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How Private Companies Are Transforming The Public Health Agenda

Foreign Affairs:

During the 1970s and 1980s, the World Health Organization and other global health leaders often strove to improve the health of the world’s poor by targeting private sector excesses. They imposed restrictions, codes, and “ethical criteria” on the marketing of infant formula, pesticides, and tobacco, unnerving executives and stifling business plans. Success hinged on the cooperation of local governments, but where policymakers implemented recommendations they achieved real results. Breastfeeding rates rose, pesticide poisonings fell, and tobacco consumption declined.

Since then, the global health establishment has been turned on its head. Over the last two decades, the private sector has emerged as the world’s top source of financing and leadership in the fight against deadly disease. The resources of some of the private industry players involved in global health today dwarf those of the WHO. Groups such as the Global Business Coalition aim to turn “business assets into disease-fighting assets”; the GBC boasts a membership of nearly 200 companies, including multinationals such as Coca-Cola, Exxon Mobil, and Pfizer. Why the interest? Firms are responding to local demands for corporate social responsibility, but they also have come to realize, as they look to emerging markets for future growth, that underwriting public health is a long-term investment. As development economist Daniel Altman recently explained, in a global economy, “these people are your consumers, your workers, your investors.” Several former WHO officials now work on public health issues for private industry. Most telling is the fact that voluntary contributions from private interests and others now bankroll four out of every five dollars of the WHO’s budget.

The problem is that the companies most active in global health projects today hail from a narrow range of industries, many of which are under fire for their negative impact on public health. These private firms are playing a double game: disrupting local communities with one hand and writing big checks to ostensibly help them with the other. Often, their core financial interests are directly at odds with the business of improving the health of the poor, in ways that are distorting the global health agenda.

The extractive industry is a prime example. The mining industry, which includes oil and gas firms, has been at the forefront of many prominent global health projects. This year, the GBC handed out awards to six companies for their achievements. Mining multinational Rio Tinto was lauded for its anti-malaria work in Equatorial Guinea. The mining giant Gold Fields Limited was praised for HIV prevention efforts in Ghana. Anglo American has been widely praised in global health circles for providing free antiretroviral therapy to its HIV positive workers in Africa; its former chairman co-chairs the GBC. And ExxonMobil now contributes more money to fight malaria than any company outside the pharmaceutical industry.

But by its nature the mining industry’s core business of extracting natural resources is a disruptive process. Accordingly, these firms come to work on public health with blemishes on their reputations. Rio Tinto boasts successes against malaria in Equatorial Guinea, but in Papua New Guinea, the company dumped billions of tons of toxic wastes and was complicit in repressive violence that led to over 10,000 deaths, according to a class-action suit filed in 2000. Gold Fields has reduced sexually transmitted infections by its mineworkers in Ghana by 90 percent since 2004, but local NGOs and independent experts report that its operations there have contaminated waterways with dangerously high concentrations of heavy metals, depriving local villages of drinking and irrigation water. Anglo American plays a leadership role in global health circles, but a former UN High Commissioner for Human Rights has called the company’s exploitation of land and water around mines in Ghana a “violation of communities’ right to maintain a sustainable livelihood.”

These examples speak to more widespread environmental disruptions committed across the mining industry: in Nigeria’s oil-rich Niger delta, for instance, oil companies — including ExxonMobil — contaminated local waterways and fishing grounds with more than 2.4 million barrels of spilled oil between 1976 and 1996, according to Nigerian government analyses. After the oil companies launched community development programs to stanch criticism, the anti-poverty charity Christian Aid called the Niger delta a “veritable graveyard of [such] projects, including water systems that do not work, health centers that have never opened and schools where no lesson has ever been taught.”…

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Fraud Scandal Fuels Debate Over Practices of Social Psychology

The Chronicle Of Higher Education:

The discovery that the Dutch researcher Diederik A. Stapel made up the data for dozens of research papers has shaken up the field of social psychology, fueling a discussion not just about outright fraud, but also about subtler ways of misusing research data. Such misuse can happen even unintentionally, as researchers try to make a splash with their peers—and a splash, maybe, with the news media, too.

Mr. Stapel’s conduct certainly makes him an outlier, but there’s no doubt he was a talented mainstream player of one part of the academic-psychology game: The now-suspended professor at Tilburg University, in the Netherlands, served up a diet of snappy, contrarian results that reporters lapped up.

Consider just two of his most recent papers: “Power Increases Infidelity Among Men and Women,” from Psychological Science, and “Coping With Chaos: How Disordered Contexts Promote Stereotyping and Discrimination,“ from Science—two prestigious journals. The first paper upended a gender stereotype (alpha-female politicos philander, too?!), while the second linked the physical world to the psychological one in a striking manner (a messy desk leads to racist thoughts!?). Both received extensive news coverage.

Even before the Stapel case broke, a flurry of articles had begun appearing this fall that pointed to supposed systemic flaws in the way psychologists handle data. But one methodological expert, Eric-Jan Wagenmakers, of the University of Amsterdam, added a sociological twist to the statistical debate: Psychology, he argued in a recent blog post and an interview, has become addicted to surprising, counterintuitive findings that catch the news media’s eye, and that trend is warping the field.

“If high-impact journals want this kind of surprising finding, then there is pressure on researchers to come up with this stuff,” says Mr. Wagenmakers, an associate professor in the psychology department’s methodology unit.

Bad things happen when researchers feel under pressure, he adds—and it doesn’t have to be Stapel-bad: “There’s a slippery slope between making up your data and torturing your data.”

In September, in comments quoted by the statistician Andrew Gelman on his blog, Mr. Wagenmakers wrote: “The field of social psychology has become very competitive, and high-impact publications are only possible for results that are really surprising. Unfortunately, most surprising hypotheses are wrong. That is, unless you test them against data you’ve created yourself.”

Is a desire to get picked up by the Freakonomics blog, or the dozens of similar outlets for funky findings, really driving work in psychology labs? Alternatively—though not really mutually exclusively—are there broader statistical problems with the field that let snazzy but questionable findings slip through?

Statistical Significance

Discovering important results in small samples of test subjects is always a tricky business, and psychologists who want to reform the field’s practices have noted that much hinges on the statistical tools used.

To show just how easy it is to get a nonsensical but “statistically significant” result, three scholars, in an article in November’s Psychological Science titled “False-Positive Psychology,”first showed that listening to a children’s song made test subjects feel older. Nothing too controversial there.

Then they “demonstrated” that listening to the Beatles’ “When I’m 64″ made the test subjects literally younger, relative to when they listened to a control song. Crucially, the study followed all the rules for reporting on an experimental study. What the researchers omitted, as they went on to explain in the rest of the paper, was just how many variables they poked and prodded before sheer chance threw up a headline-making result—a clearly false headline-making result.

The odds of statistical bogosity grow when researchers don’t have to report all the ways they manipulated their data in exploratory fashion. For example, the researchers “used father’s age to control for baseline age across participants,” thereby fudging the subjects’ actual ages. They factored in lots of completely irrelevant data. And, rather than establish from the outset how many subjects they would test, they tested until they obtained the false result.

The authors of that provocative paper were Joseph P. Simmons and Uri Simonsohn of the University of Pennsylvania, and Leif D. Nelson of the University of California at Berkeley. “Many of us,” they wrote—”and this includes the three authors of this article”—end up “yielding to the pressure to do whatever is justifiable to compile a set of studies that we can publish. This is driven not by a willingness to deceive but by the self-serving interpretation of ambiguity. … “

In a forthcoming paper, also to appear in Psychological Science, Leslie K. John, an assistant professor at Harvard Business School, and two co-authors report that about a third of the 2,000 academic psychologists they surveyed admit to questionable research practices. Those don’t include outright fraud, but rather such practices as stopping the collection of data when a desired result is found, or omitting from the final paper some of the variables tested.

And Mr. Wagenmakers himself was an author of a paper this year, “Why Psychologists Must Change the Way They Analyze Their Data: The Case of Psi.” It appeared in the Journal of Personality and Social Psychology, inspired by that journal’s publication of a much-discussed, and much-ridiculed, paper on “psi,” or psychic phenomena, like “precognition,” or perceiving an event before it occurs.

The Cornell University psychologist Daryl Bem had reported evidence that people could predict the future at a better-than-chance rate under some circumstances—whether an image would appear on the left or right side of a screen, for instance. That such a hypothesis could be “proved” in labs, even though clearly no one is getting rich by deploying psi in casinos, was more than a little problematic, Mr. Wagenmakers argued. Only dubious statistics could explain such a finding, he said.

The technical complaints about current statistical testing in psychology are by now familiar to those in the field. The standard measure of “statistical significance” is the “P value,” which indicates the likelihood that a result is due to chance. By definition, a P value of 0.05 means there’s a 1-in-20 likelihood the finding is a fluke. Add the researcher’s freedom to explore multiple variables without reporting the extent of the searching in the final paper, and problems multiply. Add the so-called file-drawer effect—failed attempts to establish correlations seldom get published, but the odd lucky strike will—and the problems multiply further.

The Great Headline

Mr. Wagenmakers adds an argument involving a feedback loop between researchers looking for surprising findings and news media hungry to report them.

Unlike most other critics, he’s not afraid to call out specific papers that he thinks are bogus: “Through prestigious publications and extensive media coverage,” he writes in a draft of a new paper, a portion of which he shared with The Chronicle, ”the general public has been informed that engineers have more sons and nurses have more daughters, … that people choose spouses, places to live, and professions because they share letters with their name (e.g., Jenny marries Jim, Phil moves to Philadelphia, and Dennis becomes a dentist, … that people make better decisions when their bladder is full, … that ovulation makes it easier for women to distinguish heterosexual from homosexual men, … and that brief exposure to an image of the American flag can push people toward the Republican end of the U.S. political spectrum, even when the flag image was presented eight months earlier.”…

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Citizen Consumer, Ethical Consumption

Boston Review:

June 29, 2007 I waited in line for hours—something I hadn’t done since college rock-concert days—for the privilege of purchasing a first-generation iPhone. From the increasingly frenzied media coverage, I knew everything about the phone’s specs: its processor, memory, screen size, camera resolution, software. But I knew virtually nothing about the story behind the phone. I didn’t know where it was made, by whom, or with what effects on the environment, workers, communities, even my health.

My ignorance began to change as Greenpeace and other nongovernmental organizations (NGOs) launched campaigns highlighting Apple’s use of toxic chemicals and the iPhone’s contribution to the growing problem of “e-waste.” By August 2009 reports started to surface in China about worker illnesses at a factory owned by Wintek, one of the contractors producing iPod and iPhone screens. In January 2010 Wintek employees went on strike over poor conditions, exposure to toxic chemicals, and resulting illnesses. Later that spring Chinese newspapers reported a spate of worker suicides at the Shenzhen factory of one of the main suppliers for iPhones, Foxconn.

Apple, revered as one of the world’s most innovative consumer-products companies, almost overnight became a symbol of worker exploitation. Apple’s core customers, usually unwavering in their loyalty, debated the scandals on blogs such as Apple Insider and Mac Rumors. After the Foxconn suicides, the technology critic Joel Johnson concluded in Wired:

I can no longer look at the material world as a collection of objects but instead see interfaces, histories, and materials. . . . When 17 people take their lives, I ask myself, did I in my desire hurt them? Even just a little? And of course the answer, inevitable and immeasurable as the fluttering silence of our sun, is yes.Apple was forced to respond to these concerns. In June 2010 Tim Cook—then the company’s chief operating officer and now its CEO—was dispatched to China to inspect Foxconn with a team of auditors. Foxconn quickly announced a 30 percent pay raise for their workers, which Apple partly funded out of reduced profits on iPads and iPhones. In February Apple released a “Supplier Responsibility Progress Report” that documented rates of noncompliance in their supplier factories, admitted worker illnesses at Wintek, acknowledged that Apple had been forced to terminate contracts with three suppliers, and discussed the company’s response to the suicides at Foxconn. Past reports had not so much as acknowledged the names of suppliers. In August, in what the Financial Timescalled a “highly unusual move for Apple,” the company agreed to sit down with environmental critics in China to talk about pollution from its suppliers.

In the past, scandals such as these would probably not have reached the public’s attention. Few outside of the byzantine world of global supply chains had ever even heard of Foxconn, despite its position as the world’s largest manufacturer of electronics. But today a global network of labor and environmental activists helps to bring such stories to the mainstream. And as consumers become aware of labor and environmental issues, they seem to care more.

It is tempting to write off such avowed interest. Survey after survey shows that 30–70 percent of consumers want to buy greener, healthier, more socially responsible products, but there is a massive gap between what consumers say they care about and what they actually buy. Yet it would be an error to disregard consumers as agents in creating more just and green manufacturing and supply chains. In the United States almost 70 percent of GDP is driven by what the government calls “personal consumption expenditures,” a sizable portion of which is consumer products.

Not only do consumers have clout, but traditional state and intergovernmental regulation has failed to ensure ethical manufacturing. Global production systems continue to challenge the capacities of states, international organizations such as the United Nations, and NGOs to curb labor and environmental exploitation and human rights violations. Complex cross-border transactions, rapid movement between suppliers, and limited transparency have made it virtually impossible for national governments to regulate global production. The U.S. government does not regulate the production methods of U.S. firms operating in other countries (in part because of WTO rules), and the Chinese government has shown little inclination and even less capacity to regulate companies such as Foxconn, which is now China’s largest private employer. NGOs, which are effective in advancing transparency and alerting consumers to problems in supply chains, are less able to monitor and enforce compliance with global standards and, aside from the threat of public exposure, lack mechanisms with which to incentivize supply-chain improvements.

Even in low-tech industries such as apparel, the supply chains linking the cotton fields of Uzbekistan to weavers in Southeast Asia to cut-and-sew operations in China have been more effectively influenced by consumer-focused campaigns than by national governments and international organizations. Consumers have directly targeted global brands, including Nike, Gap, and Levi’s. Similarly, in electronics, consumer campaigns in the United States and Europe have done more to focus attention on resource conflicts in Africa (particularly those surrounding tungsten, tin, and tantalum coming from the Congo), water pollution, and labor rights in China than have government initiatives. Even when governments regulate—as the U.S. government has via new reporting requirements for conflict minerals—they often do so only after the launch of consumer-focused campaigns.

Consumer campaigns have more effectively influenced manufacturing than has government regulation.

Consumers thus emerge as a crucial point of leverage: they can provide muscle for NGOs by generating feedback that can harm sales of global brands, pressure companies to change suppliers or to demand improvements, and create market opportunities for “better” products. Roberta Sassatelli paraphrases fellow sociologist Ulrich Beck, who has argued:

If modernity is a democracy oriented to producers, late modernity is a democracy oriented to consumers: a pragmatic and cosmopolitan democracy where the sleepy giant of the ‘sovereign citizen-consumer’ is becoming a counterweight to big transnational corporations.Consumers, however, are mostly still sleeping and are rarely truly sovereign. We are often irrational and driven by habit, fear, and concern for status. But while consumers may not be the all-powerful citizens voting with their dollars that Beck and others hope for, we do have agency. And under certain conditions and given certain decisions, we can be reflective and sometimes even political.

The critical question is how big a role do consumers actually play, and can we do more?

What Is Ethical Consumption?

Calls for ethical consumption have existed since the early days of capitalism. The patriots who organized and participated in the original Tea Party boycotted British goods and encouraged coordinated consumer action. In the 1890s consumers leagues—which would in 1899 coalesce as the National Consumers League—issued “white lists” to help consumers identify companies that treated their workers fairly. A continent away Gandhi’s Swadeshi movement called for Indians to buy Indian-made rather than British products.

Ethical consumption today covers a wide range of issues and agendas. Fair trade and organics are the two most prominent areas of concern, but ethical consumers also care about sweat-free, locally made, union-made, and environmentally friendly products; artisan production; collaborative consumption—sharing instead of buying; slow food; farmers’ markets; do-it-yourself manufacturing; non-genetically modified (GMO) food; humane animal treatment; and voluntary simplicity…

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Hot Stock Tip

This image has been posted with express written permission. This cartoon was originally published at Town Hall.

Negotiations Explained

This image has been posted with express written permission. This cartoon was originally published at Town Hall.