How far does cardiovascular disease and heart health depend on shareholder democracy?

Companies involved: Altria Group, Inc. (shareholders vote here); Philip Morris International Inc. (shareholders vote here); The Kroger Co. (shareholders vote here)

The filings held for this report show the 2024 Altria and Kroger proposals. No vote result for the Altria proposal appears in the documents read.

The World Health Organization places tobacco use among the most important behavioural risk factors for heart disease and stroke, and the CDC states that smoking damages the heart and blood vessels.

What two listed companies make and sell is this obstacle rather than a contributor to it. Altria and Philip Morris International manufacture the combustible products that the World Health Organization names among the most important behavioural risk factors for heart disease and stroke, and the CDC says cigarette smoking damages the heart and blood vessels. A vote reaches both the product range and the political spending behind it. Trinity Health and five co-filers asked Altria shareholders in 2024 to have the company report on the congruence of its lobbying with its stated positions, and the Sisters of St. Francis of Philadelphia asked Kroger to count the public health costs of its tobacco sales. Tobacco interference in policymaking is documented well enough to have its own peer-reviewed literature. Owners can direct what a tobacco company sells, which is why this is rated Pivotal.

Companies involved: PepsiCo, Inc. (shareholders vote here); The Coca-Cola Company (shareholders vote here); Mondelez International, Inc. (shareholders vote here); Nestle S.A. (shareholders vote here); Food and Drink Federation (an industry group, no shareholder vote)

The World Health Organization lists unhealthy diet among the behavioural risk factors for cardiovascular disease and traces raised blood pressure, cholesterol and obesity back to it.

Food companies decide how much salt, sugar and fat go into everyday products, and they have spent heavily to keep public policy off that decision. A trade association speaking for Nestle, Coca-Cola and Mars lobbied the United Kingdom government on its healthy eating plans, and a Guardian investigation found the guidance for retailers was then dropped. A separate 2026 investigation counted 235 lawsuits brought against governments in five countries since 2010, with Mondelez, Coca-Cola and PepsiCo among the companies going to court. Cardiovascular researchers in the BMJ concluded that a voluntary deal with the food industry stalled a salt reduction strategy that had been working. Shareholders have asked directly: eight investors led by Sisters of the Sorrowful Mother International Finance put a sweetener risk assessment to PepsiCo's 2025 meeting. The rating is Pivotal, from that political spending.

Companies involved: Exxon Mobil Corporation (shareholders vote here)

The Majority Action filing is a campaign to vote against directors rather than a shareholder proposal, and the documents held for this report do not carry its result.

The World Health Organization puts stroke and ischaemic heart disease among the disease outcomes most strongly linked to air pollution exposure.

Listed companies produce, carry, burn and sell the fuel whose combustion loads the air that raises stroke and heart disease risk, and a call to action in the American Heart Association's journal states that the fossil fuel industry has played a major role in orchestrating the failure to cut those emissions. ShareAction's 2026 investor briefing puts the exposure in freight and logistics, construction, retail and automotive companies that depend on urban road transport, which is a list of companies a vote reaches. Majority Action asked Exxon Mobil shareholders to vote against three directors over the company's refusal to align its lobbying with the Paris Agreement. Governments still set air quality limits and households still choose how they travel, so owners remove an obstacle here that nothing else removes while others must also act.

We found no shareholder advocacy on this obstacle in the documents read for this report.

The World Health Organization reports that 31% of adults and 80% of adolescents fall short of recommended physical activity, and counts physical inactivity among the leading risk factors for noncommunicable disease deaths.

Streets, schools, workplaces and the shape of the day decide how much people move, and most of that is built by households, schools and local government rather than by any company. The World Health Organization's own recommendations name schools, workplaces, childcare centres and healthcare as the settings, alongside access to walking, cycling and non-motorized transport. Employers, transport operators and property developers sit in that chain and can widen or narrow the chance to move, which is real and is not the critical path. No shareholder advocacy on physical activity appears in the documents read for this report. Owners can help at the margin here, through what employers require of their own workplaces, and the obstacle itself belongs to public planning and daily routine, which is why this is rated Helpful.

Companies involved: Heineken N.V. (shareholders vote here); Anheuser-Busch InBev SA/NV (shareholders vote here); Drinks Ireland (an industry group, no shareholder vote)

We found no shareholder proposal at an alcohol company on cardiovascular health in the documents read for this report.

The World Health Organization names harmful use of alcohol among the most important behavioural risk factors for heart disease and stroke, and an American Heart Association scientific statement finds three or more drinks a day consistently associated with worse outcomes in every cardiovascular disease entity studied.

Listed producers decide what is in the bottle, how it is marketed and what the label says, and they have spent to keep the label quiet. The World Health Organization's European office holds that prominent health warning labels on alcoholic beverages are essential and calls the measure simple and inexpensive. Ireland legislated for them in 2018, and the Institute of Alcohol Studies reports that industry pushback delayed them by a further two years and that the industry lobbies extensively to block, delay or weaken the policy. An investigation of the United States lobbying register found Heineken and AB InBev each meeting the US Trade Representative while those labels were under discussion. Governments set tax and licensing and households decide what they drink, so owners remove an obstacle here that nothing else removes while others must also act.

Companies involved: Eli Lilly and Company (shareholders vote here); Johnson & Johnson (shareholders vote here); Pfizer Inc. (shareholders vote here)

A public health review of access to diabetes, hypertension and dyslipidaemia care found affordability and availability of medicines to be the most reported barrier across income groups.

Drug companies set the prices and the patents that decide whether a person with high blood pressure can afford to stay on treatment, and a public health review found affordability and availability of medicines to be the most reported barrier to care for hypertension and diabetes. Those decisions are already on ballots. Trinity Health and five co-filers asked Eli Lilly shareholders in 2024 to have the company weigh patient access before applying for secondary or tertiary patents, Mercy Investment Services asked Johnson & Johnson shareholders in 2025 for a human rights assessment covering access to medicines, and the Interfaith Center on Corporate Responsibility filed across the sector on pricing strategy. Health systems, insurers and public budgets carry the rest of this obstacle, so owners remove part of it that nothing else removes while others must also act.

Companies involved: The Kroger Co. (shareholders vote here)

An American Heart Association review finds that the economic, social, environmental and psychosocial factors grouped as social determinants of health play a significant role in cardiovascular risk, illness and death.

Pay is a social determinant of heart health that a listed employer sets directly, and the American Heart Association finds economic and social factors playing a significant role in cardiovascular risk, illness and death. Kroger shareholders voted on exactly that in 2024, on a proposal from The Shareholder Commons asking the board to set wage policies reasonably designed to give workers the minimum earnings a family needs. The company had raised its average hourly wage to $18 in 2023, while research from the Massachusetts Institute of Technology put the living wage for two working adults in a family of four at over $25 an hour each. Housing, schooling and tax policy carry much of the rest, so owners remove part of this obstacle that nothing else removes while others must also act.

Companies involved: Pfizer Inc. (shareholders vote here)

We found no shareholder proposal on the benzathine penicillin supply in the documents read for this report.

The World Health Organization describes rheumatic heart disease as preventable with a steady supply of benzathine penicillin G, and states that the antibiotic is prone to global shortages.

One cheap injection stands between a child's sore throat and a damaged heart valve, and whether it is made is a company decision. The World Health Organization states that a steady supply of benzathine penicillin G is an essential prerequisite for prevention, that the antibiotic is prone to global shortages, and that high manufacturing costs alongside low purchase prices have pushed manufacturers out. Australia and other high income countries have depended on a single preparation, Pfizer's Bicillin-LA, which has held the only Australian approval since the 1990s. A board that keeps a low-margin medicine in production is making a decision its owners can reach. Housing, sanitation, early detection and health systems carry the rest of this obstacle, so owners remove part of it that nothing else removes while others must also act.