On December 5, 2006, the New York City Board of Health voted to ban the use of almost all artificial trans fat in the city’s more than 11,000 restaurants and fast food outlets. Harold Goldstein, the executive director of the California Center for Public Health Advocacy, told the New York Times that, “New York City has set a national standard” and already several cities and states have introduced similar legislation.
In 1994, the Center for Science in the Public Interest (CSPI), a national advocacy organization, petitioned the Food and Drug Administration (FDA) to require that food manufacturers label the trans fat content of their food products. The petition was based on research showing that replacing trans fat with healthier oils could prevent between 30,000 and 100,000 premature cardiovascular deaths in the United States each year. Some researchers have suggested that replacing trans fats with healthier alternatives could also significantly reduce the incidence of Type 2 diabetes in the US.
In 1999, despite the opposition of the food industry, the FDA proposed to include the trans fat content of food on the standard food label. The agency claimed that strengthening food labeling was likely to yield significant health and economic benefits, including saving up to 5,600 lives and $8 billion a year.1 Three years later, the Institute of Medicine concluded that they could not determine a healthful limit of trans fat and urged action to reduce its presence in the American diet.2 In January 2006, the FDA rule requiring food labels to include information on trans fats went into effect, but the FDA has turned down requests to ban the product altogether.
New York City took on trans fat in 2005. According to the New York City Department of Health and Mental Hygiene (NYC DOHMH) Health Commissioner Thomas R. Frieden, “New Yorkers are consuming a hazardous artificial substance without their knowledge or consent. Trans fat causes heart disease. Like lead in paint, artificial trans fat is invisible and dangerous, and it can be replaced. While it may take some effort, restaurants can replace trans fat without changing the taste or cost of food. No one will miss it when it is gone.”
The department began its efforts with a year long education campaign to help restaurants voluntarily reduce trans fats. However, a survey before and after this voluntary educational campaign showed that overall use of trans fat did not decline at all. As a result, the Commissioner proposed the ban. Speaking on behalf of the ban, Dr. Walter Willett, Chair of the Department of Nutrition at the Harvard School of Public health noted, “If New Yorkers replace all sources of artificial trans fat, by even the most conservative estimates, at least 500 deaths from heart disease would be prevented each year in New York City — more than the number of people killed annually in motor vehicle crashes. Based on long term studies, the number of preventable deaths may be many times higher. Trans fat from partially hydrogenated vegetable oil is a toxic substance that does not belong in food.”
Some in the food industry supported the ban. Carnegie Deli owner Sanford Levine said, “We’ve been using 100% canola oil for 20 years because it has a better taste and is better for customers. It’s easy to replace artificial trans fat, it costs the same, and the food tastes great. Our cakes and other baked goods are already trans fat free. If we can do it, so can other restaurants.”
But others in the food and restaurant industry vigorously opposed the ban. Although no New Yorker ever walked into a restaurant to order a portion of trans fat, some argued that the ban would interfere with New Yorkers’ freedom. In an op-ed in the Daily News, Richard Berman, a food lobbyist and executive director of the Center for Consumer Freedom wrote, “the proposal to eradicate all artificial trans fats from every restaurant in the city is nothing short of hysterical.” It subjects the restaurant industry to a terrible case of regulatory whiplash. “If they can declare New York City a trans fat free nanny state by bureaucratic fiat, what can’t Commissioner Thomas Frieden and his minions ban?.. Maybe the radical solution is to let consumers not bureaucrats dictate what restaurants do.
In the months leading up to the vote, dozens of New Yorkers wrote impassioned letters to the editor on the subject, newspaper editorial boards took opposing sides on the issue, and hundreds of New Yorkers submitted documents or testified at public hearings on the subject.
In the proposal approved in December, the Board of Health made some concessions to the food industry, extending the time restaurants had to comply with the new rules. In the weeks and months following the New York City debate on phasing out artificial trans fat, several national companies announced their intention to eliminate trans fat from some or all of their product lines. These included KFC, Red Lobster, Olive Garden, Crisco, and Starbucks.
Lessons Learned for Changing Corporate Practices that Harm Health
So what lessons does New York City’s ban on trans fat in restaurants offer for public health professionals and advocates concerned about protecting the public against harmful corporate practices?
Local health departments can play a leading role in challenging harmful corporate practices. The campaign to phase out artificial trans fats was initiated and led by the local health department, which defined its mission as protecting the health of the public against significant threats. While advocates, researchers and health professionals played important supporting roles, the success of the effort depended on a Mayor and Health Commissioner who made public health a priority and were willing to engage in some battles to achieve their goals. Similar efforts in other jurisdictions to control smoking, restrict access to handguns, and reduce exposure to lead paint show the important role local officials can play in protecting public health against health damaging corporate practices.
Voluntary educational campaigns may be a useful starting point.
The health department was able to win over public support for the phase out in part because they first tried a voluntary campaign and were able to demonstrate that this effort was not sufficient to achieve desired public health goals. In some cases, voluntary educational campaigns may work, but beginning with this activity may help to mobilize support for stronger action should it fail.
Framing the issue as protecting people against involuntary threats helps to mobilize people. In the health department’s aggressive media campaign to win support for the proposal to phase out artificial trans fat, spokespeople emphasized that New Yorkers did not choose to eat trans fat. Since the product was neither labeled nor disclosed, the argument that consumers were choosing this product was harder to make. Comparing trans fat to lead paint and labeling it a toxic product was also a clever strategy, since New Yorkers had debated regulation of lead paint for more than 20 years and most New Yorkers understood and strongly supported government action to protect children against lead paint poisoning. Thus, framing policy debates in local terms may help to generate support.
Creating controversy can help to advance public health.
Debate about trans fat received extensive coverage in local newspapers, television and other media for several weeks. While food industry defenders and some libertarians opposed the proposal, many New Yorkers supported it. In the course of the debate, the topic changed from whether to ban trans fat to how best to do it and on what timetable. The conflict provoked discussion and engaged diverse constituencies in the issue.
Some public health professionals have a predictable approach to conflict: partnerships with all stakeholders, compromise, and a willingness to be “reasonable”. By staking out a principled position and sticking to it, the NYC Department of Health achieved its goals, educated the public and set an example for other local health departments across the country.
Forceful advocacy sets the stage for subsequent victories.
While the New York City Department of Health took the lead on this issue, its campaign to phase out artificial trans fat stood on the shoulders of previous advocacy. In 1994, the Center for Science in the Public Interest began a 12 year effort to win the FDA requirement for trans fat labeling on store-bought foods. In 2003, Denmark passed a law that made it illegal for any food to contain more than 2% transfat. A May 2003 lawsuit by Ban Trans Fat against multinational food company Kraft led to a settlement in which Kraft agreed to produce trans fat free Oreo cookies for school markets. Ban Trans Fat also sued McDonalds for false advertising regarding its use of reduced trans fat cooking oil. In 2005, McDonalds settled the case by agreeing to act to limit trans fat and to pay the American Heart Association to sponsor public education on trans fats. In 2006, the American Heart Association became the first major medical organization to urge a specific limit on trans fat in the diet. In 2006, the New England Journal of Medicine published a study that concluded that daily consumption of 5 grams or more of trans fats raised the risk of heart attacks by 25% and that many of the “large” size fast food meals served by McDonalds and KFC exceeded this 5 gram limit. (The study also found that a New York City McDonalds meal had the highest trans fat content of any site in the 20 countries tested around the world.)3
These various efforts helped to educate the public about trans fats, to convince policy makers that it was an issue that deserved attention and set the stage for more assertive actions such as the New York City ban.