Corporate Accountability International: Global Action Challenging Unhealthy Corporate Practices

Posted on by Corporations and Health Watch

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.

Current Campaigns

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.

Tobacco Campaigns

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

Interview with Richard Daynard

Posted on by Corporations and Health Watch

In March 2006, the newsletter Informed Eating interviewed Richard Daynard, professor at Northeastern University School of Law.

Food activists often ask what lessons they can learn from the fight against Big Tobacco. In this interview, published in March 2006 in Informed Eating, a newsletter of food politics and analysis, Richard Daynard, a professor at Northeastern University School of Law, chair of the Tobacco Products Liability Project, and director of the Public Health Advocacy Institute’s Law and Obesity Project, describes his views on the similarities and differences between the public health advocacy on food and tobacco.

Update on Pharmaceutical Industry: New threats to Pharma’s public reputation

Posted on by Corporations and Health Watch

In the past, the pharmaceutical industry was often seen as a positive social force, contributing life saving drugs and bringing new developments in medicine and science to the public. In recent years, however, public opinion has begun to shift. In 2005, for example, a Kaiser poll showed that for first time, more people said drug companies generally do a “bad job” (48%) than a “good job” (44%) of serving consumers, marking a nine year decline in such ratings. While drug companies were still rated more favorably than tobacco and oil companies, banks, airlines and HMOs were rated more favorably. In a 2005 Harris poll, a majority of US adults(51%) thought that pharmaceutical industries should be more regulated , a larger proportion than supported more regulation of tobacco companies(36%) or the health insurance industry (46%). Between 2003 and 2005, the proportion of respondents who believed that the pharmaceutical industry could be considered “honest and trustworthy” fell by 31%, from 13% in 2003 to 9% in 2005.

In this report, we highlight some recent reports that might explain the declining public perceptions of the pharmaceutical industry.

Marketing to Doctors

In order to maintain a license to practice medicine, most states have an ongoing medical education requirement for physicians. While many doctors seek out such education at accredited universities and medical associations, increasingly medical providers attend educational courses funded by the pharmaceutical industry. Since 1998, funding by Big Pharma for continuing medical education has quadrupled and now totals more than $1 billion (1). In order to fund medical education, pharmaceutical companies hire for-profit – medical education communication companies – which receive their content from the drug industry and then deliver the educational material to physicians in continuing education courses. Such practices have come under fire and recently Senators Max Baucus and Charles Grassley released a report on the unethical funding of medical education by the pharmaceutical industry.Read more about marketing to physicians here.

In medical education courses paid for by drug companies, often the benefits of a specific drug are touted without mention of potential side effects. For example, pharmaceutical makers plug sleep aids to consumers and physicians as an effective solution to insomnia, again often failing to mention concerns about efficacy, and potential side effects ranging to dependence to increased mortality amongst adults. (2) Now new research demonstrates that sleep aids are increasingly being prescribed to children.

In July, a subsidiary of Jazz Pharmaceuticals pleaded guilty in federal court to felony charges of improperly promoting their narcolepsy drug “Xyrem” for unapproved uses. Jazz Pharmaceuticals promoted the drug for depression, insomnia, and fibromyalgia. Xyrem is a powerful anesthetic and is the prescription version of the street drug “gamma hydroxybutyrate,” which has been linked to date rape and has a high risk of overdoes. The street version of Xyrem is listed by the Drug Enforcement Administration as a Schedule I drug, a drug considered to be the most dangerous. As part of their off label marketing campaign, Jazz Pharmaceuticals worked with doctors to improperly promote the drug on their behalf. Read more.

Marketing to doctors and patients

In 2006, drug company Merck launched its Human papillomavirus (HPV) vaccine “Gardasil” in the United States and in the European Union. With over 20 million people in the United States believed to be infected with HPV and with rates rampant around the world, Gardasil was touted as a “wonder drug” as it targeted four subtypes of HPV. HPV is the umbrella term used to describe a group of viruses that includes more than 100 unique types. Escalating rates of HPV have raised concern as more than 30 of these strains are sexually transmitted and of those, approximately one third can lead to the development of cervical cancer. With vaccination, it has been hoped that the rates of cervical cancer could be drastically reduced. Given this, lawmakers in the US and around the world have pushed for mandatory HPV vaccination. However, there is reason to doubt the “wonder drug” status of Gardasil. In a four part series, Judith Siers-Poisson examines the facts and hype around Gardasil, explores what pharmaceutical giant Merck stands to gain through practices such as mandatory vaccination, and reviews the reception of Gardasil on the global front. Read the articles.

Direct-to-consumer marketing, a strategy Big Pharma uses to create brand loyalty and encourage patients to ask for specific drugs, has been a controversial practice and is currently legal only in the United States and New Zealand. In an attempt to create interest in and a market for “Restylane,” a dermal injection designed to reduce the appearance of wrinkles, Medicis Pharmaceutical Company recently paired with YouTube to target middle-income consumers. While generally products such as Botox or Restylane have been considered safe, they have been known to result in side effects from rashes to flu-like symptoms to temporary facial “drooping.” The market for these products is large and growing; in 2005, $12.4 billion was spent on such cosmetic treatments (3). Until now, these cosmetic products have been considered the bastion of the wealthy. Thus, to broaden the market Medicis is finding new ways to reach potential consumers such as the YouTube advertisement. Read about Medicis “Hottest Mom” contest and its other advertising campaigns.

Lobbying

During the first half of 2007, The Pharmaceutical Research and Manufacturers of America, (PHRMA), a drug industry lobby group, spent $10.7 million to lobby the U.S. government. PHRMA’s members include Eli Lily & Co., Pfizer Inc., Amgen Inc. and other major drug companies. The lobby pressured lawmakers on Medicare, drug fees safety, importation, patient reform and international trade. The current president and chief executive of PHRMA is former Louisiana Representative Billy Tauzin, who is also a registered lobbyist for the group. Read more.

FDA Approval

After FDA advisory panels on the diabetes drug “Avandia,” produced by GloxoSmithKline, a decision was reached that the product will now come with warnings that it may significantly increase the risk of heart attack. Gerald Del Pan, the director of the FDA’s Office of Surveillance and Epidemiology, was one of many voices criticizing the decision: “Cardiovascular disease being the leading cause of death of people with diabetes, having a treatment that causes that is something that doesn’t make sense to me.” Read more about the FDA decision.

Controversy over the drug rosiglitazone has led to further criticism over the FDA’s approval process. Dr. Clifford Rosen, who recently chaired the FDA advisory panel on rosiglitazone stated that while the new product had been considered a “wonder drug,” ultimately it was “approved prematurely and for the wrong reasons by a weakened and underfunded government agency subjected to pressure from the industry.” He further noted that the lax approval process lead to harm for patients. Read Rosen’s report on rosiglitazone and the FDA approval process.

Designer Drugs & Targeted Marketing

In “Race in a Bottle” in a recent issue of Scientific American, Jonathan Kahn writes about BiDil, a drug for heart failure marketed specifically to African-Americans. Some researchers have questioned the scientific grounding for BiDil’s race-based targeting given that in the clinical trial on which the FDA based its approval, the drug was only tested on African Americans and thus true comparisons among racial groups cannot be made. Others have pointed to the danger of race-based medicine itself, noting that it (re)locates social categories within biology. In addition, such a conceptualization of health disparities overlooks contributing structural reasons for them. More than twenty years ago, researchers began exploring the effectiveness of combining two vasodialators (hydralazine and isosorbide dinitrate, hereafter H/I) on heart failure. While angiotensin-converting enzyme (ACE) inhibitors soon gained prominence in treating heart disease, some doctors prescribed H/I for those who failed to respond to the ACE treatments. Convinced of the efficacy of H/I, in 1987 cardiologist

John Cohn, who was one of the original researchers studying their combination, applied for a patent on the method using the drugs together to treat heart failure in the population at large. Because the drugs were already available in generic form, Cohn could not patent the drug combination itself. After receiving a patent on the method, he licensed the rights to the small pharmaceutical company Medco which released the two drugs in a single pill form known as “BiDil”, a combination of two previously tested and available in generic form, was first tested in the early 1990s. After the FDA refused to approve BiDil,the cardiologist who had led these earlier studies, returned to the data from these first trials and noticed that the small number of African-Americans on whom the combination was tested, responded positively to treatment. Cohn then filed a new patent application marketing the drug specifically with Black patients. Two years ago, the FDA gave approval for BiDil to NitroMed (the pharmaceutical company to whom Cohn reliscenced the drug). The event marked the first time an “ethnic drug” was approved for use.

Taking on the Pharmaceutical Industry

One of the latest organizations fighting questionable pharmaceutical industry practices is the Prescription Project. The campaign, led by Community Catalyst – a health-care consumer advocacy group based in Boston – was funded by the Pew Charitable Trusts to reduce the influence of the drug industry on the prescribing practices of doctors. Currently, drug companies spend approximately $7.2 billion per year on marketing to doctors and provide $16 (million?) worth of samples. This amounts to more than half of what the industry spends on research and development per year. The Prescription Project promotes the creation and implementation of guidelines that would restrict or ban the pharmaceutical industry from engaging in funding continuing medical education and providing incentive items and gifts. Read more

In May 2007, Nigerian authorities filed in their state and federal courts a multi-billion dollar lawsuit and criminal charges against the pharmaceutical giant Pfizer for testing an experimental drug on children. Pfizer has asked a Nigerian court to throw out the lawsuit, which stems from its testing of the experimental drug – Trovan – in 1996 during a meningitis epidemic. Trovan resulted in the deaths of 11 children and injured an additional 189 others. While Pfizer claims that the trial was explained to parents and their consent was obtained orally before the drug was given to their children, Nigerian authorities claim the drug company did not tell families that their children would be participating in a study using an experimental drug.Read more.

 

References

1. Carlat, D. Diagnosis: Conflict of Interest. New York Times. June 13, 2007. 
2. Mozes, A. Most Sleepless Kids Prescribed Drugs: Study. Practice is widespread, even though FDA doesn’t approve pediatric use. Healthfinder.gov. 2007. 
3. Jennings, A. Contests, YouTube and Commercials Converge for Skin Product. New York Times. June 27, 2007

 

Photo Credits:
Photo 1: courtesy of Stanford University
Photo 2: copyright: Merck
Photo 3: courtesy of CA.gov

Commentary: Voluntary Guidelines vs Public Oversight: Finding the right strategies to reduce harmful corporate practices

Posted on by Corporations and Health Watch

Last July, in an effort to reduce obesity, eleven major food and drink companies announced plans to restrict television advertisements to US children under the age of 12. Federal Trade Commission Chair Deborah Platt Majoras hailed this voluntary move, claiming that “industry action can bring change more quickly and effectively than government regulation of speech.” Since advocates seeking to reduce the harmful health consequences of the food, tobacco, alcohol, pharmaceuticals, firearms and automobile industries need to make decisions about the relative merits of voluntary industry action and public oversight, it is worth considering the evidence on this issue.

One way to assess the truth in Commissioner Majoras’s assertion is to examine other examples of industry self-regulation of products that harm health. For example, in his new history of the tobacco industry, The Cigarette Century, Harvard historian Allan Brandt explains that for decades, the tobacco industry claimed that its voluntary advertising guidelines precluded the need for stronger government regulation. For decades, until the 1970s, industry arguments  – and their political contributions – persuaded Congress not to act. Smoking continued to increase until restrictions on advertising, bans on public smoking, and tobacco tax hikes helped to bring smoking rates down. Had the government resisted tobacco industry pressure by instituting these measures two decades earlier, when most of the scientific evidence against tobacco was already established, hundreds of thousands of premature tobacco deaths could have been averted.

Beer industry self-regulation

To avoid regulation of alcohol marketing, the beer industry established voluntary guidelinessetting rules on advertising content and placement. A 2006 independent review of the beer industry’s compliance with these guidelines found that beer makers met three of its 15 recommended standards, partially met four and failed to meet eight, hardly strong evidence for compliance. Research shows that exposure to alcohol advertising contributes to increased youth drinking. Each year about 4,500 young people die in the United States from alcohol-related causes, and two million more are injured.

 

Oversight of global food companies

Returning to the food industry, in 2005, the World Health Organization asked three nutritionists to evaluate how well McDonalds and Kraft, signatories to this week’s agreement, had kept their own promises to improve practices related to obesity. The reviewers found that the companies had, at best, made modest changes and continued to market unhealthy products to children. They concluded that “for business reason alone,” food companies “cannot” and “will not” “stop making and marketing nutritionally questionable food products to children” and therefore only regulatory intervention could protect children’s health.

Corporate arguments against public oversight

Interference with free speech. Corporations offer three main arguments against stronger public oversight of their health practices. First, they claim limits on advertising interferes with their right to free speech. The legal theory that the First Amendment protects corporations – commercial activities is relatively recent. Not until 1976 did the Supreme Court assert that corporate commercial speech warranted constitutional protection (Virginia State Board of Pharmacy v. Virginia Citizens Council, 1976). In that decision, the court found that a Virginia regulation banning advertising of pharmaceutical prices was unconstitutional. A consumer group argued that people had a right to pricing information, and the Supreme Court agreed. However, whether the right to provide consumers with factual information about a product also applies to speech promoting unhealthy food to children or potentially dangerous drugs to patients raises different legal issues. Since the current Supreme Court is more favorably disposed to corporate interests than at any time in its history, in the short run, the prospects for reducing successful challenges to expanded protection are slim. In the long run, however, giving commercial speech similar protection to political speech has created new threats to public health that require public consideration. Public health professionals may have the credibility to initiate this debate.

Nor is the FTC the only regulatory agency to take on a more pro-business slant during the Bush Administration. On September 1, 2007, the New York Timespublished a story on its investigation of the capacity of the Consumer Products Safety Commission to fulfill its mission. According to the Times, under President Bush, the CPSC has “blocked enforcement actions, weakened industry oversight rules and promoted voluntary compliance over safety mandates.” At a time when imports from China and other Asian countries surged, creating an ever greater oversight challenge, the Bush-appointed commissioners voiced few objections as the already tiny agency – now just 420 workers – was pared almost to the bone. By weakening the agency and failing to enforce its legislative mandates, charge consumer advocates, this Administration has turned its belief in the superiority of voluntary guidelines versus public oversight into a self-fulfilling prophecy.

Restriction of personal choice. The second principal argument against public oversight of harmful corporate practices is that it will prevent Americans from enjoying their freedom to eat, drink, or smoke what they want. In fact, in past decades, the loudest and most consistent influence on health and lifestyle today comes not from the “nanny state” but from corporate America. McDonalds spends more than a billion dollars a year to persuade children and their parents to fill up on high-fat Happy Meals that contribute to the nation’s obesity and diabetes epidemics. Philip Morris targets young people with ads that show smoking is fun, sporty and sexy while warning them that smoking is only for adults, a sure way to encourage experimentation. While courts force governments to use the least restrictive method possible to regulate private behavior that harms public health, corporations face no such limits in their efforts to persuade us to consume. Advertisers expose children to more than 20,000 television ads a year, placing their advertising in formerly non-commercial spaces such as cell phones, school classrooms, the sides of busses, taxis and even private SUVs, and use “viral marketing” techniques in which teens are hired to persuade their friends to buy certain products.

Leave it to Markets. The third argument against public oversight is that market forces are sufficient to modify harmful corporate practices and that well-intentioned but inadequately informed oversight will disrupt the market and produce unwanted and unintended side effects. The most frequently invoked historical example is the prohibition of alcohol, which is alleged to have created a black market, encouraged organized crime and promoted disrespect for the law. In the case of tobacco, however, market forces appear to have played a small role in controlling a product that contributed to 100 million premature deaths in the twentieth century. In fact, the market has been the principal savior of the tobacco industry, allowing it to find new populations to addict when public oversight restricted access in one place or to one group.

Public Health Arguments for Voluntary Guidelines

If only corporate leaders and their allies supported voluntary guidelines over public oversight, the task of public health advocates would be straightforward albeit challenging. We would need to make public arguments for oversight, mobilize constituencies who supported this position and convince policy makers to enact measures to protect public health. In fact, however, the public health community itself is divided on this question. Thus, it is necessary to examine the public health arguments for voluntary guidelines and to encourage open dialogue on this question within the profession.

Useful step in the right direction. Supporters of voluntary guidelines to modify corporate behavior advance several arguments. First, some claim that voluntary guidelines, even if inadequate, are a useful step in the right direction. When the advertising industry revised its voluntary guidelines for ads targeting children last November and several major food companies announced a new “healthy lifestyle” marketing campaign aimed at children, Dr. J. Michael McGinnis, a distinguished public health leader who served as chair of the Institute of Medicine’s Children’s Food Marketing Committee, said, “This is a move in the right direction. . . . It would be a pretty substantial change.” Critics responded that the guidelines didn’t go far enough. “I don’t see any substantial changes,” commented Susan Linn, a Harvard psychologist and author of Consuming Kids. Companies “will continue to be able to market junk food to children — and their marketing is going to be even more confusing for children because it will be linked to ‘healthy lifestyle’ messages.” In the case of tobacco, advocates argued that the industry crafted its voluntary guidelines to advance its business interests, limit future liability and avoid future regulation, not to protect public health, making the guidelines a step in the wrong direction.

Best possible deal under circumstances. A more pragmatic defense of voluntary guidelines is that however inadequate, such rules are better than nothing and perhaps the best option possible given political and economic constraints. Proponents of this position maintain that public disclosure of voluntary guidelines encourages political debate on the issue or sets the stage for later regulation. For example, in 2005, the New York City Department of Health and Mental Hygiene called on the restaurant industry to reduce voluntarily the use of trans fats. When a later survey showed that its call had gone unheeded, the Board of Health successfully instituted mandatory rules to eliminate trans fat.

Only public private partnerships have power to make meaningful changes. The belief that any public health successes require collaborative partnerships between the public and private sectors is deeply ingrained in mainstream American ideology. For example, Drs. Simon and Fielding, two leaders of the Los Angeles County Department of Health Services, assert that “all businesses and public health agencies share an interest: ensuring a healthy population. Businesses should have a financial interest in supporting organized public health efforts, and collaborative efforts can increase the reach and effectiveness of public health.” For those who believe that business and public health have an inherent confluence of interest, it is natural to seek partnerships. By allying with the power of big business, say the supporters of this approach, public health has a better chance of achieving its objectives.

Some advocates have a more critical view of partnerships. They argue that business can just as easily co-opt as support public health and that voluntary partnerships can be used as a substitute for more substantive protection. In a review of lessons for reducing obesity from advocacy efforts to modify tobacco, alcohol, firearms and automobile industry practices, Dorfman and her colleagues conclude:

Clearly both extremes – working too closely with the industry, or considering the entire industry a monolithic enemy – have downfalls. The best approach is to deal with the industry from a base of power. After the community organizing effort gels and there is a strong base of support in the community and solid strategic direction, then advocates can talk with the industry on their own terms.

In this view, the question is not whether to engage in discussions with industry about voluntary changes but rather under what circumstances, when and with what goals.

Conclusions

In summary, public health professionals offer compelling but contradictory arguments for and against voluntary corporate guidelines and stronger public oversight as strategies to reduce harmful corporate practices. To move beyond ideological assertions of the merits of one path or another will require systematic evidence that analyzes the outcomes of each option in a variety of circumstances. By focusing public health research on this question, public health officials and advocates can move towards evidence-based decisions that are based on concrete analyses of specific situations.

The stakes for finding the right balance between the two could not be higher. A recent study in the New England Journal of Medicine warned that if current trends on obesity and diabetes continue, our children and grandchildren will have shorter lifespans than we do. Choosing the right path to reduce the promotion of unhealthy food can help us avoid this prediction. Similarly, it is estimated that one billion people will die from tobacco-related diseases in the 21st century, a fate that can be changed only if the tobacco industry plays a different role in this century than in the last one.

Thus, providing more definitive guidance on how to choose when to support voluntary industry initiatives and when to insist on strong public oversight is literally a matter of life and death.

Nicholas Freudenberg is Distinguished Professor of Public Health at Hunter College, City University of New York.

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