Public Health Ethics and Laws
Dr. Naof Faiz Al-Ansary
Food and Beverage Marketing to Youth
Background
Children are exposed to a greater intensity and frequency of marketing than ever before. Evidence has demonstrated that marketing of food and beverages to children contributes adversely to health, affecting food knowledge, attitudes, dietary habits, consumption practices, and health status. Marketing to children has always raised concerns. But recently, numerous nongovernmental and international organizations and all levels of government have expressed their concern about food and beverage marketing and advertising to children as a public health issue. Often used interchangeably with “advertising,” the term “marketing,” actually encompasses a broader range of issues. The World Health Organization (WHO) (2010) defines marketing as “any form of commercial communication or message that is designed to, or has the effect of, increasing the recognition, appeal and/or consumption of particular products and services.
It comprises anything that acts to advertise or otherwise promote a product or service.” Two large-scale global systematic reviews of evidence in the last decade have concluded that food and beverage marketing substantially affects young people and is associated with adverse health outcomes. In 2003, the U.K. Food Standards Agency commissioned a systematic review of the influence of food promotion on children’s food-related knowledge, preferences, and behaviors (Hastings et al. 2003). WHO updated the report in 2007 and 2009 (Hastings et al. 2007; Cairns et al. 2009). In 2006, the U.S. Institute of Medicine conducted a systematic review of the influences of food and beverage marketing on the diet and diet-related health of children and youth (McGinnis et al. 2006). Key findings from these reports follow: • Food and beverages developed for and advertised to young people are predominantly calorie dense and nutrient poor; • Marketing influences children’s food and beverage preferences, purchase requests, and short-term consumption, even among young children (ages 2–5 years); and • There is strong evidence that child and youth exposure to television advertising is significantly correlated with poor health status, although sufficient evidence of a causal link with obesity is not yet available. In recent years, many food and beverage companies, working with industry associations, have issued voluntary pledges to alter marketing practices toward children. For example, such pledges typically include criteria for the nutritional quality of foods advertised to children, limitations on the use of licensed characters, and marketing in schools. However, critics argue that these types of voluntary changes are not sufficient to reduce the risks of food marketing to children in a substantive way. Despite this array of interventions, the absence of widespread agreement on the most appropriate form of collective action has led many policy makers to default to inaction.
Case Description
You direct the Healthy Public Policy program for a large municipal public health department that recently has come under fire in a newspaper exposé about contributions from fast food companies to after-school programs for youth that the city government runs. The exposé highlighted the contributions of Big Boss Burger, a local fast food hamburger chain with 12 locations across the city. Big Boss Burger donates cooking equipment to the city’s high-priority, after-school cooking program for 9- to 11-year-olds. Although the program is well-liked by youth, it is regularly threatened by funding cuts. The chain has recently offered to scale-up its annual cash donation to cover all food and equipment costs in exchange for renaming the program “The Big Boss Burger Community Kitchen” and for placing the chain’s logo on all signage and promotional materials. The highly successful Big Boss Burger chain is owned by a beloved, self-made restaurateur who has spent his entire career in the local food industry. Considered a colorful local personality, he frequently sends Twitter updates that reflect his over- the- top advertising style. One tweet, for example, offered a free sample of the chain’s “quadruple bypass” burger to anyone who visited one of the chain’s locations within the hour. Media spokespersons for the mayor, meanwhile, have reiterated the community benefits of cultivating positive partnerships with local businesses. They note that only registered public health nutrition staff run the city’s cooking programs, while insisting that Big Boss Burger has no influence whatsoever on city policies or youth curricula. The media furor nevertheless has prompted city officials to explore developing a sponsorship policy for municipal child and youth programs. The Medical Health Officer has asked you to prepare a briefing note outlining the key public health considerations that such a sponsorship policy needs to address. You face a dilemma. On the one hand, several years ago your Healthy Public Policy team launched a study of the impact of food and beverage advertising on children. Last year’s update on the study to the Board of Health included a recommendation that city-operated venues and programs avoid commercial advertising of food and beverages targeting children younger than 13 years of age. Thus far, the recommendation has not led to any formal policy changes. Municipal employees partly attribute this inaction to the reluctance of local authorities to act when there are no state or national policies that govern sponsorship or marketing restrictions. On the other hand, the financially strapped city relies on engagement with the local business community to fund many city-run programs, including health education activities. It is also well-known that the owner of Big Boss Burger grew up in a local low- income community and frequently volunteers his time at events in his former neighborhood.
Discussion Questions
1. What ethical considerations will influence your briefing note?
2. What population groups are you most concerned about with regard to the sponsorship policy? What if the cooking program sponsored by Big Boss Burger was for 14- to 16-year- olds instead of 9- to 11-year-olds? For adults? For children in a high-income neighborhood?
Source: Public Health Ethics: Cases Spanning the Globe. Barrett, Drue H. Springer International Publishing, 2016.
