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Cash for Clunkers: who benefits?

The Car Allowance Rebate System, better known as “Cash for Clunkers,” is a federal program that gave car buyers a rebate of up to $ 4,500 on a new car if they trade in an older, less fuel efficient car. The program is meant to stimulate the ailing U.S. economy and reduce pollution caused by cars by committing U.S. tax dollars to the foundering auto industry. Late last month, the federal government ended the Cash for Clunkers program two weeks early because the three billion dollars budgeted for the program had been nearly exhausted. Although hundreds of thousands of Americans took advantage of the rebate opportunity to purchase a new car, and nearly the entire budget was spent, it isn’t clear that Americans (and America) will emerge both economically and environmentally healthier. In this profile, CHW examines the impact of the Cash for Clunkers program on our nation’s health and the environment.

Clash for Clunkers was dramatically more successful in engaging new car buyers than Congress or the White House had imagined: the initial one billion dollar budget intended to last through Labor Day was exhausted so quickly that after just 10 days, Congress funneled another two billion dollars into the program to keep up with demand.

President Obama has declared the program a “proven success” citing the “50% increase in fuel economy” and “$700 to $1000 in annual savings for consumers in reduced gas costs alone…”1 The White House’s assessment of the Cash for Clunkers program has reported some large and impressive numbers to back up their declaration of resounding success: nearly 700,000 cars were sold, $2.9 billion  spent,2 and an estimated 42,000 jobs will be created or saved during the second half of the year as a result of the Cash for Clunkers program. Motor vehicle output added 0.20 percentage point to the second-quarter change in real GDP.3

Has Cash for Clunkers Met its Goals?

Although hundreds of thousands of Americans took advantage of the rebate opportunity to purchase a new car, some environmentalists question whether Americans (and America) will emerge both economically and environmentally healthier. They focus on two issues. First, buyers who took the rebate still had to buy a brand new car at costs coming in somewhere around $25,000 to $30,000. This might have simply shifted consumers spending from one place to another. So instead of spending additional money that they wouldn’t have, new car buyers might now be unable to spend on “appliances, clothes and other stuff that consumers will not buy…now that they have the burden of lease or loan payments for their new vehicles.” 4 If this effect is significant, Cash for Clunkers may end up being simply a government plan to favor the success of the auto industry over the many other industries whose goods American could consider consuming. It is also estimated that 60 percent of the cars purchased under Cash for Clunkers would have been purchased this year anyway, meaning that we might see a post-Clunkers lull in business.4

What about the impact on air pollution? The difference between the average miles per gallon of the trade-ins versus the new cars bought through Cash for Clunkers was about nine miles per gallon.5 According to Jack Hidary, an architect of the Clash for Clunkers program, $700 is the gas savings for driving a car that is 10 miles per gallon more efficient, so it is likely that many buyers will save money by getting a new more fuel-efficient car. The Cash for Clunkers program, however, allowed consumers to trade vehicles in for cars that were only slightly more fuel-efficient.  In the case of passenger cars, consumers could use the rebate to purchase a new car with just four miles per gallon more efficient gas use. In the case of light-duty trucks, the rebate was good for new vehicle purchases that got just one or two additional miles per gallon, emphasizing that reducing emissions was a secondary priority for the program.6

But even if new cars purchased under the program were significantly more fuel efficient, it seems unlikely that the program’s impact will be big enough to improve air quality on its own. One columnist noted that if the new cars purchased under the rebate program get “ten miles per gallon more than the Clunkers they replace, the reduction in gasoline consumption will cut our oil consumption by 0.2 percent per year, or less than a single day’s gasoline use.” 4 Few interventions of any kind can contribute to significant, long-term change unilaterally, so it is not surprising that a program like Cash for Clunkers can’t single-handedly make drastic environmental improvements. Perhaps the only undoubted success of Cash for Clunkers has been its impact on the auto industy: Ford and General Motors saw ten and 21 percent increases in sales in August compared to July.7 Toyota posted even bigger gains.

Measuring Up a “Proven Success”

So was Cash for Clunkers good, bad, or a wash? It is worth remembering that public policies to improve the economy and environment are implemented because unemployment and pollution undermine the long- and short-term health and well-being of human, not because the government or civil society has an interest in the physical environment or job markets in and of themselves. Therefore, measuring the success of the Clash for Clunkers program must compare the opportunities provided and lost to improve public health.

Several news articles have mentioned the safety benefits of Cash for Clunkers: newer cars have better and more safety features, therefore the program will put safer cars on the road. As Consumer Reports mentions:

“…450,778 SUVs and other light trucks that likely lacked electronic stability control and other modern safety equipment [were taken off the road through Cash for Clunker]. The National Highway Traffic Safety Administration has estimated that making ESC standard on new cars would save as many as 10,000 lives a year. This program has taken a significant step toward that goal.”5


This is great news, but thinking about vehicle safety also begs the question: why should the federal government spend three billion tax dollars on bailing out an industry whose products kills and injures so many Americans? In 2008, there were 37, 261 people killed in motor vehicle crashes (a record low) and nearly 2.35 million injured. By those figures alone, the morbidity and mortality caused each year by motor vehicles dwarfs the potential safety gains from Cash for Clunkers. In 2007, a total of 288 people were killed on mass transit of any kind, a number less than 1% of those killed by passenger vehicles.8 In 2006 there were 19, 238 people injured on all forms of mass transit, 122 times fewer injuries than the more than two million caused by motor vehicles.9 Yes, these are absolute numbers- so how do these numbers compare when looking at rates? Motor vehicles kill five times as many people per passenger mile than mass transit.10

Public transportation systems, especially light and heavy rails systems, also create less fuel emissions than motor vehicle, and therefore provide a much longer-term investment in environmental health than Cash for Clunkers can achieve. What if Congress had instead given the auto industry $3 billion to invest in developing new capacities for making mass transit vehicles?

The Cash for Clunkers program also represents a lost opportunity to improve public health in other ways. The nearly three billion dollars spent to boost the auto industy did very little for a key piece of our economic crisis: inequality. The proportion of wealth and earnings by the richest 10% of our communities has steadily risen in the past 30 years. This growing inequality was intimately connected to the underlying causes of the current economic crisis: predatory lending and banking practices that promised to earn executives and their brokers exorbitant amounts of money. Inequality has been documented in public health research as a causal factor in social and health outcomes as diverse as teen birth and mortality. The Cash for Clunkers program, however did little to provide a way for low-income folks to benefit from the government commitment to stimulate the economy. For example, despite the claimed objective to get “clunkers” off the road, cars older than 25 years could not be traded in for the rebate, even though they are the most-polluting, and least fuel efficient and safety advanced vehicles. Also, all cars that were traded in, even if they were fairly new and running well, had to be destroyed under the program’s rules, bringing up the questions of what to do with 700,000 newly junked cars. Will lower-income families who cannot afford a brand new car now have more trouble finding a used (but less than 25 year old) car at all, since trade-ins have to be legally destroyed? Will the destroyed cars pose another set of environmental problems?

As one columnist argued: “…By mandating the destruction of trade-ins, Congress removed 700,000 cars from the used-car market, inevitably driving up prices of the cars that lower-income consumers tend to buy.”4

While no data have come out showing this prediction to be true, it seems that the Cash for Clunkers program did not take advantage of what we know about public health: policy approaches to reduce inequality have economic and health benefits. These same policy approaches, however, also require abandoning the government’s monetary, legislative, and otherwise political support of corporations that harm health. From the subsidizing of harmful industries like the auto industy to the extreme financial deregulation of a decade ago, these pro-corporate polices may appear to be bids for a strong economy, but the impacts are much different. For example, financial deregulation led to the lending practices that disproportionately preyed upon low-income communities and communities of color, and led to the current economic recession.

How About Cash for Buses and Subways?

Why, then, should the federal government’s stimulus efforts ensure that the auto industry survives, as opposed to investing in any other businesses or industries in the United States? An alternative to bailing out a failing industry is to invest in an industry that has seen sharp growth in the past year: mass transit. Currently, mass transit systems across the country are experiencing tremendous cuts to their already inadequate budgets. For example, in July alone the New York City Metro Transit Authority announced 360 jobs cuts, despite having experienced a significant uptick in ridership since the U.S. economy took a downturn. Although mass transit systems are efficient and affordable for riders, urban municipalities that currently maintain such systems do not have sufficient funds to maintain and upgrade them, and fare revenues cover only from 20 to 50% of the costs of maintaining the transit systems.11

src=”uploads/images/old_archives/img/mass_transit_promotion.png” alt=”mass transit promotion by Metro Library and Archive” hspace=”10″ vspace=”5″ width=”250″ height=”250″ align=”right” />A stimulus package that invests in the research, business planning, and workforce to upgrade and create effective mass transit systems has multiple benefits. Cash for Clunkers may have caused an uptick in the employment and earning of auto industry workers, but as many have pointed out, nearly 60% of the sales made under Clash for Clunkers would have happened in the next year anyway, leaving auto workers to brace for another severe dip in demand. Investing in mass transit infrastructure, on the other hand, will lay the groundwork for strong job markets in a variety of fields (from engineering to sanitation) required to support smart, efficient public transportation. The recession has caused a surged in mass transit use across the country, causing its use to reach a 50-year high11,12 and therefore providing a key opportunity to shift transportation trends in the U.S. towards the long-term, permanent growth of these infrastructures. In fact, the Obama Administration’s stimulus package did commit just over eight billion dollars to capital improvements in mass transit systems, including high speed rail lines.12,13 Hopefully this infusion of funds represents more than a temporary stimulus, but a longer-term investment in health promoting industries than can provide sustainable employment, and provide for safe, effective transportation for many times more Americans than just those who can afford a new car.

The gains to the health of U.S. economy and environment as a result of the Cash for Clunkers program can be considered modest at best, and at worst, the U.S. government’s political investment in supporting an industry whose products, cars and trucks, directly contributes to poor health in several ways. The need for government to spur spending, and therefore job growth, could have dovetailed with environmental and public health goals much more effectively. Public policies that foster investments in public transportation is just one of those alternatives. Strengthening mass transit will stimulate job growth and retention in an industry that can be counted on to continue to experience thriving market demand, reduce American consumers’ impact on the environment, and promote public health.



1 Hedgpeth D; Bacon P.With Senate Vote, Congress Refuels ‘Clunkers’ Program. The Washington Post August 7, 2009. Available at: Accessed August 16, 2009.

2 Puzzanghera J; Zimmerman M. ‘Cash for clunkers’ final tally: nearly 700,000 cars sold. Los Angeles Times. Available at:,0,2161518.story?page=2 Accessed August 31, 2009.

3 Bureau of Economic Analysis. Available at: Accessed September 1, 2009.

4 Stelzer I. Seven lessons of Cash for Clunkers’ failure The San Francisco Examiner. August 28, 2009. Available at: Accessed September 1, 2009.

5 Evarts E. Consumer Reports. August 27, 2009. Available at: Accessed September 1, 2009.

6 Fact Sheet: Cash for Clunkers Committee on Energy and Commerce. June 8, 2009. Available at:
. Accessed August 2, 2009.

7 Barth L. September 2, 2009. Available at: Accessed September 2, 2009.

8 United States Department of Transportation Federal Transit Administration. Available at: Accessed September 1, 2009.

9 Bureau of Transportation Statistics. Table 2-33c: Table 2-33a: Transit Safety Data by Modea for All Reported Incidents. Available at:
. Accessed August 25, 2009.

10 Morris EA.The Danger of Safety. Freakonomics Blog from The New York Times.July 2, 2009. Available at: Accessed September 1, 2009.

11 Public Transit Faces New Pressures.  March 10th, 2009. Available at: Accessed September 1, 2009.

12 Epstein, D. For Ailing Transit Systems, Stimulus Windfall Is a Mixed Blessing. June 21, 2009. Available at: Accessed September 2, 2009.

13 Hochberg A. A Hitch For Rail Riders: Getting To Final Destination. September 2, 2009. Available at: Accessed September 2, 2009.


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The health impact of retail practices: towards a research agenda

Every day, owners and managers of hundreds of thousands of retail establishments across the United States make decisions that influence the health of the American people. They decide what to sell, which products to promote, where to display goods and how much to charge for them, and where to locate new outlets.  Their decisions shape the choices consumers face in the market and make it easier or harder for people to buy tobacco, alcohol, food and beverages, medicines, firearms, automobiles or many other products associated with current patterns of health and disease.  In this review, Corporations and Health Watch provides an overview of the impact of retail practices on health and suggests some directions for future research that can guide policies to encourage health-promoting and discourage health-harming retail practices.

Retail practices are the decisions that owners and managers of retail establishments make about how, where and when to sell what to whom.  These practices, listed below, are shaped by corporate policies, the state of the economy, government regulations, customer behavior and many other factors. Other business practices such as product design, pricing and advertising influence and are influenced by decisions about retailing, making it difficult to isolate the unique impact of decisions about retail operations.

While public health officials and advocates have sometimes looked at specific retail practices such as the sales of tobacco products to minors or food safety procedures in restaurants, few public health agencies or researchers have systematically considered retail practices as an important influence on health or considered alternative approaches to encouraging healthier retail business practices.


Selected Retail Practices

Point of purchase advertising
Local advertising 
Internet merchandising
Location and density of stores
Product placement within stores and on shelves
Shelf space dedicated to various products
Sales and pricing
Labeling and warning signs
Verification of customer eligibility (e.g. tobacco, alcohol and guns)


As we shall see, growing evidence makes a compelling case for studying the health impact of retail practices more carefully and of developing new approaches to preventing their adverse consequences.  First, retail outlets are everywhere, as shown below.  No community and few neighborhoods are without several convenience stores, fast food establishments, tobacco and alcohol outlets and drug stores.  Most Americans can buy a gun or an automobile within a few miles of their home. On any given day, up to 100 million Americans visit a convenience store.1 Thus retail outlets are a ubiquitous part of our social environment that play a major role in determining  patterns of the sale and consumption of healthy and less healthy products.


Prevalence of Selected Retail Outlets in US

19,700 new car and truck dealers 2

30,000 beer, wine and liquor stores 3

35,394  supermarkets with $2 million or more in annual sales4

54,000 federally licensed gun dealers5

56,000 retail pharmacies6

80,000 casual-dining restaurants7

144,875 convenience stores8

195,000 fast-food establishment7


Second, data suggest that number of retail outlets or their size is growing, at least in some categories. Between 1970 and 2001, for example, the number of fast food restaurants in the United States increased more than seven-fold, from 30,000 to 222,000.9 While the overall number of super markets appears to have declined, the number of very large stores has increased significantly. Wal-Mart, for example, the world’s largest public corporation, operated 125 stores in the United States in 1975 and 3,800 by 2005.10 The vastly expanded shelf space available in Wal-Mart superstores puts many more products, some healthy and many unhealthy, at the fingertips of consumers across the United States, profoundly influencing the diet of millions of Americans. Similarly, the growth of pharmacy retail chains puts many drug, food and other products within easy reach.

Third, a growing body of research evidence shows that the characteristics of retail establishments influence health and health behavior. For example, local gun retail availability is significantly associated with increased risk of firearm injury and homicide,11 and alcohol outlet density is associated with self-reported driving after drinking and drinking frequency.12Patients living in areas with fewer pharmacies are less likely to fill prescriptions for medications.13 Exposure to point-of-purchase tobacco advertising is associated with higher tobacco use.14 These and dozens of other studies show that retail practices influence health, making a summary and synthesis of these diverse studies an important priority. For a selected bibliography on the health impact of retail practices in the alcohol, automobile, firearm, food and beverage, pharmaceutical and tobacco industries, click here.

In addition, differences in retail practices in different types of communities may contribute to socioeconomic and racial disparities in health. For example, the differing retail face of the alcohol, tobacco and food industries in better off and poor neighborhoods and in Black, Latino and white areas may explain some of the differences in cancer prevalence among these communities. 15 In some studies, differences in the density of supermarkets and fast food outlets in neighborhoods with different socioeconomic and racial/ethnic characteristics have been associated with differences in rates of obesity.16 17

Convenience stores illustrate well how retail outlets can become amplifiers of ill health. Often sited at gasoline stations, convenience stores sell candy, ice-cream, soft drinks, and processed food as well as other products and perhaps some groceries. They are often located along busy highways, in densely-populated urban neighborhoods, or near transportation hubs. Some are open 24 hours a day. In 1994, there were 98,200 convenience stores in the US, today the count is 144,875, an increase of almost 50%.8 In 2008, as shown below, convenience stores sales of cigarettes and other tobacco products accounted for 36.6 % of in-store sales; packaged beverages, mostly sweetened sodas, accounted for 14.1 %; food service, often high fat, sugar and salt cooked products, accounted for 13.9% and beer for 10.2 %.18 This product mix makes these outlets convenient places to purchase the products associated with the nation’s most serious health problems including heart disease, diabetes, stroke, cancer and alcohol-related motor vehicle accidents.


Percentage of Products Sold at Convenience Stores, 2008

Convenience stores sell the products associated with the nation’s most serious health problems including heart disease, diabetes, stroke, cancer and alcohol-related motor vehicle accidents.


Changing Retail Practices to Improve Health

Fortunately, there are several domains of experience in modifying the health impact of retail practices that provide evidence that can guide policy and practice. As shown below, local, state and federal governments, consumers, corporations and retail owners themselves can each take action to change harmful practices. To date, most of these approaches have been tried somewhere but few studies provide evidence about which strategies or mix of strategies are most effective in promoting health and under what circumstances.


Strategies for Changing Retail Practices to Promote Health and Prevent Disease

Changes initiated by government

  • Regulation of products (what is sold, price (via taxes or subsidies), quality; customers (age, sobriety, mental status, criminal record); store environment (safety, hygiene, etc.)
  • Requirements for posting of labels or warning signs
  • Requirements on density of outlets, distance from schools or churches
  • Regulations on hours of operations

Changes initiated by consumers

  • Community organizing to encourage police or regulatory action
  • Boycotts of stores or products

Changes initiated by corporations

  • Slotting fees to support healthier products
  • Development and promotion to retailers of healthier products

Changes initialed by retailers

  • Voluntary posting of health information
  • Strict enforcement of rules on sales to minors
  • Discounts on healthier products

To illustrate with tobacco, perhaps the industry with the best studied retail practices, change can come about through:

  • Restrictions on sales to minors
  • Requirements for warning labels in stores
  • Zoning laws limiting density of tobacco outlets
  • Requirements for placement of displays of tobacco products
  • Consumer boycotts of merchants who continue to sell to minors
  • Ending tobacco industry payments and incentives to merchants who sell their  products
  • Voluntary retailer agreement to stop selling or displaying tobacco products

A review of the evidence on retail practices provides some grounds for optimism that changes in these practices can contribute to healthier environments, behaviors and health outcomes. For example, the decision by a single gun store owner in Milwaukee to stop selling cheap Saturday night special hand guns was associated with a 96% decrease in recently sold, small, inexpensive handguns use in crime in Milwaukee, a 73% decrease in crime guns recently sold by this dealer, and a 44% decrease in the flow of all new, trafficked guns to criminals in Milwaukee.19 In 2007, New York City required restaurant chains to post prominently the caloric content of the food they sold, a policy subsequently adopted by many other municipalities and states. Preliminary evidence suggests that calorie posting may be associated with changes in consumer behavior and in the products that restaurants offer but more research is needed.20 21 22 23 Synthesizing findings such as these from policy, programmatic, voluntary and mandatory efforts to change retail practices across industries and jurisdictions may contribute to new approaches to primary prevention.

Research Questions on Retail Practices and Health

Available evidence suggests that retail practices influence health, that intentional changes in these practices can promote health, and that some jurisdictions have successfully implemented such changes. Thus, the development of a systematic body of knowledge to guide elected and public health officials and advocates may help to accelerate these changes, thus reducing the prevalence and inequities in chronic diseases, accidents and injuries and other health problems. What are some research priorities for a better understanding of the impact of retail practices on health?

  1. How do retail practices change over time and place?

In the last few decades, the density and size of many retail outlets has increased significantly. Some sectors have become increasingly vertically integrated—think Wal-Mart –giving them far greater influence in the economy and in communities. How do macro-economic forces change retail practices? The current recession seems to be favoring retailers who offer bargains and hurting more high-end outlets. What are the health consequences of these changes? Does the recession present any opportunities for more effective oversight of harmful retail practices? What are the best metrics for studying changes in retail practices? For example, a recent study found that that the cumulative shelf-space allocated to energy-dense snack foods was positively but modestly associated with BMI24, suggesting that the imaginative selection of indicators such as shelf-space may help to assess the impact of changes in retail practices.

  1. What’s the role of retailers in the supply chain and what decisions do they make?

From the time a product is manufactured until it reaches the consumer’s hands, it passes through many other hands, including growers, factory workers, packagers, wholesalers, distributors, and truckers. What is the influence of each of these stages on the health impact of retail practices? What are the opportunities for intervention at each stage? In addition, retailers vary in the degree of vertical integration and autonomy granted to local managers.25 How do the health-related retail practices of a vertically integrated company like Wal-Mart,10 which provides detailed real-time data on purchases to store managers, differ from those of chains that give franchisees more autonomy, such as the Subway fast food chain or independent retailers?

To change retail practices will require identifying who makes what decisions. At McDonald’s, for example, managers have little control over what products to offer, suggesting that campaigns to modify product mix will need to target the national corporate level. Bodegas and grocery stores, on the other hand, could decide to display alcohol and tobacco products less prominently, perhaps in exchange for support from health officials for displaying healthier products. Some chain stores set retail prices nationally, while others give local managers discretion. Mapping decision-making across industries and levels (e.g., global and national corporate, regional and local) might help health officials decide on appropriate levels for intervention to achieve a specified change in practice.


  1. What’s the impact of retail practices on disparities in health?

As noted previously, differences in retail practices in communities with different socioeconomic and racial/ethnic characteristics appear to contribute to health inequities.15 What is the fraction of inequities in obesity, diabetes or heart disease that can be attributed to such differences? What are the windows of opportunity for changing disparity-enhancing retail practices such as higher density of alcohol outlets in poor communities or more lax enforcement of tobacco regulations? Does the human rights perspective or civil rights law offer a way of re-framing these issues? For example, some community groups have charged that higher densities of fast food outlets in Black or Latino neighborhoods constitutes a form of racial profiling that widen disparities in health.

On another front, health advocates need to ensure that health-promoting changes in retail practices do not end up exacerbating health inequities. For example, if a supermarket offers healthier food at a higher price, only better off customers may benefit, widening existing socioeconomic disparities in obesity or other food-related health conditions.

  1. What incentives can health officials use to encourage health-promoting changes in retail practices?

For retailers to change practices voluntarily, the costs of change and the adverse impact on their bottom lines need to be low and the promise of a better reputation and increased sales volume and profits needs to be high. A pharmacist may be willing to offer discounts on some prescription medicine to attract customers or a fast food outlet may add salads or fruits to their menus to entice health-conscious mothers and their children. When do these changes lead to real improvement in health and when are they merely public relations window dressing? Health officials and advocates with a firm grasp of how retailers make decisions might be better able to negotiate meaningful changes than those who have to rely on retailers’ good will. For example, a study of how fast food owners made decisions about their menus found that obstacles to healthier menus included the belief that the demand for healthier foods is low and that healthier menu items have a short shelf life and take more time and money to prepare.26 Finding ways to help managers overcome these obstacles may lead to change.

  1. What advocacy strategies are most effective in changing retail practices?

Only a few studies have compared advocacy strategies across industries27 28, and none appear to have focused specifically on campaigns to change retail practices. Developing evidence-based guidelines for selecting the most effective activities to change practices such as location of retail outlets, point-of-purchase marketing or store-based labeling can help health officials and advocates to make more informed strategic decisions.

From a community organizing perspective, one asset for mobilizing for changes in retail practices is that retail outlets have a visible presence in most communities, making them an attractive target. On another level, small business owners often identify with their communities, making them perhaps more open to moral appeals for changing harmful practices and also less likely to leave for other jurisdictions in response to demands for change.

For retail outlets that are closely controlled by a single corporation – McDonalds, Wal-Mart, Walgreens or CVS Pharmacies — shareholder actions by national consumer groups or corporate campaigns using internet or other new communications media might be an option. For global companies whose brand names and logos are their most valuable asset, the threat of a campaign that could engage customers in boycotts or brand shifting at local outlets around the country or world remains a powerful fear.29

Aggregating and analyzing advocacy and health department experiences from diverse efforts to change retail practices can help to develop a framework for selecting effective and efficient strategies.


  1. How can advocates integrate local and global efforts to reduce the harm of retail practices?

Activists seeking to change corporate practices that harm health have learned that successes in one place can lead to defeats in others. In tobacco control, for example, success in changing the practices of the tobacco industry in the United States and other developed nations has led to more aggressive marketing and public relations campaigns in Africa, Asia and Latin America.  Forcing harmful practices to migrate to another region or country can unintentionally maintain or exacerbate developed and developing nation disparities.  How can public health officials and advocates avoid this outcome as they seek to change retail practices?  One strategy that some corporate reform groups have used is to establish global websites and networks, providing a forum for activists working across issues, industries and continents to share information and debate strategy. Some of these focus more on labor and environmental issues than on the retail consumer practices described here.  The box below shows some sources on monitoring retail practices.


Selected resources and organizations on monitoring of retail practices

Corporate Accountability International Value the Meal

Cruz TB. Monitoring the tobacco use epidemic IV. The vector: Tobacco industry data sources and recommendations for research and evaluation. Prev Med. 2009;48(1 Suppl):S24-34.


Slater S, Giovino G, Chaloupka F. Surveillance of tobacco industry retail marketing activities of reduced harm products. Nicotine Tob Res. 2008;10(1):187-93.


Wagner MM, Robinson JM, Tsui FC, Espino JU, Hogan WR. Design of a national retail data monitor for public health surveillance. J Am Med Inform Assoc. 2003;10(5):409-18.

Wagner MM, Tsui FC, Espino J, et al.  National Retail Data Monitor for public health surveillance. MMWR Morb Mortal Wkly Rep. 2004 Sep 24;53 Suppl:40-2

Wal-Mart Watch


Towards a public health agenda on retail practices 
In sum, retail outlets constitute a critical intermediary between the producers and consumers of products that influence health. A better understanding of the forces that shape retail environments and practices may help to inform new approaches to primary prevention of our most serious health problems in these settings. By defining research, advocacy and policy agendas to enhance health- promoting and discourage health-damaging or disparity-widening retail practices, health professionals can contribute to improved population health.


By Nicholas Freudenberg, Distinguished Professor of Public Health at Hunter College, City University of New York and the founder and director of Corporations and Health Watch.



1 Aruvian Research. Convenience Stores in United States – Porter’s Five Forces Strategy Analysis. March 2009. Available at:

2 About the National Automobile Dealers Association. No date. Available at:

3 Hoovers. Beer, Wine and Liquor Stores Industry Overview. No date. Available at:,-wine,-and-liquor-stores/–ID__200–/free-ind-fr-profile-basic.xhtml.

4 Food Marketing Institute. Industry Overview 2008. Available at:

5 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):765-75.

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

7 Fitzgerald M. Making fast food even faster. October 27, 2007. New York Times. Available at:

8 National Association of Convenience Stores. About NACS. No date. Available at:

9 Paerataku S, Ferdinan D, Champagne C, Ryan D, Bray G. Fast food consumption and dietary intake profiles – Fast Food. Nutrition Research Newsletter, Nov, 2003. Available at:

10 Lichtenstein. N The retail revolution How Wal-Mart created a brave new world of business.; New York: Metropolitan Books, 2009.

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

12 Gruenewald PJ, Johnson FW, Treno AJ. Outlets, drinking and driving: a multilevel analysis of availability. J Stud Alcohol. 2002;63(4):460-8.

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

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

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

16 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.

17 Morland KB, Evenson KR. Obesity prevalence and the local food environment. Health Place. 2009;15(2):491-5.

18 Reuters. Convenience Store Sales, Profits Showed Gains in 2008, According to NACS. April 7, 2009. Available at:

19 Webster DW, Vernick JS, Bulzacchelli MT. Effects of a gun dealer’s change in sales practices on the supply of guns to criminals. J Urban Health. 2006;83(5):778-87.

20 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 ;5:51.

21 Ludwig DS, Brownell KD. Public health action amid scientific uncertainty: the case of restaurant calorie labeling regulations. JAMA. 2009;302(4):434-5.

22 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):1680-6.

23 Gerend MA. Does calorie information promote lower calorie fast food choices among college students? J Adolesc Health. 2009;44(1):84-6.

24 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):214-9.

25 Paik Y, Choik DY. Control, autonomy and collaboration in the fast food industry. International Small Business Journal 2007; 25(5):539-562.

26 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):383-8.

27 Nathanson CA. Social movements as catalysts for policy change: the case of smoking and guns. J Health Polit Policy Law. 1999;24(3):421-88.

28 Freudenberg N, Bradley SP, Serrano M. Public health campaigns to change industry practices that damage health: an analysis of 12 case studies. Health Educ Behav. 2009;36(2):230-49.

29 Jones P, Comfort d., Hillier d. Anti-corporate retailer campaigns on the internet. International Journal of Retail Distribution Management 2006;34(12): 882-891.


Photo Credits:
1. roadsidepictures
2. k-ideas
3. glasgows
4. loneprimate
5. walmartmovie

Is the Food Industry Playing with our Brains? New book by former FDA commissioner David Kessler examines neuroscience of overeating

In his new best-selling book titled The End of Overeating: Taking Control of the Insatiable American Appetite, David Kessler, M.D., former U.S. Food and Drug Administration Commissioner, presents research on the newest discoveries of neuroscience related to appetite and eating, as well as the insights he learned from top food industry executives that resulted in his theory on overeating.

It’s no longer news to point out that Americans are gaining weight and most public health folks have heard the alarming projection that if current trends continue, by 2015, 75% of American adults will be overweight and 41% will be obese1 And it’s also no news that many Americans are trying to lose weight. We  spend nearly $60 billion annually on weight loss products and diets 2. This year Weight Watchers stands to earn a $1.58 billion in revenue (excluding sales of food products), and Jenny Craig will earn nearly $610 million 2. Unfortunately, most dieters return to their initial weight within three to five years 3, suggesting that more dieting isn’t going to solve America’s obesity problem.

In his new book The End of Overeating: Taking Control of the Insatiable American Appetite David A. Kessler, M.D., a physician and lawyer who served as Commissioner of the U.S. Food and Drug Administration (FDA) from November 1990 until March 1997, brings a fresh perspective to the obesity problem.  He argues that it is not faulty metabolism or lack of will power that causes people to eat too much or fail at dieting but rather complex brain functions that lead to “conditioned hypereating.” Acording to Kessler, environmental cues trigger biological drives for foods high in fat, sugar and salt  and eventually overwhelm the mechanisms that controlled overeating in earlier eras when unhealthy food was less promoted and less available.

Having spent many years at the FDA synthesizing research on the addictive powers of tobacco, Kessler turned his attention to high fat, salt and sugar foods, which,  after tobacco, are the second leading killer of Americans.   His new book is the result of seven years of research, and last month it emerged on the top-ten bestsellers list for non-fiction in the New York Times Book Review. In his book, Dr. Kessler presents research on the newest discoveries of neuroscience related to appetite and eating, as well as the insights he learned from his interviews with food industry executives.

Hyperpalatable foods engineered by industrial chefs and conditioned overeating

In essence, Dr. Kessler maintains that foods high in fat, salt and sugar alter brain chemistry in a way that compels people to overeat.  While these foods have always been “salient” to humans, the modern food industry has taken advantage of this phenomenon.  Kessler describes how industrial chefs have engineered “hyperpalatable” foods that are layered in fat, sugar and salt to trigger a release of the neurotransmitter dopamine, resulting in “conditioned hypereating.” He profiles engineered foods from some of the most popular brand manufacturers, chain restaurants, and fast food restaurants, including the Cinnamon Crunch Bagel at Panera (430 calories, 8g fat, 430mg sodium), and the Sowthwestern Eggrolls (910 calories, 57g fat, 1960mg sodium) and Boneless Shanghai Wings (1260 calories, 71g fat, 3030mg sodium) from the nation’s second-largest restaurant chain Chili’s Grill and Bar. Dr. Kessler said he estimates that approximately 70 million Americans are affected by hypereating4, and he maintains that  what “the food the industry is selling is much more powerful than we realized.” 5

Advertising: “The emotional gloss”

When  hyperpalatable foods are combined with modern-day marketing and advertising (“the emotional gloss,” as Dr. Kessler puts it), the result is changed social norms that make it acceptable for Americans to eat foods daily that used to be considered occasional treats.  According to Dr. Kessler, “We took down all these barriers; now you can eat anytime, anywhere.  It’s socially acceptable.  We have this constant stimulation, and we’re no longer eating for nutrition.  We took fat, sugar, and salt, made it very appealing, put it on every corner, and made it socially acceptable.” 6 While some have argued that advertising serves an important function in informing consumers about products, Dr. Kessler’s research reveals that food advertisements in fact serve as cues to induce people to eat these engineered, unhealthy foods4. Constant bombarding by advertisements that link these foods to fun and good times makes it more difficult for people to address their overeating.5

Dr. Kessler’s inspiration for the book

In interviews, Dr. Kessler describes his inspiration for the book as well as his own struggles with overeating.  Before he wrote the book, he said that he didn’t know the causes of overeating, but that he knew it “wasn’t just a matter of diet and exercise.” 6 Kessler says his inspiration came seven years ago when he was watching a woman on The Oprah Winfrey Show 5, 6 who in tears, described how she could not control her eating.  He said, “I was sitting there trying to listen as a doctor, but I could also relate to what she was talking about from my own experience.  I needed to understand what was driving her behavior.6

Solutions to the overeating epidemic

This book promises to be highly influential in changing the way that Americans view the practices of the food industry as well as the epidemic of overeating. In an interview with a Huffington Post reporter, Kessler summarized the basic premise of his theory, “Now, we know that highly palatable foods – sugar, fat, salt – are highly reinforcing and can activate the reward center of the brain.  For many people that activation is sustained when they’re cued.  They have such a hard time controlling their eating because they’re constantly being bombarded …For decades the food industry was able to argue, ‘We’re just giving consumers what they want.’ Now we know that giving them highly salient stimuli is activating their brains.” 4

Dr. Kessler says that his book is not meant to be a policy prescription.  Instead, he wants to explain why people  have such a difficult time with overeating. 6 Based on his tobacco experience at the FDA, Dr. Kessler has noted that there are many parallels between problems associated with food and tobacco  industry practices. Both industries manipulate consumer behavior to sell products that are harmful to health.5 He maintains that while government has a role to play, many of the great public health successes have come from changes in the way people perceive the product.4 He states, “We did this with cigarettes. It used to be sexy and glamorous but now people look at it and say, ‘That’s not my friend, that’s not something I want.’ We need to make a cognitive shift as a country and change the way we look at food.” 5


1 Wang Y, Beydoun MA. The obesity epidemic in the United States – gender, age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and meta-regression analysis. Epidemiologic Reviews. 2007;29:6-28. Available at:

2 Miley M. New Year, new round of diet programs. Advertising Age. January 12, 2009.

3 Wadden TA, Phelan S. Behavioral assessment of the obese patient.  In: Wadden Ta, Stunkard AJ, eds.  Handbook of Obesity Treatment. New York: Guilford Press, 2002:186-226.

4 McCready L. Interview with Dr. David Kessler, author of The End of Overeating, on why we can’t stop eating. The Huffington Post. May 6, 2009. Available at:

5 Layton L. Crave man: David Kessler know that some foods are hard to resist; now he knows why. The Washington Post. April 27, 2009. Available at:

6 Hobson K. David Kessler on why we’re prone to eating too much. U.S. News & World Report. May 4, 2009.


Photo Credits:
1. publiccitizen

Researching for Advocacy: The Industry Trade Press as a Resource for Activists

A recent report put out by the Berkeley Media Group, entitled, Navigating the Trade Press: What are the food and beverage industries discussing?, recommends public health advocates concerned with obesity regularly monitor various publications, including trade journals and magazines, to stay on top of the latest developments in the food and beverage industries. This review of the report features links to the report and key trade publications recommended for tracking.

To plan effective advocacy campaigns to change health-damaging corporate practices, activists need to understand what company managers are thinking and what business and political strategies they are planning.  Unlike big corporations and trade associations, few advocacy groups or independent researchers have the resources to hire investigators to gather this intelligence.  One practical and inexpensive alternative is to monitor business and trade press coverage of the industry in question.

A few years ago, the Berkely Media Stduies Group released a useful guide called Navigating the Trade Press: What are the food and beverage industries discussing? [pdf] It provides a starting point not only for activists seeking to change the food industry but also for other corporate campaigners who need an overview of the world of trade presses, business publications geared towards industry insiders.  In the report, author Lori Dorfman and Elena Lingas argue that “reading these sources makes it easier to articulate the divergent goals of public health and the food, beverage, and advertising industries,” enabling advocates, who often go up against companies with many times more resources, to more effectively and efficiently contest the practices of these industries that harm heath.

A web link to a 200-item annotated bibliography of key sources for tracking activities of these industries is a main highlight of Navigating the Trade Press. Separating the sources into business and science- focused categories, and then into tiers according to their direct proximity to issues of interest to most obesity prevention advocates, the report highlights the most relevant sources (including websites) for all public health advocates whose work is affected by these industries.  In addition to these sources, the report recommends that advocates choose specialty journals from the bibliography, in addition to the more general sources listed below, in order to stay on top of  industry practices that affect the issues they work on.   Dorfman and Lingas note that most sources offer an opportunity to sign up for periodic newsletters and news alerts via email, making it easy to monitor issues of interest.

Key sources for tracking food and beverage industry activities:

New York Times Business section (see especially the Advertising column)
Wall Street Journal Marketplace section
LA Times
Washington Post
Ad Age
Ad Week
Grocery Manufacturers of America
Food Institute
Food Chemical News
Obesity Policy Report

Some of these publications may require a subscription for viewing full contents on line. Most large public or university libraries have such electronic subscriptions, making these institutions a useful resource for activist researchers.

Future Corporations and Health Watch postings will examine how policy advocates can use the trade press of other industries (e.g., pharmaceutical, firearms, alcohol, tobacco, etc.) in their work. We invite readers to send suggestions to

To read the full Navigating the Trade Press report and download the excel spreadsheet of food industry sources, please visit:

Mapping the Debate on Food

The Impact of Corporate Practices on Health Inequities in the United States

This month, Corporations and Health Watch focuses on the role of corporate practices in producing or maintaining socioeconomic, racial/ethnic or other inequities in health. In our interview, Stephen Thomas [pdf], the director of the Center for Minority Health at the University of Pittsburgh Graduate School of Public Health and founding co-chair of the new Academy for Health Equity, describes the ways corporate decisions contribute to health disparities and assesses various strategies for putting this issue on the agenda in Black, Latino and other low income communities. In the second feature,Martha Lincoln, a PhD student in anthropology at the CUNY Graduate Center, tells the story of Bidil, a prescription drug approved by the US Food and Drug Agency in 2005 for treatment of congestive heart failure. Bidil is the first “race-specific” pharmaceutical to be awarded federal approval. Lincoln describes the ethical, health and financial issues raised by “racial targeting” of a specific population with a specific drug. The third contribution is a selected bibliography and abstracts of recent scientific publications on the role of corporate practices on health disparities. Finally, Alexandra Lewin examines the impact of rising food prices on the school lunch program, suggesting that these price hikes may further reduce access to healthy food for vulnerable populations.

In this commentary, I review some of the pathways by which corporate practices may contribute to health inequities, describe some of the strategies advocates have used to reduce harmful corporate practices or policies and suggest some directions for research and advocacy.

Pathways: How corporate practices contribute to health inequities

How do corporate practices influence the differential burden of disease on different population groups? In previous work, my colleagues and I have identified four business practices that influence health: product design, marketing, retail distribution and pricing. 1, 2 Let’s examine how each contributes to disparities in health.

Product design

By designing products to appeal to specific groups, producers hope to increase sales to these markets. When the product harms health or the targeted population has other vulnerabilities that can magnify its adverse impact, this practice can lead to differential disease profiles. For example, the tobacco industry added menthol to tobacco products in the belief that African-Americans preferred mentholated cigarettes.3 Some research suggests that menthol cigarettes increase the risk of dependence and tobacco-related illnesses.4, 5, 6 As a result, concludes one researcher, menthol “may be partly responsible for the disproportionately high tobacco-related disease and mortality among African Americans generally and African American males particularly.”3 Similarly, the production of malt liquor, characterized by high alcohol content, a sweet taste and often sold in 40 ounce containers, is designed to appeal to male African-Americans, where it has been associated with higher rates of binge drinking and alcohol-related health and safety problems.7 In both the case of menthol cigarettes and malt liquor the problems associated with a product designed to appeal to a specific population were aggravated by heavy marketing to that group.

Targeted marketing

Tobacco, alcohol, and food companies target advertising at Blacks, Hispanics and low-income communities, leading to greater exposure to health-damaging messages.8, 9, 10 In some cases, differential media exposure further exacerbates the adverse impact. Since African-Americans watch more television than whites, they are more exposed to unhealthy food or alcohol advertisements. One study found that 52% of food and beverage advertisements in magazines for Hispanic women were for unhealthy foods and drinks compared to only 29% in this category in mainstream women’s magazines aimed mostly at white women.11 Other forms of marketing such as product promotions and corporate sponsorships also often target vulnerable groups,12, 13 contributing to the health burden these groups experience.

Retail distribution

Corporations play a role in deciding where to locate retail outlets for their products. The density of such outlets results in differential access by socioeconomic status and race/ethnicity to unhealthy products such as tobacco, alcohol, and high fat foods and less access to healthy products such as fresh fruits and vegetables.14, 15 For example, a study in Detroit found that the nearest supermarket was, on average, 1.1 miles further away from neighborhoods in which African Americans resided than from White neighborhoods.16 Decisions to preferentially locate retail outlets selling unhealthy products in Black, Latino or low income communities and those selling healthy products in better off areas may result solely from an assessment of where opportunities for profit are highest or also from implicit or explicit racial prejudice. The motivation, however, does not change the impact of these decisions on health.

Corporate decisions on retail distribution are also a consequence of patterns of racial segregation. Kwate argues that housing segregation drives out supermarkets, which often sell healthier foods, and attracts fast food outlets, which sell calorie dense but nutrient low foods at an affordable price.17 In this case, housing and real estate policies and corporate decisions intersect to create food environments that contribute to obesity, now increasingly concentrated in low income and Black and Latino neighborhoods.


By developing pricing policies that make unhealthy products more accessible or healthy products less available to low income, Black, Latino or other ethnic populations, corporations contribute to health disparities. In some cases, this differential pricing is the result of impersonal market forces, e.g., super markets cannot offer volume discounts on products for which a strong demand already exists, making some healthy foods more expensive in poor neighborhood than better off ones. In other cases, big companies choose not to confront pricing practices in the informal or black market economy because they are ultimately profitable. The easy availability of unregulated inexpensive handguns (“Saturday night specials”) in poor communities served as a profit center for many gun manufacturers, even though it also contributed to higher rates of homicides and gun injuries.18, 19 Similarly, the ubiquity of “loosies”, single cigarettes, and untaxed black market cigarettes, helps the tobacco industry to attract and keep young and poor customers and also serves to concentrate tobacco-related diseases on the lower end of the socioeconomic spectrum.20

Corporations make decisions that can contribute to maintaining or increasing disparities through these four business practices, but also through their opposition to stronger government regulation. Weak public health regulation adversely effects all populations but especially those with fewer resources to escape or protect themselves from harm. For example, the automobile industry’s success in avoiding more stringent air pollution standards may have a more detrimental effect on low income and Black and Latino populations since these communities are less able to block or move away from highways or other high traffic areas.21 The tobacco industry’s global success in delaying enforcement of laws against illegal sales of cigarettes contributes to the differential impact of the illicit tobacco market by income and race/ethnicity. For example, one California study found that underage Black and Latino youth were 2.5 times more likely to be sold cigarettes than their white counterparts.22 Finally, vulnerable populations may have less access to public health campaigns that provide the knowledge and skills to reduce the impact of health-damaging industry practices.23 When corporations and their allies advocate privatization of public health services, oppose increased taxes to improve public services or sponsor media campaigns that emphasize individual responsibility for health, they may further undermine the capacity of poor Black or Latino communities to protect themselves from harmful corporate practices.

In sum, the pathways by which corporate decisions may create, maintain or widen socioeconomic or racial/ethnic inequities in health suggest that these business practices can be viewed as a significant determinant of health disparities. In the next section, I describe some of the advocacy strategies that have been used to reduce these disparities.

Strategies 24

In recent years, many organizations and individuals have mobilized to change the practices of the industries that contribute to ill health.25 In some cases, these campaigns have targeted industry practices that contribute directly to health inequities. For example, in Philadelphia, a coalition of African American, community, church, and health organizations led a campaign to force R.J. Reynolds Tobacco Company to drop plans for test marketing Uptown cigarettes, a brand aimed at African Americans. 26

Similarly, a coalition of Chicago Black and Latino groups and the attorneys general of several states worked together to force R.J. Reynolds to modify its Kool Mixx, a tobacco promotional campaign that used hip hop music to appeal to young Blacks and Latinos.27 A neighborhood coalition and a university in Chicago joined forces to advocate bans on alcohol and tobacco billboards in low-income communities of color.28 Many communities have used land-zoning regulations to reduce the density of alcohol, tobacco, and fast food establishments.29

In other cases, community or health advocacy organizations have launched counter-advertising campaigns using African American or Latino images and themes designed to counteract industry’s use of similar elements. In schools across the country, including many in big cities with high proportions of low-income students, parents and advocacy organizations are working to force food companies to end marketing of high-calorie low-nutrient foods within schools.30

In sum, public health campaigns to modify health damaging industry practices are a promising strategy for the primary prevention of health inequity. Using social justice and health equity as themes for community mobilization and policy change may help to bring new constituencies into the effort to reduce disparities.25

A Research and Policy Agenda

For researchers, considering corporate practices as a social determinant of health inequity raises many challenging questions:

  • What is the differential impact of business practices such as product design, marketing, retail distribution and pricing on health disparities?
  • How does the relative impact vary by health condition, industry and population characteristics?
  • What is the attributable risk for business practices in producing health disparities? How do business practices compare to (and interact with) other determinants such as poverty, social hierarchy, and social stress?
  • What policy and programmatic interventions are most effective in reducing the harmful impact of business practices?
  • How do strategies for reducing harmful business practices compare in the preferential benefits they bring to disadvantaged groups?
  • How do the business practices that contribute to health inequities in the United States and other developed nation compare to those operating in the global south?

By focusing attention on these and related questions, conducting systematic studies of the efficacy of various intervention strategies, and better documenting the many existing efforts to change industry practices, researchers and health professionals can bring evidence-based lessons to policymakers that would assist them in selecting policies to maximize the potential for the reduction of disparities.31

For policy makers and policy advocates, framing corporate practices that harm health as a cause of health inequity opens the door for new alliances among those working across industries, e.g., food, tobacco, and guns; across political levels, e.g., local, national and global; and across issues, e.g. corporate reform and responsibility, human rights, and consumer protection. Recent calls for the development of social movements to reduce disparities32 create opportunities for dialogue on these issues. To date, however, more attention ahs focused on public rather than corporate policies that contribute to disparities. By expanding our understanding of the causes and solutions to health inequities, public health advocates can help to move from description of disparities to action to end them.


Nicholas Freudenberg is fonder and Director of Corporations and Health Watch and Distinguished Professor of Public Heath at Hunter College, City University of New York.



1. Freudenberg N. Public health advocacy to change corporate practices: implications for health education practice and research. Health Educ Behav. 2005;32(3):298-319.
2. Freudenberg N, Galea S. The impact of corporate practices on health: implications for health policy. J Public Health Policy. 2008;29(1):86-104. 
3. Gardiner PS. The African Americanization of menthol cigarette use in the United States. Nicotine Tob Res. 2004; 6 Suppl 1:S55-65.
4. Garten S, Falkner RV. Continual smoking of mentholated cigarettes may mask the early warning symptoms of respiratory disease. Prev Med. 2003;37(4):291-6. 
5. Richardson TL. African-American smokers and cancers of the lung and of the upper respiratory and digestive tracts. Is menthol part of the puzzle? West J Med. 1997;166(3):189-94.
6. Wackowski O, Delnevo CD. Menthol cigarettes and indicators of tobacco dependence among adolescents. Addict Behav. 2007;32(9):1964-9. 
7. Time to reclassify malt liquor and flavored malt beverages as a distilled spirit? Available at
8. Moore DJ, Williams JD, Qualls WJ. Target marketing of tobacco and alcohol-related products to ethnic minority groups in the United States. Ethn Dis. 1996; 6(1-2):83-98.
9. Alaniz ML. Alcohol availability and targeted advertising in racial/ethnic minority communities. Alcohol Health Res World. 1998;22(4):286-9. 
10. Balbach ED, Gasior RJ, Barbeau, EM. R. J. Reynolds’ targeting of African Americans: 1988-2000. Am J Public Health. 2003; 93:822-827.
11. Duerksen SC, Mikail A, Tom L, Patton A, Lopez J, Amador X, Vargas R, Victorio M, Kustin B, Sadler GR. Health disparities and advertising content of women’s magazines: a cross-sectional study. BMC Public Health. 2005;18;5:85. 
12. Rosenberg NJ, Siegel M. Use of corporate sponsorship as a tobacco marketing tool: a review of tobacco industry sponsorship in the U.S.A, 1995-99. Tob Control. 2001;10(3):239-46.
13. Kuo M, Wechsler H, Greenberg P, et al. The marketing of alcohol to college students: the role of low prices and special promotions. Am J Prev Med. 2003;25(3):204-11. 
14. Schneider JE, Reid RJ, Peterson NA, et al. Tobacco Outlet Density and Demographics at the Tract Level of Analysis in Iowa: Implications for Environmentally Based Prevention Initiatives. Prev Sci. 2005; 15;1-7.
15. Harwood EM, Erickson DJ, Fabian LE, et al. Effects of communities, neighborhoods and stores on retail pricing and promotion of beer. J Stud Alcohol. 2003; 64(5):720-6.
16. Zenk SN, Schulz AJ, Israel BA, et al. Neighborhood racial composition, neighborhood poverty, and the spatial accessibility of supermarkets in metropolitan Detroit. Am J Public Health. 2005 Apr;95(4):660-7. 
17. 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. 
18. Wintemute GJ. Ring of Fire: The Handgun Makers of Southern California, 1994. Violence Prevention Research Program. 19. Wintemute GJ. The relationship between firearm design and firearm violence. Handguns in the 1990s. JAMA. 1996 275(22):1749-53. 
20. Smith KC, Stillman F, Bone L, Yancey N, Price E, Belin P, Kromm EE. Buying and selling loosies in Baltimore: the informal exchange of cigarettes in the community context. J Urban Health. 2007;84(4):494-507. 
21. American Lung Association. Urban air pollution and health inequities: a workshop report. Environ Health Perspect. 2001; 109 Suppl 3:357-74. 
22. Landrine H, Klonoff EA, Campbell R, et al. Sociocultural variables in youth access to tobacco: replication 5 years later.Prev Med. 2000 May;30(5):433-7. 
23. LaVeist, TA. Disentangling Race and Socioeconomic Status: A Key to Understanding Health Inequalities. Journal of Urban Health. 2005;82:iii26-iii34(1). 
24. An earlier version of this section appeared in: Freudenberg N, Galea S, Fahs M. Changing corporate practices to reduce cancer disparities. J Health Care Poor Underserved. 2008;19(1):26-40.
25. Freudenberg N, Bradley SP, Serrano M. Public Health Campaigns to Change Industry Practices That Damage Health: An Analysis of 12 Case Studies. Health Educ Behav. 2007 Dec 12. [Epub ahead of print] 
26. Robinson RG, Sutton C. The coalition against uptown cigarettes. In: Jernigan D, Wright PA, eds. Making news, changing policy: case studies of media advocacy on alcohol and tobacco issues Washington, DC: U.S. Department of Health and Human Services, 1994; 89-108. 
27. National African American Tobacco Prevention Network (NAATPN). National African American Tobacco Network demands that Kool’s stop targeting the hip-hop generation. Press Release. Summerville, NC: NAATPN, 2004 Apr 8. 
28. Hackbarth DP, Schnopp-Wyatt D, Katz D, et al. Collaborative research and action to control the geographic placement of outdoor advertising of alcohol and tobacco products in Chicago. Public Health Rep. 2001;116(6):558-67. 
29. Ashe, M., Jernigan, D., Kline, R, et al.. Land use planning and the control of alcohol, tobacco, firearms, and fast food restaurants. Am J Public Health. 2003; 93: 1404-1408. 
30. Peterson KE, Fox MK. Addressing the epidemic of childhood obesity through school-based interventions: what has been done and where do we go from here? J Law Med Ethics. 2007;35:113-30. 
31. Gibbs BK, Nsiah-Jefferson L, McHugh MD, Trivedi AN, Prothrow-Stith D. Reducing racial and ethnic health disparities: exploring an outcome-oriented agenda for research and policy. J Health Polit Policy Law. 2006; 31(1):185-218.
32. Prevention Institute. Laying the Groundwork for a Movement to Reduce Health Disparities Report II. Prevention Institute, Oakland, CA, April 2007.

Films on Corporate Practices and Health

Feature Films

 Too Big to Fail (2011). This feature film maps the 2008 financial crisis with Treasury Secretary Henry Paulson as protagonist.

Fast Food Nation (2006). This fictionalized version of the book by the same title looks at the impact of fast food and corporate control over food production on health, society and the environment.

The Constant Gardener (2005) Based on the John Le Carre novel by the same title, The Constant Gardener explores how pharmaceutical companies knowingly test dangerous AIDs drugs on populations of developing countries.

Side Effects (2005). A film about a young pharmaceutical rep who is torn between earning a good living and living a good life.

Thank You for Smoking (2005). A satirical look at the practices of the tobacco, alcohol and gun industries and their impact on health.

The Runaway Jury (2003). Based on a John Grisham thriller about the tobacco industry’s efforts to manipulate juries, the film switches to the gun industry’s role in avoiding liability damages.

A Civil Action (1998). A slick lawyer takes on two giant chemical companies for their pollution of a town’s water.

Class Action (1991). Courtroom drama in which father and daughter represent opposite sides in a suit against a negligent auto company.



Fed Up (2014). An examination of how the food industry contributes to America’s obesity epidemic

Food Chains (2014). A look at food workers in America and the challenges they face at the hand of corporations- in this case, supermarkets.

Inside Job (2011). Feature-length documentary about the 2008 financial crisis

Corporate Fascism: The Destruction of America’s Middle Class (2010). How do corporates impact our political system?

Food Inc. (2008). An eye-opening look at how corporations control the food industry

Forks Over Knives (2008). Investigates how the major diseases of our time- chronic diseases related to lifestyle, can be combatted by a diet that rejects processed and animal-based foods.

Poultrygeist (2007) “Poultrygeist” is a satirical look at the fast food industry, examining what happens when “American Chicken Bunker,” a military-themed fried-chicken chain, builds a restaurant on the site of an ancient Indian burial ground. The film was written by a fast-food employee, produced with the support of PETA, and shot almost entirely through volunteer effort.

Bad Seed: the Truth about our Food (2006). An examination of the hidden costs of genetic engineering of food told through the perspectives of farmers, victims of genetically-engineered products, leading scientists, food safety advocates and more.

Big Bucks, Big Pharma: Marketing Disease & Pushing Drugs. This documentary examines how pharmaceutical companies profit through the creation, definition, and redefintion of disease, direct marketing of pharmaceutical products to consumers, and the increasing medicalization of mental and physical health.

The Future of Food (2004) Looking at the effects of genetic engineering in Mexico, the United States and Canada, this film explores the health impact of genetically engineered food and the dangers of increased corporate control over the food system.

Supersize me (2004) Filmmaker Morgan Spurlock examines the impact of fast food consumption by eating nothing but McDonalds food for 30 days and by looking at the impact of the fast food industry on health and society.

The Corporation (2003) Using case studies, this documentary examines corporations through a psychological lens, argues that corporations fit the criteria for psychopathy, and highlights the dangers that corporate practices can have on the environment and society.

Deadly Deception (1991). This academy-award winning documentary bringing to light the side effects caused by the General Electric Company’s production of nuclear materials.


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Restoring Scientific Integrity in Washington 2009

CHW covers the recent Washington conference, Rejuvenating Public Sector Science, where scientists, congress people, commissioners and others convened to address the need for scientific integrity in public policy development. This report covers the conference and takes a look at the presidential candidates’ plans to restore science to the national policy process and re-establish guidelines for ethical science.

Birmingham Steel Plant

One of the most alarming casualties of the last eight years has been the integrity of the science used by the White House and its agencies to guide public policy.  On issues from climate change to reproductive health, energy policy to endangered species, food protection to drug safety, this Administration has manipulated, covered up or censored the work of government scientists and government scientific advisory panels at the Food and Drug Administration, the Environmental Protection Agency, the National Marine Fisheries Service, the US Centers for Disease Control and Prevention, and the National Aeronautics and Space Administration.

At a recent Center for Science in the Public Interest’s (CSPI) conference, Rejuvenating Public Sector Science, Representative Brad Miller, Chairman of the Investigations and Oversight Subcommittee on the House Science Committee, noted that the Bush Administration “celebrates secrecy as a virtue”; muzzles global warming experts; overruled the FDA on emergency contraception; eliminated a scientific committee at Health and Human Services that did not align with the Administration’s ideology and replaced them with industry insiders; closed part of the Environmental Protection Agency’s library network; and censored the Surgeon General.

Several recent reports document the scope of the problem.  A survey of government scientists by the Union of Concerned Scientists found that of the 900 EPA researchers who responded, 60 percent reported at least one incident of political interference in the last five years and nearly 100 scientists reported direct interference from the White House. In a recent article in Mother Jones, Chris Mooney, author of The Republican War on Science, described the “pernicious neglect” of government science and the weakening of rules that limited industry influence on government scientists.

William Hubbard, former Senior Associate Commissioner at the Food and Drug Administration and a speaker at the recent CSPI conference, argued that our current system is “out of kilter.” He listed a litany of problems including weak congressional support, demands for an ever higher burden of proof, an increase in de novo decision making, non-scientists making science decisions, diminished credibility of scientists, and reduced morale among those who do want to restore a less politicized form of science.

Clean energy protester

A new Administration in Washington will have the opportunity to restore scientific integrity—and whoever is elected will have some assets to bring to this battle.   Multiple Senators and Congressmen have fought for public interest science—Senator Boxer has helped to create higher EPA standards, Senator Grassley has proposed rules to reduce conflicts of interest, and both Congressmen Dingel and Waxman have sought to document the Administration’s interference with science and the failure of Congress to follow science.

Moreover, Merrill Goozner, Director of CSPI’s Integrity in Science program, has noted how “greater exposure [to scientific manipulation] has led to greater disclosure.”  Oil companies are now advertising what they’re doing about global warming and Exxon recently announced that they are going to stop funding global warming deniers, Goozner stated.  “The tide is turning on scientific integrity”, he said, as “congressional oversight is making itself felt on Capitol Hill.” And it will be up to the next President of the United States to continue this restoration process. A new Administration, Congressmen Miller stated, “will not be the end for a need for vigilant protection of public sector science.”

Hubbard calls for decisions that are driven by science and made by scientists, congressional and public support for scientists, reduced political appointees at the agency level, support for whistleblowers, presidential leadership and a revisiting of rulemaking procedures.

The Candidates

In a recent National Public Radio All Things Considered interview, both presidential candidates said they will “restore integrity to federal science agencies.” Senator Obama’s adviser called the Bush Administration’s years a “war on science” and vowed that his Administration would have increased transparency.  McCain’s adviser stated how, “He [McCain] has always felt that sound science is a foundation of good public policy,” and that “He believes deeply that the science should be the science.”

Their presidential campaign websites reveal some additional general information on government oversight.

Sen. Obama

Senator Obama’s website lists three ethics problems, two of which relate to scientific integrity:

  1. Lobbyists Write National Policies: For example, Vice President Dick Cheney’s Energy Task Force of oil and gas lobbyists met secretly to develop national energy policy.
  2. Secrecy Dominates Government Actions: The Bush administration has ignored public disclosure rules and has invoked a legal tool known as the “state secrets” privilege more than any other previous administration to get cases thrown out of civil court.

His plan to fix these problems includes specific actions to shine the light on Washington lobbying and federal contracts, tax breaks and earmarks, to bring Americans back into their government and to free the Executive branch from special interest influence.

Sen. McCain

Senator McCain’s website has government reform sub-sections entitled:

  1. Seal the Pork Barrel
  2. Stop the revolving door and restore ethics
  3. Democracy is Not for Sale

The website claims that, “As President, John McCain would shine the disinfecting light of public scrutiny on those who abuse the public purse, use the power of the presidency to restore fiscal responsibility, and exercise the veto pen to enforce it.” It also states that, “As President, John McCain will see to it that the institutions of self-government are respected pillars of democracy, not commodities to be bought, bartered, or abused.”

Looking Ahead

As a relatively unchecked issue for the past eight years the bar for scientific integrity is at an all time low.  It will be up to the public and to the government oversight committees to hold the next Administration accountable for their words and actions.   With an unprecedented climate crisis, high childhood obesity rates, many approved drugs found to have unexpected and serious side effects and an increase in health disparities between the better off and the less well off, it is crucial that both the public and policy makers receive accurate science.  Scientific integrity is crucial to a sound policy process.  As Congressmen Miller reinforced at the CSPI conference, the “manipulation of science is fundamentally incompatible with a democratic debate.”


Photo Credits:
1. NARA/EPA via pingnews
2. teamaskins
3. jurvetson
4. jim.greenhill