Anna Gilmore, public health researcher: “Just four products cause at least a third of all deaths.”

It's not just our genetic code and postal code that determine an individual's health. Everything around us, from the air we breathe to the products we buy at the supermarket, also plays a much more decisive role than anyone could imagine. Behind the habits and products that fill our daily lives are powerful corporations whose actions, however seemingly trivial, can have enormous repercussions on people's lives, says Anna Gilmore, professor of Public Health and director of the Centre for 21st Century Public Health at the University of Bath (United Kingdom): "The simplest way to look at this is to look at the magnitude of the damage caused by four products: tobacco, fossil fuels, alcohol, and food. We estimate that these four products alone cause between one-third and two-thirds of all deaths worldwide."

Gilmore (London, 57) has spent decades investigating the footprint— and modus operandi —of large corporations influencing health, policies, and public opinion. In the scientific world, all these industry products and actions are known as the commercial determinants of health. “They are the ways in which the commercial sector impacts health,” she summarizes.

The scientist visited Barcelona to participate in a conference on the social determinants of health organized by Pompeu Fabra University and spoke to this newspaper during a break from the conference. She spoke leisurely and elaborated, at times vehemently, on the tricks used by large corporations to make their views known. “All industries, regardless of the products they manufacture, can also cause harm through their practices. For example, the way an employer treats its staff can have enormous impacts, both negative and positive. We also see companies cutting corners in health, safety, and their supply chains to increase profits. And this causes harm: accidents, chemical leaks into waterways, and river pollution. There are many ways in which they harm health and society, and they are all preventable,” she explains.

Question: Are we citizens aware of all these practices?

Answer: There's a lot going on behind the scenes. With food products, we don't see how they're manipulated to make them increasingly desirable, almost addictive. Everyone knows the story of the tobacco industry, which hid the harms of its products; or the fossil fuel industry, which hid the problems of climate change ; what they don't know is that other industries engage in the same scientific practices to hide the harms of their products or exaggerate the benefits. Perhaps what we're least aware of is the way they shape what I would call norms, our beliefs and our thinking. A Pepsi-Cola executive once said that "if all consumers exercised, if they did what they were supposed to do, the obesity problem wouldn't exist." That's simply false and makes people believe that obesity is simply their fault, when in reality, it's much more complex.

P. It's like everything is our responsibility.

A. Large corporations shape the norms to blame the individual. Carbon footprint is a term developed by British Petroleum to try to blame the individual, to say that the problem here isn't about the big fossil fuel companies, but about people, who need to change the way they use their cars and transport, for example. And when the public and policymakers don't understand that corporations are shaping the way they think, when you ask what we do about obesity, their minds are filled with these ideas that corporations have instilled in them that people just need to exercise. But that's never going to solve obesity.

Another thing that's really hidden is when it comes to influencing policy . One example is tobacco companies, which are no longer trusted because we have so much evidence of their misconduct. Now what they do is create a bunch of front groups: they create other organizations that they fund and hide behind. Now it's those organizations that approach governments and say, "Oh, this policy is going to be bad." And very often, lobbying is done through these third parties, and again, governments often fall into the trap of thinking, "Wow, all these different groups are telling us this policy will be bad." But what they don't realize is that all of those groups are funded by tobacco companies. And other companies, like food companies, are doing something similar.

Q. It feels like these companies control the world.

A. They have a lot of power. They fund much more science than the public sector. They can create and fund these third parties, including charities, so their power and influence are everywhere. The people who sit on their boards are connected; there's a kind of elite, so to speak, that's able to influence at many levels, often behind the scenes. The rest of us are like puppets they control: they influence us to buy their products, share their beliefs, and blame us for the harm they cause.

"Large corporations shape our beliefs to blame the individual."

Q. You're an expert on the effects of smoking. We know smoking kills, yet people keep smoking. What's going on?

Q. Smoking is highly addictive, and we know that tobacco companies manipulate cigarettes to make them more addictive. The evidence is clear: if the best policies are implemented, smoking rates will decrease. But governments are sometimes afraid to implement them. We need to increase the price of cigarettes. We need to ban advertising, we need plain packaging, we need to ban smoking in public places. And we need denormalization campaigns.

But another thing we should consider is that, as fewer people smoke, tobacco companies and their profits are increasingly threatened , and so they're fighting back. And they're recovering, in part, by launching new products (e-cigarettes, heated tobacco products, nicotine products) and funding massive public relations campaigns to claim they've changed, once again deceiving us about what they're up to. Globally, tobacco sales were declining, and now they're rising again.

That's why I think it's very important to step back and think about this broader framework of commercial determinants: tobacco companies can continue to harm and deceive us because the system hasn't changed. They continue to make huge profits and can still fund the science and data they mislead and get it published in medical journals; they still have access to governments… We need a new approach because our current system of capitalism isn't working in the public interest. We need to restructure our economic model.

Q. In Spain, 20% of the population smokes daily. What can you say to readers to encourage them to quit?

A. Two out of three smokers will eventually die from smoking. It's so risky... Would they jump from the fourth floor of a building? No, because it's too risky, but smoking is often started in youth when the risks aren't fully understood, and then it's very addictive and difficult to stop. So I would tell them to do everything they can to quit smoking. The best thing is to use pharmaceuticals that have been proven to help with smoking cessation within a smoking support service. And what's really important is ensuring that children don't start, which is why we need all those policies in place so that children don't see smoking as a normal activity.

However, one of the problems is that smoking is increasingly concentrated among the poorest groups in society. It's key to increase the price of cigarettes through taxes and then be able to use those taxes to provide support for people to quit smoking. This is the only intervention that has been shown to reduce smoking the most among the most disadvantaged. The other thing our work shows is that tobacco companies are very clever at manipulating their prices to undermine tax increases. What they've done is produce new, very cheap, ultra-low-priced cigarettes, and when the government increases taxes, they absorb these increases to keep the cheap products affordable. Meanwhile, they make money by raising the prices of their more expensive brands because wealthier people smoke them and can afford to.

Q. Aside from tobacco companies, which now also sell e-cigarettes, do other large corporations, such as food and alcohol, operate in the same way?

A. Yes. If you think about alcohol companies, for example, they sell alcohol and also low-alcohol or 0% alcohol beverages. It's a win-win situation for the industry: they make money from their primary, more harmful products, and then they make slightly less harmful ones and make money from those too.

Q. There are many advertisements and slogans that shift all responsibility to the consumer. For example: "Drink in moderation, it's your responsibility." What is the industry's responsibility? Does it exist?

A: This is the core of the problem. I was talking earlier about how industry is shaping thinking, but what they've also done is spend a lot of money on massive public relations campaigns trying to convince the public and governments that they're part of the solution. What needs to be done is regulate these companies. They'll never change voluntarily. It doesn't matter if it's tobacco, food, tissues, or cups. If the industry is affected by a policy, it shouldn't be at the table where policy decisions are made. We must recognize these conflicts of interest and exclude them from policymaking.

Q. Of all the tactics of these large corporations, which is the most dangerous?

A. Reputation management . What they do is invest in what they call corporate social responsibility, which means, "We're the good guys. I'm your friend, and I'm going to help you." A colleague in Colombia told me that soft drink manufacturers use all the local water, leaving no water for people to drink. So people buy soft drinks because that's all there is, and they ruin their teeth, become obese... But then the soft drink manufacturer runs a corporate social responsibility campaign, comes with a bottle of water, takes a picture, makes it look good to the government, and disappears. The government falls into the trap and doesn't regulate. This is just one example, but similar situations are happening all over the world.

Q. Do you have any hope that this can change?

A. I am hopeful, and I believe the best solution is to move toward a different economic model. The world is realizing that we cannot maintain capitalism as it is. Look at the planet, global warming, biodiversity loss, increasing inequalities, poverty, health problems, the fact that between one-third and two-thirds of all deaths are due to just four corporate products. Governments will have to realize that they are allowing corporations to cause this damage, but they are not bearing the costs. People are getting sick, the environment is being destroyed. Who is footing the bill? You, me, the governments. Corporations are making ever-increasing profits, and then they are using those profits to influence and control. We have a pathological system. Governments need to wake up. It is unsustainable.