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New Report Calls on United Kingdom to Tackle Obesity More Forcefully; Advocates Urge Action Now

If current trends continue, warns a new British government report released in October 2007, 60% of men, 50% of women and 25 of children in the UK will be obese by 2050.  Changes in food production and marketing, fewer opportunities for physical activity, and current eating habits have made obesity the default option. “If we just behave normally we will become obese,” said Sir David King, the UK government’s chief science adviser.

The report, “Tackling Obesities: Future Choices” was prepared by Foresight, a government research group, to examine how the UK can deliver a sustainable response to obesity over the next 40 years.  The project has assembled evidence and expertise from academic disciplines as diverse as epidemiology, food science, genetics, psychology and sociology, and from professionals and interested organizations within and beyond Government.  While the report acknowledges that reducing the prevalence of obesity will require long-term action from numerous stakeholders at multiple levels, it concludes that “the lead must come from Government.”

The report attracted extensive media coverage and the UK health secretary Alan Johnson warned that the public health threat posed by obesity in the UK is a “potential crisis on the scale of climate change.”  However, in recognition of the report’s pessimistic outlook for obesity and the epidemic’s  deep roots in British society, UK public health minister Dawn Primarolo announced that the UK was delaying its goal of halting the rise in childhood obesity from 2010 to 2020.

Advocates charge report lacks blueprint

In response to the report, the Children’s Food Campaign, an alliance of more than 300 organizations, urged stronger and more immediate action.  It suggested three specific steps the government could take to reduce obesity.

First, the Campaign called on the government to ban all TV junk food advertising before 9 pm.  Second, the UK should act to reduce children’s exposure to online and cell phone junk food advertising. Third, it should enact a simpler “traffic light” food labeling system that provides consumers with clear guidance.

Finally, British schools should make food skills a required part of the curriculum so that every child leaves school knowing how to make simple nutritious meals.

According to Dr. Mike Rayner, Director of the British Heart Foundation Health Promotion Research Group at Oxford University and Chair of the Children’s Food Campaign, “the government has to make a philosophical leap.  It should no longer see its role as gently guiding the food industry towards more responsible behavior, but instead as the protector of children’s interests, ready to take action to improve children’s diet and well being.”

Sue Davies, chief policy adviser to the UK consumer organization Which? also urged the government to go “further and faster” by enacting tougher rules against promotion of unhealthy food to children within three months.  “Obesity is a complex problem, she said, “but the solutions currently on the table are not up to the task.”  Which? recently initiated a campaign to force the British food industry to market food more responsibly and produced a campaign toolkit to help parents groups and community organizations to pressure government and industry to act more forcefully.

New Public Debate on Food Policy and Role of Food Industry

In many ways, the British debate on food policy mirrors the discussions in the United States.  However, the new Foresight report and the forceful and widely covered criticism by public health and nutrition researchers and advocates has put the question about the roles of government and industry in reversing the obesity epidemic squarely on the public agenda.  Whether the US 2008 Presidential election as well as the local, regional and national mobilizations to improve children’s diet, promote food justice and reduce obesity can provide a similar opportunity here in the United States remains to be seen.

Corporate Accountability International: Global Action Challenging Unhealthy Corporate Practices

For thirty years, Corporate Accountability International has fought and won campaigns against corporate abuse in the Food, Energy, Tobacco, Water, Oil, and Agribusiness industries. Many of those victories have set precedents in the fight for corporate accountability.

Early history as focused on Nestlé and infant formula

Corporate Accountability International began in 1977, under the name Infant Formula Action Coalition (INFACT). Its first target was the multinational food company Nestlé. At that time, Nestlé was the world’s largest producer of infant formula. Its aggressive global advertising and marketing campaigns promoted infant formula at the expense of breastmilk, despite overwhelming evidence that breast milk was the healthier choice.

Public health advocates were especially critical of Nestlé’s marketing in impoverished regions where money to purchase the formula, access to clean water, and proper sanitation of bottles was scarce or absent all together. As a result, the product was widely misused as people watered down the formula in an attempt to save money. The resulting health problems for mothers, children and families as well as population health were a direct result of Nestlé’s marketing practices.INFACT led a campaign and boycott of Nestlé which centered on bringing the company’s health and human rights abuses into public view and holding the corporation accountable. After nearly 10 years of fighting to restrict Nestlé’s behavior, INFACT saw victory as the World Health Organization (WHO) established global infant formula marketing standards. Nestlé then altered its marketing practices in “economically poor” regions that had been specifically hard hit by their practices, although battles between global infant formula companies and public health activists continue. According to Corporate Accountability International, the Nestle Boycott was an unprecedented victory for grassroots consumer campaigns—the first time a major corporation came to the table with ordinary consumers and agreed to make changes in its behavior worldwide.

Transformation to more broadly focused organization

Since the success of their Nestlé boycott, Corporate Accountability International has expanded, launching several successful campaigns related indirectly or directly to public health. For example, from 1984-1993, Corporate Accountability International (still INFACT at the time) took on General Electric, then the largest producer and promoter of nuclear weapons, for their role contributing to Cold War nuclear arms race. The organization began an international boycott of GE’s commercial goods that highlighted GE’s role in nuclear arms manufacturing. According to Corporate Accountability International, the boycott contributed to GE’s decision to drop its nuclear weapons business.

Beginning in the early 1990’s, Corporate Accountability International launched their Challenge Big Tobacco campaign and by 2003 achieved what its activists view as their biggest accomplishment: the WHO’s enactment of a global tobacco treaty, known as the Framework Convention on Tobacco Control (FCTC). The global tobacco treaty is the world’s first public health and corporate accountability treaty. It has the potential to save millions of lives and change the way tobacco corporations operate around the world. The treaty sets powerful precedents for regulating other industries like the pharmaceutical, water, food and agribusiness and oil industries. In 2004, INFACT changed its name to Corporate Accountability International to more accurately reflect the organization’s expanded mission.

Current Campaigns

Corporate Accountability International currently runs campaigns focusing on the Water, Tobacco, Oil, Food and Agribusiness, and Big Box Retail Industries. Its campaigns target some of the world’s largest corporations with the most direct impact on health, the environment and human rights.

“Think Outside the Bottle”

Corporate Accountability International’s current Challenge Corporate Control of Water campaign fights the privatization of water and the corporations that are attempting global control of this vital resource. The organization has seen national success with the ‘Think Outside the Bottle’ campaign that targets corporations like Pepsi, Coke and Nestlé for their practice of bottling tap water and selling it back to the public. Initial achievements include working to convince mayors to cancel bottled water contracts and to pass a resolution at the June 2007 U.S. Conference of Mayors that supported municipal water and called for a study of the impact of bottled water on cities.

Another water victory came as a direct result of a Corporate Accountability International campaign. Yielding to pressure from that group and other activists, Pepsi announced in July that it will make changes to the Aquafina bottled water drink label naming the waters actual source: the tap. In a press release, Corporate Accountability International called Pepsi’s concession an important first step. In a recent interview on Democracy Now!, Gigi Kellett, the group’s associate campaigns director, explained, she found that:

People on the street… don’t know where the water is coming from. And the bottled water corporations have spent tens of millions of dollars on ads that make people think that bottled water is somehow better, cleaner, safer than our public water systems. And in reality, we know that that’s not true. And so, we want to make sure that we’re increasing our people’s confidence in their public water systems once again and knowing that we need to be investing in our public systems.

Corporate Accountability International defines the success of its campaigns by their ability to persuade corporations to change policies or practices. In exchange for such corporate concessions, the organization ends the boycotts it has organized such as those against Nestlé, General Electric, and Philip Morris/Altria-owned Kraft. This approach relies on grassroots participation, both national and international, to expose unhealthy corporate behaviors and the political ties that keep corporations unchecked by the public sector. The campaigns seek to create public visibility and open debate of key global public health issues.

Tobacco Campaigns

In its Tobacco Industry Campaign, which began in 1993, Corporate Accountability International worked closely with the World Health Organization to target the tobacco industry.

In the early 1990s the organization began campaigns against Philip Morris (now Altria) and RJR Nabisco (now Reynolds American Tobacco). The campaign called for a boycott of then Philip Morris/Altria-owned Kraft, during which Corporate Accountability International exposed Big Tobacco’s attempts to hide behind Kraft’s family friendly image and to disguise its political influence. This campaign may have contributed to the recent company spin-off of Kraft. For the past 14 years, Corporate Accountability International members have attended Philip Morris’ annual shareholders meetings to raise health, human rights and other issues.

At the 2007 Philip Morris/Altria shareholder meeting, for example, Corporate Accountability International Executive Director Kathryn Mulvey called on PM/Altria CEO Louis Camilleri to honor a commitment the company had made to halt sponsorship of Formula One auto racing. Your corporation continues to sponsor these races. You are violating an agreement you signed six years ago—and the global tobacco treaty, which bans tobacco advertising, promotion and sponsorship in ratifying countries. In this effort, the group used the success of the Framework Convention for Tobacco Control (FCTC), to regulate the promotion of tobacco, as a tool to put pressure on individual companies.

As a result of the FCTC, the tobacco industry has faced new scrutiny in its marketing practices and new pressure to adhere to global standards. Corporate Accountability International, as one of many NGOs around the world with official relations with the WHO, played a key role in securing a strong FCTC and in strengthening enforcement action. Together, these hundreds of small and large NGOs have the potential to create a united front against Big Tobacco.

Last month, the President’s Cancer Panel, in which the U.S. Department of Health and Human Services, the National Institutes of Health and the National Cancer Institute were represented, released a report urging the President to ratify the FCTC and to more vigorously regulate food companies that promoted high fat, high calorie, low nutrient carcinogenic diets. The report, “Promoting Healthy Lifestyles,” reminds us; Even absent ratification, by signing the FCTC, the U.S. is obligated not to undermine the goals of the treaty. Thus, the Cancer Panel’s recommendations echoed the call of Corporate Accountability International Senior Organizer Megan Rising, who said, The time has come for the President to heed the call of his top health advisors and the U.S. public and submit the global tobacco treaty to the Senate for ratification. With even a presidential panel accepting its recommendations, it’s clear that Corporate Accountability International has contributed to putting corporate accountability on the nation’s public health agenda.

Photo Credit: All photos courtesy of Corporate Accountability International

Interview with Richard Daynard

In March 2006, the newsletter Informed Eating interviewed Richard Daynard, professor at Northeastern University School of Law.

Food activists often ask what lessons they can learn from the fight against Big Tobacco. In this interview, published in March 2006 in Informed Eating, a newsletter of food politics and analysis, Richard Daynard, a professor at Northeastern University School of Law, chair of the Tobacco Products Liability Project, and director of the Public Health Advocacy Institute’s Law and Obesity Project, describes his views on the similarities and differences between the public health advocacy on food and tobacco.

Update on Pharmaceutical Industry: New threats to Pharma’s public reputation

In the past, the pharmaceutical industry was often seen as a positive social force, contributing life saving drugs and bringing new developments in medicine and science to the public. In recent years, however, public opinion has begun to shift. In 2005, for example, a Kaiser poll showed that for first time, more people said drug companies generally do a “bad job” (48%) than a “good job” (44%) of serving consumers, marking a nine year decline in such ratings. While drug companies were still rated more favorably than tobacco and oil companies, banks, airlines and HMOs were rated more favorably. In a 2005 Harris poll, a majority of US adults(51%) thought that pharmaceutical industries should be more regulated , a larger proportion than supported more regulation of tobacco companies(36%) or the health insurance industry (46%). Between 2003 and 2005, the proportion of respondents who believed that the pharmaceutical industry could be considered “honest and trustworthy” fell by 31%, from 13% in 2003 to 9% in 2005.

In this report, we highlight some recent reports that might explain the declining public perceptions of the pharmaceutical industry.

Marketing to Doctors

In order to maintain a license to practice medicine, most states have an ongoing medical education requirement for physicians. While many doctors seek out such education at accredited universities and medical associations, increasingly medical providers attend educational courses funded by the pharmaceutical industry. Since 1998, funding by Big Pharma for continuing medical education has quadrupled and now totals more than $1 billion (1). In order to fund medical education, pharmaceutical companies hire for-profit – medical education communication companies – which receive their content from the drug industry and then deliver the educational material to physicians in continuing education courses. Such practices have come under fire and recently Senators Max Baucus and Charles Grassley released a report on the unethical funding of medical education by the pharmaceutical industry.Read more about marketing to physicians here.

In medical education courses paid for by drug companies, often the benefits of a specific drug are touted without mention of potential side effects. For example, pharmaceutical makers plug sleep aids to consumers and physicians as an effective solution to insomnia, again often failing to mention concerns about efficacy, and potential side effects ranging to dependence to increased mortality amongst adults. (2) Now new research demonstrates that sleep aids are increasingly being prescribed to children.

In July, a subsidiary of Jazz Pharmaceuticals pleaded guilty in federal court to felony charges of improperly promoting their narcolepsy drug “Xyrem” for unapproved uses. Jazz Pharmaceuticals promoted the drug for depression, insomnia, and fibromyalgia. Xyrem is a powerful anesthetic and is the prescription version of the street drug “gamma hydroxybutyrate,” which has been linked to date rape and has a high risk of overdoes. The street version of Xyrem is listed by the Drug Enforcement Administration as a Schedule I drug, a drug considered to be the most dangerous. As part of their off label marketing campaign, Jazz Pharmaceuticals worked with doctors to improperly promote the drug on their behalf. Read more.

Marketing to doctors and patients

In 2006, drug company Merck launched its Human papillomavirus (HPV) vaccine “Gardasil” in the United States and in the European Union. With over 20 million people in the United States believed to be infected with HPV and with rates rampant around the world, Gardasil was touted as a “wonder drug” as it targeted four subtypes of HPV. HPV is the umbrella term used to describe a group of viruses that includes more than 100 unique types. Escalating rates of HPV have raised concern as more than 30 of these strains are sexually transmitted and of those, approximately one third can lead to the development of cervical cancer. With vaccination, it has been hoped that the rates of cervical cancer could be drastically reduced. Given this, lawmakers in the US and around the world have pushed for mandatory HPV vaccination. However, there is reason to doubt the “wonder drug” status of Gardasil. In a four part series, Judith Siers-Poisson examines the facts and hype around Gardasil, explores what pharmaceutical giant Merck stands to gain through practices such as mandatory vaccination, and reviews the reception of Gardasil on the global front. Read the articles.

Direct-to-consumer marketing, a strategy Big Pharma uses to create brand loyalty and encourage patients to ask for specific drugs, has been a controversial practice and is currently legal only in the United States and New Zealand. In an attempt to create interest in and a market for “Restylane,” a dermal injection designed to reduce the appearance of wrinkles, Medicis Pharmaceutical Company recently paired with YouTube to target middle-income consumers. While generally products such as Botox or Restylane have been considered safe, they have been known to result in side effects from rashes to flu-like symptoms to temporary facial “drooping.” The market for these products is large and growing; in 2005, $12.4 billion was spent on such cosmetic treatments (3). Until now, these cosmetic products have been considered the bastion of the wealthy. Thus, to broaden the market Medicis is finding new ways to reach potential consumers such as the YouTube advertisement. Read about Medicis “Hottest Mom” contest and its other advertising campaigns.

Lobbying

During the first half of 2007, The Pharmaceutical Research and Manufacturers of America, (PHRMA), a drug industry lobby group, spent $10.7 million to lobby the U.S. government. PHRMA’s members include Eli Lily & Co., Pfizer Inc., Amgen Inc. and other major drug companies. The lobby pressured lawmakers on Medicare, drug fees safety, importation, patient reform and international trade. The current president and chief executive of PHRMA is former Louisiana Representative Billy Tauzin, who is also a registered lobbyist for the group. Read more.

FDA Approval

After FDA advisory panels on the diabetes drug “Avandia,” produced by GloxoSmithKline, a decision was reached that the product will now come with warnings that it may significantly increase the risk of heart attack. Gerald Del Pan, the director of the FDA’s Office of Surveillance and Epidemiology, was one of many voices criticizing the decision: “Cardiovascular disease being the leading cause of death of people with diabetes, having a treatment that causes that is something that doesn’t make sense to me.” Read more about the FDA decision.

Controversy over the drug rosiglitazone has led to further criticism over the FDA’s approval process. Dr. Clifford Rosen, who recently chaired the FDA advisory panel on rosiglitazone stated that while the new product had been considered a “wonder drug,” ultimately it was “approved prematurely and for the wrong reasons by a weakened and underfunded government agency subjected to pressure from the industry.” He further noted that the lax approval process lead to harm for patients. Read Rosen’s report on rosiglitazone and the FDA approval process.

Designer Drugs & Targeted Marketing

In “Race in a Bottle” in a recent issue of Scientific American, Jonathan Kahn writes about BiDil, a drug for heart failure marketed specifically to African-Americans. Some researchers have questioned the scientific grounding for BiDil’s race-based targeting given that in the clinical trial on which the FDA based its approval, the drug was only tested on African Americans and thus true comparisons among racial groups cannot be made. Others have pointed to the danger of race-based medicine itself, noting that it (re)locates social categories within biology. In addition, such a conceptualization of health disparities overlooks contributing structural reasons for them. More than twenty years ago, researchers began exploring the effectiveness of combining two vasodialators (hydralazine and isosorbide dinitrate, hereafter H/I) on heart failure. While angiotensin-converting enzyme (ACE) inhibitors soon gained prominence in treating heart disease, some doctors prescribed H/I for those who failed to respond to the ACE treatments. Convinced of the efficacy of H/I, in 1987 cardiologist

John Cohn, who was one of the original researchers studying their combination, applied for a patent on the method using the drugs together to treat heart failure in the population at large. Because the drugs were already available in generic form, Cohn could not patent the drug combination itself. After receiving a patent on the method, he licensed the rights to the small pharmaceutical company Medco which released the two drugs in a single pill form known as “BiDil”, a combination of two previously tested and available in generic form, was first tested in the early 1990s. After the FDA refused to approve BiDil,the cardiologist who had led these earlier studies, returned to the data from these first trials and noticed that the small number of African-Americans on whom the combination was tested, responded positively to treatment. Cohn then filed a new patent application marketing the drug specifically with Black patients. Two years ago, the FDA gave approval for BiDil to NitroMed (the pharmaceutical company to whom Cohn reliscenced the drug). The event marked the first time an “ethnic drug” was approved for use.

Taking on the Pharmaceutical Industry

One of the latest organizations fighting questionable pharmaceutical industry practices is the Prescription Project. The campaign, led by Community Catalyst – a health-care consumer advocacy group based in Boston – was funded by the Pew Charitable Trusts to reduce the influence of the drug industry on the prescribing practices of doctors. Currently, drug companies spend approximately $7.2 billion per year on marketing to doctors and provide $16 (million?) worth of samples. This amounts to more than half of what the industry spends on research and development per year. The Prescription Project promotes the creation and implementation of guidelines that would restrict or ban the pharmaceutical industry from engaging in funding continuing medical education and providing incentive items and gifts. Read more

In May 2007, Nigerian authorities filed in their state and federal courts a multi-billion dollar lawsuit and criminal charges against the pharmaceutical giant Pfizer for testing an experimental drug on children. Pfizer has asked a Nigerian court to throw out the lawsuit, which stems from its testing of the experimental drug – Trovan – in 1996 during a meningitis epidemic. Trovan resulted in the deaths of 11 children and injured an additional 189 others. While Pfizer claims that the trial was explained to parents and their consent was obtained orally before the drug was given to their children, Nigerian authorities claim the drug company did not tell families that their children would be participating in a study using an experimental drug.Read more.

 

References

1. Carlat, D. Diagnosis: Conflict of Interest. New York Times. June 13, 2007. 
2. Mozes, A. Most Sleepless Kids Prescribed Drugs: Study. Practice is widespread, even though FDA doesn’t approve pediatric use. Healthfinder.gov. 2007. 
3. Jennings, A. Contests, YouTube and Commercials Converge for Skin Product. New York Times. June 27, 2007

 

Photo Credits:
Photo 1: courtesy of Stanford University
Photo 2: copyright: Merck
Photo 3: courtesy of CA.gov

Commentary: Voluntary Guidelines vs Public Oversight: Finding the right strategies to reduce harmful corporate practices

Last July, in an effort to reduce obesity, eleven major food and drink companies announced plans to restrict television advertisements to US children under the age of 12. Federal Trade Commission Chair Deborah Platt Majoras hailed this voluntary move, claiming that “industry action can bring change more quickly and effectively than government regulation of speech.” Since advocates seeking to reduce the harmful health consequences of the food, tobacco, alcohol, pharmaceuticals, firearms and automobile industries need to make decisions about the relative merits of voluntary industry action and public oversight, it is worth considering the evidence on this issue.

One way to assess the truth in Commissioner Majoras’s assertion is to examine other examples of industry self-regulation of products that harm health. For example, in his new history of the tobacco industry, The Cigarette Century, Harvard historian Allan Brandt explains that for decades, the tobacco industry claimed that its voluntary advertising guidelines precluded the need for stronger government regulation. For decades, until the 1970s, industry arguments  – and their political contributions – persuaded Congress not to act. Smoking continued to increase until restrictions on advertising, bans on public smoking, and tobacco tax hikes helped to bring smoking rates down. Had the government resisted tobacco industry pressure by instituting these measures two decades earlier, when most of the scientific evidence against tobacco was already established, hundreds of thousands of premature tobacco deaths could have been averted.

Beer industry self-regulation

To avoid regulation of alcohol marketing, the beer industry established voluntary guidelinessetting rules on advertising content and placement. A 2006 independent review of the beer industry’s compliance with these guidelines found that beer makers met three of its 15 recommended standards, partially met four and failed to meet eight, hardly strong evidence for compliance. Research shows that exposure to alcohol advertising contributes to increased youth drinking. Each year about 4,500 young people die in the United States from alcohol-related causes, and two million more are injured.

 

Oversight of global food companies

Returning to the food industry, in 2005, the World Health Organization asked three nutritionists to evaluate how well McDonalds and Kraft, signatories to this week’s agreement, had kept their own promises to improve practices related to obesity. The reviewers found that the companies had, at best, made modest changes and continued to market unhealthy products to children. They concluded that “for business reason alone,” food companies “cannot” and “will not” “stop making and marketing nutritionally questionable food products to children” and therefore only regulatory intervention could protect children’s health.

Corporate arguments against public oversight

Interference with free speech. Corporations offer three main arguments against stronger public oversight of their health practices. First, they claim limits on advertising interferes with their right to free speech. The legal theory that the First Amendment protects corporations – commercial activities is relatively recent. Not until 1976 did the Supreme Court assert that corporate commercial speech warranted constitutional protection (Virginia State Board of Pharmacy v. Virginia Citizens Council, 1976). In that decision, the court found that a Virginia regulation banning advertising of pharmaceutical prices was unconstitutional. A consumer group argued that people had a right to pricing information, and the Supreme Court agreed. However, whether the right to provide consumers with factual information about a product also applies to speech promoting unhealthy food to children or potentially dangerous drugs to patients raises different legal issues. Since the current Supreme Court is more favorably disposed to corporate interests than at any time in its history, in the short run, the prospects for reducing successful challenges to expanded protection are slim. In the long run, however, giving commercial speech similar protection to political speech has created new threats to public health that require public consideration. Public health professionals may have the credibility to initiate this debate.

Nor is the FTC the only regulatory agency to take on a more pro-business slant during the Bush Administration. On September 1, 2007, the New York Timespublished a story on its investigation of the capacity of the Consumer Products Safety Commission to fulfill its mission. According to the Times, under President Bush, the CPSC has “blocked enforcement actions, weakened industry oversight rules and promoted voluntary compliance over safety mandates.” At a time when imports from China and other Asian countries surged, creating an ever greater oversight challenge, the Bush-appointed commissioners voiced few objections as the already tiny agency – now just 420 workers – was pared almost to the bone. By weakening the agency and failing to enforce its legislative mandates, charge consumer advocates, this Administration has turned its belief in the superiority of voluntary guidelines versus public oversight into a self-fulfilling prophecy.

Restriction of personal choice. The second principal argument against public oversight of harmful corporate practices is that it will prevent Americans from enjoying their freedom to eat, drink, or smoke what they want. In fact, in past decades, the loudest and most consistent influence on health and lifestyle today comes not from the “nanny state” but from corporate America. McDonalds spends more than a billion dollars a year to persuade children and their parents to fill up on high-fat Happy Meals that contribute to the nation’s obesity and diabetes epidemics. Philip Morris targets young people with ads that show smoking is fun, sporty and sexy while warning them that smoking is only for adults, a sure way to encourage experimentation. While courts force governments to use the least restrictive method possible to regulate private behavior that harms public health, corporations face no such limits in their efforts to persuade us to consume. Advertisers expose children to more than 20,000 television ads a year, placing their advertising in formerly non-commercial spaces such as cell phones, school classrooms, the sides of busses, taxis and even private SUVs, and use “viral marketing” techniques in which teens are hired to persuade their friends to buy certain products.

Leave it to Markets. The third argument against public oversight is that market forces are sufficient to modify harmful corporate practices and that well-intentioned but inadequately informed oversight will disrupt the market and produce unwanted and unintended side effects. The most frequently invoked historical example is the prohibition of alcohol, which is alleged to have created a black market, encouraged organized crime and promoted disrespect for the law. In the case of tobacco, however, market forces appear to have played a small role in controlling a product that contributed to 100 million premature deaths in the twentieth century. In fact, the market has been the principal savior of the tobacco industry, allowing it to find new populations to addict when public oversight restricted access in one place or to one group.

Public Health Arguments for Voluntary Guidelines

If only corporate leaders and their allies supported voluntary guidelines over public oversight, the task of public health advocates would be straightforward albeit challenging. We would need to make public arguments for oversight, mobilize constituencies who supported this position and convince policy makers to enact measures to protect public health. In fact, however, the public health community itself is divided on this question. Thus, it is necessary to examine the public health arguments for voluntary guidelines and to encourage open dialogue on this question within the profession.

Useful step in the right direction. Supporters of voluntary guidelines to modify corporate behavior advance several arguments. First, some claim that voluntary guidelines, even if inadequate, are a useful step in the right direction. When the advertising industry revised its voluntary guidelines for ads targeting children last November and several major food companies announced a new “healthy lifestyle” marketing campaign aimed at children, Dr. J. Michael McGinnis, a distinguished public health leader who served as chair of the Institute of Medicine’s Children’s Food Marketing Committee, said, “This is a move in the right direction. . . . It would be a pretty substantial change.” Critics responded that the guidelines didn’t go far enough. “I don’t see any substantial changes,” commented Susan Linn, a Harvard psychologist and author of Consuming Kids. Companies “will continue to be able to market junk food to children — and their marketing is going to be even more confusing for children because it will be linked to ‘healthy lifestyle’ messages.” In the case of tobacco, advocates argued that the industry crafted its voluntary guidelines to advance its business interests, limit future liability and avoid future regulation, not to protect public health, making the guidelines a step in the wrong direction.

Best possible deal under circumstances. A more pragmatic defense of voluntary guidelines is that however inadequate, such rules are better than nothing and perhaps the best option possible given political and economic constraints. Proponents of this position maintain that public disclosure of voluntary guidelines encourages political debate on the issue or sets the stage for later regulation. For example, in 2005, the New York City Department of Health and Mental Hygiene called on the restaurant industry to reduce voluntarily the use of trans fats. When a later survey showed that its call had gone unheeded, the Board of Health successfully instituted mandatory rules to eliminate trans fat.

Only public private partnerships have power to make meaningful changes. The belief that any public health successes require collaborative partnerships between the public and private sectors is deeply ingrained in mainstream American ideology. For example, Drs. Simon and Fielding, two leaders of the Los Angeles County Department of Health Services, assert that “all businesses and public health agencies share an interest: ensuring a healthy population. Businesses should have a financial interest in supporting organized public health efforts, and collaborative efforts can increase the reach and effectiveness of public health.” For those who believe that business and public health have an inherent confluence of interest, it is natural to seek partnerships. By allying with the power of big business, say the supporters of this approach, public health has a better chance of achieving its objectives.

Some advocates have a more critical view of partnerships. They argue that business can just as easily co-opt as support public health and that voluntary partnerships can be used as a substitute for more substantive protection. In a review of lessons for reducing obesity from advocacy efforts to modify tobacco, alcohol, firearms and automobile industry practices, Dorfman and her colleagues conclude:

Clearly both extremes – working too closely with the industry, or considering the entire industry a monolithic enemy – have downfalls. The best approach is to deal with the industry from a base of power. After the community organizing effort gels and there is a strong base of support in the community and solid strategic direction, then advocates can talk with the industry on their own terms.

In this view, the question is not whether to engage in discussions with industry about voluntary changes but rather under what circumstances, when and with what goals.

Conclusions

In summary, public health professionals offer compelling but contradictory arguments for and against voluntary corporate guidelines and stronger public oversight as strategies to reduce harmful corporate practices. To move beyond ideological assertions of the merits of one path or another will require systematic evidence that analyzes the outcomes of each option in a variety of circumstances. By focusing public health research on this question, public health officials and advocates can move towards evidence-based decisions that are based on concrete analyses of specific situations.

The stakes for finding the right balance between the two could not be higher. A recent study in the New England Journal of Medicine warned that if current trends on obesity and diabetes continue, our children and grandchildren will have shorter lifespans than we do. Choosing the right path to reduce the promotion of unhealthy food can help us avoid this prediction. Similarly, it is estimated that one billion people will die from tobacco-related diseases in the 21st century, a fate that can be changed only if the tobacco industry plays a different role in this century than in the last one.

Thus, providing more definitive guidance on how to choose when to support voluntary industry initiatives and when to insist on strong public oversight is literally a matter of life and death.

Nicholas Freudenberg is Distinguished Professor of Public Health at Hunter College, City University of New York.

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Local, National and Global Action Against Motor Vehicle Pollution: Making healthy breathing a right

According to the World Health Organization, about 800,000 people die each year from the effects of air pollution. In the United States, 60,000 premature deaths can be attributed to air pollution and automobile exhaust is the largest single source, reports the American Heart Association. Despite recent progress in reducing air pollution, 160 million tons of air pollution were released into the air in the United States in 2002 and more than 152 million Americans now live in counties with unhealthy levels of ozone or particulate matter, the two most prevalent of the principal air pollutants. Air pollution contributes to a variety of diseases including cancer, asthma, cardiovascular disease and stroke. In many developing world cities, the rapid increase in the number of automobiles and lax air pollution standards make automobile exhaust a growing threat to health. Automobile pollution also contributes to global warming, providing another rationale for action.

These grim statistics demonstrate the benefits of reducing air pollution. Since motor vehicle exhaust is a major contributor to air pollution, decreasing what comes out of the tailpipes of cars, busses and trucks has become a focus for public health action. Recently, advocates and policy makers have initiated efforts at the local, national and global levels to clean the air we breathe. An examination of these activities may help to identify the relative advantages and limitations of working at each level.

 Community Groups Document Perils of Air Pollution in Milan and New York, Demand Change.

“We want people to rebel and politicians to pay attention. This is really bad for health.”

Concerned about the impacts of air pollution on health, community organizations such as Parents Against Pollution in Milan, Italy and both West Harlem Environmental Action (WE ACT) and the Harlem Children’s Zone Asthma Initiative in New York City are fighting to clean up urban air. These groups link youth researchers, scientists, medical professionals and lawyers to take on both the motor vehicle industry and city planners, calling for cleaner air, improved public health and environmental justice.

In Milan, Italy, where the levels of air pollution are among the worst in Europe, “Parents Against Pollution” has armed young people with portable monitors to measure ultrafine pollution particles. Participating scientists helped to design the measurement strategies and interpret the results. Sixteen year old Tommaso Abbate wore the monitor for 24 hours. During that period, his average exposure to air pollution levels was 127 micrograms per cubic meter, 117 g higher than the standard of 10 micrograms per cubic meter set by the World Health Organization (WHO) as a safe target. Responding to these findings, Anna Gerometta , President of Parents Against Pollution stated, “We want people to rebel and politicians to pay attention. This is really bad for health.” Earlier this spring, Milan exceeded both the WHO and European Union (EU) standards for particulate air pollution on 80 days. Italy, home to Fiat, Alfa Romeo, Ferrari, Lamborghini and others, was warned by the EU that its current emission reduction plan is inadequate and the city will face billions of euros in fines if it fails to remedy the situation.

Milan is taking notice. Milan now imposes “car-free Sundays” in which the use of cars and motor scooters is banned throughout the better part of the day and public transportation is increased to compensate. In order to further reduce air pollution and improve health, Parents Against Pollution would also like to see free public transportation for children, dedicated bike lanes and special lanes for buses, and a charge for cars entering the city center.

In New York City, the greatest source of air pollution comes from vehicle exhaust. In Harlem, WE ACT and the Harlem Children’s Zone Asthma Initiative, two community organizations, have demonstrated the disproportionate effect that air pollution has on residents’ health. A sanitation truck depot and six of the seven NYC bus depots operated by the Metropolitan Transit Authority of New York (MTA) are located in Harlem. (The MTA operates public transportation in the New York metropolitan region.) At these depots, which house more than a third of the city’s fleet of buses, vehicles are parked, repaired, fueled and relaunched each day. The asthma rate for children in Harlem is 25%, one of the highest ever documented in the United States and considerably higher than the national childhood average of 7%. Harlem and the Bronx have the highest rates of hospitalization for asthma in New York City and African Americans and Latinos are hospitalized at a rate of of 3 – 5.5 times that of whites. The neighborhood has consistently exceeded National Ambient Air Quality Standards for particulate matter, likely as a result of the high concentration of bus depots, nearby commuter highways, local traffic, as well as regional upwind emissions, incinerators and industrial facilities. Local traffic is particularly an issue given that Amsterdam and Broadway avenues – two of the major north-south thoroughfares in Manhattan – pass through the center of Harlem. These routes are the main truck routes for transporting goods in the area since trucks are prohibited from traveling on the highways that run east and west of Manhattan.

A partnership between the Harlem Children’s Zone and the Harlem Hospital Center Department of Pediatrics led to the Harlem Children’s Zone Asthma Initiative. The goal of the project is one of intervention and the Initiative seeks to improve the health of the estimated 13,000 residents of Central Harlem. Initial screening resulted in rates far higher than initially expected and study researchers ultimately found rates of asthma four times the national average and three times the national average for African Americans. Researchers involved in the study stated “Childhood asthma in Central Harlem is not only highly prevalent, but severe.”

WE ACT challenges the structural conditions that cause high rates of respiratory distress and other health conditions in Harlem and fights to keep pollution out of poor and people of color communities. Founded in 1988, WE ACT works to improve environmental policy, public health and quality of life in communities of color. The organization challenged the MTA regarding its use of diesel buses which are primarily housed in upper Manhattan and emit 30-100 times more particles than do gasoline engines with emission control devices. Working with Columbia University researchers to demonstrate the impact of air pollution on Harlem, WE ACT measured air pollution levels in the neighborhood over the course of five days at four intersections in Harlem. The group found rates of fine particle concentrations ranging from 22-69 micrograms per cubic meter, far higher than the standard proposed by the 1998 Environmental Protection Agency of 15 micrograms per cubic meter. As inMilan, WE ACT also worked with youth researchers to demonstrate that young people in Harlem are exposed to levels of diesel exhaust known to contribute to respiratory health problems.

Although WE ACT has not so far been successful in its legal actions against the MTA, the Authority has substantially reduced the age of its fleet of buses and cut emissions by 85%. Still, WE ACT has demanded that the city close one of the bus depots, upgrade the fleet to the use of hybrid vehicles at all uptown sites, and relocate some of the remaining depots to other locations in the city. These battles continue.

Researchers, Activists Demonstrate Importance of Clean Air for Lifelong Health, While Auto Industry Opposes Stricter Fuel Standards, Sways Lawmakers

Public health researchers and advocates have urged the federal government and the auto industry to reduce automobile air pollution both to prevent pollution-related illnesses and, more recently, to reduce global warming. In the last two decades, the incidence of asthma has increased and if current patterns continue, it is estimated that the rate of asthma will double in the United States by 2020, affecting 29 million individuals. Although the auto industry publicly shows support for improved emission standards, their efforts to stall stricter emissions bills in the United States and their financial and political support for lawmakers who sought to weaken the bill illustrates that clean air and better health are still not top priorities.

Within the United States, emissions from cars and trucks accounts for approximately one third of greenhouse gases. Thus, researchers, environmentalists and community health activists are increasingly joining forces to make the point that better fuel economy not only reduces the need for foreign oil but reduces emissions that are linked to both environmental and public health concerns. These groups point to the particular impact that pollution has on children. Combustion related air pollution is linked to cancer and serious respiratory and cardiovascular concerns for both children and adults and there is evidence to suggest that the fetus and infants are more vulnerable to environmental toxins which can affect pre and postnatal development. A Columbia Center for Children’s Environmental Health study found in preliminary analyses that 46% of infants between birth and three months of age experienced wheezing and other respiratory symptoms as did 54% of babies at six months and 50% at nine months. Children who live near busy streets are more likely than their peers who live in quieter areas to have health problems, including asthma and lung disease, stunted lung development and premature death. While asthma has many causes, nationally, children who live in low-income neighborhoods, areas more likely to be near highways and other high congestion zones, are four times more likely to be hospitalized for asthma than children living in wealthier neighborhoods. Health problems developed in childhood continue throughout adulthood and increase their risk of serious breathing problems.

Although new research evidence and health advocacy have called attention to the health and environmental benefits of less polluting and more fuel efficient motor vehicles, U.S. fuel efficiency standards have not been raised since 1983. However, in late June, the U.S. Senate passed a bill that would require that new cars, SUVs and light trucks to achieve an average of 35 miles per gallon (mpg) by 2020 compared to the average of 25 mpg today. Although the Senate bill (known as the Stevens Amendment) passed, it was opposed by House and by Senate Democrats from Michigan, who at the behest of the auto industry looked to weaken the proposal.

Despite the fact that the auto industry has admitted that increased fuel economy standards are necessary, automakers complained that the increases proposed in the June Senate bill were too strict and not economically feasible. Dave McCurdy, President and CEO of the Alliance of Automobile Manufacturers, issued a statement in which he commended the efforts of Senators who “worked to eliminate provisions of concern in the energy bill.” Arguing that the proposed increased standards would reduce auto safety, cost jobs and hurt the economy, Steven Douglas, Director of Environmental Affairs for a consortium of auto manufacturers, suggested officials move gradually toward a national increase in fuel economy and reduced emissions. Automakers were especially opposed to a provision of the bill that combined light trucks and the passenger fleet into one group, setting a common emissions standard which manufacturers claimed was economically untenable. Throughout the 1990s, the auto industry depended on high profit, high pollution SUVs and light trucks to make their money. Even though this strategy has contributed to the near collapse of the US auto industry, Detroit automakers find it difficult to kick the habit of depending on big polluting vehicles for their profits.

Consumer group Public Citizen expressed criticism about the Senate bill in a press release. In addition to not setting mandatory emission standards, the bill would allow auto makers to produce vehicles that achieve less than 35 mpg if they could justify the lower standard based on a cost-benefit analysis. Public Citizen noted that cost-benefit analyses have often been used and abused by the auto industry and thus it seems unlikely that automakers would find raising emission standards to be economically feasible, despite the fact that foreign manufacturers manufacturers have already met and exceeded such standards. The House is currently working on their version of the bill and some reports indicate that a final vote may be delayed until later in the year.. Regardless of which version is ultimately passed, it seems unlikely that strong, mandatory emission standards will be set. Public Citizen President Joan Claybrook stated, “Even if it were mandatory, the 35 mpg target is not strong enough. The best-in-class fuel economy performers on the road today are already well on their way to achieving fuel economy in excess of this target. We can do much better much sooner.”

Making clean air a right: Next steps?

Through community-based organizing and alliances with researches, local groups such as WE ACT and Parents Against Pollution have mobilized their communities on the health impact of motor vehicle pollution. They have convinced city officials to take action to reduce pollution, such as car-free Sundays in Milan and the MTA’s commitment to upgrade their fleet of diesel buses. Both groups have also successfully crated new alliances among young people, researchers, and community organizations. To date, however, these local organizations have not yet been able to put direct pressure on the motor vehicle industry to design safer, less polluting vehicles.

On the other hand, national campaigns such as the one led by Public Citizen and JumpStart Ford, a joint project of Global Exchange, the Rainforest Action Network and the Ruckus Society, have elicited some response from the industry. Through internet campaigns, letter writing, media campaigns and direct action, these organizations have been able to draw the attention of manufacturers and have had some success in changing corporate practices, such as JumpStart Ford’s “Adopt a Dealer” campaign. However, without strong community-based links, national campaigns may be less able to motivate individuals to take sustained action or to put another pressure on Senators, Congressional representatives and a White House to overcome the powerful influence of the auto industry.

Growing local, national and global concerns about air pollution, health and global warming have sparked new action to reduce air pollution and create healthier and more sustainable forms of transportation. On the one hand, the creativity, passion and tactical flexibility of pollution control activists have created the potential for a movement that can challenge an industry that values its profits more highly than public health and governments that seem reluctant to make clean air a basic human right On the other hand, to date these activists have yet to forge a framework or policy agenda that can link these different levels and arenas of action. Only when clean air advocates achieve the same vertical and horizontal integration that the global automobile industry practices will they be able to achieve their health and environmental objectives.

Photo credits:
Photo 1: Department of Transportation, Federal Highway Administration.
Photo 2: Marc Baptiste, copyright 1997 West Harlem Environmental Action
Photo 3: Environmental Protection Agency

Alcohol and Food Advocacy: What’s the same? What’s different? An Interview with Michele Simon, Director of Research and Policy, Marin Institute

Michele Simon is a lawyer and policy advocate who recently became Research and Policy Director at the Marin Institute, a California-based organization that serves as a watchdog of the alcohol industry. (In April 2007, Corporations and Health Watch described Marin’s successful campaign to ban alcohol advertisements from the Bay Area Rapid Transit system.) Prior to joining the Institute, Simon had been active in food policy advocacy and is author of Appetite for Profit How the Food Industry Undermines Our Health and how to Fight Back. Earlier this year, Corporations and Health Watch founder Nicholas Freudenberg interviewed Michele Simon in San Francisco about her experiences as a public health advocate on food and alcohol. These are excerpts from that interview.

CHW: Michele, you just started your job at Marin Institute a few months ago. Tell me what you’re doing there and some of your plans for the future.

MS: My title is research and policy director and Marin’s mission is to be an alcohol industry watchdog. In the  past, Marin Institute has focused more on environmental strategies, mainly looking at locally-based policy solutions. In the last year, the strategic plan has been refocused to become more state and nationally focused with a specific emphasis on the alcohol industry.  My role is to provide our advocacy agenda with research support and look at the major trends and how they influence public policy.  We will then target certain policies to bring about changes that will counter industry’s negative influences. One major area that we are focusing on is marketing of alcohol so I’m developing activities that will support those goals.

CHW: And what made Marin shift from a local emphasis to more state and national policy work?

MS: I actually wasn’t involved in that decision but I can tell you that there is a serious lack of non-profit groups that have that focus on alcohol. Marin’s review of who’s doing what in the field showed that there was no major national player serving solely as a watchdog of the alcohol industry.

CHW: So tell me some of the things you are actually doing to carry out that.

MS: Well, right now I’m developing a series of industry profiles, looking at the major players.  For example, Anheuser-Busch sells half the beer in this country, and so we’re getting specific data about their sales, their board members, and their other operations.  Just getting an understanding of who the industry players are, how much money they make, how much money they spend on advertising, just really getting to know who they are is the first step in planning activities to change their practices.  I think we have to start there to know who we’re dealing with.  We’re also working to get a sense of how the industry operates in terms of brand ownership.  Most people think of products in terms of brands.  They notice there’s Budweiser, there’s Molson, there’s Coors and so on.  But really there are major industry players that own dozens and hundreds of brands. Also, in alcohol there has been a lot of consolidation going on. (See Box 1 on the next page for some of the products in the Anheuser Busch “Family”.)  In the past, there used to be clear separation between beer, wine, and distilled spirits.  Well, now you have, for example, Diageo, which owns products across all three of those categories.  I think that changes, for example, how we look at the wine industry.  We used to think wine, that’s not a problem, but when it’s owned by a major multinational company that can shift things. So, we’re trying to paint a picture of who the major industry players are, how powerful they are, and then next step would be to look at their activities, lobbying, advertising etc. That’s one of my first projects.  And we have collected that kind of information in the past but we are updating it to keep up with a changing industry.

CHW: And is the goal to be able to say well how do you get Anheuser Busch to do something different in terms of marketing?

MS: Well, I think for now the goal is to have at our fingertips certain key data that will come in handy for whatever our advocacy target is. For example, Anheuser-Busch’s latest marketing strategy is internet television, internet portal television. We know that Anheuser Busch is projecting to spend a hundred million dollars over the next few years on this.  So right now it just really making sure we have data at our fingertips so when we’re talking to media we have talking points that can be rather dramatic. It’s interesting to me to see that they’re spending far more money on television advertising than anything else.  So that gives us some ideas about what direction to take. If we’re considering going after outdoor alcohol advertising, we might think about is that really where our best use of resources is given that they have decided to spend so much more on television.

Anheuser Busch Beverage Products

Budweiser Family
Budweiser
Bud Light
Budweiser Select
Bud Dry
Bud Ice
Bud Ice Light

Busch Family
Busch
Busch Light
Busch Ice

Energy Drinks
180 Red with Goji
180 Orange Sugar-Free
180 Energy X-3
180 Blue-Low Calorie
180 Blue
180 Sport Drink
180 Energy

Natural Family
Natural Light
Natural Ice

Michelob Family
Michelob
Michelob Light
Michelob ULTRA
Michelob ULTRA Amber
Michelob Honey Lager
Michelob AmberBock
Michelob Golden Draft
Michelob Golden Draft Light

Malt Liquors
Hurricane High Gravity
Hurricane Malt Liquor
Hurricane Ice
King Cobra

Import Family
Kirin Light
Kirin Ichiban
Grolsch Light Lager
Grolsch Blonde Lager
Grolsch Amber Ale
Grolsch
Harbin Lager

Seasonal Beers
Michelob ULTRA Fruit Infused
Beach Bum Bolnde Ale
Michelob Bavarian-Style Wheat

Specialty Beers Family
Redbridge
Ascent 54
Mule Kick Oatmeal Stout
Demon’s Hop Yard IPA
Burnin’ Helles
Ray Hill’s American
Pilsner
Rolling Rock
Bud Extra
Bare Knuckle Stout
ZiegenBock Amber

Speciality Malt Beverages
BACARDI SILVER Mojito
BACARDI SILVER Peach
BACARDI SILVER Watermelon
BACARDI SILVER Raz
BACARDI SILVER O3
BACARDI SILVER Big Apple
BACARDI SILVER Big Apple
BACARDI SILVER Strawberry
BACARDI SILVER PEELS
Tequiza
TILT

Spirits Family
Jekyll & Hyde

Specialty Organic Beers
Stone Mill Pale Ale
Wild Hop Lager

Nonalcoholic Brews
O’Doul’s
O’Doul’s Amber

Alliance Partner Products
Redhook Ale
Widmer Brothers

CHW: In other industries, –like tobacco, food and guns, for example  we have seen that the health impact of these products is often influenced by the relationship between the industry—the big corporations that produce the products and retailers—those who sell to the public.   I wonder how you think about that around alcohol .  What’s the connection between a company like Anheuser Busch and the retail distribution?

MS: What really counts is the capacity to distribute your product to every local market and bar. And the beer wholesalers have been extremely effective as a lobbying group. The National Beer Wholesalers Association (NBWA), founded in 1938, is a trade association for more than 2,750 beer distributors nationwide. For the most part, its activities are hidden from the public eye. So for a product like Budweiser, their power comes in their distribution.  I don’t think anyone in public health understands how this works. I don’t have the policy solution yet or the policy angle, but I do want to understand how the distribution system works. It was created after Prohibition, with rules for wholesalers and retailers and we need to understand how it works so we can develop strategies to reduce the harm from alcohol.

CHW: Can you describe the three alcohol control groups working at the national level? How does Marin distinguish itself from the two other groups?

MS: The Center for Science in the Public Interest has done great work on nutrition but they have only two people, maybe one and a half, working on alcohol issues.  That’s obviously, a limitation there. Lately they’ve been focusing on the role of the alcohol industry in college sports. (See Corporation and Health’s January 2007 interview with CSPI’s George Hacker on their alcohol projects.)  And the other major national group is the Center on Alcohol Marketing to Youth at Georgetown University.  CAMY has done important research on alcohol marketing to young people. We aim be an advocacy organization on policy issues that also go beyond marketing to youth.

CHW: In Marin’s work, who do you see as your key stake holders? Who are your consumers and who are the people you interact with in order to achieve your goals?

MS: People on the frontlines are absolutely our constituency. And the challenge for us is how to support ongoing community-based activities while also rallying their support for our state and national activities. Part of our challenge is still how can we help local groups clean up a neighborhood harmed by excess alcohol sales and then help them stay connected to community groups  and statewide coalitions. I think that our audience must be anyone who is working on alcohol related issues.  I think my role is to get people who are in the trenches to shift their current educational activities and get them to understand the importance of policy, and the importance of the alcohol industry in their world.

CHW: What about the professionals in alcohol related work—how do you interact with them?

MS: Professionals in the field are another really important constituency. I really hope to get them to apply a public health perspective to see the benefits of moving way upstream to fix the problems caused by the alcohol industry.  I’ve been to community meetings where it just breaks my heart to see people talking only about “Well, how can we deal with these problems with our corner liquor stores and bars and how can we change the licensing, etc.”. I think they’re not focused on the real causes of their problems. They are struggling to clean up the mess that is caused by industry spending hundreds of millions of dollars a year to get people to drink more and the problems caused by government policy.  I don’t know exactly  how best to bring these different levels of work together but I want to find a way… I understand that on a day to day level, the immediate problems are the reality and if I just go in and talk about the big picture stuff,  the community may not be getting the help they want. On the other hand, it kind of just spins your wheels working only at the community level. And while the national level works present a whole other set of challenges, I don’t think our focus on only is a solution.  I do understand it’s sometimes easier to work at the local level and to get something done, butt it’s also so possible just to get all that undone and you never really get at the root of the problem.

CHW: Let’s switch gears and talk about what you have learned from moving from doing food policy advocacy to alcohol. What’s the same? What’s different?

The alcohol industry seeks to blame the individual for drinking too much just like the food industry blames individuals for eating too much.

MS: For the most part, the talking points are the same. For example, the whole focus on the individual is identical. I’m talking about industries’ blame games and the personal responsibility message.  It doesn’t matter if you’re talking about tobacco, food or alcohol. The alcohol industry seeks to blame the individual for drinking too much just like the food industry blames individuals for eating too much.  I’m very amused by the “drink responsibly” tagline I see on every alcohol advertisement now shown. And some companies actually use that line as part of their marketing.  So that whole thing is very clearly the same.  But what’s different from what I expected is that I thought alcohol somehow would be more like tobacco than food. But food is so hard because everyone has his or her opinion, whereas tobacco is much clearer—people understand it’s harmful. What I’m finding is that alcohol has much more in common with food than with tobacco. In part, it is because of this whole grey area where, unlike tobacco, alcohol isn’t an on/off switch. You can drink a little and be fine, and then there’s the complicating factor, the alleged health benefits of alcohol. So similar to food there is a lot of grey area.  I don’t think alcohol is anywhere as stigmatized as tobacco is. Also, food is such a hot topic now that in a way alcohol is getting less concern. Like other health issues, alcohol has had its peak in terms of funding and attention by foundations and politicians.  Unfortunately, some of the major funders have now pulled out of alcohol. Working on alcohol has been more challenging than I expected.  I’ve been struck by how little advocacy there is given that it’s a pretty serious public health problem.  Of course there are challenges that are similar, getting people to wrap their heads around the problems, understanding the history of marketing and promoting alcohol. In terms of policy, at least people get that marketing to underage youth is a problem. When they understand that kids are being targeted by alcohol marketers, most say “Oh, yeah, that shouldn’t be happening.”   With food marketing, on the other hand,   it’s taken for granted that kids are going to be marketed to. It’s more acceptable — people just blame the parents. And with alcohol, people accept that government has a role in policy making – regulating retail sales, taxing alcohol and so on -these are accepted.  So some people might disagree about whether or how much to raise alcohol taxes but they understand it as a policy to reduce consumption, especially among young people. With food, we don’t yet accept a government policy role that helps to encourage health.

CHW: And what do you think about the potential for mobilizing people across the issues of food and alcohol? Do you think there is some common ground there?

MS: Well, first let me describe what I see as the problem in bringing these two efforts together.  Alcohol really suffers from this perception that the problem’s confined to a small subset of individuals, those who are alcoholics, and underage drinkers. I think the perception is that it’s not a general problem. Only half the population actually drinks alcohol so they may think it’s not a problem for them. Not realizing they could be hit by a drunk driver any minute. Food is more of an emotional issue for people.  They get angry about food, they have opinions about it.  If alcohol is not affecting them personally, than they don’t really think about it.

CHW: On a more practical level, do you see potential for bringing these two sectors together.  Is there common work that we could be doing around both food and alcohol?

In poor neighborhoods we have many corner liquor stores and very few healthy food options. Why is that? What can be done about it?

MS: I’ve started thinking and talking about it. One obvious connection is that in poor neighborhoods we have many corner liquor stores and very few healthy food options. Why is that? What can be done about it?  Then there’s land use and zoning — city planners thinking about how we can use zoning laws to make healthy choices in more accessible and unhealthy ones less so. Restricting access to alcohol has sometimes been a hard sell and if we can bring food and tobacco folks into this maybe we can get more traction.

CHW: And many have observed that it may be inefficient for public health advocates to take on one harmful product at a time.  What do you see as the potential for common policy goals?  Is there a social or policy agenda for protecting communities from corporate practices that damage health?

MS: My approach is not to look so much at the product we’re talking about but rather at industry tactics.  So whatever your health advocacy issue, whatever your tactics and strategy, industry strategies are pretty much identical: denial and obstruction of the scientific evidence, emphasis on individual responsibility. Working in food policy, I have found many people didn’t get that companies exist to make money. It’s their legal obligation as corporations to make money for their shareholders, even if it undermines health. Yet companies spin this unbelievably good public relations and advertising about their being responsible and caring, promoting good things, all this positive stuff.  So the first step in building any movement is educating people, helping them understand what’s going on. So when the alcohol ads say drink responsibly, do they really care about my 18 year old daughter not drinking until she’s 21?  No, they care about painting a picture of making it look like they care so policymakers stays off their back. I think it’s so incredible that many people still don’t understand that about corporate behavior.

CHW: What do you think advocates for healthier policies on tobacco, food, alcohol and guns, to name a few, need to be doing to make that point?

MS: Well, for starters I think too many people think that the tobacco industry is an isolated example, different from other types of industries. I have just been struck by how many groups working on food, from community groups to big groups like the American Heart Association, want to work with food companies, think they can engage food companies in protecting health.

What we need to do is paint the picture so they can get it.  So many people think that their well- intentioned but modest educational programs are going to make the differences against what one friend of mine calls the “marketing of diseases” by the tobacco, alcohol and food industries. If people don’t understand the nature of corporate motivation, then I don’t think we’re going to be able to make much progress in protecting health.

So our goal has to be to move alcohol, food and tobacco policy upstream.  While education is important and community interventions are important, alone, they’re not going to solve the problem.  We need to develop a new understanding of the causes of the health problems associated with food, alcohol and tobacco.