Case Studies on Corporations and Global Health Governance: Impacts, Influence and Accountability

Book info: Case Studies on Corporations and Global Health Governance: Impacts, Influence and Accountability (Hardcover, 288 pages) – Rowman & Littlefield, 2016. Language: English.

There is growing evidence of the wide-ranging impacts of corporations in selected industries on global patterns of health and disease. However, limited analysis has been undertaken of the increasing corporate involvement in collective action needed to effectively address these impacts.This book brings together a wide ranging collection of case studies that provide new empirical research on how corporations impact on, influence of, and could be held more accountable to, global health governance. Written by leading and emerging scholars from a broad range of disciplinary perspectives, each case study seeks to expand the methods, conceptual approaches and sources of data used to address three key questions:What impacts are corporations having on global health governance?How do corporations shape and influence global health governance in ways that protect and promote their own interests?What forms of global health governance are needed to mediate these corporate impacts in ways that protect and promote population health?Also, for a practical guide on how to conduct research on the impact of corporations on global health and global health governance, see the partner volume: http://www.rowmaninternational.com/books/researching-corporations-and-global-health-governance

Excerpt. © Reprinted by permission. All rights reserved. Case Studies on Corporations and Global Health GovernanceImpacts, Influence and AccountabilityBy Nora Kenworthy, Ross MacKenzie, Kelley LeeRowman & Littlefield International, Ltd.Copyright © 2016 Nora Kenworthy, Ross macKenzie and Kelley Lee
All rights reserved.
ISBN: 978-1-78348-356-3
ContentsPreface, vii,
List of Acronyms, xi,
List of Figures, xv,
List of Tables, xvii,
1 Introduction Kelley Lee, Nora J. Kenworthy and Ross MacKenzie, 1,
I: Impacts of Corporations on Global Health, 9,
2 Governing through Production: A Public-Private Partnership's Impacts and Dissolution in Lesotho's Garment Industry Nora J. Kenworthy, 11,
3 Medicalisation and Commodification of Smoking Cessation: The Role of Industry Actors in Shaping Health Policy Ross MacKenzie and Benjamin Hawkins, 27,
4 The Influence of the Food Industry on Public Health Governance: Insights from Mexico and the United States Courtney Scott, Angela Carriedo and Cécile Knai, 41,
5 Examples of Failures to Regulate Mining and Smelting Emissions and Their Consequent Effects on Human Health Outcomes Mark Patrick Taylor and Steven George, 53,
II: Corporate Influence of Global Health Governance, 71,
6 Informal Channels of Corporate Influence on Global Health Policymaking: A Mapping of Strategies across Four Industries Elina Suzuki and Suerie Moon, 73,
7 How Corporations Shape Our Understanding of Problems with Gambling and Their Solutions Rebecca Cassidy, 89,
8 Corporate Manipulation of Global Health Policy: A Case Study of Asbestos John Calvert, 103,
9 The Entrenchment of the Public-Private Partnership Paradigm Michael Stevenson, 119,
10 Trade and Investment Agreements: The Empowerment of Pharmaceutical and Tobacco Corporations Ashley Schram and Ronald Labonte, 131,
11 Health Policy, Corporate Influence and Multi-Level Governance: The Case of Alcohol Policy in the European Union Chris Holden and Benjamin Hawkins, 145,
12 Tobacco Industry Strategies to Influence Global Governance Ross MacKenzie and Kelley Lee, 159,
III: Holding Corporations to Account, 175,
13 A Proposed Approach to Systematically Identify and Monitor the Corporate Political Activity of the Food Industry with Respect to Public Health Using Publicly Available Information Melissa Mialon, Boyd Swinburn and Gary Sacks, 177,
14 Regulating Baby Food Marketing: Civil Society versus Private Sector Influence Tracey Wagner-Rizvi, 199,
15 Epidemiology in the Struggle over Contamination of the Ecuadorian Amazon: Communities, Controversy and Chevron Ben Brisbois, 213,
16 Citizens United, Public Health and Democracy: The Supreme Court Ruling, Its Implications and Proposed Action William H. Wiist, 227,
17 Conclusion Nora Kenworthy, Ross MacKenzie and Kelley Lee, 243,
Index, 251,
About the Contributors, 265,


CHAPTER 1

Introduction

Kelley Lee, Nora J. Kenworthy and Ross MacKenzie

The rapid rise of corporate power since the 1990s has been the defining change to the world economy brought about by globalisation. The size and scope of corporations have expanded on multiple fronts: from traditional industrial sectors to sectors hitherto deemed within the public sphere; from high- to low- and middle-income countries; and from involvement with wealth generation to increased participation in the governance of societies. As the most powerful form of business organisation, corporations hold unprecedented economic power in the early twenty-first century, and rapidly growing political legitimacy as 'citizens'. At the national level, countries such as the United States, through its Citizens United decision, have enshrined corporate personhood. This recognition, in turn, has become embedded in a growing number of institutional arrangements at the global level, such as multilateral trade and investment agreements. Consequently, there are profound concerns of a widening 'governance gap', between a fast-moving world economy heavily populated by transnational corporations (TNCs), and existing political institutions struggling to manage their social and environmental impacts (Urban 2014; Wiist, this volume).

This collection of case studies focuses on emerging governance gaps and growing corporate power in global health governance (GHG), a sphere where corporations have rapidly expanded their role since the 1990s. Globalisation has contributed not only to the rise of corporations, but also to the emergence of new transboundary health issues that pose acute challenges to existing forms of international health cooperation. The epidemiological transition from international to global health challenges has also prompted a governance transition, involving new institutions and a wider range of actors and resources in collective health action (Lee 2001; Brown et al. 2006). As global health has become 'firmly established on the global political agenda' (Schrecker 2012, 1), it has also emerged as a key domain of contestation and cooperation among state, market and civil society actors. The role of corporations has been seminal to debates on the appropriate structure and function of GHG. In the meantime, corporations have become major players in a wide range of global health initiatives, giving rise to concerns about fundamental conflicts between public and private interests (Richter 2001).

The existing literature on corporations and public health is already substantial, focusing on corporations' operations, goods and services, and their individual and population health outcomes. Corporate impacts on public health are increasingly diverse, ranging from the production of health-related goods and services (e.g., pharmaceuticals, medical technologies), to the marketing of goods and services that directly impact public health (e.g., food, tobacco, alcohol), to the production of goods and services that impact the social determinants of health (e.g., asbestos) (Wiist 2010; Freudenberg 2014). Although average measures of health and wellness have steadily improved around the world since the early twentieth century, recent evidence points to an unprecedented reversal in life expectancy among specific populations since the late twentieth century, largely attributed to the rise of non-communicable diseases (NCDs) such as diabetes, cancers and heart disease (Kindig and Cheng 2013). Almost all industries make decisions that have profound consequences for the social determinants of health, from choices about how much to pay workers or which occupational hazards workers will be exposed to, to decisions about whether and to what extent the industry will produce environmental harms. Thus, as the power and geographic reach of corporations has expanded over recent decades, so too have the public health harms associated with many industries.

This book is not just about 'when corporations rule the world' (Korten 2001), but why and how they have come to do so, focusing on their rule in the domain of global health. The aims of this book are threefold. First, the case studies bring together a broader range of disciplines — including public health, political science, international relations, law, public health, social policy, anthropology — than previously assembled. Our goal is not only to share insights across disciplinary boundaries, but also to facilitate understanding of how new research can be generated and applied, to inform ongoing debates.

Second, the case studies broaden the scope of research on corporations and GHG in terms of industries and geography. Research to date has largely focused on individual industries (notably the alcohol, tobacco, food and beverage, pharmaceutical industries), resulting in specialist knowledge. We aimed to include, but not limit ourselves to, the primary 'harm industries' that have been the focus of the most extensive research on corporations and global health (Benson and Kirsch 2010). Moreover, the limited comparative analysis to date (Wiist 2010; Stuckler et al. 2012) suggests similarities across industries in terms of impacts and influence. In keeping with our understanding of corporations as operating within a world increasingly defined by economic globalisation, our geographical lens goes beyond traditional dichotomies of 'developed' and 'developing' countries, and North versus South. Undoubtedly, acute inequities persist, but in many cases the fault lines are dynamic, creating new geographies of 'haves' and 'have nots'. The case studies seek to capture this layering of old and new inequalities.

Our third aim is to build a generational bridge, across early, mid- and advanced career scholars, in the study of corporations and GHG. This book brings together established scholars with deep expertise in selected industries, and scholars emerging from a broad range of disciplines and industry interests. This cross-fertilisation of ideas, approaches, methodologies and knowledge, alongside the accompanying research guide, is intended to foster new insights and capacity.

KEY CONCEPTS: GLOBALISATION, GLOBAL HEALTH GOVERNANCE AND CORPORATIONS

This book grapples with four key concepts that have been the subject of intensely contested theorising and empirical analyses. For the purposes of this book, we focus on economic globalisation, by which the

straightforward exchange between core and peripheral areas, based upon a broad division of labour, is being transformed into a highly complex, kaleidoscopic structure involving the fragmentation of many production processes and their geographical relocation on a global scale in ways which slice through national boundaries. (Dicken 1998, 2)

Since the 1990s, the restructuring of the world economy, encompassing both reterritorialisation and deterritorialisation (Scholte 2008), has intensified and extensified to embrace almost all societies and locales (Held et al. 1999).

Globalisation, inter alia, has led to a transformation of patterns of health and disease, and their broad determinants, on a transplanetary scale. This transition includes the territorial expansion of known health problems such as the spread of unhealthy lifestyles, as well as emergent risks that demonstrate new patterns of causation and outcome, such as antibiotic resistance and pandemic disease (Lee 2003). These global health dynamics suggest a certain 'levelling' of risks faced by all populations but, simultaneously, the creation of new health inequalities (Labonté and Schrecker 2007).

The advent of global health determinants and outcomes has spurred a proliferation of institutional arrangements commonly referred to as global health governance (GHG). Global governance per se has been the subject of intense scholarly scrutiny since the 1980s, characterised by the diffusion of authority from state-based institutions to new arrangements embracing both state and non-state actors (Rosenau and Czempiel 1992). In global health, the latter include corporations, civil society organisations (CSOs) and philanthropic organisations, which have come to play a substantial role in GHG (Biehl and Petryna 2013; Frenk and Moon 2013). Defined as a 'range of formal and informal institutional arrangements and processes operating among state and non-state actors that orient collective action on health issues which affect populations worldwide', GHG is not synonymous with formal government structures (Lee and Kamradt-Scott 2014). Nor is it singular: governance denotes an array of venues, institutions and processes in which power is contested and authority becomes fragmented and ephemeral.

In the context of intensified economic globalisation, and the search for effective global governance, this book focuses on the corporation (rather than the private sector or privatisation). Dating from the seventeenth century, the corporation has grown from 'relative obscurity to become the world's dominant economic institution' (Bakan 2004) in the early twenty-first century. In essence, a corporation is a legal entity acting for an association of individuals, created to exist and operate independently of its members. Corporations, bestowed with legal personhood, may enter into contracts, engage in transactions, exercise rights and responsibilities, and incur liabilities distinct from its members. While corporations operate in both the public and private spheres, this book is concerned with for-profit business corporations.

The unprecedented economic power of large corporations in the world economy is now widely recognised (Korten 2007). Power is also increasingly concentrated among fewer actors, with forty-three thousand transnational corporations controlling 80 percent of the world economy, and a 'super-entity' of 147 tightly knit companies controlling 40 percent of total wealth (Vitali, Glattfelder and Battiston 2011). Analyses of why and how this has occurred, however, have been 'deflected into wider debates about "globalisation" and related arguments about how the structures of global capitalism shape the capacities, resources, and even the ideologies of actors' (Bell 2012, 661). However, structural explanations have paid less attention to the precise dynamics of business power and, in particular, to corporations as actors shaping the world economy and other institutional arrangements (Fuchs and Lederer 2007). It is this dual relationship, between structure and agency, which forms a key starting point for the case studies in this book.

Another analytical contribution of this book is the dual importance given to both material and ideational power. The material power of a corporation is traditionally measured by tangible resources to pursue its business operations or further its interests, such as financial and other assets, intellectual property, goodwill and human capital. The capacity of corporations to bring together, and generate, material power on an unprecedented scale has led to present forms of economic globalisation in which they dominate. Equally important, however, is the role of ideational power. Carstensen (2015) identifies three forms of ideational power: (a) power through ideas (the capacity of actors to persuade other actors to accept and adopt their views of what they think and do); (b) power over ideas (the capacity of actors to dominate the meaning of ideas); and (c) power in ideas (the authority certain ideas enjoy in structuring thought at the expense of other ideas). As discussed in the concluding chapter of this book, corporate influence of GHG has derived from all three forms of ideational power, alongside material power.

STRUCTURE OF THE BOOK

As a collection of case studies seeking to broaden our understanding of corporations and GHG, through multidisciplinary perspectives and expanded concepts of corporate power, the structure of this book centres on three key themes. The case studies in part I examine the impacts of corporations on GHG through analyses of industries familiar to global health researchers (tobacco, pharmaceuticals and food), as well as those less familiar (garment manufacturing, lead smelting). Part II investigates the diverse ways that corporations influence GHG encompassing structural and agency power, as well as material and ideational power. Again, the case studies embrace a broad range of issue areas and institutional settings to demonstrate how corporations influence problem definition and identified solutions, which, in turn, shapes global health priority setting. Part III discusses strategies, challenges and possibilities for holding corporations to account for their impacts on global health and influence over GHG. These case studies offer important insights for ways in which to address the profound governance gaps opened up by the uncritical proliferation of institutional arrangements to strengthen collective action for global health. As readers are likely to note, however, there are significant and purposeful overlaps between these sections. For example, corporations' influence extends to the ways that public health problems and their solutions are constructed, and corporate influence itself is evident as another kind of public health harm in many of these chapters. Perhaps most importantly, as the conclusion explores in further depth, all of these cases offer lessons for how the corporate role in global health governance should be understood and contested.

CHAPTER 2

Governing through Production

A Public-Private Partnership's Impacts and Dissolution in Lesotho's Garment Industry

Nora J. Kenworthy

A common critique of global health programs is that they are short-lived and vertically implemented, due to budget timelines and shifting global priorities (Pfeiffer and Nichter 2008; Biesma et al. 2009). This situation was exacerbated when donor funding plateaued following the 2008 financial crisis, and programs faced further threats to their longevity (IHME 2012). Against this backdrop, public-private partnerships (PPPs) in global health continue to gain popularity (Richter 2004) based on perceptions of greater sustainability, in part due to their private financing models (Buse and Harmer 2007). Yet few studies have examined the sustainability of PPPs, or the conditions under which corporate-led partnerships come to an end, and empirical research on the impacts of global health program closures is rare (Abramowitz 2015; Prince 2014; Qureshi 2015).

This chapter examines the closure of a successful PPP providing HIV services in Lesotho's garment industry, the Apparel Lesotho Alliance to Fight AIDS (ALAFA). Rather than interrogate the internal micropolitics that may have contributed to its dissolution, this chapter asks what ALAFA's closure reveals about the political and moral governance of HIV programmes in Lesotho. The moment of program closure provides unique insight into PPPs' impacts on the governance of struggling health systems and the health of populations, beyond the direct provision of services. To fully understand PPPs' political impacts, we must examine the broader health and social systems in which they are embedded. This chapter argues that, rather than simply offering technical solutions or convenient collaborations, PPPs produce specific and varying health outcomes in populations, and manufacture certain notions of responsibility for population health.

Drawing on ethnographic data gathered intermittently over six years, this chapter describes the conditions under which ALAFA provided care to the garment industry's heavily HIV-affected workforce. It then discusses ALAFA's closure, drawing on garment factory workers' perspectives. Findings suggest that PPPs are directly involved in the consumerisation of health and disease, producing specific kinds of health in a transnational industry reliant on the marketing of clothing produced by HIV-affected workers. The chapter concludes by discussing how PPPs have altered the moral and practical politics that underlie Lesotho's urban health system.

BACKGROUND

The debate on PPPs is highly polarised. A prominent form of corporate involvement in global health governance (GHG), PPPs vary greatly, and empirical research on their forms, purposes and impacts remains limited (Brada 2011; Ramiah and Reich 2005). Context-specific and data-rich ethnographic research can provide insight into the complicated and productive 'frictions' (Tsing 2004) of partnerships. Following the work of Rajak (2011a), this chapter focuses on PPPs as a driving force behind moral and ethical shifts within local and transnational governance systems. As Rajak (2011a, 13) argues with regard to Corporate Social Responsibility (CSR), the power of corporations' ethical engagements exists in the way these efforts provide 'them with a moral mechanism through which their authority is extended over the social order'.

PPPs are a popular institutional arrangement for the management of CSR activities, though CSR can also encompass charitable donations and more ad-hoc contributions by corporations to specific causes. PPPs offer corporations an institutional structure for CSR activities that privileges the roles and voices of private stakeholders and, like CSR, creates a moral governance regarding whether, how and to whom entitlements will be granted. This form of GHG is enacted at transnational and national levels, but also individually, changing citizens' expectations of the health system and their rights. It intersects with Foucault's theories of governmentality, wherein the modern state (and, in this case, its partners) wields a power that extends into social and personal realms, influencing individual dispositions and behaviours (Foucault 2008). This chapter is less concerned with how PPPs impact the 'conduct of conduct' (Foucault 1994, 237), and instead asks how they influence a country's collective understanding of the health system and the rights of citizens.

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