As I noted last week, it is not the case that the private sector automatically harms health.
Indeed, in a wide variety of ways, the private sector is what I called producers of health — they build our homes, grow our food, produce beneficial medicines, create good jobs and provide many other important determinants of health.
As a public-health physician, dedicated to protecting and enhancing the health of the population, I want to encourage activities that improve the health of the population — especially the health of the poorest, most disadvantaged and vulnerable populations.
But even more important, I want to change or stop those private-sector activities that harm health.
There are many ways in which the private sector harms health, and the World Health Organization and others think of the harms as being either direct or indirect.
Direct harm can be built in to the product itself — tobacco and guns are prime examples — or result from use or misuse of the product — think of alcohol, fossil fuels, fast and junk food or cars.
In addition, direct harm can result from the extraction or manufacturing processes — the occupational and environmental health problems related to mining, for example.
Indirect harm comes from the way the private sector “influences the social, physical and cultural environments through business actions and societal engagements; for example, supply chains, labour conditions, product design and packaging, research funding, lobbying, preference shaping and others,” WHO says.
By far the most egregious and offensive private-sector activity that directly harms health is the tobacco industry.
Tobacco is unique in both the scale of death and disease it causes and the fact that it does so when used exactly as intended. The WHO is clear and blunt: “The tobacco epidemic is one of the biggest public health threats the world has ever faced.”
A 2014 article in the New England Journal of Medicine stated: “If current smoking patterns persist, tobacco will kill about 1 billion people this century” — yes, that’s one billion!
In its July 2023 Fact Sheet, the WHO reported tobacco “kills up to half of its users who don’t quit,” about seven million people each year, as well as a further “1.3 million non-smokers who are exposed to second-hand smoke.”
That is over eight million deaths a year, almost one-seventh of the roughly 60 million deaths globally.
Added to that, of course, are the many years preceding death when tobacco-users experience a multitude of diseases and poor health.
So serious is the problem that tobacco was the basis of the WHO’s first ever global treaty, the Framework Convention on Tobacco Control, in 2003.
Currently, 182 countries are parties to the treaty, of which Canada is one. The convention covers 90 per cent of the world’s population.
The WHO has developed six practical, cost-effective initiatives to reduce demand for tobacco: Monitor tobacco use and prevention policies; protect people from tobacco use; offer help to quit tobacco use; warn about the dangers of tobacco; enforce bans on tobacco advertising, promotion and sponsorship, and raise taxes on tobacco.
As a result, the proportion of adults who smoke daily has fallen from 34 per cent in 2000 to 23 per cent in 2020, and most steeply in low- and middle-income countries, according to a recent report from Our World in Data.
And yet the tobacco industry continues to produce and market its deadly products around the world, particularly in low- and middle-income countries, according to a recent report from Our World in Data, even though “smoking in the developing world has been shown to reinforce poverty as already deprived smokers spend less on healthcare, children’s education, food, and clothes,” according to a 2019 fact sheet from Action on Smoking and Health.
Moreover, the group notes, “transnational tobacco companies have been shown to target women and children in developing countries,” adding that “adolescent smoking is also considerably higher in LMICs, over four times the level in the U.K.”
“The tobacco industry is fighting to ensure the dangers of their products are concealed,” the WHO Fact Sheet said.
But we need to shine a spotlight on tobacco, because when you put it all together, it is clear the tobacco industry is a truly lethal and evil industry that needs to be stamped out.
Dr. Trevor Hancock is a retired professor and senior scholar at the University of Victoria’s School of Public Health and Social Policy.
