit's potential.

In an article posted online August 23 in the British Medical Journal, author Deborah Cohen, MD, investigations editor for the BMJ in London, United Kingdom, asks whether industry influence will derail the UN summit.

One example she describes lies at the intersection of industrial interests and the current economic instability and employment: "When traffic light labeling on food was discussed in Europe, companies tried to persuade members of the European Parliament that restrictions on the food industry would inevitably lead to job losses — among other things," her article recalls. The food industry lobbied against the labeling with "sponsored science," using articles in journals that might influence policy makers. The traffic light labeling was not implemented.

In the present economic situation, "Some cash strapped EU governments and the US — among the chief donor countries — may not want to risk rising unemployment rates at the expense of fending off ill health in low and middle income countries," observed Dr. Cohen.

However, complex issues have more than one side. Dr. Cohen also mentioned a professor of health system economics, who suggested that reducing UK consumption of red meat would decrease farmers' income around the world, resulting in lost jobs, increased poverty, and potentially more health problems than the consumption of red meat.

Diseases of Poverty

The World Health Organization has clearly stated that NCDs are "diseases of poverty" and should be attacked as "social determinants of health." Taken together, the 4 targeted NCDs are responsible for more than half the deaths in countries with low and mid-level incomes.

Nevertheless, the United Kingdom's secretary of state for international development issued a letter in May asserting that "the majority of [NCD] sufferers tend still to be in the wealthier quintiles of the population." The Lancet corrected this claim in a commentary, but Dr. Cohen expects that the misinformation may reappear.

Recent changes in the UN outcomes document (seen by the BMJ) reflect interests of the food industry, Dr. Cohen writes. For example, the G77 states, a group of developing nations within the UN, want a reduction in saturated fats, sugar, and salt in processed foods; however, the European Union, Canada, Australia, and the United States are resisting this recommendation.

The article also quotes an "academic" who writes: " 'Note that effective evidence based measures on alcohol (controlling price, availability and marketing) are being deleted, and industry favoured measures (partnership working, community actions, and health promotion) being substituted.... These changes bear the mark of the drinks industry and are a result of heavy industry lobbying in New York."

Regarding tobacco use, the United States, Canada, the European Union, and Japan are all resistant to including any language in the draft on taxing tobacco; similarly, tobacco-producing countries in the G77 group will not acknowledge any "conflicts of interest between the tobacco industry and public health" and have refused to sign the Framework Convention of Tobacco Control.

Partnerships Also an Issue

The idea of establishing partnerships between governments and industry or nongovernmental organizations is also facing a roadblock, with concern that the partnerships might foster a "close," rather than "arms-length," relationship with business.

The basis for this concern was evident at a June UN meeting designed to permit charities and the public to express their ideas about the draft document. Participants included affiliates of the International Federation of Pharmaceutical Manufacturers and Associations, the International Food and Beverage Alliance, and the World Federation of the Sporting Goods Industry. Looking ahead to the September summit, the US delegation includes representatives of the Global Alcohol Consumers Group; beverage companies from the United Kingdom also are represented.

Of course, not only industry but also politicians have own best interests in mind, which typically involve vote getting and setting priorities related to other crises. "Even if the politics are overcome," summarizes Dr. Cohen, "tackling [NCDs] is a long-term game."

NCDs Not a High Priority

A BMJ commentary provides further discussion of the issue.

Authors David Stuckler, MPH, PhD, a university lecturer in the Department of Sociology, Cambridge University, United Kingdom; Sanjay Basu, MD, a physician at the University of California–San Francisco; and Martin McKee, MD, professor of European public health, London School of Hygiene & Tropical Medicine, United Kingdom, present information about the epidemiology of NCDs (eg, "High blood pressure is the second leading risk factor for death in low income countries...and high blood glucose is the fifth"), as well as evidence for the large gap between funding for NCDs and that for communicable diseases.

They note that less than 10% of the budget of the World Health Organization, which is the strongest global supporter of attention for NCDs, is allocated for NCDs. All too often, NCDs fall through the cracks: "Because [NCDs] are not part of the goals, development agencies fail to prioritize them; [and] health ministers in turn do not seek support for prevention and control because of the lack of available funding," observed the commentators.

They give 3 examples of cost-effective interventions known to work:

  • increased tobacco and alcohol taxes to reduce consumption and raise government revenues;

  • doubling the price of alcoholic beverages to decrease alcohol-related mortality by 35%, traffic crash deaths by 11%, and STDs by 6%, according to some studies; and

  • salt reduction to lower blood pressure and cardiovascular disease risk and save billions in annual healthcare costs.

Unlike HIV advocacy, which had strong social issues at the root, "advocacy on [NCDs] has been described by young people as 'dull' and 'uninspiring,' lacking an emphasis on social justice or inequality and missing a sense of outrage and urgency against continued inaction," write the commentary authors. One result of this attitude has been to give large corporations free rein in setting the NCD agenda, they say.

At recent meetings in New York City, consensus for taking action on NCDs was blocked after lobbying by food, alcohol, tobacco, and drug company representatives, and "negotiations have now stalled," according to the commentators. They view the UN high-level meeting on NCDs as "a battleground, pitting public interests against powerful private ones. But unlike the HIV activism of the past, the voices of people affected by [NCDs] are mostly quiet."

The authors and commentators have disclosed no relevant financial relationships.

BMJ. Published online August 23, 2011. Article full text, Commentary extract

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