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

Taking on Big Soda over Taxes: Lessons Learned from Fighting Big Alcohol

Posted on by Corporations and Health Watch

With soda taxes becoming an increasingly attractive policy option to help prevent diabetes and obesity and to fill empty state coffers, the soft drink industry is fighting back, and hard. While tobacco is often mentioned as the analogous issue, in fact, alcohol and soft drinks have much in common. In this piece, experienced alcohol control advocate Michele Simon translates lessons learned from the ongoing fight against Big Alcohol into six practical lessons for soda tax advocates.

Since I started working at Marin Institute, an alcohol industry watchdog group, in 2007 it’s become painfully clear that corporations have the same playbook. Whether it’s the food industry, tobacco, or alcohol, they all use the same talking points and lobbying strategies. While Big Tobacco may be most infamous for decades of hiding scientific evidence of harm and the deceptive marketing, all industries have similar tactics.

In my work at Marin Institute, raising alcohol taxes has been a primary focus of our policy agenda because we know that increasing prices is one of the most effective ways to prevent underage drinking and adult overconsumption.

With soda taxes becoming an increasingly attractive policy option to help prevent diabetes and obesity, the soft drink industry is fighting back, and hard. While tobacco is often mentioned as the analogous issue, in fact, alcohol is more similar to soft drinks.

Besides the obvious (they are both beverages), alcohol and soft drinks each hold a special place in American culture. There’s nothing more American than relaxing with a Coke, or a Bud. Also, unlike smoking, which everyone (well, except the tobacco industry) can agree should simply be stopped, when it comes to beverages, the message is more about cutting down.

Here, I offer a few of the lessons that alcohol control advocates have learned from decades of fights with industry over raising taxes, fights that continue to this day.

Lesson One:
Don’t let industry claim that soda doesn’t cause obesity or that taxes won’t work.

This is a tried and true tactic: attack the science, discredit the scientists, and make unscientific predictions that are in direct conflict with the published science. As is the case with tobacco, the alcohol industry has abandoned its futile attempts at claiming there is no scientific connection between alcohol consumption and health problems. However, because the science is less far along in obesity, the soda industry attempts to refute what science there is on the connection between drinking soda and poor health. Still, this argumentation is easily countered by showing those studies that claim no connection between soft drinks and obesity tend to be funded industry, big surprise.1

A related argument is that raising taxes will not result in the desired public health goal of lowered consumption, and thus fewer health problems. The alcohol industry does try to make this argument, claiming that people will continue to drink and of course, what we really need instead is better education and parental oversight. The soft drink industry loves to point out how there are “many causes” of obesity and that they should not be singled out, and that soda taxes won’t work due to this “complexity.”

Now it’s true that we do have less science when it comes to predicting behavior change from soda taxes than either tobacco or alcohol, both of which have been studied for decades by economists and other researchers. So it’s imperative that when we are making claims related to “elasticity” (the economic term for consumer response to price change) that we get it right.

We also have to be honest by saying that we may need more research to fully understand pricing effects. One thing we’ve learned from alcohol is that taxes can be a very blunt instrument in effecting price change because companies are very clever in how they absorb the added business expense. Companies can keep cheap products cheap while marking up more expensive products, or simply cut costs instead. Product pricing is extremely complex and cannot always be predicted accurately. One study suggests that minimum pricing on all alcohol may be a better policy than raising taxes, due to price manipulation by industry.2 Minimum pricing is when the government sets a floor; for example, that retailers cannot sell below cost. Such a policy has a more direct impact on prices than taxes. Perhaps minimum pricing should be considered for soda.

Lesson Two:
Don’t let industry claim that a penny per ounce tax will cause massive job loss.

Job loss and adverse economic impacts are industry’s most effective talking points. It cannot be underestimated how powerful and persuasive this argument is with politicians, as it gives them a convenient excuse to curry favor with industry by voting against a tax increase. Already, lobbyists for Big Soda have descended on New York State to convince lawmakers there to vote against a tax, with unsubstantiated claims of massive job loss. A recent story in the New York Daily News estimated that the beverage industry spent $3 million on lobbying against the state soda tax proposal.

The alcohol industry has been extremely effective claiming job losses so it’s no surprise the soda industry is following this path. And of course, in these tough economic times, such arguments carry even more weight. “We are already struggling. Don’t kick us when we are down. This is the worst time to raise taxes,” we hear all the time. Of course, meanwhile, every state legislature is in the red, desperate for revenue, which is precisely why soda taxes are even being considered in so many states in the first place.

But there is no good time to raise taxes. If and when the economy improves, the soft drink industry won’t suddenly stop opposing taxes. Alcohol control advocates have countered industry’s job loss claims in a few ways. First, they argue that the tax increase being proposed is so small that the impact on business will be negligible. Of course, it will still be enough to see a public health impact, but it won’t put anyone out of business, even the small “mom and pop stores.” Secondly, there is no good science to back up industry’s wildly exaggerated claims of job losses. Unfortunately, we do not have any science on the public health side either to examine what any potential job loss might be based on, either from an alcohol or soda tax increase, and this is an area of research that is sorely needed. We do have decent studies on indoor smoking laws that showed bars did not go out of business, despite industry claims to the contrary during those battles.3

Another response to the economic argument is that when people stop buying one type of product (whether tobacco or alcohol or soda) those consumer dollars do not disappear. Rather, people spend that money in other parts of the economy, so there is no net loss. Moreover, the money to be gained in tax revenue will be spent on programs that will create jobs. For example, in New York, the Healthcare Education Project is projecting that 29,000 healthcare jobs will be lost if the soda tax there does not pass. This dwarfs the beverage industry’s job loss projections of 6,000 if the soda tax is passed.

Lesson Three:
Don’t let industry claim they care about poor people and working families.

The beer industry has been particularly shameless about arguing that beer taxes are regressive because they hurt poor Joe and Jane Six-pack. We make the obvious counter argument, that beer, like soda, is not a necessity of life. (Moreover, research shows that people with higher incomes actually consume more alcohol.) The soda industry, through its ad campaigns and front group, Americans Against Food Taxes, is promoting the imagery of family picnics, and claiming that average Americans would never be in favor of such policies. In alcohol, polling has proven very useful to demonstrate the overwhelming support for higher alcohol taxes, especially when the funds are applied to alcohol-related programs. Polling could also be useful in countering soda industry claims that all Americans think taxes are always bad. Positive polls also offer politicians cover.

Lesson Four:
Make sure to index all excise taxes to inflation. (Industry hates this.)

One of the biggest challenges in the alcohol field is that excise taxes (based on volume sold) are not indexed to inflation. As a result, because most states have not raised their excise taxes in years, the real value of tax revenue has significantly declined. For example, in California, the real value of alcohol excise tax revenue, which was last raised in 1991, has declined 37 percent. (See Marin Institute’s maps that demonstrate the impact of neglected and outdated alcohol excise taxes in each state.) This amounts to a subsidy for industry, since product prices remain artificially low. Here, you have not only industry to battle, which hates indexing to inflation for obvious reasons, but also many lawmakers who do not believe in placing automatic increases on taxes. But without it, you will find yourself fighting the same battles year after year for increases. Note that because sales taxes are usually assessed as a percentage of price, sales taxes will go up as prices increase. This is one benefit to sales tax over excise tax.

Lesson Five:
If and when you start gaining success locally, do not allow industry to get preemption at the state or federal level. (This is really important.)

Most excise taxes on products such as tobacco and alcohol are assessed at both the federal and state level and for good reason, as both levels of government rely on the revenue generated by taxing these products. Some states also allow the local taxation of tobacco and alcohol, which is of critical importance, especially now when so many counties and cities are hurting for revenue. And of course, it’s at the community level that the adverse impact of harmful products is felt most severely. Unfortunately, the alcohol industry has successfully preempted localities from assessing taxes in most states. In other words, only states can levy alcohol taxes, not cities or counties. (There are some exceptions; for example, California allows local fees under limited circumstances.)

For soda taxes, it’s imperative that cities and counties retain the right to assess local taxes and fees as they see fit. Also, if there is ever to be a soda tax at the federal level, under no circumstance should such a law preempt state-level taxation. Doing so would be a public policy disaster and makes no sense from a states-rights or public health perspective.

Lesson Six:
Be Prepared for the Long Haul.

Finally, do not underestimate how much industry will lobby to the death against taxes. This is unlike any other fight–school food, menu labeling, you name it–and the food industry cares more about taxes. Taxes go to the heart of the corporate business model: having complete control over pricing, which is critical to maintaining steady profits.

Also, unlike other issues for which there may be grounds for compromise (such as menu labeling), industry will not compromise on taxes. This issue is non-negotiable.

Instead, industry will kill bills, and when they can’t stop a bill, they will successfully water it down to a much lower, perhaps insignificant tax rate. (Then when you try to raise it next time, it will look like a huge, unreasonable increase, which will be used against you.) Big Soda, in cahoots with distributors, restaurants, and the retail sector, will out-spend and out-maneuver public health advocates for decades to come. Already the soft drink industry has increased its lobbying against soda taxes by750 percent both in Congress and the states, which indicates how seriously they take this threat. They can spend millions of dollars fighting taxes and still get a good return on that investment due to the money they save in the long run.

And the fight will never be over, because even if you get a tax this year, it will probably be small, and you will have to fight to increase it next year, and the year after that. Public health advocates will have to decide if the enormous resources it will take to succeed are ultimately worth spending decades fighting on taxes, or if other policies, such as reducing corn subsidies, would be more effective. Either way, the lobbyists will remain employed.

Michele Simon is the Research and Policy Director for Marin Institute, an alcohol industry watchdog group, and the author ofAppetite for Profit: How the Food Industry Undermines Our Health and How to Fight Back. Visit her website and read herblog.

References

  1. Vartanian LR, Schwartz MB, Brownell KD. Effects of Soft Drink Consumption on Nutrition and Health: A Systematic Review and Meta-Analysis, Am J Public Health. 2007;97:667-675.
  2. Gruenewald PJ, Ponicki WR, Holder HD, and Romelsjoe A. Alcohol Prices, Beverage Quality, and the Demand for Alcohol: Quality Substitutions and Price Elasticities. Alcohol Clin Exp Res, 2006; 30 (1): 96-105.
  3. See e.g., Klein EG, Forster JL, Erickson DJ, Lytle LA, and Schillo B. Does the Type of CIA Policy Significantly Affect Bar and Restaurant Employment in Minnesota Cities? Prev Sci. 2009 Jun;10(2):168-74.

 

Interview with T.J. Faircloth from Corporate Accountability International

Posted on by Corporations and Health Watch

Is it time for Ronald McDonald to hang up his clown shoes? T.J. Faircloth, Research Director for Corporate Accountability International (CAI), thinks that it is. In March, CAI launched a campaign called “Value [the] Meal” to pressure fast food companies to stop aggressively marketing to children, blocking labeling laws, and interfering with the development of healthier public policies. We interview T.J. to find out more about the campaign’s strategy and rationale.

On March 11, Corporate Accountability International launched a new campaign called “Value [the] Meal” to pressure fast food companies to stop aggressively marketing to children, blocking labeling laws, and interfering with the development of healthier public policies. Corporate Accountability International (CAI) has been waging campaigns to end corporate abuses for 30 years. In April, Corporations and Health Watch staff person Marissa Anto interviewed T.J. Faircloth, the Research Director of CAI, about the Value [the] Meal campaign. What follows is an edited version of that interview.

CHW: What inspired the Value [the] Meal Campaign to focus on Ronald McDonald as the target of your campaign against fast food advertising to children?

TJF: Basically our Value [the] Meal Campaign was inspired by rampant corporate abuse of our food system. We looked at the entire food system from seed to plate and we realized that corporations were playing a negative role in our food system by spurring the epidemic of diet-related diseases, specifically the staggering increase of childhood obesity and diet-related illnesses like type II diabetes that really have a profound impact on children’s health all over the world.

Even globally we’ve seen the rates of diet-related illnesses spike. We wanted to start a campaign that would ultimately help reverse this epidemic by targeting the irresponsible actions of transnational corporations who play a major role in spreading this epidemic. Through understanding the various abuses of transnational corporations, we became interested in the marketing of unhealthy foods to children and that’s where we started to hone our attention towards McDonald’s being the industry leader and their brand spokes-character, Ronald McDonald.

CHW: Ronald is both a symbol but also an important part of McDonald’s brand value. What do you think are the pros and cons of using Ronald as the focus on your campaign?

TJF: Ronald, in our opinion, is really the face of a broken food system. For 50 years, there has been this iconic character who has hooked kids on an unhealthy product. There’s no one out there who would disagree that fast food is unhealthy. When we examined the role of the fast food industry in the current epidemic of diet-related diseases, it was clear that the marketing of unhealthy food to children is a key contributor to the problem.

McDonald’s as an industry leader has pioneered an irresponsible business model that depends on hooking kids on an unhealthy product early. When you start to pull apart their brand you find that their key to success is from establishing this lifelong relationship starting with Ronald McDonald and the toys and the happy meal and the playgrounds. This relationship begins at childhood and then continues throughout a person’s lifetime. So the pro for us is that by going after Ronald we were really going after the heart of their business model. We wanted to demonstrate the scope of Ronald’s market reach and more broadly the marketing of unhealthy foods in general. Whether it’s the fast food industry, the soda industry, the candy industry or even packaged foods; we thought that by going after Ronald and going directly after the McDonald’s business model, it would help people to organize around this problem.

Ultimately, the cons are that since McDonald’s has made such an effort to establish this lifelong relationship with its customers, people really have an emotional attachment to this corporate clown. As a result, some people have had a reaction when initially hearing about our campaign [to retire Ronald McDonald]. If they didn’t have a lot of context, they ask, “Why would you go after a beloved children’s character?” So we really have to deconstruct this emotional attachment that many adults still have with this character.

The other potential con is that McDonald’s has been so savvy with their marketing that they have the Ronald McDonald House charities and they have positioned Ronald McDonald as the face of those charities. We honestly commend the work of those charities and in no way have any issue with what the charities do. Our issue is more around the irony that, on the one hand, you have this corporate figure who supposedly helps kids, but he’s also contributing greatly to diet-related diseases among children. So those are two things on the con side that we’ll have to work on throughout the course of this campaign.

CHW: How did you come up with the Ronald McDonald tracking idea? What are its goals?

TJF: We wanted to demonstrate that marketing does have a profound impact on children’s health. Corporations have billions of dollars to spend on marketing and they don’t do it because it doesn’t work; they do it because it does influence the eating habits of children. The initial idea was let’s try to demonstrate the scope of Ronald McDonald’s reach and also the scope of the marketing of unhealthy food and how many children it reaches through various venues.

We wanted to show that marketing is having an effect that most parents and educators and even public health officials don’t really understand. It’s no surprise that nearly every child can recognize this corporate icon.

CHW: What is the Value [the] Meal campaign’s strategy?

TJF: The strategy really depends upon building a public climate here in the U.S. that connects McDonald’s with its impact on public health and that mobilizes people to demand change from the corporation. Our basic strategy is to mobilize tens of thousands of people across the country through the campaign to put pressure on McDonald’s to change its irresponsible marketing practices that target children. In that effort we’ve joined with teachers, parents, public health professionals, community leaders, faith communities, even socially responsible investors and elected officials to call for Ronald’s retirement with the understanding that any meaningful change in their marketing practice would need to start with their iconic children’s character.

CHW: What do you think is the biggest barrier to making fast food restaurants more accountable to the general public and the public’s health?

TJF: We feel like the biggest barrier is the immense power that these industries can wield. It not only allows them to exert control over our food system but it also allows them to manipulate public opinion, nutrition science, and public health policies. McDonald’s is a 32 billion dollar brand. They have really deep pockets, and can spend millions on public relations campaigns and marketing campaigns that can convince the public that their food is not harmful to health. Corporations like McDonald’s also have tremendous political power and they hide behind trade associations, the main one being the National Restaurant Association, which we’ve found has lobbied against legislation and public health policies relating to the fast food industry and the restaurant industry at large.

CHW: Can you describe some of the instances you report where corporations have attempted to influence scientific research concerning the negative effects of fast food?

TJF: A story in the Washington Post in 2004 reported that there are at least 30 McDonald’s restaurants located in hospitals nationwide, including in children’s hospitals in Los Angeles, Philadelphia, New York, and Cleveland. In some cases, Ronald McDonald is actually in the lobby hailing patients. And there was a study published in Pediatrics that estimated that fast food restaurants can be found in 30% of U.S. hospitals with pediatric residency programs. The reason why that’s a big deal is the study had shown that when fast food is directly located in hospitals, particularly children’s hospitals, the parents of those children who are in the hospital change their opinion about the nutrition value of fast food. So when those parents were asked how they felt about the nutrition quality of fast food, they had higher opinions of fast food when fast food was directly located in hospitals.

We’re also concerned about industry funding of national health groups. The American Academy of Family Physicians has formed their own partnership with McDonald’s. The company is now a sponsor of the AAFP’s Americans in Motion Program. If fast food corporations have these kinds of partnerships with health groups it sends a mixed message to people who might be concerned about the impact of fast food on public health.

Another example would be the American Dietetic Association (ADA). They received funding from many food corporations, such as Coke and Pepsi and even McDonald’s and other fast food companies, and you see these companies show up at the ADA’s annual conference and they have exhibitions, so again these partnerships skew the perception of how healthy fast food is.

One of the other issues we’re interested in is the Health Advisory Boards/Health Advisory Councils that many fast food companies have. McDonald’s has a global advisory council that has several health officials and doctors who advise them on nutrition and health. For us, that really sends mixed messages to people that fast food is healthier than it is.

And the last thing we keep an eye on is the direct funding of nutrition science from fast food. For example, a couple years ago the Scripps Research Institute and McDonald’s announced a collaboration regarding research and an educational initiative to drive progress towards a solution to childhood obesity and type II diabetes. McDonald’s donated $2 million to address these issues facing America’s children. If McDonald’s just changed some of their practices, they’d have a tremendous impact on type II diabetes and childhood obesity. It’s not really necessary for them to fund science. We know Scripps will be unlikely to come out with research that is negative towards the fast food industry because of that.

CHW: Can you discuss your findings from your most recent report on fast food advertising to children?

TJF: There were three main findings. First, we confirmed that corporate icons, children’s characters, and targeted fast food marketing to children have a profound negative impact on children’s health. Children do not understand the persuasive intent of brand marketing and they quickly develop brand loyalty that carries over into adulthood. For example, a 2007 study from Stanford University found that preschool children reported that food in McDonald’s wrappers tasted better than identical food wrapped in plain wrappers, suggesting that branding can even trump sensory input. In addition, marketing fast food to children really undermines parental authority by tapping into what the industry calls “pester power” where kids relentlessly pester parents to purchase unhealthy products, so even the most diligent parents can eventually succumb to this pressure in order to appease their children.

Second, we discovered, just as McDonald’s says, Ronald McDonald is literally everywhere. We had hundreds of members submit details of all the venues, locations, and events that Ronald frequents. We know he’s in schools, in educational materials, libraries; we saw him at the Olympics and other sporting events that appeal to children, parades like the Macy’s Day parade, children’s museums, in and around children’s hospitals, and on TV and the internet. Basically, almost anywhere where children tend to gather. So really just understanding the scope of Ronald’s reach was another major finding.

The last important finding was based on a national poll we conducted with Lake Research Partners that provided insight into McDonald’s use of Ronald McDonald. One question was, “What sort of impression do Americans have of Ronald McDonald?” We found that 65% of Americans actually have a favorable impression of Ronald McDonald. Not surprisingly, directly connected to that, about 65% of Americans actually have a favorable opinion of McDonald’s. But though the clown is well liked, we still found that a majority, 52% of Americans, favored stopping corporations from using cartoons and other children’s characters from selling harmful products to children. So that was one revelation. Even among those who have a favorable impression of Ronald McDonald, about half of those, 46%, actually support retiring Ronald. Looking more closely at the demographics, among parents who have children under the age of 18 and have favorable impression of Ronald and the McDonald’s Corporation, half support Ronald’s exit to the nearest retirement home. It was interesting to see that despite this widespread support for both the corporation and Ronald and the emotional attachment to the character, you still have a pretty broad base support for getting rid of him.

CHW: What role can President Obama or the First Lady and her Childhood Obesity Campaign have in improving fast food practices?

TJF: There’s a Voluntary Corporate Initiative housed under the Better Business Bureau called the Children’s Food and Beverage Advertising Initiative in which companies, including a dozen or so fast food companies, have now made these pledges to reduce the marketing of unhealthy food to children under 12. However, this voluntary initiative has been in effect for two years and several reports show that this it is ineffective, having no impact on the quality of food that these companies are marketing to children. So it’s clear that voluntary agreements with the industry will not work.

So the President’s or Michelle Obama’s initiatives requesting that the industry take voluntary action it just won’t be effective. The President should work to quickly implement the national menu labeling legislation that was part of health care reform. This would be a mandatory regulation under health care reform that would require, similar to what has happened in New York City, that all chain restaurants post calories on their menu boards. This would give customers the information they need to make more informed decisions. That would be one immediate thing the President could do, because it’s looking like it would take 2-3 years for this legislation’s implementation.

The President could also restore the Federal Trade Commission’s authority to regulate food marketing to children. There’s a joint interagency Working Group on Food Marketing to Children that includes representatives from the Federal Trade Commission, Food and Drug Administration, Centers for Disease Control and Prevention, and U.S. Department of Agriculture – that produced and presented in December a set of recommended nutritional standards for foods marketed to children. Those recommendations were supposed to be finalized in February, but they haven’t been finalized yet. They appear on the surface to be strong, so the President should work to have the guidelines finalized and then to make them into mandatory regulations.

CHW: Your campaign focuses on one company, the biggest one. What do you think of broader efforts to ban all unhealthy food advertising to children? I heard that Dennis Kucinich proposed legislation to ban tax deductions on advertising unhealthy food to children, so what do you think of efforts like that?

TJF: We totally agree with those efforts. As I’ve mentioned, when you look at this issue, it’s not just the fast food industry. I think a lot of people are interested in the fast food industry and agree that really any fast food is inherently unhealthy. That is different from packaged food products, which are sort of a mixed bag. When you think about the junk food industry, you’re really talking about the soda industry, the confectionery candy industry, packaged foods, and then fast food. We’re organizing around fast food but the problem is really widespread and all those other pieces of the junk food industry market to children and have a profound impact on their health. I think that fast food advertising may be more visible and the scope may be larger. But we totally support those efforts to really ban the marketing of all unhealthy marketing to children whether it’s fast food, soda, candy, or packaged foods.

CHW: Are there any fast food chains that are doing the right things? If so what are they doing that can serve as models for the rest of the industry?

TJF: There are some chains working to improve their supply chain, reducing pesticide use, increasing organics, and increasing local acquisition of food. There are many that are providing healthy options, which is different from healthier options. We’ve seen some movement among the bigger fast food chains that provide healthier children’s meals or salads that still have a ton of calories (dressings, condiments). But there are some chains that actually provide some healthy options. There are some chains that, even before the regulation, labeled nutrition information prominently and made that information available prior to the sale. McDonald’s will say that they’ve provided that information for many years now but it’s often after the products are sold. For example, customers can see calorie on the tray liners, after they’ve purchased the products. There are some smaller chains that have actually coordinated with local public health officials to address diet-related diseases in the communities they operate in. That seems like a very good step since public health concerns may differ from community to community. Some communities may be having a huge issue with hypertension and may need to reduce salt so restaurants need to take steps to reformulate salt content, that sort of thing.

CHW: What can academics, activists, and the average person do to compel fast food companies to improve the quality of their food?

TJF: We certainly respect the work that Corporations and Health Watch and the City University of New York have been doing to expose the irresponsible activities of the food industry that are greatly contributing to the epidemic of diet-related diseases and childhood obesity. Those academics and activists should continue to work on that front to expose the irresponsible corporate activities that are having negative health outcomes. The best first step for the average person to take is to get involved: to join our Value [the] Meal campaign to pressure McDonald’s and other fast food chains to stop marketing to children, and specifically regarding McDonald’s, to retire Ronald McDonald. Anyone can engage with the campaign by signing Ronald’s retirement card and joining our organizing effort. We’re making great progress in pressuring McDonald’s with exciting and compelling actions designed to engage the average person in the effort to protect children’s health.

For more on McDonald’s and the Value [the] Meal Campaign, see:

Prior CHW reports on McDonald’s:

PepsiCo vows to cut salt, sugar, and fat: Is Big Food getting healthy?

Posted on by Corporations and Health Watch

In March, PepsiCo Inc. announced that it was setting goals to substantially reduce the amount of sodium, sugar, and fat in its products over the next decade. Other Big Food companies like Kraft Foods Inc., ConAgra Foods Inc., and the Campbell Soup Co. have also recently vowed to make healthier products. CHW editor Emma Tsui briefly explores where this wave of industry health consciousness is coming from and how people are reacting to it.

On March 22, 2010, PepsiCo Inc. announced that it was setting goals to substantially reduce the amount of sodium, sugar, and fat in its products over the next decade. Specifically, the corporation hopes to cut the average sodium per serving in some of their brands by 25% by 2015, and to reduce average saturated fat and added sugar by 15% and 25% by 2020. Called “Performance with Purpose,” the initiative also seeks to increase the whole grains, fruits, vegetables, nuts, and seeds available among PepsiCo’s products, as well as to improve the corporation’s commitments to environmental sustainability and the health of its workforce.

PepsiCo’s global food and beverage business includes not only Pepsi-Cola, but numerous other familiar brands like Frito-Lay, Tropicana, Dole, Gatorade, Tazo teas, and Quaker, the maker of oatmeal, which is considered to be the company’s leading healthy food brand. Other Big Food companies like Kraft Foods Inc., ConAgra Foods Inc. (maker of Chef Boyardee, Healthy Choice, and Slim Jim products, among others), and Campbell Soup Co. have also recent publicly vowed to improve the healthfulness of their products by reducing their sodium content.

So where has this wave of industry health consciousness come from? PepsiCo emphasizes the dual objectives of responding to consumer preferences and improving the health of consumers in their decision to improve the healthfulness of their products. “Consumers are heading toward ‘good-for-you,’” MSNBC quoted PepsiCo CEO Indra Nooyi as saying during the recent investor meeting. Not only that, but as a limited liability corporation, Nooyi has said that it is important for companies like hers to recognize, “…if we are operating with a license from society, we owe that society a duty of care.” More cynical observers speculate that PepsiCo, like other food companies, is trying to avoid government regulation, which might set tougher standards and impose sanctions for violations. As one commentator noted, “Considering the vast resources large companies like PepsiCo, Kraft, and Campbell Soup Co. have at their disposal, these firms are wise to invest [in] research and development now, rather than scrambling later to avoid congressional hearings and even government regulations.”

Though reducing sodium, fat and sugar in processed foods may seem like an encouraging sign for the public’s health, there’s no doubt that PepsiCo’s interest in health is closely tied to its enduring interest in profit. “We believe that a healthier future for all people and our planet means a more successful future for PepsiCo,” Nooyi noted in the company’s press release. MSNBC added that PepsiCo’s portfolio of healthier or “good for you” products currently earns them approximately $10 billion (approximately one-fifth of their total revenue), and indicated that Nooyi estimates that this amount will grow to $30 billion within the decade.

But what impact can we expect these kinds of changes to have on health? Reaction to news of the “Performance with Purpose” initiative casts doubt on its health benefits, and responses to the company’s work to create what reporters have dubbed “designer salt” have been particularly skeptical. In these studies, by altering the shape of the salt, PepsiCo researchers have been able to increase the percentage of salt that dissolves on the tongue and is tasted, so that less salt can be used. In response to this news, the New York Times pointed toward the need to reduce consumption of snack foods, writing, “It’s not enough for snacks to have artificial sugar and new-fangled salt. High-tech or not, we also have to eat less of them.” Hemi Weingarten of the Huffington Post was in agreement, but blamed the marketing practices of PepsiCo and other major corporations in addition to consumer behavior. “So long as mega-corporations continue to manufacture and sell snacks as their main line of business, people will be encouraged by their aggressive marketing to consume more and more snacks and less real foods,” he wrote.

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 credits:

  1. wallyg
  2. roadsidepictures

Globalization accelerates woes for Toyota, world’s leading car manufacturer

Posted on by Corporations and Health Watch

For more than a decade, Toyota customers have reported incidents of sudden acceleration, resulting in crashes, injuries, and deaths. The company now faces charges that it intentionally hid defects from customers. Nick Freudenberg explores what role globalization may have played in accelerating Toyota’s woes, and what can be done to prevent such corporate catastrophes in the future.
About a year ago, Toyota became the world’s largest car manufacturer by sales after General Motors, the previous leader, was hit by the economic crisis. The Japanese company built its reputation and sales by emphasizing safety and quality, contrasting its products with less durable and dependable American vehicles. In the last year, however, Toyota has faced accelerating woes – declining sales, safety problems such as sticky accelerators and faulty brakes, and a spate of lawsuits, regulatory actions and unfavorable media coverage. In this report, CHW examines Toyota’s troubles, analyzes their links to broader global trends, and assesses the implications for automobile safety and public health.

Sticky accelerators and faulty brakes

For more than a decade, Toyota customers have reported incidents of sudden acceleration. At first Toyota attributed these reports to driver problems, then to problems with floor mats. Now both the company and the U.S. National Highway Traffic Safety Administration (NHSTA) have launched major investigations into sticky accelerators. By the end of March 2010, according to Reuters, Toyota had recalled about 8.5 million vehicles around the world. In early April, the New York Times reported that the U.S. Transportation Department (DOT) was seeking a $16.4 million fine against Toyota, the largest allowed, because the company had failed to promptly notify the government about potential problems with accelerator pedals. Toyota seems likely to pay rather than contest the fine.

According to Safety Research and Strategies Inc., an auto safety advocacy group, between 1999 and the end of January 2010, 2,262 cases of sudden acceleration involving Toyota vehicles were reported, resulting in 815 crashes, 341 injuries and 19 deaths. To add to Toyota’s troubles, in February, the U.S. Transportation Department opened an investigation into brake problems in the 2010 Toyota Prius, the company’s best-selling hybrid car. Shortly thereafter, Toyota recalled more than 400,000 cars. The company’s most recent problem was a Consumer Reports “no buy” warning for the Lexus GX 460 due to its rollover risk. Toyota suspended sales of its SUV the next day.

In testimony before a Congressional hearing in February, Akio Toyoda, the company’s president and grandson of its founder, apologized for the company’s missteps. “I fear the pace at which we have grown may have been too quick”, he told House members. “I regret that this has resulted in safety issues described in the recalls we face today, and I am deeply sorry for any accidents that Toyota drivers have experienced.”

Investigations and lawsuits

To determine the causes of the accelerator problems, the U.S. DOT last month asked experts from the National Administration for Space and Aeronautics (NASA) to analyze Toyota’s electronic throttles to determine if they have contributed to unintended acceleration. In an interview with Reuters, Secretary of Transportation Ray LaHood said, “We are determined to get to the bottom of unintended acceleration.” Nine NASA scientists are expected to bring expertise in electronics, electromagnetic interference and software integrity to the DOT investigation.

Key legal questions are what Toyota knew when and what they did with that information. In addition to the fine the DOT is seeking, a bevy of lawyers are pursuing these questions:

  • By early February, Toyota faced at least 30 lawsuits in the U.S. and Canada seeking class-action status on sudden acceleration.
  • In March, Orange County (CA) District Attorney Tony Rackauckas filed a civil lawsuit against Toyota, charging that the company had intentionally hid defects from consumers. “We intend to prove that Toyota ignored, omitted, obfuscated and misrepresented the evidence that was amassing for many years regarding serious safety defects in their cares,” he told reporters.
  • In September 2009, a former Toyota attorney told CBS News that Toyota had illegally withheld evidence in hundreds of rollover deaths and injury cases. The plaintiff, Dimitrios Biller, filed a racketeering lawsuit charging that his complaints about the company’s legal misconduct led to his firing. Company lawyers said that Biller had “breached his ethical and professional obligations…by violating attorney-client privilege.”
  • The inspector general of U.S. Department of Transportation is reviewing the NHTSA’s handling of the investigations into unintended acceleration, and the National Academy of Sciences is examining unintended acceleration and electronic vehicle controls throughout the auto manufacturing industry.
  • In addition, according to Fair Warning, an online publication on health, safety and corporate conduct, Toyota faces a federal criminal investigation and inquiries by the Securities and Exchange Commission, the Connecticut Attorney General, and a U.S. Attorney in New York.

Globalization – the fundamental cause of Toyota’s problems?

For public health researchers, Toyota’s troubles provide a case study of how global market forces can lead companies to engage in practices that threaten health.

How did this happen? First, in an effort to beat its U.S. competitors, Toyota pushed to expand production, move into new markets and dominate the growing market for smaller, more fuel-efficient cars. Although the results of current investigations will not be known for several months, it appears that Toyota cut safety corners to realize these opportunities, as CEO Toyoda tacitly admitted in his apology to Congress.

Second, the current practice of sourcing and using parts around the world means that once a defective part gets into the supply chain, it can cause global problems, a trend Christian Science Monitor reporter David Grant called the “dark side of globalization.” Toyota has blamed the accelerator problem on a faulty accelerator mechanism manufactured by Chicago Telephone Supply Company, a U.S .company founded in Chicago in 1896, now located in Elkhart, Indiana. In additional to its use in Toyota vehicles sold in the United States, the CTS part was also used in 1.8 million Toyotas sold in Europe, a Ford car produced in China and the Pontiac Vibe, formerly made by General Motors. All have now been recalled for repair. Global sourcing may make it easier for producers to lower costs but they also risk spreading dangerous products around the world, as also shown by the global spread of contaminated peanut butter manufactured by the Peanut Corporation of America in Blakely, Georgia last year and the 2007 recall of tainted pet food made in China.

Third, the growth of multinational corporations and the weakening of national regulatory agencies have made it more difficult for governments to keep an eye on big companies. At Congressional hearings on Toyota acceleration problems, NHTSA Administrator David Strickland promised that his agency would take a “hard look” at the power it has. Current authority, he said, may not be sufficient to regulate modern technology. Strickland also told the panel it was unclear whether the agency can regulate “in a way that allows the auto industry to build and sell safe products that the consumer wants to drive.” DOT Secretary La Hood has also called for more resources for regulating auto safety. The $16 million fine proposed by DOT is a drop in the bucket of profits Toyota earned in the decade since accelerator problems were first identified.

Globalization – the possible solution to Toyota’s problems?

Just as multinational company-led globalization created the problems that Toyota now faces, bottom-up globalization may suggest new solutions. The intense international media and consumer group scrutiny of Toyota and regulatory and legal action on many fronts and continents makes it harder for Toyota to ignore the problem and easier for advocates to share information and resources and to plan common strategies.

As public health authorities expand the use of global treaties to regulate tobacco, alcohol and perhaps food, might a Framework Convention on Motor Vehicle Safety follow? Such an approach might slow a race to the bottom in which big companies look for the lowest cost supplies and the quickest route to showrooms, even if such measures compromises safety. An enforceable global treaty could also protect more scrupulous manufacturers from their less responsible competitors. In 2000, a new UN treaty set in motion the development of global standards for automobile manufacturing. Such a treaty could set the stage for future harmonization for technical regulations on vehicles, ranging from pollution and fuel-use standards to anti-theft devices and windshield wipers. However, to date industry groups have dominated this process and enforceable standards are nowhere in sight.

Each year about 400,000 people around the world are estimated to die in automobile crashes and 30% of the victims are under the age of 25, making auto deaths an important cause of overall mortality and premature deaths. Many more die from exposure to automobile pollution that could be prevented by available technology. By adding their voice to the call for stronger auto safety and pollution standards and for tougher oversight of the auto industry, public health advocates can help improve the safety of cars on the road, while also increasing space in the market for safer and more sustainable forms of transportation.

By Nicholas Freudenberg, Distinguished Professor of Public Health at the CUNY School of Public Health at Hunter College and founder of Corporations and Health Watch.

Related CHW reports:

The Reluctant Activist: An Interview with Robert Pezzolesi from Center for Alcohol Policy Solutions in Syracuse

Posted on by Corporations and Health Watch

What moves people to become activists concerned about business practices and health? How can ordinary citizens move from outrage to action? To answer these questions and to learn more about current efforts to change alcohol industry marketing practices, Corporations and Health Watch interviewed Robert Pezzolesi, the Founder and President of the Center for Alcohol Policy Solutions in Syracuse, New York. The interview was conducted by Marissa Anto, a CHW staff person on December 17, 2009.

CHW: You have sometimes described yourself as a “reluctant activist.” What do you mean by that?

RP: I patterned the phrase after the novel and film “The Accidental Tourist.” In November 2001, my ex-wife pointed out to me a billboard for Captain Morgan rum that was across the street from an inner city high school in a multi-ethnic, multi-racial neighborhood in Syracuse. The high school has a low graduation rate – about 36% – and is located in one of the most impoverished neighborhoods in America (http://www.unitedway-cny.org/results/initfund/index.html). The Captain Morgan ad had a scantily-clad woman and the message and iconography of the ad was “Drink this and you’ll get her.” It just shouldn’t have been so close to a high school, it was directly across from the school, maybe 100 feet away.

I hadn’t been directly involved in fighting against something like that, but I believed somebody had to do something. I sent an e-mail to the Director of Public Affairs for the mayor at the time and I got a pleasant reply but there was no committment to do anything about it. At the time I was a temp worker for a New York State agency and my supervisor was a member of the Syracuse Onondaga Drug & Alcohol Abuse Commission. She suggested I talk to the Commission about it. I did and soon after the company removed the billboard. Apparently the contract was up anyway. But a few months later, that same billboard had beer advertisements on each side.

CHW: So what did you do then?

RP: I investigated and found out that the Outdoor Advertising Association of America, the primary billboard trade group, had a self-regulatory ethical code stating that they would not place billboards advertising products illegal for minors 500 feet from schools or churches. I also found out that the primary local billboard company was routinely violating this rule all around the city. So I documented the problem, going around to measure billboards with a measuring wheel and taking photos. Also, I read up on alcohol marketing practices and current industry marketing strategies, liquor industry attempts at “cultural normalization.” After documenting the problem, I went to a few local organizations to ask them to sign on to a request to have this company abide by this code. A big key for me was contacting people in other cities and getting their input. We called ourselves the Syracuse Partnership for Responsible Outdoor Advertising, based on a similar group in San Diego. They were very helpful. About a year later the Syracuse billboard company agreed to abide by the code and, with a couple of exceptions, it has abided by it ever since. By the way, it was exactly 7 years ago today that the company agreed to abide by this standard. It was personally rewarding to see that I could make a difference.

CHW: But you didn’t stop then, did you? What made you stick with this activism?

RP: Through research I had learned about the staggering impact that alcohol abuse and dependence has on our society – the impact on public health both mortality and morbidity and public safety. My experience with alcohol marketing showed me that the alcohol industry was a big contributor to those problems. And I also learned, with regard to alcohol, research shows that downstream, individual-level prevention is not that effective in the long-term. What does seem to work are broader environmental measures such as restrictions on pricing, availability and marketing. I decided to get involved more seriously so I founded a 501(c) (3) called the Alcohol Advertising Reform Initiative (AARI) that looked at environmental prevention of alcohol across the board. By the way, we’ve since changed the name to the Center for Alcohol Policy Solutions.

In addition, I was encouraged by contact I had had with national organizations working on the issue: the Center for Science in Public Interest, the Center on Alcohol Marketing and Youth, and the Marin Institute. I wouldn’t have continued to work on those issues without their help.

CHW: Can you talk a bit more about what that organization does?

RP: When AARI began, we focused primarily on alcohol advertising and marketing. For example, in the fall of 2003 we filed a formal complaint against a campaign for Goldschläger liquor, a so-called “shooter” liquor. Syracuse seems to be a big target for campaigns of this nature because of Syracuse University and some other colleges. The campaign was actually brought to my attention by friends of mine who are social drinkers and not at all involved in public health advocacy. They asked “Have you seen those Goldschläger billboards around town? Those models look awfully young.” I get a lot of my best information from those friends. So we sent a formal complaint to DISCUS, the Distilled Spirits Council of the United States, which is the industry council representing “producers and markets of America’s favorite brands of distilled spirits.”

CHW: So what happened?

RP: Diageo, the company that makes Goldschläger, is the world’s largest liquor company. DISCUS and Diageo seemed to formulate a very careful PR response, whereby the company was able to withdraw the campaign, kind of like a sports coach resigning before being fired. Their statement was along the lines of “Our Goldschläger ad doesn’t really violate anything but we’re going to take it down because we’re so intensely socially responsible.” However, after the campaign was supposed to have been terminated, I contacted people in other states and these ads still weren’t down, leading me to believe that part of the strategy for these companies is to placate local activists while continuing to run the campaign elsewhere, counting on a lack of communication. The crux of the matter is that there are no sanctions for violations, so the worst they’ll have to do is take the billboard down. Here’s a comparison: Let’s say I cheat on my taxes, I have to pay a penalty to the IRS. If the worst thing that could happen would be that someone would just have to pay what they owe anyway, then there would be a lot more tax cheats. That’s the fundamental flaw with the “self-regulatory” process.

CHW: What else did your group do?

RP: Thanks to Brad Finn of the Prevention Network in Syracuse, our nonprofit group got a small grant to get a laptop and buy some advertising data. Otherwise, I did everything as a volunteer. I did a lot of PowerPoint presentations and I would go wherever people would hear me. It was a personal passion for me, and so few people were really dealing with alcohol advertising in our area at the time. As a public health issue, alcohol often gets overlooked.

We also worked locally around awareness about alcohol advertising and violence against women. We modified a campaign from California called Dangerous Promises that the Berkley Media Studies Group worked on. [See Woodruff, K. Alcohol advertising and violence against women: A media advocacy case study. Health Education Quarterly, 1996 23(3):330-345, for more information]. I designed a presentation based on theirs and we looked at a Molson Canadian marketing campaign called the “Making Friends” campaign where they promote the beer as a facilitator of sexual activity. I connected with our local domestic violence shelter and rape crisis center, and their Executive Directors and I collaborated on a letter to the editor and tried to raise awareness. Promoting alcohol that way is extremely irresponsible considering that alcohol is the a date rape drug and it’s connected to so many health problems related to sexuality and sexually transmitted infections.

CHW: What do you think has been your biggest success since you started this advocacy work?

RP: That’s not an easy question, because most of the time prevention work has what Bernard Turnock has called an “invisible constituency.” To paraphrase him, there haven’t been a lot of state capitols who have seen candlelight demonstrations by people who have not been a victim of alcohol-related violence. But I’d say the forced withdrawal of the Goldschläger campaign was certainly our effort that got the most public attention. I’ve also been encouraged about some of the work we’re doing around GIS – Geographic Information Systems – in communities. My desire to push further in this work, from an avocation to a vocation, led me to pursue a Masters in Public Health (MPH) degree, which I just finished this past March. My MPH practicum project was looking at alcohol outlet density in the city of Syracuse using GIS. I did it to show the problems of alcohol density here and to suggest policy changes that would be beneficial to the community.

CHW: What did you find in that research?

RP: I found that some residential neighborhoods in Syracuse had unexpectedly high densities of alcohol outlets. The project was not designed to prove causation through sophisticated statistical analysis, but it did suggest that there was a relationship between the density of alcohol outlets and assault and DWI arrests. In some ways, that seems like a no-brainer.

CHW: Well a lot of the research that we do just shows common sense problems but you need it to push forward advocacy efforts, right?

RP: Exactly. The alcohol industry and their allies try very hard to frame those problems in a way that advances their economic interests. They try to cast doubt on even the most basic research. It’s similar to what the tobacco industry did with lung cancer, just trying to create enough of a doubt to freeze advocacy efforts and stop policy change.

Our GIS project has led to working with communities who are interested in using GIS as a tool to reduce alcohol problems. There are advocates in several counties in New York State who are at some stage of a GIS project—including Madison, Jefferson, St. Lawrence, Oneida, Cortland, and Franklin, among others.

CHW: Along those lines, how do you think researchers can contribute to more effective oversight of the alcohol industry?

RP: There’s a delicate balance there. A recent article by James Marks in Preventing Chronic Disease discusses the creative tension between advocacy and research. Researchers are careful to remain objective, while advocates sometimes don’t want to wait for the fifth confirming study, they want to forge ahead and improve health policy. Obviously, there are ethical standards for academic research. No matter how strong the results are, academic integrity requires careful wording and explicit acknowledgement of a study’s limitations. According to Thomas McGarity and Wendy Wagner, some researchers even avoid policy-relevant science because they dislike controversy and conflict. At the same time, Marks quotes Bill Foege as saying that public health is inherently activist. That connection between research and activism has to be reaffirmed.

Right now, in the alcohol field, there’s a good news/bad news situation. On the one hand, there has been a lot of solid, exciting research on alcohol and alcohol policy over the last several years. We have a much better understanding of what really works to reduce alcohol problems. On the other hand, there is a kind of advocacy deficit. There needs to be a lot more advocacy work, more additional energy and encouragement for advocacy, particularly as resources have been diverted from the alcohol field to other areas of public health and human services in recent years—and those resources were meager to begin with.

CHW: Could you talk about some of the strategies that the alcohol industry uses to promote youth drinking?

RP: Contrary to their claims that they have an interest in preventing underage drinking, the prime movers in the alcohol industry want youth consumption to be as high as reasonably possible. Currently, the underage market accounts for between 10 and 20% of consumption. [For more discussion, see The More Things Change: Examining Alcohol Industry Issues Management Strategies.] While alcohol companies claim they do not want those profits, if the industry lost between 10 and 20% of sales, they would be in dire straits. A friend of mine who’s an aerospace engineer pointed out to me that there have been airlines that have gone under because they lost 10% of their fares. So their current business model requires those youth sales. Moreover, they know that they have to cement brand identity fairly young. The prime example of a brand that has been successful at this is Budweiser, they’re very good at putting their logo everywhere. One of the ways they do that is through sport sponsorship and sports signage. Young men, especially, watch a lot of televised sporting events and thus are constantly exposed to those marketing messages. I would challenge anyone to turn on ESPN at any hour of the day—even in the morning—and see if a half-hour passes without seeing an advertisement or logo for a product from Anheuser-Busch InBev or MillerCoors. It’s no wonder that market research organizations and other studies have found disturbing levels of brand awareness for Budweiser, Bud Light, and among teenagers and even elementary school-aged children.

I also believe that their frequent use of animals in their advertisements—cute animals, funny animals—have a particular appeal to young people. The industry and their allies maintain, “Adults like them too.” Well, there are adults who like everything—after all, there are adults that collect Hello Kitty merchandise. The issue is whether or not the advertising has a disproportionate appeal to youth. Kids marketing guru Dan Acuff points out that children have a very special relationship with animals, with animals making up to 90% of the content of the dreams of young children.

If the alcohol industry genuinely worked to de-market to children and youth—keeping ad content limited to adult appeal and reducing media exposure to levels proposed by David Jernigan at CAMY—they could significantly reduce levels of underage drinking, I believe. But the question goes beyond acts of omission to those of commission – whether the marketing to youth been intentional. A lot of evidence seems to point to the fact that it has. For example, the youth appeal of the Captain Morgan brand seems to be too strong to be accidental. And it’s that lifestyle advertising—where you see attractive people having a great time without any hint of negative consequences—that propelled beer to its status and that the distilled spirits sector is working hard to emulate.

CHW: I was riding the subway in New York, and I saw the Remy Martin cognac ads showing all these attractive people connected by chains around their neck and the ad just says “Things are getting interesting” and kids are riding the subways.

RP: That’s a good example. It’s really inappropriate for public transportation systems to have alcohol advertising. The Marin Institute has done a great job of bringing attention to that issue. They had success in removing it from the Bay Area, and there’s been movement on the issue in Boston. Our elected officials in New York need to be made aware of the disconnect between making pronouncements about the evils of underage drinking and then turning around and exposing kids to Corona ads on their way to school. [See an earlier CHW report on a campaign to rid NYC subways of alcohol ads.]

CHW: That leads into my next question, how do you think alcohol advertising encourages irresponsible drinking patterns?

RP: Jean Kilbourne has done excellent analysis of that issue. She suggests that alcohol companies understand the minds of problem drinkers better than many treatment providers. For example, in some beer advertisements, the wife or partner is interested in some type of romantic activity and the man has no interest until she says his favorite brand of beer is available, and then, all of a sudden, he’s interested. These ads feed into an alcoholic mindset that sees the beverage as the be-all and end-all—where the drinker is literally willing to jump off a plane to get the Bud Light. Or sometimes the ads show people drinking in isolation, for stress relief. We have a series of ads for a regional beer called Saranac that show a beautiful bucolic scene on a lake with the text “Unwind.” That sounds perfectly innocent. Except when one considers that if somebody has to have that alcohol to unwind, they’re really advocating alcohol as stress reduction – which is problematic alcohol use. Does that mean everybody who has a beer to unwind is drinking in an irresponsible way? No, of course not. But when you bring it in as a deliberate advertising point you run the danger of promoting alcohol to relieve stress. I would call that irresponsible advertising. Another ad for a bourbon brand shows a scene from a saloon in the Old West with the tag line “When the bottle was the glass.” If we were to make a formal complaint, the company would likely claim that it’s a historical reference.

But if you gauged the actual perceptions of the people in the target psychographic who read that ad—as opposed to the claimed intentions of the alcohol company—they would perceive it as glorifying that kind of hypermasculine excess. “Drink this bourbon because it’s what hard drinkin’ menfolk drink! It will make you a latter-day cowboy!”

That is why the only accurate way to determine the impact of a marketing campaign is to determine the perceptions of the target market. Anyone can claim innocent intentions.

Perfect_timing

CHW: In your opinion, what is the top alcohol control issue that advocates like you should focus on in the coming year.

RP: I’ll talk about two different issues: an overarching national issue that reaches across the federal, state, and local levels, and a concern about New York State.

The national issue is that of alcohol taxes. George Hacker of the Center for Science in the Public Interest has rightly called increases in alcohol taxes the gold standard of evidenced-based alcohol control policy. The body of research shows that increasing alcohol taxes limits alcohol abuse, especially among young people who are particularly price-sensitive. Alex Wagenaar at the University of Florida has been a leader in assembling that evidence, and the book Paying The Tab: The Costs and Benefits of Alcohol Control by Philip J. Cook does an excellent job of presenting what he calls the “unique advantages” of alcohol taxes as an alcohol control measure.

When you combine all that evidence with state governments’ “revenue hunger” precipitated by the economic crisis, increased alcohol taxes should be on the top of the public policy agenda. But that hasn’t been the case.

CHW: Why is that?

RP: A lot of it is due to the influence of the alcohol industry. Earlier this year, there was a bill proposed in the House of Representatives to roll back the beer tax from what it’s been since 1991 (H.R. 836). Now, bear in mind, this is a tax that hasn’t been adjusted for inflation, so it’s already historically low—about one-fourth the value it was fifty years ago. Even so, 242 members of Congress signed on as co-sponsors of the beer tax rollback, which really shows the enormous power the alcohol industry has in Washington. [In 2008, according to Open Secrets, the beer, wine and liquor industries made political contributions totaling $14,122,519, the highest level since reporting began in 1990.]

CHW: You also mentioned a New York State concern?

RP: Yes, many of my colleagues – most notably my colleagues with the Council on Addictions of New York State (CANYS) – are concerned about recent attempts to deregulate our state alcohol control system. There have been several bills proposed in our state legislature that appear to have been written by alcohol industry lobbyists. One bill (A08026) actually proposes that wine be excluded from the state sales tax on wine, arguing that because current guidelines exclude products that are over 70% fruit juice, and is a “beverage made wholly from fruit juice.” It would be laughable if it were not for the fact that an elected official actually. Another bill (S6184) seeks to shift the mission of the New York State Alcohol Beverage Control law from one of public safety and public health to one where the state would “promote economic development and job opportunities by promoting the expansion and profitability of the beer, wine and liquor production industries in this state.” It’s difficult to imagine a proposal that is more radical or more wrong-headed.

Another New York State issue that has been bubbling over is the proposed expansion of wine and/or liquor into grocery and drug stores. The proponents of that expansion have framed it as an economic issue of grocery stores versus liquor stores, conveniently sidestepping the public health implications. In reality, research has shown that states that offer wine and/or liquor in more places have higher levels of alcohol consumption, and thus more alcohol problems. In addition, big grocery stores in New York State have pushed the local economic benefits, as if the primary effect will be greater availability of boutique New York State wines in their gourmet section. But the proposal would result in corner stores, conveniences stores and bodegas being allowed to sell fortified wines like Thunderbird and Mad Dog, which are street drinks that are designed for abuse. To make these products available so widely would really be a nightmare for public health and public safety.

Our leaders need to realize that alcohol—in the words of the World Health Organization—is “no ordinary commodity”. Or, as alcohol policy consultant Pam Erickson has put it, we can’t sell alcohol like tires and mayonnaise.

CHW: You mentioned the alcohol tax, what are some other alcohol control measures that have reduced harm associated with drinking in the past few decades?

RP: The reraising of the Minimum Legal Drinking Age, putting it back to 21 after it had been lowered to 18 or 19 in several states—has been shown to have a number of positive public health effects.

Also, the lowering of the Blood Alcohol Content standards for driving to .08 grams of alcohol per 100 grams of individual’s blood has been unquestionably positive.

CHW: How would you try to persuade those who aren’t involved in public health or substance abuse issues that alcohol control policies are worth while, How do you convince the general public that alcohol control policies are a critically important issue?

RP: Sometimes it’s a tough sell now, for several reasons. Most Americans accept that tobacco is a threat to public health, and that we should be moving toward a tobacco-free society. In addition, with all the research and the exposure of the tobacco industry after the Master Settlement Agreement, it’s been relatively easy to portray the tobacco industry as largely irresponsible. There’s a different reality and a different history with alcohol. Most people outside of the field really don’t have a lot of information about the impact of alcohol or the tactics of the alcohol industry. And the goal for alcohol control advocates is arguably more complex: reducing overall consumption, reducing high-risk drinking, reducing underage drinking, and limiting alcohol-related harms while still acknowledging the role of low-risk drinking and the possible health benefits of light consumption for individuals over the age of 35.

And the people in the alcohol industry and their allies and symbionts have used public relations techniques effectively to polarize that debate. They’ve done this pretty explicitly—painting anyone who wants to implement effective alcohol control policy as a “Neo-prohibitionist,” tied to a cartoonish popular understanding of Prohibition. So it’s the false dichotomy with Prohibition on one side and laissez-faire and “self-regulation” on the other.

As a result, most of our societal efforts are still focused on education and reactive punitive approaches. It’s going to take sustained advocacy to help people understanding the public health research of the last 30 years, especially the relationship between general availability and alcohol problems. We need to disseminate the research in ways that people can relate to. It’s really basic economics. If you make something more available, reducing the opportunity cost, the more you’ll get of it.

CHW: What about educating the public about the cost burden associated with the misuse of alcohol and greater per capita consumption like Fetal alcohol syndrome, domestic violence and drunk driving. I know with drunk driving you have organizations like MADD but it seems like there isn’t a cohesive manner going about this kind of advocacy.

RP: Yeah, getting folks to communicate across these silos is one crucial element. A broad, national public health campaign – whether from a private public health organization or the Office of National Drug Control Policy—would also be beneficial. It’s a matter of finding the political will.

Alcohol is the third leading cause of mortality and it’s extremely costly to society, because many its victims are often young, resulting in considerable DALYs [Disability Life Years].

As Lori Dorfman and her colleagues at the Berkley Media Studies Group have pointed out, changing hearts and minds about these issues is largely about media advocacy and framing. When an alcohol-related tragedy affects our community, how do we frame it?

CHW: Can you give me an example?

RP: We had a tragic case in the Syracuse area a few years ago, where an underage drinker drove under the influence and crashed, killing her best friend who was a passenger in her car. At this young lady’s funeral, her young friends put bottles of Captain Morgan and Bud Light on her tombstone because those were her favorite beverages. When we consider a tragedy such as this, how are we going to frame the problem? Are we just going to see it in terms of individuals and poor choices and not look at the environments which contributed to those poor choices? Or should we also point out that the alcohol brands placed on her tombstone are brands that have been aggressively marketed and have been shown to have youth appeal?

CHW: How can our readers learn more about alcohol control policy? How can they be better advocates, whether with their local elected officials representatives or in their community?

RP: As for resources, I’ve put together a resource list on alcohol policy at my blog.

First, I would say don’t underestimate alcohol as a problem, regardless of your personal experience with drinking. Pathological drinking is more of a burden to society than they probably suspect. For example, when I talk about the connection between alcohol and gonorrhea, people are frequently surprised. [Cohen DA, Ghosh-Dastidar B, Scribner R, Miu A, Scott M, Robinson P, Farley TA, Bluthenthal RN, Brown-Taylor D. Alcohol outlets, gonorrhea, and the Los Angeles civil unrest: a longitudinal analysis. Soc Sci Med. 2006; 62(12):3062-71.] Alcohol problems are so systemic and ingrained in our society that they touch on nearly every social problem and public health issue. We in the alcohol control field need other public health practitioners to become our allies and to find ways to help each other.

Secondly, I would urge advocates not to underestimate the impact of the alcohol industry on alcohol-related problems. In some ways, the alcohol industry has been even more effective than the tobacco industry in stanching reform. They’ve picked their fights more carefully and learned from the tobacco industry’s mistakes. If they can’t beat ’em, they buy ’em, as when Anheuser-Busch hired Mike Moore, the Attorney General of Mississippi who led the Master Settlement against the tobacco industry, as a consultant. That tactic is typical of that industry’s ethical orientation.

Clearly, it’s going to take sustained, united effort to reverse these trends.

Image Credits:

1. Bulleit Bourbon Credit: schluesselbein
2. Saranac Credit: mdu2boy