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.WE EXPLORED THE EMERGING relationships between the alcohol industry, academic medicine, and the public health community. Current trends suggest increasing involvement of the alcohol beverage industry in areas that traditionally have been the main foci of public health and academic medicine, such as scientific research, alcohol education, prevention programs, and alcohol control policies.1,2 Many of these activities can be interpreted in terms of corporate social responsibility (CSR) initiatives that many large corporations practice.3 We define CSR as business practices that help companies manage their economic, social, and environmental impacts as well as their relationships in key areas of influence, such as the marketplace, the supply chain, the community, and the public policy arena.To provide a context for an evaluation of the alcohol industry’s CSR activities, we reviewed the most prominent health issues that threaten the viability of the alcohol industry as a whole and that represent points of contention with public health and academic medicine. We have described the industry’s CSR activities and the risks involved for the academic community. We have provided an evaluation of the theoretical, scientific, and public health challenges that have emerged from industry involvement in alcohol-related health issues.     

The corporate medical department and AIDS.

HIV infection in the workplace reflects the dimensions and distribution of the problem in the community at large. Despite this, accommodation of ill employees has been the general pattern and disruptions of any kind the exception. Corporate medical departments can be important participants in the clinical and social response to AIDS. Recognition of the illness itself, collaboration in the provision of health services, referral when necessary for treatment and counselling, assistance with medical benefits, and arranging for appropriate workplace modifications are among ways in which medical departments can assist concerned or ill employees. Confidentiality is essential in all of these interactions. Education of the workforce about AIDS is especially important from a public health as well as from an administrative standpoint. Providing input on relevant corporate policies and in determination of corporate philanthropy can be other dimensions of corporate medical departments'' response to AIDS.     

Motivation of chemical industry social responsibility through Responsible Care

Advocates of corporate social responsibility argue corporations should not only meet the needs of shareholders, but other key stakeholders including the community, customers, suppliers, and employees. Since 1988, the chemical industry has engaged in a major self-regulatory "Responsible Care" industry-wide social responsibility campaign to ensure environmental, public health, safety, and security performance among member companies. Contrary to the arguments of advocates of corporate social responsibility that such efforts meet the needs of stakeholders other than shareholders such as the community, the primary goal of the Responsible Care effort has been to change public concerns and opinion about chemical industry environmental and public health practices while also opposing support for stronger and more expensive public health and environmental legislation and regulation of chemical products, even if warranted.     

Turning the tide: preserving community mental health services

As part of its continuing mission to serve trustees and staff of health foundations and corporate giving programs, Grantmakers In Health (GIH) convened a group of experts from the fields of philanthropy, research, government, and health care on September 19, 2002 to examine the status of community-based services for people with mental disorders. This Issue Dialogue, "Turning the Tide: Preserving Community Mental Health Services," explored how health grantmakers can support community programs that provide critical mental health intervention and treatment services to children and adults. This Issue Brief synthesizes key points from the day's discussion with a background paper previously prepared for Issue Dialogue participants. It includes quantitative and qualitative information on mental health, as well as profiles of public sector, private sector, and grantmaker strategies for promoting improvements.     

Using community-based participatory research to address social determinants of health: lessons learned from Seattle Partners for Healthy Communities.

Seattle Partners for Healthy Communities (SPHC) is a multidisciplinary collaboration of community agencies, community activists, public health professionals, academics, and health providers who conduct research aimed at improving the health of urban, socioeconomically marginalized Seattle communities. SPHC uses a community-based participatory research approach to address social factors that affect the health of these communities. This article describes three SPHC projects that focus on social determinants of health, particularly the development of social support and improving housing quality. The characteristics of community participation in each of these projects are discussed and show a spectrum of participation. Although projects successfully addressed proximal social factors affecting health, influencing more distal underlying factors was more difficult. Implications for researchers using a community-based participatory research approach and public health practitioners seeking to engage communities in addressing social determinants of health are presented.     

External collaboration and performance: North Carolina local public health departments, 1996

OBJECTIVES: This study examined the extent to which local public health departments in North Carolina collaborated with other groups and organizations, the health problems on which they worked together, and the effect of external collaboration on health departments' performance on core public health functions. METHODS: The author mailed a questionnaire asking about interactions with city and county government agencies, boards of health, schools, nonprofits, physicians/private clinics, community health centers/migrant clinics, community members, citizens' groups, state and federal agencies, and universities to all of the directors of local public health departments in North Carolina. Sixty-four directors returned the questionnaire, for a response rate of 74.4%. RESULTS: Local public health departments most frequently interacted with boards of health, state agencies, community members, schools, city and county government agencies, and nonprofit agencies. Large majorities reported productive relationships with boards of health, state agencies, city and county government agencies, schools, nonprofit agencies, and hospitals. Greater frequency of interaction with several types of partners was associated with better performance. CONCLUSIONS: While questions exist about whether performance on core functions improves the community's health status, the results suggest that it is important for local public health departments to continue to build relationships with other organizations in the community.     

Unsafe neighborhoods, social group activity, and self-rated health.

The purpose of this project was to assess the importance of stressors and social supports in influencing self-rated health in a community sample so that public health programs could be designed to address the root causes of poor health. The municipal health department in Amarillo, Texas, contracted for a Behavioral Risk Factor Surveillance survey in 2002. The dependant variable for the study was self-rated health. Results suggest that programs targeted at improving neighborhood safety and increasing involvement in organized social groups are needed. Public health agencies may need to collaborate with other governmental agencies in order to craft effective policies.     

Corporate philanthropy, lobbying, and public health policy

To counter negative publicity about the tobacco industry, Philip Morris has widely publicized its philanthropy initiatives. Although corporate philanthropy is primarily a public relations tool, contributions may be viewed as offsetting the harms caused by corporate products and practices. That such donations themselves have harmful consequences has been little considered. Drawing on internal company documents, we explored the philanthropy undertaken as part of Philip Morris's PM21 image makeover. Philip Morris explicitly linked philanthropy to government affairs and used contributions as a lobbying tool against public health policies. Through advertising, covertly solicited media coverage, and contributions to legislators' pet causes, Philip Morris improved its image among key voter constituencies, influenced public officials, and divided the public health field as grantees were converted to stakeholders.     

Institutional investors’ sustainability policies and the outcomes for the healthcare sector portfolios

The article reviews policies with respect to responsible investment in health as well as actual portfolio holdings in drug development firms by five large public pension funds in the US, Japan, Norway, the Netherlands and Canada. In spite of commitment to “sustainable corporate value”, no discernible tilt towards companies conducting research in the areas of high disease burden and unmet medical need is observed. Rather investments very closely track the size (market capitalisation) of the portfolio firms. A representative drug development company in portfolios of large public pension funds is constructed by taking a weighted average of product track records of individual companies included in those portfolios. The weights are based on the share of the fund's portfolio allocated to individual companies. According to this calculation, only 1 in 10 new medicines brought to the market by a representative drug development company makes a substantial contribution to illnesses they target compared to the existing treatments. Nevertheless, developing and sharing best practices for sustainable investment is a relatively new agenda pursued by large public and quasi-public asset owners worldwide, which presents an opportunity for the medical research community to contribute to meaningful guidelines for responsible evidence-based investment into commercial medical research.     

The voice of the public in public health policy and planning: the role of public judgment

Community involvement with public health planning and implementation are vital to improving community health. There are a variety of community health models that are available. We describe these four models from the perspective of how they involve the broader community. These models are evaluated from a different perspective about linking the community and politics and agencies, that involves naming issues, framing options, public deliberation and public acting. We suggest ways that these models can be further refined to connect citizens to the processes that we use for community health improvement.     

Victims of our own success: will immunization remain the paradigm of effective prevention? Grantmakers In Health

As part of its continuing mission to serve trustees and staff of health foundations and corporate giving programs, Grantmakers In Health (GIH) convened a select group of grantmakers and national experts who have made a major commitment to childhood immunization. The roundtable explored various factors influencing public acceptance of childhood immunization, with discussions ultimately centering on the importance of ensuring and conveying accurate information to the public and policymakers. Current and potential roles for health philanthropy were also discussed. This report brings together key points from the day's discussion with factual information on childhood immunization drawn from a background paper prepared for the meeting. When available, recent findings, facts, and figures have been incorporated.     

The state's role in promoting population health: public health concerns in Canada, USA, UK, and Sweden

Despite the expanding literature on the importance role public policy plays in influencing the broader determinants of the public's health, profound differences exist among jurisdictions in the attention placed by the State - as represented by public health authorities and agencies - upon such activities. In this paper we examine the dominant public health models of Canada, USA, UK, and Sweden. The Canadian and USA public health communities are focused upon individualized approaches to risk management. In contrast, the UK and Swedish public health scenes are more oriented toward broader approaches to health determinants. We argue that the extent to which governments, public health agencies and public health workers concern themselves with public policy approaches to address broader determinants of health depends upon the particular model of health adhered to within each jurisdiction. And whether a health model is adopted depends upon the ideological and political context within which a nation is situated. Canada represents a situation where concerted effort to influence governmental policy directions by the public health community could reap significant benefits.     

The social contract challenge in medical education

Medical education has been criticized for loss of touch with the health needs of society. A social contract implies that medical schools, their students and teaching staff have certain rights and privileges in return for serving society. Commitment to this important reciprocal relationship makes it necessary to ensure that medical students gain understanding of the basic health needs of the communities they will serve. Health, Illness and the Community (HIC) is a mandatory course in the first and second years of the curriculum at the University of Toronto. Its goal is to provide students with community learning experiences by involving over 300 community agencies as learning sites. The course takes place one half-day per week throughout first and second year. All 177 students initially work with patients in their homes and in public health units and related agencies. Students are then assigned to agencies using health determinants and health promotion strategies. In the second year, each student selects an agency in the community, and carries out for the entire year a major project focused on the interaction of a health problem with a social issue. This educational initiative has been received well by community agencies and patients. Teaching staff have been enthusiastic and students have performed very well. A major obstacle has been the negative attitudes of some students to community-based learning, but these appear to be improving with time. Involving multiple agencies as learning sites is a feasible method for enabling students to learn about community health needs.     

Encouraging big food to do the right thing for children’s health: a case study on using research to improve marketing of sugary cereals

Addressing concerns about unhealthy food marketing to children, food companies pledge to advertise only ‘healthier dietary choices’ in ‘child-directed media’. However, public health advocates question whether the food industry will voluntarily improve their child-targeted marketing practices in a meaningful way. In this paper, we evaluate progress made by manufacturers of one food category – ready-to-eat breakfast cereals – in promoting nutritious choices to children, and the potential role of scientific research to influence corporate behavior. Beginning in 2008, researchers at the Rudd Center for Food Policy & Obesity conducted a series of studies to evaluate child-targeted marketing by cereal companies using a variety of research methods. We aimed to understand the extent and impact of cereal marketing to children; disseminate these findings to parents, the media, the public health community, policy-makers, and industry representatives; and encourage cereal companies to shift child-targeted marketing toward the more nutritious products in their portfolios. A follow-up analysis in 2012 demonstrated some improvements in the nutritional quality and marketing of child-targeted cereals, although child-targeted cereals remain the least healthy products in company portfolios. This analysis provides a case study of the potential for success, as well as the limitations, of a public health strategy to incent food companies to voluntarily improve child-targeted marketing practices through strategic research and communications.     

2010年青岛市预防保健与社区卫生服务机构间分工合作情况调查分析

[目的]找出制约预防保健机构与社区卫生服务机构之间建立分工协作关系的症结,提出建设性意见。[方法]2010年,用6种调查问卷,对全市疾病预防控制、妇幼保健和12个社区卫生服务机构的负责人和工作人员进行调查,了解其合作关系状况、服务情况和效果等。[结果]72.22%的疾控人员、68.06%妇幼人员认为预防保健机构的技术指导滞后,90.28%的疾控人员、91.67%妇幼人员认为信息沟通不畅,65.28%的疾控人员、68.06%妇幼人员认为合作关系未理顺;不同机构对存在问题的态度存在显著性差异。[结论]应明确预防保健机构的职能定位,理顺其与社区卫生服务机构的合作关系,完善技术指导和信息报告制度,以促进基本公共卫生服务工作的顺利开展。     

Organizational capacity and implementation change: a comparative case study of heart health promotion in Ontario public health agencies

This paper reports the results of a comparative case study that examines factors influencing changes in implementation of heart health promotion activities in Ontario public health units. The study compared two cases that experienced large changes in implementation from 1994 to 1996, but in opposite directions. Multiple data sources were used, with an emphasis on secondary analyses of quantitative surveys of health units and other community agencies, and in-depth interviews of public health staff, collected as part of the Canadian Heart Health Initiative Ontario Project. Guided by social ecological and organizational theories, changes in implementation were explained by examining changes in (1) organizational predisposition to undertake heart health promotion activities, (2) organizational practices to undertake these activities, (3) other internal organizational factors and (4) external system factors. Findings show that in communities with diverse characteristics, implementation change was most strongly influenced by an interplay of changes in internal features of public health agencies; notably, leadership, structure and staff skills. Findings support a social ecological approach to health promotion by demonstrating the importance of the institutional context in the implementation change process, the interaction of individual (skills) and organizational (structure) levels in explaining implementation change, and community context in shaping the change process. Findings also reinforce the value of strengthening capacity within public health agencies and suggest further research on the implementation change process, especially in different systems and over longer periods of time.     

Shared vision,shared vulnerability: A content analysis of corporate social responsibility information on tobacco industry websites

Tobacco companies rely on corporate social responsibility (CSR) initiatives to improve their public image and advance their political objectives, which include thwarting or undermining tobacco control policies. For these reasons, implementation guidelines for the World Health Organization's Framework Convention on Tobacco Control (FCTC) recommend curtailing or prohibiting tobacco industry CSR. To understand how and where major tobacco companies focus their CSR resources, we explored CSR-related content on 4 US and 4 multinational tobacco company websites in February 2014. The websites described a range of CSR-related activities, many common across all companies, and no programs were unique to a particular company. The websites mentioned CSR activities in 58 countries, representing nearly every region of the world. Tobacco companies appear to have a shared vision about what constitutes CSR, due perhaps to shared vulnerabilities. Most countries that host tobacco company CSR programs are parties to the FCTC, highlighting the need for full implementation of the treaty, and for funding to monitor CSR activity, replace industry philanthropy, and enforce existing bans.     

Social inequality and healthy public policy.

For decades, health education programmes have been based on the assumption that individual behaviours (for example smoking, drug use, eating patterns) are the major risk-factors in contemporary illness. This assumption often led to interventions that subtly "blamed the victim" for his or her ill-health. In recent years the broader social conceptualization of health and illness has directed many health educators' attention towards socio-economic and environmental factors which condition and constrain lifestyle choices, and which may be directly associated with increased disease risks. While it is becoming common for government health departments and agencies to acknowledge poverty, unemployment and other forms of social inequality as potent health hazards, programmes to ameliorate such conditions are rare. Since 1983, the Toronto health department has developed programmes based upon a socio-environmental model of disease which specifically targets social systems rather than individual behaviour for change. Elements of this approach include extensive media reports on the health implications of such issues as welfare benefits, poverty, unemployment and housing; health education programmes to stimulate a critical understanding of the causes and structure of social inequality; health advocacy initiatives to influence political and legislative reforms; and a community development orientation which involves the department in broad-based coalitions working towards healthy social change. Most recently, the department has become a resource to groups attempting to create employment and service community needs through cooperative forms of economic development. Several examples of the department's programmes in each of these areas are provided. To meet the challenge of the World Health Organization's Alma Ata Declaration, health educators must examine their own potential to act as social-change agents, and must become more sophisticated in the political analysis of their practice.     

Building Community Disaster Resilience: Perspectives From a Large Urban County Department of Public Health

An emerging approach to public health emergency preparedness and response, community resilience encompasses individual preparedness as well as establishing a supportive social context in communities to withstand and recover from disasters. We examine why building community resilience has become a key component of national policy across multiple federal agencies and discuss the core principles embodied in community resilience theory—specifically, the focus on incorporating equity and social justice considerations in preparedness planning and response. We also examine the challenges of integrating community resilience with traditional public health practices and the importance of developing metrics for evaluation and strategic planning purposes. Using the example of the Los Angeles County Community Disaster Resilience Project, we discuss our experience and perspective from a large urban county to better understand how to implement a community resilience framework in public health practice.BUILDING COMMUNITY resilience to disasters—the ability to mitigate and rebound quickly—has received increased attention in the relatively new field of public health emergency preparedness and is now a central focus and a required activity for all public health departments that are recipients of Centers for Disease Control and Prevention (CDC) Public Health Emergency Preparedness (PHEP) grants.1 Critical lessons from Hurricane Katrina in 2005, the H1N1 pandemic of 2009, and, most recently, Hurricane Sandy continue to demonstrate that underlying issues of lack of trust and the absence of sustainable engagement with community-based organizations, faith-based organizations, and other neighborhood-level organizations create significant disparities in population health outcomes following emergencies and disasters. This situation hampers public health interventions in both everyday public health work and emergency response.2,3 As a theory and approach, community resilience provides a framework that embraces principles of equity and social justice with a focus on developing the core capacities of populations both to mitigate disasters and to rebound from them.4 The challenge is to clearly and operationally define community resilience, develop principles and practices that expand and enhance current community-based activities, and, through these changes, better align and integrate traditional public health and public health emergency preparedness.Although the term community resilience is relatively new to emergency preparedness, the emerging operational frameworks embrace many of the core components of effective community-based public health practice and, in many ways, represent a reframing of long-standing approaches to improve community well-being that have not been incorporated in preparedness programmatic activities.5We review the origins of the community resilience framework in the multidisciplinary research on individual resilience and assess how community resilience and related frameworks are shaping federal policies in all agencies involved in disaster and public health emergency response. We describe how the community resilience framework augments public health preparedness and reinforces longer-standing public health approaches to improving community health by examining a multiyear process developed by the Los Angeles County Department of Public Health (LACDPH) to implement this approach. The strategy consists of operationalizing community resilience through the following steps:

• Improving the community engagement skills of health department staff and building sustainable community engagement processes;
• Developing a resilience tool kit that can be used by community organizations to build coalitions and coordinated neighborhood strategies to increase community preparedness and specific mitigation skills; and
• Identifying metrics so that systematic interventions that can improve the abilities of communities to promote resilience and mitigate disaster impacts can be measured and evaluated.

     

Alcohol,ideological schisms and a science of corporate behaviours on health

Consensus is fast building in the public health community around the need to research and address the ‘industrial epidemics’ of non-communicable disease across both Global North and South. However, while it is agreed that the effects of corporate behaviour on health are serious, there have been limited attempts to map out what a ‘science’ of these interrelationships might be. To do this requires actively engaging with the ways in which corporate actors generate and shape risk behaviours, public perceptions and influence policy. Moving forward, this ‘science’ will inevitably require critical reflection on the consequences of the deepening ‘ideological schism’ within the public health community in its attitudes towards industry. To date, of all the ‘unhealthy commodities industries’, alcohol has arguably received the least empirical attention from researchers. This gap is even more significant given the growing adversity between the public health community and the industry from the national scale to that of the WHO. This paper explores the nature of the ideological schism within alcohol research and its significance for the future development both of a ‘science’ of the effects of corporate behaviour on health and the advocacy that will be needed to change future regulatory and business environments in more health-promoting ways.