In a recent article in the Journal of Public Health Management and Practice, Corporations and Health Watch contributing writer Lainie Rutkow and her colleagues at the Johns Hopkins School of Public Health conclude that schools of public health face a curricular gap, with relatively few offerings courses that teach students about the relationship between the private sector and the public’s health. While 75% of the 46 accredited programs they surveyed offered at least one course on the private sector and public health, more than 40% of the courses reported focused on a single industry such as health insurance or pharmaceuticals. Few focused on business and corporations as a social determinant of health and it did not appear that any emphasized teaching students how to investigate the health impact of corporation’s business and political practices.
A new resource that can help public health researchers and students to fill this gap is Strategic Corporate Research, a new website developed by Tom Juravich, Professor of Labor Studies and Sociology at the University of Massachusetts and graduate students in the UMass Labor Center. Although the resource is based largely on union corporate campaigns, its method for researching corporate structures and practices will be of value to planners of public health campaigns to modify health damaging corporate practices. The site includes information sources on US and Canadian publicly traded corporations, privately held firms and nonprofits and charities. It also offers a practical tutorial for aspiring corporate researchers.
More than 50 years ago – way before the internet was invented, notes Juravich, sociologist C. Wright Mills argued that we were being overwhelmed by information and that what we needed is not more information but a framework to make sense of that information. The website introduces a framework and a visual representation of the 24 areas (see below) where corporate researchers can focus their effort. Juravich explains this framework in Beating Global Capital: a Framework and Method for Union Strategic Corporate Research and Campaigns and on the website.
Previous CHW posts that described additional resources for public health researchers on studying corporations include:
Last year, writes J. Adam Skaggs of the Brennan Center for Justice in the New York Times, the N.R.A. outspent the leading gun control lobby 73 to 1. Senators facing tough re-election campaigns ignore the wishes of 90 percent of Americans because they fear the gun lobby could mount a $9 million ad campaign against them. The solution to this political dysfunction is to empower regular voters as a counterweight to big political money. The Empowering Citizens Act, sponsored by Representatives David Price and Chris Van Hollen, would do precisely that. By matching grass-roots donations from regular voters with public funds, the system would give Congressional candidates an alternative path to victory in which they depend on constituents and voters, instead of deep-pocketed donors seeking political favors.
Corporations and Health Watch contributing writer Bill Wiist reviews “Salt Sugar Fat: How the Food Giants Hooked Us” by Michael Moss on PLOS Medicine Community Blog. He writes that Moss shows that “the industry deliberately manipulates the level of sugar, salt and fat in their products so that consumers crave the products, or according to some scientists, become “addicted.” But, he goes on “ I was appalled by the proposed solution with which Moss concluded the book. After detailing the industry’s intentional manipulations, subterfuge, deceit, and carefully crafted products and advertising, his solution was the age-old ‘blame the victim’ platitude about raising consumer awareness to make better choices, a model that public health has been moving away from for decades.”
This statement reflects views and recommendations that emerged from a consortium meeting convened by the Center for Policy Analysis on Trade and Health (CPATH) and the Center for Tobacco Control Research and Education (CTCRE) at the University of California-San Francisco on Feb. 19, 2013, in San Francisco, to reinvigorate strategies to advance tobacco control in California and the U.S., and to strengthen public health and medical voices to inform trade policy.
Public health and medical organizations in the U.S. and internationally are increasingly engaged in addressing the nexus between tobacco control and global trade. Trade rules and trade agreements, including present efforts to negotiate the Trans Pacific Partnership (TPP), present challenges to tobacco control, at local, state, and national levels. Tobacco companies have recently accelerated their use of trade rules to attempt to delay and reverse tobacco control measures in the U.S., Australia, Uruguay, Norway, and Ireland. In negotiating the TPP, a new agreement for the 21st century, the United States has the opportunity to be a leader to safeguard public health and reduce the enormous burden of disease related to tobacco use.
The following proposals articulate concerns, goals, and key strategies to achieve them, that were discussed during the Consortium Meeting. Many have been consistently advanced by the medical, health care, and public health communities.
Concerns:
Tobacco is a unique product. Tobacco use is the leading preventable cause of death worldwide, and the only legal substance that, when used as intended, kills people.
Curtailing tobacco use must be a central element of policies to reduce preventable childhood morbidity and mortality, a key goal of the present U.S. Administration.
Trade agreements and trade rules offer the tobacco industry powerful tools to undermine and supersede local, state, and national measures to implement and enforce tobacco control measures.
The closed process of negotiating and adopting trade agreements uniquely privileges commercial interests, without the benefit of democratic public dialogue and debate, and review of evidence. Public health principles and perspectives are shut out.
Current proposals for a Trans-Pacific Partnership, and a trans-Atlantic US-EU trade agreement, present particular and urgent threats to public health.
Strategies for Creating a 21st Century Trade Agreement:
Incorporating Health-Related Concerns into Global Trade Negotiations and Agreements
We call on the United States to advance a trade proposal in the Trans Pacific Partnership negotiations that will safeguard public health, advance tobacco control measures that contribute to reducing the enormous burden of disease related to tobacco use, and prevent incursions by the tobacco industry against those measures.
Trade agreements must guarantee nations’ rights to protect public health from tobacco use.
Incorporate reference to the Framework Convention on Tobacco Control (FCTC) in trade agreements. Acknowledge deference to FCTC principles, as an expression of the international consensus on tobacco control, and affirm the right of nations to protect public health from tobacco and tobacco products in the text of all relevant chapters of trade agreements. (Policy Coherence)
Incorporate in the text of each regional and bilateral trade agreement the WTO Doha Declaration on countries’ rights to protect public health. The 2001 World Trade Organization (WTO) Doha Declaration on the TRIPS Agreement and Public Health affirms that WTO members may use “to the full” the flexibilities in the Agreement on Trade-Related Aspect of Intellectual Property Rights (TRIPS) “to protect public health and, in particular, to promote access to medicines for all…” This right can and should be extended to tobacco control measures. (Policy Coherence)
Strengthen the primacy of public health principles. Strengthen adoption and implementation of FCTC recommendations within and across nations to protect the public’s health from tobacco and tobacco products.
2. The TPP must not undermine the right and ability of participating countries from exercising their domestic sovereignty in order to adopt or maintain measures to reduce tobacco use and to prevent the harm it causes to public health.
Exclude tobacco control measures from existing and future trade agreements. The medical, health care, and public health community has consistently supported removing tobacco, tobacco products, and tobacco control measures from trade agreements as the most effective solution.
Remove investor-state dispute settlement (ISDS) provisions. Eliminate the rights of tobacco and other corporations to contest governments’ domestic sovereignty over public health and other policies, and to sue nations directly for financial damages through the global trade arena.
3. We must set trade policy through a transparent process that involves the public.
Trade agreements and trade rules which may affect public health, including preventing disease and death from tobacco, should be discussed and debated publicly, and in Congress.
Include effective public health representation in setting trade policies at the national, state, and local levels.
We further propose that advocacy for these goals can be strengthened by identifying and communicating with related constituencies concerned with trade: Labor, environment, access to medicines, sustainable agriculture, sustainable economic development, internet access; policy-makers at the local, state and national levels.
A recent study in the European Respiratory Journal examined the role of auto pollution on chronic disease progression. Investigators estimated the burden of childhood asthma attributable to air pollution in 10 European cities by calculating the number of cases of asthma caused by near road traffic-related pollution and of acute asthma events related to urban air pollution levels. They concluded that pollutants along busy roads are responsible for a large and preventable share of chronic disease and related acute exacerbation in European urban areas.
A new study published online by the Journal of Internal General Medicine compared information provided by pharmaceutical sales representatives to primary care physicians in cities in Canada, France and the United States. “Minimally adequate safety information” did not differ in the US and Canadian sites, despite regulatory differences. In France, consistent with stricter standards, more harm information was provided. However, the authors found that in all sites, physicians were rarely informed about serious adverse events, raising questions about whether current approaches to regulation of sales representatives adequately protect patient health.
Search engine operator and online marketing company Google has decided to stop advertisements of alcohol and alcoholic beverages in Finland from Tuesday, reported the Financial Times. The decision follows introduction of a new rule by Google in its advertisement policy that bans advertisement of alcoholic products. The ban will be also applicable in China, Poland, Vietnam, and South Korea. Google decided to ban advertisements of alcoholic products on its own volition, its product manager Sami Kankkuan said, adding that no country had directed them in this regard.
The New York Times reported last week that the United Nations General Assembly voted overwhelmingly to approve a pioneering treaty aimed at regulating the enormous global trade in conventional weapons, for the first time linking sales to the human rights records of the buyers. Although implementation is years away and there is no specific enforcement mechanism, proponents say the treaty would for the first time force sellers to consider how their customers will use the weapons and to make that information public. The goal is to curb the sale of weapons that kill tens of thousands of people every year.
Last week, the BRICS nations—Brazil, Russia, India, China and South Africa– met in Durban, South Africa, to create a new set of financial institutions designed to better meet their needs than the World Bank and the International Monetary Fund. They took steps to create their own credit rating agency and a BRICS Development Bank designed to fund infrastructure and sustainable development projects.
These new developments highlight the rapid growth of BRICS and their growing global influence. A recent report by the United Nations Development Program noted that “for the first time in 150 years, the combined output of the developing world’s three leading economies – Brazil, China and India – is about equal to the combined GDP of the long-standing industrial powers of the North”.
As BRICS nations develop, industrialize and urbanize, they are also becoming the world’s leading producers of chronic diseases and injuries – the by-products of the western model of consumption oriented economic growth. And here the question is will BRICS nations take a different path in public health than the western nations that have increasingly allowed market forces to set public health policy?
Two recent policy debates in South Africa illustrate the tensions. Last month, South Africa’s Department of Health announced new regulations designed to lower the salt (sodium) content of certain categories of food manufactured in South Africa. Research studies had shown that South Africans had higher salt intake than other populations. South Africans also have one of the highest rates of hypertension worldwide. An estimated 6.3 million people are believed to be living with high blood pressure in SA, making them more susceptible to life-threatening diseases like stroke and heart disease. Lowering the salt content in the foods most associated with salt intake was described as a cost effective measure to lower health care costs associated with NCDs. Initially, many major South African industries supported the new regulations, claiming it would create a more level playing field for all food companies. The Department of Health consulted extensively with food industry representatives and modified the regulations in response to industry suggestions.
Outside experts hailed South Africa for taking such concrete steps for reducing salt or sodium consumption. Professor Graham Macgregor, chairman of the World Action on Salt and Health (WASH) described South Africa as taking a “pioneering” role in salt reduction programmes. “Achieving a long and healthy life, free from disease,” he said, “is a right not just for South Africans but for everybody in the world. It is time that Western governments stopped being pressurised by their tobacco and food industry and follow South Africa’s example by setting specific targets for reducing non-communicable diseases (NCDs), including salt reduction to less than 5g a day, particularly in developing countries where the major burden of NCDs lies.”
But after the regulations were issued, the Consumer Goods Council, the trade association representing South African food manufacturers, changed its tune. In a statement, it said the Council was:
shocked and disappointed by the article regarding the salt reduction regulations. Following the process of policy promulgation(salt reduction), the CGCSA on behalf of its food members wrote to the Minister of Health on alternative approaches to ensure effective implementation of this initiative. The industry fully supports the goal of reducing salt in order to enhance public health. However, we are concerned that should these alternative measures not be taken into consideration, the impact of these good intentions will not be effective due to a number of reasons such as unrealistic timelines; lack of consumer education and cost implications as per the proposed draft regulations.
Some knowledgeable observers attributed the change in industry position to lobbying by multinational food companies, who feared that the South African regulations might set a precedent other countries would follow.
In another example of industry involvement in public health policy in South Africa, last week the government of Western Cape Province abruptly withdrew proposed regulations to restrict Sunday sales of alcohol only a few days before they were to go into effect. Western Cape Province is led by the Democratic Alliance, a political party that is regarded as more business friendly than the opposition African national Congress Party. Commenting on the apparent about-turn by the DA‚ the opposition party the African National Congress (ANC)‚ said the decision was a “political ploy by the DA after in realized that big business‚ its key constituency would be the hardest hit.” The ANC generally supported the by-law because alcohol abuse was a “serious problem in our communities”. South African Liquor Traders Association president Saint Madlala welcomed the decision on Thursday but said “they should not keep us in suspense‚ they should just scrap the whole idea” of restricting alcohol sales.
BRICS nations differ from each other politically and economically and face internal as well as external pressures to follow rather than guide market influences. But the Durban meeting showed the potential for emerging nations to chart new paths for sustainable development and human-oriented economic growth. In this context, the continued vulnerability of South Africa –and other BRICS nations- to corporate pressure to weaken public health protection shows that like Western nations, BRICS countries will need to find new ways to protect their people’s health from corporate interference.
Corporations and Health Watch 
