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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

Youth-Involved Street Survey of Health Enhancing and Health Damaging Messages in Disparate Urban Neighborhoods Using Digital Technology

Neighborhood environments can both promote health (Ewing 2005) and encourage disease (Satterthwaite 1993). Differences in presence of health enhancing and health damaging messages and environments may account for some differences in health among neighborhoods with different socioeconomic and racial/ethnic characteristics (Kipke et al. 2007; Macdonald, Cummins, and Macintyre 2007; Pasch et al. 2007; Snyder et al. 2006; Stafford and Marmot 2003). In this pilot study, our hypothesis is that health-enhancing messages are more prevalent in wealthier neighborhoods and health damaging ones more prevalent in economically impoverished neighborhoods.   For the purposes of this pilot study, we define “health enhancing” messages as messages which promote the consumption of whole grains, fresh fruit and vegetables, low fat dairy and meats or public health service advertisements (e.g., a smoking cessation ad) and “health damaging” as advertisements for alcohol, tobacco and high fat, low nutrient foods.  In preparation for a larger scale study, our goal here was to test a methodology for comparing such messages across communities with differing sociodemographic and environmental characteristics


Disparate Urban Neighborhoods: Upper East Side, East Harlem

To carry out this study, we involved youth researchers in measuring the health enhancing and health damaging messages in two, disparate urban neighborhoods: the affluent and predominantly white Upper East Side of Manhattan, and the neighboring but economically impoverished and predominantly Black and Latino East Harlem. Lexington Avenue, a major thoroughfare, runs through both neighborhoods.    The youth researchers worked in two phases measuring health enhancing and health damaging messages along Lexington Avenue in the two neighborhoods.  The first phase included a class of thirty-three Hunter College undergraduate students; the second phase, a smaller group of three high-school-aged students recruited from Global Kids, a community-based youth organization.   In each phase, the youth surveyed ten block segments of Lexington Avenue in the two neighborhoods.

Using Digital Technology to Measure Health Enhancing and Health Damaging Messages

Researchers at Hunter College partnered with the Fund for the City of New York (FCNY), a nonprofit research and policy group, to modify their ComNET software to measure health enhancing or damaging messages.  FCNY developed the ComNET software to document problems in the urban environment and engage community members in notifying the responsible municipal agencies to address those problems in the urban environment.  ComNET is designed for use on handheld digital devices, equipped with digital cameras.  The use of ComNET and digital technology made this project possible and offered a number of advantages.

First, the handheld devices serve as an important incentive for the engaging the youth.  Young people, most of whom have grown up immersed in digital technologies, quickly learn how to manipulate the devices and yet still see them as fun, innovative “toys.”    It would be much more difficult to engage youth in this research without the use of digital technology.   Second, the ability to quickly upload the data and have it almost immediately available for data cleaning and analysis is an invaluable asset of working with the ComNET software.   The decade-long development of the technology by FCNY and the infrastructure that they have in place to ensure the smooth functioning of the devices, upload, cleaning and analysis of the data, provided a strong foundation for the methodology used here and obviated the research group from investing time and money in developing such a technology.

Findings

The hypothesis that health enhancing messages are more prevalent in better off neighborhoods and health damaging ones more prevalent in poorer neighborhoods appears to be supported by the data from our pilot study. Table and Figure 1 shows that in the 10-block segment our project surveyed, the percentage of health harming ads in East Harlem is 29% greater than in the Upper East Side.  East Harlem also contains nearly 10% fewer health promoting ads than does the Upper East Side.  Both neighborhoods have a higher concentration of health harming than health promoting advertisements.  Tables 2 and 3 illustrate that tobacco and alcohol advertisements are more prevalent in East Harlem than in the Upper East Side where health-harming ads tend to be food-related.

For access to charts/graphs, please access pdf here

Limitations 

The findings here are necessarily limited because this was a pilot study.  First, the sample size (ten block segments measured by two groups) was too small to confidently generalize to all urban areas, all New York City, or even the two neighborhoods studied here.   Further limitations include some challenges with digital technology.  The ComNET software is very effective at measuring some types of problems in the urban environment, but needs further modification to accurately and efficiently measure health enhancing and health damaging messages. Specifically, the addition of a feature that would allow for multiple features for one entry would speed up the process considerably. The limitations of this admittedly small and suggestive pilot study can be addressed in a larger and more systematic follow-up study.

Conclusion

New York City neighborhoods of East Harlem and the Upper East Side represent stark disparities in income, racial composition and health outcomes.  This pilot study examined one aspect of the disparities between these neighborhoods that may contribute to unequal health outcomes: health promoting and health damaging messages.   In general, we found that East Harlem has more ads (of all kinds), more health harming ads, and fewer health-promoting ads than the Upper East Side.     And, we also found that both neighborhoods have more health harming ads than health promoting.   While the presence of health damaging ads cannot account for all the negative health outcomes in a particular urban neighborhood, the disproportionate display of the health damaging ads in East Harlem as compared to the Upper East Side, suggests that some New York City residents bear a greater burden of these messages.  The disparity in the types of health ads that city residents in different neighborhoods are exposed to is a subject that demands further study.  In addition, our pilot study demonstrates that young people can be engaged in studies to document the health characteristics of their communities, an activity that can be a first step in analysis of differences in health and action to reduce inequities in health.

References

Ewing, R. 2005. Building environment to promote health. J Epidemiol Community Health 59 (7):536-7.

Kipke, M.D., E. Iverson, D. Moore, C. Booker, V. Ruelas, A.L. Peters, and F. Kaufman. 2007. Food and park environments: neighborhood-level risks for childhood obesity in East Los Angeles. J Adolesc Health 40 (4):325-33.

Macdonald, L., S. Cummins, and S. Macintyre. 2007. Neighbourhood fast food environment and area deprivation-substitution or concentration? Appetite 29 (1):251-4.

Pasch, K.E. , K.A.  Komro, C.L. Perry, M.O.  Hearst, and K. Farbakhsh. 2007. Outdoor alcohol advertising near schools: what does it advertise and how is it related to intentions and use of alcohol among young adolescents? . J Stud Alcohol Drugs68 (4):587-96.

Satterthwaite, D. 1993. The impact on health of urban environments. Environ Urban 5 (2):87-111.

Snyder, L. , F.  Milici, M.  Slater, H.  Sun, and Y. Strizhakova. 2006. Effects of alcohol exposure on youth drinking. Archives of pediatrics and adolescent medicine 160 (1):18-24.

Stafford, M., and M. Marmot. 2003. Neighbourhood deprivation and health: does it affect us all equally? Int J Epidemiol 32 (3):357-66.

 

For more information on this study contact Jessie Daniels at jdaniels@hunter.cuny.edu

Books on Corporations and Health, 2007

With thousands of new books published each year, it’s hard to find titles of interest. To help readers sort through the piles, we present an idiosyncratic list of 10 books published in 2007 (or early 2008) that address the relationships among corporations, markets, government and health. These books may help Corporations and Health Watch readers to understand better the impact of corporate practices on health, to occupy cold winter nights, or to pick a gift for a deserving friend. We invite you to submit titles of other books you suggest, limiting titles to those published in 2007.


Ten Titles on Corporations and Health

Benjamin R. Barber. Consumed How Markets Corrupt Children, Infantilize adults, and Swallow Citizens Whole. W.W. Norton and Company, New York, 2007. Political theorist argues over-production of goods forces markets to infantilize consumers and undermine democracy.

Allan M. Brandt. The Cigarette Century The Rise, Fall and Deadly Persistence of the Product that Defined America. Basic Books, New York, 2007. Medical historian analyzes impact of tobacco industry on US and global health and politics.

Jillian Clare Cohen, Patricia Illingworth , & Udo Schuklenk, editors. The Power of Pills: Social, Ethical and Legal Issues in Drug Development, Marketing and Pricing. Pluto Press, London, England, 2007. Three academics edited this interdisciplinary collection of essays that analyze and critique the global pharmaceutical industry.

Philip J. Cook. Paying the Tab The Costs and Benefits of Alcohols Control. Princeton University Press, Princeton, NJ, 2007. Economist analyzes US alcohol policy and suggests increasing taxes to reduce harm.

Devra Davis. The Secret History of the War on Cancer. New York, Basic Books, 2007. Toxicologist describes how industry shapes US response to cancer at expense of prevention.

Richard Feldman. Ricochet Confessions of a Gun Lobbyist. Hoboken, N.J., John Wiley and Son, 2008. Former NRA lobbyist describes how group “betrays trust” of gun supporters.

David Harsanyi. Nanny State: How Food Fascists, Teetotaling Do-Gooders, Priggish Moralists, and other Boneheaded Bureaucrats Are Turning America into a Nation of Children. Broadway, New York, 2007. Libertarian columnist for the Denver Post rants against government interference on health.

Tim McCarthy. Auto Mania Cars, Consumers and the Environment. Yale University Press, New Haven, CT, 2007. Historian describes how auto industry transformed United States in the twentieth century.

Michael Pollan. In Defense of Food: An Eater’s Manifesto. Penguin, New York, 2008. Food journalist suggests actions that individuals, communities and policy makers can take to reclaim food from industrial producers.

Robert B. Reich. Supercapitalism. The Transformation of Business, Democracy, and Everyday Life. Alfred A. Knopf, New York, 2007. Policy analyst and former Clinton Labor Secretary argues that new global competitive pressures force business to serve investors and consumers at expense of society and suggests public policies to restore democratic control of markets.

Commentary: Teaching about Corporations and Health: Bringing Corporate Practices into Public Health Classrooms

Increasingly the decisions made in corporate boardrooms, executive offices and in advertising, law, public relations and lobbying firms shape population health in both developed and developing nations. The investment, product design, marketing, pricing and retail practices of the tobacco, food, alcohol, firearms, automobile, pharmaceutical, energy and other industries have contributed to the growing global burden of chronic diseases, injuries and pollution-associated illnesses and deaths. While a growing body of evidence examines the influences of corporate practices on health [1], for the most part the public health curriculum does not address this issue and most public health students do not learn about how corporations influence health and what public health professionals can do protect the public against harmful corporate practices or to encourage healthy ones.

In those places where the subject is considered, e.g., in occupational or environmental health courses or in the study of tobacco and health, usually faculty and students examine one exposure, industry or health outcome at a time, limiting the ability to identify generalizable intervention strategies. As a result, public health agencies often lack the capacity or tools to take on one of the most powerful – and remediable – social determinants of health.

In this commentary, I explore how academic public health programs can introduce concepts, competencies and skills that will help students to identify and analyze corporate influences on health and take action to encourage healthy and discourage unhealthy policies and practices.

Why teach about corporations and health in schools of public health?

In order to bring the subject of corporate induced disease into the curriculum of schools and programs in public health, proponents will first need to convince faculty, students, administrators and accrediting bodies that this subject is important. What arguments might persuade our colleagues to take on this topic?

First, as noted, evidence suggests that corporate induced diseases impose a substantial and growing burden of disease. (Here the term “corporate induced disease” is used to describe the burden of illness whose agents are industrial products or processes that are harmful to consumers who buy them, workers who work with them at their job, and community residents who are exposed to them in the ambient environment.[2] ) In the twentieth century, 100 million people died of tobacco-related causes and in the 21st century one billion people are expected to die as a result of tobacco use. Obesity, caused in part by the food industry’s relentless efforts to persuade people to eat more, is a growing cause of illness and death, especially of rising rates of diabetes. Other diseases are related to heavily promoted high fat, high salt, high sugar and low nutrient processed foods. The automobile industry contributes to injuries and deaths associated with accidents, air pollution and physical inactivity and the firearms industry produces and distributes products that contribute to homicide, suicide and gun injuries. The pharmaceutical industry over-promotes some dangerous products, like Vioxx, and prices some beneficial drugs others out of reach of patients who could benefit. In pursuing these lethal but usually legal activities, corporations are simply meeting their mandate to maximize profits for shareholders.

In other circumstances, corporations make positive contributions to population health by, for example, making healthy products both more available and affordable, providing workers with sufficient income to purchase food, housing and the other necessities of life, or by making philanthropic contributions. Only by empirical investigation can public health researchers identify those corporate practices associated with harm or benefit and suggest strategies to reduce the former or increase the latter. By preparing public health students to carry out such investigations, academic programs fulfill their basic mission of educating professionals who can assure population health.

A second argument for adding a focus on corporate-induced disease to the public health curriculum is that it opens new doors for intervention. Controlling special interests that threaten the health of the public has always been a public health priority. In a 1999 publication listing the ten great public health accomplishments of the twentieth century, the US Centers for Disease Control and Prevention identified five that required changing corporate practices: reducing the harm from tobacco, improving food safety, reducing automobile accidents, improving worker safety, and reducing deaths from coronary heart disease [3]. How can organized public health extend these accomplishments into this century? What are realistic goals for reducing the burden of corporate-induced chronic diseases, injuries, and pollution in the 21st century? Only by putting these questions at the center of our curriculum will public health programs graduate the professionals who can answer them.

More broadly, the study of corporate induced diseases can provide insights into pathways and mechanisms by which social factors influence health. In its 2003 report Who Will Keep the Public Healthy? [4], the Institute of Medicine called for the public health curriculum to put added emphasis on several concepts including systems thinking, ecological approaches to health, public health policy and law, public health ethics, public health biology and global health. Studying how governments and markets interact to shape patterns of disease, the biological and social pathways by which corporate practices become embodied into states of health, and the legal, political and other strategies that can be used to change corporate practices and policies that harm health provide opportunities for applying these new concepts and methods.

Finally, deeper study of corporate-induced diseases also offers the public health curriculum another opportunity to integrate the many disciplines that inform public health (e.g., law, engineering, economics, political science, medicine, sociology, anthropology and others), thus preparing students for the complexity of interdisciplinary study and intervention.

Convincing colleagues to bring the subject of corporate induced diseases into the public health curriculum will also require addressing their resistance to such a move. Some argue that consideration of corporate induced disease is too political, a diversion from our commitment to objective science. Moreover, assert these critics, critiquing social arrangements is not the role of public health professionals. But public health has always debated the influence of social and economic factors on health. By its definition, public health must consider the impact of political factors on health. Objecting to such investigations is like insisting that researchers on ocean tides cannot consider the influence of the moon.

And even if investigators bring their biases into their research, the methods they use have the potential to provide clear cut answers. Whether the vector for a particular disease is a mosquito or a tobacco company, the same methodologies can be used to study the pathways and distribution of the resulting illnesses and to plan and evaluate control strategies. As Brandt has recently described in his history of cigarettes [5], the objections to controlling tobacco resulted not from any lack of credible scientific evidence but from the political opposition of the tobacco industry. Scientists can apply their methods rigorously or sloppily but the role of corporate decisions in health and disease is no more nor less political than any other causal factor.

Another objection is that some analysts may bring an ideological bias to research on corporations and health – that their research seeks not to uncover the truth but to advance an anticorporate political agenda. But the scientific community has created a variety of mechanism to detect and reveal bias: replication of results, peer review, the requirement for plausible mechanisms of action, an accumulated weight of evidence, etc. These standard methods should be applied to research on corporations and health, whether it is sponsored and carried out by political activists, independent scientists or industry staff.

Another criticism of a focus on corporate-induced disease is that it insufficiently addresses the role of individual behavior. In this line of reasoning, to smoke tobacco, eat too much, drive carelessly, or consume unneeded or harmful medications is always at the most proximal level an individual choice. Focusing on upstream factors like advertising or pricing may play some distal role in disease causation but unless we can persuade individuals to act differently, our health problems will continue. This line of reasoning is particularly resonant in American culture and is also vociferously championed by business.

Some public health professionals agree that industry plays a significant role in shaping patterns of health and disease but believe that it is futile for public health workers to attempt to change as basic a feature of our social arrangement as free market dominance of the economic sphere. In this view, studying and seeking to change corporate practices is tilting at windmills and public health professionals and students should better spend their time engaged in more productive activities.

Finally, some public health faculty believe that our curriculum is already too crowded and perhaps fragmented. Adding one more topic to a 15 session course will simply push out other important concepts, they say. In this view, whatever the current clamor for new teaching on emergency preparedness, public health biology, informatics or corporate induced diseases, principled faculty should resist these topics du jour.

In summary, to succeed in introducing the subject of the corporate impact on health into the public health curriculum will require developing and articulating the epidemiological and other arguments that support this move and understanding and addressing our colleagues concerns about such a move.

What to teach about corporations and health?

Once faculty have made a decision to include the role of corporations in health as a topic within the public health curriculum, the question arises as to what specifically to teach. In Box 1, I suggest 10 key concepts to introduce. These suggestions are intended to spark discussion and debate – to elicit additional recommendations for priority concepts.

Box 1

Ten Key Concepts about
Corporations and Health

1. Corporations and their practices can be considered as vectors of 
disease. (e.g., the tobacco, alcohol, and food industries 
distribute and promote pathogenic products) and as 
social determinants of health.

2. Decisions made in corporate boardrooms and executive offices 
have a profound influence on health.

3. Corporate practices account for a significant proportion of the 
attributable risk for many major causes 
of mortality and morbidity.

4. Differential exposure to unhealthy corporate practices 
contributes to socioeconomic, racial/ethnic 
and other health inequities.

5. Corporate marketing is a major determinant of 
lifestyle and thus health.

6. In order to increase profits, corporations often promote disease.

7. Public health researchers have a responsibility 
to study major determinants of health and to 
report findings to public, even if such findings challenge the status 
quo.

8. Reducing harmful corporate practices and 
encouraging health-promoting ones is an 
appropriate task for public health professionals and 
has led to prior public health successes.

9. Strategies to reduce harmful corporate practices 
must consider local, national and global responses, 
otherwise the burden is merely shifted to another population.

10. Changing corporate practices will require changing 
the relationship between government and business.


How to bring the subject of corporations and health into the public health curriculum

Faculty can use a variety of pedagogical strategies to bring this topic into the public health curriculum. First, concepts and examples related to corporations and health can be integrated into the five required public health core courses. This strategy ensures that all public health MPH students will be introduced to this topic. Box 2 shows various concepts that can be included in each of the core courses. A variety of pedagogical methods can be used: case studies, literature reviews, mini-research studies, term reports, etc.

Box 2

Integrating Concepts on Corporations and Health into the Core Public Health Curriculum

Core Course

Selected Concepts

Biostatistics

Methods to assess roles of industry in causation; history of industry efforts to challenge statistical methods and assumptions

Epidemiology

Attributable risk, corporate practices as social determinants, industry challenges to various epidemiological methods, contested science, multilevel methods to assess impact of corporate practices on behaviors

Health Policy and Management

Roles of insurance and pharmaceutical industries in health and health policy, prevention vs. treatment, roles of special interests in shaping policy, advocacy strategies to change policies

Environmental Health Sciences

Roles of industry in setting standards and regulatory practices, pathways by which products influence health and environment, sustainability, links between occupational and consumer exposures to dangerous products

Health and social behavior

Corporate disease promotion vs health promotion, corporate influences on lifestyle and health behavior, strategies to modify corporate practices, community organizing and coalitions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A second strategy is to develop specific courses in corporations and health. Such courses provide interested students an opportunity to explore selected topics in more depth. Some subjects that have or can be considered as a public health elective course include: Globalization and health; Role of the tobacco, alcohol and food industries in population health; Interdisciplinary perspectives on roles of corporations and government in health; Public health strategies to modify corporate practices, and History of corporations and public health. Some of these courses may fit within a specific public health department while others lend themselves to interdisciplinary approaches, a perspective encouraged by the Institute of Medicine report on education for public health.

Third, students and faculty can develop research projects on the subject of corporations and health. These projects can be part of field placements, Master’s projects or course assignments. For example, students at the public health program at Hunter College have conducted a survey of alcohol advertising in the New York City subway system and have compared the street-level presence of the tobacco, alcohol and food industries in two New York City neighborhoods with differing socioeconomic characteristics.

Similarly, students can complete field placements or internships in research or advocacy organizations engaged in work on the tobacco, food, pharmaceutical, automobile or other industries. Such placements provide practical experience in documenting the impact of corporate practices on health, participating in research studies or advocacy campaigns to modify corporate practices or conducting policy analyses to identify appropriate control strategies. In some cases, such projects include collaborative work among local health departments, researchers, community or youth organizations and advocacy groups.

Finally, some public health program may develop tracks, interdisciplinary concentration areas, or centers on corporations and health. Such institutional arrangements can provide protected spaces outside traditional academic structures such as departments; provide opportunities for faculty and students across schools and disciplines to engage in dialogue and inquiry; and create ongoing links with other researchers, advocacy organizations, think tanks, public officials and others. For the most, part such units have to date focused on a specific industry or product. For example, the Center for Alcohol Marketing and Youth at Georgetown Universityor the Center for Tobacco Control Research and Education at University of California-Berkeley serve as critical academic resources for the efforts to reduce the harm from alcohol and tobacco use.

First steps in changing how public health schools approach corporations and health

Transforming the curriculum of public health academic programs is not something that will happen overnight. Rather, as faculty, students, researchers, advocates and public health officials find new ways to bring the subject of the impact of corporate practices on health into the classroom, curriculum and research practice of their programs, this approach will gain support. Eventually, future generations of students will ask what we were thinking in excluding this topic from our scrutiny. Box 3 lists some of the activities that faculty or students groups have used or are considering to get started on this path. Corporations and Health Watch visitors are encouraged to send their suggestions and experiences for future posting.

Box 3

Getting Started

Organize a faculty seminar on corporations and health and invite interested researchers from throughout your university

Create a websites or list serve on corporations and health for your school or university

Share course syllabi and discuss how to integrate the topic into core and other courses

Organize sessions on corporations and health at professional meetings

Encourage the Council on Education for Public Health, the American Public Health Association, those planning the public health certifying exam and other organizations to consider this topic

Create model academic and research programs where critical mass of faculty and resources exist.

 

By Nicholas Freudenberg, Founder and Director, Corporations and Health Watch.

 

References

1. See for example the selected bibliographies on the alcohol industry and the food industry as well as other references in theResources section of this website. 
2. Jaliel R. Presentation at Meeting of Industrial Diseases Study group of Ecole des Hautes Etudes Superieure, Washington, D.C. November 7, 2007. 
3. CDC. Ten great public health achievements–United States, 1900-1999. MMWR 1999;48:241-3.
4. Board on Health Promotion and Disease Prevention. Institute of Medicine. Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21st Century. Washington, D.C.: National Acadmey Press, 2003.
5. Brandt A. The Cigarette Century. New York: Basic Books, 2007.

Photo Credit:

1. Mountainbread