Finance is a key driver in cancer prevention, as has been evidenced by the influence of tax on the consumption of products such as cigarettes and alcohol. Going up against a huge industry like Big Tobacco will almost certainly be met with tremendous opposition, but understanding the industrial marketing strategies they use, particularly in low resource countries that face the greatest cancer burden, may help to inform interventions and allow for the transferability of cancer-prevention strategies from high- to low-resource economies, according to Rob Moodie, MBBS, MPH, Professor of Public Health, College of Medicine, University of Malawi, and the University of Melbourne’s School of Population and Global Health.1
Rob Moodie, MBBS, MPH
Of the world’s top 100 economies, 71 are corporations. Walmart makes more money than Spain, the Netherlands, or Australia, noted Dr. Moodie. “This gives us context about who actually makes decisions and runs the globe,” he said, at the 2018 World Cancer Congress in Kuala Lumpur, Malaysia. “The world is changing in terms of where the power lies. These corporations are no longer multinational or even transnational, they are supranational.”
British American Tobacco recently acquired Reynolds American to become a giant in the tobacco industry; the company has now expanded its reach from standard cigarettes to nicotine alternatives such as e-cigarettes and heat-not-burn tobacco products. According to Dr. Moodie, the behaviors of these global firms must be monitored at a national level, just as those who work in communicable diseases monitor the mosquito. “If you’re interested in malaria control, you watch what those vectors do,” he said. “These supranational corporations are the vectors of the 21st century epidemics. National surveillance systems should be watching and learning.”
Big Tobacco has focused significant resources on marketing to low- and middle-income countries in recent decades. As a result, the annual growth rate of tobacco consumption has increased in those parts of the world.
‘Best Buys’ in Low-Resource Settings
Certain “Best Buy” interventions from high-resource countries can successfully be transferred to lower-resource countries (ie, tax increases on tobacco, bans on tobacco advertising, tax increases on alcohol, and reduced salt in food) but be ready to face opposition, he warned. To begin, “be prepared with evidence: be it health-related or economic,” he cautioned. “If [it is] not yours, then from other countries. Building that is absolutely essential.”
The local context has to be carefully considered in regard to building political will, resources, data, technical capacity, or industry presence. “No matter how universal we think some of these best buys are, local context really counts,” he emphasized.
Dr. Moodie suggests being strategic and incremental. Sometimes public health interventions take decades; plain tobacco packaging was introduced in Australia in 2012, but the initiative behind it began 20 years prior. “These things take time,” he said. “There’s three parts of good public health: persistence, persistence, and persistence.”
Next, Dr. Moodie recommends developing a broad base of support, both locally and globally. “The notion that somehow countries are going to put their own resources [into these interventions] without having the technological capacity or global and regional networks to utilize and learn from is fanciful,” commented Dr. Moodie. He noted that the reason for effective progress in treating people infected with HIV was due to considerable amounts of official development assistance.
Monitoring the behavior of tobacco, alcohol, and fast food industries must become a normal part of public health surveillance. It has to be more than an art; it has to be a science.— Rob Moodie, MBBS, MPH
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Next, Dr. Moodie focused on the importance of becoming thoroughly familiar with legislative changes, particularly in regard to taxation, and preparing for industry interference: supranational campaigns are utilizing existing and new forms of media, including advergames, social networking, mobile marketing, and geotargeting.
Fundamentally, marketing is about two things: mental availability—getting the consumer to notice, recognize, and think of a brand in a buying situation—and physical availability—the ability of the consumer to access a brand in time and space. As tobacco and soda corporations expand the breadth of their distribution as well as build and refresh memory structures through constant reminders, monitoring becomes even more crucial.
According to Dr. Moodie, we need to further advance “the science of corporatology” by monitoring the upstream drivers of harmful consumption, such as production, cost, availability, advertising, sponsorship, and the legislative and regulatory environment relevant to these commodities. “Monitoring the behavior of tobacco, alcohol, and fast food industries must become a normal part of public health surveillance,” he said. “It has to be more than an art; it has to be a science.”
Dr. Moodie advised avoiding the practice of lumping the private sector into one homogeneous group, as it is enormously diverse. It is necessary, he added, to work with industries and businesses that promote the importance of people living long and healthy lives (ie, investment banking, sustainable agriculture, health insurance, activity industries) and disinvest from others.
Finally, according to Dr. Moodie, it is wise to become familiar with digital strategists and marketers, who understand how to adapt to and utilize the rapidly changing and expanding online and virtual worlds. He urged investing inour own lobbyists who live and work in the corridors of power, investigative researchers who revel in uncovering the hypocrisy and deception of supranatural corporations, public health lawyers, advocates who enjoy the battle and are prepared to fight, and international campaign groups who may be able to influence the balance of power.
“Get to know these people. They have incredible expertise, and we need that to help us countermarket,” said Dr. Moodie. “Start hugging, at least metaphorically.” ■
DISCLOSURE: Dr. Moodie reported no conflicts of interest.