We are in a time of national reckoning with racial inequity in the United States. Part of this is understanding structural racism effects on health risks and outcomes, including obesity and diet-related chronic diseases, which affect Black/African American and Hispanic/Latino children and adults disproportionately.Reference Ogden, Fryar, Martin, Freedman, Carroll, Gu and Hales 1 In this article, we consider the marketing of unhealthy foods and beverages to Black and Latino children and adults in the United States through this lens. Here, “unhealthy foods” refers to foods or beverages high in fat (saturated or trans fat), salt, or sugar (HFSS).Reference Kraak, Rincón-Gallardo Patiño and Sacks 2 We build on prior workReference Grier and Kumanyika 3 and propose that there are patterns of racialized food marketing resulting from the intersection of three factors (see Figure 1): (1) the business model in which profits come primarily from marketing an unhealthy mix of foods, (2) the standard marketing strategies of segmenting, targeting and positioning products to appeal to individuals and groups, including racial or ethnic groups; and (3) structural racism as a force in the background of all societal processes — including the marketplace. This racialized food marketing contributes to health disparities and requires race-conscious, structural solutions.
Figure 1 Racialized Marketing of Food and Beverages to Black and Latino Consumers in the United States, Demonstrated and Hypothesized Relationships
Racialized Food Marketing
Unhealthy dietary patterns are the leading risk factor for deaths in most countries.Reference Afshin, Micha, Khatibzadeh, Schmidt, Mozaffarian, Brown, Yamey and Wamala 4 But the profit-making model of large food and beverage companies is not aligned with the public health goal of shifting eating patterns in healthier directions. Food and beverage company profits come primarily from the sale of shelf-stable, packaged foods and beverages.Reference Nestle 5 Such foods are convenient and can be critical for food and nutrition security for certain markets.Reference Weaver, Dwyer, Fulgoni, King, Leveille, MacDonald, Ordovas and Schnakenberg 6 However, a 2018 report found that 70% of a sample of products (n=6,469) from the 10 largest U.S. food and beverage manufacturers failed to meet the bar set for healthy products. 7 This mix of products (along with other HFSS food, e.g. fast food) contributes to the high rates of diet-related diseases observed across demographic groups in the United States, and the significant rates seen globally. 8
Black and Latino consumers experience a disproportionate level of exposure to marketing of HFSS foods, which contributes to higher morbidity and mortality from diet-related diseases. Structural racism shapes the environments in which people live and shapes their access to healthy and unhealthy food, and it shapes the marketing practices that create and support food environments. These food environments and marketing practices in turn shape people’s food choices.
This generally problematic model of food marketing sets the stage for racialized marketing as a structural racism issue. 9 Marketing involves an integrated system with standard practices that divide consumers into segments defined by various characteristics, including geographic characteristics and demographic characteristics such as race and ethnicity or income. As a result of these marketing practices, and the ways in which they operate against a background of structural racism, Black and Latino consumers experience a disproportionate level of exposure to marketing of HFSS foods, which contributes to higher morbidity and mortality from diet-related diseases. 10 Structural racism shapes the environments in which people live and shapes their access to healthy and unhealthy food, and it shapes the marketing practices that create and support food environments. These food environments and marketing practices in turn shape people’s food choices.Reference Grier and Kumanyika 11
Marketing strives for synergy across four dimensions: Product, Price, Place, and Promotion.Reference Kotler and Armstrong 12 Here we identify racialized aspects of each dimension.
Promotion: Group-level targeting results in greater exposure to food marketing among Black and Latino groups. “Promotion” refers to advertising and other promotional activities. Group-level targeting has historically meant that Black and Latino audiences, like other groups, were distinguished from “mainstream” audiences and specific efforts made to reach and appeal to these audiences. This includes promotions through Black and Latino media, including TV channels and programs with high Black and Latino viewership, and Black and Latino-oriented social media. In combination with higher media consumption, this results in Black and Latino consumers having greater total exposure to HFSS food advertising across media types.Reference Eisenberg, Avery, Mathios, Ernst and Cawley 13
Ethnically tailored content increases the impact of food marketing. Some food marketing has ethnically tailored content.Reference Grier 14 Research suggests that Black and Latino youth are more interested in, and respond more positively to, marketing that contains ethnic cues and features spokespersons or characters of similar ethnicity.Reference Harris, Frazier, Fleming-Milici, Hubert, Rodriguez-Arauz, Grier and Appiah 15 The dearth of positive role models and cultural symbols, and more generally a lack of positive representation in the mediaReference Mastro and Greenberg 16 may render Black and Latino youth more in need of and responsive to marketing that contains positive representations.Reference Teeny, Siev, Briñol and Petty 17
Digitally targeted marketing is increasingly sophisticated and combines group-level targeting with individually-tailored content based on geographic and other information gathered from mobile devices and online tracking.Reference Montgomery, Chester, Nixon, Levy and Dorfman 18 Food, beverage and restaurant marketers are leaders in targeting communities of color via digital advertising.Reference James, Lee, Zhang and Williams 19
Place: Unhealthy foods are relatively more available in Black and Latino communities. Black and Latino people are more likely to experience higher availability of fast food and lower access to healthier foods in their neighborhoods;Reference Stowers, Jiang, Atoloye, Lucan and Gans 20 this is enabled by residential segregation,Reference Havewala 21 a product of past housing discrimination and other factors. 22
Marketing by geographic area also results in higher exposure of Black and Latino consumers to HFSS advertising and promotions. Geographic marketing strategies include outdoor advertising, the placement of products within retail food outlets in Black and Latino neighborhoods, and sponsorship (for example, a company sponsoring a playground or an event). For all of these strategies, there is evidence that the food industry intentionally targets Black and Latino consumers.Reference Herrera and Pasch 23 Sponsorship may be welcomed by low-resource Black and Latino communities and contribute to product or brand loyalty. However, this should be understood against the backdrop of structural racism that has contributed to concentrated poverty in these communities. Lack of resources makes sponsorships from private companies valuable and attractive. Digital targeted advertising intersects with place-based strategies and the background of structural racism, including segregation and income inequality, resulting in greater exposure to advertising for fast food for residents of neighborhoods with many fast food restaurants.Reference Grewal, Bart, Spann and Zubcsek 24
Product: Some products formulated to be marketed to Black and Latino consumers are less healthy. Food products are formulated to appeal to specific tastes, and marketers claim that their products fulfill consumers’ specific preferences. For example, Kraft Foods’ Latino-targeted Kool-Aid “Mandarina Tangerine” flavor, packaged in English and Spanish, marked the first “broad and complete approach to developing and marketing a product to the Hispanic market” in 1998. 25 But products formulated to be marketed to Black and Latino consumers are generally less healthy (e.g., sweeter or higher in fat and sodium) than those marketed to the “mainstream” (e.g., white) population. 26 These products are then advertised to Black and Latino groups, and priced attractively to encourage purchase and cement the racialized preference. In this way, the racialized marketing of foods is analogous to the marketing of menthol-flavored cigarettes marketed to Black consumers. 27
Price: Pricing strategies capitalize on the price-sensitivity of low-income consumers. For example, promotions of sugary beverages are timed to coincide with the receipt of food assistance benefits, and there are volume discounts on unhealthy products pricing.Reference Moran, Musicus, Findling, Brissette, Lowenfels, Subramanian and Roberts 28 Because Black and Latino consumers are disproportionately poor relative to white consumersReference Semega, Kollar, Shrider and Creamer 29 (a reflection of structural racism), strategies meant to appeal to low-income groups are another way that food marketing is racialized.
Effects of Racialized Food Marketing
A 2013 review found that children’s exposure to advertising of sugar-sweetened beverages, presweetened cereal, candy, snacks, and fast foods was linked to increased snacking, energy consumption, and lower healthy food consumption; subsequent research confirmed these relationships.Reference Cairns, Angus, Hastings and Caraher 30 There is also experimental evidence that positive attitudes toward food marketing (i.e., receptivity to food marketing) are associated with higher consumption of sugary beverages and fast food, and with obesity.Reference Chaffee, Werts, White, Couch, Urata, Cheng and Kearns 31 Thus greater exposure to marketing of HFSS foods and more positive attitudes towards food marketing — two aspects of racialized food marketing — likely contribute to higher consumption of HFSS foods among Black and Latino consumers.Reference Dunford, Popkin and Ng 32
Promoting a Racially Equitable Marketplace
On our analysis, racialized food marketing results from marketers’ strategic decisions (e.g., segmenting by race/ethnicity or tailoring marketing strategies to price-sensitive consumers) as well as the disparate effects that marketing practices have against a background of structural racism. Of note, while marketers create racially- or ethnically-specific marketing strategies, this is not an unusual marketing practice, nor need it be motivated by any discriminatory intent. Nonetheless, these standard marketing practices leverage the processes and outcomes of structural racism and, in so doing, exacerbate health disadvantage.
The example of racialized food marketing demonstrates a point made by RIM (Race in the Marketplace) scholars: some have historically argued that the marketplace is a neutral force and will naturally counter racism, because racism is an inefficiency that the market’s competitive pressure will eliminate; however, the marketplace does not hang free from structural racism,Reference Grier, Thomas, Johnson, Johnson, Thomas, Harrison and Grier 33 and can amplify racial inequity. Given this, a racially equitable marketplace requires more than the absence of discriminatory intent. It requires identifying the relationships between the marketplace, on the one hand, and different forms of racial inequity and manifestations of structural racism, on the other, and then actively pursuing marketplace activity that advances rather than undermines racial equity. In doing this, it is important to recognize that these relationships are complex. This can be seen in the divergent reactions within the Black community to food marketing, with some seeing it as a cause of diet-related health disparities, others seeing themselves marketed to as a sign that they are valued in the marketplace,Reference DiSantis, Kumanyika, Carter-Edwards, Young, Grier and Lassiter 34 and still others seeing food marketing as a positive force for Black entrepreneurship and communities’ economic development and advancement.
Jou (2017) describes some of the relevant history. Starting in the 1960s, U.S. federal policy, including loans from the Small Business Administration (SBA) led to a proliferation of fast-food restaurants, with major outreach targeting African-American entrepreneurs. This was apparently a politically-motivated, expedient strategy to address poverty and economic disparities. It was also seen as a potential way to avoid civil unrest by improving the business climate in Black communities and leveraging other appealing aspects of fast food (e.g., convenience and low prices). Black franchise owners were seen to benefit from the corporate umbrella and the overall profitability of this model. 35 In this way, Black ownership of fast food franchises can be seen as a dimension of racial equity. Analogously, some have argued that receipt of food and beverage advertising by Black-owned media companies is a dimension of racial equity. 36
The history of racialized marketing practices by beverage companies is another instructive example. Coca-Cola marketing was originally oriented to white communities and influenced by racist perceptions of Black people. Pepsi, as a competitor to Coca-Cola, initially used a proactive racialized approach to develop a “Negro market” and salesforce for its product.Reference Capparell 37 This targeted advertising of Pepsi was a positive form of recognition and arguably a step in a more racially equitable direction, as was job creation in the Black community. Fast forward to today, however, and sugary drink consumption is significantly higher among Black people, is the largest source of added sugar in the diet, and is a significant contributor to excess energy intake, weight gain, diet-related illness and accordingly, health disparities. Reference Ng, Ostrowski and Li 38 Together, these examples demonstrate a pitfall of the racialized marketplace: mitigating one dimension of racial inequity (economic disparities in Black business ownership, or exclusion of Black consumers from the marketplace) can exacerbate another (Black consumers are disproportionately exposed to unhealthy food marketing). What we should strive for instead are approaches that advance racial equity along multiple dimensions without undermining it along any.
Addressing Racialized Food Marketing
Addressing racialized food marketing requires that companies consider the differential effects of their products on communities of color when formulating their business models, creating products, and designing marketing practices. However, a recent survey of 15 food and beverage companies, restaurant brands, and retailers found that some donate money to racial justice causes or public health efforts, or have food security initiatives, but “many companies did not directly address how their existing business models might perpetuate and exacerbate racial disparities. Instead, they seemed to fall back on philanthropic and diversity initiatives that did not address the underlying systemic issues.” 39 One concrete step forward would be for food and beverage companies to conduct racial equity audits and share their results.Reference Hills, Iyer, Kirschenbaum, McAfee and Whittaker 40
Greater exposure to marketing of HFSS foods and more positive attitudes towards food marketing — two aspects of racialized food marketing — likely contribute to higher consumption of HFSS foods among Black and Latino consumers.
Public policy and regulation can also do more to address racialized food marketing. Reducing overall exposure to unhealthy food advertising may seem like an obvious move, but regulating advertising has been an uphill battle. The First Amendment to the U.S. Constitution forbids government from making a law “abridging the freedom of speech.” 41 Traditionally, free speech protections were given primarily to political, religious and artistic speech, 42 but starting with Virginia State Board of Pharmacy in 1976, the U.S. Supreme Court extended First Amendment protections to the marketing of commercial products. 43 Over the ensuing 40 years, large corporations successfully mustered the commercial speech doctrine as a defense against government intervention in commercial activity;Reference Liptak 44 current court decisions support this business-friendly definition of the First Amendment. However, alliances of reformers and social movements have changed public opinion and then court decisions on such contested topics as legal segregation and marriage equality. If public health advocates work now to de-normalize the acceptance of marketing of unhealthy products — such as building on the Children’s Online Privacy Protection Act (COPPA) — they can set the stage for future changes to the law.
Another regulatory approach is to curb business conduct, thereby indirectly regulating marketing, rather than directly regulating the marketing itself. Examples include warning labels, policies requiring that healthy foods accompany toy give-aways, product placement regulations, taxes, healthy zoning, and setting nutrition standards for foods sold in schools and on government property. A yet untested strategy — Performance-Based Regulations already used to improve public education and address climate changeReference Sugarman 45 — is also worth considering. This strategy would set dietary outcome sales targets for the nation and/or for specific population groups (for example, aggregate reductions of 25 percent sales in sugar, salt and saturated fat) to which individual regulated enterprises would be held. The regulated enterprises themselves, not the government , would decide, behind-the-scenes, how to achieve sales targets to match the dietary targets in the most efficient way. Failure to achieve their regulatory targets would subject them to substantial financial penalties.
Another way to respond to racialized food marketing is with targeted social marketing (including counter-marketing) and efforts to improve marketing literacy. In the past, critics of racially targeted marketing of unhealthy products led community campaigns using social marketing to counteract industry advertising. In some cases, these campaigns have appealed to racial identity to reject the claims of industry marketers. In the 1990s, often led by Black church groups, communities mobilized to challenge alcohol advertising messages and to limit the placement of ads.Reference Herd 46 Similarly, Black health and community organizations have challenged tobacco marketing to Black communities, demanding the right for communities to have a voice in determining the messages on tobacco their children received.Reference Johnson, Wine, Zack, Zimmer, Wang, Weitzel-O’Neill, Claflin and Tercyak 47 More recently, groups in Oakland, California, New York City, and elsewhere have launched unhealthy food counter-marketing campaigns urging communities of color to reject the claims of fast food, sugary beverage, and snack food marketers.Reference Kansagra, Kennelly, Nonas, Curtis, Van Wye, Goodman and Farley 48 Such social marketing campaigns could be adopted by community organizations, as well as governments; however, Grier and Schaller (Reference Grier and Schaller2020) find some hesitancy among policy actors to adopt racially targeted interventions.Reference Grier and Schaller 49
Conclusion
Structural racism means that some individuals, families and communities have fewer resources and options and have more stress in their everyday lives, and thus especially need food products that improve rather than complicate their life circumstances. Were food and beverage companies to market a range of affordable, convenient and appealing products that help consumers achieve good health and well-being, this would be an advance for racial equity — a way of mitigating the harms of structural racism rather than amplifying them. Based on the experience of recent decades, such a change will require some mix of government regulation, community mobilization, and the willingness of at least some food and beverage companies to take up the challenge of minimizing food marketing’s amplification of structural racism.
Acknowledgements
We would like to thank participants at the 2021 Levi Symposium, held at the Johns Hopkins Berman Institute of Bioethics. The ideas in this paper originated in and grew out of the Symposium.
Note
The authors do not have any conflicts of interest to disclose.
