Table 1 Examples of TNC impacts on health

Transnational corporations operate in many sectors including food and beverages, extractive industries, tobacco, alcohol and pharmaceuticals. They have the capacity to both promote and harm health. Examples of beneficial health impacts from TNCs include a range of shared value initiatives:

• Mars (chocolate) engaging in sustainable cocoa initiatives through employing science, technology, and certification to assist farmers through increasing yields and sustainable supply [21].

• Nestlé adding micronutrients including iron and iodine to foods to improve health in impoverished regions [22].

• BHP Billiton improving the quality and reliability of local suppliers through the “World Class Supplier Program” in Chile, leading to significant employment growth [23]. Examples of adverse health impacts from TNCs are:

• In 1998, at a time when the largest number of HIV/AIDS afflicted people lived in South Africa, 41 transnational drug companies sued the government of South Africa for initiating measures to reduce prices of anti-retrovirals [24].

• Coca Cola’s depletion and pollution of groundwater in India to make a product with 10 teaspoons of sugar per serving, contributing to global epidemics of obesity and diabetes [25].

• In June 2009 an outbreak of E.coli food poisoning in the United States was linked to Toll House refrigerated cookie dough produced by Nestlé at a plant in Danville, Virginia. The company recalled all Toll House products in the country, but it came to light that the plant had previously refused to give inspectors from the federal Food and Drug Administration (FDA) access to internal records relating to matters such as pest control and consumer complaints [26].

• The 1984 toxic gas leak from the Union Carbide chemical plant in India, which included the loss of life of thousands of people in Bhopal where the community still suffers the aftermath and is campaigning for adequate clean-up, compensation and justice [27].

• Philip Morris Asia Limited sued the Australian government to repeal plain packaging laws despite the fact that 1 billion tobacco-related deaths are predicted globally this century [28].

• Tax avoidance strategies by McDonald’s global operations have potentially cost European governments 1.0 billion Euros and the Australian Government $497 million dollars in unrealised receipts between 2009 and 2013 alone, reducing amounts government have to invest in health promoting infrastructure and services [29].

• Extractive industries have huge negative environmental and social impacts. Since the Australian TNC BHP began mining in Papua New Guinea in the 1980s, hundreds of millions of tons of waste have been dumped into the Tedi River causing irreversible damage to the river ecology and mass deforestation of surrounding areas and resultant health impact on Indigenous peoples [30].

• A narrative review indicated that pharmaceutical corporations suppress and misinterpret scientific evidence which leads to systematic overestimation of the safety and efficacy of products, and also exerts pressure on regulatory bodies against disclosure of adverse effects which are deemed to be ‘trade secrets’ [31].

These examples are indicative, but not exhaustive, of the scope of cumulative local, regional, national and global health impacts that potentially result from the activities of TNCs. They are also indicative of the ways in which the economic power of TNCs is likely to influence the pressures on governments and other stakeholders to make trade-offs between economic and social goals within processes of national development.