by SONIA SHAH
UNAIDS Executive Director Michel Sidibé (left) with John Tedstrom, President of the Global Business Coalition on AIDS, Tuberculosis and Malaria.
PHOTO/UNAIDS
During the 1970s and 1980s, the World Health Organization and other global health leaders often strove to improve the health of the world’s poor by targeting private sector excesses. They imposed restrictions, codes, and “ethical criteria” on the marketing of infant formula, pesticides, and tobacco, unnerving executives and stifling business plans. Success hinged on the cooperation of local governments, but where policymakers implemented recommendations they achieved real results. Breastfeeding rates rose, pesticide poisonings fell, and tobacco consumption declined.
Since then, the global health establishment has been turned on its head. Over the last two decades, the private sector has emerged as the world’s top source of financing and leadership in the fight against deadly disease. The resources of some of the private industry players involved in global health today dwarf those of the WHO. Groups such as the Global Business Coalition aim to turn “business assets into disease-fighting assets”; the GBC boasts a membership of nearly 200 companies, including multinationals such as Coca-Cola, Exxon Mobil, and Pfizer. Why the interest? Firms are responding to local demands for corporate social responsibility, but they also have come to realize, as they look to emerging markets for future growth, that underwriting public health is a long-term investment. As development economist Daniel Altman recently explained, in a global economy, “these people are your consumers, your workers, your investors.” Several former WHO officials now work on public health issues for private industry. Most telling is the fact that voluntary contributions from private interests and others now bankroll four out of every five dollars of the WHO’s budget.
The problem is that the companies most active in global health projects today hail from a narrow range of industries, many of which are under fire for their negative impact on public health. These private firms are playing a double game: disrupting local communities with one hand and writing big checks to ostensibly help them with the other. Often, their core financial interests are directly at odds with the business of improving the health of the poor, in ways that are distorting the global health agenda.
The extractive industry is a prime example. The mining industry, which includes oil and gas firms, has been at the forefront of many prominent global health projects. This year, the GBC handed out awards to six companies for their achievements. Mining multinational Rio Tinto was lauded for its anti-malaria work in Equatorial Guinea. The mining giant Gold Fields Limited was praised for HIV prevention efforts in Ghana. Anglo American has been widely praised in global health circles for providing free antiretroviral therapy to its HIV positive workers in Africa; its former chairman co-chairs the GBC. And ExxonMobil now contributes more money to fight malaria than any company outside the pharmaceutical industry.
But by its nature the mining industry’s core business of extracting natural resources is a disruptive process. Accordingly, these firms come to work on public health with blemishes on their reputations. Rio Tinto boasts successes against malaria in Equatorial Guinea, but in Papua New Guinea, the company dumped billions of tons of toxic wastes and was complicit in repressive violence that led to over 10,000 deaths, according to a class-action suit filed in 2000. Gold Fields has reduced sexually transmitted infections by its mineworkers in Ghana by 90 percent since 2004, but local NGOs and independent experts report that its operations there have contaminated waterways with dangerously high concentrations of heavy metals, depriving local villages of drinking and irrigation water. Anglo American plays a leadership role in global health circles, but a former UN High Commissioner for Human Rights has called the company’s exploitation of land and water around mines in Ghana a “violation of communities’ right to maintain a sustainable livelihood.”
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