Why Industries Choose Africa: The Policy Space Is Wide Open for Corporate Exploitation

"These unhealthy industries usually move to low-income countries like Africa. There are some reasons why they are moving towards such countries. One is the population size. They have a very good size of consumers that they are targeting. The other one is there is cheap labor. And also the policy space is open for them to act in any way that they can do their business without any limitation or any policy barriers for them. So the playground is in countries like in Africa."

"As researchers, we believe we have not been wrong. The evidence that we generate is useless if it's not taken into action."

"Our main mission is really generating evidence, strengthening research-related capacity, and also engaging in policy to inform action. We don't only do actual research, we also train others to do research across the continent and actually translate the evidence into actionable data. Therefore, my research is not academic research that is done in the lab, it is research that is done close to policy and communication."

"We work very closely with the Kenya Ministry of Health, and also we work with the NCD Division, which is the Ministry of Health, closely with Gladwell and others. We continue to work with many African countries, ready to transform lives through research."

"We did a study around 500 schools in Kenya, and we found a lot of advertisements around schools. More than 50% of advertisements are actually related to ultra-processed foods. The same thing on TV, radio, and social media. And these are tactics to promote the consumption, especially among children."

"They target the children because the children have the best power to actually ask their parents to procure those foods. The children are the future market, and they are easier to influence. Once you win the children, you have won the whole population."

"You may see that they have CSR activities where they went and fed these many kids. It's marketing for them. For example, schools. When I was in elementary school, I was getting scholarships from a beer company. For top 3 students in class, they were giving us scholarships to cover our educational expenses. So, the first beer in my life which I tasted was that industry, that scholarship, who paid my scholarship. They know they are very wise because after 10 or 15 years, I will be well-accustomed to that beer industry. They know I am highly educated."

"Do our schools have any rules and regulations that govern such kind of relationship? Maureen was mentioning about Indomie. Okay, they gave to the children. How is that relationship? So, we have to explore that."

"Globally, two-thirds of the NCDs are linked to the five main risk factors: tobacco use, harmful use of alcohol, unhealthy diet, physical inactivity and air pollution. As you can see, most of those are actually commercial determinants of health. If you can address commercial determinants of health, then you can actually reduce NCD substantially through that."

"Globally, the most affected countries are the low-income countries. There is what we call premature deaths. When you are between the age of 30 and 69, you are productive and you are not supposed to die. That is why we talk about premature deaths. 85% of the deaths due to premature deaths due to NCDs occur in low-income countries. And that's how serious commercial determinants of health are."

"Over 50% of all our admissions are due to NCDs. And the NCDs are rising in the country. They are now number two killer in the country. Very soon it will outstrip all other diseases if we don't take action."

"The industries which contribute to this disease are rising in our country. Partly this is because of our own promotion of this, because we think we are promoting investment, and on the other hand, we are actually reducing productivity in the country."

"Between 2009 and 2019, the price of soda reduced by half, and consumption doubled from 600 million liters to 1,200 million liters. In a population where 40% is poor, definitely there are more people who are poor and consuming these products."

"Where there's food insecurity, they are not given one choice. Or where people don't have a choice, they might have to still buy the vegetables and fruits and buy unhealthy products. And then the poor person has no choice, who's going for the cheap option which is lacking in healthy quality."

"These companies are marketing in rural places. Coca-Cola is providing fridges, refrigerators for free in rural places. I know the quantities for other products may not be as much as what is available in the urban population, but the point is these products are reaching rural places and affecting low-income consumers."

"To examine how health governance can be enhanced by managing conflict of interest and promoting policy coherence. We want to understand what is the context and what is the situation. That is one of the fertile ground where they are free to play whatever way they want."

"What are the existing practices? What is happening? How, for example, are government entities dealing with these industries? How is their relationship? And we want to examine what are the policies out there. When, for example, the Ministry of Health is working with these industries, do we have any policy frameworks, guidelines? Are there any laws that can govern us? Because when you have any relationship, you need rules. Governance is important. Even marriage is a big institution. You have rules, regulations that govern your marriages with your partners. You need to have that. So what about with these industries? Do we have any policy frameworks? Any principles? How is it governed?"

"We are losing close to 24,000 people annually from household-level air pollution due to kerosene use for cooking. Putting it inclusive of outdoor air pollution, our model is putting it at 67,000 annually here in Kenya."

"What is the definition of scope when you talk of fossil fuel? Are you targeting at the household level or also industrial use because the impact differs? There are a lot of policies coming up in terms of transition, including LPG, we have a national strategy for that. But what can we do in terms of addressing issues of air quality? We have talked about unhealthy foods, but also we are unhealthy from air pollution."

"It's a holistic system, not certain industries alone. It's a holistic system and a little bit more research should be done, including medicines, wastewater that is the water that you drink, which has side effects and you never get cured of it. So antibiotic resistance is a major influence in Africa."

"We know that breast cancer is leading in Kenya and the Americas, around 16% based on our data. And the population that is really affected is those aged 45 to 55. And we know that the risk of cancers in women is higher in the state of women of course because of the hormonal changes. But alcohol consumption among women who are menopausal latest research shows us evidence that alcohol risk is to be increased. Even with low consumption of alcohol, the guidance is that you should actually be on zero for those specific risk groups."

"This is the age group of ladies who are able to afford a drink, do social work, eat a glass of wine. But we are getting information on that. We are seeing very big increases in breast cancer in women aged 45 to 55, and I think this is a conversation we must have."

"Political interference, the person that was needed by the government, actually is a big problem. And people say politics is a letdown, I think it is true. And there is a lot of political interference everywhere in the country, unfortunately."

"What the ministry is doing is to ensure that there is transparency when it comes to policy formulation and strategy. To ensure that everybody is on board and everybody understands why we are insisting on what we are insisting to be done. And that's why public participation is an element that we have taken up very, very seriously."

"We are ensuring that our policies are free from conflict of interest through public participation. We are enhancing partnerships bringing together civil society, academia, community, the church, healthcare providers and community groups. This is also another way of addressing political interference because it is quite huge, especially in the tobacco industry."

"We just returned from a workshop in Brazil where we were getting experiences for personal and political and medical responses. They have not gone back to the national debt because of policies like taxation of unhealthy products and restriction of marketing. Those are really sure evidence-based approaches. Brazil has shown that countries can make progress even with pressure."

"These are bottled with cooking oil. These are the mothers at the market place packaging cooking oil using alcohol bottles. So now the mothers are thinking, you buy oil in a used alcohol bottle and you take it to your house. So maybe the next time you send your child to buy cooking oil, he will go for the alcohol bottle thinking it's oil. These are the challenges, commercial challenges that we are facing."

"It's almost impossible to differentiate between the ultra-processed food industry and the plastics industry because they're so reliant on each other. We do a lot of work with colleagues in Brazil and their fabulous nutrition guidelines boil down to the recommendation to cook more, peel more, unpack less. That kind of articulates the intersection between nutrition and environmental and sustainability agendas that we need to do a better job of unpacking."

"Any industry whose commercial activity is causing harm is unhealthy. It's bad for food, it's bad for alcohol, it's bad for tobacco. Any commercial activity that you are doing that is having health impact is unhealthy."

"Out of the six focus areas, we focus on the area of the unhealthy commodity industry. That's where exactly our work here focuses. We are working closely with governments. We started in Kenya, Uganda, Tanzania but now expanding to other countries to lead the work in the ministries to develop policies and support the implementation of evidence that is available and generating more evidence to drive these policies."

"We have done a lot of work in the food environment. We have been working from 2018 up to now and that has resulted into drafting of four policies with the Minister of Health that does include unhealthy food taxation."

"Here we will analyze the trends of advertising, also have online data on expenditure of alcohol and food advertising. The more companies are spending on advertising, the more the products are likely to be consumed. So we are going to look at increasing the items of advertising, and the data from Euromonitor will also provide that kind of information."

"We are going to get data from Kenya National Bureau of Statistics. They conduct surveys. And based on that, we should be able to look at the distribution of these sales by population categories. And then we will be able to know if the consumption of these products is more vulnerable for vulnerable groups."

"To do that, we will do document analysis, government policy documents, different ministries and organizations, advocacy and research organizations. I know there might be some organizations who can be supported by industries. So how is the relationship? How can we control that?"

"We will do semi-structured interviews with policymakers. We will come to your office some of you to do these interviews. Different organizations, key informants, and we will have also deliberated stakeholder dialogues. We will present our findings."

"We do individual capacity strengthening. We support internships. In a year we take up to 100 internships at APHRC. This includes masters students and PhDs. We also support PhD programs in eight universities in Africa. We have offered scholarships to over 250 PhDs. These are actually faculties from different universities across Africa."

"We strengthen capacity of institutions through training them in management of grants, grant applications and so forth. We strengthen the ecosystem, the environment in which research is done. We train on grant writing, trainings on grants management."

"Our approach is through three thematic areas: Research, we do large research-related capacity strengthening, and then policy engagement and communications. We don't only do actual research, we also train others to do research across the continent and actually translate the evidence into actionable data."