McDonald’s and Children’s Health: The Production of New Customers

In a recent study published in the Archives of Pediatrics and Adolescent Medicine, 1 researchers found that low income 3 to 5 year old children preferred the taste of hamburgers, chicken, French fries, carrots or low fat milk if they thought the products were from McDonald’s, whether or not they actually were. Thus, in their first years of life, children had come to associate McDonald’s branding with desirable foods, creating a lifetime potential for obesity and over consumption of the high fat, low nutrient products that McDonald’s features. To understand its success in imprinting even the youngest children, Corporations and Health Watch investigated the range of McDonald’s activities geared towards children. By focusing on the specific ways that one company goes about reaching children, we hope to gain insights that can guide public health strategies to reduce childhood obesity.

According to its 2006 Annual Report, McDonald’s is the leading global foodservice retailer with more than 30,000 local restaurants serving 52 million people in more than 100 countries each day. Its 2006 revenues were $ 21.6 billion, up 16% from 2004.

 

McDonald’s leads in food advertising to children

Marketing directly to children began in the 1960s. McDonald’s founder Ray Kroc, along with Walt Disney, has been credited with recognizing that children constitute a valuable and distinct market segment. Kroc observed that, “A child who loves our TV commercials and brings her grandparents to a McDonald’s gives us two more customers.” 2(p. 41) Developing brand loyalty in children influences both later purchases and the buying patterns of parents. At the forefront of marketing to children, McDonald’s spends more on advertising in general than any other brand. 2(p. 4) In 2006, McDonald’s spent almost $2.5 million a day on traditional advertising in the United States. About 40% of McDonald’s total advertising budget is directed at children. 3(p.102)

The use of cartoon characters and icons

Ronald McDonald, the face of McDonald’s, is a symbol of the corporation’s dedication to reaching young customers. The only fictional character with a higher degree of name recognition by children is Santa Claus. 2(p.4) A study of 9-10 year old Australian youth demonstrated that more than half believed that Ronald McDonald knew what was best for them to eat. 3(p.100) To reinforce the association of fun and entertainment with its fast food, McDonald’s offers a line of videos featuring Ronald McDonald and the McDonaldland characters. McDonald’s use of cartoons to market to children extends to the Internet as well. An earlier version of the McDonald’s children’s website told young visitors Ronald was the “ultimate authority on everything” and they were encouraged to send Ronald an email telling him their favorite food items, their favorite sports team, favorite book and their name. 2(p. 45) Directly soliciting children for personal information is now prohibited without parental approval thanks to the Children’s Online Privacy Protection Act of 2000. One of the McDonald’s current websites aimed at children, Ronald.com, tells children they can “learn, play and create while having fun.” On the site, children interact with “adver-games” which are designed to engage children with both the game and an advertisement. The site’s games all feature Ronald McDonald somewhere in the game. Happymeal.com, a site designed to encourage children toward physical activity, also prominently features the “Happy Meals” logo each time a new game is opened.

Restaurant design

The atmosphere of McDonald’s itself is designed to be “family friendly.” McDonald’s operates more than 8.000 playgrounds around the United States, more than any other private American corporation and far more than any municipality. Originally modeled on Disney World, the playgrounds provide an environment that is designed to appeal to children through bright colors, toys and clowns, and also to parents by providing a safe place for children to play. For children who live in low-income neighborhoods without safe or adequately maintained public parks and playgrounds, McDonald’s may offer one of the few opportunities for such forms of play and sociality. Birthday and other parties can be held at many McDonald’s which provides, on a cost per child basis, the food, invitations, paper and plastic wear, party entertainers, party favors and clean-up afterward. These design elements contribute to associating McDonald’s with fun and socialibility.

Toys and entertainment

In 1979, McDonald’s launched its first “Happy Meal,” which included numerous toys such as a “McDoodler stencil,” a puzzle book, and McDonaldland character eraser in a cardboard box with a circus theme. By 2003, 20% of McDonald’s meals sold were Happy Meals and they accounted for $3.5 billion in revenues. The fast food giant stands as one the United State’s largest distributors of toys. 2(p. 4) In addition to toys, McDonald’s appeals directly to children through cartoon characters, catchy jingles, and food shaped and colored to appeal to children. In addition, McDonald’s develops strategic partnerships, sponsorships, character licensing agreements and endorsements with celebrities and corporations such as NBA stars, Disney, the Fox Kids Network, DreamWorks and the Olympics. 2 Among the celebrities who have done product endorsements for McDonald’s are Venus and Serena Williams, Cedric the Entertainer, Kobe Bryant and Michael Jordan. Through such alliances, McDonald’s aims to have children associate the good feelings they have about celebrities, characters and companies with McDonald’s itself. That fit and celebrated athletes promote its products further associates McDonald’s with health and fitness.

In addition to television commercials featuring celebrities and promoting cartoon character toy give-a-ways, McDonald’s targets children through product placement and sponsorship. The fast food company has paid to have its food products featured in such children’s films as “George of the Jungle,” “The Flintstones,” and “Richie Rich.” 3(p.113) McDonald’s also sponsored the children’s show “The Teletubbies” and distributed toys representing the four characters. As with the Teletubbies, the company produces multiple versions of toys associated with movies and television. 4(p. 181) Children are encouraged to collect them all to obtain the full set, thus encouraging return visits—and more Happy Meals. In 1999 alone, McDonald’s released eighty different versions of Furby. 2(p.47)

McDonald’s marketing to children extends beyond television commercials, kid-friendly websites, toys and playgrounds. In 1987 McDonald’s launched their “McKids” line of clothing that was initially sold at Sears, Roebuck & Co. It was later picked up by Wal-Mart which dropped the line in 2003. Now McKids is offering a line of branded toys such as bikes, skateboards and scooters designed to encourage children to be more active between their visits to the Golden Arches.

McEducation

In their 2005 study of the clustering of fast food restaurants around public schools, Bryn et al reported that “Fast-food restaurants are concentrated within a short walking distance from schools, exposing children to poor-quality food environments in their school neighborhoods.” In the early years of McDonald’s, founder Ray Kroc actually flew in a Cessna scouting for new sites near schools. 2(p. 66) Like other fast food companies, McDonald’s does more than just place itself close to schools; in recent years it has opened outlets within high school cafeterias. According to a recent CDC survey, in 2006, 24% of the nation’s high schools and 19% of its middle schools offered on-site brand name fast foods.

McDonald’s also sponsors Channel One programming, provides educational curricula that feature information about working at McDonald’s and offers incentive programs, like “McSpellit Club,” whereby students can earn meals at the restaurant for spelling, reading and good attendance. 4,5 In addition, McDonald’s is a client of Cover Concepts, a company which provides branded textbook covers free to students and schools. 5 Finally, in 2005, with 31,000 elementary schools around the country, McDonald’s launched its “Passport to Play” program, aimed at encouraging physical fitness for third through fifth graders. Each time children play a game from around the country, they receive a golden arches stamp on a pretend passport. The website states, “Passport to Play is a fun way to keep kids’ minds engaged and bodies active. Teach your students how kids from around the world play, snack and grow [emphasis added].” Bryn Austin, assistant professor of pediatrics at the Boston Children’s Hospital suggested the program might be a “Trojan Horse” created to keep McDonald’s name in schools.

But McDonald’s doesn’t just take money from students; it raises money for them. In New Haven, CT, a group of teachers and staff from the New Haven Middle School participated in a McDonald’s educational program working a 4 hour shift at the counters and the drive-up window. By doing so, their school received 20% of the profits during the time they staffed the establishment. While the teachers worked, students decorated the walls of the restaurant with pictures of the golden arches. 3(p. 130) On October 13 of this year, 450 McDonald’s establishments in Tennessee participated in a similar “McTeachers Night” program. In addition, the corporation sponsors young people’s sports teams such as the McDonald’s All American High School Basketball Team.

Strategic Locations and Charity 

To keep its name in front of young people, McDonald’s develops partnerships with institutions where children are likely to be found. In August 2001, the fast food corporation began a 10 year, $16 million contract with the Smithsonian Institution’s Air and Space Museum. The museum features McDonald’s food as well as food from two other companies owned by McDonald’s, Boston Market and Donatos Pizzeria.3(p. 300) The Philadelphia Children’s Hospital and other children’s hospitals around the country feature a McDonald’s in their facilities. Finally, The Ronald McDonald House Charities has provided housing and meals to families with more than two million seriously ill children, further reinforcing the idea that Ronald McDonald and the McDonald’s corporation care about children’s health.

Influencing parents to reach children

Children are believed to influence approximately $500 billion of spending each year. 3(p. 101) Thus, while McDonald’s focuses much of its marketing on children, the fast food giant also seeks to influence parents’ purchasing decisions. Corporate memos discuss the company’s desire for adults to feel like “good parents” by taking their children to McDonald’s in order to make them happy. 2(p. 50). To counter criticism that fast and junk foods contribute to obesity and other health problems, McDonald’s recently launched a contest to recruit mothers for three day paid field trips where they will be given access to the farms “where our fresh ingredients are grown, to our world-class suppliers and to our restaurants.”

McWorld

As McDonald’s saturates US markets and succeeds in attracting young Americans as lifetime customers, growth increasingly depends on expanding its consumer base through overseas marketing. McDonald’s opens about four new restaurants every day overseas. 2(p.229) The table below shows the growth in McDonald’s outlets in various parts of the world between 1991 and 2001. 3(p.58)

Growth in McDonald’s Outlets by World Region, 1991-2001

In preparation for the 2008 Beijing Olympics, McDonald’s is promoting aninternational contest for 300 children, 100 from China, to win trips to the games.

The increased visibility and availability of McDonald’s around the world has succeeded in reaching greater numbers of children. At one primary school in Beijing, all of the children recognized and liked Ronald McDonald, and believed that “Uncle McDonald was funny, gentle, kind and…understood children’s hearts.” 2(p. 231) In Japan, 98% of children recognized Ronald McDonald; In England the figure was 93%. 3(p. 99) Ronald McDonald speaks to children in twenty-five languages including Russian, Portuguese, Tagalog, Hindi, Cantonese and Papiamento. 3(p. 13) A 1996 survey of children’s television programming in Australia, Austria, Belgium, Denmark, Finland, France, Germany, Greece, Netherlands, Norway, Sweden, UK and the United States found that McDonald’s was the most prolific advertiser overall.

But does it work?

Commenting on the results of the previously mentioned study of children’s preference for food with a McDonald’s packaging, company spokesman Walt Riker stated that McDonald’s had been “actively addressing” the issue of children and nutrition and that McDonald’s was “providing solutions.” However, Dr. Victor Stasbuger, an author of American Academy of Pediatrics policy calling for limits on marketing to children argued that the study illustrated the success of fast food marketing to children: “Advertisers have tried to do exactly what this study is talking about–to brand younger and younger children, to instill in them an almost obsessional desire for a particular brand-name product.”

Impact on health

In 1998, 89% of children in the United States eight years of age or younger had visited a McDonald’s at least once a month. In response to this information, R.J. Milano, a McDonald’s Vice President stated that their goal for the following year was to reach 100%. He boasted “I’m going to own every kid transaction out there.” 3(p. 291). The health impact for both youth and adults of increased intake of salt, fat and sugar associated with the consumption of fast and junk foods has become clear as rates childhood obesity and type 2 diabetes have escalated. At least 30% of calories in the average child’s diet are currently derived from fast food, salty snacks, sweets and soft drinks. In response to increased media attention and legal action, fast food companies such as McDonald’s claim to be offering healthier alternatives. In addition, McDonald’s was one of 11 major food companies that recently agreed to limit voluntarily its food advertising to children . Recently McDonald’s began offering Happy Meals with slices of apples and milk. However, while the new Happy Meals did reduce overall fat and calorie content, the “Apple Dippers” included in the meal increased the sugar content. Additionally, while McDonald’s has done away with its “supersize” option for adults, in 2001 it introduced “Mighty Kids Meals” which offer more food for only slightly more money.

Regulations around the world

More than 50 other countries currently regulate marketing directed at children. Twenty-five European states prohibit advertising during children’s programming of a duration of 30 minutes or less. In 1992, Sweden banned all television marketing directed at children twelve and under. Similarly, advertising in children’s programming have been banned in Ireland, Norway, Belgium and Holland.1 Since 2001 Broadcasting Commission of Ireland has prohibited the use of celebrities and cartoon characters to advertise food. Regulations disallowing advertising to children 13 years or younger have been in effect since 1980 in the Canadian province of Quebec. In the United States, the Federal Trade Commission lacks the authority to restrict television advertising. Given the previous failure of voluntary guidelines to reduce growing rates of obesity, numerous advocacy and public health groups have called for government regulations.

Recommendations

Many public health organizations in the United States and elsewhere have made specific recommendations. In December 2005, the Institute of Medicine (IOM) released a comprehensive report on the impact of food marketing to children in the United States. The report found that American children are not achieving basic nutritional goals both in terms of underconsumption of important nutrients and overconsumption of fat, salt and sugar. While the dietary patterns of children are a complex in origin and include cultural values, economic status, social environments and media environments, the IOM concluded that food and beverage marketing “influences the preferences and purchase requests of children, influences consumption at least in the short term, is a likely contributor to less healthy diets, and may contribute to negative diet-related health outcomes and risks among children and youth.”

Strategic Alliance, a coalition of nutrition and physical activity advocates in California, recommends that all marketing and advertising of junk and fast foods be eliminated for children and youth. Amongst other measures, International Association of Consumer Food Organizations (IACFO)—an international association of non-governmental organizations representing consumer interests in the areas of nutrition, food safety, and food policy—urges governments to restrict or ban all food advertisements to children and prohibit the marketing of soda, junk and fast foods in schools. The IACFO also points to the importance of global action on this issue, noting that restrictions in the developed world often send multinational corporations overseas to the global south where they market unhealthy products with greater ease. Given escalating global rates of diet related chronic disease, public health and advocacy calls for more stringent and federally and globally enforceable standards seem warranted. In the words of Gro Harlem Brundtland , former Director General of the World Health Organization: “Marketing approaches matter for public health. They influence our own–and in particular our children’s–patterns of behavior. Given that they are designed to succeed, they have serious consequences for those at whom they are targeted.”

Zoe Meleo-Erwin, MA is graduate student in sociology at The Graduate Center, City University of New York.

 

References

1. Robinson, TN; Borzekowski, DLG; Matheson, DM & Kraemer, HC. Effects of Fast Food Branding on Young Children’s Taste Preferences. Archives of Pediatrics and Adolescent Medicine. 2007. 161(8):792-797.
2. Schlosser, E. Fast Food Nation: The Dark Side of the All-American Meal. 2001. Boston: Houghton Mifflin.
3. Brownell, K. & Horgen, KB. Food Fight: The Inside Story of the Food Industry, America’s Obesity Crisis & What We Can Do About It. 2004. New York: McGraw Hill.
4. Nestle, M. Food Politics: How the Food Industry Influences Nutrition and Health. 2002. Berkeley: University of California Press.
5. Story, M. & French, S. Food Advertising and Marketing Directed at Children and Adolescents in the US. International Journal of Behavioral Nutrition and Physical Activity. 2004;1:3. Available at: http://www.ijbnpa.org/content/1/1/3. Accessed October 21, 2007.

Photo credits:

1. La Fotodama 
2. Sama Sama – Massa
3. Petite-Tomo

Interview with Kathryn Montgomery

Kathryn Montgomery is a professor in the Public Communication division of the School of Communication at American University where she heads the University’s Center for Social Media’s “Youth, Media and Democracy” project. She also works with the Center for Digital Democracy and the Berkeley Media Studies Group. In 1991, Montgomery founded the media advocacy group the Center for Media Education where she served as President for twelve years before the Center was closed. She is the author of two books, Target: Prime Time. Advocacy Groups and the Struggle over Entertainment Television (Oxford University Press, 1989) and Generation Digital: Politics, Commerce, and Childhood in the Age of the Internet (MIT Press, 2007), as well as other numerous publications including the 2007 report Interactive Food & Beverage Marketing: Targeting Children and Youth in the Digital Age which she coauthored with Jeff Chester. Montgomery has been a strong advocate in the areas of youth, health, education, and the democratic use of media.

Her research and advocacy work helped lead to the passage of a Federal Communications Commission ruling which required a minimum of three hours per week of educational/informational television programming for children; a television content based ratings system, and the first federal legislation designed to protect children’s privacy on the internet.

Corporations and Health Watch spoke with Kathryn Montgomery about the new digital media environment, how corporations target children and young people as consumers in increasingly sophisticated ways, and what efforts might be taken to curtail such corporate practices.


CHW
: Tell me about your early work on youth, digital media and marketing with the Center for Media Education.

KM: Early on we began looking closely at digital media. Here was a powerful new medium coming into place and not very many people were really looking at how it was going to affect children. The debates were mainly about pornography and safety online. We were given funding in the mid 90s by the Carnegie Corporation of New York to examine the marketing targeted to children on the Web. We also got a research grant from the Robert Wood Johnson Foundation to look at Alcohol and Tobacco marketing on the web. Even though there were a lot of people concerned about advertising in traditional media, not enough people were looking at the digital media. And this is where all marketing and advertising are going. If you’re going to do any interventions, you have to understand where it’s all headed. We also wanted to educate not only our fellow advocates and the professionals and academics in the field, but the regulators themselves. So we provided the kind of details that could help them in their investigations. Our efforts to document the marketing practices targeted at children resulted in the first law to protect children’s privacy on the internet.

CHW: Can you give me an overview of the current scope of marketing to youth?

KM: Well you know it’s kind of hard to put a figure on it. I know that at the present time all marketing online figures are something like 80 billion. It’s growing very rapidly, and children and teenagers are a very big market online. It is important to understand that in this new media environment the distinctions between online and offline are being completely blurred and, in some cases, obliterated, so we’re really just talking about an overall shift in the way marketing is done this notion of the “360 degree” approach which we wrote about in our report. The marketing encompasses a lot of different platforms; it is designed to be ubiquitous in children’s lives, following them wherever they go, online and off.

CHW: Although there’s a lot of integration, how is internet marketing to children different than what you would find in television or other forms of media like magazines?

KM: We’re talking about a complete integration of advertising and content. In many cases we’re talking about websites and other digital content areas that are engaged not just in marketing to children, but enlisting their involvement in market research. So it’s a very different, more all encompassing kind of medium and the marketing may be more subtle because it isn’t just that you’re seeing a lot of commercials but it’s a website; it might be an adver-game a gaming site that’s really for a product.

CHW: What can you tell me about adver-games? Unlike product placement, this seems like a very active engagement of youth with corporate marketing.

KM: Right. Some of the advertising in interactive games that we documented in our food marketing report is pretty similar to product placement but it’s interactive: you’ve got players who can interact with the ad. The ads are programmed and the software is programmed to track people’s behavior; they do profiling so that they know who you are. The whole thing is engagement; they want you engaged with these products.

CHW: Have you seen any data that would suggest that this sort of interactive marketing is more effective than just passively seeing a commercial?

KM: Except for those who are working for industry, I haven’t seen anything that really tries to address these things. A lot of market research is proprietary. To my knowledge there has been very little, if any, research within the academic community. I’ve been trying to get other academics to do this kind of research for a long time. I think partly because it’s changing so quickly, it’s kind of hard to get a handle on. And it’s not easy to develop research designs that will work. But if you look at the literature, and we cite a huge amount of it in our report, there’s documentation from the industry that these things are successful. Now obviously they’re experimenting with some of them, some things work better than others, but they are spending huge amounts of money in market research. This digital generation is the most researched generation in history.

CHW: Can you explain how “cradle to grave marketing” works?

KM: Marketers have been saying for at least twenty years, that with young people, in addition to the fact that they have money to spend, you want to instill brand loyalty. So you want to be able to get those young people to want your product at a young age. And now, interactive marketing and this incredible capability for profiling adds new meaning to “cradle to grave” because they can not only get you to feel loyal to the product they can actually follow you from cradle to grave, across platforms.

CHW: What about the tobacco or alcohol corporations that are specifically prohibited from marketing to children, how do they go about this?

KM: Of course they [the tobacco industry] say they’re not doing it, but then their efforts have been curtailed obviously. The settlement with the attorneys general forbade certain practices but we also know that they try their best to use other venues. The work that we did predated that decision because our report came out in 1997, but we did not find a lot of overt marketing online of these tobacco products to young people. Now it’s a lot harder to track. We know that in other media they’ve used the kinds of strategies that are designed to circumvent any rules and regulations and we still have major problems with teen smoking. So whether it’s some sort of peer-to-peer effort, there are all kinds of strategies that these companies may be using. We know that for all product categories targeting youth if you can link your product up with pop culture that’s very successful.

The alcohol companies don’t want any regulation on their marketing and they would argue that they’re not marketing to young people. But what we’ve found, and I’m not sure this has really changed, is that online they make a lot of their websites and their marketing efforts very appealing to young people of course they’re saying that you have to be 21, but there are many ways to get around that.

CHW: Can you describe how the food industry, which is not prohibited from marketing to youth, uses digital media and integrative media strategies?

KM: There are a million different ways they do it and they have really developed a panoply of interactive techniques that are designed to engage young people with their brand. They’re very complicated. Anything from putting their ads on mobile technology, offering coupons, having young people spread the word through email to their friends or working through social networks like MySpace and FaceBook to encourage people to use the brand icon, to putting what are known as viral videos on YouTube. Also there’s user generated video, this idea that you get young people to actually create the ads themselves for the products. Pizza Hut did this: “We can make you the vice president of pizza if you’ll make an ad.” They get hundreds and hundreds of young people, probably many more than that, creating their own ads, posting them, and then it spreads like wildfire. And we also know that food marketers and beverage marketers and others are researching who the most effective influencers are, and are recruiting them to promote brands among their peers.

CHW: How do they go about recruiting these influential young people?

KM: Oh there are all kinds of ways they do it. Market researchers can study social networking sites to find the young people with the largest networks of friends, for example. They have found ways to identify online who the “brand sirens” are, the people who like to talk about brands among their friends. There’s a company called Tremor that recruits young people to be part of this elite group of “tremorites.” It’s run by Proctor and Gamble and they work for other clients as well, including some of the beverage companies. Teens are invited to become a part of a privileged group and then given new products and programs in advance and encouraged to tell their friends about them.

The other thing to understand about marketing, particularly to adolescents in the new digital media, is that a lot of these efforts are designed to tap into the fundamental developmental needs of young people. Young people are experimenting with their identities: “how do I show who I am?” Of course marketers have done this for a long time. But now they have techniques that are even more powerful. So if you’re creating your profile on MySpace, in addition to your friends, you can include the brands that you like and that express who you are. Peer-to-peer involvement and being able to use the new digital media to convey your own ideas and to express what you think and feel lends itself beautifully to viral marketing.

CHW: One of the ways in which corporations go about getting their message out there broadly is through market segmentation: breaking up potential groups into discreet groups that can be reached with unique messages. Can you talk about some of the ways that food, alcohol, tobacco, and other industries go about trying to reach a broad range of young people?

KM: This is a rapidly changing digital media marketplace, so as we speak new techniques are being developed. But what I think we are seeing generally with market segmentation in the digital era is further, more refined and more microtargeted marketing that breaks people down not just by their preferences, demographic groups, spending and zip codes, but by their behavioral qualities that can be tracked online through behavioral profiling and database marketing. The important thing is that with these new, sophisticated technologies and the interactive media, people are marketed to as individuals not as segmented groups. Marketers are able to find out what you personally will respond to and they can adjust their advertising accordingly. And particularly looking at the social networking platforms where they can use the information you post about yourself, it’s incredible what these marketers are able to know about you. I think that most consumers don’t have a clue; I don’t think parents have a clue.

CHW: What’s your opinion about the recent announcement by eleven major food and drink companies to voluntarily limit television advertisements to US children under the age of 12?

KM: Well I’ve been monitoring this pretty closely and I was a speaker at the Federal Trade Commission workshop when the most recent announcement was made. There are some very important limitations to what these industries have agreed to do. First of all, the fast food restaurants were not well represented; we’ve got Burger King, before we had McDonald’s, but that whole industry is still not on board. Secondly, the changes that they have vowed to make are only going to apply to marketing that’s targeted at children under the age of 12. That’s totally leaving out adolescents and I would say its even leaving out “tweens” because they watch the stuff that’s targeted at older kids. Adolescents are very much at risk for obesity and they also make more of their own decisions about what they eat.

They’re not at the store saying, “buy me that;” they’re out in those fast food restaurants with their friends. So they need some interventions and the industry hasn’t come forward with anything. Finally, most of the voluntary advertising guidelines are focused on television, with very few changes to the emerging practices in the digital media.

CHW: Would you say that this announcement was something of a preemptive strategy by the industry to avoid further criticism?

This is a pattern: the industry will try to get by with as little as it can and hope the problem goes away. It will not bring up anything else unless we say “aha, but you’re doing this” and there’s a huge outcry about it and the government cares. So they are way ahead of the regulators and way ahead of the public on this stuff. I’m not suggesting that the industry is doing nothing; yes they are doing something, but they don’t want to be regulated. So they’re doing something to keep from being regulated. We need ongoing pressure on the industry and ongoing monitoring of what the practices are and the government has to play a leadership role. And I think the FTC is, but we’ll see what happens next. This is a longterm problem that’s going to take longterm strategies and none of the advocates and health professionals and other stakeholders can afford to let up the pressure. We have to continue; we’re in here for the long haul and its very important.

CHW: What do you think are the best policy solutions to curtail the influence of corporate marketing on youth and youth spaces?

KM: Well it’s a tough area to regulate directly. I don’t think it’s politically viable to call for a ban on advertising. These bans have not worked in the past. You cannot reverse these trends. But I think you can call for some rules of the game, which could include identifying certain practices that marketers should not use. When you deal with products like junk food, soft drinks, fast food restaurants, alcohol and tobacco, there you can have more restrictions. We haven’t had a very courageous government in the past that has wanted to tackle these marketing practices, and unfortunately the advocacy community has not had the knowledge and sophistication about the nature and extent of digital marketing to push an agenda. But we’re working to try to educate people to really see that there are some areas where interventions should be made and there is a proper role for government in developing them.

CHW: And do you see policy efforts as something that should happen at the national or international levels or is there potential for change at the state and municipal levels as well?

KM: Most of these are global corporations, so I think there is a need for some global initiatives, for groups across the world to work together and for regulatory agencies to work together. But at the same time I think there could be some statebased interventions or local interventions, certainly in terms of public accountability and education. In the tobacco control and alcohol control movement there have been some very successful efforts at the local and the state level.

CHW: What does digital marketing to youth look like outside of the United States? Is it a worldwide phenomenon, or is it more based in developed countries?

KM: We know this is a global phenomenon. In many ways, digital marketing is leapfrogging over national boundaries and directly into developing countries. Marketers are moving in very swiftly and very aggressively in many of these countries and sometimes I think too quickly to do anything about it. At the same time, we need to recognize that there are other critical international policy issues in addition to addressing the role of marketing. For example, we need to ensure equitable access to digital technologies. Because these technologies are a good thing for young people and we still have a digital divide in many places throughout the world. We will also need policies to ensure that the digital media are harnessed to improve the lives of young people.

CHW: In terms of advocacy efforts to change corporate practices, what tactics do you see as being effective?

KM: I think we need a multiple set of strategies coming from all kinds of different directions, at the national level, at the international level, at the state level, at the local level. And we need many more groups and individuals involved. And I think that the press is very important. If the pressure does not involve public exposure and what the health advocates have called “public shaming” then its not going to have much of an impact. You have to put heavyduty pressure on the industry, which will, in turn succeed in educating the public and letting policy makers know this is a problem. Strategic use of the media is a critical part of it.

CHW: Do you think that there’s any potential for digital media to serve as a counterforce against marketing to youth?

KM: I do think there’s a potential. The study we did in 2004 on the Internet and youth civic engagement showcased hundreds of nonprofit websites for and by young people. But we also found that many of these ventures were seriously underfunded. It was really not easy to compete in the powerful marketplace. Nor was it easy to recruit young people to be involved when you have the glitz of a MySpace or the popularity of a FaceBook. So I think they’ve got a lot of challenges facing them. But I believe there’s a huge amount of potential there. There’s a lot of great stuff going on that’s sort of spontaneously built by young people. It’s a wonderful thing that kids can get involved. And a number of young people are launching political campaigns within social networking platforms.

CHW: What do you believe are the implications of digital viral marketing on health and wellbeing of young people?

KM: What people need to understand about the digital media environment is that it is completely different from what we’ve seen before with our conventional media. This new digital media culture is everywhere, all the time, in the lives of young people and not only connecting you to other people, but also connecting you through this interactive umbilical cord to corporations. We are looking at a compelling culture that ties one’s sense of identity closely to corporate imperatives. It is designed to engage us and socializes us at an early age into being consumers. There is positive potential to promote health, so I think it’s not all one way or the other but you need to be very careful that the consumer culture part of it doesn’t smother and overwhelm the other parts. We need a broad public debate about how this new media culture can be a positive force in children’s lives.

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

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

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

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

Advocates charge report lacks blueprint

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

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

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

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

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

New Public Debate on Food Policy and Role of Food Industry

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

Corporate Accountability International: Global Action Challenging Unhealthy Corporate Practices

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

Early history as focused on Nestlé and infant formula

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

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

Transformation to more broadly focused organization

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

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

Current Campaigns

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

“Think Outside the Bottle”

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

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

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

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

Tobacco Campaigns

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

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

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

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

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

Photo Credit: All photos courtesy of Corporate Accountability International

Interview with Richard Daynard

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

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

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

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

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

Marketing to Doctors

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

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

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

Marketing to doctors and patients

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

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

Lobbying

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

FDA Approval

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

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

Designer Drugs & Targeted Marketing

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

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

Taking on the Pharmaceutical Industry

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

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

 

References

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

 

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

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

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

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

Beer industry self-regulation

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

 

Oversight of global food companies

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

Corporate arguments against public oversight

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

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

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

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

Public Health Arguments for Voluntary Guidelines

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

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

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

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

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

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

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

Conclusions

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

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

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

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

Photo Credits:

Tracking the Effects of Corporate Practices on Health