Intersectoral policy on industries that produce unhealthy commodities: governing in a new era of the global economy?

Abstract

Tobacco, alcohol and unhealthy foods are key contributors to non-communicable diseases globally. Public health advocates have been proactive in recent years, developing systems to monitor and mitigate both health harms and influence by these industries. However, establishing and implementating strong government regulation of these unhealthy product-producing industries remains challenging. The relevant regulatory instruments lie not only with ministries of health but with agriculture, finance, industry and trade, largely driven by economic concerns. These policy sectors are often unreceptive to public health imperatives for restrictions on industry, including policies regarding labelling, marketing and excise taxes. Heavily influenced by traditional economic paradigms, they have been more receptive to industry calls for (unfettered) market competition, the rights of consumers to choose and the need for government to allow industry free rein; at most to establish voluntary standards of consumer protection, and certainly not to directly regulate industry products and practices. In recent years, the status quo of a narrow economic rationality that places economic growth above health, environment or other social goals is being re-evaluated by some governments and key international economic agencies, leading to windows of opportunity with the potential to transform how governments approach food, tobacco and alcohol as major, industry-driven risk factors. To take advantage of this window of opportunity, the public health community must work with different sectors of government to(1) reimagine policy mandates, drawing on whole-of-government imperatives for sustainable development, and (2) closely examine the institutional structures and governance processes, in order to create points of leverage for economic policies that also support improved health outcomes.

Learning from intersectoral action beyond health: a meta-narrative review

“…In the design and implementation of inter-sectoral interventions, the role of power and politics is considerable, and it is common for traditional command and control forms of power to be upheld by statutory institutions. The process of coordination and regulation may lie outside the authority of the health ministry and may be in the hands of the ministries of finance, industry, or agriculture, who are also more powerful, having profound effects on public accountability ( WHO, 2017 ; Lencucha and Thow, 2020 ). However, it is also important to note that traditional hierarchies are challenged during the process of implementation as such bureaucracies are often ill-equipped to work across institutions/across boundaries.…”

An Overview of the Policy and Market Landscape of Tobacco Production and Control in Mozambique

“…With roughly 98% of tobacco being produced by SHFs [ 9 ], the crop is grown in a concession system with Mozambique Leaf Tobacco (MLT), a local subsidiary of the multinational Universal Corp [ 17 ]. The company operates in four provinces in central and northern Mozambique: Zambézia, Manica, Niassa, and Tete (See Figure 2 for production by province).…”

“…This perspective starts from the premise that tobacco should be phased out both as a consumer product and as an agricultural commodity. This perspective is not often one that is taken in the economic and agribusiness sectors [ 5 , 9 , 45 ]. The entry of China National Tobacco Company in Mozambique illustrates that production will likely continue to be guided by economic rather than health protection considerations.…”

“…In order to move towards stronger tobacco control measures, and the implementation of the demand and supply measures in the FCTC specifically, it is critical to understand the policy landscape across sectors. The principal rationale for pursuing this understanding is that comprehensive tobacco control cuts across sectors and require the participation and support of not just health ministries but also finance, industry, agriculture, trade and others [ 9 ]. To understand this policy landscape is to better understand the points of intervention and potential existing conflicts and complementarities across government policies.…”

Who influences nutrition policy space using international trade and investment agreements? A global stakeholder analysis

“…In that vein, “the single most powerful thing food industries can do is to support government policy attempts to create healthier, more sustainable food systems and, especially, refrain from undermining them ” (emphasis ours). (67 p8) On the other hand, there may be opportunities for a public health nutrition coalition to build bridges with the economic sector in new and constructive ways that explicitly remove support from unhealthy commodity-producing industries in favour of industries, consumer products and modes of production that are sustainable, health-promoting, and contribute to the economy [ 71 ]. In this regard, we posit that understanding the influential actors and their beliefs can give insights regarding how, and with whom, to engage effectively.…”