david hammond phd - home - stop marketing to kids...
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DISCLOSURE
CONSULTANT / PAID SPEAKER / ADVISORY COMMITTEES
• Regulatory agencies e.g., Canada, Australia, UK, EC, etc.
• Non-governmental associations e.g., CCS, HSF
• International public health authorities e.g., WHO
PUBLIC HEALTH LITIGATION • San Francisco vs. American Beverage Association Warnings on SSB ads
• UK, Department of Health Point of sale legal challenge & Plain packaging
• Commonwealth of Australia Plain packaging
• Government of Canada Health care cost recovery litigation
• Uruguay Health warnings / “Single Presentation Rule”
• Irish Department of Health Plain packaging
• Class actions • Craft v. Philip Morris USA
• Milner v. Philip Morris USA
• Donovan et al. v. Philip Morris USA
Global sugar consumption has risen from 5kg to 23 kg/person in past century. 1900-2013
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Canadian adults consume 26 teaspoons of sugar each day.
Source: Langois K, Garriguet D. Sugar consumption among Canadians of all ages. Statistics Canada, 2014.
Canadian children consume 33 teaspoons of sugar each day.
Source: Langois K, Garriguet D. Sugar consumption among Canadians of all ages. Statistics Canada, 2014.
SUGAR
Free-sugar intake
10% of total energy intake RECOMMENDED
5% of total energy intake SUGGESTED
World Health Organization. Guideline: Sugars Intake for Adults and Children. Geneva; 2015. http://apps.who.int/iris/bitstream/10665/149782/1/9789241549028_eng.pdf?ua=1.
SUGAR
Health effects
Direct health effects from excess energy intake are mediated through BMI and Type 2 diabetes.
HEART & STROKE
Ischemic heart disease Ischemic stroke Hemorrhagic stroke Hypertensive heart disease
CANCER Esophageal cancer Colon and rectum cancer Liver cancer Gallbladder and biliary tract cancer Pancreatic cancer Breast cancer (before menopause; after menopause) Uterine cancer Ovarian cancer Kidney cancer Thyroid cancer Leukemia
OTHER Type 2 diabetes mellitus Chronic kidney disease Osteoarthritis Dental diseases
SUGAR
Health effects
SUGAR
Health effects
Do sugars have a unique effect on obesity beyond energy intake?
Are sugars a direct cause of other diseases?
https://green-mom.com/natural-sugar-substitute-for-kids/#.WNvjk1XyuUk
Do all sugars have the same health effects?
NATURAL SUGAR SUBSTITUTES FOR KIDS
We’ve all heard about the dangerous health effects caused by refined white sugar and high fructose corn syrup (HFCS)…. …. let’s think of ways we can give our kids the occasional sweet treat without feeding them toxic refined white sugar or HFCS.
GREENMOM.COM
No evidence that ‘natural’ or ‘raw’ sugars are more healthy.
SUCROSE (table sugar)
50% fructose, 50% glucose HIGH FRUCTOSE CORN SYRUP 55% fructose, 45% glucose
"A rose by any other name would smell as sweet…’
SIMPLE CARBOHYDRATE
4 calories per gram of sugar
SUGAR IS SUGAR.
White sugar, brown sugar, raw sugar, honey, maple syrup, agave and corn syrup...
TOTAL SUGAR
Includes natural sugars in fruits and milk (‘lactose’).
World Health Organization. Guideline: Sugars Intake for Adults and Children. Geneva; 2015. http://apps.who.int/iris/bitstream/10665/149782/1/9789241549028_eng.pdf?ua=1.
SUGAR
Total, ‘added’ and ‘free’ sugars
‘ADDED’ SUGAR
Sugars added during the processing of foods, including syrups and honey, and sugars from concentrated fruit or vegetable juices.
‘FREE’ SUGAR
Same as added sugars, including sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates
Source: http://www.cbc.ca/news/health/obesity-research-confirms-long-term-weight-loss-almost-impossible-1.2663585
Need for primary prevention
SOURCE OF PROBLEM
Changing environments
66% off all packaged foods contain added sugar
63% Dairy drinks 3g vs 11g sugar
78% Sports/Energy drink/Flavoured water 4g vs 27g sugar
80% Juice 16g vs 24g sugar
Rapid delivery of high levels of sugar.
Low nutrient density.
Liquids ‘bypass’ physiological mechanisms that regulate appetite.
SOURCE: LANGOIS K, GARRIGUET D. SUGAR CONSUMPTION AMONG CANADIANS OF ALL AGES. STATISTICS CANADA, 2014. HTTP://WWW.STATCAN.GC.CA/PUB/82-003-X/2011003/ARTICLE/11540-ENG.HTM
SUGAR
Why focus on drinks?
500% Increase soft drinks consumption since 1950.
Sources: Langois K, Garriguet D. Statistics Canada (2014); Bray GA1, Popkin BM. Pediatr Obes (2013); Lasater G, Piernas C, Popkin BM. Nutr J. (2011).
60% Increase in SSB consumption among kids. 1989-2008
20% Proportion of calories from drinks among kids.
Sugar Sweetened Beverage Consumption
Fruit juice and fruit drinks are the largest source of sugar among Canadian children.
SOURCE: LANGOIS K, GARRIGUET D. SUGAR CONSUMPTION AMONG CANADIANS OF ALL AGES. STATISTICS CANADA, 2014. HTTP://WWW.STATCAN.GC.CA/PUB/82-003-X/2011003/ARTICLE/11540-ENG.HTM
SUGAR INTERVENTIONS
Industry opposition
http://www.canadianbeverage.ca/news-media/press-releases/canadian-beverage-association-statement-in-response-to-calls-for-taxation-on-sugar-sweetened-and-artificially-sweetened-beverages/
SSB interventions not needed:
SSBs have already declined.”
SOURCE: JONES AC, VEERMAN JL. HAMMOND D. THE HEALTH AND ECONOMIC IMPACT OF A TAX ON SUGARY DRINKS IN CANADA. MARCH 2017.
SOURCE: JONES AC, VEERMAN JL. HAMMOND D. THE HEALTH AND ECONOMIC IMPACT OF A TAX ON SUGARY DRINKS IN CANADA. MARCH 2017.
SUGARY DRINK CONSUMPTION
SOURCE: JONES AC, VEERMAN JL. HAMMOND D. THE HEALTH AND ECONOMIC IMPACT OF A TAX ON SUGARY DRINKS IN CANADA. MARCH 2017.
SUGARY DRINK CONSUMPTION
SOURCE: USDA Economic Research Service 1947-87; Beverage Digest 1997-204, as cited in: https://cspinet.org/sites/default/files/attachment/liquid_candy_final_w_new_supplement.pdf.
Soft drink production in US 12 Oz CANS / PERSONS
Tobacco consumption in Canada PER CAPITA 1921-1995
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578 ml Youth 9 -18/ per day Estimated sugary drink intake 2015
NON-DIET POP
FRUIT JUICES & DRINKS
FLAVOURED MILK
FLAVOURED WATERS
ENERGY DRINKS
SPORTS DRINKS
SWEETENED TEA AND COFFEES
DRINKABLE YOGHURT
SOURCE: JONES AC, VEERMAN JL. HAMMOND D. THE HEALTH AND ECONOMIC IMPACT OF A TAX ON SUGARY DRINKS IN CANADA. MARCH 2017.
Total health care costs 2015-2041 (CAD)
SUGAR SWEETENED
BEVERAGES
SUGARY DRINKS
$33.7 billion
$50.6 billion
SUGARY DRINKS
Health & economic impact
SOURCE: HTTP://WWW.CBC.CA/NEWS/POLITICS/FOOD-REGULATION-MARKETING-CHILDREN-JANE-PHILPOTT-1.3818267
PUBLIC EDUCATION
NUTRITION FACT TABLE
Proposed changes
46
Source: http://www.hc-sc.gc.ca/fn-an/alt_formats/pdf/label-etiquet/nutrition-facts-valeur-nutritive-fs-fr-eng.pdf
• Improvements in how sugars are labelled in ingredient list
•% Daily Value for total sugar
•No separate amounts of added sugars
NFT new information
What additional information would you like to see on food products? N=2,001
8% “Other”
46% Allergy
47% Organic
61% Country of
origin
60% Genetically
modified
63% “High”
Symbols
Source: Hammond et al., Nutrition Facts Table: Consumer perceptions among young adults; 2014.
SOURCES:
JOHN , 1999
POTVIN KENT M, DUBOIS L, WANLESS A. INTERNATIONAL JOURNAL OF PEDIATRIC OBESITY, 2011; 6: E433–E441.
POTVIN KENT M, DUBOIS L, WANLESS A. OBESITY (2011) DOI:10.1038/OBY.2011.161.
POTVIN KENT, DUBOIS & WANLESS, 2012)
•One fifth of TV ads seen by kids are food related.
• 90% of ads are for unhealthy foods and beverage.
•Children under the age of 5 cannot distinguish ads from content.
ADVERTISING REGULATIONS
Marketing to kids
Self-regulation and voluntary
measures ineffective at reducing
marketing of unhealthy food to kids.
SOURCES: HARRIS, WEINBERG, SCHWARTZ, ROSS, OSTROFF, & BROWNELL, 2015; POTVIN KENT & WANLESS, 2014; HEBDEN, KING, GRUNSEIT, KELLY, & CHAPMAN, 2011; POWELL, SZCZYPKA,& CHALOUPKA, 2010
http://news.gc.ca/web/article-en.do?nid=1037069
Promote public health by….introducing new
restrictions on the commercial marketing of unhealthy
food and beverages to children, similar to those now
in place in Quebec…
MANDATE LETTER TO HEALTH MINISTER
Yes.
MARKETING CHALENGES
Do SSB taxes work?
Powell L.M., Chriqui J.F., Khan T., Wada R., Chaloupka F.J. Obesity Reviews. 2013;14:110–128.
POLICY INNOVATION
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SSB TAX CHALLENGES
Industry opposition
http://www.canadianbeverage.ca/news-media/press-releases/canadian-beverage-association-statement-in-response-to-calls-for-taxation-on-sugar-sweetened-and-artificially-sweetened-beverages/
“SSB taxes don’t work.”
SSB TAX CHALLENGES
Population level impact
• Prevent 700,000+ cases of overweight and obesity
• 215,000 Type 2 diabetes cases
• 60,000 Ischemic heart disease cases
• 20,000 cancer cases
• $11 billion in direct healthcare cost savings
• $43 billion in annual revenue
ADAPTED FROM LONG ET AL. AM J PREV MED 2015;49(1):112-123.
20% EXCISE TAX ON SUGARY DRINKS 2015-2040
SSB TAX CHALLENGES
Industry opposition
http://www.canadianbeverage.ca/news-media/press-releases/canadian-beverage-association-statement-in-response-to-calls-for-taxation-on-sugar-sweetened-and-artificially-sweetened-beverages/
“Taxes won’t solve obesity.”
http://www.theglobeandmail.com/report-on-business/rob-commentary/what-canada-can-learn-from-mexicos-sugar-tax-its-no-panacea-for-obesity/article28233833/
“As health economist John Cawley concludes in a
recent paper for the Journal of Health Economics,
there is no dominant cause of obesity and no magic
bullet that will reduce it.”
INTERPRETING POLICY IMPACT
https://publichealthmatters.blog.gov.uk/wp-content/uploads/sites/33/2015/11/obesity-map-full-hi-res-page-001.jpg
EVIDENCE
HTTP://WWW.EATRIGHTPRO.ORG/RESOURCES/ABOUT-US/ADVERTISING-AND-SPONSORSHIP/MEET-OUR-SPONSORS
Conflict of interest
Summary
• Sugar consumption makes an important contribution to excess energy intake, including sugar intake from beverages.
• Population-level interventions and policies will be required to reduce intake.
• Modest, incremental changes have substantial impact on health and economic burden from sugar intake.
Thank you.
David Hammond PhD
CIHR PHAC APPLIED PUBLIC HEALTH CHAIR
SCHOOL OF PUBLIC HEALTH & HEALTH SYSTEMS
UNIVERSITY OF WATERLOO
EMAIL WWW.DAVIDHAMMOND.CA
TWITTER @DAVIDHAMMONDPHD