Bilatzailea
The market at the expense of health
One third of preventable deaths worldwide are caused by four industries: fossil fuels, alcohol, tobacco and ultra-processed foods. This was confirmed by The Lancet, a special section on commercial health determinants published in 2023. Trade conditioners are practices that are exploited by industry and the market to influence behaviour or consumption for the benefit of their economic gains, putting the health of users or consumers at risk.
According to the biomedical model of health, the state of health of a person is conditioned by biological parameters, and the condition is due to physical causes. However, this approach is very blunt and is currently replaced by the biopsychosocial model.
In this model, in addition to biological factors, psychological, social and cultural factors are also taken into account as triggers of health and disease. Proof of this is the phrase popularized by epidemiologists: "The postal code affects people's life expectancy more than the genetic code." Without going any further, in Bilbao, the difference in life expectancy between the two extreme neighborhoods is 6 years for women and even more for men: 9 years.
'The postal code affects people's life expectancy more than the genetic code'
The commercial conditions constitute a biopsychosocial model that shows very clearly that the power of the market rules over lives. The oil and automotive industries go hand in hand and are a clear example of how they have driven consumption and use since their inception, even by defrauding laws and regulations to protect the environment and people’s health.
What the oil industry hid
Even before legal limitations were imposed, oil companies knew that their activity was harmful. For example, the president of the largest oil industry in the U.S., Frank Ikard of the American Petroleum Institute, at his annual meeting, cited a report titled “Restoring the Quality of Our Environment.” This report was published a few days earlier by the scientific advisors of the President of the United States, Lyndon Johnson. it was 1965.
Icard explained the essence of the report to the industrialists: “We are still in time to save the peoples of the world from the catastrophic effects of pollution; but time is running out.” He also explained to them one of the most important predictions of the report: “Carbon dioxide that is being added to the atmosphere by burning coal, oil and natural gas is increasing at such a high rate that by the year 2000 the heat balance will be completely transformed and there will be significant changes in the climate.”
The advisors proposed economic incentives to stop polluting, as well as excise duties against those who polluted. It has now been confirmed that the climate forecast has been fulfilled, significant changes are taking place, and authorities and institutions are now proposing measures similar to those suggested in that report, since the rate of carbon dioxide emissions into the atmosphere has not slowed down, on the contrary.
The oil industry is also responsible for the automotive sector with combustion engines. The power of these industries is so great that they continue to prevail over political commitments. Proof of this is the fact that the European Union is repeatedly postponing the end of motor vehicles, despite the fact that it prevents them from reaching the targets agreed in international agendas and conventions.
Tobacco and alcohol
Historically, tobacco and alcohol have followed the same line as the oil and automotive industries, and continue to be significant examples of commercial health determinants today.
In the case of tobacco, since the 1950s and for many years, the industry has denied studies showing the relationship between smoking and lung cancer. But the evidence is clear. Today, no one can doubt that there is a direct relationship between tobacco and certain cancers and that it is an important risk factor for other diseases. Therefore, public health has taken drastic measures to combat smoking.
And yet, the strength of the industry is so evident that last year the World Health Organization (WHO) launched the slogan on the International Day against Smoking "Let's take away the mask of attractiveness from tobacco: the tactics of the tobacco and nicotine products industry."
Under this motto, special attention was paid to products aimed at young people, with attractive smells, flavors and designs to mask their natural hardness and make them desirable. According to the WHO, this type of product expands the spectrum of consumers and generates addiction almost from childhood. In fact, in the Basque Country, tobacco consumption is falling and the greatest decline is taking place among young people. The goal of the industry is to stop this decline.
Alcohol has more consumers than tobacco, and young people start to try alcoholic beverages very early. But consumption is steadily declining, especially in the younger ones. The time when alcohol was almost considered a universal drug has been left behind: as can be seen in the ads, it was analgesic, soothing, stimulating, digestive, lethargic, revitalizing
“Alcohol has more consumers than tobacco, and young people start trying alcoholic beverages very early.”
The industry still tries to convince us that alcohol is beneficial when consumed “moderately” or “responsibly”, such as for cardiovascular health (especially wine) or isotonic (beer). However, scientists have long demonstrated that these claims are fraudulent and harmful even at low doses. However, the rules for limiting alcohol are not very strict and remain accessible to almost anyone. On the other hand, the industry has resorted to diversification and new non-alcoholic beverages are being marketed.
The obesogenic industry
For public health officials, sugary drinks and ultra-processed foods are the main causes of the "obesity epidemic". Therefore, effective measures have long been called for to limit the power of this industry and protect the population from its influence, especially children and young people.
In the Autonomous Community of the Basque Country, for example, the Children and Adolescents Act 2024, in its advertising section, states verbatim that advertising may not “encourage consumption, behavior or activity harmful to health, such as fast food or energy drinks”. A similar determination is made in the section on obesity. However, there are contents and activities that encourage the consumption of this type of products.
Of course, the impact of this industry is not limited to minors; its power is embedded in the structure. An example of this is a trend that in recent years can be seen both in series and in reality, where the growing supply of prepared food, small kitchens of new flats, the distribution of time and living alone come together.
Slimming drugs
In this context, drugs such as Ozempic (semaglutide), Monjauro (tirzepatide), etc., represent a paradigm shift. They were originally designed to treat diabetes. In fact, they act on some hormones that are produced in the intestine and their function is precisely to regulate the level of glucose in the blood. At the same time, the researchers found that the patients lost weight.
Therefore, in this line, the development of drugs aimed at losing weight began. in 2015, the first drug of its kind for the treatment of obesity, liraglutide, was approved, but its success came with semaglutide (marketed under the name Wegovy if it is to lose weight).
They are followed by others, all based on a similar mechanism, which produce fewer side effects and lose more weight. In the clinic, the European Association for the Study of Obesity (EASO) has given them a prominent role in the treatment of obesity and its associated complications. In fact, they have also been shown to be beneficial in metabolic and cardiovascular health.
Although in principle they must be taken under medical prescription, they are also taken in another way, not to improve health, but to have a certain appearance. According to a 2024 study by KFF, an independent health policy organization in the United States, one in eight adults (12%) reported ever taking or taking a drug of this type, and 40% of them, to lose weight.
Thus, the market for these slimming drugs in the US has grown by 600% since 2018 and, according to experts, it will continue to grow. This is also suggested by the studies that pharmacological companies are carrying out, some of them interested in being able to take it in pills (until now they are injectable) and others in clinical sessions with adolescents.
A woman's goal
For Mijo Lizarzaburu García, a transfeminist and lobster philosopher, all this is related to another issue: women, in particular, are made to feel bad about their bodies. In some ways, they generate a loss of self-esteem and, at the same time, the illusion that it will be solved through consumption.
“They make women feel bad about their bodies.”
He makes it clear that he does not deny the benefit of pharmacology, but he takes it with caution: “I really think that if the pharmacy helps people achieve well-being, it’s fine. But we will have to see what the long-term consequences of this thick-phobic pharmacology are.” In fact, it should be noted that they have recently arrived on the market and that the long-term evidence is limited.
In the same vein, Lizarzaburu believes that public pharmacy should be promoted, with public funding, and that the results should also be made available to the entire population. In fact, it is evident that the pharmaceutical industry seeks its benefit in the research it promotes.
In addition, his power to produce speeches also seems dangerous to him: “This illusion of slimming is already embedded in society. Therefore, even if it is later shown that these drugs are not so good, people will continue to consume them or look for others that have the same effect. After all, there were already plenty of slimming drugs. They seem to be more efficient.” Therefore, it proposes to create discourses that support women’s sovereignty.
Gender roles
In the same context of gender discrimination, other products and services aimed at women are intertwined. In all of them, the strategy is to convince women that they need it, that they will have better health and that they will better fulfil their role in society. Clear examples are menstrual products and menstrual follow-up applications, assisted reproduction, formula milk and menopause.
For example, the formula milk industry uses fraud to make newborns think their products are better for newborns than breast milk. One of the strategies she has been using in recent years is the creation of social media clubs under the pretext of advising and supporting new mothers.
In the case of older women, menopause has gone from being a taboo to a business opportunity. the British Medical Journal (BMJ) editorial explains that most of the services offered directly to the consumer in connection with menopause are useless and do not improve care. It refers in particular to hormonal tests, personalized hormone therapies and supplements. He warns that, in addition to not having a scientific basis, they can be dangerous, among other things, they can also cause cancer.
“Most of the services offered in connection with menopause are useless and do not improve care.”
Men are also not exempt from the pressure to play their roles, for whom the hormone market also has a special offer, both for young people and the elderly. Health is also one of the excuses in the messages addressed to them, but as in women, researchers report that they are harmful to health. Thus, testoterone supplements taken outside of medical control increase the risk of cardiovascular problems and liver and prostate cancer.
Capitalism, a systemic pathogen
Joan Benach de Rovira is the director of the Pompeu Fabra Health Inequalities Research Group, among others, and has been researching the issue and developing policies to address it for years. It considers it more appropriate than a commercial determinant of health to call it political or even ecosocial.
It literally defines the ecosocial conditions as follows: “These are strategies, processes, products and interventions used by large corporations and global capital to generate profits within the framework of capitalism. Such activities often have adverse effects on the health of the population and the environment. Ecosocial conditions are the result of power relations that allow a corporate elite—ultimately the richest countries and classes in the world—to make profits at the expense of the health and life of the majority, and especially of the poorest and most vulnerable sectors.”
“Ecosocial determinants are the result of power relations.”
According to him, the issue goes beyond the aforementioned industries. Thus, he describes the current neoliberal phase of capitalism as a “systemic pathogen”, with three examples: the commodification of housing and work, which generates precariousness to the detriment of physical and mental well-being; the climate and ecosocial crisis, based on extractivism and the externalisation of its consequences; and the commodification and medicalization of health.
Pro-life policies
According to Benach, to counteract the impact of ecosocial conditioning, education or awareness campaigns are not enough: “We have to influence power structures.” It supports the promotion of radical public and community policies “for life, health and social justice.” Its objective is to balance power to favor human beings and ecosystems and not the private accumulation of capital.
Although this is far from being achieved, he believes that immediate measures can be taken to strengthen public health in the face of corporate interests. Among these priority measures, it proposes, first of all, the acquisition of democratic control of production, distribution and consumption through drastic measures to corporate lobbies. It also favours a progressive taxation system for the payment of universal public services through taxes on large goods: health, education and housing.
It also proposes the de-commodification of work, housing, health, care, food, water and medicines, and the promotion of a social and solidarity economy through the promotion of cooperatives and community enterprises that promote the benefit of the environment and people. In addition, prioritise health and equity in all sectors (labour, economic, environmental, transport) and promote independent, publicly funded scientific research to clarify the consequences of precarious work, pollution or drug abuse, among others.
Finally, Benach proposes empowering communities by strengthening citizen movements to resist corporate power and ensure pro-life policies.
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