Increasing Corporate and Business Domination of the Public Policy Agenda

Two threads in the public health literature focus on corporate and business influences upon health equity-related public policy. The first falls under the heading of the commercial determinants of health and focuses on how profit making drives the production and marketing of health threatening food and drink.76,154,155 The second focuses on corporate and business influences upon the quality and distribution of social determinants of health of income, housing and food, governmental supports, and health care.62–70,156,157

Holden and Lee detail two ways corporate power shapes public policy. Structural power is when governments have no choice but to safeguard the needs of business due to the ability of corporations to move elsewhere. 158 This may include reducing taxes on these corporations and the wealthy, reducing social spending, limiting the ability of workers to unionize, weakening legislation on employment security and working conditions, including wages and benefits, facilitating financialization of the housing market and food industries by large corporate interests and privatizing previous public institutions such as electricity, transportation, and health care. All of these serve to increase capital accumulation, but do at the expense of social reproduction, as indicated by declining quality and equitable distribution of the social determinants of health and access to health care.

When structural power is insufficient to achieve their goals, corporate interests turn to agency approaches of political engagement through direct lobbying and providing gifts and funds to politicians, as well as indirect lobbying and political activities (for example, via the creation and support of think tanks, consultancies and research institutes).159,160 Institutional participation (for example, with business people holding key positions on government commissions and boards of hospitals and schools) provides a further avenue for influence. 156