WHO's Commercial Determinants of Health and a nod to "transformative partnerships"
Newsletter Edition #105 [The Weekly Primer]
For much of the last two years, we have been focused on the here and the now, as the world has scrambled to make new rules during this pandemic.
It is therefore refreshing to take a step back and pay attention, even if briefly, to the slow and subtle changes beneath the surface of global health policymaking.
WHO has published a fact sheet on the Commercial Determinants of Health. The importance of this should not be lost in an era of multistakeholder partnerships and the increasing involvement of the private sector in policy-framing, financing to implementation activities in global health.
It also gives a nod to the role the private sector can play (“transformative partnerships”) in shaping positive health outcomes.
Write to us to help us understand the power and the politics underlying the commercial determinants of health. There is more than meets the eye.
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I. POLICY UPDATES
In a brief and yet, precise statement on the power of the private sector in shaping health outcomes, a new WHO fact sheet discuses regulatory capture, scientific denialism and a shift in global governance to describe the importance of the commercial determinants of health.
WHO has published a fact sheet on the commercial determinants of health, where it notes that these determinants are “private sector activities that affect people’s health positively or negatively.”
The all-encompassing influence of the private sector has an impact on “the social, physical and cultural environments through business actions and societal engagements; for example, supply chains, labour conditions, product design and packaging, research funding, lobbying, preference shaping and others,” the fact sheet says.
This has an impact on “a wide range of health outcomes including obesity, diabetes, cardiovascular health, cancer, road traffic injuries, mental health and malaria.”
It adds that “unhealthy commodities worsen pre-existing economic, social and racial inequities.” Pressure from multinational actors are greater on certain countries and regions, such as small island states and low- and middle-income countries, it acknowledges.
Some excerpts on how the commercial determinants of health shape health outcomes:
"Commercial determinants of health are the conditions, actions and omissions by corporate actors that affect health. Commercial determinants arise in the context of the provision of goods or services for payment and include commercial activities, as well as the environment in which commerce takes place. They can have beneficial or detrimental impacts on health.”
….Company choices in the production, price-setting and aggressive marketing of products such as ultra-processed foods, tobacco, sugar-sweetened beverages and alcohol lead to non-communicable diseases such as hypertension, type 2 diabetes, certain cancers, cardiovascular disease and obesity…”
The fact sheet discusses a range of impacts including the risks from advertising on young people; how deforestation causes vector-borne disease; the ways in which pollution drives respiratory diseases; the processes in intensive animal agriculture that contribute to antimicrobial resistance and higher rates of non-communicable diseases.
It also puts the rush towards digital health in perspective. It says, “Commercial action in knowledge environments can foment inappropriate doubt and thus contribute to scientific denialism. During the COVID-19 pandemic some governments responded hastily with technologies and interventions that lack scientific evidence of therapeutic effectiveness.”
Discussing the positive role by the private sector to public health, it lists efforts including the reformulation of goods and products to reduce harm and injury, ensuring living wages, paid parental leave to improve child health outcomes, sick leave and access to health insurance, ensuring adequate occupational health and safety standards and hygiene practices, among others.
Significantly, the fact sheet also articulates the deeper impact of private sector on governance, finances and politics:
“Recent decades have seen a transfer of resources to private enterprise, which now plays an increasing role in public health policy and regulation and outcomes. The emergence of non-State actors in the geopolitical arena, together with a shift in global governance, are fundamental to understanding the development of commercial determinants of health. Various authors have catalogued pathways of private sector health strategies and impact, including influencing the political environment, the knowledge environment and preference shaping.”
The fact sheet also describes regulatory capture (albeit at national levels only!). Apart from lobbying efforts, it also notes the subtle influence of the private sector - “corporations influence the direction, volume of research and understandings through funding medical education and research, where data may be skewed in favour of commercial interests.”
It also underlines how sections of the civil society have also been captured by these efforts. “To further shape preferences, they capture civil society through corporate front groups, consumer groups and think tanks, allowing them to manufacture doubt and promote their framings.”
It notes that some governments have addressed commercial determinants of health by introducing bans on tobacco advertising, regulating junk food advertising, taxing sugary soft drinks, offering maternity leave, among other measures.
It flags, WHO’s new programme of action, the Economic and Commercial Determinants of Health, that seeks to strengthen the evidence base; develop tools and capacity to address the commercial determinants; convene partnerships and dialogue; and raise awareness and advocacy.
Reflecting current realities, this fact sheet should have also mentioned how private sector policies have also constrained the access to medical products during this pandemic. COVID-19 has shown an acute effect of the commercial determinants of health - whether one dies of or survives SARS-CoV-2, will depend on getting access to vaccines, tests and drugs.
TRIPS Council Meeting: 5 November
The WTO TRIPS Council Meeting met last week on November 5 both in a formal and an informal mode. While no major "breakthrough" has been reported yet during the consultations among WTO members on the TRIPS waiver over the past few weeks, sources said that countries are still hopeful of reaching consensus ahead of the 12th ministerial conference.
TRIPS Council Chair, Dagfinn Sørli, Norway’s Ambassador to the WTO, has said, there was a "shared view" among countries, that those vaccine manufacturers which are ready to produce, should be able to begin production of COVID-19 vaccines without worrying about patents. However, delegations were divided on whether this can be done under existing TRIPS flexibilities or under a waiver approach.
The next TRIPS Council meeting is expected on 16 November. An oral status report on the discussions will be provided at the WTO General Council on that meets 22-23 November, ahead of the ministerial later in the month.
South Africa said during the meeting that the resolve of co-sponsors to the TRIPS waiver remains intact. It also expressed disappointment that a small minority of delegations continue to refuse to even engage in text based negotiations.
The EU reported on working with a number of delegations to further its proposal on improving the compulsory licensing system. It is of the view that areas of convergence are emerging and has favored bilateral consultations in the coming days.
In addition, at the meeting, countries also agreed on a draft ministerial decision on the moratorium on non-violation and situation complaints (NVSCs).
The draft decision on “TRIPS non-violation and situation complaints” for the Ministerial Conference says:
"We take note of the work done by the Council for Trade-Related Aspects of Intellectual Property Rights pursuant to the General Council Decision of 10 December 2019 on "TRIPS Non-Violation and Situation Complaints" (WT/L/1080), and direct it to continue its examination of the scope and modalities for complaints of the types provided for under subparagraphs 1(b) and 1(c) of Article XXIII of GATT 1994 and make recommendations to the 13th Ministerial Conference. It is agreed that, in the meantime, Members will not initiate such complaints under the TRIPS Agreement."
II. WHAT WE FOUND INTERESTING
Global jurists call for waiver of global intellectual property rights for COVID-19 vaccines and therapeutics: International Commission of Jurists
Big Tobacco are exploiting loopholes in European menthol ban: The Bureau of Investigative Journalism
EU's 'secret' vaccine negotiators: Who's dealing with Big Pharma? Investigate Europe
There Are Holes in Joe Biden’s Trade Team: Council on Foreign Relations
The G20 Disappoints on Global Health, but That's OK with the United States: Think Global Health
FROM THE JOURNALS/REPORTS:
A pandemic treaty, revised international health regulations, or both? Globalization and Health
Estimated cost-based generic prices for molnupiravir for the treatment of COVID-19 infection: Melissa J Barber (Harvard T. H. Chan School of Public Health), Dzintars Gotham (King’s College Hospital, London)
Global Tobacco Industry Interference Index 2021: STOP (Stopping Tobacco Organizations and Products)
III. WHAT WE ARE WATCHING
Codex Alimentarius Commission- 44th session. 8-18 November
WHO - Launch of new report: Keeping the 100-year old promise – making insulin access universal. 12 November
IV. TWEETS THIS WEEK
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