New York State’s Tax on Sugar-Sweetened Beverages Goes Down the Drain: Lessons for Nutrition Advocates

The soda tax came and went this year in New York. Here, CHW examines the campaign to pass a sugar-sweetened beverage tax, the likely factors that led to its failure, and also offers important lessons for future efforts.

On December 15, 2008, media sources revealed elements of New York State Governor Paterson’s proposal for the 2009-2010 state budget. Among the many new fees and fines that the Governor proposed in order to close the estimated $15 billion deficit was an 18% sales tax on sugar-sweetened beverages. With the new fiscal year less than four months away, the announcement of this tax spurred advocates and opponents to quickly mobilize constituents, engage the media, and lobby state legislators. Less than three months later, on March 11, 2009, state legislative leaders announced that the sugar-sweetened beverage tax would not be included in the final budget. This report examines the campaign to pass a New York State sugar-sweetened beverage tax and the likely factors that led to its failure. This analysis also offers several important lessons for future efforts in public health advocacy designed to make unhealthy food less available.

A Dual Crisis in New York State

At the end of 2008, two major problems were occurring in New York State. The first was a growing obesity epidemic. In the past decade, adult obesity in New York State has nearly doubled, and currently about two-thirds are overweight or obese.1 The weights of children and adolescents have also increased during this time; the most recent data show that one-third of New York State Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants and more than one-quarter of state high school students are overweight or obese.2,3 Black, Latino, and low-income New Yorkers experience disproportionately high rates of obesity, diabetes, and other diet-related diseases, increasing the already large health inequalities among these groups. In all, obesity-related illnesses are estimated to cost the state more than $6 billion annually.4

With this steady rise in obesity, per capita consumption of sugar-sweetened beverages has also increased during this time. Although we cannot say definitively that drinking soft drinks and other “liquid candy” causes obesity, studies consistently show that the more soda we drink, the more calories we consume and the higher our body mass index (BMI),5 a measure of obesity. With such a growing and significant contributor of calories for many Americans, nutritionists and public health professionals have stressed the importance of reducing sugar-sweetened beverage consumption to prevent and decrease obesity and other diet-related health conditions.

By the end of 2008, New York State was facing a second problem—a large and rapidly growing state budget deficit. In the midst of a global economic crisis, New York was experiencing a triple loss: declining personal income tax revenue from lost jobs and bonuses, decreasing corporate income tax revenue from disappearing business profits, and waning sales tax revenue as shoppers limited their spending. Estimated at $6.4 billion in July 2008, the budget deficit more than doubled to $15 billion by the end of the year.6,7 As a result, the state needed to rein in spending and find revenue alternatives through new fees, fines, and taxes.

In order to tackle these two issues simultaneously, Governor Patterson introduced what was quickly nicknamed by the media as the ‘obesity tax.’ The two goals of the proposed 18% sales tax on sugar-sweetened beverages were to raise an estimated $404 million in the first year, while at the same time creating a cost differential that was expected to convince shoppers to instead buy the cheaper low, or no-calorie alternatives, thus helping to curb weight gain and obesity.

The Campaign to Pass a New York State Tax on Sugar-Sweetened Beverages

During the three months after the tax was announced, state and local children’s advocacy groups and public health organizations—particularly the American Academy of Pediatrics, Citizens’ Committee for Children, New York Academy of Medicine, New York City Department of Health and Mental Hygiene, New York State Department of Health, New York State Healthy Eating and Physical Activity Alliance, New York State Public Health Association, and the Public Health Association of New York City—targeted state legislators by employing the following strategies:

  1. Media advocacy
      via press releases, letters to the editor, and op-eds

    Constituent mobilization

      through the use of e-mail action alerts, in-person and online education, and a memo of support

    Direct lobbying

      by providing testimony at budget hearings, mailing information packets, and visiting key legislators

However, the campaign faced multiple barriers, including a politically weak and wavering Governor and a growing economic crisis that did not provide a receptive public climate for tax increases. In addition, the campaign had a strong and united group of opponents who were also targeting state legislators. A coalition called New Yorkers Against Unfair Taxes emerged, including more than 80 national, state, and local business and citizen groups, most notably the Business Council of New York State; National Restaurant Association; New York State Restaurant Association; Grocery Manufacturers Association; Bodega Association of the United States; Coca-Cola Bottling Company of Buffalo, Inc.; and Pepsi Cola Bottling Newburgh; among many others.

Although not part of this coalition, another vocal opponent was the American Beverage Association, the trade association representing companies that manufacture and distribute non-alcoholic beverages in the United States—the very products that would be taxed under the Governor’s proposal. Between 2006-2008, these groups collectively spent more than $4 million to gain political influence in New York State via campaign contributions and lobbying.8

Despite the campaign’s use of multiple strategies, Governor Patterson—in agreement with legislative leaders after several days of closed-door meetings—announced on March 11, 2009 that the sugar-sweetened beverage tax would not be included in the final budget. Advocates attribute the failed policy to two key factors. The first was the Governor’s public statement of doubt at a town hall meeting. The New York Times quoted him as saying, “The tax on soda was really a public policy argument. In other words, it’s not something that we necessarily thought we would get. But we just wanted the population to know some issues about childhood obesity.”9 Once this hit the newsstands and airways, advocates felt that the sugar-sweetened beverage tax was dead. Secondly, campaign members believe that the tax was doomed from the start because of how it was introduced by the Governor’s office. Several advocates noted that rather than singling out the sugar-sweetened beverage tax and focusing on its public health benefits, it was instead lumped in with a list of other fees referred to by opponents, the media, and even some legislative leaders as regressive or nuisance taxes.

Even though the campaign was not successful in achieving the tax increase on sugar-sweetened beverages, advocates believe that they were effective in constituent mobilization. Still, more could have been done to engage those outside of the public health and child advocacy groups. Comparatively, New Yorkers Against Unfair Taxes created a website, blog, cell phone texting service, online petition, and Facebook profile that together spread their opposing message to thousands of people. Advocates made no equivalent use of new media technologies or social networking strategies. Most legislators heard more from opponents than supporters.

One organization, Citizens Committee for Children (CCC), a multi-issue child advocacy group, initially proposed an excise tax on sugar-sweetened beverages rather than a sales tax. They made the case that an excise tax would be levied on bottlers and distributors rather than consumers and would result in a higher price for large volumes, thus serving as a more effective deterrent for high consumption. The excise tax would also have generated significantly more revenues for the state and CCC proposed that a portion of these revenues be dedicated to nutrition education or obesity prevention. Statewide polling data showed support for this approach.10 The Governor rejected the idea of an excise tax, in part because it would take additional months to establish a system for collecting the revenues, whereas sales tax revenues could be collected immediately. When the Governor’s office rejected this approach, CCC backed the sales tax proposal but some advocates continued to believe that the excise tax strategy was a more effective public health and economic approach.

Finally, many nutrition advocates had mixed feelings about the sugar-sweetened beverage tax. Supporters acknowledged that it would financially burden the poor most, although they argued it would also benefit them most by helping to reduce disparities in obesity rates. Opponents of the soda tax claimed that making healthy food more available in poor communities was a moral and public health imperative. Some supporters replied that in the absence of reducing the availability of unhealthy food, it would be difficult to lower obesity rates. One compromise proposed by advocates is to use revenues from a sugar-sweetened beverage tax to subsidize the purchase of healthy foods, thus counteracting any regressive effects the tax might have.11

Lessons for Round Two

Even if public health campaigns are not able to fulfill their main policy goals, they can still successfully mobilize constituencies and contribute to public debate. One of the key lessons for advocates is the need for a strong policy introduction and legislative champion. In this case, the tax may have been more successful if it was introduced on its own, rather than with other unpopular fees and fines, though this may not be true for all policy proposals. Additionally, policies need to be framed with messages that invoke values such as social justice, rather than getting bogged down with the details. By using value-based messages from the very beginning, advocates may be more likely to create and maintain a supportive policy framework and overcome statements made by opponents and the media. And as indicated by several advocates, the sugar-sweetened beverage tax was effectively viewed as dead after the Governor publicly stated that he didn’t think it would be approved. With a stronger legislative champion willing to stand by the tax until the end, the outcome may have been different.

This campaign also illustrates the importance of context in affecting outcomes. Advocates must understand the historical, social, and political environments in order to identify windows of opportunity, frame messages appropriately, and utilize effective strategies. In this case, imposing a new tax in the midst of an economic crisis was bound to be unpopular for many residents. The campaign tried to define the issue more broadly by linking the tax to improved health and lower healthcare costs, though this still did not involve enough stakeholders and diverse groups to pass the tax. Perhaps early messages that countered the campaign’s opponents, such as disclosing the beverage industry’s behind-the-scenes lobbying tactics and targeted marketing strategies, may have helped change the public discourse surrounding the tax.

In the same vein, advocates of public health measures probably fare better if they are united in their support for a proposal and if they have resolved moral or other ambiguities prior to public debate. The lack of prior internal dialogue among advocates on the value and limits of taxes on unhealthy food and the short interval available for mobilization may have handicapped their ability to bring clear and consistent messages into the policy arena.

Finally, it is important to remember that it may take two or more attempts to pass legislation, especially when there is little precedent for the policy. Not knowing in advance opponents’ strategies and messages, this first attempt at a sugar-sweetened beverage tax in New York State was actually a valuable learning experience. Campaigns should evaluate their efforts and those of their opponents in order to increase the likelihood of future success. Measures of outputs and outcomes should include surveys of constituents, policymakers, and the media.



1 Centers for Disease Control and Prevention. BRFSS Prevalence and Trends Data: New York, 2007. Available at: Accessed March 20, 2009.

2 Edmunds LS, Woelfel ML, Dennison BA, et al. Overweight trends among children enrolled in the New York State Special Supplemental Nutrition Program for Women, Infants, and Children. J Am Diet Assoc. 2006;106(1):113-117.

3 Centers for Disease Control and Prevention. YRBSS Youth Online: Comprehensive Results. Available at: Accessed March 30, 2009.

4 Office of the State Comptroller. Preventing and reducing childhood obesity in New York. October, 2008. Available at: Accessed March 30, 2009.

5 Vartanian LR, Schwartz MB, Brownell KD. Effects of drink consumption on nutrition and health: a systematic review and meta-analysis. Am J Public Health. 2007;97(4):667-675.

6 Hakim D. Governor calls for session on fiscal crisis. NY Times. July 30, 2008. Available at: Accessed March 31, 2009.

7 Fiore M. Studies weigh in on logic behind ‘obesity’ tax. Fox News. December 17, 2008. Available at:,2933,468245,00.html. Accessed March 16, 2009.

8 Deep pocketed sugar sweetened beverage tax opponents spend over $4 million to influence public health policy [press release]. New York: New York State Health Eating and Physical Activity Alliance; March 12, 2009.

9 Confessore N. Paterson lowers expectations on soda tax, calling approval unlikely. NY Times. February 14, 2009. Available at: Accessed March 9, 2009.

10 Citizens’ Committee for Children of New York, Inc. Voter preferences for closing the New York State budget gap. December 12, 2008. Available at: Accessed March 13, 2009.

11 Brownell KD, Frieden TR. Ounces of prevention—the public policy case for taxes on sugared beverages. N Engl J Med. 2009;360:1805-1808.


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News Updates: New Reports on the Alcohol, Tobacco and Firearms Industries

The gun industry’s role in trafficking weapons to Mexico, the FDA set to regulate tobacco, and the new venues of alcohol advertising: the influence of corporations on population health is all over the news! Check out highlights from three new reports that focus on regulation.


Out-of-Home Alcohol Advertising: A 21st: Century Guide to Effective Regulation

Downdload the PDF

This report, by the Marin Institute (March 2009), the alcohol policy advocacy center, provides advocates and policymakers with suggestions for designing effective regulation of alcohol advertising at the state and local levels. With an eye on emerging trends in out-of-home advertising (e.g., digital billboards, advertising in public transit), this 12-page report focuses on the strengths and weaknesses of laws on the books in various jurisdictions across the U.S. It summarizes the factors advocates should consider when designing effective oversight of alcohol advertisements. With examples of restrictions likely and unlikely to withstand legal challenge and examples of model language from current laws on the books in cities in California and Pennsylvania, this report can help those interested in achieving effective regulation of alcohol advertising in their communities.


The Family Smoking Prevention and Tobacco Control Act

On April 2nd, the House of Representatives passed H.R. 1256, the Family Smoking Prevention and Tobacco Control Act by a vote of 298 to 112. This act amends the Federal Food, Drug, and Cosmetic Act (FFDCA) to grant the FDA authority to regulate the manufacturing, marketing and sale of tobacco products. The bill adds a new chapter to the FFDCA to regulate tobacco products. Tobacco products would not be regulated under the “safe and effective” standard currently used for other products under the agency’s purview, but under a new standard—”appropriate for the protection of the public health.” With the support of President Obama, Senator Edward Kennedy is expected to soon introduce a version of the house bill in the Senate. Two tobacco-state senators, Richard Burr, a Republican, and Kay Hagan, a Democrat, both from North Carolina, have submitted a weaker substitute bill that would create a new tobacco regulatory agency within the Department of Health and Human Services. As the New York Times noted in an April 25th editorial, “such a fledgling agency would almost certainly be much less effective than the F.D.A., especially since the senators don’t propose to grant it the broad powers and ample resources provided by the House-passed bill.”

Key features of the House of Representatives-passed bill include:

  1. Restrictions on marketing and sales to youth
  2. Specific authority granted to FDA to restrict tobacco marketing
  3. Detailed disclosure required of ingredients, nicotine and harmful smoke constituents
  4. FDA allowed to require changes to tobacco products to protect the public health
  5. Strictly regulated “reduced harm” products
  6. Requirement for bigger, better health warnings
  7. FDA activity funding through a user fee on manufacturers of cigarettes, cigarette tobacco and smokeless tobacco, allocated by market share

For a special report on the Family Smoking Prevention and Tobacco Control Act from the Campaign for Tobacco Free Kids, go to:


Exporting Gun Violence: How Our Weak Gun Laws Arm Criminals in Mexico and America

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The Brady Center to Prevent Gun Violence has issued a new report on the problem recently reported in the New York Times (“Loopholes to let gun smuggling to Mexico flourish,” April 14, 2009) entitled, “Exporting Gun Violence: How Our Weak Gun Laws Arm Criminals in Mexico and America.” Arguing that same laws that allow gun trafficking into Mexico have long allowed trafficking of guns to American criminals, the Brady campaign supports new laws that make background checks mandatory for all gun purchases and beefing up the authority of the Bureau of Alcohol, Tobacco and Firearms (ATF) to enforce laws.

In the report, the Brady Campaign urges U.S. leaders to look further than just enforcement of existing laws, and strengthen American gun laws to make it harder for Mexican criminals to arm themselves with U.S. firearms. The report stresses the urgent need for stronger gun laws that make it more difficult for military-style assault weapons and other guns to be sold by American gun dealers to gun traffickers who take guns over the border into Mexico, supplying weapons to fuel the violent drug cartels.

Is McDonald’s Lovin’ the Economic Crisis? Hard times, fast food and health

Despite the slumping economy, tightening credit market, rising food prices and growing concern about obesity, 2008 was a very good year for the McDonald’s Corporation, the world’s largest fast food company. By the end of the year, Mickey D’s hadposted 55 consecutive months of increases in global same–store sales; operated a record 32,000 restaurants in 100 countries and increased the value of shares by 6% and revenues by 7%. Its return on equity, a measure of a firm’s efficiency in generating profits, was 29%, nearly triple the industry average of 10% and the company increased its dividend by 33%. These increases,said the company’s CEO Jim Skinner, show that we are delivering what customers count on from McDonald’s—choice, variety and high–quality food and beverages at affordable prices.

In this report, Corporations and Health Watch examines how McDonald’s has responded to the economic crisis and considers the health implications of recent changes in its corporate practices. The larger goal is to identify new opportunities for public heath advocates to advance their health agenda in a changing economic and political climate.

Only a few years ago, McDonald’s faced some daunting challenges, recently summarized in the New York Times. A rapid pace of expansion had led to declines in service and quality as McDonald’s was unable to hire and train staff quickly enough. In addition, a bevy of critics made McDonald’s a target. In 1999, a crowd of French protesters led by slow food activist Jose Bove dismantled a McDonald’s outlet just days before it was due to open, loaded the rubble onto trucks and tractors, drove it through town and dumped it outside the town hall, winning approval from many French eaters. Eric Schlosser’s 2001 best seller Fast Food Nation revealed the company’s sleazy employment, food safety and environmental practices. Two years later McDonald’s experienced its first quarterly loss ever and its stock dropped sharply. In 2004, Morgan Spurlock’s documentary Super Size Mewarned millions of consumers about the health dangers of the Happy Meal diet.

In 2004, McDonald’s hired a new CEO, Jim Skinner, a long time company manager who had started his career flipping burgers, to revitalize the company’s fortunes. His actions helped to turn the company around. In part in response to declining sales, McDonald’s sold off some recent acquisitions. In 2007, it sold Boston Market, a US chain that is a leader in the fast–casual restaurant category, and a year earlier it had dropped its investment in Chipotle Mexican Grill. Also in 2007, the company sold most of its businesses in Latin America to a developmental licensee organization. In 2008, McDonald’s sold its interest in the British–based Pret–A–Manger, a global company that bills itself as a healthy alternative to fast–food outlets. These divestitures helped McDonald’s to refocus on its core business.

Another change was that McDonald’s learned to rapidly modify its menu in response to economic changes. In the current economic downturn, for example, McDonald’s has emphasized value rather than nutrition. Its 2008 US profits came from increased sales on breakfast biscuits (729 calories, 49 gms fat, without syrup or margarine), Southern style chicken sandwiches (419 calories, 19 gms fat) and drinks. The Dollar Menu is an example of a promotion to encourage customers concerned about price to walk through the Golden Arches anyway. As the company website explains, the Dollar Menu provides you with quality menu items at a good value… We understand how important it is to you—especially these days. That’s why you can depend on us to give you value across our entire menu.

In contrast, a year ago, in better times and a more prosperous place, McDonald’s succeeded in increasing market share in Europe by going upscale. In 2007, the company spent more than $828 million to renovate its European outlets, adding healthier items, catering to regional tastes and adding features such as Internet access and rental I Pods. Sales rose 15%. By the end of that year, the chain was serving 10 million customers a day in Europe, contributing 36% to the companies operating income.

Increasingly, McDonald’s depended on other countries for growth and profits. In 2007, revenues in Europe topped those in the United States. Growth was also strong in Asia, the Middle East and Africa. 
In November 2008, for example, just as the economic crisis was spreading, McDonald’s global sales increased 171% more than its US sales. As Mickey D’s brought its signature products to Europe, Asia and the Middle East, it also sought to accommodate local tastes, a process some have labeled glocalization. In India, for example, it took beef off some menus to accommodate Hindus who don’t eat it.

McDonald’s also changed its marketing, responding to critics more forcefully and using more innovative strategies. For example, its Quality Correspondents program, seeks to win over mothers by taking them on tours of its kitchens, highlighting food quality and healthful options. This cadre of volunteer sales moms can enhance the company’s image and help overcome the single largest barrier to more McD’s sales to children: mothers’ health concerns.

In 2006, McDonald’s introduced a campaign to create gyms in its restaurants, adding exercise bikes, basketball hoops and climbing structures. Its ad campaigns featured svelte, active urban parents and children—their idealized patrons, rather than the more typical customers who were often overweight and struggling to make ends meet. While an editorial in PR Weekcongratulated the company for its emphasis on healthy living, critics charged that the focus on physical activity, like the company’s philanthropic contributions to school fitness programs, served to distract public attention from the company’s role in the obesity epidemic.

McDonald’s has also agreed to take voluntary steps to modify its products to improve their nutritional quality. In 2006, under the auspices of the Council of Better Business Bureaus (CBBB) and the National Advertising Review Council (NARC), McD’s joined 9 other major food companies to increase the percentage of healthy foods in advertisements targeting children younger than 12; change the product mix in ads targeted at children, stop advertising their products in elementary schools and stop deals for product placement in TV shows and movies. In 2008, with Burger King and KFC, McDonald’s promised the British Food Standards Agency, to cut the levels of fat and salt in their products and to serve more salad.

At the same time, the company took on its critics more forcefully. Fictititous information irresponsibly published and reported in the media has people questioning the quality and safety of fast food in general, said CEO Skinner. In 2006, according to the Wall Street Journal, McDonald’s hired a public relations firm to counter Eric Schlosser’s charges against the company.

By 2008, these changes—and a declining economy—had helped to turn the company around. The growing sales and healthy profits led financial analysts to be bullish on Mickey D. Goldman Sachs analyst Steven Kron told investors that recent growth in sales and profits temper lingering concerns that a global economic slowdown will impact the company’s results. CEO Skinner saidWorldwide turbulence is barely affecting our business. We are growing worldwide, especially in Europe we have significant gains.

New Vulnerabilities

Despite the optimism on Wall Street and at corporate headquarters, McDonald’s does face some vulnerabilities. Although McDonald’s may be better able to weather the credit squeeze than smaller chains, some analysts see clouds on the horizon. The company plans to build McCafes, specialty coffee bars in its 14,000 US locations, at a cost of $100,000 each. Jonathan Kaufman, chair of McDonald’s national advertising committee, told investors that lenders will definitely be looking at your ratios, your cash flow, your profit and loss, which they always did, but I know they’re going to take a harder look. What will change absolutely is interest rates. To date, 6,500 of the US outlets have installed McCafes. If the remaining franchises have trouble getting credit, they might not be able to join what the company hopes will be a promising profit center that can draw in new customers.

Another threat is the gyrating commodity prices. In the first part of 2008, global food prices rose sharply and in July 2008, McDonald’s warned investors that rising chicken and beef prices might reduce profits. Increases in beef and cheese prices recently led McDonald’s to take the double cheeseburger (468 calories, 26 gms of fat and 1137 mg of sodium) off the Dollar Menu, advising franchises to price it at $1.19. To make up for the loss, the company added a new McDouble Burger made with two all–beef patties and a single slice of cheese—one less than in the chain’s traditional double cheeseburger. This change will save McDonald’s six cents a burger and spare eaters some calories, fat and sodium. In the longer term, rising demand for beef and chicken in emerging markets in Asia, Latin America and elsewhere is likely to lead to further price increases, making it difficult for fast food companies to keep prices down and cost conscious customers in.

And while globalization has contributed to McDonald’s profits, it also raises some risks. In the last decade, Mickey D has become a symbol for the United States and as US power and prestige have declined, that identification can present problems. At a recent demonstration against the Israeli attack on Gaza held in Malaysia, reports Al Jazeera, former Prime Minister Mahatir Mohamed urged those working for McDonald’s and other US companies to quit their jobs. In October 2008, the Venezuelan government of Hugo Chavez ordered more than one hundred McDonald’s restaurants to close down for 48 hours because of alleged tax irregularities. Whether a new adminsitation in Washington will make the US and its products less of a target remains to be seen.

Globalization also offers critics of McDonald’s opportunities to learn from each other and devise global strategies to counter the company. Now that Mickey D has agreed to hold the salt in its British outlets, it can be expected that health advocates and officials in the US and elsewhere will make similar demands. Evidence shows that the salt in processed food is a major contributor to cardiovascular and other diseases.

At a recent meeting of the International Task Force on Obesity in Sydney, Australia, several public health organizations proposed the Sydney Principles to spell out what governments need to do to reverse the epidemics of obesity and diabetes. (See Box 1). With their focus on protecting children from deceptive or manipulative advertising, strong regulation and global standards, these principles could be seen as a threat by McDonald’s and other global chains. Should pressure build for an international treaty to give these principles the force of law, marketing opportunities for children could be constrained, threatening profitability and the important task of recruiting lifetime customers for Happy Meals.

Box 1

The Sydney Principles

      Regulations need to align with and support the United Nations Convention on the Rights of the Child and the Rome Declaration on World Food Security which endorse the rights of children to adequate, safe and nutritious food.

      Children are particularly vulnerable to commercial exploitation, and regulations need to be sufficiently powerful to provide them with a high level of protection. Child protection is the responsibility of every section of society – parents, governments, civil society, and the private sector.

      Only legally–enforceable regulations have sufficient authority to ensure a high level of protection for children from targeted marketing and the negative impact that this has on their diets. Industry self–regulation is not designed to achieve this goal.

      Regulations need to encompass all types of commercial targeting of children (e.g. television advertising, print, sponsorships, competitions, loyalty schemes, product placements, relationship marketing, Internet) and be sufficiently flexible to include new marketing methods as they develop.

      Regulations need to ensure that childhood settings such as schools, child care, and early childhood education facilities are free from commercial promotions that specifically target children.

      International agreements need to regulate cross–border media such as Internet, satellite and cable television, and free–to–air television broadcast from neighbouring countries.

    The regulations need to be evaluated to ensure the expected effects are achieved, independently monitored to ensure compliance, and fully enforced.


More broadly, the tension between globalization, a single brand identity with a relatively homogenous international market, and glocalization, a segmented and diversified market, also presents challenges. Each approach demands a different business model and different marketing strategies. Whether Mickey D’s can straddle that divide remains to be seen. AsNaomi Klein and global justice advocates point out, the power of a global brand is also its Achilles heel. On the other hand, the risk of one hundred local variants is that the global company loses its competitive edge and the potential for economies of scale. In either choice, McDonald’s greatest vulnerability is its image and both global and local strategies offer critics and food advocates tempting targets including health, the environment, labor practices, animal rights, and the company’s disproportionate political influence.

Impact on Health

In the coming years, how McDonald’s responds to the changing economy could set new standards for the fast food industry and therefore for global health. In the worst case scenario, Mickey D and other fast food companies continue to search for the cheapest foods, emphasizing the lower cost and higher profit calorie dense and nutrient poor processed foods at the expense of fruits, vegetables and healthier options. In addition, in this scenario, these companies continue heavy and aggressive marketing, using a mix of low prices and sometimes deceptive health claims to entice customers with stretched budgets and few other options for eating out. As more people fall into poverty, cheap calories will become more attractive, leading to growing rates of obesity and greater disparities in obesity and diabetes between the better off and the poor.

Some nutritionists worry that a continuing recession could worsen this trend, contributing to obesity. In a recent interview, Adam Drewnowski, the director of the Nutrition Sciences Program at the University of Washington in Seattle told Reuters that consumers are going to economize and as they save money on food they will be eating more empty calories or foods high in sugar, saturated fats and refined grains, which are cheaper. He noted that obesity is a toxic result of a failing economic environment and that studies in California suggested that a 10 percent rise in poverty translates into about a 6 percent increase in obesity among adults. Eileen Kennedy, Dean of the Friedman School of Nutrition Science and Policy at Tufts Universityexplainedthe reality is that when you are income constrained the first area you try to address is having enough calories in your diet. And cheap sources of calories tend to be high in total fats and sugars. Thus, the McDonald’s Dollar Menu offers consumers the dubious bargain of might saving money at the expense of their waistline and health.

On the international front, continued pressure from developed nations to improve their business practices could lead McDonald’s and other companies to move even more aggressively to capture markets in India, China and elsewhere, visiting American–style epidemics of obesity and diabetes on these nations as well.

A more optimistic scenario is that McDonald’s and other fast food companies, governments and local, national and global public health organizations could agree on new ground rules that would require companies to consider the health impact of their practices and reject strategies that were good for business but bad for health. Preliminary assessments of compliance with voluntary agreements do not provide much grounds for optimism. A 2006 review of McDonald’s compliance with its voluntary agreements to restrict marketing to children commissioned by the World Health Organization found thatindustry’s voluntary efforts to self–regulate are inadequate. Our case studies support this conclusion. McDonald’s continues to emphasize marketing of its core products to children. The authors concluded food companies cannot resolve the childhood obesity dilemma on their own. For business reasons alone, they cannot—and will not—stop making and marketing nutritionally questionable food products to children.

This report suggests that the economic crisis has helped McDonald’s to attract new customers with inexpensive products high in calories, fat, sodium and salt; to extend its global reach; and to avoid the criticisms leveled by nutritional and environmental critics. While McDonald’s is by no means the worst offender on these fronts, its size and market share make it an important force and a global pace setter. By developing new ground rules for corporate behavior and new responsibilities for governments to protect health, food advocates can help to prevent the current economic crisis from exacerbating global health crises.


Nicholas Freudenberg is Distinguished Professor of Public Health at Hunter College and Founder and Director ofCorporations and Health Watch.


Posted January, 2009

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Check out CHW’s profile on McDonald’s from November, 2007, McDonald’s and Children’s Health: The Production of New Customers, and visit the Corporations and Health Watch archives for interviews, profiles, and news on industry influence in science and health.


Films on Corporate Practices and Health

Feature Films

 Too Big to Fail (2011). This feature film maps the 2008 financial crisis with Treasury Secretary Henry Paulson as protagonist.

Fast Food Nation (2006). This fictionalized version of the book by the same title looks at the impact of fast food and corporate control over food production on health, society and the environment.

The Constant Gardener (2005) Based on the John Le Carre novel by the same title, The Constant Gardener explores how pharmaceutical companies knowingly test dangerous AIDs drugs on populations of developing countries.

Side Effects (2005). A film about a young pharmaceutical rep who is torn between earning a good living and living a good life.

Thank You for Smoking (2005). A satirical look at the practices of the tobacco, alcohol and gun industries and their impact on health.

The Runaway Jury (2003). Based on a John Grisham thriller about the tobacco industry’s efforts to manipulate juries, the film switches to the gun industry’s role in avoiding liability damages.

A Civil Action (1998). A slick lawyer takes on two giant chemical companies for their pollution of a town’s water.

Class Action (1991). Courtroom drama in which father and daughter represent opposite sides in a suit against a negligent auto company.



Fed Up (2014). An examination of how the food industry contributes to America’s obesity epidemic

Food Chains (2014). A look at food workers in America and the challenges they face at the hand of corporations- in this case, supermarkets.

Inside Job (2011). Feature-length documentary about the 2008 financial crisis

Corporate Fascism: The Destruction of America’s Middle Class (2010). How do corporates impact our political system?

Food Inc. (2008). An eye-opening look at how corporations control the food industry

Forks Over Knives (2008). Investigates how the major diseases of our time- chronic diseases related to lifestyle, can be combatted by a diet that rejects processed and animal-based foods.

Poultrygeist (2007) “Poultrygeist” is a satirical look at the fast food industry, examining what happens when “American Chicken Bunker,” a military-themed fried-chicken chain, builds a restaurant on the site of an ancient Indian burial ground. The film was written by a fast-food employee, produced with the support of PETA, and shot almost entirely through volunteer effort.

Bad Seed: the Truth about our Food (2006). An examination of the hidden costs of genetic engineering of food told through the perspectives of farmers, victims of genetically-engineered products, leading scientists, food safety advocates and more.

Big Bucks, Big Pharma: Marketing Disease & Pushing Drugs. This documentary examines how pharmaceutical companies profit through the creation, definition, and redefintion of disease, direct marketing of pharmaceutical products to consumers, and the increasing medicalization of mental and physical health.

The Future of Food (2004) Looking at the effects of genetic engineering in Mexico, the United States and Canada, this film explores the health impact of genetically engineered food and the dangers of increased corporate control over the food system.

Supersize me (2004) Filmmaker Morgan Spurlock examines the impact of fast food consumption by eating nothing but McDonalds food for 30 days and by looking at the impact of the fast food industry on health and society.

The Corporation (2003) Using case studies, this documentary examines corporations through a psychological lens, argues that corporations fit the criteria for psychopathy, and highlights the dangers that corporate practices can have on the environment and society.

Deadly Deception (1991). This academy-award winning documentary bringing to light the side effects caused by the General Electric Company’s production of nuclear materials.


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Selected references on automobile industry practices and health

This month CHW continues its series on selected references from the peer-reviewed scientific literature with a listing of 47 references on the health impact of automobile industry practices.

Corporations and Health Watch is conducting a search for articles that assess the impact of corporate practices on health for various industries. This list includes selected publications from the peer-reviewed literature that describe and analyze the marketing, product design, retail and pricing practices of the automobile industry.

Arbesman M, Pellerito JM Jr. Evidence-based perspective on the effect of automobile-related modifications on the driving ability, performance, and safety of older adults. Am J Occup Ther. 2008;62(2):173-86.

Arbogast KB, Durbin DR, Kallan MJ, Winston FK. Effect of vehicle type on the performance of second generation air bags for child occupants. Annu Proc Assoc Adv Automot Med. 2003;47:85- 99.

Ballesteros MF, Dischinger PC, Langenberg P. Pedestrian injuries and vehicle type in Maryland, 1995-1999. Accident Analysis and Prevention. 2004;36:73-81.

Bedard M, Guyatt GH, Stones MJ, Hirdes JP. The independent contribution of driver, crash, and vehicle characteristics to driver fatalities. Accident Analysis and Prevention. 2002;34:717-727.

Buckeridge DL, Glazier R, Harvey BJ, Escobar M, Amrhein C, Frank J. Effect of motor vehicle emissions on respiratory health in an urban area. Environ Health Perspect. 2002;110(3):293-300.

Cohen MJ A social problems framework for the critical appraisal of automobility and sustainable systems innovation .Mobilities 2006; 1(1): 23-38.

Crandall CS, Olson LM, Sklar DP. Mortality reduction with air bag and seat belt use in head-on passenger car collisions.American Journal of Epidemiology. 2001;153:219-224.

Daly L, Kallan MJ, Arbogast KB, Durbin DR. Risk of injury to child passengers in sport utility vehicles. Pediatrics. 2006;117:9-14.

Duvall T, Englander F, Englander V, Hodson TJ, Marpet M. Ethical and economic issues in the use of zero-emission vehicles as a component of an air-pollution mitigation strategy. Sci Eng Ethics. 2002;8(4):561-78

Farmer C. Effect of electronic stability control on automobile crash risk. Traffic Inj Prev. 2004;5(4):317-25.

Farmer CM, Braver ER, Mitter EL. Two-vehicle side impact crashes: The relationship of vehicle and crash characteristics to injury severity. Accident Analysis and Prevention. 1997;29:399-406.

Farmer CM, Lund AK. Trends over time in the risk of driver death: what if vehicle designs had not improved? Traffic Inj Prev. 2006;7(4):335-42.

Ferguson SA. The effectiveness of electronic stability control in reducing real-world crashes: a literature review. Traffic Inj Prev. 2007;8(4):329-38.

Ferguson, S.A., Hardy, A.P., Williams, A.F. (2003). Content analysis of television advertising for cars and minivans: 1983-1998. Accident Analysis and Prevention, 35:825-831.

Ferguson SA, Schneider L, Segui-Gomez M, Arbogast K, Augenstein J, Digges KH. The blue ribbon panel on depowered and advanced airbags – status report on airbag Performance. Annu Proc Assoc Adv Automot Med. 2003;47:79-81.

Geyer R. Parametric assessment of climate change impacts of automotive material substitution Environ Sci Technol. 2008;42(18):6973-9.

Hart-Munchel, D.L. Comment: hybrid cars: how they can reduce American air pollution and oil consumption, but why they are not replacing traditional gas guzzling cars and trucks just yet. Penn State Environmental Law Review Fall 2001

Keefe R, Griffin JP, Graham JD. The benefits and costs of new fuels and engines for light-duty vehicles in the United States.Risk Anal. 2008;28(5):1141-54

Knight S, Cook LJ, Nechodom PJ, Olson LM, Reading JC, Dean JM. Shoulder belts in motor vehicle crashes: A statewide analysis of restraint efficacy. Accident Analysis and Prevention. 2001;33:65-71.

Mannino DM, Redd SC. National vehicle emissions policies and practices and declining US carbon monoxide-related mortality. JAMA. 2002;288(8):988-95.

Mayrose J, Jehle DVK. Vehicle weight and fatality risk for sport utility vehicle versus passenger car crashes. The Journal of Trauma, Injury, Infection and Critical Care. 2002;53.

Mazzi, E.A., Dowlatabadi, H. (2007). Air quality impacts of climate mitigation:UK policy and passenger vehicle choice.Environmental Science and Technology, 41:387-392.

McAuley JW. Global sustainability and key needs in future automotive design. Environ Sci Technol. 2003;37(23):5414-6.

McGwin G Jr, Modjarrad K, Reiland A, Tanner S, Rue LW 3rd. Prevalence of transportation safety measures portrayed in primetime US television programs and commercials. Inj Prev. 2006;12(6):400-3.

Mott JA, Wolfe MI, Alverson CJ, Macdonald SC, Bailey CR, Ball LB, Moorman JE, Somers JH, Sheerman B. Motor industry should introduce soft impact car bodies, says MP. BMJ. 2002;324 (7346):1117.

Nichols, M.W. (1998). Advertising and quality in the US market for automobiles. Southern Economic Journal, 64(4):922-939.

Nirula R, Mock CN, Nathens AB, Grossman DC. The new car assessment program: does it predict the relative safety of vehicles in actual crashes? J Trauma. 2004 Oct;57(4):779-86

Paulozzi LJ. United States pedestrian fatality rates by vehicle type. Inj Prev. 2005;11(4):232-6.

Rivara FP, Cummings P, Mock C. Injuries and death of children in rollover motor vehicle crashes in the united states. Injury Prevention. 2003;9:76-81.

Rivara FP, Koepsell TD, Grossman DC, Mock C. Effectiveness of automatic shoulder belt systems in motor vehicle crashes.JAMA: The Journal Of The American Medical Association. 2000;283:2826-2828.

Roberts I, Wentz R, Edwards P. Car manufacturers and global road safety: a word frequency analysis of road safety documents. Inj Prev. 2006;12(5):320-2.

Robertson LS. Prevention of motor-vehicle deaths by changing vehicle factors. Inj Prev. 2007;13(5):307-10.

Robertson LS. Reducing death on the road: the effects of minimum safety standards, publicized crash tests, seat belts, and alcohol. Am J Public Health. 1996;86(1):31-4.

Robertson LS. Blood and oil: vehicle characteristics in relation to fatality risk and fuel economy. Am J Public Health. 2006 Nov;96(11):1906-9.

Samet JM. Traffic, air pollution, and health. Inhal Toxicol. 2007;19(12):1021-7.

Shin, P.C., Hallet, D., Chipman, M.L., Tator, C., Granton, J.T. (September 2005).

Unsafe driving in North American automobile commercials. Journal of Public Health, 27(4):318-325.

Stephan CH, Sullivan J. Environmental and energy implications of plug-in hybrid-electric vehicles. Environ Sci Technol. 2008;42(4):1185-90.

Streff FM. Field effectiveness of two restraint systems: The 3-point manual belt versus the 2-point motorized-Shoulder/Manual lap belt. Accident Analysis and Prevention. 1995;27:607-610.

Tamburro, R.F., Gordon, P.L., D’Apolito, J.P., Howard, S.C. (2004). Unsafe and violent behavior in commercials aired during televised major sporting events. Pediatrics, 114:694-698.

Trowbridge MJ, McKay MP, Maio RF. Comparison of teen driver fatality rates by vehicle type in the United States. Acad Emerg Med. 2007 Oct;14(10):850-5.

Wenzel TP, Ross M. The effects of vehicle model and driver behavior on risk. The effects of vehicle model and driver behavior on risk. Accid Anal Prev. 2005 May;37(3):479-94.

Williams AF, Wells JK, Farmer CM. Effectiveness of Ford’s belt reminder system in increasing seat belt use. Injury Prevention. 2002;8:293-296.

Wilson N, Maher A, Thomson G, Keall M. Vehicle emissions and consumer information in car advertisements. Environ Health. 2008;7:14.

Woodcock J, Banister D, Edwards P, Prentice AM, Roberts I. Energy and transport. Lancet. 2007;370(9592):1078-88.

Yanchar NL, Kennedy R, Russell C. ATVs: motorized toys or vehicles for children? Inj Prev. 2006 Feb;12(1):30-4.

Readers are invited to send additional citations to


Presentation on the Role of Infant Formula Industry in Discouraging Breastfeeding

In this presentation, Deborah Kaplan describes the role of the infant formula industry in discouraging breastfeeding and promoting its own products. She also describes the health consequences of these actions.

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In a presentation format suitable for use in college and community classes, nutritionist Lauren Dinour provides an overview of some of the approaches that policy makers and advocates are using to protect the public against promotion of unhealthy food.

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