What Philadelphia's soda tax can teach us about health framing

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In the days following Philadelphia's historic passage of a tax on sugary drinks, many public health advocates have been asking what this means for soda tax messaging efforts in other cities. Although Philly's tax will ultimately benefit health — funds will go toward universal preschool, which is linked to better health outcomes — the tax wasn't framed that way. One of the main messages coming from the city was much broader, with local leaders portraying the tax as a much-needed source of revenue that would help ease the city's struggles with poverty and build a better future for all Philadelphians, especially its children.

Should other locales follow Philly's lead and think outside of explicit health frames, or should they take a cue from Berkeley, California, whose 2014 passage of the country's first soda tax was more overtly health-focused?

The answer: It depends on the community. A one-size-fits-all approach to messaging rarely works for public health policy. In some places, and with some issues, a health-forward lens may be the perfect fit. With others, it may be counterproductive.

For example, BMSG research on the public debate surrounding fast-food zoning found that land-use policy proposals that focused on nutrition faced the fiercest opposition and were characterized as an unwelcome government intrusion. In contrast, proposals that focused on other benefits, such as protecting the local economy or reducing nuisances like litter, met less resistance and were more likely to pass.

Health framing has also proved insufficient when it comes to boosting support for breastfeeding. A 2010 BMSG analysis of breastfeeding news and advocacy materials found that an exclusive focus on the health benefits of breastfeeding had the unintended consequence of placing sole responsibility for babies' health on mothers. This, in turn, masked the policies and practices, such as short maternity leaves and a lack of lactation rooms in the workplace, that undermine women's efforts to breastfeed. Without those policies in view, it's hard to garner support for changing them.

We can also learn a lot about health messaging from tobacco control. According to Glenn Schneider, chief program officer for The Horizon Foundation, in the early part of the movement, tobacco taxes were not passed in response to health concerns. Between 1921, when Iowa passed the first state excise tax on cigarettes, and 1970, when cigarette taxes had become the norm, states passed such taxes to satisfy their need for revenue and programs.

"It wasn't until Prop 99 in California (1988) that a cigarette tax was passed that included a significant health component to the funding," Schneider said. "This was many years after it was well established scientifically and in the minds of the public that tobacco products caused disease."

So, just because health framing may not be ubiquitous for soda taxes yet doesn't mean that won't be the case in the future.

"As [soda taxes] become more commonplace, we will have more evidence on consumption and health impact," Schneider explained. "That's when we'll see a renaissance of additional taxes passed to improve health, prevent further sugar-sweetened-beverage addiction, and further reduce chronic diseases caused by sugary drinks."

In the meantime, advocates will need to get to know the needs of their communities to determine what will work best for them.

"Tie your efforts to tangible initiatives that people care about," Philadelphia Mayor Jim Kenney said in a recent news conference. "When it comes up, acknowledge that it is a good thing to drink less sugar-sweetened beverages, but tie it to things that people care about."

In fact, that is something Berkeley and Philadelphia have in common: Both put their ears to the ground and put the desires and voices of the community first. In doing so, both cities also put forth a strong message of equity — one that they made all the more powerful by bringing together multiple sectors, from nonprofits to local government, and presenting a united front.

"There were more similarities between the two campaigns than have gotten played up in media," Sara Soka, the campaign manager of Berkeley's soda tax campaign, wrote recently in an email to public health advocates.

"In Berkeley, we did talk more about health and health disparities — especially diabetes — than Philly chose to, but there was an important similarity in our framing," Soka added. "In Berkeley, we always pointed back to the soda industry and their target marketing. Mayor Kenney made similar points from the beginning: 'And the argument [our opposition will] make is that this is a tax on the poor. Well, [the soda industry has] been taxing the poor for generations, and what we're looking to do is take some of that profit and put it back into the neighborhoods.' Berkeley had the exact same intent."

Whether advocates lead with health, poverty or some other community concern in their attempts to reduce soda consumption, our collective compass is pointed in the same direction: Toward addressing inequities and improving quality of life for everyone.

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