Category Archives: Auto

Selected Bibliography on Retail Practices and Health by Industry

Selected Bibliography on Retail Practices and Health in the Alcohol, Automobile, Firearms, Food and Beverage, Pharmaceutical, and Tobacco industries.

Alcohol Industry

Cohen DA, GhoshDastidar B, Scribner R, Miu A, Scott M, Robinson P, et al. Alcohol outlets, gonorrhea, and the Los Angeles civil unrest: A longitudinal analysis. Soc Sci Med. 2006;62(12):3062-3071.

Gruenewald PJ, Freisthler B, Remer L, Lascala EA, Treno A. Ecological models of alcohol outlets and violent assaults: Crime potentials and geospatial analysis. Addiction. 2006;101(5):666-677.

Gruenewald PJ, Johnson FW, Treno AJ. Outlets, drinking and driving: A multilevel analysis of availability. Stud Alcoho. 2002;63(4):460-468.

Gruenewald PJ, Millar AB, Treno AJ, Yang Z, Ponicki WR, Roeper P. The geography of availability and driving after drinking.Addiction. 1996;91(7):967-983.

Kotecki JE, Fowler JB, German TC, Stephenson SL, Warnick T. Kentucky pharmacists’ opinions and practices related to the sale of cigarettes and alcohol in pharmacies. J Community Health. 2000;25(4):343-355.

Lapham SC, Gruenwald PJ, Remer L, Layne L. New Mexico’s 1998 driveup liquor window closure. Study I: Effect on alcohol involved crashes. Addiction. 2004;99(5):598-606.

Miller T, Snowden C, Birckmayer J, Hendrie D. Retail alcohol monopolies, underage drinking, and youth impaired driving deaths. Accid Anal Prev. 2006;38(6):1162-1167.

Montgomery JM, Foley KL, Wolfson M. Enforcing the minimum drinking age: State, local and agency characteristics associated with compliance checks and Cops in Shops programs. Addiction. 2006;101(2):223-231.

Reynolds RI, Holder HD, Gruenewald PJ. Community prevention and alcohol retail access. Addiction. 1997;92 Suppl 2:S261-S272.

Treno AJ, Gruenewald PJ, Johnson FW. Alcohol availability and injury: The role of local outlet densities.  Alcohol Clin Exp Res. 2001;25(10):1467-1471.

Treno AJ, Gruenewald PJ, Wood DS, Ponicki WR. The price of alcohol: A consideration of contextual factors. Alcohol Clin Exp Res. 2006;30(10):1734-1742.

Treno AJ, Grube JW, Martin SE. Alcohol availability as a predictor of youth drinking and driving: A hierarchical analysis of survey and archival data. Alcohol Clin Exp Res. 2003;27(5):835-840.


Automobile Industry

Devaraj S, Matta KF, Conlon E.  Product and Service Quality: The Antecedents of Customer Loyalty in the Automotive Industry.Production and Operations Management.  2001; 10(4): 424-439.

Hellinga LA, McCartt AT, Haire ER. Choice of teenagers’ vehicles and views on vehicle safety: Survey of parents of novice teenage drivers. J Safety Res.2007;38(6):707-713.

Joetan E, Kleiner BH. Incentive practices in the US automobile industry. Management Research News. 2004;27(7):49–62.

Koppel S, Charlton J, Fildes B, Fitzharris M. How important is vehicle safety in the new vehicle purchase process? Accid Anal Prev. 2008;40(3):994-1004.

Koppel S, Charlton J, Fildes B. How important is vehicle safety in the new vehicle purchase/lease process for fleet vehicles?Traffic Inj Prev. 2007;8(2):130-136.

Van Alst JW.  Fueling Fair Practices: A Road Map to Improved Public Policy for Used Car Sales and Financing, National Consumer Law Center, (March 5, 2008), Available at


Firearms Industry

Cook, PJ, Molliconi S, Cole, TB.Regulating gun markets. The Journal of Criminal Law and Criminology. 1995;86(1):59-92.

Lewin NL, Vernick JS, Beilenson PL, Mair JS, Lindamood MM, Teret SP, Webster DW. The Baltimore Youth Ammunition Initiative: A model application of local public health authority in preventing gun violence. Am J Public Health. 2005;95(5):762-765.

Miller M, Azrael D, Hemenway D. Firearm availability and unintentional deaths, suicide, and homicide among 5-14 year olds. The Journal of Trauma. 2002;52(2):267-275.

Miller M, Azrael D, Hemenway D. Firearm availability and unintentional deaths. Accident Analysis and Prevention. 2001;33:477-484.

Miller M, Azrael D, Hemenway D. Firearm availability and unintentional deaths, suicide, and homicide among women.Journal of Urban Health. 2002; 79(1):26-38.

Sorenson SB, Berk RA. Handgun sales, beer sales, and youth homicide, California 1972-1993. Journal of Public Health Policy. 2001;22(2):182-197.

Vernick JS, Mair JS. How the law affects gun policy in the United States: Law as intervention or obstacle to prevention. J Law Med Ethics. 2002;30(4):692-704.

Vernick JS, Webster DW, Bulzacchelli MT, Mair JS. Regulation of firearm dealers in the United States: An analysis of state law and opportunities for improvement. J Law Med Ethics. 2006;34(4):765-775.

Webster DW, Vernick JS, Buzacchelli MT. Effects of a gun dealer’s change in sales practices on the supply of guns to criminals. The Journal of Urban Health. 2006; 83(5):778-787.

Webster DW, Bulzacchelli MT, Zeoli AM, Vernick JS. Effects of undercover police stings of gun dealers on the supply of new guns to criminals. Inj Prev. 2006;12(4):225-230.

Webster DW, Vernick JS, Bulzacchelli MT. Effects of state-level firearm seller accountability policies on firearm trafficking. J Urban Health. 2009;86(4):525-537.

Webster DW, Vernick JS, Hepburn LM. Relationship between licensing, registration, and other gun sales laws and the source state of crime guns. Inj Prev. 2001;7(3):184-189.

Wintemute GJ. Where the guns come from: The gun industry and gun commerce. The Future of Children. 2003;12(2):55-71.


Food and Beverage Industry

Altekruse SF, Yang S, Timbo BB, Angulo FJ. A multi-state survey of consumer food-handling and food-consumption practices.Am J Prev Med. 1999;16(3):216-221.

Angell SY, Silver LD, Goldstein GP, Johnson CM, Deitcher DR, Frieden TR, Bassett MT. Cholesterol control beyond the clinic: New York City’s trans fat restriction. Ann Intern Med. 2009;151(2):129-134.

Austin SB, Melly SJ, Sanchez BN, Patel A, Buka S, Gortmaker SL. Clustering of fast food restaurants around schools: A novel application of spatial statistics to the study of food environments. Am J Public Health. 2005;95(9):1575-1581.

Baker EA, Schootman M, Barnidge E, Kelly C. The role of race and poverty in access to foods that enable individuals to adhere to dietary guidelines. Prev Chronic Dis. 2006;3(3):A76.

Borgmeier I, Westenhoefer J. Impact of different food label formats on healthiness evaluation and food choice of consumers: A randomized-controlled study. BMC Public Health. 2009;12(9):184.

Burton S, Creyer EH, Kees J, Huggins K. Attacking the obesity epidemic: the potential health benefits of providing nutrition information in restaurants. Am J Public Health.2006;96(9):1669-1675.

Cassady D, Housemann R, Dagher C. Measuring cues for healthy choices on restaurant menus: Development and testing of a measurement instrument. Am J Health Promot. 2004;18(6):444-449.

Creel JS, Sharkey JR, McIntosh A, Anding J, Huber JC Jr. Availability of healthier options in traditional and nontraditional rural fast-food outlets. BMC Public Health. 2008;8:395.

Dumanovsky T, Nonas CA, Huang CY, Silver LD, Bassett MT. What people buy from fast-food restaurants: Caloric content and menu item selection, New York City 2007. Obesity (Silver Spring). 2009; 17(7):1369-1374.

Dwyer JJ, Macaskill LA, Uetrecht CL, Dombrow C. Eat Smart! Ontario’s Healthy Restaurant Program: Focus groups with non-participating restaurant operators. Can J Diet Pract Res. 2004.;65(1):6-9.

Economos CD, Folta SC, Goldberg J, Hudson D, Collins J, Baker Z, Lawson E, Nelson M. A community-based restaurant initiative to increase availability of healthy menu options in Somerville, Massachusetts: Shape Up Somerville. Prev Chronic Dis. 2009.;6(3):A102

Fielding JE, Aguirre A, Palaiologos E. Effectiveness of altered incentives in a food safety inspection program. Prev Med. 2001;32(3):239-244.

Ford PB, Dzewaltowski DA. Disparities in obesity prevalence due to variation in the retail food environment: Three testable hypotheses. Nutr Rev. 2008 Apr;66(4):216-228.

French SA, Harnack L, Jeffery RW. Fast food restaurant use among women in the Pound of Prevention study: Dietary, behavioral and demographic correlates. International Journal of Obesity & Related Metabolic Disorders. 2000;24(1):1353.

French SA. Pricing effects on food choices. J.Nutr. 2003;133(3):841S-843S.

French SA, Jeffery RW, Story M, Breitlow KK, Baxter JS, Hannan P, et al. Pricing and promotion effects on lowfat vending snack purchases: The CHIPS Study. Am J Public Health. 2001 ;91(1):112-117.

French SA, Story M, Neumark Sztainer D, Fulkerson JA, Hannan P. Fast food restaurant use among adolescents: Associations with nutrient intake, food choices and behavioral and psychosocial variables. Int J Obes Relat Metab Disord.2001;25(12):1823-1833.

Fried EJ, Nestle M. The growing political movement against soft drinks in schools. JAMA.2002 ;288(1):2181-2181.

Gerend MA. Does calorie information promote lower calorie fast food choices among college students? J Adolesc Health. 2009;44(1):84-86.

Glanz K, Resnicow K, Seymour J, Hoy K, Stewart H, Lyons M, Goldberg J. How major restaurant chains plan their menus: The role of profit, demand, and health. Am J Prev Med. 2007;32(5):383-388.

Hannan P, French SA, Story M, Fulkerson JA. A pricing strategy to promote sales of lower fat foods in high school cafeterias: Acceptability and sensitivity analysis. Am.J.Health Promot. 2002 ;17(1):16,ii.

Hanni KD, Garcia E, Ellemberg C, Winkleby M. Targeting the taqueria: Implementing healthy food options at Mexican American restaurants. Health Promot Pract. 2009;10(2 Suppl):91S-99S.

Harnack LJ, French SA. Effect of point-of-purchase calorie labeling on restaurant and cafeteria food choices: A review of the literature. Int J Behav Nutr Phys Act. 2008 Oct 26;5:51.

Harnack LJ, French SA, Oakes JM, Story MT, Jeffery RW, Rydell SA. Effects of calorie labeling and value size pricing on fast food meal choices: Results from an experimental trial. Int J Behav Nutr Phys Act. 2008 ;5:63.

Jacobson MF, Brownell KD. Small taxes on soft drinks and snack foods to promote health. Am J Public Health 2000;90:854-857.

Jetter KM, Cassady DL. Increasing fresh fruit and vegetable availability in a low-income neighborhood convenience store: A pilot study. Health Promot Pract. 2009 Feb 12. [Epub ahead of print]

Kim D, Kawachi I. Food taxation and pricing strategies to “thin out” the obesity epidemic.  Am. J. Prev. Med.2006;30(5):430-437.

Kimathi AN, Gregoire MB, Dowling RA, Stone MK. A healthful options food station can improve satisfaction and generate gross profit in a worksite cafeteria. J Am Diet Assoc. 2009;109(5):914-917.

Kuo T, Jarosz CJ, Simon P, Fielding JE. Menu labeling as a potential strategy for combating the obesity epidemic: A health impact assessment. Am J Public Health. 2009;99(9):1680-1686.

Kwate N O A. Fried chicken and fresh apples: Racial segregation as a fundamental cause of fast food density in black neighborhoods. Health and Place. 2008;14:32-44.

Kwate NO, Yau CY, Loh JM, Williams D. Inequality in obesigenic environments: Fast food density in New York City.Healthand Place. 2009;15(1):364-73

Lang T, Rayner G, Kaelin E. The Food Industry, Diet, Physical Activity and Health: A Review Of Reported Commitments And Practice Of 25 Of The World’s Largest Food Companies. 2006.

Larson NI, Story MT, Nelson MC. Neighborhood environments: Disparities in access to healthy foods in the U.S. Am J Prev Med. 2009;36(1):74-81.

Ludwig DS, Brownell KD. Public health action amid scientific uncertainty: The case of restaurant calorie labeling regulations.JAMA. 2009;302(4):434-435.

Lynch RA, Elledge BL, Griffith CC, Boatright DT. A comparison of food safety knowledge among restaurant managers, by source of training and experience, in Oklahoma County, Oklahoma. J Environ Health. 2003;66(2):9-14, 26.

Macdonald L, Cummins S, Macintyre S. Neighbourhood fast food environment and area deprivation-substitution or concentration? Appetite. 2007l;49(1):251-254.

Maddock J. The relationship between obesity and the prevalence of fast food restaurants: State level analysis. Am J Health Promot. 2004;19(2):137-143.

Mashta O. UK firms sign up to display calories on menus. BMJ. 2009;338:b182.

Morland KB, Evenson KR. Obesity prevalence and the local food environment.  Health and Place. 2009; 15(2):491-495

Nielsen SJ, Siega Riz AM, Popkin BM. Trends in food locations and sources among adolescents and young adults. Prev Med.2002;35(2):107-113.

O’Dougherty M, Harnack LJ, French SA, Story M, Oakes JM, Jeffery RW. Nutrition labeling and value size pricing at fast-food restaurants: A consumer perspective. Am J Health Promot. 2006;20(4):247-250.

Phillips ML, Elledge BL, Basara HG, Lynch RA, Boatright DT. Recurrent critical violations of the food code in retail food service establishments. J Environ Health. 2006;68(10):24-30, 55.

Pomeranz JL, Brownell KD. Legal and public health considerations affecting  the success, reach, and impact of menu-labeling laws. Am J Public Health. 2008;98(9):1578-1583.

Roberto CA, Agnew H, Brownell KD. An observational study of consumers’ accessing of nutrition information in chain restaurants. Am J Public Health. 2009;99(5):820-821.

Rose D, Hutchinson PL, Bodor JN, Swalm CM, Farley TA, Cohen DA, Rice JC. Neighborhood food environments and Body Mass Index: The importance of in-store contents. Am J Prev Med. 2009;37(3):214-219.

Rydell SA, Harnack LJ, Oakes JM, Story M, Jeffery RW, French SA. Why eat at fast-food restaurants: reported reasons among frequent consumers. J Am Diet Assoc. 2008;108(12):2066-2070.

Sharkey JR, Horel S, Han D, Huber JC Jr. Association between neighborhood need and spatial access to food stores and fast food restaurants in neighborhoods of colonias. Int J Health Geogr. 2009;8:9.

Song HJ, Gittelsohn J, Kim M, Suratkar S, Sharma S, Anliker J. A corner store intervention in a low-income urban community is associated with increased availability and sales of some healthy foods. Public Health Nutr. 2009:1-8.

Spencer EH, Frank E, McIntosh NF. Potential effects of the next 100 billion hamburgers sold by McDonald’s.Am.J.Prev.Med. 2005 ;28(4):379-381.

Story M, Kaphingst KM, Robinson-O’Brien R, Glanz K. Creating healthy food and eating environments: Policy and environmental approaches. Annu Rev Public Health. 2008;29:253-72.


Pharmaceutical Industry

Brooks JM, Doucette WR, Wan S, Klepser DG. Retail pharmacy market structure and performance. Inquiry. 2008;45(1):75-88.

Carroll NV. Estimating the impact of Medicare part D on the profitability of independent community pharmacies. J Manag Care Pharm. 2008;14(8):768-779.

Fincham JE. An unfortunate and avoidable component of American pharmacy: Tobacco. Am J Pharm Educ. 2008;72(3):57

Garattini L, Motterlini N, Cornago D. Prices and distribution margins of in-patent drugs in pharmacy: A comparison in seven European countries. Health Policy. 2008;85(3):305-313.

Gellad WF, Choudhry NK, Friedberg MW, Brookhart MA, Haas JS, Shrank WH. Variation in drug prices at pharmacies: Are prices higher in poorer areas? Health Serv Res. 2009;44(2 Pt 1):606-617.

Gitlin M, Wilson L. Repackaged pharmaceuticals in the California workers’ compensation system: From distribution and pricing options to physician and retail dispensing. Am J Ind Med. 2007;50(4):303-315.

Montoya ID, Jano E. Online pharmacies: Safety and regulatory considerations. Int J Health Serv. 2007;37(2):279-289.

Retail and mail copayments on the rise. Manag Care. 2009;18(6):50.

Rudholm N. Entry of new pharmacies in the deregulated Norwegian pharmaceuticals market– consequences for costs and availability. Health Policy.2008;87(2):258-263

Stafford E. Pharmacy initiatives target prescription drug costs. J Mich Dent Assoc. 2008;90(9):22.

Stevenson FA, Leontowitsch M, Duggan C. Over-the-counter medicines: Professional expertise and consumer discourses.Sociol Health Illn. 2008;30(6):913-928.

Tobacco Industry

Andersen BS, Begay ME, Lawson CB. Breaking the alliance: Defeating the tobacco industry’s allies and enacting youth access restrictions in Massachusetts. Am J Public Health. 2003;93(11):1922-1928.

Celebucki CC, Diskin K. A longitudinal study of externally visible cigarette advertising on retail storefronts in Massachusetts before and after the Master Settlement Agreement. Tob Control. 2002;11 Suppl 2:ii47-53.

Chriqui JF, Ribisl KM, Wallace RM, Williams RS, O’Connor JC, el Arculli R. A comprehensive review of state laws governing Internet and other delivery sales of cigarettes in the United States. Nicotine Tob Res. 2008;10(2):253-265.

Feighery EC, Ribisl KM, Achabal DD, Tyebjee T. Retail trade incentives: How tobacco industry practices compare with those of other industries. Am J Public Health. 1999;89(10):1564-1566.

Feighery EC, Ribisl KM, Clark PI, Haladjian HH. How tobacco companies ensure prime placement of their advertising and products in stores: Interviews with retailers about tobacco company incentive programmes. Tob Control. 2003;12(2):184-188.

Feighery EC, Ribisl KM, Schleicher N, Lee RE, Halvorson S. Cigarette advertising and promotional strategies in retail outlets: results of a statewide survey in California. Tob Control. 2001;10(2):184-188.

Feighery EC, Ribisl KM, Schleicher NC, Clark PI. Retailer participation in cigarette company incentive programs is related to increased levels of cigarette advertising and cheaper cigarette prices in stores. Prev Med. 2004;38(6):876-884.

Gilbertson T. Retail point-of-sale guardianship and juvenile tobacco purchases: assessing the prevention capabilities of undergraduate college students. J Drug Educ. 2007;37(1):1-30.

Gilpin EA, White VM, Pierce JP. How effective are tobacco industry bar and club marketing efforts in reaching young adults?Tob Control. 2005;14(3):186-192.

Glanz K, Sutton NM, Jacob Arriola KR. Operation storefront Hawaii: Tobacco advertising and promotion in Hawaii stores. J Health Commun. 2006;11(7):699-707.

Henriksen L, Feighery EC, Schleicher NC, Cowling DW, Kline RS, Fortmann SP. Is adolescent smoking related to the density and proximity of tobacco outlets and retail cigarette advertising near schools? Prev Med. 2008;47(2):210-4.

Henriksen L, Feighery EC, Schleicher NC, Haladjian HH, Fortmann SP. Reaching youth at the point of sale: cigarette marketing is more prevalent in stores where adolescents shop frequently. Tob Control. 2004;13(3):315-318.

Henriksen L, Feighery EC, Wang Y, Fortmann SP. Association of retail tobacco marketing with adolescent smoking. Am J Public Health. 2004;94(12):2081-2083.

Lavack AM, Toth G. Tobacco point-of-purchase promotion: Examining tobacco industry documents. Tob Control. 2006;15(5):377-384.

Loomis BR, Farrelly MC, Mann NH. The association of retail promotions for cigarettes with the Master Settlement Agreement, tobacco control programmes and cigarette excise taxes. Tob Control. 2006;15(6):458-463.

Loomis BR, Farrelly MC, Nonnemaker JM, Mann NH. Point of purchase cigarette promotions before and after the Master Settlement Agreement: exploring retail scanner data. Tob Control. 2006;15(2):140-

Pollay RW. More than meets the eye: on the importance of retail cigarette merchandising. Tob Control. 2007;16(4):270-274.

Sepe E, Ling PM, Glantz SA. Smooth moves: bar and nightclub tobacco promotions that target young adults. Am J Public Health. 2002;92(3):414-419.

Slater S, Chaloupka FJ, Wakefield M. State variation in retail promotions and advertising for Marlboro cigarettes. Tob Control. 2001;10(4):337-339.

Slater S, Giovino G, Chaloupka F. Surveillance of tobacco industry retail marketing activities of reduced harm products.Nicotine Tob Res. 2008;10(1):187-193.

Slater SJ, Chaloupka FJ, Wakefield M, Johnston LD, O’malley PM. The impact of retail cigarette marketing practices on youth smoking uptake. Arch Pediatr Adolesc. Med. 2007;161(5):440-445.

Slater SJ, Chaloupka FJ, Wakefield M, Johnston LD, O’Malley PM. The impact of retail cigarette marketing practices on youth smoking uptake. Arch Pediatr Adolesc Med. 2007;161(5):440-445.

Smith EA, Blackman VS, Malone RE. Death at a discount: how the tobacco industry thwarted tobacco control policies in US military commissaries. Tob Control. 2007;16(1):38-46.


Studies of Multiple Industries

Ashe M, Jernigan D, Kline R, Galaz R. Land use planning and the control of alcohol, tobacco, firearms, and fast food restaurants. Am J Public Health. 2003;93(9):1404-1408.

Feighery EC, Ribisl KM, Achabal DD, Tyebjee T. Retail trade incentives: how tobacco industry practices compare with those of other industries. Am J Public Health. 1999;89(10):1564-1566.

Freudenberg N, Galea S, Fahs M. Changing corporate practices to reduce cancer disparities. J Health Care Poor Underserved.2008; 19(1):26-40.

Hemenway D. The public health approach to motor vehicles, tobacco, and alcohol, with applications to firearms policy. J Public Health Policy. 2001;22(4):381-402.

Kotecki JE. Sale of alcohol in pharmacies: results and implications of an empirical study. J Community Health. 2003;28(1):65-77.


Commentary: Driving change: the global health impact of the restructured auto industry

In the last several months, the global auto industry has undergone a transformation as profound as any in its history. Despite a $50 billion taxpayer bailout, two of the three biggest US automakers, General Motors and Chrysler, have filed for bankruptcy. As the auto industry plans for its new smaller future, public health advocates need to consider how this restructuring will affect health. In this Commentary, CHW briefly describes some of the recent changes in the global auto industry, examines the possible health impact of these changes, and suggests possible directions for public health research and policy advocacy.

In the last several months, the global auto industry has undergone a transformation as profound as any in its history.  Despite a $50 billion taxpayer bailout, two of the three biggest US automakers, General Motors (GM) and Chrysler, have filed for bankruptcy. Almost 300,000 auto workers have been laid off and more than 2,000 auto showrooms closed.  While every sector of the industry has been hurt by the economic crisis, foreign car makers like Honda, Toyota and Hyundai continue to gain market share and Fiat, an Italian car maker, is expected to soon complete its purchase of Chrysler. After decades of government stalling, in May, President Obama announced tougher new federal fuel emission and mileage standards for US autos, creating new pressure for change.1 As the auto industry plans for its new smaller future, public health advocates need to consider how this restructuring will affect health.  In this Commentary, Corporations and Health Watch briefly describes some of the recent changes in the global auto industry, examines the possible health impact of these changes, and suggests possible directions for public health research and policy advocacy. Our goal in this preliminary report is to raise questions   for more systematic analysis in the months and years ahead.

Downsizing Detroit

In the last 18 months, 289,000 workers in the US auto industry lost their jobs, about half were auto assemblers and the other half worked in the auto supply networks.2 Between September 2008 and March 2009, these two sectors of the auto industry accounted for nearly 20% of the decline in the nation’s gross domestic product.  In Spring 2009, US car makers were producing 423,000 vehicles a month, down from 600,000 late last year.2 Some industry analysts predict that by the end of 2009, a total of 3,800 auto dealerships will be closed, almost double the number closed to date.  The auto industry’s troubles predate the economic crisis –rising oil prices, a collapsing market for SUVs, and intense competition from European and Asian car makers all contributed to the industry’s meltdown.

Globally, the auto industry is also running off the road.  The London-based HIS Global Insight Automotive Group estimates that total 2009 passenger car and light truck production will fall to 59.8 million units in 2009, a 16% drop from 2007.3 In the last year, car sales have declined in Japan, Europe and elsewhere.  In 2008, auto sales in China hit a ten year low, although the Chinese stimulus plan, which provides subsidies for car purchases, has helped to lift sales more recently.  As Michel Freyssnet observed in Le Monde, what is striking about the current crisis in the automobile industry is that “there is not any major market nor any manufacturer that is not in decline.” 4

In January 2009, people in China bought 748,000 cars, a 4.6% reduction from the year before while in the U.S., people bought 657,000 cars in January, a 37.1% reduction.4 This statistic highlights the changing face of the global auto industry.  In the coming decade, most analysts agree that European, Japanese, and Chinese car makers will outpace the US industry, with Brazil, South Korea and India not far behind.

In China, for example, the high cost of gasoline is pushing even tougher fuel emission mandates than those announced by President Obama.  In a plan released in May, China will require car makers to improve fuel economy an additional 18% by 2015, creating new pressures for more fuel efficient and smaller cars.5 Already China imposes a sales tax of 1% on fuel-efficient cars and 40% on gas-guzzling SUVs and sports cars.  Since most multinational auto companies are vigorously competing for a share of the Chinese auto market, China has the potential to play a leading role in setting global environmental and production standards. As Dieter Zetsche, the chairman of Daimler, said at the opening day of the Shanghai auto show in April, “The center of gravity is moving eastward. This has, if anything, only accelerated through the crisis.”6

Auto industry analysts, from the  World Watch Institute7 to KPMG8 to the US Department of Commerce9, seem to agree that if the auto industry is to survive, it must make fewer, smaller and better cars, with an emphasis on more environmentally friendly  and fuel efficient vehicles.  It also seems likely that carmakers in other countries, especially China, will continue to grow in influence.  While the emerging auto markets in the global South are likely to demand smaller and more fuel-efficient cars, if their goal is to achieve developed nation levels of car ownership the overall adverse impact of cars on health and the environment may continue to grow.  In the coming decade, this tension between equity in ownership levels and sustainable patterns of automobile production will dominate the debates among the global automobile industry, policy makers and environmentalists.  On the one hand, the developed nations have no right to tell Asians, Africans and Latin Americans that they can’t have cars. On the other hand, a continued rise in automobile use will inevitably choke our cities, pollute our air, injure and maim growing numbers of people, and exacerbate human-induced climate change, all trends that will hurt the global south more.  Only by reframing the issues can we escape this dilemma.

In the coming decade, this tension between equity in ownership levels and sustainable patterns of automobile production will dominate the debates among the global automobile industry, policy makers and environmentalists.

One important influence on how much Americans will drive and what kinds of cars they will buy is the price of gasoline.  In the United States, oil demand has dropped without interruption for more than 15 months. Globally, the International Energy Agency estimated that daily average oil consumption would decline by 3% in 2009. 10 A rapid economic recovery, new oil production and consumer optimism could lead to more driving and fewer incentives to buy small cars.  Conversely, a long recession, high gas prices, or continued political conflict in Nigeria, Iraq, Russia, Venezuela or other major oil-producing countries could accelerate the trends to less driving and smaller, more fuel-efficient vehicles.

How does the auto industry influence health?

For the last century, the auto industry has been a major influence on health.  It has changed the air we breathe, the form of our cities and suburbs, and contributed to rising rates of obesity by encouraging sedentary behavior.  An extensive literature documents the profound social and environmental impact of the automobile.11, 12, 13 At the individual level, automobile ownership has been associated with various health benefits.  As Macintyre et al. note, car ownership can increase access to employment, shops selling healthy affordable food, leisure facilities, social support networks, health services and open space and help owners to avoid crime.14

At the population health level, more attention has been focused on the adverse impact of the density of automobile ownership.  Here we consider its impact in four separate domains: air pollution, climate change, automobile accidents and injuries, and physical inactivity.  Also of vital importance but considered only briefly below is the industry’s impact on the well-being of its workers and the communities in which its factories are located.

Air pollution Outdoor air pollution causes an estimated 800,000 deaths around the world  each year and motor vehicles are a major source of  such pollutants as nitrogen oxides (NOx) and volatile organic compounds (VOCs)—which interact to form ground level ozone—and of microscopic particulate matter (PM10).  It is estimated that 1.4 billion people are exposed to urban air pollution above World Health Organization (WHO) limits. Deaths from air pollution are only the tip of the iceberg. For example,  for every death caused by PM10  there will be 34 emergency admissions, 407 asthma days, 6,085 reduced activity days, and 18,864 acute respiratory symptom days.15

Climate change In April 2009, the US EPA issued a proposed finding that carbon dioxide (CO2) poses a danger to health and welfare, opening the door to federal regulation of CO2 from all sources.16 According to Environmental Defense, the United States has 5% of the world’s population and 30% of the world’s automobiles, but it contributes 45% of the world’s automotive CO2 emissions.17 Thus, reducing car use and increasing fuel efficiency of cars are essential steps in reversing human-induced climate change.  According to Dan Becker, the Director of the Safe Climate Campaign, the improvements in fuel efficiency standards that President Obama announced last month are, “the biggest single step to curbing global warming.  It’s a major step forward in cutting auto emissions.” 18

Accidents In the last century or so, cars have killed at least 30 million people, perhaps many more—each year cars kill 1.2 million and injure 50 million.19 According to the World Health Organization, traffic deaths and injuries are rising worldwide, likely to double by 2020 and automobile accidents are the leading cause of death for 10 to 24 years old.19 Children in less developed countries (LDCs), especially those in densely populated cities, experience the highest burden of automobile injuries, dying at six times the rate of children in higher income countries and accounting for 96% of all children killed in traffic collisions.13 The US automobile industry has a long record of opposing public health measures to improve car safety including seat belts, air bags and auto-locking brakes.  Over the 20th century, as consumer and government pressure forced the US auto industry to add safety devices, auto deaths and injuries fell dramatically.  Still, in the 1990s, automaker decisions to promote SUVs at the expense of sedans contributed to thousands of preventable deaths in the US from rollovers, crashes and collisions with pedestrians.20

Obesity/physical inactivity More recently, automobiles and the cities and suburbs designed to accommodate them have been implicated as one factor contributing to rising rates of obesity.  As cars have become more central in many transport systems, people are less likely to walk to shops or work and fewer children walk to school. One study found that each additional hour spent in the car was associated with a 6% increase in the likelihood of obesity.21

How will the restructuring of the auto industry influence its impact on these and other health outcomes?

Box 1 lists possible implications of some of the previously described trends.  Future research will need to test these possible associations across time and place, seeking to gain insights into the pathways by which changes in auto industry practices lead to changes in health and health behavior.  In addition, changes in the automobile industry are likely to be associated with other changes in the global economy, trends which may interact to produce positive or negative health consequences.

Box 1. Possible Health Consequences of Changes in the Auto Industry


Possible Health Effects

Fewer automobiles produced

Less driving, less air pollution including C02 emissions, fewer accidents and injuries, more walking and less obesity

Higher proportion of smaller more fuel efficient cars

Less air pollution including less carbon dioxide emissions and less global warming

Fewer miles driven

Less air pollution, fewer accidents and injuries, more walking and less obesity

Higher rates of automobile ownership  in Asia, Africa and Latin America

More air pollution, more accidents and injuries, and less physical activity, exacerbating North-South health inequities

Finally, any review of the health consequences of the auto industry restructuring must acknowledge the profound adverse impact on workers in the automobile industry and on the communities where the auto industry has been centered.  Hundreds of thousands of auto workers have and will lose their jobs and often their health insurance, putting them at risk of prolonged unemployment, home foreclosure, and high levels of stress.  In addition, these catastrophic losses are concentrated in a few cities and regions, most notably Detroit and its suburbs, in the US, where they further jeopardize the well-being of populations already suffering from more than two decades of deindustrialization.

Future policy and research for a healthier auto industry

In the US, as in the rest of the world, the goal is not simply to restore the auto industry to a health that has often sickened the world by producing unsafe, polluting and environmentally damaging cars.  To avoid this future, auto makers, government policy makers, public health and environmental professionals, labor unions, and advocates will need to engage in an ongoing dialogue.  Here, Corporations and Health Watch suggests some proposals that may help to spark this dialogue.

1. Move from state to federal regulation for automobile safety and environmental standards.

In the past many years, public health and environmental activists have often emphasized state rather than federal regulation because of the business friendly environment in Washington. The recent economic crisis and the 2008 election may provide a window of opportunity to move the action back to Washington where decisions can benefit the population as a whole and pressure industry to meet consistent standards.   Industry may now be willing to support such a move, at least in those cases where federal regulation doesn’t threaten profits. As the Alliance of Auto Manufacturers noted in May, a national program for regulating CO2 “avoids conflicting standards from different regulatory agencies, and it gives automakers much needed certainty for long-term product planning.”22

2. Reinvigorate the National Highway Safety and Transport Administration and the Environmental Protection Agency.

For the federal government to play a positive role in reducing the health and environmental consequences of the automobile industry, it will need a vigorous and science-based regulatory infrastructure, much of which was decimated under the Bush Administration.  Rebuilding these agencies will provide the means to implement new policies.

3.  Consider the quid that tax payers can expect for the quo of the auto industry bailout.

Bailouts are not, by themselves, a solution to the auto industry’s problem.  As Joseph Romm, a former US Energy Department staffer, wrote recently in Salon, “when you bail someone out of jail, there is no guarantee that he won’t jump bail, and even less of a guaranteed that he won’t ultimately end up in jail anyway.”23 So continued government support has to be contingent on auto makers acting in the public interest.  Among the auto industry practices US tax payers ought not to subsidize are: deceptive advertising that implies big cars are safe, design of cars that are environmentally damaging, or lobbying to thwart public health protections.

Film maker Michael Moore, who 20 years ago showed the seamy side of GM in his film “Roger and Me,” recently suggested that President Obama24 follow the example President Roosevelt set after the attack on Pearl Harbor.  Then, FDR ordered GM to halt car production and begin to produce planes, tanks and machine guns. Now, Moore urged Obama to convert our auto factories into ones capable of building mass transit vehicles and alternative energy devices.

4. Construct clear, compelling narratives and frames to present the issues facing the American auto industry to the American public.

For decades the US auto industry has opposed reforms that will reduce the public health and environmental harms its products cause, and, for decades, the American public has had difficulty contesting the industry’s self-serving arguments. Now the American public is much less likely to trust auto industry executives to decide what’s best for America. To realize this opportunity, public health and environmental advocates will need to find new language and narratives to help Americans consider their options.  Recently, the psychologist Drew Westen and the pollster Celina Lake suggested some frameworks for discussions about auto industry reform, illustrated in the diagram below, in which the words in blue suggest future directions and those in red the policies we want to escape.25

In the coming years, the auto industry will continue to change. Whether public health and environmental advocates will be able to influence those changes for the better depends on our success in engaging a wide variety of constituencies in policy debates about the future of the car.  By understanding the health and environmental consequences of these changes and communicating them clearly, we have an opportunity to join the discussion.

By Nicholas Freudenberg, Distinguished Professor and Founder and Director of Corporations and Health Watch.


1 Broder JM. Obama to Toughen Rules on Emissions and Mileage. New York Times, May 18,2009. Available at:

2 Uchitelle L. Once a key to recovery, Detroit adds to the pain.  New York Times, June 1, 2009, p. B1, 3.

3 Cited in Rennert M. Global auto industry in crisis.  Worldwatch Institute, May 18,2009. Available at:

4 Freyssenet.A Major Battle Is Joined Over the Transition to the Clean Car. Tuesday 03 March 2009. Truthout. Originally Published in Le Monde  Available at

5 Bradsher K.  Miles to go in China.  Thursday, May 28, 2009, p. B1.

6 Bradsher K. China influence grows with car sales. New York Times, April 20, 2009.

7 Rennert M. Global auto industry in crisis.  Worldwatch Institute, May 18,2009. Available at:

8 KPMG International.  Momentum: KPMG’s Global Auto Executive Survey 2009.  Available at:

9 International Trade Administration.  The Road Ahead for the U.S. Auto Market.  U.S. Department of Commerce, Washington, D.C., 2008.

10 Mouawad J. Gas is up; drivers may not cut back.  New York Times, May 21, 2009.

11 Ladd B.  Autophobia Love and hate in the Automotive Age.  Chicago: University of Chicago Press, 2008.

12 Woodcock J, Aldred R. Cars, corporations, and commodities: Consequences for the social determinants of health. Emerg Themes Epidemiol. 2008 ;21;5:4.

13 Dauvernge, P. 2008. The Shadows of Consumption  Consequences for the Global Environment. Cambridge, MA: MIT Press, 2008.

14 Macintyre S, Ellaway A, Der G, Ford G, Hunt K. Do housing tenure and car access predict health because they are simply markers of income or self esteem? A Scottish study. J Epidemiol Community Health. 1998;52(10):657-64.

15 “Urban Transport.” Encyclopedia of Public Health. Ed. Lester Breslow. Gale Cengage, 2002. 2006. 23 Jun, 2009

16 Broder JM. EPA clears way for greenhouse gas rules. New York Times, April 18,2009. Available at:

18 Tankerley R, Simon R. US to limit greenhouse gas emissions from autos.  Los Angeles Times, May 19th, 2009. Available at

19 World Health Organization and World Bank. World Report on Road Traffic Injury and Prevention. Geneva, Switzerland, 2004.

20 Bradsher K. High and Mighty SUVs: The World’s most Dangerous Vehicles and how they Got that Way. New York, NY: Public Affairs; 2002.

21 Frank LD, Andresen MA, Schmid TL. Obesity relationships with community design, physical activity, and time spent in cars. Am J Prev Med. 2004 Aug;27(2):87-96.

22 Alliance of Automobile Manufacturers,. Automakers support President in development of national program for autos. Press Release, May 18, 2009. Available at:

23 Romm, J. Is Detroit Worth Saving? Salon.  November 12, 2008. Available at:

24 Moore, M. Goodbye GM. June 1, 2009. Available at:

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1. trashd 
2. thomashawk
3. httpdcmaster


Selected references on automobile industry practices and health

This month CHW continues its series on selected references from the peer-reviewed scientific literature with a listing of 47 references on the health impact of automobile industry practices.

Corporations and Health Watch is conducting a search for articles that assess the impact of corporate practices on health for various industries. This list includes selected publications from the peer-reviewed literature that describe and analyze the marketing, product design, retail and pricing practices of the automobile industry.

Arbesman M, Pellerito JM Jr. Evidence-based perspective on the effect of automobile-related modifications on the driving ability, performance, and safety of older adults. Am J Occup Ther. 2008;62(2):173-86.

Arbogast KB, Durbin DR, Kallan MJ, Winston FK. Effect of vehicle type on the performance of second generation air bags for child occupants. Annu Proc Assoc Adv Automot Med. 2003;47:85- 99.

Ballesteros MF, Dischinger PC, Langenberg P. Pedestrian injuries and vehicle type in Maryland, 1995-1999. Accident Analysis and Prevention. 2004;36:73-81.

Bedard M, Guyatt GH, Stones MJ, Hirdes JP. The independent contribution of driver, crash, and vehicle characteristics to driver fatalities. Accident Analysis and Prevention. 2002;34:717-727.

Buckeridge DL, Glazier R, Harvey BJ, Escobar M, Amrhein C, Frank J. Effect of motor vehicle emissions on respiratory health in an urban area. Environ Health Perspect. 2002;110(3):293-300.

Cohen MJ A social problems framework for the critical appraisal of automobility and sustainable systems innovation .Mobilities 2006; 1(1): 23-38.

Crandall CS, Olson LM, Sklar DP. Mortality reduction with air bag and seat belt use in head-on passenger car collisions.American Journal of Epidemiology. 2001;153:219-224.

Daly L, Kallan MJ, Arbogast KB, Durbin DR. Risk of injury to child passengers in sport utility vehicles. Pediatrics. 2006;117:9-14.

Duvall T, Englander F, Englander V, Hodson TJ, Marpet M. Ethical and economic issues in the use of zero-emission vehicles as a component of an air-pollution mitigation strategy. Sci Eng Ethics. 2002;8(4):561-78

Farmer C. Effect of electronic stability control on automobile crash risk. Traffic Inj Prev. 2004;5(4):317-25.

Farmer CM, Braver ER, Mitter EL. Two-vehicle side impact crashes: The relationship of vehicle and crash characteristics to injury severity. Accident Analysis and Prevention. 1997;29:399-406.

Farmer CM, Lund AK. Trends over time in the risk of driver death: what if vehicle designs had not improved? Traffic Inj Prev. 2006;7(4):335-42.

Ferguson SA. The effectiveness of electronic stability control in reducing real-world crashes: a literature review. Traffic Inj Prev. 2007;8(4):329-38.

Ferguson, S.A., Hardy, A.P., Williams, A.F. (2003). Content analysis of television advertising for cars and minivans: 1983-1998. Accident Analysis and Prevention, 35:825-831.

Ferguson SA, Schneider L, Segui-Gomez M, Arbogast K, Augenstein J, Digges KH. The blue ribbon panel on depowered and advanced airbags – status report on airbag Performance. Annu Proc Assoc Adv Automot Med. 2003;47:79-81.

Geyer R. Parametric assessment of climate change impacts of automotive material substitution Environ Sci Technol. 2008;42(18):6973-9.

Hart-Munchel, D.L. Comment: hybrid cars: how they can reduce American air pollution and oil consumption, but why they are not replacing traditional gas guzzling cars and trucks just yet. Penn State Environmental Law Review Fall 2001

Keefe R, Griffin JP, Graham JD. The benefits and costs of new fuels and engines for light-duty vehicles in the United States.Risk Anal. 2008;28(5):1141-54

Knight S, Cook LJ, Nechodom PJ, Olson LM, Reading JC, Dean JM. Shoulder belts in motor vehicle crashes: A statewide analysis of restraint efficacy. Accident Analysis and Prevention. 2001;33:65-71.

Mannino DM, Redd SC. National vehicle emissions policies and practices and declining US carbon monoxide-related mortality. JAMA. 2002;288(8):988-95.

Mayrose J, Jehle DVK. Vehicle weight and fatality risk for sport utility vehicle versus passenger car crashes. The Journal of Trauma, Injury, Infection and Critical Care. 2002;53.

Mazzi, E.A., Dowlatabadi, H. (2007). Air quality impacts of climate mitigation:UK policy and passenger vehicle choice.Environmental Science and Technology, 41:387-392.

McAuley JW. Global sustainability and key needs in future automotive design. Environ Sci Technol. 2003;37(23):5414-6.

McGwin G Jr, Modjarrad K, Reiland A, Tanner S, Rue LW 3rd. Prevalence of transportation safety measures portrayed in primetime US television programs and commercials. Inj Prev. 2006;12(6):400-3.

Mott JA, Wolfe MI, Alverson CJ, Macdonald SC, Bailey CR, Ball LB, Moorman JE, Somers JH, Sheerman B. Motor industry should introduce soft impact car bodies, says MP. BMJ. 2002;324 (7346):1117.

Nichols, M.W. (1998). Advertising and quality in the US market for automobiles. Southern Economic Journal, 64(4):922-939.

Nirula R, Mock CN, Nathens AB, Grossman DC. The new car assessment program: does it predict the relative safety of vehicles in actual crashes? J Trauma. 2004 Oct;57(4):779-86

Paulozzi LJ. United States pedestrian fatality rates by vehicle type. Inj Prev. 2005;11(4):232-6.

Rivara FP, Cummings P, Mock C. Injuries and death of children in rollover motor vehicle crashes in the united states. Injury Prevention. 2003;9:76-81.

Rivara FP, Koepsell TD, Grossman DC, Mock C. Effectiveness of automatic shoulder belt systems in motor vehicle crashes.JAMA: The Journal Of The American Medical Association. 2000;283:2826-2828.

Roberts I, Wentz R, Edwards P. Car manufacturers and global road safety: a word frequency analysis of road safety documents. Inj Prev. 2006;12(5):320-2.

Robertson LS. Prevention of motor-vehicle deaths by changing vehicle factors. Inj Prev. 2007;13(5):307-10.

Robertson LS. Reducing death on the road: the effects of minimum safety standards, publicized crash tests, seat belts, and alcohol. Am J Public Health. 1996;86(1):31-4.

Robertson LS. Blood and oil: vehicle characteristics in relation to fatality risk and fuel economy. Am J Public Health. 2006 Nov;96(11):1906-9.

Samet JM. Traffic, air pollution, and health. Inhal Toxicol. 2007;19(12):1021-7.

Shin, P.C., Hallet, D., Chipman, M.L., Tator, C., Granton, J.T. (September 2005).

Unsafe driving in North American automobile commercials. Journal of Public Health, 27(4):318-325.

Stephan CH, Sullivan J. Environmental and energy implications of plug-in hybrid-electric vehicles. Environ Sci Technol. 2008;42(4):1185-90.

Streff FM. Field effectiveness of two restraint systems: The 3-point manual belt versus the 2-point motorized-Shoulder/Manual lap belt. Accident Analysis and Prevention. 1995;27:607-610.

Tamburro, R.F., Gordon, P.L., D’Apolito, J.P., Howard, S.C. (2004). Unsafe and violent behavior in commercials aired during televised major sporting events. Pediatrics, 114:694-698.

Trowbridge MJ, McKay MP, Maio RF. Comparison of teen driver fatality rates by vehicle type in the United States. Acad Emerg Med. 2007 Oct;14(10):850-5.

Wenzel TP, Ross M. The effects of vehicle model and driver behavior on risk. The effects of vehicle model and driver behavior on risk. Accid Anal Prev. 2005 May;37(3):479-94.

Williams AF, Wells JK, Farmer CM. Effectiveness of Ford’s belt reminder system in increasing seat belt use. Injury Prevention. 2002;8:293-296.

Wilson N, Maher A, Thomson G, Keall M. Vehicle emissions and consumer information in car advertisements. Environ Health. 2008;7:14.

Woodcock J, Banister D, Edwards P, Prentice AM, Roberts I. Energy and transport. Lancet. 2007;370(9592):1078-88.

Yanchar NL, Kennedy R, Russell C. ATVs: motorized toys or vehicles for children? Inj Prev. 2006 Feb;12(1):30-4.

Readers are invited to send additional citations to


The Financial Crisis and Public Health: Hidden Opportunities for Prevention?

In this commentary, CHW founder and director Nicholas Freudenberg examines how the current financial crisis may influence corporate health practices and asks whether the crisis may present the public health community with new opportunities to advance healthier policies and to restore a more just balance between markets and government.


Continue reading The Financial Crisis and Public Health: Hidden Opportunities for Prevention?

EcoDriving USA The Auto Industry’s Response to Low Car Sales, High Gas Prices, Climate Change… and the 2008 Election Campaign Debates on Energy Policy

This month CHW profiles EcoDriving, an auto industry campaign launched over the summer when driving prices were at their highest. Our report describes the campaign, analyzes the auto industry’s motivation for launching it now and looks at the presidential candidates’ stance on energy policy.

The US Department of Transportation announced that Americans drove 53 billion fewer miles on US roads this year compared to last year,1 a record decline attributed to the soaring price of gasoline. To capitalize on this trend and to forestall or weaken new federal fuel economy standards, the Alliance of Automobile Manufacturers, the trade group of the American, auto companies and dealers, and two US governors are recommending drivers become individually responsible for their carbon emissions and start “driving green.”

EcoDriving USA, a new auto industry campaign, seeks to inspire consumers to get back into car showrooms and behind the wheel. California Gov. Schwarzenegger, a sponsor of the campaign, says “We hear a lot of ideas from politicians about lowering the gas prices and fighting global warming, whether it’s biofuels, offshore drilling or nuclear power. But none of those will affect the gas prices right now. Only you can do that.”  Ecodriving USA urges drivers to join the “ecodriving movement.”

Many agree that reducing demand for gas will help keep pump prices down, but as new evidence links carbon dioxide (CO2) emissions to health and environmental problems, will asking drivers to become responsible for their own fossil fuel emissions be enough?

EcoDriving USA

The campaign hopes to shift consumer habits from driving less, a trend that worries the auto industry, to driving with tactics that can reduce carbon dioxide (CO2) emissions. For example, EcoDriving suggests drivers avoid jackrabbit starts, maintain good tire pressure, leave excess cargo at home, and take advantage of synchronized traffic lights.  EcoDriving USA advocates staying on the road with a website full of fuel-saving checklists, a CO2 calculator and a ‘Virtual Road Test’ that allows users to try EcoDriving tips from their computer. Users can learn a few money saving tricks and will also have a chance to learn about the latest fuel efficient models being produced by EcoDriving partners, including BMW, Chrysler, Ford, General Motors, Mercedes-Benz, Mitsubishi, Toyota and Volkswagen. According to EcoDriving USA, their ecodriving tips can save consumers about 15% in fuel expenses.

Some critics are not enthusiastic about EcoDriving.  Motor Trend calls its website “redundant, as tips fall short of being revolutionary.”2 In fact, the campaign’s fuel-saving advice is virtually identical to recommendations made by several others, including the US Department of Energy, Environmental Protection Agency, and Energy Efficiency and Renewable Energy at Ecodriving, or hypermiling, was first introduced by the online fuel economy forum as a combination of driving techniques, that when followed can help to maximize fuel economy.

Human-generated CO2 emissions and health

In 2007 Intergovernmental Panel on Climate Change (IPCC) Fourth Assessment report summarized the latest evidence that links human-generated greenhouse gases and global climate change. Other recent reports have spelled out the health implications. For example, a study published this year in Geophysical Research Letters shows a correlation between CO2 emissions and human mortality. The study’s principal investigator, Mark Jacobson says, “The study is the first specifically to isolate carbon dioxide’s effect from that of other global-warming agents and to find quantitatively that chemical and meteorological changes due to carbon dioxide itself increase mortality due to increased ozone, particles and carcinogens in the air.”3

The Environmental Protection Agency’s (EPA) newly released Analyses of the Effects of Global Change on Human Health and Welfare and Human Systems describes human health, settlement and welfare vulnerabilities in this country. The report, says that the US can expect health effects that are “very likely to accentuate the disparities already evident in the American health care system,” with the poor, elderly, disabled and uninsured to bear much of the global climate change burden.4

While the report does not respond to specific CO2 emission scenarios, much of the analysis is based on science showing health risks in specific areas and regions. Urban areas, for example, are known to have high CO2 emissions which increase health risks, but the report goes beyond by warning that “the impacts of higher temperatures in urban areas and likely associated increases in tropospheric ozone concentrations can contribute to or exacerbate cardiovascular and pulmonary illness.”4

Fuel economy standards, changes and ‘new’ plans

The US and other large emission polluters are often the target of proposed fuel emission standards change. And with good reason. Using the most current numbers available from the Energy Information Administration (EIA), the US is the largest importer and consumer of oil. For example:

  • In 2007, the US consumed over 9.2 million barrels of motor gasoline per day, almost three times more oil than any other country.
  • The US was responsible for the worlds most extensive tailpipe pollution, unloading about 1.9 billion metric tons of CO2 emission in 2004 (three times more than industry, electrical power, residential and commercial CO2 emissions combined) according to the Pew Center on Global Climate Change.

Changing this pattern, however, requires changing more than drivers habits. In the US, fuel economy is regulated by CAFE (Corporate Average Fuel Economy) standards which are enforced by a combined effort of the National Highway Traffic Safety Administration (NHTSA) and the Environmental Protection Agency (EPA). While CAFE places the production of fuel efficient vehicles on automobile manufactures, CAFE standards themselves are determined on a federal level by the Secretary of Transportation.

The most recent changes to fuel efficiency standards came with the new energy bill in late 2007, which calls for a 40% increase (to 35 mpg) in CAFE standards to be realized by 2020. But the Union of Concerned Scientists says Bush administration proposals for achieving the new energy goal leave loopholes for the auto industry and fails to utilize new technologies. Jim Kliesch, a senior engineer with the Clean Vehicles Program said, “Automakers today have technology sitting on their shelves that could cost-effectively improve fuel economy… We could blow the doors off 35 mpg with conventional technology alone, but [the] proposal would leave us stuck in second gear.”5

Energy Policy and the 2008 Presidential Campaign

Policy change that would include reductions in CO2 emissions is a part of each major party Presidential candidates’ energy platform. Senator Obama’s ‘New Energy for America Plan‘ proposes a 4% per year increase in CAFE standards and an 80% reduction in greenhouse gas emissions by 2050. Senator McCain’s ‘Lexington Project‘ calls for enforcing existing CAFE standards and a 60% reduction in greenhouse gas emissions by 2050. While McCain’s plan calls for significant tax cuts for corporations, Obama’s plan seeks to penalize oil companies with a windfall profit tax. For an in depth analysis of industry influence in Obama and McCain’s energy plans see OpenSecrets ‘Power Struggle: Energizing the Presidential Race‘ and Center for American Progress ‘The True Cost of McCain’s Oil Industry Subsidies for Every State.’

Changing Energy Policies and Driving Habits?

While the Presidential candidates debate energy policy, auto makers and dealers are competing for fewer and fewer new car buyers.6 As the industry looks to regain momentum, EcoDriving USA, may be just the marketing technique needed to move customers into the showroom. The campaign’s main sponsor, The Alliance of Automobile Manufacturers (AAM), says it’s on board with the new energy bill. Dave McCurdy, AAM President and CEO says “Congress has set an aggressive, single, nationwide standard and automakers are prepared to meet that challenge. This proposal represents an important mile marker on the road to at least 35 miles per gallon by 2020.”7 Like other industries that have changed tactics after losing regulatory battles, the auto industry now seeks to reframe the debate on fuel efficiency and climate change to more individual terms.

As a blogger from the National Resources Defense Council, Roland Hwang, says the EcoDriving USA campaign is limited because it diverts attention from the need for a federal policy response. “It is clear that EcoDriving programs will never fully replace the need for stricter fuel economy or CO2 standards, especially since we need much deeper cuts in CO2 emissions to solve global warming and break our dependence on oil.”8

More broadly, Ecodriving illustrates the power of industry to mobilize its resources to frame health and environmental issues. Just as Coke and Pepsi propose more physical activity as an antidote to sweetened-beverage induced obesity, Philip Morris urges action against youthful smoking (making it more appealing to youth) and alcohol makers call for “responsible drinking”, the auto industry’s call for ecodriving puts the burden for change on individuals rather than corporations.


1. U.S. Department of Transportation. August 13, 2008American Driving Reaches Eighth Month of Steady Decline. Available at:

2. Evans, Scott. Auto manufacturers, government take up hypermiling, change name to EcoDriving. Motor Trend. Aug 19 2008. Available at:

3. Jacobson, MZ. On the causal link between carbon dioxide and air pollution mortality. Geophys Res Lett. 2008;35. Available at:

4. Analyses of the Effects of Global Change on Human Health and Welfare and Human Systems. Environmental Protection Agency. 2008, p. 18. Available at:

5. New Fuel Economy Proposal Starts Strong, Then Puts on the Brakes: Pace Set in Proposal’s Final Years Would Cause Fleet to Fall Short of Legally Required Minimum, Science Advocacy Group Warns. Union of Concerned Scientists. Press Release. April 22, 2008. Available at:

6. Bunkley N. U.S. car sales fall sharply in August, but some see signs of respite. International Herald Tribune. Sept 3, 2008. Available at:

7. Automakers respond to new nationwide fuel economy proposal. Alliance of Automobile Manufacturers. Press Release. April 22, 2008. Available at:

8. Hwang R. Saving Fuel Through “EcoDriving” Can Help Cool Off Oil Prices. Natural Resources Defense Council. Aug 18, 2008. Available at:

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3. post406

Tracking on Corporations and Health

Those seeking to modify corporate practices that harm health often have to track changes in corporate or government policy to assess their progress. Here, Corporations and Health Watch describes a few databases and websites useful for tracking local and nation policy and the social responsibility performance of major corporations.

Tracking local policies:

Looking for policies to propose to solve a local problem related to food industry practices that reduce access to healthy food? Visit Prevention Institute’s Local Policy databasean online resource of local policies that can improve opportunities for healthy eating and physical activity. For example, a search for policies on unhealthy foods located 21 specific local policies, mostly in California, enacted to reduce promotion of unhealthy foods.


Tracking federal legislation:

Open Congress tracks legislative proposals and bills on various issues and industries. Its website explains different ways to use the site. For example, OpenCongress bill pages bring together news coverage, blog buzz, insightful comments, and more. Linking to OpenCongress thus gives readers access to the big picture as well as the official details on specific legislative proposals. If you write a blog post about a bill and include the official title (for example, H.R.800), then a link to your blog post will appear on that bill page. Another section shows the most-viewed bills, or hot bills by issue area. The site includes one-click sharing to Digg, StumbleUpon, Facebook, e-mail a friend, and more. It also allows visitors to find their members of Congress and to track their actions and what people are saying about them.

To illustrate topics of interest to Corporate and Health Watch readers, visitors can track legislative proposals on the following topics, among many others:

Alcohol taxes
Automobile industry
Food industry
Pharmaceutical research
Tobacco industry


Tracking corporate responsibility:

Several organizations have ranked corporations on their social responsibility.

Fortune Magazine ranks 100 of the Fortune 500 on business responsibility.

The Ethics & Policy Integration Centre provide a user-friendly resource for tracking US and emerging global standards in corporate responsibility. It includes sections on environmental and human righs standards, but not health or consumer protection standards.

Corporate Responsibility Index The British group Business in the Community’s CR Index is the United Kingdom’s leading benchmark of responsible business. It helps companies to integrate and improve responsibility throughout their operations by providing a systematic approach to managing, measuring and reporting on business impacts in society and on the environment. Each year the CR Index lists and rates the top 100 companies in the UK.


The Perils of Short-term Profiteering: U.S. Automakers Focus on SUVs Hurts Their Profits and Our Health

With record high gas prices dominating the news, Americans are finally facing the music. The big SUVs and pick up trucks that the US auto industry relentlessly promoted in the 1990s are now economically unsustainable, as well as more accident-prone and polluting than the sedans and compacts that have allowed the European and Asian auto industries to prosper. Though environmentalists have long argued that these vehicles are environmentally unsustainable, for more than a decade, SUVs and trucks had been the top selling vehicles in America. Of course, U.S. consumers shoulder some of the blame for the SUV and large truck craze that has left vehicles languishing in used car lots or drive ways as drivers shy away from a fill-er-up that can top $100. But in the 1990s, the US auto industry spent more than $9 billion on advertising to convince Americans the highly profitable SUVs were safer, more convenient and more manly than the alternatives. In this report Corporations and Health Watch examines how the US auto industry’s desire for short-term gain has led to plummeting profit margins and jeopardized the industry’s future viability while condemning American consumers to unsafe and polluting vehicles.

On the heels of the housing crisis and a declining economy, gas prices have set record highs this spring and summer, with the average price per gallon increasing by more than a dollar since February. As fuel prices rise, Americans are finding ways to cut back on fuel costs by walking and biking, taking public transportation, carpooling, limiting errand trips and curtailing summer travel plans. The Federal Highway Administration estimates that in April, the number of miles traveled on U.S. roads was down 1.8% compared to April of 2007, a reduction in miles traveled on public roads for the sixth month in a row. In March, the number of miles was down 4.3% as compared to a year ago and was the greatest decline in travel on public roads since 1979. At the end of June, MasterCard reported its ninth consecutive week in declining gas sales with overall annual gasoline declining for the first time in over 17 years.

Changes in US auto market

But U.S. consumers are making other changes too: they’re no longer buying as many SUVs and trucks, looking instead for smaller, fuel-efficient cars, a move Ford VP of marketing Jim Farley called “breathtaking.” In April 2008, one in five cars sold in the US was a compact or subcompact car, compared to one in eight a decade ago when SUV sales were booming. Pickup truck sales were down 5% overall from last year and Chrysler saw a 22% drop in SUV sales this year. In May, GM reported that overall sales plunged by nearly 28%. Marketing firm J.D. Power & Associates estimates that annual motor vehicle sales will be the lowest since 1995, with a decline of 1.2 million vehicles since last year.

Meanwhile, Japanese manufacturers report booming sales in many of their lines as hybrid vehicles and other fuel-efficient cars are in high demand. The Toyota Prius was the ninth best selling car in the United States in 2007, selling more than 64,000 of the hybrid vehicles and Toyota has now sold 1.5 million hybrid vehicles around the world and plans to sell one million a year after 2010. In May, Honda passed Chrysler in U.S. sales for the first time and Toyota became the number two American seller. In a first, during the same month, Detroit’s Big Three, GM, Ford and Chrysler, together held only 44.4% of the market share as compared to 48.1% held by Asian manufacturers. Toyota is close to passing GM as the world’s top auto seller.

To encourage sales of large trucks and SUVs, some automakers are offering incentive programs: Chrysler has offered buyers the opportunity to lock-in gasoline prices at $2.99 a gallon for three years and Ford announced it would offer “employee pricing” on their F-Series truck, which had previously been the most popular line of vehicles in the country for two decades. Past promotional sales of this kind have led to increased sales but lower profits, another example of the short-termism that has undermined the US auto industry. The Big Three of U.S. auto manufacturers have also cut back on production, with GM announcing it planned to close four North American plants to focus on bringing fuel-efficient vehicles to market.

New marketing and production strategies

U.S. automakers are also shifting their marketing and production strategies. For the last two decades, the SUV and the large truck were marketed to the U.S. public as all-around vehicles used for for hauling large or heavy items, for a quick trip to the store and for the family vacations. These oversized vehicles have also been painted as representing safety, security, power and prestige. Realizing the gravity of declining sales, analysts predict that manufacturers will have to reframe the way SUVs and large trucks are marketed, portraying them as supplemental and used for specific purposes, like hauling heavy loads and work. Manufacturers are currently highlighting SUV hybrids, trying to sell them as more fuel-efficient and environmentally sound. Finally, automakers are boosting production of “small crossovers,” or vehicles that look like SUVs but are built on car underpinnings. These moves suggest the U.S. auto industry is desperate to hang onto that sector of new vehicle sales that brings in the most profit, even as other auto makers have adapted to changing conditions.

However, Detroit’s Big Three are also diversifying their offerings, bringing more hybrids and smaller, fuel-efficient cars to the market. Alan R. Mulally, Ford’s chief executive, explained that current shifts are not temporary, but rather “structural in nature.” While some vehicles are new to the market, others are imported from overseas. General Motors and Ford, for instance, are adding smaller vehicles, such as the Saturn Astra and the Ford Ka, sold in Asia and Europe, to its United States offerings. Officials at Ford see the small car market as a growing one and estimate that global car sales will hit 38 million in 2012, up from 23 million in 2002. In the United States, Ford predicts 2012 small car sales of 3.4 million, up 25% from a decade ago. Manufacturers are also developing a number of new hybrid, ethanol-based and electric vehicles for the market. To compete with the Japanese manufacturers that dominate hybrid car sales and are developing electric cars, in 2010 GM plans to begin production of the Cheverolet Volt, a battery-powered vehicle with a small gasoline engine that allows for recharging.

While some are declaring the era of the SUV and large truck over, US manufacturers, as we have seen, are not ready to let go of the big-ticket items for the domestic market. G.M. plans to manufacturer large trucks and SUVs with diesel engines, claiming that this switch can increase the mileage of large trucks by up to 70%. Japanese maker Toyota remained confident in the recovery of the large-scale truck market, with group VP Bob Carter noting that those who needed larger vehicles would not be willing or able to make the switch to smaller cars.

Surprise or closed eyes?

Although auto analysts and environmentalists have been criticizing the US auto industry’s reliance on SUVs for more than a decade, Detroit’s Big Three seem unified in their shock and surprise at the rapidly declining sales in large trucks and SUVs. George Pipas, Ford’s market analyst stated, “This seismic shift in the marketplace has definitely taken us and everybody else by surprise.” Kelley Blue Book executive market analyst Jack Nerad suggested that top U.S. manufacturers saw a shift toward smaller, more fuel-efficient cars coming in years, not in months. Unlike the gas shocks of the 1970s and 1980s, automakers now hold that high oil prices are here to stay and that the shift toward smaller, fuel-efficient vehicles will be a permanent one.

But how much of a surprise is this shift? In Europe, the use of diesel engines has been standard as they are more fuel-efficient than those based on gasoline and new technology has reduced pollution through the development of cleaner burning engines. Given the current state of oil prices and auto sales, European manufacturers are increasingly looking to the U.S. as a market for the newer diesel engine cars. Japanese manufacturers, meanwhile, have long dominated the production and sale of hybrid vehicles, with Toyota introducing the hybrid in 1997. These manufacturers continue to develop new fuel-efficient and hybrid cars for the market. Nissan plans to introduce an electric car by 2010. European automakers are also shifting production toward even more fuel-efficient vehicles. French maker Renault has partnered with the California-based Project Better Place to produce electric cars for markets in Denmark and Israel with the Israeli government promising to cut taxes on the sale of these vehicles to promote their sale.

The Role of Government

But the decisions of U.S. vs. Japanese and European automakers also needs to be seen in light of the different relations between automakers and government. After the oil shocks of the 1970s and 1980s, European governments sharply raised fuel taxes and promoted the use of diesel by taxing gasoline at higher rates. After the crisis, European governments purposefully retained high fuel taxes to discourage consumption, thus encouraging the design and purchase of smaller, fuel-efficient vehicles as well as the use of public transportation – something more heavily supported by European governments that in the United States.

During the oil shocks, the United States witnessed the first ever fuel economy standards and reductions in speed limits. Small car sales in America increased temporarily with an attendant rise in fuel economy. When gas prices dropped, however, larger vehicles sales increased, due in part to heavy promotion. The United States was the only major developed nation to increase oil consumption during this period and not until this past spring, after 32 years, did Washington lawmakers again pass new energy laws requiring new cars and trucks, as an average, to meet a standard of 35 miles per gallon by 2020. With some of the lowest gasoline prices, lowest energy taxes and most fuel inefficient vehicles in the developed world, “about a quarter of the world’s oil goes to the United States every day, and of that, more than half goes to its cars and trucks,” reports the New York Times.

And in Japan, where fuel taxes resemble those of Europe rather than the United States, making small cars more popular, lawmakers have encouraged the sale of hybrid vehicles over the last decade by offering buyers a $3000 rebate for choosing the more fuel-efficient cars. Seven years before the United States pushed through stricter emission standards, Japanese regulators required manufacturers to achieve gas mileage of 35.5 miles per gallon by 2010. During the mid 2000s, sales of larger vehicles declined in Japan due to the passing of stricter diesel emissions standards that prompted Japanese manufacturers to shift away from the production of trucks or to look to the U.S. for markets. By and large, Japanese and European auto manufacturers who have not relied on big-ticket, large vehicles for the bulk of their profits are now not in the position of dealing with plummeting sales and growing inventories of vehicles. Currently, four out of ten of the fastest-selling vehicles in the U.S. are hybrids, with the Toyota Prius moving quickest with sales occurring, on average, just four days after arriving in dealers’ showrooms.

The China Solution?

Rather than taking a lesson from Europe and Japan, U.S. automakers are turning to China as a new market for big, gas-guzzling vehicles. According to the International Energy Agency (IEA), the world’s demand for energy will increase by 65% during the next twenty years with petroleum remaining as the top energy source. While the United States remains the top energy consumer, the IEA predicts China’s oil demand will double by 2030, with much of this increase being due to the increasing demand for cars. Between 1990 and 2006, the number of vehicles in China increased sevenfold and China now represents the second largest car market in the world and may overtake the largest market, the United States, by 2015. Given this, U.S. and other automakers are looking to China as a strong market for the SUVs and large trucks that Americans are now refusing to buy. During January and February of this year, sales of SUVs in China rose 38% as compared to one year ago. At a spring auto show in Beijing, executive VP of Shanghai General Motors – a partnership between GM and a Chinese partner – Robert Scocia stated “we’re all trying to get into this market.” Looking increasingly toward Chinese markets for growth, GM plans to sell and export over $1 billion in vehicles to one if its Chinese partners while Ford plans to sell over 30,000 vehicles plus transmission components in its own joint venture. However, China does not present an entirely rosy picture for manufacturers committed to producing these high-ticket, gas guzzling vehicles: the Chinese government is increasingly demanding that automakers increase fuel economy, including by producing electric and gasoline-electric hybrid cars. China also recently imposed vehicle taxes based on engine size. Despite these measures, however, China sets price controls on the price of fuel which helps increase demand for larger, fuel-inefficient vehicles associated with prestige as has been the case with the United States.

The World Health Organization reports that 800,000 people die each year from the effects of air pollution. A variety of diseases including cancer, asthma, cardiovascular disease and stroke have been attributed to air pollution. Under pressure from automakers, U.S. lawmakers, particularly under the Bush Administration, have lagged behind European and Japanese governments in passing stricter fuel economy standards and promoting the use of smaller, fuel-efficient cars by raising gasoline taxes. For almost two decades, U.S. automakers focused on the production and marketing of big-ticket, gas guzzling vehicles, contributing to increasing health and safety problems and contributing to global warming. The result: plummeting sales, massive lay-offs of workers and a serious threat to the future viability of the auto industry, previously a central force in the US economy.

In the last 30 years, US businesses have led a concerted and largely successful campaign to get government “off its back” and allow its executives and market forces to solve any economic and social problems that arise. The current plight of the US auto industry may lead some observers to question the wisdom of this strategy and to ask whether the US auto industry, its shareholders, US drivers and the environment would be in better shape today if government had provided more forceful oversight of its business decisions.