LETHAL BUT LEGAL

This seminal book about the impact of corporate policies on public health has been widely endorsed by leading figures in the field and aptly described by Ralph Nader as a reservoir of constructive indignation. This indignation is equally matched by strategic nous as the author details how these policies can be reversed while restoring democracy over lobbying interests. The main thesis is that corporations are enriching themselves at the expense of public health and that this is an unsustainable situation. He focuses on six industries: food, tobacco, alcohol, pharmaceutical, gun and auto; these last two are in a somewhat different category, but nevertheless have destructive side effects. The two main parts of the book define the problem and suggest potential solutions, which will have to be applied on a global level.

Freudenberg begins by showing how unhealthy products have become ubiquitous and that corporations are effectively manufacturing illness under the general heading of diseases of affluence or civilisation, with accompanying obesity. New science and technology have been used to promote profit rather than prevent illness and are seen by government in many cases as engines of desirable economic growth. However, spiralling health costs make this unsustainable. Already, the US is spending $174 billion a year on treating diabetes. The author introduces some useful new terminology under the heading of the corporate consumption complex representing a network of corporations, financial institutions, banks, trade associations, advertising, lobbying and legal firms, all of whom promote what he calls hyperconsumption – a pattern of consuming directly linked to premature mortality and preventable illness or injury. These interests, as Al Gore pointed out in his recent book, threaten public health and undermine democracy.

These policies result from decisions made by executives in the industries already referred to. Pressure from shareholders and short-term profit targets mean that more money is spent on promoting products described as 'fun to you' than those healthy options 'good for you.' As other books have also shown, scientific research is used to establish the bliss point in the brain of competing products so as to maximise the chances of consumers becoming addicted. Executives are trying to increase their 'share of stomach' and activate buying impulses in the customers. Mexico makes a particularly worrying case study where US trade liberalisation policy has directly contributed to the rocketing levels of obesity in that country. Food, alcohol and tobacco industries have used similar tactics and do their best to water down or block any legislation designed to regulate their market penetration through lobbying, campaign contributions and helping formulate business friendly trade agreements – currently the secretive Trans-Pacific Partnership (TPP) that will allow corporations to sue governments for unfriendly regulations.

The author documents in some detail how corporate practices have contributed to global epidemics of chronic diseases and injuries, the last being caused by guns and car accidents. By 2030, non-communicable diseases will cause three quarters of all deaths in the world. Almost 10,000 young people aged 15 to 24 died in 2010 as a result of suicide or homicide. Cumulatively since 1960, over 1 million US citizens have been killed by firearms and 2 million have suffered non-fatal gun injuries. This represents 13 times more people killed by firearms than soldiers in wars in Vietnam, Iraq and Afghanistan combined. 44% of the US population have one or more chronic conditions, and this is set to rise to over 50% in the next 10 years. The book also covers the pharmaceutical industry and their role in misrepresenting risk, selling sickness and co-opting doctors to make a profit. Overall, this situation represents a major public health challenge that will require leadership at NGO and grassroots level as well as government.

The next chapter explains how corporations have taken control of the economy and the factors that have brought about the current situation: short-termism, financialisation, deregulation, tax relief, privatisation and market concentration. Between 2000 and 2005 alone, the number of registered lobbyists in Washington DC more than doubled to nearly 35,000. A chapter specifically on the corporate consumption complex explains the various interconnections between institutions and gives chilling examples of business practices at McDonald's leading to 'rising rates of diet related diseases, unsustainable agricultural practices and environmental damage, lower wages, rising income inequality and diminished democracy' - the author comments that what is good for business may be bad for human well-being. Similar tactics are employed at the Pharmaceutical Manufacturers Association.

There is a very useful discussion of the core beliefs associated with the corporate ideology of consumption, and many of these shift responsibility away from the company towards the consumer. They include education as the best means of helping customers make better choices when exposed to advertising, that free trade is good for everyone and that promoting consumption is essential for economic growth and prosperity. This ideology is in turn underpinned by dubious scientific claims that also reinforce a deterministic and controlling outlook. The author shows how such claims can be dismantled and cites examples of social groups acting to create ideological alternatives, providing a corresponding set of core beliefs and values (p. 152) such as making a profit by sickening others is wrong, that the goal of social policy should be to make healthy choices easy choices, and that every generation should leave the world a better place.

By this point, some readers may be somewhat discouraged, but the second part provides robust reasons for optimism and activism. The author gives historical examples from food and drug safety, child labour, food justice movements, the California air resources board and health professionals resisting capture by the pharmaceutical industry. The tobacco industry is heavily lambasted, including by the director-general of the WHO. We can learn from successful strategies already implemented by campaigns to change the business and political practices of multinational corporations. This will involve constructing and popularising an alternative ideology of health and democracy, dismantling the corporate consumption complex and forging a policy agenda offering a vision of a healthier and more democratic future. This may seem a tall order, but the alternative is to accept continuing rises in global premature deaths and preventable illnesses and injuries. The author urges campaigns to engage the mind and emotions, targeting specific companies to generate outrage fuelling advocacy and framing efforts in clear moral terms. We need to evict these corporations from our consciousness, our communities and our political system. He also provides a detailed policy agenda a movement for a healthier future, showing how some of these ideas are already being implemented. This chapter alone is worth the price of the book, providing as it does a coherent intellectual and moral framework for change. Interested readers can also consult www.corporationsandhealth.org but I would urge those directly concerned with these issues to read this remarkable and highly informative book.