In letters to the Food and Drug Administration and the Federal Trade Commission, Center for Science in the Public Interest reported that its tests of eight products marketed online as addressing the symptoms of opioid withdrawal showed the as were “riddled with pseudo-scientific jargon and frighteningly ill-informed.” CSPI urged the FDA to issue immediate warning letters and bring enforcement action that required “cessation of these sales and other such products and allow inspectors to seize products.” It also asked the two agencies to work together to ensure that these companies will not be able to mislead consumers and profit from bogus claims.
How do the business and political practices of corporations conflict with protecting public health? In a talk last week sponsored by the Mexican civil society group El Poder del Consumidor, Corporation and Health Watch founder Nicholas Freudenberg described three types of conflicts of interest: scientific, policy and ideological. In each of these domains, the private—or business –interests of corporations, maximizing profits, market share and return on investment, conflict with the public interest of preventing harm and reducing health inequities.
Read the talk in English here. A Spanish language version, Corporaciones compran partidos y miman gobiernos para exprimir a la gente, afirma catedrático, was published in the Mexican online newspaper Sinembargo and is available here.
Science helps keep us safe and healthy. The public safeguards that keep our drinking water clean and our children’s toys safe rely on independent science and a transparent policymaking process. And we all rely on scientific information to make informed choices about everything from what we eat to what consumer products we buy for our families. But the results of independent science don’t always shine a favorable light on corporate products and practices. In response, some corporations manipulate science and scientists to distort the truth about the dangers of their products, using a set of tactics made famous decades ago by the tobacco industry. In a new guide called The Disinformation Playbook, the Union of Concerned Scientists describes five of the most widely used “plays” and some of the many cases where they have been used to block regulations or minimize corporate liability, often with frightening effectiveness—and disastrous repercussions on public health and safety.
An article in the November American Journal of Public Health analyzes the social networks of the major stakeholders in mobile health app development and describes their financial relationships to each other and to global corporations in technology, pharmaceuticals and entertainment, prime investors in the rapidly expanding mHealth business. The authors conclude that public health researchers need to “extend their scrutiny and advocacy beyond the health messages contained within apps to understanding commercial influences on health and, when necessary, challenging them.” In an accompanying editorial, CHW’s Nicholas Freudenberg notes that in their effort to maintain profitability in a crowded marketplace, corporations selling the 259,000 mHealth apps now on the U.S. market may make misleading claims, cover up defects or market unscrupulously, thus harming rather than helping users. Those mHealth apps that are effective and safe risk widening inequalities in health by being more accessible to the users who can afford them.
In 2014, 64 of the largest economies in the world were corporations and 36 were governments. Two years later, in 2016, 69 were corporations and 31 governments. The source for estimated revenues for governments was The CIA World Factbook and for corporations The Global Fortune 500 List, which reported 2016 annual revenues.
Between 2014 and 2016, total revenues for the 100 largest economies fell by 9%, from $29.9 trillion to $27.2 trillion. In that same period, the ratio of government to corporate revenues of the economies on the top 100 list fell from 1.9 in 2014 to 1.7 in 2016. In both years, governments on the list spent almost twice as much as corporations. This suggests that among the world’s largest economies, governments continue to play a crucial role in spending. What they do and don’t spend their revenues on has a crucial impact on health.
In 2016, the top 5 corporations accounted for about 16% of the revenues reported by businesses on the list. For governments, the five largest accounted for 59% of government spending, a mark of the continuing spending power of the governments of the world’s largest economies: United States, China, Japan, Germany and France. In 2016, the five largest governments outspent the five largest corporations by a ratio of almost six to one. Among the world’s largest economies, Big Government is still much bigger the Big Corporations.
Between 2014 and 2016, government revenues fell for a striking 26 of the 31(84%) governments that were on the list both times. For the 52 corporations on the list in both years, revenues fell for 32(62%), a lower percentage of revenue losers than among governments. Declines in oil prices contributed to falling revenues for both countries and corporations that lost revenue between 2014 and 2016.
Annual revenues are of course only one indicator of the size of a government or corporation but it is one metric that enables comparison of the two. Understanding the changing dynamics between governments and corporations is a critical priority for public health researchers seeking to take on the social determinants of health.
As the debate on the Republican plan for tax reform that promises big reductions in taxes for the wealthy and corporations heats up, public health professionals may have the opportunity to expand the national discussion on taxes and health. One way that Congress could balance the cuts in taxes for the well-off is to reduce the tax deductions that corporations now use. Since the federal tax code was created in 1913, businesses have been able to immediately deduct their full advertising costs. But over the years, proposals to limit the deduction have been floated as a way to raise revenue. In May, The Hill reported that industry groups and more than 100 lawmakers want to prevent tax reform legislation from curbing the deduction for businesses’ advertising expenses. Opponents of dropping this deduction include both Democrats and Republicans and Senate Minority leader Chuck Shumer. “If you make advertising more expensive, there will be less information available to the public,” Jim Davidson, executive director of the Advertising Coalition told The Hill.
For more than 35 years, however, public health advocates and researchers have examined the public health consequences of Internal Revenue Service rules that allow corporations to deduct advertising expenses from their income for tax purposes. The conclusions of that research suggest that advertising by the tobacco, pharmaceutical, ultraprocessed food, alcohol, firearms, automobile and other industries does much more than provide information to the public. It encourages and promotes use of products that are associated with major causes of premature death and preventable illness in the United States. And after getting a tax deduction for this health damaging marketing, corporations then send another bill to their consumers and the public: for the costs of health care and lost productivity generated by the illnesses their aggressively promoted products induce.
Corporations and Health Watch readers who want to become familiar with the evidence on the health impact of the tax deductibility of advertising costs can consult the following sources:
- In 1981, James Mosher and Lawrence Wallack urged the Bureau of Alcohol, Tobacco and Firearms to reconsider the tax deductibility of the billion a year the industry then spent on advertising, given the costs this advertising imposed on the nation.
- In 1992, the American Public Health Association passed a resolution urging Congress to eliminate the tax deductibility of expenses for promoting and advertising of alcohol and tobacco products.
- According to a 2008 study in the Journal of Law and Economics, eliminating the deductibility of costs associated with unhealthy food marketing could reduce rates of obesity by five to seven percent, which would mean 700,000 to 1 million fewer obese children.
- By revoking the tax deductions for Direct to Consumer Advertising, argued a 2012 report in the Santa Clara Law Review, Congress could minimize the harms associated with that practice by using a “sin tax” to force pharmaceutical companies to consider more fully the consequences of such marketing.
- In the 1990s, the automobile industry spent 9 billion tax deductible dollars advertising sports utility vehicles, their most profitable product but also one associated with higher rates of accidents, fatalities and pollution. Once again, tax payers were asked first to subsidize the promotion of these vehicles, the pay again for the higher costs these vehicles incurred.
By introducing this evidence into the current public debate on taxes, public health advocates can set the stage for revisiting an end to the tax deductibility of advertising products that contribute substantially to our nation’s most serious public health problems.
With a new semester getting underway, students and faculty in public health and related fields are looking for additional ways to gain the skills and competencies they need to become effective public health professionals. One promising approach may be to bring corporations more squarely into the public health classroom. No, we’re not talking about giving away McDonald’s branded backpacks to our students, as some schools in Detroit are doing. Nor are we suggesting inviting Fortune 500 CEOs to teach public health classes on corporate social responsibility or market solutions to global health problems.
Today corporations play a decisive role in shaping patterns of health and diseases, public health policy and what the public knows about lifestyles and health. Yet few schools of public health teach systematically about the health impact of corporations or prepare their students to analyze the role of corporations in health and social policy.
In this post, I suggest a few resources for public health faculty and students who want to bring a deeper understanding of corporations into the public health curriculum. These sources can help public health faculty to add assignments and readings about the role of corporations to required and elective public health courses in policy, health education, epidemiology, public health history and environmental and occupational health. They can also help students to write papers, find field work opportunities and pursue careers that help to define appropriate roles for public and private sectors and to prevent or reduce corporate practices that harm health.
Five Useful Websites on Corporations and Health
Corporate Accountability International. One of the oldest and largest global corporate accountability groups with documents covering its campaigns against infant formula, tobacco, fast food, water, nuclear weapons and other industries. Organizes and supports global campaigns to end abusive corporate practices.
Corporations and Health Watch Monitors the impact of corporate business and political practices of food and beverage, firearms, automobile, pharmaceutical, alcohol and tobacco industries. Contains repository of media articles and scientific publications on these topics.
Corporate Watch Provides information on the social and environmental impacts of corporations and capitalism. Since 1996 its research, journalism, analysis and training have supported people affected by corporations and those taking action for radical social change.
The Poison Papers Documents the Hidden History of Chemical and Pesticide Hazards in the United States. The “Poison Papers” represent a trove of rediscovered chemical industry and regulatory agency documents and correspondence stretching back to the 1920s. The papers show that both industry and regulators understood the extraordinary toxicity of many chemical products and worked together to conceal this information from the public and the press. These papers will transform our understanding of the hazards posed by certain chemicals on the market and the fraudulence of some of the regulatory processes relied upon to protect human health and the environment.
Toxic Docs Contains millions of pages of previously secret documents about toxic substances. They include secret internal memoranda, emails, slides, board minutes, unpublished scientific studies, and expert witness reports — among other kinds of documents — that emerged in recent toxic tort litigation. Based at Columbia University and the City University of New York.
Know of other non-profit websites or organizations useful in learning more corporations and health? Send us link and description and we will update resources.
Five Useful Recent Books
These books published in the last year or two introduce recent scholarship on corporations and health. They provide faculty and students with an overview of the topic and can be used in teaching about the health impact of corporations.
Freudenberg N. Lethal But Legal: Corporations, Consumption, and Protecting Public Health. Paperback Edition With new Afterword. Oxford University Press, 2016.
Kenworthy N, MacKenzie R. Lee K, eds. Case Studies on Corporations and Global Health Governance: Impacts, Influence and Accountability 1st Edition Rowman & Littlefield International; 1 edition (July 18, 2016)
Lee K, Hawkins B. Researching Corporations and Global Health Governance An Interdisciplinary Guide. Rowman and Littlefield, 2016.
Quelch JA, ed. Consumers, Corporations, and Public Health: A Case-Based Approach to Sustainable Business . Oxford University Press, 2016.
Walker MJ. (Editor)Corporate Ties That Bind: An Examination of Corporate Manipulation and Vested Interest in Public Health, 2017.
Know of other recent books that might help public health professionals learn more about corporations and health? Send us link and description and we will update resources.
15 Recent Useful Articles
This selection of articles from the last two years shows some of the questions public health researchers are asking about corporations and should provoke discussion in a variety of public health classes. They might also serve as starting points for semester projects or research papers for public health students.
Ajunwa I, Crawford K, Ford JS. Health and Big Data: An Ethical Framework for Health Information Collection by Corporate Wellness Programs. J Law Med Ethics. 2016 Sep;44(3):474-80.
Anaf J, Baum FE, Fisher M, Harris E, Friel S. Assessing the health impact of transnational corporations: a case study on McDonald’s Australia. Global Health. 2017 Feb 6;13(1):7.
Baker P, Friel S. Food systems transformations, ultra-processed food markets and the nutrition transition in Asia. Global Health. 2016 Dec 3;12(1):80
Banerjee D. Markets and Molecules: A Pharmaceutical Primer from the South. Med Anthropol. 2017 May-Jun;36(4):363-380.
Baum FE, Sanders DM, Fisher M, Ana J, Freudenberg N, Friel S, Lamont R, London L, Monteiro C, Scott-Samuel A, Sen A. Assessing the health impact of transnational corporations: its importance and a framework. Global Health. 2016 Jun 15;12(1):27.
Brisbois BW, Cole DC, Davison CM, Di Ruggiero E, Hanson L, Janes CR, Larson CP, Nixon S, London K, Stim B. Corporate sponsorship of global health research: Questions to promote critical thinking about potential funding relationships. Can J Public Health. 2016 Dec 27;107(4-5): e390-e392.
Casswell S, Callinan S, Chaiyasong S, Cuong PV, Kazantseva E, Bender T, Chuckle T, Parker K, Rialtos R, Wall M. How the alcohol industry relies on harmful use of alcohol and works to protect its profits. Drug Alcohol Rev. 2016 Nov;35(6):661-664.
Delobelle P, Sanders D, Puoane T, Freudenberg N. Reducing the Role of the Food, Tobacco, and Alcohol Industries in Noncommunicable Disease Risk in South Africa. Health Educ Behav. 2016 Apr;43(1 Suppl):70S-81S.
Hawkins B, Holden C, Eckhardt J, Lee K. Reassessing policy paradigms: A comparison of the global tobacco and alcohol industries. Glob Public Health. 2016 Mar 21:1-19.
Hawkins B, Holden C. a Corporate Veto on Health Policy? Global Constitutionalism and Investor-State Dispute Settlement. J Health Polit Policy Law. 2016 Oct;41(5):969-95.
Hernandez-Aguayo I, Zaragoza GA. Support of public-private partnerships in health promotion and conflicts of interest. BMJ Open. 2016 Apr 18;6(4): e009342.
Robaina K, Babor TF. Alcohol industry marketing strategies in Latin America and the Caribbean: the way forward for policy research. Addiction. 2017 Jan;112Suppl 1:122-124.
Scrinis G, Monteiro CA. Ultra-processed foods and the limits of product reformulation. Public Health Nutrition 2017;(in press) 1–6.
Weishaar H, Dorfman L, Freudenberg N, Hawkins B, Smith K, Razum O, Hilton S. Why media representations of corporations matter for public health policy: a scoping review. BMC Public Health. 2016 Aug 30; 16:899.
Zoller HM. Health Activism Targeting Corporations: A Critical Health Communication Perspective. Health Commun. 2017 Feb;32(2):219-229.
Know of other recent books that might help public health professionals learn more about corporations and health? Send us citation and link and we will update this list.
Some Corporate Related Competencies for Public Health Students
As the Council on Education for Public Health and other professional bodies are requiring schools of public health to revise and update their competencies and learning objectives, schools have an opportunity to introduce new expectations for their students –and faculty. The competencies listed below can be used in several ways. Core public health courses can include sessions on these topics as they relate to, for example, epidemiology, health policy, environmental health, or health education. Some public health programs have developed specialized courses on the topic, allowing students to pursue this interest. Or a student-faculty interest group can bring together those who want to pursue research, advocacy or practice on the corporate impact on public health
1. Identify corporate business and political practices that affect health.
2. Elucidate the pathways by which they shape patterns of health and disease.
3. Develop public health strategies to encourage health-promoting corporate practices and discourage or end health-damaging ones.
4. Analyze the public health advantages and disadvantages of various government/market relationships
5. Create alliances with consumer, environmental, labor and health organizations and movements that seek to change harmful corporate practices and policies
6. Describe the roles of public health professionals and researchers in modifying harmful corporate practices or policies.
Do you have a syllabus to share or suggested additional competencies? Send them (or a link) to us for posting.