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Corporate Practices as a Determinant of Health Disparities: An Interview with Stephen Thomas

Stephen Thomas, Ph.D. is the director of the Center for Minority Health (CMH) and the Philip Hallen Professor of Community Health and Social Justice in the University of Pittsburgh Graduate School of Public Health. He has written widely about racebased disparities and is founding cochair, with Thomas LaVeist from Johns Hopkins University, of the new Academy for Health Equity, an organization whose mission is to “utilize rigorous scientific research, policy development, and community advocacy to eliminate health disparities and create a social movement designed to ensure equal opportunity for health.” Recently Corporations and Health Watch director Nick Freudenberg interviewed Dr. Thomas about his views on corporate practices as a social determinant of health and as a creator of disparities in health, an interview excerpted here.

CHW: In your view, what role do the practices of food, alcohol, and tobacco industries play in explaining differences in black and white health status?

ST: I think this question about fast food, alcohol, and tobacco marketing is an underrecognized burden driving racial and ethnic health disparities simply because of the artificial tension between market forces and issues of personal judgment. I don’t think they’re all artificial but they are sometimes set up as if they are mutually exclusive. In a free society we assume that people have the right to choose and therefore if they choose to make bad choice it’s their fault, not the fault of the broader society or the environment in which they live and operate. And that gives a false choice that has resulted in many African American communities suffering disproportionately from very sophisticated targeted marketing in black neighborhoods when it comes to legal commercial products that are known risk factors associated with poor health outcomes. For a long time, the tobacco industry put a lot of money into cultivating publications and organizations serving African Americans including, but not limited to, Jet and Ebony magazines. Additionally, they’ve sponsored conferences with civil rights organizations like the Urban League and NAACP as well as demonstrate their commitment to “diversity” by hiring black executives to get them into the African American community and establish market share and brand loyalty. The industry’s successful use of “cultural tailoring” resulted in a positive dynamic with black leaders and those spheres of influence in which they operate. In this way tobacco and alcohol industry executives have more “bottom line credibility” than those of us in public health.

CHW: Do you see differences between tobacco and food and alcohol, other industries which play an important role in health, both in the way they’ve acted in black communities and in the way they’re perceived in the black community?

ST: Yes. First of all the alcohol and tobacco industries market products that are not required to sustain life, and yet the food industry does. And both the alcohol and tobacco industries have used sophisticated marketing techniques to penetrate the black community with products that are known to be associated with negative health outcomes. Tobacco is the most egregious because there’s no healthy way to use their products, but the alcohol industry has also been very sophisticated in their penetration. For the food industry, it was only recently that we had enough scientific evidence to show that these poor food choices, (empty calories, fat, supersizing), and the marketing of fast food in black neighborhoods is directly related to poor health outcomes.

Billboard for Uptown Cigarettes, a product developed by RJ Reynolds to market to African Americans but withdrawn after community protests.

CHW: Given these differences, how would you suggest that public health researchers and those concerned about health disparities address the food industry?

ST: I don’t think we’ll be able to fight that battle in the food industry the way we did with tobacco because you do have to eat to live, and so it requires a partnership. We cannot demonize fast food like we demonized tobacco. It’s not likely that we’ll have the equivalent of a tobacco settlement with fast food companies. We might consider following the path of the Robert Wood Johnson Foundation, which is partnering with the food industry as a way of trying to address the national problem of childhood obesity. So it is a Faustian bargain when McDonald’s starts distributing pedometers and positioning themselves to be the promoters of physical activity and good health.

CHW: As food companies look to partner, particularly with African American communities, what should communities do in order to ensure fair partnerships?

ST: I don’t think you can have a fair partnership on an unfair playing field. So I can think of no equal partner when you talk about the industry. I think therefore that vulnerable neighborhoods, be they Black, Hispanic, or poor of any color are always at a disadvantage. So they’d end up trading jobs and economic benefits that do not reduce the risk of the products that’s being marketed in the community. I don’t think it could be done fairly, in other words I think that there is a role for the federal government and for regulation in those kinds of interactions.

CHW: The federal government has said eliminating disparities in health is one of its goals. Do you think Federal, state and local government can make real differences in health disparities by targeting the disparity producing activities of the industries that we’re discussing?

ST: Well the goal to eliminate racial and ethnic health disparities outlined in Healthy People 2010 was really set in motion before the current administration was in place. But the current administration has actually supported decreased regulation and an increase in letting the market decide policy. Their focus has been on personal responsibility and as a result, poor food choices and exposure to alcohol and tobacco advertisements have been seen more as individual choices and moral failings rather than actual business practices, business policies, and federal policies that make urban city communities in particular vulnerable. It’s my hope that in Healthy People 2020 we do not lose the focus on eliminating racial and ethnic health disparities. The sevenpart Public Broadcasting documentary “Unnatural Causes” will hopefully raise awareness about the role that policy and poverty and social determinates of health play in population health. However, if you don’t watch public TV you may not even know that the documentary exists. It’s really up to us as a community to use the documentary to mobilize at the local level as a grassroots movement for health equity. I think grassroots movements can affect change at these broader levels where social determinants of health operate. But it cannot be done unless the community is educated.

CHW: As you’ve probably seen, there’s a lot of discussion in public health about how public health advocates frame issues in order to successfully mobilize communities. I wonder if you think there’s potential for using the disparities in health and the racial targeting frames as a way of approaching industry and personal responsibility for health.

ST: I think that the health disparity and health equity frame has created a space to move beyond the biomedical model, organ systems model and the diseasespecific model, so that we really can address these broader issues. The problem is that the language really doesn’t capture headlines. One need only look at the national news to see literally a story every day focused on a new medical breakthrough for some rare and odd disease and seldom do we have that kind of focus on racial and ethnic health disparities. So we need to do work in how to frame our issues also in a very aggressive media market. Currently, there is no national organization currently focused on health disparity. However, this summer will be the founding meeting of the Academy for Health Equity in Denver and I think that’s the nascent beginnings of a national organization to provide leadership in this area. But, like any new nonprofit organization, it is vulnerable to changes in funding cycles and other startup issues. And because they’ve staked out their moral and scientific ground in “health equity”, the organization may not be able to morally take money from pharmaceuticals and other [such] businesses because it would be a contradiction … inconsistent with their philosophical foundation.

CHW: As you know, advertisers, including alcohol, tobacco and food corporations, use cultural and racial ethnic images and themes to sell products that are health damaging. How do you think this targeting is viewed in the black community and does it raise ethical issues for you?

ST: I think the targeting is viewed positively, even if the product is negative, because the images are so compelling. In other words, the industry has trumped public health in understanding how to shape behavior. They have powerful imagery and we have no equivalent in terms of matching this level of sophistication. So when you see a McDonald’s or any fast food product ad that takes place in a black church or has the gospel theme music, automatically black people resonate with that even though the product may be a well known “killer” of black people. Someone inside the public relations firm has tapped into the cultural understanding of black people. And I have yet to see public health counter with our version of this understanding. And even if we did, we’d never get the market share or broadcast time. So here again we are on an unequal playing field: ethnic targeting works. Our aim should not be to criticize it because they’re being successful with promoting negative behaviors, but to somehow harness it to do just the opposite.

CHW: Do you think that there’s room within ethnic targeting to contest how the food, alcohol and tobacco corporations do that? For instance, the “Truth” Campaign around tobacco targeted youth around a specific set of values.

ST: I think that we can attack it but there are several things I’ve seen that diminish my enthusiasm for how effective it can be. For example, we have tobacco companies now doing primetime TV spots, very highly produced, supposedly promoting antismoking among teens. But if you talk to anyone in the professional health communication industry, they will very clearly tell you that the methods being used don’t work. So what you’re seeing is that the industry is using their market share to promote antismoking messages that they already know don’t work. In the environmental area, we have oil companies promoting environmental friendliness. We will soon see alcohol companies promoting “don’t drink”. I don’t think that we can count on them to actually do things that are not in their selfinterest. And so on the surface it looks like they’re promoting health messages and in reality they’re actually using techniques that have already proven to be unsuccessful in health behavior change. We have no equivalent counter point to this type of PR insurgency. . The Truth campaign was excellent, but fragile in the sense that it is vulnerable to funding cuts and it is vulnerable to only being able to be used on one area like tobacco. We need the equivalent of that across the full range of products being marketed that are known to cause disease.

CHW: Let’s say some grouping of public health professionals and advocates working in African American and Latino communities asks for your advice about how to create such a broadbased mobilization. What advice could you give them? What strategy could they take to counter multiple industries and multiple products to compete effectively with these industries in the middletolong term?

ST: I believe we have to think completely outside of the box. I’m going to be radical here for a moment and say that there should be a tax on companies with products that are known to be associated with premature illness and death. These funds would go into a national endowment to support the media campaign, a campaign that is not under industry control and that would use people like Chris Rock and other entertainers to produce the health education message as part of their public service contribution. I don’t think the reach of the entertainment industry can be underestimated in terms of getting the word out. But there has to be a sustainable funding base that’s not so vulnerable to a downturn in grants and those kinds of things.

CHW: What piece of that do you think can happen on the neighborhood level?

ST: I’ll give you an example around the issue of tobacco: in Philadelphia people literally went out and whitewashed billboards where there were tobacco ads. That was front page news; it was highly visible. It definitely mobilized people, but the problem is that it also destroyed property. And when it was all over, after the media cycle, was what next? The billboards were back up. I think that at the local level, we need to have a billboard audit and to have a policy where some percentage of billboards is controlled by the community to promote health and prevent disease.

CHW: Earlier you talked about the role of tobacco philanthropy in the black community. Do you have any suggestions or thoughts about how to raise that as an issue for dialogue and debate within African American or for that matter other communities?

ST: I think it has to be raised by black people. When white public health professionals raise the issue, they never come up with a way of replacing the revenue that’s lost. As a result, a black magazine or a black organization can’t have its national meeting because the revenue’s lost. So it looks like well wishing white liberals not understanding the dynamics of what it takes to sustain black publications or black organizations. It’s like a false choice, a trap. So there have to be credible African Americans leading this charge.

CHW: Perhaps the tax fund that you talked about could offer a real alternative for supporting arts and cultural and other organizations that would address race and class based health disparities.

ST: Absolutely. Unfortunately, black advocacy groups in Washington that could take on this issue have lost their credibility because they’ve taken money from the tobacco and alcohol industries in order to support their lobbying efforts on behalf of the black community. We shouldn’t underestimate the power of the marketplace. If we get African Americans and other minorities to change their habits then we don’t have to rely solely on the practices of advertisers. There is probably some history of how industries have changed simply because the consumer has changed and I think we need to look back and find examples, especially coming out of the civil rights movement, and see if we can replicate it. I also think that we need enforcement. Finally, I would say that we have to look in the mirror as public health officials and harness the new technology of YouTube, the web and Wikipedia to really break out beyond the traditional channels. Right now as you can see with what’s happened with digital music; the whole industry’s business model is upsidedown. That has opened up space for us in public health to use digital media as a way of creating a new space where the playing field is more equal to create innovative messaging that can promote health and prevent disease. I don’t think we’ve done enough in that arena. And we cannot simply complain; we also have to produce. Now is the time for less talk and more action!

Selected recent peer-reviewed articles on corporate targeting and the impact of corporate practices on socioeconomic, racial/ethnic, gender and age inequities in health

A small but growing number of studies examine how corporate practices influence health inequities. Studies have described and analyzed how corporations target selected populations for marketing of unhealthy products, assessed the impact of these practices on differences in health behavior and health, and explored other ways that corporate decisions maintain or exacerbate health disparities. Here Corporations and Health Watch summarizes a few of these recent reports and invites readers to submit additions to the list for subsequent posting.

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

Analyzes the results of an audit of community supermarkets and fast food restaurants to assess the location and availability of food choices that enable individuals to meet the dietary guidelines established by the U.S. Department of Agriculture. The researchers used supermarket and fast food restaurant audit tools to assess the availability of healthy food choices in the urban area of St. Louis, Missouri. The researchers found that two factors (race and income) are associated with the location of food outlets and the selection of foods available. Individuals living in mixed or white high-poverty areas and in primarily African American areas are less likely to have access to foods that would enable them to make healthy food choices. The researchers recommend collaborations with the business community and political structures to make it economically viable to provide equal access to healthy food choices.

Brody H, Hunt LM. BiDil: assessing a race-based pharmaceutical. Ann Fam Med. 2006; 4(6): 556-60.

Analyzes scientific evidence on BiDil, the first drug approved by the Food and Drug Administration to be marketed to a single racial-ethnic group, African Americans, for the treatment of congestive heart failure. The authors discuss the problems that can arise when race is viewed as a biological-medical construct, leading to an overly simplistic assumption of a racial and hence presumed genetic difference while obscuring the “economic, social, cultural, and ethical issues lurking in the background.” The authors predict that the manufacturer will launch a publicity campaign targeting African Americans, and that family medicine doctors will be asked by their patients for the new “for blacks only” medication.

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

Reviews data on disparities in cancer morbidity and mortality in the United States, and reviews evidence on corporate practices contribute to cancer risk behavior, incidence, and cancer disparities. The authors propose that the practices of the tobacco, alcohol and food industries be considered as modifiable social determinants of health. The authors conclude with recommendations for research, practice, and policy that would lead to what they term “less carcinogenic” corporate practices.

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.

Analyzes pathways by which racial segregation contributes to higher density of fast food outlets in Black neighborhoods in US. The author proposes that population characteristics, economic characteristics, physical infrastructure and social processes of Black neighborhoods each contribute to creation of “localized geographic areas for targeting by fast food corporations and operators.”

Kwate NO, Lee TH. Ghettoizing outdoor advertising: disadvantage and ad panel density in black neighborhoods. J Urban Health. 2007;84(1):21-31.

Investigates correlates of density of outdoor advertising in predominantly African American neighborhoods in New York City. Authors found that that black neighborhoods have more outdoor advertising space than white neighborhoods, and these spaces disproportionately market alcohol and tobacco advertisements. By linking census data with property data at the census block group level, investigators found that two neighborhood-level determinants of ad density were income level and physical decay.

Macdonald L, Cummins S, Macintyre S. Neighbourhood fast food environment and area deprivation-substitution or concentration? Appetite. 2007l;49(1):251-4.

Investigates associations between area deprivation and the location of the four largest fast-food chains in Scotland and England. The authors report statistically significant increases in density of outlets from more affluent to more deprived areas for each individual fast-food chain and all chains combined. They conclude that these findings support a “concentration” effect whereby environmental risk factors for obesity appear to be ‘concentrated’ in more deprived areas.

Monsivais P, Drewnowski A. The rising cost of low-energy-density foods. J Am Diet Assoc. 2007; 107(12): 2071-6.

Discusses the results of a study on the energy density and retail prices of 372 foods and beverages in major supermarket chains in the Seattle, WA metropolitan area in 2004 and 2006 (energy density and prices were calculated in terms of $/100g and $/1,000 kcal). The researchers discuss the role of lower energy-density foods as a strategy for managing overweight and obesity. The two-year price change for the least energy-dense foods was +19.5% whereas the price change for the most energy-dense foods was -1.8%. The researchers suggest that the lower price of energy-dense foods and the resistance of energy-dense foods to price inflation may help explain why the highest rates of obesity in the United States are observed among those with limited economic means.

Morrison MA, Krugman DM, Pumsoon P. Under the radar: smokeless tobacco advertising in magazines with substantial youth readership. Am J Public Health. 2008; 98(3): 543-48.

Reviews the level of advertising of smokeless tobacco products before and after the Smokeless Tobacco Master Settlement Agreement (STMSA). The researchers determined that the STMSA appears to have had a limited effect on adolescents’ exposure to the advertising of smokeless tobacco in magazines with high youth readership. The researchers determined that adolescent boys (aged 12-17) are at greatest risk for exposure to smokeless tobacco advertisements.

Primack BA, Bost JE, Land SR, Fine MJ. Volume of tobacco advertising in African American markets: systematic review and meta-analyses. Public Health Rep. 2007; 122(5): 607-15.

Reviews the peer-reviewed literature on the density of pro-tobacco media messages. Of the studies identified for inclusion, 11 met the eligibility criteria for the current review. The researchers pooled the results of these studies in a meta-analysis and conclude that African Americans are exposed to a higher volume of pro-tobacco advertising. The researchers also cite evidence demonstrating that African Americans bear the greatest morbidity and mortality burdens due to smoking, and that exposure to pro-tobacco media messages predicts cigarette smoking.

Schor JB, Ford M. From Tastes Great to Cool: Children’s Food Marketing and the Rise of the Symbolic. Journal of Law, Medicine & Ethics. 2007; Spring issue on Childhood Obesity: 10-21.

Discusses the increasing participation of children in the consumer markets, their heavy media use and exposure to high levels of advertising. The researchers discuss deteriorating diets and rising obesity, as well as the shift in children’s food advertisements from product attributes to symbolic messages. The researchers cite studies that demonstrate that exposure to junk food marketing is much higher for low-income children as well as racial and ethnic minority children, groups that also have higher rates of obesity.

Thompson DA, Flores G, Ebel BE, Christakis DA. Comida en venta: after-school advertising on Spanish-language television in the United States. J Pediatr. 2008; 152(4): 576-81.

Analyzes the content of food and drink commercials aired during after-school hours (3 to 9 p.m.) on two Spanish-language television stations in the United States. The researchers found that children viewing Spanish-language television in the United States after school are exposed to food and drink commercials, mostly advertising unhealthy foods, including fast foods and sugared drinks. The researchers propose that food and beverage advertising to children via Spanish-language television may contribute to the high rates of obesity among Latino children.

Yerger VB, Przewoznik J, Malone RE. Racialized geography, corporate activity, and health disparities: tobacco industry targeting of inner cities. J Health Care Poor Underserved. 2007; 18(4 Suppl): 10-38

Reviews more than 400 internal documents from the tobacco industry to explore the ways in which the tobacco industry targeted inner cities populated predominately by low-income African American residents in the 1970s-1990s. The authors cite studies demonstrating that smoking rates remain higher among the poor, the less educated and other underserved populations, despite significant reductions in the overall smoking rate in the United States. This archival analysis demonstrates how the tobacco industry’s promotion activities and the “menthol wars” fought by tobacco companies in America’s inner-cities have contributed to the tobacco-related health disparities that we observe today.

Corporations and Campus Research: How private industry dollars influence scientific discovery and threaten public health

On March 26, 2008, the New York Times published a front page story revealing that the Liggett Group, a major tobacco company, had supported research at Weill Cornell Medical College showing the benefits of early screening for lung cancer. The article, published by the New England Journal of Medicine in 2006 did not disclose the source of funding. The Journal’s editor, Dr. Jeffrey M. Drazen, told the Times“In the seven years that I’ve been here, we have never knowingly published anything supported by a cigarette maker.” The authors of the report and officials at Weill Medical College denied any effort to cover up the source of the funding. However, former New England Journal editor Dr. Jerome Kassirer, author of a book about medical conflicts of interest, expressed skepticism about this denial. He told the Times that he believed that Weill Cornell had created the foundation to hide its receipt of money from a cigarette company. You have to ask yourself the question, ‘Why did the tobacco company want to support her research?’ They want to show that lung cancer is not so bad as everybody thinks because screening can save people; and that’s outrageous.

Last November, the University of California at Berkeley and BP, the global energy company formerly known as British Petroleum, signed a $500 million, 10-year deal to create the Energy Biosciences Institute to conduct research on energy and environmental issues. BP will appoint four of the Institute’s eight directors and, according to the Daily Cal, the Berkeley student newspaper, at least 50 BP scientists will be able to conduct proprietaryresearch at UC Berkeley and the University of Illinois. These researchers work under the sole control and discretion of BP, and their work can remain secret and thus free from scrutiny. Critics expressed concerns about the academic integrity of the Institute and also questioned a partnership with a company that has been indicted in numerous environmental violations and illegal business practices. Only a few months prior to signing the contract with Berkeley, BP and its subsidiaries paid $373 million to settle dozens of legal cases, including one that involved the leaking of crude oil from pipelines in Alaska.

To prove that UC doesn’t limit sponsorship to industries under attack by public health and environmental advocates, University of California at Davis recently accepted an endowed chair in chocolate science from the Mars Corporation in order to study the antioxidant properties of cacao.In fiscal year 2006-7, UC received more than $16.6 million from Philip Morris for tobacco research, and in September 2007, the Board of Regents voted 14 to 4 to continue accepting tobacco money for faculty research. According to the San Francisco Chronicle, nearly all the regents expressed disdain for the tobacco industry’s criminal behavior and distortion of research, but several of those who voted to continue to accept funding said they were deferring to faculty concerns about academic freedom. Intended to shield researchers from tobacco industry influences, the resolution adds new administrative procedures. Under this new measure, research proposals seeking tobacco industry funding are now required to pass through a scholarly review and receive approval from the campus chancellor. In addition, the UC president must present annual reports to the Regents on the number of proposals submitted, approved and funded, along with a description of each.

Moving east, the University of Virginia’s School of Medicine decided in 2006 to accept $25 million from Philip Morris to fund research on youth and tobacco. When challenged on the decision, Dean Arthur Garson insisted the answer was simple, a company has offered us $20 million to develop better ways so kids don’t smoke. Period.

These and many similar accounts highlight a growing trend in academia to accept industry money to pay for research, new laboratories, and high-powered professors. In 2005, industry provided universities with $2.3 billion for research and development. While the dollar amount has been growing, according to Daniel Greenberg, author of Science for Sale The Perils, Rewards and Delusions of Campus Capitalism,1 industry actually contributes only a tiny fraction of the overall university research budget—far more comes form government sources such as the National Institutes of Health (NIH) and the National Science Foundation (NSF). In New York State, for example, total university spending on research and development in 2004 was $3.4 billion, of which only $146 million—just over 4%—came from industry.

Why the new push for corporate funding for university research?

If industry pays for only a small part of academic research, why are universities now so eager to pull in industry dollars? Why are they willing to cede control of their own research, a prerogative often jealously guarded in the past? And what are the consequences of this growing source of support for academic institutions and for public health research? In this reportCorporations and Health Watch examines industry influence on academic research; assesses its impact on universities, science and public health; and describes critics’ efforts to counter this trend and pose other policy options.

As in any intimate relationship, changes reflect the concerns of both partners. For universities, the most obvious starting point is dollars. Between 1970 and 2003, federal funding for research increased dramatically, making it easy for many universities and researchers to steadily increase their research revenues. Just between 1999 and 2003, the NIH budget more than doubled from $13 billion to $27 billion.2 But since then, the Bush Administration has cut funding for scientific research at both NIH and NSF, forcing universities to turn elsewhere to support their habit.

On the business side, the quest for a stronger and more direct presence in university research reflects the downturn in federal funding but also a recognition that direct funding offers some advantages. These include the right to conduct research that benefits companies directly; to withhold information that could jeopardize profits; and to send university scientists to appear in public forums to advance the company’s agenda, perhaps with greater credibility than their own staff. In the longer run, these trends can help business to privatize university research, allowing market forces and the search for profits—rather than academic traditions—to dictate the rules of research. As Robert Reich notes in his new book Supercapitalism,3 increased competition among global companies forces them to seek every competitive edge they can find. Increasingly, bought scientists are one such edge.Rather than discontinue research projects altogether, universities and health institutions are taking up partnerships with corporations, exchanging rights to intellectual property for financial support. While this practice is not uncommon to university engineering and technology programs, its increasing presence in the biomedical and other health sectors is of particular concern to the health of the public.

The BP deal with Berkeley illustrates these benefits of direct funding, allowing dozens of scientists to pursue a research agenda shaped by the company on university property, where scientists benefit from the publicly supported (through California tax support and prior NIH funding) research infrastructure but escape the usual obligation to share their findings with the public and the wider scientific community.

The tobacco industry has long hired scientists to ‘debunk,’ or increase doubt about accepted scientific findings that show that tobacco causes cancer and other health conditions. Research studies show that several industries often withhold research findings that could cause a problem for their products or choose to require scientists to pose their research questions in a way that minimizes the possibility for finding harm.

In 2005, the British newspaper The Observer reported that a respected osteoporosis researcher at Sheffield University had questioned American pharmaceutical giant Procter and Gamble’s (P&G), decision to publish drug research in his name even though he had not been given full access to the data that the paper reported, and that the report was written by a ‘ghost writer’ paid for by P&G before being given to him.When researchers change findings at the behest of the sponsoring company to or fail to disclose industry sponsorship of their work, companies exploit the credibility of apparently independent scientists. In the case of Vioxx, the painkiller withdrawn from the market by Merck after it was linked to serious cardiovascular side effects, it appears that university scientists changed their findings at the behest of the company. The editor of the New England Journal of Medicine, which originally published the study, charged that an internal company memo showed that the researchers knowingly suppressed data on three additional heart attacks among Vioxx users that was available months before the paper was published.4 Had that data been included, Vioxx would have looked much riskier.

If universities and companies benefit from new partnerships, what’s the problem?

While growing corporate academic research partnerships may bring benefits to both universities and companies, they raise serious problems for academic integrity, scientific credibility and public health.

First, the imperative to produce findings that benefit the bottom line encourages biased, even dangerous science. For example, on his blog (BrodyHooked) and in his new book Hooked: How Medicine’s Dependence on the Pharmaceutical Industry Undermines Professional Ethics,5 Howard Brody, Director of the Institute for the Medical Humanities University of Texas Medical Branch notes that commercially sponsored studies paid for by the pharmaceutical industry are roughly four times more likely than neutral studies to favor the company’s drug. So commercial bias has been shown to be real and substantial.Similarly, researchers found that studies sponsored by the food industry to evaluate the health benefits of their product were 7.6 times more likely to find such benefits than were studies wholly funded by independent sources.6

Closer corporate ties may also jeopardize traditional academic values of freedom of inquiry, an obligation to share and disseminate research findings freely, and to criticize other researchers’ work without fear of reprisal. In exchange for their dollars, companies often ask universities to sign agreements that restrict publication rights, assign patents or other intellectual property to the company rather than the scientist or the public, and compromise protections for human volunteers.This biased evidence base can skew public policy deliberations—if negative findings have been suppressed, policy makers may falsely assume a product has been demonstrated to be safe. Moreover, increased media focus on industry manipulation of scientific research to benefit its bottom line, whether by suppressing negative findings, ghost writing articles, or preventing authors from sharing proprietary discoveries that could benefit the sponsoring company, can tarnish all scientists. This increased distrust of scientists can make it harder for researchers to participate in public debate as independent voices. For example, when it turned out that much of the research evidence—and advocacy—on behalf of the Human Papilloma Virus vaccine was sponsored by Merck & Co., the maker of the vaccine Gardasil, many citizen groups opposed mandatory vaccinations, even though most public health officials believe the vaccine is a public health advance.7

Since companies support research that they believe will bring in new revenues, they are more likely to fund projects that yield intellectual property that can be patented and sold, such as alternative fuel sources, new processed foods, or medical drugs and devices. Some of these products may promote population health but others do not. Significantly, research that benefits the public but does not generate profits is avoided, thus skewing the research enterprise. As corporate funding increases and government funding declines, this trend may accelerate.

Companies often attach many strings to their gifts, ensuring they can maintain control of the research. For example, in the partnership between BP and UC Berkeley, BP requires that it appoint company representatives for 4 out of 8 board of director seats. Corporate ties to university leaders are especially prevalent in medical schools. In a national survey of department chairs at 140 medical schools and teaching hospitals, Eric Campbell, Senior Scientist at the Institute for Health Policy at Massachusetts General Hospital, found that 60% of department chairs and 67% of departments as administrative units had relationships with industry—as a consultant, member of an advisory board, paid speaker, officer, founder, or member of the board of directors.8 When such ties are normative, resisting undue corporate influence may be especially difficult.

Developing guidelines for reducing corporate influence on university research

In summary, closer ties with corporations may represent a threat to universities because they can undermine academic freedom, divert university resources from other more pressing scientific questions and social needs, and make universities accessories to corporate interests rather than free-standing critical institutions.

In recent years, several research organizations and researchers have proposed guidelines to reduce corporate influences on university research. Many professional organizations, university administrators and researchers are resisting the corporate takeover and seeking to establish professional guidelines and standards that limit corporate influence on the university.

Public Citizen’s Health Research Group, for example, lays out a framework in which one can begin to think about solutions to or prevention of potential conflicts. In a 2007 report to the Institute of Medicine’s Committee on Conflict of Interest in Medical Research, Education, and Practice, the Health Research Group described three basic approaches that can be taken up by institutions—legal restrictions, policy restrictions, and disclosure.9

As an example of a policy decision, the University of Texas’ McCombs School of Business recently turned down an offer of money from Altria Group, the former parent company to Philip Morris. For UT McCombs, the decision was an ethical one. Dean George stated the leadership of the school felt that in some sense it was tainted money, that it is money gotten from a product that is significantly harming people. Associate Dean Paula Murray called the decision to turn down Altria’s money a no-brainer. 10

Professional associations like the International Epidemiology Association, the Institute on Medicine as a Profession, and the Union of Concerned Scientists, as well as advocacy campaigns such as the Restoring Scientific Integrity Network, the Prescription Project, theCenter for Tobacco Control Research and Education, and the Center for Science in the Public Interest work to educate researchers about corporate influences on university research and advocate for the adoption of policies that will remove industry interests from academic research endeavors.

Both the Center for Science in the Public Interest (CSPI) and the Union of Concerned Scientists offer explicit policy options for universities and individual researchers.

 

How to get corporate interests out of academic research

1. Universities can adopt corporate funding policies to protect their autonomy and preserve researchers’ academic freedoms.

2. Universities can prohibit representatives of corporate donors from sitting on research programs’ governing boards.

3. Universities can prohibit industry donors from controlling the content and direction of research programs.

4. Universities can eliminate ‘first rights’ intellectual property clauses from donor agreements.

5. Universities can ensure that company representatives cannot make substantive editorial changes in manuscripts or delay their publication.

Source: The Center for Science in the Public Interest. Strings Tied to Industry-Academic Collaborations at ‘Big Oil U.’ Press Release. Jan 22, 2008.

And the Union of Concerned Scientists called on the scientific community to hold Congress accountable to upholding the pursuit of scientific integrity with the following suggestions:

Scientists employed by government institutions commit themselves to serve the public good free from undisclosed conflicts of interest and to carry out science that is reliable and useful, while respecting statutory limitations such as national security laws. Therefore, government scientists should, without fear of reprisal or retaliation, have the freedom to:

  • Conduct their work without political or private-sector interference;
  • Communicate candidly their findings to Congress, the public, and their scientific peers;
  • Publish their work and to participate fully in the scientific community;
  • Disclose misrepresentation, censorship, and other abuses of science; and
  • Have their technical work evaluated by scientific peers.

A third set of guidelines, shown below, has been proposed by the Royal Netherlands Academy of Sciences.11 These provide detailed suggestions for how to negotiate university industry agreements that do not compromise academic integrity or bias results. By using these various guidelines, academic institutions and university researchers can begin to reassert their rights and responsibilities to set the terms for their scientific inquiries.

Declaration of scientific independence*

1. The structure of the research shall not be geared towards producing the desired outcome for the client.

2. The assignment and its objective shall preferably be formulated jointly by the client and the researcher.

3. Remuneration and other tokens of appreciation shall never depend on the outcomes or interpretation of the research.

4. The results of the scientific research shall be published irrespective of whether they are favourable to the client.

5. The scientist shall always be free to publish the findings of the research within a specified reasonable period of time. In this context two months can be regarded as a reasonable period, with six months generally the maximum (this period being calculated from the moment that the final results are submitted to the client). An exception should be made where there are issues of intellectual property in which case a period of no longer than 12 month would be acceptable.

6. The methods of publication shall be stipulated in the contract. Publication in a scientific journal shall take place in consultation with the client, but the researcher shall have the final say on the contents, the authors, the form of publication and where the research will be published.

7. External financiers of research assignments and/or other sponsors shall be mentioned by name in publications and other forms of disclosure.

8. Relevant interests and/or advisory relations of the researcher(s) shall be cited in publications and other forms of disclosure.

9. The text of the contract shall be available for inspection in confidence by the National Council on Research Integrity (LOWI).

 

*This Declaration forms the heart of the code of conduct proposed by the Royal Netherlands Academy of Sciences.

Source: Van der Meer J et al, 2007.11

References

1. Greenberg DS. Science for Sale The Perils, Rewards and Delusions of Campus Capitalism.ChicagoILUniversity of Chicago Press; 2007.
2. Mervis J. NIH Shrinks, NSF Crawls as Congress Finishes Spending Bills. Science. 2006:311(5757):28–9. 
3. Reich RB. Supercapitalism: The Transformation of Business, Democracy, and Everyday Life. New York: Kopf; 2007. 
4. Curfman GD, Morrissey S, Drazen JM. Expression of concern: Bombardier et al., Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. N Engl J Med. 2000;343:1520-8. 
5. Brody H. Hooked: How Medicine’s Dependence on the Pharmaceutical Industry Undermines Professional Ethics. Rowman & Littlefield Publishers, Inc.: Lanham, MD; 2008.
6. Lesser LI, Ebbeling CB, Goozner M, Wypij D, Ludwig DS. Relationship between funding source and conclusion among nutrition-related scientific articles. PLoS Med. 2007 Jan;4(1):e5. 
7. Allen TJ. Merck’s Murky Dealings: HPV Vaccine Lobby Backfires. Special to CorpWatch, March 7th, 2007. Available at:http://www.corpwatch.org/article.php?id=14401. Accessed March 24, 2008. 
8. Campbell EG. Institutional academic industry relationships. JAMA. 2007;298(15):1779-86.
9. Lurie P. Presentation before the Institute of Medicine’s Committee on Conflict of Interest in Medical Research, Education, and Practice (HRG publication #1830). November 5, 2007. Washington, DC. Available at:http://www.citizen.org/publications/release.cfm?ID=7553
&secID=1656&catID=126
. Accessed on March 24, 2008. 
10. Finder A. Some Campuses Decide Tobacco Company Money Is ‘Tainted.’ The New York Times. Feb 4, 2008. Available at:http://www.nytimes.com/2008/02/04/education/04tobacco.html. Accessed on March 24, 2008. 
11. van der Meer JW, de Gier AM, van Swaaij WP, Katan MB. Independent medical research. Neth J Med. 2007;65(4):124-6.

Corporations, Health and the 2008 Presidential Race, Part 2: Clinton, Obama and McCain on the Role of Corporations

The next President of the US faces some important decisions on the role that corporations will play in politics, the economy and health. He—or she—will need to decide whether to continue or end the Bush Administration’s dismantling of the federal regulatory apparatus, whether and how to restore the FDA’s capacity to protect our food and drugs, what role global corporations will play in setting trade rules, whether to limit or expand the role of money and special interests in politics, and whether or how to counter the health influences of the food, tobacco, alcohol, pharmaceutical, gun, automobile and other industries. As Americans elect their next Decider-in-Chief, what do we know about the positions of the main contenders on these critical issues? In the first of two reports, Corporations and Health Watch reviews the evidence on the positions of Senators Hilary Clinton, John McCain and Barack Obama on these questions.

Predicting how a candidate will act once elected is always difficult. As we have seen, he who campaigns as a compassionate conservative can morph into Scrooge. With three sitting Senators running for office, it is possible to compare their votes on critical issues. In addition, by tracking which industries contribute to whom, we can at least see how industry leaders use their checkbooks to rate the candidates. Finally, public statements, campaign websites and prior involvement with corporations provide additional sources of evidence, as do Presidential ratings by advocacy and political groups of various political perspectives.

Role of federal government in corporate oversight

In the last few years, the US Senate has voted on several issues related to government oversight of corporations, providing some insights into the candidates’ views. For example, Senator Clinton voted for restricting rules on personal bankruptcy (2001) (the business position) and for repealing the tax subsidy for companies that move jobs offshore (2005) (against the business position). She has said there is a culture of corruption and cronyism in Washington and that we need to stop outsourcing critical government functions to private companies, close the revolving door between government and the lobbying shop, and end no-bid contracts.1 Recently, her office has issued a report describing her economic blueprint for the 21st century that includes more populist language on corporations than in earlier campaign documents. She calls for leveling the playing field by reducing special breaks for big corporations, and goes on to note:

Over the past seven years, big corporations and special interests have been given a free pass to profit, often at the expense of the American worker. As President, Hillary will make it a priority to scale back special benefits and subsidies to these corporations and put those resources to work for our economy again. She will again take on the special interests and restore the voices of working families. Hillary’s plan to reign in the special interests will take back at least $55 billion per year from drug companies, oil companies, and firms that ship jobs overseas and invest those resources to improve the lives of working families.2

Senator Obama voted against reforming bankruptcy to include means testing and restrictions (2005) and for repealing the tax subsidy for companies that move jobs offshore (2005), both votes against the business position. Obama has said that corporations should be responsible for work conditions and pensions and that there should be tax incentives for corporate responsibility. He has criticized the excess influence of agribusiness lobbying and said he would work to reduce this if he were president. He states that the US should close tax loopholes for companies that relocate abroad and end tax breaks for companies that outsource jobs.1

In these votes, McCain voted for restricting rules on personal bankruptcy (2001), for reforming bankruptcy to include means testing and restrictions (2005), and against repealing the tax subsidy for companies that move jobs offshore (2005)1 all votes in favor of the business positions on these issues. In January 208, McCain advocated making the Bush tax cuts for corporations permanent, noting, I would make sure that not only the tax cuts are made permanent, but we cut corporate income taxes. That would keep businesses here, and it would keep jobs here and create jobs here.

In 2006, based on 12 key Senate votes, the US Chamber of Commerce noted that John McCain endorsed their positions on 100% of the votes, Senator Clinton on 67%, and Senator Obama on 55%. Seventeen other senators, all Republicans, shared McCain’s perfect business rating. Twenty eight senators, all Democrats and one independent, had lower scores than Obama, i.e., were rated less business friendly according to the US Chamber of Commerce criteria. These ratings suggest that both Obama and Clinton vote with business more often than their Democratic colleagues while Senator McCain represents the most-business friendly sector of Republican Senators. More recently, the Chamber of Commerce lowered its rating of Senator McCain to 80%.

Despite this voting record, compared to the other Republican Presidential candidates, Senator McCain has been perceived to be less friendly to business interests. The ISI Group, a New York brokerage firm, noted, If there was a bill negative for HMOs or pharmaceutical companies during the past eight years, chances were good that John McCain was the Republican sponsor.4

On tobacco, in 1998, McCain proposed anti-smoking legislation that would raise taxes on cigarettes, restrict the industry’s ability to advertise, and grant the Food & Drug Administration broad new authority over tobacco companies. The proposal would also have limited liability suits against the Big Tobacco. McCain estimated that his package would cost the industry more than half a billion dollars over 25 years. In an aggressive lobbying campaign, the tobacco industry defeated the measure in the Senate.

In the 2008 primary campaigns, McCain received less money from the tobacco industry than other Republican candidates and less than Clinton and Obama.5 A Republican operative observed that Senator McCain is not well-beloved by the lobbying world, to say the least, and he’s used that to his advantage with voters.3 The recent New York Times story that Senator McCain had a close and what the Times called an inappropriate relationship with a telecommunications lobbyist.

In the 2007 checkbook primary, lobbyists cast their dollar-votes for Senator Clinton, contributing $823,087 to her, compared to $416,321 to Senator McCain and $86,283 to Senator Obama.7

Energy and the Automobile Industry

The next President will need to decide whether to make incremental or substantive changes in US energy policy. What do their voting records say about the current top contenders?

Senator Clinton voted against terminating CAFE standards within 15 months (2002), for targeting 100,000 hydrogen-powered vehicles by 2010 (2003), against the Bush administration’s energy policy (2003), for banning drilling in the Arctic National Wildlife Refuge (ANWR) (2005), for factoring global warming into federal project planning (2007), for making oil-producing and -exporting cartels illegal (2007), and for removing oil and gas exploration subsidies (2007).1

Senator Obama voted for banning drilling in ANWR (2005), for reducing oil usage by 40% by 2025 (2005), for factoring global warming into federal project planning (2007), for making oil-producing and -exporting cartels illegal (2007), and for removing oil and gas exploration subsidies (2007).1

Senator McCain voted for oil drilling in ANWR in 2000 and against oil drilling in ANWR in 2002, promising new images of flip-flops in coming days. He voted against terminating CAFE standards within 15 months (2002), for targeting 100,000 hydrogen-powered vehicles by 2010 (2003), against the Bush administration’s energy policy (2003), for banning drilling in ANWR (2005), and against reducing oil usage by 40% by 2025 (2005). His positions on energy policy are more pro-environmental than President Bush but less than his Democratic opponents.1

On emission standards, the US Chamber of Commerce observes that Clinton has said as President, she would increase fleetwide fuel economy standards to 55 miles a gallon by 2030 with funds to help automakers modernize; Obama would double fleetwide fuel economy standards within 18 years with tax credits and loan guarantees to help automakers modernize and McCain supports raising fuel economy standards but has not specified by how much.2

The Campaign for America’s Future, a strategy center for the progressive movement that advocates more sustainable energy policies, has given Senators Obama and Clinton a rating of 100% and Senator McCain a rating of 17%.

Regulating the drug industry

Another key decision facing the next president is how to shape the nation’s approach to regulation of the drug industry. In the past eight years, the FDA’s reputation and credibility have declined sharply, both because of under-funding and close ties to the industries it regulates.

Senator Clinton has advocated that the FDA should provide more oversight over pharmaceutical companies’ financial relationships with providers. There is no mention of direct-to-consumer advertising or data marketing practices, but seems to focus solely on the relationship with prescribers. Senator Obama has said that some drug manufacturers are explicitly paying generic drug makers not to enter the market so they can preserve their monopolies and keep charging Americans exorbitant prices for brand name products. He has said his health care plan will work to ensure that market power does not lead to higher prices for consumers. In the Iowa primary, McCain said that if there are ways to bring greater competition to our drug markets by safe re-importation of drugs, by faster introduction of generic drugs, or by any other means we should do so….8

A pro-drug industry website that monitors the FDA noted that Clinton, McCain and Obama all favor drug importation. That means that it is inevitable that a president who favors importation will be in the White House with a Democratic House and Senate that will be more receptive to the concept than at any time prior.8

Money in politics

It is likely that the influence of money on politics will be a topic for discussion in the 2008 general election, yet the heavy reliance of all candidates on corporate money (see Corporations, Health and the 2008 Presidential Elections, Part 1, Following the Money) makes it difficult to imagine any pf the candidates supporting substantial reforms.

While McCain has been a strong supporter of limiting the influence of money in politics—he once said his support for McCain-Feingold bill was an issue of transcendent importance to him—he will have a hard time reconciling this commitment with his promise to appoint Supreme Court justices like Scalia and Thomas—consistent supporters of Big Business and opponents of campaign finance reform. A recent story in Business Week asked, Is John McCain Good for Business?, observing that McCain has crusaded against the influence of corporate lobbyists, yet has more K Street fixers raising money for his campaign than any other Presidential candidate.9 The recent New York Times and Washington Post stories on his relationship with a lobbyist emphasize his vulnerability on this issue. In the 2007 primary cycle, 78% of McCain’s contributions campaign from corporate funds. Meanwhile, Hillary Clinton appeared on the cover of Fortune magazine as Big Business’s candidate; and last Spring Obama was the top recipient of Wall Street contributions, suggesting that no matter who wins, business will have ready access to the next President.

In future articles in this series, Corporations and Health Watch will examine the candidates’ positions on free trade, the food industry and on FDA reform.

References

1. Campaign Issues 2008.
2. Hilary Clinton. Solutions for America. Economic Blueprint. Hillary Clinton’s Economic Blueprint for the 21st Century
3. US hamber of Commerce. Senate Vote Scorecard, 2006.
4. Quoted in Calmes J, Frangos A. “McCain’s Breaks with GOP left scars but could increase his “electability”.” Wall Street Journal. February 7, 2008, p A1 and A16.
5. Corporations and Health Watch. Corporations, Health and the 2008 Presidential Elections Following the Money.
6. Rutenberg R, Thompson MW, Kirkpatrick D, Laboton S. “For McCain, Self-Confidence on Ethics Poses Its Own Risk.” New York Times. February 21, 2008, p. A1.
7. Open Secrets.
8. Eye on the FDA. Where the Candidates Stand Parts 1-8.
9. Javers E. Is John McCain good for business? Business week. February 6, 2008.

 

View CHW’s coverage on Corporations, Health and the 2008 Presidential Race:

Part 1: Following the Money
Part 2: Clinton, Obama and McCain on the Role of Corporations Part 3: Clinton, McCain, Obama and the Food Industry

Strategic Alliance: Tools for Shifting the Food Debate Upstream

As more communities become concerned about finding ways to reduce increasing rates of obesity, many coalitions struggle to find a way to move beyond changing individual behavior and local government policies that contribute to overweight to taking on the food industry and other more upstream influences. The Strategic Alliance for Healthy Food and Activity Environments (SA) provides a model for this more holistic approach. SA works to improve the health of Californians by providing solutions for community organizations and residents to take action to create healthier food and physical environments. Here we focus on their work to change the food and beverage industry’s influence on food choices.

The alliance’s programs examine and challenge the food and beverage industry’s influence on daily life, with a particular emphasis on practices that reach the lives of children. For example, SA has worked with others to change corporate policies on food marketing in stores and on television, the use of celebrities to endorse unhealthy products, and exclusive soda and fast food contracts with school districts. are just some of the areas where SA rallies for change. By equipping advocates with resources, research, information, training and assessment tools, SA assists communities to reduce the promotion of unhealthy food.

SA views local initiatives as the driving force for changing local, state, federal and corporate policies. By supporting these initiatives with education, media analyses and policy advocacy, the Alliance strengthens and accelerates the creation of healthier food and activity environments.

Education

SA encourages concerned citizens and organizations to learn more about the ways corporations shape nutrition and physical activity environments. To educate and mobilize parents, advocates, young people and health providers, SA publishes reports, sponsors training programs and distributes assessment tools. For example, a report called Setting the Bar: Recommendations for Food and Beverage Industry Action calls on the food, beverage and restaurant industry to “make meaningful changes to support people in making nutritious food choices.” It lists simple steps these industries can take in the areas of product, price, place, and promotion. The box below shows the suggestions that food industries can use to make products healthier. Presented in simple language, the 3 page report serves as a tool for activists and a guide for sympathetic business owners who want to make changes.

Important Steps for the Food and Beverage Industry

Provide healthy food and beverages as the standard in all children’s meals and on children’s menus.

Add new menu items that are healthy, affordable, tasty, and satisfying, including entrées, appetizers and side dishes.

Reformulate food products to decrease calories and lower saturated fat, trans fat, sodium, and added sugars, and add more fruits, vegetables, whole grains, legumes, nuts, and seeds.

Make available, and promote low calorie or no calorie beverage options without artificial sweeteners (e.g., water, low-fat milk) that help customers to manage their calorie intake.

Eliminate large and extra-large food and beverages portions.

SA also created the Environmental Nutrition and Activity Community Tool (ENACT), an interactive, networking tool and development guide designed to connect communities with effective strategies to counter health harming industry practices. The guide allows users to review successful programs, input specific needs, and evaluate ongoing projects.

For example, alliance members can use ENACT to determine the extent to which fast food endorsements of preschool educational materials effect children’s health in their communities in order to decide whether to make this action a priority.

The American Public Health Association endorses ENACT, saying it “provides a road map for change, offering a practical starting place for communities and making healthy eating and regular activity a realistic option for everyone.” [1]

Through its educational activities, SA provides materials to create initiatives and challenge the food and beverage industry’s influence in childcare centers, schools, after school programs, neighborhoods, workplaces, health care providers and government agencies. This support has helped local initiatives to, for example, limit fast food businesses in the neighborhood, improve nutrition standards in public schools, and remove unhealthy food marketing in local groceries.

Media Analysis

Since the media exert a powerful influence on food choices and public opinion on food policy options, SA also assists activists and advocacy organizations to analyze media coverage of food issues, to frame their own messages more effectively, and to design media advocacy campaigns in support of policy objectives. To achieve these goals, SA teamed up with the Berkeley Media Studies Group (BMSG) to create an advocacy project called the Rapid Response Media Network. The project serves as an action network and resource for nutrition and physical activity advocates. The goal of the project is to unravel health harming messages that blame individuals for diet related diseases, and move toward an analysis that holds corporate practices and government policies responsible for shaping our daily environments.

Advocates can engage the Rapid Response Media Network through several resources. The project monitors, analyzes and produces reports on food and beverage industry current events. Armed with the network’s reports, alliance members are encouraged to carve out the front-lines of nutrition and physical activity advocacy. The project also provides consulting services and issues ‘Framing Briefs,’ helping tease out complex messages and aiding a unified voice.

To give an example, the Network helped members analyze a quote from Jim Skinner, CEO of McDonald’s, that appeared in the Wall Street Journal. “We [McDonald’s Corp] are not going to solve the world’s obesity problem. But what we can do is be productive and be part of the solution” by providing consumers with “choices” [2].

How can advocates contextualize the underlying health messages in Skinner’s comment? The Rapid Response Media Network ‘Framing Brief,’ Reading Between the Lines, compares Skinner’s focus on “choice” to other corporate marketing and sponsorship campaigns. Philip Morris, PepsiCo and Kraft also attempted to redirect negative media attention away from unhealthy products by evoking the same strategy.

According to the ‘Framing Brief,’ “The emphasis on choice reinforces the common frame in American culture that individuals are solely responsible for their own health. Choice links directly to personal responsibility. Personal responsibility is extremely important, but decisions are always made in a context. Focusing on choice obscures the context” (p. 3).

Larry Cohen, founder of SA’s parent organization, The Prevention Institute, and author of Prevention is Primary (2007), details the importance of broadening media coverage around nutrition and physical activity environments. Cohen’s 2005 article in the California Journal of Health Promotion, The O Word [3], says that an individual-focused prevention response to obesity does not improve health and, in fact, can adversely affect communities. “…The persistent drumbeat of ‘obesity’ oversimplifies a complex issue. It places the blame squarely on the individual, without taking into account the social and economic influence of where people live, work and play” (p. 154).

Using similar reasoning, Lori Dorfman of BMSG, calls on advocates to “reframe” public health issues. To Dorfman, nutrition is just one example of how health prevention efforts can shift from individually-focused efforts to a more holistic context. In order to “reframe” issues, Dorfman says the social, economic and political context must also be considered [4].

By supporting media analysis and advocacy, SA and The Prevention Institute advance their mission of strengthening local efforts to influence corporate and government practices that shape daily nutrition and physical activity environments.

Policy Advocacy

In addition to its educational and media work, SA also seeks to advance a policy agenda that addresses local, state, federal and corporate food policies. Its steering committee includes such organizations as The California Adolescent Nutrition and Fitness Program, California Center for Public Health Advocacy, California Food Policy Advocates, California Pan Ethnic Health Network; California Park & Recreation Society; California Project LEAN; California WIC Association, Child Care Food Program Roundtable; Latino Health Access Prevention Institute, and the YMCA of the East Bay, giving the group access to hundreds of organizations and thousands of individuals. By bringing consistent policy messages to legislators, Mayors and the Governor from these sources, SA enhances its political clout.

Its policy recommendations, included in reports such as Taking Action for a Healthier California: Recommendations to Improve Healthy Food and Activity Options, recommend steps the food and beverage industry can take to improve food environments and also public policies to monitor industries impact on health more carefully. Several recommendations are open-ended, allowing communities to tailor community-specific programs. For youth involved in pre-school, public school and after-school settings, for example, SA recommends the removal of advertising and marketing of unhealthy food, provisions for nutritious food standards, and increasing physical activity programs.

Taking Action for a Healthier California is changing the way some California cities approach prevention efforts. As a result of local policy advocacy, San Francisco and the City of Berkeley have endorsed many of SA’s recommendations, joining more than 75 organizations that have committed to improving nutrition and physical activity environments.

Working to further develop action at the policy level, SA tracks local policy decisions related to food and physical activity through the ENACT Local Policy Database (ENACT LPdB). Policy coverage includes school district, city, county and state levels where community activities and coalitions have worked to achieve change.

Advocates are encouraged to use the ENACT website and ENACT LPdB as both educational and development models. The approach endorsed by SA is designed to motivate advocates to “act locally” through social organizing around the role of the built environment.

A year ago, the Strategic Alliance issued a report called Where’s the fruit? charging the food industry with deceptive labeling and advertising of many processed foods by implying they contained more fruit than they did. The report attracted broad television and newspaper coverage, educating millions of people about the issue. “The deception is really intolerable,” Larry Cohen, executive director of the Prevention Institute, told the San Francisco Chronicle [5]. “There is really no excuse for misleading parents in a way that weakens their ability to encourage their children’s health” [5]. By bringing together researchers, community organizations and policy advocates SA had helped to ‘reframe’ the way society views health behavior and politically popular policy recommendations. Equally important, SA had given local activists the tools they needed to move their fight for healthier food upstream, from individual and parental responsibility to corporate accountability.

 

References

1. Food and Nutrition Resources. American Public Health Association. Summer 2006 Newsletter. Available at: http://www.apha.org/membergroups/ newsletters/sectionnewsletters/food/summer06/2494.htm.

2. Adamy J. Boss Talk: How Jim Skinner Flipped McDonald’s. Wall Street Journal. Jan 5, 2007. B1. Available at: http://wsjclassroomedition.com/monday/mx_07jan08.pdf.

3. Cohen L, Perales DP, Steadman C. The O Word: Why the focus on obesity is harmful to community health. California Journal of Health Promotion. 2005;3(3):154-61. Available at: http://www.csuchico.edu/cjhp/3/3/154-161-cohen.pdf.

4. Dorfman L, Wallack L. Moving Nutrition Upstream: The case for reframing obesity. J Nutr Educ Behav. 2007;39(2 Suppl):S45-50. Available at: http://linkinghub.elsevier.com/retrieve/pii/S1499404606006014.

5. Finz S. Fruit Shown on Lable Often Not in Box, Kids’ Food Study Says. San Francisco Chronicle. Jan 26,2007. Available at: http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2007/01/26/ MNGMHNPK671.DTL.

New Resources on Global Trade and Public Health

At the November 2007 meeting of the American Public Health Association in Washington, D.C., several sessions addressed the issue of trade and health.  Many of these sessions were sponsored by the new Trade and Health Forum and address global economic policies that generate health disparities.

Presentations on global trade and public health are now posted on the CPATH website at:  http://www.cpath.org/id28.html

Corporations, Health and the 2008 Presidential Elections, Part 1: Following the Money

Presidential elections provide one opportunity to shine some light on how Big Business seeks to create a political environment favorable to its interests. Between now and November 2008, Corporations and Health Watch will include periodic reports on the positions of leading Presidential candidates on public oversight of corporate practices that influence health; the elections roles of the pharmaceutical, food, tobacco, automobile and other industries, and the prior legislative records and corporate involvement of major candidates. Our first report focuses on the role of money: what industries are contributing to the various candidates. Our focus here and in future reports is on the role of the industries monitored by Corporate Health Watch: alcohol, automobiles, firearms, food and beverages, pharmaceuticals and tobacco.

Using analyses conducted by Open Secrets at the Center for Responsive Politics, we can identify contributions made to the 2008 Presidential campaigns by both political action committees (PACs) and individuals affiliated with a particular industry (usually as a result of employment) through September 30, 2007. Final 2007 reports will be available at the end of January 2008. Our report covers the 3 major Democratic candidates and the 5 leading Republicans.

PAC and Individual Contributions by Selected Industries for 2008 Presidential Candidates

Candidate Registered Lobbyists Pharma & Health Products Health Profs Tobacco
Democrats        
Hillary Clinton $567,950 $269,436 $1,695,830 $36,600
John Edwards $18,900 $15,000 $419,326 0
Barack Obama $76,859 $261,784 $1,330,743 $8,885
Republicans        
Rudolph W. Giuliani $212,100 $138,850 $1,026,452 $77,400
Mike Huckabee $6,964 $500 $70,750 0
John McCain $340,365 $69,300 $568,880 $5,600
Mitt Romney $229,475 $260,535 $1,041,267 $32,400
Fred Thompson $90,000 $26,900 $174,675 $1,250

Totals on these charts are calculated from PAC contributions and contributions from individuals giving more than $200, as reported to the Federal Election Commission. Individual contributions are generally categorized based on the donor’s occupation/employer, although individuals may be classified instead as ideological donors if they’ve given more than $200 to an ideological PAC. Shows contributions through September 30, 2007.
Source: Open Secrets

As shown above, Hilary Clinton led the Democratic field in contributions from all four categories of contributors, although Barack Obama was a close second in contributions from the pharmaceutical industry and from health professionals and their organizations. On the Republican side, Mitt Romney led the pack in total fund raising form these four sources with Rudolph W. Giuliani a close second. Health professionals split their contributions fairly evenly among Republicans and Democrats as did the pharmaceutical industry and registered lobbyists. Only tobacco consistently favored Republicans, giving about twice as much to them as to Democratic candidates. Note that on the Democratic side, the level of contributions were somewhat similar to the level of support received from Iowa caucus goers and New Hampshire voters. For the Republicans, however, Iowa winner Mike Huckabee received few contributions perhaps because of his late rise in the campaign, while candidate Rudolph Giuliani won substantial support from contributors but not Iowa or New Hampshire voters.

Industry’s bipartisan approach to political contributions reflects both the heterogeneity of these categories, at least within mainstream American politics, but also the hedge- your-bets philosophy of special interests. No matter who wins, they want a friend in the White House. Registered lobbyists larger contributions to Clinton and McCain may demonstrate these candidates’ longer tenure in Washington and thus their established relationships with lobbyists.

While both the pharmaceutical and health products industry and health professionals (hospitals, medical associations, medical suppliers) provided substantial support to several candidates, these industries were not the major contributors to these campaigns. Donors from the securities and investment, legal, hedge fund and real estate industries were more significant donors to most major candidates than the industries shown in the table above.

Role of the Pharmaceutical Industry

As James Ridgeway and Joan Casella noted in Mother Jones recently, “Any candidate who genuinely plans to confront Big Pharma must be prepared to give up a boatload of cash”. Between 1998 and 2007, the pharmaceutical industry spent more on lobbying than any other industry, spending a total of $1.3 billion with $191 million in 2006 alone. Between 1990 and 2007, drug manufacturers contributed a total of $149 million to federal election campaigns. On the Democratic side, John Edwards has failed to raise significant contributions from Big Pharma, perhaps because of his prior life as a trial lawyer who won large settlements from pharmaceutical and health care industries.

PAC Contributions

Another perspective comes from an examination of PAC contributions to the Presidential candidates. According to the Center for Responsive Politics, as shown below, business PACS heavily favor Republican candidates and Labor PACS, not much of a presence in 2008 contributions to date, heavily favor the campaign of John Edwards. Single issue groups are organizations that span the ideological spectrum and support or oppose issues such as abortion, gun control, or gay marriage. They constitute a major component of Barack Obama’s PAC contributions but without analyses of the specific sources it is difficult to draw conclusions.

Finally, it is worth noting that PAC contributions constitute no more than 1% of total contributions to any candidate and do not play a major role in funding campaigns. Their value lies in showing how organized political interests are rating the various candidates.

Per cent sources of PAC Contributions for 2008 Presidential Candidates

The totals in these charts are calculated from PAC contributions, as reported to the Federal Election Commission. Contributions from individuals are not included in this breakdown.
Source: Open Secrets

View CHW’s coverage on Corporations, Health and the 2008 Presidential Race:

Candidate Business Labor Single Issue Groups Total contributions
Democrats        
Hillary Clinton 56% 11% 33% $748,052
John Edwards 4% 52% 44% $11,587
Barack Obama 26% 0% 74% $12,437
Republicans      
Rudolph W. Giuliani 70% 1% 29% $265,992
Mike Huckabee 60% 0% 40% $27,974
John McCain 72% 1% 27% $458,307
Mitt Romney 60% 0% 40% $298,700

 

Part 1: Following the Money
Part 2: Clinton, Obama and McCain on the Role of Corporations Part 3: Clinton, McCain, Obama and the Food Industry