Commercial determinants of health

Dear ladies and gentlemen,

We have a major public health issue. After decades of actions including monitoring, reporting, evidence gathering and policy action plans, NCDs prevalence still continues to grow in the EU, in the European region of WHO and globally.

Today, NCDs are the world’s biggest killers. With a staggering toll of 41 million lives lost annually, NCDs, including diabetes, cardiovascular and respiratory diseases, and cancers, account for 90% of global deaths.

NCDs put an extreme burden on individuals and their families. But also on the entire healthcare system, on economies, employment, and many other sectors.

For example, in Belgium, we spend approximately €3.3 billion yearly for healthcare due to excess body weight. This represents approximately 10% of our national yearly budget reserved to healthcare. On top of this, productivity loss due to work absenteeism poses an average cost of €1.2 billion yearly that could be attributed to overweight and obesity in the Belgian working population.

In Europe, OECD estimated that around €70 billion is spent annually for healthcare and productivity loss due to obesity.[1]

On the other hand, we know that a great proportion of NCDs is preventable: Studies suggest that 80% of all heart disease, stroke and diabetes, and 40% of cancer cases could be prevented if the main risk factors for NCDs were better addressed.

At the global level, we committed to reduce premature deaths from NCDs by one third by 2030 within the framework of the Sustainable Development Goals.

At the EU level, during the informal meeting of health ministers under the Belgian EU Council presidency in April reconfirmed that we want to scale up our efforts to address the risk factors of non-communicable diseases. And we will normally formalize this commitment through EU council conclusions later this month.

Still, despite the evidence and commitment, we are still struggling to reverse the tendency.

Why?

At least part of the answer is being addressed today: it’s about the “commercial determinants of health” – the way in which commercial factors impact people’s health.

Healthcare costs do not lobby. Absenteeism doesn’t do marketing campaigns or buy you VIP tickets to a sports event. But unfortunately health harming industries do.

I congratulate WHO for its report shedding light on aspects that we already had to deal within the context of tobacco policy, but that have not been addressed in such a clear manner before: the commercial determinants of health. The report clarifies the array of different ways in which commercial factors impact health and underscores that the issue is systemic, cross-sectoral and surely complex.

Some parts of the report are really eye-opening. And they certainly help to understand the complexity of strategies used by commercial actors that affect health.

The industries emphasized in the report are not only the evident ones – the usual suspects: tobacco and alcohol. Also industries processing food and fossil fuels are in the scope. And also the pharmaceutical and medical devices sectors have – obviously – a significant impact on health of people, both positive - of course - but also in terms of over-consumption, marketing, in-efficiency, undue high pricing, etc.

Nevertheless, the list of examples in the report is not exhaustive. We should also keep our eyes open for products such as pesticides and other chemicals …

We really need to re-think. For too long we have linked risk factors as being mostly linked to individual choices. We need to re-frame the problem as a systemic problem, where policy has to counter “hyper-consumption environments”, restrict marketing, stop interference in policy making…

And I know then when we propose this, that we are told that this is against freedom of choice. It’s the contrary. It’s about positive freedom, it’s about autonomy for the individual. It’s about this whole distinction between positive and negative liberty. This is about positive liberty. It’s a fight for the individual. That is the kind of frame we need. And also obviously we need operational strategies.

But our current efforts are still insufficient in regulating the harmful practices of commercial actors on health, and especially those of health harming industries.

Governments, parliamentarians and policy-makers need to recognise the scale of this problem and the far-reaching impact that industry practices have on public health and also our democratic processes.

When designing public health policies, we must be driven by evidence. And the evidence needs to be reliable. Therefore science - as well - must also be free from industry-interference, be it in terms of agenda setting or in terms of research design or publication.   The health of our population must be our compass, and the tactics of industry and trade actors should not undermine the evidence base or implementation of ambitious public health policies.

Let’s be very clear about this: we know how powerful the tobacco industry is and the report gives an idea of the power of other industries. This means we have to be at least as strong in our determination to implement the necessary regulations on health harming products.

And finally, in the long run, we need to consider the big picture: alternative economic strategies, where health and well-being  are duly taken into account next to measures of GDP growth. Such as the concept of the “economy of wellbeing” suggests. Where the objectives of improving public health and economic development are better balanced.

Through the concept of the “health in all policies approach” we know since a long time that addressing NCDs demands action beyond the healthcare sector. The WHO report confirms that we need to be bolder. We need to reduce and liberate us from the influence of health harming industries. Quoting WHO Director General, Dr Tedros: “It is time for a paradigm shift. Public health cannot and will not improve without action on the commercial determinants of health, from the local to global level.”

Thank you for your attention.