Show Summary Details

Page of

Printed from Oxford Research Encyclopedias, International Studies. Under the terms of the licence agreement, an individual user may print out a single article for personal use (for details see Privacy Policy and Legal Notice).

date: 27 January 2022

Corporations, Health, and Global Politicsfree

Corporations, Health, and Global Politicsfree

  • Nicholas FreudenbergNicholas FreudenbergSchool of Public Health, City University of New York

Summary

Since the mid-20 century, corporations have gained increasing political and economic power to shape the living conditions, lifestyles, governance processes, and environmental exposures that determine global patterns of health and disease. Globalization, the growth of the financial sector, deregulation, and increasing corporate control of science and technology have provided corporations with new power to influence the mechanisms that determine human and planetary health. A growing body of public health and social science scholarship analyzes how corporate use of this economic and political power has become a fundamental determinant of the most serious health crises facing the world. In response, governments, civil society groups and social movements have developed new strategies to challenge corporate power to shape global health governance, protect public health, and reduce health inequities.

Subjects

  • Environment
  • Organization
  • Political Economy

Introduction

In the first two decades of the 21st century, the world has faced a variety of global public health challenges that have worsened population health and widened international, national, and local inequities in health. These include:

In several wealthy nations, so-called deaths of despair—from opioid addiction, suicide, and gun violence—have emerged as leading causes of mortality. Other threats to mental health include the widespread dissemination of digital technologies and social media that facilitate bullying, increase social isolation, jeopardize privacy, and aggravate social conflict and political polarization.

Climate change poses another overwhelming threat. In the early 2020s, it contributed to massive wildfires, droughts, and tropical storms. The global climate emergency also triggers heat waves that sicken and kill the elderly and the poor, disrupts the food supply, and facilitates the spread of infectious diseases.

The growing incapacity of our global food system to adequately nourish the world’s population is a third problem. In 2019, more than 690 million people around the world still go hungry, and the COVID-19 pandemic has increased that number substantially. At the same time, unhealthy food is fast becoming the leading cause of preventable illness and premature deaths around the world, making the quest for affordable food that sustains health a daily challenge for much of the world’s population.

Changes in work—including the rise of precarious employment, the loss of insurance and unemployment, new barriers to unionization, and the dismantling of health-and-safety regulations—leaves the rising number of low-wage workers with inadequate income, benefits, and workplace safety protection, putting them at risk of early death, serious illness, and disrupted lives.

Finally, the COVID-19 pandemic had already infected more than 219 million people and killed at least 4.5 million around the world by September 2021. In the coming years, the social and economic consequences of the pandemic are expected to push many more people around the world into ill-health.

While these five health crises have differing causes, each emerged as corporations consolidated their power to shape the global economy in ways that increased their ability to influence health-and-living conditions. While corporations gained power, individuals, communities, and government lost their capacity to make the decisions that shaped their well-being and their lives.

An examination of the role of corporations in these five major health crises suggests answers to key questions facing public health in the early 21st century.

1.

What roles have corporations played in worsening or ameliorating these and other major global health problems?

2.

What are the underlying political goals of corporations and how does their use of political power influence global health?

3.

What political strategies do corporations and their allies use to achieve these goals?

4.

How have other social actors such as government, civil society groups, and social movements operated in the political arena to modify corporate practices that harm health and strengthen those that benefit health?

Corporations are business entities created in the 17th century to pool wealth and share risks for projects too large for wealthy individuals to shoulder on their own (Pettigrew & Veevers, 2018). Corporations are a component of the political and economic system known as modern capitalism, defined here as the global political and economic system that took shape in the 1970s (Cornwall, 1977) and that makes generating profits, increasing markets, and reducing political uncertainty its priority goals. A corporation is a collective body carrying out economic activities, able to pay taxes, and distinct from the individuals running or employed by it. The law considers corporations as a legal “person” that can sue and be sued. Their legal independence prevents shareholders from being personally liable for corporate debts while the legal “person” status of corporations gives the business perpetual life; deaths of officials or stockholders do not alter the corporation’s structure (Berle & Means, 1991). Over the years, corporations have won rights that increase their power to act in the political arena. As well as limited liability, which makes a corporation liable for actions while shielding the actual humans behind the corporation, corporations have won rights to make campaign contributions, limit their taxes, and protect their intellectual property (Mikler, 2018). As Milton Friedman (1970) famously put it, “the social responsibility of business is to increase its profits.” In this contested view, a company has no social responsibility to the public or society; its only responsibility is to its shareholders.

Corporations are embedded in a web of other relationships that define their capacity to exert power. They are key actors in the private sector, in markets, and in global organizations such as the World Trade Organization. Corporations both cooperate and compete with other companies and together they create trade associations and business organizations that operate at the local, national, and global levels. Corporations also interact with government and civil society organizations, sometimes cooperating to achieve common goals and other times opposing the initiatives of these groups.

Since corporations are rooted in a political and economic system, their behavior can only be understood in the context of the structures, rules, and interactions that define that system (Knai et al., 2018; Sell & Williams, 2020). While the characteristics of national and global political and economic systems are dynamic and situated in a particular time and place, in the third decade of the 21st century, the dominant global system is modern capitalism. Defining features of modern capitalism and key drivers of its influence on human and planetary well-being are corporate-managed globalization, the growing role of the financial sector, monopoly concentration, deregulation, privatization, and corporate control of science and technology (Sell & Williams, 2020). Any effort to understand how corporate power influences health in this era must consider how these drivers structure the formal and informal rules that characterize 21st-century capitalism (Freudenberg, 2021).

Recent public health scholarship has focused on a concept labeled the “commercial determinants of health” (de Lacy-Vawdon & Livingstone, 2020; Maani et al., 2020). Broadly defined by West and Marteau (2013) as “factors that influence health which stem from the profit motive,” the concept of commercial determinants of health provides a firm link to the global discourse on social determinants of health (Marmot & Wilkinson, 2005), a dominant influence of public health scholarship and activism in the last 40 years. Together these two intersecting bodies of literature provide a foundation for the study of the influence of corporate power on global health.

Public health and social science scholars seek insights on corporate power that can guide the development of more effective and equitable policies and programs to promote human and planetary well-being. To do so, they will need to move beyond simplistic dichotomies to empirical and theoretically informed investigations that examine the exercise of power across specific times, places, economies, and business sectors. In these more grounded studies, states are neither merely “handmaidens of corporations” (Strange, 1997, p. 184) nor all-powerful independent actors. Corporations are not faceless organizations moved only by market forces—as U.S. Senator Mitt Romney said during his 2012 presidential campaign, “corporations are people, my friend . . . Everything corporations earn ultimately goes to people” (Rucker, 2011).

The intersections of three bodies of academic work from the first 2 decades of this century constitute the foundation for an examination of the contemporary role of corporations in health and global politics. The first, from political economy and history, describes how capitalism has changed since the 1970s and how corporations have accumulated growing political and economic power (Hall, 2015; Harvey, 2007; Mikler, 2018; Piketty, 2020, 2014). The second, from public health, builds on the concept of social determinants of health, the deeper social, economic, and political influences on local and global patterns of health and disease, to build a body of evidence on the commercial determinants of health, defined as the market forces and actors that shape the distribution of human and planetary states of health (de Lacy-Vawdon & Livingstone, 2020; Knai et al., 2018; Maani et al., 2020, 2021; West & Marteau, 2013). Finally, an eclectic mix of social scientists and activists have produced scholarship on global health governance and the role of social movements and civil society in modifying corporate business and political practices (Anaf et al., 2020; Brown & Fee, 2014; Lee & Kamradt-Scott, 2014; Meier & Gostin, 2018; Musolino et al., 2020). While each of these domains has been reviewed extensively, it is their intersections that inform an analysis of the role of corporations in shaping global health.

How Corporations Affect Global Health Problems

COVID-19

The COVID-19 pandemic, the worst infectious-disease outbreak in a century, was caused by a virus first identified in China, which then spread rapidly around the world. While the pathways by which the COVID-19 virus infected individuals were determined by viral and human biology, who got sick, who recovered, and who died was inexorably shaped by the decisions of corporations. A few examples illustrate.

Availability of Personal Protection, Drugs, and Vaccines

The pharmaceutical industry used its technical capacity, mastery of relevant science, and productive infrastructure to produce several effective vaccines relatively quickly, a clear example of how corporations can benefit global health. Throughout the pandemic, however, shortages of personal protective equipment (PPE), emerging treatment options, and, later, vaccination, enabled some people to acquire these health protections and others not to. On the one hand, the rising need for these prevention and treatment services led some companies to expand production and expedite the research and development of new products. On the other hand, these producers used increased market demand to increase prices, a basic dynamic of market economies—a decision that limited access to these services to those with fewest resources, thus widening health inequalities. Moreover, the fact that any pharma industry-led distribution system had to meet profit targets ensured that meeting human needs or targeting those at highest risk would not be priorities (Sell, 2020).

Working Conditions

The pandemic also led some companies to modify the working conditions of their employees in order to meet the increased demand for their products or to respond to the economic changes precipitated by the pandemic. The U.S. meat-packing industry, for example, used its political influence to convince the Trump administration to lift health-and-safety regulations during the pandemic and to increase the speed of production lines to increase profits. As a result, 4 months after the epidemic struck, the U.S. Centers for Disease Control reported 16,233 cases in 239 meat-processing-and-packing facilities (Waltenburg et al., 2020).

Access to Health Care and Vaccines

In the United States and many other countries, corporate decisions designed to maximize profits and increase revenues expedited access to care for some while depriving others. Moreover, cuts in public health and public medical-care funding over the last decade, triggered by tax cuts promoted by business interests, left the public health and medical-care systems unprepared for the pandemic and without the resources to launch an effective rapid response.

Through its use of exclusive and secret contracts with vaccine makers, many governments allowed these companies to make windfall profits without ensuring efficient implementation of vaccine administration (Rosenthal, 2020). The pharmaceutical industry—with the help of massive investment from governments—was able to devise effective vaccines within a year, illustrating corporate capacity for innovation. But the failure of industry and government to administer vaccines expeditiously and equitably shows the limits of this capacity to actually improve population health (Legge, 2020). As a result, people in low-income countries and low-income populations in wealthy countries had less and slower access to vaccinations than the better off.

Vulnerability to Infection

Individuals with diabetes, heart disease, and obesity were at higher risk of COVID-19 infection, hospitalization, and death (de Siqueira et al., 2020). These conditions are more prevalent in low-income communities; in part, because the food industry has heavily marketed and made widely available unhealthy food—products high in fat, sugar, salt, and multiple additives and flavorings that elevate risk for these conditions. Global food companies have increased the protection and promotion of these products because they are profitable, appealing, and easy to ship and sell around the world. In this case, practices that benefit global food corporations also elevated the risk for COVID-19 infection as well as many other diseases.

Climate Change

In 2009, a commission sponsored by The Lancet and University College London Institute for Global Health concluded that “Climate change is the biggest global health threat of the 21st century” (Costello et al., 2009). Climate change endangers health via multiple pathways. It increases the frequency, magnitude, and human impact of “natural” disasters such as floods, droughts, heat waves, and tropical storms; facilitates the spread of infectious diseases; disrupts agriculture and food production in ways that limit the food supply and bankrupt small-and-medium farmers; reduces access to clean drinking water and increases exposure to contaminated water; increases exposure to pollutants, such as ozone and particulate matter; forces people to migrate to escape disasters or find work, putting them at risk of physical and mental health problems; and intensifies political and social conflict and thus exposure to violence and psychosocial stress (Cianconi et al., 2020; Smith et al., 2014; Willett et al., 2019).

Corporations have mitigated or prevented climate change by switching from fossil fuels to renewable energy sources and by reducing energy waste in their own and their suppliers’ production and distribution processes, promoting environmentally sustainable public policies, disinvesting from polluting industries, and encouraging their employees to reduce fossil fuel energy (Dunn, 2002).

But businesses have also exacerbated the adverse impact of climate change by undermining local, national, and global public policies designed to reduce carbon and greenhouse gas emissions, failing to modify their own production practices, and initiating and funding campaigns to misinform and deceive the public about the risks and their role in the world’s growing climate emergency (Oreskes & Conway, 2011; Wright & Nyberg, 2015).

Hunger and Diet-Related Disease

In the past 50 years, as the world’s capacity to grow more food has increased; the primary determinant of rising rates of hunger and food insecurity in high-, middle-, and low-income countries is not the supply of healthy food but rather its distribution through a market system that adequately feeds (or in some cases overfeeds) those with the resources to afford food but imposes food insecurity and hunger on those who lack these resources. At the same time, the global food industry has created what sociologist Gerardo Otero calls the neoliberal diet, a global diet that offers multiple choices to the better off and limited choices to the low-income and vulnerable populations (Otero, 2018), a system some call “food apartheid” (Washington, 2018).

A growing body of research suggests that this neoliberal diet, composed of food that is industrially processed, high in fat, sugar, salt, and other additives, designed to be hyperappealing and marketed aggressively around the world, plays a growing role in rising rates of obesity, diabetes, heart diseases, hypertension, and some types of cancer (Bonaccio et al., 2021; Elizabeth et al., 2020; Pagliai et al., 2020) This ultra-processed diet is attractive to global food corporations because it is cheap to produce, easy to transport and market around the world, and depends on inexpensive staple crops. Thus, a diet that meets the business needs of global food corporations but compromises the health of its consumers, widens diet-related inequalities in health, and, through its agricultural practices, contributes to climate change, has become the world’s default diet.

Global food corporations have advanced their ability to promote the ultra-processed diet by using their scientific-and-technical capacity to develop hyperpalatable products; negotiating global trade treaties that favored the expanded distribution of these products; winning subsidies and tax breaks for agricultural and production practices that lower their production and distribution costs; successfully opposing policies such as sugar taxes, package labeling, and nutrition standards and regulation that would discourage production or raise the cost of these products. Like other industries, they have also sponsored misinformation campaigns about, for example, the roles of diet and physical activity in diet-related diseases (Lacy-Nichols et al., 2020; Nestle, 2013; Stuckler et al., 2012).

Deaths of Despair

In their book, Deaths of Despair and the Future of Capitalism, Anne Case and Angus Deaton (2020) explore the role of modern capitalism in increases in mortality from drug overdoses, suicide, and alcohol-related liver disease, especially among middle-aged and older working-class White Americans. They identify long-term trends such as the decline of manufacturing jobs, full employment, and income for White people without college degrees; increased workplace injuries; the failures of market-based healthcare; and declining incomes and perceived status, especially among middle-aged and older working-class White Americans, as fundamental causes of rising mortality. More proximate causes include aggressive marketing of opioids for pain relief, the ready availability of firearms, and the increasing consumption of alcohol in this cohort. While most studies of deaths of despair have focused on the United States and Western European nations, the contributory role of deindustrialization and falling social status suggest this phenomenon could also arise in middle-income countries (Scheiring et al., 2020).

What role do corporations play in rising deaths of despair? Their decisions to automate jobs, move manufacturing plants from higher to lower-income nations, and shift investments from manufacturing to financial businesses—choices made as a result of changes in global capitalism—determine the changes in working-and-living conditions for large sections of the working class. The aggressive promotion of OxyContin and other opioids by firms such as Purdue Pharma, Johnson & Johnson, Endo Pharmaceuticals, and others, including their payments to physicians for prescribing their products, led to widespread overuse of these addictive drugs (Hadland et al., 2019). Increased marketing of alcohol and firearms and widespread retail availability, combined with the targeted marketing of alcohol to problem drinkers and firearms to aggressive and fearful individuals, exacerbated higher use by vulnerable populations, leading to increases in alcoholrelated disease and injuries. Although problem drinkers account for a minority of those who consume alcohol, they contribute the majority of revenues to the alcohol industry, making them a prominent target for industry advertising campaigns (Boseley, 2016). Similarly, the heavy marketing of firearms and easy retail availability, policy options implemented by and defended against any limitations by the firearms industry and its supporters, makes these products readily available to those contemplating suicide, partner violence, or mass murder. Firearms are the primary cause of death for suicides in the United States (Kaskie et al., 2016).

Low-Wage Work

In the first decades of the 21st century, the proportion of workers earning low wages increased in many parts of the world. In the United States, about 2 in 5 workers—53 million people—earn low wages, with many lacking benefits, health-and-safety protections, or the right to unionize (Ross & Bateman, 2019). Other studies show rising wage inequality among the workforces in other high-income countries (Tomaskovic-Devey et al., 2020). A growing body of social science and public health scholarship suggests that the rise of low-wage work is both a key driver and a consequence of income and wealth inequality (Congressional Research Service, 2020), itself a fundamental cause of health inequities (Bor et al., 2017).

The rise of low-wage work contributes to a variety of health problems. Low-wage workers in agriculture, construction, domestic work, and some public-facing retail settings experience higher rates of workplace injuries and exposure to occupational hazards (Grimshaw, 2011; Steege et al., 2014). Because they seldom belong to unions, low-wage workers often lack the health and safety and other protections that these organizations offer. Without mechanisms to redress grievances, they may be less likely to complain or pursue compensation when their rights are violated. Since many low-wage workplaces are privatized, deregulated, or outside the formal economy, the occupational health-and-safety regulations that protect other workers do not exist or go unenforced. Finally, in the United States, undocumented immigrants, women, Black people, and Latinos are disproportionately represented in low-wage jobs, exposing them to the double or triple burden of workplace sexual harassment, racism, and bias.

Low-wage and precarious workers are also more likely to work extra hours, nights, or irregular shifts, imposing work-family conflicts, especially on women workers. These conflicts, combined with the inadequate household income and inadequate or nonexistent benefits that low-wage jobs offer, increase anxiety, depression, and psychosocial stress, which can in turn precipitate or aggravate more serious and persistent mental health problems (Rönnblad et al., 2019).

The health consequences of low-wage work are the direct consequences of business decisions and public policies on wages, benefits, working conditions, gender and racial discrimination, and regulation, decisions shaped by contemporary political and economic structures and governance. Some of these practices are set by employers while others are shaped by public policy. As in other areas, corporations and their allies have often used their political influence to support wage, regulatory, and tax policies that benefit their bottom line and oppose those that jeopardize profits.

These five public health problems illustrate some of the ways that corporate power has influenced global health in the first decades of the 21st century. Corporations can use their power to improve or harm health. Examples of corporate activities that have improved health include discovering and deploying vaccines and essential medicines, increasing food production to reduce hunger and food insecurity, bringing to market new technologies that can make it easier and less expensive for individuals to communicate and exchange information, and using automation to eliminate jobs that endanger health. While business leaders and some scholars emphasize these positive contributions, public health researchers often focus on adverse health consequences. This reflects both their professional mandate to identify and address threats to public health and the historical origin of public health in reform movements to modify the health-harming effects of industrialization and business-led economic development.

These contemporary examples of how corporations use power in ways that influence health can inform a conceptual model to guide public health practice and research. This model, shown in Figure 1, shows some of the pathways by which structural factors such as stratification systems, governance processes, laws, norms, and values influence the business and political practices that corporations use to exert their power. In turn, these practices then shape the prevalence and distribution of health outcomes via several pathways.

Figure 1. A conceptual framework for investigating the influence of corporate power on global health.

In this view, structural influences determine the pathways and interactions as well as the opportunities and constraints through which corporations use business and political practices to deploy their power. In this complex and dynamic system, corporations choose and use a mix of practices to achieve their desired goals. Finally, the model sets the stage for investigating the biological, social, economic, and other pathways by which these exercises of power influence patterns of health, disease, and health equity at individual, community, national, and global levels.

The Political Goals of Corporations

To set the stage for considering how corporations use their power to influence global health, this section briefly reviews some of the ways that scholars have analyzed corporate power. According to the political scientist Robert Dahl, “A has power over B to the extent that he can get B to do something that B would not otherwise do” (Dahl, 1957, pp. 202–203). But how A uses his power to get B to act or not act in a certain way can differ considerably. In shaping norms, values, and beliefs, corporations use their soft power (Lukes, 2007) to enlist public support for their goals and limit the risks that can result from more adversarial exercises of power. Table 1 shows some of the classification systems used to characterize different types of corporate power.

Table 1. Types of Corporate Power That Can Harm Global Health

Type of Power

Definition

References

Example

Hard vs. soft power

Hard power is the ability to coerce others to choose a desired course through use of economic, political, or military power.

Šehovic, 2019

Tobacco companies use their economic power and political power to defeat or discourage taxes or smoking bans.

Soft power is the ability to attract and co-opt others to choose a desired course of action by making the choice seem appealing and attractive.

Lukes, 2007; McBride et al., 2019

By promoting the belief that soda taxes hurt small businesses, soda companies enlist support of small business organizations in opposing such taxes.

Market or business vs. political power

Market power derives from corporations’ ability to generate profit, capture market share, and outperform competitors. Increased monopoly concentration leads to increased market power.

Khan, 2017

Pharmaceutical companies use increased market power to charge customers more, thus reducing access to essential medicines.

Political power is the capacity to achieve norms, laws, regulations, and policies that favor business interests.

Geppert & Dörrenbächer, 2014

Business organizations use campaign contributions and lobbying to enlist legislators in opposing higher corporate taxes, depriving governments of revenues to support well-being.

Structural power vs. organizational power

Structural power describes social and political mechanisms that generate, configure, and maintain the socioeconomic position of corporations.

Krumeich & Meershoek, 2014

Neoliberal restructuring of government responsibilities (e.g., through privatization or austerity measures) diminishes its capacity to protect health or invest in public health.

Organizational power describes the governance processes and business and political practices of actors such as corporations. It stems from human and organizational agency.

Mikler, 2018

Pharmaceutical industry defeats proposals to set limits on drug prices.

Material vs. ideational power

Material power describes the capacity of corporations to obtain, distribute, and use resources such as financial and human capital and technology.

Mikler, 2018

Auto and Big Tech industries maintain control of Autonomous Vehicle technologies so they can set ground rules.

Ideational power describes the capacity to develop, distribute, and use ideas in ways that persuade others of the cognitive validity of their worldview.

Carstensen & Schmidt, 2016

Source: Adapted from Lee and Smith (2019); McInnes et al. (2019)

Across space, time, and business sectors, corporations use their power to achieve common economic and political goals. Economic goals focus on increasing profits, while political goals seek to increase corporate control and reduce uncertainty about changes in the environments in which corporations operate. In practice, these two goals intersect, and some corporate strategies seek to achieve both types of goals.

Use of Power to Increase Profits

Since the 1970s, investors have increasingly pressured corporations to maximize returns for shareholders. The globalization of capital, the growing dominance of the financial sector over the manufacturing sector, and the monopoly consolidation within many business sectors have contributed to this trend. For example, both the tobacco and alcohol industries, each governed by different regulatory regimes that vary by country, have used similar marketing, growth, and consolidation strategies to achieve their profit goals (Hawkins et al., 2018).

To maximize profits, corporations seek to increase market share, set prices to raise more revenue, discourage competition, buy back stocks, and reduce costs. They achieve these goals by using their economic power and their political power. Sugary beverage makers, for example, increase their share of the soda market by aggressive and targeted marketing, expanding marketing in low-and-middle-income countries, lowering prices to win new customers, buying up or merging with competitors, fixing prices with competitors, and expanding to other regions and countries (Kleiman et al., 2012).

Public companies buy back stock to increase dividends for shareholders choosing to use their revenues to achieve this goal rather than to invest in scientific innovation or higher wages for their workers. The prices corporations charge their users, another revenue and profit generating practice, determine who can and cannot afford a product and can also contribute to enhancing or diminishing the success of business competitors.

Corporations also use their mastery and control of science and technology to maximize returns on investment. This source of power enables pharmaceutical companies, for example, to use intellectual property rights to maintain exclusive patents on profitable medicines or car companies to lower costs and increase profits by using their know-how to evade costly pollution-emission standards.

Corporations also increase profits by cutting costs. They cut costs by achieving economies of scale by growing markets or buying other companies, reducing wages and benefits, producing cheaper products, and reducing their taxes. Changing tax laws or their enforcement is a political strategy while moving profits to tax havens or evading taxes could be considered an economic strategy.

The business power of corporations springs from their economic dominance, their capacity to move capital, goods and services, and workers across borders to achieve cost reductions, their control of capital, and their influence on work and consumption. This economic power is exercised both by individual corporations but also by trade associations, banks (which decide who gets loans at what interest rates), and other financial institutions (McKee et al., 2019; Mikler, 2018).

Some scholars have noted the rise of a counternarrative to profit maximization as the overriding goal of corporations, an alternative perspective labeled “stakeholder capitalism” in which investors are expected to consider the needs of consumer, labor, communities, and governments as well as shareholders (Schwab, 2019). In the theory of stakeholder capitalism, corporations and their directors balance the needs of these constituencies, seeking to optimize benefits for all. In practice, however, the “stakeholder” perspective has often seemed more symbolic or rhetorical than a significant influence on the exercise of corporate power. Another term, “corporate social responsibility,” describes actions a corporation takes to demonstrate its responsibility to constituencies other than shareholders (Agudelo et al., 2019).

Use of Power to Increase Control and Reduce Uncertainty

The other main goal of corporations is to increase their control of the political and social environments in which they operate and to reduce uncertainty about the future. Uncertainty jeopardizes profitability and disrupts planning for the future, both key corporate goals.

Corporations use their political power to lower their taxes, reduce business regulation and enforcement, counteract demands for higher wages and benefits, protect intellectual property, and promote global trade. To achieve these goals, they also use their power to shape public opinion, discourage opposition, and promote public support for their activities. Nestle has described how the sugary beverage industry has used these strategies to create more favorable environments for their businesses (Nestle, 2015).

While the business and political goals of corporations are inextricably intertwined, the activities designed to pursue each are carried out in conceptually distinct arenas—the former, within the markets where goods and services are exchanged—and the latter, within the political system where laws, regulations, social norms, and governance are determined.

Some business activities fall into both categories. Investors, banks, and other financial institutions, for example, can choose to disinvest or threaten to avoid future investments in certain activities in order to influence legislation, appointments, or policy implementation. These “capital strikes” (Young et al., 2018) can have an important impact on public policy.

Pathways through Which Corporate Pursuit of Business and Political Goals Influences Global Health

Examples from the five public health crises facing the world can be used to highlight the impact of corporate business and political power on patterns of global health and disease, and to illustrate how these patterns become embodied within individuals and populations (see Figure 1). Corporations use a variety of strategies to achieve their goals as do public health professionals, researchers, advocates, and others seeking to reduce adverse impact and enhance the positive effects of corporate power on health.

Changes in Lifestyle

Corporations influence health by encouraging some changes in lifestyle and health behaviors while discouraging others (Freudenberg, 2012). They decide what to produce, how to design and market a product, how to distribute it, and what price to charge. In the case of ultra-processed food, the world’s largest transnational food companies have found it profitable to produce and sell hyperpalatable products with long shelf lives and market these products globally. Their basic ingredients—corn, soy, and sugar—are global commodities that agricultural policies have made cheap to produce and distribute. The largest global retailers rely on these products for the bulk of their profits, even as they also sell healthier fresh produce to better-off customers. Agricultural producers, food manufacturers, food retailers, and fast-food chains, as well as their trade associations, lobby aggressively and make campaign contributions to ensure low taxes; lax workplace regulations (enabling them to keep labor costs low); favorable trade agreements; and limited restrictions on false or misleading advertising.

Through these activities, unhealthy food is more available, cheaper, more convenient, and more heavily marketed than healthier food for a large proportion of the population of high- and middle-income countries and a growing proportion of those in low-income countries. In these ways—not through a conspiracy to sicken the world’s population—but as a consequence of global trends and specific corporate decisions, food corporations have made an unhealthy diet easier to consume than healthier ones. And as a result of the choices on offer from the food industry, the global diet imposes a burden of diet-related diseases that have become the leading global cause of premature death and disability (Forouzanfar et al., 2016).

Corporations could choose to make healthier food a priority and some have experimented with this path, but when the PepsiCo CEO proposed spending more on marketing “good for you” products and less on unhealthy “fun for you” products, such as sugar-sweetened beverages, the corporate board vetoed this choice, noting that this switch jeopardized profits. Using “health halos” to market a few products in a portfolio of unhealthy ones is often more public relations than public health improvements (Simons, 2011).

By offering varying lifestyle choices to different socioeconomic groups, tech companies show how corporate decisions can exacerbate health inequities. Each year medical device, tech, and pharmaceutical companies design and market tens of thousands of new health apps. These products are rarely tested rigorously, minimally regulated, and designed to maximize profits rather than improve individual or population health (Grundy et al., 2017). Without these protections, buyers find it difficult to make informed choices, and those with lower incomes are especially vulnerable to use cheaper less-reliable products. In these ways, the design, production, and marketing of new health apps can result in widening rather than shrinking inequities in health. Electronic devices for home monitoring of hypertension, a technology that could improve health outcomes, is more likely to be used and therefore benefit the better off, further widening economic and racial/ethnic disparities in hypertension outcomes (Palacholla et al., 2019).

Changes in Environmental Exposures

Corporate decisions also shape who is exposed to what harmful (or health-enhancing) physical and social environments. The methods that mining and energy companies use to extract minerals or metals from the ground (Stewart, 2019), timber and agricultural companies use to harvest or burn forests (Ellwanger et al., 2020), the automobile industry’s choices on energy sources and pollution-control devices for the vehicles they produce (Lelieveld et al., 2020), and the production and disposal methods of chemical and agricultural products companies (Whitmee et al., 2015), each has major influences on the well-being of nearby residents and on planetary health. In many parts of the world, the decisions companies make have created “sacrifice zones,” often in places where indigenous people reside, in which the potential for healthy living has been damaged (Lerner, 2012).

Corporations also structure environments through commercial decisions and the influencing of zoning, design, and economic development. This, in turn, shapes individual and community choices about what to purchase, where to live, and how to get from one place to another, all social determinants of health (Rossen & Pollack, 2012).

Together, these exercises of corporate power increase the exposure of large segments of the world’s population to harmful pollutants and unhealthy social environments, an important pathway to the growing prevalence of environmentally related diseases and inequitable distribution of global health and disease.

Changes in Culture and Value

Corporations use their political and business capacities to influence social norms, values, and beliefs, all-powerful influences on health. A few examples illustrate this dynamic. Western culture and history have both communitarian and individualist traditions (Avineri & De-Shalit, 1992), but for the past century corporate marketing, public relations, and policy advocacy have emphasized the virtue of individual choice and the perils of governmental interference on choice (Ewen, 2008). With their dominance of most channels of communication, corporate advocacy of individualism has reinforced this belief and weakened support for public or collective solutions to social problems. Corporate lobbyists then use this public playing field—that they have tilted—to effectively argue that regulation, public safety nets, and higher taxes on the wealthy violate individual rights and strengthen authoritarian or nanny states. A related cultural trope is the concept that freedom is defined as choice among commodities, that having your burger “your way” is the equivalent of choosing what type of government rules or what political and economic rights minorities can depend on.

Another belief, this one promoted by former UK Prime Minister Margaret Thatcher and U.S. President Ronald Reagan, and ardently endorsed by their business supporters, is that “there is no alternative” to the economic and political arrangements that constitute modern capitalism (Swyngedouw & Wilson, 2014). By enlisting a substantial portion of the population in endorsing that idea, whatever their dissatisfaction with the status quo, the current system is inevitable and immutable, corporations and wealthy individuals disarm proponents of alternative visions of the world.

Changes in Governance for Health

Finally, corporations use their power to influence the governance processes that shape health. Through this pathway, the corporate exercise of power in formal and informal governance mechanisms alters the likelihood or risk of individuals or populations experiencing declines—or improvements—in health. Over the 20th century, as corporations gained power while governments lost influence, gaps in global health governance emerged. An examination of the global response to the COVID-19 pandemic illustrates this trend (Legge, 2020).

As the coronavirus spread around the world in 2020, the World Health Organization was slow to respond effectively and rapidly (Kuznetsova, 2020). Its capacity was diminished by cuts in financial support from countries where economic crisis and business influence had led to austerity and tax cuts for the wealthy, diminishing the resources available to support global (or national) health. Although foundations created by billionaires such as Bill Gates, Ted Turner, Carlos Slim, and others, have picked up some of the slack in global health funding, they are not accountable to any constituency, often favor solutions that do not disrupt the political status quo, and tend to bypass governments for global nonprofits. As a result, this “philanthrocapitalism” can weaken the public health capacity of national public health authorities (Birn & Richter, 2018).

Tax evasion, tax cuts, and austerity budgets, often promoted by corporate leaders, also weaken national governance for health (Wiist, 2018). In the United States and other Western countries, in response to the COVID-19 pandemic, governments encouraged corporations to produce more PPE and ventilators and to speed development of vaccines and in some cases paid them to do so. While these measures helped to mount more effective responses to the pandemic, they also opened the door for profiteering, insider trading, production of shoddy or inadequate products, and inequitable distribution of essential supplies, actions that amplified the spread of the pandemic and its inequitable impact by class and race/ethnicity (Oxfam America, 2020).

Another change in global health governance that has amplified ill-health is the rising influence of corporations in setting global trade agreements. By strengthening protection of their intellectual property rights, pharmaceutical companies have made essential medicines more expensive and less accessible in many low- and middle-income nations (Wirtz et al., 2017). By limiting national governments from regulating tobacco or food in violation of free trade agreements, business groups have diminished the space in which national governments can protect public health (Friel et al., 2015).

In the United States, the success of extending free speech rights to corporations and insisting that corporations have the same rights as people have enabled corporations and their allies to undermine democracy, make majority rule more difficult, and diminish the voice of citizens in setting public health policy (Wiist, 2011). By using their political power to further expand their rights and their access to and influence on the inner circles of government, corporations have increased their capacity to set rules and policies that favor their interests and to defeat or delay changes that would diminish their voice or disrupt the status quo in ways that threaten their interest. Paradoxically, in pursuing this path, corporations increase their political power to escape the competitive market forces their ideology claims governs them (Mikler, 2018).

How Corporations and Their Allies Achieve Their Goals

While corporations engage in political activities in multiple ways, eight strategies commonly used across industries and countries are assessed here. While these strategies are used to confront various threats to corporate success (e.g., labor issues, taxes, trade, public trust), the focus here is on how they are used in ways that influence the impact of corporate practices on human and planetary health.

Table 2 summarizes the potential and limits of several strategies corporations use to advance their goals.

Table 2. An Assessment of Advantages and Disadvantages of Selected Strategies Corporations Use to Achieve Their Goals

Practice

Rationale

Potential

Limits

Selected References

Investment

Corporations invest (or disinvest) in their own or other businesses to take advantage of new business opportunities, disadvantage competitors, or persuade elected officials to pursue desired policy goals.

By expanding profitable operations or investing in new businesses through mergers or acquisitions, businesses can grow market share, achieve economies of scale, and outperform competitors; investment and disinvestment can also pressure governments to enact desired policy goals; investments in health-enhancing activities can win public support.

New investments can divert capital from other purposes (e.g., innovation, higher wages for a more stable workforce).

Delany et al., 2018; Pronk et al., 2015; Young et al., 2018

Lobbying

Lobbying influences policymakers’ decisions, frames definitions of the problem and solution, and gives businesses inside knowledge of possible changes in policy.

In the current political system, lobbying is an effective, accepted, and legal way for businesses to persuade policymakers to support their goals. Lobbying is also used to gather actionable policy insights.

Can elicit strong public distrust or opposition; may not be effective in the face of strong public support for change.

De Figueiredo & Richter, 2014; Kaiser, 2009; Miller & Harkins, 2010

Campaign contributions

Corporations use campaign contributions to win access to elected officials and to persuade them to endorse policies that favor business interests at the expense of the public good.

Corporate campaign contributions can help to create a receptive audience for negotiation with policymakers and access to inside information.

Can elicit strong public distrust or opposition; does not always lead to success.

Flavin, 2015; Gulzar et al., 2021; Richter & Werner, 2017

Litigation

Business groups use the courts to reverse regulatory, tax, or other policies they disagree with and to change the policies and practices of opponents.

Litigation provides a highly structured arena in which to win policy decisions without the resources needed for legislation. It can also be used to intimidate opponents.

Outcomes are unpredictable, so can lead to defeats.

Eberhardt & Olivet, 2012; Gostin et al., 2019

Sponsored research

Corporations sponsor research to gain proprietary knowledge that can benefit them or to discredit independent science and delay regulatory action.

Sponsored research gives corporations private access to knowledge that can benefit them and can also be used to contest science that threatens their interests.

Can elicit scientific or public opposition and damage industry credibility.

Fabbri et al., 2018; Lundh et al., 2017

Public relations

Corporations or trade associations sponsor public relations campaigns to win public support, enhance trust and credibility, and influence how media, policymakers, and public frame policy options.

Public relations can help frame conflicts in ways that maximize likelihood for success and can also be used to counteract or discredit opponents.

May reinforce rather than counteract public mistrust.

Cutlip, 2013; Miller & Dinan, 2008; Ong & Glantz, 2001

Funding front groups

Corporations and business groups sponsor civil society groups to promote their agenda, believing these groups are more credible messengers than the industry itself.

Consumer or community groups can make the case for corporate goals without engendering the mistrust that corporations themselves may elicit; industry skill in presenting these groups as authentic voices makes them hard to challenge.

Can backfire if opponents reveal corporate sponsorship; businesses may have less control than over their own public relations.

Aaron & Siegel, 2017; Lyon & Maxwell, 2004;

Scott, 2019

Philanthropy

Corporations give away money to support activities they believe in, advance their political and business agendas, and enhance their reputations and influence.

Philanthropy provides an opportunity to sponsor desired scientific research, further policy objectives, and demonstrate social responsibility.

Can be perceived as a conflict of interest or tainted.

Bertrand et al., 2018; Birn & Richter, 2018; Youde, 2020

Source: Freudenberg, 2014, 2021.

Corporate leaders, in partnership with their public relations, legal, scientific, and philanthropic staff and consultants, determine the optimal and feasible portfolio of strategies to deploy to achieve their goals. Two well-studied examples, the tobacco industry’s efforts to defeat or delay regulation and taxation and the fossil fuel industry’s multifaceted campaign to avoid policy actions that could constrain their freedom to release carbon, illustrate how corporations use power to achieve their goals.

Among the strategies both industries have used are:

Sponsoring scientific research to discredit independent studies that document harm from tobacco or fossil fuels (McCambridge et al., 2019).

Seeking to diminish power of governments in low- and middle-income countries from developing or enforcing public health regulations (Gilmore et al., 2015).

Making campaign contributions to elected officials who will support their political goals.

Funding “astroturf” groups, organizations that appear to be independent citizens but are in fact industry supported and created (Durkee, 2017).

Lobbying local, state, and federal legislators and executive branch officials to advance industry objectives.

Enlisting academics, journalists, and others in promoting their cause, often without disclosing their payments to these individuals (Michaels, 2020; Oreskes et al., 2018; Proctor, 2011).

Corporations use their political power in both traditional and novel settings. At the local and national levels, corporations and their allies operate in legislative, electoral, judicial, executive, and regulatory settings, using their financial resources, their human capital (e.g., lobbyists and public relations staff), and their practice-acquired skills and knowledge. In these arenas, corporations can often outspend and outmaneuver their opponents from government and civil society, giving them an advantage in these contests.

In the 20th and 21st century, new governance mechanisms have emerged which create opportunities for corporations to exercise their power. These include their role in global organizations and their evolving governance and dispute mechanism processes, bilateral trade negotiations, public–private partnerships, and other multistakeholder initiatives. At the United Nations and its affiliated organizations, for example, corporations have actively sought to influence policy. Representatives of the food, alcohol, and pharmaceutical industries used the World Health Assembly, the governing body of the World Health Organization, to advance the Framework for Engagement with Non-State Actors, a policy document that offered corporations equal and similar status to civil society organizations in participating in World Health Organization deliberations (Rached & Ventura, 2017). Investor-state dispute settlement processes in international trade and investment agreements provide a forum for businesses to settle trade disputes that enable transnational corporations to bypass national governments and make their case in private, following rules that in the view of public health critics favor corporate interests (Hawkins & Holden, 2016).

Public–private partnerships, in which corporations and governments develop voluntary agreements to cooperate, constitute another arena for the exercise of power (Marks, 2019). Gavi, formerly known as the Global Alliance for Vaccines and Immunization, brings together pharmaceutical companies, governments, foundations, and civil society organizations to deliver vaccines to populations around the world. By coordinating action across sectors and regions, Gavi supports the immunization of almost half the world’s children, giving it power to negotiate better vaccine prices for the world’s poorest nations and lower the commercial risks for vaccine manufacturers, a seeming win-win for all (Ikilezi et al., 2020). Critics charge that Gavi has become a forum that is unaccountable to voters or government oversight, one that sets policies that unfairly benefit the makers of vaccines (People’s Health Movement, 2017).

In addition, more established practices such as revolving door policies in which corporations and lobbying firms hire recently departed government officials, and government agencies hire former corporate executives, have created a peer group that shares values, social and political connections, and expertise in advancing policy that enables them to advance their shared corporate-friendly goals (Robertson et al., 2019; Vandenbergh et al., 2019).

While most scholarly consideration of the exercise of corporate power focuses on use of legitimate (i.e., legal) governance mechanisms, corporations also use bribery, corruption, violence, tax evasion and other illegal strategies to achieve their goals. Examples include Walmart’s conviction for bribery of officials in Mexico in order to win permits to expand their number of stores (Barstow, 2012); Purdue Pharma’s guilty plea, admitting to lying to the federal government about sales of its blockbuster painkiller OxyContin (Benner, 2020); Volkswagen’s fines and executive jail sentences in multiple countries, after it was found to have installed emission-control cheat devices on its diesel vehicles (Ewing & Boudette, 2017); and the tax evasion and offshore bank accounts of multiple corporations and wealthy individuals as revealed by investigative journalists in their reports on the leaked documents in the Panama Papers and the Paradise Papers (Lipton & Creswell, 2016). Each of these and other examples of corrupt or illegal corporate behavior has damaged the health of individuals and populations. An emerging body of work on corporate corruption and abuse of power (Michalowski & Brown, 2020; Nyberg, 2021; Zyglidopoulos et al., 2017) can help researchers and policymakers to assess their impact on global health and develop strategies for preventing such practices.

Challenges to Corporate Power to Influence Health

While corporations have gained additional power to influence global, national, and local health over the last 50 years, that power is not monolithic. As Friel (2020) observes, “Everyone has agency, including civil, market and state actors.” Around the world, populations, institutions, and social movements have found ways to challenge corporate power, seeking to minimize or reverse damage to health and the environment, encourage alternative practices, and create alternative more democratic governance processes. A review of the experiences, successes, and limitations of these challenges to corporate power highlights possible avenues for intervention.

In a mirror image of the ways that corporate use of power influences health (whether intentionally or unintentionally), civil society and state actors can exert their agency to end harmful practices or products and to reduce corporate influence within the political system.

Governments

Until recently, governments were the dominant influence on patterns of population health, although they always shared their power to shape well-being with other actors including organized religion, business, wealthy elites, and civil society organizations. As corporations increased their political and economic power, governments lost power and had to find new ways to negotiate the rules that governed their actions on health.

Despite the significant changes in allocation of market and public power since the 1970s (Harvey, 2007), only governments have the authority and mandate to set taxes, pass and enforce regulations, operate services assigned to the public sector, and maintain established governance processes. Even as corporations have challenged government in each of these domains, states still influence in major ways how corporations exercise their power.

The varying roles governments have played vis-a-vis the management and prevention of noncommunicable diseases (NCDs) illustrate the range of interactions. To manage and prevent NCDs, states can regulate and tax the food, alcohol, and tobacco industries, producers of the main products contributing to the rise of NCDs. They can provide public funding for the preventive campaigns and primary health care that can reduce the burdens of NCDs. They can strengthen the authority and resources of global organizations such as the World Health Organization and they can join international agreements such as the Framework Convention on Tobacco Control (Collin et al., 2002) or sign onto the International Code of Marketing of Breastmilk Substitutes, an agreement to limit marketing of infant formula so as to encourage breastfeeding (Michaud‐Létourneau et al., 2019).

By choosing to adopt such policies, governments can challenge corporate activities that promote NCDs—or, following a more laissez-faire approach, leave businesses to make their own decisions with the hope that the invisible hand of the market will eventually discourage harmful practices.

A growing body of scholarship analyses the varying decisions governments have made on the food (Swinburn et al., 2013), tobacco (Puska & Daube, 2019), and alcohol (Jernigan, 2009; McCambridge et al., 2018), industries and a few have looked at government–corporate relationships across sectors (Lencucha & Thow, 2019; Moodie et al., 2013; Thorn, 2018). These studies show that implementation of government policy to regulate corporate practices that contribute to NCDs varies across sectors, governance regimes, and political circumstances, suggesting the value of investigation of the determinants of this variance. Some investigators have proposed new frameworks and metrics to measure corporate influence cross-nationally (Lee & Freudenberg, 2020; Lima & Galea, 2019).

What strategies can governments use to exercise more effectively their power to limit harmful corporate practices? One recommendation is to strive for policy coherence, where, for example, trade, health, and tax policies are aligned to achieve common public goals rather than having different governmental agencies implement conflicting or contradictory strategies (Thow et al., 2018). Similarly, the World Health Organization’s (2014) “Health in All Policies” approach encourages states to mandate all public agencies, not only health units, to make protecting health and preventing disease a priority at both the national and local levels (Guglielmin et al., 2018).

A third strategy is to look across government levels and branches to identify spaces where effective action to limit industry power is available. In California, for example, the California Air Resources Board (CARB), an organization located within the state’s Environmental Protection Agency, has, since its founding in 1967, forged the authority, capacity, popular support, and technical know-how to regulate vehicle emissions in the state (Balmes, 2021). Despite automotive industry lawsuits, conservative governors, and sometimes sharp challenges from the more industry-friendly federal government, CARB has been able to set standards for vehicle emissions that are more stringent than national rules. CARB’s success has led other states to adopt its standards, and forced the automotive industry to decide it is cheaper to meet a single more stringent standard than multiple state rules. Even other countries have followed the CARB approach to reducing vehicle emissions.

Civil Society Organizations

Civil society organizations (CSOs) operate outside government and market sectors (Commission on Social Determinants of Health, 2007; Greer et al., 2017); they are also sometimes also called nongovernmental organizations (Brass et al., 2018). Investigators have not agreed on a single definition. A basic question is whether civil society groups must by definition pursue the common good or whether “special interest” civil society groups, including the “astroturf” groups formed by industry (Lyon & Maxwell, 2004) to put a community face on their advocacy, also belong in this category. Another debate within the World Health Organization asks whether “nonstate actors” such as corporations and business associations require similar or different rules for engagement in policy deliberations (Rached & Ventura, 2017).

Whatever the definition, CSOs are heterogenous organizations that arise from different circumstances, operate on different scales, use different strategies, and articulate different visons and values (Salamon et al., 2017). A brief description of a few broad categories of CSOs that have used their power to influence corporate practices—international and national human rights; environmental and labor groups; community-based organizations; and social movements—captures this diversity. Table 3 illustrates examples of several efforts by groups of these kinds to influence corporate practices.

Table 3. Civil Society Organizations Use of Power to Modify Corporate Practices

Type of Civil Society Organization

Illustrative Organizations, Campaigns, and Activities

Selected References

International human rights, environmental and labor groups

EarthRights International: litigation to hold corporations accountable for environmental harm; La Via Campesina: campaigns in several nations against use of agrotoxics in farming; Infant Formula Action Coalition (INFACT): global campaign to change Nestle’s marketing of infant formula.

Johnson & Duckett, 2020; Martinez-Torres & Rosset, 2010; Mowery, 2002

National human rights, environmental and labor groups

Coalition of Immokalee Workers: organizing to win fair wages for agricultural workers in Florida, USA; Treatment Action Group: campaigns to force drug companies to lower prices of HIV medicines in South Africa; El Poder del Consumidor: a consumer-led campaign to win approval for Mexican sugar tax.

Carriedo et al., 2020; Friedman & Mottiar, 2005; Rosile et al., 2021

Community-based organizations

Stop Uptown Cigarettes: A Philadelphia, USA, campaign to force a tobacco company to withdraw a new cigarette targeted at Black people; Community mobilizations to stop or regulate mineral extraction in Indonesia; a coalition of neighborhood organizations, labor unions, and others blocked Amazon from opening a corporate headquarters in New York City.

Conde & Le Billon, 2017; Freudenberg et al., 2009; Goodman & Weise, 2019

Social movements

People’s Health Movement: Creation of global network of health activists challenging neoliberalism across borders; Brazilian Zero Deforestation Campaign to halt the destruction of Amazon forests; Global AIDS social movements: changed global access to HIV medicines.

Boucher et al., 2013; Kapstein & Busby, 2013; Musolino et al., 2020

The various categories of CSOs in Table 3 are not mutually exclusive groups and some organizations may show characteristics of two or more categories. Moreover, the four types of CSOs often work together to achieve shared goals. Each, however, operates on a different scale and is characterized by distinct features. Human rights, labor, environmental, and other types of issue or population-specific CSOs work at the international or national levels, seeking to change norms, rules, or practices at that level. Community-based CSOs have a more focused geographic scale, although they may join regional or national alliances to exert influence at a higher level. The strength of community-based groups is their local roots and their capacity to mobilize wide sections of a specific population. Sometimes their action targets a specific corporation or industry whose practices they perceive as being unjust. In the case of Stop Uptown Cigarettes, a local Philadelphia-based CSO targeted Reynolds Tobacco Company, a transnational cigarette company. Their success in attracting national media attention to a product aimed at Black smokers led the company to decide not to release the Uptown brand of cigarettes anywhere, an example of local power having a wider influence (Freudenberg et al., 2009).

Social movements have several distinct features, including a clearly defined grievance, the desire to act repeatedly over time and place, a commitment to promoting social justice, and usually a willingness to use both conventional and unconventional political strategies (Morris, 2000). Several scholars have described the emerging anticorporate activism focused on harmful health practices as a social movement (Brown et al., 2011; Freudenberg, 2014; Musolino et al., 2020; Wiist, 2006).

How do CSOs use their power to influence health-related corporate practices? Like corporations, they use conventional political strategies such as litigation, legislation, electoral, and regulatory strategies. Unlike businesses, however, they also openly use transgressive and unconventional strategies such as boycotts, demonstrations, sit-in, strikes, civil disobedience, and other forms of resistance (Tarrow, 2011). This strategic flexibility sometimes allows social movements to adapt more rapidly to changing circumstances and to deploy their political power more adroitly and effectively than better resourced corporations more constrained by convention and reputational liability.

Several political practices illustrate CSOs’ flexible use of political/organizational (Mikler, 2018), structural (Krumeich & Meershoek, 2014), and ideational power (Carstensen & Schmidt, 2016). A public health campaign to change corporate practices has been defined as “an advocacy initiative in which one or more organizations mounted targeted activities of variable duration designed to achieve explicit changes in corporate or industry practices perceived to harm health” (Freudenberg et al., 2009). These campaigns enable opponents of a particular business practice to target a specific corporation, industry, or government agency; mobilize a broad cross section of partners at the local, regional, national, or global levels; and change tactics and messages in response to changing conditions. Campaigns are also accessible to a variety of constituencies, allowing their organizers to engage support from diverse actors.

Regional, national, and global partnerships enable CSOs seeking to modify corporate practices or structures to enlist partners across constituencies and scales. They can strengthen the power, reach, and impact of any single CSO, thus amplifying their influence and the pressure on their opponents to respond. Partnerships allow for both horizontal integration with organizations working on other issues at the same level and vertical integration with those working on the same issue at other political levels (e.g., local, national, or global). South Africa’s Treatment Action Coalition worked with activist groups in the United States and elsewhere to modify the pricing practices of transnational pharmaceutical companies in South Africa (Friedman & Mottiar, 2005).

Framing contests engage CSOs with corporations in battles to frame the salient issues in ways that maximize each party’s opportunities to achieve their goals (Dorfman et al., 2005). When the tobacco-control movement succeeded in modifying the public policy frame from “the rights of smokers to smoke” to the “rights of ordinary people to breathe clean air,” they made their task of winning new restrictions on public smoking much easier (Nathanson, 1999).

CSOs also exert ideational power to reframe conventional wisdom by “denormalizing”—making socially unacceptable—legal but harmful corporate practices. Activists seeking to prevent NCDs have sought to denormalize the marketing of tobacco, unhealthy food, and alcohol, especially to children and youth (Mahood, 2004).

In another example, activists working to limit the power of transnational corporations have contrasted their approach at the World Social Forum (Mac Lorin, 2020), where globalization can be seen as a bottom-up process, with the corporate-managed globalization promoted at the World Economic Forum in Davos. By proposing that the question is not whether or not to globalize but to ask who controls this process, these activists have reframed the debate, creating new opportunities for public discussion (Samli, 2008).

Conclusion and Recommendations

In the 20th and 21st century, corporations have won new economic and political powers that have enabled them to play a growing role in shaping patterns of global health and disease. These new powers are the result of underlying developments in modern capitalism, including expanding globalization, the growing role of financial transactions in the world economy, deregulation, privatization, and an aggressive corporate campaign designed to increase their influence on national and global politics. Operating through multiple pathways, these changes have increased the capacity of corporations and their allies to influence the structures, norms, policies, and living conditions that shape human and planetary well-being.

A growing body of scholarship has mapped this new landscape, investigated these changes, and analyzed the mechanisms by which corporate structures and practices influence the prevalence and distribution of various states of health across place and time. But for governments, policymakers, and public health professionals to fully realize the potential to improve global health as a result of better understanding of how corporate power shapes health, much remains to be studied.

In the 2020s, researchers from many disciplines need to explore the following questions:

1.

What are the advantages and disadvantages of various strategies designed to reduce the prevalence and impact of corporate practices that damage health? How do the public and corporate costs and benefits of these strategies vary across business sectors, place, and time? What are the common and differing characteristics of effective strategies to reduce harmful corporate practices?

2.

How do differing governance regimes (e.g., authoritarian, democratic, or neoliberal) influence the power, impact, and effectiveness of various strategies to reduce harmful corporate practices? What role do democracy, civic participation, accountability, transparency, scientific expertise, and other key governance characteristics play in determining the effectiveness of various strategies to limit harmful corporate practices?

3.

How have different actors including governments, CSOs, global organizations, and social movements exercised their power and agency to modify harmful corporate practices? How do corporations and their business allies respond to these different strategies? How do these exercises of power vary in impact and effectiveness across, place, business sector, economic conditions, and political regimes?

4.

What are effective and ineffective roles for government in seeking to reduce harmful corporate practices at various levels? Similarly, what are more and less effective and ineffective CSOs, global organizations, and social movements in developing effective strategies and policies to reduce harmful corporate practices and encourage healthier ones? Finally, what are more and less effective corporate strategies to reduce these health-damaging influences?

The research studies that can begin to answer these questions need to be interdisciplinary or transdisciplinary, intersectoral, and engage key constituencies (including policymakers and advocates) in designing studies, collecting data, and interpreting results. While researchers can gain important insights from consulting policymakers and business leaders about their research, they also need to establish clear boundaries to prevent conflicts of interest or the risk of being co-opted by powerful actors with private interests (Krimsky, 2019).

Researchers also need to pay more attention to synthesizing existing evidence across disciplines, business sectors, and geographies, rather than simply accumulating more unconnected evidence. More empirical research is urgently needed, but scholars and others also need to develop and test theoretical and conceptual frameworks to inform and be informed by these empirical studies. Future research needs to address the question of scale of problems and solutions more systematically. Among the methodologies and approaches that can contribute to this new body of research are systems science and modeling (Knai et al., 2018), Big Data and spatial methodologies such as GIS and artificial intelligence (Barrett et al., 2013), and participatory-action research (Baum, 2016).

In the 21st century, there is no more fundamental determinant of global health and disease than the exercise of corporate power. By synthesizing, consolidating, testing, and expanding the body of research that documents how that power influences health and how to enhance its beneficial impact and reduce its harmful consequences, social science and public health researchers can help inform the next chapter of global health history.

Further Reading

  • Fabbri, A., Lai, A., Grundy, Q., & Bero, L. A. (2018). The influence of industry sponsorship on the research agenda: A scoping review. American Journal of Public Health, 108(11), e9–e16.
  • Farnsworth, K., & Holden, C. (2006). The business–social policy nexus: Corporate power and corporate inputs into social policy. Journal of Social Policy, 35, 473–494.
  • Freudenberg, N. (2014). Lethal but legal: Corporations, consumption, and protecting public health. Oxford University Press.
  • Freudenberg, N. (2021). At what cost: Modern capitalism and the future of health. Oxford University Press.
  • Friel, S., Hattersley, L., & Townsend, R. (2015). Trade policy and public health. Annual Review of Public Health, 36, 325–344.
  • Harvey, D. (2007). A brief history of neoliberalism. Oxford University Press.
  • Hawkins, B., Holden, C., Eckhardt, J., & Lee, K. (2018). Reassessing policy paradigms: A comparison of the global tobacco and alcohol industries. Global Public Health, 13(1), 1–19.
  • Knai, C., Petticrew, M., Mays, N., Capewell, S., Cassidy, R., Cummins, S., Eastmure, E., Fafard, P., Hawkins, B., Jensen, J. D., Katikireddi, S. V., Mwatsama, M., Orford, J., & Weishaar, H. (2018). Systems thinking as a framework for analyzing commercial determinants of health. The Milbank Quarterly, 96(3), 472–498.
  • Lee, K., & Smith, J. (2019). The role of the business sector in global health politics. In C. McInnes, K. Lee, & J. Youde (Eds.), The Oxford handbook of global health politics (pp. 387–408). Oxford University Press.
  • Lukes, S. (2007). Power and the battle for hearts and minds: On the bluntness of soft power. In F. Berenskoetter & M. J. Williams (Eds.), Power in world politics (pp. 83–97). Routledge.
  • Maani, N., Collin, J., Friel, S., Gilmore, A. B., McCambridge, J., Robertson, L., & Petticrew, M. P. (2020). Bringing the commercial determinants of health out of the shadows: A review of how the commercial determinants are represented in conceptual frameworks. European Journal of Public Health, 30(4), 660–664.
  • McInnes, C., Lee, K., & Youde, J. (2019). Global health politics. In C. McInnes, K. Lee, & J. Youde (Eds.), The Oxford handbook of global health politics (pp. 1–17). Oxford University Press.
  • Oreskes, N., & Conway, E. M. (2011). Merchants of doubt: How a handful of scientists obscured the truth on issues from tobacco smoke to global warming. Bloomsbury.
  • Sell, S. K., & Williams, O. D. (2020). Health under capitalism: A global political economy of structural pathogenesis. Review of International Political Economy, 27(1), 1–25.

References

  • Aaron, D. G., & Siegel, M. B. (2017). Sponsorship of national health organizations by two major soda companies. American Journal of Preventive Medicine, 52(1), 20–30.
  • Agudelo, M. A. L., Jóhannsdóttir, L., & Davídsdóttir, B. (2019). A literature review of the history and evolution of corporate social responsibility. International Journal of Corporate Social Responsibility, 4(1), 1–23.
  • Anaf, J., Baum, F., Fisher, M., & Friel, S. (2020). Civil society action against transnational corporations: Implications for health promotion. Health Promotion International, 35(4), 877–887.
  • Avineri, S., & De-Shalit, A. (Eds.). (1992). Communitarianism and individualism. Oxford University Press.
  • Balmes, J. R. (2021). California’s integrated approach to air quality and climate change. In K. E. Pinkerton & W. N. Rom (Eds.), Climate change and global public health (pp. 541–548). Humana Press.
  • Barrett, M. A., Humblet, O., Hiatt, R. A., & Adler, N. E. (2013). Big data and disease prevention: From quantified self to quantified communities. Big Data, 1(3), 168–175.
  • Barstow, D. (2012, April 21). Wal-Mart hushed up a vast Mexican bribery case. New York Times.
  • Baum, F. E. (2016). Power and glory: Applying participatory action research in public health. Gaceta Sanitaria, 30(6), 405–407.
  • Berle, A. A., & Means, G. C. (1991). The modern corporation and private property. Transaction.
  • Bertrand, M., Bombardini, M., Fisman, R., Hackinen, B., & Trebbi, F. (2018). Hall of mirrors: Corporate philanthropy and strategic advocacy. National Bureau of Economic Research Working Paper, No. w25329.
  • Birn, A. E., & Richter, J. (2018). US philanthrocapitalism and the global health agenda: The Rockefeller and Gates Foundations, past and present. In H. Waitzkin (Ed.), Health care under the knife: Moving beyond capitalism for our health (pp. 155–174). Monthly Review Press.
  • Bonaccio, M., Di Castelnuovo, A., Costanzo, S., De Curtis, A., Persichillo, M., Sofi, F., Cerletti, C., Donati, M. B., de Gaetano, G., & Lacoviello, L. (2021). Ultra-processed food consumption is associated with increased risk of all-cause and cardiovascular mortality in the Moli-Sani Study. American Journal of Clinical Nutrition, 113(2), 446–455.
  • Bor, J., Cohen, G. H., & Galea, S. (2017). Population health in an era of rising income inequality: USA, 1980–2015. The Lancet, 389(10077), 1475–1490.
  • Bosworth, B. (2018). Increasing disparities in mortality by socioeconomic status. Annual Review of Public Health, 39, 237–251.
  • Boucher, D., Roquemore, S., & Fitzhugh, E. (2013). Brazil’s success in reducing deforestation. Tropical Conservation Science, 6(3), 426–445.
  • Brass, J. N., Longhofer, W., Robinson, R. S., & Schnable, A. (2018). NGOs and international development: A review of thirty-five years of scholarship. World Development, 112, 136–149.
  • Brown, P., Morello-Frosch, R., & Zavestoski, S. (Eds.). (2011). Contested illnesses: Citizens, science, and health social movements. University of California Press.
  • Brown, T. M., & Fee, E. (2014). Social movements in health. Annual Review of Public Health, 35, 385–398.
  • Carriedo, A., Lock, K., & Hawkins, B. (2020). Policy process and non-state actors’ influence on the 2014 Mexican soda tax. Health Policy and Planning, 35(8), 941–952.
  • Carstensen, M. B., & Schmidt, V. A. (2016). Power through, over and in ideas: Conceptualizing ideational power in discursive institutionalism. Journal of European Public Policy, 23(3), 318–337.
  • Case, A., & Deaton, A. (2020). Deaths of despair and the future of capitalism. Princeton University Press.
  • Cianconi, P., Betrò, S., & Janiri, L. (2020). The impact of climate change on mental health: A systematic descriptive review. Frontiers in Psychiatry, 11(Art 74), 1–15.
  • Collin, J., Lee, K., & Bissell, K. (2002). The framework convention on tobacco control: The politics of global health governance. Third World Quarterly, 23(2), 265–282.
  • Commission on Social Determinants of Health. (2007). Civil society report. WHO.
  • Conde, M., & Le Billon, P. (2017). Why do some communities resist mining projects while others do not? Extractive Industries and Society, 4(3), 681–697.
  • Cornwall, J. (1977). Modern capitalism: Its growth and transformation. Martin Robertson.
  • Costello, A., Abbas, M., Allen, A., Ball, S., Bell, S., Bellamy, R., Friel, S., Groce, N., Kett, A. J. M., Lee, M., Levy, C., Maslin, M., McCoy, D., McGuire, B., Montgomery, H., Napier, D., Pagel, C., Patel, J., de Oliveira, J. A. P., . . . Patterson, C. (2009). Managing the health effects of climate change: Lancet and University College London Institute for Global Health Commission. The Lancet, 373(9676), 1693–1733.
  • Cutlip, S. M. (2013). The unseen power: Public relations: A history. Routledge.
  • Dahl, R. A. (1957). The concept of power. Behavioral Science, 2(3), 201–215.
  • De Figueiredo, J. M., & Richter, B. K. (2014). Advancing the empirical research on lobbying. Annual Review of Political Science, 17, 163–185.
  • de Lacy-Vawdon, C., & Livingstone, C. (2020). Defining the commercial determinants of health: A systematic review. BMC Public Health, 20(1), 1–6.
  • Delany, L., Signal, L., & Thomson, G. (2018). International trade and investment law: A new framework for public health and the common good. BMC Public Health, 18(1), 1–12.
  • de Siqueira, J. V. V., Almeida, L. G., Zica, B. O., Brum, I. B., Barceló, A., & de Siqueira Galil, A. G. (2020). Impact of obesity on hospitalizations and mortality, due to COVID-19: A systematic review. Obesity Research & Clinical Practice, 14(5), 398–403.
  • Dorfman, L., Wallack, L., & Woodruff, K. (2005). More than a message: Framing public health advocacy to change corporate practices. Health Education & Behavior, 32(3), 320–336.
  • Dunn, S. (2002). Down to business on climate change. Greener Management International, 39, 27–41.
  • Durkee, M. J. (2017). Astroturf activism. Stanford Law Review, 69, 201–268.
  • Elizabeth, L., Machado, P., Zinöcker, M., Baker, P., & Lawrence, M. (2020). Ultra-processed foods and health outcomes: A narrative review. Nutrients, 12(7), 1955.
  • Ellwanger, J. H., Kulmann-Leal, B., Kaminski, V. L., Valverde-Villegas, J., Veiga, A. B. G., Spilki, F. R., Fearnside, P. M., Caesar, L., Giatti, L. L., Wallau, G. L., & Chies, J. A. B. (2020). Beyond diversity loss and climate change: Impacts of Amazon deforestation on infectious diseases and public health. Anais da Academia Brasileira de Ciências, 92(1), 1–33.
  • Ewen, S. (2008). Captains of consciousness advertising and the social roots of the consumer culture. Basic Books.
  • Ewing, J., & Boudette, N. (2017, March 10). Guilty plea for VW, and turmoil may deepen. New York Times.
  • Fabbri, A., Lai, A., Grundy, Q., & Bero, L. A. (2018). The influence of industry sponsorship on the research agenda: A scoping review. American Journal of Public Health, 108(11), e9–e16.
  • Farnsworth, K., & Holden, C. (2006). The business–social policy nexus: Corporate power and corporate inputs into social policy. Journal of Social Policy, 35(3), 473–494.
  • Flavin, P. (2015). Campaign finance laws, policy outcomes, and political equality in the American states. Political Research Quarterly, 68(1), 77–88.
  • Forouzanfar, M. H., Afshin, A., Alexander, L. T., Anderson, H. R., Bhutta, Z. A., Biryukov, S., Brauer, M., Burnett, R., Cercy, K., Charlson, F. J., & Carrero, J. J. (2016). Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: A systematic analysis for the Global Burden of Disease Study, 2015. The Lancet, 388(10053), 1659–1724.
  • Freudenberg, N. (2012). The manufacture of lifestyle: The role of corporations in unhealthy living. Journal of Public Health Policy, 33(2), 244–256.
  • Freudenberg, N. (2014). Lethal but legal: Corporations, consumption, and protecting public health. Oxford University Press.
  • Freudenberg, N. (2021). At what cost: Modern capitalism and the future of health. Oxford University Press.
  • Freudenberg, N., Picard Bradley, S., & Serrano, M. (2009). Public health campaigns to change industry practices that damage health: An analysis of 12 case studies. Health Education & Behavior, 36(2), 230–249.
  • Friedman, M. (1970, September 13). A Friedman doctrine: The social responsibility of business is to increase its profits. New York Times Magazine.
  • Friedman, S., & Mottiar, S. (2005). A rewarding engagement? The treatment action campaign and the politics of HIV/AIDS. Politics & Society, 33(4), 511–565.
  • Friel, S. (2020). Redressing the corporate cultivation of consumption: Releasing the weapons of the structurally weak. International Journal of Health Policy and Management, 10(10), 1–9.
  • Friel, S., Hattersley, L., & Townsend, R. (2015). Trade policy and public health. Annual Review of Public Health, 36, 325–344.
  • Geppert, M., & Dörrenbächer, C. (2014). Politics and power within multinational corporations: Mainstream studies, emerging critical approaches and suggestions for future research. International Journal of Management Reviews, 16(2), 226–244.
  • Gilmore, A. B., Fooks, G., Drope, J., Bialous, S. A., & Jackson, R. R. (2015). Exposing and addressing tobacco industry conduct in low-income and middle-income countries. The Lancet, 385(9972), 1029–1043.
  • Goodman, J. D., & Weise, K. (2019, February 16). A brash city was too much: Amazon fled. New York Times.
  • Gostin, L. O., Monahan, J. T., Kaldor, J., DeBartolo, M., Friedman, E. A., Gottschalk, K., Kim, S. C., Alwan, A., Binagwaho, A., Burci, G. L., & Yamin, A. E. (2019). The legal determinants of health: Harnessing the power of law for global health and sustainable development. The Lancet, 393(10183), 1857–1910.
  • Greer, S. L., Wismar, M., Pastorino, G., & Kosinska, M. (Eds.). (2017). Civil society and health: Contributions and potential (Vol. 48). World Health Organization.
  • Grimshaw, D. (2011). What do we know about low wage work and low wage workers? Analysing the definitions, patterns, causes and consequences in international perspective. International Labor Organization.
  • Grundy, Q., Held, F., & Bero, L. (2017). A social network analysis of the financial links backing health and fitness apps. American Journal of Public Health, 107(11), 1783–1788.
  • Guglielmin, M., Muntaner, C., O’Campo, P., & Shankardass, K. (2018). A scoping review of the implementation of health in all policies at the local level. Health Policy, 122(3), 284–292.
  • Gulzar, S., Rueda, M. R., & Ruiz, N. A. (2021). Do campaign contribution limits curb the influence of money in politics? American Journal of Political Science.
  • Hadland, S. E., Rivera-Aguirre, A., Marshall, B. D., & Cerdá, M. (2019). Association of pharmaceutical industry marketing of opioid products with mortality from opioid-related overdoses. JAMA Network Open, 2(1), Article e186007.
  • Hall, P. A. (2015). Varieties of capitalism. In R. A. Scott & S. M. Kosslyn (Eds.), Emerging trends in the social and behavioral sciences: An interdisciplinary, searchable, and linkable resource (pp. 1–15). John Wiley & Sons.
  • Harvey, D. (2007). A brief history of neoliberalism. Oxford University Press.
  • Hashimzade, N., Myles, G., & Black, J. (2017). Corporation: A dictionary of economics (5th ed.). Oxford University Press.
  • Hawkins, B., & Holden, C. (2016). A corporate veto on health policy? Global constitutionalism and investor–state dispute settlement. Journal of Health Politics, Policy and Law, 41(5), 969–995.
  • Hawkins, B., Holden, C., Eckhardt, J., & Lee, K. (2018). Reassessing policy paradigms: A comparison of the global tobacco and alcohol industries. Global Public Health, 13(1), 1–19.
  • Ikilezi, G., Augusto, O. J., Dieleman, J. L., Sherr, K., & Lim, S. S. (2020). Effect of donor funding for immunization from Gavi and other development assistance channels on vaccine coverage: Evidence from 120 low and middle income recipient countries. Vaccine, 38(3), 588–596.
  • Jernigan, D. H. (2009). The global alcohol industry: An overview. Addiction, 104(s1), 6–12.
  • Johnson, D. A., & Duckett, L. J. (2020). Advocacy, strategy and tactics used to confront corporate power: The Nestlé boycott and international code of marketing of breast-milk substitutes. Journal of Human Lactation, 36(4), 568–578.
  • Kaiser, R. G. (2009). So damn much money: The triumph of lobbying and the corrosion of American government. Vintage.
  • Kapstein, E. B., & Busby, J. W. (2013). AIDS drugs for all: Social movements and market transformations. Cambridge University Press.
  • Kaskie, B. P., Leung, C., & Kaplan, M. S. (2016). Deploying an ecological model to stem the rising tide of firearm suicide in older age. Journal of Aging & Social Policy, 28(4), 233–245.
  • Khan, L. M. (2017). The ideological roots of America’s market power problem. Yale Law Journal Forum, 127, 960–979.
  • Kleiman, S., Ng, S. W., & Popkin, B. (2012). Drinking to our health: Can beverage companies cut calories while maintaining profits? Obesity Reviews, 13(3), 258–274.
  • Knai, C., Petticrew, M., Mays, N., Capewell, S., Cassidy, R., Cummins, S., Eastmure, E., Fafard, P., Hawkins, B., Jensen, J. D., & Weishaar, H. (2018). Systems thinking as a framework for analyzing commercial determinants of health. The Milbank Quarterly, 96(3), 472–498.
  • Krimsky, S. (2019). Conflicts of interest in science: How corporate-funded academic research can threaten public health. Simon and Schuster.
  • Krumeich, A., & Meershoek, A. (2014). Health in global context: Beyond the social determinants of health? Global Health Action, 7(1), Article 23506.
  • Kuznetsova, L. (2020). Covid-19: The world community expects the World Health Organization to play a stronger leadership and coordination role in pandemics control. Frontiers in Public Health, 470, Article 8, 1–6.
  • Lacy-Nichols, J., Scrinis, G., & Carey, R. (2020). The evolution of Coca-Cola Australia’s soft drink reformulation strategy, 2003–2017: A thematic analysis of corporate documents. Food Policy, 90, 101793.
  • Lazzarini, S. G., & Musacchio, A. (2018). State ownership reinvented? Explaining performance differences between state‐owned and private firms. Corporate Governance: An International Review, 26(4), 255–272.
  • Lee, K., & Freudenberg, N. (2020). Addressing the commercial determinants of health begins with clearer definition and measurement. Global Health Promotion, 27(2), 3–5.
  • Lee, K., & Kamradt-Scott, A. (2014). The multiple meanings of global health governance: A call for conceptual clarity. Globalization and Health, 10(1), Article 28, 1–10.
  • Lee, K., & Smith, J. (2019). The role of the business sector in global health politics. In C. McInnes, K. Lee, & J. Youde (Eds.), The Oxford handbook of global health politics (pp. 387–408). Oxford University Press.
  • Legge, D. G. (2020). COVID-19 response exposes deep flaws in global health governance. Global Social Policy, 20(3), 383–387.
  • Lelieveld, J., Pozzer, A., Pöschl, U., Fnais, M., Haines, A., & Münzel, T. (2020). Loss of life expectancy from air pollution compared to other risk factors: A worldwide perspective. Cardiovascular Research, 116(11), 1910–1917.
  • Lencucha, R., & Thow, A. M. (2019). How neoliberalism is shaping the supply of unhealthy commodities and what this means for NCD prevention. International Journal of Health Policy and Management, 8(9), Article 514.
  • Lerner, S. (2012). Sacrifice zones: The front lines of toxic chemical exposure in the United States. MIT Press.
  • Lima, J. M., & Galea, S. (2019). The corporate permeation index: A tool to study the macrosocial determinants of non-communicable disease. SSM-Population Health, 7, 1–11.
  • Lipton, E., & Creswell, J. (2016, June 5). Panama papers show how rich United States clients hid millions abroad. New York Times.
  • Lukes, S. (2007). Power and the battle for hearts and minds: On the bluntness of soft power. In F. Berenskoetter & M. J. Williams (Eds.), Power in world politics (pp. 83–97). Routledge.
  • Lundh, A., Lexchin, J., Mintzes, B., Schroll, J. B., & Bero, L. (2017). Industry sponsorship and research outcome. Cochrane Database of Systematic Reviews, 2, Article MR000033, 1–140.
  • Lyon, T. P., & Maxwell, J. W. (2004). Astroturf: Interest group lobbying and corporate strategy. Journal of Economics & Management Strategy, 13(4), 561–597.
  • Maani, N., Collin, J., Friel, S., Gilmore, A. B., McCambridge, J., Robertson, L., & Petticrew, M. P. (2020). Bringing the commercial determinants of health out of the shadows: A review of how the commercial determinants are represented in conceptual frameworks. European Journal of Public Health, 30(4), 660–664.
  • Maani, N., Schalkwyk, V. A. N., Petticrew, M., & Galea, S. (2021). The commercial determinants of three contemporary national crises: How corporate practices intersect with the COVID-19 pandemic, economic downturn, and racial inequity. The Milbank Quarterly, 99(2), 1–16.
  • Mac Lorin, C. (2020). The World Social Forum: The paradoxical quest for strength in plurality. Globalizations, 17(2), 250–258.
  • Mahood, G. (2004). Tobacco industry denormalization: Telling the truth about the tobacco industry’s role in the tobacco epidemic. Non-Smokers’ Rights Association.
  • Marks, J. H. (2019). The perils of partnership: Industry influence, institutional integrity, and public health. Oxford University Press.
  • Marmot, M., & Wilkinson, R. (Eds.). (2005). Social determinants of health. Oxford University Press.
  • Martinez-Torres, M. E., & Rosset, P. M. (2010). La Vía Campesina: The birth and evolution of a transnational social movement. Journal of Peasant Studies, 37(1), 149–175.
  • McBride, B., Hawkes, S., & Buse, K. (2019). Soft power and global health: The sustainable development goals (SDGs) era health agendas of the G7, G20 and BRICS. BMC Public Health, 19(1), Article 815.
  • McCambridge, J., Daube, M., & McKee, M. (2019). Brussels declaration: A vehicle for the advancement of tobacco and alcohol industry interests at the science/policy interface? Tobacco Control, 28(1), 7–12.
  • McCambridge, J., Mialon, M., & Hawkins, B. (2018). Alcohol industry involvement in policymaking: A systematic review. Addiction, 113(9), 1571–1584.
  • McInnes, C., Lee, K., & Youde, J. (2019). Global health politics. In C. McInnes, K. Lee, & J. Youde (Eds.), The Oxford handbook of global health politics (pp. 1–17). Oxford University Press.
  • McKee, M., Steele, S., & Stuckler, D. (2019). The hidden power of corporations. BMJ, 364, Article 14.
  • Meier, B. M., & Gostin, L. O. (2018). Framing human rights in global health governance. In B. M. Meier & L. O. Gostin (Eds.), Human rights in global health governance: Rights-based governance for a globalizing world (pp. 63–86). Oxford University Press.
  • Michaels, D. (2020). The triumph of doubt: Dark money and the science of deception. Oxford University Press.
  • Michalowski, R., & Brown, M. (2020). Poisoning for profit: Regulatory rollbacks, public health, and state-facilitated corporate crime. Journal of White Collar and Corporate Crime, 1(2), 113–122.
  • Michaud‐Létourneau, I., Gayard, M., & Pelletier, D. L. (2019). Translating the international code of marketing of breast‐milk substitutes into national measures in nine countries. Maternal & Child Nutrition, 15(S2), Article e12730.
  • Mikler, J. (2018). The political power of global corporations. John Wiley & Sons.
  • Miller, D., & Dinan, W. (2008). A century of spin: How public relations became the cutting edge of corporate power. Pluto Press.
  • Miller, D., & Harkins, C. (2010). Corporate strategy, corporate capture: Food and alcohol industry lobbying and public health. Critical Social Policy, 30(4), 564–589.
  • Moodie, R., Stuckler, D., & Monteiro, C. (2013). Profits and pandemics: Prevention of harmful effects of tobacco, alcohol, and ultraprocessed food and drink industries. The Lancet, 381(9867), 670–679.
  • Morris, A. (2000). Reflections on social movement theory: Criticisms and proposals, Contemporary Sociology, 29(3), 445–454.
  • Mowery, L. A. (2002). Earth rights, human rights: Can international environmental human rights affect corporate accountability? Fordham Environmental Law Journal, 13(2), 343–373.
  • Musolino, C., Baum, F., Freeman, T., Labonté, R., Bodini, C., & Sanders, D. (2020). Global health activists’ lessons on building social movements for Health for All. International Journal for Equity in Health, 19(1), 1–14.
  • Nathanson, C. A. (1999). Social movements as catalysts for policy change: The case of smoking and guns. Journal of Health Politics, Policy and Law, 24(3), 421–488.
  • Nestle, M. (2013). Food politics: How the food industry influences nutrition and health (3rd ed.). University of California Press.
  • Nestle, M. (2015). Soda politics: Taking on Big Soda (and winning). Oxford University Press.
  • Ong, E. K., & Glantz, S. A. (2001). Constructing “sound science” and “good epidemiology”: Tobacco, lawyers, and public relations firms. American Journal of Public Health, 91(11), 1749–1757.
  • Oreskes, N., & Conway, E. M. (2011). Merchants of doubt: How a handful of scientists obscured the truth on issues from tobacco smoke to global warming. Bloomsbury.
  • Oreskes, N., Conway, E., Karoly, D. J., Gergis, J., Neu, U., & Pfister, C. (2018). The denial of global warming. In S. White, C. Pfister, & F. Mauelshagen (Eds.), The Palgrave handbook of climate history (pp. 149–171). Palgrave Macmillan.
  • Otero, G. (2018). The neoliberal diet: Healthy profits, unhealthy people. University of Texas Press.
  • Oxfam America. (2020). Pandemic profits exposed.
  • Pagliai, G., Dinu, M., Madarena, M. P., Bonaccio, M., Iacoviello, L., & Sofi, F. (2020). Consumption of ultra-processed foods and health status: A systematic review and meta-analysis. British Journal of Nutrition, 125(3), 308–318.
  • Palacholla, R. S., Fischer, N., & Coleman, A. (2019). Provider- and patient-related barriers to and facilitators of digital health technology adoption for hypertension management: Scoping review. JMIR Cardio, 3(1), Article e11951.
  • People’s Health Movement. (2017). Gavi and Global Fund: Private governance structures trump public oversight in public private partnerships. In People’s Health Movement (Ed.), Global health watch 5: An alternative world health report (pp. 298–315). Zed Books.
  • Pettigrew, W. A., & Veevers, D. (2018). The corporation as a protagonist in global history, c. 1550–1750. Brill.
  • Piketty, T. (2014). Capital in the twenty-first century. Harvard University Press.
  • Piketty, T. (2020). Capital and ideology. Harvard University Press.
  • Proctor, R. N. (2011). Golden holocaust: Origins of the cigarette catastrophe and the case for abolition. University of California Press.
  • Pronk, N. P., Baase, C., Noyce, J., & Stevens, D. E. (2015). Corporate America and community health: Exploring the business case for investment. Journal of Occupational and Environmental Medicine, 57(5), 493–500.
  • Puska, P., Daube, M., & WHO FCTC Impact Assessment Expert Group. (2019). Tobacco Control, 28(S2), s81–s83.
  • Rached, D. H., & Ventura, D. F. L. (2017). World Health Organization and the search for accountability: A critical analysis of the new framework of engagement with non-state actors. Cadernos de Saude Publica, 33(6), Article e00100716.
  • Reiser, D. B. (2011). Benefit corporations: A sustainable form of organization. Wake Forest Law Review, 46, 591.
  • Richter, B. K., & Werner, T. (2017). Campaign contributions from corporate executives in lieu of political action committees. Journal of Law, Economics, and Organization, 33(3), 443–474.
  • Robertson, N. M., Sacks, G., & Miller, P. G. (2019). The revolving door between government and the alcohol, food and gambling industries in Australia. Public Health Research and Practice, 29(3), Article e2931921.
  • Rönnblad, T., Grönholm, E., Jonsson, J., Koranyi, I., Orellana, C., Kreshpaj, B., Chen, L., Stockfelt, L., & Bodin, T. (2019). Precarious employment and mental health: A systematic review and meta-analysis of longitudinal studies. Scandinavian Journal of Work, Environment & Health, 45(5), 429–443.
  • Rosenthal, E. (2020, July 6). How a Covid-19 vaccine could cost Americans dearly. New York Times.
  • Rosile, G. A., Boje, D. M., Herder, R. A., & Sanchez, M. (2021). The Coalition of Immokalee Workers uses ensemble storytelling processes to overcome enslavement in corporate supply chains. Business & Society, 60(2), 376–414.
  • Ross, M., & Bateman, N. (2019). Meet the low-wage workforce. Brookings Institution.
  • Rossen, L. M., & Pollack, K. M. (2012). Making the connection between zoning and health disparities. Environmental Justice, 5(3), 119–127.
  • Rucker, P. (2011, August 11). Mitt Romney says “corporations are people.” The Washington Post.
  • Salamon, L. M., Sokolowski, S. W., & Haddock, M. A. (2017). Explaining civil society development: A social origins approach. Johns Hopkins University Press.
  • Samli, A. C. (2008). Globalization from the bottom up. Springer.
  • Scheiring, G., Stuckler, D., & King, L. (2020). Deindustrialization and deaths of despair: Mapping the impact of industrial decline on ill health. Political Economy Research Institute, University of Massachusetts, Amherst.
  • Schwab, K. (2019, December). Why we need the “Davos Manifesto” for a better kind of capitalism. World Economic Forum and Project Syndicate.
  • Scott, M. J. (2019). Ripping up the astroturf: Regulating deceptive corporate advertising methods. Iowa Law Review, 105, 431–461.
  • Šehovic, A. B. (2019). Soft and hard power. In K. Lares & R. Wittlinger (Eds.), Understanding global politics: Actors and themes in international affairs (pp. 329–342). Routledge.
  • Sell, S. K. (2020). What COVID-19 reveals about twenty-first century capitalism: Adversity and opportunity. Development, 63(2), 1–7.
  • Sell, S. K., & Williams, O. D. (2020). Health under capitalism: A global political economy of structural pathogenesis. Review of International Political Economy, 27(1), 1–25.
  • Simon, M. (2011). PepsiCo and public health: Is the nation’s largest food company a model of corporate responsibility or master of public relations. CUNY Law Review, 15(1), 9–26.
  • Simon, P. A., & Fielding, J. E. (2006). Public health and business: A partnership that makes cents. Health Affairs, 25(4), 1029–1039.
  • Smith, K. R., Woodward, A., Campbell-Lendrum, D., Chadee, D., Honda, Y., Liu, Q., Olwoch, J., Revich, B., Sauerborn, R., Aranda, C., Berry, H., & Butler, C. (2014). Human health: Impacts, adaptation, and co-benefits. In C. B. Field, V. R. Barros, D. J. Dokken, K. J. Mach, M. D. Mastrandrea, T. E. Bilir, M. Chatterjee, K. L. Ebi, Y. O. Estrada, R. C. Genova, B. Girma, E. S. Kissel, A. N. Levy, S. MacCracken, P. R. Mastrandrea, & L. L. White (Eds.), Climate change 2014: Impacts, adaptation, and vulnerability—Part A: Global and sectoral aspects; Contribution of Working Group II to the Fifth Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge University Press.
  • Steege, A. L., Baron, S. L., Marsh, S. M., Menendez, C. C., & Myers, J. R. (2014). Examining occupational health and safety disparities using national data: A cause for continuing concern. American Journal of Industrial Medicine, 57(5), 527–538.
  • Stewart, A. G. (2019). Mining is bad for health: A voyage of discovery. Environmental Geochemistry and Health, 42(4), 1153–1165.
  • Strange, S. (1997). The future of global capitalism; or, will divergence persist forever. In C. Crouch & W. Streeck (Eds.), Political economy of modern capitalism: Mapping convergence and diversity (pp. 182–191). SAGE.
  • Stuckler, D., McKee, M., Ebrahim, S., & Basu, S. (2012). Manufacturing epidemics: The role of global producers in increased consumption of unhealthy commodities including processed foods, alcohol, and tobacco. PLOS Medicine, 9(6), Article e1001235.
  • Swinburn, B., Vandevijvere, S., Kraak, V., Sacks, G., Snowdon, W., Hawkes, C., Barquera, S., Friel, S., Kelly, B., Kumanyika, S., & INFORMAS. (2013). Monitoring and benchmarking government policies and actions to improve the healthiness of food environments: A proposed government Healthy Food Environment Policy Index. Obesity Reviews, 14(S1), 24–37.
  • Swyngedouw, E., & Wilson, J. (2014). There is no alternative. In J. Wilson & E. Swyngedouw (Eds.), The post-political and its discontents: Spaces of depoliticisation, spectres of radical politics (pp. 299–312). Edinburgh University Press.
  • Tarrow, S. G. (2011). Power in movement: Social movements and contentious politics (3rd ed.). Cambridge University Press.
  • Thorn, M. (2018). Addressing power and politics through action on the commercial determinants of health. Health Promotion Journal of Australia, 29(3), 225–227.
  • Thow, A. M., Greenberg, S., Hara, M., Friel, S., & Sanders, D. (2018). Improving policy coherence for food security and nutrition in South Africa: A qualitative policy analysis. Food Security, 10(4), 1105–1130.
  • Tomaskovic-Devey, D., Rainey, A., Avent-Holt, D., Bandelj, N., Boza, I., Cort, D., Godechot, O., Hajdu, G., Hällsten, M., Henriksen, L. F., & Tufail, Z. (2020). Rising between-workplace inequalities in high-income countries. Proceedings of the National Academy of Sciences, 117(17), 9277–9283.
  • Vandenbergh, M. P., Gilligan, J. M., & Feuerman, H. (2019). The new revolving door. Case Western Reserve Law Review, 70(4), Article 1121.
  • Waltenburg, M. A., Victoroff, T., Rose, C. E., Butterfield, M., Jervis, R. H., Fedak, K. M., Gabel, J. A., Feldpausch, A., Dunne, E. M., Austin, C., & Honein, M. A. (2020). Update: COVID-19 among workers in meat and poultry processing facilities―United States, April–May 2020. Morbidity and Mortality Weekly Report, 69(27), Article 887.
  • West, R., & Marteau, T. (2013). Commentary on Casswell (2013): The commercial determinants of health. Addiction, 108(4), 686–687.
  • Whitmee, S., Haines, A., Beyrer, C., Boltz, F., Capon, A. G., de Souza Dias, B. F., Ezeh, A., Frumkin, H., Gong, P., Head, P., Mace, G. M., Marten, R., Myers, S. S., Nishtar, S., Osofsky, S. A., Pattanayak, S. K., Pongsiri, M. J., Romanelli, C., Soucat, A., . . . Yach, D. (2015). Safeguarding human health in the Anthropocene epoch: Report of the Rockefeller Foundation–Lancet Commission on planetary health. The Lancet, 386(10007), 1973–2028.
  • Wiist, W. H. (2006). Public health and the anticorporate movement: Rationale and recommendations. American Journal of Public Health, 96(8), 1370–1375.
  • 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(7), 1172–1179.
  • Wiist, W. H. (2018). Public health and corporate avoidance of US federal income tax. World Medical & Health Policy, 10(3), 272–300.
  • Willett, W., Rockström, J., Loken, B., Springmann, M., Lang, T., Vermeulen, S., Garnett, T., Tilman, D., DeClerck, F., Wood, A., Jonell, M., & Murray, C. J. (2019). Food in the Anthropocene: The EAT–Lancet Commission on healthy diets from sustainable food systems. The Lancet, 393(10170), 447–492.
  • Wirtz, V. J., Hogerzeil, H. V., Gray, A. L., Bigdeli, M., de Joncheere, C. P., Ewen, M. A., Gyansa-Lutterodt, M., Jing, S., Luiza, V. L., Mbindyo, R. M., & Reich, M. R. (2017). Essential medicines for universal health coverage. The Lancet, 389(10067), 403–476.
  • World Health Organization. (2014). Health in all policies: Helsinki statement—Framework for country action.
  • Wright, C., & Nyberg, D. (2015). Climate change, capitalism, and corporations. Cambridge University Press.
  • Youde, J. (2020). Philanthropy and global health. In C. McInnes, K. Lee, & J. Youde (Eds.), The Oxford handbook of global health politics (pp. 408–425). Oxford University Press.
  • Young, K. A., Banerjee, T., & Schwartz, M. (2018). Capital strikes as a corporate political strategy: The structural power of business in the Obama era. Politics & Society, 46(1), 3–28.
  • Zyglidopoulos, S., Hirsch, P., Martin de Holan, P., & Phillips, N. (2017). Expanding research on corporate corruption, management, and organizations. Journal of Management Inquiry, 26(3), 247–253.