Dr. Norah Campbell:

I thank the Deputy for the two question. I always try to say to people that when considering the causes of disease we look at the full range of commercial activities in these health harming products. Most of us tend to see marketing and advertising and focus on how can we restrict marketing and advertising. It is absolutely a part of it but really with commercial determinants of health we are trying to look at all of the activities across what is known as the value chain. Consider the case of food, for example, where we have farmers who make food; manufacturers who process it; brands that package it; retailers that distribute it; and the consumers who consume it. Then there are the State and private agencies that dispose of the materials afterwards. This is all the value chain. There are also insurance agencies and so on but they are second tier. When we look across that chain one thing we notice really quickly when we follow the profit pools of who is benefiting from a system, which is quite frankly not working, is we start to see very evidentially that the profit pool in this country is in manufacturing and the ultra processing of the food. The top three ultra processed food producers in this country had a combined revenue of over €15 billion last year. It really put into focus that the idea is big farmers are the ones somehow profiting from this, when it is not.

On practical interventions it is a really important to note that with commercial determinants of health, we are trying to say there is a difference between upstream and downstream. Research all over the world is showing that a small number of upstream interventions are so much more efficacious than downstream ones. Consider distribution for example. Setting up green zones of 500 m, 200 m, and 50 m around schools where certain products are not available has been shown to be more effective than a campaign in schools about how to eat healthily. Using a subsidy structure to subsidise fruit and vegetables is much more efficacious than using the subsidy structure to use taxpayers' money to support health-harming industries like ultra-processed food, breast milk substitutes, and alcohol. These are the two practical areas: changing the subsidy structure; and changing the distribution and the proximity people have from these.

A lot of people earlier today spoke about tobacco. We can absolutely see there has been a big decrease in the numbers of smokers in this country and around the world. It is not because of education campaigns, posters and behavioural nudges. None of those worked ever. The only things that shifted the index of disease downwards were tobacco controls that were top down.