Research shows voluntary commitments by big food companies on marketing unhealthy foods don’t work

4 Sep 2022

New research from Wits University’s Centre for Health Economics and Decision Sciences, just published in Nature Food, shows that voluntary commitments by major food and drinks companies to take actions in support of public health don’t work. And not only that, in low- and middle-income countries like South Africa, they actually weaken governments’ attempts to create stronger policies that would be better for public health because they appear to reduce the ‘need’ for legislation.

Halfway through the 2017 school year, a major soft-drinks company made a surprising voluntary commitment in support of South African children’s health. It promised to stop supplying its brands of sugar-sweetened beverages (SSBs) to primary schools throughout South Africa.

In a country that has a childhood obesity risk of six out of 11, with already alarming overweight and obesity rates (68% of women, 31% of men and 20% of children are either overweight or obese), this seemed a hopeful step in the direction of reducing South Africa’s burgeoning obesity and diabetes problems. Drinking just one sugary drink per day increases a child’s likelihood of being overweight by 55%, and increases anyone’s risk of developing type 2 diabetes by 25% (liquid sugar is particularly harmful).

Two years later, in 2019, University of the Witwatersrand researcher Agnes Erzse, and others from the South African Medical Research Council Centre for Health Economics and Decision Science (PRICELESS), decided to investigate what had happened: “We were interested to see, what does the school environment look like two years after this pledge?” Erzse told Maverick Citizen.

The research team visited more than 100 fee- and no-fee primary schools in Gauteng and found that the company’s brands remained available in the majority (54%) of the schools with tuckshops. Most of the no-fee schools did not have their own tuck shops but did have food and drink outlets located within 50m of school premises.

The major beverage company (let’s call it the MBC) had also pledged to replace the unhealthy products with alternatives (low-calorie and no-sugar drink options), to offer smaller-pack sizes to support portion control, and to remove all its branding and advertising from within school premises.

But, Erzse explained, “When we looked at availability of alternative low-calorie products, we found that none of the school tuck shops sold only low-calorie drinks, for example, which meant that low-calorie drinks and water were not being substituted for sugary drinks.”

In addition, the MBC’s branding remained largely in place.

The MBC’s pledge ultimately “did not protect children from SSB sales and marketing”, Erzse said, “counter to what the company stated as their intention.”

All this got Erzse and her Wits colleagues thinking. They wondered how – or if – similar pledges by food multinationals in other low- and middle-income countries (LMICs), with similarly accelerating obesity and noncommunicable disease (NCD) epidemics, have worked any better?

The outcome of Erze’s broader question was a paper published in Nature Food in August, showing that, in many of these cases, the “voluntary actions” (VAs) have effectively dampened LMIC governments’ perceived need for statutory measures, because the VAs appear to take the “need” for legislation out of governments’ hands. But the problem, the research finds, is that these kinds of pledges don’t work.

More specifically, the study found no evidence that VAs have a positive impact on public health – and, in addition, found that such commitments in fact have a damaging impact on governments’ taking action to put stricter regulations in place.

This is the first time that both public health and policy environment impacts have been considered in the same study.

Under the pressure of government proposals to regulate industry, the authors found that the underlying purpose of VAs was “to provide a mechanism for industry to pre-empt the introduction of more binding and less flexible public regulation”.

What the study looked at

The team examined academic literature on 20 voluntary actions, in countries such as Brazil, India, Mexico, Thailand, the Philippines, Turkey and South Africa. The 20 VAs were chosen because they related to four key World Health Organisation-endorsed recommendations, which countries are increasingly adopting in their efforts to curb obesity and NCDs. The four recommendations were:

product reformulation (replacing unhealthy ingredients with less-unhealthy ones);

restricting the marketing of harmful products to children,

taxing sugar-sweetened beverages,

and product labeling.

They were looking for “why something worked, who it worked for, and what context it worked in”, Erzse said.

Safura Abdool-Karim, one of Erzse’s co-authors, and a lawyer, explained that, in trying to establish the actual, real-world outcomes of voluntary actions, they found that instead of having demonstrable public-health outcomes the VAs had “more of a policy substitution effect, or a weakening of governments’ ability to regulate”.

Making voluntary commitments thus effectively allows powerful food companies to enact their own policies. While ostensibly in the service of public health, these are never assessed or monitored against the stricter, evidence-based criteria that would form the basis of government-defined policy.

Examples of this in the paper included pledges to restrict marketing to children in South Africa that were initiated two years after, and in Brazil three years after, government proposals to regulate advertising to children. This has resulted in “substantial delays” in introducing relevant and stricter policies in these countries, the paper says. (And an open-ended delay in South Africa: As of this writing, the South African government has still not introduced into law the draft regulations on marketing and labeling of foods published for public comment in 2014.)

In high-income countries, voluntary commitments occur, too.

Research from the US, Canada, Australia and Europe shows that voluntary pledges are ineffectual and allow continued promotion of unhealthy foods and beverages, Erzse said.

“The pledges use weak nutrition criteria and limit scenarios for when and where they restrict marketing. It’s very similar to our findings on SSBs (sugar-sweetened beverages) in schools, and this allows the participating companies to directly market to children foods and drinks that are not considered healthy against more impactful and objective nutrition standards.”

Consumers’ right to choose

Abdool-Karim emphasised that highly concentrated control of the food market takes away consumer choice, because the majority of available, affordable food is engineered to be unhealthy.

Consumer decisions about which foods to buy are influenced by “a myriad of factors”, she says, “but I think the biggest one, hands down, has to be that these corporations push ultra-processed foods more than any other type of food, because profit margins are exceptional on them – and in that way they are influencing what we eat, and pushing us towards unhealthier food as consumers.”

Abdool-Karim describes the highly concentrated control of South Africa’s food supply, and says, “they have created a narrative around things like the sugary-beverage tax (Health Promotion Levy) that [they say] takes away consumer choice, takes away consumer freedom”.

Stronger government leadership, ie. creating stronger rules for “Big Food” to abide by, would support consumer freedom, by encouraging consumer awareness of what is healthy and what is not, and in this way strengthening consumers’ demand for affordable, healthy food.

Better something than nothing?

“Tobacco [offers] the most concrete evidence that these things [VAs] don’t work,” Abdool-Karim says, “but food is more complicated.” If voluntary pledges by tobacco and alcohol companies to restrict child-directed marketing have been shown to have failed, why do international organisations continue to endorse them when it comes to food?

“The biggest reason,” Abdool-Karim says, “is because these organisations believe that ‘public-private partnerships’ are part of addressing this, and have invited industry to the table when developing things like these endorsements. It is complicated when you’re dealing with an organisation like UNICEF that is trying to combat child undernutrition, and these companies control so much of the food supply.”

Another reason is that food is a more complex sector to regulate. “Food is not the same as tobacco and alcohol,” Abdool-Karim explains. “The fact that the tobacco and alcohol industries are incompatible with public health objectives is evident – but this is not necessarily the case when it comes to food, which is critical to human health.”

The same corporations are often producing both healthy and unhealthy foods – for example, minimally processed oatmeal and ultra-processed crisps.

“It’s often unclear how to differentiate those food-industry actors that can be viewed as capable of contributing positively to population health and those that cannot,” Abdool-Karim says.

In addition, she told Maverick Citizen, “adopting government regulation is incredibly resource-intensive, and, so in certain settings, especially in low-income countries, the attitude is kind of ‘better something than nothing’, because they feel like governments won’t be able to enforce the regulations. The administrative burden is too high.”

Conflict of interest, anyone…?

In poorer settings in South Africa and similar markets, VAs also consist of things like putting in a soccer field at a school or sponsoring children to play cricket, Abdool-Karim explains. “They [corporations] do a lot of service-provision activities, and in many senses in low- and middle-income countries these corporations are stepping into the shoes of government.

“So, when the government tries to regulate them, people in these under-served communities say, ‘They are the ones that are giving us free water, they are the ones that are maintaining our schools, so you shouldn’t be regulating them’.”

In countries such as South Africa, realistically this may continue to happen, with multinationals offering both VAs (such as the Consumer Goods Council of South Africa (CGCSA) Healthy Food Options initiative) and “additional services”, which happen to further their own marketing aims – because no one is telling them that they can’t.

Maverick Citizen requested comment from the CGCSA on the new research and received a reply by email saying, “Research findings are most welcome and more studies should be encouraged to ensure VAs are improved where there are shortcomings.”

But, according to Erzse and Abdool-Karim, improving voluntary actions is not the answer.

During the research, industry actors in Brazil and South Africa “articulated the voluntary and collaborative nature of their actions”, the study says, “lulling policymakers into thinking the problem is being addressed in line with government’s objectives.”

And as time goes on, companies’ degree of compliance with their pledges gets worse.

“As years go by,” Erzse says, “more and more companies violate what they said they would do.”

Coca-Cola Beverages Africa (CCBA), one of the companies whose VAs were examined in the latest research, responded to Maverick Citizen, with an email from head of reputation and communication Wendy Thole-Muir, saying: “As part of the Coca-Cola system, Coca-Cola Beverages Africa follows Coca-Cola’s global responsible marketing policy which respects the role of parents and caregivers by not marketing directly to children under 13, as well as the school beverage policy which clearly specifies the types of beverages that can be sold in primary schools.

“In South Africa, we only sell water and juice products to primary schools, in fact our systems are set up in such a way that the sale of any other products to primary schools is blocked, to ensure this doesn’t happen. Also, we communicate our policy extensively to primary schools we sell to along with a request for a signed undertaking to make sure they are aware of our policy. And in line with the responsible marketing policy, we have removed all signage and branded coolers from primary schools.”

Despite these seemingly well-intended promises from corporations, Erzse’s view is that government action remains essential, and “needs to come in a package, as a set of actions”.

“And, besides taxing unhealthy products, [addressing] marketing and labeling, government regulation must set and enforce strict standards for which food and beverage-products can be produced, sold and marketed,” she says. DM/MC

You can read the original article in Nature Food here.

DISCLOSURE: Adèle Sulcas is a consulting editor for the Wits Centre for Health Economics and Decision Science.

NOTES:

South African children consume an average of 50g of sugar per day – that’s around 10 teaspoons’ worth, and more than double the WHO’s guideline maximum for “free” sugars (including fruit juice).

“Free” or added sugars are often “hidden”: Sugar is added to processed and ultra-processed foods (think baked beans, sweet chili sauce, fruit-flavoured yogurts). This also includes sugary beverages and other unhealthy drinks and snacks that are easily available to children in school tuck shops and through informal vendors.

Children in South Africa are widely exposed to advertising and marketing of unhealthy foods and drinks; one study of poorer schools in Western Cape found that 60% of primary schools had signage on school premises advertising well-known beverage companies.

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