The Risks to Public Health from Partnerships with Corporations

Corporations often promote the importance of their role in partnerships with government, multi-lateral organizations, not-for-profit health organizations, community groups,  professional organizations, and academia in preventing disease, promoting health, protecting the environment, and research.Some corporations set up special units within the corporation to further those goals and hire prominent public health and medical experts to direct those corporate programs.2,3

MOU between Alliance for a Healthier Generation and several beverage manufacturers

Effects of Partnerships

The reliance of independent nonprofit organizations on corporate funds creates dependency and conflict of interests, co-opts the nonprofit into becoming an ally,and results in undue corporate influence in decision-making processes and control of health standards. Corporations also bring influence on multi-lateral organizations. The sugar industry brought U.S. political pressure on the World Health Organization to lower proposed standards for dietary intake of sugar.5

The deleterious influence of corporate funding on research has been documented in a variety of specialties. Reviews of journal research articles have shown that corporate funded research leads to compromises in integrity6 and produces results favorable to the corporate funder.7

Corporate support for, and partnerships with, professional organizations, such as the association of the American Academy of Family Practice and Coca-Cola, have been controversial.8,9 Because of potential conflict of interest arising from corporate funding of professional education, some medical groups have established guidelines regarding corporate funding of their education programs.10 While corporations are readily visible in the exhibit area of the annual meeting of the American Public Health Association,11 and corporations provide financial support to the organization in various ways, the Association has a policy regarding acceptance of advertisers, exhibitors, gifts and donations.12, 13 In 2006 APHA established a committee to evaluate proposed gifts and donations, including from corporations.

The director of the Contra Costa Department of Health Services, Dr. William Walker, announces that he is resigning his 25-year membership in American Academy of Family Practice after it signs a deal with Coca Cola.

A Major Reason Partnerships Are Attractive

One of the reasons that partnerships with corporations or receipt of corporate funding is attractive to community groups, government agencies, and academia is because of the decrease in government funding available for programs, regulation and research. The funding shortage is due in part to the failure of corporations to carry their share of societal obligations through paying their share of federal income taxes. A report from the U.S. Government’s General Accountability Office (GAO) showed that from 1998 to 2005, 34 percent of foreign corporations in the U.S. and 24 percent of U.S. corporations paid no taxes for at least half of those years.14 In 2002 and 2003, 82 out of 275 most consistently profitable Fortune 500 corporations collectively paid no federal tax at least one of those years; 275 paid less than half the 35% statutory rate.15 Recent news reports showed that in 2010 General Electric earned $5.1 billion in profits in the U.S. and Exxon Mobil had $37.3 billion in pretax income in the U.S. but neither paid any U.S. federal income taxes.16,17 The loss of that tax money does affect the government budget. For example, because in 2002 corporations did not pay the statutory tax rate, the US government treasury had $172 billion less with which to operate.18

Thus, because community organizations need funding to conduct programs for the communities they serve, academics need funding to conduct research, and health professions organizations need money to operate, they turn to corporations.

What Corporate Money Buys

Because of the power and influence corporations, industries, and industry alliances have through corporate financial contributions to election campaigns and through lobbying, legislators pass laws that protect corporations and cut budgets that eliminate or reduce health programs, including decreases in agency’s ability to monitor and regulate corporate practices. Corporate political influence also results in government appointment of corporate or industry representatives to government advisory panels, committees and boards that set health standards and policies, influence health program and research funding priorities, and evaluate medicines and devices. Through political influence corporations can prevent citizens from having the right to universal healthcare, environmental protections, education, a safe and healthful workplace, a living wage, and housing. Thus, because of corporate influence on government policies and budgets, society must rely on corporate funding and partnerships, local community and religious institutions, and philanthropic donations (much of which is of corporate origin) for basic needs and protections that are the responsibility of government.19

The Dangers of Partnerships

Any partnership with industry in which there is corporate remuneration or exchange, whether indirect or quid pro quo, creates a conflict of interest and compromises the independence of the beneficiary. The old adage against “biting the hand that feeds you” is relevant here. If an individual, community or organization receives money from a corporation, they can be co-opted, becoming an ally of positions the corporate funder takes and more willing to compromise their standards. They may also be less likely to oppose the more egregious health harming products, operations or policies of the corporation. Also, if community organizations become dependent on corporate funds for providing services, this leaves the entire community vulnerable to deprivation in health services and activities.

The purpose, goal and values of public health and that of the corporation are fundamentally different. Public health’s goal is to protect and promote the health of the public. Legally the corporation’s sole purpose can only be to make a profit to return to investors (despite corporate public relations rhetoric about social responsibility, which can only be in service to the bottom line). Partners cannot have fundamentally conflicting goals. Public health professionals cannot allow corporate enticements of partnerships and funding to blur or disguise the distinction between the differing purposes, goals and values. The corporation has neither the mandate, nor based on their absence from the constitution, the right or authority to make decisions on what is in the public interest.

Some organizations or individuals in public health and medicine who accept corporate financing, grants or gifts and who support partnerships with corporations may believe that the positions stated here are too dichotomous and antagonistic to current realities. However, history shows that movements to abolish slavery, gain the right of women to vote, and labor its right to organize were out of necessity uncompromising and militantly assertive. They did not fight for nor compromise for incremental or partial rights. Similarly, public health cannot bargain away health standards, monitoring, and accountability through incremental comprises with the corporation. We need real and fundamental reforms more than distracting incremental change. Reliance on corporate financing subjugates the independent voice of public health to commercial goals.  We must take a stand to either work to strengthen the ability of the democratic processes and governments to better protect and promote health, or to work to increase corporate profits.

What Public Health and Community Organizations Can Do

Below are a few things that the field of public health and the not-for-profit world of community organizations should get the corporate world to agree to do before partnering with them or accepting funding from them.20 Implementation of these would help prevent conflict of interest and co-optation, and help ensure that government and private-public partnerships are not dominated by corporate influence.

1.      Provide independent public health professionals and community representatives: a) access to corporate records, facilities, workers, research reports, health promotion budgets, and communications to conduct independent audits of the corporation’s health promotion, environmental, worker health and safety programs and human rights activities, and b) the right to immediately provide an independent written report to the public.

2.      Fund independently developed health promotion publicity campaigns in amounts equivalent to the corporation’s advertising budget.

3.      Keep all corporate health promotion and health education programs and activities free of corporate logos, the corporation’s name, products, symbols, figures, etc.

4.      Not make any contributions to election campaigns to political parties, political action committees, independent campaign advocacy organizations or lobbyists, or on ballot referenda or amendments.

5.      No corporate officials accept employment or appointment to government regulatory agencies, boards or committees that have authority for any part of their industry.

6.      Pay the full statutory federal corporate tax rate.

7.      Submit all products and their contents to independent testing for safety, healthfulness, and efficacy prior to marketing to the public.

In order to avoid conflict of interest and conduct truly independent, objective research, researchers need to work out written agreements with corporate funders about such matters as integrity of the research methods and analyses, compensation, timing and freedom of publication and presentations, and access to data before accepting corporate funding.21

 

References

1. Yach D, Feldman ZA, Bradley DG, Khan M. Can the food industry help tackle the growing global burden of undernutrition.Amer J of Public Health. 2010; doi/10.2105/AJPH.2009.174359

2. Norum, KR. Invited commentary to Yach editorial: PepsiCo recruitment strategy challenged. Public Health Nutrition. 2008; 11(2):112-113. DOI: 10.1017/S1368980007001632.

3. Byrnes, N. Pepsi Brings In the Health Police. January 14, 2010. Bloomberg Business Week. Accessed April 22, 2010.

4. Jacobson, MF. Lifting the veil of secrecy from industry funding of nonprofit health organizations. International Journal of Occupational and Environmental Health.2005; 11:349–355.

5. Bosely S. Political context of the World Health Organization: Sugar industry threatens to scupper the WHO.  International Journal of Health Services 2003; 33(4): 831-833.

6. Tereskerz P, Hamric AB, Uterbock TM, Moreno JD. Prevalence of industry support and its relationship to research integrity. Accountability in Research. 2009; 16:78–105.

7. Lexchin J, Bero LA, Djulbegovic B, Clark O. Pharmaceutical industry sponsorship and research outcome and quality: systematic review. BMJ. 2003; 326:1160-1170.

8. Howard B. Professional medical organizations and commercial conflicts of interest: Ethical issues. Annals of Family Medicine. 2010; 8(4):354-358Top of Form.

9. Heim, L. Identifying and addressing potential conflict of interest: A professional medical organization’s code of ethics.Annals of Family Medicine. 2010; 8:359-361.

10. Accreditation Council for Continuing Medical Education. ACCME Standards for commercial support. Standards to ensure the independence of CME activities. 2007. Accessed April 25, 2011.

11. American Public Health Association. Final Program: Social Justice: A public health imperative. Exhibitor Booth Description. 138th Annual Meeting and Exposition November 6-10, 2010, Denver, CO. Pp 213-234.

12. Executive Board of the American Public Health Association. APHA policy for advertisers and exhibitors. January 2001. Accessed April 25, 2011.

13. Executive Board of the American Public Health Association. Guidelines for Gifts and Donations. American Public Health Association. 2001. Accessed April 25, 2011.

14. General Accountability Office. Comparison of the Reported Tax Liabilities of Foreign- and U.S.-Controlled Corporations, 1998-2005. July 2008; GAO-08-957. April 29, 2010.

15. Institute on Taxation and Economic Policy. State corporate tax disclosure: Why it is needed. Policy Brief # 16. 2005. Accessed April 29, 2010.

16. Kocieniewski D. G.E.’s strategies let it avoid taxes altogether. New York Times. March 24, 2011. Accessed March 27, 2011.

17. Hoffman D. The top 7 corporate tax evaders. April 15 2010. Accessed February 25, 2011.

18. Komisar, L. Corporate tax evasion via offshore subsidiaries: A primer. Pacific News Service. April 9, 2004. Accessed April 27, 2010.

19. Gostin, LO. Public Health Law: Power, Duty, Restraint. Berkeley, CA: University of California Press; 2000.

20. Wiist, WH. The corporate play book, health, and democracy: The snack food and beverage industry’s tactics in context. In Stuckler, D., & Siegel, K. Sick Societies: Responding to the Global Challenge of Chronic Disease. UK: Oxford University Press; In Press.

21. Rowe S, Alexander N, Clydesdale F, Applebaum R, Atkinson S, Black B, Dwyer J, Hentges E, Higley N, Lefevre M, Lupton J, Miller S, Tancredi D, Weaver C, Woteki C, Wedral E. for the International Life Sciences Institute (ILSI) North America Working Group on Guiding Principles. Funding food science and nutrition research: financial conflicts and scientific integrity. Nutrition Reviews. 2009; 67(5):264–272.

 

Image credits:

1.      Alliance for a Healthier Generation

2.      Contra Costa Health Services

3.      Accreditation Council for Continuing Medical Education