2017 GH Sesi 6 YM International Trade in Health Services 2
Commercial determinants of NCDs in
low- and middle-income countries
Yodi Mahendradhata
Obesity prevalence*
35
30
25
20
15
10
5
0
USA
Mexico
South Africa
UK
*http://www.indexmundi.com/g/r.aspx?v=2228
Australia
Canada
Germany
Belgium
Brazil
Malaysia
Indonesia
Diabetes prevalence (age 20-79)*
14
12
10
8
6
4
2
0
Mexico
Singapore
Canda
USA
South Africa
India
Brazil
*http://www.indexmundi.com/facts/indicators/SH.STA.DIAB.ZS/rankings/
China
Germany
Bangladesh
Indonesia
Sugar consumption per person per day*
140
120
100
80
60
40
20
0
USA
Mexico
Canada
France
Japan
Brazil
South Africa
Malaysia
Thailand
Philippines
Indonesia
*https://www.washingtonpost.com/news/wonk/wp/2015/02/05/where-people-around-the-world-eat-the-most-sugarand-fat/
Per capita consumption of Coca-Cola*
800
700
600
500
400
300
200
100
0
Mexico
USA
Australia
South Africa
Brazil
Germany
Japan
France
Thailand
China
Indonesia
http://www.statista.com/statistics/271156/per-capita-consumption-of-soft-drinks-of-the-coca-cola-company-by-country/
Coca cola tweets
15,3 million per year
41,900 per day
1,747 per hour
Increasing consumption of processed food
and soft drinks in Asia*
*Baker et al (2014)
•
•
•
•
119 countries
35,000 outlets
US$ 27,5 billion in revenue
68 million customers daily
• 118 countries
• 18,875 outlets
• US$23 billion in sales
Komposisi:
Seasoning (Salt, Monosodium Glutamate, Garlic
Powder, Spice Extractives, Onion Powder), Soy Protein
Concentrate, Rice Starch and Sodium Phosphates.
Battered With: Water, Wheat Flour, Leavening (Sodium
Acid Pyrophosphate, Sodium Bicarbonate,
Monocalcium Phosphate), Salt, Dextrose, Monosodium
Glutamate, Spice and Onion Powder. Predusted With:
Wheat Flour, Wheat, Gluten, Salt, Dried Egg Whites,
Leavening (Sodium Acid Pyrophosphate, Sodium
Bicarbonate), Monosodium Glutamate, Spice and
Onion Powder. Breaded With: Wheat Flour, Salt, Soy
Flour, Leavening (Sodium Acid Pyrophosphate, Sodium
Bicarbonate), Monosodium Glutamate, Spice, Nonfat
Dry Milk, Onion Powder, Dextrose, Extractives of
Turmeric and Extractives of Annatto. Breading Set in
Vegetable oil.
Komposisi:
Enriched flour (bleached wheat flour, malted barley
flour, niacin, reduced iron, thiamin mononitrate,
riboflavin, folic acid), water, high fructose corn syrup
and/or sugar, yeast, soybean oil and/or canola oil,
contains 2% or less of the following: salt, wheat gluten,
calcium sulfate, calcium carbonate, ammonium sulfate,
ammonium chloride, dough conditioners (may contain
one or more of the following: sodium stearoyl lactylate,
datem, ascorbic acid, azodicarbonamide, mono- and
diglycerides, ethoxylated monoglycerides, monocalcium
phosphate, enzymes, guar gum, calcium peroxide),
sorbic acid, calcium propionate and/or sodium
propionate (preservatives), soy lecithin.
Tactics of the corporations
Political
Public
relations
Product
Finance
Extra
legal
1 Peso per liter sales tax on sugary beverages ->
10% price increase of soft drinks
Estimated and counterfactual volumes of taxed
beverages purchased per capita in Mexico, 2014–15
(Cochero et al 2017)
Policy options to minimize exposure
to sugary drinks (Popkins and Hawkes 2016)
• Taxation
• Restrictions of availability in schools
• Marketing restrictions
• Public awareness campaigns
• Front-of-pack labelling
• Reformulation and portion size reduction
• Substitutes for sugar-sweetened beverages
A policy agenda for a movement for a healthier future
(Freudenberg 2014)
• E pa d co su ers’ right to k ow a d corporatio s’ dut to
disclose the health consequences of corporate practices and
products
• Require corporations to pay for the health and environmental
consequences of their products and practices
• Establish global health standards for product design and marketing
• Restore public ownership of science and technology
• Restore the visible hand of government in public health protection
• Prevent corporations from using their money and power to
manipulate democratic processes
Strategies to promote global health?
Medical
intervention
Lifestyle
modification
Changing
corporate
practice!
Digital activism: the practice of using digital
technology for political and social change
Goal of
Social/
political
change
Digital
technology
Digital
activism
Top tools for digital activism
Tool
Uses
Brands
Social network
• Interact with supporters
• Share short news
• First contact
Facebook
Blog
• Interact with supports
• Share longer analysis
• Gain influence
Blogger
Wordpress
Micro-blog
• Interact with supports
• Share shorter analysis
• Gain influence
Twitter
Email group
• Internal coordination
Google
Yahoo
SMS
• Inviting people to events
Mobile phones
Video
• Getting attention with emotion
YouTube
Vimeo
Digital activism for NCD prevention
Create
awareness for
NCD prevention
Shape public
opinion on NCD
prevention
Plan action for
NCD prevention
campaign
Prioritize NCD
prevention
Mobilize action
for NCD
prevention
Affirm
communities of
NCD activists
Take action for
NCD prevention
Commercial determinants of health
“trategies and approaches used by the private
sector to promote products and choices that are
detri e tal to health
Kickbusch et al 2016
Challenges for global health community*
• Marketing by multinational corporations (MNCs) presents a major
threat to public health; children are especially vulnerable
• MNCs’ arketi g threatens our physical and mental wellbeing,
exacerbates inequalities, and encourages unsustainable consumption
• Global health community should take a lead in addressing these
issues, revitalise its upstream, political functions, and regain its role as
a champion of the underprivileged
*Ref: Hastings (2012)
[email protected]
low- and middle-income countries
Yodi Mahendradhata
Obesity prevalence*
35
30
25
20
15
10
5
0
USA
Mexico
South Africa
UK
*http://www.indexmundi.com/g/r.aspx?v=2228
Australia
Canada
Germany
Belgium
Brazil
Malaysia
Indonesia
Diabetes prevalence (age 20-79)*
14
12
10
8
6
4
2
0
Mexico
Singapore
Canda
USA
South Africa
India
Brazil
*http://www.indexmundi.com/facts/indicators/SH.STA.DIAB.ZS/rankings/
China
Germany
Bangladesh
Indonesia
Sugar consumption per person per day*
140
120
100
80
60
40
20
0
USA
Mexico
Canada
France
Japan
Brazil
South Africa
Malaysia
Thailand
Philippines
Indonesia
*https://www.washingtonpost.com/news/wonk/wp/2015/02/05/where-people-around-the-world-eat-the-most-sugarand-fat/
Per capita consumption of Coca-Cola*
800
700
600
500
400
300
200
100
0
Mexico
USA
Australia
South Africa
Brazil
Germany
Japan
France
Thailand
China
Indonesia
http://www.statista.com/statistics/271156/per-capita-consumption-of-soft-drinks-of-the-coca-cola-company-by-country/
Coca cola tweets
15,3 million per year
41,900 per day
1,747 per hour
Increasing consumption of processed food
and soft drinks in Asia*
*Baker et al (2014)
•
•
•
•
119 countries
35,000 outlets
US$ 27,5 billion in revenue
68 million customers daily
• 118 countries
• 18,875 outlets
• US$23 billion in sales
Komposisi:
Seasoning (Salt, Monosodium Glutamate, Garlic
Powder, Spice Extractives, Onion Powder), Soy Protein
Concentrate, Rice Starch and Sodium Phosphates.
Battered With: Water, Wheat Flour, Leavening (Sodium
Acid Pyrophosphate, Sodium Bicarbonate,
Monocalcium Phosphate), Salt, Dextrose, Monosodium
Glutamate, Spice and Onion Powder. Predusted With:
Wheat Flour, Wheat, Gluten, Salt, Dried Egg Whites,
Leavening (Sodium Acid Pyrophosphate, Sodium
Bicarbonate), Monosodium Glutamate, Spice and
Onion Powder. Breaded With: Wheat Flour, Salt, Soy
Flour, Leavening (Sodium Acid Pyrophosphate, Sodium
Bicarbonate), Monosodium Glutamate, Spice, Nonfat
Dry Milk, Onion Powder, Dextrose, Extractives of
Turmeric and Extractives of Annatto. Breading Set in
Vegetable oil.
Komposisi:
Enriched flour (bleached wheat flour, malted barley
flour, niacin, reduced iron, thiamin mononitrate,
riboflavin, folic acid), water, high fructose corn syrup
and/or sugar, yeast, soybean oil and/or canola oil,
contains 2% or less of the following: salt, wheat gluten,
calcium sulfate, calcium carbonate, ammonium sulfate,
ammonium chloride, dough conditioners (may contain
one or more of the following: sodium stearoyl lactylate,
datem, ascorbic acid, azodicarbonamide, mono- and
diglycerides, ethoxylated monoglycerides, monocalcium
phosphate, enzymes, guar gum, calcium peroxide),
sorbic acid, calcium propionate and/or sodium
propionate (preservatives), soy lecithin.
Tactics of the corporations
Political
Public
relations
Product
Finance
Extra
legal
1 Peso per liter sales tax on sugary beverages ->
10% price increase of soft drinks
Estimated and counterfactual volumes of taxed
beverages purchased per capita in Mexico, 2014–15
(Cochero et al 2017)
Policy options to minimize exposure
to sugary drinks (Popkins and Hawkes 2016)
• Taxation
• Restrictions of availability in schools
• Marketing restrictions
• Public awareness campaigns
• Front-of-pack labelling
• Reformulation and portion size reduction
• Substitutes for sugar-sweetened beverages
A policy agenda for a movement for a healthier future
(Freudenberg 2014)
• E pa d co su ers’ right to k ow a d corporatio s’ dut to
disclose the health consequences of corporate practices and
products
• Require corporations to pay for the health and environmental
consequences of their products and practices
• Establish global health standards for product design and marketing
• Restore public ownership of science and technology
• Restore the visible hand of government in public health protection
• Prevent corporations from using their money and power to
manipulate democratic processes
Strategies to promote global health?
Medical
intervention
Lifestyle
modification
Changing
corporate
practice!
Digital activism: the practice of using digital
technology for political and social change
Goal of
Social/
political
change
Digital
technology
Digital
activism
Top tools for digital activism
Tool
Uses
Brands
Social network
• Interact with supporters
• Share short news
• First contact
Blog
• Interact with supports
• Share longer analysis
• Gain influence
Blogger
Wordpress
Micro-blog
• Interact with supports
• Share shorter analysis
• Gain influence
Email group
• Internal coordination
Yahoo
SMS
• Inviting people to events
Mobile phones
Video
• Getting attention with emotion
YouTube
Vimeo
Digital activism for NCD prevention
Create
awareness for
NCD prevention
Shape public
opinion on NCD
prevention
Plan action for
NCD prevention
campaign
Prioritize NCD
prevention
Mobilize action
for NCD
prevention
Affirm
communities of
NCD activists
Take action for
NCD prevention
Commercial determinants of health
“trategies and approaches used by the private
sector to promote products and choices that are
detri e tal to health
Kickbusch et al 2016
Challenges for global health community*
• Marketing by multinational corporations (MNCs) presents a major
threat to public health; children are especially vulnerable
• MNCs’ arketi g threatens our physical and mental wellbeing,
exacerbates inequalities, and encourages unsustainable consumption
• Global health community should take a lead in addressing these
issues, revitalise its upstream, political functions, and regain its role as
a champion of the underprivileged
*Ref: Hastings (2012)
[email protected]