Warning: Don’t Let the Beverage Industry Harm Your Kids

This issue of AJPH brings some good news for everyone concerned about childhood nutrition: in a rigorous, randomized controlled trial—the first study of its kind to my knowledge—Krieger et al. (p. 1997) found that countermarketing on social media could reduce purchases and consumption of sugary fruit drinks and increase consumption of water among Latino/a/x¹ parents and their children. The key to understanding the significance of this study is in the definition of “countermarketing,” a technical term that directs audiences’ attention to the behavior of industry.

DENORMALIZING INDUSTRY PRACTICES

Unlike general social marketing or other communications campaigns, countermarketing is designed “to reduce the demand for unhealthy products by exposing the motives of their producers and portraying their marketing activities as outside the boundaries of civilized corporate behavior.”^2(p120) The spectrum of health communications can stretch from inspiring individual behavior change on one end to campaigns that influence policy, systems, and environmental change on the other; countermarketing sits at the systems end of the spectrum, with the intention of shining the light on institutions with the power to change environments.³ At scale, countermarketing improves health by denormalizing the marketing practices—the normal business practices—of companies producing products that harm health.²

The messages Krieger et al. tested put the beverage industry’s manipulative marketing front and center. For example, one of their messages shows a girl with severe tooth decay holding a fruit drink pouch bearing an “all-natural” claim and the text “Just because a label states ‘all-natural’ doesn’t make a fruit drink healthy. Don’t let the beverage industry harm your kids.” (I encourage AJPH readers to view the images in the supplemental material to feel their, well, punch.) The study demonstrated the strength of the messages with statistically significant reductions in parents selecting fruit drinks in the virtual store and in their reported consumption in real life later.

As Krieger et al. note, tobacco control has had celebrated success with countermarketing. Indeed, the study’s message is reminiscent of a countermarketing message from California’s storied campaign Warning: The Tobacco Industry Is Not Your Friend, a campaign credited with tripling the decline in smoking in California.⁴ But such campaigns are expensive. California’s multimillion dollar tobacco education campaign was funded by a statewide tobacco tax, and a similarly robust early effort, the original “truth” campaign in Florida, was funded with $200 million from Florida’s $11.3 billion settlement with the tobacco industry.⁵ Krieger et al. suggest that their findings will help local organizations without such deep pockets reach parents with successful countermarketing because the messages were tested on social media, in this case, Facebook.

QUESTIONS OF HEALTH AND RACIAL EQUITY

Herein lies an irony: is Facebook the solution or the problem? Krieger et al. point out the affordability of social media campaigns, but reach is still an issue. Posts from alcohol, tobacco, and food companies often generate millions of views, whereas community-organized grassroots health-focused social media might generate views that number in the hundreds.⁶ Getting to scale, even on social media, can be expensive.

The social media platforms themselves, including Facebook, are now the largest junk food marketers. Google and Facebook alone account for the majority (nearly 60%) of digital ad spending worldwide,⁷ and social media is where food and beverage companies go to reach children.⁸ Facebook has worked with Coca-Cola, PepsiCo, Unilever, Nestlé, and many other companies to enable sophisticated marketing across its platform.⁸ Consider just one example: in 2019, Pepsi partnered with Facebook’s Instagram to produce 230 million bottles of soda imprinted with mobile phone codes that triggered “full-screen immersion” augmented reality effects to stimulate purchases of 20-ounce bottles of Pepsi.⁸ Even with the low entry fees to social media, it will be hard for public health to compete with immersive, enticing, and ever-present digital campaigns.

Sugary beverage marketing is a health equity issue because the food, beverage, and digital marketing industries hold the power over what children see. It is also a racial equity issue because children of color are heavily targeted with marketing for sugary beverages and other junk food.⁹ Although parents control the products they serve their children, it is not fair to hold parents solely responsible for the effects of marketing they do not control. These power imbalances force us to turn our attention not just to the decisions individual parents make about what they and their families consume but also to the policies that shape the environment in which those decisions are made.

Countermarketing can help when the messages are part of policy campaigns to rein in industry behavior. Recent research has demonstrated, for example, that messages emphasizing the intersections among industry behavior, parental decisions, and community efforts may be particularly effective in moving diverse constituents to support policy such as marketing restrictions, and communities of color in particular may be more attuned, perhaps through lived experience with aggressive target marketing, to the value of policy in shaping industry behavior.¹⁰ Current legislative and legal antitrust actions against tech giants, including Facebook, are an opportunity to restrict marketing practices across digital platforms, including marketing for sugary drinks.⁸

CONCLUSIONS

In the early 1990s, the task of the tobacco control movement was “to publicly identify the tobacco cartel as the enemy, and to fight to dislodge it from its positions of power.”^11(p35) Countermarketing was an important tool in tobacco control. Krieger et al. have shown that we can wield the same tool to improve childhood nutrition by making visible the actions of food and beverage marketers targeting children. Let’s put this good news to use by placing responsibility at the feet of the platforms and companies profiting from directly and incessantly targeting children with marketing the food and drink they should avoid.