Small Island Developing States take big decision to put people first

Caring begins with putting people first. While it may sound simple, the reality is that governments around the world fail to create environments that support people leading healthy lives – which often starts with the food we have on our plates.

The reason behind this often comes down to corporate interests interfering in policymaking. What’s healthy for people and planet is not always profitable for health-harming industries wielding immense power over governments – especially those of countries with low resources.

Large food corporations for instance have yearly net incomes above the annual GDP of many SIDS – giving them strong leverage and bottomless budgets which they use to block healthy food and nutrition policies, and this has had devastating effects on islanders’ health.

But SIDS are saying ‘enough’ and committing to bold action to protect their populations and the environment with the Bridgetown Declaration on NCDs and Mental Health, adopted by all SIDS leaders in 2023. It recognises SIDS’ vulnerabilities and sets concrete actions to address the commercial determinants of health and climate change – in other words, to get a grip on undue corporate influence in policymaking.

Addressing shared vulnerabilities through the Bridgetown Declaration

There are 58 SIDS and they are found all over the world, but they share many unique social, economic, commercial, health and nutrition, climate and environmental vulnerabilities.

They have small economies which lack economic diversity and are heavily reliant on external industries like tourism. While SIDS make up 1% of the world's population and economy, emitting less than 1% of greenhouse gases, they are disproportionately and severely affected by climate change and natural disasters.

Climate change poses an existential threat for SIDS, which is worsened by the fact that people in SIDS are disproportionately affected by NCDs. 52% of people living with NCDs in SIDS die prematurely (aged 30-69 years), while mental health disorders affect an estimated 15.2% of the population in the Caribbean and 11.2% in the Pacific. Furthermore, Pacific SIDS rank among the top ten countries with the highest rates of diabetes in the world.

Risk factor prevalence is also notably high, with rates for tobacco and alcohol use, physical inactivity, and unhealthy diets well above the global average in many SIDS.

The Bridgetown Declaration unites and aligns all SIDS leaders in the decision to put human and planetary health first. It is a commitment to care and a roadmap to protect and promote the health of SIDS populations and ecosystems.

The Declaration lays out concrete actions to address the commercial determinants of health and climate change as the main drivers of NCDs in SIDS. It also provides solutions to build health-enabling environments and food systems, such as fiscal policies for health and regulations on marketing of unhealthy products.

Furthermore, the Declaration calls for the full integration of essential NCD and mental health services into UHC, emphasising increased integration of prevention and management of NCDs. It recognises that UHC cannot be achieved fully without people-centred food systems that work to ensure safe, sustainable, and nutritious food reaches plates.

Corporate capture of health policies: how can it be overcome?

One thing is clear – until the undue influence over policymaking of health-harming industries is under control, we will not achieve health for all and UHC.

The NCD burden will continue to grow, high temperatures driving climate change will continue to rise, and many people will face avoidable suffering or death. People living in SIDS are particularly vulnerable, as are Indigenous people around the world, and resource-low communities and countries, amongst many other groups.

In SIDS, the effects of corporate power are glaring – in many SIDS, over 80% of food is imported, flooding these islands’ food systems with highly profitable ultra-processed foods and undermining their ability to choose healthier options. Profits are gained by multinational corporations at the expense of islanders’ health. This story repeats many times over in all countries.

Just four industries - tobacco, ultra-processed food, fossil fuel, and alcohol – account for at least one-third of global deaths, and evidence suggests this number is likely to be much higher. Meanwhile, civil society and the academic community continue to identify more tactics and industries that are harmful to our health.

September’s UN High-Level Meeting on UHC represents a critical opportunity to highlight the need for affordable people-centred health systems and the realisation of a UHC which responds to the planetary, social, and commercial determinants of health. Governments must choose to take bold action to cut out corporate interests that put profit above health.