Because the corporate goal is to obtain the highest profit possible, not social welfare, public health or environmental sustainability, business interests often give little or no consideration to the effects of corporate practices on indigenous peoples. Thus, the estimated 257 to 370 million indigenous peoples in about 5,000 communities in 70 countries, speaking 5,000 of the 6,000 existing languages, often experience severe detrimental consequences from commercial activity. The effects of extractive industries such as mining, agricultural crops and timber, and the theft of intellectual property rights illustrate some of those consequences.
In many parts of the world, indigenous people inhabit areas that have been identified as areas with abundant resources that are in demand as profitable ventures for global industries:
Forests for the logging industry; oil and gas for exploration and drilling industries; gold and other minerals for mining companies and agriculture; use of the land for mono crop farming such as tobacco, palm oil, coffee, rubber; dams on indigenous land to create lakes or use of rivers to produce electrical energy; and nature reserves established in areas where they displace the indigenous peoples living there.
These extractions are reminiscent of early European appropriation of the Americas under the concept of “terra nulius” that is, land not belonging to anyone, and therefore available for the taking, even though millions of indigenous peoples had inhabited an area for thousands of years prior to European explorations.
The various extractive industries have several effects in common relative to indigenous peoples: 
The industrial operations displace indigenous people from their ancestral homes and land which have been integral to their spiritual, physical, mental and emotional life, requiring indigenous people to move to other remote but unfamiliar areas, or to migrate to the unsanitary, unhealthful fringes of urban areas with unlikely means of earning a decent livelihood. As a result the indigenous people experience social disorganization in their relationships to each other, and disruption of their relations with other indigenous group. They are forced to interact in new and unfamiliar settings with unfamiliar types of people, practices and ways of behavior.
This displacement, dispersion and migration leads to loss of their language and culture.
Their ancestral land may be confiscated with no or little financial remuneration for the land or for the extracted substance.
With loss of land, they lose their traditional livelihood, subsistence farming or place for gathering food and traditional medicinal plants.
Their sacred land or water be polluted by the extractive operations.
Contacts with extractive industry workers may expose the indigenous peoples to new diseases that they then transmit to their families, neighbors and other groups of indigenous peoples.
The Case of the Nahua and Nati Peoples in Peru
Napolitano described a 20 year history of an indigenous peoples’ contact with extractive industries within a territorial reserve the government established for four groups of indigenous people in an isolated area of the Amazon River.  Logging of mahogany and cedar, and oil operations in or near the area during the 1970s and 1980s led to some violence against the industry operations, some displacement of one indigenous group, and interethnic clashes between groups. In about 2001, work began on a gas field concession granted by the Peruvian government, 75 percent of which was within the territorial reserve.
Loggers working in an area of the Amazon encountered members of the Nahua indigenous group. Some of the Nahua went down river and interacted with the loggers. Upon their return up river, epidemics, including pneumonia, complicated by parasites and malaria, began among the Nahua. The people were too sick to hunt, fish or harvest. There were too many dead to bury and the bodies were left on the ground. The indigenous people became dependent upon the loggers and missionaries for sustenance. Logging expanded and virtually took over the area of the indigenous people. Many of the indigenous people moved to a town but later became dissatisfied and returned to their communities. Some also worked in the logging industry. In the area occupied by another group, the Nati, a mission and a school were established where respiratory and gastrointestinal infections were brought from down river, leading to many deaths.
Epidemics of respiratory and diarrheal disease also began in company work camps where some indigenous workers also lived. Indigenous peoples’ movements between camps and their home communities facilitated the spread of disease, including scabies outbreaks from donations of clothing from worker camps to the indigenous peoples.
After extractive industries entered the area, infant mortality was high and there were fewer pregnancies, due in part to changes in traditional gender roles of food gathering and cultivation and the growth of industry jobs that led to malnutrition and thereby comprised resistance.
Pharmaceutical and agricultural corporations have an interest in commercialization of medicinal plants that indigenous peoples have developed and used over thousands of years. Collectors and researchers (that is, “bioprospectors”) travel into indigenous peoples’ territories and obtain information from them about their traditional medicinal plants, the preparation and use, and they collect and take specimens with them. They return to their labs, test the plants, develop products from the active ingredients, patent and sell them with no credit or compensation to the indigenous people. This is one aspect of what indigenous communities call “biopiracy.” 
A similar process sometimes occurs with indigenous food crop seeds that indigenous people have produced through selective genetic breeding research over centuries. The corporation sells those patented seeds to farmers and prohibits the farmers from saving seeds from their own crops for the next year, and requires them to buy company seeds. In some areas of India where this has occurred, the suicides of many farmers has been attributed to the poverty that resulted from this process.
There is commercial interest in mapping the genomes of indigenous peoples in order to develop new medications and other treatments. Indigenous people have had their blood specimens taken and used for this purpose without their permission, and without any compensation for the products developed from the research on their tissue.
Some indigenous cultures have beliefs about extracting bodily parts, contact with human tissue and specific practices for discarding tissue that may not be respected by those who collect the specimens.
The symbols and designs of indigenous peoples have been used in commercial products without their permission and without financial compensation. Without a history of private ownership, patents and copyright of art is a new concept to indigenous peoples, requiring them to learn about and develop new procedures and practices.
Protection of Indigenous Rights
Within the United Nations, progress has been made toward protecting indigenous peoples’ rights:
Respect international standards on the right to lands, territories and resources and attendant rights;
Submit to independent and credible monitoring;
Be accountable for the environmental disasters, destruction and human rights violations as a result of their operations;
Employ proven technology and adhere to the precautionary principle at all levels and in each project;
Recognize the specific vulnerability of indigenous women to the negative impacts involved with extractive industries;
Ensure full transparency in all aspects of their operations, and especially to ensure affected communities have full access to information in forms and languages they can understand; and
Conduct and implement environmental, social, cultural, and human rights impact assessments to the highest international standards ensuring independent review and participation of indigenous peoples.
A Role for Public Health
The public health profession can take a variety of actions to address the effects of commerce on the health of indigenous peoples.
Strive continuously to make the issues of indigenous people visible in discussions about commerce and health, and to bear witness to injustices resulting from business;
Engage indigenous organizations and individuals in health professions organizations, and collaborate with them;
Ensure that there are public health programs to address personal health and environmental health issues wherever commerce intersects with indigenous peoples;
Create specific official organizational policies to support indigenous rights and health in policy processes and commercial agreements.
1. Mander, J. & Tauli-Corpuz, V. Paradigm wars: Indigenous peoples’ resistance to globalization. San Francisco: Sierra Club Books, 2006.
2. Napolitano, D.A. Towards understanding the health vulnerability of indigenous peoples living in voluntary isolation in the Amazon rainforest: Experiences from the Kugapakori Nahua reserve, Peru. EcoHealth 2007; 4, 515-531.
3. Gheorghiu, V.A. Sailing The seas of treaties: Biopiracy in the wake of the International Treaty on Plant Genetic Resources for Food and Agriculture. Fourth World Journal, 2007; 7 (2), 1-39.
In 2009, there were 2,733 corporate foundations with assets of more than $10 billion and an annual donation of $2.5 billion. In that year foundations made grants of more than $38 billion of which $15.41 billion was from family foundations.In 2009, the 50 largest contributors to health donated more than $3 billion through almost 5,000 grants. The extent of corporate-based foundation funding in public health raises two critical questions for public health policy, research, and programming. First, should corporate-based foundations be setting the public health research and program agenda? Second, is the corporate business model appropriate for guiding foundation public health grants and programs?
In this commentary, I seek to answer these questions to focus our attention on fundamental philosophicaland ethical issues about the causes of disease and injury and the approaches we take to addressing the root, social determinants of health.
“There are a thousand hacking at the branches of evil to one who is striking at the root, and it may be that he who bestows the largest amount of time and money on the needy is doing the most by his mode of life to produce that misery which he strives in vain to relieve.” Thoreau, Walden
In 2009, there were 2,733 corporate foundations with assets of over $10 billion and an annual donation of $2.5 billion. Foundations contribute substantial amounts of grant funding for a variety of purposes. In 2009 foundations made grants of over $38 billion of which $15.41 billion was from family foundations. In 2009 the top 50 largest contributors to health donated more than $3 billion through almost 5,000 grants.
Some foundations were established by funds coming primarily from an individual’s corporate ownership, income and stock, with much of the foundation’s continuing income derived from stock investments in corporations. For example, the Bill and Melinda Gates Foundation, based on Gates’ earnings from Microsoft and from Warrant Buffett’s donations from his finance industry earnings  with $37.1 billion assets in trust endowment, has made more than $25 billion in grant commitments since its founding in 1994, including about $14.5 billion to global health. Other billionaires have also pledged their wealth to charity. Here such foundations with largely corporate-derived funding will be referred to as “corporate-based.”
Foundations and the For-profit Corporate Business Model
The modus operandi of foundations has become that of applying a corporate, business model  to their efforts to try to solve public health problems (see table below). The business model typically emphasizes technological solutions to achieve quantifiable, quick, short-term “results” and “outcomes.” The basic business model approach to problems is that technology plus science plus the market brings results. This model appears to dominate much of the foundation philanthropy, particularly among the so-called “philanthrocapitalists” the corporate officers and financiers who made much their fortunes during the period of extreme capitalism of the 1980s and 1990s. Many of those individuals are now setting up foundations to distribute their wealth, some taking a venture capitalist, social investment approach.[10,11] These individuals typically retain funding decisions for themselves. They personally choose which public health issues will have highest priority, which areas of research to support and which programs will receive funds, including setting up entirely new programs under their direction. Similar to the corporate management from which they came, corporate-based philanthrocapitalist foundations are not democratically managed institutions. The philanthrocapitalist decision-making process suggests a belief that they are better qualified than public health professionals, professional associations, national governments, or community organizations to determine the public health agenda. They may form partnerships with other foundations, or corporations, or multi-lateral or national organizations but the funding and agenda are generally distanced from the level of local citizens of the community. And the size of the foundation funding gives disproportionate weight to the foundation’s influence, that is, the wealthy individual whose foundation it is.
The philanthrocapitalists’ application of the corporate model is understandable considering that many philanthropists, and the foundation boards and officers have backgrounds in the business world rather than public health or community organizations. Their associates in their education, business and social affairs are often like-minded individuals with a similar socioeconomic status who share belief in the primacy of the market and the for-profit corporate business model. They hold the belief in common that the for-profit business model is the best way to meet societal goals.
Basic to a critique of contemporary philanthrocapitalism is the question of why should we hold up the business model as the standard to emulate in operating foundations and as the guide for the programs and research they fund? Critics note that most businesses are mediocre, and many fail so why should the mediocrity of the business sector model be applied to the social sector? The world is in greater need of more civil society influence than more business influence. Also, inherent in corporate legal purpose is maximization of profit, including by avoiding taxation and minimizing regulation, which often results in externalizing costs onto society through a variety of mechanisms.
Approaching global health problems from the perspective of the corporate business model may lead philanthrocapitalist foundations to similarly ignore or to denigrate social and environmental factors as irrelevant to the foundation’s business-analogous, results orientation. Doing so may be a thoughtless imposition of the business model rather than a conscious awareness of other approaches and the model’s effects. A fundamental critique is that “marketized philanthropy” simply places a screen between global capitalism and its effects. By fostering the global market system Philanthropcapitalists’ foundation agenda and activities may be similar to earlier foundations whose goals and programs supported the U.S. foreign policy agenda. They may, without conscious intention, cause adverse effects on societies and the natural environment.
Some defenders of philanthrocapitalism argue that the philanthrocapitalist earned his or her wealth and is therefore entitled to spend it in whatever manner they choose. That argument assumes that the individual accumulated wealth on his or her own rather than acknowledging that wealth arises from a “community.” Most business success draws upon the knowledge and technology developed earlier by others and is built upon the hard work of corporate employees who have not shared equitably in corporate profits. The argument also fails to consider that many corporate products, services or technology are based on government-sponsored basic or applied research funded with tax-payer dollars, discoveries which the corporation did not purchase nor repay the government for.
The corporation from which the philanthrocapitalist’s foundation wealth was derived may not have paid the federal statutory income tax rate, [29,30] or state taxes, [31,32] and the tax rate paid may have included deductions for expenses related to morally or legally questionable management practices. In addition, the philanthropocapitalist’s foundation may have set up her or his compensation in ways that avoid or minimize personal income tax, even if benefits are small. Thus they accumulate wealth to fund a foundation whereby they control distribution of that wealth through the foundation. The foundation also receives tax benefits on investment returns and grants.
Some foundations’ earnings are from investments in the stock of corporations whose operations, products or services are contrary to the programs and priorities that the foundation funds, or to public health in general.[34,35,36,37] However, while some foundations screen investments for social responsibility and others retain a separation between investments and programs, some philanthrocapitalists take the position that one stockholder cannot change corporate practices  or they are unwilling to try to do so. There also may be potential conflict of interests through interlocking foundation board membership with boards of corporations related to foundation programs and/or whose products or practices could be adverse to health.
With some exceptions, foundations do not consider or fund programs for redistribution, social justice, power and politics (factors that drive social transformation) through independent groups that would change the socioeconomic-political system.Historically such systemic change has been achieved through social movements, involving politics, government, civil society, and often resisted by business. Examples include the civil-rights movement, the women’s movement, and the environmental movement. Philanthropy is not a neutral, objective, apolitical process. By their nature foundations can only take actions that reinforce the corporatist financial system from which they arise and by which they thrive. The personal philosophy, beliefs, and political positions of philanthropocapitalists’ influence their preferences for which type of programs or research to fund. Some funding of political positions by corporate-based foundations have generated controversy because their wealth affords them power and influence disproportionate to that of average income citizens, including access to policy-makers and influence on democratic processes.[44,31] Such access and influence may have been gained despite the philanthropocapitalist or the funding corporation not carrying their full share of financial responsibility.Historically, critics of early foundations (e.g., Carnegie, Rockfeller) raised questions about the corporate source of the philanthropist’s funds (e.g., monopoly, workplace conditions, political corruption), inequitable sharing of corporate earnings with workers, and the undemocratic manner in which decisions were made about how foundation funds were distributed.[41,33] A common argument about earlier foundations was that a society would have been better served if corporate profits would have been shared rather than accumulated in a foundation to be distributed solely at the discretion of the corporation’s owner (foundation director). Similar questions could be raised about contemporary philanthrocapitalists’ foundations.
The funding for foundations may have resulted from the philanthropocapitalist having paid a lower tax rate than is paid by less wealthy tax-payers. They may have also benefited from a lower long-term capital gains tax, and from their corporations that either paid a lower income tax rate than the federal statutory rate or paid no income tax, that paid minimum wage or opposed unionization of workers in order to lower wages and reduce benefit costs. Consequently some critics question why we would allow people who avoid paying taxes to be called “philanthropists” because they set up a foundation or contribute money to the arts, universities, religions, or health (the most common recipient of donations). Critics ask why would we allow billionaires to play a larger and larger role in determining social policy without any input from the rest of us? The influence of philanthropcapitalists’ money may have double influence on society and specifically, on public health. First, through the corporate source of foundation funds where the corporation may have “bought” political influence through contributions to candidates’ election campaigns, and through lobbying which may have led to laws or regulations with adverse effects on health. Secondarily through foundation donations, and foundation investments in corporations whose products or practices are detrimental to public health.
Public Health Analyses
In some professional fields the influence and power of corporate funding-based foundations have been analyzed and criticized. For example, some journalists have pointed out issues of conflict of interest of news media and corporate funded foundations.[45,46,47] Some educators have been critical of the extent of the influence some foundations have on the direction and operations of public education.[44,48,49] But it appears that few public health professionals [50,51,40] have examined corporate-based foundations, including whether funding is appropriately directed at needs.[52,53] While much of the news media coverage of the foundations is favorable, occasional investigative reports or unflattering stories are published.[34-36, 54] More critical commentary about foundations occurs on blogs (for example, techrights and Seattle Education.)
Questions for Public Health Professionals to ConsiderPerhaps the lack of criticism by public health professionals is due to conflict of interests arising from the ubiquitous and large amount of foundation funding3 for public health programs and researchers. Public health professionals and organizations may be fearful of loss of funding or denial of application for funds for criticizing the foundations. Because foundations are sometimes in partnership the reaction to such critical analysis could easily diffuse across foundations and put a critic at risk at multiple foundations. Some philanthrocapitalists are sensitive to criticism and find it incredulous that anyone would consider them anything other than heroes whose financial and technological innovations they believe represent the future. They isolate themselves and become more closely associated with the other wealthy around the world than they are to average members of society and to their own country, and seem to scorn the middle class.
While this essay is necessarily an incomplete examination of the issues about corporate-based, philanthropocapitalist foundations, it does suggestion some questions that public health professionals might consider about the influence of such funding, including:
1. Is the corporate business model an effective and ethical method for addressing the social determinants of health?
2. Should a few wealthy individuals, without professional public health training and isolated from society, be setting the public health agenda through an undemocratic decision-making process, and one which likely excludes the population for which funding and programs are intended?
3. What processes would public health recommend that foundations use to incorporate community input into the funding decision process?
4. When a corporation that is the source of a foundation’s funds makes a product, provides a service or engages in practices that are detrimental to the public’s health, should a foundation use their investment power to influence?
5. What can public health do to encourage societal engagement in social action advocacy that gives voice to those who suffer rather than engaging in a philanthropy based on consumption and profit?
6. Have public health professionals been co-opted by their reliance on corporate-based foundation funding so that they are reluctant to critically examine the role of foundations in setting public health priorities and research and program agendas? If so, what action should the profession take to remediate and prevent a lack of critical examination of foundations’ role in public health?
Because of the pervasiveness of the business model perspective, public health professionals also have an advocacy role related to corporate influence on public health policy such as working toward the elimination of corporations’ rights of personhood which enables them to contribute unlimited amounts of corporate funds to federal election campaign advertising.
Needed Public Health Research
In addition to examining the policy and program influence of foundations, there are areas of corporate-based foundation philanthropy that public health researchers need to study, including:
1. Study the interlink between the boards of various foundations that fund public health; how those foundations are linked to corporate boards, and what conflicts of interest may result from those links,
2. Analyze the composition, links and backgrounds of networks of officers, board members and staff of foundations that fund public health and assess how representative of society those networks are, and how the background of those individuals may influence funding decision-making processes and biases in funding priorities,
3. Establish surveillance systems to conduct frequent periodic monitoring, tracking and public reporting of foundations’ contributions to public health, based on amounts funded and areas funded; effectiveness in creating infrastructure and long-term capacity building; emphasis given to innovation, radical change, social transformation, and structural change, i.e., social determinants,
4. Compare foundation investments, returns, administrative costs and taxes paid with the amounts and types of its funding for public health,
5. Analyze and periodically publically report on foundations’ decision-making process: public transparency and accountability; peer review of grant applications, and involvement and role of role of officers and board, other foundations, corporations, health professionals, and community representatives in the foundations’ public health funding allocation decisions.
6. Study the network connections of foundation officers to politicians, elected officials and officials of multi-lateral international organizations, and the foundations’ direct and indirect tactics to influence public health policy through those connections,
7. Examine the source of foundation funding, including origination funding and on-going investments, and determine the cost-benefits of funds contributed to public health compared to the externalized costs of the corporate products, services and practices from which foundation funds are derived, and the amount of taxes paid by the corporate sources and philanthropocapitalists.
Through the large number of grants and the amounts of funding awarded, philanthropic foundations have a large influence on the field of public health. The size of foundation assets and the choices of issues to which the foundations contribute enable them to wield significant influence on society, including politics, policy, and the education and public health agendas.
Unilateral decisions about funding priorities without the input of the community, lionizing individual wealth accumulation over community welfare, and dominance of the for-profit corporate business model, without regard for social or environmental consequences, are not consistent with the social justice foundations of public health.Within a market-based society the emphasis of philanthropocapitalists’ foundations on the for-profit, corporate business model perpetuates a market-based economic approach to solving public health problems. Public health professionals need to give greater consideration to the effects and ramifications of applying the business model to global public health problems. The business model-based philanthropy also warrants additional public health research. References
24. Wiist, W.H. (2006). Public health and the anticorporate movement: Rationale and recommendations. American Journal of Public Health, 96 (8), 1370-1375.
25. Wiist, W.H. (2011, in press). The corporate play book, health, and democracy: The snack food and beverage industry’s tactics in context. In Stuckler, D., & Siegel, K. Sick Societies: Responding to the Global Challenge of Chronic Disease. UK: Oxford University Press.
40. Stuckler D., Basu S., & McKee, M. (2011) Global Health Philanthropy and Institutional Relationships: How Should Conflicts of Interest Be Addressed? PLoS Med 8(4): e1001020. doi:10.1371/journal.pmed.1001020
41. Maich, S. (July 21, 2008). The Gospel According to Bill. Maclean’s121 (28):36-40.
42. Edwards, M. (2009). Gates, Google, and the Ending of Global Poverty: Philanthrocapitalism and International Development. Brown Journal of World Affairs, 15 (2):35-42.
49. Sinclair, M.N. & Vander Ark, T. (Spring 2010) Two Viewpoints. High School Journal. Pp. 94-97.
50. McCoy, D., Kembhavi, G., Patel, J., & Luintel, A. (2009). The Bill & Melinda Gates Foundation’s Grant-making programme for global health. The Lancet, 373(9675):1645-1653.
51. Sridhar, D. & Batniji , R. Misfinancing global health: a case for transparency in disbursements and decision making. Lancet 2008; 372: 1185–91
52. Black, B.E. Bhan,M.K., Chopra, M., Rudan, I., & Victora, C.G. Accelerating the health impact of the Gates Foundation Lancet, 373: 1584-1585. May 9, 2009.
53. Essner, D.E., & Bench, K.K. (2011). Does Global Health Funding Respond to Recipients’
Needs? Comparing Public and Private Donors’ Allocations in 2005–2007. World Development, 39(8): 1271-1280.
54. Wilhelm, I. (March 6, 2008). Gates Foundation Accused by U.N. Official of Creating Scientific ‘Cartel’. Chronicle of Philanthropy; 20(10): 12.
55. Wiist, W.H. (2011). “Citizens United, public health and democracy: The Supreme Court ruling, its implications, and proposed action” American Journal of Public Health, 101:1172-1197. DOI 10.2105/AJPH.2010.300043, March 18, 2011.
Corporations often promote the importance of their role in partnerships with government, multi-lateral organizations, not-for-profit health organizations, community groups, professional organizations, and academia in preventing disease, promoting health, protecting the environment, and research.1 Some corporations set up special units within the corporation to further those goals and hire prominent public health and medical experts to direct those corporate programs.2,3
MOU between Alliance for a Healthier Generation and several beverage manufacturers
Effects of Partnerships
The reliance of independent nonprofit organizations on corporate funds creates dependency and conflict of interests, co-opts the nonprofit into becoming an ally,4 and results in undue corporate influence in decision-making processes and control of health standards. Corporations also bring influence on multi-lateral organizations. The sugar industry brought U.S. political pressure on the World Health Organization to lower proposed standards for dietary intake of sugar.5
The deleterious influence of corporate funding on research has been documented in a variety of specialties. Reviews of journal research articles have shown that corporate funded research leads to compromises in integrity6 and produces results favorable to the corporate funder.7
Corporate support for, and partnerships with, professional organizations, such as the association of the American Academy of Family Practice and Coca-Cola, have been controversial.8,9 Because of potential conflict of interest arising from corporate funding of professional education, some medical groups have established guidelines regarding corporate funding of their education programs.10 While corporations are readily visible in the exhibit area of the annual meeting of the American Public Health Association,11 and corporations provide financial support to the organization in various ways, the Association has a policy regarding acceptance of advertisers, exhibitors, gifts and donations.12, 13 In 2006 APHA established a committee to evaluate proposed gifts and donations, including from corporations.
The director of the Contra Costa Department of Health Services, Dr. William Walker, announces that he is resigning his 25-year membership in American Academy of Family Practice after it signs a deal with Coca Cola.
A Major Reason Partnerships Are Attractive
One of the reasons that partnerships with corporations or receipt of corporate funding is attractive to community groups, government agencies, and academia is because of the decrease in government funding available for programs, regulation and research. The funding shortage is due in part to the failure of corporations to carry their share of societal obligations through paying their share of federal income taxes. A report from the U.S. Government’s General Accountability Office (GAO) showed that from 1998 to 2005, 34 percent of foreign corporations in the U.S. and 24 percent of U.S. corporations paid no taxes for at least half of those years.14 In 2002 and 2003, 82 out of 275 most consistently profitable Fortune 500 corporations collectively paid no federal tax at least one of those years; 275 paid less than half the 35% statutory rate.15 Recent news reports showed that in 2010 General Electric earned $5.1 billion in profits in the U.S. and Exxon Mobil had $37.3 billion in pretax income in the U.S. but neither paid any U.S. federal income taxes.16,17 The loss of that tax money does affect the government budget. For example, because in 2002 corporations did not pay the statutory tax rate, the US government treasury had $172 billion less with which to operate.18
Thus, because community organizations need funding to conduct programs for the communities they serve, academics need funding to conduct research, and health professions organizations need money to operate, they turn to corporations.
What Corporate Money Buys
Because of the power and influence corporations, industries, and industry alliances have through corporate financial contributions to election campaigns and through lobbying, legislators pass laws that protect corporations and cut budgets that eliminate or reduce health programs, including decreases in agency’s ability to monitor and regulate corporate practices. Corporate political influence also results in government appointment of corporate or industry representatives to government advisory panels, committees and boards that set health standards and policies, influence health program and research funding priorities, and evaluate medicines and devices. Through political influence corporations can prevent citizens from having the right to universal healthcare, environmental protections, education, a safe and healthful workplace, a living wage, and housing. Thus, because of corporate influence on government policies and budgets, society must rely on corporate funding and partnerships, local community and religious institutions, and philanthropic donations (much of which is of corporate origin) for basic needs and protections that are the responsibility of government.19
The Dangers of Partnerships
Any partnership with industry in which there is corporate remuneration or exchange, whether indirect or quid pro quo, creates a conflict of interest and compromises the independence of the beneficiary. The old adage against “biting the hand that feeds you” is relevant here. If an individual, community or organization receives money from a corporation, they can be co-opted, becoming an ally of positions the corporate funder takes and more willing to compromise their standards. They may also be less likely to oppose the more egregious health harming products, operations or policies of the corporation. Also, if community organizations become dependent on corporate funds for providing services, this leaves the entire community vulnerable to deprivation in health services and activities.
The purpose, goal and values of public health and that of the corporation are fundamentally different. Public health’s goal is to protect and promote the health of the public. Legally the corporation’s sole purpose can only be to make a profit to return to investors (despite corporate public relations rhetoric about social responsibility, which can only be in service to the bottom line). Partners cannot have fundamentally conflicting goals. Public health professionals cannot allow corporate enticements of partnerships and funding to blur or disguise the distinction between the differing purposes, goals and values. The corporation has neither the mandate, nor based on their absence from the constitution, the right or authority to make decisions on what is in the public interest.
Some organizations or individuals in public health and medicine who accept corporate financing, grants or gifts and who support partnerships with corporations may believe that the positions stated here are too dichotomous and antagonistic to current realities. However, history shows that movements to abolish slavery, gain the right of women to vote, and labor its right to organize were out of necessity uncompromising and militantly assertive. They did not fight for nor compromise for incremental or partial rights. Similarly, public health cannot bargain away health standards, monitoring, and accountability through incremental comprises with the corporation. We need real and fundamental reforms more than distracting incremental change. Reliance on corporate financing subjugates the independent voice of public health to commercial goals. We must take a stand to either work to strengthen the ability of the democratic processes and governments to better protect and promote health, or to work to increase corporate profits.
What Public Health and Community Organizations Can Do
Below are a few things that the field of public health and the not-for-profit world of community organizations should get the corporate world to agree to do before partnering with them or accepting funding from them.20 Implementation of these would help prevent conflict of interest and co-optation, and help ensure that government and private-public partnerships are not dominated by corporate influence.
1. Provide independent public health professionals and community representatives: a) access to corporate records, facilities, workers, research reports, health promotion budgets, and communications to conduct independent audits of the corporation’s health promotion, environmental, worker health and safety programs and human rights activities, and b) the right to immediately provide an independent written report to the public.
2. Fund independently developed health promotion publicity campaigns in amounts equivalent to the corporation’s advertising budget.
3. Keep all corporate health promotion and health education programs and activities free of corporate logos, the corporation’s name, products, symbols, figures, etc.
4. Not make any contributions to election campaigns to political parties, political action committees, independent campaign advocacy organizations or lobbyists, or on ballot referenda or amendments.
5. No corporate officials accept employment or appointment to government regulatory agencies, boards or committees that have authority for any part of their industry.
6. Pay the full statutory federal corporate tax rate.
7. Submit all products and their contents to independent testing for safety, healthfulness, and efficacy prior to marketing to the public.
In order to avoid conflict of interest and conduct truly independent, objective research, researchers need to work out written agreements with corporate funders about such matters as integrity of the research methods and analyses, compensation, timing and freedom of publication and presentations, and access to data before accepting corporate funding.21
1. Yach D, Feldman ZA, Bradley DG, Khan M. Can the food industry help tackle the growing global burden of undernutrition.Amer J of Public Health. 2010; doi/10.2105/AJPH.2009.174359
2. Norum, KR. Invited commentary to Yach editorial: PepsiCo recruitment strategy challenged. Public Health Nutrition. 2008; 11(2):112-113. DOI: 10.1017/S1368980007001632.
11. American Public Health Association. Final Program: Social Justice: A public health imperative. Exhibitor Booth Description. 138th Annual Meeting and Exposition November 6-10, 2010, Denver, CO. Pp 213-234.
19. Gostin, LO. Public Health Law: Power, Duty, Restraint. Berkeley, CA: University of California Press; 2000.
20. Wiist, WH. The corporate play book, health, and democracy: The snack food and beverage industry’s tactics in context. In Stuckler, D., & Siegel, K. Sick Societies: Responding to the Global Challenge of Chronic Disease. UK: Oxford University Press; In Press.
21. Rowe S, Alexander N, Clydesdale F, Applebaum R, Atkinson S, Black B, Dwyer J, Hentges E, Higley N, Lefevre M, Lupton J, Miller S, Tancredi D, Weaver C, Woteki C, Wedral E. for the International Life Sciences Institute (ILSI) North America Working Group on Guiding Principles. Funding food science and nutrition research: financial conflicts and scientific integrity. Nutrition Reviews. 2009; 67(5):264–272.
Little more than a year after the January 21, 2010 ruling by the U.S. Supreme Court in the Citizens United v Federal Elections Commission, it is already apparent that the effects of the ruling are widespread, contaminate the democratic processes, and could be long-lasting. Because the effects of the ruling on the 2010 election campaign were significant, the potential effects on public health could be pervasive (1, 2). Finding new ways to undo its pernicious consequences is an important public health goal.
The Citizens United ruling (3) overthrew previous laws andcourt rulings ranging from the early 1900’s to parts of the 2002 Bipartisan Campaign Reform Act, sometimes known as the McCain-Feingold law. The Court ruled that previous laws and regulations were so restrictive as to prohibit free speech. The ruling gave corporations the right to use unlimited amounts of money directly from the corporation’s treasury for independent election campaign advocacy. The results of the decision were immediately revealed in the November 2010 mid-term U.S. Congressional election campaign and its aftermath.
The Relevance of the Court’s Ruling to Public Health
Corporate wealth gives companies the special ability to develop and test communications that frame issues, appeal to emotions, provide inaccurate and incomplete information, and increase the cognitive availability of ideas (4). This allows them to take advantage of voters’ decision-making vulnerabilities. Thus, corporate campaign election funds could be directed into tailored messages for or against candidates who take positions on a variety of public health issues ranging from abortion(5), coal-fired power plants, menu labeling, and worker health, to budget appropriations and other aspects of health that are vulnerable to market forces (6). Corporate lobbyists could pressure elected officials based on their contributions to the official’s campaign as a means of gaining legislative favors. Donations from insurance and pharmaceutical corporations in the 2008 election cycle seem to have gained them access and influence during health care financing reform (2). After the 2010 election Representative Issa (R-Calif.), chair of the House Oversight and Government Affairs Committee, reportedly asked 150 trade associations, corporations and think tanks to provide a wish list of public health, environmental and other public protections they wanted eliminated (7). The Court’s ruling in Citizens United has raised concerns about the government’s ability to regulate the commercial speech of tobacco and other corporations in advertising their products (8).
Follow the money
More money ($4 billion) was spent on the 2010 congressional elections by political parties and outside groups than in any previous midterm election cycle (9). According to reports by Public Citizen, in the 2010 election independent organizations that were the direct beneficiaries of corporate largess after the Citizens United ruling increased spending more than 400% over the 2006 mid-term election. About 54% of them disclosed anything about their sources. The groups that did not disclose information about sources spent 46% of the total $294 million spent by outside organizations on the election. In 60 of the 75 Congressional elections in which the seat was won by a candidate from a party different than the incumbent, the spending by outside organizations favored the winner. In the Senate election, winners had a 7-to-1 advantage in spending by outside organizations (10). The corporate funding ties and the political expenditures of some of the most influential of the independent organizations are known (11).
Campaign finance and disclosure laws in more than 24 states have been invalidated (10). The Citizens United ruling may have set a precedent to find that the public accommodations section of the 1964 Civil Rights Act is unconstitutional because it prevents businesses from freely expressing themselves in a discriminatory manner (12). The Supreme Court considered a case in which AT&T requested a privacy exemption to government release of its records but the Court rejected a corporate right to personal privacy (13). A bill was introduced in Congress that would eliminate public funding of the presidential campaign (14). Several individuals tried to appropriate the Court’s ruling for personal reasons, including former U.S. House of Representative’s Majority Leader, Tom Delay in his appeal of his conviction for money laundering and conspiracy (15).Someone else announced that they want to marry a corporation (16).
Activities to Redress the Ruling
There are a variety of legislative options to redress the effects of the Court’s ruling (17,18). The Fair Elections Now Act with 160 co-sponsors in the House and 35 in the Senate would have provided federal election campaign funding on a four to one match to candidates who raised small donations of $100 or less (19). The Democracy is Strengthened by Casting Light on Spending in Elections Act (DISCLOSE) includes requirements that corporate CEOs take responsibility and inform investors. Both the Fair Elections and DISCLOSE acts had strong support in both houses of the 111th session of Congress but did not pass, due in part to a Senate filibuster. Another bill was introduced for a constitutional amendment to enable Congress to regulate corporate expenditures for political speech (20). Eight Senators and 40 Representatives have endorsed a constitutional amendment (21). Other legislation would require permission from a majority of stockholders of advance notice (18). Bills considered in the 2010 Congressional session will have to be reintroduced in the current (2011) session.
Organizational Supporters of the Fair Elections Now Act
At least 16 states have passed laws with a variety of responses to Citizens United such as mandating disclosure of funding sources and prohibiting foreign contributions (10, 21). Seven state legislatures have introduced resolutions calling for a constitutional amendment to redress the Court’s ruling (22). The City of Pittsburgh passed an ordinance that denied corporations the right of personhood and affirmed the rights of nature (23). A group of over 50 former federal and state attorneys general and law professors sent a letter to the Senate and House opposing the Court’s decision and calling for a constitutional amendment (24).
Organizations that advocate for a constitutional amendment to deny corporations personhood or to remove their right of political speech include Public Citizen, Move to Amend, Free Speech for People, the Progressive Democrats of America, the Coffee Part, and others. The broad support for such a change is suggested by the strategy development conference held in 2010 by the Network of Spiritual Progressives and their proposed personhood and environmental responsibility constitutional amendment.25 Business for Democracy supports a constitutional amendment to prohibit corporate campaign funding but which would not ban corporate political speech. By August after the Court’s ruling 400,000 people had already signed a petition supporting a constitutional amendment (26).
Common Cause asked the U.S. Justice Department to investigate possible conflict of interest by Supreme Court Justices Clarence Thomas and Antonio Scalia because of their possible connection to election campaign contributors while the Citizens United case was before the Court (27).More than three-fourths of U.S. citizens disagreed with the Court’s ruling, believe that congress should take action to curb the effects of the Citizens United ruling, and favor reinstating spending limits; positions that cross political party affiliation (28). The first anniversary of the Court’s ruling saw more than 100 protest demonstrations and rallies across the U.S. (21)
What Public Health Professionals Can Do
Public health professionals must first recognize that on almost every health issue corporations are the opposition, ranging from issues of health behaviors, environmental or occupational health, access to safe and inexpensive medications, to healthcare (29). Rather than focusing advocacy efforts on a specific product, practice, policy, or on a specific corporation or industry, public health efforts might be more efficient in addressing the underlying, common factor: the rights given to corporations that allow them their influence and power over democratic processes, and thereby influence over public health policy and funding. The American Public Health Association (APHA) could pass related policies, educate members about the issue, and organize advocacy activities with its state affiliates in collaboration with outside organizations that have the similar aim of corporate reform. It is likely that only effective action by a larger, strong and coordinated grass roots movement will be able to counter corporate money and influence.
Academic public health programs need to conduct research on corporate influences and incorporate the study of corporate influence into curricula (30). Research is needed on the influence of corporate election campaign contributions and lobbying on the positions elected representatives take on public health policy issues. Research is also needed about the influence of the “revolving door” on government agency regulations and standards, and on monitoring and enforcement.
More academic curricula could include courses such as those at CUNY Hunter College (31). and Northern Arizona University32 that focus on or integrate corporate influences on health. Public health curricula must help students understand the pervasive and fundamental influence of corporations on public health and democracy. Graduates must be prepared to conduct research, health policy development, and advocacy campaigns that will take back democracy from corporations and protect and promote the health of the public.
Note: An analysis of the Citizens United decision by Bill Wiist that will appear in a forthcoming issue of the American Journal of Public Health can be found in First Look.
1. Rutkow L, Vernick JS, Teret SP. The potential health effects of Citizens United. N Engl J Med. 2010; 362(15): 1356-1358.
2. Wiist, WH. (March 17, 2011) Citizens United, public health and democracy: The Supreme Court ruling, its implications, and proposed action. American Journal of Public Health. Early release electronic version: DOI 10.2105/AJPH.2010.300043.
3. Citizens United v. Federal Election Commission, US 130 876 (2010).
4. Walker Wilson M.J. Too much of a good thing: Campaign speech after Citizens United.
Cardozo Law Review. 2010; 31(6):2365-2392.
5. Jacobson, J. Corporate cash secretly funneled to extremist Tea Party candidates who want to outlaw abortion — even contraception. October 16, 2010. Available at
10. Public Citizen Congress Watch (January 2011). 12 Months After: The Effects of Citizens United on Elections and the Integrity of the Legislative process. Washington, DC: Public Citizen.
11. People for the American Way. After Citizens United: A Look into the Pro-Corporate Players in American Politics. An Updated Look into the Groups Empowered by the Citizens United Decision that are Propagating Their Pro-Corporate Agenda. Available at http://www.pfaw.org/sites/default/files/cit-u-follow-up-report.pdf. Accessed February 12, 2011.
12. Center for Media and Democracy. The Supreme Court’s “Citizens United” Decision Threatens the 1964 Civil Rights Act. Available at http://www.prwatch.org/node/9426. Accessed September 9, 2010.
13. Liptak A. (March 1, 2011). Supreme Court Rules on AT&T Case. Available at
17. Whitaker LP, Lunder EK, Manuel KM, Maskell J, Seitzinger MV. Legislative Options After Citizens United v.FEC: Constitutional and legal issues. March 8, 2010. Congressional Research Service Report 41096.
18. Garrett RS. Campaign Finance Policy After Citizens United v. Federal Election Commission: Issues and Options for Congress. February 1, 2010. Congressional Research Service Report 41054. Available athttp://assets.opencrs.com/rpts/R41054_20100201.pdf Accessed March 11, 2011.
19. Alterman, E. Kabuki democracy—and how to fix it. The Nation. January 24, 2011; 11-18.
20. Nichols, N. Donna Edwards’ no corporate monopoly of elections amendment. February 3, 2010. Available at
22. oskebuckley’s blog. Updated: 2010 state resolutions introduced in support of amending the Constitution. February 2, 2011. Available at http://freespeechforpeople.org/node/189. Accessed Marcy 11, 2011.
23. Community Environmental Legal Defense Fund. Pittsburgh bans natural gas drilling.