Published 2 October 2008, doi:10.1136/bmj.a1761
Cite this as: BMJ 2008;337:a1761

Head to Head

Should we use regulation to demand improved public health outcomes from industry? No

¹ Oxford Health Alliance, London W1W 8RZ

Preventable chronic diseases are a major threat to health worldwide. Stephen Sugarman (doi:10.1136/bmj.a1750) argues that setting targets for companies will produce innovative solutions, but Stig Pramming believes collaboration is the best way to improve health

This debate about regulation of business to improve public health goes back many years. Those who support regulation believe that the pursuit of profit is the only abiding principle of the business world and that companies cannot be trusted to moderate their practices in order to promote the public good. However, this simplistic and outdated view is less and less useful in the 21st century.

Regulation doesn’t change behaviour

Arguments about economic systems, motives, and who is to blame for preventable disease are unproductive.¹ In the case of smoking, a hugely profitable industry produces and promotes a harmful, addictive, and unnecessary product. However food is not tobacco, and issues of cause and effect just aren’t the same. Obesity is, in a sense, an unintended consequence of progress. Moreover, even if regulation succeeded in forcing businesses to promote better portion control or pedestrianism or healthier snack foods, such efforts are not guaranteed to change behaviours. Civil authorities build bike lanes that do not, alone, change traffic patterns: this is about a more fundamental sociocultural change.

As urbanisation and lifestyle change sweep across the world, we see a dramatic rise in associated diseases. The plague of chronic disease, if unchecked, will be a disaster in China, India, and elsewhere. But regulation will not satisfy the global hunger for lifestyle change or influence billions of individuals to moderate their food intake, to maintain a reasonable level of physical activity, or prevent children from ever picking up a cigarette.

People power

Businesses today operate in an increasingly transparent environment and are rapidly becoming sensitised to the consequences of their practices and policies. New media and globalisation have not turned capitalists into angels, but they have changed the terms of the discussion. The stakeholders of business can no longer be disregarded—workers can no longer be hidden away in some faraway country working under sub-human conditions and food manufacturers can no longer disregard consumers’ health. Corporate social responsibility includes protecting the health of employees and of consumers. Global business cannot afford to neglect this responsibility given the current explosion of chronic disease. Neglect will cause companies to lose brand value and customers’ goodwill, which will eventually affect their ability to operate.

It is true that many businesses and even entire industries still operate with a ruthless disregard for the damage they cause,² and that most corporations consider profit their first priority. It would be foolish to think that enlightened self interest will lead all the world’s business to realise that being part of the solution is the most effective long term strategy. Activists joining forces against the epidemic must be organised and persuasive in eliciting business involvement, and we must act now.

One example of how this can be done is the development of the Oxford Health Alliance, which engages business, health professionals, policy makers, and other stakeholders as equal partners in finding solutions to public health problems.³ The private and public sectors are mutually dependent. Most government programmes—from welfare and education to health care—depend on a market economy to pay for them. Business, in turn, cannot thrive without an infrastructure, which includes roads and railways and a legal system that upholds property rights. A sensible business will try to balance short term profitability with a longer term perspective, particularly when accountability is becoming so much more public.

Signs of change

Many major companies, including supermarket chains and food manufacturers, see the opportunities in business strategies that promote healthy choices and behaviours. The North American supermarket chain Hannaford has done this by implementing its own nutrition score for in-store products in order to guide consumers to the healthiest alternative in each food group.⁴ In a clear example of corporate responsibility, the UK based supermarket chain Sainsbury’s has invested millions of pounds in the development and roll-out of a large childhood obesity programme called MEND (Mind, Exercise, Nutrition . . . Do it), which helps overweight families to live healthier lives.⁵ Nestlé has lowered the content of salt, fat, and sugar in selected products and prioritised developing healthier lower energy alternatives to their existing portfolio, worldwide.⁶ PepsiCo has within the past 10 years merged with Quaker Oats and bought the fruit juice company Tropicana. The diversification has been prompted by the shift in the beverage market away from sugary drinks to healthier alternatives.⁷ Recently, seven of the world’s largest food and beverage companies have given a commitment to action on the World Health Organization’s global strategy on diet, physical activity and health.

These developments are encouraging, but it would be foolish to become complacent. Instead we must form a partnership with the most progressive companies and put as much pressure as possible on those who postpone the inevitable. Progress has serious side effects: when traditional diets are replaced by energy dense processed foods, when tobacco use soars, when too many take in more than they consume, preventable diseases spread rapidly. Cooperation is an urgent priority, and we must act to ensure that business is part of the solution. Regulation is no substitute for collaboration. We have no time left to lose.

Cite this as: BMJ 2008;337:a1761

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Competing interests: None declared.

References

1. Colagiuri R, Pramming S, Leeder SR. The Oxford Health Alliance: a risky business? Med J Aust 2007;187:652-3.[Web of Science][Medline]
2. Richter J. Holding corporations accountable: corporate conduct, international codes and citizen action. London: UNICEF, 2001.
3. Oxford Health Alliance. www.oxha.org.
4. Hannaford. Hannaford guiding star—nutritious shopping made simple. www.hannaford.com/Contents/Healthy_Living/Guiding_Stars/index.shtml%5.
5. J Sainsbury. Sainsbury’s announces £3 million-plus national partnership with MEND to help tackle childhood obesity. Press release, 7 Dec 2006. www.j-sainsbury.com/index.asp?PageID=424&subsection=&Year=2006&NewsID=840.
6. Nestlé. Nutrition. www.nestle.com/Brands/Overviews/Nutrition.htm.
7. PepsiCo. Overview of company structure. www.pepsico.com/PEP_Company/Overview/index.cfm.

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