The United States is in the midst of an obesity epidemic. This public health crisis demands urgent attention and action, including removing the little-known tax subsidy for junk food advertising to children.
Childhood overweight and obesity
In the past three decades, obesity has more than doubled among children and quadrupled among adolescents. Today, nearly 13 million American children aged 2 – 19 years are obese. Childhood obesity is a serious health condition with immediate health effects including increased risk of pre-diabetes, bone and joint problems, and psychological problems. Longer-term health effects include increased risk for heart disease, some cancers, and type 2 diabetes.
Junk food advertising to children
Junk food advertising contributes to childhood overweight and obesity. In 2009, 48 food and beverage companies reported spending $1.79 billion on marketing to children and adolescents. This included $695 million on traditional media, including television, radio, and print and $122.5 million on new media advertising, including online, mobile, and viral. Many of these advertisements promote nutritionally poor, calorie dense foods and beverages that are high in fats, salt, and added sugars. The extensive, pervasive, and integrated marketing of junk foods influences children’s food preferences, purchase requests, and consumption patterns. Children are particularly vulnerable to advertising because they cannot identify persuasive intent.
Tax subsidy for junk food advertising to children
Under the Federal Income Tax Code, advertising costs may be deducted as ordinary business expenses. Assuming a corporate tax rate of 12.6%, the US Government provided food and beverage companies a subsidy of over $103 million in respect of the $817.5 million worth of traditional and new media advertising to children and adolescents purchased in 2009. In theory, the elimination of the subsidy would reduce the incentive for food and beverage companies to advertise junk food to children, resulting in less exposure to such advertisements among children. In turn, this would result in children eating less junk food, leading to health benefits and reduced healthcare costs.
Law-makers have tried to eliminate the tax subsidy before. Various bills have been proposed, including by Senators Blumenthal and Harkin and Representative DeLauro. Although none of these bills have passed, there is mounting evidence of the positive impact that eliminating the subsidy would have on children’s health outcomes and healthcare costs, including a 2015 study by Sonnerville et al., which modelled “the effect of a national intervention that eliminates the tax subsidy of advertising nutritionally poor foods and beverages on TV to children aged 2-19 years.” The study found that the intervention would result in a small reduction in obesity prevalence resulting in increases in quality-adjusted life years (QALYs) and substantial reductions in healthcare expenditures. The authors also concluded that “the intervention was “cost saving,” as it would result in an increase in QALYs and reduction in total costs compared with current practice.”
A comprehensive approach to reducing marketing of junk food to children
Eliminating tax subsidies is one of many possible approaches to reducing rates of child and adolescent overweight and obesity. Indeed, the World Health Organization, the American Academy of Pediatrics, and many other important authorities recommend banning junk food advertising to children. Although the US Government has not moved to adopt a ban, many scholars argue for this approach, adding that the correct interpretation of the First Amendment allows for regulations to protect children from junk food advertising.
In the meantime, eliminating tax subsidies for such advertising is a step in the right direction. Eliminating the subsidy may also play a role in increasing public awareness of children’s unique vulnerability to advertising and generate public support for a comprehensive ban.
Posted in Non-communicable diseases;
This post was written by Janelle Langan, an LL.M. in Global Health Law candidate at Georgetown University Law Center. Any questions or comments about the post should be directed to firstname.lastname@example.org.
The rebellious, rugged images of the Marlboro Man linked the idea of smoking filtered Marlboro cigarettes with masculinity to promote tobacco sales at the cost of public health. The idea of glamorizing tobacco use is nothing new. However, over the past decade, the regulation of tobacco products as well as increased awareness has helped to educate consumers on the dangers of smoking in order to protect public health. Until recently, the popularity of electronic cigarettes (e-cigarettes) was largely driven by the lack of regulation upon its use and marketing. E-cigarettes have been a controversial topic since they entered the marketplace nearly a decade ago.
E-cigarettes are composed of a battery, a nicotine cartridge, and an atomizer. Through “vaping,” nicotine is delivered in an aerosol form that is exhaled by the user in vapor form, which e-cigarette manufacturers market as a healthier alternative to traditional cigarettes. Confusion surrounding the categorization of e-cigarettes created a wild west-like environment that contributed to its popularity. Unlike smokers who are stigmatized and banished to remote, unpleasant, outdoor locations, vaping was often permitted inside public areas. Additionally, manufacturers were able to target younger audiences through marketing practices that included advertising at sporting events and providing free samples.
Under the Food, Drug, and Cosmetic Act, as amended by the Family Smoking Prevention and Tobacco Control Act, the Food and Drug Administration (“FDA”) was granted the power to regulate the sale and distribution of “tobacco products,” which specifically includes cigarettes, cigarette tobacco, roll-your-own tobacco, and smokeless tobacco. In order for the FDA to regulate other forms of tobacco products, it must “deem” the product within its regulatory authority.
The degree to which e-cigarettes should be regulated has been the source of a vigorous debate. Some advocate for minimal regulations because e-cigarettes may help smokers reduce or cease nicotine consumption. However, the level of nicotine varies greatly depending upon the product’s characteristics, user’s puffing behavior, and nicotine solution concentration. Thus, others advocate for harsher regulations, arguing that e-cigarettes contain addictive and harmful ingredients that pose significant public health risks.
This past week, the FDA expanded the definition of “tobacco products” to deem electronic nicotine delivery systems (“ENDS”) within its regulatory authority. ENDS specifically includes: e-cigarettes, e-cigars, e-hookah, vape pens, personal vaporizers, and electronic pipes. In addition to expanding the definition of tobacco products, the FDA issued the following consumer-based restrictions:
These restrictions, which take effect in 90 days, are aimed at reducing e-cigarette use amongst young consumers as nicotine exposure during adolescence may adversely affect brain development. Beyond these regulations, manufacturers are subject to additional regulations, which include: registering manufacturing establishments and providing product listings; reporting ingredients, and harmful and potentially harmful constituents; undergoing premarket review and authorization of new tobacco products; placing health warnings on product packages and advertisements; and not selling modified risk tobacco products including those described as “light,” “low,” or “mild” unless authorized by the FDA.
The new regulations are aimed at striking a delicate balance between deterring young tobacco use without preventing the use of a product that may aid traditional smokers in reducing or ceasing nicotine use. This recent action by the FDA: (1) makes a preliminary step forward by creating much needed regulation upon the use of electronic nicotine delivery systems and (2) focuses upon requiring more data on the nature of health risks posed by the use of electronic nicotine delivery systems.
 See, e.g. Martin McKee, Electronic Cigarettes: Proceed with Great Caution, 59 Int’l J. Pub. Health 683, 684 (2014).
May is National Hepatitis Awareness Month. The CDC has designated May 19th, 2016 as National Hepatitis Testing Day in the U.S. This campaign is particularly timely this year given the report released this Wednesday by the CDC which states that new infections and deaths caused by Hepatitis C (HCV) are at the highest rates ever reported. The number of acute cases of Hepatitis C rose from 850 in 2010 to 2,194 in 2014. There were 19,659 deaths caused by HCV in 2014, a sharp rise from 15,106 deaths reported in 2007.
Hepatitis C has few noticeable initial symptoms, so most who are infected are unaware of their status until the illness causes severe symptoms such as liver inflammation and scarring. This means that it is likely that there are many more undiagnosed and underreported infections attributable to HCV than noted in this report. Dr. John Ward, Director of the CDC’s Division of Viral Hepatitis, states that the estimate of actual new infections in the U.S. is closer to 30,000 per year. Chronic and untreated Hepatitis C infections can cause cirrhosis, liver cancer and liver failure.
Americans who fall into the “Baby Boomer” demographic – people born between 1945 and 1965 – are at high risk for having chronic and undiagnosed Hepatitis C infections. This is due to many in this group receiving blood transfusions and organ transplants prior to 1992, when HCV screening of donated blood and organs became standard. However, the recent rise in new infections is largely attributed to infections spread by persons who inject illegal drugs (PWID). This cohort is comprised mainly of younger people, and also lends to an increased risk of HCV transmission from mother to child, as many of the women in this high-risk group are of child-bearing age.
Screening for Hepatitis C requires a simple blood test. However, this screening is still not widely conducted on many in the population. The CDC is trying to address this issue by raising awareness both amongst the public and the health care system of the risk factors for HCV infection and the long-term benefits of early detection and treatment. The existence of highly effective curative drug treatments for HCV infections allow acute infections to be easily treated and will greatly reduce the long-term and potentially deadly health complications that arise from chronic Hepatitis C infections.
If you haven’t been recently screened for HCV, ask your health care provider for a test.
You can learn more about all types of Hepatitis infections at the CDC’s website at http://www.cdc.gov/hepatitis/index.htm.
At a recent event in Washington, DC, South African Minister of Health and chair of the Stop TB Partnership Aaron Motsoaledi, spoke of the difficulty of lighting the fire under TB, to get the world’s attention, even as this scourge kills 1.5 million people per year, making it the second most deadly infectious disease after acute lower respiratory infections. Is it because though all are at risk of contracting TB, those who are most vulnerable belong to marginalized populations – among them, prisoners, migrants, people living with HIV/AIDS, and poor people living in crowded, unsanitary conditions?
It is as though some deaths – and lives – just don’t seem to matter much to the world. There is sadly nothing new about that. But perhaps this tragically obvious point contains the seeds of one way to begin to change that.
What if policies were to force these lives to matter by assuring that their deaths did not pass unnoticed – helping make every life count by making every death count? There is a model for this: maternal, child, and newborn mortality audits.
The World Bank describes maternal mortality audits thus:
“A maternal death audit is an in-depth systematic review of maternal deaths to delineate their underlying health social and other contributory factors, and the lessons learned from such an audit are used in making recommendations to prevent similar future deaths. It is not a process for apportioning blame or shame but exists to identify and learn lessons from the remediable factors that might save the lives of more mothers in future.”
The same approach applies to child and newborn death audits, examining each child or newborn’s death to determine its cause, with the goal of understanding how to better prevent such deaths in the future.
A basic principle behind such audits is that every life counts, so every death must be understood. No maternal, child, or newborn death should be accepted as a given – as the vast majority of these deaths, like the vast majority of TB deaths, are avoidable. It is necessary to understand the cause for each death, enabling measures to change the factors that led to that death, and thus avoid future deaths stemming from similar causes.
Such an approach seems well-tailored to the global goal of ending TB, a goal captured by one of the Sustainable Development Goal targets (“By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases”; ending TB is defined as reducing TB incidence to 10/100,000 population globally (page 20, n. 2). Meanwhile, there is a growing understanding of how to eliminate TB, and a movement afoot to establish Zero TB Cities. No TB death should be accepted, or taken for granted.
Perhaps, then, these maternal, child, and newborn death audits could be adapted to the TB context. As with these existing audits, the idea of TB mortality audits would be to establish a system to examine every TB death and to endeavor to understand why it happened and what could have been done to prevent it (or at least to greatly reduce the risk to similarly situated people).
There could be a number of benefits from TB mortality audits. They could:
• lead to valuable lessons on what adjustments might be needed in a country’s (or sub-national) TB strategy;
• require engagement with the community on TB through investigations into the deaths – which could in turn contribute to more community action and advocacy, as community members are forced to regularly engage with TB. The investigations could heighten the visibility of TB and perhaps have more people asking why their neighbors are dying, as they see how the deaths could have been avoided;
• lead to increased media attention, reporting on the audits, and possibly particular deaths that could and should have been prevented;
• build community expectations that no TB death should be accepted — which could in turn contribute to advocacy and build political pressure.
Hopefully TB audits could, to borrow from Dr. Motsoaledi, help light the fire.
There are well-developed tools and guides for maternal death audits, such as from the World Bank and from the International Federation of Gynecology and Obstetrics. Similar tools could be developed for TB.
TB death audits might be piloted to better understand their potential and how they would operate, including to understand the possible costs (economically and in people’s time) of such a project, perhaps initially working with highly vulnerable communities (e.g., miners) or populations (e.g., prisoners).
Such audits would hardly eliminate the need to move full steam ahead with other efforts to end TB, from rolling out new tools such as bedaquiline, a antibiotic for multi-drug resistant TB, and a new rapid test, along with continued research and development, scaling up investments, health system strengthening with particular focus on health workers, and addressing the social determinants of health and inequalities that drive TB. TB mortality audits could serve as one more pressure point for the heightened focus that TB demands.
On April 5, the O’Neill Institute, in collaboration with Fundacion InterAmericana del Corazon Argentina (FIC Argentina) and Action on Smoking and Health (ASH), participated in a hearing before the Inter-American Commission on Human Rights (the Commission) on the “Right to Health and Tobacco Addiction in the Americas”. It was the first time that the Commission considered the intersection of tobacco control, non-communicable diseases, and human rights.
Posted in Global Health, Human Rights, Non-communicable diseases, Tobacco; Tagged: children, health and human rights, human rights, industry, Inter-American Commission, marginalized populations, NCDs, regulation, right to health, tobacco, tobacco control, vulnerable population, women.
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The views reflected in this blog are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.