Anna Gilmore is a professor of Public Health, Director of the Tobacco Control Research Group and Co-Director of the Center for 21st Century Public Health at the University of Bath in England. In an interview with The News-Letter, she discussed her work defining the influence of commercial entities on public health — known as commercial determinants of health (CDOH) — and further described the topics of her talk hosted by the Institute for Global Tobacco Control through the Bloomberg School of Public Health on Nov. 6, 2024.
CDOH refers to how corporations influence healthcare policy through their production and marketing of harmful products, including tobacco, ultra-processed foods, fossil fuels and alcohol. These industries are estimated to be responsible for about 19 million deaths annually, or approximately 34% of all deaths. However, defining and combating CDOH remains complex due to the difficulty in obtaining reliable data and the pervasive influence of these industries on shaping public perception.
Gilmore’s previous experience working as a clinician made her aware of the limitations of traditional healthcare. In particular, she was interested in directly addressing the root causes of public health issues she had observed as a doctor, focusing on tobacco control and the tobacco industry.
Through her work with Martin McKee at the London School of Hygiene and Tropical Medicine, Gilmore was able to view internal documents released by the British American Tobacco Company (BATCo) and its parent company, BAT Industries. This archive was established in response to litigation from the State of Minnesota and Minnesota Blue Cross Blue Shield against multiple tobacco companies.
“I was one of the first researchers to go to the BAT archive and realized how much you could get out of these documents,“ Gilmore said. “We started to discover…how BAT was influencing policy [and] that it was engaged in a global cigarette smuggling operation.”
From there, Gilmore delved into other industries and found similarities between how BAT and corporations in other fields influenced public policy and shaped the narrative around the health risks of the products they sold. Some of these strategies included: using legal methods to prevent industry evidence from being accessed; contracting messengers to develop scientific “echo chambers” of a singular, pro-industry message; funding materials such as textbooks, letters to editors, and factsheets that package science in a way that looks upon industry favorably; and maximizing industry-favorable media coverage.
Gilmore discussed some of the difficulties her team faced in supporting legislation against these powerful industries. A key example she provided was regarding the development of a piece of legislation in the UK that made cigarettes available in plain packaging. The process of passing this legislation began with discussions in 2008. Despite overwhelming evidence that decorative packaging was used by the tobacco industry to promote the consumption of an unhealthy product across the globe, the legislation did not pass in the UK until eight years later in May of 2016 and was not fully implemented until 2017 due to a one-year transitional period for retailers to comply.
“It's unethical that you have to spend 8 years, even in a highly resourced environment like the UK, to get a single piece of policy through. And so, if we're going to be able to address NCDs [non-communicable disease] and global warming in the timescale that we need to do so, we will have to address the system problem,“ Gilmore explained. “It was the battle for standardized packaging of tobacco in the UK that really made that clear to me.”
One major challenge Gilmore emphasized is that corporations position themselves as unbiased actors in society. By positioning themselves as a friend of the consumer, corporations are able to subtly influence public opinion and frame health problems as issues of individual action rather than systemic issues built and perpetuated by industry titans. Gilmore described that the responsibility to resolve these issues is shifted onto individuals, absolving corporations from any accountability for the negative health impacts of their products. She explained that companies are thus able to sidestep public scrutiny and continue the sale and production of harmful commodities largely unchallenged.
Gilmore then argued that the issue is further compounded by the powerful corporate influence on the media landscape. She highlighted that the shift in media ownership towards wealthy actors with vested corporate interests biases media coverage and favors narratives that align with corporate interests, making the consumption of harmful products seem more ethical than it is.
To combat corporate influence, Gilmore argued for stronger legal frameworks to curb corporate influence, drawing on lessons from tobacco control. Article 5.3 of the World Health Organization’s Framework Convention on Tobacco Control is a policy designed to prevent the tobacco industry from interfering in public health policy. She advocated for a similar policy across other industries, and also called for greater rules surrounding media ownership to reduce corporate media influence and ensure that the public receives unbiased health information.
“What we really need is an Article 5.3 across the board for all these industries, which is basically saying, we need a conflict of interest policy and appropriate governance that recognizes the clear conflicts of interest,“ Gilmore argued. “We need full transparency…and we need to move to a position, for example, where these corporations cannot fund political parties or presidential candidates.”
Gilmore contended that corporations continue to have a substantial influence on scientific research, another pressing area of concern. Although guidelines exist to ensure research transparency and adequate scientific justification in research studies, Gilmore pointed out that companies have become adept at finding loopholes in these standards. For example, though some journals have policies against publishing research funded by the tobacco industry, corporations circumvent these rules by conducting research funded by external third-party organizations. This form of indirect funding, Gilmore argues, obscures the true source of research sponsorship, allowing companies to influence scientific narratives while appearing neutral and disconnected from the scientific research process.
A second key contributor to the pervasiveness of corporate influence is the growing disparity between public and private sector funding of scientific research. Public funding for research is stagnating, while the private sector’s influence on scientific inquiry is only growing. Gilmore described that corporations are strategically funding studies that align directly with industrial interests, a shift that skews the existing body of scientific literature. Over time, she contended that industry-friendly findings will be emphasized over those that may reveal health risks associated with popular commercial products.
To counter this issue, Gilmore recommended the establishment of a publicly accessible database detailing researchers' and authors' conflicts of interest — this system would increase transparency, making it easier to identify potential biases in research. She additionally proposed taxing corporations and directing these funds toward independent research initiatives. To address the disparity between public and private-sector funding for research, Gilmore suggested a reevaluation of research funding mechanisms and a shift towards a model that prioritizes public funding.
Gilmore's work reveals the urgency of adopting systemic changes in both policy-making and scientific research to mitigate the impact of CDOH. She concluded by emphasizing the importance of looking at the bigger picture, challenging systemic issues across multiple industries and considering how they influence healthcare and research.
“We can’t just do these piecemeal changes. We need to do that now, because every little bit will help. But we also need to see the bigger picture and try and make those system[ic] changes,” Gilmore concluded.
