The Psychology, Biology and Politics of Food

PSYC 123 - Lecture 18 - The Politics of Food II: The Issues, the Fights and Who Controls the Frame

Chapter 1. General Housekeeping for the Course [00:00:00]

Professor Kelly Brownell: Well good morning everybody. What a night last night, huh? Well, however you feel about the outcome, you certainly have to admit there was a lot of drama and so much lead in. I mean, basically two years of thinking about the politics of this election. It was really quite amazing. If you're like me you stayed up late watching it all last night, and then of course that put me behind on preparing this lecture, so I had to get up at 4:00 in the morning to do this.

You might wonder why Professor are you waiting to last minute to do the lecture? Well, part of it is because of the topic, the politics of food, just like the politics of anything happens quickly, can change on a dime, and all these breaking developments happen that are really very interesting. In fact, if we get a chance later in class, it'll be interesting to speculate about what the election will mean in terms of the landscape of food in politics. Some things have happened very recently, including just last week that I put into the lecture because they're so interesting in this context.

Before we get into the topic, I just want to discuss for a moment a little bit more about the OpEd. Here are a few things to keep in mind as you're it, again it's due on November 17th. The object of the OpEd is to encourage you to put together in a small space 650 words, more or less, your opinion on some issue and it's your attempt to try to persuade people of some point of view that you take or interest them in a topic. Again, you can take any position on any topic relevant to the class and they'll be graded on how persuasive you are and how well you put together a coherent argument.

As I mentioned, a lot of OpEds that we and others have published are in the course readings and the syllabus provides links to even more examples, so you'll see a lot of examples of how they're written. Again, you can submit them anywhere you want. Somewhere that's refereed, that is, somewhere there's a gatekeeper who has to determine whether it gets published, so a blog really wouldn't count unless it's one of the big time things. But community newspapers, regular newspapers, anywhere else that does editorial type things, even websites that do editorial type things would be perfectly fine.

You'll be graded not on whether it gets accepted. I just want to make sure that you submit is somewhere so that you feel activated, and that you have a voice in this. The fact is, you do have a voice, your OpEd may or may not get accepted for publication but it might; and if it does, I'll see the exemplary ones anyway and scan most of them myself, but the teaching fellows will do the grading.

If you do get it accepted for publication somewhere, even if it's down the road sometime, please send it to me because I keep a library of these. The last time I did this, I put together a booklet of the ones that had been submitted and sent it over to President Levin and Dean Salovey to show them how the Yale students are out there making a difference in the world.

One thing I wanted to mention is, you've heard a lot about the work going on at The Rudd Center throughout the course of the semester. There are several things I wanted to bring your attention to if you're interested; not required for the class in anyway, but one is the free email newsletter we have. If you go on the website, you can subscribe to the newsletter, you get a monthly email that has the newsletter embedded in the email. It discusses the work of The Rudd Center, but much more important than that, the landscape of food and food politics itself.

The other resource that we have that's just terrific are a series of podcasts that we've recorded and are available to play on your computer, or of course, can be downloaded into your music player as podcasts. We have such an impressive list of people who have come through to do these. Example of the people would be Gina Kolata who's a well known writer for The New York Times, so we have a journalist. We have Joan Gussow, who was really one of the original people pushing for healthy, organic foods. Mark Gold, an expert on the issue of food and addiction. Marion Nestle — and you've read plenty of her things in the class — a well known researcher at New York University who deals with food politics. Michael Pollan, of course, and Walter Willet, who's a very influential nutrition researcher and you've heard or read about some of his work in the class. If you care to avail yourself of these resources, feel free to do it.

Chapter 2. The Basis for Government Action on Diet, Nutrition and Food [00:04:40]

Today, I'd like to talk about the government and its role in people's food choices. Rogan Kersch, from the last class, did a very nice job of introducing this topic. We're going to talk more about specifics today, but some of the broad issues that he outlined were very helpful.

The question is, should government play a role? Should government take an active stance in trying to deal with food and nutrition issues? Some people will believe yes, some people will believe no, but if people believe yes, then the question is how should it be done most constructively?

Where does — what's government been doing so far, and how would we grade them if you'd like to do it that way? Well, I'd like to talk about six examples. I'm going to add a seventh in a later class, a very interesting and hot topic on menu labeling, but these are the things we're going to talk about today. I'd like to just ask you — yourself, what do you think about this?

Should government be involved in helping shape the diet of the nation and of individuals? If you believe that's the case, and I'd just like to get some responses from you guys, if that's the case, what are the triggers? What are the — not the sort of broad social triggers that Rogan Kersch talked about in the past which were sort of overall things going on in the society, but what would be important in your mind for saying, some threshold has been crossed, I'm now convinced along some dimension that something has happened and government should be involved? What would be those kinds of factors? I'd just like to get some responses from you guys about that.

Do you think government should be involved in this issue, and if so, what are the thresholds? What are the triggers? What are the key issues in your mind for making those kinds of judgments? Let's just see some hands and have some people volunteer. What would be the relevant criteria for you to say government should be involved or not? Okay yes?

Student: [inaudible]

Professor Kelly Brownell: Good point. Okay, the point was government already — you anticipated a slide I'm going to show in a minute — the government already is involved in these sorts of decisions, so we might as well do it as constructively as possible. What are some other thoughts on this? I mean, what would persuade that these are important enough problems for government to take a role in private behavior as Rogan talked about? Yes.

Student: [inaudible]

Professor Kelly Brownell: If there were some criteria showing that a substance like sugar was addictive, then that might trigger government action, okay good point. Any others like the — weigh in on this topic? Let's move ahead then.

If we think about this, I'm going to use a statistical term of regression to describe how we make decisions based on these. The regression equation looks like this: that people score — the people score or behave in certain ways on a dimension we'll call the first dimension A. Then there might be another dimension care about, another series of issues that matter to people, that would be B, and then what you do is you add all these things up that matter to people and what comes out of that is our position on something.

Each of these things may be weighted differently, some may affect the others, and so there's statistical ways to do all this stuff that we won't go into, but more or less what it means is that our position, our stance, our political feelings about something are affected by a variety of things, and everybody has a different set of things, everybody weights them differently, but what comes out of it is an opinion on something.

If we ask you a question like should we tax junk food, we'd get a wide variety of answers. If I asked how much it should be taxed, we'd get a wide a variety of answers, and something like this would be at work. You'd be balancing a lot of different factors. If we think about whether government should be involved, the seven triggers that Rogan Kersch talked about when he spoke on Monday, captures some of these things if you're looking at it from a social point of view.

I'd like to talk about other possible thresholds and barriers that people may have to think about what government would be involved. Some of the things that often get listed in this, or I think often get considered, are the factors you see here. How serious is the problem? What are the perceived causes? What do we know about the affected population, and are they stigmatized?

In the case of nutrition issues, you have very powerful weight bias going on in the country, anti-fat bias essentially; and then you also have the poor in the population who are stigmatized and marginalized in their own way, affected by both hunger and obesity. Who the population that's affected is, will weigh into our decision. Then we have to ask these other kinds of questions when we decide whether government should be involved.

Now anticipating the slide, government is involved now, and there are a whole lot of ways government's involved in this. When the conservative critics of proposed action on food nutrition issues complain, one of the grounds on which they do is that government should stay out of what we eat and stay out of our private lives.

In fact, you're right, the point that was made earlier is exactly right: government is involved in a big way already, and isn't involved in a constructive way. Should it be more involved? Should it back off and be less involved? Are you one of those people that believes that government always screws things up so they might as well get out of it and not try to deal with it? There are lots of different positions people could have.

Chapter 3. Framing the Issue in Public Debate [00:10:46]

One of the issues that's very important in this is who controls the way we discuss an issue. Who frames the issue in the public debate is a very powerful force indeed. When we talk about food and nutrition issues, there's a great deal at stake. There are a lot of parties who want to control the frame, and have quite differing opinions on what the frames should be. Who prevails in that? Who is most persuasive in the public eye? Who can testify before Congress and be most persuasive about we should take Path A or Path B has as lot of power indeed, and so the way we think and frame — think about frame issues are pretty important.

Now there are a variety of different frames, but just to give you two examples — and these two slug it out a lot in the press, testifying before Congress, and the like — a corporate and government frame. In this case I'm talking about not all government, but the people in government who are allies of the business world; and then on the other side would be the public health frame and a variety of non-government organizations, NGOs, would support that frame.

There are a variety of dimensions on which this battle occurs. What's causing these nutrition problems? Who's affected? What — is there a big impact or not? In the issue of obesity, the people who oppose government action say that the health experts are overstating its importance; that they're really — the prevalence isn't that high, it's really not that dangerous, so what is there to worry about? The health experts are saying, no that's not really true, and these other things are important as well. I'll use — I'll come back to the word defaults as I have before.

Here's one dimension on which things vary. Whether this is caused by personal misbehavior or the environment, the people who are afflicted are characterized much differently, with compassion and caring on the sort of — on the public health and NGO front, that these people are victims of a bad environment and deserve our help and support and aid; and on the other hand, that there's something wrong with these people so why would they deserve our help, support and aid? The impact is very often characterized as the cost to other people of the problem, or the cost to the individuals in terms of suffering. What is the target of change? The individual versus the social driver. Treatment is evoked in one arena and systemic change in the other, and then education versus prevention.

These are profoundly different frames that have much different implications for what might be done. If a person who believed in the frame on the left was to sit down and write legislation, and the person who believed in the frame on the right was to do the same thing, they would look a lot different. If I'm a believer in one of those frames and then I'm testifying before the Senate against somebody else who's a believer in the opposite frame, which of us is most powerful and persuasive says a lot. That's one reason why things like OpEds can be strategically important, because you can help shape the way the public looks at these issues.

Part of this has to do with perceptions of risk, and where the blame and risk for things are placed in society. Some of you may have had courses from Jacob Hacker, who is a professor here at Yale in Political Science who's written a really interesting book that I found useful myself called, The Great Risk Shift. He doesn't talk as much about the health arena as he does about other issues related to politics and economics, but he does talk about health to some extent.

His basic premise in this book is that there has been a systematic, organized, and quite effective push in the American political world to shift risks from institutions and government to individuals. It says a lot about how much we provide aid and support for the poor, for how we blame people for various financial woes, for restrictions or lack of restrictions on government and — or on business institutions and the like. This is an interesting book in that context.

Now this frame comes down a lot to the issue of personal responsibility. I'm going to show you quotes by three people, none of whom are in their positions of power anymore, but were for a long time. See if you can tell us which quote goes with which person. Each of these people were asked in various contexts, why do we have so much obesity in the United States and what should be done about it?

We have the Surgeon General, Richard Carmona on the left, we have Steven Anderson who at the time was the President of the National Restaurant Association, so a business industry trade group, a big one and powerful one; and then Tommy Thompson who was a former Governor of Wisconsin but was appointed by George W. Bush to be Department — Secretary or Head of the Department of Health and Human Services, so the top health officer in the country. You might think, at first glance, that the Surgeon General and the top health officer in the United States would have a different view of the issue than would the present — the person who represents the restaurant industry, which has been accused by a lot of people of contributing to the obesity problems for various reasons.

One the people said this, "It's about personal responsibility." Another said, "Personal responsibility is a very important part of this because we can't look at someone else and solve our problems;" and the third one said, "We have to continue to work hard to spread the gospel of personal responsibility." Well the fact is they're indistinguishable, so there's no way to know which one goes with which person. If you happen to be interested, we can see the way the lines go and they go this way.

The fact that they're indistinguishable says a lot about how the conservatives that have been in power for such a long period of time, going way back to Reagan, and then beyond that of course, how the priorities of the health establishment, because of the people who get appointed, lines up more with business than it might really with public health. I'll come back to Tommy Thompson again in a moment.

I'm going to show you some political cartoons that have been — this one I showed in the beginning of the last class of people who have rebelled against the concept that government or business might be partially responsible for diet, nutrition, and obesity problems. Here you see this very overweight individual pointing his finger at Ronald McDonald. The message there, of course, is how ludicrous it is that that man would blame poor little Ronald sitting there at the table with the frown on his face, for his problem.

Here would be another example, and then here would be another. So these are the use of political cartoons to capture a frame: the frame that people are responsible for their problem, and if they argue otherwise, they're idiots, because in fact they're responsible and everybody knows it.

Now, the opposite frame comes from popular things like this, from the Supersize Me movie, and then from The Fast Food Nation book and movie. Here the idea is that the environment and corporate interest of [inaudible] dirt to people is really the cause of these kinds of problems. This comes with its own series of cartoons and here would be one of them. You can see how these things get characterized. The frame gets characterized in books and movies, and public discourse, in testimony, and even in political cartoons.

The issue of personal responsibility is terribly important in this context. We can really debate it on several grounds. First, how do we believe morally about issues like personal versus collective responsibility? Second is what does science tells us about it? When we look at causes for something like obesity of hunger, or food deserts and communities, how responsible are people for the environment that they're around and for their own food conditions? Then there's sort of the pragmatic view of this, is okay if you believe in the personal responsibility ability approach, what roads does it lead down in terms of public policy and are those productive paths? Is it working? Does that philosophy work or not? Here are the questions that one can ask about these sort of things.

I'd like to walk you through a little bit about why we believe the way we do about personal responsibility, and whether this matches up with the science. First, the morality and philosophy of these things plays a big role. Americans have a set of beliefs. Those are not the same beliefs that are held around the world, and those set of beliefs help drive the way our world and our government responds or fails to respond to various issues.

Several things come together to help shape the American mindset about these issues. One is the Protestant work ethic, the second is something that psychologist's have studied called just world bias, and then the third is just plain old American values. How do those first two things come together and shape American values?

Now the Protestant Puritan work ethic is interesting in this regard. The people who have written about this have basically talked about these as its main components. That the road to success is hard work and determination; that people have control over their destiny, and if they fail to do well, then it's their fault.

As an example of this, I was at some social event with some person about a month ago, and the issue came up about the number of children in New Orleans who can't read. This person, and the person he was talking to were kind of shocked by how high the number was, but they responded much differently to it. The person whose response really surprised me said something like, oh it's the parents — like if the parents only tried harder the kids — then their literacy would really go up. The other person was believing the opposite, that it's the poverty, the social conditions, of course school systems, all these sort of things that might help contribute to this — much different frame.

The self-determination is the key to success and happiness. These things are moral imperatives. So if you're not exerting self-determination, you're not working hard, and you're not succeeding, there's something wrong with you because you have failed the moral test of the Protestant work ethic. Then the 'pull yourself up by the boot straps' is the colloquialism that gets used to do this.

Now another part of our thinking has to do with, as I said, what the psychologists have studied called the just world bias. There's this — the just world bias and there's something related to it called the fundamental attribution error, that has to do with the way we think about things that happen to ourselves and others that may be good or bad.

The just world bias is the way we look at the outside world and other people as Americans — aain, this isn't true everywhere in the world — but that things happen for reasons, that if good things happen to people it's because they're good, bad things happen to people it's because they're bad. Then the corollary of this is that people get what they deserve and they deserve what they get. When people get something like obesity or Diabetes, or they're poor, it's because they deserve it, there's something wrong with them and they deserve it; only bad people deserve bad conditions. There is a moral overlay to things that affect people's health, and these are very important in the way we think about the world.

The fundamental attribution error that psychologists talk about, says something that's related to this. It says that when we look at ourselves and something bad happens to ourselves we tend to blame conditions like, I was tired, or it was bad luck, or it was just the roll of the dice, things like that. Whereas, we look at bad things that happen to other people, we tend to attribute to them to something wrong with them — that they did something wrong: that if they were too tired and screwed up on a test, well, it's because they didn't study hard enough. There would be examples like that of things.

You put these two things together, with the Protestant work ethic, you have the translation to American values that looks like this. This gets played out every day in public debate about food and nutrition issues. If one were to do a systematic analysis of opinion pieces written by people who embrace different frames, you would see these themes come up time and time again.

Number one here is very important, that freedom gets coupled with issues of personal responsibilities. For example, if you propose something that would be government action involving food, the opponents of that are very likely to say that this is a matter of personal responsibility, and that if you choose to intervene, you're intruding on personal freedoms. So this American — the American belief in liberty and freedom and things like that gets brought into this in very interesting ways that help affect the frame.

Now if we look at the science on this, I mean one could theoretically have a scientific question. Let's just take the problem of obesity: are people personally responsible for obesity? Well, you could have a moral opinion on this; you could have a subjective opinion from just your exposure to the culture; but what about the science on it? Science could really help say what percentage of it is genetic; what's biological; what's in the brain; what's going on there; how much is marketing; how much are economics; how much are all these factors that we've talked about in the class and what might be left over could be the personal responsibility.

In the class we've gone through all these sorts of things. We've shown that a variety of factors effect what people eat, their living conditions, how much money they have, where they live in the world, what's happening with climate change, and famine, and all these things have a big impact on food and nutrition and body weight issues. To ascribe it totally to personal responsibility would be pretty hard to defend if you look at the science.

Then of course there is the pragmatism, the fact is since obesity was identified as a big public health issue, which really started in the late 1960s and in the 1970s, the country, our country, has embraced this personal responsibility approach. That has led down a role where government has been fairly inactive, has had weak programs, and hasn't really taken this on as some people think they should.

There's the pragmatic view of okay, we gave that a shot, we used the personal responsibility frame, we used the public policies that would follow from it, and where has it taken us? You could say, well we have high levels of hunger still in the U.S. and around the world, we have high levels of obesity, kids are eating a terrible diet, the marketing they're exposed to is having a very negative influence on them.

You could say all those factors are true and say that from a pragmatic point of view we gave it a shot but it just didn't work, so we have to come up with Plan B, and Plan B might involve looking at it a different way. Others might say I believe so strongly in the personal responsibility frame that we're not going to try a Plan B; we're going to keep using Plan A and hope that it works. So people vary on this.

The question is: is there a nuanced view that might be used here that strikes some sort of a compromise between social causes and individual causes for these nutrition problems? Does it have to be dichotomized in such a clear way that you see happening in the press a lot?

Well, here's how we come down on it, and this doesn't necessarily mean this is the way you should, but it's just the way we have chosen to reconcile these competing frames. First of all, the fact that society is recognizing these nutrition problems in a different light is really helping change the frame, and help, I think, lead to a nuanced view of these sorts of things.

You could take poor diet and call it a lot of different kinds of problems or an issue. It's a personal problem to be sure, poor diet leads to personal problems, leads to medical problems, but it's an issue. It's a public health issue, and then as we've talked about in the class it's these sorts of things as well.

Well, we made a big advance when the line shifted from here to here. That is, problems of poor diet were considered less a person's moral failing and more an issue of what was happening to them medically. There was this medicalization that Rogan Kersch talked about. So there was a lot of debate in years past, still is, about whether obesity for example should be considered a disease, once people started recognizing the medical consequences of these, that put things in a somewhat different light.

That — the time of just looking at it that way has passed. Now, you see the line down here underneath the public health issue. Above the line is more or less the way people are looking at the issue now. A small number of people, and a growing number, and especially some people in powerful positions, are starting to look at these issues as all these things.

That means that you would explore a number of different possibilities and you'd have a nuanced view of where responsibility really rests. Yes, some responsibility rests with the individual, but some rests with economic, social, political conditions, etc. I'm going to loop back to what I talked about in the public health lecture, the issue of optimal defaults in this case.

Our typical view of these sorts of things is this: that if you believe in the personal responsibility frame, what you hope to do is make people more responsible. So you implore them, you plead with them, you do whatever you can to motivate them and then you educate them and you hope that those things lead to better dietary conditions.

Again, we've been doing this for a while, hasn't really worked, so the alternative way to view this as I showed you before, is to look at issues that happened before the individual, and intervene in these sorts of arenas and create what you hope are going to be a different set of defaults, the optimal defaults.

Now you guys are smart, you might wonder why I'm showing you this twice. If there's anything you remember from the class I hope it's this. That people respond to their default conditions, we respond to how much money we have, we respond to the neighborhood we live in, we respond to the education that we have access to, these things are very important. Some people have optimal circumstances, other people don't.

Can we make social change by trying to optimize the conditions that affect diet and nutrition issues in order to improve health of the population? This particular philosophy underlies an awful lot of what we do at The Rudd Center and an awful lot of what other groups are doing to try to help tackle these nutrition issues: change the defaults that affect people's behavior.

The framing and positioning would look like this: the nuanced view that brings together all this sort of thing into our position looks like this, that personal responsibility is important. You want people to act in as responsible a way as possible, and so that's a good value. The real question then becomes, what's so hard? Why are current conditions making it so hard for people to behave in this responsible way?

In other words, what's undermining it? What's making it so tough for people to behave in a responsible way? That becomes the arena in which you intervene. How can we enhance personal responsibility? How can we get people more agency, more authority over their own lives, more ability to shape their health future? Well, we do things like this. Here, the word freedom gets used in a positive way to support the social environmental frame, rather than used to oppose it, by the people who use the peer personal responsibility frame. That freedom that in order to be truly free, you have to know what you're exposed to, you have to know what your environment is.

To give you a small example, all of you are wearing clothing that has a tag on it that tells you what it's made of and perhaps what country it comes from. That enhances your freedom a little bit, because if those things matter to you, then you have the ability to know because laws have been passed that require that information to be put on your clothing. That would be an example of providing information to consumers, like menu labeling does — that we'll talk about later — and it enhances freedom.

Freedom is also enhanced if you're healthy. Your ability to take advantage of freedom is enhanced if you're healthy. We believe as a country that we should not be drinking contaminated water, and so we authorize the health authorities to monitor this, to crack down on polluters, and to do things like that, because we believe our freedom is enhanced if our environment is safe.

Should those same standards be applied to food? Well, they already are to some extent. I mean you can more or less go to the Yale dining halls or to the restaurants in the local area and eat and be confident that you're not going to get sick from the food. Now sometimes the system breaks down, and sometimes disease breaks through the monitoring system, but more or less that's the case.

We believe our freedom is enhanced if we eat safe food and we're not going to get sick from it. Should, in this context of food safety, the quality of food be considered? Is part of food security and food safety confidence that people have enough food to eat that it's the right balance of nutrients and it's not going to make them sick because they're getting too little of some things or too much of others. That's where the freedom comes into the frame.

This is the way — this is our view of this and how we choose to bring together these issues. Of course, as I said, it doesn't have to be your view, may not be your view; but this is how we try to reconcile these otherwise two warring points of view.

Chapter 4. The Politics of Sugar [00:34:46]

Let's give some examples of how this gets played out in politics. I'd like to begin talking about the politics of sugar. Now I was very happy when Derek Yach was here that he talked a little bit about his experience at The World Health Organization and the whole issue of sugar. He mentioned the OpEd that Marion Nestle and I had written in this context, and this was part of your reading.

Let me explain a little bit more of the history of that then was in the OpEd piece that we wrote because it's very, very interesting. It speaks a lot to how politics affects world health nutrition standards and how the industry can be so powerful here. Here's the OpEd that Marion Nestle and I wrote in The New York Times in 2004 and it was in direct response to what was happening on the world scene regarding nutrition standards and The World Health Organization.

Here's how it went: right before that time in 2003, The World Health Organization had released a draft of — on something called The Global Strategy on Diet, Physical Activity and Health. It was a document that said, 'here's what the world should be thinking about in terms of these issues.'

If you read it today, and even if you'd read it then, you would have thought it was pretty tame. Everything would have made common sense: people are eating too little of certain things in the world, they're eating too much in others, and here is what reasonable nutrition standards should be. But there was one thing in this report, six words or seven words in this report, that sent the sugar industry into a frenzy of political activity.

Here's the timeline. February 2003, the draft report got issued. By March, the Sugar Association, the trade association that represents the sugar industry, writes to the WHO Director General, the top official there, a letter that talked about how awful this report was, and how the particular recommendation that people should eat less sugar was completely flawed and would actually hurt the world.

They talked about this expert panel, which was a great panel of esteemed scientists from all around the world. For example, either the chair, one of the key people on the committee had been the President of The University of Oslo in Norway, some top American nutrition scientists were on the committee. It was really a very good group. They said that this expert panel completely disregarded the preponderance of scientific evidence; that the scientists whose job it is to distill this information had ignored what was otherwise this compelling body of evidence that sugar isn't really bad for you.

They said that the recommendation would confuse and mislead the public and that it would distract from the very solutions that we all seek. The implication here is that the Sugar Association and its constituent companies are trying to seek a solution to the obesity problem, and that they know what that solution is — and that this report would distract the public from it.

In March of 2003, the industry also sent a letter to Tommy Thompson — the person I mentioned before and he'll come up again — the Secretary of Health and Human Services. What they said to him is that there are these poor people around the world who are sugar farmers, and countries that depend on the income from sugar who would really get hurt by this recommendation. So they present themselves as a caring group in that regard. They said that the unfounded recommendations of this nature confuse the public, mislead the press, and generally forestall the science based solutions we all seek. Again here's a trade association saying that it's a science-related organization because we all seek science-based solutions.

The letter was signed by The Corn Refiners Association, The Snack Food Association, and The Sugar Association, and other groups as well. The Corn Refiners Association are the people who launched the ad campaign recently about high fructose corn syrup and how it's no different for you than sugar.

In March 2003, two senators, Larry Craig — who became well known for other reasons later, and who was from Idaho — and John Breaux from Texas, who believe it or not, collectively formed the U.S. Senate Sweetener Caucus. There is, or was or maybe still is, such a thing and they were in charge of it.

They sent a letter to Tommy Thompson and Ann Veneman who was the head of the U.S. Department of Agriculture and here's what they said. They urged their "prompt and favorable attention to the issues raised by these food and commodity organizations." That means favor the positions of the business interest over the recommendations of the WHO. So here two elected officials putting pressure on appointed officials, the heads of these powerful government agencies to pressure the WHO to change its recommendations, and then you can see what else was listed in this letter.

This didn't work. Thompson and others did things to pressure the WHO and then had to up the ante as you'll see. Then the letter goes from the Sugar Association to the Director General getting a little more stern than the previous language of the letter. It said "It is difficult to believe the standards of the WHO have slipped to such a low point, and they said the "WHO's, as well as the Food and Agriculture Organization's future integrity is at risk," so there's a threat woven into that.

You could read it as you wish, but there's clearly some kind of a funding threat written into that that will get more explicit in just a moment. It's difficult to believe the standards of the WHO have slipped to such a low point, what did they do? Eat less sugar, that's what they said. This is all about 'eat less sugar.' Now there aren't many people in the nutrition world, my guess is not even many people in the public, would disagree with the premise that we're eating too much sugar.

Here's how the industry responded. Then in April, a letter goes from The Sugar Association to the Director General, here they're talking about how much they care about the third world and hardworking sugar growers and their families, and here's the threat, very clear and explicit. "We will exercise every avenue available to expose the dubious nature of the report, including asking Congressional appropriators to challenge future funding to the WHO."

So here's the WHO: It's dealing in every corner of the world with Aids, with malaria, with epidemic influenza, with diet and nutrition issues, with every health issue. You could imagine having its appropriations threatened because of 'eat less sugar.'

Now it's hard to blame The Sugar Association for doing this; one could, but of course that's what they're in the business to do, is to try to protect their interests. But when government colludes in doing this — as you'll see in a moment — then you have to start asking whether government's helping or hurting.

Tommy Thompson came through. The Senators asked him to come through, The Sugar Association asked him to come through and he delivered, so a 28-page single spaced report went to the WHO criticizing the science of the report line by line, by line. It criticized the transparency, it criticized the science — now these were bureaucrats criticizing the interpretation of science by the scientists and they concluded things in this letter like there's really no problem with things like fast foods and soft drinks.

Well, who won? Well it's interesting. The WHO, all along had resisted the Americans' attacks on its integrity, and internally, word had it from people at the WHO, that they were highly insulted by the American behavior and felt that it was bullying behavior at its worst. What was happening behind the scenes is that the WHO has a governing body like The United Nations have done. It's made up a representative sample of its constituent countries. The word had it that the U.S. was going behind the scenes to pressure the smaller countries that were on this governing board to support the U.S. position, but none of them did support the U.S. position because it was so obviously the wrong position from a scientific point of view. They were doing these bullying techniques, making the other people in the WHO mad and giving America a real black eye but this is what happened.

Several things occurred then to expose this. Our OpEd piece in The New York Times did some of this and what was probably even more powerful is that the BBC has a showed called Panorama. They did an expose on what was happening behind the scenes for eat less sugar business and exposed the behavior of the American government, the sugar industry, how they were colluding to pressure the WHO, etc.

The WHO Director Gro Brundtland, who was the former Prime Minister of Norway held firm, didn't back down. The report got published, and finally, after all the embarrassing behavior that the Americans had engaged in and how it got exposed, the Americans came along and supported the report. This would be an example of government at work.

Now, I mean you can obviously tell from the way I've presented the case how I feel about it, and it was all there in the OpEd, so there's no hiding that. One might have different opinions on this, you might say well that's free enterprise, business has a right to protects its own interests, business is — they have their right to talk to legislators just like the rest of us do. It really depends on how you think about it, but you obviously know how I do. It's a very interesting case history.

Chapter 5. Government Position on Subsidies [00:45:10]

Here's another interesting case history and we're going to come back to Tommy Thompson here. Government position on subsidies — we've talked a lot about the subsidies and the role they play in the American diet. I'm going to play you an interview that was aired on an ABC Special where the former news correspondent, Peter Jennings, interviewed Tommy Thompson and basically is asking Thompson, do the subsidies really affect health and what should be done about it? You can see Thompson's response.

Now again, this is not to get down on Thompson — he just happened to be the one who was put in office during this time. One might guess that anybody else that was appointed by that administration would have a similar view. Let's hear the interview [video].

Now, an interesting take on things because you have people in government, high people in government, who are in charge of different things. You've got the Secretary of the U.S. Department of Agriculture whose job it is to help promote good nutrition, but who has a more important priority the way the job gets laid out, to help protect American agriculture and sell as much food as possible. So that person has sort of a conflict of interest and ambiguous dueling positions if you will.

There is no ambiguity in the position of the top U.S. health officer. He was asked very directly, are the subsidies having an impact? Well, they do have an impact, and you've seen abundant evidence for that throughout the class, he said no they don't. Jennings asked him, should you do anything about it? Well I'm not going to criticize Congress. This has been the case throughout the ages. It's just the way it is. The critics of that position would say well why aren't you trying to change it, it's your job to protect the health of population. Then when he said — when he was asked about why these policies are set up, and he said, well that's not a determination that can be made from Washington, D.C. That's exactly where the determination comes from. It's exactly those agriculture policies that come from Washington, D.C. that do drive these things.

One could argue as some have, that Thompson at least in this particular context, was doing more harm than good for the public health, even though he was appointed to the position where it's his job to defend the public's health. Now that doesn't mean he might not have done well in other arenas that I'm less familiar with, but at least in this arena he was not taking the position that would have been justified by the reality of the situation on the science on the issue. Now again, maybe things will change with the new administration. There are some powerful forces that are going to make that difficult, but if there's enough will, perhaps it can happen.

Chapter 6. Government Nutrition Programs [00:50:58]

What does the government do on the nutrition program front? Government has the ability and the resources to do nutrition education, set up nutrition policies, and things like that to help. Now we talked about some of these in the class, but there are some that we haven't really talked about.

Somebody calculated the following number that I thought was pretty interesting. They did this in 2002 and what they was they took all the money for nutrition education across all the government agencies that might have a stake in this, all the money and added it all up. And they figured that it came to one-fifth the annual advertising budget for Altoids Mints. I mean, here's this little niche product and it has five times the budget that the government spends trying to educate people about good nutrition.

Back when we talked about the food guide pyramid, I probably made the case — although I can't remember if I did or not — but I probably made the statement that it almost doesn't matter what the food guide pyramid is, because you could take it and then create the exact opposite of what the standards are now, and would it matter? Well no, it probably wouldn't matter at all. No money is put into publicizing it, very few people pay attention to it, it really has no cache in the world, it has very little visibility, some people don't even know it exists, some people know that it exists but very few know the details of it, so it almost doesn't matter what goes into it and these kind of statistics suggest why.

This was 2002, have things changed? Well, that's a long period of time and during that period of time the obesity problem grew worse, people are more aware of food nutrition issues, more people concerned with organic food, local foods, sustainability, and things like that. Have things changed?

Well, here's the main government program to deal with the obesity issue. It's called The Small Step Program and it's — so it's at smallsteps.gov if you want to go fetch the website and it's put together by the Department of Health and Human Services. This was begun under Tommy Thompson's reign as Secretary of HHS. What is this? Well here's — it's a small step program, as I said, and what it does is it's — not much money goes into it, so my guess is none of you have even — had anybody even heard of this by the way? Okay one person out of this whole class, a highly educated group had even heard of this. So that speaks to how visible it is and how well funded it is.

Again, it almost doesn't matter what goes into it, but what does go into it? Well, it's a series of tips about what one can do. The basic concept here is that we don't need to make big changes, all we need to do are make small changes and they'll really add up. So little changes in your day to day life are going to help you deal with the obesity problem, and that will help America address the obesity problem for the population in general.

You can see the tip of the day here, get a dog and walk him. This is sort of the government's level of interest in this problem thus far. Now, by the way, I've got nothing against dogs — in fact I have two myself that you see in the picture here. We have a little bitty one whose snuggled up next to his Yale bulldogs that he's very fond of, a little hard to see him up there but he is up on the pillow and then we have a big dog named Ralph and so they have a nice time. I have nothing against dogs; I just wanted to make that clear.

You have to wonder about the small steps program. One could claim that small steps is a euphemism for small vision; and that small vision leads to small impact; and small impact preserves the status quo. It doesn't interfere with things that have important economic ramifications, doesn't interfere with subsidies, doesn't interfere with the ability of the food industry to market price, size, its products, and ways that maximize intake.

It would be pretty hard to argue now, I believe, that government is playing a very active and constructive role in this problem. Now it's — again you could come down on the political front of saying, well that's exactly what government should do. We want less government, they're going to mess it up so let's just not get involved.

That's a defensible position to be sure, but where the disconnect occurs is when government says it's doing something about the problem, but doesn't. Then it gives the illusion of taking the issue seriously and dealing with it when it's not really doing that. If government were honest and just said, okay we don't believe the government should be involved in food issues, and we're going to back out of this because that's our political position, fine; then the behavior of the government lines up with what it's saying publicly. But right now those two things are quite disconnected.

Chapter 7. Business Self-Regulation vs. Government Regulation [00:56:02]

Let's talk about business self-regulation and government role. Now this is a really very pressing issue because a lot is happening right now on this topic. Industry will very often argue that they can police themselves, and the government doesn't need to step in because we can self-regulate. This is happening in spades in the whole food arena.

Here are the three most prominent self-regulatory pledges the food industry has made. In 2006, The Clinton Foundation, along with The American Heart Association, helped broker a deal with the players who sell foods in schools, who pledged to cut back how many foods of unhealthy nature are sold in schools. There was debate about how much of that has actually happened. The main results on it so far have from the industry itself, so we're still waiting for more objective information to see whether their pledge has held up.

In 2007, The Council of Better Business Bureaus brokered a deal with a variety of the major food companies, who pledged to do less marketing to children. Then, just a little bit more than a week ago, there was a pledge by a number of the major food players to take part in a program called Smart Choices where they will assign symbols to foods, symbols that are universal and used by all the companies to designate which foods are better than others for people to eat.

When does business ask to self-regulate? Under what conditions does business say we can regulate ourselves, please back off? Well, these are the three primary ones, at least that I see.

When public opinion turns against an industry, and this happened with tobacco, it's happened with alcohol, it's happened in other businesses too. The industry will very often step forward with programs that they think will help quell the negative public opinion, so they become public relations tools.

Second, when government intervention looms, and industry is frightened that government may do things to it that it doesn't want, it will argue that we can police ourselves, government doesn't need to get involved.

Then the other set of conditions, is when the federal government fails to act, but local governments or state governments do and creates standards that are different from place to place, and that creates a business model problem for industry. Say, for example, in the food arena if New York City says restaurants can't have Trans fats in foods, but New Jersey allows Trans fats, then what's the industry going to do? Well, it can just take Trans fats out of everything, but it may not want to do that — they're making these things and perhaps a central processing plants are doing two versions of the same food becomes difficult and you could see that.

If they want — if the menu labels that one state requires on calories and what's in food are going to be different from another state, and the industry wants to change its products in response to that, it's got a problem because the standards are different from place to place.

This would be an example where the industry goes asking for something called preemption. They're asking that the federal government pass a law that preempts anything else that could happen at state or local levels, or that the state government passes a law that preempts what local governments could do.

As we'll explain, this has been played out right now in California with menu labeling, where the City of San Francisco and San Mateo, and other places were considering it as well, had passed quite strict menu labeling requirements, or were considering it, much like New York had required. The industry got in and worked with some NGO groups and the state government to pass a law that was weaker than what these local bodies of government had passed, but it would be statewide and it would preempt cities from doing anything that they might otherwise do.

When government starts — when industry starts fearing these conditions, it goes looking for government intervention to preempt what might happen otherwise; but it also asks at the same time for the ability to self-regulate. The question is, should they be granted the power to do that? Should we trust them? Is this a good thing? Should government back out, not be involved, let industry go to it using its own creativity, ingenuity, and resources to help solve these problems?

Well, it's an interesting thing. There was a good book written about this by a Yale professor named Benjamin Cashore called, Governing Through Markets; some of you may have taken classes from him. He is in the Department of Forestry and Environmental Sciences and has written a lot about self-regulation, not in the food industry but in the forestry industry. He has talked about how that industry, which faces a different set of concerns and circumstances than the food industry, can effectively police itself and regulation at least to some — self-regulation, at least to some extent has worked.

Now with forestry, and there also is a parallel set of self-regulatory circumstances in the marine fisheries industry, where they face a depleted resource. There's a finite amount of forest, finite amount of fish, and if the resource gets over used the industry will have trouble. The industry steps in to police rogue players to self-regulate, self-govern, and has had some positive effects through that. There are examples where self-regulation has worked.

There are other examples where it has been abominable failure. The tobacco industry would be an example of that. The tobacco industry lied, it cheated, it distorted science, it covered up realities like nicotine was addictive, and one can count as other experts have done — not me, the millions of people who have died as a consequence. Ceding the self-regulatory authority to the tobacco industry was a horrible, horrible failure. Ceding it to the forestry industry worked better; so what about food? Where does it fit in that?

Well, we have to think about that. The world picture, say with food marketing let's say, which is part of the self-regulatory pledges, varies a lot. There are places in the world where there are bans or severe restrictions on food marketing, other places where the action is being considered, and then you have the United States as a clear outlier in this.

One of the papers that was in your assigned readings from an earlier class was this paper on The Sydney Principles for Reducing the Commercial Promotion of Foods and Beverages to Children. This was initiated at a 2006 meeting in Oslo, Norway that I attended.

The concern at the meeting was that in some countries there will be good action taken to regulate food marketing, but in other countries like the United States, such action is less likely. Can standards be created that would help industry regulate itself and have some benchmarks to compare industry behavior to? As you saw in that paper on The Sydney Principles, these are some of the things that were written into that paper. Part of it — part of the criteria for knowing whether self-regulation can work is whether it occurs with this transparent process, and whether there can be outside objective evaluation and monitoring.

The example that I mentioned that's happened very recently, within the past two weeks, is this Smart Choices Program. Industry is saying the government doesn't need to come up with a series of symbols, we'll do it ourselves. We will define what is healthy and not, and then we will assign symbols accordingly, and we'll put those on our products. You can go to the website here — it's quite new — and you can look at what criteria they use to assign their symbols.

Now we did a quick pass through this over at The Rudd Center the other day, and what we did was we looked at the criteria that the Smart Choice Program, the industry generated program, had used to define nutrition in cereals. Then we went to Consumer Reports, which had recently done a report on cereals. They had taken the twenty-seven best selling cereals to see how many would meet good nutrition criteria, and only a small number of them, I think four or something, met criteria for good nutrition, for really good nutrition. Then there were some in the middle that were okay in nutrition, and then there were a bunch that were bad nutrition out of those twenty-seven.

We took the industry-defined Smart Choices criteria and applied them to this — to those same cereals that Consumer Reports had rated and what we found was that either twenty-three or twenty-four met the Smart Choice criteria for being healthy. Is this a good system? Well, it's not going to be good if it has no specificity. That means if everything crosses the bar, what good are the cereals? I mean, what good are the criteria? For the cereals, at least, I'm not sure it happens in other areas, but at least for cereals there doesn't tend to be much specificity and everything crosses the bar.

Is this an example of industry developing self-serving, self-regulatory criteria and using them in a way that protects their interest, locks in the status quo, and undermines public health? Or is this a good faith effort by industry to do something good? Well, you come to your own conclusions about that and we'll do more analysis like the one I just talked about. It's possible in areas outside of cereal, the criteria make more sense. One at least has to be alert and vigilant to the possibility given the terrible history in some other industries, of the possibility, that the industry is using this in a self-serving way that won't help public health very much at all, will forestall government action when it might otherwise be helpful.

Chapter 8. Taxing Foods and the Tobacco Precedent [01:07:35]

Now, the most radical change of all when it comes to proposed policies has to do with the idea of taxes. Taxing foods and will it ever be viable to put a tax on foods to help improve public health? The rationale for doing something with taxes are things that we've talked about in the class, that healthy foods cost more than unhealthy food, it's a real problem for the poor, so could you use tax policy, for example, to put a tax on foods that you'd like to see people eating less of, take the money and then use it as a subsidy to support things like fruits and vegetables. This is a topic that we've been thinking about for years.

There is a precedent in the tobacco arena. If you look around the country at the amount of tax there is on a pack of cigarettes, you can see that it varies widely from state, to state, to state. Some cases there are large taxes, the biggest ones are in New Jersey and Rhode Island, that are about $2.50 per pack, and this is the state excise tax that gets put on tobacco. The smallest, I think, is South Carolina which is $.07, so there's a big difference between $.07 and $2.50. The tobacco researchers have shown now for years that taxes are the single most effective way to curb levels of smoking in the population. Other things matter and have an impact but taxes have had the largest impact.

These are — those are current data, those are from 2007 that I just showed you. These data are about a year older than that, so the numbers don't quite match up exactly, but if you look at the top four states that are going to be on the right that have the highest taxes, and on the left, the taxes — the states that have the lowest taxes you see numbers like this, so quite a big difference between the highest and the lowest states.

Then of course, you can anticipate what I'm going to show you which are rates of smoking in those same states and you see the numbers looking like this. There's not a perfect relationship. You have Michigan here that has a fairly high level of smoking despite a high tax; but for the most part, you see the relationship changing here because of the tax. So they do matter, they affect behavior. Could there be something equivalent in the food arena?

To show you how much difference this makes to health, in California there was a heavy tax put on cigarettes, but the money was specifically earmarked to go toward anti-tobacco programs, which doesn't happen in all the states. This happened first in 1988. It was Proposition 99, $.25 tax increase per pack of cigarettes. It generated $90 million a year, which again was earmarked to — for programs to help curb smoking. So some of you have seen the Truth Campaign and the ads that paint a very negative picture of tobacco industry executives; that really was launched in California by the State Department of Health.

By 1999, there had been a 27% decrease in smoking in California; 19% decrease in lung cancer deaths, this is 10% better than the rest of the country, and so you see quotes like this that talked about what was happening in California. Now that's a powerful, powerful finding: 19% reduction in lung cancer deaths, just by a tax. Talk about optimal defaults; could you imagine trying to produce that through education? Well, you couldn't do it. It would cost way too much, and nobody would ever come up with the money anyway. Or you can just write a law that changes the tax.

Those are staggering findings, and they suggest the importance of the optimal default. That didn't come from small steps. That didn't come from advice like 'go get a dog and walk it.' That came from changing the law and putting in a tax. If a tax is done in this kind of way, potentially it would have beneficial effects.

The OpEd that was in your reading that I wrote first on this was in 1994 in The New York Times. I didn't choose that title because I don't think it's very appropriate for what I said, but the basic idea was that raise taxes, generate money, earmark the revenue for anti — for healthy nutrition programs, and then you might get somewhere in public health.

This was met with very interesting response in 1994, and I think I may have told you about some of this before, but here is an example. This was the Weekly World News came out shortly after that so this — The Weekly World News is one of those things like aliens abduct Princess Di type things, but it was interesting — so here 'dingbat health freaks push for fat tax, I'm madder then Ronald McDonald at a Burger King at those Yale University eggheads who want to ban junk food.' So you guys are among eggheads, I just hope you know that.

It says down here, it's a well known fact that General George Washington lived on hamburgers while he was fighting the British, so you got George Washington brought in there. If you look at that and blow it up it's interesting. In one fell swoop I got called a dingbat, a freak, an egghead, and that I sniff, so pretty interesting.

That's a sort of a funny one, but there was a critical editorial in The Wall Street Journal, as I may have mentioned, Rush Limbaugh went after me at least three or four times on his radio show for this idea of taxing food. There was a lot of criticism about this, but times have changed and people are thinking about it more. As Derek Yach mentioned in 1998, I was the Nanny of the Year by one of these conservative groups.

And then here was a good one, I got this anonymous — not anonymous but you can't read who wrote it, from somebody that said "mind your own damn business, you're motivated like nearly all liberals by book sales, caring less about a person's diet, what a person eats is none of your business — or teacher's business or the government," and then the last line, "a pox on your house." I had to go buy a pox detector. Unbelievable what this will do to you!

Before I get to this, where do things stands with — even the most radical suggestion is being considered in countries around the world; England's considered, Ireland, Australia and several other countries have considered the idea of a tax, so it will probably happen at some point. The question I leave you with, is what role do you feel government should take in this whole process? Is it taking a constructive role now? How could it take a more constructive role in the future? That's of course for you to decide.

I wanted to announce that our guest speaker for next Monday's class is a terrific person, Associate Dean of the School of Public Health at Johns Hopkins University, Stephen Teret, who's going to talk about the application of the law to diet and nutrition issues. He comes from this with a very interesting perspective, so I guarantee you're going to enjoy it. So we'll see you guys next week.

[end of transcript]