Comment

Public health research funding: independence is important

Product reformulation– the process of altering a food or beverage product's recipe or composition to improve the product's health profile – is a prominent response to the obesity and noncommunicable disease epidemics in the U.S. To date, reformulation in the U.S. has been largely voluntary and initiated by actors within the food and beverage industry. Similar voluntary efforts by the tobacco and alcohol industry have been considered to be a mechanism of corporate political strategy to shape public health policies and decisions to suit commercial needs.

We propose a taxonomy of food and beverage industry corporate political strategies that builds on the existing literature. We then analyzed the industry's responses to a 2014 U.S. government consultation on product reformulation, run as part of the process to define the 2015 Dietary Guidelines for Americans. We qualitatively coded the industry's responses for predominant narratives and framings around reformulation using a purposely-designed coding framework, and compared the results to the taxonomy.

The food and beverage industry in the United States used a highly similar narrative around voluntary product reformulation in their consultation responses: that reformulation is “part of the solution” to obesity and NCDs, even though their products or industry are not large contributors to the problem, and that progress has been made despite reformulation posing significant technical challenges. This narrative and the frames used in the submissions illustrate the four categories of the taxonomy: participation in the policy process, influencing the framing of the nutrition policy debate, creating partnerships, and influencing the interpretation of evidence. These strategic uses of reformulation align with previous research on food and beverage corporate political strategy.

La independencia de la formulación de políticas de salud pública puede verse afectada por distintos agentes con objetivos contrarios a la salud de la población, como son las grandes corporaciones. La crisis económica puede agravar la falta de independencia por la menor financiación de los órganos reguladores relacionados con la salud, o de otras actuaciones de protección de la salud. Las grandes corporaciones han influido en la formulación de determinadas políticas con incidencia en la salud, como son las relacionadas con el tabaco, la industria química, la nutrición, las bebidas alcohólicas, la industria farmacéutica y la de tecnologías sanitarias. Los principales ámbitos en que se ejerce influencia son la ciencia, la formación, la política y la sociedad en general. Ante esta situación, las sociedades científicas de salud pública deben tomar un papel activo que vele por la imparcialidad de las decisiones políticas, con acciones como: proponer actuaciones que garanticen la independencia e imparcialidad de las políticas de salud pública y aplicarse a sí mismas criterios de imparcialidad y transparencia; oponerse a que las administraciones públicas colaboren con corporaciones que son parte del problema de salud que se desea prevenir; contribuir a una comunicación fiable y eficaz en salud pública creando un organismo legitimado para ello que permita contrarrestar la carencia de fuente autorizada de información en salud pública; promover el análisis crítico de la definición de los problemas de salud, de sus soluciones y del establecimiento de las agendas relacionadas (científica, política y mediática); y, establecer alianzas para que la formación continua de los profesionales de salud sea independiente.

Independence in the formulation of public health policies can be affected by various agents with objectives contrary to population health, such as large corporations. This lack of independence may be exacerbated by the economic crisis due to lower funding for health regulatory bodies or other measures designed to protect health. Large corporations have influenced the formulation of certain policies with an impact on health, such as those related to the tobacco industry, the chemical industry, nutrition, alcohol, pharmaceuticals, and health technology. The main areas in which these companies can influence policies are science, education, politics, and society in general. In this scenario, public health associations should take an active role in ensuring the independence of political decisions via actions such as the following: supporting strategies that guarantee the independence of public health policies and apply criteria of impartiality and transparency; rejecting those public-private partnerships launched to prevent health problems partly caused by these corporations; establishing partnerships to achieve independent training of health professionals and an institution with scientific authority in order to improve public health communication and counteract the lack of sound public health information; promoting a critical analysis of the definition of health problems and their solutions, and establishing related agendas (scientific, political and media) and alliances, so that continuing training for health professionals is independent.

The UN High-Level Meeting on Non-Communicable Diseases (NCDs) in September, 2011, is an unprecedented opportunity to create a sustained global movement against premature death and preventable morbidity and disability from NCDs, mainly heart disease, stroke, cancer, diabetes, and chronic respiratory disease. The increasing global crisis in NCDs is a barrier to development goals including poverty reduction, health equity, economic stability, and human security. The Lancet NCD Action Group and the NCD Alliance propose five overarching priority actions for the response to the crisis—leadership, prevention, treatment, international cooperation, and monitoring and accountability—and the delivery of five priority interventions—tobacco control, salt reduction, improved diets and physical activity, reduction in hazardous alcohol intake, and essential drugs and technologies. The priority interventions were chosen for their health effects, cost-effectiveness, low costs of implementation, and political and financial feasibility. The most urgent and immediate priority is tobacco control. We propose as a goal for 2040, a world essentially free from tobacco where less than 5% of people use tobacco. Implementation of the priority interventions, at an estimated global commitment of about US$9 billion per year, will bring enormous benefits to social and economic development and to the health sector. If widely adopted, these interventions will achieve the global goal of reducing NCD death rates by 2% per year, averting tens of millions of premature deaths in this decade.