Food Politics

I’ve been at meetings in London and Geneva on non-communicable (what we call chronic) diseases and how to prevent them. 

On the way to Europe, I did some catching up on reading past issues of The Lancet and ran across this letter from Sally Casswell of the School of Public Health at Massey University in Auckland. 

Professor Casswell was responding to an article arguing that a major priority in chronic disease prevention should be to strengthen the capacity of countries to deliver primary care services.

Yes, professor Casswell writes, primary care is important.  But it is even more important to focus prevention efforts on the environmental factors that influence the behavior of individuals and cause them to need primary care services in the first place.

Do we really want to continue to live in a world where the oversupply and marketing of tobacco, alcohol, unhealthy processed foods, and soft drinks is tolerated simply to allow continuing profits for the shareholders of the transnational corporations producing and distributing them, while the taxpayer funds the health services and pharmaceutical response to the ensuing disease and injury?

This is a refreshing way to look at this problem, and one well worth pondering.

The Future of Food conference in Washington last week is now pretty much online (although I’m still having trouble with some of the links).  Much of it is well worth a listen, certainly Prince Charles’ thoughtful speech on sustainability, but also the one that I thought the most powerful—comments by Robert K. Ross, head of the California Endowment.

In the first 8 minutes of his talk, Dr. Ross explained that he comes to the issues discussed at the conference from the angle of public health and obesity, yet climate change, soil quality, hunger, and economic development are all wrapped up in the obesity issue.   Here is my paraphrase of what he said (with my emphasis):

If you care about these issues, you have to decide whether you are a group, network, or a movement.

Nothing short of a powerful movement will reverse the trends that are in front of us.

The tobacco battle is the proudest victory of public health, although not yet fully accomplished.

The scientific community first understood that tobacco was bad for health in 1921.  Hundreds of studies followed.  Yet it was not until 1965 that the Surgeon General first got permission for a warning label on cigarettes.  Only in the 1990s did we have policy and practice changes that included environmental incentives to drop the tobacco habit.

In other words, we have had a 100-year war on tobacco.

A side-by-side comparison of food and tobacco indicates that food, health, and sustainability are far more complex issues than tobacco.  We do not have 100 years to deal with these problems.

The tobacco wars were not about lack of scientific data.  They were and are a power issue.

The only way to confront power is to build a movement that wields power.

Science-based, evidence-driven policy wonks and researchers want more science.  But if you think you are in a policy debate and the other side thinks it is in a fight, you are not going to come out too well.

We need to bring as much rigor to the fight as we do to the science.

Food advocates: take careful note.

Anti-tobacco advocates have been worried for years that concerns about obesity would draw funding away from anti-smoking initiatives (see previous posts).  Their fears are justified, as described in today’s New York Times and in a recent editorial in the New England Journal of Medicine.

Years of experience have taught anti-smoking advocates that countering the marketing efforts of cigarette companies required constant vigilance.  It also taught them that cigarette companies take immediate advantage of any weakening of resistance to their efforts.

Cigarettes remain the leading cause of preventable deaths among Americans.  Cigarette marketing aimed at children remains a national—and international—public health scandal.

Health should not be a zero-sum game.  Anti-obesity advocates have much to learn from anti-smoking advocates.  How about joining forces to improve the health of Americans?

I’ve just read an enlightening paper in the July issue of the American Journal of Public Health (see Note below) about the tobacco industry’s role in and funding of “We Card,” a program ostensibly aimed at discouraging smoking among young people by encouraging retail cigarette sellers to “card” underage buyers.

The paper is an analysis of internal food company discussions about this program in cigarette company documents released as part of the 1998 Master Settlement Agreement.  These documents are now publicly available on the University of  California San Francisco (UCSF) website.

This analysis demonstrates that the actual purpose of tobacco industry support for the program was to make the industry look good (public relations) and to convince legislators and health officials that regulation would be unnecessary.

The industry effectively recruited astonishing numbers of private business, retail, and trade groups (expected) and state health, legal, and police agencies (which should have known better) as partners in this program.  The paper lists these groups in tables that take up nearly five pages.

As the paper explains:

Economic theory predicts that industry self-regulation will achieve social benefits far smaller than those gained from government regulation, although governments increasingly view self-regulation as a means to achieve public goals without public spending. However, industries and governments may have competing agendas, suggesting that public health advocates should be wary of self-regulation strategies…. This program’s success in reaching tobacco retailers and attracting independent allies has made We Card one of the tobacco industry’s major public relations achievements. However, despite industry claims that the program is effective, internal industry evidence suggests that We Card has not reduced tobacco sales to minors and that it was not designed to do so. Instead, We Card was explicitly structured to improve the industry’s public image and to thwart regulation and law enforcement activity.

The authors’ conclusion: “Policymakers should be cautious about accepting industry self-regulation at face value, both because it redounds to the industry’s benefit and because it is ineffective.”

Proponents of food industry self-regulation and of partnerships and alliances with food companies should read this study carefully.

Note: Only the Abstract is available to non-subscribers.  The reference is Apollonio DE, Malone RE, The “We Card” Program: Tobacco Industry “Youth Smoking Prevention” as Industry Self Preservation.. Am J Public Health 2010;100:1188-1201.

The Rudd Center at Yale is devoted to establishing a firm research basis for obesity interventions.  Its latest contribution is a paper in the Milbank Quarterly from its director, Kelly Brownell, and co-author Kenneth Warner, an equally distinguished anti-smoking researcher from the University of Michigan.  Its provocative title: The perils of ignoring history: Big Tobacco played dirty and millions died.  How similar is Big Food?

The paper is getting much attention.  A spokesman for the American Dietetic Association, a group well known for its close ties to food companies, emphasizes that food is not tobacco.  Of course it’s not.  But food companies often behave like tobacco companies, and not always in the public interest.  The Milbank paper provides plenty of documentation to back up the similarity.  Worth a look, no?

April 3 update: Evidently, FoodNavigator.com thinks so.  It is asking readers to file 100 word comments on issues raised by the paper by April 8.   And here are the comments.