Twenty years ago, I attended the World Health Organization’s fourth global conference on health promotion. This was at a time when neo-conservative influences were pushing the WHO to be more receptive to private-sector funding, so the pharmaceutical industry was there as a sponsor.
But this got me thinking: What could their interest be in health promotion, given that if we did our job right — if everyone lived in good health to a ripe old age and then just dropped dead — they would be out of business?
Their interest, I supposed, was that they would be able to sell us medications that would either prevent disease or control it, enabling us to live longer, healthier lives.
But there is not necessarily a lot of money to be made in preventing a disease, whereas chronic diseases are a godsend to the pharmaceutical industry; we can be on their medications for decades, a steady and reliable source of income.
So fundamentally, I concluded, we did not share the same bottom line. Their bottom-line interest was a long life in chronic ill health, while ours was a long life free of illness. Yet they were purporting to be our partners, just as soft-drink companies want to be our partners on physical activity and sporting events such as the Olympics, even though their drinks are very unhealthy.
And that got me thinking: Who should public-health professionals and organizations partner with? Who does make money out of good health? So I wrote an article called “Caveat partner” — beware of your partner — in which I tried to figure that out. Sadly, I concluded there were many ways to make money out of bad health, but not so many ways to profit from good health.
First, there are the corporations that profit by selling us stuff that sickens or injures and ultimately kills us, from tobacco to junk food, alcohol to asbestos. Add to that the fact that corporations regularly complain about and try to undermine or avoid what they see as unnecessary regulations, many of which are there to protect us or the environment; think of the resistance on the part of carmakers over the years to new safety regulations, or of a wide variety of industries to pollution controls or occupational health and safety measures.
A third category of unhealthy corporate actors are those who pay their workers as little as possible, making it hard for them to live a decent life, or move their production to countries that have low wages and lax environmental and occupational-health laws and enforcement, so they can maximize profit.
But I did identify three categories of business that share our bottom line, who make more money when the population is healthier. First are industries whose profits depend upon a healthy population and environment, including the life- and health-insurance industries; if we pay them premiums and don’t use their products, that would presumably be profitable. Also, the leisure, recreation and tourism industries, since we generally need to be healthy to use their services.
Second are what I call the real producers of health; the people who build our homes, grow our food, keep our water safe and our environments clean, educate our kids, keep our communities safe and produce all the other goods and services that are the roots of good health.
Of course, they don’t necessarily do these things in a healthy way (there are lots of unhealthy homes and unhealthy foods, for example), but they could.
Finally, at least in theory, the entire private sector — and society as a whole — profits from good health. If people are healthy, they will likely be more productive and more creative, they will not miss work or retire early due to ill health or stress, they will remain independent, pay taxes and contribute in many other ways to society.
So we need taxes, incentives and regulations that both punish the private sector financially, ensuring they lose money when they harm health, and reward them financially for actions that improve health. We need to make health creation profitable, and we need a new breed of health-enhancing entrepreneurs to do this, a topic I will explore in future columns.
Dr. Trevor Hancock is a professor and senior scholar at the University of Victoria’s school of public health and social policy.