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.

Time to reclassify malt liquor and flavored malt beverages as a “distilled spirit?”

Ten years ago, Harlem community activists and Bill Perkins, Harlem’s representative to the New York City Council, led a successful campaign to rid Harlem of malt liquor ads that they calledpornographic and disrespectful(1). Several years earlier, legal action had forced malt liquor advertisers to remove similar ads. In the ensuing decades, activists launched comparable campaigns against the advertising and distribution of malt liquor in Portland, Oregon; Chicago; Philadelphia; Washington, D.C. and many other cities, often in the African-American neighborhoods targeted by malt liquor manufactures.

Now, major U.S. breweries are facing declining revenues due to decreased demand for mass market product lines such as Budweiser and a trend toward increased wine consumption and specialty and imported beers (2,3). For the beer industry, young consumers who have not yet established brand and drink preferences are an obvious target for the more aggressive marketing of malt liquor products (2,3).

This story of marketing malt liquor and the resistance to it illustrates some of the ways that free markets can collide with public health. It also demonstrates both the potential and limits of community activism to resist the promotion of unhealthy products. ThisCorporations and Health Watchreport summarizes the health risks associated with malt liquor consumption and describes the marketing of newer flavored malt liquors and caffeinated energy malt liquors to young people. It reviews actions by community activists to restrict the sale and advertisement of malt liquor products in low-income urban communities, and concludes with policy recommendations designed to better protect young people from the risks associated with malt liquor.

The most common malt liquor beverages are produced by the major U.S. brewing companies. These include beverages produced by Miller Brewing Company (Olde English 800 and Mickey’s), Pabst Brewing Company (St. Ides and Colt 45), Anheuser-Busch (King Cobra and Hurricane), and SABMiller (Steel Reserve). Newer products includeFMBs(Flavored Malt Beverages) ormalternativessuch asHard Lemonade,and other malt liquors with added flavors and sweeteners that appeal to younger adults and teens.

Malt liquor is a type of beer that has artificially high alcohol content, produced by adding sugar, corn, rice, dextrose or other adjuncts. The resulting alcoholic beverage is too strong to be legally labeled asbeer,and so it is labeled asmalt liquor.Beers typically have an alcohol content of around 5% by volume, whereas malt liquor has an alcohol content of 6 to 11% alcohol by volume. Malt liquor, which is typically a very pale amber color, tends to lack the bitterness associated with many types of beer because it is produced without hops. Flavored malt beverages are produced in the same manner as malt liquor, but with several additional steps to remove the color and flavors typically associated with beer and malt liquor. The result is a potent, flavorless alcoholic base that manufacturers combine with candy-like flavors and coloring, then market with youth-oriented advertisements.

The public health case against malt liquor

Objections to street corner distribution of 40 ounces

Most malt liquor advertisements urge young men to adopt amasculineidentity by consuming large quantities of potent alcohol in a single sitting, a pattern of consumption that increases the risk for excessive alcohol intake and alcohol dependency (4). In a study funded by the National Institute on Alcohol Abuse and Alcoholism, the University of Buffalo’s Research Institute on Addictions found that malt liquor users were more likely to smoke marijuana when they drink and to consume dangerous levels of alcohol (5). Due to the high alcohol concentration and super-sized bottles, a drinker who downs one or two 40-ounce bottles of malt liquor could be consuming the equivalent of up to 14 standard drinks in one sitting (5).

Another objection is the low cost and ready availability in small groceries in minority neighborhoods (6), stores that often ignore laws prohibiting the sale of alcohol to minors. The high density of these outlets also make them more difficult to police. A 40-ounce bottle, commonly referred to as a40,sells for less than $2, often at a price as low as 99 cents. Because malt liquor is classified as beer, many small grocery vendors are permitted to sell the product and the product is taxed at a lower rate than wine and spirits.

Currently under review by the Tax and Trade Bureau, the division of the U.S. Treasury Department that regulates malt liquor labeling, is a proposal that would allow for the advertisement of malt liquor based on potency (7). Such advertisement of malt liquor is currently prohibited, out of concern that breweries will engage instrength warsusing advertising designed to win over young drinkers with the high potency of their brews (7,8).

In sum, the industry’s marketing plans make a potent and potentially dangerous product readily available at affordable prices in our most disadvantaged communities. The alcohol industry then aggressively markets the products to young men, using sexual images that imply consumption enhances masculinity.

Objections tokiddie boozeandgirlie drinks,also known asalcopops

Another marketing strategy also raises concerns for health professionals. Recently, the alcohol industry has added caffeine, guarana, ginseng, and energy-producing claims to malt liquor products, in addition to flavoring malt liquors and test marketing fruit-flavored malt liquorshots.Flavored malt liquors such as Mike’s Hard Lemonade, a lemon-flavored malt alcoholic beverage made by a producer in Canada, are popular with teens and young adults, especially girls. This gender-specific product design and marketing is making malt liquors an equal opportunity substance, increasing the likelihood that both genders are at risk of malt liquor’s harm.

Groups such as the American Medical Association, the American Public Health Association, the International Institute for Alcohol Awareness, the Center on Alcohol Marketing and Youth, and the Center for Science in the Public Interest have taken issue with marketing practices associated with malt liquor and the over-saturation of the market withkiddie boozeflavored malt beverages and advertisements (9-14). The American Medical Association has commissioned a survey of underage girls, finding that a third of all girls older than 12 have triedgirlie drinksoralcopopsand that teenage girls report drinking alcohol more often than their male counterparts (9). Alcopops is a term used to describe sweetened malt beverages and other sweetened alcoholic drinks. In their paperGirlie Drinks. . . Women’s Diseases,the American Medical Association warns young girls that manufactures use thesweet fruity flavorof thesestarter drinksto appeal to young girls (9), and the Marin Institute credits the increased availability and marketing of inexpensivealcopopsto increased female consumption of alcohol (15).

Due to pressure exerted by national substance abuse prevention organizations, numerous state attorneys general, and public interest groups, Anheuser-Busch ultimately agreed to stop the marketing of its Spykes product line in May 2007 (16-18). Spykes, which were 12% alcohol by volume, were sold within arm’s reach of many cash registers in grocery stores and delis for under $2. Sold in flavors such as spicy mango, hot chocolate, hot melon, and spicy lime, the product was designed for young girls and teens who do not like the taste of hard alcohol and beer, as a product that could be taken either as ashotor added to beer or vodka to mask the taste of alcohol with sweet, fruity flavor. Pam Erickson of the Oregon Partnership applauded the effort noting,From the beginning, we thought this product was aimed at underage drinkers and thanks to others who thought the same thing, it’s now gone(19).

Similar victories were reached back in 1997 with the wave of protest that resulted from the introduction of frozen malt liquors such as St. Ide’s Freeze and Squeeze. At that time, then Mayor Rudy Giuliani, civic and church groups, local borough presidents, and the New York City commissioner of consumer affairs united against small stores selling fruit-flavored frozen malt liquor to children and teens (20-24).

Community struggles against 40 ounce malt liquor

Activists in urban communities of color have long battled for restrictions on the sale of malt liquor, as they struggled with high rates of violence and substance abuse in their communities. Community activists have called for numerous measures, including restrictions on advertising, higher taxes, and better policing of sales to minors. Some groups have urged filmmakers and rap artists to end their promotion of malt liquor. In their desire to target young African Americans, malt liquor makers have hired such artists as LL Cool J, DJ Quik, Bone Thugs-n-Harmony, E-40, Dr. Dre, Snoop Dogg, Eric B & Rakim, EPMD, Wu-Tang Clan, and the Geto Boys to promote their products.

Community activists have also charged that the sale of malt liquor encourages public drunkenness, loitering, urinating in public, and littering. Some research shows that malt liquor 40s are the beverage of choice for many homeless adults and unemployed adults (25), as well as teens (4). Single malt liquor sales are currently prohibited in the state of Florida, and community residents in Washington, D.C. were recently successful in banning the sale ofsinglesin several communities. These coalitions were led by politicians such as Washington D.C. Mayor Adrian M. Fenty (Democrat) and Councilman Tommy Wells (Democrat) and by community groups such as the South Columbia Heights Neighborhood Association and the Anacostia Coordinating Committee, where many residents had long complained about theoversaturation of liquor-selling establishments and the impact they’ve had on neighborhoods(26-28).

In Philadelphia, when Colt 45 malt ads began to appear on city buses and trains, residents immediately complained and the ads were removed in August 2007. Councilmember Jim Kenney complained about the ads, notingpeople have been fighting these take-out beer delis for years now(29). As in Harlem, the victories in controlling malt liquor promotion in one setting or time are often difficult to sustain, requiring activists to maintain vigilance and be ready to take on new products or advertising campaigns.

In Portland, Oregon, neighborhood activists concerned about underage and binge drinking protested a billboard advertisement for 40-ounce bottles of Olde English malt liquor. According to Carl Flipper of the Humboldt Neighborhood Target Association, the billboard showedgang members in the ‘hood having a good time drinking large containers of beer.As a result of the protests, Miller discontinued their plans for 44 billboard ads but continues to run local radio, TV and print media ads. The company refused to take any responsibility for youth drinking in a statement, writing,We aren’t responsible for all the drinking problems in your community(30).

Other African American coalitions have protested the sale of malt liquor in 40s calling itliquid crack,with members of the Citizen Reform Action Committee in Philadelphia urging manufacturers of 40s to fund anti alcohol abuse messages (31). In Chicago, an African American Catholic priest named Father Michael Pfleger has generated headlines time and again for his efforts to protect his parishioners from tobacco, alcohol, drugs and gang violence (32). With his 1983 Battle of the Billboards Campaign,he and parishioners counted 118 alcohol and tobacco billboards within a 10-block radius of the parish. He was arrested several times for destruction of property when he took part in whitewashing or removing the billboards. His actions did contribute to ending the distribution of Powermaster, a potent malt liquor sold in African American communities.

A new market for the traditional 40-ounce?

While malt liquor advertisers have traditionally targeted African American communities, the search for new markets continues. On its website, Pabst promotes Colt 45, sayingIt has become an urban American icon. If you’re looking for a thick 40, or an ice cold shorty, Colt 45 is the malt liquor that works EVERYTIMETM!Pabst encourages readers to visit their new website designed for whitehipstersand where they can create their own tales of Colt 45 on paper bags (www.talesofcolt45.com) (33,34).

The case for tighter regulation According to a recent Advertising Age commentary, the new ad campaign is part of an effort to revive the Colt 45 brand, once viewed as anexploitative product that preyed on the urban poorand make it anedgy choice for young hipsterswith creative graphics drawn on brown paper bags (35). On the same website, Pabst adds,A big part of our promise is to be responsible—and we trust that you’ll do the same.

Public health lawyers have sought, so far without success, to reclassify sugary sweet alcopops and flavored malt beverages from their current classification as a beer to a distilled spirit, a category that allows higher taxes (8). Such measures would increase the cost of the products, making them less appealing to young teens, as well as remove them from the shelves of thousands of retail outlets not permitted to sell wines and spirits. By reclassifying malt liquor and flavored malt beverages as distilled spirits, these potent alcoholic beverages would be sold only in establishments licensed to sell distilled spirits. Such a reclassification would reduce young people’s access to alcoholic beverages, thereby reducing underage drinking, drunk driving, and the adverse health consequences associated with alcoholism and alcohol abuse. Other measures designed to reduce the harm from malt liquor include restrictions on outdoor advertisements for alcohol and restrictions on advertisements for alcoholic beverages in youth-oriented magazines and television programs.

For public health professionals and advocates, the story of malt liquor shows how declining profits and the quest for increased market share can push industry to act in ways that threaten public health. While community activism has played an important role in curbing this promotion of malt liquor, the fact that these mobilizations have persisted for more than 25 years, often being forced to re-emerge to defend previous victories, suggests the limits of this approach. In the long run, only government agencies that have the backbone and the resources to fulfill their mandates can ensure that special interests don’t threaten the health of the public.

References

1. Siegal, N.Councilman Condemns Beer Ads as Crude, Racist.New York Times, February 21, 1999.
2. Hirsh J.Beer firms unite, seek a potent mix; SABMiller and Molson Coors hope to better compete for market share as consumers turn to other beverages.Los Angeles Times, October 10, 2007.
3. Ward A.US brewers cry into their beers: competition from imports and local specialty brews hitting home.Financial Times, July 31, 2006.
4. Bradizza CM, Collins RL, Vincent PC, Falco DL. It does the job: Young adults discuss their malt liquor consumption. Addictive Behaviors. 2006; 31: 1559-1577.
5. Collins RL, Bradizza CM, Vincent PC. Young-adult malt liquor drinkers: Prediction of alcohol problems and marijuana use. Psychology of Addictive Behaviors. 2007; 21: 138-146.
6. Bluthenthal RN, Cohen D, Farley T, Scribner R, Beighley C, Schonlau M, Robinson PL.Alcohol availability and neighborhood characteristics in Los Angeles, California and Southern Louisiana.Presentation given at American Public Health Association Annual Meeting, November 6, 2007.
7. Kitsock G.Beer laid bare: labels that tell all.The Washington Post, August 29, 2007.
8.Federal Trade Commission Alcohol Marketing and Advertising: A report to Congress, September 2003. Accessed February 10, 2008.
9.Girlie Drinks. . . Women’s Diseases.American Medical Association. Accessed February 10, 2008.
10.The battle over ‘Alcopops.American Public Health Association newsletter, Winter 2007. Accessed February 2, 2008.
11.Flavored Alcoholic Beverages: The Wolf in Sheep’s Clothing.Policy Brief, International Institute for Alcohol Awareness, April 2006.
12.Underage drinking in the United Sates: A Status Report, 2005.The Center on Alcohol Marketing and Youth, March 2006.
13.Center for Science in the Public Interest. Accessed February 10, 2008.
14.The Center on Alcohol Marketing and Youth. Accessed February 10, 2008.
15.The Marin Institute, Alcopops.Accessed February 19, 2008.
16. Associated Press.Hot melon in your beer? Bud tests additives.MSNBC.com. January 25, 2007.
17. CSPI Newsroom.Anheuser-Busch’s ‘Spykes’ labels illegal, group says,April 16, 2007. Updated April 30, 2007:TTB agrees; A-B halts production to fix labels.
18. Associated Press.Anheuser-Busch pulls ‘Spykes.’CBS News, St. Louis. May 18, 2007. 19. Oregon Partnership press release.Oregon Partnership claims victory as Anheuser-Busch drops Spykes,May 18, 2007. Accessed February 19, 2008.
20. Kinosian J. “`Alcopops’ Causing a Brewhaha,” Los Angeles Times (Washington Edition), March 17, 1997.
21. Halbfinger DM. “Icy, Fruity Malt Liquor Lures Minors, Critics Say,” New York Times, July 24, 1997.
22. Halbfinger DM. “Malt Drink: Cold, Fruity, Discontinued,” New York Times, July 25, 1997.
23. Halbfinger DM. “Selling Alcohol Disguised As Punch,” New York Times, July 27, 1997.
24. Etzioni A. “Son of Joe Camel,” Washington Post, August 17, 1997.
25. Bluthenthal RN, Brown Taylor D, Guzman-Becerra N, Robinson PL. Characteristics of malt liquor beer drinkers in a low-income, racial minority community sample. Alcoholism: Clinical and Experimental Research. 2007; 29: 402-409. 26. Emerling G.Beer rule a tough sell to retailers; no singles can be sold in Ward 4.The Washington Times, August 14, 2007.
27. Williams C.Grocery is flash point for changing neighborhood; newcomers, longtimers clash over beer sales.The Washington Post, December 10, 2007.
28. Emerling G.Beer rule a tough sell to retailers; no singles can be sold in Ward 4.The Washington Times, August 14, 2007.
29. Vasquez D.Colt 45 wraps pulled off Philly buses.Media Life Magazine, August 3, 2007.
30. Join Together.Miller agrees to drop Portland malt liquor ads.August 17, 2000.
31. Emeno A.Coalition protests sale of malt liquor in ’40s’ Black leaders called the 40-ounce bottles ‘Liquid Crack.’ They want brewers to fund antialcohol abuse messages.The Philadelphia Inquirer, July 10, 2000.
32. Csillag R.Chicago’s renegade priest.The Toronto Star. November 8, 2003.
33.Pabst Brewing Company website. Accessed February 2, 2008.
34.Colt 45 website. Accessed February 2, 2008.
35. Mullman J.Challenge: Make malt liquor look good on paper. Pabst uses icon from controversial brand’s past to reposition it as edgy to new generation of drinkers.Advertising Age, January 28, 2008.

Strategic Alliance: Tools for Shifting the Food Debate Upstream

As more communities become concerned about finding ways to reduce increasing rates of obesity, many coalitions struggle to find a way to move beyond changing individual behavior and local government policies that contribute to overweight to taking on the food industry and other more upstream influences. The Strategic Alliance for Healthy Food and Activity Environments (SA) provides a model for this more holistic approach. SA works to improve the health of Californians by providing solutions for community organizations and residents to take action to create healthier food and physical environments. Here we focus on their work to change the food and beverage industry’s influence on food choices.

The alliance’s programs examine and challenge the food and beverage industry’s influence on daily life, with a particular emphasis on practices that reach the lives of children. For example, SA has worked with others to change corporate policies on food marketing in stores and on television, the use of celebrities to endorse unhealthy products, and exclusive soda and fast food contracts with school districts. are just some of the areas where SA rallies for change. By equipping advocates with resources, research, information, training and assessment tools, SA assists communities to reduce the promotion of unhealthy food.

SA views local initiatives as the driving force for changing local, state, federal and corporate policies. By supporting these initiatives with education, media analyses and policy advocacy, the Alliance strengthens and accelerates the creation of healthier food and activity environments.

Education

SA encourages concerned citizens and organizations to learn more about the ways corporations shape nutrition and physical activity environments. To educate and mobilize parents, advocates, young people and health providers, SA publishes reports, sponsors training programs and distributes assessment tools. For example, a report called Setting the Bar: Recommendations for Food and Beverage Industry Action calls on the food, beverage and restaurant industry to “make meaningful changes to support people in making nutritious food choices.” It lists simple steps these industries can take in the areas of product, price, place, and promotion. The box below shows the suggestions that food industries can use to make products healthier. Presented in simple language, the 3 page report serves as a tool for activists and a guide for sympathetic business owners who want to make changes.

Important Steps for the Food and Beverage Industry

Provide healthy food and beverages as the standard in all children’s meals and on children’s menus.

Add new menu items that are healthy, affordable, tasty, and satisfying, including entrées, appetizers and side dishes.

Reformulate food products to decrease calories and lower saturated fat, trans fat, sodium, and added sugars, and add more fruits, vegetables, whole grains, legumes, nuts, and seeds.

Make available, and promote low calorie or no calorie beverage options without artificial sweeteners (e.g., water, low-fat milk) that help customers to manage their calorie intake.

Eliminate large and extra-large food and beverages portions.

SA also created the Environmental Nutrition and Activity Community Tool (ENACT), an interactive, networking tool and development guide designed to connect communities with effective strategies to counter health harming industry practices. The guide allows users to review successful programs, input specific needs, and evaluate ongoing projects.

For example, alliance members can use ENACT to determine the extent to which fast food endorsements of preschool educational materials effect children’s health in their communities in order to decide whether to make this action a priority.

The American Public Health Association endorses ENACT, saying it “provides a road map for change, offering a practical starting place for communities and making healthy eating and regular activity a realistic option for everyone.” [1]

Through its educational activities, SA provides materials to create initiatives and challenge the food and beverage industry’s influence in childcare centers, schools, after school programs, neighborhoods, workplaces, health care providers and government agencies. This support has helped local initiatives to, for example, limit fast food businesses in the neighborhood, improve nutrition standards in public schools, and remove unhealthy food marketing in local groceries.

Media Analysis

Since the media exert a powerful influence on food choices and public opinion on food policy options, SA also assists activists and advocacy organizations to analyze media coverage of food issues, to frame their own messages more effectively, and to design media advocacy campaigns in support of policy objectives. To achieve these goals, SA teamed up with the Berkeley Media Studies Group (BMSG) to create an advocacy project called the Rapid Response Media Network. The project serves as an action network and resource for nutrition and physical activity advocates. The goal of the project is to unravel health harming messages that blame individuals for diet related diseases, and move toward an analysis that holds corporate practices and government policies responsible for shaping our daily environments.

Advocates can engage the Rapid Response Media Network through several resources. The project monitors, analyzes and produces reports on food and beverage industry current events. Armed with the network’s reports, alliance members are encouraged to carve out the front-lines of nutrition and physical activity advocacy. The project also provides consulting services and issues ‘Framing Briefs,’ helping tease out complex messages and aiding a unified voice.

To give an example, the Network helped members analyze a quote from Jim Skinner, CEO of McDonald’s, that appeared in the Wall Street Journal. “We [McDonald’s Corp] are not going to solve the world’s obesity problem. But what we can do is be productive and be part of the solution” by providing consumers with “choices” [2].

How can advocates contextualize the underlying health messages in Skinner’s comment? The Rapid Response Media Network ‘Framing Brief,’ Reading Between the Lines, compares Skinner’s focus on “choice” to other corporate marketing and sponsorship campaigns. Philip Morris, PepsiCo and Kraft also attempted to redirect negative media attention away from unhealthy products by evoking the same strategy.

According to the ‘Framing Brief,’ “The emphasis on choice reinforces the common frame in American culture that individuals are solely responsible for their own health. Choice links directly to personal responsibility. Personal responsibility is extremely important, but decisions are always made in a context. Focusing on choice obscures the context” (p. 3).

Larry Cohen, founder of SA’s parent organization, The Prevention Institute, and author of Prevention is Primary (2007), details the importance of broadening media coverage around nutrition and physical activity environments. Cohen’s 2005 article in the California Journal of Health Promotion, The O Word [3], says that an individual-focused prevention response to obesity does not improve health and, in fact, can adversely affect communities. “…The persistent drumbeat of ‘obesity’ oversimplifies a complex issue. It places the blame squarely on the individual, without taking into account the social and economic influence of where people live, work and play” (p. 154).

Using similar reasoning, Lori Dorfman of BMSG, calls on advocates to “reframe” public health issues. To Dorfman, nutrition is just one example of how health prevention efforts can shift from individually-focused efforts to a more holistic context. In order to “reframe” issues, Dorfman says the social, economic and political context must also be considered [4].

By supporting media analysis and advocacy, SA and The Prevention Institute advance their mission of strengthening local efforts to influence corporate and government practices that shape daily nutrition and physical activity environments.

Policy Advocacy

In addition to its educational and media work, SA also seeks to advance a policy agenda that addresses local, state, federal and corporate food policies. Its steering committee includes such organizations as The California Adolescent Nutrition and Fitness Program, California Center for Public Health Advocacy, California Food Policy Advocates, California Pan Ethnic Health Network; California Park & Recreation Society; California Project LEAN; California WIC Association, Child Care Food Program Roundtable; Latino Health Access Prevention Institute, and the YMCA of the East Bay, giving the group access to hundreds of organizations and thousands of individuals. By bringing consistent policy messages to legislators, Mayors and the Governor from these sources, SA enhances its political clout.

Its policy recommendations, included in reports such as Taking Action for a Healthier California: Recommendations to Improve Healthy Food and Activity Options, recommend steps the food and beverage industry can take to improve food environments and also public policies to monitor industries impact on health more carefully. Several recommendations are open-ended, allowing communities to tailor community-specific programs. For youth involved in pre-school, public school and after-school settings, for example, SA recommends the removal of advertising and marketing of unhealthy food, provisions for nutritious food standards, and increasing physical activity programs.

Taking Action for a Healthier California is changing the way some California cities approach prevention efforts. As a result of local policy advocacy, San Francisco and the City of Berkeley have endorsed many of SA’s recommendations, joining more than 75 organizations that have committed to improving nutrition and physical activity environments.

Working to further develop action at the policy level, SA tracks local policy decisions related to food and physical activity through the ENACT Local Policy Database (ENACT LPdB). Policy coverage includes school district, city, county and state levels where community activities and coalitions have worked to achieve change.

Advocates are encouraged to use the ENACT website and ENACT LPdB as both educational and development models. The approach endorsed by SA is designed to motivate advocates to “act locally” through social organizing around the role of the built environment.

A year ago, the Strategic Alliance issued a report called Where’s the fruit? charging the food industry with deceptive labeling and advertising of many processed foods by implying they contained more fruit than they did. The report attracted broad television and newspaper coverage, educating millions of people about the issue. “The deception is really intolerable,” Larry Cohen, executive director of the Prevention Institute, told the San Francisco Chronicle [5]. “There is really no excuse for misleading parents in a way that weakens their ability to encourage their children’s health” [5]. By bringing together researchers, community organizations and policy advocates SA had helped to ‘reframe’ the way society views health behavior and politically popular policy recommendations. Equally important, SA had given local activists the tools they needed to move their fight for healthier food upstream, from individual and parental responsibility to corporate accountability.

 

References

1. Food and Nutrition Resources. American Public Health Association. Summer 2006 Newsletter. Available at: http://www.apha.org/membergroups/ newsletters/sectionnewsletters/food/summer06/2494.htm.

2. Adamy J. Boss Talk: How Jim Skinner Flipped McDonald’s. Wall Street Journal. Jan 5, 2007. B1. Available at: http://wsjclassroomedition.com/monday/mx_07jan08.pdf.

3. Cohen L, Perales DP, Steadman C. The O Word: Why the focus on obesity is harmful to community health. California Journal of Health Promotion. 2005;3(3):154-61. Available at: http://www.csuchico.edu/cjhp/3/3/154-161-cohen.pdf.

4. Dorfman L, Wallack L. Moving Nutrition Upstream: The case for reframing obesity. J Nutr Educ Behav. 2007;39(2 Suppl):S45-50. Available at: http://linkinghub.elsevier.com/retrieve/pii/S1499404606006014.

5. Finz S. Fruit Shown on Lable Often Not in Box, Kids’ Food Study Says. San Francisco Chronicle. Jan 26,2007. Available at: http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2007/01/26/ MNGMHNPK671.DTL.

New Resources on Global Trade and Public Health

At the November 2007 meeting of the American Public Health Association in Washington, D.C., several sessions addressed the issue of trade and health.  Many of these sessions were sponsored by the new Trade and Health Forum and address global economic policies that generate health disparities.

Presentations on global trade and public health are now posted on the CPATH website at:  http://www.cpath.org/id28.html

Corporations, Health and the 2008 Presidential Elections, Part 1: Following the Money

Presidential elections provide one opportunity to shine some light on how Big Business seeks to create a political environment favorable to its interests. Between now and November 2008, Corporations and Health Watch will include periodic reports on the positions of leading Presidential candidates on public oversight of corporate practices that influence health; the elections roles of the pharmaceutical, food, tobacco, automobile and other industries, and the prior legislative records and corporate involvement of major candidates. Our first report focuses on the role of money: what industries are contributing to the various candidates. Our focus here and in future reports is on the role of the industries monitored by Corporate Health Watch: alcohol, automobiles, firearms, food and beverages, pharmaceuticals and tobacco.

Using analyses conducted by Open Secrets at the Center for Responsive Politics, we can identify contributions made to the 2008 Presidential campaigns by both political action committees (PACs) and individuals affiliated with a particular industry (usually as a result of employment) through September 30, 2007. Final 2007 reports will be available at the end of January 2008. Our report covers the 3 major Democratic candidates and the 5 leading Republicans.

PAC and Individual Contributions by Selected Industries for 2008 Presidential Candidates

Candidate Registered Lobbyists Pharma & Health Products Health Profs Tobacco
Democrats        
Hillary Clinton $567,950 $269,436 $1,695,830 $36,600
John Edwards $18,900 $15,000 $419,326 0
Barack Obama $76,859 $261,784 $1,330,743 $8,885
Republicans        
Rudolph W. Giuliani $212,100 $138,850 $1,026,452 $77,400
Mike Huckabee $6,964 $500 $70,750 0
John McCain $340,365 $69,300 $568,880 $5,600
Mitt Romney $229,475 $260,535 $1,041,267 $32,400
Fred Thompson $90,000 $26,900 $174,675 $1,250

Totals on these charts are calculated from PAC contributions and contributions from individuals giving more than $200, as reported to the Federal Election Commission. Individual contributions are generally categorized based on the donor’s occupation/employer, although individuals may be classified instead as ideological donors if they’ve given more than $200 to an ideological PAC. Shows contributions through September 30, 2007.
Source: Open Secrets

As shown above, Hilary Clinton led the Democratic field in contributions from all four categories of contributors, although Barack Obama was a close second in contributions from the pharmaceutical industry and from health professionals and their organizations. On the Republican side, Mitt Romney led the pack in total fund raising form these four sources with Rudolph W. Giuliani a close second. Health professionals split their contributions fairly evenly among Republicans and Democrats as did the pharmaceutical industry and registered lobbyists. Only tobacco consistently favored Republicans, giving about twice as much to them as to Democratic candidates. Note that on the Democratic side, the level of contributions were somewhat similar to the level of support received from Iowa caucus goers and New Hampshire voters. For the Republicans, however, Iowa winner Mike Huckabee received few contributions perhaps because of his late rise in the campaign, while candidate Rudolph Giuliani won substantial support from contributors but not Iowa or New Hampshire voters.

Industry’s bipartisan approach to political contributions reflects both the heterogeneity of these categories, at least within mainstream American politics, but also the hedge- your-bets philosophy of special interests. No matter who wins, they want a friend in the White House. Registered lobbyists larger contributions to Clinton and McCain may demonstrate these candidates’ longer tenure in Washington and thus their established relationships with lobbyists.

While both the pharmaceutical and health products industry and health professionals (hospitals, medical associations, medical suppliers) provided substantial support to several candidates, these industries were not the major contributors to these campaigns. Donors from the securities and investment, legal, hedge fund and real estate industries were more significant donors to most major candidates than the industries shown in the table above.

Role of the Pharmaceutical Industry

As James Ridgeway and Joan Casella noted in Mother Jones recently, “Any candidate who genuinely plans to confront Big Pharma must be prepared to give up a boatload of cash”. Between 1998 and 2007, the pharmaceutical industry spent more on lobbying than any other industry, spending a total of $1.3 billion with $191 million in 2006 alone. Between 1990 and 2007, drug manufacturers contributed a total of $149 million to federal election campaigns. On the Democratic side, John Edwards has failed to raise significant contributions from Big Pharma, perhaps because of his prior life as a trial lawyer who won large settlements from pharmaceutical and health care industries.

PAC Contributions

Another perspective comes from an examination of PAC contributions to the Presidential candidates. According to the Center for Responsive Politics, as shown below, business PACS heavily favor Republican candidates and Labor PACS, not much of a presence in 2008 contributions to date, heavily favor the campaign of John Edwards. Single issue groups are organizations that span the ideological spectrum and support or oppose issues such as abortion, gun control, or gay marriage. They constitute a major component of Barack Obama’s PAC contributions but without analyses of the specific sources it is difficult to draw conclusions.

Finally, it is worth noting that PAC contributions constitute no more than 1% of total contributions to any candidate and do not play a major role in funding campaigns. Their value lies in showing how organized political interests are rating the various candidates.

Per cent sources of PAC Contributions for 2008 Presidential Candidates

The totals in these charts are calculated from PAC contributions, as reported to the Federal Election Commission. Contributions from individuals are not included in this breakdown.
Source: Open Secrets

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

Candidate Business Labor Single Issue Groups Total contributions
Democrats        
Hillary Clinton 56% 11% 33% $748,052
John Edwards 4% 52% 44% $11,587
Barack Obama 26% 0% 74% $12,437
Republicans      
Rudolph W. Giuliani 70% 1% 29% $265,992
Mike Huckabee 60% 0% 40% $27,974
John McCain 72% 1% 27% $458,307
Mitt Romney 60% 0% 40% $298,700

 

Part 1: Following the Money
Part 2: Clinton, Obama and McCain on the Role of Corporations Part 3: Clinton, McCain, Obama and the Food Industry

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 http://www.fda.gov/ohrms/dockets.) 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.

 

References

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 http://www.ama-assn.org/ama/pub/category/print/16461.html

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 http://www.iom.edu

5. World Health Organization, Global Strategy on Diet, Physical Activity and Health. Cardiovascular Disease: Prevention and Control. Accessed January 9, 2008 at http://www.who.int/dietphysicalactivity/publications/facts/cvd/en/

6. Consensus Action on Salt and Health. Accessed January 9, 2008 at http://www.actiononsalt.org.uk

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 http://www.cspinet.org/salt/saltreport.pdf

8. Salt Assault: Brand-Name Comparisons of Processed Foods. Washington, DC: Center for Science in the Public Interest.http://www.cspinet.org/salt/updated_saltreport.pdf

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 http://www.cfsan.fda.gov/~comm/registe7.html

11. EU Salt, European Salt Producer’s Association. Accessed December 22, 2007 at http://www.eusalt.com

12. The Salt Institute. Accessed December 22, 2007 at http://www.saltinstitute.org/2.html

13. The Salt Institute. December 2007 Newsletter. Accessed December 22, 2007 at http://www.saltinstitute.org/news07-dec.html#article1

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 athttp://www.foodcomm.org.uk/hexagon.htm

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.

Tracking the Effects of Corporate Practices on Health