Commercial Determinants of Health: Dr. Mélissa Mialon on the power & politics of food corporations

**Below is AI-generated (with some editing) **

Discover the commerical forces shaping our health as Dr. Mélissa Mialon describes the intricate web woven by large agri-food companies to influence health policies and sway public opinion. Our latest episode is a deep dive into the world where corporate interests meet public health, uncovering the stealthy methods these corporations use to assert their agenda. Dr. Mialon guides us through the labyrinth of systemic racism and the convolutions of the current healthcare system, exacerbated by the COVID-19 pandemic, while offering actionable strategies to dismantle these harmful influences.

Grapple with the double-edged sword of corporate social responsibility; is it a genuine effort towards societal betterment or a smokescreen for deeper systemic issues? Dr. Mialon aids us in peeling back layers of corporate strategies to reveal the true motivations behind initiatives that often present themselves as benevolent. Our conversation takes a critical turn towards the interplay between capitalism and public welfare, stirring a debate on whether a capitalist system can ever truly align with the interests of public health over profit. We also address the imperative need for transparency in the corporate influence on public policy, highlighting global approaches to democracy that can either impede or foster progress.

In conclusion, we reflect on the collective power of grassroots movements. The episode leaves listeners inspired by the influence that dedicated individuals and communities can exert on holding corporations accountable.  Join us for a conversation that not only challenges but also encourages each of us to actively participate in the movement towards a healthier, more equitable world.

Undisciplinary - a podcast that talks across the boundaries of history, ethics, and the politics of health.
Follow us on Twitter @undisciplinary_ or email questions for "mailbag episodes" undisciplinarypod@gmail.com

Transcript

Speaker 1: 0:00

Undisciplinary is recorded on the unceded lands of the Wadawurrung peoples of the Kulin Nation in Geelong and the Gadigal peoples of the Eora Nation in Sydney. We pay our respects to Elders, past and present.

Speaker 3: 0:14

The world's first high-strung plant has been performed. Medical history has been made in South.

Speaker 2: 0:19

Africa. Reports of systemic racism in the healthcare system, and COVID-19 has made the issue even more urgent.

Speaker 3: 0:27

Characterised as a pandemic.

Speaker 1: 0:31

Welcome to Undisciplinary, a podcast where we're talking across the boundaries of history, ethics and the politics of health, co-hosted by Chris Mays and Jane Williams. Okay, so welcome to another episode of Undisciplinary.

Speaker 2: 1:08

Jane, how are you going? Well, sort of good, Heavy cold, Chris. I feel like last time we did this I had COVID or something like that. I'm coming across as a sickly person.

Speaker 1: 1:21

I will say normally my voice sounds nicer than this, very good.

Speaker 2: 1:24

But it's nice to be back.

Speaker 1: 1:26

It is nice to be back. It does feel like we have been doing less episodes. We should try to do more regular episodes, but we are both busy, especially since teaching is quite heavy at the moment. But today I'm really excited to be talking about this particular topic. We're going to be talking about the commercial determinants of health, or the commercial determinants on health. We can talk about whether there is a meaningful distinction between on or of with our guest. But this is something that has, you know, pops up from time to time Well, not time to time, it's quite, you know, in the context of public health and the media. You know, often will talk about it and often talk about it from my sort of observation, about things like pester power, kids. And you know, when you're going through the shopping centre and you're checking out and there's chocolates there and they'll have sort of morning show talk show hosts talking about how this is such a bad thing.

Speaker 2: 2:30

But it doesn't seem to really get at the issue.

Speaker 1: 2:32

I mean, I don't know if you've sort of seen this general discourse around commercial determinants of health, Jane.

Speaker 2: 2:40

Me. I was just thinking about how lovely it is to not have somebody nagging me to buy stuff at the checkout.

Speaker 1: 2:48

Yes, yeah, your kids are older.

Speaker 2: 2:53

So for me, where it comes into it is usually in the news headlines and often things that I see on Twitter where I'm just outing myself right now as a person who still uses Twitter, although not as much as I used to where you hear a lot of stories about companies behaving badly, basically, and it's always like oh my God, I can't believe they get away with that.

Speaker 2: 3:18

And then it's kind of like on to the next story and I'm speaking for myself here, so I'm not covering myself in glory right now, um, but but I I think that there is this perception that there are a lot of sort of big agri-food companies who do all sorts of terrible things in all sorts of terrible you know not all terrible places in all sorts of places, um. But then it's kind of like ah well, well, what are you going to do? So I am super excited to be talking to our guest today about what we're going to do.

Speaker 3: 3:51

Should I introduce her.

Speaker 1: 3:52

Yes, you should.

Speaker 2: 3:53

Yes. So today we're talking to Dr Melissa Mielon. She is the Inserm I'm sure you don't say it, inserm in French, inserm the junior professor chair on research on health services. Dr Mialon Melissa is based in interim unit on health services at the French School of Public Health in Reims in Brittany. She is also a visiting research fellow at the Trinity Business School at Trinity College, Dublin in Ireland. Research fellow at the Trinity Business School at Trinity College, dublin in Ireland.

Speaker 2: 4:29

Her research is funded by the Agence Nationale pour la Recherche I have to keep saying these bits in French, maybe not At the National Cancer Institute and from the Health Research Board in Ireland. Her research focuses on the commercial determinants of health, particularly the practices of corporations that influence public health policy, research and practice. She developed a novel approach to identify and monitor the political practices of the food industry at the national level and she also conducts research on solutions, which I'm excited about, to address the commercial determinants of health. She is author of Big Food Co, which is currently only available in French and possibly Spanish, but is coming to English soon, hopefully, and I'm super excited to read more than the abstract, which was all I managed in French. So welcome, melissa. Thanks for joining us.

Speaker 3: 5:25

Thank you, Jen and Chris. Thank you for the invitation and I'm excited to be with you as well.

Speaker 1: 5:29

Yes, thanks a lot. I guess first up a question we start with is, in reflection of our title and focus, about Undisciplinary. It'd be interesting just to hear a little bit about your journey into looking at the commercial determinants of health and what led you there and perhaps different disciplinary backgrounds and perspectives that you have brought along the way or developed along the way.

Speaker 3: 6:01

Yeah, yeah, sure. So I'm a food engineer by training. I was trained in France and we have specific food engineering schools and engineering schools more broadly. So it was really about you know how do you develop foods at a large scale with technologies and in the industry, also about safety, things like that. I had a specialty on nutrition and health, but that was mostly about marketing, so reformulating your products, but that didn't make them really any healthier, and we knew that somehow. We had some examples where we knew that the food or or the products were not much healthier but you know, still we would market them as as that.

Speaker 3: 6:51

Um so, and I was with my husband, I have to say, which I don't mention often but we did the same training, which was somehow helpful because we could discuss our criticism of of what we were learning, also with a group of friends. And so then I decided I did my last internship in a charity in France which is called Action Against Anger. So the question of anger was really interesting to me and still in that space of nutrition and health where I could do the training and the internship, as part of that internship what I did was looking at the future of anger for the charity. And what was very clear is that people will have, you know, in the countries so Africa, asia and other countries where the charity was working, people would have more and more problems like diabetes, cancer etc. On top of of the anger problem. And it was very clear that the food industry has a huge role, you know, in penetrating we call that penetrating those markets with unhealthy products and also very aggressive marketing practices etc. So it was kind of a challenge for me because I was a food engineer, so I had that diploma. I could have gone to the industry and around me people you know in total honesty. Well, you know, our family friends were telling me like go there, you will be paid well and you will try to change things from the inside. I didn't believe in that. So then I decided to do a PhD. I discovered the work that was done at Deakin University University in Australia, which was kind of critical of what I was seeing. So I did.

Speaker 3: 8:29

Before that I actually did an internship at the UN. It was called the United Nations Standing Committee on Nutrition. It was a coordinating committee between the different branches of the UN. So FAO, the Food and Agriculture Organization, world Health Organization, unicef, all of the organizations of the UN, so FAO, the Food and Agriculture Organization, world Health Organization, unicef, all of the organizations of the UN who were working in the in the nutrition space, and the same like there was a huge capture by corporations. I could see that, you know, in the discussion that we were having. We were preparing a big congress on nutrition, but there was also a space for being critical about what was going on with the food system.

Speaker 3: 9:07

So that's when I started doing my PhD in Australia in public health, public health nutrition, where I have been looking at what we call the corporate, corporate political activity of the food industry. That work was very much based, I decided to be I'm sure that that someone, something was done about another industry. So instead of reinventing the wheel, I was just and I took time to look at the literature and indeed there was a lot of work for the tobacco industry in the public health space. So a lot of what I did for my PhD was based on what colleagues had done for the tobacco industry, you know, dissecting their, the different practices of that industry, and we could see that for the food industry they were using quite a very some of the very similar practices, which is not surprising.

Speaker 3: 9:53

I'm a food engineer. Most of my friends working in the food industry now, you know, from back at the time, from the time when I was doing my engineering school, those people were with me, but now some of them work also for big pharma, some of them work in the alcohol industry. So when you are on the other side in the industry, you can use your knowledge on marketing or research and development, and you can use that in any, any industry. So I thought we should also do that more in public health. You know, compare the different industry, without saying that they act exactly the same way, but there are things that they learn from each other. And and then you know, I've I've also worked on the alcohol industry, et cetera, and that's how we started. You know, at the same time there was that discussion also in public health about what we now call the commercial determinants of health. So that's how it started. And so my journey also was the journey of the field. I guess you know we all grew with, you know, by learning from each other.

Speaker 2: 10:55

So you just you just used the phrase commercial determinants of health. I feel like probably our listeners might not know what that means. Can you explain what it means? And I'm assuming it was coined, I guess, as an extension of social determinants of health, which was sort of gathering traction in the way that things that we don't think strictly of as health really shape our experiences of incapacity for health. Can you tell us about the commercial determinants of health and what that is, how it works?

Speaker 3: 11:33

Yeah, sure, yeah. So I mean, without reading the definition. I mean it's the practices, the systems and, as you know, we define them the system, practices, pathways through which commercial actors drive health and equity. That's the definition that we developed in. We had the Lancet series published. So, you know, the medical journal, the Lancet, published a series of three publications on the topic last year.

Speaker 3: 12:01

We kept that definition neutral somehow, because some of those, you know, some of the products, some of the practices, might be beneficial to health from those commercial actors. In reality, you know, most of us look at the negative practices, I mean the practices that have a negative impact on our health. But that's, you know, that's the idea that you know commercial actors have an impact on our health. But that's, you know, that's the idea that you know commercial actors have an impact on our health and our planet. And we are now, you know, studying that much more broadly than we were, you know, a few years ago. So, um, we had a number, I think, which was very, um, interesting for industries. So fossil fuels, alcohol, tobacco and the food industry are responsible for 30% of global death with their products and the way that they aggressively push us to consume those products. So those companies, those commercial actors have a huge impact on our health.

Speaker 1: 13:00

It's interesting, jane, earlier on you mentioned, I don't know, something about Twitter, about you not being on it or shamefully being on it. There's no shame in being on Twitter and Twitter is how I think part of the reason I reached out to Melissa to get her on here, which was because she tweeted, and if you don't mind, I'm going to read out the tweet, which I thought was thought was excellent, which is uh, yes, it's trendy to put commercial determinants of on health, on everything that you do, but unless you question power, asymmetry, neoliberalism and other foundations of the commercial determinants on health, then your works, your work specifically on marketing or the healthiness of products, etc. But not the commercial determinants of health. And I thought that was, I guess, right. I mean, I liked it, I think.

Speaker 1: 13:54

And then you know, I think I sent it to you, jane, and then sent a message to Melissa. Because, back to that sort of initial my experience of seeing people, or some people, talk about commercial determinants of health, they'll say things like, oh, we should not have candy near the front of the supermarket or these sorts of things, and you know not to suggest that they're unimportant, but they don't seem to really be getting at the, as you say here, the sort of power asymmetries and the neoliberalism and the sort of broader involvement of sort of transnational capitalism that's going on, which seems to be, then, what you're wanting to look at at center in the commercial determinants yeah, so.

Speaker 3: 14:37

So, yes, some of like the, the colleagues who work, for example, on tobacco. You know, yes, at the beginning you look at the commercial determinants by specifically looking at the product that is making us sick. You look at the marketing, et cetera. But soon you realize that there are foundations for corporations to behave the way that they are behaving. And you know, I mean, with each of our journey. You know which is OK. Not everyone has to understand that. You know power is behind all of those things, which is okay. Not everyone has to understand that. Power is behind all of those things and those foundations, as I said as well racism, patriarchy, colonialism, etc. Those are the foundations of the commercial determinants of health. You have people in power and a small elite of people controlling the world and we have the put and profits being put before the health of people or education or other. Um, ours are important things for our society and really, you know, I have seen people talking about the commercial determinants of health, putting that into their CVs because it's trendy, as I said, you know, in my tweets. Um, they work perhaps on.

Speaker 3: 15:44

You know, some people work on marketing and changing behavior of people, but that's a bit incoherent with what we said in the Lancet series. People behave in that way because they are, you know, pushed to behave in that way. So what we are trying to address is the system, this system that makes you behave in the way that you are behaving. Address is the system, this system that makes you be like behaving the way that you are behaving. So, um, ultimately, we shouldn't be talking about people behavior when we talk about the commercial determinants of health, but the behavior of corporations. If there is something we, you know, we should focus on, um. So in the lancet series, you know, the first publication is about those definitions and also saying that the system, you know, the capitalist system and neoliberal policies, et cetera, they are responsible actually for the way and of course, corporations are also pushing for that system to stay in place.

Speaker 3: 16:32

But unless we question that system, then you are not really working on the commercial determinants of health. You are working on some specific practices of corporations. But if you are to, you know, discuss the commercial determinants of us, we should not forget that other aspect, and what was frustrating for some of us is that we've been in conferences where in plenary, you know, in plenary sessions, in public health conferences, people would invite us to talk about the commercial determinants of health, but then the conclusion is that, yes, we can change people's behavior, but putting some marketing policies in place or front-of-back labeling for tobacco or food, that's not the idea. The idea is to question that power. So, as a conclusion, we should collectively question that power. Health professionals and it's frustrating to see that discussion, you know, not happening. Yeah.

Speaker 1: 17:32

I guess something you know that I find interesting, and just thinking about your response there and about focusing on behaviours, it reminded me of Jane, when, so Jane works in infectious disease among many other things.

Speaker 1: 17:46

But I remember when we were talking about COVID I mean, we still do talk about COVID, but more so, you know, you were saying it's a virus and it behaves like a virus.

Speaker 1: 17:58

And this is when people were sort of again sort of wanting to put people's behavior on trial for, like, why they're spreading COVID rather than well, it's a virus and it behaves like a virus.

Speaker 1: 18:09

And I think similarly in how you're responding about I think this desire to focus on people's behavior then takes away from corporations, and corporations are going to behave like corporations, which we can get into a conversation about corporate responsibility, but most of them are seeking to increase their profits. But then also, I guess I'd be interested in your insights or reflections on different you know you've worked across and in different nationalities and different sort of cultures of expectations of what markets and corporations should do. So Americans may think that corporations have more of a role and that any kind of socialist economic thinking is just out of the question, whereas perhaps in France and Ireland there may be more openness to being critical of corporations and their role in society, and perhaps Australia is a halfway point between those. I'm not sure I'd be interested in your reflections on, yeah, within these public health conversations, do you how you see those different cultural influences on the place or otherwise of corporations in our society in general?

Speaker 3: 19:32

yeah, no, no. So yeah, thanks, thanks for the like, um, uh, the analogy with an epidemic. And we have that analogy actually from Gile. He wrote about the industrial epidemic and how corporations are spreading a disease, which are those cancers and diabetes and other diseases, and the vector really is the industry. So we actually have that also, you know, similarity with, because I think it's important to see.

Speaker 3: 20:05

You know the corporations, you know corporations and commercial actors as the problem here and also you know I mean it's not all against commercial actors. You know everyone tells me that I'm McKinney and, like you know, I'm against commercial actors. I'm not, you know, we are just looking at the bad side of it and you know there is a space perhaps for some other forms of commercial actors, just in terms of, you know, challenging. You know those commercial actors, their practices, discussing about the commercial determinants of health. So in France I guess we have different points of view. So if I talk with people in political sciences, social sciences, they would agree Because we had Bourdieu, we had a lot of philosophers and social scientists before us who discussed those issues with commercial actors and power etc. But for example, my employer, it's a biomedical research institute. If I talk to those people they wouldn't understand. They told me that it's political, it's not scientific to say that capitalism is making us sick.

Speaker 3: 21:13

We published that, I'm always saying, and it's the front cover of the Lancet. You know, when we published the Lancet series, the front cover of the magazine, of the journal, was, you know, discussing capitalism. I can read it, you know, it's on my desk. The shift towards market fundamentalism and increasingly powerful transnational corporations has created a pathological system in which commercial actors are increasingly enabled to cause harm and externalize the cost of doing so. That's the front cover of one of the most prestigious scientific medical journals. So it's not political, it's absolutely scientific. We wouldn't have been able to publish that in the journal if it wasn't based know, based on on the best available evidence that we have in in medicine.

Speaker 3: 22:00

So in France we are between the two. Like you know, people and that's the issue also we discussed in the Lancet series you know doctors and those working in the in the health system don't really have that approach that you know. I mean they understand prevention but they don't understand the broader. You know they understand the social determinants of health but not the other probably not other forces you know, that are driving their behavior and also the health of their patients and the population. You know, people are sick because of those, uh, those commercial actors. Not only, of course, it's not the only reason, but that's the big, a big part of the problem.

Speaker 3: 22:40

Um, australia is probably like france, you know, somehow in the middle, and then, of course, you would have the us where you know it's. It's it's very hard to question the power of corporations and capitalism, etc. You would have very good people doing it. I just listened to a talk by Naomi Oreske, an historian, and she wrote an excellent book on the history actually of the development of capitalism as an idea and with the business schools and other schools, economics in the US. So you have people doing excellent work in the US, and I've lived in Latin America, so Latin America is completely different from, and not all countries in Latin America, but so power is really back to the people.

Speaker 3: 23:31

They would include much more citizens around the table women, peasants, black and indigenous people, et cetera.

Speaker 3: 23:41

So democracy has a better meaning, I feel, than in most of our countries.

Speaker 3: 23:51

So the commercial actors are still very much around the table and discussing and trying to influence, as they are doing in other countries, but there is a better balance between and it's always very, very prone to be questioned. You know, in in Brazil, for example, bolsonaro was in power and has destroyed all of that social movement in in just a few months, but then it's back, you know, and the values of the people are very much ingrained into that. You know importance, the importance of democracy and how everyone should have a voice in the political decisions. So, to me, latin America was really, was really, really a big motivation for continuing my work, even when, you know, despite some of the challenges that we face, I have hope because I know that some countries are going in the right direction. I mean, if we put health of the people before profits, of course it's not, you know, not everyone has the same values as we have but if you think health is important, then Latin America, for example, is a region we can look at.

Speaker 2: 25:06

Can I jump in and ask a question which is a little bit different? So when you were starting at the beginning, you were talking about your studies and the work that you've done on marketing, and so I was interested in thinking about, like corporate social responsibility and the encouragement for big companies or sort of the requirement really for big companies to have corporate social responsibility programs, social responsibility programs and the slippage, I imagine, between what a corporate social responsibility program looks like and what a marketing opportunity looks like. And I'm thinking about that in terms of some work that I did with the gosh. I can't remember what the acronym, the IMFPA or something.

Speaker 2: 25:59

Let me just scroll for a second IFPMA, the International Federation of Pharmaceutical Manufacturers and Associations. They have a huge number of what they call humanitarian projects around the world where they claim to collaborate for global health progress, to improve lives everywhere. They're all pharmaceutical companies. I'm not suggesting that you know drugs are bad, but I think there must be some sorts of slippage here between the, the, what they are seeing as as helpful or brand marketing as corporate, corporate social responsibility and the sorts of practices that you investigate, I guess, as being potentially harmful. How do you kind of manage that corporate social responsibility marketing side of things.

Speaker 3: 27:03

Yeah, yeah, so thank you. Yeah, thank you for the question and it's hugely important. So just one thing you know that is important to understand is that corporate social responsibility is often managed within the marketing departments in corporations and in companies. So it tells a lot about what's the intention with corporate social responsibility. In our discussion on the corporate political activity or, you know, commercial determinants of health more broadly, we classify corporate social responsibility as a way for corporations to manage their reputation.

Speaker 3: 27:53

So it's a tokenistic, you know, solution. They just invest a few, even if it's a few millions, you know that's nothing compared to, you know, the problem that they are causing and also some of those you know the biggest corporations should have paid a lot of taxes, for example, in some of the countries where they operate. They don't do that. It deprives countries from having that money to invest in education or health or anything that you would invest in if you were. You know if you are in a democracy and that you had, you know, do that money from the corporations. So that's not democratic. You know corporate social responsibility where the money goes, it's decided by the companies. It's tokenistic. It's not money that you know could have been used by our states democratically. It also provides the industry.

Speaker 3: 28:45

So, as I said, you know, it helps with their reputation, seeing them as a white savior. Often they, you know, go in other countries you know, and show that they are, you know, here to help you. But in reality they are always putting their logo on those activities that they're doing. So it's a way for them to market their brands or their companies to the rest of the world, so places often where they don't have yet a lot of customers. So it's just a way for them to penetrate those markets while, you know, showing that they're good people in our high-income countries. So there are a lot of problems with that commercial, social, corporate, social responsibility and other activities also of corporations. I'm quite, very critical of those activities that they are.

Speaker 1: 29:39

I don't want to sort of get you into any kind of trouble.

Speaker 3: 29:44

No, no, tell me.

Speaker 1: 29:48

More of this because I was listening to Rob Moody talk about the commercial determinants of health and obviously you know there's a whole range of people. He was one of the editors of the series, yes, and you know obviously everyone. There's a huge number of authors on all these different papers and no one's expected to all have the same view. But he, I guess, like a lot of other public health people talking around corporations, was wanting to be very clear that they're not anti-capitalist as such, or at least anti-corporation, and and trying to present, I guess, the triple bottom line argument that, yeah, you know, corporations can be good for society, good for the environment and health and good for their profits and to.

Speaker 1: 30:35

To me there's a longstanding tension, it seems, within the history of public health, with public health emerging out of a form of liberalism, in the UK as well, as well and other areas, and then also, I'd say, another strand in terms of Western public health being more Marxist and critical of the way society has been established, and that runs through, I think, still in some of the co-authors on those papers, someone like Fran Baum, and you know apologies for the Australian focus here, but that's more than I know and different ways that people think about the role of corporations.

Speaker 1: 31:19

So fran, in her work, has been, to my mind, much more critical of corporations and explicitly drawn on marxism and, you know, drawn on zizek and other sorts of thinkers like that, whereas there also seems to be this, I would say, a kind of neoliberal public health that, um well, we can kind of have everything. Uh, if we sort of just tweak a few things around here, if we make the same, you know, better trade agreements there, um, we have the right people around the corporate, around the stakeholder table, then we'll be able to achieve a better outcome. I'm not quite sure what I'm going to ask.

Speaker 1: 32:02

I'm not wanting to get you to comment on what you think of. Rob's position or anything but that seems to relate to this corporate social responsibility and sort of hangover of that.

Speaker 2: 32:13

And can I just throw in there, chris, this email that I got from Uber last night telling me about their sustainability plans. And so their sustainability plans involve, I guess, more electric cars and transitioning to like disposable packaging that's more compostable or something, but not, you know, stopping Uber and like doing something good about public transport, which is completely rubbish around where I am or I don't know. You know so it's. So. It's a way of tweaking the edges of this, this company that encourages travel by car, it encourages poor employment practices, it encourages all sorts of like I don't know, just different kinds of consumption that aren't good for anybody, right? So this seems like an example of what you've just said, that that rob would say would be okay if we change the packaging, then maybe it is okay yeah, I, I mean, yeah, you've, you've, it's an excellent, uh, you know analysis actually of of what's happening.

Speaker 3: 33:16

I think it's an excellent, you know analysis of what's happening. I think it's very healthy because, you know, I think we were something like 25 authors on three publications. So it's not easy to, you know, get everyone to agree on what we should be writing. We had kind of an agreement, but yet there is that spectrum of people, you know. Some of them think that we can change capitalism for a better capitalism. Other, like you know, fran and I, sit more on that side. You know, and I'm very clear with anyone. They know that technologies and science, and you know, try to tweak the system and improve things for, you know, better for having less of a negative impact on the planet, perhaps, and people. So there is a space for that.

Speaker 3: 34:08

But you know, some of us, with the evidence that we have, we just believe that, you know, we should put the human right to health before, you know, before profit or anything else. So it was a tension even when we wrote, you know, that Lancet series, I think, you know, in the third publication we wrote that we were not anti-capitalism and some of us don't agree with that you know, or at least there is not the need to say that you know. If you just you know if your conclusions, your research shows that capitalism has a negative impact on the planet, you don't need to say that you are against. You know capitalism or not you know, you just say, as a scientific, I'm here to you know, share the evidence and then it's up to people to decide collectively on. You know what direction we should take. What direction we should take. Perhaps you know we want to continue with the economy, or perhaps you know we want to protect people and our planet and, you know, try to remove that influence from corporations.

Speaker 3: 35:04

But I think you know one of the examples and my colleagues know that we had an exchange, you know is that when we launched the series, the Lancet series, last year, there was a webinar and at the end of the webinar there was that woman and you know I won't name them, but she was invited from an African country. She was working for what is called B Corp. So B Corp is a certification for corporations who supposedly are doing better things for our health and planet. But when she was presenting like she was presenting Danone, for example, and other corporations are doing good as doing good things and I know from my work that you know that's not an example of a good company because, yeah, perhaps you know in one or two spaces they are doing good things, but overall you know they are harming our planet and health. So we had that discussion afterwards. You know why did we invite that? You know, woman, uh, why would we? You know, given all of the evidence that we had in the series and we didn't name any specific company. But you know, clearly, the certification, big corp or, you know, corporate social responsibility or those things were not.

Speaker 3: 36:13

It's not solution, or at least it has to be much more researched before we push that as a solution, you know. So, even amongst us, you know people were not as critical as you know some of us were about those solutions and, as I said, I think it's very healthy. You know we need to research more. The problem for me is that you know it will take us. I know it will take us 20, 30, 40 years before we understand the harms of those new solutions. I don't think that they are challenging the system. I think it's just against tokenistic solutions, trying not to challenge the market, trying not to challenge, power, know in that sense, but all based on the science that we have, you know, with us. It's not a radical because it's my you know my personal position. It's because the evidence shows us that we need to be radical if we are to address the commercial determinants of health.

Speaker 1: 37:05

Well, maybe we should move to solutions just in terms of time and to be able to give enough time to that, because that would be interesting to hear more about. So, so, some of the things you've talked about seem embedded in the economic and political norms of the neoliberal reality that we live in. What are some of the possible solutions to address the commercial determinants of health?

Speaker 3: 37:36

Yeah, yeah. So I mean, I'm not an expert, like you know, on the political economy. I'm not a social scientist or, you know, a political economist, but you know, from our public health perspective. So two different levels. My research specifically is on the corporate political activity, so the influence of corporations on public policy. Again, those are like short-term solutions. I would say they wouldn't address the system.

Speaker 3: 38:02

But you already have some very good things in place. We did a review of the literature on that. You know, for example, you have countries with a good register of lobbyists or some limitations on, also on who can lobby your government. You have limits on donations to political parties. You have the, and Australia is very good for that. You have the agenda and diaries of our ministers. Or you know people in the government and that's publicly available so people can know who is talking to who. So transparency is, you know, a form of, you know, increasing, you know, our and making our democracy better, making our democracy better. So you have those sorts of mechanisms that exist in some countries and we could push our governments to adopt those mechanisms. So in my research, that's what I'm doing, for example, in France and Ireland, comparing what Ireland has put in place and what France has put in place. It's a list of, I think, 40 mechanisms for our government, mechanisms for our government.

Speaker 3: 39:04

Then, if you look at more broadly the commercial determinants of health, just questioning as a society what, and collectively? I think you know collectively is really what we, this collective effort is really what we want. You know having alternative ways of exchanging our food and you know having alternative ways of exchanging our food and you know products, et cetera, cooperatives that are led by the workers, for example, is an option for that. Also, you know you have investigative journalism, which is, you know, we have to support those type, that type of journalism instead of, you know, just the mainstream media having better protection for whistleblowers when they expose things from the industry. So you know we could have good laws around that.

Speaker 3: 39:52

And then, really, you know, collectively should we want? And sometimes that's you know, it might be the case that the economy is very important. So I give you just one concrete example Colombia. There was a company which was producing asbestos in a small city. Everyone was sick in the city, of course, the workers, you know they were sick because they were in contact with asbestos, but when it came, when they had, you know, a discussion on should we remove that company from the city? They didn't want because it was the only source of income. So economy, you know, was more important. Didn't want because it was the only source of income. So economy, you know, was more important.

Speaker 3: 40:30

And but often, you know, corporate social responsibility or companies being present in cities and giving us employment and jobs, that could be replaced by a strong government, a strong public sector. So often there is, you know, the government is not there and that's why we rely on the private sector, on corporations, and I had this discussion yesterday, even in France, with my colleagues yes, you can accept money from the pharmaceutical industry, but if you accept it, then you are not pushing for the government to invest in your research. And, of course, our governments, if they can rely on someone else to pay for all of those public services, then you know they would do it. So I think, collectively, we have to address and think again about, you know, what we want. What we want to protect, you know, is our health and education, for example, are those things important to us and we want to protect them as as public goods. Or, you know, are we okay to rely on the industry but you know, with all of the arms that and externalities that come, you know, with relying on those commercial actors. So it's really a discussion that you know needs to happen, about lot of movement, for example on climate change and the climate emergency happening. So I think we could have the same discussions also around health.

Speaker 3: 41:54

The thing is that we risk being like young people also. I've seen some of the movement being captured by the industry. So you have corporations and inviting those people to discuss and OK, you know we can come around the table and discuss and change, you know what we do to be better. That's not what we want. I think we want to disrupt the system and I have seen that in Chile, for example.

Speaker 3: 42:16

I've lived in Chile. You know the most neoliberal country. I was doing my research on the food industry. Colleagues told me like no one will talk to you about, you know negatively about the industry. We don't have any trade union I mean unions for workers or we don't have any civil society organization or consumer organization.

Speaker 3: 42:37

And all of a sudden, a month after I arrived in Chile, there was a protest clearly questioning the capitalist system, clearly questioning what corporations had done to the country. And that's because the tickets in the metro had increased and people couldn't face like young people, couldn't face the price of it. And yes, for the last 30, 40 years there was an increase in the way that people lived. Like you have, chile really looked like Europe, you know, and Australia. They had good cars, you know, and very nice hospitals, education etc. But everyone was, everything was privatized and the younger generation, they don't have access to that, they don't have access to that education or it costs them a lot. So the inequities also are increasing.

Speaker 3: 43:29

And I was just surprised because even if you didn't have that organized collective movement, people understood the issue and what was the root of the issue and who was? You know what was the root of the issue and it was, you know, that capitalist system and it was clearly. Then, you know, all of a sudden written on the streets. You know capitalism was born in Chile and it will die in Chile or things like that. So even in the most, even in the countries you know we've discussed the different cultures, even in the countries where you know capitalism and neoliberalism is really ingrained into the society, then people still understand that those are the causes of harm for our planet and health. So you know, deep down they are. You know, perhaps they are ready to challenge that system as well.

Speaker 2: 44:24

Do you know? It's interesting because you were saying a little bit earlier, melissa, about this being comparatively new and they're not necessarily have not enough time for long term evidence about impacts and so on. I was just reflecting that there has been a boycott Nestle in some. What Nestle boycott in some form or another pretty much my whole life, as far as I know. Um, I remember it, you know, in the 80s and the 90s.

Speaker 2: 44:54

I remember in the 2000s and I feel like I'm I'm interested in the extent to which a comparatively, possibly comparatively small number of committed people can can make a difference. Feels weird, but David and Goliath.

Speaker 3: 45:15

Yeah, I mean. So the the you know boycott is is is interesting, but I think it's still a market, a market way of contesting, you know, power. So you just boycott a product or a company when the issues. And that it's how corporations but not just Nestle behave in different countries. So it's important, but we see that doesn't change much how those corporations are behaving. So it sends a signal, but to me that not, you know that's not how we will. We are going to address the problem. So you know it's very strong. And in the breastfeeding you know breastfeeding and versus infant formula space, um, we are very, very strong, um, civil society advocates, people who have done a beautiful work, you know, in protecting the health of our babies and children. But you know, I think we need to do much more than that.

Speaker 1: 46:05

Yeah, Just on that idea of civil society and also, yeah, I think so, in addition to listening to Rob Moody talking about commercial determinants of health, I was hearing sort of some people talk about tobacco control and the health.

Speaker 1: 46:25

I was hearing sort of some people talk about tobacco control and the history of that and more sort of the future and what people are doing now and in some ways and I'm going to sort of this is broad brushes here and certainly nothing directed towards you, melissa, but for some public health, or a lot of public health that I've been exposed to, the sort of more inside discussion within academia, there's this sense that there are public health researchers, there are lobbyists and there are government policy people and they're the ones who sit around and make the decisions and who wins the day with the argument is then, what sort of may get passed into law or policy or those sorts of things, and if there's a success like tobacco control, that was because of particularly these men, usually men who were able to sort of lead the charge on this.

Speaker 1: 47:20

And again, thinking sort of longer history about public health and I know john snow gets a bit, maybe too much attention, but that idea of the streets and direct action and like just you know there's a problem with the pump, let's take the handle off the pump. Um, again, like lots of people have said, that that kind of direct action isn't always good, but even with, say, tobacco control and early on in Australia, the people who would go and deface posters and do those sorts of direct action by vandalising the advertisements or women's health movements around environmental toxins, not only in relation to breast cancers but asthma and these sorts of things.

Speaker 1: 48:10

AIDS in France is another AIDS in France and AIDS in the US as well with research and just obviously we can do multiple things and we need to do multiple things.

Speaker 1: 48:21

I don't think it's one or the other. That's certainly not what I'm suggesting. But from my exposure to maybe more Australian public health and US public health, folks, there seems to have sort of forgotten some of those grassroots movements, not just as a they're the people who were protecting, but more they're the people who may have the power to actually change some of this. And just one other final example I remember from the US when people were talking about wanting to increase taxes on fast food and it was around the same time McDonald's workers were the first time trying to unionize to increase the minimum wage and it seemed that there was a perfect opportunity because McDonald's was saying, well, if we increase the minimum wage. And it seemed that there was a perfect opportunity because McDonald's was saying, well, if we increase the minimum wage, then the food price is gonna go up. But that would be a nice solution, I guess, to the public health problem if the public health academics and scholars were linking up more closely with these grassroots community activists and organizations. And yeah, that.

Speaker 1: 49:28

So I really like what you were saying, with the need for the civil society to be engaged as well and the examples that you pointed to of, and going back maybe to your own biography, you were working with those organisations around hunger and that seems to be a key example of working with the communities that are most affected by these kinds of corporate influences.

Speaker 3: 49:58

Yeah, no, absolutely. I mean, I agree. You know, and again, you know, a very good example of where that works perfectly is Latin America. You know around, you know the right to food, I would say. You know Colombia, for example, brazil. They have wonderful movements of people from different backgrounds. You know academics, civil society organizations, even people you know working within the government, who can you know as one voice? You know being very clear about the need to protect the right of people. So so there is. You know it would be important if we were doing that.

Speaker 3: 50:32

The problem is that you know academia, for example, in france or australia it's we are still part of a small elite, so a lot of us haven't been exposed to. Some of you know the arms that we are talking about. So I I'm, you know, I have a dual citizenship. I'm also Mauritian, so from Mauritius. So racism, for example, I understand it because I live it. So I, you know, when I talk about that problem, when I talk about the deep roots of you know colonialism and how it's linked with imperialism, for example, and you know how the corporations that behave today have been. You know how the corporations that behave today have been. You know they have that heritage, also from you know, a long time ago, and it impacts our health. You know, even today I can talk about that because I live it.

Speaker 3: 51:17

You know, because I live that problem, I feel a lot of us, you know, in public health. They, you know, don't face those issues. We are still part of that small elite that we are trying to criticize those issues. We are still part of that small elite that we are trying to criticize. So, um, you know some, the ones you know of us who understand those issues. I think we have to push for broadening of our understanding of you know how important it is to talk about those, the root causes of um, of ill-fail, ill health story. And also, you know, know how connecting with, you know, civil rights movements, civil society movements, et cetera, is of utmost importance. Yeah, absolutely.

Speaker 1: 51:52

Well, unfortunately that is a spot to end, but it's you, you know, said it so beautifully and you know. More strength to you, and this is really interesting and important work, and it would be great to have you back to talk at greater detail about both when your book comes out in English, because we are very well, very Anglo-centric. A running joke throughout this podcast is my poor attempt at trying to learn to speak french. Uh, it's been a 20-year journey, um, chris, and that's a bit more like a must see. Um, that's okay.

Speaker 3: 52:39

No, no problem, it would be great to have you back when your book is out.

Speaker 1: 52:46

It looks amazing.

Speaker 3: 52:48

Merci, beaucoup. Merci. Thank you so much. Thank you, thank you.