We continue our review of a special edition of the Future Healthcare Journal which is all about conflicts of interest and “the commercial elephant in the room”. (The first part is here.)
Lord Bethell
The hereditary peer and former nightclub entrepreneur Lord Bethell has written about ‘The soft power forcefield that protects the junk food industry’. He has noticed that people rather like the food they grew up with and are not too keen on replacing it with reformulated mush. This, he assumes, must be due to cunning marketing by the ‘junk food’ industry.
The biggest problem for health campaigners is the seemingly intrinsic role that junk food plays in the personal identity of our people, the cultures of our country and the relationships that bind us all together. And the industry works hard to promote this connection, and to mobilise it through their hard-won political networks.
As we shall see, Bethell’s definition of junk food is a broad one.
Junk food marketing deliberately taps into powerful psychological principles which exploit our emotional vulnerabilities, sensory preferences, and desire for social connection. They particularly target children’s brains, which are still developing, making them more susceptible to the persuasive tactics used in food marketing strategies. And they use our sense of identity in a way that creates strong emotional ties, which politicians find impossible to challenge.
The devices they use include techniques drawn from the political playbook.
The beauty of the ‘playbook’ is that it hasn’t been written down, so you can mention anything that annoys you while affecting to refer to an established body of knowledge. Here are the ‘junk food marketing’ techniques that Bethell claims have been drawn from the mythical playbook…
First up, sausages!
Resistance to foreign competition: By emphasising their role in national food culture, junk food companies foster consumer loyalty and resistance to foreign alternatives. This strategy plays on consumers’ local identity and potentially xenophobic tendencies. The British Banger. The Full English.
Sausage rolls!
Regional pride: Some fast food chains become symbols of regional identity, allowing companies to create a sense of local pride and loyalty among consumers. Like Gregg’s of Newcastle and Irn-Bru of Glasgow.
Bread!
Nostalgia marketing: By tying their products to childhood memories and longstanding national traditions, junk food companies create a sense of nostalgia that can be powerful in maintaining customer loyalty. Like the Hovis bread ad of 1973: ‘As good for you today as it’s always been.’
Kebabs!
Sponsorship of national events: Many junk food brands sponsor major national sporting events or cultural festivals, associating themselves with moments of national pride and unity, including the National Kebab Awards.
Is xenophobia really used to market sausages? Are sausages even junk food? Is Hovis junk food? Aren’t kebabs a bit foreign? Such questions do not detain his lordship. He is more concerned that doctors have not rallied to his cause.
The first port of call should be doctors. But the problem is that our clinical leadership are not stepping up to the fight. Many are sceptical that anything can be done about obesity. Research demonstrates that frontline primary care doesn’t believe that behaviour change is possible.
A poll conducted by Sermo, a global social network for physicians, found that 69% of doctors believe that parents are either completely or mostly to blame for the childhood obesity epidemic.
A study involving 3,267 resident physicians revealed that nearly 40% agreed with the statement ‘Fat people tend to be fat pretty much through their own fault’. Almost half agreed that ‘Some people are fat because they have no willpower’.
A survey of healthcare providers showed that 58% believe obesity is mainly due to lifestyle choices, and 43% think that those living with obesity can reach a healthy weight if they only ‘try hard enough’.
Who knew doctors could be so sensible? I’m starting to warm to them.
It should be noted that none of these survey results show that “frontline primary care doesn’t believe that behaviour change is possible”. On the contrary, they suggest that doctors think that behaviour change is not only possible, but is essential if people are going to lose weight. This goes against ‘public health’ dogma which portrays personal responsibility as a myth and the commercial environment as all-powerful, but then ‘public health’ academics don’t meet as many patients as doctors do.
We desperately need clinicians and their institutions to shake off these prejudices and start calling out the junk food industry for its impact on our national health.
Prejudices!
Conclusion
Conservative Party leader Kemi Badenoch sparked controversy by declaring she was ‘not a sandwich person’ and that sandwiches are ‘not real food’. This led to a response from prime minister Keir Starmer, who defended sandwiches as ‘a great British institution’ contributing significantly to the UK economy.
In this environment, it barely takes a nudge, a piece of polling research or a snappy phrase to undermine a thoughtful intervention on junk food. Actors are warned to avoid working with animals. Politicians are warned to avoid a row over food. We cannot expect them to run into a hail of bullets until we find a way to attack from the flank. And for that, we need to bring our clinicians to bear on the argument in a much more emphatic way.
It is difficult to tell from this concluding passage whether Lord Bethell is pro- or anti-sandwiches. Since the main component is sliced bread, I assume he thinks they are ‘junk food’ and that he was appalled by Starmer’s xenophobic defence of them.
Bite Back 2030
The issue contains two articles by people from Bite Back 2030, an astro-turf group created by Jamie Oliver that I discussed back in April when they claimed that young activists in one of the poorest parts of London had bought up a vast quantity of advertising space. Neither article is particularly interesting, but one of them is worth mentioning because it includes a telling fallacy.
The illusion of choice
A common assertion suggests that promoting healthier food options in advertisements, as frequently or even in lieu of junk food advertisements, could counteract the effects of junk food marketing. However, systemic barriers make this impractical. Healthy food is disproportionately expensive, often placing it out of reach for many families.
As anyone who has their wits about them knows, healthy food tends to be rather cheap.
Moreover, genuinely healthy options are scarce. Popular ‘health’ products like Innocent smoothies, Glaceau Vitamin Water and Naked smoothies are all owned by Coca-Cola and PepsiCo respectively – corporations whose primary sales come from unhealthy products.
This is a non-sequitur. Ownership of the brands has nothing to do with the supposed scarcity of the options. Since Coca-Cola and PepsiCo have massive distribution networks, you would expect to find these products everywhere. And indeed you do. The real objection of this ‘youth activist’ isn’t that these healthy options are “scarce” but that they are owned by big corporations who also sell ‘unhealthy’ options.
At the very least, perhaps finding a healthy and affordable breakfast will be easier? Cereals such as Special K, Crunchy Nut and Coco Pops are all produced by Kellogg’s, a company where 77% of sales stem from unhealthy products.
Kellogg’s don’t get to decide what proportion of their sales come from ‘healthy’ breakfast cereals. All they can do is give people a range of options and let them pick their favourite. I can’t even work out which of the three named cereals the author thinks is healthy/unhealthy, but none of them is hard to find. Again, the objection is not that people don’t have access to Special K, it is that the manufacturers of Special K make more money from supposedly ‘unhealthy products’.
But there are so many options ... right? These corporations mask their dominance behind various brand names, ensuring that even those attempting to make healthier choices inadvertently support their monopoly. Between the marketing mind games and the illusion of choice, young people, often with fewer financial resources and limited access to alternatives, are not left with very many healthy and affordable options. Young people are left with little choice but to consume these products.
Some people have complained that the food industry is largely an oligopoly. It is certainly true that companies like Unilever own a huge number of different brands. But the ‘youth activist’ is making a different complaint. She is claiming that because the food industry is dominated by a few big players, people don’t have choice. That is patently untrue. The average supermarket contains at least 20,000 different products, including pretty much every fruit and vegetable you could hope to find.
This is not just sloppy thinking. It gives the game away. These people are not really interested in consumers having choice. They just hate corporations.
Gambling
The issue includes two articles about the ‘commercial milk formula industry’ which I will ignore, except to note that the word ‘commercial’ is redundant when you already have the word ‘industry’ and that it is mad to equate a product that saves lives with tobacco (as one of the articles does).
I will also skirt over an article about the alcohol industry by Mark Petticrew and colleagues because it is just a rehash of his usual paranoid, cherry-picked attacks on DrinkAware that I have written about before. Suffice to say that he reckons there is “much to learn from tobacco control”, which is the theme that runs through this issue of the journal.
Instead, let’s see what Petticrew’s protégé and co-author May van Schalkwyk has to say about gambling. In an article petulantly titled ‘Why do we tolerate the activities of the gambling industry?’, she has teamed up with the anthropologist Rebecca Cassidy. It soon becomes clear that they don’t know much about gambling at all.
It begins thus…
The gambling industry behaves like the tobacco industry and its products cause serious harm, but it is treated as a valued part of UK plc.[1]
That is quite a sweeping statement. What is the evidence that the gambling industry “behaves like the tobacco industry”? If you look up reference [1] you will find it is an article written by none other than May van Schalkwyk. The article makes a risible attempt to draw parallels between a notorious advertisement put out by the American tobacco industry in 1953 (saying they were very concerned about claims that smoking causes lung cancer and were looking into it as a matter of urgency) and an advert put out by some British bookmakers in 2014 (saying that they were cutting down on their advertising).
Why have we been encouraged to see the sector as the supplier of fun and those who are harmed by its products as faulty?
Because gambling is fun and problem gambling is a psychiatric disorder.
Why are inherently unsafe products marketed by the industry not banned?
I would be interested to know which gambling “products” the authors think are “inherently unsafe” and should be banned. Roulette? Poker? Fruit machines? Maybe all of them. Alas, they do not say.
Instead, they take a tenuous and somewhat pretentious detour in which they make strained comparisons between the gambling industry and the American gun lobby, the American opioid epidemic and the global mining industry. I won’t bore you with it, but it contains such gems as this…
US strip malls sell high-calibre firearms, UK high streets provide high-speed gambling machines.
And this…
Like the mining industry, the gambling industry will extract to extinction if allowed to do so.
One gets the impression that the authors would rather talk about anything other than the actual market for gambling “products” and the workings of the gambling industry, but anti-gambling is where the money is these days (thanks to the new levy) so they cannot ignore it indefinitely. Eventually, they have to answer the question: “What do you actually want to do?”
I will quote their answer in full. I wouldn’t blame you if you don’t read it all, but there is no other way of showing you how vacuous these people are and how little they have to offer.
When faced with this situation, those who seek to prevent gambling harm ask, reasonably, what policies need to be adopted and implemented, what steps need to be taken? We have argued that the greatest barrier to meaningful change is the acceptance of the terms on which debates about gambling regulation currently take place. These include the default assumption, enshrined in UK legislation, that all forms of gambling should be permitted. They also include the assumption that regulation should ‘balance’ the interests of industry and the harm caused by dangerous products. The purpose of this article has been to draw on unconventional but illuminating examples from other sectors and places to demonstrate that these assumptions are both contingent and harmful.
Our paper also has a broader ambition. By writing this paper, we are cultivating and promoting the art of noticing, extending the fields of gambling studies and public health and refusing the limitations of disciplinary boundaries and pragmatism. Our intention is to promote spaces for discussion, much like this special edition, where innovative ideas can flourish and communities can draw on diverse experiences to address the many problems that we face, creating new, perhaps temporary or unanticipated synergies and relations that undermine entrenched ideas and make the future more open and progressive. This critical reflection on our ideas, methodologies and ways of working is essential. As Audre Lourde said in 1979, ‘the master’s tools will never dismantle the master’s house’.
Rrrrright.
Anna Gilmore
Let’s wrap things up with Anna Gilmore, a ‘public health’ careerist of no obvious ability who has turned her vapid observations about the world of business into a lucrative hustle, not only rinsing taxpayers for the last 20 years (her article in this journal is the product of a £9 million slush fund) but getting millions of pounds out of Mike Bloomberg. In her latest article she gives guest editor Chris van Tulleken what he wants: “Lessons from tobacco”. The whole idea is to butter the slippery slope, but first she feels she needs to explain that tobacco is a plant and cannot have conflicted interests.
Many have mistakenly understood the conflict of interest that has been recognised and addressed within tobacco control as relating specifically to tobacco and therefore not applicable to other corporations. But tobacco is simply a product, albeit a uniquely harmful one; it does not have ‘interests’, it does not seek to influence policy or science, or to maximise profits. The conflict instead lies between the interests of the tobacco companies (to maximise sales and profits) and the public interest and by extension, therefore, the government’s interest, given its duty to act in the public interest.
Thanks for clearing that up.
The rest of the article is the usual stuff. She says that conflicts of interest are so pernicious that journals shouldn’t publish articles by people who have them and policy-makers shouldn’t speak to people who have them. She is, of course, only talking about corporate conflicts of interest. If you are an academic who has received huge sums of money from a billionaire who wants to wipe out smoking and vaping and you write articles undermining e-cigarettes and attacking the tobacco industry and run a website funded by that billionaire to attack advocates of tobacco harm reduction, that is perfectly alright, apparently…
Declaration of competing interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
I think you give a misleading impression of this Bethel character by referring to him as a former nightclub entrepreneur. He is much more dubious than this. According to Wikipedia, he is a failed politician who owed his presence as a govt minister entirely to the fact that an ancestor four generations back was made a Lord as a result of his banking and political connections. So he inherits a title and then that clown, Boris Johnson, puts him into the Department of Health just in time for Covid. And what does he do? He negotiates lots of dodgy deals for his friends involving multi-millions of pounds, and then conveniently loses all his Whatsapp messages setting up the deals. He gives three different explanations for not having the messages, but confronted with the evidence admits he deleted them all "because he thought they were backed up". He also, inter alia, sponsored a Parliamentary Pass for the lover of the then Minister of Health, Hancock.
His is a record of malpractice, deception, corruption and failure. Why waste time reading what this pathetic crook writes? It says something about the times that this individual can achieve some prominence despite achieving nothing worthwhile in his lifetime. His great great grandfather has a lot to answer for in accepting an hereditary peerage which has allowed this good-for-nothing descendant to live off the public purse.
As for Van Schalkwyck and Gilmore, yet more academics (I nearly put pseudo in front there, but these days they are all pseudo) who reel off all the right (ie left) phrases that the grant giving woke institutions adore. At least you have given me a few more names to avoid in the future. My list grows longer by the day.
Great post. Along with just ignoring that people have agency and can make decisions based upon what they like, the biggest problem on my view with the Commercial Determinants of Health BS is that it distracts from the other very well documented problems of social determinants of health, things over which people often have no control but that seriously affect their health. If you just blame big junk food, big alcohol, etc you give the social structural inequities a pass that they do not deserve. Ironically (and you and I may argue about this) both point to problems of capitalism but one is an illusion and one is very real. (It's the aspirational lefty paradise thing that also irritates me although I am a lefty)