Industrial epidemics, public health advocacy and the alcohol industry: lessons from other fields

The global health network on alcohol control: successes and limits of evidence-based advocacy

Global efforts to address alcohol harm have significantly increased since the mid-1990 s. By 2010, the World Health Organization (WHO) had adopted the non-binding Global Strategy to Reduce the Harmful Use of Alcohol. This study investigates the role of a global health network, anchored by the Global Alcohol Policy Alliance (GAPA), which has used scientific evidence on harm and effective interventions to advocate for greater global public health efforts to reduce alcohol harm. The study uses process-tracing methodology and expert interviews to evaluate the accomplishments and limitations of this network. The study documents how network members have not only contributed to greater global awareness about alcohol harm, but also advanced a public health approach to addressing this issue at the global level. Although the current network represents an expanding global coalition of like-minded individuals, it faces considerable challenges in advancing its cause towards successful implementation of effective alcohol control policies across many low- and middle-income countries (LMICs). The analysis reveals a need to transform the network into a formal coalition of regional and national organizations that represent a broader variety of constituents, including the medical community, consumer groups and development-focused non-governmental organizations. Considering the growing harm of alcohol abuse in LMICs and the availability of proven and cost-effective public health interventions, alcohol control represents an excellent 'buy' for donors interested in addressing non-communicable diseases. Alcohol control has broad beneficial effects for human development, including promoting road safety and reducing domestic violence and health care costs across a wide variety of illnesses caused by alcohol consumption.

Tobacco industry use of personal responsibility rhetoric in public relations and litigation: disguising freedom to blame as freedom of choice

We examined the tobacco industry's rhetoric to frame personal responsibility arguments. The industry rarely uses the phrase "personal responsibility" explicitly, but rather "freedom of choice." When freedom of choice is used in the context of litigation, the industry means that those who choose to smoke are solely to blame for their injuries. When used in the industry's public relations messages, it grounds its meaning in the concept of liberty and the right to smoke. The courtroom "blame rhetoric" has influenced the industry's larger public relations message to shift responsibility away from the tobacco companies and onto their customers. Understanding the rhetoric and framing that the industry employs is essential to combating this tactic, and we apply this comprehension to other industries that act as disease vectors.

Patterns of change in implementation of state alcohol control policies in the United States, 1999-2011

AIMS

To examine state alcohol control policy implementation by policy efficacy and intent.

DESIGN

A descriptive longitudinal analysis of policy implementation.

SETTING

The United States, 1999-2011.

PARTICIPANTS

Fifty states and the District of Columbia.

MEASUREMENTS

Twenty-nine state-level policies were rated based on an implementation rating (IR; range = 0.0-1.0) gathered from the Alcohol Policy Information System, government and industry reports and other sources; and expert judgment about policy efficacy for addressing binge drinking and alcohol-impaired driving among the general population and youth, respectively.

FINDINGS

On average, implementation of the most effective general population policies did not change [mean IR = 0.366 in 1999; 0.375 in 2011; slope for annual change = 0.001; 95% confidence interval (CI) for the slope -0.001, 0.002]. In contrast, implementation increased over time for less effective policies (mean IR = 0.287 in 1999; 0.427 in 2011; slope for annual change compared with most effective policies = 0.009; slope 95% CI = 0.002-0.007), for youth-oriented policies (mean IR = 0.424 in 1999; 0.511 in 2011; slope for annual change compared with most effective policies = 0.007; slope 95% CI = 0.005-0.009), and for impaired driving policies (mean IR = 0.493 in 1999; 0.608 in 2011; slope for annual change compared with most effective policies = 0.0105; slope 95% CI = 0.007-0.014).

CONCLUSIONS

Implementation of politically palatable state alcohol policies, such as those targeting youth and alcohol-impaired driving, and less effective policies increased during 1999-2011 in the United States, while the most effective policies that may maximally protect public health remained underused.

Effect of screening and lifestyle counselling on incidence of ischaemic heart disease in general population: Inter99 randomised trial

OBJECTIVE

To investigate the effect of systematic screening for risk factors for ischaemic heart disease followed by repeated lifestyle counselling on the 10 year development of ischaemic heart disease at a population level.

DESIGN

Randomised controlled community based trial.

SETTING

Suburbs of Copenhagen, Denmark.

PARTICIPANTS

59,616 people aged 30-60 years randomised with different age and sex randomisation ratios to an intervention group (n = 11,629) and a control group (n = 47,987).

INTERVENTION

The intervention group was invited for screening, risk assessment, and lifestyle counselling up to four times over a five year period. All participants with an unhealthy lifestyle had individually tailored lifestyle counselling at all visits (at baseline and after one and three years); those at high risk of ischaemic heart disease, according to predefined criteria, were furthermore offered six sessions of group based lifestyle counselling on smoking cessation, diet, and physical activity. After five years all were invited for a final counselling session. Participants were referred to their general practitioner for medical treatment, if relevant. The control group was not invited for screening.

MAIN OUTCOME MEASURES

The primary outcome measure was incidence of ischaemic heart disease in the intervention group compared with the control group. Secondary outcome measures were stroke, combined events (ischaemic heart disease, stroke, or both), and mortality.

RESULTS

6091 (52.4%) people in the intervention group participated at baseline. Among 5978 people eligible at five year follow-up (59 died and 54 emigrated), 4028 (67.4%) attended. A total of 3163 people died in the 10 year follow-up period. Among 58,308 without a history of ischaemic heart disease at baseline, 2782 developed ischaemic heart disease. Among 58,940 without a history of stroke at baseline, 1726 developed stroke. No significant difference was seen between the intervention and control groups in the primary end point (hazard ratio for ischaemic heart disease 1.03, 95% confidence interval 0.94 to 1.13) or in the secondary endpoints (stroke 0.98, 0.87 to 1.11; combined endpoint 1.01, 0.93 to 1.09; total mortality 1.00, 0.91 to 1.09).

CONCLUSION

A community based, individually tailored intervention programme with screening for risk of ischaemic heart disease and repeated lifestyle intervention over five years had no effect on ischaemic heart disease, stroke, or mortality at the population level after 10 years.Trial registration Clinical trials NCT00289237.

Overturn of the proposed alcohol advertising ban in Lithuania

BACKGROUND

In response to the dramatic increase in alcohol-related problems in Lithuania, policy measures, including alcohol advertising and availability restrictions combined with taxation increase, were implemented in 2007-08. Simultaneously, a full alcohol advertising ban was adopted to take effect from 1 January 2012. Therefore, the alcohol industry responded with extensive lobbying aiming to revoke this ban, and ultimately they succeeded at the end of December 2011.

AIM

To document and analyse actions of stakeholders and events during the alcohol advertising ban cancellation process in Lithuania.

METHODS

Policy analysis includes a development of event time-line, description of key stakeholders' actions and a review of policy context.

FINDINGS

The alcohol industry in Lithuania used similar tactics as the tobacco industry globally, such as creating strong and diverse opposing groups. The industry successfully exerted pressure to change alcohol control legislation, while non-governmental organizations had the important role of a watchdog, blunting industry's efforts. Unequal power distribution made it difficult to withstand combined local and international lobbying to cancel the ban.

CONCLUSION

Given the global nature of the alcohol industry, there is a need for international regulation to limit the influence of vested interests on national lawmaking.

The illusion of righteousness: corporate social responsibility practices of the alcohol industry

BACKGROUND

Corporate social responsibility (CSR) has become an integral element of how the alcohol industry promotes itself. The existing analyses of CSR in the alcohol industry point to the misleading nature of these CSR practices. Yet, research has been relatively sparse on how the alcohol industry advances CSR in an attempt to facilitate underlying business interests, and in what ways the ongoing display of industry CSR impacts public health. This paper aims to investigate the alcohol industry's recent CSR engagements and explain how CSR forms part of the industry's wider political and corporate strategies.

METHODS

Our study used qualitative methods to collect and analyse data. We searched for materials pertaining to CSR activities from websites of three transnational alcohol corporations, social media platforms, media reports and other sources. Relevant documents were thematically analysed with an iterative approach.

RESULTS

Our analysis identified three CSR tactics employed by the alcohol companies which are closely tied in with the industry's underlying corporate intents. First, the alcohol manufacturers employ CSR as a means to frame issues, define problems and guide policy debates. In doing this, the alcohol companies are able to deflect and shift the blame from those who manufacture and promote alcoholic products to those who consume them. Second, the alcohol corporations promote CSR initiatives on voluntary regulation in order to delay and offset alcohol control legislation. Third, the alcohol corporations undertake philanthropic sponsorships as a means of indirect brand marketing as well as gaining preferential access to emerging alcohol markets.

CONCLUSIONS

The increasing penetration and involvement of the alcohol industry into CSR highlights the urgent needs for public health counter actions. Implementation of any alcohol control measures should include banning or restricting the publicity efforts of the industry's CSR and informing the public of the alcohol industry's notion of social responsibility. More significantly, an internationally binding instrument should be called for to enable countries to differentiate between genuine concerns and spurious altruism, and in doing so, resist the industry's attempt to erode alcohol control.

Bennett A. Introduction to the special issue: drugs, wars, military personnel, and veterans

This special issue examines major structural, sociocultural, and behavioral issues surrounding substance use and misuse among U.S. military personnel and veterans who served in recent military conflicts in Iraq and Afghanistan. This introduction provides a brief historical review of the US's experiences of the linkages between war and substance use, misuse, and abuse. It then describes how the various topics covered in this issue span the military-veteran life course and explains the significance of each contribution.

Addiction industry studies: understanding how proconsumption influences block effective interventions

The legalized consumption of products with addiction potential, such as tobacco and alcohol, contributes in myriad ways to poor physical and mental health and to deterioration in social well- being. These impacts are well documented, as are a range of public health interventions that are demonstrably effective in reducing harm. I have discussed the capacity for the profits from these substances to be deployed in ways that block or divert resources from interventions known to be effective. Addiction industry studies constitute a new and previously neglected area of research focusing specifically on understanding the salient relationships that determine policy and regulation. This understanding will increase the odds of adopting effective interventions.

Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries

The 2011 UN high-level meeting on non-communicable diseases (NCDs) called for multisectoral action including with the private sector and industry. However, through the sale and promotion of tobacco, alcohol, and ultra-processed food and drink (unhealthy commodities), transnational corporations are major drivers of global epidemics of NCDs. What role then should these industries have in NCD prevention and control? We emphasise the rise in sales of these unhealthy commodities in low-income and middle-income countries, and consider the common strategies that the transnational corporations use to undermine NCD prevention and control. We assess the effectiveness of self-regulation, public-private partnerships, and public regulation models of interaction with these industries and conclude that unhealthy commodity industries should have no role in the formation of national or international NCD policy. Despite the common reliance on industry self-regulation and public-private partnerships, there is no evidence of their effectiveness or safety. Public regulation and market intervention are the only evidence-based mechanisms to prevent harm caused by the unhealthy commodity industries.

Public health, academic medicine, and the alcohol industry's corporate social responsibility activities

We explored the emerging relationships among the alcohol industry, academic medicine, and the public health community in the context of public health theory dealing with corporate social responsibility. We reviewed sponsorship of scientific research, efforts to influence public perceptions of research, dissemination of scientific information, and industry-funded policy initiatives. To the extent that the scientific evidence supports the reduction of alcohol consumption through regulatory and legal measures, the academic community has come into increasing conflict with the views of the alcohol industry. We concluded that the alcohol industry has intensified its scientific and policy-related activities under the general framework of corporate social responsibility initiatives, most of which can be described as instrumental to the industry's economic interests.

The alcohol industry lobby and Hong Kong's zero wine and beer tax policy

BACKGROUND

Whereas taxation on alcohol is becoming an increasingly common practice in many countries as part of overall public health measures, the Hong Kong Special Administrative Region Government is bucking the trend and lowered its duties on wine and beer by 50 percent in 2007. In 2008, Hong Kong removed all duties on alcohol except for spirits. The aim of this paper is to examine the case of Hong Kong with its history of changes in alcohol taxation to explore the factors that have driven such an unprecedented policy evolution.

METHODS

The research is based on an analysis of primary documents. Searches of official government documents, alcohol-related industry materials and other media reports on alcohol taxation for the period from 2000 to 2008 were systematically carried out using key terms such as "alcohol tax" and "alcohol industry". Relevant documents (97) were indexed by date and topic to undertake a chronological and thematic analysis using Nvivo8 software.

RESULTS

Our analysis demonstrates that whereas the city's changing financial circumstances and the Hong Kong Special Administrative Region Government's strong propensity towards economic liberalism had, in part, contributed to such dramatic transformation, the alcohol industry's lobbying tactics and influence were clearly the main drivers of the policy decision. The alcohol industry's lobbying tactics were two-fold. The first was to forge a coalition encompassing a range of catering and trade industries related to alcohol as well as industry-friendly lawmakers so that these like-minded actors could find common ground in pursuing changes to the taxation policy. The second was to deliberately promote a blend of ideas to garner support from the general public and to influence the perception of key policy makers.

CONCLUSIONS

Our findings suggest that the success of aggressive industry lobbying coupled with the absence of robust public health advocacy was the main driving force behind the unparalleled abolition of wine and beer duties in Hong Kong. Strong public health alliance and advocacy movement are needed to counteract the industry's continuing aggressive lobby and promotion of alcoholic beverages.

Tobacco control, global health policy and development: towards policy coherence in global governance

The WHO Framework Convention on Tobacco Control (FCTC) demonstrates the international political will invested in combating the tobacco pandemic and a newfound prominence for tobacco control within the global health agenda. However, major difficulties exist in managing conflicts with foreign and trade policy priorities, and significant obstacles confront efforts to create synergies with development policy and avoid tensions with other health priorities. This paper uses the concept of policy coherence to explore congruence and inconsistencies in objectives, policy, and practice between tobacco control and trade, development and global health priorities. Following the inability of the FCTC negotiations to satisfactorily address the relationship between trade and health, several disputes highlight the challenges posed to tobacco control policies by multilateral and bilateral agreements. While the work of the World Bank has demonstrated the potential contribution of tobacco control to development, the absence of non-communicable diseases from the Millennium Development Goals has limited scope to offer developing countries support for FCTC implementation. Even within international health, tobacco control priorities may be hard to reconcile with other agendas. The paper concludes by discussing the extent to which tobacco control has been pursued via a model of governance very deliberately different from those used in other health issues, in what can be termed 'tobacco exceptionalism'. The analysis developed here suggests that non-communicable disease (NCD) policies, global health, development and tobacco control would have much to gain from re-examining this presumption of difference.

Alcohol industry influence on UK alcohol policy: A new research agenda for public health

The British government has been criticised for according industry interests too much weight in alcohol policy-making. Consequently, it has been argued that alcohol strategy in the UK is built around policies for which the evidence base is weak. This has clear implications for public health. The purpose of this commentary is to map recent developments in UK alcohol policy and related debates within the alcohol policy literature, thus laying the foundations for a systematic examination of the influence of the alcohol industry on alcohol policy. It highlights the changing structure of the industry and summarises what is known about the positions and strategies of industry actors towards alcohol policy. In so doing, it aims to contribute not just to debates about alcohol policy, but to a broader understanding of health policy processes and the relationships between government and other stakeholders. It advances a new research agenda focused on the role of corporate actors in the field of alcohol policy and public health more broadly.

The case against a smoker's license

Tobacco continues to kill millions of people around the world each year and its use is increasing in some countries, which makes the need for new, creative, and radical efforts to achieve the tobacco control endgame vitally important. One such effort is discussed in this PLOS Medicine Debate, where Simon Chapman presents his proposal for a "smoker's license" and Jeff Collin argues against. Chapman sets out a case for introducing a smart card license for smokers designed to limit access to tobacco products and encourage cessation. Key elements of the smoker's license include smokers setting daily limits, financial incentives for permanent license surrender, and a test of health risk knowledge for commencing smokers. Collin argues against the proposal, saying that it would shift focus away from the real vector of the epidemic--the tobacco industry--and that by focusing on individuals it would censure victims, increase stigmatization of smokers, and marginalize the poor.

Global health governance and the commercial sector: a documentary analysis of tobacco company strategies to influence the WHO framework convention on tobacco control

BACKGROUND

In successfully negotiating the Framework Convention on Tobacco Control (FCTC), the World Health Organization (WHO) has led a significant innovation in global health governance, helping to transform international tobacco control. This article provides the first comprehensive review of the diverse campaign initiated by transnational tobacco corporations (TTCs) to try to undermine the proposed convention.

METHODS AND FINDINGS

The article is primarily based on an analysis of internal tobacco industry documents made public through litigation, triangulated with data from official documentation relating to the FCTC process and websites of relevant organisations. It is also informed by a comprehensive review of previous studies concerning tobacco industry efforts to influence the FCTC. The findings demonstrate that the industry's strategic response to the proposed WHO convention was two-fold. First, arguments and frames were developed to challenge the FCTC, including: claiming there would be damaging economic consequences; depicting tobacco control as an agenda promoted by high-income countries; alleging the treaty conflicted with trade agreements, "good governance," and national sovereignty; questioning WHO's mandate; claiming the FCTC would set a precedent for issues beyond tobacco; and presenting corporate social responsibility (CSR) as an alternative. Second, multiple tactics were employed to promote and increase the impact of these arguments, including: directly targeting FCTC delegations and relevant political actors, enlisting diverse allies (e.g., mass media outlets and scientists), and using stakeholder consultation to delay decisions and secure industry participation.

CONCLUSIONS

TTCs' efforts to undermine the FCTC were comprehensive, demonstrating the global application of tactics that TTCs have previously been found to have employed nationally and further included arguments against the FCTC as a key initiative in global health governance. Awareness of these strategies can help guard against industry efforts to disrupt the implementation of the FCTC and support the development of future, comparable initiatives in global health.

Vulnerability of health to market forces

OBJECTIVES

This article reviews adverse influences of for-profit enterprises on health care and public health, and examines significance for public policy.

RESEARCH DESIGN

Narrative review.

RESULTS

For-profit health-care industries may increase costs and reduce quality, leading to market failure and contributing to the USA's unflattering position in international comparisons of health-care efficiency. Drug and device corporations use strategies such as making biased inferences, influencing scientists and physicians, marketing rather than informing the public, and lobbying to control their own industry regulations to create market advantage. Successful marketing leads to the increased use of costly profit-making drugs and procedures over cheaper, nonpatented therapies. Because resources are limited, the overuse of costly modalities contributes to expensive health care, which presents a challenge to universal coverage. The free market also fosters the proliferation of industries, such as tobacco, food, and chemicals, which externalize costs to maximize profits, seek to unduly influence research by paying experts and universities, and attempt to control the media and regulatory agencies. Most vulnerable to the cumulative harm of these tactics are children, the poor, the sick, and the least educated.

CONCLUSIONS

The free market can harm health and health care. The corporate obligation to increase profits and ensure a return to shareholders affects public health. Such excesses of capitalism pose formidable challenges to social justice and public health. The recognition of the health risks entailed by corporation-controlled markets has important implications for public policy. Reforms are required to limit the power of corporations.

The alcohol industry and public interest science

AIMS

This report argues that the growing involvement of the alcohol industry in scientific research needs to be acknowledged and addressed. It suggests a set of principles to guide ethical decision-making in the future.

METHODS

We review relevant issues with regard to relationships between the alcohol industry and the international academic community, especially alcohol research scientists. The guiding principles proposed are modelled after expert committee statements, and describe the responsibilities of governmental agencies, the alcohol industry, journal editors and the academic community. These are followed by recommendations designed to inform individuals and institutions about current 'best practices' that are consistent with the principles.

FINDINGS AND CONCLUSIONS

Growing evidence from the tobacco, pharmaceutical and medical fields suggests that financial interests of researchers may compromise their professional judgement and lead to research results that are biased in favour of commercial interests. It is recommended that the integrity of alcohol science is best served if all financial relationships with the alcoholic beverage industry are avoided. In cases where research funding, consulting, writing assignments and other activities are initiated, institutions, individuals and the alcoholic beverage industry itself are urged to follow appropriate guidelines that will increase the transparency and ethicality of such relationships.

Vested interests in addiction research and policy alcohol policies out of context: drinks industry supplanting government role in alcohol policies in sub-Saharan Africa

BACKGROUND

In this paper, we describe an analysis of alcohol policy initiatives sponsored by alcohol producer SABMiller and the International Center on Alcohol Policies, an alcohol industry-funded organization. In a number of sub-Saharan countries these bodies have promoted a 'partnership' role with governments to design national alcohol policies.

METHODOLOGY

A comparison was conducted of four draft National Alcohol Policy documents from Lesotho, Malawi, Uganda and Botswana using case study methods.

FINDINGS

The comparison indicated that the four drafts are almost identical in wording and structure and that they are likely to originate from the same source.

CONCLUSIONS

The processes and the draft policy documents reviewed provide insights into the methods, as well as the strategic and political objectives of the multi-national drinks industry. This initiative reflects the industry's preferred version of a national alcohol policy. The industry policy vision ignores, or chooses selectively from, the international evidence base on alcohol prevention developed by independent alcohol researchers and disregards or minimizes a public health approach to alcohol problems. The policies reviewed maintain a narrow focus on the economic benefits from the trade in alcohol. In terms of alcohol problems (and their remediation) the documents focus upon individual drinkers, ignoring effective environmental interventions. The proposed policies serve the industry's interests at the expense of public health by attempting to enshrine 'active participation of all levels of the beverage alcohol industry as a key partner in the policy formulation and implementation process'.

Corporate Power and Social Policy: The Political Economy of the Transnational Tobacco Companies

Drawing on published tobacco document research and related sources, this article applies Farnsworth and Holden's conceptual framework for the analysis of corporate power and corporate involvement in social policy (2006) to the transnational tobacco companies (TTCs). An assessment is made of TTCs' structural power, the impact upon their structural position of tobacco control (TC) policies, and their use of agency power. The analysis suggests that, as a result of the growth of TC policies from the 1950s onwards, TTCs have had to rely on political agency to pursue their interests and attempt to reassert their structural position. The collapse of the Eastern bloc and the liberalisation of East Asian economies presented new structural opportunities for TTCs in the 1980s and 1990s, but the development of globally coordinated TC policies facilitated by the World Health Organisation's Framework Convention on Tobacco Control has the potential to constrain these.

A common standard for conflict of interest disclosure in addiction journals

This paper presents a common standard for conflict of interest disclosure. The common standard was drafted by the authors, following consultation with a multi-disciplinary group of journal editors, publishers, bioethicists and other academics. It is presented here for the benefit of authors, editorial managers, journal editors and peer reviewers to stimulate discussion and to provide guidance to authors in reporting real, apparent and potential conflicts of interest. It is particularly relevant to addiction specialty journals because of the potential conflicts of interest associated with funding from the alcohol, tobacco, pharmaceutical and gambling industries. Following an appropriate period of vetting the common standard within the scientific community, it is recommended that journal editors adopt journal policies and reporting procedures that are consistent across journals.

Reducing harm from alcohol: call to action

Despite clear evidence of the major contribution alcohol makes to the global burden of disease and to substantial economic costs, focus on alcohol control is inadequate internationally and in most countries. Expansion of industrial production and marketing of alcohol is driving alcohol use to rise, both in emerging markets and in young people in mature alcohol markets. Cost-effective and affordable interventions to restrict harm exist, and are in urgent need of scaling up. Most countries do not have adequate policies in place. Factors impeding progress include a failure of political will, unhelpful participation of the alcohol industry in the policy process, and increasing difficulty in free-trade environments to respond adequately at a national level. An effective national and international response will need not only governments, but also non-governmental organisations to support and hold government agencies to account. International health policy, in the form of a Framework Convention on Alcohol Control, is needed to counterbalance the global conditions promoting alcohol-related harm and to support and encourage national action.

Alcohol research and the alcoholic beverage industry: issues, concerns and conflicts of interest

AIMS

Using terms of justification such as 'corporate social responsibility' and 'partnerships with the public health community', the alcoholic beverage industry (mainly large producers, trade associations and 'social aspects' organizations) funds a variety of scientific activities that involve or overlap with the work of independent scientists. The aim of this paper is to evaluate the ethical, professional and scientific challenges that have emerged from industry involvement in alcohol science.

METHOD

Source material came from an extensive review of organizational websites, newspaper articles, journal papers, letters to the editor, editorials, books, book chapters and unpublished documents.

RESULTS

Industry involvement in alcohol science was identified in seven areas: (i) sponsorship of research funding organizations; (ii) direct financing of university-based scientists and centers; (iii) studies conducted through contract research organizations; (iv) research conducted by trade organizations and social aspects/public relations organizations; (v) efforts to influence public perceptions of research, research findings and alcohol policies; (vi) publication of scientific documents and support of scientific journals; and (vii) sponsorship of scientific conferences and presentations at conferences.

CONCLUSION

While industry involvement in research activities is increasing, it constitutes currently a rather small direct investment in scientific research, one that is unlikely to contribute to alcohol science, lead to scientific breakthroughs or reduce the burden of alcohol-related illness. At best, the scientific activities funded by the alcoholic beverage industry provide financial support and small consulting fees for basic and behavioral scientists engaged in alcohol research; at worst, the industry's scientific activities confuse public discussion of health issues and policy options, raise questions about the objectivity of industry-supported alcohol scientists and provide industry with a convenient way to demonstrate 'corporate responsibility' in its attempts to avoid taxation and regulation.

The role of corporate credibility in legitimizing disease promotion

OBJECTIVES

We explored what corporate "credibility" means to tobacco companies to determine why it matters to companies and what a lack of credibility means to them.

METHODS

We collected documents from an online tobacco industry document archive and analyzed them with an interpretive approach.

RESULTS

Tobacco companies conceptualized credibility not as being worthy of belief or confidence but as inspiring it. Thus, credibility was understood primarily as altering public perception of the industry. "Truth" was largely absent from tobacco industry conceptualizations of credibility, which were linked with "responsibility" and "reasonableness." However, industry research found that the public regarded credibility and responsibility differently, expecting these to entail truth telling, advertising reductions, less harmful products, apologies for deception, making amends, or exiting the tobacco business altogether. Overall, industry credibility-building projects failed repeatedly.

CONCLUSIONS

Public health discourse increasingly attends to the roles of corporations in promoting disease. Industries such as tobacco and alcohol have been identified as profiting from harmful products. Yet corporations' ability to continue business as usual requires sustaining an implicit societal assent to their activities that depends on corporate credibility. For public health to address corporate disease promotion effectively, undermining corporate credibility may be strategically important.

Corporation-induced diseases, upstream epidemiologic surveillance, and urban health

Corporation-induced diseases are defined as diseases of consumers, workers, or community residents who have been exposed to disease agents contained in corporate products. To study the epidemiology and to guide expanded surveillance of these diseases, a new analytical framework is proposed. This framework is based on the agent-host-environment model and the upstream multilevel epidemiologic approach and posits an epidemiologic cascade starting with government-sanctioned corporate profit making and ending in a social cost, i.e., harm to population health. Each of the framework's levels addresses a specific level of analysis, including government, corporations, corporate conduits, the environment of the host, and the host. The explained variable at one level is also the explanatory variable at the next lower level. In this way, a causal chain can be followed along the epidemiologic cascade from the site of societal power down to the host. The framework thus describes the pathways by which corporate decisions filter down to disease production in the host and identifies opportunities for epidemiologic surveillance. Since the environment of city dwellers is strongly shaped by corporations that are far upstream and several levels away, the framework has relevance for the study of urban health. Corporations that influence the health of urban populations include developers and financial corporations that determine growth or decay of urban neighborhoods, as well as companies that use strategies based on neighborhood characteristics to sell products that harm consumer health. Epidemiological inquiry and surveillance are necessary at all levels to provide the knowledge needed for action to protect the health of the population. To achieve optimal inquiry and surveillance at the uppermost levels, epidemiologists will have to work with political scientists and other social scientists and to utilize novel sources of information.