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:
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.
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.
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.
Each New Year, millions of Americans resolve to quit smoking, drink less alcohol and give up the high fat, sugar and salt diets that lead to expanding waistlines and higher risk of diabetes and heart disease. Sad to say, however, most resolvers fail to realize their goals. According to the US Centers for Disease Control, fewer than one in ten smokers wanting to quit in 2010 actually succeeded. For the 38 million adult Americans who report binge alcohol drinking, about 80 to 90% of those who try to stop can expect to relapse. About 45 million Americans go on a diet each year but 80% of dieters fail to lose weight and a third actually gain. Worse, almost 70% of US adults are now overweight or obese.
The cost of these failed New Year’s resolutions hurts not only the pride and well-being of those who try to make changes in their lifestyle. According to the World Health Organization, overconsumption of tobacco, alcohol and unhealthy food are main causes of the growing burden of premature deaths and preventable illnesses from chronic diseases like diabetes, heart disease, cancer and stroke in the United States and around the world. So why is so hard for us to give up the products that lead to early death, pain, and rising costs?
One main reason is that the big alcohol, food, and tobacco corporations that profit from this hyperconsumption have created a world where the easy choice is one that brings them profits, not the one that keeps us healthy. They load their products with the nicotine, alcohol, sugar and fat that appeal to our vulnerabilities to addiction and our craving for release from stress and anxiety. They market their products relentlessly, using every technology at their disposal to get under our cognitive radar so they can manipulate our own and our children’s most primitive fears and hopes. In 2012, the fast food industry spent $4.6 billion to advertise mostly unhealthy products, often targeting children and young people. It significantly increased use of internet advertising, allowing advertisers to bypass parental controls of television advertising. Alcohol, food and tobacco companies make their products ubiquitous, cheaper and easier to find than healthier alternatives. To add insult to injury, these corporations and their trade associations use their political clout and campaign contributions to undermine public policies that protect health or make healthier choices more available. For example, when the Obama Administration suggested voluntary standards to restrict advertising unhealthy food to children, a Reuters investigation last year found that the big food companies spent more than $175 million over three years lobbying to defeat the proposal.
Given this corporate effort to promote consumption of products associated with the country’s most serious health problems, it’s hardly surprising that so many of us aren’t able to fulfill our New Year’s resolution to live healthier lives. So this year, let’s try some new resolutions:
1. Elect a Congress more willing to stand up to the tobacco, food, and alcohol industries. In the 2012 election, these three industries contributed more than $60 million to Congressional candidates in expectation of advancing their objectives of less regulation and lower taxes. In 2014, let’s resolve to support candidates who pledge to put protecting our health ahead of protecting corporate profit.
2. Encourage our cities and towns to use their zoning power to make unhealthy products less ubiquitous. Research shows that a lower density of alcohol outlets leads to less problem drinking, and fewer fast food outlets make it easier for people to choose healthier food. Zoning laws were created more than a century ago to protect against earlier threats to health, such as polluted air and water, inadequate sanitation, and unsafe housing. Let’s now update our zoning rules to safeguard our communities against the promotion of alcohol, tobacco, and unhealthy food that cause today’s killer chronic diseases.
3. Encourage our mutual and pension funds, and our religious, hospital and university endowments, to stop investing in companies that profit from promoting diseases. Companies change their business practices when government regulation, consumer and investor pressure and market forces make it less profitable to stay the course than make changes. A few years ago CALPERS, the pension fund of California public employees, dropped all investments in tobacco. In 2014, let’s resolve to begin a grassroots campaign to reward companies that end health damaging practices, and take our business and investments away from those who don’t.
4. Support public health officials who seek to restore the visible hand of government to protect public health. Proponents of market-knows-best have raised the bogey man of the Nanny State to defeat efforts to restrict marketing of tobacco, alcohol, fast food and soda. But it’s Nanny Ronald McDonald, Nanny Marlboro and Nanny Budweiser that are trying to persuade our children and young people to consume sickening products. This year, let’s resolve to better protect our children from these bad nannies.
5. Require corporations to pay for the health consequences of what they sell. One important reason companies continue to profit from promoting unhealthy products is that they can avoid paying for the damage. Instead, they shift the costs for tobacco, alcohol and diet- related diseases to tax payers and consumers. By ending their ability to externalize these costs, new policies and laws could create incentives for companies to create healthier products.
As individuals, we have limited power to resist the pressure to consume the alcohol, tobacco and unhealthy foods that lead to early death and preventable illness. In 2014, let’s together resolve to create the environments and policies that make health the easy choice for all Americans.
Nicholas Freudenberg is Distinguished Professor of Public Health at the City University of New York School of Public Health and author of Lethal but Legal Corporations, Consumption and Protecting Public Health (Oxford, Feb. 2014).
On November 3, the American Public Health Association begins its an 141st Annual Meeting in Boston Massachusetts, the home of the nation’s first Tea Party– the one that challenged corporate control of trade, unlike the current Tea Party, which takes its money from the wealthiest.
credit: APHA
Several CHW contributors will be presenting their work in Boston and below are listed a selection of the more than 30 sessions or presentations that examine the role of corporations in our society and their impact on health. Forward this list of sessions to your friends and colleagues who might be interested in learning more about how corporations shape population health during their time in Boston. For more details on these sessions, click on the number or the title. The first session listed below features CHW writers, the following sessions are listed in the order of presentation.
Featured CHW Presentation
5133.0 Advocacy for Reducing the Role of the Global Alcohol, Food and Beverage, and Tobacco Industries in Health Education
11:10am Medical implications of the nuclear age Helen Caldicott, Founding president Physicians for Social Responsibility, noted author and lecturer on nuclear and environmental issues
291710 Women farmers first: Food companies, food security and the rights of women at the bottom of supply chains
279511 They’re still after our kids: Tobacco industry use of “youth smoking prevention” programs emphasizing personal responsibility to shift blame for addiction and disease to children and parents
Monday, November 4, 2013 : 2:30 PM – 2:50 PM
Lissy C. Friedman, JD , Public Health Advocacy Institute, Northeastern University School of Law, Boston, MA
Mark A. Gottlieb, JD , at Northeastern Univ. School of Law, Public Health Advocacy Institute, Boston, MA
3386.0 Corporate Malfeasance and the Public’s Health #1: Coal and Fracking Monday,
284243 Lessons from the Who’s Framework Convention on Tobacco Control: An advocacy-based approach for applying legal precedents that challenged big tobacco to challenge the food industry and reverse diet-related disease
Monday, November 4, 2013 : 5:00 PM – 5:15 PM
Sara Deon, MS , Corporate Accountability International, Boston, MA
292143 Corporate campaigning and public health: Ten tips and tricks to hold the private sector accountable
Monday, November 4, 2013 : 5:30 PM – 5:45 PM
Sarah Kalloch , Oxfam America, Boston, MA, Andy Harris, MD
Tuesday, November 5, 2013
4011.0 Community Health and Technology: Systems of Corporate Control and Implications for the People’s Health
275839 High-tech tobacco tax stamps: New technologies for fighting counterfeiting and tax evasion
Tuesday, November 5, 2013, Poster, 12:30 PM – 1:30 PM
Ryan Patrick, JD , Center for Health Policy and Legislative Analysis, The MayaTech Corporation, Silver Spring, MD ; Noah Kingery, BA , Hpla, The MayaTech Corporation, Silver Spring, MD; Carissa Holmes , CDC, Atlanta, GA ;Allison MacNeil, MPH , Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA;Gabrielle R. Promoff, MA, Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA
Brandon Kenemer, MPH , Office on Smoking and Health, Carter Consulting, Inc., Atlanta, GA
Kisha-Ann S. Williams, MPH, CHES , NCCDPHP, Centers for Disease Control and Prevention, Atlanta, GA
282028 Tobacco products marketing in urban Bangladesh – a rapid assessment
293114 Corporate liability, state responsibility, and labor rights intervention as a strategy to address a public health crisis: Developing a framework for protection of sugarcane workers in Nicaragua
Tuesday, November 5, 2013
1:30 PM – 1:45 PM , Y-Vonne Hutchinson, JD , La Isla Foundation, Leon, Nicaragua Purvi Patel, JD/MPH , La Isla Foundation, Leon, Nicaragua
4351.0 Corporate Malfeasance and the Public’s Health #2
Lethal But Legal: Corporations, Consumption, and Protecting Public Health
By Nicholas Freudenberg published by Oxford University Press in February 2014 with new paperback edition with an afterword by the author released in March 2016.
“In his new book, “Lethal but Legal: Corporations, Consumption, and Protecting Public Health” Freudenberg’s case is that the food industry is but one example of the threat to public health posed by what he calls “the corporate consumption complex,” an alliance of corporations, banks, marketers and others that essentially promote and benefit from unhealthy lifestyles. It sounds creepy; it is creepy. .. Freudenberg details how six industries — food and beverage, tobacco, alcohol, firearms, pharmaceutical and automotive — use pretty much the same playbook to defend the sales of health-threatening products. This playbook, largely developed by the tobacco industry, disregards human health and poses greater threats to our existence than any communicable disease you can name.” – Mark Bittman, contributing op-ed writer,New York Times
“A superb, magnificently written, courageous, and compelling exposé of how corporations enrich themselves at the expense of public health—and how we can organize to counter corporate power and achieve a healthier and more sustainable food environment. This should be required reading for anyone who cares about promoting health, protecting democratic institutions, and achieving a more equitable and just society.” –Marion Nestle, Professor of Nutrition, Food Studies, and Public Health, New York University; author of Food Politics: How the Food Industry Influences Nutrition and Health.
In this century, it is estimated that one billion people will die prematurely because of tobacco use, according to “Lethal but Legal,” a smart new book about corporate irresponsibility by Nicholas Freudenberg, a professor of public health at City University of New York. Put that one billion in perspective. That’s more than five times as many people as died in all wars of the 20th century. Freudenberg notes that smoking grew in part because of deliberate manipulation of the manipulation of the public by tobacco companies. For example, tobacco executives realized that they could expand their profits if more women smoked, so they engineered a feminist-sounding campaign to get females hooked: “Women! Light another torch of freedom! Fight another sex taboo!”– Nicholas Kristof in the New York Times
“A reservoir of constructive indignation that can arouse all Americans who adhere to basic human values.” ―Ralph Nader
“Freudenberg is optimistic that, despite the enormity of the challenges facing us as we confront the power of the multinational companies, a tipping point will be reached when the many thousands of pro-health organisations around the world come together and create the political power—and therefore the political will—necessary for success. Lethal But Legal buoyed my optimism.” Robert Beaglehole, The Lancet
“A real eye-opener. Freudenberg lays out the labyrinth of connections between corporate misbehavior and the health of the world, then gives a roadmap to fix it. I love this book.” –Cheryl G. Healton, Director, NYU Global Institute of Public Health; former President and CEO, American Legacy Foundation
“After documenting how multinational corporations manipulate us into hyperconsumption, this book goes on to identify the strategies we can, together, use to liberate ourselves.” –Richard Wilkinson, Emeritus Professor of Social Epidemiology, University of Nottingham
Lethal but Legal examines how corporations have shaped ― and plagued― public health over the last century, first in industrialized countries and now in developing regions. It is both a current history of corporations’ antagonism towards health and an analysis of the emerging movements that are challenging these industries’ dangerous practices. The reforms outlined here aim to strike a healthier balance between large companies’ right to make a profit and governments’ responsibility to protect their populations. While other books have addressed parts of this story, Lethal but Legal is the first to connect the dots between unhealthy products, business-dominated politics, and the growing burdens of disease and health care costs. By identifying the common causes of all these problems, then situating them in the context of other health challenges that societies have overcome in the past, this book provides readers with the insights they need to take practical and effective action to restore consumers’ right to health. Nicholas Freudenberg, DrPH, is Distinguished Professor of Public Health at the City University of New York School of Public Health and founder and director of Corporations and Health Watch, an international network of activists and researchers that monitors the business practices of the alcohol, automobile, firearms, food and beverage, pharmaceutical, and tobacco industries.
First Lady Michelle Obama delivers remarks during a “Let’s Move!” food marketing convening in the State Dining Room of the White House, Sept. 18, 2013. (Official White House Photo by Amanda Lucidon)
Last week, First Lady Michelle Obama spoke to executives from the food, advertising, and media industries; advocates; parent leaders; government agency representatives; and researchers about the power of marketing to influence kids’ food choices and the need for using this power to influence healthier food options for our nation’s children. The goal of the White House meeting, sponsored by Let’s Move, the national campaign to reduce child obesity, was “to begin a constructive, collaborative dialogue and strategize about ways to shift the marketing of unhealthy products to healthier products and decrease the marketing of unhealthy products to kids.”
Obama said, “I’m here today with one simple request — and that is to do even more and move even faster to market responsibly to our kids.” She told food executives “you guys know better than anyone how to get kids excited. You’ve done it before, and we need you to do it again. And fortunately you have everything it takes to get this done because through the magic of marketing and advertising, all of you, more than anyone else, have the power to shape our kids’ tastes and desires.” You can see the full speech here.
Michelle Obama’s talk appropriately focused attention on the role of food marketing to children. Her pleas to begin a “lively and constructive dialogue” on food marketing to children should be informed by several recent scientific reports on the subject. Health advocates and researchers can contribute to this dialogue by ensuring their findings are part of the discussion.
In Obesity Reviews, Sara Galbraith-Emami and Tim Lobstein published their systematic review of the data on the impact of codes on food marketing to children. They compiled data on the levels of exposure of children to the advertising of less healthy foods since the introduction of such statutory and voluntary codes. They reported that results showed “a sharp division in the evidence, with scientific, peer-reviewed papers showing that high levels of such advertising of less healthy foods continue to be found in several different countries worldwide. In contrast, the evidence provided in industry-sponsored reports indicates a remarkably high adherence to voluntary codes.” They concluded that “adherence to voluntary codes may not sufficiently reduce the advertising of foods which undermine healthy diets, or reduce children’s exposure to this advertising.”
Last June, an international group of researchers issued the Bellagio Declaration on Countering Big Food’s Undermining of Healthy Food Policies. The Conference concluded that “the actions of Big Food have been the most significant force in blocking public health efforts to promote healthy food policies and reduce obesity in many parts of the world.” Sixteen scientific reports on child obesity in various region and on assessments of food marketing presented at the conference provided the evidence to support this conclusion.
Finally, a recent article in the American Journal of Preventive Medicine analyzed the self-regulatory Children’s Food and Beverage Advertising Initiative (CFBAI), the code of the US food and beverage industry. They concluded the initiative is “limited in scope and effectiveness: expenditures increased for many noncovered marketing techniques (i.e., product placement, movie/video, cross-promotion licenses, athletic sponsorship, celebrity fees, events, philanthropy, and other); only two restaurants are members of CFBAI, and nonpremium restaurant marketing expenditures were up by $86.0 million (22.5% inflation-adjusted increase); industry pledges do not protect children aged >11 years, and some marketing appears to have shifted to older children; and, nutritional content remains poor. Continued monitoring of and improvements to food marketing to youth are needed.”
These and other reports suggest that the weight of the evidence is that the food industry does not play a constructive role in developing healthier food marketing policies. As public officials in both the United States, the United Kingdom and elsewhere call for “constructive dialogues” with the food industry, those seeking to promote evidence-based policies will need to challenge those who promote strategies that appear to be ineffective.
This recent evidence suggests three important lessons for the type of collaborative program Michelle Obama was advocating. First, before negotiating any partnerships or collaboration, health advocates need to define clear terms of engagement with the food industry and explicitly define potential conflicts of interest Second, any food industry commitments need to be evaluated by an independent group with adequate resources for assessment. Finally, partnerships are not a substitute for regulation or community mobilization to pressure industry. Allowing food companies or their trade association to substitute the former for the latter undermines government authority to protect public health.
As the summer draws to an end and the start of a new semester looms, those of us in the health teaching and learning business consider how best to make sure how our Fall courses prepare students to meet their professional responsibilities. To assist CHW readers who believe that public health professionals ought to understand more about how business practices influence health, I suggest 10 articles that can be added to a variety of Fall courses, including courses on health behavior, epidemiology, global health, health policy, public health history, health ethics, or health equity. To suggest others, send a message to newsletter@corporationsandhealth.org and we’ll post a compilation of your responses. The goals of these readings are to encourage students to analyze corporate practices as a modifiable social determinant of health and consider public health strategies to change harmful corporate practices. They can also help readers to assess the similarities and differences among the strategies these different industries use.
Ten Recent Articles to Add to Health Courses on the Impact of Corporate Practices on Health
Baum FE, Sanders DM. Ottawa 25 years on: a more radical agenda for health equity is still required. Health Promot Int. 2011 Dec;26 Suppl 2:ii253-7. pdf
Brandt AM. Inventing conflicts of interest: a history of tobacco industry tactics. Am J Public Health. 2012 Jan;102(1):63-71. Abstract
Douglas MJ, Watkins SJ, Gorman DR, Higgins M. Are cars the new tobacco? J Public Health (Oxf). 2011 Jun;33(2):160-9. pdf
Freudenberg N. The manufacture of lifestyle: the role of corporations in unhealthy living. J Public Health Policy. 2012;33(2):244-56. Abstract
Igumbor EU, Sanders D, Puoane TR, Tsolekile L, Schwarz C, Purdy C, Swart R, Durão S, Hawkes C. “Big food,” the consumer food environment, health, and the policy response in South Africa. PLoS Med. 2012;9(7):e1001253. pdf
Labonté R, Mohindra KS, Lencucha R. Framing international trade and chronic disease. Global Health. 2011 Jul 4;7:21. pdf
Monteiro CA, Cannon G. The impact of transnational “big food” companies on the South: a view from Brazil. PLoS Med. 2012;9(7):e1001252. pdf
Moodie R, Stuckler D, Monteiro C, Sheron N, Neal B, Thamarangsi T, Lincoln P, Casswell S; Lancet NCD Action Group. Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries. Lancet. 2013 Feb 23;381(9867):670-9. Abstract
Siegel M, Dejong W, Naimi TS, Fortunato EK, Albers AB, Heeren T, Rosenbloom DL, Ross C, Ostroff J, Rodkin S, King C, Borzekowski DL, Rimal RN, Padon AA, Eck RH, Jernigan DH. Brand-specific consumption of alcohol among underage youth in the United States. Alcohol Clin Exp Res. 2013;37(7):1195-203. Abstract
Steinman MA, Landefeld CS, Baron RB. Industry support of CME–are we at the tipping point? N Engl J Med. 2012;366(12):1069-71. pdf
And for those of you planning to teach on this topic in the Spring 2014 semester, here’s a shameless self-promotion. My new book Lethal but Legal Corporations, Consumption and Protecting Public Health will be published by Oxford University Press in January 2014. It’s available for pre-order at Oxford and at Amazon. More details in future posts on CHW.
In a recent article in The Atlantic, David Freedman argues that demonizing fast food may be dooming many people to obesity and disease and that embracing fast food could make us all healthier. Freedman’s How Junk Food Can End Obesity uses the familiar journalistic trope of man-bites-dog to make the case that what he calls “the whole food movement” (aka Pollanites, after Michael Pollan) is the obstacle to reducing obesity while junk food companies willingness to modify their products is the solution.
Freedman makes some important observations: he highlights the class composition of the some parts of the food movement, he calls attention to the limits of making processed food the villain of the American diet, and he faults the food movement for rarely considering the scale of changes needed to make healthy food available throughout the country, much less the world.
But for the most part, Freedman so ignores the political and economic realities of America that his arguments are silly, like your contrarian cousin who claims Rand Paul ought to be President. I’ll focus on three gaps in his arguments.
First, Freedman ignores the role of market forces. He writes that fast food companies should be encouraged to use food technology to market healthier products, claiming that “these roundly demonized companies could do far more for the public’s health in five years than the wholesome-food movement is likely to accomplish in the next 50.” But how has that strategy played out in the last five years?
In 2008, with much fanfare, Indra Nooyi, the Chair and CEO of beverage and snack manufacturer PepsiCo, announced plans to double the revenues from its nutritious products by 2020, from 20 percent to 40 percent. She invested in product reformulation, increasing the research and development budget by 25 percent between 2008 and 2010, while PepsiCo’s advertising emphasized images of health.(1)
When these new products failed to quickly deliver profits, however, investors and the Board of Directors demanded change. Their argument was mathematical: surveys showed that while 65 percent of Americans indulge in high fat, sugar and salt snacks, only 25 percent choose “healthy snacks”.(2) PepsiCo shifted gears to re-focus on its more profitable and indulgent brands. Products that PepsiCo calls “good for you” still account for only about 20 percent of revenue. The bulk of the money still comes from drinks and snacks the company dubs “fun for you,” including Lay’s potato chips, Doritos corn chips and Pepsi–by far the company’s biggest seller with about $20 billion in annual retail sales globally.(2) Sixteen of the company’s 22 “billion-dollar” brands are “fun-for you” (but make you sicker quicker) high sugar or fat products and three are diet sodas.(3) By confusing Big Food hype for their actual practices, Freedman misleads his readers.
Second, Freedman doesn’t consider the political record of Big Food in resisting democratic efforts to hold them accountable for their business practices. According to a 2012 special investigative report by Reuters, between 2009 and 2012, more than 50 leading food and beverage companies and trade associations spent $175 million to lobby the Obama Administration against the federal effort to write tougher — but still voluntary — nutritional standards for foods marketed to children.(4) This expenditure was more than double the $83 million spent in the previous three years, during the Bush Administration. The food and media companies hired Anita Dunn, Obama’s former White House communications chief, to run their media strategy. In contrast, Reuters found, the Center for Science in the Public Interest, widely regarded as the lead public health advocacy organization lobbying against the food industry, spent about $70,000 lobbying last year — roughly what those opposing the stricter guidelines spent every 13 hours.(4) And Freedman wants to leave these companies to decide how to improve the American diet and reduce obesity? Who’s being naive now?
Finally, Freedman writes as if one segment of the food movement, what he calls the “wholesome foodies”, is the entire food movement. What about the white, Black, Latino and Asian parents from low and middle income neighborhoods in Brooklyn working with the Brooklyn Food Coalition to improve school food in New York City? The fast food workers organizing in Los Angeles, Chicago, New York and elsewhere? The many groups looking to convert SNAP from a subsidy for Big Food into a force for health for poor and hungry Americans? By demonizing one admittedly influential sector of the food movement as if its views were monolithic, Freedman missed an opportunity for constructive debate within the movement. By parroting the slurs on the food movement that Big Food executives like to use at their shareholder meetings (elitists who look to take choices away from poor Americans), Freedman ends up reinforcing those stereotypes.
In the final analysis, it’s not processed food, it’s not McDonald’s and it’s not soda that are the chief reasons our food system contributes so much to poor health. Rather, it’s a food—and economic — system that values the profits of a handful of big companies more highly than the health and nutritional needs of the population or the well-being of the environment that sustains life.
Last week, the Institute of Medicine (IOM) released Priorities for Research to Reduce the Threat of Firearm-Related Violence, a report intended to inform scientific research that can guide policies to reduce gun violence. The report was in part a response President Barack Obama’s directive to the Centers for Disease Control and other federal agencies after the Newton Connecticut shootings to resume scientific research on gun violence. In 1996, at the behest of the gun industry and its supporters, Congress had ended most federal funding for research on gun violence.
In 2010, firearms injured or killed more than 105,000 Americans, with twice as many nonfatal firearm-related injuries (73,505) as deaths. “The complexity and frequency of gun-related violence combined with its impact on the health and safety of the nation’s residents make it a topic of considerable public health importance,” said Alan Leshner, chairman of the IOM study committee and chief executive of the American Association for the Advancement of Science. The IOM works outside of government to provide unbiased and authoritative advice to decision makers and the public.
The report calls for additional research on several topics including:
The characteristics of firearm violence,
Risk and protective factors,
Interventions and strategies to reduce gun violence ,
Gun safety technology, and
The influence of video games and other media.
It proposes a research agenda that will produce results in three to five years. The report makes the case that “the evidence generated by implementing a public health research agenda can enable the development of sound policies that support both the rights and the responsibilities central to gun ownership in the United States. In the absence of this research, policy makers will be left to debate controversial policies without scientifically sound evidence about their potential effects.”
To illustrate the dangers of ideology rather than evidence-based policy, the report notes that while “firearm safety education programs are widespread in public schools… they are inadequately studied and the few evaluations that have been conducted provide little evidence of effectiveness.” This directly contradicts the NRA’s assertion that these programs have been shown to reduce gun injuries and deaths and should be the foundation of public policy.
The report is an important step forward in defining a research agenda on gun violence and provides scientific credibility for several important lines of research. But the IOM report is as important for what it does not say as for its recommendations. The term “gun industry” or “firearm industry” does not appear in the report. The words “National Rifle Association”, the organization that is the main obstacle to sensible gun policy, do not appear, except in the Appendix as identifications for two witnesses to the panel. The word “political” appears once and “campaign contributions” and “lobbying” not at all. These omissions are not surprising because in mainstream scientific discourse describing the political or corporate influences on research is as impolite and inappropriate as farting in public.
Some readers may argue that such criticism of a worthwhile report is unfair —this was after all a scientific report not a political analysis. But corporate practices have become an increasingly important influence on health and health policy. As the firearms, pharmaceutical, automobile, alcohol and food and beverage industries—among others—use their political and financial clout to influence health policy, failing to address these political dimensions makes it less likely that effective policies will emerge. Ignoring their role and failing to support research that documents industry influence on policy leaves advocates of healthier policies unequipped to succeed in the political arena where policies are shaped. It’s bad science and bad policy analysis.
As long as the behavior of corporations is off the polite scientific agenda, it will be difficult to design research studies or develop public health policies and programs that can address the most important causes of premature mortality and preventable illness and injury in the world today. In failing to discuss the need for research on the role of the gun industry and its supporters in gun violence, the IOM panel missed an important opportunity to educate the public, policy makers and scientists.
Corporations and Health Watch 