Why the ‘Costs of Doing Business’ Are Costing Us Our Lives

We have all been understandably absorbed in infectious diseases for the past few years: the ongoing COVID-19 pandemic, long COVID and the resurgence of other ailments like whooping cough, respiratory syncytial virus and measles.

Meanwhile, a host of other diseases have continued to beset us: the non-communicable diseases like Type 2 diabetes, cardiovascular diseases, hypertension and some cancers. We’ve long known that such diseases are largely due to the social determinants of health — every social class is healthier than the one below it, and sicker than the one above it.

Some social determinants are gaining more interest among public health experts: namely the commercial determinants of health, which the World Health Organization defines as “the private sector activities that affect people’s health, directly or indirectly, positively or negatively.”

Positively, the private sector can produce safe drinking water, effective pharmaceuticals and so on — at least to those who can afford them.

The major negative commercial determinants of health are the industries that produce alcohol, tobacco, ultra-processed foods and drinks, and air pollution from fossil fuels.

According to a 2023 report in The Lancet, these four industries are responsible for one-third of global deaths each year.

According to database.earth, 60 million people died in 2023. Applying The Lancet’s global death numbers to this data, about 20 million of those who died last year died from the product of just four legal, regulated industries (in many countries, tobacco and alcohol are sold by government agencies).

Still more illnesses and deaths result from gambling, dangerous working conditions and even some aspects of health care.

Taking care of business

The World Health Organization has just published “Commercial Determinants of Noncommunicable Diseases in the WHO European Region,” a long examination setting out the serious public health consequences that result from simply taking care of business in what WHO calls the “health-harming industries.” It focuses on the 53 nations of the WHO European region, but many of its findings are applicable to Canada.

Those findings are shocking: “Nearly 7,500 deaths per day in the region are attributed to commercial determinants, such as tobacco, alcohol, processed food, fossil fuels and occupational practices. These commercial products and practices contribute to 25 per cent of all deaths in the region.”

That makes an estimated total of 2.7 million European deaths each year — just from noncommunicable diseases.

That number should make us pause and think. In 53 European nations, a quarter of the deaths are what economists call “externalities”— costs of business that business offloads onto others. If commercial actors wanted to, they could reduce that toll — or at least European governments could oblige them to make an effort. But that would mean lower revenues and fewer jobs.

The WHO report meticulously works its way from defining the commercial determinants of health to describing how marketing strategies “glamourize and normalize the use of harmful products, including harmful ones often targeting children and socioeconomically disadvantaged groups and others.”

It shows how businesses can influence government policy through monopoly control and price manipulation, as well as straightforward lobbying. Trade and investment agreements give priority to commercial interests over public health.

‘Pinkwashing’ and ‘artwashing’

Commercial actors, we learn, can aggressively cast doubt on evidence, spread misinformation and weaken public health guidelines. “Good corporate citizens” use corporate social responsibility to mute criticism and stall regulation.

Among the case studies in the report, one deals with “pinkwashing” the alcohol industry by associating itself with support for research into breast cancer. Another describes “artwashing, where the pharmaceutical industry and gambling industry promote arts and culture.”

The pharmaceutical industry, the report says, is also very good at designing medical trials that make its products look good and minimize any negative effects.

And of course it will charge what it can for drugs in demand. According to a recent report in the Guardian, Wegovy — a drug used in weight-loss programs — costs US$1,349 per month in the United States, US$140 in Germany and US$92 in the United Kingdom.

A CBC report says a month of Wegovy injections in Canada costs about $400. So the beneficiaries of such drugs are those who can afford them.

The WHO report implies a kind of ecosystem of health-harming industries. If ultra-processed foods and sugary soft drinks lead to obesity and Type 2 diabetes, then Wegovy can reduce obesity while the same drug, in a different dosage and marketed as Ozempic, can help diabetics.

Junk-food consumers can transition to drug consumers (if they can afford to), and health-harming industries prosper all around.

Medicine: a health-harming industry?

Medicine itself can be a health-harming industry. The promotion of prescription opioids like OxyContin resulted in hundreds of thousands of preventable deaths — 10,568 in the United States in 2022, out of a total of 78,012 overdose deaths from prescription and illicit drugs.

B.C., meanwhile, has seen over 14,000 overdose deaths since 2016.

In an exquisite irony, anti-vaxers damn Big Pharma for supposedly producing deadly vaccines; in the pandemic, the harm’s been done by the failure of producers to supply vaccines to low- and middle-income countries.

Commercial actors prefer to blame the consumer rather than the system they’ve created: The BC Lottery Corp. advises gamblers to “know your limit, play within it”; if they exceed their limit and become addicted to gambling, they can turn to the corporation for help.

At BC Liquor, a case study in commercial determinants

Similarly, BC Liquor promotes “responsible use” of a substance that killed 3,875 British Columbians in 2021 — up from 3,200 in 2019.

Governments encourage more alcohol consumption (and improved revenues) by permitting drinking in Vancouver parks and making beer and wine available in Ontario convenience stores.

The WHO report concludes with recommendations that will take a long time to adopt, let alone have an effect: “Developing a narrative based on the core values of equity, sustainability and resilience involves connecting corporate behaviours to their negative effects on these values. For example, public health actors must highlight how industries that engage in tax avoidance reduce public funds available for health, exacerbating health inequities. On the other hand, pricing strategies on tobacco, alcohol, and sugar-sweetened beverages raise revenue, reduce consumption and exert progressive effects if the money raised is invested in services to reduce disparities.”

After being consistently ignored or undercut by governments since the start of the pandemic, public health officials will now have to try to persuade both the public and their political masters to make junk food, booze, tobacco and gasoline more expensive — to pay for the damage caused by health-harming industries.

It’s a noble goal, but a near-impossible one.

Air pollution from fossil fuels kills over eight million a year, but we’re not about to ban fossil fuels. Or clear the supermarket shelves of potato chips and frozen pizzas, or halt online sports betting, or punish pharmaceutical companies for their predatory pricing.

Mitigation, but not elimination

The best we can hope for is some degree of harm reduction: somewhat cleaner air, both inside and outside. Fewer sales of cigarettes and alcohol, and lower incidence of cancer and liver disease. Less consumption of junk food and therefore fewer diabetes cases — and less demand for Wegovy and Ozempic. But people will still smoke, drink and eat too much junk food; they’ll still have to breathe less-polluted air.

The report should also make us realize that those in charge of health-harming industries and of our governments have the information that should make them aware of the harms they are doing. But they are not acting on that information except performatively. They may blame us for our addictions and our self-destructive appetites, but they tailored their products to be addictive, or at least critical to making a living in an industrial culture.

Government regulators have gone along. The resulting mortality hasn’t caused an outcry, after all. Life goes on, for most of us.

And that may explain the behaviour of governments in the ongoing COVID-19 pandemic: they know, from their experience with health-harming industries, that their populations will tolerate sickness and death even when it is easy to prevent.

So dissolving public health into “personal responsibility” makes perfect sense, just as it does with gambling and drinking.

Only when the public moves back into public health, and demands real control over the health-harming industries, will we save the millions of lives now being lost as a cost of doing business.