Researching Corporations and Global Health Governance

An Interdisciplinary Guide

Kelley Lee, Benjamin Hawkins

• Publisher: Rowman & Littlefield International
• Year: 2016
• ISBN:
  9781783483617
• Edition: 1
• Topic: Social Sciences
• Subtopic: Global Development Studies
• Index: Social Sciences

The profound changes to the world economy since the late twentieth century have been characterised by a growth in the number and size of transnational corporations. In this context, there is now increasing evidence of unprecedented reversals in health indicators among populations around the world. Research in this area has focused on documenting the global health impacts arising from the economic activity of corporations. The challenge for public health researchers is to understand the ways in which corporations are regulated by, and participate in global health governance and implications for health and well-being across the globe. This book is an introductory guide to conducting research on the role of corporations in global health governance from a range of disciplinary perspectives and gives an overview of different approaches, methodologies and data sources.
Also, for case studies providing interdisciplinary empirical analysis of the impact of corporations on global health and global health governance, see the partner volume: http://www.rowmaninternational.com/books/case-studies-on-corporations-and-global-health-governance

Chapter 1

Researching Corporations and Global Health Governance

Kelley Lee, Benjamin Hawkins and William H. Wiist

The increased importance of corporations in societies worldwide, since the end of the Second World War, has been widely acknowledged by scholars, policymakers and practitioners across a range of disciplines and fields (Sklair 2001; Fuchs 2007). This attention initially focused on the growing concentration of economic resources in the hands of a small number of increasingly large corporations within key industrial sectors (Gelles 2014). This economic might led to growing concerns about the capacity of corporations to influence political processes at the national level (Wilks 2013). By the late twentieth century, however, the accelerating processes of globalisation, and the consequent growth of transnational corporations (TNCs) whose business interests transcend national frontiers, led to increasing concerns about the exercise of corporate political power beyond and across states (Korten 2001; Bakan 2004; George 2015).

Concerns about the increasing political power of TNCs arise from three key developments. First, corporate activity has shifted into spheres traditionally deemed to be located in the public sector such as health and education (Wiist 2006). Corporations are no longer just economic actors but position themselves as key stakeholders in policy debates and are increasingly involved in the development and implementation of policy measures. Second, corporations are able to exert significant influence on policy at both the national level and global level (Fuchs 2007), including the United Nations through initiatives such as the Global Compact (Fall and Zahran 2010). Third, the proliferation of bilateral and regional trade agreements concluded during the early twenty-first century, potentially extending the legal standing and rights of corporations to challenge public policy making, may embed corporate political power further (Hawkins and Holden 2016). Through these processes, the interests of TNCs come to be institutionally protected and promoted, while the regulatory capacity of public institutions to act in the collective interest is undermined. This volume and the accompanying one (Kenworthy, Mackenzie and Lee 2016) are a response to these concerns, which aim to support a complete understanding of these developments and to inform more effective responses to them.

CORPORATIONS AND GLOBALISATION

While the focus of this book is on the role of corporations in global governance in the early twenty-first century, it is important to acknowledge the historical context of contemporary challenges. Over the course of the twentieth century, corporations became the most powerful form of economic organisation. As they outgrew their domestic markets, they looked beyond their home countries for ‘emerging markets’ in order to effectively compete in an increasingly globalised world economy. At the same time, high-income countries (particularly in Europe and North America) remain the headquarters of most of the largest TNCs. The resultant structure of the world economy, in many ways, is an extension of a colonial history whereby ‘discovered’ lands are taken, natural and human ‘resources’ are usurped and commodified and local societies are fundamentally altered to fit with the acquisitive and profit-seeking rationale of capitalism (Johnson 2013).

Corporate-led economic globalisation, in this form, has impacted all societies worldwide but is layered upon historically embedded inequities. The concepts of ‘Global North’ and ‘Global South’ reflect this perpetuation of colonial principles and practices (Stewart-Harawira 2005; George 2015). The former is advantaged by mobility of capital, labour and ideas, which are used to institutionally expand and reinforce privilege. Access to capital, favourable tax regimes, circumscribed regulatory oversight and public subsidies to support certain forms of economic activity are all examples of embedded advantages, which have enabled corporations to expand and extend their global reach (Farnsworth 2004, 2012, 2013).

The starting point for this book is that corporations are social constructs, defined and enabled by particular normative frameworks, and distributions of material power (Polanyi 1957). Direct forms of influence include lobbying, political campaign contributions and public communications. Corporate interests are furthered by networks among themselves, as to elite levels of state and market institutions (Vitali, Glattfelder and Battiston 2011). These networks extend to international organisations, such as the Group of Twenty, Organisation for Economic Co-operation and Development, World Economic Forum, World Trade Organisation, World Bank and International Monetary Fund (IMF), which govern the increasingly globalised world economy. In addition, corporations further their interests through the regulation of capital markets, forms of corporate governance, philanthropy, business associations and alliances, consultative bodies and public–private partnerships. As Polanyi (1957, 44) described, ‘No economy prior to our own, even approximately [has been so] controlled and regulated by markets.’

While remarkably efficient at mobilising and generating absolute levels of wealth, corporations have created complex patterns of inequity within and across societies worldwide. The ‘losers’ from the late twentieth-century economic globalisation suffer undue levels of hardship, in part, from historical disadvantage and, in part, by bearing a disproportionate share of the consequent social and environmental costs. These costs include financial insecurity and instability, environmental degradation, reduced social protections and lack of access to basic needs. These detrimental effects have led to popular resistance worldwide, broadly described as an anti-globalisation movement, embracing indigenous people’s protests against extractive industries (Dunbar-Ortiz 2014), Occupy protests against the extreme concentration of the world’s wealth in a few hands, popular protests against trade agreements and austerity measures and the rise in support for radical left- and right-wing political parties. In short, corporate-led globalisation has restructured and divided societies at a pace that has raced ahead of the commensurate development of global governance institutions which are needed to, inter alia, regulate the adverse social and environmental impacts of corporate activity, address market failures and achieve a fair distribution of the costs and benefits arising from globalisation. The present weakness of such institutions is contributing to an increasingly unsustainable world order. Research to strengthen global governance, in ways that meet these complex challenges, must thus address the role of the corporation.

EXISTING LITERATURE ON CORPORATIONS AND GLOBAL HEALTH

Corporations have long been on the analytical radar of the health research community (Relman 1980). Debates about the appropriate balance between the public and private sectors in health financing and service provision date from the establishment of public health systems during the nineteenth century (Freeman 2000). The theme of health reform has been ongoing in high-income countries, intensifying during the debt crises of the 1970s and the rise of neoliberalism and intensifying with the global financial crisis since 2008. This period has seen widespread retrenchment of the public sector via policy measures ranging from privatisation to the introduction of market-inspired practices in the public sector (Hoffman 2003). While these processes were first evident in high-income settings, since the 1980s, they have spilled over to low- and middle-income countries. For example, the introduction of Structural Adjustment Programmes, as a conditionality of World Bank and IMF financing, pressured debtor governments to reduce the size of the public sector. The subsequent increase of private sector actors, including corporations, in the provision of key public services and utilities has received substantial research attention (Freeman 2000; Marquand 2004; Brezis and Wiist 2011).

The epidemiological shift, from communicable to non-communicable disease (NCD) burdens, has focused largely on the contribution to these trends of health-harming industries. The focus to date has largely been on documenting the impacts of certain industries, notably tobacco, alcohol and processed food, on health determinants and outcomes (Jahiel 2008; Stuckler et al. 2012; Baum et al. 2016). Not only the strategies that corporations use to produce and market goods and services with adverse health impacts but also their efforts to prevent or weaken regulation of their activities have become a major concern for the public health community (Michaels 2008; Wiist 2010; Freudenberg 2016). These concerns have divided the public health community on the risks and benefits of engaging with corporate actors (Alexander, Yach and Mensah 2011; Gilmore, Savell and Collin 2011).

A further source of health research on corporations has been the study of global health governance (GHG). GHG research that began in the 1990s heavily focused on the institutional arrangements for collective action. The strengths and weaknesses of specific international organisations, notably the World Health Organization (WHO), have been the subject of much pondering (Walt 1993; Forss, Stenson and Sterky 1996; Lee et al. 1996; Vaughan et al. 1996). By the early 2000s, the growing number of public–private partnerships led to scholarly efforts to understand what they do, assess their effectiveness at achieving global health goals and advise on how they might operate more effectively (Buse and Walt 2000; Widdus 2001). By the mid-2000s, an important distinction began to be drawn, between private sector actors as providers of health financing and services, on the one hand, and participants in rule-making (governance), on the other (Ståhl et al. 2006). Buse and Lee (2005), for example, review the diverse roles of the ‘commercial sector’ in GHG. A rich literature has since emerged, documenting and interrogating how corporate influence is exerted in GHG (Gill and Benatar 2016).

PURPOSE OF THIS BOOK

This book seeks to support an expanded research agenda on corporations and GHG. This is a complex endeavour, both intellectually and practically, requiring multi-disciplinary perspectives, conceptual and theoretical innovation, mixed-method approaches and diverse data sources. The book is an introductory guide to how researchers in different scholarly disciplines approach this subject and how further research could be undertaken to strengthen knowledge and practice. More specifically, as the companion volume to Case Studies on Corporations and Global Health Governance (Kenworthy, MacKenzie and Lee 2016), this book seeks to make three distinct contributions.

First, although research on corporations is being undertaken within many fields and disciplines, a detailed study of corporations and GHG is limited. The book aims to strengthen understanding, and support the development, of new research on a critical aspect of global health at a time when policymakers seek to build more effective forms of collective action. Second, much of the existing literature has been polarised and even deadlocked (Hernandez-Aguado and Zaragoza 2016), with advocates for more public–private partnerships (Majestic 2009; Sturchio and Goel 2012; Quelch 2016) lined up against critics of corporate involvement in policy making and implementation (Richter 2001; Benatar, Bill and Bakker 2011; Hastings 2012). This volume and the accompanying one are intended to stimulate the new application of theories and concepts, and to generate empirical evidence, for understanding and regulating the health-related activities of corporations as a core function of GHG. Third, research on corporations and GHG to date has tended to focus on selected and individual industries. The result is fragmentation of research and public policy. There is a clear need to bring together diverse scholarships across time, space, populations and industries (Brownell and Warner 2009; Dorfman et al. 2012), perhaps through the application of complex systems theory (Hill 2011; Haffeld 2012), in order to draw together findings about the corporation as a health-impacting societal institution (Wiist 2006). Ultimately, the books aim to help rebalance the institutional checks and balances required for sustainable human and planetary health.

KEY CONCEPTS AND TERMINOLOGY

Research on corporations and GHG is hindered, to some degree, by conceptual inconsistency and confusion. This is due, in part, to differences across academic disciplines in the ways in which frequently used terms are defined. While acknowledging disciplinary differences, we provide definitions for key concepts and terms used in this book. In some cases, it is challenging and even impossible to fully reconcile different scholarly traditions and values. Moreover, the study and practice of GHG is divided by diverse normative frameworks (McInnes and Lee 2014). The definitions provided are starting points for this book, which, as part of an expanded research agenda, encourages reflexivity by researchers on how the subject is studied.

The term private sector is a useful starting point for locating the subject of this book, which can be broadly defined as those parts of a society that are not a direct part of, or under the control of, government. The private sector can, in turn, be divided into organisations that operate as for-profit and not-for-profit. Buse and Lee (2005, 6) define the commercial sector as the former, namely ‘organisations that seek to make profits for their owners (e.g. firms increasing shareholder value). Profit, or a return on investment, is the central defining feature of the commercial sector’. This distinction can often be left unclear, and even conflated, in health research. For example, Sturchio and Goel (2012, 3) appear to refer to both for-profit and not-for-profit organisations when they write, ‘The central question is not whether the private sector has a role to play … in many developing countries the majority of health care services are already delivered through the private sector – but how to put the particular skills of the private sector to best use.’

The term corporation most often evokes images of large companies, like Coca-Cola or Sony, operating and pursuing markets worldwide. However, it is important to define the specific nature of the corporation, as a particular type of business entity, if we are to understand how it has grown so powerful and what regulatory responses are needed to protect global health. The corporation as an economic institution first emerged in the sixteenth century (Nace 2003, 23). There are many ways to structure the ownership of a business: state or private; sole proprietorship, partnership or limited partnership; for-profit or not-for-profit; limited liability; and corporation (and cooperative). As Bakan (2004, 6) describes:

Unlike the prevailing partnership form, in which relatively small groups of men, bonded together by personal loyalties and mutual trust, pooled their resources to set up businesses they ran as well as owned, the corporation separated ownership from management – one group of people, directors and managers, ran the firm, while another group, shareholders, owned it.

This book is thus primarily concerned with research about large, for-profit corporations whose stock is publicly traded (or privately held) and whose operations transcend national boundaries.

The term global health is used to mean health issues that fall within one of four categories:

1. Transboundary or crossborder problems, which originate in one state but have ramifications for others (e.g. communicable disease outbreak)
2. Commons problems, which concer...