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Manipulation by association: tobacco, food and public health in India

By Upendra Bhojani
on October 23, 2015




Policy-making for NCDs: riddled with conflicts and contestation

The rising burden of non-communicable diseases (NCDs) globally has turned the policy makers’ attention towards regulating some of the common ‘risk’ products including tobacco, alcohol and ultra-processed foods rich in sugar, salt and harmful fats. Consumption of these products can have negative health impacts on people. NCDs are a major killer in India accounting for 60% of total deaths – or over 9.8 million deaths in the year 2014. India has taken regulatory measures to warn people about the health impact (ultra-processed food, tobacco, alcohol) and curb promotion and/or consumption of some of these products (tobacco, alcohol) while also realizing the need for a multisectoral response for the prevention and control of NCDs. However, the public health interests pursued through these regulatory measures often go against the economic interests of industries dealing with these products, and often also against any vested interests of certain sections of governments (that see trade in these products as a source of revenue and foreign investment). In addition, some international development agencies that are influential in driving the policy agenda and dialogues get associated, often indirectly, with industries dealing in these ‘risk’ products.  So the policy-making in this area remains a highly contested and conflicted process. Still largely missing in these policy battles, are, however, political will and actions to manage these conflicting interests.

This is not a new phenomenon; it’s an age old battle. We still see politicians with overt industrial interests and industry leaders themselves being part of committees/bodies making public health policies related to tobacco control and food safety. For example, governments in India provide subsidies, invest money and to some extent own the tobacco industry. These are overt conflicts of interest and issues which have already been written about, and discussed in the public domain.


Manipulation by association

It is not difficult to notice the indirect and subtle associations between the tobacco and ultra-processed food industry with governments and international development agencies.

Such associations are often ways for industries to build a more positive image (and legitimacy) and access policy makers for influencing public policies. For instance, the tobacco industry is notorious for its ingenuity in sustaining relationships with governments, across the world. ITC, India’s largest cigarettes manufacturer, funded the 10th Sustainability Summit organized recently in the national capital. It has been funding these summits for a long time. In fact, these summits are being organized by the CII-ITC Center of Excellence for Sustainable Development. The government ministries (Housing & Urban Poverty Alleviation; Environment, Forests & Climate Change) and several government agencies were partners for the 10th summit, as was GIZ (German Society for International Cooperation, Ltd.). A UNDP (United Nations Development Programme) representative appeared in the speakers’ list. No wonder the bigwigs of tobacco industry featured in key positions in these summits, often alongside ministers and influential policy makers. The summit brought back memories of the World Business and Development Awards, an initiative supported by the UNDP to recognize private sector players working to achieve Millennium Development Goals. ITC, whose main profits come from the cigarette business, won an award in the 2012 edition of the Initiative. In another example from earlier this year, the International Tax and Investment Centre (ITIC), a known front group of the tobacco industry with some big tobacco people as board members and sponsors, organized the 2015 Asia Pacific Tax Forum in Delhi. The forum featured high-level government delegations from the region, including ministers and top officials from the government of India. Taxation is a proven effective instrument for tobacco control and this is not the first time that the ITIC has tried to negatively influence taxation policies. Also in 2012, a day before government delegations from across the world – party to the WHO-Framework Convention on Tobacco Control (WHO-FCTC) – were to meet and deliberate on economics and trade related issues in Moscow, the ITIC had organized a briefing on tobacco excise taxation inviting these government delegations. The WHO-FCTC secretariat had to issue a note verbale to the member countries alerting them about ITIC’s tobacco industry connections and suggesting them to avoid participating in an ITIC organized briefing. The 2015 Asia Pacific Tax Forum had listed the World Bank as funder and supporter on their website, which they later removed.

Such indirect engagements of tobacco industry are not uncommon, nor undocumented; I have written elsewhere on how Indian cigarette companies have been using so-called independent industry groups to influence tobacco control policies in India. Pranay Lal through an editorial in Tropical Medicine and International Health and a comment in the Lancet highlights how some international aid agencies and development partners have indeed assisted the tobacco industry and some continue to do so.

The food industry, particularly the sectors related to ultra-processed food and sugary-beverages also present a similar story. Arun Gupta and others, in their commentary in the Economic and Political Weekly, demonstrate how the food industry used ‘manipulation by association’ as a strategy to undermine nutrition policies – from food industry voices in the Lancet to funding of Indian universities by Nestle. Indeed, so-called corporate social responsibility (CSR) and sustainability have provided popular and often legitimate avenues for these industries to partner with governments/reputed organizations and fund (read influence) research/programs related to health and development. While the disclosure by Coca-Cola, spending (on its own) 118.6 million USD on scientific research and health and wellbeing partnerships, many of which were reputed health organizations, in the US in the last five years might surprise us for the sheer scale of it, it is not new for Indian companies producing tobacco and sugary drinks in India to partner with and fund reputed health and development organizations. For example, PepsiCo, one of India’s largest producers of sugary drinks and ready snacks, and ITC, one of the largest cigarette manufacturers, have associated themselves with reputed health and development organizations to support initiatives including lifestyle and nutrition programs for children. In fact, nearly all the big tobacco and food/beverage companies in India produce ‘sustainability’ reports, often lengthier than their annual reports, highlighting their CSR contributions towards health, development and sustainability in general.


Corrective actions: too little, too late?

Article 5.3 of the WHO-FCTC, signed and fully ratified by India, requires member countries to adopt policies, which prevent conflicts of interest between governments and the tobacco industry’s interference in public policies with regard to tobacco control.  In a public interest litigation (Institute of Public Health Vs Union of India and others), the health ministry on behalf of the government of India had promised the Karnataka High Court to bring in a code of conduct for public officials with regard to their dealings with tobacco industry.  After over four years of the court intervention, the government is yet to adopt a code or a policy along these lines. There are some positive examples too: in 2013, the Karnataka government issued a letter to all the elected leaders and bureaucrats advising them not to participate and associate with tobacco-industry funded events. More recently, the Punjab government formulated a committee to focus on implementing the WHO-FCTC article 5.3. However, effective implementation remains a challenge as the incidence  of government and political representatives associations with the tobacco industry are not uncommon.

A member of parliamentarians from Tamil Nadu introduced the Prevention and Management of Conflicts of Interest bill in 2011, which lapsed and was subsequently reintroduced in 2015. The bill is still pending. Meanwhile, earlier this year, amendments were proposed to the existing national tobacco control legislation adding that the government of India should ‘protect the development and implementation of public health policies with respect to tobacco control from the commercial and other vested interest of the tobacco industry’. These amendments are still in a proposal form. While the WHO clearly denounces CSR activities of tobacco industry, the Companies Act (2013) by the Ministry of Corporate Affairs mandates CSR by big Indian companies, in turn legitimizing CSR by big tobacco and food companies in India.

Some development agencies have adopted policies of not supporting tobacco industry operations. The World Bank already did so in 1991. But the process is far from straightforward. By way of example: after we, at the Institute of Public Health (Bangalore), wrote to the Bank on the problematic nature of their association with the 2015 Asia Pacific Tax Forum, the Bank’s India office sent us a written response indicating that they had indeed received requests from the ITIC for financial and technical support, which, after careful consideration, the Bank had declined. Subsequently, the forum website removed the Bank’s mention as a supporter of the forum. However, soon after, the Bank was in the news for the wrong reasons (again) – its pension fund was invested in tobacco, coal and mining companies, especially mentioning the name of the tobacco giant, Philip Morris International, among others.

A letter to the UNDP by an Indian activist, Bobby Ramakant, pointed out problems with the UNDP giving the World Business and Development Award to the ITC. This yielded a response from the UNDP administrator, Helen Clark, regretting the oversight. Subsequently, while responding to a comment on UNDP’s associations with the tobacco industry, Helen Clark indicated that the UNDP is working out a policy in this regard. Inspired by UNDP’s proposal, we tagged UNDP on twitter questioning their participation in the tobacco industry funded Sustainability Summit. We received a response; they adopted a policy of not engaging with tobacco manufacturers in 2013 and deeply regretted the oversight. What is worrying is that many development partners do not have a policy in this regard and that those who do have such a policy in place are not fully compliant all the time. Our challenges to government agencies also led a few government agencies to regret their participation in the summit.


Need to denormalize ‘problematic partnerships’

There is a need to devise a comprehensive policy framework preventing conflicts of interest within governments/development agencies and prohibiting the CSR activities by industries producing products known to be harmful to health. We need to actively keep in check and denormalize such partnerships through timely actions. It is in this context that the civil society actions are important including initiatives such as the IndiaTobaccoWatch or the Alliance Against Conflicts of Interest. I sincerely hope that the government led by Mr. Narendra Modi with its stated ambition of ‘Minimum Government and Maximum Governance’ recognizes this problem as one of inadequate governance where economic interests are not managed in the broader ambition of human wellbeing. We do need both – effective governance and government interventions – especially when public health is at stake.



(Radhika Arora and Kristof Decoster provided some editorial support for this blog post)

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