This month, from 17-22 May, the World Health Organization annual World Health Assembly will convene and deliberate on important and urgent issues. One item on its agenda, in the context of prevention and control of obesity, is the marketing principally by transnational companies of branded food and drink products to children. In the opinion of many independent and knowledgeable people, including public health nutritionists, current industry policies and practices are outrageous, and if not as bad, at least in the same league of scandal as the aggressive marketing of artificial baby formula feeds.

What’s up?

The abuse and exploitation of children, especially young children, for profit, is wrong. Some will say that such practices are wicked. An example is the advertising and marketing throughout the world by transnational and other very big companies of branded, energy-dense, fatty or sugary food and drink products directly to children. This is intrinsically exploitative. Also, practically all independent evidence and testimony confirm common sense, which is that such marketing is an important reason why childhood overweight and obesity has become an uncontrolled pandemic.

The marketing of branded food and drink products to children, including to younger children under the age of 12, and also to young children under the age of 6, is now globalised. By use of worldwide, national and local sponsorships, multi-media shows, television, the internet, cell phones, retail advertising, vending machines, school literature, toys, infiltration into school playgrounds, and other methods, children of all ages in all but remote rural areas in low income countries and territories, and everywhere in high-income countries, are exposed, targeted and exploited.

A basic purpose of this marketing is to imprint in the minds of parents as well as children, lifelong loyalty to transnational brands, and to products which are mainly made up from the cheapest starches, sugars and fats on the world market. These are made palatable and attractive with the addition of salt and preservatives and cosmetic chemical additives, together with colossal spends on packaging and promotion.

In the USA alone, the total spend on advertising and marketing of foods and drinks to children in 2004 was $US 10 billion, half of which was on television advertising (1). In these days of national debts and bank bailouts, this may seem to be small change, but with 75 million children in the USA, it amounts to over $US 130 per year per child. The sum now will be higher – maybe approaching $US 200 per child per year. Virtually all the products were – and are – energy-dense, fatty, sugary or salty. The most heavily marketed categories were – and remain – soft drinks, fast food, confectionery (candy), and sugared breakfast cereals. In the last few years, less money is being spent on television advertising, and much more on ‘viral’ and other more insidious methods. All these methods are effective.

So what’s to be done?

Plans for protection of children

As stated, one item on the World Health Assembly (WHA) agenda this month is the prevention and control of non-communicable diseases, including obesity (2). The relevant agenda item includes a detailed annex on the issue of food and drink marketing to children, with recommendations, as required by member states at the 2007 WHA.

The thinking of the WHO secretariat on this issue has been informed by a series of reports prepared by Corinna Hawkes, the leading scholar on this topic, in consultation with interested parties throughout the world. The first of these, published by WHO in 2004, was commissioned by the then relevant WHO executive director Derek Yach (3), and the second, also commissioned by WHO, was published in 2007 (4). Then Dr Hawkes was invited by WHO to chair an expert group to report on the topic, and to make recommendations directly to the WHO director-general Margaret Chan. The group met in Geneva on 1-4 December 2008, and its report was submitted to Dr Chan on 30 January 2009. The report has not been disclosed or published (5).

Meanwhile, the WHO secretariat had prepared a working paper. Consultation with some international non-governmental organisations (NGOs) recognised by WHO took place on 20 November 2008. Consultation with industry, or to be more exact transnational manufacturers and caterers (General Mills, Kellogg’s, Kraft, Mars, Nestlé, PepsiCo, Coca-Cola, Unilever, McDonalds) and the advertising industry, took place four days later (6). WHO briefings were circulated to governments; 66 had responded by September 2009. Follow-up consultations with NGOs and industry also took place in 2009.

What emerged from this process is the annex to the agenda for the 2010 World Health Assembly, prepared as always by the WHO secretariat (2). There are differences between the documents. The first three, and in particular the January 2009 unpublished report, emphasise the strength of evidence, the central role of government in policy-making, and the need for statutory and other formal regulation, or at least for industry self-regulation that is monitored, enforced and independently audited. The annex on the agenda this month in Geneva gives more stress to the need for more research, omits the point that governments should make policy, instead positions governments more in a co-ordinating role, allows the option of industry taking the lead with self-regulation, and is rather vague about mechanisms for audit.

So what now?

Transnational industry is duplicitous

The position of the transnational food and drink industries is that everything is already practically under control. They say that the self-regulation they have offered is changing the fast food and soft drink ‘landscape’.

This is not so The American Journal of Public Health is about to publish a commentary, now posted on-line, whose lead author is Association founder member Carlos Monteiro of the School of Public Health at the University of São Paulo (7). This reviews the pledges made by a number of transnationals in December 2007 to restrict advertising and marketing of their foods and drinks to children in Europe (8).

It turns out that the pledges apply only to advertisements in media vehicles with an audience of at least 50 per cent of children under 12 years of age. They exempt all products that conform to nutrition criteria that are devised by the individual companies themselves. They exclude secondary schools, and allow promotions in primary schools ‘where specifically requested by or agreed with the school administration for educational purposes’. Moreover, they do not include packaging. The pledges apply only to marketing solely addressed to children; whereas packaging, including that aimed at children under 6, is not seen by industry as advertising and marketing of a type that needs any restraint (9,10). Also, while all colossal, the industries who have signed the pledges together amount only to a large fraction of the food processing industry as a whole.

As specific examples, Pepsi-Co allows advertising to children of any age of any of its products whose levels of fat, saturated fat, trans fat, dietary cholesterol, added sugar or sodium exceed the limits specified by WHO (11), if the levels of any single one of these items is reduced by 25 per cent relative to the 2004 formulation (12). Breakfast cereals and snacks with up to 25 per cent of added sugar may be advertised with no restriction to children of any age, if they contain 2.5 grams of dietary fibre per serving (12). Kellogg’s also continues to advertise to children of any age, products with up to 25 per cent of added sugar (13). Much the same points apply to the global pledges made by transnationals in a letter to Margaret Chan in May 2008 (14).

‘But this is not all’ say Carlos Monteiro and his colleagues. ‘Voluntary codes so far are not addressing other troublesome, sociopathic and pathogenic aspects of processed foods and drinks, such as high energy density,… consumption of high levels of calories in the form of sugary cola and other soft drinks, glamorisation of over-consumption, inducement of snacking in streets and while watching television, discouragement of meals and cooking, association of processed foods and drinks with sex appeal, and equation of happiness with spending’.

The outstanding independent document on the topic of the restriction of food and drink promotion to children has been produced by the International Obesity Task Force (15).It includes seven Sydney Principles, the product of a global consultation including with industry that produced 220 responses. The principles specify policies and actions that uphold the rights of children, afford substantial protection to children, are statutory, define ‘promotion’ broadly, guarantee commercial-free environments for children, work cross-national borders, and that are independently evaluated, monitored and enforced. The only significant disagreement evident in the consultation was that industry responses were against statutory regulation.

Can the UN make a difference?

Has the UN system lost the plot?

So what will happen this month at the World Health Assembly? From the point of view of protection of child health, there are a number of reasons not to be cheerful. The largest transnational food and drink industries have turnovers larger than the gross domestic product of many smaller African countries, and have vast promotion, publicity and public relations budgets that can be deployed at will. They employ and hire resourceful, ambitious and experienced people, on salaries and fees far beyond the reach of the public sector. On global strategic issues they hunt as a pack. Their jointly agreed position is that they should be free to promote their products any legal way they choose, everywhere in the world, and their policy is to dismantle all laws and formal regulations that may impede their profitability.

Industry is taking many powerful initiatives. The corporate affairs departments of various manufacturers have, last year and this, been rolling out announcements designed to reinforce the idea that ‘public-private-people partnerships’ are in the public interest. These say what the transnationals are doing to fight famine and alleviate hunger in Africa, and to combat climate change, protect the environment, and endow scholarship, as well as control obesity, while maintaining their commitments to increased market share and the bottom line. In the current jargon these are known as ‘win-win situations’. Meanwhile, the food systems of lower-income countries are being deeply penetrated by transnationals, who take over some national firms, drive others out of business, and work with politicians at all levels.

Governments still tend to avoid their primary responsibility of governance. Despite their pledges, the transnationals press incessantly for the abandonment of any form of statutory control of their activities. Their commercial interests converge with the ‘free market’ ideology that since the 1980s has gripped or paralysed the governments of almost all powerful countries and most other countries, with important exceptions (16). National governments are increasingly unwilling – or, with the rise of international bodies that have statutory powers, such as the World Trade Organization, unable – to govern. National delegations from many countries to WHO meetings include members who work for or who are funded by sectors of industry whose interests conflict with those of public health.

The UN system seems to have lost its way. Starved of funds, relevant UN agencies are forced to rationalise partnerships with sectors of industry whose profits depend on unhealthy products. The heads of two key agencies, UNICEF and the World Food Programme, are US government appointments. The positions of senior UN staff who have retired are not being filled. Other senior UN staff who have left now advise or work for industry, the best-known example being Derek Yach, now a senior vice-president with Pepsi-Co. The UN Standing Committee on Nutrition, set up to strengthen and harmonise joint UN policies and programmes, is currently out of funds, and its governing body proposes to admit industry – which in practice means transnational food and drink processors – as full partners.

In what may turn out to an eccentric example, the Pan-American Health Organization (PAHO), a branch of WHO, has just launched a ‘Partners Forum’ meant to prevent chronic diseases (17). Its initial policy was set out with the World Economic Forum, and also a body called the International Business Leaders Forum, whose four managing directors include two men from Coca-Cola and one from the alcoholic drinks conglomerate Diageo (18). Most members of the Forum are from food and drink processors, and most of these from publicity and public relations departments. The Forum agenda so far follows that already set out by transnational industry. Its programme has no mention of marketing of food and drink products to children. There is also no reference to independent audit.

A report on the World Health Assembly deliberations and conclusions on the marketing of food and drink products to children will be posted on this site next month, on 1 June. The first step towards change for the better is awareness of realities. If this month in Geneva, enough member states uphold the UN system, and insist on the central role of governments and on the need for legislation to protect children, change for the better may come.

The editors

References

1. Institutes of Medicine. Preventing Childhood Obesity: Health in the Balance.
   Washington DC: IOM, 2005.
2. World Health Organization. 2010 World Health Assembly agenda item A63/12. Includes Annex: Set of recommendations on the marketing of food and non-alcoholic beverages to children. Obtainable at: http://apps.who.int/gb/ebwha/pdf_files/WHA63. Issue date 1 April 2010.
3. Hawkes C. Marketing Food to Children: the Global Regulatory Environment. Geneva: WHO, 2004.
4. Hawkes C. Marketing Food to Children: Changes in the Global Regulatory Environment 2004-2006. Geneva: WHO, 2007.
5. World Health Organization. Report of meeting and recommendations from the members of the ad-hoc expert group on marketing of foods and non-alcoholic beverages to children to the Director-General of the World Health Organization. Submitted 30 January 2009. Unpublished.
6. World Health Organization. Consultations with NGOs and industry on the marketing of food and drink products to children. Obtainable at: http://who.int.dietandphysicalactivity/marketing-food-to-children/en/index.html.
7. Monteiro C, Gomes F, Cannon G. The snack attack. American Journal of Public Health, June 2010. Published on-line 15 April 2010. Obtainable at: www.ajph.org
8. EU-Pledge. Food and drink companies pledge to change advertising to children. Press Release. http://www.eu-pledge.eu/pres.php?id=1.
9. Hawkes C. Regulating and litigating in the public interest: Regulating food marketing to young people worldwide: trends and policy drivers. American Journal of Public Health 2007; 97: 1962-1973.
10. Hawkes C. Food packaging: the medium is the message. Invited commentary. Public Health Nutrition 2010; 13(2): 297-299.
11. World Health Organization. Diet, Nutrition and the Prevention of Chronic Diseases. Report of a joint WHO/FAO expert consultation. Geneva; 2003. (WHO Technical Report Series, 916).
12. EU-Pledge. EU Pledge Initiative PepsiCo Commitment. http://www.eu-pledge.eu/pledges.php?id=8.
13. EU-Pledge. EU Pledge Kellogg Commitments. http://www.eu-pledge.eu/pledges.php?id=6.
14. Powell K, Mackay D, Rosenfeld I, Michaels P, Bulcke P, Nooyi I, Kent M, Cescau P. A global commitment to action on the global strategy on diet, physical activity and health. Letter from food and beverage CEOs to Dr Margaret Chan, Director General of WHO, 13 May 2008. http://www.idec.org.br/pdf/OMS_companies_commitment_WHO.pdf.
15. The Sydney Principles for reducing the commercial promotion of foods and beverages to children. International Obesity Task Force working group on marketing to children: Swinburn B, Sacks G, Lobstein T, Rigby N, Baur L, Brownell K, Gill T, Seidell J, Kumanyika S. Public Health Nutrition 2008; 11(9): 881-886.
16. Klein N. The Shock Doctrine. The Rise of Disaster Capitalism. New York: Holt, 2007.
17. Partners Forum. Information obtainable at: www.paho.hq.partnersforum.
18. International Business Leaders Forum. Information available at:
    www.iblf.org.

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Please cite as: Anon. Marketing food products to children: Are the UN agencies helpless? [Editorial] Website of the World Public Health Nutrition Association, May 2010. Obtainable at www.wphna.org

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