Can we leave industry to lead efforts to improve population health? YesBMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f2279 (Published 17 April 2013) Cite this as: BMJ 2013;346:f2279
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Consumer habits are greatly influenced by advertising; sport sponsorship is one area which highlights the difficulties of relying on industry to improve population health.
Whilst money has poured into the elite level game - allowing athletes to train harder, eat better, and think smarter than ever before - public health has not shared in the spoils. Toeing the ‘anything in moderation’ line has allowed the "disease inflicting industries"(1) – soft drinks, fast foods and alcohol - to come to dominate sport advertising across the globe. Even the London Olympics, the embodiment of sporting excellence and healthy living, were sponsored by McDonald’s (exclusive retail food services), Coca-Cola (exclusive non-alcoholic beverage provider) and Heinekan (alcoholic beverage provider).(2)
The relationship between alcohol and sport has received considerable attention in recent years – here, advertising helps drives a glamorous association between alcohol and sporting success, and regularly exposes young people to drinking.(3) It seems incongruous that the wide viewing age of sport necessitates an apology for aired expletives, yet draws no apologies for the level of alcohol exposure. Indeed, there are even major sporting trophies named after various beverages, such as the 'Carling' cup (football), the 'Heiniken' cup (rugby), the 'John Smith’s' Grand National (horseracing). There is a wide range of sponsorship and commercial advertising which brings in revenue to sports, but at what social cost?
Focusing on individual choice and the moderate drinker allows the alcohol industry to evade responsibility from the wider social and health impact of their sales;(4) a similar story can be told of the fast food and soft drink sectors. The financial resources at the disposal of these industries eclipse those of public health, this makes the lobbying influence one even the most powerful governments find it difficult to regulate.(1)
Industry has a role in improving public health, however, in the midst of today’s burgeoning obesity levels, widespread alcohol problems and non-communicable disease epidemic, we need a clear vision of how to turn the tide. Although a libertarian-paternalistic, ‘nudge’, approach is politically favoured over explicitly paternalistic policies in the UK,(5) we must ultimately use evidence-based solutions which work. The implications for population health cannot be overstated.
1. Hastings G. Why corporate power is a public health priority. BMJ 2012;345:e5124.
2. Malhotra A. Viewpoint: Ban junk food sponsors from Olympic sport. BBC News, 9th July 2012. Available from http://www.bbc.co.uk/news/health-18708790 (Last accessed 27/04/2013).
3. British Medical Association. Under the Influence: the damaging effect of alcohol marketing on young people, 2009.
4. Casswell S. Vested interests in addiction research and policy. Why do we not see the corporate interests of the alcohol industry as clearly as we see those of the tobacco industry? Addiction 2013;108(4):680-5.
5. Marteau TM, Ogilvie D, Roland M, Suhrcke M, Kelly MP. Judging nudging: can nudging improve population health? BMJ 2011;342:d228.
Competing interests: No competing interests
No - but the food industry can cooperate if government is sufficiently committed.
The best example being the North Karelia Project in Finland, Finland which when rolled out as a national program reduced the incidence of ischaemic heart disease over 24 years by 65%. (Ref).
This was a result of the realisation in the 1960s that Finland had an exceptionally high rate of heart disease with high levels of risk factors – high fat diet, smoking and hypertension. There was a national consensus that action was required which involved education through the media, identification and management of risk factors by health professionals and community initiatives.
The community initiatives involved identifying opinion leaders in every community and collaboration with voluntary organisations e.g. the national housewives’ organisation.
The report states that ‘In response to the evolving consciousness among its customers the Finnish food industry has pursued the development of new low –fat products with great diligence and creativity’
The government liberalized regulations on food production to allow mixing dairy fats and vegetable oils and low fat spreads. Explicit labeling enabled consumers to select genuinely low fat products.
In 1985 a major collaborative project to change diet was financed by the Ministry of Agriculture and Ministry of Commerce to help farmers change from dairy to berry production and development of a domestic rape seed oil. Collaboration with the baking industry lead to a change from butter use to vegetable oil margarine.
The healthy eating message was reinforced through children being given a free school lunch and children’s weight was monitored at school.
Results were that high fat milk consumption dropped from 70% to 14% among men and 60% to 10% among women with reduced consumption of other fat sources. Total cholesterol fell by 16% and the proportion of men with levels over 6.5mmol/L fell from 60% to 28% in keeping with dietary modification being a major cause in the reduction of heart disease.
This project covered other aspects of health promotion including smoking cessation and increased exercise. Over 21 years there was a drop in all cause mortality of 39% with a 42% reduction in cerebrovascular disease, a 17% reduction in cancer deaths and an improvement in perceived health status.
The report illustrates that food industries can respond to a concerted program to improve health.
Ref - North Karelia Project in Finland, 20 Year Results and Experiences, Pekka Puska, National Public Health Institute, Finland,1995
Competing interests: No competing interests