Does public health want to be best friends with soft drinks industry?

I wrote a piece for Crikey today looking at how the soft drink companies are trying to rebrand themselves as the new best friends of public health.

In the US, Coca Cola has done a deal with the American Academy of Family Physicians new corporate membership program, enabling it to help “educate consumers about the role their products can play in a healthy, active lifestyle”.

Closer to home, Dr Derek Yach, a former tobacco control advocate with the WHO who is now a senior executive of PepsiCo, has been visiting Australian health and research organisations, spruiking the industry’s willingness to change to address global obesity concerns.

Last week, Yach participated in an evening debate at the University of Sydney with public health nutritionist Dr Rosemary Stanton in which he argued that the food industry in general and his company in particular were making changes to address the concerns. You can watch the debate at SlowTV.

A trouble with these sort of staged events is that they don’t really lead to a free-flowing discussion that enables competing arguments to be measured and weighed – everyone is usually in too much of a hurry to get home.

To keep the discussion going, here are some of the responses that Croakey has gathered from those who attended.

Jane Martin, a Senior Policy Adviser to the Obesity Policy Coalition

I made an effort to hear what he had to say because I know Derek’s work in tobacco control (which is my background), he was incredibly smart and really knew his stuff, but I disappointed at the extent of his ‘corporate capture’. In hindsight I probably should not have expected anything less from someone who has moved from public health to the corporate world.

I thought the presentation was a PR stunt and an opportunity for Pepsi to talk about what they are doing that they feel will appease the public health community and, more importantly – government.  We saw the letter to Rudd about their fabulous work.  Just as an aside, it would be good to find out if he is meeting with Rudd and Roxon, giving Pepsico’s take on the PHT recommendations, along with presenting the Pepsico “responsible corporate citizen” agenda.

I think that Pepsico has made changes, but these are developed by industry, for industry and do not meaningfully limit many of the ways used to market and sell their products.  The focus for business is about protecting the bottom line and maximising profits. For example, they have moved advertising away from Pepsi Max to sugar-free varieties and this has not eroded their brand share of full sugar products.

From their point of view changes are are allowable, but they have to be on their terms.  For example limiting marketing to under 12s is a good example, targetting the television programs which are predominantly this audience has only a minor effect because there are very few programs that would be viewed predominantly by children under 12, kids are watching prime time television and this is where food advertisers spend their money so as to reach the greatest number of children.

I felt insulted, but also very concerned, that he boasted that he knew the Preventative Health Taskforce reports and recommendations better than those attending the lecture.  That shows how important and relevant obesity prevention initiatives are to their business, it is also concerning that they are likely to be working to influence government to adopt the recommendations that are less effective and to lobby against those that are likely to have an impact.  For example, Pepsico threatened to move their corporate headquarters out of New York when the state was examining the potential of a sales tax on sugary soft drinks.

I was hoping for a more sophisticated take on areas where collaboration could work, however this was not the agenda. I think that there are potential areas where industry could work together with others, however there are clearly areas where government intervention is required, such as with unhealthy food advertising to children and taxing unhealthy foods.

I thought it was interesting that he said that “tax was a blunt instrument” particularly given the US situation, see above.  I would argue that they may describe it as blunt, but likely to be very effective as it passes the Chapman “scream” test….

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Professor Louise Baur, consultant paediatrician, Children’s Hospital, Westmead

I think Derek Yach is genuinely trying to effect change.  HOWEVER, I think that, for Pepsico, this is more PR than anything else, at  least at this stage.  We did not see any data on whether junk food products were going down  in consumption. I suspect everything is going  up!

An interesting note from the presentation: Nine food companies control 83% of retail food expenditure (correct?) internationally.

We need people trying to effect change from both inside  and outside. At this stage there is still a lot to be done in flying the public health flag and influencing public opinion (the Rosemary approach!).  The important player who must be involved is the Federal government as we need  governmental regulation on such issues as FOP labelling (this may drive change  in food composition) and  marketing.

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Lesley King, Executive Officer, Physical Activity Nutrition Obesity Research Group (PANORG)

Pepsico are making minimal and almost cosmetic changes rather than substantive changes. As Yach said, he is able to dsicuss changes in a number of categories – marketing, labelling etc; however, the proposed changes amount to very little.

So, discussing the idea of limiting marketing to children under 12 when they are a majority of audience means little or nothing. For example, if children are less than 20% of a population, how frequently would they be a majority of audience? We know from Australian audience data that this is never on free TV! Thus my scepticism is coloured by knowing how insignficant their marketing commitments are, and therefore suspecting that other proposed changes are equally thin.

There was nothing said last night that suggested further depth of change. What is really disappointing is that society could benefit greatly if industry really did behave responsibly; yet even though they now see the need to reorient their profile and look as if they are behaving responsibly, there is no evidence that they actually are.

Nothing was suprising, except that the presentation wasn’t especially glossy or persuasive (I expected something cleverer really). The data on the ACCENTURE evaluation of changes in marketing in Europe is not publicly available as far as I know – although I understand it has been presented to WHO as part of their industry consultations. The graph showing 56% decrease in overall food marketing (not just to children) is of some interest – but unfortunately there were no epidemiological or methodolgical details that would help us know where  this came from, what it covered etc./ The use of /FORESIGHT I guess was there to establish show some expert credentials. The position of representing PEPSICO but not food industry generally (so only  responsible for 5%) was disappointing and designed to ‘slide through’  any challenges. So obvious and simplistic!

Public health and media have made obesity a political issue – and industry clearly believes it needs to look more responsible. So the next round has to be to get them to actually make some changes. However, there is no current indication that they will make real changes unless there is a large consumer driven change. So it seems that the problem needs people on the outside to push hard and strongly – lots of people playing many different roles. Perhaps that creates opportunities for public health people on the inside to operate in health interests – that I wouldn’t really know. Perhaps they are only there so they have face validity in PR with politicians and for window
dressing.
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Bridget Kelly, NSW Cancer Council

PepsiCo are certainly making all of the right moves to “look like” they are being responsible – hiring figurehead public health people, developing an international code on food marketing to kids, claiming that they will display large tabs showing energy content on drinks (yet to see this…).

However, I think the devil is in the detail. The front-of-pack labelling for example will use %DI labelling – which has been shown in consumer studies to be less effective in guiding people towards healthier choices. And as we have seen with industry marketing codes developed in Australia, for which PepsiCo is a signatory, these really lack any teeth. Despite Derek’s claims, these do not have adequate monitoring or complaints systems, do not cover all forms of marketing to kids and the nutrition criteria guiding the types of foods that can be advertised are very lenient.

There is definitely merit to the approach of working both within and in opposition to industry (We call it the “pincer movement”). Although, associating yourself with industry has the effect of delegitimizing your reputation. Take the Heart Foundation’s Tick program after it was associated with McDonald’s.

But we can’t forget that industry is a big and powerful lobby and some public health interventions will be very difficult/lengthy to achieve if all public health groups and industry are too polarised. So, I think it is important to have public health people working within industry – as long as they are doing it for the right reasons.

I think that it is worth highlighting that during the discussion some points were made about the potential effectiveness of taxing unhealthy food. Derek responded that this taxation would be a blunt instrument, however the taxation of tobacco products was highly successful in decreasing tobacco use – and is precisely the type of policy that Derek himself would have supported!

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Simon Chapman, Professor of Public Health, University of Sydney (who was overseas at the time of the debate but helped organise it)

I have the utmost respect for what he did with tobacco regulation, and I completely agree that the food industry must be part of the solution. Growing all one’s own food is completely beyond the reach of most people, so we are all obliged to interact with the food industry. Many of us try to patronise companies which really try — like Sanitarium.

But PepsiCo? I heard Derek talk about changing the company from the inside, but from here in Cambodia and Laos from where I write, full-cal Pepsi advertising is everywhere and low-call is nowhere to be seen. Same in Thailand and India where I was earlier in the year.

I fear that the company may see him as a kind of strategic investment in ‘air cover’ which allows them a profile among public health circles associated with striving to be a company selling healthy products, while down the corridor in the global marketing division, its business as usual.

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Kathy Chapman, NSW Cancer Council

I think Pepsico has taken “fairy steps” in the right direction due to pressure from public health groups and consumers.  There was still the usual line about reinforcing the need for physical activity.  It would have been useful to have a step by step critique from Rosemary on what Pepsi has undertaken – eg where their nutrient criteria fall down and the limitations of the times when Pepsi have decided not to advertise to children.

The presentation was pretty much as I expected it be from a food industry perspective.  I was expecting a bit more about his own personal motivations from going from WHO to the “dark side”.

As to the pros and cons of public health people trying to work from the inside with industry,I think there needs to be a pincer movement – food industry will be more likely to respond if they are getting  pressure from public criticism by people like Rosemary Stanton and groups like Parents Jury, as well as if there is a push from within to deliver healthier food products.

It must be extremely frustrating working within food industry and feel like your are hitting your head against a brick wall.  The public health input is so often used to pad out these little fairy steps that industry is willing to make.

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Dr Rosemary Stanton

The changes at PepsiCo are more about PR when it comes to obesity although I think they are serious about reducing salt and changing the fats they use. Neither is relevant to obesity, but they are relevant to cardiovascular disease.

Mainly, however, I think they want to avoid being included among the damned. It’s also a way to knowck smaller companies who may produce junk foods, but don’t have the resources that Pepsico does to play in  the same ball park as the big boys of public health.

His bits on reducing advertising to children were as useless as the Australian proposals. They reduce advertising only in programs made specifically for kids. The industry data shows that most kids watch general family TV – eg Australian Idol. The ABC programs made specifically for kids actually rate well. We’re also aware that advertisers are moving away from TV ads to involve kids in advergaming. It’s far more effective as the kids are connected to the product for at least 30 minutes rather than 30 seconds.

Derek Yach was actually a great guy when he worked on anti-smoking campaigns. I can’t imagine why he went to Pepsico, but from his use of photos in the presentation, I suspect he’s trying to prove that he still hobnobs with other Public Health people. Those who are directly employed by Pepsico would be getting salaries that are way beyond the reach of anyone working in PH. I think it’s not all that difficult to justify to yourself that you may be able to make a difference from the inside. The high salary may help the justification process.

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In short – the general response from the public health crowd seems to be extreme wariness about its “new best friends”.