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Health

In shortfall: about 4.6 billion people were not fully covered by essential health services in 2023, and 2.1 billion faced financial hardship from health costs in 2022, per WHO.

Necessary Owners remove an obstacle nothing else removes. Others must also act.

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Why shareholder democracy is necessary

Health systems are financed and run by governments, but a striking share of preventable ill health traces to the products, prices and politics of listed companies. Research in The Lancet attributes an estimated 19 million deaths a year, 41 percent of deaths from non-communicable disease, to just four commercial products: tobacco, alcohol, ultra-processed food and fossil fuels. Access to treatment also depends on pharmaceutical pricing and patent conduct. Investors targeted it with 2024 proposals at AbbVie, Eli Lilly, Gilead, Johnson and Johnson, Merck and Pfizer on how patent-extension strategies restrict access. Corporate political influence is a documented obstacle on the prevention side. The WHO FCTC knowledge hub on industry interference calls tobacco industry interference the single greatest obstacle to tobacco control implementation. The Investors for Opioid Accountability coalition has already shown that owner pressure can change conduct across 20 companies. The delivery of care, health financing and state-owned actors such as China National Tobacco remain outside any proxy vote. Owners supply a necessary input and remove documented obstacles while governments must build and fund the systems.

How this was scoredNecessary

Necessary. Owners remove an obstacle nothing else removes. Others must also act.

We have not yet written down the two answers behind this rating. Recording them on every item, so a reader can check the reasoning and not only the conclusion, is work in progress.

Every rating is the higher of two answers, one for what companies do and one for what they spend to stop the outcome, because the same vote reaches both. See the full method.

Sources

8 campaigns on record

Interfaith Center on Corporate Responsibility members, Investors for Opioid and Pharmaceutical Accountability, and Oxfam America at AbbVie, Eli Lilly, Gilead Sciences, Moderna, Pfizer Inc.☆ Follow2022 · shareholder resolution

Proposals asked companies to examine whether stacking secondary and tertiary patents on existing drugs (a strategy investors said AbbVie used to extend Humira's exclusivity to 19 years through 130 patents and 27 price increases) was limiting patient access, to align lobbying with stated access commitments, and, at Moderna and Pfizer, to study transferring vaccine-manufacturing know-how so generic versions could be made.

Result: Sixteen proposals were originally filed; twelve survived company challenges at the SEC and went to a vote. Two proposals at Amgen were withdrawn after the company reached an agreement with the filers; two other proposals, at Pfizer and Moderna, were also withdrawn.

Amgen's agreement with the filers led those two proposals to be withdrawn rather than voted on; the source describing this did not specify what Amgen committed to do, and we found no further documentation of that commitment.

2022 Shareholder Proposals at Pharma Companies Prevail at SEC, Interfaith Center on Corporate Responsibility

Oxfam America, with the People's Vaccine Alliance at Pfizer Inc., Moderna☆ Follow2022 · shareholder resolution

Resolutions asked Moderna and Pfizer to study transferring COVID-19 vaccine technology and manufacturing know-how to lower-income regions and to share technical knowledge with the World Health Organization, and asked Johnson & Johnson to explain how public research funding had affected its pricing and what it meant by distributing vaccine on a 'nonprofit' basis.

With People's Vaccine Alliance

Result: This source does not report the vote outcome for the 2022 annual meetings.

Moderna agreed to sell 500 million vaccine doses to COVAX and 110 million to the African Union and committed not to enforce its patents during the pandemic, which Oxfam called insufficient; Pfizer partnered with South Africa's Biovac for fill-finish production, though Biovac could not produce the active vaccine ingredient itself; Johnson & Johnson's nonprofit-basis distribution remained limited to emergency pandemic use with details Oxfam said were still unclear.

'These lives matter': Oxfam and partners urge J&J, Pfizer and Moderna investors to focus on vaccine equity efforts, Fierce Pharma

American Baptist Home Mission Society at Tyson Foods☆ Follow2021 · shareholder resolution

Asked Tyson's board to prepare a report on human rights due diligence, covering whether the company was doing enough on paid sick leave, COVID-19 testing and case counts, workload, and meaningful engagement with workers after over 12,500 workers were infected and dozens died during the pandemic.

With 22 co-filing institutional and faith-based investors

Result: Sources disagree on the exact figure. Investor Advocates for Social Justice reported the proposal won 78.7% support among independent (non-Tyson-family) shares but only 18.4% of total votes cast, because the Tyson family's Class B supervoting shares give it majority voting control regardless of other shareholders. PR Newswire separately reported 'nearly 82 percent' support among independent shareholders for a package of proposals that included this one plus a lobbying-disclosure resolution.

Investor Advocates for Social Justice reported that Tyson 'largely failed to engage meaningfully,' did not address the concerns raised, withheld preliminary vote results at the meeting, and gave no opportunity for questions; the annual meeting lasted less than 30 minutes. We found no documented policy change at Tyson attributable to this vote.

Tyson Dismisses Shareholders' Human Rights Concerns at Annual Meeting, Investor Advocates for Social Justice

n/a (multi-organization coalition sign-on, not a shareholder resolution vote) at Tyson Foods☆ Follow2020 · investor statement

A coalition of over 120 organizations demanded Tyson Foods provide personal protective equipment, paid sick leave, slower slaughter-line speeds, comprehensive COVID-19 testing, physical distancing, protection from retaliation for workers who organize, and elimination of a punitive attendance point system, after over 8,500 workers across 37 facilities tested positive for COVID-19 and more than 25 died.

With Friends of the Earth, HEAL Food Alliance, The Humane League, Venceremos, 120+ other organizations

Result: This was a public pressure campaign and sign-on letter directed partly at Tyson's institutional investors, not a shareholder resolution put to a vote.

We found no documented company-wide policy change directly attributed to this July 2020 campaign; continued investor dissatisfaction with Tyson's response is documented in the February 2021 shareholder vote listed separately above.

120+ organizations target meatpacking giant Tyson Foods for failing to protect workers from Covid-19, Friends of the Earth

United Church Funds, on behalf of Interfaith Center on Corporate Responsibility members at AbbVie☆ Follow2018 · shareholder resolution

The resolution asked AbbVie's compensation committee to report each year on whether executives were being rewarded, through incentive pay, for pricing strategies that drew public criticism over drug costs.

Result: The proposal won 21 percent shareholder support. AbbVie had asked the SEC to exclude it from the proxy ballot; that challenge failed, and proxy advisor ISS recommended shareholders vote in favor.

We found no documented follow-up report or compensation-policy change that AbbVie made as a result of this specific vote in the sources reviewed.

21% of Abbvie shareholders favor report on how drug pricing risks are integrated into exec incentive programs, Interfaith Center on Corporate Responsibility

International Brotherhood of Teamsters (pension-fund investors) at McKesson Corporation☆ Follow2018 · board campaign

The Teamsters asked shareholders to vote against McKesson's executive pay package, arguing the company had not held leadership accountable for its role in distributing opioids, and separately pushed to split the CEO and board-chair roles.

Result: McKesson's executive pay package received only 26.6 percent shareholder support in the 2018 vote, described at the time as one of the worst results among S&P 500 companies. This was a vote-no campaign against a management-sponsored say-on-pay proposal, not a shareholder-filed resolution.

McKesson cut CEO John Hammergren's total pay by about $1.95 million (roughly 10 percent) and said it would factor opioid-related compliance risk into future pay decisions; in 2021, after an $8.1 billion opioid settlement, the board also imposed a further $2.9 million discretionary reduction to CEO Brian Tyler's pay and cut a former CEO's payments by $780,000.

McKesson Reduces CEO's Pay 10% Following Revolt by Investors, Teamsters (International Brotherhood of Teamsters)

Investors for Opioid Accountability (coalition co-led by Mercy Investment Services and the UAW Retiree Medical Benefits Trust) at McKesson Corporation, Cardinal Health☆ Follow2017 · shareholder resolution

The coalition asked opioid distributors and manufacturers to strengthen board oversight of opioid-related risk, review whether executive bonuses were tied to opioid sales volume, and add clawback policies so pay could be taken back after misconduct.

With Interfaith Center on Corporate Responsibility members, state and city pension funds, Catholic and other faith-based investors

Result: As of October 15, 2018, one year into the campaign, the coalition had submitted 35 resolutions at 11 public companies, of which 10 had received shareholder votes, including majority votes among independent voters at Assertio Therapeutics (formerly Depomed) and AmerisourceBergen, per National Catholic Reporter. The Interfaith Center on Corporate Responsibility's later retrospective gives a wider total of 20 companies engaged, reports that a majority of shareholder proposals, 52%, led to agreements with the companies rather than a vote, and counts seven resolutions winning majority votes at Rite Aid, Walgreens, Mallinckrodt, Mylan and Assertio Therapeutics plus two more winning majority support at AmerisourceBergen. The coalition's resolutions were filed across the 2017 to 2019 proxy seasons, and SHARE's account of the full run to 2023 describes more than 100 proposals.

Twelve of the companies engaged conducted opioid-related risk assessments, ten adopted misconduct clawback policies, and three separated the chair and CEO roles, those three being McKesson, Cardinal Health and AmerisourceBergen, according to the Interfaith Center on Corporate Responsibility's account of the coalition's tally.

To stem opioid crisis, investment coalition pressures supply chain, National Catholic Reporter

Interfaith Center on Corporate Responsibility members at AbbVie, Amgen, Biogen, Bristol-Myers Squibb Company, Eli Lilly, Gilead Sciences, Pfizer Inc., Regeneron Pharmaceuticals, Vertex Pharmaceuticals☆ Follow2016 · shareholder resolution

Shareholders asked each company to publish a report showing how much it had raised prices on its top-selling brand-name drugs from 2010 through 2016, explain the reasoning behind those increases, and assess the legislative, reputational, and financial risk of its pricing strategy.

Result: All ten companies filed petitions with the SEC to exclude the proposals from their proxy ballots (a 'no-action' request), so none of the resolutions ever reached a shareholder vote.

We found no documented change in drug-pricing disclosure practice that resulted from this specific 2016-2017 round of proposals; the resolutions were blocked before a vote could occur.

Interfaith investor coalition pushes shareholder resolutions on drug prices, STAT News

Explore more the boundaries we live within

Doughnut Economics, every item scored for how far it depends on owners voting their values, with the reasoning and the sources behind each rating.

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How this rating was made

Every item on every one of our maps is read against one question: how far does this depend on the people who own companies voting their values? We answer it twice, once for what companies do and once for what they spend to stop the outcome, and take whichever answer is higher, since the same vote reaches both. The score carries its reasoning and its sources so that a reader can check it rather than take it.

  • Pivotal. Owners voting their values can deliver most of the outcome.
  • Necessary. Owners remove an obstacle nothing else removes, and others must also act.
  • Helpful. Owners voting their values help, and others carry most of it.
  • Independent. This moves without owners. Other levers carry it.

The advocacy record on this page holds only what a source we opened says happened. Where we searched and found nothing, the page says so rather than leaving a silence. Where a campaign names a filer the source does not name, it says that too. Ratings are ours; the list of subjects is Doughnut Economics's, and we link to their original.

How we score dependency, in full.