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Protecting public health from big food

Threatened by government scrutiny over their exploitative marketing practices, manufacturers of sugary, ultra-processed foods and beverages repeatedly tout self-regulation as a more effective alternative. But both research and experience show that voluntary corporate pledges do not improve public health
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The writer, executive director of Amandla.mobia, is a Mulago Foundation Rainer Arnhold fellow and an Atlantic Fellow for Racial Equity

Food and beverage giant Nestlé recently updated its “responsible marketing to children practices.” As part of its new policy, which takes effect in July, the company says it will limit the marketing of unhealthy and ultra-processed foods to children under 16 and praises itself for being “one of the first food and beverage companies to voluntarily adopt such strict standards.”

Nestlé’s move is not surprising. When faced with the threat of government scrutiny, companies and industry associations often tout self-regulation as a more effective alternative to protect public health. In fact, the opposite is likely to be true. A recent study by PRICELESS SA and researchers at the University of Witwatersrand School of Public Health, for example, reviews 20 voluntary actions by food and beverage companies in low- and middle-income countries and finds that these measures “often aim to protect industry interests rather than improve public health.”

Africa’s ongoing struggle with chronic illnesses underscores the urgent need for governments to crack down on Big Food, as they did on Big Tobacco. Noncommunicable diseases (NCDs) such as hypertension, diabetes, cardiovascular conditions, and cancer now account for 51% of deaths in South Africa and for roughly 37% of deaths in Sub-Saharan Africa. The number of African adults with diabetes, currently at 24 million, is expected to grow by 129% by 2045.

South Africa’s recent experience offers policymakers useful lessons about the dangers of self-regulation. In 2018, South Africa introduced a tax on sugary beverages called the Health Promotion Levy. While the tax is too low, studies show that it has already had a positive effect, reducing consumption of sugar-sweetened beverages.

In the lead-up to the tax, and with childhood obesity on the rise, Coca-Cola announced that it would not market its products to children under 12 and no longer supply outlets on school grounds with fizzy, sugary beverages. Two years after the pledge, a study examining 105 public schools in the country found “some preliminary evidence that voluntary pledges by commercial entities are not sufficient to remove [sugary beverages] and advertisements from schools” and recommended a sales and advertising ban. Government action, the authors concluded, would most likely be far more effective.

Moreover, it is difficult to see how policymakers can trust large food and beverage manufacturers to regulate themselves when these companies routinely flout national laws and regulations. In 2012, for example, South Africa announced new rules restricting the marketing of baby formula for children under the age of three, in line with the World Health Organization’s recommendations for regulating breast-milk substitutes. Nestlé has repeatedly undermined these regulations by sponsoring conferences and events on infant and child nutrition.

In 2021, for example, Nestlé teamed up with prominent South African media outlets to host an online forum that the company claimed would benefit “all moms, grandmas, aunties, and guardians of little ones” by teaching them everything they needed to know about infant and child nutrition. Those in attendance stood a chance of winning a R500 ($28) grocery-store voucher, an effective ploy during a period of skyrocketing food prices. The event was ultimately canceled following protests by nutrition experts and civil-society groups claiming that the event violated the prohibition on providing “incentives, enticements or invitations of any nature which might encourage the sale or promotion” of breast-milk substitutes.

These types of exploitative tactics are not limited to South Africa or Nestlé. In addition to parent events, companies also increasingly undermine regulations by targeting new mothers on social media. A multi-country study examining the $55 billion baby-formula industry, commissioned by the WHO, reveals the “shocking extent” of these practices, which include paying social-media influencers and platforms to “gain direct access to pregnant women and mothers at some of the most vulnerable moments in their lives.”

The marketing of unhealthy, ultra-processed foods and beverages creates unhealthy food environments. There is overwhelming evidence that the availability of these foods and beverages, together with the industry’s insidious marketing practices, contributes to morbidity and mortality and impedes policymakers’ efforts to bring NCDs under control.

Governments must take decisive action to reduce the NCD burden. The failure of voluntary pledges shows that there is no substitute for strict, evidence-based regulation of the marketing of ultra-processed foods and drinks. With NCDs on track to become the leading cause of death in Sub-Saharan Africa, the stakes are too high to prioritize the interests of profit-seeking corporate giants over sound public-health policies. -- @ Project Syndicate

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