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.
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
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
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
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
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.
- Institutes of Medicine.
Preventing Childhood Obesity: Health in
Washington DC: IOM, 2005.
- 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.
Issue date 1 April 2010.
- Hawkes C. Marketing
Food to Children: the Global Regulatory
Environment. Geneva: WHO, 2004.
- Hawkes C. Marketing
Food to Children: Changes in the Global
Regulatory Environment 2004-2006.
Geneva: WHO, 2007.
- 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.
- World Health
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- Monteiro C, Gomes F,
Cannon G. The snack attack. American
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Published on-line 15 April 2010. Obtainable
- EU-Pledge. Food and drink
companies pledge to change advertising to
children. Press Release.
- 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;
- Hawkes C. Food packaging:
the medium is the message. Invited
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2010; 13(2): 297-299.
- World Health
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Geneva; 2003. (WHO Technical Report Series,
- EU-Pledge. EU Pledge
Initiative PepsiCo Commitment.
- EU-Pledge. EU Pledge
- 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.
- 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.
- Klein N. The Shock
Doctrine. The Rise of Disaster Capitalism.
New York: Holt, 2007.
- Partners Forum.
Information obtainable at:
- International Business
Leaders Forum. Information available at:
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Please cite as: Anon. Marketing food products to
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Website of the World Public Health Nutrition
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