Combatting the Rise of Soda - Mike Jacobson
Michael Jacobson, senior scientist at and co-founder of the Center for Science in the Public Interest (CSPI), tracks the rise of soda consumption, proliferation of research on its health effects, and industry responses over the years. As former Executive Director of CSPI for 40 years until 2017 and author of books such as Nutrition Scoreboard: your guide to better eating and the recently released Salt Wars: The Battle Over the Biggest Killer in the American Diet, Mike draws on decades of experience as a nutrition advocate. He describes in depth the deeply politicized nature of the fight for SSB taxes and efforts to preempt them both on local and national levels. In addition to SSB taxes, Mike explains the wide array of innovative strategies advocates have used to reduce sugary drink consumption, including removing sugary beverages from schools, children's meals, and checkout aisles and the need for research to assess both efficacy and messaging around various strategies. While he notes that there has been a 25% reduction in per capita consumption of carbonated soft drinks since 1998, Mike argues that further decreasing SSB consumption across the nation--and centering equity in these efforts-- will require deep engagement with the communities and geographies most impacted.
This episode of In Praxis is a part of Season 2: Sugar Sweetened Beverage Taxes. Learn more about Praxis’ work around SSB taxes on our Centering Community & Equity Through Sugary Drink Tax Investments page.
The information, opinions, views, and conclusions proposed in this episode are those of our podcast guests.
You can also tune into this episode on Anchor, Spotify, Apple Podcasts, Google Podcasts, and Stitcher. Below is a transcript of the episode, edited for readability. You can also watch this episode on YouTube with subtitles for accessibility.
Combatting the Rise of Soda - Mike Jacobson
Podcast Transcript
I created an algorithm that looked at the nutritional quality of different foods giving them positive points for the good stuff in them, and I subtracted points for the bad stuff. A can of Coke had a score of -92, the worst score of any, because a soda had no positive nutrients and just a ton of sugar.
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[In Praxis Intro] You are listening to In Praxis, a podcast by The Praxis Project created to support, hear from, and uplift the stories coming out of the ecosystem of basebuilding organizing. An ecosystem that includes frontline basebuilding groups and the folks who help support their important work. In this season of In Praxis, our hosts, Julian Johnson and Kourtney Nham, focus on sugar sweetened beverage taxes. We have compiled interviews from advocates working on issues surrounding the reduction of sweet and sugary beverages as well as the taxation of these products. Participants of this podcast are community members, public health practitioners, health department representatives, and concerned parents that span across the country. In each episode, you will hear about their phenomenal work as well as their perspective on the health effects of sugary consumption, and in what ways policy can be used to combat this and lead to reinvestment in our communities.
Kourtney Nham: Hi everyone. I’m here today with Michael Jacobson. We're going to be interviewing him about SSB taxes. Mike, do you mind introducing yourself and telling us a little bit about yourself to get started?
Mike Jacobson: Sure, I’m currently a Senior Scientist at the Center for Science in the Public Interest. I’m also co-founder of the organization. Two other scientists and I co-founded the Center for Science in the Public Interest from CSPI in 1971. Then, I was the Executive Director of the organization for about 40 years, until 2017, when I turned the reins over to Peter Lurie. From the very beginning of CSPI's existence, I worked on food safety and nutrition. I got into that because, after I got a PhD from MIT, I went down to Washington to work with Ralph Nader, and when I got there, he and one of his colleagues wondered what are they going to do with this guy, he's got a PhD in microbiology, and here he is in Washington. It turned out that Nader's associate had just finished a book about the Food and Drug Administration. They suggested that I look into food additives, something that the FDA regulates. I actually wrote a book on food additives, and one of my conclusions was while some food additives are harmful, they're nowhere near as harmful as the nutritional quality of the American diet.
Kourtney Nham: Great and this next question again kind of leads into that and I think you touched on it in your introduction, but when did you realize that sugary drinks in particular were you know a pressing health problem that needed to be addressed?
Mike Jacobson: Well, when I think back to—what is it? 45 years ago—to my work on nutrition, I created an algorithm that looked at the nutritional quality of different foods, giving them positive points for the good stuff in them and I subtracted points for the bad stuff. A can of Coke had a score of -92, the worst score of any, because a soda had no positive nutrients and just a ton of sugar. That made me realize just you know kind of how bad soda was nutritionally, and back then we created a little poster showing a circle with a line going through it, and the image was of a bottle of soda, a hot dog in a white bun. So lots of sugar, lots of fat, lots of salt and white flour, and that was kind of our logo for bad nutrition. Back then, there wasn't much scientific information about the harmfulness of soda. The consumption back then was far, far less than it was these days, but it was just intuitively obvious that it was junk. That it either added calories to the diet or it replaced more nutritious foods, and there's almost nothing there was less nutritious. That's when I began working on soda. Then over the next well 20 years or so, I was monitoring per capita consumption of carbonated soft drinks—you know, far and away the biggest source of added sugars, then and now—and I just watched, year by year, consumption increasing into seemingly inexorably increasing.
Twenty some years later in 1998, I wrote a booklet called Liquid Candy, and that looked at the consumption patterns and health consequences of carbonated soft drinks, maybe a little fruit drinks, and as before energy drinks came out. Kind of the most startling thing I saw was that in 1995, the most recent national surveys, youths were drinking twice as much soda as milk. Twenty years earlier, they were drinking twice as much milk as soda. You know and that's just a remarkable change in eating patterns. There were little bits and pieces of research indicating the health effects of drinking a lot of soda. There was a little research on tooth decay, almost no research on obesity, and very little research on heart disease or anything else. The striking thing was the huge increase in consumption. I saw that back in 1942, the American Medical Association was warning people not to drink so much soda, even though in 1942 or 1941—I don't know when their data came from—soda consumption was microscopic compared to what it was in 1998. The soda industry just expanded enormously after World War II. I wrote Liquid Candy in 1995, kept an eye on the research, meanwhile scientific research was ginning up.
I went back, probably 2004-2005, and re-read Liquid Candy, and what struck me was how little research there was on the health effects of diets high in sugary drinks. I decided to take another look, and then in 2005 consumption hadn't increased much over the past five years, and it turned out that 1998 was the peak year of soda consumption, but it was much more evidence of harm. I think in particular of David Ludwig's study on obesity in children, where he did a randomized controlled trial, and found that sugar drinks led to more weight gain in youths than non-caloric soft drinks. I think that led to a lot more research. Both of those Liquid Candy reports got just a huge amount of publicity. For one of them, I remember we went to Walmart and bought, I don't know, something like 600 cans of soda pop—all different brands—and made this colorful wall of those 600 cans, reflecting what the average teenager was consuming in a year. Those two reports just generated a huge amount of attention, and I think got a lot of people interested in soft drinks and trying to figure out what could be done in terms of advocacy. Meanwhile, the scientific community was marching along and submitting grant proposals. Beginning certainly in 2005 and even somewhat earlier, CSPI really started investing a lot of energy in reducing the consumption of carbonated soft drinks and other sugar-sweetened beverages, particularly fruit drinks, which are the beverage of choice of two-year-olds and three-year-olds.
Kourtney Nham: Yeah, thank you so much for that incredible over-the-years overview of what you've been doing and your involvement in this issue. You're kind of leading into this, but I’m curious which strategies have you in particular use to reduce sugary drink consumption and did you find that any certain strategy was more effective than others.
Mike Jacobson: Well as Mao Ze Dong said, “plant a thousand flowers.” We didn't know which strategies would be most effective, so we've used a range of strategies over the years. I’m not sure which has been most effective, but one of the things that is really impossible to measure is publicity. There's been so much bad publicity about the soft drinks over the past 20 or 25 years, it's really had an impact on the medical community, parents, teenagers… The adverse publicity has really helped reduce consumption. It's no longer cool to be drinking a soda as it was 30 years ago. A soft thing, but I think that has been a really important factor. We also focused on getting soft drinks out of schools, and not that schools provided a high percentage of soft drinks that people were consuming, but having soft drinks in schools kind of gave them a blessing. ‘Oh the school authorities think they're good enough to be in schools, we’re society's model on what's good.” And so, we made that a priority. I think was around 2006 or so, we threatened Coke, Pepsi, Dr. Pepper, and Snapple to get rid of soda from schools. We negotiated with them for about six months, and they kind of were slow walking the whole thing. Finally we said okay, look we're going to file a lawsuit unless you get back to us soon. Lo and behold, they didn't get back to us, but they had worked out a deal with the Clinton Foundation and the American Heart Association where there was an agreement that they would remove sugar-sweetened beverages from all schools within two years. They figured that they were on the losing end of an argument, and they'd much rather be at a positive press conference with former President Clinton than be the butt of a press conference that Center for Science and the Public Interest held. To give the industry credit, they have removed sugar sweetened beverages from essentially all schools. That's no longer a problem. We've also looked at checkout aisles in supermarkets. In so many checkout aisles have sugar sweetened beverages, and so we've urged supermarkets to get rid of the soft drinks, and candy bars, and other junk foods from the checkout aisles. Also, we've had a great deal of success, Margot Wootan has led the efforts, in getting chain restaurants to get rid of soft drinks from kids meals. Where you go to McDonald's and get a happy meal, it used to be hamburger, fries, and a coke. McDonald's, Wendy's, and all the other big companies have taken soft drinks out of kids meals as the default beverage and even remove soft drinks from the menu board in the kids section. So that was significant.
Kelly Brownell published an op-ed in the New York Times pushing for an excise tax on soft drinks. Nothing like raising prices to reduce consumption. Then, I think was written in 2000 or so, Kelly and I co-authored an article in the American Journal of Public Health calling for a small excise tax on soft drinks, and frankly, I thought there would be a public revolt if the activists push for a high tax like 10 or 20 cents a can of soda, so we proposed a much lower tax. That helped energize and really got people thinking about taxes. That's another strategy. The taxes, certainly in the Bay Area, Seattle, Philadelphia, have imposed excise taxes that have clearly had a significant impact on consumption of sugar-sweetened beverages in those areas. But pushing for a local excise tax or state excise tax in the Deep South, the Mountain States, much of the Midwest that's just a loser—very little public support. State legislatures are doing more to ban taxes than to advocate for taxes, and nationally we've tried to get a tax, but Republicans just would not let a national tax get through Congress. We had hoped that in the health care debate we proposed that soda taxes helped fund Obamacare, but that didn't go anywhere.
So, those were many of the strategies that we've used. We also, you know in terms of publicity, I should have mentioned, we did a terrific video called the Real Bears that's on YouTube that got several million views, and that helped contribute to the adverse publicity about soda. But it's really hard to mount education campaigns via social media now, or videos, or tv commercials. It’s very expensive and really hard to have a big impact. But anyhow, all of these strategies and other people have been doing—so many people have been working on this locally—that there's been a 25% reduction in per capita consumption of carbonated soft drinks since 1998. That's one of the biggest changes in the food supply. I never would have imagined we could get a 25% reduction, but it's still over almost 25 years. It's not exactly fast progress and the progress has really slowed in the past few years. I think the progress is due to all the activism, the publicity, policy changes to get rid of sodas from vending machines and government property, but much of the decrease has been due to the rise in bottled water availability and consumption. Say what you want about solid waste and plastic bottles littering the environment, soda and SSBs are just a total detriment to public health unlike bottled water. It became cool for teenagers, in particular, to be drinking bottled water instead of soda. I think that the bottled water industry, some of which is owned by Coke and Pepsi, but bottled water has helped reduce consumption of carbonated soft drinks.
Back to your question, I don't think there's been any one particularly effective national strategy to reduce consumption of soft drinks. Locally, in the Bay Area, Philadelphia, it's clear that excise taxes have had a really significant impact, but to try to get excise taxes in Mississippi, and Alabama, and Montana… you know, it's probably pretty hopeless.
Kourtney Nham: Yeah, I know this work is real tough, but thank you for sharing you know all those wide array of strategies that you've used and that other advocates have used. To pivot the conversation a little bit there seems to be a few more different initiatives to improve health these days that specifically center health equity, and I’m curious if you could talk a little bit about some of the ways that health equity can be centered in soda tax policy specifically. If any of these approaches are better than others well.
Mike Jacobson: I don't know which is better, but in terms of soda taxes, you know I think the biggest beneficiary are low-income people, people of color… the greatest consumers of SSBs. There are a lot of other high consumers of SSBs. A lot of middle-class whites, and poor whites drink a whole lot of SSBs. Those would be the biggest beneficiaries of soda tax in two ways: one is the increased prices would reduce consumption and improve people's health, that can be a hard message to sell; so, the other half of it is okay you raise millions of dollars with soda tax, how can you use the money to preferentially benefit the people who have the poorest health and have been victimized most by the soda companies. Seattle and Berkeley and Philadelphia have wisely used the revenues from the SSB taxes to fund health or educational programs. So in Philadelphia, getting preschool programs funded. I think Seattle is using the funds to help with the costs of the pandemic. It's really important to work with legislators to figure out what messages would resonate best with soda drinkers and people opposed to taxes in general. And how to use the revenues. That's probably a local decision whether it's to provide broadband access to low-income people or better funding for healthcare care clinics. There's so many options and for a sizable metropolitan area, for a state, soda taxes really would generate millions or tens of millions of dollars.
One proposal that I alluded to was getting soda out of the SNAP program, food stamp program, so that soft drinks, like alcoholic beverages, wouldn't qualify to be paid for with SNAP benefits. There have been several surveys—the Harvard school of Public Health did one, New York City Department of Health and Mental Hygiene did a survey—finding that SNAP recipients, obviously low-income people, wouldn't mind not having a soda pop covered with SNAP benefits. You know and but it's an illusion to think that SNAP recipients would rebel if soft drinks, just like prepared meals and alcoholic beverages, were not covered. So that's one response to your question. If at all possible, and it can't be done without the approval of the Department of Agriculture, we need studies on what is the impact of making SSBs ineligible for SNAP benefits. If pilot projects show that doing that would actually reduce consumption, then I think that would set the stage for a national change for SNAP. Frankly if it had no effect on consumption, then I wouldn't fight the SNAP battle.
Kourtney Nham: Yeah. Thank you so much. I think you brought up a lot of great points. I especially appreciated your mentioning of specific local examples. I know in your answer also you started talking a little bit about messaging, and I was wanting to expand on that a little bit more. The beverage industry is really aggressive and persistent in the way that they resist policies that might limit their sales, and they're especially hard on fighting back against soda taxes. And, as I’m sure you're aware the beverage industry comes out with a lot of strong messaging around this to bolster their side. For example, they make a lot of arguments about regressivity that the soda tax will hurt people with lower incomes as well as other things. I’m wondering if you have a good counter message to this industry staple, and what is a good counter message that really centers health equity
Mike Jacobson: You know, it's true that an excise tax is regressive, but a tax on SSB's is progressive when it comes to public health. That's something that I think needs to be pushed. Something one could also point out is that if a tax is imposed, people could easily avoid it by just not buying soft drinks or by buying non-caloric drinks. Or you can reduce the impact of the tax by switching from a national brand like Coke or Pepsi to a house brand like Safeway's brand or Kroger's or whatever, which would save a lot of money rather than paying for the high price of a nationally advertised brand. But you know I don't know I don't know how effective those industry arguments are with voters, with legislators. We need to work with legislators where we can, and it's a challenge to find jurisdictions that might be amenable to soda taxes. You think of places like Boston. Why has Boston allowed the Bay Area to impose a soda tax before Boston did. Cleveland, Detroit, Chicago could impose the tax. I don't know if there's state laws that are problems, but I think activists need to push for taxes, especially because the industry hates them so much. Industry hate excise taxes on their products, because they know that the taxes are going to drive down sales and drive down profits. So the exact wording of a legislative measure how the revenues would be used really depends on the local situation. So local activists, need to find and then work closely with local legislators who would really push this legislation through. The activists should focus on the communities that have the greatest consumption of sugary drinks. When you look at CDC data, there are just remarkable disparities. The West Coast, where there's been the most activism, the most measure is like taxes, there's the least consumption. That was predated the taxes. The West Coast has been a much more health-oriented region. We need to focus a lot more on the Deep South and minority communities like Philadelphia, which does have a tax now and it's going to help. But when you look at consumption by African-American teenagers, and you look at the disparities between a city like Philadelphia or Detroit, compare that to San Francisco or Georgia, there's such disparities. We need to focus on really prioritizing the communities that have the greatest consumption and presumably the greatest health problems from such high SSB consumption.
Kourtney Nham: I appreciate that, and I like how you really push this idea of centering you know communities that are most impacted. But going off of that another thing that the beverage industry really likes to do is refute existing research and evidence against sugary drinks. They make claims about how sugary drinks are the wrong target despite this wealth of evidence that sugary drinks are bad for health. On the advocate side of this, there's a need to present really robust research showing why this rhetoric and these claims are wrong. So I’m curious as someone that's been working on this issue for so long, what do you think is the most pressing research need you see for advocates to continue to advance in our efforts to oppose industry claims?
Mike Jacobson: Well, I think all those industry claims can be picked apart. Most of it's just phony. The Center for Science and the Public Interest and others—Public [Health] Advocates, Praxis—have published all kinds of documents rebutting the industry's claims. But it's also worth recognizing that sugar is not the only problem in the average American diet or low income folks diet. It's inadequate consumption of fruits and vegetables. We should switch from refined grains to whole grains. Cut down on high sodium foods. We have plenty of other problems. We don't have to say sugar and soda are the only problems. In terms of scientific research, we could use more research on SSBs and cardiovascular disease. But there's certainly enough research that has permitted very conservative organizations, like the Department of Health and Human Services, or the U.S. Department of Agriculture, or the American Heart Association to criticize over-consumption of sugar drinks. I think the scientific evidence is there. Maybe we need more research on what you alluded to: what kind of counter messaging would be best, and which approaches would be best, which combination of approaches—you know, are there some things that are just a waste of time, that don't persuade people, that haven't had any impact ever—so, maybe that sort of research. It could be done nationally, but identifying 10 prime targets for sugar drinks or warning labels. San Francisco has pushed for warning notice in advertising. I should have mentioned earlier that my organization has formally petitioned the Food and Drug Administration, both to set limits on recommended sugar consumption, which it has done in the new nutrition facts label, but also to have a national warning notice on sugar drinks. I think getting these warning labels is long overdue. I hope the activists in San Francisco and the legislators in the city prevail to try to identify 10 or 20 prime areas for soda taxes, or warning notices, or some other measure that would presumably have a very significant impact. It might be for communities in the south and in the east that have large populations—and large populations, especially with people of color—so that might be an interesting research project. But it's not the lack of scientific research. We have it. It's a matter of really getting to work and different people have different skills—with some people it might be educating kids in daycare, in others it might be more political organizing working with the local and state legislator—we need to do a whole lot of things and continue the progress or revive the progress. Because with sugary carbonated soft drinks, fruit drinks, and energy drinks progress has slowed down tremendously in the last five years. Something like that. That suggests that the industry has been effective at blunting our efforts. They pour so much money into advertising, and distribution, and price promotions, and even though they set a goal to reduce consumption by 20% by 2025, they're not going to make that goal because they're not really trying to reach that goal. So we got to really get to work.
Kourtney Nham: Yeah, I think you make a great point that it's you know not for the lack of evidence or lack of research that sugary drinks are bad, because we have, we have so much. I’m curious as as someone that's been working on this for such a long time, for you what does it look like when advocates win? And what is the end game? And what is the ideal outcome from the wealth of work and organizing and research going into battling the industry?
Mike Jacobson: What does success look like. Well one thing is to reduce the disparities so that people of color, their consumption, is returned to kind of the national average. We've got a lower consumption among people of color. That would be one indication of progress. Another is to cut consumption of SSB's. We've gotten a 25% reduction. If we could get a 75% reduction, that would be success. I’m not saying we'd need to ban all sugar drinks. It's not necessary. If they return to what they were in the 1940s or 1950s kind of a special treat and not something you consume in large quantities every day, that would be success. We would not have to worry about SSB's anymore. We've got 25% reduction. To get to 75%, we've got a lot more work to do. We have the scientific foundation in which to do the work, and we just have to do it.
Kourtney Nham: I think those are really great and very concrete ‘what does success look like.’ Well, I really enjoyed our conversation and the incredible insight that you had on SSB's and just your work in general. Is there anything else that you'd like to add before we close?
Mike Jacobson: I don't think so. You covered a lot of territory. Thanks, Kourtney.
Kourtney Nham: All right thank you so much
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[In Praxis outro] Thank you for listening to this episode of In Praxis. We hope you all enjoyed it. Make sure to visit our website, www.thepraxisproject.org, where you can check out additional episodes of other guests as well as learn more about our work.
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