What are the potential benefits and harms of continuing to accept the sponsorship if Big Boss Burger and other local businesses? What are the

Step 1: Analyze the Ethical Dimensions of the Public Health Issue and Context

You direct the public health policy program for a large city health department. You have been asked to prepare a brief outlining the key public health considerations in this case. Your guidance has long-term policy implications because the city council will use your information as they make decisions about whether or not regulate corporate sponsorships in your city. Respond to the following prompts:

How will public opinion inform your briefing note?
Should a city department define rules for sponsorship? If so, which department? (You may want to look at the website for a local city to see what departments make up municipal government.)
How would your perspective as a parent enter into your professional decisions on this issue? How does your perspective as a citizen enter into your judgment?

Step 2: Formulate Alternative Courses of Action and Evaluate their Ethical Dimensions

Your briefing note will influence policy makers to make one of two choices:

Continue to accept sponsorship from Big Boss Burger and other local businesses, accepting their conditions, for example the requirement to use their logos.
Restrict the sponsorships of these businesses in some way.

Respond to these prompts:

What are the potential benefits and harms of continuing to accept the sponsorship if Big Boss Burger and other local businesses?
What are the potential benefits and harms of restricting sponsorship from local businesses like Big Boss Burger?
What are the ethical dimensions of each option?

5.7 Case 1: Municipal Action on Food and Beverage Marketing to Youth Catherine L. Mah Faculty of Medicine Memorial University St. John’s , NL , Canada e-mail: catherine.mah@mun.ca Brian Cook Toronto Food Strategy, Toronto Public Health Toronto , ON , Canada Sylvia Hoang Social and Epidemiological Research Department Centre for Addiction and Mental Health Toronto , ON , Canada Emily Taylor Dalla Lana School of Public Health University of Toronto Toronto , ON , Canada This case is presented for instructional purposes only. The ideas and opinions expressed are the authors ’ own. The case is not meant to refl ect the offi cial position , 5 Chronic Disease Prevention and Health Promotion 154 views , or policies of the editors , the editors ’ host institutions , or the authors ’ host institutions . 5.7.1 Background Children are exposed to a greater intensity and frequency of marketing than ever before. Evidence has demonstrated that marketing of food and beverages to children contributes adversely to health, affecting food knowledge, attitudes, dietary habits, consumption practices, and health status. Marketing to children has always raised concerns. But recently, numerous nongovernmental and international organizations and all levels of government have expressed their concern about food and beverage marketing and advertising to children as a public health issue. Often used interchangeably with “advertising,” the term “marketing,” actually encompasses a broader range of issues. The World Health Organization (WHO) ( 2010 ) defi nes marketing as “any form of commercial communication or message that is designed to, or has the effect of, increasing the recognition, appeal and/or consumption of particular products and services. It comprises anything that acts to advertise or otherwise promote a product or service.” Two large-scale global systematic reviews of evidence in the last decade have concluded that food and beverage marketing substantially affects young people and is associated with adverse health outcomes . In 2003, the U.K. Food Standards Agency commissioned a systematic review of the infl uence of food promotion on children’s food-related knowledge, preferences, and behaviors (Hastings et al. 2003 ). WHO updated the report in 2007 and 2009 (Hastings et al. 2007 ; Cairns et al. 2009 ). In 2006, the U.S. Institute of Medicine conducted a systematic review of the infl uences of food and beverage marketing on the diet and diet-related health of children and youth (McGinnis et al. 2006 ). Key fi ndings from these reports follow: • Food and beverages developed for and advertised to young people are predominantly calorie dense and nutrient poor; • Marketing infl uences children’s food and beverage preferences , purchase requests, and short-term consumption, even among young children (ages 2–5 years); and • There is strong evidence that child and youth exposure to television advertising is signifi cantly correlated with poor health status , although suffi cient evidence of a causal link with obesity is not yet available. The authors of the 2009 WHO report suggest that existing research “almost certainly underestimates the infl uence of food promotion” and that more research is needed, especially for newer forms of media (Cairns et al. 2009 ). As part of its global strategy for the prevention and control of noncommunicable diseases (WHO 2004 ), WHO subsequently endorsed policy recommendations for governments to take action on food and beverage marketing to children ( 2010 , H. Schmidt 155 2012 ). The recommendations emphasize governments’ key role in developing policies to protect the public interest, including leadership roles in managing intersectoral processes and negotiating stakeholder rights and responsibilities. The scope of existing policy interventions that address food advertising to children includes statutory regulation (i.e., general restrictions or outright prohibitions) and industry self-regulatory codes. Globally, industry self-regulatory approaches tend to be the most common approach. Many organizations promote the adoption of comprehensive public policy interventions , with the scope of these interventions ranging from total ad bans (all commercial advertising) to food ad bans or junk food ad bans (WHO 2012 ). Other organizations suggest stepwise approaches that target particular exposures, products, ages, or specifi c forms of marketing or media. For example, such approaches could include limiting marketing in venues such as schools , restricting junk food , protecting children younger than a certain age, defi ning certain television broadcasts as children’s programs, or restricting promotions in television broadcasts before 10 pm, respectively (WHO 2012 ). In recent years, many food and beverage companies, working with industry associations, have issued voluntary pledges to alter marketing practices toward children. For example, such pledges typically include criteria for the nutritional quality of foods advertised to children, limitations on the use of licensed characters, and marketing in schools. However, critics argue that these types of voluntary changes are not suffi cient to reduce the risks of food marketing to children in a substantive way. Despite this array of interventions, the absence of widespread agreement on the most appropriate form of collective action has led many policy makers to default to inaction. 5.7.2 Case Description You direct the Healthy Public Policy program for a large municipal public health department that recently has come under fi re in a newspaper exposé about contributions from fast food companies to after-school programs for youth that the city government runs. The exposé highlighted the contributions of Big Boss Burger, a local fast food hamburger chain with 12 locations across the city. Big Boss Burger donates cooking equipment to the city’s high-priority, after-school cooking program for 9- to 11-year-olds. Although the program is well-liked by youth, it is regularly threatened by funding cuts. The chain has recently offered to scale-up its annual cash donation to cover all food and equipment costs in exchange for renaming the program “The Big Boss Burger Community Kitchen” and for placing the chain’s logo on all signage and promotional materials. The highly successful Big Boss Burger chain is owned by a beloved, self-made restaurateur who has spent his entire career in the local food industry. Considered a colorful local personality, he frequently sends Twitter updates that refl ect his over5 Chronic Disease Prevention and Health Promotion 156 the- top advertising style. One tweet, for example, offered a free sample of the chain’s “quadruple bypass” burger to anyone who visited one of the chain’s locations within the hour. Media spokespersons for the mayor, meanwhile, have reiterated the community benefi ts of cultivating positive partnerships with local businesses. They note that only registered public health nutrition staff run the city’s cooking programs, while insisting that Big Boss Burger has no infl uence whatsoever on city policies or youth curricula. The media furor nevertheless has prompted city offi cials to explore developing a sponsorship policy for municipal child and youth programs. The Medical Health Offi cer has asked you to prepare a briefi ng note outlining the key public health considerations that such a sponsorship policy needs to address. You face a dilemma . On the one hand, several years ago your Healthy Public Policy team launched a study of the impact of food and beverage advertising on children . Last year’s update on the study to the Board of Health included a recommendation that city-operated venues and programs avoid commercial advertising of food and beverages targeting children younger than 13 years of age. Thus far, the recommendation has not led to any formal policy changes. Municipal employees partly attribute this inaction to the reluctance of local authorities to act when there are no state or national policies that govern sponsorship or marketing restrictions. On the other hand, the fi nancially strapped city relies on engagement with the local business community to fund many city-run programs, including health education activities. It is also well-known that the owner of Big Boss Burger grew up in a local low- income community and frequently volunteers his time at events in his former neighborhood.

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