Health wash in Helsinki

In June 2013 the 8th Global Conference on Health Promotion on Health in All Policies was held in Helsinki. The fourth plenary session featured speakers from the World Bank and World Economic Forum (WEF) and immediately reminded us of corporate ‘green wash’ whereby companies grossly exaggerate their environmental sustainability credentials to gain social credibility and consumer comfort. In Helsinki we witnessed a similar ‘health wash’, in which the private sector was portrayed as an essential and beneficent ‘partner’ in promoting health by providing its expertise and much needed resources. Jané-Llopis and Xydia-Charmanta (2013) (Director, WEF) reminded us that 44% of the world's 100 top economies are corporations rather than countries, and argued that the private sector is flexible, innovative and more attentive to consumer convenience and satisfaction than the public sector. This portrayal of the private sector's role in health promotion contrasted sharply with that of World Health Organization's (WHO) Director General Dr Margaret Chan who, in her opening address, condemned the economic power and destructive health impact of large industries, including food, tobacco, soda and alcohol: ‘In the view of WHO, the formulation of health policies must be protected from distortion by commercial or vested interests’, whose tactics ‘include front groups, lobbies, promises of self-regulation, lawsuits, and industry-funded research that confuses the evidence and keeps the public in doubt’ (Chan, 2013). This theme echoed through the following five days. The Irish Minister for Children and Youth, Frances Fitzgerald, talked of the need to make the lobbying tactics of industry transparent and to ensure that health promotion advocates have the same access to politicians as industry representatives. Ilona Kickbusch spoke of the commercial determinants of health. The twitter wall at the conference was busily rinsing off this corporate ‘health wash’ with comments about the need to deal with industry's adverse impacts. But the big question confronting the health promotion movement is how best to control corporate interests? The answer to this requires understanding why corporations have and maintain such power. Our global economic regime is structured to meet the needs of rich countries and transnational corporations. This is done through trade agreements that make the world safe for capitalism (Chang, 2008), taxation regimes that enable corporations to pay little tax (Tax Justice Network, 2013) and investment treaties that allow foreign companies to sue governments for new public health regulations that might put a dent in their profits (Khor, 2012). The fall of the Soviet Bloc has meant an ideological domination for capitalism that crowds out ideas for alternative economic regimes in dominant discourse and rich country media. Gramsci's (1971) hegemonic capitalism has well and truly come to pass. It is this ideological climate that makes a ‘health wash’ so easy for industry to get away with. What reasonable person would oppose a public private partnership to provide more health services or gain more funds for a children's hospital by having Ronald MacDonald as a mascot? How could you object to a healthy eating campaign by Coca Cola? Why shouldn't we be pleased that Nike is promoting a fitness campaign, or that Philip Morris is running ads encouraging teenagers not to smoke, or that Pepsi's bottled water in India is replenishing more water (an essential for health) than it takes? Some of the reasons are obvious: sweat shop labour hardly supports a fit and healthy lifestyle (though Nike has improved considerably on that front after 20 years of campaigning); Philip Morris knows that an anti-smoking ad is image ‘health washing’ even as it aggressively fights tobacco control policies worldwide; and Pepsi's extravagant water claim has been shown to have more leaks than a rusty colander (IRC, 2011). Health washing occludes the many ways in which corporations operate to reduce the potential for health. Their skilled evasion or avoidance of taxation reduces the capacity of countries at all levels of development to build strong public sectors that can develop cross-sector policy coherence for health. Health groups are left scrambling for funds and become ripe pickings for corporate sponsors: and so Yum! Brands, owners of several global fast food chains, partners with a major US cancer charity to sell pink buckets of fried chicken; the American Dietetic Association partners with Hershey chocolates in an on-line service to dieticians recommending a daily ration of chocolate as part of a healthy diet; and Save the Children, after partnering with Pepsi-Cola and applying to the same with Coca-Cola, reverses its policy calling for soda taxes to reduce soft drink consumption (Freedhoof and Hébert, 2011). The growth of the corporate health services industry is another threat, if not to health then certainly to health equity. Public–private partnerships are being vaunted right, centre and (yes) sometimes even left, as austerity-mad governments move public services off their books and investors eye the several trillion dollars spent annually in the health sectors of the Organization for Economic Cooperation and Development (OECD) and Brazil, Russia, India and China (BRIC) nations (PWC, 2012). This ‘win–win’ model, however, assumes that health workers will be paid less for more (PWC, 2012), that even the poor will have to pay some user charges (The Global Health Group, 2009) and enables profit taking by the private sector while the public sector absorbs the risk of market failures (Acerete et al., 2011). The burden of evidence indicating that strong public provision of health services is essential for equitable access to health care is conveniently ignored. In the face of the power yielded by corporations what should the health promotion response be? Three areas for action appear vital: The advocacy effort started in Helsinki with corporate power being recognized in the official conference statement (WHO, 2013) and through a Call to Action issued by the People's Health Movement (2013). If Health in All Policies is to mean anything then beware the corporate health wash! Regulation: health promotion must argue the case for the importance of government regulation and negate industry's claims that this is just the ‘nanny state’ in operation. Big Food is profiting from the obesity epidemic and controls on its ability to market fat and sugar need to be implemented. Globally, the Framework Convention on Tobacco Control (Muggli et al., 2013) offers a regulatory framework that could be extended to other health-damaging products. Taxation: health promotion must campaign for progressive taxation and for much tighter national and international regulation to shut down tax havens and loopholes than enable corporations to pay very little tax on their profits. Transparency: conflicts of interest should be made transparent in WHO, other international organizations and national governments, and lobbying activity should be documented and monitored so that access to power is no longer covert and behind doors. F.B. is supported by an Australian Research Council Federation Fellowship and R.L. by a Canada Research Chair.

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