Category Archives: Food & Beverage

Corporate Targeting and the Impact of Corporate Practices on Socioeconomic, Racial/ethnic, Gender and Age Inequities in Health

Selected Peer-reviewed Articles

A small but growing number of studies examine how corporate practices influence health inequities. Studies have described and analyzed how corporations target selected populations for marketing of unhealthy products, assessed the impact of these practices on differences in health behavior and health, and explored other ways that corporate decisions maintain or exacerbate health disparities.

Here Corporations and Health Watch summarizes a few of these recent reports and invites readers to submit additions to the list for subsequent posting.


Baker EA, Schootman M, Barnidge E, Kelly C. The role of race and poverty in access to foods that enable individuals to adhere to dietary guidelines. Prev Chronic Dis.2006; 3(3):A76.

Analyzes the results of an audit of community supermarkets and fast food restaurants to assess the location and availability of food choices that enable individuals to meet the dietary guidelines established by the U.S. Department of Agriculture. The researchers used supermarket and fast food restaurant audit tools to assess the availability of healthy food choices in the urban area of St. Louis, Missouri. The researchers found that two factors (race and income) are associated with the location of food outlets and the selection of foods available. Individuals living in mixed or white high-poverty areas and in primarily African American areas are less likely to have access to foods that would enable them to make healthy food choices. The researchers recommend collaborations with the business community and political structures to make it economically viable to provide equal access to healthy food choices.


Brody H, Hunt LM. BiDil: assessing a race-based pharmaceutical. Ann Fam Med. 2006; 4(6): 556-60.

Analyzes scientific evidence on BiDil, the first drug approved by the Food and Drug Administration to be marketed to a single racial-ethnic group, African Americans, for the treatment of congestive heart failure. The authors discuss the problems that can arise when race is viewed as a biological-medical construct, leading to an overly simplistic assumption of a racial and hence presumed genetic difference while obscuring the “economic, social, cultural, and ethical issues lurking in the background.” The authors predict that the manufacturer will launch a publicity campaign targeting African Americans, and that family medicine doctors will be asked by their patients for the new “for blacks only” medication.


Freudenberg N, Galea S, Fahs M. Changing corporate practices to reduce cancer disparities. J Health Care Poor Underserved. 2008; 19(1):26-40.

Reviews data on disparities in cancer morbidity and mortality in the United States, and reviews evidence on corporate practices contribute to cancer risk behavior, incidence, and cancer disparities. The authors propose that the practices of the tobacco, alcohol and food industries be considered as modifiable social determinants of health. The authors conclude with recommendations for research, practice, and policy that would lead to what they term “less carcinogenic” corporate practices.


Kwate N O A. Fried chicken and fresh apples: Racial segregation as a fundamental cause of fast food density in black neighborhoods. Health and Place 2008;14:32-44.

Analyzes pathways by which racial segregation contributes to higher density of fast food outlets in Black neighborhoods in US. The author proposes that population characteristics, economic characteristics, physical infrastructure and social processes of Black neighborhoods each contribute to creation of “localized geographic areas for targeting by fast food corporations and operators.”


Kwate NO, Lee TH. Ghettoizing outdoor advertising: disadvantage and ad panel density in black neighborhoods. J Urban Health. 2007;84(1):21-31.


Investigates correlates of density of outdoor advertising in predominantly African American neighborhoods in New York City. Authors found that that black neighborhoods have more outdoor advertising space than white neighborhoods, and these spaces disproportionately market alcohol and tobacco advertisements. By linking census data with property data at the census block group level, investigators found that two neighborhood-level determinants of ad density were income level and physical decay.


Macdonald L, Cummins S, Macintyre S. Neighbourhood fast food environment and area deprivation-substitution or concentration? Appetite. 2007l;49(1):251-4.

Investigates associations between area deprivation and the location of the four largest fast-food chains in Scotland and England. The authors report statistically significant increases in density of outlets from more affluent to more deprived areas for each individual fast-food chain and all chains combined. They conclude that these findings support a “concentration” effect whereby environmental risk factors for obesity appear to be ‘concentrated’ in more deprived areas.


Monsivais P, Drewnowski A. The rising cost of low-energy-density foods. J Am Diet Assoc. 2007; 107(12): 2071-6.

Discusses the results of a study on the energy density and retail prices of 372 foods and beverages in major supermarket chains in the Seattle, WA metropolitan area in 2004 and 2006 (energy density and prices were calculated in terms of $/100g and $/1,000 kcal). The researchers discuss the role of lower energy-density foods as a strategy for managing overweight and obesity. The two-year price change for the least energy-dense foods was +19.5% whereas the price change for the most energy-dense foods was -1.8%. The researchers suggest that the lower price of energy-dense foods and the resistance of energy-dense foods to price inflation may help explain why the highest rates of obesity in the United States are observed among those with limited economic means.


Morrison MA, Krugman DM, Pumsoon P. Under the radar: smokeless tobacco advertising in magazines with substantial youth readership. Am J Public Health. 2008; 98(3): 543-48.

Reviews the level of advertising of smokeless tobacco products before and after the Smokeless Tobacco Master Settlement Agreement (STMSA). The researchers determined that the STMSA appears to have had a limited effect on adolescents’ exposure to the advertising of smokeless tobacco in magazines with high youth readership. The researchers determined that adolescent boys (aged 12-17) are at greatest risk for exposure to smokeless tobacco advertisements.


Primack BA, Bost JE, Land SR, Fine MJ. Volume of tobacco advertising in African American markets: systematic review and meta-analyses. Public Health Rep. 2007; 122(5): 607-15.

Reviews the peer-reviewed literature on the density of pro-tobacco media messages. Of the studies identified for inclusion, 11 met the eligibility criteria for the current review. The researchers pooled the results of these studies in a meta-analysis and conclude that African Americans are exposed to a higher volume of pro-tobacco advertising. The researchers also cite evidence demonstrating that African Americans bear the greatest morbidity and mortality burdens due to smoking, and that exposure to pro-tobacco media messages predicts cigarette smoking.


Schor JB, Ford M. From Tastes Great to Cool: Children’s Food Marketing and the Rise of the Symbolic. Journal of Law, Medicine & Ethics. 2007; Spring issue on Childhood Obesity: 10-21.

Discusses the increasing participation of children in the consumer markets, their heavy media use and exposure to high levels of advertising. The researchers discuss deteriorating diets and rising obesity, as well as the shift in children’s food advertisements from product attributes to symbolic messages. The researchers cite studies that demonstrate that exposure to junk food marketing is much higher for low-income children as well as racial and ethnic minority children, groups that also have higher rates of obesity.


Thompson DA, Flores G, Ebel BE, Christakis DA. Comida en venta: after-school advertising on Spanish-language television in the United States. J Pediatr. 2008; 152(4): 576-81.

Analyzes the content of food and drink commercials aired during after-school hours (3 to 9 p.m.) on two Spanish-language television stations in the United States. The researchers found that children viewing Spanish-language television in the United States after school are exposed to food and drink commercials, mostly advertising unhealthy foods, including fast foods and sugared drinks. The researchers propose that food and beverage advertising to children via Spanish-language television may contribute to the high rates of obesity among Latino children.


Yerger VB, Przewoznik J, Malone RE. Racialized geography, corporate activity, and health disparities: tobacco industry targeting of inner cities. J Health Care Poor Underserved. 2007; 18(4 Suppl): 10-38

Reviews more than 400 internal documents from the tobacco industry to explore the ways in which the tobacco industry targeted inner cities populated predominately by low-income African American residents in the 1970s-1990s. The authors cite studies demonstrating that smoking rates remain higher among the poor, the less educated and other underserved populations, despite significant reductions in the overall smoking rate in the United States. This archival analysis demonstrates how the tobacco industry’s promotion activities and the “menthol wars” fought by tobacco companies in America’s inner-cities have contributed to the tobacco-related health disparities that we observe today.

Corporations, Health and the 2008 Presidential Race, Part Three: Clinton, McCain, Obama and the Food Industry

As public concern about obesity and nutrition has increased, the food and beverage industry has worked tirelessly to avoid any additional regulation of its practices. Most recently, legislation to restore the Federal Trade Commission’s power to restrict junk food marketing, update school food standards, and mandate nutrition information on chain restaurant menus have all been introduced but none have been successful. Among others, the American Beverage Association, National Restaurant Association, Grocery Manufacturers Association, the Snack Food Association and the National Automatic Merchandising Association work to hold on to their ability to have their members rather than the government monitor their business practices. The industry and its trade associations use their political muscle to shift the decision-making process away from Congress and the President and into their own hands.

To help achieve this outcome, during the 2006 Congressional election cycle, the food and beverage industry contributed more than $3.5m to Democrats and nearly $7.5m to Republican federal candidates (from both PACs and individuals). In 2008, according to the Center for Responsive Politics, the food and beverage industry has already contributed more than $2m to Democrats and more than $3m to Republicans.

The top twenty food and beverage industry
political donors 2008
  1. The National Restaurant Association ($426,500)
  2. Osi Restaurant Partners ($340,500)
  3. McDonald’s Corp ($134,420)
  4. Coca-Cola Co ($97,750)
  5. Ilitch Holdings ($96,100)
  6. Starbucks Coffee ($84,979)
  7. Wendy’s ($82,850)
  8. Mjkl Enterprises ($65,100)
  9. Brinker International ($63,650)
  10. Coca-Cola Enterprises ($60,250)
  1. Yum! Brands ($55,950)
  2. Triarc Companies ($51,150)
  3. Coca-Cola ($47,575)
  4. Aramark Corp ($45,160)
  5. Darden Restaurants ($42,050)
  6. American Beverage Assn ($41,350)
  7. Pizza Hut Franchisees Assn ($39,750)
  8. Waffle House ($36,800)
  9. Trident Seafoods ($34,700)
  10. Davco Restaurants ($34,200)


Presidential Candidates and the Food Industry

In the 2008 primary campaign, Senator Clinton has been the top recipient of money from the food and beverage industry ($689,378); Senator Obama ranks fourth ($216,273), and Senator McCain, sixth ($114,600), as of February 11, 2008.

As obesity rates continue to climb and as we near the presidential election, it’s critical to examine how the three remaining Presidential candidates have responded to the food industry’s political agenda to avoid government oversight.

mcdonalds The “Cheeseburger Bill,” known officially as the Personal Responsibility in Food Consumption Acti in the House and the Common Sense Consumption Act in the Senate, would protect food companies from being sued by individuals for weight gain. It passed in the House in 2004 and 2005, failed to pass in the Senate but has garnered more co-sponsorship support than perhaps any other federal food-related bill. Republicans have been the main backers of the Cheeseburger Bill. Neither Senator Clinton, Senator McCain nor Senator Obama has supported any version of this bill.

The majority of the bills to further regulate the food and beverage industry go through the Senate’s Agriculture, Nutrition and Forestry Committee. None of the three candidates sit on this committee. Other health-related bills fall under the jurisdiction of the Health, Education, Labor and Pensions (HeLP) committee. Both Senators Clinton and Obama are members of this committee. An examination of their committee work and the bills they have co-sponsored can provide a window into these candidates’ perspectives on multiple health-related issues.

Perhaps the bill with the most momentum this year (although it ultimately died) was Senator Harkin’s bill (S.771) to revise the definition of “foods of minimal nutritional value” which would further regulate competitive foods sold in schools, at any time of day. Senator Clinton supported this bill along with 27 of her Senate colleagues. Senator McCain and Senator Obama did not cosponsor this bill.

Below is a table showing how the three main candidates chose to sponsor or cosponsor additional selected obesity-related bills in 110th Congress. Some of these bills would work to further regulate the food and beverage industry. For example, one element of Senator Harkin’s Healthy Lifestyles and Prevention America Act (S.1342) requires some restaurants and vending machines to provide nutritional information about each food available for purchase.

2008 Presidential Candidates sponsorship and cosponsorship of obesity-related bills in the 110th Congress


Bill # Bill Title Clinton McCain Obama
School Foods
S.2066** A bill to establish nutrition and physical education standards for schools(aswell as other food issues) N N Y (sponsor)
S.1432 A bill to amend the Food Stamp Act of 1977 and the Richard B. Russell National School Lunch Act to improve access to healthy foods, and for other purposes. Y N N
Physical Activity
S.2173 A bill to amend the Elementary and Secondary Education Act of 1965 to improve standards for physical education. N N N
S.651 A bill to help promote the national recommendation of physical activity to kids, families, and communities across the United States. Y N
S.2066** See above N N Y (sponsor)
Funding and Research
S.1068 A bill to promote healthy communities. Y N Y (sponsor)
S.866 A bill to provide for increased planning and funding for health promotion programs of the Department of Health and Human Services. Y N N
S.1067 A bill to require Federal agencies to support health impact assessments and take other actions to improve health and the environmental quality of communities, and for other purposes. Y N Y (sponsor)
S.1172 A bill to reduce hunger in the United States. Y N Y
Employee Wellness
S.1753 A bill to amend the Internal Revenue Code of 1986 to provide a tax credit to employers for the costs of implementing wellness programs, and for other purposes. N N N
S.1342 A bill to improve the health of Americans and reduce health care costs by reorienting the Nation’s health care system toward prevention, wellness, and self care. N N N

Source: THOMAS, Library of Congress.

**Although Senator Obama did not support Senator Harkin’s bill to update school food standards, he did sponsor S.2066. This bill would also update standards for competitive foods sold in schools. Standards would be consistent with recommendations made by the Institute of Medicine’s Report Nutrition Standards for Food in Schools. It is stalled in the Ag, Nutrition and Forestry Committee and has no cosponsors.

In a previous Congressional session, Senator Clinton spoke about her concern for media’s effect on children. On March 8, 2006, she explained her support for Children and Media Research Advancement Act (S.1902):

The bill I introduced with Senators Lieberman, Brownback, Santorum, Bayh, and Durbin included pilot projects to look at the effect of media on young children, and to look at food marketing and obesity. Although those projects were not included in this manager’s package, I continue to be very pleased with the bill. It’s a step forward for children. And I look forward to working with my colleagues in other venues to ensure that the pilot projects get done.

None of the candidates have cosponsored Senator Harkin’s Menu Education and Labeling (MEAL) Act, requiring, among other practices, nutrition information on chain restaurant menus.

Junk Food Marketing

Commonsense Media posed the following questions on junk food marketing to the presidential candidates.

Childhood obesity has reached epidemic proportions in this country. The latest research suggests that junk food ads are a major contributing factor. Would you support legislation to regulate the type of foods that could be advertised during children’s programming (similar to laws considered in Australia and the United Kingdom)?

Senator Clinton’s response:

According to a Kaiser Family Foundation report released this year, “Food for Thought: Television Food Advertising to Children in the United States,” a committee convened by Institute of Medicine found that “television advertising influences the food preferences, purchase requests, and diets, of children under age 12 years and is associated with increased rates of obesity among children and youth.” That’s why, according to the report, policymakers in Great Britain have banned ads for foods high in fat, salt, or sugar in programming aimed at children under 16 years of age and have prohibited the use of premiums or children’s characters in food ads to young people.

In the United States, we are going in the right direction: In December 2006, 10 of the top food companies in the country announced a new Children’s Food and Beverage Advertising Initiative that includes a commitment to devote at least 50 percent of all advertising to healthier foods or to messages that encourage fitness or nutrition. I believe there is more work to be done. I would like to see the entire food industry come together to develop voluntary guidelines that take their responsibility to children seriously. I think that there are a lot of steps that the private sector and the public sector, working together, can take to curb marketing and availability of unhealthy products to our children. In the Senate, I co-sponsored the Improved Nutrition and Physical Activity Act — which passed in the Senate — to address obesity and eating disorders in children, and I introduced the School Food Fresh Program that links schools with local farmers to bring healthy locally grown snacks to schoolchildren. When I am president, I will continue to explore these options and support measures to put our children on a path to healthy living.

As I mentioned earlier, I championed the Children and Media Research Advancement Act to study the impact of electronic media on child development. This bill provides targeted funding to research the links between advertising and childhood obesity. Since 1980, the proportion of overweight children has doubled, and the rate for adolescents has tripled. We have to understand the relationship between advertising and obesity if we are to build the public will to take action.

And Senator Obama responded:

We’re never going to be able to shield our children from all the potentially bad influences out there. And it would be counterproductive to just build walls that shield them entirely. Our best hope is to educate our children and give them the information and the tools they need to make wise choices. Our children are bombarded by all sorts of messages all the time. If it’s not from television commercials, it’s from somewhere else. We need to teach them how to sort out these messages. I question whether legislating to control certain types of advertising is going to help our children in the long run. I think there are other, helpful steps we can take to reduce childhood obesity. A generation ago, nearly half of all school-aged children walked or biked to school. Today, nearly 9 out of 10 children are driven to school. And once there, children are not very physically active — only 8 percent of elementary schools require daily physical education. Childhood obesity is nearly epidemic, particularly among minority populations, and school systems can play an important role in tackling this issue. For example, only about a quarter of schools adhere to nutritional standards for fat content in school lunches. I will work with schools to create more healthful environments for children, including assistance with contract policy development for local vendors, grant support for school-based health screening programs and clinical services, increased financial support for physical education, and educational programs for students.

Senator McCain has yet to issue a response to these questions. On his campaign website he explains his belief in personal responsibility:

  • We must do more to take care of ourselves to prevent chronic diseases when possible, and do more to adhere to treatment after we are diagnosed with an illness.
  • Childhood obesity, diabetes and high blood pressure are all on the rise. We must again teach our children about health, nutrition and exercise – vital life information.
  • Public health initiatives must be undertaken with all our citizens to stem the growing epidemic of obesity and diabetes, and to deter smoking.

In their focus on education, Senators Obama and McCain reinforce a more conservative framework that emphasizes teaching children as the key to healthier lifestyles, rather than restricting, regulating or more closely monitoring the food industry. Senator Clinton’s language does address junk food advertising directly, but she advocates voluntary self-regulation and increased funding to study the links between advertising and childhood obesity.

The Candidates on Family Farms

Both Senator Clinton and Senator Obama preach support for family farms. In a questionnaire from the Congressional Hunger Center and Drake University Law School, the presidential candidates were asked:

In both rural and urban areas, many Americans lack convenient access to food. As President, how would you increase individuals’ and communities’ access to food?

Senator Clinton’s response:

I will work to increase access to locally grown and distributed food. As Senator, I was proud to start the Farm-to-Fork initiative, to provide consumers with better access to fresh, high quality, locally grown products through farmers’ markets, retailers, restaurants and schools. Given Farm-to-Fork’s success, I would consider working to replicate it around the country.

And Senator Obama’s response:

I support improved access to food through local and regional food systems. As president, I will emphasize the need for Americans to Buy Fresh and Buy Local, implement USDA policies and promote local and regional food systems, support funding for farm-to-school projects, and allow schools to give priority to local sources when ordering food (and grow vibrant and rural economies).

Senator McCain did not respond by the deadline.

Both Clinton and Obama voted for an amendment which would limit farm subsidies in the 2007 Farm Bill. McCain did not cast a vote but was a cosponsor of this amendment, initially introduced by Senator Dorgan (D-ND). This amendment has since been rejected.

All three candidates failed to vote either for or against the 2007 Farm Bill. This Bill, passed in the Senate this past December, is largely viewed as more of the same – subsidies to the largest agribusinesses — and would have been an opportunity for these candidates to take a stand against Big Food. The Senate and the House have passed distinct versions of the bill which now must be negotiated in Congress.

Can food be a political issue in the 2008 election?

At the end of the day, none of the candidates have been outspoken critics of the powers that rest in the hands of the food and beverage industry, nor have any called on the federal government to take a more direct approach in restricting this industry’s influence on society. As the Presidential campaign plays out in the coming months, nutrition,food advocates and journalists have the opportunity to ask the candidates – and voters – to consider what role the next President should play in addressing our nation’s food problems and confronting the growing epidemics of obesity and diabetes.

Alexandra Lewin is a doctoral studuent in nutrition at Cornell University and is completing her dissertation on federal obesity policy.


View CHW’s coverage on Corporations, Health and the 2008 Presidential Race:

Part 1: Following the Money
Part 2: Clinton, Obama and McCain on the Role of Corporations

New Alliances: Food Safety and Animal Welfare Organizations Join Forces to Demand Change

This past February, the nation saw the largest recall of meat in American history. More than140 million pounds of frozen ground beef slaughtered by the Hallmark Meat Packing Corporation in the last two years and supplied to Westland Meat Company was recalled after an undercover Humane Society of the United States (HSUS) video revealed evidence of widespread mistreatment of “downed” cattle. Hallmark employees were seen attempting to force downed cattle to slaughter by kicking them, applying electrical shocks, battering them with the blades of forklifts, and jabbing them in the eyes. In addition to outrage over inhumane treatment, the video raised the alarm of food safety organizations, as downed cattle are more likely to be infected with foodborne pathogens. Such concerns were heightened by the disclosure that Westland Meat Company was a supplier to the National School Lunch Program and commercial outlets.

In this case, researchers, advocates and policy makers concerned about public health, food safety and animal rights worked together to expose and seek to correct a situation that they believed violated food safety rules, animal rights and basic public health principles.On February 20, 2008, one day after the the United States Department of Agriculture announced the recall of Hallmark/Westland beef, seven food safety and animal rights organizations wrote a joint letter to USDA Secretary Ed Schafer urging the department to list the retail recipients of the Hallmark/Westland meat to better inform consumers about the recall. These organizations, Center for Foodborne Illness Research & Prevention; Center for Science in the Public Interest; Consumer Federation of America; Consumers Union; Food & Water Watch; Government Accountability Project and Safe Tables Our Priority [S.T.O.P.], further urged Schafer to enforce a rule proposed in March 2006 that would allow the agency to list retail consignees on USDA press releases. Though the rule had widespread consumer support it has not been approved.

The seven organizations argued that the public had a right to know to which retail outlets Westland had distributed the meat. Consumers Union issued a press release on February 28, 2008 stating that thanks to a 2007 law that Consumers Union (CU) helped to pass, the State of California had published the names of retailers that had carried the recalled Hallmark/Westland meat. However, because USDA had not taken action to approve changes to its internal policies regarding recall disclosure, consumers outside of the California received no such information. “Recalled meat was shipped beyond California’s borders, and because of USDA’s continuing secrecy about the names of the retailers, consumers in other states have no way of knowing if they purchased any of the recalled beef,” CU argued. The organization located the recent recall in a series of food safety failures that CU including bacterial contamination of chicken and the rise of beef contaminated with E Coli and suggested the incidents cumulatively suggested a “gaping hole in the food safety net.”

CSPI, an organization with a long history of fighting for the release such information from the USDA, argued that the USDA’s obscuring the names of retail establishments that received recalled beef “creates confusion by suggesting that recalled products do not reach consumers. In fact, the bulk

Protecting Industry at the Expense of Public Health and Safety

When the USDA published January 2004 regulations on   Bovine Spongiform Encephalopathy (BSE) following the first U.S. case in December of 2003, the agency claimed that all meat from downed cattle would be prohibited from entering the food supply. However, following publication of the regulations, the agency issued Notice 5-04 which instructed inspecting veterinarians to allow those downed cattle which appeared healthy and whose nonambulatory status was the result of an injury rather than illness. Food safety organizations, researchers and other experts on BSE immediately took issue with the loophole arguing that because illness may predispose livestock to injury, and because the exact cause of an animal’s nonambulatory state is difficult to ascertain, all downed animals should be prohibited from slaughter for food. In written comments to the USDA, former USDA senior staff veterinarian Linda Detwiler stated, “I urge the USDA to not alter this definition and to continue to prohibit for food any bovine which cannot walk to the ‘knock box’ [area of slaughter] regardless of reason.”

Following a period of public comment, an analysis by the Humane Society illustrated that although trade associations publicly supported the regulations following the 2003 BSE case, behind the scenes these organizations worked to weaken the ban to allow for slaughter those cattle which cannot walk from injury rather than illness.

Strategic Alliances, Flexible Coalitions

Beyond working together to publicize the HSUS findings and demand that consumers have access to a full list of Hallmark/Westland retail distributions, humane treatment and food safety organizations made other alliances in the Hallmark/Westland case.

Following the HSUS investigation, Food & Water Watch published information on their website about the longstanding problems with understaffing and unfilled meat inspector vacancies at the USDA. Food & Water Watch learned from the USDA’s Food Safety and Inspection Service (FSIS) that the vacancy rate for FDA inspectors at the Alameda district in California, where Hallmark is located, was 11.33% at the end of FY 2007 and that inspectors at the Hallmark site were instructed that they should not enter the pens because a FSIS veterinarian would conduct all of the human handling checks. In a letter to USDA Secretary Schafer of the USDA, Food and Water Executive Director Wenonah Hauter and Stan Painter, President of the National Joint Council of Food Inspection Locals argued: “In slaughter plants with inspector shortages or vacancies” plant employees know there is no chance that a government official will be able to visit the pens to do any checks, until the slaughter line is stopped. This would give company employees plenty of notice to halt behaviors that violate regulations, before any government official reaches the pens.”

Weeks after the video release, HSUS posted a series of comments and letters from religious leaders around the country responding to the Hallmark/Westland case. Comments posted by HSUS illustrate that religious leaders were concerned both by the inhumane treatment of downed cows and food safety. Religious leaders emphasized the interconnectedness of life and the inconsistency between cruelty to animals and core Judeo-Christian values. Some also pointed to the importance of eating a vegetarian diet and highlighted environmental concerns associated with factory farming. Others argued for greater corporate and regulatory accountability. Brother David Andrews, Coordinator for Justice and Peace Congregation of Holy Cross stated that food companies needed to “take notice, to review their practices and to ensure that the animals in their care are treated humanely. Citizens need to be demanding that the entire food and dairy system be reviewed with an examination of the guarantees that need to be in place to protect animals from treatment evidenced by this shocking example, more than lip service or verbal assurances are needed.”

These alliances between food safety, animal welfare, labor and religious leaders, facilitated in large part by the internet and “net roots” organizing, demonstrate the potential for broad-based coalitions that can challenge inhumane and health harming corporate practices and demand a stronger regulatory system.

Each of the participating organizations has framed issue in slightly different terms. HSUS and Food and Water Watch primarily focus on the inhumane treatment suffered by downed cows but also emphasize the food safety issues associated with processing such cattle for slaughter. Food and Water watch has worked to expose the food safety, animal welfare, environmental and economic effects of factory farming which leads to conditions such as downed cattle. CSPI and Consumers Union/Consumer Reports, while touching upon humane treatment issues, focus largely upon the rights of consumers to healthful food and a stronger food safety system. What these differing emphases share is a moral stance that contrasts with the meat industry’s position that the industry itself is best suited to regulate its own behavior, a perspective challenged by the video images.

By working collectively to demand a common bottom line such coalitions – even when temporary – can mobilize broader constituencies for change. At the same time, by framing the issue in slightly different terms, the organizations maintain an independent focus on different areas of expertise. Moreover, the groups have different tactical and strategic repertoires, such as HSUS’ undercover operations or CSPI’s use of lawsuits, enabling the coalition to operate on a variety of fronts.

Moving Forward

In addition to raising concerns about the failing of the nation’s food safety inspection system, a situation that puts the health of American public and especially children and other vulnerable groups at risk, the Hallmark/Westland case also revealed the productive capacity of coalition work between humane treatment/animal rights and food safety organizations to change health harming corporate practices. One reason why these alliances seem to work is that while the animal welfare organizations highlight their opposition to cruelty to animals, including the fate suffered by factory farmed animals, and discuss a vegetarian lifestyle, they take a more moderate position than animal rights organizations such as People for the Ethical Treatment of Animals (PETA).

While alliances may be difficult where there are differences along ideological lines, the Hallmark/Westland case illustrates the potential for broader coalitions that might have broader application for other issues. For example Food and Water Watch’s work touches upon environmental and labor issues pertaining to factory farming and that group’s letter to USDA Secretary Ed Schafer was coauthored by the President of the National Joint Council of Food Inspection Locals. Working closely with environmental and labor organizations could strengthen the demand for greater food safety regulations, reduce the environmental impact of farming, and improve working conditions and humane treatment of animals.

Following the Hallmark/Westland expose, two Hallmark employees were charged in California courts for the actions captured by HSUS. While such charges may deter some future violations, these two employees were likely operating under the direction of Hallmark, which seemingly had a vested interest in getting downed cattle to slaughter. Improving conditions for farm animals would require a reconfiguration of the factory farming system. For instance, the HSUS reports that improved bedding and surface area could cut the number of downed cattle by up to 90%. However, the best footing for cows (sand) is also much harder to move and to clean than concrete floors, which are currently used. Unfortunately industry seems unlikely to make changes that would be considered cost prohibitive but would result in healthier cattle and ultimately increased food safety. Under the current administration, the USDA seems unwilling to pass rules and regulations which would favor public health and safety when they conflict with industry positions. By including labor rights, food safety and animal welfare organizations in these emerging coalitions, advocates can help to refocus attention back on industry and away from the actions of a few employees who will be held up as exceptions to the rule. When such coalitions can successfully pose an alternative approach to assuring food safety and animal protection, they can begin to mobilize the political support needed to implement these alternatives.

Food and pharmaceutical industries win big in 2007 International Bad Products Awards

In Fall 2007, Consumers International—a federation of more than 220 consumer groups in 115 countries that work together to protect and empower consumers around the world—released its International Bad Products Awards for 2007. Nominations for the list were submitted by CI international member organizations and the winners were chosen by the CI Secretariat. Topping the list this year were products of the food and beverage industry and Big Pharma.

How to sell tap water and make a profit:

Coca-Cola was one of CI’s top winners and received the honor for their repackaging of tap water sold under the brand name Dasani. Dasani’s source is not obvious on the bottle itself or in Coca-Cola’s marketing. However, in the FAQ of the Dasani website, the company states Dasani is created with the local water supply, which is then filtered for purity using a state-of-the-art process called reverse osmosis. The purified water is then enhanced with a special blend of minerals for a pure, crisp, fresh taste. The website calls attention to the mouthwatering taste of flavored Dasani beverages and notes that Dasani Plus is enhanced with nutrients and delicious flavors giving you what your taste buds want and the goodness your body craves.

Coke introduced Dasani in 1999 as a purified, noncarbonated water with minerals added. In 2003, the company hired the New York ad firm Berlin Cameron/Red Cell, part of the Red Cell division of the WPP Group, to design a campaign for Dasani. The Berlin Cameron/Red Cell ads portrayed Dasani, at that time the #2 bottled water behind Pepsi’s Aquafina, as a beverage associated with youth and sexuality. The New York Times described the ads as: replete with quick editing cuts, fast-paced music and fast-moving plot. Then, too, there is all the sexiness, as embodied by multiple scenes of attractive young people dancing, running and embracing, interspersed with shots of water splashing into open mouths.

A year later, however, questions emerged about the health benefits of enhanced tap water. Only weeks after Dasani was launched in Great Britain, Coke was forced to recall more than 500,000 bottles after tests found excess levels of bromate. Bromate is a chemical produced in Dasani’s water purification process. A recent review concluded that based on an extensive database of relevant research, it is reasonable to assume that bromate induces tumors via oxidative damage that causes chromosomal breakage. British law permits 10 parts of bromate per billion; Dasani water was found to contain up to 25 parts per billion. Long term exposure to bromate is linked to a higher risk for cancer. Following the recall, Coca-Cola halted a scheduled April 2004 release in France and Germany.

Despite these recalls, Coca-Cola’s Dasani brand sales have continued to grow internationally and in the United States. In October 2007 Coca-Cola reported a 13% quarterly profits increase, largely due to international sales. Worldwide sales volume for noncarbonated beverages rose 14%, as compared to 4% for carbonated drinks. The difference in sales between carbonated and noncarbonated beverages may be due to the increasing evidence that consumption of soda is linked to obesity. In the US, this concern has resulted in more consumers choosing water and other purportedly healthful beverage options. Although Coca-Cola does not deny the source of their Dasani water, as CI points out, their advertising is misleading in that it uses terms such as pure, crisp and fresh. As CI stated in awarding its Bad Product listing, by bottling up this universal resource to sell back to us, corporations such as Coca-Cola have created a US$100 billion industry at the same time when one billion people in the world lack access to safe drinking water. Making profits out of increasingly fragile water supplies is unsustainable, irresponsible and against the basic rights of consumers everywhere.

Hey Kids! Develop amazing physical attributes with 40% sugar!

Another winner of the 2007 Bad Product Award was the Kellogg Company for its marketing of low nutrient junk food to children. According to CI, Kellogg’s achieved global net sales of $10.9 billion in 2006 and spent $916 million on advertising. Kellogg President-CEO David Mackay stated that of the total amount spent on advertising in the United States, 27% is directed to children under age 12. Increasing concern over food and beverage marketing to children has put pressure on Kellogg’s and other big food companies. In response to this pressure, including a 2006 lawsuit threatened by Center for Science and the Public Interest and the Campaign for Commercial-Free Childhood, Kellogg’s agreed to make changes.

During the second half of 2007 and 2008, Kellogg’s promised to stop advertising many of its most popular items to children under 12 if these products did not conform to new nutrition guidelines limiting sugar to no more than 12 grams and total calories to no more than 200 per serving. The company also promised to work on reducing salt and fat, limiting per serving amounts to no more than 230 milligrams of sodium, zero grams of trans fat and no more than 2 grams of saturated fat. Kellogg’s further agreed to limit licensed cartoon characters in its ads and to not advertise in schools.

Despite these promised changes, Kellogg’s still won a CI award for its low nutrient food marketing to children. One reason for this dubious honor is that while Kellogg’s is making changes in the U.S market, it seems to be business as usual around the world. CI reported that Kellogg’s marketed cereals containing between 33-40% sugar to children around the world. In addition, Kellogg’s continued to use cartoon characters and other imagery appealing to children to market their high sugar cereals. In Australia, CI reports, Kellogg’s used social networking techniques aimed at children to promote Coco Pops while in the UK, the same cereal was cross promoted with the film Shrek. The most egregious example, however, came from Mexico where Kellogg’s ads promised children that their high sugar cereals would help children develop amazing physical attributes, according to CI. Thanks to the advocacy efforts of El Poder del Consumidor, a CI member organization, the ads were pulled.

Back to school with sleeping pills.

Top honors in the CI Bad Products Awards went to the US subsidiary of Takeda Pharmaceuticals for marketing sleeping pills to children. Takeda, a US $10 billion company, is the largest pharmaceutical maker in Japan. It was their promotion of sleeping aid Rozerem that earned them the overall Bad Product Award with CI. Why? Because of Takeda’s September 2006 ten second ad featuring images of school bus and images of children wearing backpacks and writing on chalkboards with the voiceover, Rozerem would like to remind you that it’s back to school season. Ask your doctor today if Rozerem is right for you.

Beyond the generally distressing suggestion that children be prescribed sleeping aids, Takeda’s own product labeling states that It is not known what effect chronic or even chronic intermittent use of ROZEREM may have on the reproductive axis in developing humans…Safety and effectiveness of ROZEREM in pediatric patients have not been established. In addition, Rozerem is associated with increased thoughts of suicide in adults.

According to CI, it took the FDA six months to remove the ad, long after the ‘back to school’ promotion had gone. However, in March 2007, the agency sent Takeda Pharmaceuticals a letter stating: The combination of these statements and images of school-aged children and school-related objects suggests that Rozerem is indicated for and can be safely used in the pediatric population. The FDA also noted that the ads failed to present the indication and information relating to major side effects and must make adequate provision for dissemination of the FDA-approved labeling.

Despite these violations, the FDA did not fine Takeda, which in 2006 spent $118 million on advertising Rozerem alone. During the same year, Big Pharma spent $600 million on advertising sleeping products. Sales of sleeping aids continued to rise, increasing 60% between 2000 and 2005. In addition, in the adult population, the FDA has raised concerns that sleeping aids are associated with strange side effects such as sleeping walking, hallucinations, violent outburst, nocturnal driving and engaging in sexual intercourse during sleep.

In the past, pharmaceutical companies have sought to increase their market through direct-to-consumer marketing and advertising to physicians. However, just as Big Tobacco learned the value of enticing young people to smoke or to associate tobacco brands with good feelings, it seems that Big Pharma is now increasingly and directly going after a youth market as well. As early as 2000, the New York Times described campaigns by Roche Pharmaceuticals and others to promote prescription acne medications directly to teens. One pharmaceutical industry consultant told the Times, The idea is to expand the market and just get them interested and motivated. And teenagers aren’t the easiest patients to motivate. The ad showed a boy with acne being called Pizza Face by his peers.

In recognition of this alarming trend, CI noted in its award to Takeda, This case demonstrates the lengths to which some drug companies will go to increase sales of their products, how direct to consumer advertising can promote irrational drug use, and how weak regulation can foster irresponsible corporate behaviour.

To Save Lives, Limit Salt In Processed Food

Imagine a mysterious but pervasive substance that contributed to tens of millions of deaths around the world. Imagine that simple new public rules limiting human exposure to this substance could prevent almost nine million deaths in the developing world in the next ten years. Wouldn’t you expect that governments around the word would implement such rules? Well, these facts describe the current scientific situation on salt. [1]

To answer the question requires a closer examination of the ongoing clashes on salt policy. On one side are health, scientific and advocacy bodies such as the American Medical Association, [2-3] the National Academy of Sciences, [4] the World Health Organization, [1,5] Consensus Action on Salt and Health, [6] and Center for Science in the Public Interest, [7-10] all arguing for global and national regulations to lower salt content in processed food. On the other side are groups such as the European Union Salt Producers Association and The Salt Institute, a U.S.-based salt industry trade association, who claim in scientific, policy and legal settings that excess salt intake is not harmful to human health. [11-13]

Late last year, the US Food and Drug Administration held a public hearing on this issue with a request for public comments. [10] (The transcript of this hearing will soon be available at If the FDA decides to reclassify salt (also known as sodium chloride) as a food “additive,” then it can place limits on the amount of sodium contained in prepared foods and foods served in restaurants.

In this report, Corporations and Health Watch reviews the evidence on the adverse health consequences of excess dietary salt, describes some of the policy proposals to reduce salt intake and the extent to which various jurisdictions have implemented such policies, and analyzes the political strategies that the salt industry has used to oppose or delay new limits on dietary salt.

The adverse health consequences of excess dietary salt consumption

How much salt does the average adult in the United States consume a day? Although many people consider only the amount of salt that they add to their food while cooking or at the dinner table, approximately 75% of the sodium we consume is already in the food we buy. The National Academy of Sciences recommends that adults consume no more than 2,300 milligrams of sodium daily, roughly one teaspoon of salt. The recommended maximum intake for people at risk of high blood pressure, such as adults over age 50, is 1,500 milligrams of sodium per day.

The average U.S. adult consumes about 4,000 milligrams of sodium per day—as noted above, about 75% of this intake comes from sodium added by food manufacturers and restaurants. Canned and processed foods often contain 1,000 milligrams or more per 8 ounce serving, and typical meals served in restaurants contain between 2,300 and 4,600 milligrams of sodium. [14] In addition, sodium is present in foods such as bread, diced tomatoes, and cereals,8 important sources of sodium intake often overlooked by consumers. Jeremiah Stamler, M.D., professor emeritus of Preventive Medicine, Northwestern University Medical School in Chicago, observed, “If we reduce our salt intake [at the table] that won’t solve the problem. There’s salt in bread, processed meat, cheese, canned vegetables—these are all hidden sources of salt.” [15]

Although experts debate the precise threshold for maximum daily salt intake, there is little controversy that excess salt intake is a major contributor to high blood pressure, a major risk factor for stroke, heart failure, heart attack, and kidney and vision problems. [16-18] In the United States alone, it is estimated that nearly 30% of all adults are affected by hypertension, with another third of adults affected by pre-hypertension. [17] One important way to control hypertension is to lower salt intake.

Policy proposals to reduce dietary salt intake

Many scientific and professional organizations have come to the consensus that the public would benefit from a reduction in the sodium in products sold by the food and restaurant industries. For example, in November 2002, the American Public Health Association called for a 50% reduction in the nation’s food supply over the next 10 years. [14] In June 2006, the American Medical Association also advocated lower levels of salt in processed food, observing “[i] n the continued absence of voluntary measures adopted by the food industry, new regulations will be required to achieve lower sodium concentrations in processed and prepared foods.”

Similar positions have been reached by the National Institutes of Health, National Academy of Sciences, U.S. Department of Agriculture, U.S. Department of Health and Human Services, and at least 40 other professional organizations in the U.S. [3] The American Medical Association states that “substantial public health benefits accrue from small reductions in the population blood pressure distribution.” The AMA noted that a 1.3 grams per day lower lifetime sodium intake is estimated to save 150,000 lives annually as individuals advance form age 25 to 55. [17]

Policy recommendations include: (1) broad public and consumer education on salt, new food labeling systems, e.g. the use of red, yellow and green traffic light symbols to show levels of salt in a product, (2) a requirement that some foods must be labeled as high sodium, or (3) regulations that would limit the amount of sodium in processed and some restaurant food.

What has been the national and international response to excess dietary salt consumption?

In the United States, the Center for Science in the Public Interest has petitioned since 1978 for measures to regulate sodium. In 1994, in a partial victory, the US Food and Drug Administration required that food manufacturers disclose to consumers sodium the amount of sodium and its percent of Daily Value. [9] The FDA also established guidelines for using sodium- and salt-related food claims such as “sodium free,” “low sodium,” “reduced sodium,” “salt free,” and “unsalted.” Back in 1982, the FDA had recommended that food manufacturers voluntarily reduce the amount of added salt in processed foods. However, despite these measures, it is estimated that salt intake has actually increased by in the United States by 55% from the early 1970s to 2000, [17,19] during which time the age-adjusted prevalence of high blood pressure increased substantially. [17]

Efforts are underway in several countries to reduce the amount of sodium consumed. For example, in the UK, The Food Commission has launched a campaign for safer, healthier food called the Healthy Hexagon, Eat less salt project. [20] This project aims to provide healthy eating education to more than 3,000 residents of the Hexagon Housing Association in south east London. Also, in the UK, the Sainsbury’s supermarket chain has voluntarily reduced the sodium content of its store brand products without protest by consumers. [14]

The government in the UK has divided foods into approximately 70 categories and has set target sodium reductions for each of these categories. The government hopes that sodium consumption in the UK will decrease by 33% in 5 years with these measures. The UK is also encouraging a “traffic light labeling system” for use by the food industry—with high sodium products being labeled with a red light, medium sodium products a yellow light, and low sodium products a green light.

The governments of Ireland, New Zealand, Australia and France have set similar standards to reduce the sodium intake in their populations. Finland’s government, which has focused on reducing sodium since the 1970s, has achieved a 30% reduction in average sodium consumption, from approximately 4,700 milligrams daily to approximately 3,300 milligrams daily. Researchers credit these efforts with decreasing deaths among 30 to 59-year-old men and women by 60%. [14, 21]

Strategies used by salt industry groups to oppose or delay new limits on dietary salt

The current FDA salt review was sparked by a petition filed in November 2005 by the Center for Science in the Public Interest (Docket No. 2005P-0450). [9,10] The petition seeks to have the GRAS (Generally Regarded as Safe) status of salt modified so that salt may be regulated. CSPI argues that voluntary measures over the past two and a half decades have not lowered the sodium content of foods and that more aggressive regulatory action is needed.

Under current law, sodium would need to be reclassified as an “additive” in order for it to be legally regulated. The CSPI petition further calls for food labeling requirements and ceilings on the amount of sodium in processed foods, among other measures.

Several salt industry groups, notably the European Union Salt Producers’ Association and The Salt Institute (a U.S.-based salt industry trade association) have argued against the scientific evidence and claimed that excess salt intake is not harmful to human health. [11, 12] In a clear conflict of interest, these salt industry groups have paid for medical and scientific opinions from “experts,” and they have used their popular websites to misinform the public. People without medical backgrounds may view their statements on salt and hypertension and make decisions that are contrary to medical advice. For example, the European Union Salt Producers’ Association, which represents salt producers in the EU who currently produce 45 million tons of salt per year, has issued several position papers on salt and health. In their position paper Salt and blood pressure: Controversial and misunderstood they state that “alarmist media reports and general recommendations to reduce salt intake” have the potential to cause harm. And The Salt Institute, which represents the interests of all major U.S. salt producers who produce approximately 46 million tons of salt per year, has similar statements on salt and health on its consumer website, including recommendations to adhere to a salty, Mediterranean diet.

In the December 2007 newsletter published by The Salt Institute, the authors comment on the proposed FDA regulations, likening them to the actions of Joseph Stalin, Adolf Hitler, Orwell’s “Big Brother,” and The Spanish Inquisition.[13] In this newsletter, they denounce “pathological science,” quoting John Horgan who said: “Pathological science kills people and ruins lives. Such fake science is still peddled by the PC establishment in Europe and America.” The proposed federal regulations, which would impose labeling requirements and limit the amount of sodium in processed foods, would not interfere with the ability of consumers to purchase salt and use it as they wish. The proposed regulations would simply protect U.S. adults from processed foods that increasingly contain excessive amounts of sodium. By reducing hypertension, the new rules would also reduce the burden of chronic disease in the United States. [1, 17]

In May 2007, the European Salt Producers’ Association held a conference that promoted their scientifically questionable views on salt. David McCarron, a hypertension specialist, spoke at the European Union Salt Producers’ conference. He is the same person hired by The Salt Institute to request immediate access to the complete data from the DASH study. [22] The DASH study, published in the New England Journal of Medicine in January 2001, demonstrated that reducing dietary salt could lower blood pressure, even in people without hypertension. [23] The Salt Institute filed a petition under the Data Quality Act, claiming that the researchers must turn over their data so that a “qualified member of the public” can reconduct the analysis. [21] A district court dismissed The Salt Institute’s petition, and when The Salt Institute appealed to the U.S. Court of Appeals for the 4th Circuit the petition was again dismissed. [22,24]

In the case of salt, industry opposition has prevented governments from instituting simple policies that could, over the years, prevent millions of premature deaths. In the coming weeks, the FDA has an opportunity to change the ending of this familiar story.



1. Asaria P, Chisholm D, Mathers C, Ezzati M, Beaglehole R. Chronic disease prevention: health effects and financial costs of strategies to reduce salt intake and control tobacco use. Lancet. 2007; 15;370(9604):2044-53.

2. American Medical Association. “AMA calls for measures to reduce sodium intake in U.S. diet: urges FDA to revoke ‘generally regarded as safe’ status.” June 13, 2006. Accessed December 22, 2007 at

3. CRohack, JJ. Letter from AMA to Boston Globe: Cutting sodium beneficial to Americans’ health. July 3, 2006 (published).

4. Institute of Medicine, Food and Nutrition Board. Accessed January 9, 2008 at

5. World Health Organization, Global Strategy on Diet, Physical Activity and Health. Cardiovascular Disease: Prevention and Control. Accessed January 9, 2008 at

6. Consensus Action on Salt and Health. Accessed January 9, 2008 at

7. Center for Science in the Public Interest. Salt: the forgotten killer. . . and the FDA’s failure to protect the public’s health. Accessed December 22, 2007 at

8. Salt Assault: Brand-Name Comparisons of Processed Foods. Washington, DC: Center for Science in the Public Interest.

9. Center for Science in the Public Interest. Petition to Revoke the GRAS Status of Salt, to Set Ceilings on the Amount of Sodium in Processed Foods, to Require a Health Warning on Packaged Salt, and to Reduce the Daily Value for Sodium (Docket no. 2005P-0450, U.S. Department of Health and Human Services Food and Drug Administration). Submitted November 8, 2005 by Michael F. Jacobson, Ph.D.

10. U.S. Food and Drug Administration (FDA). October 19, 2007 Notice of Public Hearing: Salt and Sodium. Petition to Revise the Regulatory Status and Establish Food Labeling Requirements Regarding Salt and Sodium. Docket No. 2005P-0450. Accessed December 22, 2007 at

11. EU Salt, European Salt Producer’s Association. Accessed December 22, 2007 at

12. The Salt Institute. Accessed December 22, 2007 at

13. The Salt Institute. December 2007 Newsletter. Accessed December 22, 2007 at

14. Havas SH, Roccella EJ, Lenfant C. Reducing the public health burden from elevated blood pressure levels in the United States by lowering intake of dietary sodium. Am J Public Health. 2004; 94(1):19-22.

15. Greeley A. A pinch of controversy shakes up dietary salt. FDA Consumer Magazine, November-December 1997.

16. Food and Nutrition Board. Dietary Reference Intakes for Water, Potassium, Sodium Chloride, and Sulfate. Institute of Medicine, 2004.

17. Dickinson BD, Havas S, for the Council on Science and Public Health. Reducing the population burden of cardiovascular disease by reducing sodium intake. Archives of Internal Medicine. 2007; 167(14):1460-1468.

18. Cappuccio FP. Salt and cardiovascular disease: Reducing sodium intake improves cardiovascular outcomes but few countries have effective policies. BMJ. 2007; 334: 859-860.

19. Briefel RR, Johnson CL. Secular trends in dietary intake in the United States. Annu Rev Nutr. 2004; 24: 401-431.

20. The Food Commission, Healthy Hexagon Eat Less Salt Project. Accessed December 22, 2007 at

21. Krappanen H, Mervaala E. Adherence to and population impact on non-pharmacological and pharmacological anti-hypertensive therapy. J Hum Hypertens. 1996;10(Supp 1): S57-S61.

22. Kaiser J. Data access. Industry groups petition for data on salt and hypertension. Science. 2003 May 30;300(5624):1350.

23. Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, Obarzanek E, Conlin PR, Miller ER, Simons-Morton DG, Karanja N, Lin PH; DASH-Sodium Collaborative Research Group. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. NEJM. 2001; 344: 3-10.

24. Raeburn P. A regulation on regulations. Sci Am. 2006 Jul;295(1):18, 20.


Photo Credit:

Salt Shaker, Supa mb

As the US moves to limit consumption of sweetened beverages, producers focus on overseas markets and alternative product sales

Following recent efforts to address obesity by banning transfats and proposing a moratorium on the opening of new fast food restaurants, in late December of 2007 San Francisco Mayor Gavin Newsom proposed a tax on soda. The sweetened beverage fee would be applied to big box retailers who sell sweetened soda and other beverages; “Mom and Pop” stores would be exempt.

Newsom proposed the measure, which will be voted on by the Board of Supervisors early this year, as a means by which to address rising obesity rates and the attendant rising health care costs. Though the surcharge on sweetened beverages has yet to be defined, proceeds from the tax will support Newsom’s “Shape Up SF,” a program designed to encourage San Francisco residents to exercise.

Though the Mayor’s office argued that there was a well developed linkbetween obesity and the consumption of high-fructose corn syrup—a corn-based sweetener preferred over table sugar by the beverage industry because of its lower cost in production. Most researchers agree that carbonated sweetened beverages have played an important role in rising rates of obesity in the United States and elsewhere. Malik et al (2006) found evidence for this relationship in their meta-analysis of 30 publications. They state: “The weight of epidemiologic and experimental evidence indicates that a greater consumption of SSBs [sugar sweetened beverages] is associated with weight gain and obesity. Although more research is needed, sufficient evidence exists for public health strategies to discourage consumption of sugary drinks as part of a healthy lifestyle.”

Despite this emerging scientific consensus, the American Beverage Association (ABA), the trade association for the non-alcoholic beverage industry, argued that taxing soda would be ineffective given the complexity and multifaceted nature of obesity. An ABA press release stated: “It makes no sense to single out one food or beverage product to address an issue created by a lack of balance between calories consumed and calories burned. It would be just as silly to tax all the high-tech companies in San Francisco and blame them for contributing to childhood obesity through their video games, computer games and Internet search engines…This idea for taxing retailers sounds more like a thinly veiled attempt to raise revenues for more city spending than a sincere effort to reduce childhood obesity.” Others criticized the Mayor of behaving in a “Nanny State” manner, a charge that has been applied to other advocates of taxes on obesic foods and beverages.

In response to proposals such as Newsom’s, the beverage industry continues to fall back on the food industry’s stock line that obesity is caused by an imbalance of calories in and out and that all foods and beverages can have a place in a well-balanced diet accompanied by an active lifestyle. Yet according to an unreleased draft report by the San Francisco Department of Public Health, sweetened beverage consumption is the leading source of added sugar in children’s diets accounting for more than 10% of the total daily caloric intake for an average child. In addition, the consumption of sweetened beverages is more strongly associated with pediatric obesity than is high fat content or decreased physical activity.

While the industry publicly rejects any particular association between sweetened beverages and obesity, it is clear that beverage makers are concerned. In the spring of 2007, Coca Cola Company Chief Creative Officer Esther Lee described obesity as an “Achilles heel” and something that works against beverage makers’ marketing strategies. Although Americans spent$105 billion on “refreshment beverages” in 2007, US sales of soda are decreasing. During 2005, the number of cases of soda sold in the US declined by .07 percent. In April of 2007, Coca Cola first quarter profits report indicated that unit case volume had declined by 3 percent.

In response to declining sales and changing markets, Big Soda is shifting its marketing and distribution practices in two ways. First, the industry is promoting the sale of alternative beverages such as “enhanced” waters, juices and energy drinks. Sales of these products more than tripled in one year, from $80 million in 2001 to $245 million in 2002 and have continued to grow since. Odwalla juices and Glaceau Vitamin Water, (owned by Coca-Cola), SoBe’s Synergy Drinks, (owned by PepsiCo) and Snapple Juices (owned by Cadbury Schweppes) have become increasingly popular as Americans seek to substitute what they perceive as more healthful drinks for soda. However, critics such as Dump Soda, a global campaign whose goals include reducing soda consumption and eliminating the marketing of sweetened beverages to youth under 16, have illustrated that these “alternative” beverages are often just as sugar and calorie-laden as the soft drinks they seek to replace.

Second, as beverage makers promote “healthful” products in the US, they have refocused the marketing and sale of their traditional, sweetened soft drinks on the global south to maintain sales. According to Dump Soda, Coca-Cola has tremendously increased spending on non-US media, rising to $1,176 billion in 2000 from $500 million in 1994. Sales of Coke and Pepsi have also risen dramatically. In 2005, sales of Coca-Cola increased eleven percent in North Asia, Eurasia and the Middle East, case volume grew by seven percent in Latin America, and by four percent in Africa. In 2006, Pepsi’s international volume growth was up 9%.

With increasing sales comes increasing consumption, raising concerns about the spread of Western-style diet and disease in the global south. By linking local efforts such as those of San Francisco Mayor Newsom to tax high sugar beverages to global campaigns such as Dump Soda, public health advocates can ensure that a move toward a healthier US does not come at the expense of the global south.

Campaign Profile: The Public Health Advocacy Institute

Are the lessons learned in the legal and advocacy fights against Big Tobacco relevant to changing the practices of the food industry that contribute to obesity? What are the benefits and limitations of litigation against producers of unhealthy foods? On what legal grounds is the food industry most vulnerable to challenge? These are the questions that staff of the Public Health Advocacy Institute (PHAI), a legal “think-and-do” tank, seek to answer.

Forged in the legal battles against Big Tobacco, PHAI was originally founded in 1979 as a Massachusetts-based public health organization which became the Tobacco Control Resource Center (TCRC) and its legal research arm the Tobacco Products Liability Project (TPLP). In 2006, the TCRC and TPLP joined forces with the Boston-based Tufts/Northeastern University Obesity and Law Project, a public health law and research organization, to form PHAI.

In its current work, PHAI seeks to use legal strategies to achieve specific public health goals. Northeastern University’s School of Law serves as a home and resource for PHAI as it seeks to nurture a new generation of professionals. Lawyers, public health advocates, policy analysts and physicians are invited to take on the food industry’s role in obesity, collaborate at annual conferences, and stay updated with the tools necessary to continue the global fight for tobacco control.

First, the group seeks to expand the repertoire of legal arguments that public health lawyers can use to challenge corporate behavior that harms health. For example, PHAI lawyers are considering ways to use laws against deceptive advertising as grounds for legal action in much the same way product liability was used in tobacco litigation cases. In the case of tobacco, large punitive damages awards were intended to deter tobacco companies from further actions that harmed health.

Second, PHAI takes the campaign to reduce obesity into new settings such as public schools and after-school settings. Research produced by their School Food Project served as a catalyst for advocating to remove high sugar sodas from public schools.

Third, PHAI attorneys remain deeply committed to global tobacco control and work to expose the illegal activities of Big Tobacco by researching internal industry documents and producing scholarly publications and amicus briefs. The group’s newest work is expanding to the global arena as members engage the World Health Organization Framework Convention on Tobacco Control (WHOFCTC) to work to connect tobacco control and human rights with health policy decision-making processes.

New Tactics and the Next Generation of Public Health Law

Each year, PHAI hosts an international conference, Legal Approaches to the Obesity Epidemic, where an interdisciplinary gathering of advocates consider new strategies to change food and beverage industry’s influence on the health of the public. Each conference chooses a theme to highlight emerging issues. For example, during the 2005 conference, speakers emphasized the need for public health efforts to target advertising campaigns that contribute to childhood obesity and related illnesses.

Marking a shift away from personal injury litigation strategies used during the ‘tobacco wars’ [1], the shift to targeting advertising incited harsh reactions from industry groups. Groups like Consumer Freedom, a food and restaurant industry lobbying group, criticized the PHAI conferences, calling them a “cabal of activists” who “use junk-science in an attempt to erode consumer freedom and turn food companies into their newest cash cow” [2]. Despite these attacks, PHAI continues to support groups such as the Physician Committee for Responsible Medicine, which have successfully used lawsuits to change Kraft’s false advertising practices [3].

While PHAI sees tobacco litigation as one strategy for making corporations more responsible, the group’s recent work emphasizes broader, population and environment-based interventions to reduce obesity—namely, policy, regulation and legislation. In a 2002 article in the Journal of the American Medical Association, PHAI President Richard Daynard acknowledged litigation as a tool to control obesity and points to the key differences between tobacco and food. “In the absence of proof that particular food industry practices cause obesity, suits seeking compensation for obesity-related injury are unlikely to succeed, while suits seeking to protect consumers from unfair or deceptive food marketing techniques are more likely to succeed” [4]. In a 2004 interview with Medscape, Daynard argued that consumer responsibility and personal responsibility “would be much more credible if the consumer was actually being told how fattening the food was and [had] a chance to say, no, I think I won’t take that order; I’ll order something else” [5]. Legal work to combat unhealthy food consumption seeks to increase product labeling and hold companies responsible for quality regulations and monitoring the actual caloric content of food marketed as “low in fat” or “high in fiber.”

Negotiating with the Food Industry

In an effort to better understand how food industry practices contribute to childhood obesity, PHAI spearheads new research design and policy recommendations. Their work has contributed to large-scale changes, such as the 2006 negotiation arranged by former President Bill Clinton, Governor Mike Huckabee, and the American Heart Association that promises to remove many sweetened beverages including Coke and Pepsi products from schools by 2009 [6]. PHAI member and Tufts Professor of Public Health and Family Medicine Aviva Must says she “would prefer these machines carry just water and low-fat dairy products, but I think this is a good start.”

To inform these campaigns, in 2006 PHAI released a report, Raw Deal: A Report on School Beverage Contracts. In a collaborative project with the Center for Science in the Public Interest (CSPI), the group conducted a national survey of school beverage contracts evaluating whether the alleged financial benefits were realized by schools. The exclusive contracts between beverage companies and schools place soft drink vending machines in accessible locations throughout elementary, middle and high school settings, and provide schools with income in exchange for exclusive “pouring rights.” However, the study found that the majority of the revenue from the contracts, was going not to the schools, but to the beverage companies. “The study highlights the need for legal tools to assist school districts in negotiating relationships that put the health and welfare of children first” [7] says Jason Smith, Associate Executive Director and head of PHAI’s Healthy Eating Law and Policy Project.

PHAI’s Healthy Eating Law and Policy Research Project also investigated how the law affects the foods available in public schools. Research from this project led to a policy guide to assist schools to develop healthier food policies. The report, Mapping School Food, highlights the need for policy makers to create school food programs informed by public health prevention strategies, and presents practical suggestions on how to quickly achieve change. Funded by a grant from the Robert Wood Johnson Foundation, the Healthy Eating Law and Policy Research Project is also expanding its research to consider food availability in after-school activity programs [8].

Acting Locally and Globally on Tobacco

To continue its effort on tobacco, PHAI’s team of lawyers and public health advocates are arming tobacco control professionals with data from newly available internal industry documents released under the provisions of the 1998 Master Settlement Agreement.

In their analyses of the formerly secret tobacco documents, PHAI Senior Staff Attorney, Sara Guardino and President Richard Daynard uncovered some of the ways that tobacco lawyers used the law to keep information about the harm of smoking from reaching the public. In their recent publication, Tobacco industry lawyers as “disease vectors,” they present evidence showing industry lawyers had “taken steps to manufacture attorney-client privilege” including assisting in the concealment of documents and the use of aggressive litigation techniques. PHAI lawyers and researchers have helped to expose illegal techniques employed by industry lawyers, including ‘scorched earth’ strategies—wherein plaintiffs’ efforts to bring tobacco companies to trial are thwarted by superfluous litigation.

PHAI’s discoveries from internal tobacco document inquiries and its history with tobacco litigation inform tobacco control policy recommendations both nationally and globally. The Tobacco Control Resource Center at PHAI provides legal and policy information to local, state and national decision-makers, files amicus briefs, and helps to build global information networks among tobacco control advocates around the world.

PHAI recently joined efforts to advance the Framework Convention for Tobacco Control, the first international public health treaty for the control of tobacco products. In Viet Nam, for example, a nation that has signed the FCTC, PHAI is helping to link tobacco control advocates with human rights organizations. In their Fall 2007 newsletter, PHAI says this approach is critical to creating change; “Linking the broader range of women’s, children, and social, economic and cultural rights with the WHO FCTC helps to highlight the ways in which these rights are inextricably interlinked, interrelated and indivisible” [9].

The Institute is now also working with health departments, NGOs, and tobacco control organizations in several nations to develop long-term strategies to reduce the influence of tobacco companies on the health of the public. By carving out legal grounds on which to challenge tobacco and food industry’s health damaging practices, PHAI helps set the stage for a unified effort toward public health solutions. Whether countering Big Tobacco’s tactics of obfuscation, assisting public school food policy development, or facilitating global tobacco control dialogue, PHAI is creating an organized public health legal approach to counter corporate influences on well-being and setting precedents for a global movement for health.



1. Daynard RA, Hash LE, Robbins A. Food Litigation: Lessons from the tobacco wars. JAMA. 2002;288(17):2179.

2. Cabal Of Activists And Lawyers Plot To Sue Food Companies. Consumer Freedom. June 19, 2003. Available at:

3. Thorn B. Conference: obesity lawsuits should focus on ads, children. Nation’s Restaurant News. Oct 17, 2005.

4. Daynard RA, Hash LE, Robbins A. Food Litigation: Lessons from the tobacco wars. JAMA. 2002;288(17):2179.

5. Barclay L. Legal Approaches to Obesity: A newsmaker interview with Richard Daynard, JD, PhD.

6. Mohl B. After Soda Ban, Nutritionists Say More Can Be Done. The Boston Globe. May 4, 2006;A1.

7. School Beverage Contracts Leaving Districts With a Bad Aftertaste: The Public Health Advocacy Institute Releases First National Study of School Beverage Contracts. Press Release. Public Health Advocacy Institute. Dec. 6, 2006.

8. PHAI Fall 2007 Newsletter.

9. PHAI newsletter fall 2007 p. 7


Photo Credits:

1. Vending Machine by warpr
2. Urban Convenience Store by coyenator