The drug company Johnson and Johnson, according to the New York Times, last week said that it would pay $158 million to settle a 2004 Texas lawsuit that accused the company of improperly marketing Risperdal, an antipsychotic drug, to state residents on the Medicaid health program for the poor, including children. The lawsuit accuses the company of pushing Risperdal as “appropriate and safe to treat a broad range of symptoms in populations and disease states for which it had no F.D.A.-approved indication, including in the child and adolescent population.”
Lobbying in Action: PepsiCo Fights Guidelines for Marketing to Kids
In a posting on theatlantic.com, Marion Nestle reports that Pepsi spent millions this year to fight a set of proposed standards that would regulate how products are presented to kids. Lobbyists are supposed to report what they do and how much money they spend doing it, but this information is not easily available to the public. CBS News reports that PepsiCo spent $750,000 to lobby the government last quarter. This comes to roughly $3 million annually, a drop in PepsiCo’s annual $30.6 billion sales in the U.S. – $57.8 billion worldwide.
The Manufacture of Lifestyle: The Role of Corporations in Unhealthy Living
What causes unhealthy lifestyles? In a new article now online at the Journal of Public Health Policy, I make the case that corporate business practices such as product design, marketing and retailing and corporate political practices such as lobbying, campaign contributions and sponsored research are fundamental causes of the of the lifestyles associated with the growing global burdens of non-communicable diseases and injuries.
By focusing attention on lifestylers, the organizations and institutions that shape lifestyles, as well as on the behaviors associated with unhealthy living (e.g., tobacco use, high fat, sugar and salt diets, excess alcohol consumption and so on), we expand our options for developing health-promoting public policies.
The figure below, described in detail in the article, illustrates some of the pathways by which corporate practices influence lifestyle.
In the article, I suggest four actions that public health professionals can take to advance policies that reduce unhealthy lifestyles.
1. Encourage governments to set advertising standards prohibiting promotion of unhealthy products and making misleading health claims.
2. Strengthen laws making corporations liable for the health-related damage associated with products they produce and promote.
3. Actively promote healthier, more sustainable lifestyles, addressing the demand for unhealthy products as well as the supply.
4. Demand political reforms that reduce corporations’ privileged voice in public policy.
The Occupy Wall Street movement and its critique – a world where fewer than one percent of the population determines the living conditions for the other ninety-nine per cent – suggests the potential to mobilize people in opposition to a corporate-controlled world. Our generation’s public health challenge: Can we find ways to link the Occupy Wall Street spirit to the task of overcoming the corporate control of lifestyles that are killing us?
Image Credit:
1. Campaign for Tobacco-Free Kids
A New Deal for Public Health in Britain: Whose Responsibility is the Health of the Public?
The recently empowered coalition government in Britain has adopted a new and controversial approach to public health. In 2010, the secretary of state for health, Andrew Lansley, released a white paper declaring that “Responsibility Deals” would be used to promote health lifestyles and reduce the public health and financial impacts of chronic diseases. Lansley specifically states that the deals are “a Conservative response to challenges which we know can’t be solved by regulation and legislation alone. It’s a partnership between Government and business that balances proportionate regulation with corporate responsibility.” The policy approach raises the ongoing issue of deciding what role government should play when it comes to protecting public health.
Similarly it begs the question of what role, if any, representatives from food, alcohol, and tobacco corporations should have when it comes to writing health policy.
It just takes a little Nudge, or does it?
The approach is founded on an idea that Geof Rayner and Tim Lang of the Centre for Food Policy at City University in London argue is an extension of neoclassical economics, where rational consumers make smart choices, and in so doing support free and responsive markets. Nudge, as this approach is called, comes out of an eponymous book by Thaler and Sunstein. Positioned as an alternative to regulation and the “Nanny State,” Nudge argues that policy interventions like legislation, taxing, regulations, and bans are ineffective and costly for governments to implement and enforce. Instead, government should work with private industry on matters of health promotion and rely more on social marketing and industry-sponsored programs such as a bank sponsored “public” bike-rental scheme in London.
“Responsible” Dealings
The responsibility deal focused on diet and physical activity has three objects, or what it calls pillars. These are:
One: To enable, encourage and incentivize consumers to adopt a better diet and to increase their levels of physical activity as part of a positive decision to lead a healthier lifestyle.
Two: To enable and encourage people to drink sensibly and responsibly.
Three: To extend the scope and effectiveness of occupational health services through businesses, especially for small and medium-sized businesses, with an emphasis on maintaining a healthier lifestyle amongst the whole workforce and thereby reducing sickness and absence.
To date, roughly 400 corporations have signed on to, or pledged, promote these goals. In keeping with the theme of voluntary action and self-monitoring, each of these corporations has drafted and submitted its own pledge to the British Department of Health. In April of this year, each will also submit a self-assessment of their success meeting their goals. As an example of the type of commitments made, 40 of the “partners” as the corporations are referred to by the Department of Health, have agreed to start calorie labeling schemes of foods eaten out of the home. McDonalds is the largest retail outlet to sign on. Others among the 40 corporations include Starbucks, Burger King, Pizza Hut, KFC, and several of the large supermarket chains. The Department of Health estimates that by 2012, 8000 food outlets in Britain will have calorie labels on their menus. While this is a move, perhaps nudge, in the right direction, it is a far cry from the scale of change likely needed to create real gains in public health. No aspect of this responsibility deal standardizes or mandates the size and/or placement of the calorie labels. No one other than the corporations themselves will be checking the accuracy of the calorie counts posted.
New York City’s experience provides a useful comparison. In New York, the calorie labeling regulation passed in 2007 applies to roughly 10 percent of the city’s 23,000 restaurants. The city’s legal battle with the food industry over the law shows that in a regulatory context with enforcement, details about the placement, accuracy, and size of calorie labels generate significant debate. For New York, the devil in these details of implementation was believed to be critical to the policy’s impact. Britain’s approach is to be hands-off on these issues.
Medical and Public Health Professionals Respond
Not surprisingly, responsibility deals raised more than eyebrows in the British medical and public health communities. Several of what would have been key partners in this collaborative approach to promoting health have refused to participate. This pushback from health advocates and professionals includes academics (like Lang and Tahyer), the British Medical Association, the British Association for the Study of the Liver, the British Liver Trust, Alcohol Concern, the Institute of Alcohol Studies, and the Royal College of Physicians. A consortium of NHS members, public health professionals, and concerned member of the public called Big Society NHS has critiqued the deals, stating that:
“The model of intervention promoted places government regulation as the last step. Once again shirking responsibility and leaving patients susceptible to corporate promotion of profits over health. In short these reforms neglect and dilute patient care, through the systematic fragmentation of the NHS, decrease in government responsibility and increase in privatisation.”
Other concerns of these constituent groups include:
- The potential for government and private industry collusion behind closed doors on public health policy
- History shows that private industry’s profit motive will prevent it from acting in ways that protect and promote health
- That several of the resource allocating mechanisms of the reform will exacerbate, rather than reduce, health inequalities
- The government white paper outlining the reform fails to include plans for monitoring the impacts of the policy
- The government white paper outlining the reform fails to include plans for recourse or regulation if it turns out that Responsibility Deals don’t improve public health
What about US?
At the heart of the responsibility deal controversy is the very old public health issue of jurisdictions at all levels of government needing independent decision makers to make the sometime tough and almost always unpopular choices that elected and appointed officials can’t. Time will tell if the responsibility deals create the positive impacts the conservatives claim they will. Or, if this collaborative approach including corporations in writing public health policy will backfire in the ways its critics claim.
For this writer the more salient questions are: do we have time to wait? Is saving money in the short-term on enforcing regulation really worth the potential damage to health and its consequences on public spending in the long-term?
As a final cautionary note, it is worth noting that elements of this approach have already worked their way across the pond. The US’s voluntary salt reduction program is modeled on one that originated in Britain. Given the unique powers and protections afforded to corporations in the US, one should wonder how irresponsible it might be to adopt these kids of deals in this context. It may seem like an impossible move today, but with the Tea Party brewing and a contentious election season on the horizon, it is worth keeping an eye on the latest in conservative, neoliberal, health policy.
Image Credits:
1. Vissago via flickr.
2. Toban Black via flickr.
3. KR Colvin via flickr.
Montana High Court Upholds Ban on Election Spending by Corporations
The Montana Supreme Court, reports the Great Falls Tribune in Great Falls, Montana, restored the state’s century-old ban on direct spending by corporations on political candidates or committees in a ruling Friday that interest groups say bucks a high-profile U.S. Supreme Court decision granting political speech rights to corporations. The decision grants a big win to Attorney General Steve Bullock, who personally represented the state in defending its ban that came under fire after the “Citizens United” decision last year from the U.S. Supreme court.
Cleveland Sues State of Ohio Over Trans Fat Ban
According to the Associated Press, the city of Cleveland sued the state of Ohio on Tuesday for the right to ban the sale of prepared foods that contain artery-clogging trans fats. The city filed suit in Cuyahoga County Common Pleas Court seeking to invalidate the state law blocking the ban. Mayor Frank Jackson said in announcing the lawsuit that the law unconstitutionally takes away the city’s home rule rights. The city ordinance passed last year would ban industrially produced trans fats in restaurant meals and grocery and bakery takeout items.
2012: The Year to Stop Playing Nice
Cross-posted from Appetite for Profit.
Instead of a potentially depressing year-in-review post, I decided to look ahead. (But do see Andy Bellatti’s amusing compilation of 2011 food news.) Given all the defeats and set-backs this year due to powerful food industry lobbying, the good food movement should by now be collectively shouting: I am mad as hell and I’m not going to take it anymore.
If you feel that way, I have two words of advice: get political.
I don’t mean to ignore the very real successes: increases in farmers markets, innovative and inspiring programs such as Food Corps, and an increasingly diverse food justice movement, just to name a few. But lately, at least when it comes to kids and junk food, we’ve been getting our butts kicked.
And it’s not just because corporations have more money to lobby, of course they do. It’s that too often, we’re not even in the game. Or, we tend to give up too easily. While I know many food justice advocates who understand this is a political fight over control of the food system, sadly I cannot say the same thing about some of my public health colleagues. Too many nonprofits, foundations, and professionals are playing it safe, afraid to take on the harder fights.
A politician from Maine I interviewed for my book was complaining to me about how food industry lobbyists were in his state capital every single day, while public health sent the occasional volunteer. His sage advice to us advocates: “You may be out-gunned, but you have to bring a gun.”
Moreover, many groups have shown that you don’t always even need a bigger gun. The small but impressive organization, Campaign for a Commercial-Free Childhood proved that this summer when it won an important victory against Scholastic regarding its corporate-sponsored materials. How did they do it? A combination of smart campaigning and effective media. Not by playing nice.
Many public health folks I know are more comfortable with research and data than politics and lobbying. But if we are to make real progress, that has to change. Back in May, after a series of defeats, my colleague Nancy Huehnergarth wrote a great call-to-action. She noted how public health advocates and its funders are “very genteel” and that when industry lobbying beats us back, advocates just want more science, believing that the new data “will finally convince policymakers and the public to take action.” But it doesn’t work that way, as she explains:
The reality is that when going up against deep-pocketed, no-holds barred opponents like Big Food, Big Beverage and Big Agriculture, public health’s focus on science and evidence is easily trumped by money and messaging. If public health advocates don’t start rolling up their sleeves and using some of the same tactics used by industry, progress in this fight to create a safe, healthy, sustainable food system is going to move very slowly.
OK, now for some good news. We are already seeing positive signs that indeed, the food movement is getting more political. Recent defeats are helping to mobilize people even more, as folks realize the food industry is not playing nice, so we can’t either. Here then, are just a few signs of hope for 2012:
1) The growing political movement opposing genetically-engineered foods, which includes a huge Just Label It campaign with an impressive list of supporters. Stay tuned also for the 2012 ballot initiative in California to label GMOs.
2) Powerful nonprofit organizations (who don’t shy away from politics) getting involved for the first time in nutrition policy. For example, the Environmental Working Group’s recent report on sugary cereals called out the utter failure of Big Food’s voluntary nutrition guidelines on marketing to children. Given EWG’s one million-plus supporters, I can’t wait to see where they go with this issue in 2012.
3) Increasing coverage in mainstream media that food industry marketing (and not just personal responsibility) bears much of the blame for the nation’s public health crisis. Examples include a front page story in a recent Sunday edition of the San Francisco Chronicle and Mark Bittman’s weekly Opinionator column in the New York Times, which is consistently smart and hard-hitting.
4) Speaking of media, as traditional investigative journalism outlets have become more scarce, a new breed of reporters may be born from an innovative project just launched in November: Food and Environmental Reporting Network. Its mission is to “produce investigative journalism on the subjects of food, agriculture, and environmental health in partnership with local and national media outlets.” Judging from its first in-depth report on dairy CAFOs in New Mexico, I am looking forward to more in 2012.
5) Finally, the Occupy movement, while still very young, has already inspired a number of food politics offshoots. As I wrote after Food Day, several others have penned calls to action showing the deep connections between corporate control of the food supply and economic injustice. (If you read just one, Tom Philpott’s Foodies, Get Thee to Occupy Wall Street should convince you.) Also, the amazing grassroots organization Food Democracy Now (based in Iowa) recently organized an “Occupy Wall Street Farmers’ March” to bring the message that family farmers are also the 99%. (Read organizer Dave Murphy’s moving account of the successful event and watch the videos of the passionate speakers – I promise you will be inspired.)
There are many other amazing groups, farmers, and eaters organizing all over the country (and the world) to take back our food supply from corporate profiteers. We’ve got plenty of challenges ahead, with the farm bill up for renewal and more school food nutrition standards to fight for, just for starters. I am hopeful that next year we will see the food movement get even more political. I just hope I can also say, by the end of 2012, that it was the year more of my public health colleagues joined in.
Image Credits:
1. Natalie Maynor via Flickr.
Altria: A Good Stock Buy for 2012?
The shares of Altria Group, the leading cigarette maker in the U.S., rose 20% in 2011’s flat market, and it’s up 50% over the past two years, nearly four times the market’s gain, reports Barron’s this week. Two weeks ago, the stock of Altria, the parent of Philip Morris USA, hit a 52-week high. But, warns Barron’s, investors have largely ignored the risks accompanying the domestic tobacco business. U.S. cigarette sales are in a severe long-term decline. Shipments are down by a third over the past 10 years. In 2011 alone, cigarette volumes fell an estimated 3.8%, reflecting the weak economy and an ever-growing public backlash against smoking. “Operating conditions in the U.S. cigarette industry are more difficult than generally recognized,” says David Adelman, long-time tobacco analyst at Morgan Stanley. He isn’t recommending any of the stocks.
The Champion of Pain Killers
Overdoses from painkillers now kill nearly 15,000 people a year and many experts doubt that they are effective in reducing long term pain. Yet a new investigation by Pro Publica, also published in the Washington Post, finds that an influential champion for painkillers is the American Pain Foundation, the nation’s largest advocacy group for pain patients. But 90% of the Foundation’s 2010 income came from the drug and medical device industry and its positions closely follow those of its corporate donors.
Interview with Joel Bakan, Author of Childhood Under Siege: How Big Business Targets Children
Joel Bakan is Professor of Law at the University of British Columbia in Canada, where he teaches and writes about constitutional law. He is author of the book The Corporation: The Pathological Pursuit of Profit and Power, (2004) and writer and co-creator of the documentary film, The Corporation. Last year, he published Childhood Under Siege: How Big Business Targets Children (Free Press, 2011). Recently, CHW’s Monica Gagnon interviewed Bakan. An edited version follows.
CHW: Your previous book, The Corporation, focused on the behavior of corporations more generally. What inspired you to look specifically at corporate targeting of children in Childhood Under Siege?JB: In The Corporation, I saw that the way that corporations targeted children was a really important topic, but I was only able to look at it as part of this larger project. As I was out on the road with both the book and the film, this seemed to be an issue that people were really concerned about. I’m also a father of two teenagers who were then around six or seven, so I was starting to see some of the effects of the corporate world on their lives and on my life as a parent. So that all came together and got me back into the writing chair to write this book.
CHW: In your new book, you write about the “new curriculum of childhood.” What do you mean by this?
JB: I found the term the “new curriculum of childhood” in another source, and it really hit me at the time. I had just finished reading a study by the Kaiser Family Foundation, which showed that children spend, on average, 8-10 hours a day engaged with commercial media. That is twice the amount of time they spend in school, and so it really seemed a propos to call this the “new curriculum of childhood.” What kids are learning from commercial media is the dominant influence in terms of their intellectual formation and their value formation. Increasingly, family influence and the influence of teachers have really subsided in relation to the influence of corporate marketers, advertisers and companies that are producing products. To me that is a quite radical shift.
CHW: You write that parents can be powerless to protect children from this harmful corporate influence. Why is this case?
JB: I think parents are the first line of defense for children, but the issues have become much larger than what parents can handle. As a society we can create conditions that are either hostile or facilitative of parents being able to do their job of protecting kids’ interests, and currently we’re creating conditions that are disempowering parents. I did an interview with a children’s environmental health expert, Dr. Bruce Lanphear, about the effect of industrial chemicals on children’s developing biological systems. I said, “How do you deal with this as a father?” and he said, “I can’t.” Parents shouldn’t be expected to be chemists. They simply don’t have the knowledge or the ability, and this is something that government regulators can and should do but are not dealing with.
Look at marketing targeted to children. When I was young, all my mother and father had to worry about was a television set in the living room and three channels. Now kids are out in the world with mobile devices, interacting with media. So how do parents control their children’s use of media in this context? How do you do it when your kids’ very social life depends on their being on Facebook, which is a marketing platform?
I look at pharmaceuticals as well. I tell the story of the tragic suicide of a girl while she was on Zoloft. The doctors and her parents thought Zoloft was a good drug. It turned out the company that produces it, Pfizer, had actually done studies that showed that when kids or teens took that antidepressant, the risk of suicide increased substantially. How is a parent supposed to protect his or her child without access to information that the company has failed to disclose, but that has crucial relevance for making decisions about their child? The problem is too big and the information too inaccessible. Parents don’t have 24 hours a day to become researchers in all of these areas. What we need to do as a society is deal with these issues in a way that makes it possible for parents to make good decisions that protect their children.
CHW: What are some of the implications of these corporate actions for public health?
JB: One of the public health issues I describe in the book is marketing. The American Psychological Association has just come out with a report that summarizes a review of a year’s literature on the effects of sexualized media on girls, and finds that there are links to low self-esteem, eating disorders and inappropriate sexual behavior. All of these things as companies are targeting younger and younger girls with more and more sexualized material. That’s a public health issue.
It’s a public health issue that many kids are becoming compulsive game players and social network participants. Currently, gaming and social network addiction are not recognized as true addictions, but I think any parent can tell you that their kids’ use of this media sometimes reaches unhealthy levels of compulsion, taking them away from interactions with family, from their school work and from sports. In the book, I look very closely at how game designers specifically rely upon behaviorists and psychological research to try to create games that are addicting.
Another issue I deal with is children’s unique vulnerability to environmental toxins. You have research showing that even very small quantities of industrial chemicals can have profound effects on developing biological systems. Industry continues to lobby for the most minimal constraints on production, distribution and emission of these chemical toxins, to the point where right now there are 90,000 industrial chemicals in the environment, and only 200 of those have been sufficiently tested for health effects. We’ve been taking this approach that chemicals are effectively innocent until proven guilty, and as a result, we’re creating an environment that is likely very toxic for children. One of the people I interviewed, an expert on children’s environmental health, Dr. Leo Trasande, said, “We are the humans in a dangerous and unnatural experiment, and it’s unconscionable.”
CHW: How have corporations responded to your criticisms?
JB: People who work in corporations really wear two hats. Yes, they make decisions that lead to actions that cause harm, but at the same time they’re human beings. They’re parents too. They live in this world too, and they’re as concerned as any other audience. I think I have, with this book, hit a nerve, because if you’re a parent there’s really nothing you care about more than your kids’ health and wellbeing. But there is a powerful feeling of disempowerment among parents today. What I suggest in the book is we have to perform our responsibilities as parents and do the best we can to protect our kids from all of this, but we also have a responsibility as citizens to try to change the conditions in which we’re parenting, to try to create a better society from the perspective of our kids.
CHW: One of the five ways corporations harm kids that you detail in your book is through pharmaceuticals. This is also one of the issues we examine at CHW. Can you give an example of how the pharmaceutical industry harms children?
JB: Over the last 30 years, pharmaceutical companies have ramped up their efforts to get kids on psychotropic drugs. In 1980, it was almost unheard of for a child to be diagnosed with a mental disorder and prescribed drugs to treat it. Now it’s as common as giving out antibiotics for strep throat. What has happened over the last 30 years? Have kids become so much more mentally ill? Is it a result of us becoming better at diagnosing mental illness? Or is there a third factor — pharmaceutical companies’ relentless marketing campaigns to doctors, to parents and children to sell the idea that certain behavioral difficulties are, in fact, psychiatric disorders that require treatment with drugs. The pharmaceutical industry has also managed, through various legal changes that took place in the early 1980s, to effectively take over medical research. The process of conducting clinical trials and publishing studies is much more driven now by corporate money than it ever was. This creates a systemic bias in favor of drug treatments that, I argue in the book, is likely leading to more kids being put on more psychotropic drugs for more disorders than is scientifically justified.
CHW: In your opinion, why is there not more governmental regulation of these issues?
JB: We’re currently going through a period where the notion of governments playing an active role in protecting public interest and promoting public good has been thoroughly undermined, and where the notion that markets and corporations should be free of any government restrictions seems to be in play. What I’m saying in this book is that as governments have pulled out of the task of trying to protect children, whether from chemical toxins or from mental toxins in the marketing context, or from undue prescriptions of psychotropic drugs, we’ve seen mounting harms to children.
CHW: Is government regulation the best solution? Are there other solutions?
JB: Government is definitely not sufficient. You can’t run childhood simply through government regulation. But, while it’s not sufficient, I do believe it’s necessary, because I don’t believe parents have the ability to protect their children from many of the harms that I outline. We need governments to step in and actually stop industry from throwing certain kinds of harms at our kids. In a democracy, that’s how it’s supposed to work. Governments are supposed to represent the people and defend the people’s interests, and somehow we’ve gone all askew on that. The main people whose interests are being protected in our current order are corporate persons. The rest of us have been told that it’s no longer the job of government to protect us.
CHW: What have you found in your research that gives you hope that corporations’ effect on children can be reversed? What can health advocates do to help?
JB: In all the areas I look at, there are real champions at all levels of government, in various non-governmental organizations and in parents’ groups. The problem, at the moment, is really a political problem. It’s that somehow the political will isn’t strong enough to address these issues in the way that they need to be addressed. There are lots of reasons for that, not the least of which that the industries involved have both feet in the door of the political process. Democracy is messy, difficult, complicated, and the only way we’re going to turn these things around is if we as citizens become active and do what we can in relation to these issues.
Corporations and Health Watch 