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Marketing to Children and Youth: A Public Health Primer Department of Health and Wellness 1.Introduction In today’s world of hyper-connectivity and consumer culture, children and youthi are being targeted by and exposed to more marketing messages than ever before. For example each year, Canadian children and youth are potentially exposed to more than 300,000 alcohol ads in places such as sporting and community events, billboards, Internet sites, magazines, TV and radio.1 A US study found that the average preschooler saw 2.7 television fast food ads per day while teens saw 4.8 ads per day.2 Similarly, Canadian children, like their counterparts in many countries, are exposed to high volumes of television advertising for unhealthy foods, using childtargeted persuasive marketing techniques.70 Fast food restaurants sponsor youth sport teams. Beer tents and alcohol logos have become customary décor at family and community events. Children’s clothing and toys feature sexy characters. New fruit flavoured tobacco products bear a striking resemblance to bubble gum, candy, and lip gloss. Whether through incidental exposure or direct targeting by corporations, young people’s increasing exposure to marketing messages has negative consequences for the physical and emotional well-being of children, youth, and communities. This primer has been created to: • • • increase understanding of the impacts of marketing on children and youth identify common marketing strategies support efforts to address marketing to children and youth in communities. The primer begins by outlining why and when marketing can be harmful, provides a rationale for what marketing actually is and why companies do it and outlines the specific harms for children. It provides a public health perspective on marketing to children and youth, gives an overview on what steps are being taken in Nova Scotia and throughout the world, and ends with some suggested next steps. The terms “marketing” and “advertising” are often used interchangeably, but they are different. In this primer, the term “marketing” is primarily used to refer to the broad array of strategies used to influence consumers. However, the term “advertising” is used if that was what was referred to in the original source of evidence. i For the purposes of this primer, “children and youth” are under the age of 19. MARKETING TO CHILDREN AND YOUTH: A PUBLIC HEALTH PRIMER 1 2. Marketing harms – an overview From bathroom stall posters to public transit billboards, from TV and radio ads to advergames and viral YouTube videos, marketing messages are everywhere. Our public and private spaces are saturated. Many of these marketing messages are linked to serious negative consequences for our physical, emotional and psychological health. Here are some specific ways in which marketing can be harmful to our health. Marketing can normalize unhealthy behaviour and encourage unhealthy consumption of unhealthy products. Research shows that exposure to certain images and messages over time results in observers perceiving them as normal and expected.3 Specifically, the marketing practices of the highly profitable alcohol, tobacco, processed food and sugar-sweetened beverage industries play a significant role in the prevalence of non-communicable diseases4 and injuries, because they normalize unhealthy behaviour (e.g. heavy alcohol or fast food consumption) and encourage unhealthy consumption.4, 5, 6, 7 Marketing campaigns from these industries promote products linked with negative health outcomes.8 For example, research shows the consumption of sugar-sweetened beverages is a key factor in the rising rates of diabetes, obesity, and poor nutrition, especially among children and youth.9, 10, 11. Alcohol is causally linked with injury and disease.12 Marketing also perpetuates our consumer-driven society. This has implications for public health and environmental sustainability.8 Marketing tactics can negatively impact mental and emotional health and well-being. In addition to promoting unhealthy products, marketing techniques themselves are associated with harms. Sex is used to sell a wide variety of products. Many industries use hypersexualized images and messages, which negatively impact mental and emotional health.15 In recent years, there has been an increase in hypersexualized images and messages in our environment.15 The use of sex to sell is also a tactic employed by industries that manufacture products targeted to children such as toys and clothing. 2 NOVA SCOTIA DEPARTMENT OF HEALTH AND WELLNESS Hypersexualization implies that our value comes from our sex appeal and sexual behaviour. Hypersexualized messages include the sexual objectification of people, the blurring of the lines between adult and child sexuality, the mainstreaming of pornography and the exploitation of sex and sexuality for marketing purposes.13 While hypersexualization is not unique to women and girls, it disproportionally affects the way that they are represented in the media.14 There is evidence to show that hypersexualization contributes to a wide variety of harms, including.15 • • • • • • • Body dissatisfaction Eating disorders Low self-esteem Depressive affect Reduced levels of physical activity Intimate partner and sexual violence Poor sexual health outcomes Marketing can limit our freedom of choice. Many individuals underestimate the power that marketing has to influence their choices, and believe they are resistant to the effects of marketing.45 However, big corporations have large marketing budgets and use psychological research to develop persuasive marketing techniques to influence our spending decisions. Our choices as consumers are limited to the choices we are presented with, and these choices are highly curated by industries. MARKETING TO CHILDREN AND YOUTH: A PUBLIC HEALTH PRIMER 3 3. How marketing works and why corporations market products that are harmful to our health. Marketing refers to the strategies businesses use to get their products noticed. And it’s the process by which these companies influence a consumer’s decision, specifically by: • • • • stimulating demand for a product or service, encouraging people to buy the product or service more frequently, building brand awareness and brand loyalty, encouraging potential or existing customers to try a new product or service.16 Marketing is broader than advertising. Advertising is the visible form of marketing. Marketing includes promotion, product packaging, price and placement. Almost all businesses engage in some form of marketing. In some cases, marketing messages can be useful — especially when they come from local businesses that contribute directly to the community. For instance, if you walk by a bulletin board in a community centre, you’ll find reams of posters promoting everything from fire wood delivery and fundraisers to yard sales and yoga classes. MARKETING16 • Broader than advertising vs. ADVERTISING16 • The most visible form of marketing that helps bring a product to the attention of consumers • A process in which a variety of strategies are used to stimulate consumer demand, promote frequency of purchases, build brand awareness and brand loyalty and encourage potential or existing customers to try new products • May be delivered through a variety of media such as television, radio, print, billboards and the Internet • Components of marketing are known as the “4Ps”: the Product (e.g. features, packaging), Place (e.g. location, distribution points used to reach target market), Price, and Promotion (advertising is a type of promotion) • Creates perceived value by persuading consumers that they are getting more than the product itself • Contributes to the success of other marketing strategies But marketing becomes harmful when, as described above, either the tactics being used or the products being promoted, are harmful to our health. 4 NOVA SCOTIA DEPARTMENT OF HEALTH AND WELLNESS You might ask yourself why a corporation would promote a product linked to negative health outcomes, or use tactics that are shown to negatively impact health. The reason: Because under corporate law, corporations are, in effect, legally obligated to make profits for their shareholders — even when the products they manufacture and the techniques they use to promote those products are linked to negative health outcomes.17 Corporation — defined A corporation is a large company or group of companies authorized to act as a single entity and recognized as such in law. Ownership of corporations is broken down into “shares” and the people or companies who own one or more of these shares are called “shareholders.” When the corporations earn profits, shareholders each get a cut of these profits – this is known as “shareholder return.” Common marketing strategies Corporations use a number of strategies to market their products. Marketing techniques are not limited to traditional forms, such as newspaper ads, billboards, or television commercials. While these kinds of promotional strategies are obvious, companies also invest a significant amount of time and money to develop techniques to deliver messages about their products that are intentionally subtle. For instance, companies invest in corporate social responsibility (CSR) initiatives designed to demonstrate concern about the welfare of society or the environment. This is especially important for industries whose products have been shown to have negative health impacts, such as tobacco, alcohol, or processed food and sugar-sweetened beverages. However many corporations engage in CSR campaigns because they create a positive association with a brand or a product. While CSR initiatives appear altruistic, they serve an underlying purpose of enhancing profitability for shareholders.18 Corporate social responsibility initiatives include tactics such as education or awareness campaigns, responsible messaging materials, and sponsorships of community groups. Self-regulation initiatives such as the Canadian Children’s Food and Beverage Advertising Initiative (CAI) are also a form of corporate social responsibility. With this initiative, leading processed food and sugar sweetened beverage corporations have committed to address childhood obesity by either not advertising to children under 12 or by only advertising products that meet industrydefined nutrient criteria. Critiques of CAI have found that it is ineffective and not making a difference to the children’s food marketing environment.71, 73 MARKETING TO CHILDREN AND YOUTH: A PUBLIC HEALTH PRIMER 5 Here are some other forms of marketing to children and youth: • • • • • • • • • • Advergaming (e.g. online video games) Social media (Facebook fan pages, company Twitter accounts) Advertising on mobile devices Display ads on children’s websites Facility sponsorship and naming rights Event sponsorship Team sponsorship Product placements in movies and music videos Celebrity endorsements Point-of-sale merchandising (Displays of sugar-sweetened beverages, foods high in sugar/salt, etc… in retail outlets/grocery stores) • Contests and giveaways • Cross-promotions (e.g. television and movie-related toy premiums associated with fast food restaurant kids’ meals) •Coupons • Promotional campaigns that resemble health promotion programs • Gifts with purchase, “buy-one-get-one” promotions • Peer-to-peer marketing (tell-a-friend promotions) From L to R: Alcohol logos on the waterfront, candy cigarettes, processed food-sponsored literacy program from an NS school library, hypersexualized alcohol marketing at Tall Ships Family Festival. 6 NOVA SCOTIA DEPARTMENT OF HEALTH AND WELLNESS 4. Why and how corporations market to children and youth Why do corporations target children? Today more than ever, we are seeing potentially harmful marketing campaigns that target children and youth — despite the fact that marketing to children has been described by the Supreme Court of Canada as manipulative.19 Corporations directly or indirectly target children and youth because, from the perspective of maximizing shareholder return, it is an effective strategy. Targeting children and youth is an effective way of reaching current adults. Although children and youth do have some disposable income, a big part of the appeal of this demographic for marketers is that children and youth influence family spending decisions. Youth-targeted marketing has been shown to influence their buying habits and brand preferences — and by extension the purchasing habits of their parents. The process by which marketers target family spending through children and youth-oriented marketing is known as “pester power”. Pester power (also known as the nag factor, or kidfluence) refers to techniques that appeal specifically to children and youth that encourage them to request certain products by “nagging” their parents or guardians.20 Targeting children and youth is a way to reach future adults. One of the other appeals of marketing to children and youth is that it is a way of creating lifelong brand loyalty and developing a customer for life. How corporations market to children and youth Many of the techniques that corporations use to make their products more attractive to consumers encourage unhealthy consumption behaviours, such as alcohol and tobacco marketing that uses glamour and sex appeal to specifically target youth.23, 24, 25 Food and beverage corporations often use cartoon mascots and fun colored packaging to attract children and youth to processed foods that are high in fat, sugar, and salt.26 Some of the strategies marketing companies use to appeal to children and youth include: • • • • • • • • • • On-line games and interactive websites Mascots, cartoon characters Comical voices Bright colors Quick animations and editing Lively music Fantasy/fun storylines Promotional websites Contests and premiums Toy with purchase On-line children’s advergame for fast-food restaurant. MARKETING TO CHILDREN AND YOUTH: A PUBLIC HEALTH PRIMER 7 These tactics are not limited to just television commercials. The design of product packaging has been shown to be influential in the development of children and youth’s preferences. For example, it is not uncommon for marketers to display a cartoon character on a product’s package in order to attract young consumers.27 Research shows that 13% of the costs associated with marketing processed food products to children and youth (approximately $208 million US) is spent on the licensing of cartoon characters.27 The use of a vibrant cartoon characters on processed foods such as breakfast cereals has certainly proven to be an effective marketing strategy for promoting processed, high sugar, high fat, and high salt foods to children, and the consumption of products like these is known to be a contributing factor in the rising rates of obesity.26,28,29 Children and youth are easy to access through a variety of modern communication channels, such as smartphones and computers, and they spread the word for free. And given that the average amount of daily screen time for NS youth ranges from 5.2 hours per day for Grade 3 students to 7.19 hours per day for Grade 11 students,21 children and youth are becoming easier than ever for marketers to reach. Screen time is advertising time.22 8 NOVA SCOTIA DEPARTMENT OF HEALTH AND WELLNESS Eye-level sugary cereal display at NS grocery store. 5. Why children and youth are especially vulnerable to marketing. When it comes to marketing, children and youth are especially vulnerable. They haven’t reached the stage of cognitive development where they are able to distinguish between marketing and entertainment. What’s more, they aren’t yet able to assess the long-term health risks associated with the unhealthy products that are being marketed directly to them. Below the age of 4, children perceive advertisements as entertainment and they are not able to consistently differentiate between regular television programs and commercials.30 Most children below the age of 8 are unable to comprehend the persuasive intent of advertisements and believe they are intended to share information and tell the truth.16,30 Children over the age of 8 may have the ability to recognize persuasive intent; however that skill may not be consistently applied until later years.16 Much of the research on children’s cognitive capacity to recognize and evaluate marketing has been done with traditional forms of advertising.16 The lines between commercial and non-commercial content on the internet are more blurred and children’s abilities to recognize advertising on the internet may be delayed.16 It is also important to consider that, even when children reach cognitive maturity, they are still susceptible to marketing. Modern marketing is grounded in psychological approaches that are designed to appeal to our emotions. For example, techniques such as celebrity endorsements and social media marketing appeal to the unique developmental needs of youth to establish their own identity.72 Modern marketing tactics are so sophisticated that, even if we are not paying attention, emotional marketing can still have an impact.72 Research shows that exposure to certain images and messages over time results in observers perceiving them as normal and expected.31 There is a significant body of evidence that illustrates not only why the consumption of certain products marketed to children and youth is harmful, but also how the strategies used to target them are negatively impacting their health. Here are some facts. Alcohol Alcohol marketing is causally linked with injury and disease.12 Early exposure to alcohol marketing strategies is positively correlated with early initiation of alcohol consumption.43 There is a link between exposure to alcohol advertising and the age of first drink, increased drinking and over consumption among youth.12 Youth who see more alcohol advertising drink more.33 Research in Nova Scotia has demonstrated that the “good times” represented in alcohol advertising influences people, including youth to consume alcohol.1 Meanwhile, the harms associated with alcohol are rarely depicted in alcohol advertising.1 Colourful bottles of alcohol and non-alcoholic pop. MARKETING TO CHILDREN AND YOUTH: A PUBLIC HEALTH PRIMER 9 Processed Food and Sugar Sweetened Beverages Marketing influences children’s food and beverage preferences and their patterns of consumption.34 Evidence suggests that there is an association between childhood obesity and TV food and beverage advertising, as well as a direct relationship between TV viewing and the consumption of advertised food, which is high in sugar, salt and fat.34, 22 The processed foods that are marketed to children are typically energy dense, high in sugar and salt, and low in nutritional value. TV character toy premium with fast food restaurant kid’s meal. Energy Drinks Youth are heavily targeted by the energy drink industry.35 Children, although not necessarily intentionally targeted, are exposed to a great deal of energy drink ads that are intended for youth.35 Child and youth exposure to energy drink advertising is contributing to the high levels of youth energy drink consumption.36 Adolescents are the most targeted age group by industry marketing and have the highest rates of consumption of any age group.36 Energy drink consumption among youth is particularly concerning because of the high levels of caffeine and other stimulants and the cross-promotion with alcohol. Energy drink logos on restaurant patio tables. 10 NOVA SCOTIA DEPARTMENT OF HEALTH AND WELLNESS Hypersexualization Children and youth are exposed to hypersexualized marketing which is a feature of our social environment. Some marketing sexualizes children. Various products intended for children such as toys, games and clothing feature sexy images and slogans. There are a variety of harms associated with hypersexualized images and messages. Hypersexualization is linked with poor mental and emotional health, body dissatisfaction, eating disorders and disordered eating, depression, lower self-esteem, poor sexual health outcomes, and greater acceptance of dating violence, rape myths and violence against women.15 Hypersexualized advertising in teen targeted magazine. Tobacco Exposure to tobacco marketing puts youth at more than twice the risk to begin smoking.37 Point of sale tobacco advertising is positively associated with smoking initiation38 and normalizes tobacco consumption. Nova Scotia has had a ban on point of sale tobacco advertising in place since 2007. A new area of concern has arisen in the tobacco control community around flavoured tobacco — such as grape or vanilla cigars — which could entice children and youth to smoke or act as a gateway to other tobacco products. E-cigarette marketing and their use among youth is also an area of growing concern. Colours and flavours: Lip gloss, glitter glue, flavoured tobacco and an e-cigarette. MARKETING TO CHILDREN AND YOUTH: A PUBLIC HEALTH PRIMER 11 How do these marketing trends affect the health of children and youth in Nova Scotia? Alcohol In Nova Scotia, the average age of first consumption of alcohol is approximately 13 years, with 27% of youth consuming alcohol more than once per month.39 Tobacco The average age of first cigarette use in Nova Scotia is approximately 13.7 years, with the prevalence of cigarette smoking among youth being 13.2%.39 Nova Scotia has seen a decrease in smoking rates in 15-19 year olds in recent years. The point of sale advertising ban which has been an important component of the comprehensive tobacco strategy has been part of this success. However, emerging concerns related to modern tobacco marketing are manifesting in our province. Forty-nine percent of high school students who smoked tobacco in the last 30 days smoked flavoured tobacco.40 Healthy Eating In Nova Scotia, approximately 80% of youth are not meeting the minimum recommendations for fruit and vegetable consumption,41 and 1 in 3 children and youth ages 2 to 17 are now overweight or obese.42 Hypersexualization Children in youth in Nova Scotia are growing up in an environment in which hypersexualization (including the mainstreaming of pornography) is normalized. This has contributed to the following:13 • • • Pornography is viewed by youth as a source of sexuality education. The real or perceived threat of sexual violence is a normal part of being a girl or woman. Some girls are consuming alcohol to lower their sexual inhibitions and meet their own and partners’ sexual expectations to act like porn stars. Youth are under a tremendous amount of pressure and are experiencing challenges navigating the hypersexualized environment. Energy Drinks More than two thirds of youth (64.3%) reported using energy drinks in 2012.39 In addition to the negative health effects associated with the use of energy drinks, youth tend to use these drinks mixed with alcohol. The combination of these two substances is associated with increased harms.39 12 NOVA SCOTIA DEPARTMENT OF HEALTH AND WELLNESS 6. A public health perspective on marketing to children and youth Due to their vulnerability and their right to healthy growth and development — which is undermined by marketing — the rights of children and youth to grow up in a supportive environment without being targeted by marketing needs to be protected.43 In working to reduce children’s exposure to harmful marketing, advocates can encounter a number of common arguments that challenge their efforts. Here are some of these arguments, followed by an explanation of a Public Health approach to the issue. Challenge #1: It is the responsibility of the parent or caregiver to teach their children about the effects of marketing. PH Approach: While parents and caregivers play an essential role in helping their children develop resiliency and media literacy, their efforts alone aren’t enough. Marketing saturates our environment, from the more obvious ways such as television commercials and magazine ads, to strategies that do not seem like they are marketing at all, such as advergames and smartphone applications.44 This saturation not only affects how children and youth perceive marketing, but parents and caregivers as well.34 Therefore, parents need the help of a supportive environment in which to raise their children34 where their children are not constantly targeted by marketing messages. While it is important to teach children and youth to have a critical eye, the fact is that children are targeted from a very young age, and are developmentally incapable of critically assessing marketing messages. Many parents lack the time or resources to compete with the money and research that the processed food and beverage, alcohol, and tobacco, industries are able to invest in trying to influence the choices of children and youth. It is impossible for parents to compete with these marketing messages or to completely control their children’s exposure to marketing. In addition, most parents are likely not aware of how much marketing their children are exposed to, or the degree to which marketing undermines parental authority. MARKETING TO CHILDREN AND YOUTH: A PUBLIC HEALTH PRIMER 13 Challenge #2: Industry self-regulation is enough to protect children from marketing. PH Approach: With the exception of Quebec, advertising and marketing to children in Canada is largely controlled by industry self-regulation. Although self-regulation is a commonly-relied upon approach to address marketing to children and youth, there is no evidence of its effectiveness.69 Industry self-regulation is not enough to protect children and youth from the harms associated with marketing.34 While self-regulation does set forth guidelines for responsible advertising to children and youth, these guidelines are voluntary, often ambiguous and industry developed.34 This gives industry the ability to create, interpret and apply guidelines at their own discretion.34 What’s more, a corporation’s legal obligation to maximize shareholder return takes precedence over voluntary guidelines to reduce marketing to children and youth. This is a fundamental conflict of interest — profit versus health-protection. Self-regulation is also problematic because it is not uncommon for industry to violate their own guidelines.66, 67,71 Any complaints about violations of self-regulations often go to the industry itself. As well, voluntary guidelines do not regulate the other ways that industries market products to children and youth, such as through product/package design, online promotions, sponsorships, character licensing, viral marketing, etc31 or the residual influences of adult directed marketing. Self-regulation has been in place for many years, but we continue to see the harmful effects of marketing to children and youth. There is little impartial evidence to show that self-regulation is effective in curtailing marketing harms to the public’s health and there is a need to enact evidence based approaches to this issue, such as legislation.32 It is hard “for industries that profit from marketing to children to act on behalf of children’s health”. William Dietz22 14 NOVA SCOTIA DEPARTMENT OF HEALTH AND WELLNESS Challenge #3: Policy impedes the public’s right to freedom of choice. PH Approach: The argument that public health policy limits choices is a tactic that has been used by the alcohol, tobacco, and food and beverage industries to distract the public from the broader, social harms that are associated with their products and how they are marketed. The choices we have are limited to the choices that are presented to us. Many individuals underestimate the power marketing has on their lives and believe they are resistant to the effects of persuasive communication.45 What they may not realize is that marketing companies have invested a significant amount of resources into studying consumers’ wants, needs, and demands in order to develop products and campaigns that will appeal specifically to them.46 For example, according to one report in the US, in 2009 the processed food industry spent $1.79 billion dollars developing ways to specifically target children and youth in their marketing campaigns.26 The intention of policy development in public health is to help create supportive environments where healthier choices are easier to make. This is very different from the mandate of corporations who market to children and youth in order to increase profits. PUBLIC HEALTH’S RESPONSIBILITY CORPORATIONS’ RESPONSIBILITY • Protect the health of populations • Legally obligated to maximize shareholder profits • Promote health and well-being • Accountable to the public • Create upstream/preventative approaches to health that can reduce long-term health care expenditures • Profit from marketing to children and youth • Accountable to shareholders • Act on behalf of the health of NS children and youth MARKETING TO CHILDREN AND YOUTH: A PUBLIC HEALTH PRIMER 15 Challenge #4: Industry should have a say in policy development. PH Approach: Given that the processed food and sugar-sweetened beverage, alcohol, and tobacco industries are comprised of corporations and corporations are legally obligated to prioritize the profits of their shareholders over the health of the public,17 there is a significant conflict of interest when industry is involved in public policy development. These industries are known to actively lobby against public health policies, representing a clear conflict of interest.32 Further, industries stand to gain financially from a lack of public policy or from policy which is weak or narrow in scope. Challenge #5: Individuals should act responsibly and make healthy decisions. PH Approach: Industry messages often focus at the individual level in an attempt to deflect attention from the harms associated with the marketing of harmful products and from policy approaches designed to address those harms. These individual level messages are often part of corporate social responsibility campaigns. For instance the common industry message of “Calories in, calories out” attempts to shift the focus from processed food and sugar-sweetened beverage consumption to an individual’s need to exercise. However, a focus on physical activity is inadequate to offset the excess energy consumption associated with the marketing of unhealthy foods.47 In fact, several studies have found that reducing exposure to TV advertising can reduce weight without any increases in rates of physical activity.22 The message “drink responsibly” builds credibility and trust in alcohol brands but does nothing to reduce alcohol-related harms.48 These messages put the onus on individuals to protect against harms without putting any onus on corporations to act responsibly. In contrast, an upstream public health approach looks beyond the individual level and focuses on building supportive environments through healthy public policy, emphasizes the importance of changing social norms and mobilizes communities to be agents of social change. 16 NOVA SCOTIA DEPARTMENT OF HEALTH AND WELLNESS Challenge #6: Education and media literacy training is enough to curb the effects of marketing. PH Approach: Education and media literacy can certainly be valuable in helping children and youth build resiliency against the harmful effects of advertising,49 but education alone is not sufficient for sustainable behaviour change. While media literacy training is intended to build youth capacity, empowering them to be able to critically evaluate media messages,49 this strategy addresses the issue at the individual level but does nothing to change the social environment that surround children, youth and parents. For example, many of us know we need to eat healthy, but Canadians are not eating enough fruit and vegetables. Instead, we eat diets comprised of processed food that are high in sugar, salt, fat, because those are the choices presented to us. Focusing on education and media literacy alone puts the onus on the individual to prevent corporate borne harms. In order to have the greatest impact, there is a need for comprehensive interventions, including media literacy in conjunction with public health policy, that address this issue from a broader social context. Challenge #7: Tobacco and alcohol marketing do not target children and youth. PH Approach: While these industries may argue that their marketing strategies do not target children and youth, the marketing tactics they are using are intended to generate youth appeal, attract new consumers, and create early brand loyalty.24, 25 These industries do not need to explicitly target children and youth for their marketing strategies to reach youth and cause harm. Repeated exposure by youth to these marketing messages in the environment creates the belief that behaviours associated with those products are normal and expected.25 33 These tactics may not target children and youth per se, but they are still influencing young people and having a negative impact. Challenge #8: The tobacco and alcohol industries provide the province with revenue. PH Approach: In fact, the direct social and economic costs of alcohol and tobacco exceed the return the province sees from revenue from these industries. In 2006, fiscal revenue from the sale of alcohol in Nova Scotia was $224.2 million, while the direct social costs to government (health and justice costs) from alcohol was $242.9 million.51 The cost of tobacco use to the Nova Scotia healthcare system was $625 million (or 50.3% of all substance abuse costs).52 Tobacco sales tax revenue in 2012 was approximately $213.5 million.53 MARKETING TO CHILDREN AND YOUTH: A PUBLIC HEALTH PRIMER 17 7. What is being done? Other countries, provinces and municipalities recognize the harms associated with marketing to children and youth and have taken action to prevent those harms. Below are just some examples of jurisdictions that have taken action to limit not only children and youth’s exposure to marketing, but the general population as well. Quebec Based on a policy recommendation made by the American Psychological Association30 to protect children and youth from the harms associated with advertising, the province of Quebec was among the first in the world to create laws banning commercial advertising to anyone under the age of thirteen.54 The Quebec Consumer Protection Act was established in 1980, and prohibits all commercial advertisements of toys, certain foods, and other commercial products designed to attract children and youth, on children’s television programs, newspapers, or magazines.55 This law was developed in the 80’s and technology and marketing methods have changed a great deal since then. While the law does not cover other forms of marketing, such as product packaging or product displays in retail outlets, they have had some success in addressing on-line violations of their provincial marketing ban, charging companies for on-line violations and achieving guilty pleas.55 In a recent study to determine the effectiveness of the Quebec ban in terms of fast-food consumption rates, it was found that prohibiting fast food advertising to children and youth in that province has contributed to a 13% decrease in fast-food consumption in the francophone population, with 13 to 18 billion fewer fast-food calories being consumed each year.56 It is also worth noting that Quebec boasts one of the lowest childhood obesity rates in the country.54 Incidentally, the rate of consumption of processed snacks and soft drinks in Quebec is the lowest in Canada, while their fruit and vegetable consumption rates are the highest in the country.34 While this is not solely attributable to the ban, children in Quebec are likely benefitting from the less commercialized food environment.34 Norway Since 1992, Norway has prohibited all advertising directed towards children under the age of twelve before, after, and during children’s television programs.57 Norway has also mandated that no advertisements will be aired 10 minutes before, and 10 minutes immediately following a program intended for a child audience.58 Further, all advertising must take into consideration that there is a chance a child may be exposed to its message, and must be sensitive to children’s vulnerability.58 However, as in Quebec, the current ban only prohibits advertising, and does not place limitations on other forms of marketing. 18 NOVA SCOTIA DEPARTMENT OF HEALTH AND WELLNESS Sweden Recognizing that children and youth are vulnerable, and need to have “protection from undue influence”, the Swedish government prohibits all commercial advertising aimed at children under the age of 12.59 Also, all forms of advertising are banned from airing before and after children’s television programming.57 In this country, the removal of industry influence is considered to be an act of protecting human rights. Swedish youth still have the potential to be exposed to television advertising signals that originate from neighboring countries.59 This ban has been in place since 1991 and does not cover other forms of marketing.57 As with Quebec’s law, technology and marketing methods have changed a great deal since the Swedish law was developed. United Kingdom The Office of Communications (OfCom), which oversees all media communications in the UK, prohibits all advertising of food and beverages that are high in fat, sugar, and salt (HFSS) targeted to children under the age of 16, on all cable and satellite television channels.57 After review of restriction in 2008, OfCom reported that children were exposed to 34% less advertising for HFSS foods than in 2005, and this is argued to have reduced the influence that HFSS advertising techniques have on children. The UK has also developed an online portal for parents and caregivers to register complaints and find out more information about how to protect children and youth from sexually provocative media and marketing content.60 ParentPort was developed as a result of the Bailey Review, which was a government commissioned review conducted to explore the commercialization and sexualization of childhood. What is currently being done in Nova Scotia? Nova Scotia has already taken steps towards reducing the influence of marketing on children and youth in the province: • • • • • In March of 2007, Nova Scotia implemented a ban on all point of sale tobacco advertising.61 Attention to the food environment in schools and the marketing and advertising of processed food and sugar-sweetened beverages are part of the Food and Nutrition Policy for Nova Scotia Schools.62 Regulated childcare settings are prohibited from using branded or promotional products to serve meals and snacks and play food are to fit within the four food groups in Canada’s Food Guide.63 In 2013, the province released Guidelines on Government Advertising which specify that advertising originating from the Nova Scotia government will not perpetuate the objectification of people, or include hypersexualized images and messages.68 Reducing the influence of marketing to children and youth is part of Thrive!, the province’s plan for a healthier Nova Scotia.41 MARKETING TO CHILDREN AND YOUTH: A PUBLIC HEALTH PRIMER 19 8. What public health can do next While there is no shortage of evidence available to demonstrate a relationship between exposure to marketing and harms to public health, it can be difficult to establish a clear line of cause and effect.64 Despite this lack of evidence of causation, the World Health Organization (WHO) argues that it is important for those working in public health to be proactive in their attempts to protect the health of children and youth.64 This includes instituting protective and preventative action where there is the potential for children’s health to be negatively affected by areas of “emerging concern”, such as the harms associated with exposure to marketing.64 The precautionary principle is a recommendation that is often applied to developing issues that have the potential to negatively affect public health, and suggests that causation need not be established in order to justify actions to protect the public from potential harms.65 Given that there is evidence to support that exposure to marketing has a detrimental effect on the healthy development of children and youth23,25,28,29,33,54, it is imperative that public health applies the precautionary principle to this issue, and begins to take the steps necessary to develop strategies that will help minimize these harms. Here are some specific steps public health can take to address the harms of child-and youthoriented marketing: • • • Raise the profile of marketing to children and youth as a key public health issue Incorporate the issue of marketing to children and youth into health promotion and prevention efforts Seek to influence the establishment and implementation of healthy public policies to reduce marketing related harms Include reference to reducing the influence of marketing to children and youth in local strategies and policies Support the development of position statements on the issue of marketing to children and youth Collaborate with others working to address harms associated with marketing (e.g. healthy eating stakeholders, community organizations concerned about hypersexualized marketing and sexual violence, addictions staff, etc) Mobilize parents, youth and communities to support policy efforts to protect children and youth from marketing related harms Support community based efforts to address the issue across settings (e.g. schools, childcare, hospitals, recreation facilities) Disseminate knowledge on marketing to children and youth Raise awareness of and advocate on the issue in communities, among municipal leaders, schools, and university and college campuses Respond to harmful marketing and promotions when they appear in communities 20 NOVA SCOTIA DEPARTMENT OF HEALTH AND WELLNESS • • • • • • • • References Public Health Services, Capital District Health Authority (2013). 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