Can Public Health Be More Persuasive?

From landmark success in regulating tobacco to more recent setbacks around sugary beverages, public health is repeatedly called on to overcome industry objections. But in the case of the debate around mandatory labeling of calories on menus, two Mailman School scholars contend that industry arguments were more persuasive than those put forward by public health.

In a Food for Thought lecture, James Colgrove and Rachel Shelton, both professors in Sociomedical Sciences, discussed the preliminary results of a content analysis conducted under the purview of the Lerner Center for Public Health Promotion, examining public comments submitted to the U.S. Food and Drug Administration in response to proposed menu labeling regulation. [Update: A related journal article now appears in the the journal Public Health Nutrition.]

In their close read of 64 comments from industry groups and 33 from public health groups, Colgrove and Shelton identified two divergent ways of framing the debate: public health used the language of social justice, prioritizing collective responsibility and cooperation, while industry emphasized the values of market justice, placing a premium on individual liberty and economic opportunity.

Uniformly, public health comments pointed to the health consequences of obesity and the growing numbers of people who eat outside the home, referencing peer-reviewed epidemiologic research. By contrast, industry marshaled a variety of data sources from reports by the Bureau of Labor Statistics and think tanks to newspaper stories, as well as their own studies, to highlight an assortment of logistical and economic hardships.

The Vermont Attorney General’s office argued that menu labeling can “help moderate caloric intake and thus reduce this contributing factor to the obesity epidemic.” Whereas, Marsh Supermarkets referenced a “billion dollar burden in the first year of compliance alone.” Domino’s Pizza went so far as to produce a video to underscore the difficulty of posting calories when pizzas are available in millions of combinations.

But industry did not ignore health concerns; many corporations said they valued the health of their customers. Starbucks and Panera portrayed themselves as ahead of the curve, pointing out that they had voluntarily posted menu labels in all their stores. “They were advocating self-regulation while reminding us that they were already doing so,” noted Shelton.

Both sides appealed to fairness. Public health argued that menu labeling would only be fair if regulations were broadly implemented to include movie theaters, grocery stores, and other venues. Industry groups countered by saying a one-size-fits-all approach was unworkable in a diverse industry and would be especially burdensome to small and family-owned businesses.

In their comment, McDonalds acknowledged its status as a global brand, but added, “our U.S. business consists primarily of franchised restaurants that are owned and operated by small and medium sized business owners” who would bear the brunt of the regulation’s cost. Adding local flavor to their opinion, supermarket chain Kroger told the stories of two “entrepreneurial chefs” who contributed their own recipes; Chef Dee Burkhardt in Ohio contributed a “delicious chicken pot pie.”

Taking Cues from Industry

The talk highlighted several ways public health policy arguments fall short and ideas for how they might improve.

According to Colgrove and Shelton, one key shortcoming was public health’s seeming unwillingness to respond to industry. In the debate over menu labeling, industry comments acknowledged the importance of health, but public health did not respond to industry arguments over financial and logistical burdens.

Case in point, the American Diabetes Association, which wrote, “calorie labeling on menus is specifically a public health issue and not a business issue.”

To explain the rhetorical disparity, Shelton observed that industry has greater experience with lobbying in a way that resonates with policymakers, whereas public heath is trained to make scientific arguments. But whether and how public health should modulate its message has become its own debate.

According to Colgrove, some in public health seek to double-down on social justice, while others say health advocates should at least acknowledge market justice arguments. Research suggests that messages which fail to acknowledge both sides are less persuasive. And ignoring industry arguments is especially risky when market justice concepts like personal responsibility are mainstream.

In the menu label debate, public health might have countered industry concerns over cost by citing the huge economic burden of treating obesity-related diseases, said Colgrove. Likewise, public health could have adopted a market justice framing by arguing that menu labeling strengthens individuals’ ability to choose for themselves. Kathleen Bachynski, a doctoral student in Sociomedical Sciences, wondered if menu labeling as a policy option was chosen to align with the values of market justice, and if so, why its arguments didn’t take advantage of this alignment. 

Industry arguments were also more compelling, in part because they had a personal touch, such as in the case of Kroger’s Chef Dee Burkhardt. “Public health needs a Chef Dee to humanize it,” said Colgrove.

Despite these rhetorical shortcomings, the FDA’s final ruling was not unfavorable to public health. In July, they ruled that movie theaters, grocery stores, and the alcohol industry would be subject to the regulations. On the other hand, implementation was delayed; the rules won’t take effect until December 2016. Meanwhile Congress has introduced legislation that would significantly weaken the regulation. The debate continues.