“For people working for decades in the public health sphere, trying to make sure that the health of the population is the primary goal, regardless of what else is happening, and then seeing no concrete results at the end of the day … it gets frustrating to the point where you just think, okay, what else can we do?”
Mashkur Isa, Youth Cancer Ambassador, Association of European Cancer Leagues
“Isn’t this a paradox: not adequately restricting the tobacco, sugar or alcohol industries, but at the same time, spending so much money on health campaigns saying, ‘Don't drink too much’ and ‘Don't start smoking’?”
Carolin Baur, Youth Cancer Ambassador, Association of European Cancer Leagues
The WHO Regional Office for Europe and the Association of European Cancer Leagues (ECL) recently ran a 2-day summer school for Youth Cancer Ambassadors on commercial determinants of cancer prevention and care.
In informing and facilitating discussions with young activists, WHO aims to raise awareness about certain commercial products and practices, and to inspire action to reduce the health harms they cause.
Studies have shown that commercial products and practices, particularly by transnational corporations, significantly impact health outcomes, including cancer incidence and mortality.
In late summer, 40 young health activists gathered in Barcelona to learn about harmful commercial practices that shape health policy, contribute to cancer incidence, and affect access to and quality of cancer care. “Commercial determinants” is a relatively new field of academic research gaining momentum because of the sheer scale and undeniable consequences of industry’s influence on population health. Linked to the “social determinants of health”, it recognises that population health is largely driven by factors outside the control of individuals.
Youth perspectives on commercial influences
Mashkur Isa was a summer school participant. From Nigeria and living in Poland, he trained as a medical doctor, has a master’s in public health and has been an active Cancer Prevention Youth Ambassador for 4 years. He welcomed the theme of the event and shared some insights on what he sees as a historical neglect around preparing health-care professionals to navigate a world full of conflicts of interest.
“The topic was really spot-on. It is one that needs our attention, it is something we need to be aware of and have knowledge about. There is little or no emphasis on commercial determinants in health professionals’ education, in general, or how to navigate it. This is quite a problem in the sense that we are the ones who have to deal with it. The decisions we make ultimately affect not only patient and public health but have consequences for the political and social contexts in which we all live.”
For him, exploring commercial determinants can shed light on the reasons why public health policy is not progressing faster.
“The Framework Convention on Tobacco Control has been in effect for 20 years, yet the tobacco industry still possesses tremendous power and this is something that raises the question: what is really happening, what does it mean? We can see something similar when it comes to alcohol, when it comes to big pharma, when it comes to sugary sweetened beverages and the like. What role do we, health-care professionals, have to play? We need to know how to navigate this terrain. Otherwise, we just end up promoting the wrong approach and do more harm than good.”
Creating a community
Carolin Baur, from Germany and living in Switzerland, also participated in the summer school. She trained as a pharmacist, working initially in community pharmacy before moving into a role in a pharmaceutical company. She joined the ECL Youth Ambassador programme this year. Community pharmacy opened her eyes to certain commercial determinants, including the pressure to sell products, the reliance on pharmaceutical representatives for information about new drugs, and the widespread use of medication in the absence of strong preventative public health and occupational policies such as adequate sick leave. For her, the summer school was both a learning opportunity and a valuable introduction to a network of young, energetic advocates she can continue to collaborate with.
“I really enjoyed meeting these people and being in this circle of people who are actively engaged in public health advocacy. I was so inspired by all these ideas and conversations about the challenges and what I can do in the future. I feel part of a community. It was a perfect way to start this new journey.”
Mashkur is involved in the climate movement, which he sees as both instructive and a source of hope for those seeking to counter commercial practices in other areas of public health (like those employed by the fossil fuel industry).
“Ultimately, when what you are doing is right, it does not really matter what the odds are, it just matters that you have people who are committed, genuinely passionate and who want to see that change happen. We are seeing this in the climate change movement. Now we have a lot of youth activists and children who are calling out and holding their governments to account, and awareness and action have really increased.”
Effective action on commercial influences
Mashkur and Carolin agree on the critical need for awareness-raising and education on commercial determinants of health.
“It is important that everyone is on board, and everyone knows exactly what we're fighting for,” says Mashkur. “We show people that it is not just something that affects them alone or their family alone, it has consequences for the whole community and for countries. Commercial practices impact people disproportionately. The most vulnerable are always those most exposed and at risk. This is something we need to be conscious of.”
Carolin is excited about the prospect of sharing her new knowledge with young people as part of her science outreach activities in schools.
“I want to show teenagers how we are manipulated by lobbying on a daily basis. I want to give them insights into the commercial tactics of the tobacco, sugar and alcohol industries. With this knowledge, I hope young people will be able to distance themselves from these pervasive and often subtle commercial influences.”
“You cannot really solve a problem if you do not know what the problem is. There are still far too many people who do not actually see this as a problem because they don't have that awareness or knowledge, and so they potentially contribute to the problem. Having platforms that provide training and awareness to young professionals or providing train-the-trainer programmes that include ethics would help. WHO has an important role to play in this as an organisation that brings knowledge and credibility.”
To address the information void around medical products, which has been long exploited by the pharmaceutical and medical device industries, and to make health professionals less susceptible to industry influence, we need new reliable information and validation systems.
“Practically, on the ground, we need a system where people can get accurate information quickly. We need to provide health professionals with the data they need,” says Mashkur. “Once you are bombarded with all these industry messages, when it comes time to making a decision, you follow what your mind is already accustomed to seeing. It’s a huge fight and the playing ground is not even, not an inch of it.”
Advocacy and lobbying
Mashkur highlights another area in which the public health community may need to strengthen its capacity to mitigate harmful commercial influences.
“The public health community invests a lot in advocacy. Industry does not really care about advocacy; industry invests in lobbying. They are on the playing field, talking directly to people who are making the decisions, and using all their power to advance their goals. Public health, of course, has an obligation to inform the public and to share knowledge, but we also need to spend energy on ensuring those in decision-making positions understand the profound long-term implications of their decisions for their populations.”
Commercial influence on health goes beyond what is directly visible; for example, the widespread marketing and availability of unhealthy food products, known to be linked to rising cases of obesity and associated cancers. Commercial actors, including the pharmaceutical sector and medical device companies, lobby behind the scenes for policies that benefit their profits and shareholders, too often to the detriment of public health. There is evidence of industry influence on clinical guidelines, the promotion of unnecessary screening and drugs, and prohibitive pricing on certain therapies.
As understood and clearly articulated by these young summer school participants, mitigating commercial influences on all policy areas that concern non-communicable diseases, including cancer, is essential to reduce the burden of ill-health in the European Region