When someone attacks you, you are more than likely to fight back – it is only natural.

But what if you are doing something that has a bad effect on other people?

Tobacco, sugary drinks, junk food and alcohol all have an adverse effect on our health, being implicated in the development of a number of non-communicable diseases (NCDs), including cancer.

All these four items are freely and legally available for purchase around the world, but not surprisingly, public health advocates are pushing for stronger measures to try and curb their consumption.

Naturally, the tobacco, F&B (food and beverage), and alcohol industries are not pleased by this attempt to decrease their sales, and have their own strategies to push back.

Industry tactics

Says Prof Dr Rob Moodie: “I’m not actually against the private sector at all. This discussion is just about the unhealthy parts.”

The professor of public health at both the University of Melbourne and the University of Malawi notes that based on his observations of the past decade in Australia, the tobacco, junk food, sugary drinks and alcohol industries have “on every possible occasion, have done everything they can to undermine any effective public health legislation”.

“So, the notion of their repetitive mantra, ‘We are part of the solution’, is completely wrong,” he says.

During the World Cancer Congress 2018 session on Addressing the Commercial Determinants of Cancer and NCDs, Prof Moodie shared the top seven tactics those industries use to undermine public health policies.

One is by attacking legitimate science by calling it junk or bad science.

“One thing they do is focussing on the inherent uncertainty of science.

“Science is legitimately uncertain – that’s the way science works, it’s by constantly putting forth hypotheses and challenging them.

“So, they build on this and they undermine it as well as they can,” he explains.

Related to this is the tactic of “manufacturing false debate, insisting on balance and always creating the impression of a controversy”.

One way of doing this, according to Prof Moodie, is to insist that reasonable journalists cover both sides of the argument equally.

“It’s a bit like saying, yes, we need to spend as much time discussing why tobacco doesn’t cause cancer as why it does – it’s just absurd.

“It’s the same notion that even though 97% of climate change scientists believe that climate change is anthropogenic (caused by man-made activity), we still need to devote 50% of every discussion to arguments against them,” he says.

Prof Dr Rob Moodie, alcohol, tobacco, sugary drinks, junk food, cancer, non-communicable diseases, World Cancer Congress 2018, Star2.com

Prof Moodie, who previously headed Australias National Preventative Health Taskforce, notes that public health advocates need to know how industry does business in order to counter their influence. — UICC

Another way is to focus on corporate social responsibility (CSR) projects that divert attention from the effects of their products, e.g. sugary beverage producers promoting physical activity to stay healthy (rather than decreasing sugary drinks and food).

“They’re also framing issues more inventively than we are,” he says.

For example, admitting that there is a problem, but it’s less severe than what everyone says; admitting there’s a serious problem, but not a life-threatening one; arguing that the problem is less severe than other problems, which should take priority instead; and arguing that the cost to solve the problem is too high.

Another tactic is to create “arms-length front organisations” in order to set out a narrative that is favourable to them, e.g. the Foundation for A Smoke-Free World, which is funded by Philip Morris, and the International Life Sciences Institute, whose members are primarily food and beverage, agricultural, chemical and pharmaceutical companies.

Related to this tactic is the funding of disinformation campaigns, usually led by celebrities and/or experts in the field.

Another target of funding is, of course, politicians and lobbyists, in order to influence the political and legislative agenda in various countries.

Alongside this, the industries also attack and intimidate legitimate scientists whose work affects them negatively.

Examples Prof Moodie gave include Prof Dr Lisa Bero from the University of Sydney’s School of Pharmacy in Australia, Prof Dr Melanie Wakefield who is the director of Cancer Council Victoria’s Centre for Behavioural Research in Cancer in Australia, and Dr Abdillah Ahsan from the University of Indonesia’s Demographic Institute.

The former two have been targeted by the beverage industry, while the latter, the tobacco industry.

“It will never be an even playing field, but we need to know the way they are doing business, so that we can understand and start to turn things around,” concludes Prof Moodie.

Structuring a soda tax

At the same session, World Cancer Research Fund International senior policy and public affairs manager Bryony Sinclair and IOGT International international vice-president Pubudu Sumanasekera both offered some tips on how to counter such industry tactics.

Sinclair shared the lessons learnt from trying to introduce taxes on sugar-sweetened beverages in various countries around the world.

The first is to be prepared with the scientific evidence backing up the necessity and effectiveness of the tax.

She notes that the World Health Organization (WHO) has included the tax as an effective intervention, while there are also evaluation reports on its efficacy from countries that have already implemented it, like Mexico and Chile.

The second is to carefully consider the local context in relation to implementing the tax.

“It’s really important to have a thorough understanding of the context of the country, the tax system and the needs of the public before starting.

“And that’s especially key in understanding how to frame the tax. If it’s framed improperly, it’s not likely to go very far,” she says.

Sinclair shares that there are three ways of framing the tax, as seen from efforts around the world: from a health perspective, from an economic perspective, and a combination of both.

Taking time to be strategic and to design the tax carefully is also important, she says, in order to withstand opposition.

She notes that the five key questions that need to be answered in designing the tax are:

• What types of products are going to be taxed?

• What type of tax is going to be used?

• How high should the tax be?

• Who should the tax be levied on?

• Should it be a general tax or an earmarked tax?

The fourth lesson is to develop a broad base of support, ranging from academia to civil society and civil servants in the various ministries involved, as well as local champions like a politician passionate about the tax and philanthropic funding to help spread the message about the importance of the tax.

“Fifth, scrutinise the tax design. Industry is definitely going to be trying to tear the tax apart, so try to look at it from the industry’s perspective and understand what the potential loopholes would be.

“And of course, prepare for pushback – experience tells us there will be pushback, so we need to be ready for it,” she says.

Increasing alcohol awareness

Meanwhile, Pubudu shared strategies to counter the alcohol industry.

First is to increase awareness on the real effects of alcohol, e.g. alcohol consumption increases the risk of seven cancers: mouth, pharynx, larynx, oesophagus, breast, liver and bowel.

Alcohol, cancer, non-communicable diseases, World Cancer Congress 2018, Star2.com

Pubudu says that it is important to increase public awareness of the negative effects of alcohol, including increasing the risk of seven types of cancer. — AFP

“And we have to expose their marketing strategies, regionally, country-wise and on the global level.

“If you are not working on the global level, please do it in your country – study the alcohol industry in your country and what are their unethical business practices there,” he says.

He adds that working with politicians and policymakers is also very important.

“We should understand the language they understand. Sometimes, academic research and studies may not interest them, you need something (different).”

Media is another important component in the push against the alcohol industry.

The Sri Lankan native says: “I know, in my country and some of the other countries in my region, how the alcohol industry places their people in media stations – electronic and print media both.

“And now, they have people working around the clock on social media to put things positive to them.”

This is why it is important to have independent science. “Then we have to amplify it, support it and we have to translate it into our local languages.”

He adds: “And the general public is our ultimate tool. So that is where we can actually get politicians to listen, and sometimes, the media to listen too.”

Giving the example of a media workshop on alcohol conducted by himself and academics from the field of economics and health in Colombo, Pubudu says: “They were shocked after the presentation.

“They said that ‘We haven’t heard about this before, because we’re always getting information from the industry’.”

Another example is when they mobilised young Sri Lankans to remove tobacco ads on billboards around the country. “That is the public pressure and the power.”

The World Cancer Congress was held in Kuala Lumpur on Oct 1-4, 2018, for the first time in South-East Asia.