Study shows companies hold back advances in public health

Less democratic countries and those where companies have more influence over government policies - because of corruption or political favouritism - are less likely to implement strong policies to prevent non-communicable diseases, new research has found.

The study, led by researchers at Karolinska Institutet and the London School of Hygiene & Tropical Medicine, shows many countries have been slow to implement the public health policies on alcohol, unhealthy foods and tobacco recommended by the World Health Organisation (WHO).

In 2013, WHO member countries signed up to a list of policies to fight heart disease, cancer, diabetes and chronic lung disease, agreeing to introduce policies to limit consumption of tobacco, alcohol and junk food. The aim was to reduce premature mortality caused by non-communicable diseases by a third between 2015 and 2030.

The researchers analysed the extent to which signed-up countries had implemented the policies, finding the average implementation score was 47% in 2020, up from 45.9% in 2017 and 39.0% in 2015.

Around two-thirds of countries had not implemented WHO recommended restrictions on marketing of unhealthy food to children in 2020, while measures targeting alcohol use, including restrictions on sales and advertising, actually eased between 2015 and 2020. Implementation of measures targeting tobacco improved somewhat.

The most widely implemented interventions were clinical guidelines and national action plans and targets to combat non-communicable diseases.

“Our study found slow overall implementation of WHO’s recommended non-communicable diseases policies, especially when it comes to measures targeted at risk factors such as smoking, alcohol and unhealthy foods,” said Hampus Holmer of Karolinska Institutet’s department of global public health.

The results are “worrying” because non-communicable diseases are the most common cause of death in the world today, said Holmer. “Several of these diseases are also linked to an increased risk of dying of infectious diseases such as COVID-19 or tuberculosis,” he said.

Progress was especially slow in low-income countries and countries with less democracy. At the bottom of the list are three countries in West Africa - Equatorial Guinea, Guinea-Bissau and Sierra Leone - with one to two partially implemented policies. Norway and Turkey are at the top of the list with 90% fully or partially implemented measures.

The researchers found that corporate political influence is associated with the degree of implementation of health policies. “The more influence corporations had, the lower the degree of implementation of preventive public health measures,” said Luke Allen, research fellow at the London School of Hygiene & Tropical Medicine.

The researchers also found that policymakers are more prone to act as the burden of non-communicable diseases grows. However, delayed action is problematic because the impact of prevention may take years to bear fruit.