Corporations have become one of the primary arbiters of our health.
- They manufacture poor health, from tobacco to ultra processed food to fossil fuels.
- They ruin our environment, polluting our air, water, and land.
- They steal our attention, with smartphones and social media platforms painstakingly designed to addict, clickbaiting us into oblivion.
- They devalue our labor, hoarding profits, busting unions, and refusing to offer sufficient paid leave or living wages.
- They destroy competition, with private equity takeovers and monopolies, leaving us with fewer options and fewer resources.
- They corrupt our politics, buying political influence with campaign donations, putting their profits above people, public health, and the planet.
The ways that corporate interests, driven by their profits, shape public health are called the commercial determinants of health (CDoH). These commercial determinants often underlie the social determinants of health that the field of public health has traditionally focused on. We cannot effectively change the social determinants of health without addressing the commercial determinants that lie further upstream.
These commercial determinants are deeply intertwined with capitalism, with its focus on profits to private actors above all else (including public health). Corporations are the private actors that rake in the most profits – and perpetrate the most harm – in our capitalist system, and thus must be a key focus of any effort to reshape our society to prioritize the health and well-being of people and the planet.
The impact of commercial determinants is particularly insidious because beyond the direct and indirect harms they cause, corporate interests distract, deny, and deceive at every turn. Big Tobacco hid evidence about the dangers of smoking cigarettes, Big Pharma lied about how addictive their painkillers were, Big Oil scammed the public into thinking plastic would be recycled, NFL covered up concussions, and Meta hid research about the negative impact of Instagram on teens. The list goes on.
To add insult to injury, these very corporations are blaming us – you and me – suggesting it is our lack of discipline and willpower that is the real problem. It is our fault that we struggle to limit our intake of drugs and foods and social media that they meticulously design to be addicting. We are the ones that need to watch our carbon footprint despite the fact that the largest companies are not only responsible for the vast majority of harmful emissions but lobby actively against laws that might help protect the planet. We should just make different choices in environments that they have manipulated to make the choice that profits them the easiest – and sometimes the only – choice.
This focus on blaming individuals for poor health outcomes further entrenches racism, reinforcing harmful stereotypes and turning attention away from systemic solutions. If – as food and beverage companies would have us believe – obesity is a product of poor individual choices, then high rates of obesity in Black communities must be due to Black people’s lack of self-control, not the concentration of fast food restaurants and targeted marketing of unhealthy foods to those communities. If – as pharmaceutical companies would have us believe – the opioid epidemic is a result of “abusers” and “reckless criminals” (descriptions Richard Sackler used in urging his colleagues to blame patients), then high rates of addiction in rural communities must be due to residents of these communities being ignorant and lawless, not the promotion of opioids to physicians by pharmaceutical companies who likely saw the combination of high rates of workplace injuries and Medicaid coverage in these regions as a sure pathway to higher profits.
This focus on blaming individuals also serves to leave us pointing fingers at each other, instead of the corporate interests that are truly to blame.
Many of us recognize the harms caused by corporations. However, it is easy to feel powerless in the face of corporate power. After all, corporations and their leaders have billions (and billions) of dollars and direct lines of influence to our politicians. How are we to compete?
Here is the truth: we are only powerless alone. We are not powerless together.
This is not an underdog story. It is a teamwork story. And communities across the country are showing us the way.
- In Pittsburgh, neighbors stopped a corporate water takeover, keeping water public, safe, and affordable.
- In Missouri, families won earned sick days and fair pay at the ballot box.
- In Oregon, farmers and residents won protections from factory farms harming local health and economies.
Let’s look at the Pittsburgh water campaign as a prime example of what is needed for a community coalition to succeed in the fight against corporate power. A few key factors played into their big win:
- They were already rooted in the community. Pittsburgh United was a coalition of community organizations that, well before this particular water crisis, had already been engaged with the city’s water authority around a clean rivers campaign, and separately, had been working on expanding affordable housing with the very same communities now most impacted by water shutoffs and rising water costs. This meant they had relationships and trust, with both the community and the water authority. They also had understanding and practice actually doing the organizing and communications work.
- They built a diverse coalition. They were able to convene community groups from across the city (many of whom were already part of their existing campaigns around clean rivers and affordable housing). Their coalition included a wide range of groups and advocates that cared not just about water, but housing, economic justice, and environmental justice. This enabled them to work across organizing siloes (as is necessary, given how interconnected all these social justice issues are), increased the size of their coalition (which enables greater reach and impact), and made others in the community and city council pay more attention to them.
- They played the inside-outside game. The coalition recognized the importance of finding allies inside the government and knew from its work on clean rivers that state water authority employees were sympathetic to their cause. By working with the state water authority, the coalition was able to get them to take helpful steps (e.g., creating a community advisory committee to oversee the public water utility, establish flexible payment plans, etc.).
These key elements helped them build community power, without which we cannot effectively fight corporate power.
On a more individual level, we can each take steps towards building community power:
- Text your neighbors, your local friend group, your book club, your church group, your basketball team, whoever your people in your local community are. Find a time to get together IRL and be intentional about what you will do in that time. Here are some options to consider: check in on how they are, discuss how you all can help each other, share how connected you each feel to your community (and what might help strengthen that), and find out if there are any local policy issues folks are interested in working together on. Whatever set of questions feels right for your particular group, explore them. Before any meaningful organizing or joint action can happen, you have to feel a sense of community and connection. At the end of the day, all of these fights are a fight with and for each other. As you move towards strategic organizing and collective action, consider applying community organizing frameworks and tools, including power analysis and mapping.
- See when your next local school board, planning commission or health coalition meeting is and put it on your calendar to attend (take a neighbor with you if you can!). Before you have a sense of what to advocate for locally, you need a lay of the land, an understanding of the key players, and a better understanding of where decision making takes place locally. This is key to figuring out when and how and with whom to engage. Attending local meetings like this can also help you gain more information about the pros and cons of various policies under consideration. Before you can have your voice heard, you have to be present and informed.
- Find your local newspaper, news website, radio station, or other media outlet – start reading/listening, subscribe to it if you can, and keep it in mind if you advertise for your company. Strong local newsrooms help us: hold local public officials, agencies, and businesses accountable; investigate community problems; highlight community solutions that work; and build community connections.
Beginning with these steps, we can take action—at a coalition level and individual level—in ways that work towards building community power and breaking corporate power.
To build community power, we need to think about:
- creating, joining, and strengthening labor, community, and advocacy groups locally,
- cultivating local businesses and co-ops,
- transforming land use policy to prioritize community connection, and
- rebuilding local news.
To break corporate power, we need to advocate for:
- getting government to stop paying corporations to cause harm (via subsidies, tax breaks, and the like),
- reducing corporate interest corruption (including corporate money in politics, corporate influence on regulatory boards, and so forth), and
- increasing competition.
Together, we can reclaim our health, our planet, and our future. Let’s go.
Authored by Vinu Ilakkuvan
Vinu Ilakkuvan, DrPH, is passionate about strengthening community-driven efforts to address the upstream, root drivers of health (pophealthllc.com/tedx). She is Founder and Principal Consultant of PoP Health, a public health consulting practice that partners with community coalitions to transform health in their communities through policy and systems change. Vinu believes deeply that the social drivers of public health are shaped by commercial and political determinants, and that protecting and advancing public health requires addressing the impact of corporations and their economic and political power through collective action. She has written extensively on commercial determinants of health and recently launched GASLIT, a project focused on building community connection and power – and reducing corporate power – in ways that strengthen and support community health.
