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.
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|
|Rudolph W. Giuliani||$212,100||$138,850||$1,026,452||$77,400|
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.
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|
|Rudolph W. Giuliani||70%||1%||29%||$265,992|
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.
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.
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.
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.
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 firstname.lastname@example.org
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.
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 , 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. ) 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 . 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? , 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 , 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.
Ten Key Concepts about
1. Corporations and their practices can be considered as vectors of
2. Decisions made in corporate boardrooms and executive offices
3. Corporate practices account for a significant proportion of the
4. Differential exposure to unhealthy corporate practices
5. Corporate marketing is a major determinant of
6. In order to increase profits, corporations often promote disease.
7. Public health researchers have a responsibility
8. Reducing harmful corporate practices and
9. Strategies to reduce harmful corporate practices
10. Changing corporate practices will require changing
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.
Integrating Concepts on Corporations and Health into the Core Public Health Curriculum
Methods to assess roles of industry in causation; history of industry efforts to challenge statistical methods and assumptions
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.
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.
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.
Kathryn Montgomery is a professor in the Public Communication division of the School of Communication at American University where she heads the University’s Center for Social Media’s “Youth, Media and Democracy” project. She also works with the Center for Digital Democracy and the Berkeley Media Studies Group. In 1991, Montgomery founded the media advocacy group the Center for Media Education where she served as President for twelve years before the Center was closed. She is the author of two books, Target: Prime Time. Advocacy Groups and the Struggle over Entertainment Television (Oxford University Press, 1989) and Generation Digital: Politics, Commerce, and Childhood in the Age of the Internet (MIT Press, 2007), as well as other numerous publications including the 2007 report Interactive Food & Beverage Marketing: Targeting Children and Youth in the Digital Age which she coauthored with Jeff Chester. Montgomery has been a strong advocate in the areas of youth, health, education, and the democratic use of media.
Her research and advocacy work helped lead to the passage of a Federal Communications Commission ruling which required a minimum of three hours per week of educational/informational television programming for children; a television content based ratings system, and the first federal legislation designed to protect children’s privacy on the internet.
Corporations and Health Watch spoke with Kathryn Montgomery about the new digital media environment, how corporations target children and young people as consumers in increasingly sophisticated ways, and what efforts might be taken to curtail such corporate practices.
CHW: Tell me about your early work on youth, digital media and marketing with the Center for Media Education.
KM: Early on we began looking closely at digital media. Here was a powerful new medium coming into place and not very many people were really looking at how it was going to affect children. The debates were mainly about pornography and safety online. We were given funding in the mid 90s by the Carnegie Corporation of New York to examine the marketing targeted to children on the Web. We also got a research grant from the Robert Wood Johnson Foundation to look at Alcohol and Tobacco marketing on the web. Even though there were a lot of people concerned about advertising in traditional media, not enough people were looking at the digital media. And this is where all marketing and advertising are going. If you’re going to do any interventions, you have to understand where it’s all headed. We also wanted to educate not only our fellow advocates and the professionals and academics in the field, but the regulators themselves. So we provided the kind of details that could help them in their investigations. Our efforts to document the marketing practices targeted at children resulted in the first law to protect children’s privacy on the internet.
CHW: Can you give me an overview of the current scope of marketing to youth?
KM: Well you know it’s kind of hard to put a figure on it. I know that at the present time all marketing online figures are something like 80 billion. It’s growing very rapidly, and children and teenagers are a very big market online. It is important to understand that in this new media environment the distinctions between online and offline are being completely blurred and, in some cases, obliterated, so we’re really just talking about an overall shift in the way marketing is done this notion of the “360 degree” approach which we wrote about in our report. The marketing encompasses a lot of different platforms; it is designed to be ubiquitous in children’s lives, following them wherever they go, online and off.
CHW: Although there’s a lot of integration, how is internet marketing to children different than what you would find in television or other forms of media like magazines?
KM: We’re talking about a complete integration of advertising and content. In many cases we’re talking about websites and other digital content areas that are engaged not just in marketing to children, but enlisting their involvement in market research. So it’s a very different, more all encompassing kind of medium and the marketing may be more subtle because it isn’t just that you’re seeing a lot of commercials but it’s a website; it might be an adver-game a gaming site that’s really for a product.
CHW: What can you tell me about adver-games? Unlike product placement, this seems like a very active engagement of youth with corporate marketing.
KM: Right. Some of the advertising in interactive games that we documented in our food marketing report is pretty similar to product placement but it’s interactive: you’ve got players who can interact with the ad. The ads are programmed and the software is programmed to track people’s behavior; they do profiling so that they know who you are. The whole thing is engagement; they want you engaged with these products.
CHW: Have you seen any data that would suggest that this sort of interactive marketing is more effective than just passively seeing a commercial?
KM: Except for those who are working for industry, I haven’t seen anything that really tries to address these things. A lot of market research is proprietary. To my knowledge there has been very little, if any, research within the academic community. I’ve been trying to get other academics to do this kind of research for a long time. I think partly because it’s changing so quickly, it’s kind of hard to get a handle on. And it’s not easy to develop research designs that will work. But if you look at the literature, and we cite a huge amount of it in our report, there’s documentation from the industry that these things are successful. Now obviously they’re experimenting with some of them, some things work better than others, but they are spending huge amounts of money in market research. This digital generation is the most researched generation in history.
CHW: Can you explain how “cradle to grave marketing” works?
KM: Marketers have been saying for at least twenty years, that with young people, in addition to the fact that they have money to spend, you want to instill brand loyalty. So you want to be able to get those young people to want your product at a young age. And now, interactive marketing and this incredible capability for profiling adds new meaning to “cradle to grave” because they can not only get you to feel loyal to the product they can actually follow you from cradle to grave, across platforms.
CHW: What about the tobacco or alcohol corporations that are specifically prohibited from marketing to children, how do they go about this?
KM: Of course they [the tobacco industry] say they’re not doing it, but then their efforts have been curtailed obviously. The settlement with the attorneys general forbade certain practices but we also know that they try their best to use other venues. The work that we did predated that decision because our report came out in 1997, but we did not find a lot of overt marketing online of these tobacco products to young people. Now it’s a lot harder to track. We know that in other media they’ve used the kinds of strategies that are designed to circumvent any rules and regulations and we still have major problems with teen smoking. So whether it’s some sort of peer-to-peer effort, there are all kinds of strategies that these companies may be using. We know that for all product categories targeting youth if you can link your product up with pop culture that’s very successful.
The alcohol companies don’t want any regulation on their marketing and they would argue that they’re not marketing to young people. But what we’ve found, and I’m not sure this has really changed, is that online they make a lot of their websites and their marketing efforts very appealing to young people of course they’re saying that you have to be 21, but there are many ways to get around that.
CHW: Can you describe how the food industry, which is not prohibited from marketing to youth, uses digital media and integrative media strategies?
KM: There are a million different ways they do it and they have really developed a panoply of interactive techniques that are designed to engage young people with their brand. They’re very complicated. Anything from putting their ads on mobile technology, offering coupons, having young people spread the word through email to their friends or working through social networks like MySpace and FaceBook to encourage people to use the brand icon, to putting what are known as viral videos on YouTube. Also there’s user generated video, this idea that you get young people to actually create the ads themselves for the products. Pizza Hut did this: “We can make you the vice president of pizza if you’ll make an ad.” They get hundreds and hundreds of young people, probably many more than that, creating their own ads, posting them, and then it spreads like wildfire. And we also know that food marketers and beverage marketers and others are researching who the most effective influencers are, and are recruiting them to promote brands among their peers.
CHW: How do they go about recruiting these influential young people?
KM: Oh there are all kinds of ways they do it. Market researchers can study social networking sites to find the young people with the largest networks of friends, for example. They have found ways to identify online who the “brand sirens” are, the people who like to talk about brands among their friends. There’s a company called Tremor that recruits young people to be part of this elite group of “tremorites.” It’s run by Proctor and Gamble and they work for other clients as well, including some of the beverage companies. Teens are invited to become a part of a privileged group and then given new products and programs in advance and encouraged to tell their friends about them.
The other thing to understand about marketing, particularly to adolescents in the new digital media, is that a lot of these efforts are designed to tap into the fundamental developmental needs of young people. Young people are experimenting with their identities: “how do I show who I am?” Of course marketers have done this for a long time. But now they have techniques that are even more powerful. So if you’re creating your profile on MySpace, in addition to your friends, you can include the brands that you like and that express who you are. Peer-to-peer involvement and being able to use the new digital media to convey your own ideas and to express what you think and feel lends itself beautifully to viral marketing.
CHW: One of the ways in which corporations go about getting their message out there broadly is through market segmentation: breaking up potential groups into discreet groups that can be reached with unique messages. Can you talk about some of the ways that food, alcohol, tobacco, and other industries go about trying to reach a broad range of young people?
KM: This is a rapidly changing digital media marketplace, so as we speak new techniques are being developed. But what I think we are seeing generally with market segmentation in the digital era is further, more refined and more microtargeted marketing that breaks people down not just by their preferences, demographic groups, spending and zip codes, but by their behavioral qualities that can be tracked online through behavioral profiling and database marketing. The important thing is that with these new, sophisticated technologies and the interactive media, people are marketed to as individuals not as segmented groups. Marketers are able to find out what you personally will respond to and they can adjust their advertising accordingly. And particularly looking at the social networking platforms where they can use the information you post about yourself, it’s incredible what these marketers are able to know about you. I think that most consumers don’t have a clue; I don’t think parents have a clue.
CHW: What’s your opinion about the recent announcement by eleven major food and drink companies to voluntarily limit television advertisements to US children under the age of 12?
KM: Well I’ve been monitoring this pretty closely and I was a speaker at the Federal Trade Commission workshop when the most recent announcement was made. There are some very important limitations to what these industries have agreed to do. First of all, the fast food restaurants were not well represented; we’ve got Burger King, before we had McDonald’s, but that whole industry is still not on board. Secondly, the changes that they have vowed to make are only going to apply to marketing that’s targeted at children under the age of 12. That’s totally leaving out adolescents and I would say its even leaving out “tweens” because they watch the stuff that’s targeted at older kids. Adolescents are very much at risk for obesity and they also make more of their own decisions about what they eat.
They’re not at the store saying, “buy me that;” they’re out in those fast food restaurants with their friends. So they need some interventions and the industry hasn’t come forward with anything. Finally, most of the voluntary advertising guidelines are focused on television, with very few changes to the emerging practices in the digital media.
CHW: Would you say that this announcement was something of a preemptive strategy by the industry to avoid further criticism?
This is a pattern: the industry will try to get by with as little as it can and hope the problem goes away. It will not bring up anything else unless we say “aha, but you’re doing this” and there’s a huge outcry about it and the government cares. So they are way ahead of the regulators and way ahead of the public on this stuff. I’m not suggesting that the industry is doing nothing; yes they are doing something, but they don’t want to be regulated. So they’re doing something to keep from being regulated. We need ongoing pressure on the industry and ongoing monitoring of what the practices are and the government has to play a leadership role. And I think the FTC is, but we’ll see what happens next. This is a longterm problem that’s going to take longterm strategies and none of the advocates and health professionals and other stakeholders can afford to let up the pressure. We have to continue; we’re in here for the long haul and its very important.
CHW: What do you think are the best policy solutions to curtail the influence of corporate marketing on youth and youth spaces?
KM: Well it’s a tough area to regulate directly. I don’t think it’s politically viable to call for a ban on advertising. These bans have not worked in the past. You cannot reverse these trends. But I think you can call for some rules of the game, which could include identifying certain practices that marketers should not use. When you deal with products like junk food, soft drinks, fast food restaurants, alcohol and tobacco, there you can have more restrictions. We haven’t had a very courageous government in the past that has wanted to tackle these marketing practices, and unfortunately the advocacy community has not had the knowledge and sophistication about the nature and extent of digital marketing to push an agenda. But we’re working to try to educate people to really see that there are some areas where interventions should be made and there is a proper role for government in developing them.
CHW: And do you see policy efforts as something that should happen at the national or international levels or is there potential for change at the state and municipal levels as well?
KM: Most of these are global corporations, so I think there is a need for some global initiatives, for groups across the world to work together and for regulatory agencies to work together. But at the same time I think there could be some statebased interventions or local interventions, certainly in terms of public accountability and education. In the tobacco control and alcohol control movement there have been some very successful efforts at the local and the state level.
CHW: What does digital marketing to youth look like outside of the United States? Is it a worldwide phenomenon, or is it more based in developed countries?
KM: We know this is a global phenomenon. In many ways, digital marketing is leapfrogging over national boundaries and directly into developing countries. Marketers are moving in very swiftly and very aggressively in many of these countries and sometimes I think too quickly to do anything about it. At the same time, we need to recognize that there are other critical international policy issues in addition to addressing the role of marketing. For example, we need to ensure equitable access to digital technologies. Because these technologies are a good thing for young people and we still have a digital divide in many places throughout the world. We will also need policies to ensure that the digital media are harnessed to improve the lives of young people.
CHW: In terms of advocacy efforts to change corporate practices, what tactics do you see as being effective?
KM: I think we need a multiple set of strategies coming from all kinds of different directions, at the national level, at the international level, at the state level, at the local level. And we need many more groups and individuals involved. And I think that the press is very important. If the pressure does not involve public exposure and what the health advocates have called “public shaming” then its not going to have much of an impact. You have to put heavyduty pressure on the industry, which will, in turn succeed in educating the public and letting policy makers know this is a problem. Strategic use of the media is a critical part of it.
CHW: Do you think that there’s any potential for digital media to serve as a counterforce against marketing to youth?
KM: I do think there’s a potential. The study we did in 2004 on the Internet and youth civic engagement showcased hundreds of nonprofit websites for and by young people. But we also found that many of these ventures were seriously underfunded. It was really not easy to compete in the powerful marketplace. Nor was it easy to recruit young people to be involved when you have the glitz of a MySpace or the popularity of a FaceBook. So I think they’ve got a lot of challenges facing them. But I believe there’s a huge amount of potential there. There’s a lot of great stuff going on that’s sort of spontaneously built by young people. It’s a wonderful thing that kids can get involved. And a number of young people are launching political campaigns within social networking platforms.
CHW: What do you believe are the implications of digital viral marketing on health and wellbeing of young people?
KM: What people need to understand about the digital media environment is that it is completely different from what we’ve seen before with our conventional media. This new digital media culture is everywhere, all the time, in the lives of young people and not only connecting you to other people, but also connecting you through this interactive umbilical cord to corporations. We are looking at a compelling culture that ties one’s sense of identity closely to corporate imperatives. It is designed to engage us and socializes us at an early age into being consumers. There is positive potential to promote health, so I think it’s not all one way or the other but you need to be very careful that the consumer culture part of it doesn’t smother and overwhelm the other parts. We need a broad public debate about how this new media culture can be a positive force in children’s lives.
For thirty years, Corporate Accountability International has fought and won campaigns against corporate abuse in the Food, Energy, Tobacco, Water, Oil, and Agribusiness industries. Many of those victories have set precedents in the fight for corporate accountability.
Early history as focused on Nestlé and infant formula
Corporate Accountability International began in 1977, under the name Infant Formula Action Coalition (INFACT). Its first target was the multinational food company Nestlé. At that time, Nestlé was the world’s largest producer of infant formula. Its aggressive global advertising and marketing campaigns promoted infant formula at the expense of breastmilk, despite overwhelming evidence that breast milk was the healthier choice.
Public health advocates were especially critical of Nestlé’s marketing in impoverished regions where money to purchase the formula, access to clean water, and proper sanitation of bottles was scarce or absent all together. As a result, the product was widely misused as people watered down the formula in an attempt to save money. The resulting health problems for mothers, children and families as well as population health were a direct result of Nestlé’s marketing practices.INFACT led a campaign and boycott of Nestlé which centered on bringing the company’s health and human rights abuses into public view and holding the corporation accountable. After nearly 10 years of fighting to restrict Nestlé’s behavior, INFACT saw victory as the World Health Organization (WHO) established global infant formula marketing standards. Nestlé then altered its marketing practices in “economically poor” regions that had been specifically hard hit by their practices, although battles between global infant formula companies and public health activists continue. According to Corporate Accountability International, the Nestle Boycott was an unprecedented victory for grassroots consumer campaigns—the first time a major corporation came to the table with ordinary consumers and agreed to make changes in its behavior worldwide.
Transformation to more broadly focused organization
Since the success of their Nestlé boycott, Corporate Accountability International has expanded, launching several successful campaigns related indirectly or directly to public health. For example, from 1984-1993, Corporate Accountability International (still INFACT at the time) took on General Electric, then the largest producer and promoter of nuclear weapons, for their role contributing to Cold War nuclear arms race. The organization began an international boycott of GE’s commercial goods that highlighted GE’s role in nuclear arms manufacturing. According to Corporate Accountability International, the boycott contributed to GE’s decision to drop its nuclear weapons business.
Beginning in the early 1990’s, Corporate Accountability International launched their Challenge Big Tobacco campaign and by 2003 achieved what its activists view as their biggest accomplishment: the WHO’s enactment of a global tobacco treaty, known as the Framework Convention on Tobacco Control (FCTC). The global tobacco treaty is the world’s first public health and corporate accountability treaty. It has the potential to save millions of lives and change the way tobacco corporations operate around the world. The treaty sets powerful precedents for regulating other industries like the pharmaceutical, water, food and agribusiness and oil industries. In 2004, INFACT changed its name to Corporate Accountability International to more accurately reflect the organization’s expanded mission.
Corporate Accountability International currently runs campaigns focusing on the Water, Tobacco, Oil, Food and Agribusiness, and Big Box Retail Industries. Its campaigns target some of the world’s largest corporations with the most direct impact on health, the environment and human rights.
“Think Outside the Bottle”
Corporate Accountability International’s current Challenge Corporate Control of Water campaign fights the privatization of water and the corporations that are attempting global control of this vital resource. The organization has seen national success with the ‘Think Outside the Bottle’ campaign that targets corporations like Pepsi, Coke and Nestlé for their practice of bottling tap water and selling it back to the public. Initial achievements include working to convince mayors to cancel bottled water contracts and to pass a resolution at the June 2007 U.S. Conference of Mayors that supported municipal water and called for a study of the impact of bottled water on cities.
Another water victory came as a direct result of a Corporate Accountability International campaign. Yielding to pressure from that group and other activists, Pepsi announced in July that it will make changes to the Aquafina bottled water drink label naming the waters actual source: the tap. In a press release, Corporate Accountability International called Pepsi’s concession an important first step. In a recent interview on Democracy Now!, Gigi Kellett, the group’s associate campaigns director, explained, she found that:
People on the street… don’t know where the water is coming from. And the bottled water corporations have spent tens of millions of dollars on ads that make people think that bottled water is somehow better, cleaner, safer than our public water systems. And in reality, we know that that’s not true. And so, we want to make sure that we’re increasing our people’s confidence in their public water systems once again and knowing that we need to be investing in our public systems.
Corporate Accountability International defines the success of its campaigns by their ability to persuade corporations to change policies or practices. In exchange for such corporate concessions, the organization ends the boycotts it has organized such as those against Nestlé, General Electric, and Philip Morris/Altria-owned Kraft. This approach relies on grassroots participation, both national and international, to expose unhealthy corporate behaviors and the political ties that keep corporations unchecked by the public sector. The campaigns seek to create public visibility and open debate of key global public health issues.
In its Tobacco Industry Campaign, which began in 1993, Corporate Accountability International worked closely with the World Health Organization to target the tobacco industry.
In the early 1990s the organization began campaigns against Philip Morris (now Altria) and RJR Nabisco (now Reynolds American Tobacco). The campaign called for a boycott of then Philip Morris/Altria-owned Kraft, during which Corporate Accountability International exposed Big Tobacco’s attempts to hide behind Kraft’s family friendly image and to disguise its political influence. This campaign may have contributed to the recent company spin-off of Kraft. For the past 14 years, Corporate Accountability International members have attended Philip Morris’ annual shareholders meetings to raise health, human rights and other issues.
At the 2007 Philip Morris/Altria shareholder meeting, for example, Corporate Accountability International Executive Director Kathryn Mulvey called on PM/Altria CEO Louis Camilleri to honor a commitment the company had made to halt sponsorship of Formula One auto racing. Your corporation continues to sponsor these races. You are violating an agreement you signed six years ago—and the global tobacco treaty, which bans tobacco advertising, promotion and sponsorship in ratifying countries. In this effort, the group used the success of the Framework Convention for Tobacco Control (FCTC), to regulate the promotion of tobacco, as a tool to put pressure on individual companies.
As a result of the FCTC, the tobacco industry has faced new scrutiny in its marketing practices and new pressure to adhere to global standards. Corporate Accountability International, as one of many NGOs around the world with official relations with the WHO, played a key role in securing a strong FCTC and in strengthening enforcement action. Together, these hundreds of small and large NGOs have the potential to create a united front against Big Tobacco.
Last month, the President’s Cancer Panel, in which the U.S. Department of Health and Human Services, the National Institutes of Health and the National Cancer Institute were represented, released a report urging the President to ratify the FCTC and to more vigorously regulate food companies that promoted high fat, high calorie, low nutrient carcinogenic diets. The report, “Promoting Healthy Lifestyles,” reminds us; Even absent ratification, by signing the FCTC, the U.S. is obligated not to undermine the goals of the treaty. Thus, the Cancer Panel’s recommendations echoed the call of Corporate Accountability International Senior Organizer Megan Rising, who said, The time has come for the President to heed the call of his top health advisors and the U.S. public and submit the global tobacco treaty to the Senate for ratification. With even a presidential panel accepting its recommendations, it’s clear that Corporate Accountability International has contributed to putting corporate accountability on the nation’s public health agenda.
Photo Credit: All photos courtesy of Corporate Accountability International