Anna Gilmore, public health researcher: ‘Just four products cause at least a third of all deaths’

It’s not just genetic code and postal code that determine an individual’s health. Everything around us — from the air we breathe to the products we buy at the grocery store — also plays a much more decisive role than anyone could imagine.

Behind the habits and products that fill our days there are powerful corporations whose actions, however seemingly trivial, can have enormous repercussions on people’s lives, says Dr. Anna Gilmore, a professor of Public Health at the University of Bath, in the United Kingdom, where she directs the Centre for 21st Century Public Health.

“The simplest way to see this is to look at the magnitude of the damage caused by four products: tobacco, fossil fuels, alcohol, and food,” she lists. “We estimate that these four products alone cause between one-third and two-thirds of all global deaths.”

The London-born Gilmore, 57, has spent decades investigating the footprint and modus operandi of large corporations, specifically how they affect health, policies and public opinion. In the scientific world, all these products and industry actions are known as the commercial determinants of health. “They’re the ways in which the commercial sector impacts health,” she summarizes.

The scientist recently visited Barcelona to participate in a conference on the social determinants of health, organized by the JHU-UPF Public Policy Center at Pompeu Fabra University. She sat down with EL PAÍS during a break from the conference. During this conversation, she spoke leisurely, and elaborated — at times vehemently — on the tricks used by large corporations to get their ideas across. “All industries, regardless of the products they manufacture, can also cause harm through their practices. For example, the way an employer treats its staff can have enormous impacts, both good and bad. We also see companies taking shortcuts in health, safety and their supply chains in order to make more profit. This leads to harms, accidents, chemical leaks into waterways and pollution in rivers. There are many ways in which they’re damaging health and society, which are avoidable,” she asserts.

Question. Are citizens aware of all these corporate practices?

Answer. There are many things that happen behind the scenes. With food products, we don’t see how they are manipulated to make them increasingly desirable, almost addictive. Everyone knows the story of the tobacco industry, which hid the harms of its products, or the fossil fuel industry, which hid the problems of climate change. What they don’t know is that other industries engage in the same scientific practices to hide the harms of their products or overstate the benefits.

Perhaps what we are least aware of is the way they shape what I would call “norms” — our beliefs and our thinking. A Pepsi-Cola executive once said that “if all consumers exercised, if they did what they were supposed to do, the obesity problem would not exist.” That is simply untrue, but it makes people believe obesity is simply their own fault, when in fact it is much more complex.

Q. It’s as if everything was our responsibility.

A. Large corporations shape norms to blame the individual. “Carbon footprinting” is a term developed by British Petroleum (BP) to try to blame the individual, to say that the problem here isn’t about big fossil fuel companies, but about people, who need to change the way they use their cars and transport, for instance. And, when the public and policymakers don’t understand that corporations are shaping their the way they think, when you ask what we do about obesity, their minds are filled with these ideas that corporations have instilled in them that people just need to exercise. But that’s never going to solve obesity.

Another thing that’s really hidden is when it comes to influencing policy. An example is tobacco companies, which are no longer trusted, because we have so much evidence of their bad behavior. What they do now is create a bunch of front groups: they set up other organizations that they fund and hide behind. [And] it’s those organizations that approach governments and say, “Oh, this policy is going to be bad.” And, very often, lobbying is done through these third parties… and, once again, governments often fall into the trap of thinking, “Wow, all these different groups are telling us that this policy will be bad.” But what they don’t realize is that all these groups are funded by tobacco companies. And other companies, like food companies, are doing something similar.

Large corporations shape our beliefs so that they can blame the individual

Q. It often feels like these companies control the world...

A. They have a lot of power. They fund much more science research than the public sector. They can set up and fund these third parties, including charities, so that their power and influence are everywhere. The people who sit on their boards are connected; there’s a kind of elite, so to speak, that’s able to influence at many levels, often behind the scenes. The rest of us are like puppets they control: influencing us to buy their products, share their beliefs and [make us] blame ourselves for the harm they are causing.

Q. You’re an expert on the effects of smoking. We know that smoking kills and yet, people continue to smoke. Why is that?

A. Smoking is highly addictive. And we know that tobacco companies manipulate cigarettes to make them more addictive. The evidence is clear: if the best policies are implemented, smoking rates will decrease. But governments are sometimes afraid to implement them. We need to increase the price of cigarettes. We need to ban advertising. We need plain packaging. We need to ban smoking in public places. And we need denormalization campaigns.

Another thing we need to think about is that, as fewer people smoke, tobacco companies and their profits are more threatened. That’s why they are fighting back. And they’re recovering, in part, by launching new products (e-cigarettes, heated tobacco products, nicotine products) and funding massive public relations campaigns to claim that they’ve changed, deceiving us once again about what they’re up to. Globally, tobacco sales were declining, and now they’re rising again.

I think it’s very important to take a step back and think about this broader framework of commercial determinants. Tobacco companies can keep causing harm and deceiving us once again because the system hasn’t changed. They are still making massive profits, can still fund science and data, and get them published in medical journals. They also still have access to governments…

We need a new approach, because our current system of capitalism isn’t working in the public interest. We need to restructure our economic model.

Q. What can you say to our readers to encourage them to quit smoking?

A. Two out of three smokers will eventually die from smoking. It’s so risky... would they jump from the fourth floor of a building? No, because it’s too risky. But smoking is generally taken up in youth, when the risks aren’t fully understood. And then it’s very addictive and hard to stop. So, I would tell them to do everything they can to quit. The best is to use pharmaceutical products shown to help quitting within a smoking support service. And what’s really important is ensuring that children don’t start, which is why we need all those policies in place so that children don’t see tobacco as a normal activity.

However, one of the problems is that smoking is increasingly concentrated among the poorest groups in society. It’s key to increase the price of cigarettes through taxes and then be able to use those taxes to provide support for people to quit smoking. That is the one intervention shown to reduce smoking more in the least well off. The other thing our work shows is that tobacco companies are very clever at manipulating their prices to undermine tax increases. What they’ve done is produce new, very cheap, ultra-low-priced cigarettes, and when the government increases taxes, they absorb these increases to keep the cheap products cheap. Meanwhile they make money by increasing the prices of their most expensive brands because wealthier people smoke them and can afford it.

Q. Aside from tobacco companies – which now also sell e-cigarettes – do other large corporations, such as those that sell food and alcohol, operate in the same way?

A. Yes. If you think about alcohol companies, for example, they sell alcohol and also low- or 0% alcohol beverages. It’s a win-win for industry: they make money from their primary, more harmful products… and then they make products that are a little less bad and make money from them too.

Q. There are many advertisements and slogans that shift all responsibility to the consumer, along the lines of: “Drink in moderation, it’s your responsibility.” But what’s the industry’s responsibility? Does it have one?

A. This is the core of the problem. I was talking earlier about how industry is shaping thinking, but what they’ve also done is spend a lot of money on massive public relations campaigns trying to convince the public and governments that they’re part of the solution.

What needs to be done is regulate these companies. They’ll never change voluntarily. It doesn’t matter if it’s tobacco, food, tissues, or cups. If the industry is affected by a policy, it shouldn’t be at the table where policy decisions are made. We need to recognize these conflicts of interest and exclude these firms from policymaking.

Q. Of all the tactics that are practiced by these large corporations, which is the most dangerous?

A. Reputation management. What they do is invest in what they call corporate social responsibility, which means, “We’re the good guys. I’m your friend, and I’m going to help you.” A colleague in Colombia was telling me that soft drink manufacturers use all the local water, and there’s no water for people to drink. And then people buy the soft drinks because that’s all there is, and they ruin their teeth, they become obese... But then the soft drink manufacturer runs a corporate social responsibility campaign, comes with a bottle of water, takes a picture, makes it look good to the government, and disappears. The government falls for this and fails to regulate. That is just one example but similar things are being repeated around the world.

Q. Do you have any hope that this situation can change?

A. I am hopeful, and I think the best solution is to move toward a different economic model. The world is realizing that we can’t maintain capitalism as it is. Look at the planet, global warming, biodiversity loss, growing inequalities, poverty, health problems, the fact that between one-third and two-thirds of all deaths are due to just four corporate products. Governments will have to realize that they are allowing corporations to cause this damage, but they are not bearing the costs. People are getting sick, the environment is being destroyed. Who is footing the bill? You, me, the governments. Corporations are making ever-increasing profits, and then they are using those profits to influence and control. We have a pathological system. Governments need to wake up. It’s unsustainable.

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