***Zoom link will be shared two hours prior to the meeting to everyone who registers***

This panel is co-hosted by the Centre for Global Health, Dalla Lana School of Public Health and the Lawrence S. Bloomberg Faculty of Nursing at the University of Toronto.

Participants that attend all of the events in this series will receive a certificate of completion.

Seminar Schedule

• November 22nd - Seminar 1: Corporate Influences on Health and Healthcare
• December 13th - Seminar 2: Part of the problem or part of the solution? Industry and harm reduction
• January 26th - Seminar 3: Regulating corporations: The interface between corporations and the public sector
• February 10th - Seminar 4: Manufacturing evidence: Industry sponsorship and conduct of research
• March 11th - Seminar 5: The Shared Strategies of Health-Harming Corporations to Influence the Policy Process
• April 19 - Seminar 6: A critical examination of Food Industry Partnerships and Practices

About This Series

The corporation is arguably the most powerful social and economic institution globally, with unprecedented power to shape scientific evidence, public policy, and lifestyles. Corporations share practices including advertising, public relations, and lobbying that are common across industries and which impact population health and health equity. For example, non-communicable diseases (NCDs) are currently the leading cause of mortality globally and account for 71% of all deaths according to the World Health Organization (WHO).1 The main risk factors for developing NCDs as identified by the WHO include harmful alcohol drinking, tobacco use, physical inactivity, and the consumption of unhealthy diets rich in overly processed foods.2 The United Nations has addressed NCDs in their Sustainable Development Goal target 3.4, which is to reduce premature mortality from NCDs by a third by 2030.3 At the same time, medically-related industry, including pharmaceutical, medical device, infant formula, and health technology companies have pervasive influence over the production of health evidence, the dissemination of health innovations, and the development of clinical practice and health policy. Critical public health analysis of the power of the corporate sector in influencing public health outcomes informed the field referred to as the commercial determinants of health. The Lancet Global Health defines the commercial determinants of health as “strategies and approaches used by the private sector to promote products and choices that are detrimental to health”.4 Corporate practices can thus be critically examined and strategically challenged in order to contribute to healthy, evidence-based public policy solutions. The Dalla Lana School of Public Health’s Centre for Global Health in partnership with the Lawrence S. Bloomberg Faculty of Nursing at the University of Toronto are hosting a seminar series entitled Health Inc: Corporations, capitalism, and the commercial determinants of health. The objective of this seminar series is to create a forum to promote conversations, research training and collaboration across sectors and disciplines regarding the impact of corporations on health. Themes that will be explored during the seminar series include but are not limited to industry’s role in harm reduction, public-private partnerships, conflicts of interests, industry sponsorship and conduct of research, health data and data justice, sustainable health care, and the role of corporations in the climate crisis and inequities.

1. World Health Organization. Non communicable diseases. World Health Organization; 2021.

2. World Health Organization. Noncommunicable diseases country profiles 2018. Geneva, Switzerland: World Health Organization; 2018.

3. NCD Countdown 2030 collaborators. (2020). NCD Countdown 2030: pathways to achieving Sustainable Development Goal target 3.4. Lancet Public Health. 396(10255): 918-934 https://doi.org/10.1016/S0140-6736(20)31761-X

4. Kickbusch, I., Allen, L., Franz, C. (2016). The commercial determinates of health. Lancet. 4(12): 895-896, https://doi.org/10.1016/S2214-109X(16)30217-0

UPCOMING SEMINAR

About Seminar six - April 19th, 2022 12pm-1pm

Title: A critical examination of Food Industry Partnerships and Practices

The corporation is arguably the most powerful social and economic institution globally, with unprecedented power to shape scientific evidence, public policy, and lifestyles such as dietary behaviours. In this seminar, we feature two speakers who will 1) critically interrogate the positioning of the food industry as a legitimate partner for the public sector and the resulting impacts; and, 2) explore the challenges with voluntary commitments, which maximize flexibility for the food industry, but that can impede the creation of a healthier food supply and food environment.

Speaker #1

Cécile Knai is Professor of Public Health Policy at the London School of Hygiene & Tropical Medicine. She is one of the leads of the newly established LSHTM Commercial Determinants Research Group. Her widely published and internationally recognised research comprises analyses of policy governance arrangements, policy evaluations, and how unhealthy commodity industries (UCIs) work to shape public health policies, with a particular focus on food (but also increasingly across UCIs). This includes a current project synthesising the effectiveness of different governance arrangements (mandatory, voluntary, or partnerships) of population interventions to improve diet. It also includes leadership in conflict of interest management guidance, for example her role as chair of the UKPRP-funded SPECTRUM consortium on the commercial determinants of health’s Interactions and Interests Review Group, and her current development of conflict of interest management guidance for LSHTM staff. She is one of the organisers of a new LSHTM Short Course on Conducting Research on the Commercial Determinants of Health (20-24 June 2022). She also leads other programmes of research, including the public health policy arm of the LSHTM Policy Innovation and Evaluation Research Unit (PIRU), and the LSHTM team of an European Commission-funded project on systems thinking to address adolescent obesity, and holds a range of editorial and committee roles.

Abstract

The normalisation of ineffective partnerships between the food industry and government to improve diets

The food industry uses the rhetoric of collaboration to normalise its role in research and policy. One of the most complex aspects of this phenomenon is the industry's positioning as a legitimate partner in global food and nutrition. This has led to the increasing acceptance of arrangements such as public-private partnerships to improve health, and voluntary mechanisms whereby commercial actors design and monitor their own standards of conduct. This seminar explores these themes and shares empirical evidence of the effectiveness of such approaches, and the complex industry strategies supporting them.

Speaker #2

Dr. Laura Vergeer is the Research Programs Officer in the Department of Nutritional Sciences at the University of Toronto, where she earned her PhD in 2021. Her thesis compared the product (re)formulation actions and commitments of the top packaged food and beverage companies in Canada and was completed under the supervision of Dr. Mary L’Abbé. Dr. Vergeer has also led or contributed to studies on food company nutrition policies, food processing, food marketing to children, food prices, dietary practices, nutrient profiling and nutrition labelling. As a graduate student, she received the CIHR Canada Graduate Scholarship Doctoral Award and the Ontario Graduate Scholarship, as well as research and leadership awards from the Canadian Nutrition Society, Obesity Canada and the University of Toronto. Dr. Vergeer also completed the Collaborative Specialization in Public Health Policy through the Dalla Lana School of Public Health.

Abstract

The effectiveness of voluntary food company commitments in helping to create a healthier Canadian food supply

The packaged food supply in Canada is dominated by energy-dense products high in nutrients of public health concern, increasing Canadians’ risk of developing obesity and non-communicable diseases. Many packaged food and beverage companies voluntarily commit to improving the nutritional quality of their products; monitoring is needed to hold companies accountable for these commitments and thereby prompt improvements. Recent studies indicate that many of Canada’s leading packaged food and beverage companies have not made meaningful improvements to the nutritional quality of their products in the last few years; however, there is considerable variation between companies in terms of their product (re)formulation actions and commitments. This presentation will give an overview of these findings and highlight challenges with voluntary commitments in creating a healthier Canadian food supply and food environment.

PAST SEMINARS

About Seminar Five - March 11th - 12:30pm - 2pm EST

Title: The Shared Strategies of Health-Harming Corporations to Influence the Policy Process.

This seminar will focus on better understanding the cross-cutting strategies that health-harming industries employ to impact public health policies.

The illicit trade in legal drugs is often seen as a law enforcement issue. Focusing on the case studies of tobacco and cannabis, Benoît Gomis will demonstrate it is also a significant public health challenge, in which transnational corporations are playing a major part. The tobacco industry has often been directly involved or complicit in smuggling their own products, while playing a central but dubious role in shaping research, policy making, and law enforcement practices on the topic. Major Canadian cannabis companies are increasingly mimicking some Big Tobacco tactics, in the name of anti-illicit trade and at the expense of public health.

Joana Lima Madureira will discuss a framework to systematically study corporations and other commercial interests as a distal, structural, societal factor that causes disease and injury. Our framework offers a systematic approach to mapping corporate activity, allowing us to anticipate and prevent actions that may have a deleterious effect on population health.

Speakers:

Dr. Joana Lima Madureira is a Health Policy Advisor at the World Health Organization Country Office in Kyrgyzstan. Prior to working in Kyrgyzstan, she was a Technical Officer for Health Equity and Social Determinants of Health also with WHO. Joana trained as a Medical Doctor, after which she pursued a Master in Global Health. After working as a public health advocate at the Brussels based European Public Health Alliance she became increasingly interested in the commercial determinants of health, how they shape the consumption of unhealthy commodities and population health. She decided to pursue a PhD in this area and in 2019 defended her thesis “The commercial determinants of health, a theoretical framework and empirical applications” at the University of Oxford.

Benoît Gomis is a Lecturer at the University of Toronto's Munk School of Global Affairs & Public Policy and a Research Fellow with the Pandemics & Borders Project at Simon Fraser University. Benoît’s research focuses on the illicit trade in drugs (in particular the role of the industry in shaping responses to it), terrorism, and borders. In an independent capacity, he works with a number of organizations including governments, think tanks, NGOs, companies, and universities. He previously worked with the University of Bath and SFU's Global Tobacco Control Research Programme, where he focused on the tobacco industry and the illicit tobacco trade. Benoît is also an Associate Fellow at Chatham House, and a frequent contributor to Jane’s Intelligence Review and World Politics Review. He was educated at Sciences Po in Aix-en-Provence, Loyola University Chicago, and the London School of Economics and Political Science.

Suggested Readings:

• Why we can’t let cannabis become the next Big Tobacco

About Seminar Four - February 10th, 2022 12pm-1pm

Title: Manufacturing evidence: Industry sponsorship and conduct of research

Famously, tobacco industry executives were quoted as saying, “doubt is our product.” The study of internal documents across tobacco, alcohol, chemical, soft drink, sugar, and pharmaceutical industries has produced a body of evidence describing the ways that corporations seek to generate and disseminate research findings that are favourable to their interests, to suppress findings that are not, and to generate doubt around scientific consensus.

In this seminar, we will have guest speakers detail their current research into the activities of corporations related to the production, funding, and dissemination of scientific research. We will discuss key questions about how to detect biases, minimize and prevent industry influence, and address the distortion of research agendas by commercial interests.

The commercial determinants of health are those activities of the private sector that affect the health of populations. Funding and disseminating unreliable or misleading research are ways that corporations can influence decisions about health. This seminar presents empirical evidence of corporate influence on health research and explores how this influence occurs throughout the entire cycle of the research process. Guest speakers will also summarize ongoing efforts to decrease commercial influences on health research.

Speakers

Dr. Lisa Bero, PhD, Chief Scientist, Center for Bioethics and Humanities and Professor of Medicine and Public Health at CU Anschutz Medical Center and Senior Editor, Research Integrity for The Cochrane Collaboration and Cochrane Public Health and Health Systems Network

Bio: Lisa Bero is a leader in evidence synthesis, meta-research and studying commercial determinants of health, focusing on tobacco control, pharmaceutical policy, and public health. Prof Bero has developed and validated qualitative and quantitative methods for assessing bias in the design, conduct and dissemination of research and has pioneered the utilization of internal industry documents and transparency databases to understand corporate tactics and motives for influencing research evidence. Prof. Bero is a prolific author of academic articles, with a focus on research integrity topics, including measuring problems with research integrity (methods issues, conflicts of interest, “spin”), testing methods to improve research integrity (training, policy development), and assessing how research is used or cited (in policy, media or scientific literature). She is internationally recognized for her work on evidence synthesis, bias, conflicts of interest and use of evidence in decisions as shown by media coverage, speaking invitations and service on international committees for the US National Academies of Science, IARC and WHO.

Greg Hallen is a Senior Program Specialist with Canada’s International Development Research Centre. As part of Canada’s foreign affairs and development efforts, IDRC champions and funds research and innovation within and alongside developing regions to drive global change.

For more than 12 years, Greg has led programs aiming to develop evidence, innovations, and policies to improve health, build healthier food systems, and prevent non-communicable and infectious diseases. Greg initially joined IDRC in 2009 to manage the former Research for International Tobacco Control program. Previously, Greg worked with the World Health Organization, advancing tobacco control in South East Asia and with government and non-government agencies in Australia on public health nutrition and NCD prevention.

Greg will share experiences and lessons from IDRC’s work on supporting population health researchers addressing policy inertia due to economic and commercial interests

About Seminar Three

Title: Regulating corporations: The interface between corporations and the public sector

January 26th 12-1pm

Corporate activities including research, development, manufacturing, marketing, advertising, and sales are typically regulated, though the regulatory processes and requirements differ across jurisdictions. This is even more the case for corporations which manufacture health-related products such as pharmaceuticals, or products that may be harmful to health, such as tobacco and alcohol. Thus, the commercial determinants of health are in part, a complex product of the interactions between corporations and regulators.

In this seminar, we will have guest speakers detail their current research into the reactions and responses of corporations to regulatory actions. We will discuss key questions about the relative roles and responsibilities of corporations and regulators for population health and well-being.

For example, drug companies typically defend the use of their drugs when new safety problems are uncovered. Does the same apply to when drugs are removed from the market because of safety problems? This talk will examine this question from the Canadian point of view and secondarily look at whether the quality of the evidence leading to a withdrawal influences the responses from companies. Finally, the talk will raise the question of whether company responses affect how Health Canada deals with safety issues.

Similarly, regulating alcohol corporations is key to controlling alcohol consumption and harm because they have capacities to both influence the designs of and avoid the effects of alcohol control policies. Using three examples from Thailand, our guest speakers will discuss how alcohol companies can influence and benefit from alcohol taxation policy design and also adjust their alcohol advertising behaviours to avoid the effects of the alcohol advertising control law. We will discuss contemporary regulatory challenges including advertising via social media, which often crosses national boundaries and regulatory jurisdictions.

Speakers:

Joel Lexchin received his MD from the University of Toronto in 1977. He is a Professor Emeritus in the School of Health Policy and Management at York University in Toronto Canada where he taught health policy until 2016. In addition, he has worked in the emergency department at the University Health Network also in Toronto for over 33 years. He has published two books since 2016: Private Profits vs Public Policy: The Pharmaceutical Industry and the Canadian State (University of Toronto Press, 2016) and Doctors in Denial: Why Big Pharma and the Canadian Medical Profession Are Too Close for Comfort (Lorimer, 2017). He is a member of the Foundation Board of Health Action International.

Dr. Jürgen Rehm is Senior Scientist in the Institute for Mental Health Policy Research and in the Campbell Family Mental Health Research Institute at CAMH. He is Professor and had been the Inaugural Chair of Addiction Policy in the Dalla Lana School of Public Health at the University of Toronto, and he also holds professorships and positions in Germany, Spain and Russia.

Dr. Rehm has been a leader in generating and analyzing the scientific data needed to inform clinicians and policy-makers of strategies to reduce alcohol-, tobacco-, and other drug-attributable harm. His recent research has increasingly included interactions between socio-economic status, poverty and substance use, including analysis of policies and interventions with respect to reducing or increasing inequalities. His work has been awarded with numerous awards and prizes, most importantly, the Jellinek Memorial Award (2003), the European Addiction Research Award (2017) and the (Inaugural) Kettil Bruun Society Award for Advancement of International Research Collaboration (2021).

Dr. Bundit Sornpaisarn, MD, PhD, is a Project Scientist at the Institute for Mental Health Policy Research and an Assistant Professor at the Dalla Lana School of Public Health, University of Toronto. He is also an adjunct staff at the Faculty of Public Health, Mahidol University, Thailand.

Dr.Sornpaisarn was the Director of Centre for Alcohol Studies, Thailand. He has been doing research on alcohol epidemiology and policy studies in Thailand for almost twenty years. He was one of the key players in advocating the first Thai alcohol control law (Alcoholic Beverage Control Act 2008 – ABCA) when he was the Director of Centre for Alcohol Studies and the Deputy Secretariat of the Parliamentarian Sub-Commission considering the ABCA Bill. He has also conducted several studies evaluating the impacts of the alcohol advertising control policy and the alcohol excise taxation in Thailand.

PREVIOUS SEMINARS

About Seminar One

Title: Corporate Influences on Health and Healthcare

November 22nd 12-1pm EST

Non-communicable diseases (NCDs) are currently the leading cause of mortality globally (1). Most NDCs are largely preventable and can be significantly attributed to the consumption of highly processed foods, excess alcohol, and tobacco driven by unhealthy commodity industries (2). At the same time, medically-related industry, including pharmaceutical, medical device, infant formula, and health technology companies have pervasive influence over the production of health evidence, the dissemination of health innovations, and the development of clinical practice and health policy. NCDs are thus widely being regarded as the product of a complex system influenced by powerful corporate actors involved in public health policy that directly impact global health outcomes. The first seminar session of Health Inc – Corporate influences on health and healthcare – will provide a thorough overview of the intricate dynamics of multi-national corporate industries, health policy and the subsequent health outcomes they influence. This session will be co-chaired by Erica Di Ruggiero, Associate Professor of Global Health and Director of the Centre for Global Health, Quinn Grundy, Assistant Professor at the Lawrence S. Bloomberg Faculty of Nursing and Daniel Eisenkraft Klein, a PhD student at the Dalla Lana School of Public Health.

1. Non communicable diseases. (2021). Retrieved from https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases

2. Knai, C et al. (2021). The case for developing a cohesive systems approach to research across unhealthy commodity industries. BMJ Global Health, 6(2), e003543. https://doi.org/10.1136/bmjgh-2020-003543

3. Knai, C., Petticrew, M., Mays, N., Capewell, S., Cassidy, R., Cummins, S., Eastmure, E., Fafard, P., Hawkins, B., Jensen, J., Katikireddi, S., Mwatsama, M., Orford J., & Weishaar, H. (2018). Systems Thinking as a Framework for Analyzing Commercial Determinants of Health. The Milbank Quarterly, 96, 472–498. https://doi.org/10.1111/1468-0009.12339

Speaker Bios

Erica Di Ruggiero is the Director for the Centre for Global Health, Director of the Collaborative Specialization in Global Health, and Associate Professor, Social and Behavioural Health Sciences Division and Institute of Health Policy, Management and Evaluation at the Dalla Lana School of Public Health (University of Toronto). Her research addresses the evaluation of population health interventions (policies, programs), their health and health equity impacts, work and health policies, the assessment of global policy agenda-setting processes in the context of the Sustainable Development Goals, the evaluation of global health research capacity building, and of knowledge utilization and exchange strategies to influence public health decision-making at national and global levels.

Daniel Eisenkraft Klein is a PhD Student at the Dalla Lana School of Public Health. His research largely focuses on the tobacco and pharmaceutical industries, exploring how and where policy stakeholders view the role of industry as policymaking partners. Daniel also works part-time as a Policy Analyst for the Tobacco Control Directorate at Health Canada. He loves all things basketball.

Quinn Grundy is a registered nurse and Assistant Professor with the Lawrence S. Bloomberg Faculty of Nursing at the University of Toronto and a Fellow with the WHO Collaborating Centre on Governance, Accountability, and Transparency in the Pharmaceutical Sector. Dr. Grundy’s research explores the interactions between medically-related industry and the public health system. Dr Grundy is the author of Infiltrating Healthcare: How Marketing Works Underground to Influence Nurses (Johns Hopkins University Press, 2018) which details the first in-depth study of the ways that registered nurses interact with pharmaceutical and medical device company representatives.

About Seminar Two (December 13th, 2021)

Industry denormalisation as a public health and policy strategy is applicable to several public health problems. These include the epidemic of tobacco-related disease, the current opioid overdose crisis , and emerging issues related to the legalisation of cannabis. Originating in the field of tobacco control, industry denormalisation is a strategy that aims to make visible and address the industrial sources of public health harms resulting from the promotion of hyper-consumption, deceptive marketing practices, or industry interference in scientific research or public policy. Numerous industries that manufacture products that may be harmful to health, including tobacco, alcohol, and prescription drugs, have sought protection from legal and regulatory action by promoting the discourse that they are normal, legal industries selling normal, legal products. Advocates of industry denormalisation seek to reverse this process.

Industry denormalisation is frequently perceived to be at odds with a harm reduction approach. For example, the tobacco control community is polarised in relation to the promotion of e-cigarettes to reduce the harms of cigarette smoking and potential partnerships with tobacco or e-cigarette companies in achieving this goal. A similar trend may be occurring with the opioid overdose crisis. Ongoing litigation against opioid manufacturers suggests the promotional activities of the pharmaceutical industry including sponsorship of pain-related educational materials and activities were the initial drivers of over-prescription and the resulting opioid-related morbidity and mortality. In looking to reduce the harms related to the toxic supply of street fentanyl, however, clinicians, researchers, and policymakers remain open to industry partnerships designed to widely disseminate and promote the use of opioid agonists such as buprenorphine-naloxone.

After decades of prohibition, corporations that produce psychedelic compounds such as psilocybin, MDMA, and ketamine have emerged as a multi-billion dollar industry akin to multinational industries commonly known as Big Pharma and Big Tobacco. Research into the potential for psychedelic therapies is enjoying a renaissance in psychiatric research largely due to an easing of some regulatory barriers, shifting public attitudes, and the lack of new treatments in psychiatry pipeline. Much like Big Pharma, Big Tobacco, and Big Food, psychedelic corporations have begun to engage in activities such as the sponsorship of scientific research. Given the limited funding options for publicly funded research, many researchers and institutions are faced with the familiar ethical dilemmas about financial entanglements with industry and conflicts of interest.

In this month’s seminar, we examine ways that industry denormalisation and harm reduction might work synergistically to create safer environments for substance use.

Speakers

Dr. Abhimanyu Sud is an Assistant Professor in Family and Community Medicine, Temerty Medicine and PhD candidate at the Institute for Health Policy Management and Evaluation at the University of Toronto. He is a leading national opioid prescribing and chronic pain medical educator, currently directing the Safer Opioid Prescribing program and Co-Chairing the Interprofessional Pain Curriculum at the University of Toronto, and having contributed to multiple other national pain and prescribing education initiatives. His research lab (www.subjectmatter.ca) uses the frame of complexity to examine the interface of clinically focused interventions, such as health professions education, and health policy. Current work focuses on the intersections of chronic pain, mental illness, and opioid use using methods ranging from clinical trials to evidence syntheses to bibliometric analyses.

Dr. Daniel Buchman is a Bioethicist and Independent Scientist at the Centre for Addiction and Mental Health. He is also an Assistant Professor in the Dalla Lana School of Public Health at the University of Toronto, a member of the University of Toronto Joint Centre for Bioethics, and an Affiliate Scientist in the Krembil Research Institute at the University Health Network. He is a Board Member of the Canadian Bioethics Society and is a Member of the Canadian Institutes of Health Research (CIHR) Standing Committee on Ethics. Dr. Buchman’s program of research explores ethical issues at the intersection of clinical practice and public health. His primary areas of research interest include ethical issues related to mental health, substance use, and chronic pain. Themes related to stigma, identity, moral responsibility, and compassion feature prominently in his work, and he has a longstanding teaching interest in empirical approaches to bioethics. Some of Dr Buchman’s currently funded projects explore stigma, chronic pain, and neurotechnologies; cannabis and corporate influences on mental health and substance use health; ethics and opioids; and ethics of big data and artificial intelligence.