Grading PespiCo’s Retiring CEO Indra Nooyi on Public Health

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When PepsiCo. Inc.’s longtime chief executive, Indra Nooyi, announced that she was stepping down, reports The Wall Street Journal, Ivanka Trump was one of many people to voice her admiration for the departing CEO. “Indra, you are a mentor + inspiration to so many, myself included,” Ms. Trump wrote on Twitter.

Ms. Nooyi is finishing her tenure with a sterling reputation as a manager. She is credited with piloting PepsiCo through a rough period for the industry, as consumer tastes moved away from sugary drinks. She successfully fought off an activist investor’s attempt to break up the company and diversified into healthier snack and drink options before many competitors did. PepsiCo’s annual revenue increased 81% during her tenure to $63.5 billion last year.

Still, from a market perspective, her tenure wasn’t a complete success. PepsiCo’s total shareholder return during her time as CEO trailed both the S&P 500 index and rival Coca-Cola Co. PepsiCo’s market capitalization was $165 billion based on last Friday’s closing price, compared with $200 billion for Coca-Cola. When Ms. Nooyi took over, PepsiCo’s market cap of $106 billion was slightly larger than Coca-Cola’s, at $104 billion.

If Wall Street gives Nooyi, mixed grades, what about public health?  Nooyi is known for her desire to expand PepsiCo’sinvolvement in “good-for-you” foods.  What were the results?

2006

2017

Percent increase

Total PepsiCo revenues

$35 billion

$63.5 billion

81%

Revenues from “healthier” foods

$13.3 billion

$31.8 billion

139%

Revenues from “less healthy” foods

$21.7 billion

$31.7 billion

46%

The table above shows that while the proportion of revenues from “healthier” product increased more than for less healthy products like soda and high salt, high fat snacks, the total annual sales of less healthy products (dubbed by Nooyi as the “fun for you” foods) increased by $10 billion – 46% during  her tenure.  

In other words, the total revenues from PepsiCo  products most associated with diet-related chronic diseases increased significantly  under Nooyi’s leadership. This suggests that PepsiCo’s contribution to the burden of premature deaths and preventable illnesses associated with these products also increased.  This illustrates a classic dilemma for public health.  Even if public health advocates succeed in persuading corporations to alter the mix of products they produce, if the company expands at the same time, its overall health damaging impact may increase even as it produces some healthier products.  Moreover, the products PepsiCo and Nooyi label as “good for you” or healthy are often still high in unhealthy ingredients, even if they are fortified with vitamins or other nutrients.  

E-cigarette maker Juul targeted teens with false claims of safety, lawsuit says

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A Juul in the hand…(credit)

When a San Diego-based mother posted an emergency alert on Nextdoor, a community discussion app, she hoped a Good Samaritan could help, according to court filings, reports The Washington Post.  Her son was hysterical after losing a flash drive with his homework near the local McDonald’s, she wrote, uploading a photo along with the message. A neighbor quickly replied, explaining that the chewing-gum-sized object in the picture was not a flash drive: It was a Juul vaping device. “That’s just an indication of how quickly Juuls became prevalent,” recounted Esfand Nafisi, a lawyer who is handling two of three lawsuits initiated against Juul Labs last month. “You blinked your eye, and suddenly they were all over the place.”

“I think Juul has been insincere from the very beginning in saying it’s only for adult smokers,” said Robert Jackler, principal investigator at a Stanford University School of Medicine program that studies the impact of tobacco advertising. He noted that Juul Labs executives have boasted that they run “the most educated company, the most diligent, the most well-researched.”

Two recent court cases challenge Juul’s practices.

Read the complaintfiled against Juul in United States District Court Southern District of New York in June 2018.

Read the complaintfiled in United States District Court District of Northern California in April 2018.

Four Recent Books on the Political Economy of Global Health

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Four recent books dealing with the political economy of global health are reviewed in a recent issue of Critical Public Health.  Drawing on the material covered in these sources, the reviewer argues that the concepts of capitalism, imperialism and class (at the national and global levels) are fundamental to a critical public health in the present era of economic globalization.

Analysis of corporate political activity strategies of the food industry: evidence from France

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A new study in  Public Health Nutrition  analyzed the corporate political activity (CPA) of major food industry actors in France. The  analysis shows that the main practices used by Coca-Cola and McDonald’s were the framing of diet and public health issues in ways favorable to the company, and their involvement in the community. The French National Association of Agribusiness Industries primarily used the ‘information and messaging’ strategy (e.g. by promoting deregulation and shaping the evidence base on diet- and public health-related issues), as well as the ‘policy substitution’ strategy. Nestlé framed diet and public health issues and shaped the evidence based on diet- and public health-related issues. Carrefour particularly sought involvement in the community. The authors found that, in 2015, the food industry in France was using CPA practices that were also used by other industries in the past, such as the tobacco and alcohol industries. Because most, if not all, of these practices proved detrimental to public health when used by the tobacco industry, we propose that the precautionary principle should guide decisions when engaging or interacting with the food industry.

Obstetrician-Gynecologists and Industry Let the Sunshine In!

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“What is an ethically responsible relationships between obstetrician-gynecologists(ob-gyns) and the pharmaceutical and medical device industries”, asks Lewis Wall in an editorial in Obstetrics & Gynecology?  He notes the inherent conflicts between the worldview of the pharmaceutical-medical device industry, where pursuit of profit overrides all other considerations, and the overriding obligation of physicians to put the health interests of their patients first.  When the trust that obligation engenders is lost, he writes “medical practice breaks down.”

Industry Payments to Obstetricians and Gynecologists Under the Sunshine Act

Another article in Obstetrics & Gynecology examines industry payments to ob-gyns. To evaluate financial relationships between obstetrician–gynecologists (ob-gyns) and industry, including the prevalence, magnitude, and the nature of payments, the authors of this report conducted a cross-sectional study using a list of industry contributions to U.S. obstetricians and gynecologists obtained through the Centers for Medicare and Medicaid Services Open Payments Database from August 1, 2013, to December 31, 2015. They concluded that obstetricians and gynecologists receive a substantial amount of payments from industry. Most of these payments were for honoraria, faculty compensation, or consulting and totaled less than $400 per health care provider. Although this total amount is less than typically received by surgical providers, the median payment value for obstetrics and gynecology subspecialists surpasses the median payment to orthopedic surgeons, the highest compensated specialty group in total. These financial relationships warrant further exploration with future research.

How a flood of corporate funding can distort NIH research

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“This month, National Institutes of Health Director Francis Collins seemed to shut down a noxious ethical problem,” writes Paul Thacker, a former Senate staff member,  in The Washington Post. “The agency released a 165-page internal investigation of an alcohol consumption study that had been funded mostly by beer and liquor companies. The study’s lead investigator and NIH officials were in frequent contact with the alcohol industry while designing the study, which, according to the postmortem, seemed predetermined to find alcohol’s benefits but not potential harms, such as cancer. In several email exchanges published in the report, NIH scientists seemed to joke about taking a drink every time somebody said “cheers,” which was a proposed acronym for their study. Collins ended the trial and promised to create new ethical boundaries for how NIH officials deal with industry.  But the intellectual corruption at our government research agencies runs much deeper, and this was only the latest scandal involving hidden corporate influence. I spent 3 1 / 2 years as a Senate investigator studying conflict-of-interest problems at the NIH and the research universities it funds. During that time, I found that the agency often ignored obvious conflicts. Even worse, its industry ties go back decades and are never really addressed unless the agency faces media scrutiny and demands from the public and Congress for change.”

Corporate Efforts to Derail Mass Transit

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In 1985, two urban policy scholars, J. Allen Whitt and Glenn Yago,  wrote:

The urban transportation systems that carry us around are not solely the result of technological innovation or efficiency. They are also a product of the rising and sinking political and market power of industrial interest groups, the changing relations among social classes, the politics of urban development struggles, and the inherent dynamics of the economic system… These factors, particularly corporate control of transportation policy, have profoundly shaped urban streetcar, automobile, bus, and rail transport in the United States during this century. We conclude that this private dominance over urban transportation policy has often led to narrow, profit-seeking behavior that has thwarted the development of more effective public transit.

This week, The New York Times reported that in the last few years Americans for Prosperity, the conservative group financed by oil billionaires Charles and David Koch has contributed hundreds of thousands of dollars to defeat plans to expand or improve mass transit in  Little Rock, Phoenix, Nashville, southeast Michigan,  and central Utah. The group has also contributed to effort to defeat more than two dozen transit-related measures such as states proposals to raise gas taxes to fund transit or transportation infrastructure.

“Stopping higher taxes is their rallying cry”,  Ashley Robbins a transportation researcher at Virginia Tech, told The New York Times. “But at the end of the day, fuel consumption helps them.”   Although Americans for Prosperity opposes pubic spending on mass transit, it supports spending tax money on highways and roads.  Koch brother-owned industries produce gasoline, asphalt, seatbelts, tires and other auto parts, businesses that could be harmed by new investments in mas transit.

Public health research shows that improving mass transit and reducing automobile use can  bring multiple health and environmental benefits:  less premature mortality from lung disease, fewer asthma symptoms, more physical activity and less sedentary time, fewer injuries and deaths from auto crashes, more social interactions and less isolation, less road rage, more walkable and attractive  cities, less air pollution, reduced carbon emissions, less urban sprawl.

Despite these benefits, for more than a century public policy at the federal, regional, state and local levels has been disproportionately influenced by commercial interests that favor increased automobile use over the well-being of our population and our environment.  Public health professionals and researchers need to explore new ways to bring this debate about democracy, health and the environment into the policy and political arenas.

Tracking the Effects of Corporate Practices on Health