The Guidelines’ evolution from a purely economic policy instrument to one that encompasses health and environmental concerns is instructive for efforts to define MNEs’ role in reducing NCDs globally. Our analysis suggests that in order to maintain ‘balance’ and stability for MNEs, the OECD responded primarily to outside pressure and a desire to ward off more direct regulatory action which could prove disruptive to business. For example, the environment chapter was strongly influenced by environmental disasters and the work of the UN, while the consumer interests chapter reflected the growth in voluntary corporate codes during the 1990s as nascent anti-corporate movements drew increasing attention to MNEs’ activities (Richter 2001
). The human rights chapter in the 2011 revision was a response to the evolving standards embodied in the UN ‘Protect, Respect and Remedy’ Framework (UN 2010b
). The considerable changes in the 2011 version may reflect a reaction to growing global anti-corporate sentiment and the increased effectiveness of the NGO community in shaping global public health measures, such as the WHO Framework Convention on Tobacco Control (FCTC) (WHO 2003
), that also address corporate practices. This suggests that effectively addressing NCDs requires stronger civil society organisations or movements aimed at holding MNEs accountable for their contributions to illness. The Framework Convention Alliance, a global coalition of NGOs that has worked to promote a strong FCTC and monitored implementation, has an initiative aimed at integrating tobacco into development agendas, and may also serve as a model for advocacy work in other health arenas (Framework Convention Alliance 2012
Despite their voluntary nature, the Guidelines can play a role in efforts to help balance the interests of MNEs and public health. The inclusion of health in the Guidelines legitimises the global discourse on MNEs’ impact on health. The Consumer Interests chapter is an explicit statement from governments to MNEs to ‘ensure the safety and quality of the goods and services they provide’ (OECD 2008
, p. 22). It is especially significant that these recommendations are made by the OECD, a respected, market-oriented organisation. By evolving to include health impacts of MNEs, the Guidelines moved the relationship between MNEs and health into the economic and business sectors, communicating the link between MNEs and public health to stakeholders who would not necessarily be moved or persuaded by actors from the health sector. The Guidelines now serve as an entry point for the international health community to engage MNEs.
The Guidelines also tie the health impacts of MNEs to a broader sustainable development agenda. NCDs inhibit economic growth through premature death of working age individuals, lost worker productivity, and increased poverty. The rising prevalence of NCDs worldwide suggests that MNEs in the tobacco, food, beverage, and alcohol industries have products and engage in business practices that are inconsistent with sustainable development (Collin 2012
). Thus, they are in violation of the Guidelines and should be held accountable. At the same time, some MNEs may contribute to health by preventing or treating NCDs through their products or practices, and these should be recognised, rewarded, and encouraged to support stronger Guidelines and standards for all companies.
The goal of maintaining flexibility within the Guidelines has permitted ambiguity in the definition of terms, scope of applicability, and identification of activities which constitute Guideline violations. This vagueness provides opportunities to negotiate how recommendations are implemented and enforced. The Guidelines, therefore, should be seen as setting the stage for further efforts to highlight MNEs’ effects on population health.