Background
Public health significance of TNCs
Transnational corporations operate in many sectors including food and beverages, extractive industries, tobacco, alcohol and pharmaceuticals. They have the capacity to both promote and harm health. Examples of beneficial health impacts from TNCs include a range of shared value initiatives: • Mars (chocolate) engaging in sustainable cocoa initiatives through employing science, technology, and certification to assist farmers through increasing yields and sustainable supply [21]. • Nestlé adding micronutrients including iron and iodine to foods to improve health in impoverished regions [22]. • BHP Billiton improving the quality and reliability of local suppliers through the “World Class Supplier Program” in Chile, leading to significant employment growth [23]. Examples of adverse health impacts from TNCs are: • In 1998, at a time when the largest number of HIV/AIDS afflicted people lived in South Africa, 41 transnational drug companies sued the government of South Africa for initiating measures to reduce prices of anti-retrovirals [24]. • Coca Cola’s depletion and pollution of groundwater in India to make a product with 10 teaspoons of sugar per serving, contributing to global epidemics of obesity and diabetes [25]. • In June 2009 an outbreak of E.coli food poisoning in the United States was linked to Toll House refrigerated cookie dough produced by Nestlé at a plant in Danville, Virginia. The company recalled all Toll House products in the country, but it came to light that the plant had previously refused to give inspectors from the federal Food and Drug Administration (FDA) access to internal records relating to matters such as pest control and consumer complaints [26]. • The 1984 toxic gas leak from the Union Carbide chemical plant in India, which included the loss of life of thousands of people in Bhopal where the community still suffers the aftermath and is campaigning for adequate clean-up, compensation and justice [27]. • Philip Morris Asia Limited sued the Australian government to repeal plain packaging laws despite the fact that 1 billion tobacco-related deaths are predicted globally this century [28]. • Tax avoidance strategies by McDonald’s global operations have potentially cost European governments 1.0 billion Euros and the Australian Government $497 million dollars in unrealised receipts between 2009 and 2013 alone, reducing amounts government have to invest in health promoting infrastructure and services [29]. • Extractive industries have huge negative environmental and social impacts. Since the Australian TNC BHP began mining in Papua New Guinea in the 1980s, hundreds of millions of tons of waste have been dumped into the Tedi River causing irreversible damage to the river ecology and mass deforestation of surrounding areas and resultant health impact on Indigenous peoples [30]. • A narrative review indicated that pharmaceutical corporations suppress and misinterpret scientific evidence which leads to systematic overestimation of the safety and efficacy of products, and also exerts pressure on regulatory bodies against disclosure of adverse effects which are deemed to be ‘trade secrets’ [31]. |
These examples are indicative, but not exhaustive, of the scope of cumulative local, regional, national and global health impacts that potentially result from the activities of TNCs. They are also indicative of the ways in which the economic power of TNCs is likely to influence the pressures on governments and other stakeholders to make trade-offs between economic and social goals within processes of national development. |
Methods
Bellagio meeting: developing a corporate health impact assessment
Predicted value to researchers |
Evidence to inform public policy decisions |
Evidence elucidating the health and health equity impacts of individual TNCs’ structures, products and practices; and how these differ between countries |
Understanding of how TNC practices affecting health are influenced by international and national regulatory structures |
Predicted value to civil society activists |
Advocacy tool to enhance community capacity to understand and engage on issues associated with health impact of TNC operations |
Facilitate community involvement in debates about TNC health impact and possible government response |
Predicted value to corporations |
Evidence to inform corporate policies and practices to reduce adverse and optimise positive impacts on health and health equity within their countries of operation; and to achieve greater equity of practices across countries |
Predicted value to governments and policy-makers |
Evidence to inform policy decisions regarding project approval and appropriate regulation |
Assessing health impact
Results and discussion
Framework for corporate health impact assessment
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Workforce and working conditions (eg. description, occupational health systems, remuneration of workers in relation to cost of living indexes, extent of unionisation, quality of provision of health care and impact on social determinants of health such as housing).
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Social conditions (eg. impact of TNC goods on locally produced goods and services and net employment levels, impact of operation on local living conditions, the value of corporate social responsibility initiatives, social dynamics created by TNC operations including impact of fly-in-fly-out workers, impacts on social, cultural and spiritual life, and the impact of migrant labour in mines affecting sexual practices).
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Environment (eg. impact on natural systems in ways that affect health or health risk, including air/water quality, exposure to pollutants, land clearing, energy consumption, water, waste disposal).
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Consumption patterns (eg. impact of quality and consumption of TNC goods on health, national marketing practices).
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Economic mediated impact on health (eg. impact on TNC operations on overall economic conditions including tax revenues, reliance and vulnerability of national economy on TNC, economic and health impacts on local businesses/farmers).