First, foundations may extract revenue from products that are harmful to health. The stock on major determinants of NCDs —highly processed foods and sugary drinks- deserves attention given the low priority the Foundation gives to NCDs, despite their growing importance in the global burden of disease. Activists in the access to medicines movement have publicly criticised this stance [ 74 ] given his involvement in initiatives such as GAVI or the Global Fund that rely heavily on relationships with the pharmaceutical industry to secure access to drugs.
The corporate co-option of grassroots formations - e. It confers legitimacy to industry claims, it deflects criticism from public health advocates and serves as a media response tool. Under the guise of a patient constituency, for instance, pharmaceutical industry founded and funded patient advocacy organisations may pressure third party payers to pay for certain drugs regardless of efficacy or efficiency or regulatory agencies for drugs to enter the marketplace more quickly despite the potential harms of an expedited review [ 75 , 76 ].
Health and patient organisations lobbying the European Institutions who receive funding from the pharmaceutical industry include the European Kidney Health Alliance, the European Respiratory Society and the European Union Geriatric Medicine Society [ 37 ]. These institutions operate under the veil of academic independence to lead public opinion and set the terms of public discussion.
Asymmetric Globalization: Global Markets Require Good Global Politics
Framing public health issues in terms of personal responsibility for making informed choices takes the onus away from the harmful composition of certain products, from their availability, marketing and advertising and ultimately from their regulation. The automobile industry has long avoided stricter regulations by shifting responsibility to the driver and claiming that the driver, not the vehicle nor the built environment in which it operates, is the problem.
This rhetoric was documented in vehicle safety regulation, alcohol blood levels, speed limits, mandatory seat belts and airbag regulations, etc. Tobacco companies have promoted campaigns to prevent violence against women and funded shelters for victims of domestic abuse [ 13 , 78 ]. Similarly, the tobacco and alcohol industries have engaged in activism and advocacy against the smuggling of alcohol and tobacco products as a means to avoid regulation of their activities [ 6 ].
For example, cigarette smuggling is often cited as an argument against a tobacco tax increase [ 79 ] even though the tobacco industry engages in the smuggling of its own products to avoid duty tax [ 4 ]. By creating new diagnostics and thresholds for medical intervention, commercial interests expand the consumer base and reduce the scope for less profitable population wide approaches for tackling diseases rooted in social and environmental problems. This may be done in two ways. One is to expand diagnostic criteria to include what were previously considered normal laboratory results, behaviours or feelings [ 80 , 81 ].
The financial ties between DSM-V panel members and the pharmaceutical industry have shed light on this mechanism [ 82 , 83 ]. More encompassing diagnostic criteria are then complemented by an effort to increase acceptability of a given condition. This is evidenced by the penetration of the pharmaceutical industry into the education sector by approaching teachers to diagnose Attention Deficit and Hyperactivity Disorder [ 84 ]. When diagnostic guidelines are not yet available, new conditions may be created by pathologizing complex behaviours and promoted directly to the public, as was the case of female sexual dysfunction [ 85 ].
The media has the power to mould perceptions of product acceptability and desirability and to shape the discourse around the role of government, personal responsibility and accountability of private interests when their products harm health. Corporations harness this power through media ownership, control over advertising as a lever over editorial decisions, and by using the media to influence jurors on litigation cases against harmful products. Together, these tactics hedge against the coverage of harmful stories and secure favourable treatment of corporate activities and image.
Combined, marketing and advertising expand the number of consumers for a given product and shape the psychological and social predisposition to accept and endorse hyperconsumption. Advertising strategies have drawn on advances in neuropsychology, anthropology, and neuroscience to capitalise on the susceptibilities of a developing brain to marketing messages [ 69 ]. Point in case, neuromarketing uses physiological and clinical information about brain functions to bypass evaluation processes underpinning decisions about what to buy that came about through millennia of evolution [ 31 ].
The yield of these technical advances is then complemented by a consonant consumption environment.
For example, well-funded marketing strategies are applied to corporate social responsibility, as it becomes the only source of health education in some settings, namely in more economically deprived environments [ 30 ]. These compete with underfunded, yet evidence based public health campaigns. Markets in traditional consumer demographics in the developed world have reached saturation, partly due to tighter regulation.
Consequently, multiple industries have turned to the developing world where disposable incomes are increasing and regulations are still weak to expand its consumer base [ 16 , 86 , 87 ].
Others expanded into previously untapped markets, e. Low income groups, for example, are a particularly profitable demographic to the alcohol industry. This is partly why it resists attempts to raise the price of alcohol, be it through minimum unit pricing or by increasing excise taxes, measures shown to discourage drinking [ 10 ]. Low prices allow industry to sell greater quantities in low income groups, who traditionally have shown higher prevalence of alcohol abuse. The breadth and depth of knowledge about corporate products and how they affect health bears directly on consumption, perceived need for consumption, and corporate image.
Accordingly, corporations carry out scientific work with the express purpose of reaching a conclusion that supports industry regulatory or litigation objectives as well as providing scientific underpinnings for a commercial venture such as a new drug [ 18 ]. Seen through a power lens, commercial interests set the research agenda, define what is studied, and thus what constitutes an issue and what does not.
The power to constitute non-issues, in turn, generates power to avert conflict over products and processes that harm health. In other words, if harmful effects of corporate products are not systematically documented and attributed to that product, ascription of responsibility will not trigger conflict. Should conflict arise nonetheless, power over research interpretation and dissemination keeps it latent. As long as conflict is averted or kept latent there is no threat to the bottom line.
Three tactics enable corporate control over the research process. First, the funder sets the research agenda by funding research at universities, in-house corporate laboratories, non-profit research institutes or for-profit science-for-hire firms. Second, funding allows control over study design, analysis methodology and ownership of the data.
Naturally, corporate funding, per se, is not a problem but there is substantial empirical evidence that the independence of the research is compromised by it. In the third mechanism, the funders may suppress or misreport unfavourable results through exclusive ownership of the data [ 24 , 25 , 94 ]. Access to unpublished trial reports submitted to drug regulatory agencies sheds light on possible side effects of the drugs because they provide more reliable data than published papers.
Editors, peer reviewers, and editorial writers who are trusted to evaluate the accuracy of the analyses are thus often unable to do so [ 95 ]. Consequently, side effects that are known only to the sponsor result in avoidable deaths, as evidenced by the Vioxx [Rofecoxib] scandal. The fact that commercial sponsors of the trial have direct access to these bodies, thwarts due course and prevents them to stop trials that endanger participants [ 96 ]. Funding of symposia, hospital lectures, and medical specialty meetings ensures that the educational content is shaped to favour certain products and procedures over others, without mandatory scrutiny of claims of superiority.
The recruitment of KOL lends scientific and pedagogic credibility to the financial efforts. This last tactic pertains to image control once health damaging effects of corporate products are made public. There is no requirement for these companies to disclose their funding when lobbying regulatory agencies or when expressing their views in other public fora.
Science Institutes fulfil a similar role [ 19 ]. The Asbestos Information Association is a front group created by this industry to dismiss public and governmental concerns about their product. It has a successful track record of weakening regulations coming from the Occupational and Safety Health Agency and the Environment Protection Agency in the United States [ 18 ]. A strategic use of the law can lower barriers to undue influence over the political process - e.
This prevents contentious public health protection issues from ever being brought to the legal system, thus averting open conflict between corporations and those advocating for public health. Influence over judicial systems may stifle legislative attempts to protect against harmful products and practices or water down more comprehensive occupational or environmental health legislation. It can also ensure that sanctions for harming population health are not enforced. Both instances are profitable because they allow, among other things, for a legal mechanism to externalise costs.
"Minimum Investment Requirements, Financial Market Globalization, and S" by Haiping ZHANG
Finally, when the interests of commercial players are in open conflict with those of population health and are brought to trial, the legal system may be used in such in a way that conflict is never resolved. This is beneficial from a corporate perspective because the product or practice in question remains available, profitable, accountability never ascertained and corporate image intact. Corporations protect themselves against accountability for wrongdoing by changing the law and reinterpreting its spirit and intent.
By averting liability, corporations avoid negative associations with their brand, reparations and regulation that may curtail further exposure to their unhealthful practices and products. In the US, 4th Amendment rights confer corporations the right to privacy and thus enable avoidance of health and environmental inspections.
In corporations claimed the right to refuse surprise inspections by the US Environment Protection Agency and the Occupational Health and Safety Administration severely limiting these agencies scope for health protection [ 64 ]. Corporations may also have an unlimited lifespan and limited liability of shareholders for corporate practices [ 69 ]. When a corporation is treated as a person under the law, it is liable for its actions. This means that its directors and managers may not be held responsible for any wrongdoing in which the company has engaged [ 98 ].
This eliminates the dissuasive effect that may deter harmful practices. The lawsuits that Philip Morris brought against Uruguay over graphic cigarette health warnings [ ] and against Australia over plain packaging, are warning signs for countries considering similar legislative attempts [ ]. This is may be an especially strong message against regulatory initiatives for poorer countries with fewer resources. Corporations may keep prices of harmful products artificially low and more available when the final price does not reflect the full cost of production. This is the case with environmental and occupational health costs when they befall on taxpayers.
Similarly, the meat industry has long kept meat prices low by avoiding the environmental, social and occupational health costs of large concentrated feeding operations for animals raised for food [ , , ]. What is more, externalizing occupational health costs is effectively sanctioned by the international trade architecture as pointed out in section 1. When, despite efforts to influence decision-making and agenda-setting, non-issues become public health issues, open conflict over those issues arises and corporations may break the law in order to secure their interests.
Direct tactics include corporate infiltration of opposition groups [ , ] as in the case of corporate infiltration of anti- bovine growth hormone advocacy groups [ 50 ]. This category includes bribing [ ], smuggling and illicit trade [ 4 , ], and price fixing [ ] among others. When these offenses are prosecuted, out of court settlements elude corporate accountability.
Corporations avert criminal prosecution and the ensuing fines are still financially attractive to companies for whom the penalty is only a small fraction of annual profits. Corporate activities have immediate and observable effects on perceptions and behaviour patterns that can lead to increased consumption of unhealthful corporate products and subsequently to changes to individual and population health. We caution that this should not be interpreted as suggesting that corporate activities are necessarily harmful to health, nor that there is anything untoward about most corporate action, which with few exceptions, operates well within legal and culturally acceptable bounds.
Our intention in critically and systematically studying the mechanisms of corporate action is to highlight how corporations may influence population health to the end of mitigating corporate action on poor health.
Our framework offers a systematic way of mapping corporate action as a way of guiding research and practice. It is meant to be used by public health practitioners, researchers, students, activists and other members of civil society, policy makers and public servants in charge of policy implementation. It can also be useful to corporate managers who wish to establish or improve triple bottom line principles. Wood [ ].
- global symmetry.
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Mario Garcia-Molina. Goran Djurfeldt. Paul Mosley. Jeffrey James. Howard Stein. Rizwanul Islam. Biswa Swarup Misra. Rob Vos. Just as the EU did in the post-war era, the Eurasian Economic Union could help the members to take liberalised steps that they are unable to take individually. Vinokurov et. The result of the research revealed that in three of the four smaller EAEU countries, a pegged exchange rate would increase macroeconomic volatility.
The second regime performs well when monetary policy reacts to Russian Ruble, and to inflation in Armenia, Kazakhstan, and Kyrgyzstan. Overall, the results indicate that the EAEU is not mature enough for a fully pegged exchange rate regime. Atik argued that the regional economic integration of the EAEU is inefficient. He claimed that the causes of inefficiency are: i an inadequate convergence with the market economy; ii differences in macroeconomic structures, including income distributions, level of industrialisation, and balance-of-payments differences; iii a lack of common goals; and iv conflicts of interest across the region.
Beside the points above, the Eurasian Development Bank has reported different criteria for integration in the region, using trade, GDP, exchange rate, and budget balance variables to identify levels of integration for these economies Eurasian Economic Integration report, However, none of these analyses have led to a concrete model that can determine the economic interaction of these economies with global and regional economies.
Geographically, this group reaches from the borders of the European Union to the Far East. GDP data for Afghanistan was not available prior to and hence it is excluded from the calculations. In order to achieve the objective of the paper, I suggest that the model for regional economic integration should consist of three types of shocks: global output shocks; regional output shocks; and country-specific output shocks.
The structural form of the above equation would be:. Therefore, the VAR model is represented as below:. However, there should be some restrictions imposed on this model in order to identify the matrix using the following formula:. This results in three restrictions. These restrictions are defined below: i regional and country-specific shocks have no long-run impact on global output; and ii country-specific shocks have no long-run impact on regional output, therefore the matrix model would be written as:.
In fact the above model is the structural vector autoregressive model developed by Blanchard and Quah Regional shocks are important to an economy as it is assumed that neighbouring countries are trade partners and may have similar economic structures. External shocks have the potential to go beyond the regional boundaries. If global shocks can affect economies in the same way, a global arrangement could be a better option for dealing with global shocks than regional arrangements.
In the case of Eurasia, if global shocks US output are relatively more important than regional shocks Chinese output , then forming a US Dollar bloc would be a better policy and vice versa for a Yuan bloc Frankel and Shang-Jin, Bayoumi and Eichengreen argued that supply shocks are more structural and less sensitive to varieties of exchange rate arrangement. If supply shocks are correlated across the region, then the region would be a candidate for common monetary arrangements.
Frankel and Rose stated that with the rise in trade, countries are likely to face increasingly similar shocks. Therefore, supply shocks may become more correlated when economic integration progresses. The stationary properties of the time series have been examined and are identified to be integrated of order one, i.
Therefore, the first-difference form of all variables is used for estimation. The structural VAR model is estimated and the degree of shock symmetry among the countries under consideration is calculated using a correlation of identified disturbances. For this reason, the correlation of three structural shocks is estimated via a structural VAR model for the twelve Eurasian economies from to , the longest possible period. It is generally assumed that if the correlation of shocks is positive, the shocks are considered to be symmetric, and if the correlation is negative or if it is insignificant, they would be classified as asymmetric.
In order to find the correlation of structural shocks, structural vector autoregressive models are estimated and the residuals of the models are used to see the correlations. Literature Sims, has suggested that if the correlation is positive, the shocks are considered to be symmetric. And if the correlation is negative or it is insignificant, then they are asymmetric. Table 1 reports the correlation between domestic supply shocks in these economies.
High correlation between supply shocks suggests that the economies are subject to symmetric shocks and may have further economic arrangements such as monetary coordination Chow and Kim, However, there are some asymmetries observed among different economies. This could be due to the fact that these countries are affected by different sources of variations, i. In order to clarify this issue, the correlations between regional and domestic shocks and also between global and domestic shocks are reported in Table 2.