Teaching about Corporations and Health

Posted on by Corporations and Health Watch

As the influence of corporations on population health grows, it will be necessary to prepare researchers, practitioners, and advocates who have the knowledge and skills to analyze and contribute to changing harmful corporate practices. One place to do that is in training programs for public health professionals. In this ongoing series, Corporations and Health Watch offers readers materials about courses on business and health.

William H. Wiist is Professor of Health Sciences at Northern Arizona University and the editor of The Bottom Line or Public Health: Tactics Corporations Use to Influence Health and Health Policy, and What We Can Do to Counter Them (Oxford University Press, 2010). In the past two years, he has taught courses on globalization and health at the University of Chile School of Public Health and at Northern Arizona University.

At the University of Chile, the “Economic Globalization and Health” course was co-taught by Dr. Wiist and Dr. Ron Labonte (from the University of Ottawa, Canada) in January 2009 and 2010. In 2010, 35 students enrolled in the course, including seven from the United States. The topics included:

  • Economic Globalization and the Social Determinants of Health
  • Global Trade and Health Equity
  • Transnational Corporations: Protagonists of Economic Globalization and Their Impact on Health
  • The Tobacco Industry
  • The Pharmaceutical Industry
  • Global Financial System: external debt, international cooperation and development
  • Chile Facing Economic Globalization
  • The Economic Crisis and its Effects on Public Health
  • Globalization from Below: Civil Society Actions to Counter the Adverse Effects of Globalization.

A syllabus provides additional details. [click here to download]

The online course at Northern Arizona is also called “Economic Globalization and Health,” though is less focused on Chile as a case study. Course requirements include reading scientific reports and political analyses, viewing popular films on corporate power, and writing an analysis of the economic determinants of a health problem that students choose. A syllabus [click here to download] gives further details.

CHW readers with other relevant syllabi or teaching materials are encouraged to submit them toresponse@corporationsandhealth.org for posting.

Previous CHW reports on teaching about business practices include:

 

Vaccine Promotion in the Hands of a Corporation: The Missed Opportunity of Merck’s Marketing of Gardasil

Posted on by Corporations and Health Watch

Over the last several years, human papillomavirus (HPV), one of the most common sexually transmitted infections in the United States, has gone from relative obscurity to a source of heated debate and, for some, a new cause for fear. Casting a new spin on an old infection, Merck Pharmaceuticals single-handedly produced more widespread familiarity with the virus and manufactured the catalyst for conversations about HPV and cervical cancer. In June 2006, Merck received FDA approval for a new vaccine that protects against four of the more than thirty types of sexually transmitted HPV, Gardasil. Even before its approval, Merck advertised the coming vaccine indirectly with the teaser “Tell Someone.” In doing so, Merck began the process of using marketing to position a vaccine that protects primarily against a common sexually transmitted infection instead as a powerful vaccine against cancer.

The HPV vaccine debuted on the market with an advertisement campaign explicitly acknowledging women’s lack of familiarity with the virus and its consequences. The television ads featured women talking directly to the camera, exclaiming, “Cancer caused by a virus…I didn’t know that!”

As the “Tell someone” campaign encouraged its viewers, sharing this knowledge with other women was critical. Concurrent with its direct-to-consumer advertising, Merck also launched an “Educate the educators” session to inform physicians about the new vaccine, anticipating a fair amount of public resistance to vaccinating girls (ages 9-26) with a vaccine that might minimize the consequences of sexual activity. The importance of this education also stemmed from the fact that HPV is not well understood even among many physicians, likely as a result of the many types of HPV that exist. In a physician education session targeting gynecologists that I attended, the majority of the session focused on the epidemiology of the virus, and session leaders failed to discuss any of the existing treatment options, which most attendees would be using in their everyday practice. In other words, Merck seemed to expect that even physicians had vague knowledge about one of the most common STIs.

At its FDA hearing, Merck explicitly focused on the vaccine as a response to a variety of working groups that sought to reduce mortality due to cervical cancer. The promotion of the vaccine and the management of the trial data stressed that the “need” was for a cancer vaccine, not for a vaccine to prevent a highly transmissible and very prevalent STI. Some of this focus may reflect the company’s desire to minimize parental resistance to the vaccine. In the months leading up to the vaccine’s distribution, a variety of popular press articles questioned whether a vaccine for an STI could really gain acceptance in the United States, with its recent history of abstinence only programs in lieu of sexual health education. The reactions from a number of conservative family organizations, like Focus on the Family, and these groups’ public acceptance of the vaccine also suggest that Merck packaged its campaign to address their concerns. Once the FDA approved the vaccine, these groups acknowledged that they were not against a vaccine that protected against cancer, but they were against government requirements of the vaccine. This carefully worded response played into Merck’s own positioning perfectly. While the vaccine does prevent the infection with some types of HPV that can cause cancer, cancer is not, in fact, an inevitable outcome of an HPV infection. This point, though small, is rather critical. Merck’s entire advertising campaign has focused on HPV’s cancer potential; a recent advertisement that leads the viewer to visit Merck-owned HPV.com portrayed a young woman’s (heteronormative) life dreams (college, travel, boyfriend, marriage) as pre-empted by her health decline into a cancer that could be prevented. HPV.com directs the viewer to learn more about preventing the STI by sending her to the Gardasil website. The tagline for this promotion is quite simple: HPV. Why risk it?

Once Merck received its FDA approval, the campaign progressed from the vague and non-specific “Tell Someone,” into “One Less” (woman/girl with cervical cancer) and then to “I Chose.”

In addition to its advertisements, Merck created a program initially called “Make the Connection,” which was renamed “Make the Commitment,” that offered make your own bracelet kits for free that would donate money to a cancer research organization. A number of celebrities participated in the purported “public service announcement” promotions, which have since been discontinued.

The Gardasil campaign, which included non-transparent lobbying of state legislatures to require the vaccine for school-entry, revealed that the pharmaceutical company’s message and the everyday experience of/practice around HPV infection were not completely coherent with each other. Merck’s education campaign pushed the vaccine as an unquestionable necessity, neglecting to mention how highly effective other technologies of gynecological care can be to reduce cervical cancer. The Pap smear, for example, has been used in the U.S. since the 1940s, and while it is an imperfect science, its institutionalization through gynecological guidelines have reduced American women’s deaths from cervical cancer to about 3,400 a year from more than 70,000 annually in the 1970s. Still, the consequences of HPV morbidity are not insignificant and reducing the spread of the disease is not inconsequential. What causes concern, however, is Merck’s positioning of Gardasil as a cervical cancer vaccine (not an STI vaccine), which in fact complicates how women may understand the benefits and limitations of the vaccine. What remains problematic about Merck’s campaign is that even with the HPV vaccine, women will need to have the same gynecological screening and treatment that women experienced before the vaccine. Women’s experiences with gynecological care may not change radically.

Merck’s vaccine (and now GlaxoSmithKline’s recently approved vaccine) is not intrinsically bad; such a position is uncomplicated and fails to take into account the fact that HPV can be a serious infection, regardless of whether it develops into cancer or not. However, the company’s willingness to use fear to incite parents and young women to vaccinate casts doubt on the insistent message that the vaccine will liberate women from traumatic health care experiences. Gynecological care is not without its limitations. Technicians read hundreds and hundreds of Pap smear slides in a day. Human errors can contribute to the progression of HPV to cervical cancer, and clinicians’ and patients’ continued uncertainty about the most appropriate interventions and even prevention make the vaccine a very powerful prophylactic.

Merck invested a lot of time and money in “educating” people — public health officials and providers in particular — about HPV and cervical cancer as the vaccine became available and widely disseminated. Tracking exactly how and where the money has gone is difficult because, like the program for Make the Connection/Commitment, Merck’s strategies appear to have included supporting a number of non-profits, such as Women in Government, an organization that lobbied in various states for the vaccine requirements in schools. But all its investment in education stressed the necessity of the vaccine, rather than focusing on preventive health as a more comprehensive strategy. Because a more comprehensive cervical health education focus might obviate the urgency of the vaccine, the emphasis in all the educational materials was on the ubiquity of HPV and the challenges of preventing its spread.

Throughout Merck’s HPV and Gardasil advertisements, little has been said about the treatability of cervical cancer or the success at preventing HPV from progressing to cancer. Much like other pharmaceutical interventions designed to make life easier, when available solutions exist to address the same problem, Gardasil offered an alternative but is not a panacea. Many of the screening techniques and preventive health services are less expensive (per use) than the high cost (and incomplete levels of protection) that the vaccine presents. Though Merck has set up programs to allow low-income women (and presumably now men, since its FDA approval in boys and men in September 2009) to receive financial assistance to get the vaccine, Gardasil debuted on the market as the most expensive vaccine. Costing nearly $350 for the three shot series, the vaccine initially was a big money maker for Merck with $1.4 billion sales worldwide in 2007. Its first quarter report in 2010, however, showed an 11% decrease in sales from the same time last year. Sales of the vaccine, however, are harder to track than other treatments, because governments fuel much of the purchasing, with programs like the United States’ Vaccines for Children program and county public health programs’ acquisition of the vaccine. Current research suggests that there are still significant disparities between women/girls who receive the vaccine and those who don’t. Much like the disparities in cervical cancer rates (and deaths), class and race seem to be the distinguishing factors in terms of who gets the vaccine. With further approval to market the vaccine to older women, Merck is capturing a large market share of people who may not benefit from the vaccine.

Because Gardasil only protects against some and not all types of HPV, promoting a more comprehensive education scheme would have not compromised Merck’s campaign. Merck’s rush to lobby state legislatures to require the vaccine for school entry, for example, seriously undermined the public’s trust in their motives. Instead of transparently lobbying (though perhaps an unrealistic expectation in American government), Merck used a number of indirect channels to promote state laws (for instance, Women in Government) that subsequently failed almost nationwide. Merck publicly announced it would no longer lobby state legislatures after the Texas governor overrode the state legislature debate. This sort of aggressive push devalues the real potential benefits the vaccine might offer young women.

It seems clear that there was an incredible opportunity available at the moment of Gardasil’s debut. A vaccine that protects against an STI that can slowly progress into cancer is a significant accomplishment. Offering women the opportunity to reduce their health risks and preempt an often painful and stressful set of morbidities associated with HPV infection was also a significant coup. Raising awareness about HPV, the difficulty in preventing it, and reducing cervical cancer mortality globally are all meaningful developments. But Merck did not manage any of these well and used its advertising campaign to manipulate women by playing on their ignorance or confusion about their health care. While the campaigns framed the decision to use the HPV vaccine as women’s own proactive involvement in their health care, the messages have been frightening and unsettling unnecessarily. Merck has handled its campaign irresponsibly, choosing not to frame the message simply and with straightforward information, perpetuating the notion that HPV and cervical cancer are a mysterious threat that can only be stemmed through vaccination. Since this is not true, and women will still get HPV and may still get cervical cancer, the message remains deeply problematic and even paternalistic.

By S.D. Gottlieb, MHS, PhD, anthropologist and author of the recent dissertation entitled, “Manufactured Uncertainty: the Human Papillomavirus and the Object Multiple.”

Photo Credit:

  1. neofedex

Corporations and the Food Movement: The Case of the KFC Double Down

Posted on by Corporations and Health Watch

In the June 10 edition of the New York Review of Books, Michael Pollan writes that while the diverse interest groups of the American food movement are starting to pull together, “It’s a big, lumpy tent, and sometimes the various factions beneath it work at cross-purposes.”

Under this tent, Pollan includes those people interested in:

school lunch reform; the campaign for animal rights and welfare; the campaign against genetically modified crops; the rise of organic and locally produced food; efforts to combat obesity and type 2 diabetes; “food sovereignty” (the principle that nations should be allowed to decide their agricultural policies rather than submit to free trade regimes); farm bill reform; food safety regulation; farmland preservation; student organizing around food issues on campus; efforts to promote urban agriculture and ensure that communities have access to healthy food; initiatives to create gardens and cooking classes in schools; farm worker rights; nutrition labeling; feedlot pollution; and the various efforts to regulate food ingredients and marketing, especially to kids.

 

This article explores what a new and much-discussed sandwich from KFC, the Double Down, can tell us about ways that corporations might try to use the lumpiness of the food movement tent to their advantage. KFC introduced the Double Down on April 12th, describing it as a “one-of-a-kind sandwich” that “features two thick and juicy boneless white meat chicken filets, two pieces of bacon, two melted slices of Monterey Jack and pepper jack cheese and Colonel’s Sauce.” KFC gushed, “This product is so meaty, there’s no room for a bun!” Advertisements for the sandwich sparked a lively debate on the Internet and beyond. This response has translated into sales, and while initially the sandwich was to be offered for just a few weeks, KFC recently announced that its availability would be extended through the summer and perhaps for as long as demand remains high.

At first, commentators repeatedly noted the blow to health that the Double Down appeared to pose for anyone who consumed it. As a reporter for the Baltimore Sun quipped, “I’d call it murder on a bun, except there is no bun.” But others argued that KFC was not alone in promoting unhealthy fare. Pop culture analyst Greg Beato wrote, “Positioning KFC as a culinary terrorist that coerces chicken-hearted consumers into eating against their best interests makes for a savory sound bite, but it’s based on faulty intelligence.”

As it turns out, the Double Down’s 540 calories, 32 grams of fat, and 1,380 milligrams of salt make for a pretty average nutritional profile as compared with that of other fast food items. The Double Down is considerably less unhealthy, for instance, than Wendy’s Triple Baconator (1,350 calories, 90 grams of fat, and 2780 mg of salt) or Burger King’s Triple Whopper (1160 calories, 76 grams of fat, and 1170 mg of salt). According to one of the more sophisticated analyses, even Burger King’s regular Whopper with cheese is slightly nutritionally worse than a Double Down. And the Double Down appears almost light next to items from restaurants like The Cheesecake Factory and California Pizza Kitchen, whose products were recently featured in the Center for Science in the Public Interest’s Xtreme Eating 2010 report.

So, miraculously, the notion of the Double Down as a nutrition disaster is morphing into an understanding of it as fast food business as usual. In their efforts to target young men, KFC has joined Hardee’s, Burger King, and Jack in the Box in launching marketing campaigns designed to increase product recognition, brand loyalty, and sales to a population characterized by rapid increases in obesity and escalating cardiovascular risk.

In conjunction with these nutritional concerns, it is interesting to note that KFC has engaged a somewhat surprising branch of the food movement—hunger activists and food banks—in its promotion of the sandwich. In their online newsroom, the corporation has written,

When introducing a bunless sandwich, the obvious question is: what happens to all the buns? To celebrate the launch of the Double Down, KFC will do some good by donating the “unneeded” sandwich buns to feed the hungry. The brand will donate both buns and funds to food banks across the country, starting with the Dare to Care Food Bank in KFC’s hometown of Louisville, Ky.

Some, like NYU Professor Marion Nestle, have wondered what purpose this aspect of the Double Down marketing serves. Nestle speculates that perhaps it is merely desperation on the part of KFC, which saw its market share fall precipitously in the latter half of the 2000s. However, even desperate acts are driven by strategy. Might bun donation have functioned as a preemptive offering to one branch of the food movement—in this case, hunger activists—to quell the anticipated outrage of other branches, like those concerned with obesity and nutrition?

Though the complex tensions between hunger and obesity are at the heart of the food movement, the mobilization around food is not just political. As Pollan puts it,

What is attracting so many people to the movement today (and young people in particular) is a much less conventional kind of politics, one that is about something more than food. The food movement is also about community, identity, pleasure, and, most notably, about carving out a new social and economic space removed from the influence of big corporations on the one side and government on the other.

Except for this last clause about corporations and government, Pollan might well be describing the soaring interest in popular food culture, through which many people now identify as “foodies” or “chowhounds.” Foodies are people who take a collector-like interest in food and restaurants. Not all foodies care about where food comes from and how it’s produced, but many do, especially those who have followed renowned and socially-minded chefs like Alice Waters and Bill Telepan into the food movement.

Chowhounds represent what some regard as the more adventurous, less high-brow end of the foodie spectrum. The name stems from an online message board started by Jim Leff and Bob Okumura in 1996. As Leff described in an interview in 2005, a chowhound is:

Someone who seeks out deliciousness in any situation and loves to discover new culinary treasures. The one who, on the way to work each morning, walks blocks out of the way to try a different muffin and isn’t satisfied until the most delectable one is found. They are people who hate to settle. In a world where titanic engines of marketing influence people’s opinions and taste, there are the guys who opt out and make their own decisions. You know how there’s adventure travel? Well, we’re adventure eaters. Which doesn’t mean that we won’t go to the obvious places if they’re great. If McDonald’s made great hamburgers, I would be there every day.

Leff’s last sentence highlights the idea that when a movement is, as Pollan writes, about “community, identity, and pleasure,” there are many possible forms that communities can take, and many (possibly conflicting) values that these communities can hold. Like the food movement, the foodie movement has gained its steam online as much as anywhere else, and many of the related communities are online ones. This is relevant to the Double Down’s success, which has been fueled by online interest. At the end of April, KFC’s spokesperson Richard Maynard was quoted as saying, “For the demographic it is intended for, primarily young males, [the Double Down] has received an unprecedented response following launch. […] We’ve never seen so many people post YouTube videos and social-media reviews of one of our products.”

However, the response to the Double Down is not limited to young men posting YouTube videos. According to KFC’s post-test marketing research, the Double Down has received high scores for “uniqueness,” precisely one of the food characteristics that chowhounds and many other foodies seek. And sure enough, many chowhounds couldn’t resist a jaunt to KFC to try the Double Down. Posts about the Double Down on chow.com (the current incarnation of the chowhound message board) have received more than 100 replies (an examplehere), often weighing in with first-hand knowledge of the sandwich.

Further evidence of the curiosity that the Double Down has produced among studied eaters and those outside of the usual fast food target audience is apparent in the unprecedented reviews (examples here, here, and here) of the fast food item, not only by numerous food and other blogs, but also by the dining sections of several major newspapers. Mina Kimes of CNNmoney.com writes that the Double Down is a “turning point for the fast food industry as a whole–proof that customers will now flock to product innovation, not just pricing promotions.”

While Pollan notes that the food movement’s diverse subgroups are beginning to converge, KFC seems to see another path. Using its awareness of tensions in the movement, KFC hopes to fuel sales of what appears to be a very successful product. The marketing of the Double Down should provoke us to ask two basic questions. First, how can a food movement resist corporate efforts to undermine people’s capacity to make healthier food choices? And second, what roles can foodies play in the food movement and what interests do they share with other reformers?

By Emma Tsui, Postdoctoral Fellow at the City University of New York School of Public Health at Hunter College and editor at Corporations and Health Watch.

 

Photo Credit:

carnesaurus

The Health Impact of Targeted Marketing: An Interview with Sonya Grier

Posted on by Corporations and Health Watch

Sonya A. Grier is an Associate Professor of Marketing at the Kogod School of Business at American University. She was previously on the faculty at the Stanford University Graduate School of Business and was a Visiting Scholar at the Federal Trade Commission, where she provided consumer research expertise as part of a presidentially mandated team examining the target marketing of violent movies, music, and video games to American youth. She also spent a semester at the University of Cape Town in South Africa conducting research on social influences on consumer responses to targeted advertising.

In March 2010, Sonya Grier and her collaborator Shiriki Kumanyika published an article in the Annual Review of Public Health entitled, “Targeted Marketing and Public Health,” which explores the complex concerns raised for public health by the use of targeted marketing. In May, Corporations and Health Watch staff person Marissa Anto interviewed Dr. Grier about her interest in targeted marketing, recent trends in the field, and how public health advocates might better harness targeted marketing for their own purposes. What follows is an edited version of the interview.

CHW: How did you become interested in targeted marketing?

SG: I’ve always been interested in the different types of strategies that marketers use to reach specific groups and how they determine what different types of strategies are necessary. My first job out of college in the late 80s was as a market research analyst at Kraft and I remember asking why there wasn’t an ethnically targeted marketing campaign for barbecue sauce. Based on my personal knowledge, it seemed like there was heavy usage in the African American community and I didn’t see that reflected in the ad campaigns that were developed. That led me to understand, especially being a research analyst, how they were using data and information and putting it together to develop these types of strategies and that really started to drive my interest in targeted marketing. I also volunteered in a corporate program for non-profits, and I was assigned to help a Women of Color Theatre Group with audience development. The marketing issue there—this is again in the 80’s—was how to market something that might be perceived as an ethnic product to the core audience, as well to others who might be interested. So these are my first experiences in the professional field of marketing as a practitioner that really drove my interest specifically in targeted marketing.

CHW: In your Annual Review article, you define targeted marketing as “the identification of a group of people who share common needs or characteristics that an organization decides to serve” (p. 350). Can you explain what that means?

SG: My definition is based on the notion that if you speak to consumers in a way that resonates with the way they think, the way they talk, their attitudes, beliefs and values, they’re going to respond favorably to targeted marketing. That’s really the crux and most important part of it. Identifying when and how to do that is the challenging and creative part.

CHW: Why do you think this issue is important for public health professionals?

SG: Well, targeted marketing strategies influence behavior, which is a key goal of many health professionals. More specifically, targeted marketing can be used to influence commercial behavior such as getting people to buy a certain product, to influence health-related behavior such as increasing fruit and vegetable consumption, or some combination of the two. Targeted marketing often influences attitudes and reinforces people’s beliefs about what they think is normal. From a commercial perspective, it attempts to increase consumption of products or services. And this is the environmental context that people face daily as they try to listen to any type of public health message, so this is significant “competition” for public health efforts and that’s why it becomes very important. Think about obesity where people talk about food marketing being a negative influence. If the majority of the messages that come to you based on food marketing strategies encourage overconsumption of less healthy food or discourage physical activity; then this is a reality that people face and public health professionals need to understand the real day-to-day experiences of people in order to change their behaviors.

CHW: That leads into my next question: Are there ways that public health researchers can learn from industries that use targeted approaches to marketing? What do you think are some of the most important concepts we can learn?

SG: Definitely. One specific area is customer orientation, which is generally the basis of all marketing efforts and especially targeted marketing efforts. Marketers work to develop a profile of their target consumers, learning everything they can about the consumer from their perspective. This includes not only how people make choices about buying one specific product—and from a public health perspective, it’s not about just engaging in one specific behavior— but it’s also about how the desired behaviors fit into their lives and the kind of constraints people face, or believe they face. Everything is viewed from the perspective of the target audience. And this may not always be the same as what the professional ‘knows.’ Industry marketers also try to speak to target audiences in their own language, which is something that often doesn’t happen in public health. What I often see in public health is that specific actions are seen as right or wrong from a health perspective. So for public health researchers, a customer orientation might be letting go of preconceived notions of what is right and what is wrong and instead focusing on the person’s perspective, understanding how they make choices and what factors are influential to them.

CHW: What role do you think targeted marketing plays in maintaining or exacerbating disparities in health?

SG: I will use an example from the area I am currently working in which is obesity. The prevalence of obesity in African American and Hispanic children and adults is significantly higher than in White populations. We know this disparity is due not only to differences in income and education, although those factors might play a role. Social marketing programs aimed at obesity prevention often promote increasing the consumption of healthy foods and decreasing that of less healthy foods. So we have to think about what the role of targeted marketing of these less healthy foods is. As I noted, commercial marketing can be in competition with desired behaviors from a public health perspective. So commercial marketing can serve to hinder or prevent prevention. Say there’s a billboard that says, ‘Don’t let your children eat unhealthy foods’ and then right next to it is a billboard for fast food, advertising this very appetizing thing for $1. Which one is going to have the most sway and persuasiveness? Which one is a person going to see a lot more of? Understanding that context becomes really important because it can serve to prevent prevention.

I did a paper with Shiriki Kumanyika in 2008 called “The context for choice: health implications of targeted food and beverage marketing to African Americans” where we conducted a systematic review of the marketing environment for African Americans and we looked at the literature on food and beverage products, promotion, accessibility and prices targeted at African Americans as compared to White consumers. We found that targeted marketing strategies may challenge the ability of African Americans to eat healthfully. The strategies that were directed towards African Americans emphasized low-cost, low-nutrient food products like candy, soda, and snacks, and they were less likely to contain health-oriented messages. We also found that distribution and pricing strategies constrain the ability of African American consumers to purchase healthy food. It’s a challenge for any consumer to eat healthfully when their choices are constrained and they don’t have access, and prices are a lot higher or they are not made aware of these other products.

CHW: Can targeted marketing ever promote health or reduce disparities?

SG: Yes. Targeted marketing is a strategy, it’s a tool, it’s a set of practices and procedures that you put together to reach a particular goal; it’s not necessarily for good or for bad, it’s just a strategy someone uses and it can definitely be used to promote health. Health is a large component of the field of social marketing which has focused on using marketing to promote health, including the reduction of disparities as a goal. [Editor’s note: For more on social marketing and public health, see an article on this topic that Dr. Grier co-authored.]

CHW: Can you discuss some of the most compelling examples where targeted marketing has promoted health and reduced disparities?

SG: One example is the VERB campaign, which was created to increase physical activity in tweens. It was targeted at tweens but it also put particular focus on ethnic minority tweens, especially Hispanic tweens and African American tweens. Some of the research shows that it was effective in improving behaviors.

CHW: How do you think targeted marketing strategies have changed over time? You’ve been in this field since the late ‘80s. What are some of the shifts you’ve seen in the use of targeted marketing to get consumers to use different products?

SG: I think that strategies have moved from relying on one demographic variable like age, race, or gender to thinking about combinations of variables. So advertisers are now getting more into lifestyle and other variables to target a market. They’re not going to target me as a Black person or as a woman or as a baby boomer, but rather, perhaps, as a person who likes live music, buys health foods, and shops at Trader Joe’s, and all these others types of variables. Because there is so much more known now, and this is driven by technology. You also have the micro-targeting of media outlets which has created all these vehicles where you can reach particular groups of people. People can now live in their own marketing worlds without really knowing what’s going on in other worlds. What one group sees may be systematically patterned relative to what another group sees. And we can only to expect this to increase as marketers look for ways to be successful in increasingly competitive marketplaces.

CHW: How has the public health community sought to modify the harmful aspects of targeted marketing? What do you think of counter-marketing?

SG: Counter-marketing is really emerging as an important strategy to modify corporate practices that harm health. By counter-marketing, I’m assuming that we’re talking about the use of marketing techniques to try to un-sell a product or to destroy demand for a product. Research suggests that counter-marketing can be effective. The Truth campaign, for example, exposed the marketing practices used by the tobacco industry and then positioned this information in a way that spoke to youths. They did this by focusing on some of the core values for young people, like a desire for independence and individuality. This is a clear case of the consumer orientation that I was talking about earlier. The Truth message was also marketed just like a commercial brand and it had money behind it and it looked like what the teens wanted to see. Research on the effectiveness showed that it influenced attitudes toward the tobacco industry and tobacco use, and contributed to a decline of smoking prevalence. Research also shows that it was cost-effective because it recouped its cost and averted future medical costs. But at the same time, counter marketing is not really a one-size-fits-all strategy, and would need to be adapted to the particular domain you’re going to use it in.

For example, the success you see in tobacco may not transfer to products like food and beverages. Cigarettes are harmful and it’s illegal to sell them to minors but that’s not the case for food and non-alcoholic beverages. And the foods that may be the least healthy, like fried foods and soft drinks, taste good, are inexpensive, convenient, and they’re the norm. Research has also shown that counter-marketing can contribute to boomerang effects. In terms of alcohol and illicit drugs, some research that shows that attempts at counter-marketing increased positive attitudes towards alcohol and drugs. There’s also research that shows that the industry may pursue efforts to undermine counter-marketing strategies such as forming partnerships or other strategies. I think the big picture is that commercial marketers face few counter-marketing campaigns relative to the messages that are out there that counter health. So that’s an area where research is needed to really understand how do you develop counter-marketing strategies that won’t have boomerang effects and be insulated from things that industry might try to do and that can be effective across different domains.

CHW: In your opinion, what are some of the most important research questions on targeted marketing?

SG: One would be research on counter-marketing. Another is the targeted marketing of healthy products. You often hear store owners say that they won’t carry healthy products because people won’t buy them. Is this because people aren’t aware of those products? Or haven’t received the same type of repetitive messages about the value of those products in a way that speaks to them as they have for less healthy products? Another question related to this is: How do some consumers maintain healthy eating although they might encounter the same marketing strategies that encourage overconsumption? Understanding ‘positive deviance’ may lend important insights. I’d also say at a broad level there is a need for research to understand the extent of corporate consciousness about the aggregate effects of the market strategies they use among particular segments. Do they know that following the basic tenets of marketing they may be providing different messages to different groups about what constitutes a normal and healthy diet? We don’t know. Sometimes there is a discussion of whether targeted marketing on the part of corporations is intentional or not. I know from my experience with corporations that they’re following basic marketing strategy. It’s not like they’re saying, “We’re going to go out and make African Americans and Hispanics fat.” But there is a whole complex web of things that work together and the question is, are they aware of and conscious of those aggregate effects?

Additionally, I think a very important area is digital targeted marketing, especially with regard to the potential negative health effects for ethnic minority youth. Digital media really supports the basic goal of targeted marketing, which is to resonate with consumer characteristics. These strategies may rely on, for example, identity-related concerns of adolescents. Marketers are recognizing both that ethnic minority youth are leaders in the use of a lot of digital media and also that they are fast becoming the majority of the U.S. population, so marketers are putting a lot of money and effort into marketing to ethnic minority youth. And these same youth are dealing with not only basic identity concerns but also ethnic minority concerns. Think about some of the location-based strategies that involve digital marketing. Through these kinds of strategies, marketers might give teens a coupon when they’re near a fast food restaurant via a mobile phone. Research shows that minority youth are frequent mobile phone users, and they’re more likely to live near a fast food restaurant or have one near their school. For these reasons, they are more likely to get a coupon and perhaps will buy something that is affordable and good-tasting but that may contribute to more weight gain in this population. This interaction between technology, health, personal characteristics, and marketing strategies in the digital realm seems like an area where much research is needed from across disciplines and paradigms, within public health as well as from the social sciences, economics, and business.

CHW: What are some current targeted marketing research questions you’re now working on?

SG: I am looking to identify the specific characteristics of African American and Hispanic youth that may make them more responsive to digital targeting, and examining the effectiveness of strategies that might harm their health. I’m also working with the African American Obesity Research Collaborative (AACORN) on a five-year grant from the Robert Wood Johnson Foundation. We’re using community-based participatory research (CBPR) to investigate how targeted marketing strategies encourage healthy eating at the community level.

CHW: What’s your opinion of the use of terms like “organic” and “green” to denote products as being healthy? Do you think it brings these products to a wider audience by making it more mainstream?

SG: I think it can confuse consumers because if there aren’t specific standards to say what it means to be “green”, what it means to be “organic”, what means to be ”all natural,” etc., people may not have an understanding of how these relate to their goals of eating healthier. And I think that’s really what’s needed: Information and knowledge that helps people understand how they can be healthier within the context of the environments that they face and the lifestyles they lead.

CHW: Do you think that corporations and commercial entities can be more responsible in their use of targeted marketing?

SG: Yes, definitely. That’s why one of my current research questions examines consumers’ consciousness of the effect of corporate strategies on specific target markets. Eventually, I want to look specifically at corporate consciousness. I mean, honestly, I’m not even sure they realize this. Companies may read in the newspapers that there’s more targeted marketing of soda to African American youth, but do they know that these are their strategies, that their strategies play a role in that? It’s such a contentious and controversial issue that it’s not like there is an open dialogue typically between companies and public health advocates in this domain.

CHW: Do you think there should be a more open dialogue and greater consciousness surrounding these issues?

SG: You see so much about targeted marketing to kids, but within targeting to kids, you have the sub-groups of African American and Hispanic children who are significantly overweight. A basic marketing principle is that you focus on the heavier users, because those are the people who will keep buying your products. In public health, you would think the focus should be on protecting those with the greatest need. So with all this concern about food marketing to children, there should be a heavy emphasis on looking more carefully at food marketing to ethnic minority youth and you don’t see that. You see lots of discussion of obesity disparities and the horrific statistics, but very little focused effort, especially effort that takes the community perspective as fundamental. From a political or policy perspective, perhaps you don’t get things done if you only focus on one group. At the same time, I don’t think public health can afford to play that policy game and ignore the need to understand these minority groups because if you look at what’s going on with the census, eventually these groups are going to be the majority. So you can ignore this at the peril that in ten years we still have very limited research on groups that by then will be the majority of the marketplace and at highest public health risk.

CHW: Thank you very much for your time and insight.

SG: Thank you for your interest in targeted marketing!

For other related CHW posts see:

California county votes to ban the use of toys to attract kids to unhealthy fast food meals

Posted on by Corporations and Health Watch

In August, Santa Clara County in California may become the nation’s first municipality to ban the use of toys in marketing high fat, high sodium fast food to kids. On May 11th the county board passed the final vote needed to ban the toys that typically accompany children’s meals in fast food chains such as McDonald’s, Burger King, and Wendy’s if those meals do no meet certain nutritional standards set forth by the Institute on Medicine.

For example, in order to come with a toy, a meal would have to have less than 485 calories and 600 mg of sodium (1). By way of comparison, the nutritional contents of several standard kids’ meals are as follows:

A McDonald’s Happy Meal of Cheeseburger, 12 ounce Sprite, and small french fries

contains

640 calories

24 grams fat

940 mg sodium

35 grams sugar

 A Burger King Kids’ Meal with Cheeseburger, 12 ounce Sprite, and apple slices

contains

490 calories

16 grams fat

800 mg sodium

45 grams sugar

 A Wendy’s Kids’ Meal with Crispy Chicken sandwich, 12 ounce Hi-C fruit punch, and kids’ french fries

contains

620 calories

22 grams fat

970 mg sodium

27 grams sugar


The fast food companies respond

The ordinance applies to all 150 or so restaurants in the unincorporated areas of Santa Clara County, but only about a dozen of these restaurants are fast food outlets that tend to offer free toys with children’s meals. The California Restaurant Association, which represents the interests of fast food companies, has launched an aggressive campaign to prevent the new ordinance from taking effect. McDonald’s and other corporations are fearful that the ban could lead other municipalities to enact similar rules. The campaign has run misleading full-page advertisements in local newspapers asking for constituents to contact their representatives. As noted by the California Restaurant Association’s director of local affairs, “It sets a tone. It could have a domino effect.” Michele Simon, author of Appetite for Profit wrote in a recent blog post about the ban, “I’ve been saying for years that it’s only a matter of time until some city or county figures out that a simple change in law is all that’s needed to make such promotions illegal at the local level. Localities have tremendous public health authority that is often underutilized.”

Fast food companies’ use of fictional characters

McDonald’s and Burger King have by far the worst track records when it comes to using popular fictional characters to peddle toxic foods. According to a recent Congressional report described in the Los Angeles Times, food companies spent about $1.6 billion in 2006 in marketing foods to children, and about $360 million of this sum was spent on the toys that come with kids’ meals. McDonald’s Corporation held an exclusive 10-year contract with Disney from 1996 to 2006, and Burger King currently has a contract with DreamWorks and Nickelodeon for co-branding (2). Both McDonald’s and Burger King use clever advertising techniques to capture children’s attention, leading them to use their “pester power” to bring their parents and families to fast food restaurants so that they can collect all of the toys. See Burger King’s website for kids here, and McDonald’s website for kids here.

Health advocates and parents grow concerned about the use of toys to sell junk food

While the fast food giants are trying to spin the issue as a matter of government officials taking decisions away from parents, or as excessive government meddling, many parents welcome the proposal, though their feelings can be complex. Comments from popular parents’ websites are a testament to this. For instance, a comment on CafeMom reads, “I’m mixed on this. . . I just wish they would stop running commercials. I do not allow my son to eat fast food but it’s getting harder cuz of their stupid commercials showing what toys they are offering.”

The county supervisor behind the proposed ordinance, Ken Yeager, told the New York Times that the new law would “level the playing field by taking away the incentive to choose fatty, sugary foods over healthier options.” Yaeger noted that “This ordinance breaks the link between unhealthy food and prizes. It helps parents make the choices they want for their children without toys and other freebies luring them toward food that fails to meet basic nutritional standards.”

While many have credited the California county with pioneering the move to ban toys in promoting fast foods, it should be noted that similar bans have been proposed in other countries where childhood obesity is of concern, such as in England in 2008, and in Brazil and Spain in 2009.

Lauren Evans is a writer for Corporations and Health Watch and student in the Doctor of Public Health program at the City University of New York.

References

  1. According to a press release dated 4/27/10 from Santa Clara County: “Restaurants cannot use toys as rewards for buying foods that have excessive calories (more than 120 for a beverage, 200 for a single food item, or 485 for a meal), excessive sodium (480 mg for a single food item or 600 mg for a meal), excessive fat (more than 35% of total calories from fat), or excessive sugar (more than 10% of calories from added sweeteners). The criteria are based on nationally recognized standards for children’s health created by the Department of Health and Human Services (DHHS) and the Department of Agriculture (USDA), and recommendations for children’s food published by the Institute of Medicine (IOM).”
  2. Institute on Medicine of the National Academies. Food Marketing to Children and Youth. Washington DC: The National Academies Press; 2006.

Image Credits:

  1. Amanky
  2. graciepoo