Public health, corporations and the New Responsibility Deal: promoting partnerships with vectors of disease

The products of tobacco, alcohol and food industries are responsible for a significant and growing proportion of the global burden of disease. Smoking and alcohol combined account for 12.5% of global deaths and 19.5% in highincome countries, while six diet-related risk factors account for 13.6 and 17.5% of deaths, respectively.1 Arguably the greatest challenge and opportunity for public health lies in reducing the contributions of tobacco use, unhealthy diet and harmful alcohol consumption to the rising global burden of non-communicable diseases.2 This demonstrates a pressing need to improve our understanding of how corporations contribute to this disease burden, both directly through the promotion of products damaging to health and indirectly through influence over public policy. The concept of an industrial epidemic—an epidemic emerging from the commercialization of potentially health-damaging products—lends itself to this purpose.3,4 Adapting traditional public health constructs, it identifies the role of the host (the consumer), agent (the product, e.g. cigarettes, alcohol), environment and, crucially, the disease vector (the corporation). The vector analogy was first described in relation to the tobacco epidemic,3 and tobacco control remains the only field where the commercial vector has been systematically studied. Analysis of millions of internal tobacco industry documents5 has revealed the multiple strategies via which the tobacco industry has sought to and, often successfully, undermined public health policies.6,7 Consequently, serious attention has been given to managing the conflicts of interest between public health and the tobacco industry. At global level, the World Health Organization (WHO) has actively sought to monitor and contain industry influence, with Article 5.3 of the Framework Convention on Tobacco (FCTC, WHO’s first global public health treaty) requiring all 172 parties to the treaty, including the UK, to protect health policies ‘from commercial and other vested interests of the tobacco industry.’8 Yet WHO’s approach to food and alcohol industries is strikingly different, with both its Global Strategy on Diet, Physical Activity and Health9 and new global alcohol strategy10 assuming scope for partnership and cooperation that the FCTC precludes. Similarly in the UK, the food and alcohol industries have recently been invited to join a ‘partnership’ with government11 from which the tobacco industry is excluded. The ‘Public Health Responsibility Deal’, on which, at the time of writing, limited details have emerged,11,12 is heavily reliant on the concept of corporate social responsibility, with a clear presumption in favour of partnerships and voluntary regulation. Businesses will reportedly be funding government campaigns in return for ‘an expectation of non-regulatory approaches’,11 with the Deal operationalized via five networks with heavy industry representation including from the food and alcohol sectors.13 While the tobacco industry’s exclusion from this model, a requirement under the FCTC, is welcome, it is apparent that broader lessons from tobacco have been implicitly rejected. Tobacco is clearly an exceptional product; no other consumer product kills one in two users when used exactly as intended. But there is little to suggest that, as a corporate actor, Big Tobacco differs fundamentally from Big Food or Big Booze.14,15 Indeed, the fiduciary responsibilities of all corporations require them to maximize profits regardless of consequences to health, society, or the environment and thus to oppose policies that could reduce their profits.16 There are, therefore, significant limits to the compatibility of industry interests with public health. Food companies, for example, have two basic strategic options to enhance shareholder revenue: to persuade consumers to eat more or to increase profit margins.17 As much higher profits come from processed compared to fresh