Why, over the last fifty years, have successive governments in New Zealand, like their counterparts overseas, consistently favoured less effective interventions for tobacco, alcohol, gambling and unhealthy food and beverages over what research indicates are more effective interventions?
This is surprising given the widespread negative impacts of these consumptions on health, wellbeing and broader society. Tobacco consumption leads the way in terms of impacts on physical health. Between 1950 and 2000, it has been estimated that smoking has led to 62 million deaths in developed countries, comprising 12.5% of all deaths, 20% of male deaths and 4% of female deaths.
Similarly, unhealthy eating is contributing to a broad range of health issues including cardiovascular health and escalating levels of type 2 diabetes. Hazardous drinking contributes to deaths globally and is the leading contributor to years lived with disability from somatic disease and injury. However, alcohol’s main contributions to harm are in terms of mental disorder, violence, crime, marital breakups and child neglect. The proliferation of commercial gambling, particularly the global spread of over 8 million gambling machines, is causing many similar negative impacts.
Despite the emergence of solid evidence on effective policy interventions and despite the combined efforts of concerned citizens, researchers and community agencies, the outcomes in terms of policy and regulation are by-and-large disappointing. For example, counter to research evidence, recent reforms of alcohol legislation in countries such as the United Kingdom, New Zealand and Canada have been weak from a public health perspective. These experiences, plus many similar histories of disappointing policy reform, speak loudly of vested interests. How have these unhealthy commodity industries managed so effectively to influence public policy?
A key aspect to the commercialization of addictive consumptions (tobacco, alcohol and gambling) is their ability to generate profits over-and-above what occurs with ordinary non-addictive consumptions such as buying petrol or televisions. For example, a pivotal feature of addictive drinking is consumption that goes well beyond what might be considered sensible.
Addicted consumers, by the very nature of addictive behaviour, will consume to excess. They may be relatively small in number compared to non-addicted consumers, but they invest heavily and, accordingly, contribute far more to the profits.
The resultant profit surplus underpins not only the motive force for these industries to seek increases in consumption but also the resource base for a range of pro-consumption initiatives that seek to influence policy makers in order to guard against any threats associated with changes in regulation.
A key area of influence-making concerns the way industry actors seek to form relationships of mutual obligation with key government actors, particularly those in a position to determine health policy. They achieve this by setting up a variety of connecting spaces for the purpose of informal friendly person-to-person contact and favour exchange. Examples of such spaces include party conference dinners, corporate boxes, shared committee meetings and appointments with ministers. These regular personal contacts increase the likelihood that industry perspectives will prevail over other perspectives, particularly those concerned about health impacts.
Politicians are likely to see themselves as unaffected by relationships with industry actors. However the cultural practices of informal relationship building, of gifting and of providing favours, are deeply embedded as a means by which we form all our relationships. The potency and subtlety of these processes often passes undetected. For example, while doctors claim gifting and favours from pharmaceutical companies (lunches, pads, conferences etc.) has little influence on their practice, research into what they actually prescribe indicates a strong favouring of drugs from the gifting company.
Recent studies in the UK have exposed some of the pathways by which alcohol industry corporations penetrate government contexts and have highlighted how building these relations typically involves long-term industry investment in relationship-building including the targeting of opposition politicians. Our knowledge of these processes is meagre because enquiry into this politically sensitive but important area is undeveloped.
What is needed is systematic study of the ways in which these unhealthy commodity industries are able to deploy their profits to subvert effective intervention.
Text and Photo by Peter J. Adams