From landmark success in regulating tobacco to more recent setbacks around sugary beverages, public health is repeatedly called on to overcome industry objections. But in the case of the debate around mandatory labeling of calories on menus, Columbia University Mailman School of Public Health professors Dr. Rachel Shelton and Dr. James Colgrove in the Department of Sociomedical Sciences, contend that industry arguments were often more persuasive than those put forward by public health. Under the purview of the Lerner Center for Public Health Promotion, they examined 97 public documents submitted to the U.S. Food and Drug Administration in response to proposed national menu labeling regulation (as part of the Affordable Care Act). Their findings appear online in the journal Public Health Nutrition.
[Photo: Drs. James Colgrove (left) and Rachel Shelton]
In their analysis of comments from industry and public health groups, Drs. Shelton and Colgrove identified two divergent ways of framing the debate: public health used the language of social justice, prioritizing collective responsibility and cooperation, while industry emphasized the values of market justice, placing a premium on individual liberty and economic opportunity.
Uniformly, public health comments pointed to the health consequences of obesity and the growing numbers of people who eat outside the home, referencing peer-reviewed epidemiologic research. By contrast, industry marshaled a variety of data sources from reports by the Bureau of Labor Statistics and think tanks to newspaper stories, as well as their own studies, to highlight an assortment of logistical and economic hardships that affected businesses would face under the policy.
Both sides appealed to fairness. Public health argued that menu labeling would only be fair if regulations were broadly implemented to include movie theaters, grocery stores, and other food retail venues. Industry groups countered by humanizing the issue and saying a one-size-fits-all approach was unworkable in a diverse industry and would be especially burdensome to small and family-owned businesses.
The researchers highlighted several ways public health policy arguments fall short and ideas for how they might improve. One key shortcoming was public health’s seeming unwillingness to directly respond to industry. In the debate over menu labeling, industry comments acknowledged the importance of the health of consumers, but public health did not respond to industry arguments over financial and logistical burdens. Case in point, the American Diabetes Association, which wrote, “calorie labeling on menus is specifically a public health issue and not a business issue.” But according to Dr. Shelton, whether and how public health should modulate its message has become its own debate.
As suggested by Dr. Colgrove, some in public health seek to double-down on social justice, while others say health advocates should at least acknowledge market justice arguments. Some research suggests that messages which fail to acknowledge both sides are less persuasive. And ignoring industry arguments is especially risky when market justice concepts like personal responsibility are mainstream.
Despite these rhetorical shortcomings, the FDA’s final ruling was not unfavorable to public health. In July, they ruled that movie theaters, grocery stores, and the alcohol industry would be subject to the regulations, now slated to take effect in late spring. “However, Congress has introduced legislation that would significantly weaken the regulation, and the debate continues,” noted Dr. Shelton.