Health and equity impacts of global consultancy firms

(2024) 20:55 Anaf and Baum Globalization and Health https://doi.org/10.1186/s12992-024-01061-9 Globalization and Health Open Access DEBATE Health and equity impacts of global consultancy firms Julia Anaf1* and Fran Baum2 Abstract Background Concern is growing over the power, influence, and threats to health and equity from the operations of large global consultancy firms. Collectively, these firms support a neoliberal policy environment promoting business interests ahead of public health. Global consultancy firms act as commercial determinants of health, an evolving area of research over recent years. However, this research mainly focuses on specific corporations or industry sectors, especially those which produce harmful products, including ultra-processed food, alcohol, and fossil fuels. It is therefore important to expand the focus to include large global consultancy firms and place a public health and equity lens over their operations. Main body Global consultancy firms have wide-ranging conflicts of interest. These arise from the ‘revolving door’ employment strategies between their own staff and those from government and regulatory bodies. These firms also advise governments on taxation and other matters while concurrently advising corporate clients on ways to minimise taxation. They advise fossil fuel corporations while also advising governments on climate and health policies. These firms undermine the capabilities of the public sector through the outsourcing of traditional public sector roles to these private interests. Consultancy firms foster private interests through their engagement with the higher education sector, and thereby weaken the tradition of transparent management of university affairs by accountable university councils. While private consultancies cannot be blamed for all the negative consequences for health and equity caused by the problems associated with globalisation and advanced capitalism, they have played a role in amplifying them. Conclusion Addressing the negative impacts of global consultancy firms will require strengthening the public sector, enforcing greater transparency, accountability, and minimising conflicts of interest. It will also demand critical thought, counter discourses, and activism to reframe the narratives supporting neo-liberal ideas of governance that are promoted in both government and business arenas. Keywords Health, Equity, Global consultants, Neoliberalism, Taxation *Correspondence: Julia Anaf 1 North Tce Campus, Stretton Health Equity, Stretton Institute, University of Adelaide, Adelaide 5005, Australia 2 Health Equity, North Tce Campus, Stretton Institute, University of Adelaide, Adelaide 5005, Australia Background Concern is growing about the power, influence, and threats to health and equity from the operations of large global consultancy firms [1–4]. These firms promote neoliberal ideology and practices that advocate for small government and free market capitalism and so are enablers of the operation of trans-national capital particularly Trans-national Corporations (TNCs). They implement the tenets of neo-liberalism through their wide-ranging global operations. One major tenet is that © The Author(s) 2024. 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The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Anaf and Baum Globalization and Health (2024) 20:55 the private sector is inherently more cost-effective and efficient than the public sector, with large consultancy firms capitalising on this view and supporting New Public Management practices over recent decades [5, 6]. Although numerous global companies offer similar forms of advice worldwide [7], the four largest professional services firms (the ‘Big Four’) are Deloitte, Ernst & Young (EY), Klynveld Peat Marwick Goerdeler (KPMG), and PricewaterhouseCoopers (PwC). They offer a wide range of services including auditing and taxation advice to private entities and governments [8]. They camouflage their broad financial interests through discursive appeals to the common good, public interest, national economic performance, and their technical expertise [8]. The ‘Big Four’ hold the dominant share of the global accounting and auditing industry with a combined revenue of US $200Billion [9] and more than 1,000,000 staff globally [10]. The three largest global consultancy and strategy firms (the ‘Big Three’), measured by revenue, are McKinsey and Co, Boston Consulting Group, and Bain and Co. Their work focuses on general strategy, organization, marketing, and operations. Together they hold revenue of approximately $US 25.5 Billion and employ 65,500 staff [11]. Collectively, these firms support the status quo on global and national regulations which reflect a neoliberal policy environment promoting business interests ahead of public health and wellbeing [12]. They have been prominent actors in establishing the post-1970s neoliberal hegemony, and have benefitted from the financialization of the economy [13]. These firms have also become skilled at manipulating rules to promote their own financial interests [4, 14, 15]. Being deeply entwined within private financial sector networks, they maintain close ties with financial lobbying groups [5, 16]. They are part of capitalism as an overarching global and historical structure that produces and co-produces transmission of ill health and disease. These transmitters include transnational capital, poverty and inequality [17]. Material interests are fostered by an institutional and ideological complex which intensifies and maintains the externalities of capitalism on human health [17]. Together, consultancy firms act as commercial determinants of health (CDoH); being part of the ‘systems, practices, and pathways through which commercial actors drive health and equity’ [18, 19]. The conceptualisation of CDoH as detrimental to health [19, 20] differs from more neutral framing of social determinants of health (SDoH) in which conditions are recognised for their potential a (...truncated)