Never before in human history has the gap between the scientific and economic potential for better health for all and the reality of avoidable premature death been greater. In the past, children died in infancy, women in childbirth, workers from occupational injuries or diseases and, above all, people of all ages perished from epidemics of communicable infectious diseases exacerbated by inadequate nutrition, contaminated water and poor sanitation. Human civilization lacked the resources and the understanding to eliminate these problems, but as societies developed science, technology and medicine advanced. People organized both through and outside of government to improve living standards. The result was that over roughly the past hundred years ever more of the world’s population has come to enjoy healthier and longer lives.

Today, although parts of the world still confront the global health challenges of earlier centuries, our old problems have greatly diminished. Unfortunately, threats of a different character have emerged. Deaths from non-communicable, chronic conditions like heart disease, cancer, diabetes and stroke have surged, today accounting for more than 60 percent of the world’s deaths. Injuries have become the leading cause of death for young people. From the wealthiest nations to the poorest, the proportion of deaths from these causes is growing.¹

Alarmingly, these new epidemics are neither the result of squalid living conditions nor of ignorance and inadequate science. In some cases the growing health burden is the result of new science and technology, when they have been used to promote corporate profits at the expense of other aims. The new chronic disease epidemics and injuries are the consequence of what most people thought were the remedies for poverty-related ill health: economic growth and higher living standards.

While many factors have contributed to this global health transformation, the most important and most easily modifiable cause is the ascendence of a political and economic system that promotes unhealthy hyperconsumption. Just a few industries have become both pillars of the global consumer economy and the dominant cause of premature death and preventable illness and injuries. This system, which I call the corporate-consumption complex, promotes a pattern of consumption directly linked to premature mortality through preventable illness and injury. It was born in the United States and has now spread throughout the world.

The health impact of modern global consumerism is surprising to many because it has been, for the most part, entirely inadvertent. There is no founding conspiracy to uncover here, no cabal of tycoons who set out to harm people’s health, no latter-day SMERSH, the nemesis of Ian Fleming’s James Bond. Certainly, too, the tension between private accumulation and public well-being is not new. But in the 21^st century the increasing concentration of power in a small number of the world’s multinational corporations has driven this tension to new levels. Over the past few decades, the directors of a few hundred corporations have changed the world to suit their needs, and as a result set the stage for the epidemics we face today worldwide. 

At the same time, the concentration of corporate power presents opportunities to create a healthier and more just future. It’s easier to change the operating principles of a few dozen large corporations than it is to change many thousands of smaller ones or the health behavior of millions of individuals. Obviously, however, taking on the world’s most powerful corporations and their allies is a formidable challenge. Consider the evidence. Tobacco companies still market cigarettes around the world, which could lead to as many as one billion premature deaths in this century. Pharmaceutical companies charge exorbitant prices for the drugs that could have helped people keep their HIV infection or diabetes under control. Fast food and soda companies still promote high fat, sugar-drenched and high-caloric products to children, making it more likely that they will become obese and therefore be at high risk of developing diabetes and other diet-related diseases. Why do they do these things? Because stopping would jeopardize profit margins, and corporate managers have by law a fiduciary responsibility to their shareholders, not to the general public.

But if decisions made in corporate boardrooms, advertising and lobbying firms, and legislative and judicial chambers created these problems, human decisions in those same places can improve things with a bit of help from social movements, honest governments, health professionals and scientists. There is a well-known and heroic history of successful challenges to special interests in America; it’s been done before, and it can be done again. Read any good biography of Theodore Roosevelt if you need a reminder.

This time around it will be harder, however. One reason is that there are at least two conceptual challenges to overcome. First, people tend to segment the problem, but we need instead to see it within an overarching unitary framework. Successful campaigns against the tobacco, food and alcohol corporations that aggressively market unhealthy products, or against Big Pharma’s efforts to promote diseases only it can cure, all seem like one-offs to aroused constituencies. But they are all part of the same dynamic. 

Second, people tend to think that health outcomes are determined by genetics, chance or individual behavior. But the social determinants of health also have profound influence: the day-to-day conditions in which ordinary people live, the political processes that govern society, and the stratifications of wealth and power that characterize today’s world. Unless we understand and make widely known the specific pathways through which business and political decisions improve or harm health, it will be impossible to challenge successfully the ideology of the corporate-consumption complex. That ideology characterizes market decisions as those made entirely by rational individuals, devoid of all social and emotional context, thus allowing the claim that, in effect, no one makes anyone consume a product that is detrimental to his or her health. If we do not debunk that argument, we will not be able to devise a better balance between private profit and public well-being.

To be clear, I am not anti-profit or anti-corporation as a matter of principle. People created corporations over the course of history to solve particular problems, and corporations have made important contributions to the world. Certainly they are here to stay in one form or another. The question is rather whether our political and economic arrangements maximize the benefits that corporations bring to society and minimize the harms, or the other way around. 

I fear that, beginning about forty years ago, things have tipped toward the latter. Many of American society’s serious problems—income inequality, compromised democracy, environmental deterioration and accelerating climate change—have their origin in the growing corporate political dominance of key American institutions. My proximate concern is focused on health-related issues, but it could be that, by leveraging change in this area of public policy, one with a huge potential social base, other problems caused by the current imbalance between private profit and public well-being may be rectified as well. 

The corporate-consumption complex is capacious, but just six industries—alcohol, automobile, firearms, food and beverage, pharmaceutical and tobacco—account for the lion’s share of the damage to global health outcomes. If we add energy and petrochemicals, entertainment and tourism, “gaming” and a few others, we get closer still to a complete account of hyperconsumption. Clearly, consumer capitalism today looks very little like the capitalism of our grandparents’ day. Why? Many causes can be identified: Changes in technology accelerated production, and the advent of larger and more integrated global markets, combined with economic growth, enabled greater consumption. But most influential has been the rise of a highly sophisticated complex to promote hyperconsumption. 

The corporate-consumption complex is a web of organizations that includes the global corporations that produce the goods of the modern consumer economy, the retail conglomerates that sell their products, and the trade associations that represent them in the political arena. It also includes the banks, hedge funds and investment firms that lend these corporations money, and the law firms, advertising agencies, public relations and lobbying groups that cater to them. It includes, too, elected officials and government regulatory agencies that these industries have captured through the revolving door, campaign contributions, the think tanks and university-based researchers that conduct studies for them, the astroturf citizens’ groups they create to advance their policy aims, and the media outlets and journalists who help promote their goals. The strands of the web serve as communications networks to exchange intelligence, money, goods and services, and political lessons. Like the military-industrial complex President Eisenhower warned of in January 1961, this new complex is dangerous not only to our democratic processes, but also to the current and future health of humanity.

As suggested above, it wasn’t always this way. In theory, a free-market economy could emphasize production, marketing and distribution practices that support human health, contributing to a virtuous cycle in which ever more people choose healthy products, leading to greater profits and more widespread availability of these goods. And for decades after World War II, American corporations did indeed contribute to improving the U.S. standard of living and, in some cases, to the health of the world’s growing middle-class population.

Today, however, the corporate-consumption complex no longer supports this virtuous cycle. Instead, consumer corporations are engaged in a race to the bottom, where companies compete to sell greater quantities of products known to cause health problems or damage the environment. Short-termism—investor insistence on a rapid return on investment—leads most large corporations to promote a small number of blockbuster products. Our legal system allows industries to externalize the adverse health consequences of harmful products, forcing consumers and taxpayers to pay the costs for health or environmental damage, further encouraging unhealthy practices. Deregulation has weakened or removed many safeguards that can protect the public, reducing the risk that corporations will have to pay more for violating health or environmental safeguards than the profits their unhealthy practices generate. Finally, the concentration of market share by a handful of global companies produces asymmetrical power and information. One side, the producers, has vastly more political power and information than the other side, the consumers. This inequality, which aligns perfectly with Mancur Olson’s well-known “logic of collective action” thesis, contradicts the basic assumption of free market theory, in which producers and consumers have equal power and information to make free exchanges.

These dynamics distort the market in favor of health-imperiling products—sports utility vehicles; drugs like Vioxx, Celebrex and Avandia; Coke and Pepsi, McDonald’s Big Macs and Oreos; youth-targeted addictive substances like alcopops and tobacco; and mass-market weapons like Bushmaster AR-15s and Glocks. And the same dynamics make these products much more profitable to produce and sell than healthier counterparts such as mass-transit buses and subway cars, non-pharmacological treatments for common chronic diseases, fresh fruits and vegetables, or stress-reducing alternatives to tobacco and alcohol.

Consider one of the most prominent examples: McDonald’s, the franchise infamous for supersizing adults and children across the world. With 33,510 restaurants serving more than 68 million people in 119 countries every day, McDonald’s is the second-largest fast food company in the world, topped only by Subway. The company is the single largest global purchaser of beef, pork, potatoes and apples. In 2011, total revenue was $27 billion, of which $8.5 billion came from the U.S. market and $10.9 billion from Europe. Its gross profit was $2.7 billion and the net profit margin was 20.38 percent. McDonald’s employs 1.2 million people worldwide. In the United States, the company employs 673,000 workers at some 14,000 domestic outlets, half of them under the age of 21. About 8 percent of Americans eat at McDonald’s on an average day, and 96 percent eat there at least once yearly. No other organization feeds more children daily.

McDonald’s spends more than $2 billion annually on global marketing and brand-building, including nearly $888 million in U.S. media alone. That helps to make it the fourth-most-valuable brand on the planet, with an estimated brand value of $81 billion in 2011. This translates into near universal brand recognition. A Sponsorship Research International poll in six countries found that 88 percent of the respondents could identify the Golden Arches, but only 54 percent could name the Christian cross.

But as Wall Street Journal columnist Holman W. Jenkins, Jr. noted, “to build a brand is to create a hostage.” McDonald’s hires a retinue of public relations and advertising firms to protect the Golden Arches, Ronald McDonald and other branded icons. Among its ad agencies are Omnicom’s DDB Worldwide Communications Group and its German affiliate Heye & Partner, designer of the global “I’m lovin’ it” campaign. Another global powerhouse ad agency, Publicis Groupe, designed the Happy Meals ad campaign. Other Publicis clients include Nestlé and Coca-Cola, giving the company a depth of expertise in finding ways to promote unhealthy food, a stellar example of how members of the corporate-consumption complex share expertise.

Since its founding in the 1950s, McDonald’s has developed a business model that views children as its most reliable customers. Ray Kroc, the key founder, noted, “A child who loves our TV commercials and brings her grandparents to a McDonald’s gives us two more customers.” In the early years of the chain’s growth, Kroc flew in a Cessna scouting for new sites near schools. To attract its target demographic, McDonald’s has developed creative ways to lure children through the Golden Arches. The company operates more than 8,000 “playlands” around the United States, more playgrounds than any other private corporation and far more than any municipality. It also includes toys in its products for children. According to the U.S. Federal Trade Commission, in 2009 the food industry spent $393 million on toys and other premiums, making McDonald’s the world’s largest toy distributor. That year fast food outlets sold more than a billion children’s meals with toys to children ages 12 and under, about 18 percent of all child customers.

Like other fast food companies, McDonald’s advertises heavily. In 2009, U.S. fast food corporations spent $4.2 billion on advertising their products, 16 percent of which targeted children. According to the Nielsen Company, a rater of advertising exposure, the average American child saw 368 McDonald’s television ads in 2009, more than one a day and almost twice as many as those of its nearest competitor, Burger King. In 2008, American children aged 2–11 saw on average 1,106 television commercials for fast food outlets, and adolescents saw on average 1,684 such ads. Adults saw on average 1,905 ads. In addition, McDonald’s uses social and other media to reach children and teens. Its corporate websites attract 365,000 unique visitors aged 12 or younger per month and 249,000 teen visitors.

This advertising unquestionably influences children’s food desires and choices, and creates customers for life. A study of young children aged three to five offered them identical combinations of foods and beverages, the only difference being that some of the foods were in McDonald’s packaging. Children were significantly more likely to choose items perceived to be from McDonald’s, showing the value of establishing brand loyalty early.

All this advertising, among other forms of marketing, brings results. One 2009 national poll by Yale University’s Rudd Center showed that a whopping 40 percent of parents reported that their child asked to go to McDonald’s at least once a week, and 15 percent of preschoolers’ parents said they fielded such a request every day. Most of the parents gave in: 84 percent reported bringing their 2–11-year-olds to a fast food restaurant within the previous week.

Health authorities have widely and frequently criticized the McDonald’s business model. According to the American Academy of Pediatrics, “Advertising directed toward children is inherently deceptive and exploits children under eight years of age.” David Ludwig, a professor of pediatrics at Harvard Medical School and a national authority on child obesity, has observed, “Fast-food consumption has been shown to increase calorie intake, promote weight gain and elevate risk for diabetes. Because African Americans and Hispanics are inherently at higher risk for obesity and diabetes, fast food will only fuel the problem.” An assessment of the nutritional quality of fast food carried out by researchers at Yale’s Rudd Center found that only 10 percent of the 101 McDonald’s food products tested met three common nutritional standards for sugar, fat and salt. Of the 158 beverages served at McDonald’s, only a third met these standards. Another study by investigators from UC Berkeley and Columbia University found that teenagers whose schools are within one-tenth of a mile of a fast food outlet are more likely to be obese than those whose schools are farther away, confirming the effectiveness of Kroc’s practice of locating outlets near schools. 

In response to public and scientific criticism, McDonald’s, like other corporations in the corporate-consumption complex, uses science and technology in a variety of ways, all of which amounts to sophisticated eyewash. First, it hires its own credentialed specialists who also serve as liaisons with professional organizations and as “ambassadors” of health, challenging negative public perceptions of the company. Second, it commissions outside researchers and companies to conduct studies. When the FDA ordered McDonald’s to remove transfats from its products by 2006, the company hired Cargill, Inc., the largest U.S. food and agricultural products company, to lead the scientific blending and testing of replacement oils. Cargill is also a principal supplier of beef and eggs to McDonald’s. McDonald’s settled on a blend of canola and soybean oils, which was then synthesized at Cargill solely for McDonald’s use. By turning to its giant corporate partner to solve a regulatory challenge, McDonald’s was able not only to find a marketable solution but also to keep that solution proprietary, preventing its competitors and their consumers from benefiting.

Finally, McDonald’s hires outside scientists to serve as public relations representatives. In 2003, it convened a Global Advisory Council on Balanced, Active Lifestyles, comprising independent experts in the areas of nutrition, public health and fitness. The Council is charged with providing input and guidance to McDonald’s on three questions: how to offer additional menu choices, how to promote physical activity, and how to provide accessible nutrition information. By bringing in researchers from universities and research institutes, McDonald’s gains access to their expertise and networks and focuses public and scientific attention on questions that do not threaten its bottom line. For example, the Council was not asked to advise McDonald’s on ending advertising to children or re-formulating its unhealthy products, but simply to weigh in on adding a few healthier options.

McDonald’s claims that it offers its consumers choices, some healthier than others, and that parents, not the company, are responsible for deciding what their children should eat. This is a variant in the ideology that reduces all choice to discrete individual decisions bereft of context, but in this case the choice is offloaded from eater to parent. In recent years, partly in response to public pressure, the company has made more choices available. It has added salads and fruit to its menus and recently made a half-portion of apple slices and a half-portion of fries standard Happy Meal fare. However, according to market research, Happy Meals constitute only 10 percent of U.S. sales and, as the economy worsened, many parents ordered the higher fat, sodium and sugar adult value meals to split between two young children, reducing the nutritional impact of the apples. Richard Adams, a former McDonald’s executive who now works as a consultant for several franchises, notes that the average store sells roughly 50 salads a day and 50–60 Premium Chicken Sandwiches, compared with 300–400 double cheeseburgers from the Dollar Menu. 

In addition, one of McDonald’s great marketing triumphs, since copied by other fast food companies, has been to make breakfast into a fast food opportunity. Then, working from that success, McDonald’s now promotes the need for a fourth meal in the wee hours of the night. In 2012, McDonald’s introduced a new advertising campaign, “Breakfast After Midnight”, with the slogan, “The moon is full, you should be too.” A survey of male consumers had showed that 45 percent of those aged 18–29 and a third of those aged 30–39 eat after seven in the evening every day. By increasing the number of fast food visits, McDonald’s recent marketing successes effectively negate the nutritional benefits of any marginal changes in product composition. Like Hardee’s Monster Thickburgers, McDonald’s Breakfast After Midnight puts young men, a population with already high rates of heart disease in their future, at higher risk.

Of course, the $2 billion McDonald’s spends annually on advertising is not a public service campaign on the benefits of choice; its intent is to direct consumers to the company’s most profitable products: hamburgers, fries and soda, the high fat, salt and sugar products that contribute to diet-related chronic diseases. To be fair, there have been some positive developments of late. Bowing to public criticism, McDonald’s has vowed to make a 15 percent reduction in sodium across its U.S. menu by 2015 and to cut added sugars, saturated fats and calories in domestic meals by 2020.

It is still highly unlikely that McDonald’s will abandon its reliance on its signature burgers and fries. Instead it will do the minimum while thickening the eyewash. Thus former CEO James Skinner once claimed:

But Skinner emphasized the role of physical activity in obesity not because he cares about the “best interest” of McDonald’s customers but in part to distract attention from the consequences of consuming its products. Lori Dorfman of the Berkeley Media Studies Group, an organization that analyzes industry use of media, has observed, “Promoting good works is a method used by many industry organizations across many different fields to deflect attention from their not-so-good works.” Through such distractions, the corporations that constitute the consumption complex create public images that mask their actual impact on health.

To oversee its operations, McDonald’s, like other corporations, has a Board of Directors. Its members bring the experience of more than thirty other corporations and other institutions to help McDonald’s plan strategy. Of note, six of its 13 members bring experience in the financial sector and four have experience in other companies targeting children and young people. Several serve companies that sell goods or services McDonald’s uses. Boards of Directors are the clubhouses and social networking sites of the corporate-consumption complex, allowing its leaders to exchange intelligence, plan strategies, and counter threats to the complex as a whole. The board also helps direct political strategy.

One of the lasting consequences of Lewis Powell’s famous 1973 call for corporations to become more active politically is the growing corporate involvement in campaign financing and lobbying. McDonald’s political activities show how big corporations engage energetically in the electoral, legislative and legal arenas. They also demonstrate how the 2010 Citizens United decision has accelerated this involvement.

According to the Sunlight Foundation, a nonpartisan group that promotes government transparency, from 1989 through 2012 McDonald’s contributed $9,970,692 to candidates for public office, of which 52 percent has gone to Republicans, 27 percent to Democrats and 20 percent to other types of candidates. Its two largest overall recipients were Barack Obama and Arnold Schwarzenegger, showing its bipartisan approach to giving. In the 2010 election, after the Citizens United decision, the McDonald’s Political Action Committee’s contributions to congressional candidates jumped 360 percent from 2008, according to Open Secrets, another government watchdog group. In the six election cycles between 2000 and 2010, McDonald’s PAC has been one of the top 100 contributors to 104 members of Congress. In the 2012 election cycle, McDonald’s made 62 percent of its contributions to Republican candidates and 37 percent to Democrats. 

McDonald’s also lobbies actively, increasingly so as public criticism of its wares has risen. Between 2007–08 and 2009–10, reported expenditures for lobbying almost tripled. One McDonald’s lobbyist is Chester C. “Bo” Bryant, Jr., senior director of government relations for McDonald’s Corporation. Prior to joining the company, he had served as the chief of staff for Congressman Mac Collins (R-GA) and as a legislative analyst at the White House. His career trajectory illustrates how revolving-door employment helps companies get the expertise they need to gain access to and influence public officials.

Much of McDonald’s lobbying explicitly seeks to thwart public health regulation. According to a 2012 Reuters special investigative report, between 2009 and 2012 more than 50 leading food and beverage companies and trade associations, including McDonald’s, spent $175 million to lobby the Obama Administration against the Federal effort to write tougher—but still voluntary—nutritional standards for foods marketed to children. This expenditure was more than double the $83 million spent during the previous three years, during the Bush Administration. The food and media companies hired Anita Dunn, Obama’s former White House communications chief, to run their media strategy. In contrast, Reuters found, the Center for Science in the Public Interest, widely regarded as the leading public health advocacy organization, spent about $70,000 lobbying last year—roughly what those opposing the stricter guidelines spent every 13 hours.

In 2009, Jon Leibowitz, Chairman of the Federal Trade Commission, the agency proposing the new guidelines, told a congressional hearing, “We are calling on the food industry to tackle this threat and boldly reinvent the food marketplace.” Three years later, after the industry onslaught, the Obama Administration conceded defeat and abandoned its effort. Leibowitz was stoic: “It’s probably time to move on.” 

In addition to lobbying, McDonald’s also influences the Federal government by having its staffers sit on six Federal government advisory committees at the Departments of Agriculture, Commerce and State. Bo Bryant, for example, was appointed by the Secretary of Agriculture and the U.S. Trade Representative to sit on the Agricultural Technical Advisory Committees for Trade in Processed Food, along with representatives from Cargill, Coca-Cola, Hershey, Yum! Brands restaurants and Walmart. This committee helps these companies learn about and influence trade agreements with other nations.

Another way that McDonald’s uses its power to influence policy is through its membership in trade associations. The company is a member of the U.S. Chamber of Commerce, the National Council of Chain Restaurants, the National Restaurant Association, and the International Franchise Association, among others. Through these organizations, McDonald’s amplifies its voice in Washington, coordinates strategies with other corporations and gains access to additional lobbying and campaign contributions. For example, by 2012 the National Restaurant Association had contributed almost $14 million to candidates since 1989 and spent just under $25 million on lobbying, far more than McDonald’s alone. McDonald’s was also a member of an industry-sponsored advocacy organization, Americans Against Food Taxes, which lobbied against proposals to tax unhealthy foods. These associations allow corporate-consumption complex members to leverage their assets to achieve common policy goals.

For example, when the FDA proposed Federal calorie labeling rules as mandated by the 2010 Patient Protection and Affordable Care Act, McDonald’s, the National Council of Chain Restaurants, the National Restaurant Association, the California Restaurant Association and many other companies and trade groups submitted their objections to the proposed rules, which were subsequently modified in response. McDonald’s also helped to create the Children’s Food and Beverage Advertising Initiative (CFBAI), a group of food manufacturers that also includes Burger King, PepsiCo and Kraft Foods. This initiative developed its own guidelines for defining foods healthy enough to market to kids, using their standards as an alternative to standards proposed by the government or independent nutrition experts. The tactic may be summarized thusly: If you can’t beat something with nothing, invent something scientifically worth nothing to do it. 

McDonald’s also seeks to influence Federal and state legislation before it is written. Ed Conklin, Senior Director of Governmental Affairs for McDonald’s, represented the company on the Executive Committee of the American Legislative Exchange Council’s (ALEC’s) Commerce, Insurance and Economic Development Task Force. ALEC claims that more than 1,000 of the bills its members draft are introduced by legislators every year, with one in five enacted into law. Conklin is also a member of the corporate-funded Council of State Governments and the State Government Affairs Council. These organizations provide McDonald’s with an opportunity to draft proposed legislation and meet privately with legislators to discuss policy issues.

Like other corporations, McDonald’s furthers its objectives through a skillful blend of marketing and public relations, often creating citizen marketers to advance its causes. Its Quality Correspondents program seeks to win over mothers by taking them on tours of its kitchens, highlighting food quality and healthful options. This cadre of volunteer moms helps to enhance the company’s image and overcome the single largest barrier to higher McDonald’s sales to children: mothers’ health concerns. In a message sent to “mother-oriented social networks and freebie product sites”, McDonald’s offered mothers a chance at “behind-the-scenes access to the farms [where] our fresh ingredients are grown.” The winning mothers were “expected to participate in as many as three ‘field trips’ lasting two to three days, and receive payment for ‘reasonable travel expenses’.” A McDonald’s spokesperson said the company will then give mothers “avenues to be able to share their findings.” Of course they will.

Should sweet talk from suborned moms not work sufficiently to gild its image, McDonald’s has a retinue of lawyers standing by, just in case. In 1986, McDonald’s sued two British environmental activists for distributing a pamphlet that charged, among other things, that McDonald’s sells unhealthy, addictive junk food; alters its food with artificial chemistry; and exploits children with its advertising. At the end of the “McLibel” trial, which at two and a half years was the longest case in British history, McDonald’s was finally awarded about $66,000. Its legal fees exceeded $16 million, and media attention hurt the company more than it helped. But the outcome served to deter critics who fear lengthy and expensive litigation. This type of suit, labeled a strategic lawsuit against public participation, or a SLAPP, is launched for precisely that purpose. A growing number of corporate-consumption complex members use SLAPPs to deter critics.

In other legal actions, McDonald’s lawyers have filed numerous trademark and defamation cases and actively defend the company’s interest in consumer lawsuits. To date, McDonald’s has won court cases for damages brought by parents of obese children. But the fear of having to pay billions to remediate the illnesses generated by its products, as in the case of the Tobacco Master Settlement Agreement, led McDonald’s, other fast food companies and their trade associations to sponsor what came to be known as cheeseburger bills. These laws prevent consumers from suing food outlets for making their customers obese or suffering from other diet-related diseases. By 2012, the National Restaurant Association reported that 20 states had passed some version of a cheeseburger bill.

McDonald’s is a global corporation, but that doesn’t stop it from getting immersed in local politics when it perceives that its interests are threatened. In autumn 2010, San Francisco passed an ordinance that set nutritional standards for restaurant food accompanied by toys or other youth-focused incentive items. At every step, McDonald’s, in partnership with Yum! Brands (a conglomerate of several national fast food chains) and the California Restaurant Association, tried to block the ordinance. When the bill finally passed, McDonald’s simply asked parents to pay ten cents for the toys, thus easily dodging the ban on giveaways.

This profile of McDonald’s, which could be augmented by many other case studies, shows how the multinational corporations that constitute the corporate-consumption complex have developed the capacity to think and act locally, nationally and globally. They find friends and partners in high and low places and use their networks of business and political connections to advance their economic and policy objectives. While these impressive accomplishments have made McDonald’s an international business success, they have also left a deep footprint on the world’s health, environment and economy. By contributing to rising rates of diet-related diseases, unsustainable agricultural practices and environmental damage and, arguably, rising income inequality and diminished democracy, McDonald’s demonstrates that what’s good for business may be bad for human beings. 

But the profile shows, too, that McDonald’s is locked in a defensive crouch in the face of rising criticism. Its defense infrastructure costs money, and these expenses reduce the company’s profit margins. But its corporate executives know what happened to the tobacco industry, and they are spending vast sums to make sure it doesn’t happen to the fast food industry. They are probably aware, too, that several strategies have been used at different times and places to reduce corporate practices that harm health. 

That said, the barriers to developing a unified effort to modify health-damaging corporate practices are many; but they are not insurmountable. Democratic action both within and outside existing political institutions can weave what are separate strands today into a transformative force for improving health in the United States and around the world. In the current political climate, any such talk may sound idealistic to the point of naive. But during the midst of the first gilded age, when plutocracy ran as rampant as it does today, similar talk must have stuck many people as equally futile—but history shows that it wasn’t. 

What was true in Mark Twain’s time, during the first gilded age, is still true today: In a society committed to public health and democracy, righting the balance between corporate behavior and the common weal is just common sense. Public opinion polls show that the majority of Americans regularly and consistently support propositions to right the balance, and would choose policies that achieve these objectives if such policies were proposed. People increasingly grasp that the need to restore the balance between government and business constitutes the public health priority of our time. 

Finally, for now, ever more Americans are beginning to understand better that the stakes extend beyond America’s shores. A country as large, wealthy and dynamic as the United States cannot help but project itself into the world at large. We have a strategic as well as a moral interest in making sure that our influence is not pernicious to the health and well-being of others. In short, we have a complex problem.