BY: SUPRIYA LAL, RD, MPH CANDIDATE
In recent years, diet-related disease has been on the rise globally .
Studies suggest “that foods and beverages high in calories, unhealthy fats, salt and sugar are [the] major cause of premature death and preventable illnesses from diet-related diseases” . Particularly in the United States, the consumption of ultra-processed food products has increased and is a key contributor to adverse health outcomes and preventable causes of mortality and morbidity .
In New York City, these health outcomes are increasingly disparate amongst those with low socio-economic status and people of color . Not only does this contribute to existing health inequalities, but also increases the burden of disease seen amongst these population subgroups. By promoting the consumption of nutritious, healthful foods, such as: fruits, vegetables, whole grains, and low-fat dairy, policy can help nudge individuals to make food choices that will benefit their overall health. However, highly persuasive and predatory food marketing by large food companies makes it increasingly difficult for individuals to discern fact from fiction when making grocery-store and restaurant food choices. This, in conjunction with a push for convenience and little economic means, makes for a cycle of poor health. Thus, New York City must act to limit predatory marketing of unhealthy foods and beverages in an attempt to curb the increasing morbidity and mortality rates from diet-related and preventable disease.
Current Predatory Marketing Policies in NYC
When looking at tobacco as an example, policies to limit advertising of tobacco have had a dramatic effect on the number of smokers in New York City. In fact, “smoking rates in New York City declined from 21.5 percent in 2002 to 13.4% percent in 2017” mostly in part due to the large number of educational campaigns that launched, warning the public of the harms of smoking and adverse health effects . If the New York City Department of Health acted in a similar manner, with targeting the advertising and marketing of unhealthful foods and promoting education around nutrition and health, the prevalence of diet-related disease could decrease. For vulnerable populations which already have elevated diet-related disease such as diabetes and hypertension, this is increasingly pressing. Evidence suggests that “white, wealthier communities are generally “protected” against predatory marketing of unhealthy food and beverages, alcohol, and tobacco”, while Black, Hispanic, and Asian communities “are disproportionately targeted and inundated with ads promoting unhealthy foods and beverages…primarily fast-food, candy, sugary drinks, and snacks” [5, 6]. Given the demographic composition of NYC and the high amounts of Black, Hispanic, and Asian communities, it is imperative that the Department of Health address food marketing in order to improve the health of New York City residents.
More specifically, the use of targeted marketing needs to be curtailed. Targeted marketing refers to “the common practice of advertising products to specific groups of individuals or communities based on their social or psychological characteristics” . Corporations have been using this marketing strategy within certain populations as a means to promote unhealthful foods, such as sugar sweetened beverages, and other products associated with premature death . Particularly, corporations play to their advantage that people might have low literacy rates, little knowledge about nutrition and label reading, and/or be swayed by misleading television or magazine advertising. In New York City, about 18% of residents do not speak English proficiently, let alone can read it, making the likelihood of them being media literate even less likely .
Current Policies Elsewhere
While few strides against predatory and targeted marketing have been taken in the United States and in New York, there have been successful efforts elsewhere that policy makers in New York can learn from. Namely, in London, Amsterdam, and the country of Chile, predatory food marketing has been targeted in an attempt to curtail obesity. In February of 2019, a policy went into effect in London which banned junk food advertising on all Transport for London public transport vehicles. This included any food that was deemed to be “less healthy” by the public health guidelines in England. Similarly, in Amsterdam in 2017, there was a policy enacted that banned all ads related to “unhealthy food aimed at children in the city’s subway system, part of a larger initiative to reduce child obesity” . Furthermore, in Chile in 2012, Law 20.606 was passed, which “established a regulatory framework on food security and healthy food with the intention of guiding consumers towards consumption that promotes public health” .
This law had 2 primary requirements: that certain foods high in calories, sugar or salt must be marked as such, and that advertising must be limited to the product itself, with no other promise of additional products . In turn, this law has prompted several countries to express interest in adopting standards similar to that of Chile in regards to labelling regulation . While there is no empirical evidence yet of success of these regulations, experts suggest that this can at least help minimize the obesogenic environment that children, teens, and adults find themselves in globally . Additionally, knowing that measures to address harmful food marketing have been successful in other cities and countries, it is not unreasonable to suggest the adoption of similar measures in New York City.
There are various measures that can address the issue of predatory and targeted marketing, however, an effective approach to begin would be a two-fold set of strategies set forth by the NYC Department of Health. On a city-level, it would be beneficial to create a series of public health education campaigns to warn people about the dangers of consumption of unhealthy foods and beverages and encourage the consumption of healthier options, such as tap water, fruits, and vegetables. Specifically, the NYC Department of Health could support local community and youth organizations to develop these campaigns, using the tobacco control messaging as an example. Additionally, the NYC Department of Health could create their own advertisements, helping to undermine the marketing messages of food industries. These advertisements could be similar to that done by the Philadelphia Department of Health, with the use of icons, images, and symbols in lieu of having too many words on an advertisement to be sensitive to those who might not be able to read in English [Figure 1, 7].
Through these city and state level changes, the NYC Department of Health could strengthen community health literacy and knowledge about the practices of food corporations, encourage companies to be more transparent in their marketing practices, promote the consumption of more healthful foods, and foster better media literacy.
While these policy changes are important, they are not without limitations and consequences. Particularly with the dissemination of more knowledge and health literacy around the consumption of healthful food and beverage items, there is no solution here that also addresses the issue of access. While one might know that they need to consume more healthy food and beverage items, this does not mean that they have the financial means or ability to access these items. Thus, it would also be imperative for the NYC Department of Health to also work with other agencies within New York City and New York State to address the issues of access and affordability of healthy foods, particularly in low socio-economic areas. Policies and funding in collaboration with entities such as but not limited to: The Center for Disease Control, The National Institute of Health, The Department of Health and Human Services, and nonprofit entities such as: The Truth Campaign, No Kid Hungry, The Hunter Urban Food Policy Institute could prove to be beneficial to address these goals.
The Role of the Dietetics Professionals
As credentialed experts within our field, it is our duty to advocate on behalf of those who either do not have the agency or authority to do so for themselves, or do not have the proper resources to effectively convey their arguments. It is imperative that Registered Dietitians (RDs) in particular be the voices that bring to light predatory food marketing behaviors, call out industry voices, and instigate lasting change by educating the public. Additionally, with local, state, and national advocacy efforts, we can promote lasting policy solutions like the ones mentioned above that can improve marketing behaviors and improve general population health. To get involved in this work, reaching out to fellow like-minded RDs within this realm would be crucial, along with additional reading on this topic from Marion Nestle, Marie Bragg, Jennifer Pomeranz, The Hunter Food Policy Institute, the Tisch Center for Food Policy, the Duke Sanford World Food Policy Center, Rudd Center for Food Policy and Obesity, and UNC Global Food Research Program.