In a decision that could help public health researchers and activists gain access to corporate information, the Supreme Court on Tuesday ruled unanimously that corporations have no personal privacy rights for purposes of the Freedom of Information Act. The decision overturned a United States Court of Appeals that had ruled for the company, saying that “corporations, like human beings, face public embarrassment, harassment and stigma”.
New Report on US Trade Policy and Food Security
The Institute for Agriculture and Trade Policy has released a new report analyzing how US trade policy can better respond to global climate and food crises and documenting the role of agribusiness in setting trade policies that benefit their bottom lines rather than global well-being.
Food Disparagement: A Threat to Freedom of Speech? Request for Assistance in Tracking
Agribusiness interests have pushed through laws designed to make the expression of critical ideas about food production seem too costly. These laws are working outside of actual courtrooms and out of public view. Corporations have gotten food disparagement laws passed in 13 states, essentially making it a litigation risk to say anything critical about food. Now that the laws have been passed, the same corporate interests use them as leverage to silence their critics, frequently sending letter to those who speak out or those who publish them, threatening to sue under these menacing laws.
Have you or someone you know received similar threats? Have you felt the effects of your voice getting silenced? We ask you to send in copies of any threats of litigation using food disparagement laws as their premise, any other evidence of corporate control of what we can say about how food is produced, or any other effects you have felt. We will keep your confidence (some of us are nearly lawyers and understand this stuff). Please email your anecdotes and pdf copies of any written threats topaulaznyc@gmail.com or ask for a mailing address to send photocopies. For more information and some examples of threats to sue under these laws in action, go to http://signalinterference.wordpress.com/.
Signal Interference’s primary researcher is Paula Z. Segal, a Haywood Burns Fellow in Civil and Human Rights at the City University of New York Law School at Queens College. Her work focuses on access to land, inclusive democratic processes and working towards a just, sustainable and sane food system. Ms. Segal does legal research for the Brooklyn Food Coalition and is on the editorial board of the New York City Law Review. She is also guest blogger at Our Rights, Our Future, the blog of the National Campaign to Restore Civil Rights.
More on Food Disparagement Laws:
- Bederman, David. Remarks Limitations on Commercial Speech: The Evolution of Agricultural Disparagement Statutes, 10 DePaul Bus. L. J. 169, 173 (1998).
- Bederman, David J. Food Libel: Litigating Scientific Uncertainty In A Constitutional Twilight Zone, 10 DePaul Bus. L. J. 191, 217 n. 149 (1998).
- Goetz, Thomas. Venerable Talk Show Host Gets First Taste of Food Disparagement Laws, Village Voice April 29, 1997, 39, available athttp://www.organicconsumers.org/disparg.html.
- Jones, Ellen Gay. Forbidden Fruit: Talking About Pesticides and Food Safety in the Era of Agricultural Product Disparagement Laws, 66 Brook. L. Rev. 823 (2001).
- Lynch, Colleen K.. Disregarding the Marketplace of Ideas: A Constitutional Analysis of Agricultural Disparagement Statutes, 18 J.L. & Com. 167, 178 (1998).
Corporate Practices in the News
In this article, we briefly describe recent health-related news on corporate practices in the alcohol, pharmaceutical, and food industries.
Alcohol
Economic crisis depresses beer sales
As the economy stagnates, the beer industry worries about falling beer sales. “They’re the worst trends we’ve ever seen,” said Benj Steinman, President of Beer Marketer’s Insights, who spoke in October at the National Beer Wholesalers Association Convention in Chicago. Steinman blamed the drop on the high jobless rates among young adult male blue-collar workers—the industry’s traditional workhorse. “If we were down another 2% next year it wouldn’t surprise me,” Harry Schuhmacher, editor of Beer Business Daily, told wholesalers. Sales of craft beers, however, continue to increase, gaining 11% so far this year as compared to last year. These trends demonstrate the deep effects the recession has on sales of alcohol, food and other products, a topic explored in a previous Corporations and Health Watch post.
Pharmaceuticals
Drug industry finds that 15-second ads don’t make the sell
To save money in a tough economy, many Big Pharma companies have shortened their direct-to-consumer television ads from 30 seconds to 15 seconds. As shown below, data compiled by Ameritest , a copy-testing firm, and Competitrack, an advertising tracking firm indicates that 15-second over-the-counter drug ads constituted 25% of drug ads in 2007, 63% last year and 65% so far this year. In the same period, Big Pharma drug makers lost market share to private label manufacturers, suggesting that shorter ads were less persuasive in winning new customers. “The companies that live and die by their advertising are stretching their budgets with 15-second ads, and frankly there’s a lot for them to learn,” said Ameritest CEO Charles Young. “It’s an awfully short form for creatives to work with. If it devolves into simply reminder advertising, you’re not building brands. You need to bring emotion and news value to those brands.”
In 2005, the drug industry spent more than $4 billion on direct-to-consumer advertising. Advertising is a tax deductible business expense and also enjoys the constitutional protection that the Supreme Court has applied to commercial speech. The rationale for such protection is that advertising helps consumers to make informed decisions. Can a 15- or 30-second ad contribute to more informed health care consumers?
Pharma spending on online advertising to reach $1 billion this year
Like the food and alcohol industries, the pharmaceutical industry is expanding its online advertising. According to a report prepared by eMarketer, online ad spending by drug companies is expected to reach $1 billion this year and keep rising through 2014. One factor slowing growth is the lack of clear guidelines for this form of advertising from the US Food and Drug Administration. A year ago, the FDA held public hearings on the topic and solicited e-mail comments. “Pharma marketers are waiting around,” said eMarketer’s Victoria Petrock, author of the report entitled DTC Pharmaceutical Marketing Online: A Slow Shift to Digital. “They are trying to test the waters but realizing that the FDA isn’t going to come down with a template or a hard-and-fast ruling. Even when that happens, there’s still going to be a process of give-and-take and experimentation.”
Food
Michelle Obama on restaurant practices
The following excerpts are from a speech Michelle Obama made in Washington, D.C. to the National Restaurant Association in September 2010:
“Together, you represent 40 percent of the nearly one million restaurants in the United States, from the biggest chains to the smallest diners. You know what Americans like to eat and what they don’t. You’ve seen how the ingredients we put in our bodies affect the way we feel and the way we feel about ourselves. And you also understand the unique role that food, and restaurants especially, play in our own lives and in the life of our nation….. And the truth is that while restaurants are offering more options and families take advantage of them more often, they aren’t always the healthiest choices…
And as America’s restaurant owners, you’re responsible for one-third of the calories our kids get on a daily basis. The choices you make determine what’s listed on the menus, what’s advertised on billboards, and what’s served on our plates.
And your decisions about how a dish is prepared, what goes into it and where is it placed on the menu, that can have a real impact on the way people eat….Together we have to do more…And we need your help to lead this effort. And today I am asking you to use that creativity to rethink the food you offer, especially dishes aimed at young people, and to help us make the healthier choice the easier choice…First, it’s important to reduce the number of empty calories that our families are consuming, calories that have no nutritional benefit whatsoever. After all, we as humans, we are programmed to crave sugary, fatty, salty foods. And as people who work to meet those needs, I know it’s tempting to respond by creating products that are sweeter, richer and saltier than ever before. But here’s the catch. See, feeding those cravings does just respond to people’s natural desires, it actually helps shape them. The more of these foods people eat, the more they’re accustomed to that taste, and after a while, those unhealthy foods become a permanent part of their eating habits.
But here’s the good news: It can work the other way around just as easily. Just as we can shape our children’s preferences for high-calorie, low-nutrient foods, with a little persistence and creativity we can also turn them on to higher quality, healthier foods.”
Image Credits:
- Grant Hutchins via Flickr
- Competitrack and Ameritest
Big Pharma Getting Legal Heat for Marketing Tactics
The pharmaceutical industry has had a lot of success in recent years. Its profit margin is about 16%, seventh highest of the 215 industries tracked by Morningstar, an investment research company. In 2003, the drug industry succeeded in getting Congress to pass and President Bush to sign the Medicare Expansion Act that, by some estimates, increased drug industry profits by $139 billion. And last year the Pharmaceutical Researchers and Manufacturers Association (PhRMA) made a deal with President Obama to cut costs for some drugs in exchange for a commitment not to allow the health care reform bill to allow importation of drugs from other countries or to fix prices. As a result, the pharmaceutical industry will get assured reimbursement for drugs for millions of additional Americans.
With these successes, one would think that the pharmaceutical industry would be satisfied with using its clout to set the rules for its own benefits. Instead, however, a recent series of news reports shows that pharmaceutical companies are regularly attracting the attention of legal authorities in their aggressive marketing of drugs. Consider the following:
- Earlier this month, the Wall Street Journal reported that US authorities have subpoenaed records of GlaxoSmithKline in an investigation of their marketing of the diabetes drug Avandia.
- In late September, according to the New York Times, the Swiss drug company Novartis agreed to pay $422.5 million to settle criminal and civil investigations into the marketing of the antiseizure medicine Trileptal and five other drugs. Novartis was accused of paying illegal kickbacks to health care professionals through speaker programs, advisory boards, entertainment, travel and meals. Novartis pleaded guilty to one misdemeanor charge of mislabeling, but denied wrongdoing.
- In April 2010, AstraZeneca completed a deal to pay $520 million to settle federal investigations into marketing practices for its blockbuster schizophrenia drug, Seroquel.
- In 2009, Pfizer signed a corporate integrity agreement over illegal marketing of the painkiller Bextra and other drugs. That plea bargain included a $2.3 billion fine, the largest criminal fine in the nation’s history.
- In October, the investigative journalism group ProPublica launched a series of stories showing that many of the doctors hired by pharmaceutical companies to promote their products had been accused of professional misconduct, were disciplined by state boards or lacked credentials as researchers or specialists.
- ProPublica also discovered that former employees of drug companies have filed a series of lawsuits that allege that the money that drug companies said they paid to physicians to educate other health providers was in fact often used for illegal purposes to pay doctors for prescribing their brand-name medications.
Why do drug companies break the law?
First, according to legal and academic observers, they don’t appear to respect or fear the law. According to federal prosecutor Michael Loucks, then the head of the health-care fraud unit of the U.S. Attorney’s Office in Boston, when lawyers for Pfizer Inc., the world’s largest drug company, promised him in January 2004 that the company wouldn’t break the law again, they knew the company was involved in other illegal promotions. “At the very same time Pfizer was in our office negotiating and resolving the allegations of criminal conduct in 2004,” said Loucks, “Pfizer was itself in its other operations violating those very same laws. They’ve repeatedly marketed drugs for things they knew they couldn’t demonstrate efficacy for. That’s clearly criminal.” According to Jerry Avorn, a professor at Harvard Medical School in Boston and author of Powerful Medicines: The Benefits, Risks, and Costs of Prescription Drugs, “Marketing departments of many drug companies don’t respect any boundaries of professionalism or the law. The Pfizer and Lilly cases involved the illegal promotion of drugs that have been shown to cause substantial harm and death to patients.”
Another reason for widespread lawlessness is that the fines represent a small portion of drug industry profits. As large as the penalties are for drug companies caught breaking the off-label law, the fines are tiny compared with the firms’ annual revenues. According to Bloomberg News, the total of $2.75 billion in fines that Pfizer has paid in off-label penalties since 2004 is a little more than 1 percent of the company’s revenue of $245 billion from 2004 to 2008.
Finally, companies break the law because they think they can get away with it. The Food and Drug Administration has been chronically understaffed, dependent on the drug industry for the fees that support its operations and using experts in the pay of the very industries they are regulating. According to Dr. Marcia Angell, a former editor of the New England Journal of Medicine, “There is growing evidence that the Center for Drug Evaluation and Research, the part of the [Food and Drug] agency that regulates prescription drugs, has become the servant of the industry it regulates.” Whether the new tougher stance of the current FDA will be able to reverse these trends remains to be seen.
In sum, the drug industry resorts to lawless activities because they face relentless pressure to maximize profits and cut costs, because they often see the law as an obstacle to profits rather than a legitimate moral framework that should govern their behavior and because the regulatory agency charged with monitoring the drug industry has often lacked the resources and sometimes the will to provide aggressive oversight. Protecting public health against dangerous and illegal promotion of prescription drugs will require changing these three dynamics.
Photo Credits:
- epSos.de via Flickr
Teaching about Corporations and Health
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:
The Health Impact of Targeted Marketing: An Interview with Sonya Grier
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:
Interview with T.J. Faircloth from Corporate Accountability International
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:
- Corporate Accountability International’s Clowning with Kids’ Health: The Case for Ronald McDonald’s Retirement
- Raj Patel’s Down on the Clown
- Frances Moore Lappe’s Retire Ronald McDonald -Do it for our kids!
- Ronald.com, the McDonald’s website for children
Prior CHW reports on McDonald’s:
The Reluctant Activist: An Interview with Robert Pezzolesi from Center for Alcohol Policy Solutions in Syracuse
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.
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
Cash for Clunkers: who benefits?
The Car Allowance Rebate System, better known as “Cash for Clunkers,” is a federal program that gave car buyers a rebate of up to $ 4,500 on a new car if they trade in an older, less fuel efficient car. The program is meant to stimulate the ailing U.S. economy and reduce pollution caused by cars by committing U.S. tax dollars to the foundering auto industry. Late last month, the federal government ended the Cash for Clunkers program two weeks early because the three billion dollars budgeted for the program had been nearly exhausted. Although hundreds of thousands of Americans took advantage of the rebate opportunity to purchase a new car, and nearly the entire budget was spent, it isn’t clear that Americans (and America) will emerge both economically and environmentally healthier. In this profile, CHW examines the impact of the Cash for Clunkers program on our nation’s health and the environment.
Clash for Clunkers was dramatically more successful in engaging new car buyers than Congress or the White House had imagined: the initial one billion dollar budget intended to last through Labor Day was exhausted so quickly that after just 10 days, Congress funneled another two billion dollars into the program to keep up with demand.
President Obama has declared the program a “proven success” citing the “50% increase in fuel economy” and “$700 to $1000 in annual savings for consumers in reduced gas costs alone…”1 The White House’s assessment of the Cash for Clunkers program has reported some large and impressive numbers to back up their declaration of resounding success: nearly 700,000 cars were sold, $2.9 billion spent,2 and an estimated 42,000 jobs will be created or saved during the second half of the year as a result of the Cash for Clunkers program. Motor vehicle output added 0.20 percentage point to the second-quarter change in real GDP.3
Has Cash for Clunkers Met its Goals?
Although hundreds of thousands of Americans took advantage of the rebate opportunity to purchase a new car, some environmentalists question whether Americans (and America) will emerge both economically and environmentally healthier. They focus on two issues. First, buyers who took the rebate still had to buy a brand new car at costs coming in somewhere around $25,000 to $30,000. This might have simply shifted consumers spending from one place to another. So instead of spending additional money that they wouldn’t have, new car buyers might now be unable to spend on “appliances, clothes and other stuff that consumers will not buy…now that they have the burden of lease or loan payments for their new vehicles.” 4 If this effect is significant, Cash for Clunkers may end up being simply a government plan to favor the success of the auto industry over the many other industries whose goods American could consider consuming. It is also estimated that 60 percent of the cars purchased under Cash for Clunkers would have been purchased this year anyway, meaning that we might see a post-Clunkers lull in business.4
What about the impact on air pollution? The difference between the average miles per gallon of the trade-ins versus the new cars bought through Cash for Clunkers was about nine miles per gallon.5 According to Jack Hidary, an architect of the Clash for Clunkers program, $700 is the gas savings for driving a car that is 10 miles per gallon more efficient, so it is likely that many buyers will save money by getting a new more fuel-efficient car. The Cash for Clunkers program, however, allowed consumers to trade vehicles in for cars that were only slightly more fuel-efficient. In the case of passenger cars, consumers could use the rebate to purchase a new car with just four miles per gallon more efficient gas use. In the case of light-duty trucks, the rebate was good for new vehicle purchases that got just one or two additional miles per gallon, emphasizing that reducing emissions was a secondary priority for the program.6
But even if new cars purchased under the program were significantly more fuel efficient, it seems unlikely that the program’s impact will be big enough to improve air quality on its own. One columnist noted that if the new cars purchased under the rebate program get “ten miles per gallon more than the Clunkers they replace, the reduction in gasoline consumption will cut our oil consumption by 0.2 percent per year, or less than a single day’s gasoline use.” 4 Few interventions of any kind can contribute to significant, long-term change unilaterally, so it is not surprising that a program like Cash for Clunkers can’t single-handedly make drastic environmental improvements. Perhaps the only undoubted success of Cash for Clunkers has been its impact on the auto industy: Ford and General Motors saw ten and 21 percent increases in sales in August compared to July.7 Toyota posted even bigger gains.
Measuring Up a “Proven Success”
So was Cash for Clunkers good, bad, or a wash? It is worth remembering that public policies to improve the economy and environment are implemented because unemployment and pollution undermine the long- and short-term health and well-being of human, not because the government or civil society has an interest in the physical environment or job markets in and of themselves. Therefore, measuring the success of the Clash for Clunkers program must compare the opportunities provided and lost to improve public health.
Several news articles have mentioned the safety benefits of Cash for Clunkers: newer cars have better and more safety features, therefore the program will put safer cars on the road. As Consumer Reports mentions:
“…450,778 SUVs and other light trucks that likely lacked electronic stability control and other modern safety equipment [were taken off the road through Cash for Clunker]. The National Highway Traffic Safety Administration has estimated that making ESC standard on new cars would save as many as 10,000 lives a year. This program has taken a significant step toward that goal.”5
This is great news, but thinking about vehicle safety also begs the question: why should the federal government spend three billion tax dollars on bailing out an industry whose products kills and injures so many Americans? In 2008, there were 37, 261 people killed in motor vehicle crashes (a record low) and nearly 2.35 million injured. By those figures alone, the morbidity and mortality caused each year by motor vehicles dwarfs the potential safety gains from Cash for Clunkers. In 2007, a total of 288 people were killed on mass transit of any kind, a number less than 1% of those killed by passenger vehicles.8 In 2006 there were 19, 238 people injured on all forms of mass transit, 122 times fewer injuries than the more than two million caused by motor vehicles.9 Yes, these are absolute numbers- so how do these numbers compare when looking at rates? Motor vehicles kill five times as many people per passenger mile than mass transit.10
Public transportation systems, especially light and heavy rails systems, also create less fuel emissions than motor vehicle, and therefore provide a much longer-term investment in environmental health than Cash for Clunkers can achieve. What if Congress had instead given the auto industry $3 billion to invest in developing new capacities for making mass transit vehicles?
The Cash for Clunkers program also represents a lost opportunity to improve public health in other ways. The nearly three billion dollars spent to boost the auto industy did very little for a key piece of our economic crisis: inequality. The proportion of wealth and earnings by the richest 10% of our communities has steadily risen in the past 30 years. This growing inequality was intimately connected to the underlying causes of the current economic crisis: predatory lending and banking practices that promised to earn executives and their brokers exorbitant amounts of money. Inequality has been documented in public health research as a causal factor in social and health outcomes as diverse as teen birth and mortality. The Cash for Clunkers program, however did little to provide a way for low-income folks to benefit from the government commitment to stimulate the economy. For example, despite the claimed objective to get “clunkers” off the road, cars older than 25 years could not be traded in for the rebate, even though they are the most-polluting, and least fuel efficient and safety advanced vehicles. Also, all cars that were traded in, even if they were fairly new and running well, had to be destroyed under the program’s rules, bringing up the questions of what to do with 700,000 newly junked cars. Will lower-income families who cannot afford a brand new car now have more trouble finding a used (but less than 25 year old) car at all, since trade-ins have to be legally destroyed? Will the destroyed cars pose another set of environmental problems?
As one columnist argued: “…By mandating the destruction of trade-ins, Congress removed 700,000 cars from the used-car market, inevitably driving up prices of the cars that lower-income consumers tend to buy.”4
While no data have come out showing this prediction to be true, it seems that the Cash for Clunkers program did not take advantage of what we know about public health: policy approaches to reduce inequality have economic and health benefits. These same policy approaches, however, also require abandoning the government’s monetary, legislative, and otherwise political support of corporations that harm health. From the subsidizing of harmful industries like the auto industy to the extreme financial deregulation of a decade ago, these pro-corporate polices may appear to be bids for a strong economy, but the impacts are much different. For example, financial deregulation led to the lending practices that disproportionately preyed upon low-income communities and communities of color, and led to the current economic recession.
How About Cash for Buses and Subways?
Why, then, should the federal government’s stimulus efforts ensure that the auto industry survives, as opposed to investing in any other businesses or industries in the United States? An alternative to bailing out a failing industry is to invest in an industry that has seen sharp growth in the past year: mass transit. Currently, mass transit systems across the country are experiencing tremendous cuts to their already inadequate budgets. For example, in July alone the New York City Metro Transit Authority announced 360 jobs cuts, despite having experienced a significant uptick in ridership since the U.S. economy took a downturn. Although mass transit systems are efficient and affordable for riders, urban municipalities that currently maintain such systems do not have sufficient funds to maintain and upgrade them, and fare revenues cover only from 20 to 50% of the costs of maintaining the transit systems.11
src=”uploads/images/old_archives/img/mass_transit_promotion.png” alt=”mass transit promotion by Metro Library and Archive” hspace=”10″ vspace=”5″ width=”250″ height=”250″ align=”right” />A stimulus package that invests in the research, business planning, and workforce to upgrade and create effective mass transit systems has multiple benefits. Cash for Clunkers may have caused an uptick in the employment and earning of auto industry workers, but as many have pointed out, nearly 60% of the sales made under Clash for Clunkers would have happened in the next year anyway, leaving auto workers to brace for another severe dip in demand. Investing in mass transit infrastructure, on the other hand, will lay the groundwork for strong job markets in a variety of fields (from engineering to sanitation) required to support smart, efficient public transportation. The recession has caused a surged in mass transit use across the country, causing its use to reach a 50-year high11,12 and therefore providing a key opportunity to shift transportation trends in the U.S. towards the long-term, permanent growth of these infrastructures. In fact, the Obama Administration’s stimulus package did commit just over eight billion dollars to capital improvements in mass transit systems, including high speed rail lines.12,13 Hopefully this infusion of funds represents more than a temporary stimulus, but a longer-term investment in health promoting industries than can provide sustainable employment, and provide for safe, effective transportation for many times more Americans than just those who can afford a new car.
The gains to the health of U.S. economy and environment as a result of the Cash for Clunkers program can be considered modest at best, and at worst, the U.S. government’s political investment in supporting an industry whose products, cars and trucks, directly contributes to poor health in several ways. The need for government to spur spending, and therefore job growth, could have dovetailed with environmental and public health goals much more effectively. Public policies that foster investments in public transportation is just one of those alternatives. Strengthening mass transit will stimulate job growth and retention in an industry that can be counted on to continue to experience thriving market demand, reduce American consumers’ impact on the environment, and promote public health.
References
1 Hedgpeth D; Bacon P.With Senate Vote, Congress Refuels ‘Clunkers’ Program. The Washington Post August 7, 2009. Available at: http://www.washingtonpost.com/wp-dyn/content/article/2009/08/06/AR2009080601656.html. Accessed August 16, 2009.
2 Puzzanghera J; Zimmerman M. ‘Cash for clunkers’ final tally: nearly 700,000 cars sold. Los Angeles Times. Available at:http://www.latimes.com/business/la-fi-clunkers27-2009aug27,0,2161518.story?page=2 Accessed August 31, 2009.
3 Bureau of Economic Analysis. Available at: http://www.bea.gov/newsreleases/national/gdp/gdpnewsrelease.htm. Accessed September 1, 2009.
4 Stelzer I. Seven lessons of Cash for Clunkers’ failure The San Francisco Examiner. August 28, 2009. Available at:http://www.sfexaminer.com/opinion/columns/Irwin_Stelzer/Seven-lessons-of-Cash-for-Clunkers-failure-55595162.html. Accessed September 1, 2009.
5 Evarts E. Consumer Reports. August 27, 2009. Available at: http://blogs.consumerreports.org/cars/cash-for-clunkers/index.html. Accessed September 1, 2009.
6 Fact Sheet: Cash for Clunkers Committee on Energy and Commerce. June 8, 2009. Available at:http://energycommerce.house.gov/Press_111/20090505/
cashforclunkers.pdf. Accessed August 2, 2009.
7 Barth L. September 2, 2009. Available at: http://blogs.consumerreports.org/cars/cash-for-clunkers/index.html. Accessed September 2, 2009.
8 United States Department of Transportation Federal Transit Administration. Available at: http://transit-safety.volpe.dot.gov/Data/samis/default.asp?ReportID=2. Accessed September 1, 2009.
9 Bureau of Transportation Statistics. Table 2-33c: Table 2-33a: Transit Safety Data by Modea for All Reported Incidents. Available at: http://www.bts.gov/publications/national_transportation_
statistics/html/table_02_33a.html. Accessed August 25, 2009.
10 Morris EA.The Danger of Safety. Freakonomics Blog from The New York Times.July 2, 2009. Available at:http://freakonomics.blogs.nytimes.com/2009/07/02/the-danger-of-safety/?apage=2. Accessed September 1, 2009.
11 Public Transit Faces New Pressures. March 10th, 2009. Available at:http://www.pbs.org/wnet/blueprintamerica/reports/transit-in-trouble/video-public-transit-faces-new-pressures-part-one/485/. Accessed September 1, 2009.
12 Epstein, D. For Ailing Transit Systems, Stimulus Windfall Is a Mixed Blessing. June 21, 2009. Available at:http://www.propublica.org/ion/stimulus/item/for-ailing-transit-systems-stimulus-windfall-is-a-mixed-blessing-621. Accessed September 2, 2009.
13 Hochberg A. A Hitch For Rail Riders: Getting To Final Destination. September 2, 2009. Available at:http://www.npr.org/templates/story/story.php?storyId=112467963. Accessed September 2, 2009.
Photo Credits:
Corporations and Health Watch 