At What Cost: Modern Capitalism and the Future of Health

In AT WHAT COST (Oxford University Press; on sale March 16, 2021; hardcover; $29.95), CUNY Distinguished Professor Nicholas Freudenberg examines how globalization, financial speculation, monopolies, and control of science and technology have enhanced the ability of corporations and their allies to overwhelm influences of government, family, community, and faith. It describes the ways that our current political and economic system has made it more difficult for ordinary people to get the food, health care, education, work, transportation, and social connections — what the book calls the six pillars of health — they need to maintain their health.   

At What Cost argues that the world created by 21st-century capitalism is simply not fit to solve our most serious public health problems, from the covid pandemic and the climate emergency to opioid addiction and deaths of despair. Moreover, capitalism and systemic racism intersect to amplify the harms of each and widen stark inequities in health. However, author and public health expert Nicholas Freudenberg also argues that human and planetary well-being constitute a powerful mobilizing idea for a new social movement, one that will restore the power of individuals and communities in our democracy.

At What Cost is available from Oxford University Press as a hardcover or e-book and from other online and independent book sellers.

Watch the book launch where Freudenberg discusses his new book with Professors Marion Nestle and Mary Bassett and read this interview with Freudenberg in Salon. Visit the At What Cost section on this website here.

Developing a cohesive systems approach to research across unhealthy commodity industries


A new report in BMJ Global Health explores the links between unhealthy commodity industries (UCIs) such as tobacco, alcohol, unhealthy food, and gambling; analyzes the extent of alignment across their corporate political strategies, and proposes a cohesive systems approach to research across UCIs. The authors conclude that UCIs employ shared strategies to shape public health policy, protecting business interests, and thereby contributing to the perpetuation of non-communicable diseases. A cohesive systems approach to research across UCIs is required to deepen shared understanding of this complex and interconnected area and to inform a more effective and coherent response. 

Continue reading Developing a cohesive systems approach to research across unhealthy commodity industries

Draining the Big Food Swamp: A Recipe for Human and Planetary Health

“Draining the Big Food Swamp”, a new report by Feed the Truth  and Maplight looks at the size and political clout of one powerful industry that has long dominated Washington politics: Big Food. Big Food is a $1.1 trillion a year industry dominated by a few, highly-consolidated corporations that influence everything from how our food is grown and how we treat essential workers to the health of our children and our ability as a nation to achieve greater racial, gender, and social equity. The report recommends:

Continue reading Draining the Big Food Swamp: A Recipe for Human and Planetary Health

Moving Upstream To Advance Understanding of and Ways To Address The Commercial Determinants of Health

How can public health professionals and researchers best address the commercial determinants of health, defined by Anna Gilmore as “the ways in which corporations influence human health and inequalities”? At a recent session at the World Congress on Public Health, a panel of researchers discussed this question.

Continue reading Moving Upstream To Advance Understanding of and Ways To Address The Commercial Determinants of Health

COVID-19 and Big Pharma: Tracking the Impact

The COVID-19 pandemic has harmed people and organizations around the world. For the pharmaceutical industry, however, it has been a more contradictory experience. On the one hand, the pandemic has interrupted supply chains, diminished contact with customers, and threatened stronger government regulation. On the other hand, the virus has created new opportunities for windfall profits, Continue reading COVID-19 and Big Pharma: Tracking the Impact

Mapping of food industry strategies to influence public health policy, research and practice in South Africa


To identify the corporate political activity (CPA) of food industry actors in South Africa, Mélissa Mialon and her colleagues, writing in the International Journal of Public Health,  studied the CPA of ten different food actors in South Africa using a systematic approach to collect and analyze information available in the public domain, including material from the industry, government, academia, and civil society. They found that food industry actors in South Africa established multiple relationships with various parties in and outside the South African government. In addition, the food industry-sponsored community programs, with a focus on poverty alleviation, undernutrition, and food industry actors who influenced science, were directly involved in policymaking and helped frame the debate on diet and public health in South Africa. They concluded with calls for increased transparency, disclosure, awareness of industry strategies, and stronger mechanisms to address and manage industry influence within South Africa.

Market Power, Inequality, and Financial Instability

A new report from two economists at the Federal Reserve concludes that over the last four decades, the U.S. economy has experienced a few secular trends, each of which may be considered undesirable in some aspects: declining labor share; rising profit share; rising income and wealth inequalities; and rising household sector leverage, and associated financial instability. The authors develop a real business cycle model and show that the rise of market power of the firms in both product and labor markets over the last four decades, can generate all of these secular trends. They derive macroprudential policy implications for financial stability.

The Commercial Determinants of COVID-19: Implications for Public Health Practice and Policy

A webinar at the George Washington University Center on the Commercial Determinants of Health explored the relevance of the commercial determinants of health framework to understanding the spread of the COVID-19 pandemic and the societal response. View the presentation of Nicholas Freudenberg, Distinguished Professor of Public Health at CUNY School of Public Health and the one of Lucy Westerman, Policy and Campaigns Manager, at the NCD Alliance. A video of the session is available here:

Lessons from Corporate Influence in the Opioid Epidemic: Toward a Norm of Separation

There is overwhelming evidence, writes Jonathan Marks in Bioethical Inquiry,  that the opioid crisis—which has cost hundreds of thousands of lives and trillions of dollars (and counting)—has been created or exacerbated by webs of influence woven by several pharmaceutical companies. Opioid companies built these webs of health professionals, patient advocacy groups, medical professional societies, research universities, and others as part of corporate strategies of influence that were designed to expand the opioid market from cancer patients to larger groups of patients with acute or chronic pain. Governments, the academy, and civil society need to develop counterstrategies to insulate themselves from corporate influence and to preserve their integrity and public trust. These strategies require a paradigm shift—from partnerships with the private sector, which are ordinarily vehicles for corporate influence, to a norm of separation.

Racism, Capitalism, the COVID-19 Pandemic, and Public Health: Tracing the Connections to Inform Strategy


As the COVID-19 pandemic unfolds at the same time as more people in the United States protest manifestations of systemic racism than at any time in the past, public health activists ask how they can respond to these threats to health and health equity.  One way is to explore more fully the connections between systemic racism, defined by NAACP President Derrick Johnson as systems and structures that disadvantage African Americans, and modern capitalism, the global economic and political system that seeks to maximize business profits and increase business control of our economy, society and government.  Two recent articles explore these connections. 

Continue reading Racism, Capitalism, the COVID-19 Pandemic, and Public Health: Tracing the Connections to Inform Strategy