Copyright and use of this thesis This thesis must be used in accordance with the provisions of the Copyright Act 1968. Reproduction of material protected by copyright may be an infringement of copyright and copyright owners may be entitled to take legal action against persons who infringe their copyright. Section 51 (2) of the Copyright Act permits an authorized officer of a university library or archives to provide a copy (by communication or otherwise) of an unpublished thesis kept in the library or archives, to a person who satisfies the authorized officer that he or she requires the reproduction for the purposes of research or study. The Copyright Act grants the creator of a work a number of moral rights, specifically the right of attribution, the right against false attribution and the right of integrity. You may infringe the author’s moral rights if you: - fail to acknowledge the author of this thesis if you quote sections from the work - attribute this thesis to another author - subject this thesis to derogatory treatment which may prejudice the author’s reputation For further information contact the University’s Director of Copyright Services sydney.edu.au/copyright The food pyramid meets the regulatory pyramid Responsive regulation of food advertising to children Belinda Reeve A thesis submitted in fulfillment of the requirements for the degree of Doctor of Philosophy Faculty of Law The University of Sydney 2014 Abstract Obesity poses an urgent threat to children’s health. The causes of obesity are many and varied, but evidence suggests that the food industry makes a significant contribution. Multinational companies use a range of communication channels and marketing techniques to promote unhealthy foods and beverages to children. This promotion has a small but significant effect on children’s food preferences and choices, their consumption patterns and diet-related health. While public health advocates call for statutory regulation of unhealthy food advertising, the food industry has mobilised government support for voluntary action. In Australia, there is significant debate over the success of two self-regulatory codes that address food advertising to children. In this thesis I evaluate the food industry’s initiatives using a new approach. Although I consider evidence of the codes’ outcomes, I focus on whether they establish the building blocks of an effective self-regulatory regime. I use regulatory studies and public health law to create a framework for evaluation, drawing particularly on the idea of responsive regulation. I also compare food, tobacco and alcohol advertising regulation to predict whether statutory regulation of food advertising is practical and politically feasible. I find that food and alcohol advertising codes contain a series of ‘escape clauses’ that permit companies to continue with most of their marketing practices. As a result, the codes do not significantly reduce children’s exposure to food and alcohol advertising, or moderate the persuasive techniques used by marketers. Food industry self-regulation lacks the features of a well-designed voluntary scheme, including clear objectives, independent administration and monitoring, effective enforcement and systematic review. Further, regulatory processes are almost entirely industry based, meaning that the scheme is not accountable to external stakeholders. The difficulty of conducting research in this area underscores this conclusion. Food and alcohol companies report high levels of compliance with the codes, and an ethical commitment to responsible marketing practices. However, the initiatives do not place demanding requirements on participants; they only codify existing best practice in advertising to children. Further, industry initiatives exclude some of the main food and alcohol advertisers. In comparison to tobacco, food and alcohol products are highly varied, making regulation a more complex exercise. More fundamentally, these industries have an economic interest in advertising unhealthy products to a wide range of age groups. Accordingly, they i are unlikely to accept any tighter restrictions on advertising to children, which might impact on their communication with adult audiences. One way of strengthening self-regulation is to include external stakeholders in regulatory processes. Public health actors engage with the food and alcohol industry (unlike the tobacco industry), creating the potential for more collaborative arrangements. However, experience with the ‘quasi-regulation’ of alcohol advertising illustrates that public health participation may not create a more transparent and accountable scheme. Also, external participation in industry schemes is highly contentious, and public health actors risk their credibility and reputation in doing so. Accordingly, government action is required to broaden the reach of self-regulation and improve its functioning. Given the strong case for government action, the question becomes what form it should take. There are significant political barriers to legislation, including the power of the food industry, and neo-liberal ideologies that favour minimal regulation. Accordingly, I consider options outside of ‘command-and-control’ regulation. Through co-regulation, the government could set clear objectives for the codes to achieve, establish an independent body for monitoring and enforcement, and formalise its oversight of the scheme. It must also threaten the industry with more intrusive regulation, should the improved scheme fail to reduce children’s exposure to unhealthy food advertising. This strategy implicitly endorses a responsive regulatory approach that begins with voluntary action by the food industry itself. However, it also recognises the central role of the state in regulation, and describes new ways for governments to protect public health. ii Acknowledgements I would like to express my thanks to the representatives of companies, public health organisations, trade associations and other organisations that participated in my research. All interviewees were very generous with their time, for which I am truly grateful. Professor Roger Magnusson was a dedicated and conscientious supervisor. Roger treated me as an equal and I felt a genuine interest in my ideas that was a source of immense encouragement. I am also very glad to have had Professor Emeritus Dorothy Broom supervise both my honours thesis and my PhD. Dorothy is a champion for clear expression and incisive thinking and she challenged me to be better at both. I began life at Sydney Law School as a research assistant for Professor Emeritus Ron McCallum. I have been blessed with his support and that of Professor Mary Crock, his wife. I also greatly appreciated working with Associate Professor Toni Schofield, and our many interesting conversations over the years. My godmother, Dr Gwyn Fox, proved an expert editor during the final stages of thesis writing. Jenny Kaldor also made helpful suggestions for improvements when I was close to completion. Sam Redfern walked me home late at night, carried my books, cooked me dinner and introduced me to a new world of ideas. I hope we can continue our journey together through podcasts, TED talks, travelling, cycling and good eats. Roz Forecast is smart, funny and always supportive. I may not really understand what she does as a theoretical physicist, but she certainly gets me. From my parents (a nurse and a doctor) I inherited a love of learning, a fascination with public health and a social conscience. I will always be grateful for this heritage, and for their unconditional love and support, even when my adventures take me far from home. I miss them very much, as well as my brothers Olly and Morgan, their partners Jane and Antoinette, and my niece and nephew Isabelle and Jack. iii Declaration of originality I hereby certify that this thesis is entirely my own work. Where it draws upon the writing of others, I have acknowledged this in the text. This thesis has not been presented for a degree or a diploma, or for any other purposes at The University of Sydney or at any other university or institution. iv Publications arising from this study The following publications and conference presentations resulted from the research undertaken for this thesis. 1. Peer reviewed journal articles Belinda Reeve, 'The Regulatory Pyramid Meets the Food Pyramid: Can Regulatory Theory Improve Controls on Television Food Advertising to Australian Children?' (2011) 19(1) Journal of Law and Medicine 128 Belinda Reeve, 'Private Governance, Public Purpose? Assessing Transparency and Accountability in Self-Regulation of Food Advertising to Children' (2013) 10(2) Journal of Bioethical Inquiry 149 Roger S Magnusson and Belinda H Reeve, 'Regulation and the Prevention Agenda' (2013) 199(2) Medical Journal of Australia 89 2. Conference presentations Belinda Reeve, 'Self-Regulation of Food and Alcohol Advertising in Australia: Can Companies Take Responsibility for Public Health?' (Paper presented at the Australasian Association of Bioethics and Health Law Conference, Auckland, 12-14 July 2012) Belinda Reeve, 'Can Responsive Regulation Reduce Unhealthy Food Advertising to Children?' (Paper presented at the Sydney Health Policy Network Forum, Strengthening Prevention Policy, Sydney Health Policy Network and Prevention Research Collaboration, The University of Sydney, 9 March 2012) Belinda Reeve, 'Promoting Compliance: Can Advertising Self-Regulation Reduce Unhealthy Food Advertising to Children?' (Paper presented at the Emerging Health Policy Research Conference, Menzies Centre for Health Policy, The University of Sydney, 17 August 2011) v Table of Contents Abstract ...................................................................................................................................... i Acknowledgements ................................................................................................................ iii Declaration of originality ....................................................................................................... iv Publications arising from this study ....................................................................................... v 1. Peer reviewed journal articles ......................................................................................... v 2. Conference presentations ................................................................................................ v Table of Contents .................................................................................................................... vi List of tables, boxes and figures .............................................................................................. 1 1. Tables .............................................................................................................................. 1 2. Boxes............................................................................................................................... 2 3. Figures............................................................................................................................. 2 List of abbreviations and acronyms ....................................................................................... 3 INTRODUCTION.................................................................................................................... 5 1. Obesity, food advertising, and regulatory approaches .................................................... 5 2. Food industry self-regulation in Australia ...................................................................... 8 3. Is there evidence of self-regulation’s success? ............................................................... 9 4. A responsive approach to food advertising regulation ................................................. 11 5. Research design ............................................................................................................ 12 6. Research methods ......................................................................................................... 14 7. Key assumptions and definitions .................................................................................. 14 8. The limits of this thesis ................................................................................................. 19 9. The thesis structure ....................................................................................................... 20 CHAPTER 1 ........................................................................................................................... 22 Setting the scene: advertising unhealthy food and childhood obesity ............................... 22 1. The problem of childhood obesity ................................................................................ 22 2. The causes of childhood obesity ................................................................................... 25 3. Food marketing to children ........................................................................................... 28 Communication channels ................................................................................................. 29 Persuasive techniques ...................................................................................................... 32 4. The influence of food advertising on children’s diets .................................................. 33 The history of research on food advertising’s effects on children ................................... 33 What the research shows ................................................................................................. 36 5. Responses to the link between food advertising and obesity ........................................ 40 vi Public health responses ................................................................................................... 40 Industry responses ........................................................................................................... 42 Governments’ response .................................................................................................... 45 6. The development of food advertising regulation in Australia ...................................... 46 7. Arguments for government regulation of food advertising to children ........................ 53 Children’s vulnerability to advertising ............................................................................ 53 Harm to wider society ...................................................................................................... 54 The failure of self-regulation ........................................................................................... 55 Advertising restrictions are highly cost-effective ............................................................ 57 Public support for regulating food advertising to children ............................................. 58 8. Conclusion .................................................................................................................... 58 CHAPTER TWO ................................................................................................................... 60 Regulation of tobacco, alcohol and food advertising in Australia ..................................... 60 1. Legislative restrictions on advertising .......................................................................... 63 The Australian Consumer Protection Law ...................................................................... 63 Tobacco control legislation ............................................................................................. 64 Food laws ......................................................................................................................... 65 2. Co-regulation under the Broadcasting Services Act 1992 (Cth) ................................... 67 The Children’s Television Standards 2009 ...................................................................... 67 Broadcasting industry codes of practice.......................................................................... 72 Enforcement of broadcast advertising regulation ........................................................... 77 3. Advertising industry self-regulation ............................................................................. 78 The Australian Association of National Advertisers’ scheme.......................................... 78 Advertising industry codes of conduct ............................................................................. 79 4. Industry codes of conduct ............................................................................................. 81 Food industry initiatives .................................................................................................. 82 The ABAC Scheme ........................................................................................................... 85 5. Conclusion .................................................................................................................... 90 CHAPTER THREE ............................................................................................................... 93 Public health and responsive regulation: a theoretical framework for public health governance .............................................................................................................................. 93 1. The increasing scope of public health law .................................................................... 93 2. Conceptualising public health governance: the role of the state ................................... 99 3. Justifying state intervention in public health .............................................................. 103 4. Regulatory theory and the state’s role in regulatory capitalism ................................. 106 5. Designing regulatory strategies ................................................................................... 110 6. The theory of responsive regulation ........................................................................... 111 vii 7. Criticisms of responsive regulation ............................................................................ 115 8. Addressing the criticisms of responsive regulation .................................................... 118 9. Conclusion .................................................................................................................. 121 CHAPTER 4 ......................................................................................................................... 123 Assessing the effects of self-regulation ............................................................................... 123 1. Food industry studies evaluating the RCMI and QSRI .............................................. 125 2. Public health research on the effects of the codes ...................................................... 127 3. Government reviews of the existing evidence ............................................................ 130 4. Problems with measuring the outcomes of the RCMI and QSRI ............................... 133 5. A different approach to evaluating food industry self-regulation ............................... 137 6. The components of an effective self-regulatory regime ............................................. 141 Scheme design ................................................................................................................ 144 Company practices......................................................................................................... 145 Industry-level characteristics......................................................................................... 146 Institutional pressures .................................................................................................... 148 7. Conclusion .................................................................................................................. 149 CHAPTER 5 ......................................................................................................................... 151 Research methods ................................................................................................................ 151 1. Document analysis ...................................................................................................... 151 2. Interviews .................................................................................................................... 153 Recruitment .................................................................................................................... 153 Researching self-regulation ........................................................................................... 157 Data reliability ............................................................................................................... 158 Data collection ............................................................................................................... 160 Ethics and consent ......................................................................................................... 161 Data management and analysis ..................................................................................... 163 3. Subsequent chapters .................................................................................................... 164 CHAPTER 6 ......................................................................................................................... 166 The content of food and alcohol advertising codes ........................................................... 166 1. An outline of the food and alcohol industry codes ..................................................... 169 The RCMI and QSRI ...................................................................................................... 169 The ABAC....................................................................................................................... 170 Food and alcohol codes’ definition of ‘children’ ........................................................... 171 2. Media ‘directed primarily to children’ ........................................................................ 172 The RCMI ....................................................................................................................... 172 The QSRI ........................................................................................................................ 176 The ABAC....................................................................................................................... 177 viii