Addressing Generic-Drug Market Failures — The Case for Establishing a Nonprofit Manufacturer

Robust competition usually keeps the price of generic drugs well below that of brand-name drugs. When there is little or no competition, however, generic-drug manufacturers can substantially increase prices, and drug shortages may occur. Such market failures can compromise care and negatively affect patients, health care providers, government insurance programs, and private health plans. We believe that market-based solutions are an important alternative approach to stimulating competition in generic-drug markets. One such solution is to establish a nonprofit generic-drug manufacturer with the explicit mission of producing affordable versions of essential drugs and ensuring a stable supply of such products. A consortium of hospitals and health plans, including Intermountain Healthcare, Trinity Health, SSM Health, and Ascension, in collaboration with the Department of Veterans Affairs and philanthropists, is following this approach and developing a nonprofit generic-drug manufacturer code-named Project Rx. Citation: Liljenquist D, Bai G, Anderson GF. Addressing Generic-Drug Market Failures -The Case for Establishing a Nonprofit Manufacturer. N Engl J Med. 2018;378 (20):1857-1859.

Public Procurement of Food in Canada

Unhealthy foods are widely available in public settings across Canada, contributing to diet-related chronic diseases, such as obesity and diet-related diseases especially among vulnerable groups, including children and seniors. Healthy food procurement policies, which support procuring, distributing, selling, and serving healthier foods, have recently emerged as a promising strategy to counter this public health issue by increasing access to healthier foods. Although numerous Canadian health and scientific organizations have recommended such policies, they have not yet been broadly implemented in Canada.  To inform further policy action on healthy food procurement in a Canadian context, the authors conducted an evidence synthesis to assess the impact of healthy food procurement policies on health outcomes and sales, intake, and availability of healthier food. Based on this review, they recommend policies and practices for governments, publicly funded institutions, decision-makers and professionals, citizens, and researchers. They conclude that implementation of healthy food procurement policies can increase Canadians’ access to healthier foods as part of a broader vision for food policy in Canada.

Citation: Raine KD, Atkey K, Olstad DL,  et al. Healthy food procurement and nutrition standards in public facilities: evidence synthesis and consensus policy recommendations. Health Promot Chronic Dis Prev Can. 2018 ;38(1):6-17.

Fast Facts on the Public Health and other Benefits of Public Transportation


  • A person can reduce his or her chance of being in an accident by more than 90% simply by taking public transit as opposed to commuting by car.
  • Traveling by public transportation is 10 times safer per mile than traveling by automobile.
  • Communities that invest in public transit reduce the nation’s carbon emissions by 37 million metric tons annually.
  • The average household spends 18 cents of every dollar on transportation, and 96% of this goes to buying, maintaining, and operating cars, the largest expenditure after housing.
  • A household can save nearly $10,000 by taking public transportation and living with one less car.
  • ​Public transportation’s overall effects save the United States 4.2 billion gallons of gasoline annually.
  • The average household spends 18 cents of every dollar on transportation, and 96% of this goes to buying, maintaining, and operating cars, the largest expenditure after housing.
  • A household can save nearly $10,000 by taking public transportation and living with one less car.
  • Public Transportation Reduces Gasoline Consumption
  • Public transportation’s overall effects save the United States 4.2 billion gallons of gasoline annually.

Source: American Public Transportation Association. Public Transportation Benefits

Automobile Advertising by the Numbers: Promoting Chronic Diseases and Injury, Pollution and Unlivable Cities

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A Cadillac Escalade, a General Motors Sports Utility Vehicle Photo Credit 

In the The Hidden Costs of Cars, posted on Medium, Todd Medema summarizes some of the ways that automobile use in the United States harm health, the environment and the pleasures of city living.  As President Trump promotes expansion of the automobile industry and relaxation of emissions and pollution controls and the auto industry increasingly relies for profits on the more polluting SUVs and light trucks, is the United States poised for a rise in auto-related harms?

The auto industry defends its promotion of more polluting vehicles as simply giving the American people what they want.  But an examination of advertising expenditures over the last decade shows that the industry spends heavily to shape those choices.  As with tobacco, alcohol and unhealthy food, the choices consumers make are influenced by what’s available on the market and the content and volume of advertising.  A look at the numbers reveals the scope of these efforts:

Screen Shot 2018-05-16 at 5.09.50 PMIn 2016, the ten largest auto makers in the United States spent $15.5 billion dollars on advertising. General Motors was the biggest spender, with almost $3.8 billion allocated to advertising.

Screen Shot 2018-05-16 at 5.09.50 PMIn 2015, light trucks and SUVs accounted for 63% of vehicles sold in the United States, up from 17% in 1980. The number of vehicles sold increased more than fivefold, from about 2 million vehicles to about 11 million.

Screen Shot 2018-05-16 at 5.09.50 PMAn automaker earns about $1,500 to $2,000 for a passenger car, said Jeff Windau, an auto industry analyst at investment house Edward Jones & Co.  “You contrast that with $10,000 to $13,000 on a truck. You can definitely see that the trucks and SUVs are driving the profitability of the automakers.”  In 2016, General Motors generated 100 percent of its U.S. profit from large SUVs and pickup trucks, according to a report from Morgan Stanley Research.

Screen Shot 2018-05-16 at 5.09.50 PMIn 2015, the top seven global auto advertisers—Volkswagen, General Motors, Daimler AG, ford, Toyota Fiat Chrysler and BMW spent almost $32 billion on advertising, contributing to increased auto and SUV purchases around the world.

Screen Shot 2018-05-16 at 5.09.50 PMIn U.S. mass media and digital advertising in 2016, automotive advertising was the second largest category, outspent only by retail chains.

Screen Shot 2018-05-16 at 5.09.50 PMFor each fatality avoided for an SUV or light-truck occupant, studies show,  more than four fatalities are inflicted on others. Furthermore, SUVs (as well as pickup trucks) were more often involved in pedestrian deaths, and upon accidents a higher pedestrian injury severity score was obtained. Light trucks and vans (including SUVs) were four times as likely to be associated with fatal injury of young children. SUVs and light trucks emit more pollution and air pollution accounts for roughly one out of nine deaths worldwide, or 11.2 percent of global deaths.  As SUV sales increase in the United States, Europe and China, these nations may face more difficulty in reducing pollution-related deaths and disease, a problem also confronting  low and middle income countries.

Holding Food Companies Responsible for Unhealthy Food Marketing to Children: Can International Human Rights Instruments Provide a New Approach?

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Public health advocates argue that unhealthy food marketing to children infringes children’s rights, given its link to obesity, and that states have an obligation under the UN Convention on the Rights of the Child (‘UNCRC’) to protect children from such marketing. This article explains how international human rights concepts could be used to impose obligations directly on companies to modify their practices to protect children from unhealthy food marketing. We draw on the global governance framework that creates human rights obligations for businesses, and evaluate voluntary codes and initiatives on responsible marketing to children in Australia, to see whether they satisfy the obligations imposed under this framework and the UNCRC. Finding significant limitations in these measures, we set out recommendations for how the food industry could take an approach to food marketing that places children’s best interests as a primary consideration.

Citation: Handsley E, Reeve B. Holding Food Companies Responsible for Unhealthy Food Marketing to Children: Can International Human Rights Instruments Provide a New Approach?  University of New South Wales Law Journal, 2018 (41)2: 1-41.

Alcohol industry corporate social responsibility initiatives and harmful drinking: a systematic review 

There is growing awareness of the detrimental effects of alcohol industry commercial activities, and concern about possible adverse impacts of its corporate social responsibility (CSR) initiatives, on public health. This systematic review examines what is known about CSR initiatives undertaken by alcohol industry actors to address harmful drinking globally. Based on a review of 21 studies, the authors identified five types of CSR initiatives relevant to the reduction of harmful drinking: (1) alcohol information and education provision; (2)drink driving prevention; (3) research involvement; (4) policy involvement and (5)  the creation of social aspects organizations. Individual companies appear to undertake different CSR initiatives than do industry-funded social aspects organizations. There is no robust evidence that alcohol industry CSR initiatives reduce harmful drinking. There is good evidence, however, that CSR initiatives are used to influence the framing of the nature of alcohol-related issues in line with industry interests.  The authors concluded that alcohol policy measures to reduce harmful drinking are needed, and the alcohol industry CSR initiatives studied so far do not contribute to the attainment of this goal.

Citation: Mialon M, McCambridge J. Alcohol industry corporate social responsibility initiatives and harmful drinking: a systematic review. European Journal of Public Health. 2018 Apr 25.

Can Public Health Advocates in Europe and the United States Together Protect Public Health Regulation?

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Nicholas Freudenberg speaks on corporations and health at DeBalie, a public lecture hall in Amsterdam.

In both Europe and the United States, public health regulation is under attack.  Despite the Volkswagen Dieselgate emission cheating scandal, the European Union has not yet developed guidelines to prevent future cheating.  Monsanto continues to block stronger regulation of glycophates in Europe and North America. In the United States, President Trump and the Republican Congress are slashing funding and rescinding public health regulations at several federal agencies.  Can public health professionals and advocates in  two of the world’s largest markets join forces to resist these trends?

At a recent series of lectures in Brussels, Amsterdam and The Hague, Nicholas Freudenberg, Distinguished Professor of Public Health at the City University of New York School of Public Health and author of Lethal but Legal: Corporations, Consumption and Public Health examined some of the issues confronting those seeking to reduce corporate practices that harm health.  In his lectures, he suggested five broad goals for a transatlantic agenda to protect public health against corporate efforts to roll back regulations.  These included:

  1. Remove corporations from public health and trade policy decisions
  2. Protect science from corporate manipulation and conflicts of interest
  3. Revitalize public sector in food, medicines and transportation to provide an alternative to corporate control
  4. Protect democracy from corporate interference
  5. Challenge the view that no other world is possible

The lecture and trip was sponsored by Wemos Foundation, a Dutch global health foundation, the European Public Health Alliance and Corporate Europe Observatory, timed to coincide with the translation of Freudenberg’s book into Dutch, Legaal Maar Fataal. Each of these organizations provides useful resources for North American public health professionals who want to better understand recent developments in Europe.

The Wemos Foundation, for example,  sponsored a forum on the interactions between the European Medicines Agency (EMA) and the pharmaceutical industry and explored strategies for reducing conflicts of interest.  A summary of the event is available here.

The European Public Health Alliance(EPHA), an organization of public health NGOs, patient groups, health professionals and disease groups, works to improve health and strengthen the voice of public health in Europe. Several recent reports focus on issues also of concern in the United States:

  • In another recent  report, EPHA and other groups call for the United Nations Institute for Training and Research (UNITAR), to end a newly formed partnership with the world’s largest beer producer, AB InBev.
  • The Unhealthy side effects of CETAexamines the Comprehensive Economic and Trade Agreement (CETA) between the European Union and Canada, the first trade agreement  between  the  EU  and a  major  world economy and  the  most far-reaching  bilateral  trade and  investment  agreement negotiated  to  It concludes that the agreement “limits the  policy  space of  governments  in the  area  of public health, tariff elimination, market access commitments, negative listing of services, its  lack  of recognition  of  the health-relevant  aspects  of the  Sustainable  Development Goals (SDGs) and ignoring key health risk  factors  and threats  such  as alcohol-related  harm  or antimicrobial  resistance.  In short, CETA fails to ensure policy coherence between trade and public health.”

The Corporate Europe Observatoryis a research and campaign group working to expose and challenge the privileged access and influence enjoyed by corporations and their lobby groups in EU policy making.

For public health advocates in the United States, these organizations and their reports can be useful resources for developing strategies to resist deregulation and reduced enforcement.  “As the U.S.  government dismantles the public health regulatory agencies developed over the last 50 years,” said Freudenberg, “researchers need to document the impact of these changes and develop new strategies to protect public health.  By partnering with European scientists and advocates, we can accelerate this process.”

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Tracking the Effects of Corporate Practices on Health