Common features of diverse industries and their health policy implications: The structure of economic abuse of health

Industries may increase the cost of health care by inducing disease (e.g. tobacco), increasing misuse and/or price of drugs (e.g. phamaceuticals) and adding administrative and marketing costs (e.g. health insurance and medical services).These industries are dominated by large corporations whose wealth and networks yield extraordinary power over policy makers and consumers and whose structure and goals are oriented toward profits and growth. After explaining the concept of economic abuse of health, I show that these industries have a common dynamic framework - Epidemic Cascade Framework (ECF)- of 1) a cascade of actions leading from their decision making center to their consumers via conduits in five sectors, namely production/marketing, product presentation/advertising. company image-making , reassurance of the public about their products, and public/professional education (Zone A); a set of interactions with governments either directly or via proxy organizations to influence policy development and implementation in the same five sectors (Zone B); and, contacts with the general public and community and professional groups to gather intelligence for their operations and to respond to threats to their profits (Zone C). Interventions to protect the public's health or control costs may target Zone A in the context of extant policies (e.g. counter-advertisinng),Zone B to modify policies (e.g. taxation) or Zone C to induce systemic structural changes (e.g. re-distribution from profit making organizations to governments). Examples of interventions to protect the public from economic abuse of health in the implementation or evolution of ACA will be presented.