The health impact of alcohol and nutrition figured among the topics that delegates from various countries discussed at the 75th World Health Assembly (WHA) in Geneva recently. While the two are recognized as a “slow-motion disaster” in the field of non-communicable diseases (NCDs), the action plans that have been adopted at the Assembly will do little to tackle the root causes of the problem.
While most countries recognized alcohol use as a public health priority and supported the proposed action plan, only a couple called for effective steps against the alcohol industry. The delegate from Estonia, for example, said that “there is an inherent conflict of interest with the alcohol industry that can undermine the development of public policies.” The delegate from the Seychelles pointed out the dangers of commercial interference and said that “ambitious measures are required against the lobbying by the industry.” The US, on the other hand, claimed that some trade-related recommendations in the action plan lay outside the WHO’s mandate and called for more multi-sectoral collaboration, code language for giving the private sector a seat at the table.
The statements presented by countries during the discussion on WHO’s strategy for food safety revealed the deficient understanding in the plan of the links between nutrition and health. Countries welcomed the strategy and reiterated the importance of ensuring food safety and working towards uniform standards, but didn’t question the larger impact of food systems on public health. Only Colombia stepped up stating that “there is a need to address our global food system, including its impact on health as well as the impact of marketing. We need to reduce the risk of future zoonotic disease.”
Alcohol and ultra-processed food kill
Worldwide, three million people die each year as a result of the use of alcohol. That’s one person every 10 seconds. Alcohol use is considered to be one of the main risk factors for poor health globally, representing about 5% of all deaths and 5.1% of the global disease burden. Similarly, ultra-processed foods are associated with an overall higher mortality risk among adults, they increase the risk of cancer and cardiovascular disease and are linked to health challenges such as obesity and stunting. Studies have shown that the negative effects of ultra-processed foods are most likely to be felt in low-income communities, where ready-to-eat or packaged meals are more accessible in comparison to fresh, nutritious food.
Yet the food and alcohol industries are doing everything they can to market and sell their products. With the increase in advertising bans and saturation of markets in many high-income countries, transnational food and alcohol companies found novel ways to promote their unhealthy products and avoid strict regulation, notably in low and medium income countries (LMICs), where the volume of soft drink consumption increased by an average annual growth rate of 5.2% per person between 1997 and 2009.
Novel marketing strategies
In early May 2022, the WHO published a report highlighting gaps in the regulation of alcohol marketing, which showed that young people and heavy drinkers are increasingly targeted by alcohol advertising to the detriment of their health. The report also shows that six transnational alcohol corporations (TNACs) are among the 100 highest spenders worldwide on advertising of any product or service, and that the industry is relying more and more on marketing techniques like promotions, product placement and online advertisements in social media.
In LMICs in particular, there have been efforts to recruit more women drinkers. Women are seen by producers as an untapped consumer group, so developing marketing programs specifically for women have become key strategies of TNACs to boost sales. These include developing “drinking rituals” to make drinking beer feel special, using social media posts with female influencers to promote alcohol brands, and giving alcoholic drinks a pink color in order to market them more easily as “women’s drinks.”
Just like the alcohol industry, Big Food promotes its unhealthy products on social media platforms and it indiscriminately advertises during global sporting events like the FIFA World Cup, viewed by billions around the globe. The industry also uses celebrities in advertisements to plant its products firmly in popular culture. McDonald’s, Coca-Cola, PepsiCo and a host of alcohol companies were quick to exploit the popularity of reality TV shows by promoting their brands on recent editions of Big Brother Brazil and Nigeria, viewed by millions and millions of youths.
Commercial interests trumping health justice
Manufacturers of unhealthy products use different lobbying tactics to avoid strict regulation and receive favorable treatment by governments, including lobbying to influence and shape government policy towards the WHO.
Direct contact between governments and the alcohol and food industry is often legitimized by the companies’ purported contribution to economic growth. Economic imperatives, mostly in the shape of trade and investment regimes, have always played a big role in facilitating the entrance of transnational companies into LMIC markets. Vietnam, for example, removed restrictions on foreign direct investment (FDI) as a requirement for entry in the World Trade Organization (WTO). This resulted in greater investment by transnational food companies and enabled significant growth in sales of sugar-sweetened beverages. Similarly, a comparison between Peru and Bolivia showed a 122% increase in soft drink production following Peru’s ratification of the US/Peru Free Trade Agreement, compared to minimal change in Bolivia which had no trade agreement with the US.
Industry also spends enormous amounts of money to build a positive public image. The food and alcohol industry uses Corporate Social Responsibility (CSR) initiatives to portray themselves in good light, leverage favorable government regulation and indirectly market their brands. Through the Project Last Mile, a public-private partnership (PPP) involving the Coca-Cola Company, USAID, the Global Fund and the Bill & Melinda Gates Foundation, Coca-Cola branded vehicles are used to deliver medical supplies to remote villages, along with their unhealthy product. During the pandemic, food and beverage industries expanded the reach of their CSR activities by fostering even stronger partnerships with governments and international agencies. PepsiCo reportedly spent $49 million in support of international organizations like Save The Children, Red Cross and local non-profits for food relief. Heineken donated €15 million to support relief efforts of the International Federation of Red Cross and Red Crescent Societies (IFRC) in Africa, Asia and Latin America.
WHA misses the point
At the World Health Assembly, countries failed to curb the commercial and economic drivers of alcohol use and the proliferation of ultra-processed foods. While more effective regulation of the food and alcohol industry is clearly needed, the action plans developed to reduce their detrimental health impact remain silent on the root causes of the problem.
The action plan (2022-2030) to effectively implement the global strategy to reduce the harmful use of alcohol as a public health priority does not provide concrete advice on countering commercial barriers to effective alcohol controls. The plan does not have an explicit section for alcohol control. It only advocates on how to deal with commercial influences and basically places civil society and governments on a par with the industry, welcoming producers of alcohol and ultra processed food as an equal partner in the implementation of the plan.
WHO’s global strategy on food safety, on the other hand, completely misses the point. It restricts its focus to food borne disease and neglects the importance of health systems for public health nutrition goals, climate change, food sovereignty and the environmental harm done by micro-plastics. Instead of looking for ways of building food sovereignty, the WHO plan is oriented towards the alignment of food standards and international trade facilitation, and favors large transnational food manufacturers over small scale local producers.
Without stronger action to counter the influence of transnational alcohol and food companies, industry-propelled health harms will continue to persist. WHO and governments must take a clearer stance against the industry and work together with civil society to ensure that trade and commercial interests don’t trump health justice.
The WHO Watch team members are Abhishek Royal, Alan Rossi Silva, Aletha Wallace, Anton Sundberg, Ben Verboom, Dian Maria Blandina, Jasper Thys, Maria Alejandra Rojas, Marta Caminiti, Sarai Keestra, Sopo Japaridze, Lauren Paremoer, Jyotsna Singh, and Gargeya Telakapalli.
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