Commercial and Social Determinants of Health: Prevention is better than cure was the focus of an insightful afternoon session at St. Luke’s Symposium during day three of the Royal College of Physicians of Ireland’s Annual Conference. The session brought together leading experts in the fields of policy, academia and research to discuss how social and commercial determinants can shape and influence health and society.
Dr Norah Campbell of Trinity Business School opened the session with a presentation that delivered insights on how commercial products and industries are a new vector of disease. Four products – alcohol, tobacco, ultra-processed food (UPF) and fossil fuels – account for 7,400 deaths per day in Europe.
Marketing and advertising of these products is only the tip of the iceberg, warned Dr Campbell: “Much of the influence of these industries is cultivated behind closed doors through lobbying to influence politicians, policy makers and political processes for favourable policies.” She cited examples of the alcohol industry in Ireland successfully lobbying to stop the introduction of cancer warning labels on bottles and Cadbury using non-market activities through sponsorship of sports camps to appear more benign.
Rather than focusing on individual companies or leadership, Dr Campbell urged the audience to consider the bigger picture and the wider systems that enable commercial interests to influence health. She also argued for a shift in emphasis from policies primarily aimed at reducing overconsumption towards measures that address the overproduction of harmful products.
The next presentation was from Catherine B. Woods on Addressing Population Levels of Physical Inactivity - The Importance of Policy. Professor Woods presentation posed the central question: how do we use policy to effect physical activity? Only 40% of adults in Ireland meet their daily exercise needs and this decreases to 30% for older cohorts.
Director of Physical Activity for Health Research at the University of Limerick, Professor Woods drew on her experience working on Ireland’s first National Physical Activity Plan in 2016. “The role of policy is to change systems, not individuals” she told the audience. She highlighted the importance of a cross-sector collaborative approach to promote physical activity by aligning it with transport, tourism, sport, education and other sectors.
Professor Woods’ presentation also reflected on challenges of translating policy into effective action and identifying gaps in approaches - particularly around policies that already exist. While Ireland ranks well when it comes to disseminating and assessing guidelines, there remains room for improvement when it comes to implementation, including by framing physical inactivity as a broader, cross-sectoral issue.
Dr Paul Kavanagh delivered the next presentation, asking viewers Can a Commercial Determinants of Health Approach Help End Tobacco Harm in Ireland? Dr Kavanagh discussed the progress made in Ireland since the introduction of the workplace smoking ban in 2004, noting that in 1998 the rate of smokers was one in three compared to one in five by 2025.
Despite this progress, smoking still causes 1,000 hospitalisations every week and leads to 4,500 deaths per year in Ireland. The introduction of new nicotine products to the market has led to a 20-fold increase in e-cigarette use in the last 15-24 years and a 50% increase in overall nicotine use. Dr Kavanagh warned that modern-day tactics around e-cigarette products resemble the same playbook used by tobacco companies around cigarettes during the 20th century.
Dr Kavanagh says that “smoking is still viewed by some as an individual problem rather than looking upstream at commercial determinants.” Lobbying from the tobacco industry remains deep and pervasive, with the intention of drowning out policy from health groups, including around the Tobacco Free Generation Bill which aims to prohibit the sale of tobacco and nicotine products for people born after January 2009.
The final presentation of the session was by Professor Frank Murray, who brought a clinical perspective on reducing alcohol harm in Europe through evidence-based policies. Professor Murray, a liver specialist at Beaumont hospital and Chair of the European Health Alliance on Alcohol, outlined the dangerous levels of alcohol consumption in Europe and the harm this causes, resulting in 800,000 deaths per year. He noted that the average male drinker in the EU consumes well above the recommended units of drink per week and one quarter of the population is drinking three quarters of the total alcohol being consumed.
Professor Murray explored effective evidence-based policies recommended by the World Health Organisation, which fall under the tree A’s – affordability, availability and advertising. “There is a clear link between affordability and consumption” said Professor Murray, citing the influence of minimum unit pricing in reducing alcohol consumption.
He also highlighted two case studies of neighbouring countries – Poland and Lithuania – with contrasting results. From 2007 onwards, Lithuania introduced several policies to reduce alcohol harm, including a comprehensive ban on alcohol advertising. These measures significantly decreased overall mortality rates and harm linked to alcohol use. Poland, in contrast, decided to abolish its independent alcohol policy agency, PARPA, and saw alcohol policy slide off the national agenda as alcohol consumption and harms increased.
Professor Murray also highlighted the economic burden of treating health and social issues caused by alcohol, which is estimated at €14 billion each year, and questioned the fairness of taxpayers bearing these costs while the alcohol industry continues to generate huge profits.
The enormous influence of the alcohol lobby has helped to shelve the introduction of alcohol warning labels on alcohol bottles in Ireland until 2029. However, blame must also be placed upon policy makers who have failed to act in the best interest of citizens.
The range of presentations reinforced the central message of the session: prevention is better than cure. Tackling the social and commercial determinants of health requires us to look upstream and take action at a systemic level. It’s clear that evidence-based policy can play a crucial role in creating healthier environments and reducing preventable diseases.