Lentis/Public Health, Sugary Drinks, and the US Beverage Lobby

Introduction

Soda occupies a unique place in American culture, serving as both a beloved indulgence and a growing public health concern. This article examines soda's evolution from an 18th-century health tonic to a staple of modern consumer culture. The historical context outlines its rise and cultural significance. The health effects section explores its link to chronic diseases. Regulatory efforts and industry lobbying highlight tensions between public health and corporate interests. Finally, the role of technology reveals soda's impact on consumer behavior and health equity. Together, these elements offer a concise look at public health, sugary drinks, and the role of the beverage lobby.

Historical Context: The Rise of Soda in America

Origins of Soda as a Health Tonic

Soda originated in the 18th century as a health tonic, inspired by the therapeutic properties of natural mineral waters. Early carbonation pioneers, like Joseph Priestley in 1767, created the first artificially produced carbonated water using chalk and acid. The 19th century introduced the bottling of soda water (1835) and the invention of the soda fountain (1819) by Samuel Fahnestock, making carbonated beverages more accessible. Initially marketed as health tonics, sodas were sold in pharmacies alongside medicines, symbolizing the intersection of science, technology, and health culture.

Emergence of Iconic Soda Brands

By the late 19th century, soda shifted from a health tonic to commercial success. Coca-Cola, created in 1886 by Dr. John S. Permberton, and Pepsi-Cola, developed in 1898 by Caleb Bradham, introduced sweetened flavored sodas that redefined the industry. During Prohibition (1920-1933), soda became a "wholesome" alcohol alternative, cementing its role in America social life. Soda fountains flourished, serving as gathering spots for families and teenagers while promoting soda as a safe and enjoyable indulgence.

Industrialization and Mass Production

The 20th century introduced technological advances that made soda a household staple. Innovations like vending machines (1920s), six-pack cartons (1923), and aluminum cans (1950s), made soda widely accessible. These developments integrated soda into daily life and solidified its cultural significance by the mid-century, symbolizing how technology reshaped consumer habits and societal norms.

Public Health Concerns

Health Effects

Sugary drink consumption is strongly linked to obesity, type 2 diabetes, cardiovascular diseases (CVDs), and certain cancers. High-fructose corn syrup (HFCS), commonly used in sodas, bypasses key regulatory steps in glucose metabolism, leading to unchecked fat production, elevated triglycerides, and insulin resistance. These metabolic effects are associated with increased risks of obesity and CVD.

Sugary drinks are also implicated in cancer risk. A study published in The BMJ revealed that a 100 mL/day increase in sugary drink consumption, including 100% fruit juices, raised the risk of overall cancer by 18% and breast cancer by 22%. This is attributed to the high glycemic load of sugary beverages, which promotes insulin resistance and chronic inflammation, key factors in cancer development.

Cardiometabolic and Cancer Risks

Sugary beverages heighten the risk of type 2 diabetes, hypertension, and metabolic syndrome through mechanisms such as increased systemic inflammation and insulin resistance. Chronic consumption also raises uric acid levels, which can lead to hypertension and CVDs. These findings underscore the need for public health measures to reduce sugary drink consumption.

Regulatory Efforts and Industry Responses

Soda Taxes

A sugar tax is an excise tax placed on distributors of sugary beverages, placing a $0.01-$0.02 tax per ounce of liquid. This tax is placed on several types of distributed goods, including sodas, energy drinks, fruit juices, and sweetened coffee and tea beverages.

Some successful benefits to the surrounding community include tax allocations to community services, subsidization of healthier options, healthier “defaults” presented on kids' menus, and healthcare savings. With a sugar tax projected to generate upwards of $133 million in a year for a large city like Chicago, this tax revenue can be allocated to address health and social disparities within the community. For example, Philadelphia used sugar tax revenue to fund pre-kindergarten programs for underserved communities. These revenues can also be used to subsidize untaxed, healthier options such as water, milk, fruits, and vegetables. Along with food and drink, programs such as child health and obesity prevention can be subsidized with this revenue. With taxes on sugary beverages and the movement to protect child health, restaurants are more likely to abstain from serving sugary drinks to children, replacing them with untaxed, healthier options on menus and in kids’ meals. Regarding healthcare, estimates suggest that, over 10 years, a tax on sugary drinks in the US would result in more than $17 billion in healthcare cost savings.

Implementation in the US and Industry Countermeasures

Case 1: Berkeley, CA

The first stories of success in implementing a sugar tax originate in Mexico and Chile. Inspired by the success of other countries, Berkeley, CA was the first city in the US to implement a similar sugar tax. This effort was spearheaded by community grassroots organizations, gaining public support and implementing the tax with 75% of community members’ approval. A study encompassing 26 grocery stores in Berkeley found that after one year, sales of sugary drinks fell by 9.6%, sales of untaxed drinks increased by 3.5%, and there was no increase in grocery bills or revenue lost in grocery stores.  The soda industry tried to counteract the success of the sugar tax by spending over $2.4 million in community efforts. However, they were unsuccessful, as the sugar tax had garnered overwhelming community support.

Case 2: Cook County, Il

The sugar tax in Cook County, Il was implemented by the city council, as a $0.01 per ounce tax levied on the consumer, rather than the distributor. The tax also was placed on artificially-sweetened beverages along with sugar-sweetened beverages. Immediately, the tax faced public backlash, with 87% of locals opposing the tax. There were many issues in implementation, resulting in multiple lawsuits against businesses and companies that incorrectly implemented the tax. The result of organizational dysfunction and public disapproval led to the sugar tax being repealed with an overwhelming 15-2 vote. In response to the initial implementation, Coca-Cola tried to counteract the tax by donating $3 million to establish fitness programs in Chicago. However, it was the efforts of businesses and the public that caused the tax to be repealed.

The Role of the Beverage Lobby

Lobbying Strategies

Leading companies in the beverage industry, such as Coca-Cola and PepsiCo, have employed aggressive lobbying strategies to oppose regulations, shape research, and create public narratives. In 2020, Coca-Cola allocated $5.48 million to lobbying, making it the lead spender amongst food and beverage companies. PepsiCo followed closely, with $3.69 million in lobbying expenditures. These substantial allocation highlight the companies’ commitment to protecting their interests at the expense of public health

Influence on Public Policy

Coca-Cola, PepsiCo, and other beverage companies have heavily lobbied against soda taxes around the world. For instance, in California, Coca-Cola and PepsiCo supported legislation that banned local governments from implementing new soda taxes for 12 years, stalling the public health efforts. Similarly in Mexico, the industry launched campaigns that warned of economic harm to low-income families by framing soda taxes as regressive. This aimed to undermine public support, which delayed the adoption of policies that could improve public health

Between 2010 and 2015, the two companies sponsored 96 national health organizations, specifically, the American Diabetes Association (ADA) and the Centers for Disease Control and Prevention (CDC). By funding these renowned health entities, they positioned themselves as contributors to health related initiatives suggesting that their branches are socially responsible and invested in public health. However, this mass funding served as a means to influence public health narratives and shape policy. Coca-Cola’s funding of the Global Energy Balance Network (GEBN) highlights this approach. The GEBN was a nonprofit organization that promoted the narrative that obesity was primarily caused by the lack of physical activity rather than poor diet. By shifting the focus away from dietary habits, Coca-Cola deflected scrutiny from its high-sugar products and put the spotlight on individuals and their lack of exercise. This narrative undermined public health campaigns that sought to educate the public about the dangers of excessive sugar consumption and its direct link to obesity, diabetes, and other metabolic disease.

Transparency and Conflict of Interest

The funding practices of Coca-Cola and Pepsi-co have raised significant concerns regarding transparency and conflicts of interest in public health initiatives. Despite their public claims of advocating for public health and wellness, analysis of their funding reveals a lack of disclosure regarding their contribution to research and non profit organizations. For instance, studies have shown discrepancies between the Coca-Cola self-reported funding and the actual extent of its financial involvement in shaping research outcomes, particularly through entities like the GEBN. These practices undermine the credibility of scientific research and promote distrust in health campaigns and the policymaking process.

Technology and Society Interface

Technology in Marketing

Industry companies use marketing to specifically target marginalized groups to promote their sugary drinks. Hispanic and African American youth are the susceptible populations for advertising sugary drinks and fast food. Beverage companies strategically brand culture into their commercials, linking their products to cultural topics such as sports or emotions like happiness. Specifically, these companies mostly target African American male adolescents whose parents had a high school education or less. The advertisements used to target this demographic often portray black characters promoting habits such as snacking and eating fast foods, and these ads failed to include adults, overweight characters, or foods in line with dietary recommendations. 

Societal Implications

The use of targeted ads towards marginalized populations is one of the causes of the disproportionate consumption of sugary beverages within income levels. In a survey conducted by journal The Conversation, they found that little more than a third of people with the highest incomes said they drink at least one sugary drink a week, compared to almost two-thirds of respondents with the lowest income. Industry’s use of targeting in marketing can lead to long-term health disparities. A study by Preventative Medicine Reports shows that Hispanic and Black youths have consistently shown the highest consumption of sugary drinks from 2009 to 2017. These trends can lead to much larger health disparities between ethnicities and income groups in the future. Therefore, it is important to have policies in place, such as a sugar tax, to counteract the targeting of marginalized communities by beverage companies.