Trevor Hancock: Profit should not come before public health

One of the problems of putting the economy at the centre of our policy process is that decision-makers prioritize economic development over human development. They thus become reluctant to constrain corporations, which themselves might put profit before people and their health.

This is not to say that governments don’t constrain the private sector in the interests of health, nor am I arguing that businesses don’t care about the health of their workforce or their community — many do.

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But if economic development is prioritized, then when there is uncertainty or controversy as to health impacts, governments tend to err on the side of their priority: economic development. In doing so, they put public health at risk. In fact, they allow business to profit from disease and death. While wrong, this is disturbingly common.

An obvious example is the tobacco industry. Tobacco is a very harmful product that would never be allowed were it coming to market today. It is lethal when used exactly as intended, and for decades has been known as the most important preventable cause of death in Canada and other high-income countries.

Small wonder it became Public Enemy No. 1 for public health. But it has taken decades to slowly push down the rates of consumption, and while governments have taken action, it has too often taken too long and been weak and slow.

Another case in point was the production and export of Canadian asbestos, which has been a known carcinogen for decades. The Harper government resisted having it listed as such by the World Health Organization. Instead, it provided loans and guarantees so that a Quebec company could continue to export this lethal product for use in countries with lax safety laws and inadequate occupational safety standards, where it was still legal. This in spite of the fact it was banned in Canada.

Indeed, like many right-wing governments, the Harper government routinely chose to put the lives of Canadians and others around the world at risk, rather than put profits at risk.

For example, in spite of evidence that salt levels in many Canadian food products, especially fast foods, are unnecessarily high, and in spite of the evidence that this contributed to hypertension and deaths from heart disease and stroke, the government elected to use a voluntary approach to reduce salt levels. As predicted, it hasn’t worked very well, and lives remain needlessly at risk.

Salt is but one of many products that can be thought of as “the new tobaccos.” They warrant this label because their producers also put profit before the well-being of the population.

Others include fossil fuels, junk food and sugar-rich pop, large portions and super-sized fast-foods.

Alcohol belongs on the list, although a moderate intake may be OK. But marketing to boost sales, pushing for wider availability and resistance to tax increases are all bad for health. Gambling also belongs on the list, especially when it is sponsored and, indeed, owned by governments as a source of revenue — itself a morally dubious way to raise revenues.

These products make a significant contribution to the burden of disease that society suffers. Not only is this bad for health, it is also very expensive, as the health-care system tries to patch up the damage they cause. That rationale prompted governments to take action on tobacco; it should prompt them to take action on these products, too.

The public-health response to tobacco included regulation of the marketing of the product, taxation, legislation to restrict use, pursuit of civil suits by private individuals and governments (resulting in the securing of large financial settlements) and even criminal prosecution. In addition the product and its users were marginalized.

The result of all this was a changing of the social norm, in which tobacco use was no longer seen as attractive, “sexy” and desirable but as socially unacceptable. In essence, we decided as a society that the profitability of the tobacco industry is secondary to the health of the public.

It is time the “new tobaccos” received the “tobacco treatment,” because the bottom line for society is — or should be — the health of the population, not the profitability of corporations.

 

Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.

thancock@uvic.ca

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