With their clever use of digital media, promoters of unhealthy products – alcohol, tobacco, junk food and gambling – are currently way out in front of both regulators and health promotion professionals. It’s not a healthy situation.
Few sectors can match the marketing savvy of the unhealthy commodity industries. Under scrutiny for the health impacts of their products, and under pressure from advertising and sponsorship regulations, the brands behind big tobacco, big alcohol, big junk and big gambling have proven remarkably resourceful. They have mounted a colourful and highly watchable marketing offensive, engaging audiences through disruptive digital media initiatives, including sponsored events, playful social media interactions and cheeky Wikipedia hacks. But they’ve also invested in defensive action, disputing and diluting public health policy and its contributing research.
Rob Moodie, a former CEO of VicHealth, is Professor of Public Health at the University of Melbourne’s School of Population and Global Health and the College of Medicine, University of Malawi.
The monitoring and intimidation of individual scientists is widespread, says Moodie, citing efforts to delegitimise the work of other Australians including Melanie Wakefield of the Cancer Council Victoria and Jane Martin from the Obesity Policy Coalition (OPC).
‘It’s not just attacking the science, they’re attacking the credibility of individuals.’
Brands have also been known to create ‘arm’s length’ entities with which to fund interest groups and sponsor research with the aim of circulating insights customised to their own marketing goals. Moodie has pointed to the work of the International Life Sciences Institute (ILSI), an organisation funded by the likes of Nestle, Coca Cola and PepsiCo (manufacturer Mars, announced plans to quit the group by the end of the year). Scientists and the health promotion sector have criticised the ILSI for its work, including a 2014 study that questioned links between sugary drinks and obesity, and a 2016 research review that concluded guidelines around limiting sugar intake did not constitute ‘trustworthy recommendations’ (‘The quality of available evidence to link sugar with health outcomes was generally rated as low to very low,’ the review concluded).
Moodie also refers to Drinkaware in the UK and Drinkwise in Australia, both of which are funded by local alcohol industries.
Last year, a study led by the London School of Hygiene and Tropical Medicine found that both organisations had omitted or obfuscated information about the links between alcohol consumption and cancer.
Representatives from across the unhealthy commodity industries are also committing significant resources to lobbying governments in attempts to influence the political agenda over issues ranging from sugar taxes to e-cigarettes and online gambling regulations.
Efforts to prevent non-communicable diseases go against the business interests of powerful economic operators.
‘These companies, this whole industry, they all lobby and increasingly they’re putting more and more effort into lobbying,’ says Mike Daube, Professor of Health Policy at Curtin University. ‘One example that comes to mind: in the European Union a year or so ago on one issue alone, Philip Morris employed 150 lobbyists.’
Former World Health Organization (WHO) Director-General Margaret Chan has noted that ‘efforts to prevent non-communicable diseases go against the business interests of powerful economic operators’. Or as Daube succinctly puts it, ‘They’ve only got one aim and that aim is to promote the sales of harmful products.’
‘It’s not just big tobacco anymore: big food, big soda, big alcohol – all of these industries fear regulation and protect themselves by using the same tactics,’ says Daube. ‘They include front groups, lobbies, promises of self-regulation, lawsuits, and industry-funded research that’s confused the evidence and keeps the public in doubt.’
Self-regulation vs ‘the nanny state’
The term ‘nanny state’ is frequently and effectively used by unhealthy commodity industry lobbyists to diminish public health initiatives.
‘They want to do as much as they can to undermine other health and health promotion work,’ says Moodie. ‘Consider the nanny state dialogue around the pokies. They’d worked carefully on that message. It all paints a picture of health promotion as an attack on individual freedom, as distinct from trying to create an environment where healthy choices are easy choices.
‘But look at the issue properly and it’s clear that industry has a far greater influence on determining our consumption behaviour than the health industry does at the moment.’
The unhealthy commodity industries are keen to promote the idea that they can self-regulate effectively and responsibly, without the need for government influence, and that they are active supporters of good health in the community.
The tactical sponsorship of ‘healthy’ sporting pursuits by the tobacco brands was banned in Australia in the 1990s, due in no small part to the VicHealth buyout of those sponsorships in the late 1980s. Today, junk food and sugary drinks brands are using the same marketing strategies to reach mass audiences (although it bears noting that pioneering marketers Coca Cola have been sponsoring the International Olympic Gamescontinuously since 1928).
‘Self-regulation tends to be the default and there doesn’t seem to be any political appetite to strengthen regulation.’ says Jenny Reimers, Principal Program Officer—Healthy Eating at VicHealth. ‘When the need for stronger regulation is raised, it tends to get that ‘nanny state’ label.’
‘We know that kids who are exposed to alcohol advertising start drinking at an earlier age and drink more. Yet, due to an exemption, we still see these ads during children’s viewing hours via sporting events and programs when we know families are watching with young kids,’ says Emma Saleeba, Manager, Alcohol and Tobacco at VicHealth. ‘The alcohol industry can say ‘well we’re not targeting kids’ but it doesn’t matter if they’re being actively targeted, they’re still being exposed to it.’
New world, new strategies
Digital media and in particular social media platforms have opened up new opportunities for the promotion of alcohol, tobacco, junk food and gambling brands. It’s an environment that offers the unhealthy commodity industries several advantages. For one, it’s an area that requires serious investment in skills and innovation of a scale that the industries’ public health counterparts find almost impossible to match. For another, it remains – for the time being at least – comparatively unrestricted.
‘We don’t have any set of regulations in those sectors,’ says Reimers. ‘We don’t even really know the prevalence. It’s so broad. It’s pop-up ads, it’s mobile apps, it’s the gamification of brands – a fun game you can play, but it’s associated with junk food. We’ve struggled to get any success with regulating advertising in traditional media, and new media’s harder.’
‘When we’re looking at the tactics the industries might use when advertising on television or billboards or similar – these are areas where there has been some progress when it comes to regulation, but social media remains unregulated,’ says Sharon Friel, Professor of Health Equity at the Australian National University.
‘These platforms are where much of the exposure is happening now and we don’t have a handle on that from a public health or a health promotion perspective.’
In 2015, for example, McDonalds courted the attention of the 18 to 35-year-olds who had so far resisted the charms of the Big Mac by sponsoring The Drop, an offshoot of Spotify where streamed artists shared exclusive images, videos and playlists. (The Drop is now sponsored by Jeep.) That tactic was pre-dated by Coca Cola’s influential Coca Cola Placelists app, another Spotify initiative that allowed listeners to hook in to music being played in real time by other listeners around the globe (‘We hope to make every Coke moment a musical moment, and every memorable musical moment a Coke moment,’ said the company’s director of entertainment marketing, Joe Belliotti.)
In the local market, Saleeba points to the Facebook activity of cider brand Little Fat Lamb. ‘This is an excellent example of an alcohol brand using social media for great effect.’
The product has a high alcohol content (8 per cent), is cheap and sold in 1.25L bottles that mimic soft-drink packaging. The Little Fat Lamb Facebook page speaks to a youthful audience, using online memes to make jokes about getting drunk on the product, prompting consumers to send in photos of them drinking a ‘fatty’ and even encouraging them to get tattoos of the brand. Despite ABAC guidelines that online alcohol marketing needs an 18-plus age verification, the Facebook page is openly available.
How does health promotion combat this?
The online environment might well be the fresh battleground for health promotion.
‘In the health promotion world, we need digital strategists, we need digital advertisers, people that understand this environment much more than we ever have before,’ says Moodie. ‘The health promotion world is way behind on this – way, way behind.’
Pete Saunders is a digital strategist and the CEO and Founder of Health Delivered. ‘Big brands currently lead the way in behaviour change because they have the resources behind them,’ says Saunders. ‘Just five years ago we were excited because we could do programmatic advertising, targeting certain people at certain times with certain messaging.
‘Now you can do that hundreds of thousands of times with minute variations of messaging just to hone in on what works, what converts. It is just so much more powerful than it ever has been.’
‘Social media has driven this but social media is just a mechanism. What really comes through is the ability to take datasets that used to be disconnected, and make meaning out of them. It is resource-intensive, but it’s also getting cheaper and more effective every day.’
As Saunders describes, the sophistication of digital advertising is developing at an accelerating pace. A few years ago, platform-based data analysis enabled advertisers to target ads to specific individuals, in specific locations, at specific points along their ‘path to purchase’. Now, those platforms are growing ever smarter in how they interpret the available data, and the signifiers are growing correspondingly more and more refined. Right now, advertisers can get data on exactly how close someone needs to be to one of their stores in order for them to respond to a sudden-impulse advertising prompt. They can also individually calibrate the price of the online item they’re promoting to match the ‘price perceptions’ generated by the user’s previous online searches for similar items.
Health promotion needs to start working in this space and employing the same sort of tools the brands use, says Saunders.
‘These tools are created by organisations like Facebook and Google to enable more brands to do more advertising, so they [the platforms] can make more money. Facebook doesn’t discriminate, so a lot of the ad tools that are available to the big brands are available to people in the health sphere. We just don’t know how to use them.’
While it could be argued that the health promotion sector has equal access to the tools required to reach digital audiences, the relative funding resources of public health advocates and the big unhealthy brand marketing teams positions this as something of a David-and-Goliath battle.
Daube thinks a concerted campaign to educate people on the unhealthy commodity industry tactics is a first step.
‘The first course needs to be to shine a light on these industry activities from promotion, to lobbying, to front groups and so on,’ he says. ‘Along with that I would like to see us establishing what I think of as harmful industry observatories whose role is to monitor what these industries are doing nationally and internationally, and to keep both health groups and the community informed.’
Daube also points to Article 5.3 of the WHO Framework Convention on Tobacco Control (calling for signatories to protect public health policies from ‘commercial and other vested interests’) as a framework for deeper interventions across the unhealthy commodity industries.
‘There’s a strong argument that we need an Article 5.3 equivalent for the other harmful industries, because they all desperately want to be involved in the policy process. They want to be on committees that advise on policy. We need something that clearly says tobacco, alcohol, gambling and junk food interests should not be involved in policy development, or the processes of policy.’
Others in the health promotion sector insist on the importance of greater regulation of the digital media environment.
‘Public health and health promotion needs to get a regulatory apparatus into play to give health promotion some of the tools that work in the environments where exposure to these commodities is so much higher,’ says Friel. ‘We need that regulatory apparatus to be carefully designed and purpose built for health sectors.’