Shifting blame/selling health: corporate social responsibility in the age of obesity
Address for correspondence: Clare Herrick, Department of Geography, King's College London, Strand, London WC2R 2LS e-mail: firstname.lastname@example.org
This paper examines how and why health has become a Corporate Social Responsibility (CSR) strategy for the global food and drink industry (FDI) in the context of current governmental and public calls to address mounting obesity rates. It argues that, despite the current prominence of health within CSR, there has not been a reciprocal interest by those adopting sociological approaches to the study of health and illness in the implications of this strategic uptake of health or in the viability and legitimacy of the state's own public health role. This omission is addressed through an empirical exploration of three contentions: first, that health and wellbeing may be used to secure brand value and consumer goodwill at a time when mounting obesity rates demand new levels of accountability from the FDI. Secondly, that the food industry, through CSR, may promote a narrow epidemiological understanding of obesity, shifting blame from ‘foods’ to ‘diet’ and from ‘diet’ to ‘sedentarism’. Thirdly, that CSR reporting and its associated practices have enabled the food industry to assume some responsibility for obesity prevention, thereby problematising the state's role in addressing its own ‘public health’ crisis.
In September 2005, California's Governor Arnold Schwarzenegger held a long-overdue summit on ‘Health, Nutrition and Obesity’ in Sacramento. Schwarzenegger is currently one of six Governors serving on the National Governors Association ‘Healthy America’ task force and has made fighting the state's mounting rates of obesity one of his chief priorities. Despite the targeted efforts of the state's public health departments, however, it is notable that the newest member of the Governor's ‘Honor Roll’ announced at the summit was Kraft Foods Inc, purveyors of, amongst other things, Oreos™ and Chips Ahoy™ cookies. Accepting the accolade, Roger Deromedi, the company's CEO stated that, ‘our health and wellness program is an important business initiative that we believe is critical to the long-term success of Kraft. We’re taking steps that are responsive to societal concerns, while at the same time driving our business results by transforming our portfolio to better align with consumer trends’ (Kraft Foods Inc, 2005b). Kraft is not alone in recognising that long-term corporate growth within the food and drink industry (FDI) now rests on the efficient materialisation of societal concerns about health into product form and their public communication through Corporate Social Responsibility (CSR) strategies (see Margolis and Walsh 2003), a trend that this paper will both explore and critique.
In the two years since Schwarzenegger's summit, the uptake of health within the FDI's CSR activities has multiplied, deepened and become ever more visible, marking the domain out as a highly fertile area of research. It seems clear that the range of issues now deemed ‘social ills’, and thus worthy of CSR attention, are widening as a result of and reaction to a number of interrelated reasons. These include: the institutional and regulatory conditions imposed by the transition from what has been termed a ‘hollowed out’ state to one now characterised as ‘congested’ (Skelcher 2000: 3), anti-globalisation sentiment expressed through academic and popular critiques of the growing power of multinational corporations relative to the state (see Bakan 2004, Korten 2001) and their ‘unethical’ activities (see Klein 1999) and wider concern with the negative externalities (individual, societal and environmental) of the FDI's products and practices (Schlosser 2002, Critser 2004). At a time when, in the UK alone, 2007 FDI revenues exceeded $70 billion and accounted for 15 per cent of the UK's total manufacturing revenue (Food and Drink Federation 2007), such corporate success has been matched by mounting strength and influence in the political realm, a situation grossly at odds with, and the simultaneous catalyst for, the development of an ‘ethical consumer sector’ (Barnett et al. 2006: 45). Amid this mounting ethical consumer consciousness and concern over the changing role of the state, the uptake of health as one of a range of CSR ‘causes’ has been widespread among the FDI, even if this has not been matched by a reciprocal interest by those adopting critical sociological approaches to health.
A series of factors thus conspire to provoke a discussion of the relationships between health and CSR: the expanding canon of what might now be termed ‘critical obesity studies’ seeking to unpack the condition's aetiological complexity and contested health outcomes (see for example Evans 2006, Braziel and LeBesco 2001, Campos 2004, Gard and Wright 2005, Oliver 2006, Herrick 2007), the ‘explosion of interest and writing, both academic and practitioner, around the themes of business ethics and CSR’ (Roberts 2003: 250, see also Campbell 2006, Kallio 2007), the Internet's key role as a health information source (Parr 2002), its creation of the ‘information-seeking’ citizen and uptake in ‘critical internet health studies’ (Seale 2005: 516) and the growing influence of NGOs on policy agendas. This paper will thus be situated at the nexus of these debates. Furthermore, it will argue that in changing the realms through which health is not only communicated, but also enacted through FDI-led obesity prevention programmes, fundamental causes of poor health, such as poverty and structural inequalities may be overlooked in favour of more individualised explanations of health status, with solutions proffered in the form of information, and cast in the language of consumer empowerment and choice. This paper thus offers a critical analysis of the rise of health as a particular strategic use of CSR by key global FDI players that has been necessitated and rendered a source of competitive advantage (Nuffield Council on Bioethics 2007) by the combination of ongoing governmental, NGO and public concern with global and national obesity rate increases, inadequate governmental FDI regulation and the increased monitoring and calls for accountability of the activities of multinationals (Campbell 2006: 929).
The ‘time bomb’ of obesity (DoH 2003: 37) still seems to be ticking with rises predicted to 2010 and far beyond in the UK (Zaninotto et al. 2006; Government Office of Science 2007), North America and the rest of Europe (Branca et al. 2007: 6). As a global public health issue, obesity has helped catalyse a spate of sociological critiques of the globalised (and, in particular, American) FDI (see Schlosser 2002, Brownall and Battel Horgan 2003, Lang and Heasman 2004, Critser 2004, Spurlock 2005). These exposés have provoked a dramatic acceleration in public, NGO and governmental interest in its products, marketing and advertising practices, particularly with ethical regard to children. It seems, therefore, that an analysis of the corporate appropriation and strategic use of ‘health’– understood as interrelated discourse, bodily practices and biomedical domain – is an overdue addition to emergent critical perspectives on the ‘obesity debate’, public health and the frequently mass-mediated relationships between the two.
The paper therefore starts with a brief overview of CSR, its definitions, use and significance set within the theoretical context of shifting state-corporate relationships. It will then use empirical examples to critically explore and discursively analyse the rise of CSR as a response to obesity by the FDI through three contentions: first, that health and wellbeing may be used as a way of securing brand value and consumer goodwill at a time when rising obesity rates are demanding new levels of accountability from the FDI. Secondly, that CSR has been used to promote and reinforce an existing narrow epidemiological rendition of obesity that shifts blame from ‘foods’ to ‘diet’ and from ‘diet’ to ‘sedentarism’, with punitive consequences for those population groups or individuals defined as making ‘inappropriate’ choices in situations where context may preclude the possibility of choice. Thirdly, CSR, as a defensive, innovative and largely inevitable response from the FDI to the threat of potentially punitive governmental regulation, has created an opening and justification for its assumption of a health and sports promotion role. In turn, this may devolve some responsibility for this from the state and may problematise conventional expectations of public health encapsulated within its definition as ‘the science and art of preventing disease, prolonging life and promoting health through the organised efforts of society’ (Faculty of Public Health 2007). In order to explore these contentions, examples are drawn from key global FDI players’ 2004–2006 CSR reports and associated ‘wellness’ programmes aimed primarily at UK and US consumers. The year 2004 was branded Time Magazine's‘Year of Obesity’ (Lemonick 2004) due to a confluence of events including the launch of the World Health Organisation's Global Strategy on Diet, Physical Activity and Health and the unparalleled media coverage of the Center for Disease Control's ill-fated assertion that ‘poor diet and physical inactivity may soon overtake tobacco as the leading cause of death [in the US]’ (Mokdad et al. 2004: 1238, Herrick 2007). As a result, this time period seems a particularly prescient temporal focus for this analysis of consumer health's emergence with CSR, the strategies adopted and their wider conceptual and practical implications for public health.
In basic terms, CSR represents ‘a way of running the entire business in a way that allows the company to manage its total impact on society and the environment commensurate with the core objective of generating stakeholder value’ (Brock 2006: 58). These economic, social and environmental concerns are frequently referred to as ‘the triple bottom line’ (GRI 2002: 15), reflecting the idea that profits and market strength are influenced by factors extending far beyond the financial, despite the seeming ‘antinomy’ of ‘corporate involvement in wider social life’ (Margolis and Walsh 2003: 268). Indeed, ever since CSR's inception in the 1950s, the goal of enacting and communicating a ‘social consciousness’ has gathered momentum, and been refined and reworked in accordance with prevailing societal concerns and corporate threats, despite ‘compelling economic reasoning not to do so’ (Margolis and Walsh 2003: 285). In the past two decades, by both necessity and invention, CSR has become a form of ‘ethical accountability’ (Roberts 2003: 256), linked into the greater external visibility of corporate conduct and a wider NGO-fuelled, public concern with the ethics of consumption in the face of (what are often assumed to be) mounting FDI profits. As Campbell (2006: 927) suggests, certain regulatory system configurations, external auditing of corporate behaviour and the presence of ‘institutionalised norms’– filtered through and narrated by the media – have long inspired the adoption of CSR across domains including the environment (e.g. mining, sustainability, etc) and employee/ occupational health. However, as these ‘stimuli’ (Margolis and Walsh 2003: 286) have become more common within the broad context of individual and public health in what has been called the ‘congested state’, emergent forms of CSR have engendered a host of new conceptual issues surrounding the ‘public-ness’ of public health, sources of authority, trust and the agency of patient-consumers.
It has been suggested that the ‘hollowed out’ state of Thatcherite and Reaganite public management and market ideologies has now given way to a ‘congested state’ (Skelcher 2000). While the ‘hollowed out’ state was characterised by ‘a loss of government legitimacy, the implementation of public management reform programmes, changed relationships between public employees, politicians and citizens, and finally a marked impact of new, transnational institutions on the nation state’ (Skelcher 2000: 5), these features did allow for the development of certain public service delivery mechanisms, all of which have made a marked and lasting imprint on the available means and legitimacy of public health. Privitisation, contractual agreements with the voluntary sector and the creation of new, task-specific ‘para-statal’ bodies are a lasting legacy which have now come to rest in what has been termed the ‘congested state’. This is reflective of the current ‘complex of networked relationships between public, private, voluntary and community actors’ which ‘have created a dense, multi-layered and largely impenetrable structure for public action’ (Skelcher 2000: 4) where the plausibility of implementation is of key concern across a range of neo-liberal countries (Exworthy and Powell 2006). ‘Tertiary structures’ and ‘mediating partnerships’ are now the commonplace institutional mechanisms for implementing solutions to societal issues, a situation now especially marked in the UK. The notable result of these shifts has been new patterns of accountability characterised by an increasingly diffuse proliferation of actors. However, such ‘dense’ and ‘impenetrable’ conditions (2000: 4) may also, it should be suggested, create spaces of opportunity for more entrepreneurial actors. It consequently comes as little surprise that health promotion information and programmes from the FDI have emerged as competing alternatives to state-led directives. Furthermore, with public concern over obesity and the FDI's suspected role within this reaching critical mass, the business case for the entwining of CSR and health is clear.
The inclusion of health within this remit therefore requires a process of creative and entrepreneurial risk management to carve out new domains of competitive advantage in the face of emboldened public, NGO and government scrutiny. While CSR has been critiqued for its definitional nebulousness and for the suggestion that it remains largely ‘an idea, if not a practical programme’ (Crook 2005: 1), this paper asserts that CSR components of Annual Reports are but one element of a range of domains now incorporated within assurances and evidence of corporate citizenship. Although this is a form of citizenship constituted, in large part, discursively, it should be noted that it is also increasingly practised through a wide range of health information websites, educational resources, teaching materials, sports sponsorship, community interventions, national health initiatives and product health claims that co-exist alongside, and to some extent compete with, current ‘multi-layered’ state-led efforts (Skelcher 2000: 4). This degree of praxis in CSR thus renders it worthy of the kind of empirical study that might shed new light on not only new spheres of health commercialisation, but also their implications for the legitimacy and authority of public health at a time when calls to develop coherent and effective policy responses to obesity may mean working with, rather than against, the FDI.
Selling health as ‘brand value’
The FDI, perhaps more than any other, relies on the creation and maintenance of consumer trust, especially at a time when many consumers might concur with journalist Gary Taubes’ (2002) assertion that they are at its ‘Pavlovian mercy’. Indeed, in order to operate successfully within this culture of criticism – not least in the wake of BSE, Foot and Mouth Disease, ongoing concern over genetic modification (see Herrick 2005), additives and childhood obesity – manufacturers must communicate their integrity, foster trust and demonstrate their willingness to be held accountable for the quality and long-term safety of their products. Consequently, as the rhetoric of neo-liberal public health policy has shifted from treatment to prevention and from state duty of care to individual responsibility, growing consumer awareness aided by the outspoken work of a host of NGO campaigns (see, for example, UK group Sustain's Children's Food Bill and the US advocacy group Ban Transfats’ movement of the same name) is demanding greater transparency and accountability from the FDI, legitimised by the neo-liberal preference for industry self-regulation. In addition, with the WHO's 2004 Global Strategy calling for private sector support to tackle the worldwide public health challenges posed by rising obesity prevalence, ‘a unique opportunity exists to formulate and implement an effective strategy for substantially reducing deaths and diseases worldwide by improving diet and promoting physical activity’ (WHO 2004: 3). In effect, health now holds a potentially huge ‘brand value’ and this has paved the route to its creative uptake in the language and practices of the FDI's CSR.
At the core of maintaining brand value for the FDI is the assurance of choice, its provision and a dedication to consumer empowerment, rhetorical tropes prominent within CSR reports in 2004–2006 and mirroring those adopted in public health policy papers, especially in the UK (see DoH 2004, Jordan 2005, Clark et al. 2006). As Lang and Raynor suggest, these ‘consciousness industries’ (or the marketing and advertising that sustain growth) now ‘frame cultural norms around food, built around an appeal to choice’ (2005: 310). Coca-Cola, for example, in its ‘wellbeing and choice’ assurances, promises over 400 brands comprising 2,600 products worldwide. Thus, this rhetoric of health constructs choice and information as a form of consumer empowerment. In practice, healthy choices come in two forms: brand extensions making existing products healthier through lowering fat, sugar, salt or carbohydrate content, or through novel product platforms with new nutritional properties, health claims and often functional ingredients. Despite stringent dietary guidelines issued every five years by both the Federal Drug Administration (FDA) and US Department of Agriculture (USDA 2005) in the US and by the UK Department of Health, it must be noted that ‘healthy choices’ are now so defined as much by the companies themselves as government agencies. This calls into question what health in the context of dietary choices may actually mean. The role (if any) of nutritional science in its definition adds a further layer of complexity to the already highly contested relationship between body weight and health.
For example, both Kraft Foods and PepsiCo have their own umbrella branding for their ‘healthier’ products which aim to cultivate both consumer trust and brand value through rhetorical appeals to choice, provision of information and adherence to government dietary guidelines all promoted through the language of consumer empowerment in the context of decision making. Kraft brands these products as Sensible Solution™, whereas PepsiCo applies the Smart Spot™ tag to differentiate them from what it calls its ‘fun for you’ products. In 2005, these 100 Smart Spot products comprised 40 per cent of the US portfolio and 30 per cent of the region's revenues (Kraft Foods Inc 2005a: 8). As ‘products that can contribute to healthier lifestyles’ their nutritional worth is ‘based on authoritative statements from the US FDA and National Academies of Science’. What these ‘authoritative statements’ are is not fully elucidated, but since the products included enjoy the fastest growth of the entire North American portfolio, their use is clearly persuasive. It is notable that neither Kraft nor PepsiCo adhere completely to the USDA's Dietary Guidelines in their umbrella branding, selecting instead certain criteria to support product health claims. For example, the most recent guidelines advise Americans to ‘consume at least three or more ounce-equivalents of whole-grains per day’ (USDA, 2005: viii). Consequently, there is now an array of products following the USDA's advice and reformulated with whole-grains that once might have fallen squarely into the ‘unhealthy’ snack category, but can now be deemed not just ‘healthy’, but may also now be included within the powerfully ambiguous ‘natural’ category. Or, for example, in the case of Kraft's Fig Newtons®, the brand may draw more specifically upon attractive health appeals such as ‘contains real fruit’.
As a second example of the cultivation of brand value through CSR, ‘mission statements’ setting out a corporate commitment to consumer health and wellbeing have become increasingly common since 2004, magnified by intra-industry competition. Yet interestingly, Unilever's Nutrition Policy (Unilever 2004, 2005) is not actually about nutrition as such but rather a statement addressing consumer demands for healthier products through assurances of dedicated research and development investment, which totalled €953 million in 2005 (Unilever 2005: 96). What is, in effect, a statement of brand value cultivation is also reiterated in Nestle's statement that it is a ‘food, nutrition, health and wellness company’ which will, moreover, ‘integrate nutritional value-added in [its] food and beverage businesses’ (Nestle Annual Nutrition and Wellness Report 2004: 2). By evaluating emerging nutritional and epidemiologic trends and conducting clinical research, the global FDI is forging ahead in the race to develop health claims as valuable marketing tools and sources of brand value. Such claims psychologically link the consumption of certain foods with good health and have, for example, reinforced the brand value of Quaker Oats (acquired by PepsiCo in 1991) ever since the FDA first allowed the product to claim the positive effect of its high soluble fibre content on heart health in 1997. The brand now enjoys a strong reputation among consumers for its healthiness, despite ardent criticism of global brand owner PepsiCo for such things as soda vending machines in schools.
The drive to maintain and enhance brand value through specific linguistic tropes not only underpins the association of health and CSR across the FDI, but it also demonstrates the faith placed in the possibility of individual behaviour change. The belief in behaviour change is further reinforced through media-driven attempts to reassure consumers that their health and nutritional needs are central to the FDI's product development, that information provision through labelling and the extensive choices offered within brand portfolios can satisfy a wide variety of consumption occasions and lifestyles. As Coca-Cola's Citizenship Report (2004) notes, ‘We are committed to offering a broad range of beverages so that consumers can choose products appropriate for their lifestyles and needs; to making our beverages available responsibly; and to providing information and opportunities for nutrition education and physical activity. We also contribute our skills and expertise to multi-sector partnerships that address obesity and promote healthy active lifestyles’ (2004: 14). The public health rhetoric of individual or personal responsibility may ally closely with Coca-Cola's notion of consumers needing to exercise ‘appropriate’ choices, but with questions of responsibility inescapably come issues of culpability, and therefore blame. At a time when policy discourse seems as much about identifying culpability as pioneering solutions, the functioning of the rhetorical uptake of ‘blame’ through CSR merits further consideration.
Shifting blame is a key theme that emerges from CSR discourse and practices concerning consumer health and wellbeing. This is perhaps an inevitable response to government calls for the food industry to assume a certain degree of responsibility and burden of duty to address obesity rates. However, the disjuncture between the complexity and uncertainty surrounding obesity's aetiology and the seeming certainty of quantitative studies showing more obese bodies, means that it has been unusual among public health ‘crises’ (US Surgeon General 2001) for the unusually high degree of outspoken and hyperbolic media attention it has attracted. ‘What is so striking about the current situation’, as Gard and Wright contend (2005: 16), ‘is the extent to which the ‘obesity epidemic’, including its central scientific ideas and knowledge claims, has infiltrated everyday talk’. Such talk suggests that there may be ‘good’ and ‘bad’ lifestyles and people can be judged on the basis of how their health status reflects the degree to which they know and act upon the knowledge that ‘food choices affect health’ (Smoyer-Tomic et al. 2006: 307). Indeed, critics suggest that the public health view of obesity is ‘built around the false belief that it is possible to determine whether someone has a healthy lifestyle by observing whether or not that person maintains a healthy [sic] weight’ (Campos 2004: 97). The clear adherence to a ‘highly idealised model of consumer behaviour’ based on the hope of the ‘rationalising utility-maximiser of economic theory’ suits the judgmental tendencies of both public health and, as a logical result, the FDI, well (Barnett et al. 2006: 45). This is especially true given that, according to this logic, ‘proponents of the market think that people should act like this . . . and critics of the market tend to assume that people do’ (2006: 45; emphasis added). As such, the adherence to the rational consumer model not only legitimises the FDI's appeals to ‘choice’, but also appears to justify redirecting blame for health outcomes squarely onto individuals through the provision of this choice and supporting product nutritional information.
Blame in the context of public health is, however, far from new. In the late 19th and early 20th centuries, for example, TB outbreaks in rapidly expanding British and US cities were frequently blamed on immigrant communities and their lifestyles (Farmer 1997, Gandy and Zumla 2003, Oshinsky 2005). Moreover, corporations have often been blamed for perpetuating disease, especially in the case of smoking-related lung cancer and access to new trial drugs for HIV (see Epstein 1998, 2007). Yet, obesity and tobacco seem to be among the few examples where an entire industry has been (and can be) held accountable for population health status and, as a result, corporations have been forced to develop a more ethical public face and invest in tangible solutions to some of the negative externalities of their own success. As obesity exists in the particularly liminal spaces between science, commercial interests, discourses surrounding rights and responsibility, basic needs, the media and state health care systems, its stakeholders and therefore the possible delineations of responsibility are exceptionally diffuse (Government Office of Science 2007). Obesity has therefore catalysed what could be termed the mass retrospective vilification of the FDI, with a host of actors blaming it for present physiological effects of past consumption choices and thus engendering the need for an effective and acceptable corporate reply.
Unsurprisingly, the food industry has not been a passive target. Instead, its proactive response, filtered through CSR strategies has been two-fold: first, a repeated adherence to the positive semantics and logic of ‘energy balance’ (calories eaten versus those expended) and secondly, the direct linkage of this to calls for ‘informed choice’. Energy balance, is of particular interest in the context of ongoing public health efforts to address obesity, as it shifts blame effectively from food to (lack of) exercise (Gard and Wright 2005). This move consequently allows the FDI to promote its products by negating the need for unappealing ‘do not eat’ messages in favour of ‘eat our identical, but healthier version’ or in the language of Kraft, ‘sensible swaps’. Furthermore, nutritionists and epidemiologists cannot agree conclusively on whether it is fat content, energy density, total calories, the type of fat or too much or too little carbohydrate that causes weight gain; therefore sedentarism, based on the generally accepted and acceptable link between physically active lifestyles and good health, has arisen as a legitimate default casual explanation within CSR discourse.
As Ahuja (2005) concurs, ‘scientists – urged to mould a socially useful comment out of scientific uncertainty – often end up recommending more physical activity and self restraint, thereby strengthening the illusion that a gluttonous lazy youth has shaped its own downfall’. As a rhetorical device, the focus on activity has the potential to create a positive brand association with sport and wellbeing more generally, but also risks glossing over structural inequalities in favour of constructing obesity as individual failure to avoid the trap of sedentarism through rationale choice-led behaviour change. Shifting blame from consumption to inactivity means that the rhetoric of choice can be employed to flip the argument, so that consumption, if no longer the problem, can be a part of the solution – a discourse again mirroring recent policy documents (see DoH 2004). Indeed, McDonalds UK's new corporate accountability site http://www.makeupyourownmind.co.uk is, in many respects, a clear example of this use of choice in action. This sidestepping of blame is also operationalised by a very tangible financial investment by the food industry in physical activity promotion. This, however, holds the potential to undermine wider agendas to address social determinants of ill-health such as poverty and inequitable access to open space or nutritious food. This discursive deflection of blame back onto individuals through CSR consequently reinforces the wider propensity to make ‘people feel responsible and culpable for their health status’ (Parish 1995: 51) and, moreover, to reinforce the assumption that there is an unproblematic causal link between obesity and poor health outcomes, despite the wealth of literature still trying to disentangle these complex relationships. Yet, in situating its CSR strategies within these prevailing tendencies, the FDI has now, somewhat ironically, created a space to assume a significant degree of responsibility for obesity prevention.
‘Responsibility’ is a term commonly associated with the governance of health. In the case of obesity, it may be fair to assert that, ‘misery loves companies’, especially in the case where ‘those problems are juxtaposed to the wealth creation capacities of firms – or to the ills that firms may have helped create’ (Margolis and Walsh 2003: 270). The potential causal role of the global FDI, its products and practices in mounting obesity rates, has entwined discourses of blame and responsibility in complex ways, especially through the media, NGO and national governmental framing of the issue. However, to assume the responsibility needed to cultivate essential brand value without, importantly, attracting blame, the global FDI has turned to three strategies: first, heavy investment in and advertisement of its health and wellness research and development efforts; secondly, continued support for its physical activity programmes, either emanating directly from companies themselves or by sponsoring state-led strategies; and thirdly, its entrance into the field of health promotion and education in both the virtual realm and the classroom. All three have been taken up in different ways and to varying degrees of financial investment by industry. They demonstrate the extent to which obesity might need to be conceptualised as a very different kind of public health (despite its simplistic characterisation as a ‘public health problem’) especially in the tenuous realms of duty, responsibility and capacity to act.
Consumption trends predicated on health tend to be lucrative and fleeting. This means that consumers’ ever-changing interests must be piqued and groomed by the expertise of dedicated teams of research scientists now employed by the FDI. Given the superior financial capacity of many key FDI players relative to the state to invest in research and development, the ability of public health bodies to compete in the realms of knowledge creation, dissemination and implementation is becoming severely compromised. For example, Danone has its ‘Vitapole’ global research facility which invested €129 million in R and D in 2005 (Groupe Danone 2004), Coca-Cola has the ‘Health and Wellness Beverage Institute’, McDonalds the ‘Global Advisory Council on Balanced Lifestyles’, Unilever has a ‘Food and Health Research Institute’ (Unilever 2007) employing 450 ‘experts’, and Kraft has a ‘Worldwide Health and Wellness Advisory Council’. All are devoted to researching ‘health . . . but not at the expense of taste’ (Groupe Danone 2007). Research has long been integral to the food industry as new products have emerged from the unending application of nutritional knowledge and technological advances. In this process of ‘scientising’ consumption, however, the boundaries between commerce and public health are becoming more porous, further adding to the inherent difficulties in creating workable structural policy solutions to the risk factors for obesity.
While nutritional research is one way of communicating a commitment to corporate responsibility, investment in sports has long been another, powerful tool of brand value creation as well as a badge of good corporate citizenship. Indeed, as the McDonalds UK strapline states, ‘it's what I eat and what I do’ (my emphasis), thereby deflecting attention from diet to activity. Sports sponsorship is common across many food companies with the Olympic contracts with McDonalds and Coca-Cola assured until 2012, Coca-Cola sponsoring the Football World Cup, Rugby World Cup and National Basketball Association and Pepsi the Superbowl and National Football League. PepsiCo donates $1.6 million annually to the YMCA (PepsiCo Smart Spot 2007). McDonalds invests heavily in the UK's Football Association and has pledged $31 million to train 8,000 voluntary coaches over the next few years. In New Zealand, McDonalds is one of the largest sponsors of junior level netball and its ‘Light Athletic Thursdays’ scheme in Poland involves over 186,000 people a year. In the US, McDonalds has sponsored High School basketball for the past 28 years, thereby providing financial and physical resources to support sport in the increasingly common situation where state support may not and often does not exist.
Despite this, latent criticism remains that altruistic voluntarism may not be a universally applicable label for these efforts (Crook 2005). This critique is especially pertinent given the virtual impossibility of finding quantitative data detailing the FDI's total CSR-related health improvement programme/sports promotion spending relative to net income or total turnover. Instead, companies tend to highlight individual donations to NGOs or charitable foundations through corporate press releases. Corporate sponsorship clearly pushes brands effectively, but as this has become ethically more difficult to justify and the threat of potential government regulation has increased, some notable FDI players have instead entered the previously state-led domain of health promotion and education. A clear example of this is PepsiCo's branded ‘Health Is Power’™ school resource kits, which were rolled out in 2004. Indeed, as the health economists’ warning of the rising state burden of health care costs (Philipson 2001) appears only to be exacerbated by obesity, the tension between ethical concerns and successful policy implementation seems only to grow stronger.
Seale (2002) contends that the basic assumption of health education and promotion is that people lack the knowledge to make informed decisions and must be held personally responsible for their health in order to reduce their economic burden on the state (DoH 2004, 2005a, 2005b). If health education brings the biomedical into the public realm, then FDI-led programmes bring the market into the sphere of health and, with it, new pragmatic considerations. Obesity has been cast as a public health issue (albeit to varying degrees of urgency) for the past two decades, but very few countries have successfully created coherent national health polices to address its rising prevalence, so strong is consumption's internal conflict between satisfying need and cultivating desire. When this conflict is set against uncertain and contested aetiological explanations for obesity and policy paradigms that have tended to favour precaution over pre-emptive action, it seems clear why the resulting gap has been filled by corporate health information. Consequently, ‘an old tension between social and medical, public and industrialised solutions for health problems has re-emerged. Indeed it rehearses, in some respects, old debates within Europe about the role of the state in relation to public health’ (Lang and Raynor 2005: 313). While it is true to say that, in some cases, this debate ‘rehearses’ older debates in Europe about the acceptable degree of state intervention in public health, this would be to underplay the extent to which the current situation poses such a novel challenge precisely because it calls upon the state to assume a new role and position vis-à-vis its citizens and the market, drawing, confusingly, upon the same language and techniques perfected by global commerce.
However ironic it may seem, the FDI now coexists as both villain in the ‘obesity time bomb’ (DoH 2003: 34) and a significant global health promoter in its own right. Several examples demonstrate the global scale of their reach: Coca-Cola's ‘Vida Activa’ scheme provides dedicated health advice to Latino communities; its ‘Step with it’ scheme has one million participants across the US; and its ‘Thai Kids on the move’ programme had 186,000 participants in 2004 and one million projected by 2007. PepsiCo has been heavily involved in school health promotion with its ‘Balance First’ programme and, most recently ‘Smart Spot Dance’ in conjunction with the national NGO America on the Move, whose educational materials are now used by a growing number of US teachers to convey the familiar message of energy balance. While the USDA and NIH have successfully pushed their Dole-sponsored ‘5 a day’ campaign, Kraft's ‘3 a day’ message encourages the daily consumption of three portions of dairy products; with direct promotional links to its Kraft Singles™ cheese slices and Breyers™ yoghurt (http://www.3aday.org).
Health promotion is traditionally seen as a task of government, but there now needs to be an acknowledgement of how its corporate uptake may be diminishing the degree of trust in the state as an authoritative source of health-related information. Government public health policy now sits alongside (and is often entwined with) corporate health improvement efforts. Indeed, such efforts, through their expensive branding, widespread dissemination and large potential audiences, adherence to the lexicon of ‘research institutes’ and advisory councils, may well prove to be the state's most enticing competitors for the public's attention. With both the UK and US governments determined to develop obesity prevention measures, it must thus be asked how the involvement of commercial enterprises seen not only as the cause of the problem, but also now as a source of research funding, product development, nutritional science knowledge creation and physical activity sponsorship, may weaken the state's legitimacy and capacity to ensure the public's health. At a time when the appropriate and acceptable degree to which the state can intervene upon individual health or risk behaviours is being debated (see, for example, Nuffield Council on Bioethics 2007), the corporate interventionist ethic demands the same degree of empirical analysis currently devoted to that of public health.
This paper has explored, through a series of empirical examples, the strategic appropriation of health by CSR and, consequently, some of the wider conceptual issues pertaining to the legitimacy of health governance and the porosity of the state-individual divide raised by this trend. However, ‘as firms become involved in fixing societal problems, we also need to know what happens to public political processes’ (Margolis and Walsh 2003: 289) especially within the increasingly contested domain of public health. Currently, strategies to prevent further climbs in obesity are at an embryonic stage across almost all countries. Indeed, one of the very few points of agreement seems to be that the situation is complex and involves a vast array of stakeholders from a number of governmental and non-governmental domains (Government Office of Science, 2007). A key theme in policy circles in both the US and UK is that ‘multi-sectoral partnership’ (DoH 2004: 27) between its many and varied stakeholders is essential if obesity is to be addressed within the same market context that perpetuates and sustains it. As the UK's Choosing Health white paper acknowledges, ‘the food industry has a corporate social responsibility to promote healthier eating’ (2004: 16). In the UK, this has been enacted through industry's adherence to voluntary codes of conduct pertaining to children's advertising and marketing, allowing CSR to be legitimately proffered as a responsible industry, self-regulating and with evidence of corporate concern for consumers’ health. In the US, the FDI's well-documented lobbying power has also favoured self-regulation over legislative change, with companies such as Kraft publicising their decision to limit children's advertising to their Sensible Solution products and boldly declaring their voluntary removal of trans-fats. Yet, there has notably been little mention in either country of potential legislative controls on the foods that are actually sold – ironic, given that specific foods, and especially those high fat, salt and sugar ‘junk foods’, still occupy centre-stage in the ongoing search for obesity's aetiology.
Health promotion is frequently based on the problematic and contentious presumption that while ‘most respondents know what constitutes a healthy diet . . . they lack awareness of what such general information means in practice’ (DoH 2004: 10). The statement seems particularly tenuous given the remarkable amount of practical information and advice concerning diets in the public realm. Set alongside this however, the deployment of ‘health’ and wellness as the strategic marketplace solutions explored in this paper would seem, in many respects, to hold the potential to not only add a potentially troublesome layer to existing consumer confusion, but also widen the gap between intention and action. Furthermore, while consumers still expect the government to assume some responsibility for addressing obesity and regulating the FDI (DoH 2004, Government Office of Science 2007), there needs to be more critical analysis of the potential implications of CSR activity for this. If left to the FDI's CSR, there is a marked danger that health promotion might reinforce the existing trend to render obesity and obese people ‘visible proof of bad food choices and refusal to exercise’ and as such, ‘the relatively higher rates amongst poor and minority groups may be invoked to blame individuals – instead of structural issues such as poverty, lack of health insurance or violence – for their poor health’ (Saguy and Riley 2005: 912). CSR strategies therefore hold the potential to perpetuate the propensity to blame individuals cast as making poor and ‘uninformed’ lifestyle choices for their health outcomes, with punitive consequences for existing health inequalities and social justice more broadly.
Moreover, these examples demonstrate that obesity may ‘highlight the limits of current public health thinking’ (Lang and Raynor 2005: 321) as it brings the potential incompatibilities and tensions between the market and the public good into sharp focus. As a result of governments’ slow uptake, reinforced by financial and structural limitations, obesity prevention has become a veritable industry in itself with the combined inputs of the FDI, NGOs and the media creating an information vortex that may ultimately threaten the viability of, and trust placed in, the state. Since, as this work clearly shows, ‘obesity falls into the gap between responsibilities’ (2005: 322), developing effective solutions will inevitably mean revisiting and realigning the means and ends of public health to better reflect the needs and demands of contemporary consumers, their ever-changing information-seeking behaviours, increasing scepticism of the global FDI and mass-mediated frames of reference. As a result, critical sociological approaches to health and illness must be attuned to the multiple manifestations and meanings of health as a commercial product that demand very particular sets of ethical, empirical and methodological considerations in their analysis.
This research was funded by the Economic and Social Research Council and some of the material in the paper was originally presented at the 2006 Association of American Geographers conference. Thanks must therefore go to the session organisers Rachel Colls and Bethan Evans and to fellow participants for their interest and opinions on the topic. My thanks also to the constructive criticism of two anonymous referees whose detailed feedback really helped me hone the central arguments and to my colleague Mike Goodman for some amazingly helpful references.
1 PepsiCo's Smart Spot labelling is in fact an acronym. Smart stands for 5 health guidelines: Start with a healthy breakfast, Move more, Add more fruits, veggies and wholegrains, Remember to hydrate and Try and lower calories or fat. All five address certain brand portfolios and each section of the website indicates which of the areas of Smart the products cater to.