Lethal but Legal: Corporations, Consumption and Protecting Public Health

This week, Oxford University Press releases a new book by Corporations and Health Watch founder Nicholas Freudenberg, Distinguished Professor of Public Health at City University of New York School of Public Health and Hunter College. Here’s an excerpt from the Preface:

 

bookcover

Never before in human history has the gap between the scientific and economic potential for better health for all and the reality of avoidable premature death been greater. In the past, babies died in infancy, women in childbirth, workers from injuries or occupational diseases, and people of all ages from epidemics of infectious disease exacerbated by inadequate nutrition, contaminated water, and poor sanitation. For the most part, the world lacked the resources and the understanding to eliminate these problems. As societies developed; as science, technology, and medicine advanced; and as people organized to improve their standards of living, more and more of the world’s population attained the living conditions that support better health and longer lives.

 

Today, the world still confronts the global health challenges of the last century. Epidemics of malaria, HIV infection, tuberculosis, and other communicable diseases still threaten well-being and economic development in many poor countries. More than a billion people live in urban slums where the average lifespan can be 35 years, half of that in better-off places where residents have certain access to adequate nutrition, clean water, and sanitation.

 

Now new threats have emerged. Deaths from chronic conditions like heart disease, cancer, diabetes, and stroke have surged, today accounting for more than 60 percent of the world’s deaths. Injuries have become the leading cause of death for young people around the world. Everywhere, from the wealthiest nations like the United States to the poorest countries in Africa, Asia, and Latin America, the proportion of deaths from these causes of death are growing. These premature deaths and preventable illnesses and injuries impose new suffering on individuals, families, and communities. They burden economies and taxpayers and jeopardize the improvements in health brought about by the public health advances of the previous two centuries.

 

Alarmingly, these new epidemics are not the result of the poverty and squalid living conditions that caused illness and death in the past, even though chronic disease and injuries afflict the poor much more than the rich. Nor are they the result of ignorance and inadequate science. For the most part, we understand the causes of these illnesses and injuries enough to prevent them. What we lack is the political will to implement the needed preventive measures. Even worse, in some cases the growing health burden is the result of new science and technology, which have been used to promote profit rather than prevent illness. These new epidemics of chronic diseases and injuries are instead the consequence of what most people thought were the remedies for poverty-related ill health: economic growth, better standards of living, and more comfortable lifestyles.

 

While many factors contributed to this global health transformation, Lethal but Legal focuses on what I consider to be most important and most easily modifiable cause: the triumph of a political and economic system that promotes consumption at the expense of human health. In this book, I describe how this system has enabled industries like alcohol, automobiles, firearms, food and beverages, pharmaceuticals, and tobacco—pillars of the global consumer economy—to develop products and practices that have become the dominant cause of premature death and preventable illness and injuries. This system was born in the United States and has now spread around the world.

 

In a global economy that focuses relentlessly on profit, enhancing the bottom line of a few hundred corporations and the income of their investors has become more important than realizing the potential for good health that the world’s growing wealth and the advances in science, technology, and medicine have enabled. This tension between private accumulation and public well-being is not new. But in the twenty-first century, it has come to shape our economy and politics in ways that profoundly threaten democracy, human well-being, and the environment that supports life. Paradoxically, the increasing concentration of power in the small number of the world’s multinational corporations also presents new opportunities to create another healthier and more just future.

 

Lethal but Legal is available online from: 

amazon-logoBarnes__Noble_t250logo

and bookstores everywhere.

Has Australia’s Food and Health Dialogue Improved Quality of Food?

The Medical Journal of Australia published a report assessing Australia’s Food and Health Dialogue, a public private partnership established by the Australian Government in 2009 to encourage production of healthier food.  The authors concluded that “the Dialogue has highly creditable goals but the mechanism for delivering on them has proved inadequate. Explicit processes and the outcomes to be delivered within defined timelines are required, along with a clear plan for remediation if they are not achieved.”

Guns Send 20 Kids a Day to Hospital

A new study in Pediatrics reports that on average, 20 US children and adolescents were hospitalized each day in 2009 due to firearm injuries. Among children, firearm injuries are 1 of the top 3 causes of death and the cause of 1 in 4 deaths in adolescents ages 15 to 19 years. The authors conclude that more public health efforts are needed to reduce this common source of childhood injury.

Super Bowl Dreaming

football
credit

A few nights ago I dreamt I watched a transformed Super Bowl. It wasn’t the Broncos or the Seahawks who starred in my dream but the ads. Instead of promoting soda, beer, SUVs and candy, the ads urged viewers to reject appeals to enrich big corporations by consuming products associated with premature death and preventable illnesses and injuries.  

 

 

 

The opening ad showed two polar bears, one emaciated, one obese, wandering through a nightmare landscape where glaciers melted in the background and dark cactuses in the shape of classic Coke bottles blocked the bear’s path. “In my world,” said the scrawny bear, “we can’t find any food and we’re dying from hunger and the stress of food insecurity.”   “In my world,” the plump one replied, “we’re all coming down with diabetes from drinking too much Coke.  My left back paw may need to be amputated and my grandkids are so fat they can hardly move. How did we get here?”

 

 

The second ad was a TV version of a print ad run a few years ago by a group called Evangelical Environmental Network .   Targeted at Christian Super Bowl viewers, the ad asked “Would Jesus drive an SUV?”  The screen flashed statistics on the higher pollution levels of Ford Explorers, F-150s, Dodge Rams and other SUVs and light trucks, the rollover danger they posed to their drivers and passengers and the danger these massive vehicles posed to pedestrians, other drivers, and our carbon emissions.  “Be a steward for the future. Protect your children and protect the environment. Don’t buy SUVs, “the heavenly announcer urged.

 

 

“Do you think Big Alcohol will clean up your vomit or bail you out of jail after the fourth drink?” asked the third ad, showing images of a young woman throwing up in a toilet and a guy in handcuffs with a black eye after being arrested in a drunken brawl.  This ad was sponsored by Drink Truth, a new group that discourages binge drinking and promotion of alcohol to young people.  Drink Truth was using the lessons from the truth campaign, designed by the Legacy Foundation with tobacco settlement dollars. Truth appealed to rebellious teens to reject the tobacco industry’s efforts to profit at the expense of their health.  Scientific studies show that it contributed to more than 300,000 teens not starting to use tobacco.

 

 

This being the Super Bowl, there were another 47 minutes of ads—worth about $300 million in ad revenue to Fox — but mercifully my dream moved on to the half time show. The opener was Super Bowl favorite Beyoncé who began by apologizing to viewers and young people in general for accepting $50 million from Pepsi to promote their high sugar, salt and fat products that put her fans at risk of early death from diet-related diseases.  To atone for her avarice, she pledged to contribute $5 million and kick off a new campaign, Water Me Now, that will support schools, colleges and hospitals to replace their beverage vending machines with free water fountains.   Beyoncé then sang her new release Water Me Now Baby which extolled the virtues of free water for life, health and love.  In the Super Bowl show, Beyoncé swam, poured and went down a water slide in a super sized version of the Water Me Now water fountain that she planned to distribute.

 

 

To reach another demographic, the next star, also a Super Bowl alumna, was Madonna.  She apologized for her role in a Smirnoff ad campaign that encouraged young women to drink vodka, a campaign that public health experts believe contributed to rising rates of alcohol-related health problems among young women, a trend that threatens to bring equal opportunity for alcohol injuries and diseases to females, who had previously been at much lower risk than young men.  Madonna promised to contribute her dollars and talent to Drink Truth’s ad campaign.

 

 

Third up was Justin Beiber, ready to make amends for his recent drunk driving arrest.  With Beyoncé, the former Material Girl, Jay Z, LeBron James (the basketball star who has $42 million of endorsement contracts from Coca Cola, McDonald’s , Dunkin Donuts and others), Beiber  announced the celebs were creating Fans United for Restoring Democracy to urge young people across the country to mobilize for the 2014 Congressional elections to elect a Congress that will overturn the Citizens United decision, support meaningful campaign finance reform, and limit special interest lobbying.  “Until young people decide that politics matter,” said Beiber, “corporations are going to continue to undermine health, threaten democracy, and endanger our environment.  We who have benefited so much from the young people who support us feel we need to give back to ensure that our fans and their children have a safer, healthier and more democratic future.”

 

 

I woke up Sunday morning asking, Is another world possible? Can Hollywood and Madison Avenue apply their genius to making a better, healthier world better instead of enriching those who profit from illness?   By Monday morning, after watching Bob Dylan pitching polluting autos and cuddly puppies shilling Budweiser beer,  I realized that as long as big corporations dominate our economy and  politics, my Super Bowl dreaming is only a fantasy.  

Drug Makers May Face Liability for Design Defects

The Legal Intelligencer reports that drug companies may face product liability claims in Pennsylvania for defectively designed drugs, the state Supreme Court has ruled. The 4-2 ruling stems from a case involving the fatal use of a diet drug made by a Pfizer subsidiary that was later taken off the market. The majority rejected the argument that manufacturing defects and inadequate warnings are the only viable product liability claims against pharmaceutical companies, and the court allowed claims to go forward alleging the drug company negligently designed and marketed the diet pill.

The Cigarette Industry Running Out of Puff

In an analysis of the future of the tobacco industry, The Economist warns that U.S. Surgeon-General Boris Lushniak’s goal of “end-game strategies” to stamp out cigarettes could put America’s three big tobacco firms, Altria, Reynolds and Lorillard, out of business and endanger the viability of Philip Morris International (PMI), which along with Altria makes Marlboro, the top-selling global brand; Japan Tobacco; and British American Tobacco and Imperial Tobacco of Britain.

Top Lessons from 50 Years of Fighting the Tobacco Industry

Cross-posted from The Guardian

credit
credit: Shahbaz Majeed

This month’s 50th anniversary of the First Surgeon General’s Report on Smoking and Health provides a bittersweet reminder of the promise and the limitations of public health activism to curb corporate promotion of behaviors and lifestyles associated with premature death and preventable illness and injury. In the half century since the report was released, the proportion of Americans who smoke has been cut in half. A new report in the Journal of the American Medical Association estimates that tobacco control efforts in the United States have prevented 8 million premature deaths and extended the average lifespan by on average almost 20 years of life for the people who did not take up smoking because of prevention campaigns, higher tobacco taxes or smoking bans. Overall, the success in reducing tobacco use has added 2.3 years to the life of the average American man and 1.6 years to the average American woman.

 

But this progress could have been achieved in far less time had not every preventive policy been opposed by the tobacco industry and had politicians beholden to the tobacco lobby severed these ties more quickly. These delays doomed many more to tobacco-related illnesses. And despite the progress in this country, the estimated toll from tobacco in this century is 1 billion premature deaths, more than 10 times the toll for the 20th century. The main reason so many more people will fall ill and die painful, early tobacco-related deaths is that the tobacco industry has adapted the lessons on marketing and undermining regulation that it learned in the United States to emerging markets in Asia, Africa and Latin America.

 

Sadly, the tobacco industry is not alone in contributing to America’s poor health standing among developed nations. In 2010, guns took the lives of 31,076 Americans in homicides, suicides and unintentional shootings, the equivalent of more than 85 deaths each day. Another 73,505 Americans were treated in hospital emergency departments for non-fatal gunshot wounds. While the scientific knowledge and technology to significantly reduce this toll are available, like the tobacco industry, the gun industry and its allies in the National Rifle Association have steadfastly blocked any progress to make guns less accessible or safer.

 

Similarly, the alcohol industry contributes to alcohol related injuries and illnesses by aggressive marketing, expanding the density of alcohol outlets, and designing products such as wine coolers and malt liquors to appeal to young drinkers. A recent study found that between 2001 and 2009, youth exposure to television alcohol advertising increased by 71%. Excess alcohol consumption accounts for about 4,700 annual deaths among underage drinkers. Another study estimated that the combined market value for the alcohol industry of illegal underage drinking and adult problem drinking accounted for between 37.5 and 48.8% of consumer expenditures for alcohol.

 

How has it come to pass that corporations now have a stronger influence on the health of Americans than public health officials, doctors or hospitals? How have corporations succeeded in convincing so many officials in the White House, Congress and the supreme court that protecting profits is a higher national priority than protecting public health?

 

In the last decades, a corporate consumption complex has solidified its influence on American politics and the economy. This web of consumer corporations, the bankers and hedge funds that lend them money, the trade associations that lobby for them, and the global ad agencies that market their products has been able to use its campaign contributions, lobbying and lawsuits to achieve its business goals even when the majority of Americans disagree with these. Like the military industrial complex that Dwight Eisenhower warned about before he left public office, the corporate consumption complex threatens our democracy as well as our health and environment.

 

Are there lessons from our partial successes in cutting tobacco use that could be applied to reducing the power of the corporate consumption complex and its brand of hyperconsumption? I suggest three.

 

1. Efforts to reduce tobacco use succeeded when Americans came to believe that the right to breathe clean air trumped the tobacco’s industry’s right to promote its products without public oversight. Today, we need to mobilize parents to demand our children’s right not to be shot and not to be targeted by marketing of fast food, sugary beverages and snacks that have contributed to a 176% increase in the prevalence of diabetes between 1980 and 2011.

 

2. Part of the success in reducing smoking came from forcing Big Tobacco to reimburse state governments for the costs of caring for people with tobacco-related illnesses. Enacting policies that would require processed food producers to reimburse taxpayers and victims of the diet-related diseases exacerbated by their promotion of high fat, sugar and salt diets and alcohol producers for those injured or killed by the binge drinking.

 

3. Fund independent hard-hitting prevention campaigns designed to undo the deceptive advertising Big Tobacco had sponsored. We can do the same thing by counterbalancing the media and ad campaigns today targeting young people to eat bad foods and glamorize guns.

 

In 1964, most observers thought it was politically impossible to defeat the tobacco industry and to bring about significant reductions in tobacco use. Today, changing the practices of the firearms, alcohol and processed food industries seems a similarly daunting task. But if we can apply the lessons from tobacco to accelerate changes in harmful business practices, perhaps we won’t need to wait another 50 years to prevent the deaths, illnesses, injuries and rising healthcare costs that today’s science could avert.

 

Post script:  219 Guardian readers commented on this column in the week since it was posted.  A review of these comments provides a good overview of public debates about individual and corporate responsibility –as well as the occasional nuttiness of online commentary.

 

Grocery Goliaths: How Food Monopolies Impact Consumers

Last month, Food and Water Watch, a group that seeks to ensure that the food, water and fish we consume is safe, accessible and sustainably produced, released a report on concentration in the food industry.  The Executive Summary is posted below.  The full report is available here.

grocerygoliaths

 

Groceries are big business, with Americans spending $603 billion on grocery products in 2012. Big-box food retailers like Walmart and national grocery store chains now dominate the grocery industry. These mega-retailers are the biggest buyers of grocery products, and they exert tremendous power over food companies and ultimately farmers. This has led to a handful of food companies producing the majority of the products in the supermarket.

 

This growing consolidation of the food supply is severe at every step of the food chain, from farm to fork. And it impacts not only farmers and food manufacturers, but also consumers in the form of reduced consumer choices and higher grocery prices. Since the Great Recession started, grocery food prices rose more quickly than inflation and wages — twice as fast between 2010 and 2012. At the same time, the largest food, beverage and grocery retail companies pocketed $77 billion in profits in 2012. Nationally, the growing size and market power of the top grocery retailers has had tremendous ripple effects across the food chain. Food & Water Watch examined 100 types of grocery products and found that the top few companies dominated the sales of each grocery item in recent years.

 

Key Findings:

 

  • In 2012, more than half of the money that Americans spent on groceries (53.6 percent) went to the four largest retailers: Walmart, Kroger, Target and Safeway. Walmart alone sold nearly a third (28.8 percent) of all groceries in 2012.
  • The top companies controlled an average of 63.3 percent of the sales of 100 types of groceries (known as categories in industry jargon). In 32 of the grocery categories, four or fewer companies controlled at least 75 percent of the sales. In six categories, the top companies had more than 90 percent of the sales, including baby formula and microwave dinners.
  • Many firms sell multiple brands of the same product, which leads consumers to believe that they are choosing among competitors when they are actually just choosing among products made by the same firm that may have been made at the same factory. This is true across the board, including organic and healthful brands typically seen as independent, but which are being bought up by large food companies unbeknownst to consumers.
  • Supermarkets engage in a host of strategies to manipulate the shopping experience, encouraging consumers to make impulse and more expensive purchases that are unknown to consumers.
  • Regulators have largely left mega-retailers to operate unchecked as they invented new ways to extract value from consumers and even large food processors. It is time for regulators to step in to protect consumers and restore some semblance of competition for consumers in grocery stores, providing a chance for innovative, small or local food companies to get on store shelves.

Surgeon General: Smoking to Kill 5.6 Million Kids if We Don’t Act Now

CBS reports that the U.S. Surgeon General’s latest smoking report warns that unless current tobacco use rates fall, another 5.6 million U.S. kids might die prematurely. The Surgeon General’s 2014 report, the first in more than a decade, found that smoking has killed more than 20 million Americans prematurely in the last half century.  

Father of Australian Victim of Alcohol Violence Pushes for Ban on Alcohol Industry Donations

The Sydney Morning Herald reports that the father of Australian assault victim Michael McEwen, who was left fighting for his life after being hit and having his head stomped by drunken assailants,  has called on the New South Wales and federal governments to consider a six-point plan to address alcohol-related violence.  Among the measures championed by Robert McEwen are a federal ban on political donations from the alcohol industry and mandatory drug and alcohol testing of perpetrators of violent attacks in NSW.