We cannot remain silent on the systematic racism that has allowed targeted advertising to deliberately push millions of black families into toxic lifestyles burdened with excess chronic disease. The lost decades of livelihood and health are insufferable and unacceptable. Black Lives Matter, and Black Health Matters, for us all.
I want to share data and historical context about how heavily targeted black communities are. Their children are even more heavily targeted by marketing campaigns, and this takes a significant and quantifiable toll on their chronic disease burden.
By raising awareness of the history of targeted advertising, particularly to our black children, we can prevent its growth and persistence in new digital mediums.
Silence is not acceptable, and we are all complicit if we do not do something or remain in denial.
References are below.
I’ve been motivated by protests across the world supporting Black Lives Matter to talk about how systemic racism kills my patients both inside and outside the operating room. I want to talk about how targeted marketing deliberately pushes millions of black families into toxic lifestyles burdened with excess chronic disease. Black Lives Matter, and Black Health Matters, for us all.
There are innumerable historical and systemic reasons why black people live shorter lives with more chronic disease than their white counterparts. Just looking at the tip of the iceberg, we have continual denial of economic and housing opportunities for black people. The labels of racism may change with the times, like slavery to sharecropping, or restrictive covenants, and redlining to food deserts. But the effects are consistent: systemic oppression by targeting black communities, like Jim Crow laws and urban disinvestment. Another evolution of racial targeting that remains pervasive today, and the effects of which I see in the OR every day, is targeted marketing of toxic lifestyles to black communities and children.
Targeted advertising ironically gained strength around the period of the civil rights movement – just look at the Harvard Business Review. Disgusting money grabs described “black is beautiful but maybe not profitable” – apparently, they needed to be better monetized. How? By preying on their low incomes and greater media exposure than white counterparts, particularly easy to target in their racially segregated communities. They wanted to win their lucrative market share in the growing fast food industry. After all, a lot of the hard work was already being done with supermarket redlining to deprive those vulnerable populations of alternative and healthier foods. Justifications were made, of course, as Professor Ivanic at the University of California, San Diego describes as working off stereotypes of Southern food. Fabricating a false narrative of heritage and culture has strongly fueled this stereotype.
So what ads have these communities been the target of? It’s a long list. Let’s start with menthol cigarettes. Menthols specifically were heavily targeted to black communities. They advertised their appealing taste but didn’t mention the higher likelihood of inhaling carcinogens and greater difficulty quitting – great business strategy. Disproportionate alcohol advertising in these communities is also not surprising. But also don’t forget those cheap, processed foods, including sugary drinks, candy, gum, fast food. And to rub salt in the wound, targeted advertisements for fast food lure these vulnerable communities by holding contests for free merchandise. How better to target the disadvantaged and impoverished?
But who is even more vulnerable than the poor and hungry? The children of the poor and hungry. They are double targeted. First by the mainstream children media and second by advertisements to the black community. Are you surprised at the ads they see for unhealthy, and I’ll call it toxic, food and drinks?
According to the University of Georgia’s Selig Center for Economic Growth, Black and Latino children are targeted for yet another reason: food and beverage companies consider them cultural leaders, trendsetters, and tastemakers — other kids follow what they do. Now that could be okay if the advertisements were promoting healthy habits. But they’re not.
In the words of the Reverend Delman Coates, “I’m deeply saddened by the way African-American slaves were used for the production of sugar and now African-Americans are dying because of sugar”.
This is not a multicultural inclusion strategy that some companies may try to justify their marketing dollars with. Last year’s report from the Rudd Center in partnership with the University of Connecticut clearly shows this marketing on Black-targeted TV and Spanish-language TV with the least nutritious products using over 80% of food marketing dollars. And they put this money where it counts, because black children and teens watch significantly more TV than their white counterparts. And advertisers adapt to the latest digital trends since black and Hispanic adolescents are significantly more likely to engage with food brands on social media.
So – where have all these targeted and predatory advertisements landed us?
Black youth with type two diabetes, a condition that was practically unheard of in youth a generation ago.
Nearly twice the obesity rate in black and Hispanic youth than their white counterparts.
Black and Hispanic youth with high blood pressure. And we know that they will likely take that health problem into adulthood with them.
Targeted advertising of these unhealthy lifestyles to black society compounds with the continual disinvestment in their communities. It’s like being knocked down twice: your community is deprived from the start then targeted with advertising to keep you in poor health. If where you live, work, play, and pray have been systematically disadvantaged, sickness and poor health become the norm. But we hear justifications, often from the racially advantaged, like they just need to “eat less and exercise more”. Even if this were scientifically accurate (which it’s not) how can this be a solution when your community has repeatedly been robbed of those opportunities and is left with roughly twice the rate of fatal heart disease.
And more strokes.
And twice the mortality from COVID-19. The list goes on.
Personally, my heart breaks every time my patient in the operating room struggles to make it through surgery alive because of their chronic disease. It doesn’t have to be this way, but it still is, and we remain silent. We treat our black patients, but we ignore WHY our black patients are ending up in our emergency departments and operating rooms every day. We ignore why so many black individuals are forced into disability from their chronic disease and lose valuable economic opportunities.
The good news is that over 70% of chronic disease can be prevented, and a similar proportion likely reversed, but we need to address the systemic and population level determinants if we are to successfully empower our individual patients to start reversing this disease burden.
Let us protest these injustices that keep health and livelihood out of reach of the millions of our friends, families, and shared humanity who need it most. Understanding the history of targeted advertising, particularly to our black children, we cannot let it grow and persist in new digital mediums.
And we CAN affect this. We already have precedent with movements to take down racially targeted housing ads on Facebook and targeted children ads on YouTube. Let’s listen, learn, and use our power to make ever bigger changes. Silence is not acceptable and we are all complicit if we do not do something or remain in denial.
Black lives matter, and to achieve that, we need to recognize that black health matters.
In the words of the 13th century Persian poet Sa’adi:
“He who has no sympathy for human suffering,
Is not worthy of being called a human being.”
Price, James H., et al. “Racial/ethnic disparities in chronic diseases of youths and access to health care in the United States.” BioMed Research International 2013 (2013).
Kris‐Etherton, Penny M., et al. “Barriers, Opportunities, and Challenges in Addressing Disparities in Diet‐Related Cardiovascular Disease in the United States.” Journal of the American Heart Association 9.7 (2020): e014433.
Alaniz, Maria Luisa. “Alcohol availability and targeted advertising in racial/ethnic minority communities.” Alcohol Research 22.4 (1998): 286.
K Garber, Andrea, and Robert H Lustig. “Is fast food addictive?.” Current drug abuse reviews 4.3 (2011): 146-162.
Nelson, Alan. “Unequal treatment: confronting racial and ethnic disparities in health care.” Journal of the National Medical Association 94.8 (2002): 666.
McGinnis JM, Gootman JA, Kraak VI. Food Marketing to Children and Youth: Threat or Opportunity? Washington, DC: National Academies Press; 2006
Information Sources on the Negro Market: Selections from Marketing Information Guide. United States. Business and Defense Services Administration. U.S. Department of Commerce, Business and Defense Services Administration, 1970.
Fleming-Milici, Frances, and Jennifer L. Harris. “Adolescents’ engagement with unhealthy food and beverage brands on social media.” Appetite 146 (2020): 104501.
Harris, J. L., et al. “Increasing disparities in unhealthy food advertising targeted to Hispanic and Black youth.” Rudd Report (2019).
National Cancer Institute. The Role of the Media in Promoting and Reducing Tobacco Use. Smoking and Tobacco Control Monograph No. 19, NIH Pub. No. 07-6242, June 2008 [accessed 2018 Jun 12].
Eisenhauer, Elizabeth. “In poor health: Supermarket redlining and urban nutrition.” GeoJournal 53.2 (2001): 125-133.