Breastfeeding protects against overweight and obesity, asthma, eczema, and type-II diabetes, and has long-term health benefits for women. The health benefits of breastfeeding are so valuable that in 1981, the World Health Organization established the International Code of Marketing of Breast-Milk Substitutes (WHO Code) that prohibits marketing infant formula to the public. The U.S. has not adopted the WHO Code and currently has few protections from most digital marketing to adults. As a result, the vast amount of consumer data expectant parents and infant caregivers generate as they navigate daily life can be used to target them with digital advertising for infant formula.
This report explores the policy frameworks and self-regulatory bodies that govern the use of sensitive consumer information about pregnancy and infant feeding used to market infant formula. It addresses the following questions:
How do marketers identify expectant parents and infant caregivers?
What digital marketing tactics are used to promote infant formula?
What laws and policies govern the collection and use of consumers’ pregnancy and infant-feeding-related information?
What role do company privacy policies and user agreements play?
How can self-regulation be used to limit infant formula marketing?
The report contains recommendations for how to better protect the public from infant formula marketing by the infant formula industry and through third-party retailers and digital platforms like Facebook and Google. Issue briefs on the topics of Consumer Privacy, Self-Regulation and Recommendations for Action summarize key findings from the full report.
The U.S. Department of Agriculture (USDA) intends to issue a rule to weaken the school food nutritional requirements of the Healthy, Hunger-Free Kids Act of 2012. The rule would allow flavored milk with added sugar, waive requirement to provide whole grains, and delay reductions of sodium levels in school foods. PHAI submitted a comment to USDA opposing this rollback of healthy eating requirements for school food.
In addition to evidence-based arguments opposing the proposed “flexibilities,” the comment notes our research in collaboration with the Berkeley Media Studies Group from 2016 that examined nutrition and policy proposals in 11 states. We found that two-thirds of relevant legislative or regulatory documents containing at least one policy argument (n=91) argued in favor of the 2012 guidelines. More than half of those arguments raised in favor of the guidelines argued that the guidelines will allow food service directors to provide healthier options or that the guidelines will benefit children’s health. In every state except Oklahoma and Texas, there were more pro-guidelines arguments than anti-guidelines arguments presented.
Access to safe and appealing drinking water in child care centers and schools is a key strategy to build healthy habits that children will use for life to maintain a healthy body weight and to support overall health.
This study sought to identify and summarize state-level policies in twenty states for drinking water quality and access in public schools and licensed child care centers. This information was then used to generate individual state profiles and general policy recommendations to achieve increased drinking water consumption by children and to ensure drinking water is safe and appealing.
The guiding principles behind these policy recommendations are to ensure that safe, potable drinking water is made available at no cost to children throughout the day. The state profiles and policy recommendations can be used to assess current policies for drinking water access and quality and to determine which policy recommendations are relevant to the needs of a particular state’s schools and child care centers. The state profiles and policy recommendations also can be used as points of comparison and sources of ideas during the policymaking process.
Despite the scientifically established link between consuming sugar drinks and obesity, type 2 diabetes, and heart disease, the Coca-Cola Company and its trade association, the American Beverage Association, deceive consumers by denying and obscuring soda’s link to those diseases, according to a lawsuit filed today.
Bringing the action filed today in the Superior Court of the District of Columbia are Reverend William H. Lamar IV, pastor of the historic Metropolitan African Methodist Episcopal Church in Washington, DC; Reverend Delman Coates, senior pastor of Mt. Ennon Baptist Church in Clinton, MD; and the Praxis Project, a nonprofit organization focused on building healthier communities. Praxis had brought, but soon withdrew, similar litigation against Coke and the ABA in California pending the addition of the new plaintiffs.
“For far too long, Coca-Cola has been convincing people, including children, that soda is a source of fun and happiness and that it is safe to drink,” said Rev. Coates. “But from my vantage point, Coca-Cola is devastating the African American community by fueling an epidemic of obesity and an epidemic of type 2 diabetes. I visit hospitals and homes, and officiate at funerals. I routinely encounter blindness, loss of limbs, strokes, and even death. Efforts to talk about the role of sugar drinks and advertising in these epidemics, including many of my own efforts—are hampered by the effects of Coca-Cola’s deceptive marketing.”
The lawsuit quotes Coca-Cola executive Katie Bayne’s much-publicized statement that “[t]here is no scientific evidence that connects sugary beverages to obesity” as representative of the kind of deception that Coke and the ABA publicly engage in. Sugar-sweetened beverage consumption is linked scientifically not only to obesity but also to type 2 diabetes and heart disease. The Centers for Disease Control and Prevention, the federal government’s 2015 Dietary Guidelines for Americans, the American Heart Association, the American Medical Association, and numerous other prominent medical and health authorities all acknowledge such links.
Plaintiffs and Andrew Rainer Discuss the Lawsuit
“When industry wanted to sell more cigarettes, it used powerful advertising to make smoking seem glamorous, and it tried to muddy the waters and make it seem as if smoking’s link to lung cancer were in doubt,” said Rev. Lamar. “Soda might not be smoking, but the tactics of the companies are strikingly similar to me: Market heavily. Cast doubt on science. People need and deserve to know the facts about soda consumption. They need to know that the beautiful bodies seen in Coke commercials are not the norm for regular soda drinkers. And they need to know about the possibility of lost limbs, blindness, sexual dysfunction, and premature death.”
Coca-Cola and the ABA’s larger advertising campaign attacks the science while promoting lack of exercise as the primary driver of obesity and related epidemics. The ABA wrote that “the anti-soda campaign misleads people with unsound science,” and that “[A]ll calories are the same regardless of food source,” according to the complaint. James Quincey, Coca-Cola’s new CEO, claimed in a widely publicized interview that “the experts are clear—the academics, government advisors, diabetes associations … a calorie is a calorie.”
Coke also paid health professionals to promote sugar-sweetened beverages on the Internet, including one dietitian blogger who suggested that an eight-ounce soda could be a healthy snack, like “packs of almonds,” according to the complaint. The complaint also cites the widely reported secret funding by Coca-Cola—$120 million between 2010 and 2015—to scientists and projects that publicly advanced the proposition that “energy balance” is more important than reducing soda consumption. Meanwhile, advertising campaigns like “Be OK” misleadingly implied that light exercise, such as laughing out loud for 75 seconds, offsets the health effects of Coke consumption, or, in the words of the ABA-funded campaign known as “Mixify,” that some afternoon Frisbee earned players “more” soda.
Coca-Cola’s Deceptive Ad Campaign
Other promotions deceptively advance sugar drinks as a safe form of essential hydration. The complaint again cites Coca-Cola’s Bayne, who claimed that “What our drinks offer is hydration. That’s essential to the human body. We offer great taste and benefits … We don’t believe in empty calories. We believe in hydration.”
“We need to put permanent protections into place that protect kids’ health by shielding them from Coke’s omnipresent and deceptive marketing,” said Praxis Project executive director Xavier Morales. “It seems to me that Coke plays the long game and wants to hook consumers young. But its marketing and advertising are putting too many Americans, especially children and teens of color—who are twice as likely to see an advertisement for soda—on a trajectory that includes obesity, diabetes, and heart disease. These medical conditions kill or maim. When one in every two Latino and African American youth born since 2000 are expected to get diabetes in their lifetime, we need to stand up and take action. Praxis is proud to be bringing this lawsuit.”
In Washington, DC, more residents die each year from complications related to obesity than from AIDS, cancer, and homicides combined, according to the city’s health department.
The plaintiffs are represented by Maia Kats, litigation director of the nonprofit Center for Science in the Public Interest; Andrew Rainer and Mark Gottlieb of the Public Health Advocacy Institute; Daniel B. Edelman of the law firm Katz Marshall and Banks, LLP; and Michael R. Reese of the law firm Reese LLP. The suit seeks an injunction under the District of Columbia’s Consumer Protection Procedures Act, which protects District residents from improper trade practices. Such an injunction would stop Coke and the ABA from engaging in the unfair and deceptive marketing of sugar-sweetened drinks—including any direct or implied claim that the drinks do not promote obesity, type 2 diabetes, or cardiovascular disease.
“For decades, the tobacco industry engaged in a systemic campaign of deception to cast doubt on the science connecting smoking to lung cancer,” said Kats. “Today Coca-Cola and the ABA are conducting their own campaign of deception to hide the science connecting sugar-sweetened beverages to obesity, and obesity-related diseases like diabetes and heart disease. We seek to protect consumers and to stop the deception.”
The Public Health Advocacy Institute’s litigation director Andrew Rainer, who has tried cases against cigarette companies, said, “Coca-Cola and the ABA have taken not just a page but a whole chapter out of Big Tobacco’s playbook for denying scientific truth. They claim there is “no science” linking their products to obesity, type 2 diabetes.”
BOSTON – Two non-profits that use litigation as a public health strategy have joined forces in a lawsuit accusing the Coca-Cola Company (“Coke”) along with the American Beverage Association (“ABA”) of misleading the public about the science that links heart disease, obesity, and diabetes to consumption of sugary beverages. For years, the Public Health Advocacy Institute at Northeastern University School of Law in Boston and the Center for Science in the Public Interest in Washington, DC relied on civil litigation as a tool to achieve policy change to benefit public health.
The lawsuit was filed today in federal court in the Northern District of California on behalf of a California non-profit, the Praxis Project, which has had to devote resources to correcting the misleading messages that Coke and the ABA have disseminated. These include spreading the notion that the main cause of obesity is lack of exercise or that “a calorie is a calorie,” regardless of whether it comes from Coke or from kale. The science, in fact, shows that sugary drinks such as Coca-Cola have been found to play a real role in the obesity crisis and that calorie intake is more significant than calorie expenditure in terms of the problems of obesity and overweight. The lawsuit also accuses Coke of failing to comply with its pledge to not market to children. The action alleges violations of California’s Business and Professional Code as well as negligent and intentional breaches of a special duty to protect the consuming public.
The plaintiffs seek a court order to enjoin Coke and ABA from denying the link between sugary drinks and obesity, diabetes, and cardiovascular disease and to stop any marketing to children. They also seek a court order for defendants to disclose and publish all research they have directly or indirectly conducted on the impact of sugary beverages on health and the impact of exercise on obesity vs sugary drink consumption. Furthermore, the plaintiff asks the court to order the defendants to fund a corrective public education campaign and place prominent warnings on their internet sites that consumption of sugary beverages can lead to obesity, diabetes, and cardiovascular disease.
The attorneys for the plaintiff include Maia C. Kats, litigation director of the nonprofit Center for Science in the Public Interest; Andrew Rainer, litigation director of the nonprofit Public Health Advocacy Institute; and Michael R. Reese of the law firm Reese LLP.
PHAI attorney Andrew Rainer considers this lawsuit to be about defending science from manipulation by those who seek to increase profit at the expense of public health. Rainer says, “the Public Health Advocacy Institute has joined in this complaint in an effort to prevent the distortion of science for corporate gain. Just as the tobacco industry manipulated and distorted science for decades to deny the dangers and addictiveness of cigarettes, and the oil industry works to systematically distort science to deny climate change, Coca Cola and the American Beverage Association are engaged in a campaign to deny the established science linking sugar-sweetened beverages to obesity and diabetes.”
Mark Gottlieb, executive director of the Public Health Advocacy Institute, characterizes this filing as, “the tip of the iceberg when it comes to purveyors of sugar-added products seeking to shift all responsibility for health harms to their consumers. Coke pays dietitians to tell consumers things like drinking coke can be a healthy snack and pays scientists to deny that sugary drinks are linked to obesity and then suggests that the main cause of obesity and related disease is lack of exercise. The hypocrisy of suggesting to consumers that burning calories through laughing can offset the harmful effects of drinking soda is no laughing matter. And, yes, Coke really suggested that.”
PHAI’s partner, the Center for Science in the Public Interest included the following bullet points from the complaint in its press release.
Coca-Cola’s senior vice president, Katie Bayne, claims that “[t]here is no scientific evidence that connects sugary beverages to obesity.”
“There is no unique link between soda consumption and obesity,” claims a post on the ABA’s website.
“Simply put, it is wrong to say beverages cause disease,” the ABA stated in another release.
Coke’s incoming CEO, James Quincey, equated sugar-sweetened beverages to any other calories, dismissing their unique contribution to the obesity epidemic by asserting such beverages contribute only two percent of calories overall.
Coke also paid health professionals to promote sugar-sweetened beverages, including one dietitian who suggested that an eight-ounce soda could be a healthy snack, like “packs of almonds.”
The Public Health Advocacy Institute set up its Center for Public Health Litigation in 2014 in order to hold responsible corporate interests that harm public health and defend policies that protect public health.
For years, the month of February has been the kick-off of the Coca-Cola Company’s sponsorship of the National Heart Lung and Blood Institute’s (NHLBI) Heart Truth campaign. Heart Truth began in 2002, with the goal of raising awareness that heart disease is the number one killer of women. The campaign fits within the general mission of NHLBI to collaborate with a range of stakeholders to promote the prevention and treatment of heart, lung, and blood diseases. As part of the Department of Health and Human Services (HHS), NHLBI provides research funding and conducts outreach with the public to improve the public health. As a federal agency, NHLBI is subject to legal limits on its use of funds and HHS’s ethical guidelines for co-sponsorship of events. These guidelines are meant to guard against conflicts of interest that would undermine the primary mission of NHLBI. Coke’s corporate funding disclosures in the Fall of 2015 indicate that as public pressure on NHLBI built, Coke shifted the bulk of its heart health giving to a tight circle of non-governmental heart health organizations consisting of the American College of Cardiology, the Preventive Cardiovascular Nurses Association, the American Dietetic Association, and Brigham and Women’s Hospital in Boston, MA.
Coke’s Heart Health Campaign
From 2008 to 2014, The Coca-Cola Company, under its Diet Coke brand, was the Heart Truth campaign’s most visible co-sponsor: Despite the fact that HHS’s ethical guidelines place a particular emphasis on avoiding the appearance of product endorsement, Heart Truth logos were printed on billions of Diet Coke cans, heart health-themed Diet Coke ads ran during the Olympic Games, Coke enlisted high-profile celebrities like Heidi Klum to appear at Heart Truth events, and Diet Coke beverages were distributed at community heart health screenings.
NHLBI’s partnership with Coke drew ire from the public health community because it seemed untenable to partner with a company that also sells sugary drinks linked to obesity and heart disease. The fact that the partnership focused on Diet Coke was particularly problematic because it closely followed the release of the NHBLI-funded Framingham Heart Study’s findings that consumption of diet soft drinks appeared to be linked to increased risk factors for heart disease.
In 2010, the Center for Science in the Public Interest (“CSPI”) called on the government agency to sever its ties with Coke, but NHLBI publicly refused to do so. The primary rationale NHLBI gave for keeping Coke as a corporate sponsor was that the company allowed the agency to extend its reach to get out the message that heart disease is an important health concern for women. CSPI’s challenge to the program led to a public debate about the role of Coke in NHLBI’s educational activities.
Coke’s Heart Truth Contracts with NHLBI
In 2010, PHAI requested Coke’s contracts with the NHLBI pursuant to the Freedom of Information Act (FOIA) and received copies of contracts the company entered into with Ogilvy Public Relations Worldwide on behalf of the NHLBI from 2007, 2008, 2009 and 2010:
At the time, the dollar amounts in these contracts were redacted as proprietary information.
Coke’s recent funding disclosures date back to 2010, and show that in 2010 the company paid NHLBI $440,000 in support of a fashion show to promote heart health awareness. Through its contracts with NHLBI for the 2010 Heart Truth Fashion Show, Coke was granted:
-Exclusivity as the only carbonated beverage category event sponsor
-Full use of the NHLBI Heart Truth logo in any Coke marketing, advertising and or promotional materials or activities
-Assistance from NHLBI’s agent, Ogilvy, in the “development of heart health content and messages” for its use
-“Access to heart health experts and spokespeople to serve on Coca-Cola’s behalf including at Coca-Cola luncheons, ambassador program, opinion shaper and other customer/VIP events”
-Highlighted attention to Coca-Cola’s partnership activities on the Heart Truth webpage
-Soundbites from NHLBI representatives at Heart Truth events for use by Coca-Cola
-The right to provide free samples of Coca-Cola products at the fashion show
-The right to feature Coca-Cola advertising in essentially all aspects of the event
-Pre-approval of “all [NHLBI] creative materials, press releases, collateral materials, signage and other items using” Coca-Cola’s trademarks
The breadth of the rights granted to Coca-Cola is in keeping with a typical private arrangement for event sponsorship, but seems startling in the context of a government run educational campaign. Ogilvy Public Relations Worldwide was awarded multi-year government contracts from the NHLBI totaling $11.9 million to execute the Heart Truth campaign on its behalf. Organizers of complex, national educational campaigns must work with sponsors to ensure events run smoothly. The contracts Ogilvy entered into on NHLBI’s behalf with Coke, however, reveal a situation where it appears that NHLBI was granting Coke rights to advance the company’s commercial agenda.
Coke Abruptly Shifts Its Heart Health Spending
In March of 2010, PHAI wrote a detailed letter to the Associate General Counsel for Health and Human Services (HHS), asking that it review NHLBI’s relationship with Coke pursuant to the agency’s written ethical guidelines for co-sponsorships of events. In its reply, HHS cited a general provision of the Public Health Service Act granting NHLBI the authority to conduct health promotion campaigns and deferred decision-making about the appropriateness of Coke’s co-sponsorship of the Heart Truth campaign to NHBLI. Despite NHLBI’s public defense of Coke in response to CSPI’s letter and apparent agency inaction after PHAI’s request to review the relationship, after 2011 Coca-Cola shifted its support for Heart Truth and other heart health activities sharply away from the NHLBI.
According to Coke’s initial funding disclosures in the Fall of 2015, between 2010 and 2015, Coke’s total funding of heart health-related organizations and educational activities was approximately $8 million (click here for a detailed description). $7.8 million of these funds went to just five organizations: NHLBI (via Ogilvy and the Foundation for the National Institutes of Health), the American College of Cardiology, the Preventive Cardiovascular Nurses Association, the American Dietetic Association, and Brigham and Women’s Hospital in Boston, MA. NHLBI-related funding of the Heart Truth totaled $1.9 million with Coke’s contributions peaking at $1 mil in 2011. Starting in 2012, Coke sharply reduced its direct NHLBI support and shifted its gifts to private organizations not subject to FOIA requests.
Coke’s Heart Truth Spending to Key Partners (2010-2015)
Brigham and Women’s Hospital Cardiologists Associated with Millions in Coke Money
Coke’s Heart Truth partnership with NHLBI was created under the leadership of then NHLBI Director Elizabeth (Betsy) Nabel, MD. Dr. Nabel is a cardiologist who left public service in 2010 to become President of Brigham and Women’s Hospital (BWH) in Boston, MA. Dr. Nabel traveled to Canada to be an official 2010 Olympic Games Torchbearer for Coke and spoke glowingly about her relationship with Coke.
It turned out that Dr. Nabel was not the only Coke heart health partner at BWH. She was joined by Dr. JoAnne Foody, MD, the Medical Director of BWH’s Pollin Cardiovascular Wellness Center. Dr. Foody is featured as a heart health expert in continuing education presentations produced by Coca-Cola’s Beverage Institute for Health, and in 2011 was selected to serve as the Editor-In-Chief of the American College of Cardiology’s (ACC) CardioSmart initiative. ACC received $2.6 million in Coke funding for CardioSmart and community screenings between 2010 and 2015. CardioSmart is described as “a patient education site committed to providing accurate, un-biased heart health information in an advertising-free environment.”
Coke clearly valued its relationship with Dr. Foody. As was reported in 2012, she was included in an email sent from Coca-Cola executive Helen Tarleton to a list of “partners” in various health organizations sharing the company’s position on a proposed New York City ordinance to limit soda portions. The email asked Dr. Foody to disseminate a Coke infographic downplaying the role of sugary drinks in the obesity epidemic. Coke’s direct request to advance a policy position potentially at odds with CardioSmart’s mission to educate heart health patients is a striking example of the depth of the relationships it formed with its public health “partners.”
In 2013 and 2014, Dr. Nabel and Dr. Foody leveraged their relationship with Coke into $1.2 million dollars of funding for a BWH cardiovascular health initiative called ClimbCorps to promote stair climbing for heart health and provide heart health education. Dr. Foody served as the ClimbCorps’ Medical Director. In 2013, Coca-Cola executive Helen Tarleton personally attended a ClimbCorps event with Dr. Nabel and Dr. Foody. The program no longer has an active website and all links to ClimbCorps redirect to the BWH general website. The program’s emphasis on physical activity fit well within Coke’s overall obesity strategy to focus on physical activity as opposed to diet.
Coke Exits the Heart Health Picture
Coke’s funding disclosures paint a more complete picture of how it operated and who it turned to when it needed to shift its giving from a highly scrutinized government agency to private organizations. In response to public pressure, Coke has since bowed out of the heart health initiatives it funded over the past five years:
Coke ended its role as a corporate sponsor of NHLBI’s Heart Truth Campaign in 2014
After being called out by the New York Times for funding junk science promoted by Coke and researchers it funded that focused on what it calls “energy balance science” (which claims that there is no established link between soda consumption and obesity and promotes exercise as the most effective way of compensating for the extra calories derived from soda consumption), Coke announced in September 2015 that it would no longer fund the American College of Cardiology including the CardioSmart program
ClimbCorps is no longer an active program of BWH
In the process, millions of dollars were spent in ways that Coke itself now admits were not adequately transparent, and were inappropriate given the company’s overwhelming commercial interests in the health issues addressed.
There is no question that funds are desperately needed for programs to address crucial diet-related public health issues like cardiovascular disease in women. Coke spent $8 million on heart health education in five years (not including the in-kind contributions it made via specially printed product packages, Heart Truth dedicated websites and television commercials), while the federal government spent just $17 million on the Heart Truth campaign over ten years. The problem with Coke’s heart health spending is that its primary goal has been to downplay the role of sugary drinks in the obesity epidemic and to position diet beverages as healthy alternatives. Neither of these positions is fully supported by actual evidence and, as such, are in conflict with the mission of truly unbiased cardiovascular health initiatives.
There remain many unanswered questions about Coke’s heart health “partnerships.” To what extent did Coke’s initial participation with NHBLI’s Heart Truth campaign give the company legitimacy through what appeared to have been the government’s imprimatur and grant it access to the private organizations it subsequently partnered with? What other requests for political support did the company make of the heart health organizations it funded? How did Coke’s funding impact the heart health activities of the organizations it funded in terms of dietary recommendations to the public or support for public health policies at odds with Coke’s agenda? The most important question left in the wake of Coke’s co-optation of the Heart Truth campaign is this: Moving forward, how can the United States create and sustain unbiased funding mechanisms for the crucial public health issues of our time?
Researchers at the University of Vermont in Burlington (UVM) published a paper describing the impact of a campus bottled water ban that was paired with a healthy beverage requirement. The study found that removing bottled water from campus had no impact on the number of plastic bottles shipped to the campus, and resulted in higher consumption of unhealthy beverages. These results do not support the sustainability or public health goals of the bottled water ban: it failed to reduce plastic trash and carbon emissions or improve the nutrition profile of beverages consumed by students, faculty and staff on the UVM campus.
The study puts a fine point on a very practical tension that exists between two highly organized movements: the obesity and oral health prevention movements with a primary focus on shifting the public from caloric beverages to non-caloric beverages like water–for the most part regardless of how they are packaged; and a segment of the sustainability movement that has honed in on bottled water as a unique source of plastic trash, carbon emissions from its transportation, and a burden on communities from where it is extracted for packaging. The public health community regards bottled water as a healthy alternative to other drinks when consumers are choosing a beverage to buy, and the environmental community considers bottled water to be a needless source of pollution. The UVM study findings call out for solutions that meet the goals of both groups, and that combine their forces for a greater collective impact.
A constructive path forward is for both movements to work together to reduce access points for all packaged beverages. A key to the bottled beverage industry’s success has been to insert itself into every aspect of daily life. Vending machines are found in parks, schools, college campuses, recreation centers, etc. And coolers selling bottled beverages are placed at the end-caps of retail check-out lines, and fill the walls of convenience stores all over the country—including in places like college campuses. These access points haven’t always been there. They’ve been inserted via private contracts over time—these are contracts that are not required to be renewed and can be radically altered to support the environment and the public health.
A strategic focus on reducing total access points for packaged beverages benefits the environment through:
Reduction in total number of plastic bottles used
Reduction in carbon emissions from transport of bottled beverages
Increase in awareness of and local support for public water systems
And benefits the public health through:
Reduction of total packaged beverages consumed, many of which contribute to diet-related chronic disease and poor oral health
Increase in investment and maintenance of plumbed drinking water access points
Increase in awareness of and local support for community water systems
A focus on a total reduction of packaged beverages is timely because demand for sugary drinks is on the decline. This new path will require both movements to expand their thinking on their respective issues and entails political risks on both sides. The obesity prevention movement will have to move beyond efforts to change the product mix in existing vending machines and other retail sales outlets and embrace phase-outs of beverage vending machines and cooler equipment. A focus on an overall total reduction in sales of bottled beverages will not be cost-neutral in terms of revenues from bottled beverage sales. This will undoubtedly raise great opposition from the beverage industry and firms and institutions that profit from packaged beverage sales.
The environmental movement will have to expand its definition of bottled water to include water that has been carbonated, sweetened, flavored or brewed and packaged in plastic. A focus on bottled water alone has strategic benefits, especially on a college campus, because plain water can be accessed via drinking fountains. Moreover, allowing other packaged beverages to remain quells critics by providing choices beyond the drinking fountain. There, however, seem to be few discernible differences between bottled water and other bottled beverages: all have water as the primary ingredient, both may have been bottled at the same factory, both are placed in plastic containers, trucked in a vehicle, refrigerated in a machine, tossed into a trash or recycling receptacle, or not properly disposed of at all.
Both movements have built momentum and achieved many accomplishments. Imagine how much more progress can be made if they join forces.
After much criticism and prodding, Fast food giants McDonald’s and Burger King agreed to depict healthier food options in advertising directed at children. Researchers at the Norris Cotton Cancer Center at Dartmouth-Hitchcock, along with the Public Health Advocacy Institute (PHAI) at Northeastern University School of Law, found that attempts to honor these pledges by depicting healthier kids’ meals frequently go unnoticed by children ages 3 to 7 years-old. In research published on March 31, 2014 in JAMA Pediatrics, these researchers found that one-half to one-third of children did not identify milk when shown McDonald’s and Burger King children’s advertising images depicting that product. Sliced apples in Burger King’s ads were identified as apples by only 10 percent of young viewers; instead most believed that the ads were depicting french fries.
Children in the study were confused by the images of food. One typical participant said, “And I see some…are those apples slices?”
The researcher replied, “I can’t tell you…you just have to say what you think they are.”
“I think they’re french fries,” the child responded.
“Burger King’s depiction of apple slices as ‘Fresh Apple Fries’ was misleading to children in the target age range,” said principal investigator James Sargent, MD, co-director Cancer Control Research Program at Norris Cotton Cancer Center. “The advertisement would be deceptive by industry standards, yet their self-regulation bodies took no action to address the misleading depiction.”
Mark Gottlieb, Executive Director of PHAI and an author of the study, observed that, “when young children believe they will be getting french fries with their meals because of deceptive or confusing advertising imagery, they may insist that the adult bringing them orders french fries instead of apple slices. Likewise, if advertising leads children to expect a sugary drink rather than milk, they may well end up getting the sugary drink. This has the effect of undermining the self-regulatory pledges that the companies made.”
Study author and PHAI Senior Staff Attorney Cara Wilking said she found it, “troubling that fast food giants would publicly make a self-regulatory pledge, fail to live up to the pledge, and receive no sanction from the relevant self-regulatory body. Such failures suggests that self-regulation is often more about public relations than about fulfilling the role of actual governmental regulation.”
Sargent and his colleagues studied fast food television ads aimed at children from July 2010 through June 2011. In this study researchers extracted “freeze frames” of Kids Meals shown in TV ads that appeared on Cartoon Network, Nickelodeon, and other children’s cable networks. Of the four healthy food depictions studied, only McDonald’s presentation of apple slices was recognized as an apple product by a large majority of the target audience, regardless of age. Researchers found that the other three presentations represented poor communication.
This study follows an earlier investigation conducted by Sargent and his colleagues, which found that McDonald’s and Burger King children’s advertising emphasized giveaways like toys or box office movie tie-ins to develop children’s brand awareness for fast food chains, despite self-imposed guidelines that discourage the practice.
While the Food and Drug Administration and the Federal Trade Commission play important regulatory roles in food labeling and marketing, the Better Business Bureau operates a self-regulatory system for children’s advertising. Two different programs offer guidelines to keep children’s advertising focused on the food, not toys, and, more specifically, on foods with nutritional value.
“The fast food industry spends somewhere between $100 to 200 million dollars a year on advertising to children, ads that aim to develop brand awareness and preferences in children who can’t even read or write, much less think critically about what is being presented.” said Sargent.
The Public Health Advocacy Institute (PHAI) at Northeastern University School of Law, along with our partners at the Center for Digital Democracy and Berkeley Media Studies Group, today releases State Law Approaches to Address Digital Food Marketing to Youth. It is a first-of-its kind resource that provides an evidence base and action steps grounded in state law. State attorneys general and other stakeholders in children’s health and privacy can use it to put a stop to troubling digital marketing practices that deceive youth and their parents.
In addition to clear explanations of how digital marketing works and why it poses privacy and health risks to youth, key legal issues for state regulators are explored. These issues include personal jurisdiction over out-of-state food and beverage marketing and media companies; the interplay of federal and state laws regulating mobile marketing; and the application of state promotions laws to child consumers.
Nickelodeon, the biggest source of food ads seen by youth, has augmented its media empire through websites, mobile apps and programming that imports content from a popular YouTube channel. All of its digital platforms are ad-supported creating new opportunities for food and beverage companies to target youth.
Digital campaigns are seamlessly woven into food packaging allowing marketers to target youth in supermarkets, convenience stores and fast food restaurants. Packaging often directs youth to digital marketing on mobile devices or online. State regulators have jurisdiction over unfair and deceptive marketing on food packages sold to consumers in their states.
Mobile marketing elements are integrated into food and beverage campaigns. The legal landscape for state oversight of mobile marketing includes federal and state SPAM and telemarketing laws, and the emerging regulation of geolocation tactics.
States are authorized to protect child privacy under federal law and have successfully done so, but teens are not covered by child privacy laws. State attorneys general can fill the teen privacy gap using their general consumer protection authority to ensure that company promises to protect privacy are honored and that teens are not duped into sharing personal information.
Facebook remains the dominant social media platform for teens. Teens growing use of social media has resulted in them being less privacy savvy. Food companies exploit this by prompting teens to login to their websites and participate in promotions via Facebook thereby granting marketers access to vast amounts of personal information.
Digital sweepstakes and contests are in widespread use by the food industry with children as young as 6 years old. Despite repeated enforcement actions by the Children’s Advertising Review Unit (a self-regulatory body); food companies continue to conduct digital promotions with children that exploit their inability to understand that a free means of entry exists or their odds of winning a prize. State attorney general action is needed to augment these self-regulatory efforts to protect children from predatory promotions.
Senior Staff Attorney, Cara Wilking, who was lead author of the report, noted that, “state attorneys general are in a unique position to leverage state law approaches to stop unfair, deceptive, or otherwise illegal digital marketing of unhealthy foods to our youngest and most vulnerable consumers.”
PHAI’s Executive Director, Mark Gottlieb, added, “there is a general failure to understand the disturbing marketing practices that are becoming commonplace in the digital marketing world. This report goes a long way toward closing the knowledge gap between those using powerful technology to sell junk to kids and those who have the responsibility to protect them.”
Support for State Law Approaches to Address Digital Food Marketing to Youth was provided by the Robert Wood Johnson Foundations Healthy Eating Research Program (#69293).
Richard Daynard, Lissy Friedman, and Mark Gottlieb have co-authored an article published today in the American Journal of Public Health, along with our research partners from Berkeley Media Studies Group (BMSG). The article is entitled: “Cigarettes Become a Dangerous Product: Tobacco in the Rearview Mirror, 1952–1965.”
BMSG’s press release appears below:
Nutrition advocates may be able to use lessons from tobacco control to help government move faster toward protecting the public from harmful food and beverage company products and marketing practices, say the authors of a new study published today by the American Journal of Public Health.
In a content analysis of public and internal documents, the authors, from Berkeley Media Studies Group and the Public Health Advocacy Institute at Northeastern University School of Law, examined national newspapers, tobacco industry documents and the Congressional Record and Congressional Index between 1952 and 1965 to learn how health harms from cigarettes were framed in the early days of anti-tobacco advocacy.
The study found that news coverage of tobacco focused primarily on its health harms — not who was responsible for addressing them. Much as nutrition advocates often see headlines today about sugary drinks, junk food or other products that fuel disease, pre-1965 conversations about cigarettes were typically disconnected from the industry that produced them.
As such, the personal responsibility rhetoric the tobacco industry became known for in the 1980s and beyond — rhetoric that food and beverage companies have borrowed and are using today to forestall government regulation and shift blame for their products’ health harms onto the consumers who buy them — was all but absent from both news coverage and industry documents. Instead, tobacco companies focused on raising doubts about cigarettes’ links to lung cancer. More than three-quarters of tobacco industry documents denied that cigarettes are harmful to health, with industry spokespeople claiming that the causes of cancer are complex and more research was needed. The industry also discussed cigarettes’ alleged benefits, such as a “feeling of well-being and refreshment.”
What little discussion there was of culpability identified both individuals and industry as sharing blame for the problem and, strikingly given today’s political discourse, called upon government to act.
“The backdrop for early tobacco control was wildly different from today’s political climate,” Lori Dorfman, the study’s lead author and director of the Berkeley Media Studies Group, said. “Profound distrust of the government has made it harder for public health advocates to make the case for protections from harmful products. In the 60s, a belief in government’s duty to act to protect public health was the norm.”
According to the study, government action was contested only in internal industry documents, not public discussion. News coverage and legislative documents questioned not whether the government should act, but how.
Nevertheless, once the dangers of cigarettes were established, actions were individually oriented and related mostly to providing consumers with more education and warnings about smoking’s health harms.
“We now take for granted how effective tobacco taxes and indoor smoking bans are,” study author and Public Health Advocacy Institute Director Mark Gottlieb said. “But moving tobacco control efforts from smoking cessation to industry regulation happened over the long haul.”
The study authors suggest that advocates now pushing for healthier food environments may be able to do the same, shifting attention from unhealthy foods and beverages to the companies that manufacture and market them. However, they will have to do so within a changed, and more challenging, political context.
Ciation: Dorfman L, Cheyne A, Gottlieb MA, Mejia P, Nixon L, Friedman LC, Daynard RA. Am J Public Health. Published online ahead of print November 14, 2013. doi:10.2105/AJPH.2013.301475.
About Berkeley Media Studies Group
Berkeley Media Studies Group researches the way public health issues are characterized in the media and helps community groups, journalists and advocates use the media to advance healthy public policy. BMSG is a project of the Public Health Institute.
About Public Health Advocacy Institute
The Public Health Advocacy Institute (PHAI) is a legal research center focused on public health law at Northeastern University School of Law. PHAI’s goal is to support and enhance a commitment to public health in individuals and institutes who shape public policy through law. PHAI is committed to research in public health law, public health policy development; to legal technical assistance; and to collaborative work at the intersection of law and public health. Their current areas of work include tobacco control and childhood obesity.
The U.S. Department of Agriculture (USDA) intends to issue a rule to weaken the school food nutritional requirements of the Healthy, Hunger-Free Kids Act of 2012. The rule would allow flavored milk with added sugar, waive requirement to provide whole grains, and delay reductions of sodium levels in school foods. 
ottled water to be a needless source of pollution. The UVM study findings call out for solutions that meet the goals of both groups, and that combine their forces for a greater collective impact.