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Effect of Focused Advertizing

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THE EFFECT OF FOCUSED ADVERTISING ON
 ETHNIC COMMUNITIES 

AS IT RELATES TO INCREASED HEALTH CARE COSTS

Melissa Duke Jones
2nd Year Law Student
The University of Dayton School of Law
May 1997

 


Introduction

This annotated bibliography attempts to provide an overview of the effects of focused advertising on ethnic American communities in general as it relates to increased health care costs. Many different issues are represented in the annotated articles that follow, including: the unequal access of ethnic Americans to the health care system; the current law pertaining to advertising of legal but lethal substances; the effects of focused advertising of ethnic Americans; the effort to hold the alcohol and tobacco industry responsible for health care costs as it relates to alcohol and tobacco related disease and illness; and what is being done to prevent ethnic communities from falling victim to focused advertising of unhealthy substances.

After reviewing this annotated bibliography the reader can expect to be familiarized with the reality of focused advertising on ethnic American communities, however the reader will still not have a strong grasp on what the direct effects are on the targeted ethnic communities. The included articles are all relevant, however, none are directly on point. There is a serious deficiency in research and studies on the effects of focused advertising on ethnic communities as it pertains to increased health care costs. The articles all heighten the awareness of the problem, but do not exploit the need for a solution. Most of the articles pointed out that there is focused advertising of unhealthy products to ethnic communities and that there is a direct increase in health care costs as a result. However, very few suggested or illustrated a solution and none suggested federal legislation that would protect ethnic Americans from such advertising.

My conclusion is that without active and aggressive change in the way certain unhealthy products are marketed to ethnic Americans, there will be no way for those communities to reach the level of health that European American now experience. Traditionally, and in reality, ethnic Americans are underserved in the health care system. Therefore, if they are the target of focused advertising of unhealthy products and can not gain access to quality health care to treat illness and disease that are a result of partaking of such products, then there can be no way for those communities to ever reach the level of health enjoyed by the European communities.

 


The following articles are included in this bibliography:

15 U.S.C.A. §§ 1331, 1333, 1335 Chapter 36---Cigarette Labeling And Advertising.

Thomas R. Burke, The Economic Impact of Alcohol Abuse and Alcoholism, Department of Health and Human Services; Public Health Reports 1988; 103, pp. 564-568, November, 1988.

K. M. Cummings, Russell Sciandra and James Lawrence, Tobacco Advertising in Retail Stores, Department of Health and Human Services; Public Health Reports 1991; 106, pp. 570-575. September, 1991.

Raymond E. Gangarosa, Frank J. Vandall and Brian M. Willis, Suits By Public Hospitals To Recover Expenditures For The Treatment Of Disease, Injury And Disability Caused By Tobacco And Alcohol, 22 Fordham Urb. L.J. 81, pp. 81-139, (1994).

Jan Howard, An Overview Of Prevention Research: Issues, Answers, and New Agendas, Department Of Health and Human Services; Public Health Reports; 103, pp. 674-683, November 1988.

Ahron Leichtman, The Top Ten Ways To Attack The Tobacco Industry And Win The War Against Smoking, 13 St. Louis U. Pub. L. Rev. 729, pp. 729-747, (1994).

Michael G. Lenett, Taking A Bite Out Of Violent Crime, 20 U. Dayton L. Rev. 573, pp. 573-617, (1995). 

Like San Francisco, Los Angeles Sues To Get Health Care Money Back, 10 No. 8 Mealey's Litigation Report: Tobacco 17, (publication page reference not available), August 15, 1996. 

Karen E. Meade, Breaking Through The Tobacco Industry's Smoke Screen: State Lawsuits For Reimbursement Of Medical Expenses, J. Legal Med. 17, pp. 113-141, (1996). 

Mattew L. Miller, The First Amendment And Legislative Bans Of Liquor And Cigarette Advertisements, 85 Colum. L. Rev. 632, pp. 632-655, (1985).

Robert J. Miller and Maril Hazlett, The "Drunken Indian": Myth Distilled Into Reality Through Federal Indian Alcohol Policy, 28 Ariz. St. L.J. 223, pp. 223-298, (1996).

Vernellia R. Randall, Racist Health Care: Reforming An Unjust Health Care System To Meet The Needs Of African-Americans, Health Matrix: Journal of Law-Medicine, vol. 3, pp. 127-194, Spring 1993.

George White and Marc Lacey, Liquor Industry Takes On Activists In Political Arena Alcohol: Well-Funded Wholesalers Wield Power In Federal, State Capitals. They Also Alter Marketing Strategies, L.A. Times 1, (publication page numbers not available), December 15, 1992.

ANNOTATIONS

 


Vernellia R. Randall, Racist Health Care: Reforming An Unjust Health Care System To Meet The Needs Of African-Americans, Health Matrix: Journal of Law-Medicine, vol. 3, pp. 127-194, Spring 1993.
 

This article provides a candid overview of how African-Americans are treated in today's health care system. African-Americans are sicker than European-Americans and are dying at a significantly higher rate. This disparity has the effect of precluding African-Americans from gaining full access to the economic system. The reality is that decent health is a precondition to getting the other attributes of life, such as money, education, and know-how. When people are sick and poor, they can not reach the level of health and economic well-being as others.

The most objective measurement of health (death) clearly indicates that African-Americans re sicker than European-Americans. If African-Americans are sicker as a result of disparate treatment in the health care system, then they are the victims of unequal access to health care. Racism is the result of this disparate treatment. Racism is both overt and covert. Covert racism originates in the operation of established and respected forces in society (termed institutional racism). Institutional racism is a term that describes practices in the U.S. nearly as old as the nation itself and comprises politics, practices, and activities that injure an individual or group based on race.

This article supports my overall conclusion about focused advertising of unhealthy products. Focused advertising, which is arguably a form of institutional racism, adversely affects the health of many ethnic Americans. Those targeted ethnic groups, in return, can not receive adequate health care to combat the evils that the advertised products do to their health. This means that as long as focused advertising is allowed to go on unregulated in ethnic communities, those targeted groups can never truly gain full access to the economic system. [Back]

 


15 U.S.C.A. §§ 1331, 1333, 1335 Chapter 36---Cigarette Labeling And Advertising.

Cigarettes are one of the most heavily advertised products in ethnic communities.(1)Çards were found to be highly concentrated in lower income and minority areas, compared to few or none in the affluent areas. Nearly half of the advertisements identified through the survey were in the two poorest neighborhoods in the inner city. In addition, 54% of the ads pictured Blacks compared to 25% that pictured whites. Women in Leadership recommended that the District of Columbia take new steps to control the proliferation of outdoor ads. 

The organization also urged the business community and private citizens to get involved to control advertising. Given the disturbing statistics of focused advertising on minority communities, I agree that more has to be done to control outdoor advertising in such communities. [Back]

 


K. M. Cummings, Russell Sciandra and James Lawrence, Tobacco Advertising in Retail Stores, Department of Health and Human Services; Public Health Reports 1991; 106, pp. 570-575. September, 1991.

The authors of this article conducted a survey of retail stores in Buffalo, New York to assess the prevalence and type of point-of-sale tobacco advertising. They chose tobacco because cigarettes are one of the most heavily advertised consumer products . The results were eye-opening. Two-thirds of the stores displayed tobacco posters and 87 percent had promotional items advertising tobacco products, primarily cigarettes. Very few stores reported having displayed any antitobacco information. Point of purchase advertising and promotion is an important element in the overall sales campaigns of the tobacco industry. Controlling such advertising is important for the industry because ads and promotions are targeted to vulnerable populations, that is the poor, teens, and minorities. 

The authors stressed the importance of establishing guidelines for responsible advertising of tobacco products in retail stores. With heightened awareness of the ubiquity of tobacco advertising in retail stores, the authors stress that citizen groups might be organized to establish community standards encouraging retail stores to adopt more responsible policies related to the advertising and sale of tobacco products. Since cigarette smoking is a preventable cause of death, the effects of focused advertising is awesome. Something more must be done to eliminate the effects of such advertising, especially in poor ethnic communities. [Back]

 


Michael G. Lenett, Taking A Bite Out Of Violent Crime, 20 U. Dayton L. Rev. 573, pp. 573-617, (1995).

This article stresses the impact that semiautomatic assault weapons, and guns violence in general, has on the American population. Such an article is important in this bibliography because advertisements of guns are targeted toward ethnic communities, and gun violence has a direct and adverse impact on the health care system. The author of this article stresses that gun violence is a multidimensional problem.

Semiautomatic assault weapons pose a multifaceted problem for American society. Whether viewed from the criminological, sociological, or epidemiological perspective, assault weapons exacerbate violent crime, hinder law enforcement , burden the public health care system, and disparately harm minorities and the young.

Semiautomatic assault weapons pose a considerable public health epidemic. Aside from the toll on human lives, the economic and health care costs from gun violence are staggering. Moreover, the effects of widespread access to assault weapons on youth and minorities are devastating. The author concludes by emphasizing that the assault weapons ban will lessen violent crime and drug-related crime and will help ease the burden on the health care system and on children and minorities. I agree with the author's conclusions, however I think that his arguments can be analogized to focused advertising of guns in general. The more we do to eliminate the existence of guns, the more we do for our ethnic communities and the health care system as a whole. [Back]

 


Robert J. Miller and Maril Hazlett, The "Drunken Indian": Myth Distilled Into Reality Through Federal Indian Alcohol Policy, 28 Ariz. St. L.J. 223, pp. 223-298, (1996). 

This article emphasizes the effects and reality of alcohol and alcoholism in Native American communities. The authors point out that according to the then most recent source, in terms of mortality rates, those of the native population exceed those of the general U.S. population for alcoholism by 332%. The Native American population has become both targets and images used in alcohol advertising. In the case of many tribes, alcohol companies are also those most willing to sponsor cultural events such as rodeos and parades.

The article cites another article that featured a thirteen year old Native American girl in alcohol treatment. She described how alcohol and alcohol advertising were a way of life from early childhood. Another cited article described the 65th annual White Mountain Apache Reservation Labor Day parade, where from the Bud float, Budweiser mascots tossed fistfuls of miniature rolls of lifesavers-style candy packaged to look like tiny beer cans to excited children. The authors emphasize the need for the tribes and other communities who are the target of such focused advertising to take control of their communities. This involves community participation and support. I agree that more must be done to eliminate efforts by the alcohol industry to target the most vulnerable populations. Focused advertising can have detrimental and everlasting effects on the targeted communities. [Back]

 


Thomas R. Burke, The Economic Impact of Alcohol Abuse and Alcoholism, Department of Health and Human Services; Public Health Reports 1988; 103, pp. 564-568, November, 1988.

This article stresses the overall economic impact of alcohol abuse and alcoholism in the United States. The author concludes that the effects of alcohol abuse are as damaging to the nation's economy as they are to our nation's health. He stresses the impact of alcohol abuse on ethnic Americans. The figures are distressful. Alcohol abuse contributes to the high health care costs of minorities including, Blacks, Hispanics, and Native Americans. Alcohol is one of the chief causes of illness and death among those ethnic populations. Cirrhosis mortality rates for Blacks are twice as high as the rates for whites.

In addition, alcohol-related illness and injury among American Indians is three times the rate of the general population. He concludes that if we could get a handle on the alcohol problem we could, in addition to improving the health and quality of life for millions of Americans, cut our expenditures for health care dramatically.

Mr. Burke emphasizes the need to counter the impact of alcoholic beverage advertising and promotion. The visibility of the problem must be raised. I agree with his conclusions. Because of the costs that are associated with alcohol abuse (for example lost productivity and increased health care costs) there is a need to reduce its negative effects. Since there is a direct effort in this county to focus alcoholic beverage advertisements to ethnic communities, there needs to be a direct effort by Americans to counter this because the economic impact affects us all. [Back]

 


Karen E. Meade, Breaking Through The Tobacco Industry's Smoke Screen: State Lawsuits For Reimbursement Of Medical Expenses, J. Legal Med. 17, pp. 113-141, (1996). 

This article provides a candid overview of how some states are trying to hold the tobacco industry responsible for medical expenses incurred due to tobacco-related illness and disease. The article explains how four states, Minnesota, Mississippi, West Virginia, and Florida have filed suit against the tobacco industry. Those states seek reimbursement for money paid through state welfare programs to treat tobacco-related disease. 

Often smokers are unable to cover the costs for treating their smoking-related diseases and turn to their state welfare programs for help. This has increased state welfare costs, burdening state systems. States appear to be the better plaintiff because individual plaintiffs have generally been barred from recovery because juries find they assumed the risks of smoking. States however can not assume those risks and have far more resources than the typical tobacco-litigation plaintiff. In addition, the fact the billions of taxpayer dollars are spent each year treating tobacco-related illnesses my influence juries.

The author concludes that the tobacco industry must be held liable for the harm caused by its products. I agree with the article in that more must be done to help cover the escalating cost of tobacco-related illness. Many ethnic communities are the target of focused advertising of tobacco products. Those communities are traditionally sicker and are thereby precluded from attaining employment with adequate private insurance. As a result, many members of ethnic communities are forced to turn to the state welfare system for health care. Therefore, if focused advertising is allowed to continue without regulation or community resistance, state welfare systems are going to continue to be burdened. Maybe losing a few lawsuits to the states will make the tobacco industry reevaluate the current marketing and advertising plans to ethnic communities. [Back]

 


Like San Francisco, Los Angeles Sues To Get Health Care Money Back, 10 No. 8 Mealey's Litigation Report: Tobacco 17, (publication page reference not available), August 15, 1996. 

This report further explores the reality of suing the tobacco industry to recoup health care costs, however, instead of the state suing, here the individual counties are suing.. In its 69-page complaint, the county of Los Angeles contends that the tobacco industry engaged in a conspiracy to conceal the harmful health effects of smoking and made "patently false, misleading, deceptive and fraudulent" statements on such effects. In support of its argument, the county cited numerous tobacco industry ads. Citing studies on tobacco use and advertising , the county contends that the companies targeted children and minorities with their advertisements and promotional campaigns for cigarettes. The county put forth three causes of action: breach of express warranty, unlawful, deceptive and unfair business practices, and fraud and misrepresentation. The county wants the tobacco industry to disgorge its profits and pay unspecified restitution to the county for its health care expenditures. This article further explores the impact focused advertising can have on a community. Here, Los Angeles county contends that the tobacco industry targeted minority and youth populations. Hopefully the more negative attention the industry receives about its marketing and advertising to ethnic communities, the more likely it will change its focused advertising campaigns. [Back]

 


Raymond E. Gangarosa, Frank J. Vandall and Brian M. Willis, Suits By Public Hospitals To Recover Expenditures For The Treatment Of Disease, Injury And Disability Caused By Tobacco And Alcohol, 22 Fordham Urb. L.J. 81, pp. 81-139, (1994).

This article stresses the need to hold the tobacco and alcohol industries responsible for health care costs, however in contrast to the above articles, the authors contend that public hospitals are the best plaintiffs in litigation and not the individual states. Public hospitals are staggering under the massive burden of illness caused by tobacco and alcohol. Public hospitals are forced to absorb the treatment costs and risks for medically indigent patients. Public hospitals are forced to subsidize commerce of harmful products by absorbing the costs of the products' health consequences. This contradicts the hospitals' own interests in preventing disease, improving therapy and treatment and competing with other hospitals.

According to a cited study by the CDC, Blacks, teenage girls and people with a high school education or less continue to pick up the habit of smoking or drinking. In addition, abusers of alcohol and tobacco products are intensive users of health care services, especially expensive emergency services. Patients characteristically served by public hospitals are those living at poverty level, without medical insurance, and having inadequate social support. Minority and low-income populations are comparatively heavy users of cigarettes and alcohol. These populations are cited as more likely to use public hospitals.

Therefore, the authors emphasize that the preferred plaintiff is the public hospital because it bears the costs of treating disease and illness caused by alcohol and tobacco, but experiences no economic benefit when a smoker or alcohol abuser dies. Suits by public hospitals avoid the problem that a state faces in the courts. When people die young from tobacco and alcohol related disease, the Medicaid system is saved the cost of treating them later. Early deaths do not save the public hospitals anything. The arguments made in this article correspond with the analogies I made in the above articles about the effects of focused advertising. Moreover, I agree that the public hospitals may be the preferred plaintiff in suits against the alcohol and tobacco industry. [Back]

 


Jan Howard, An Overview Of Prevention Research: Issues, Answers, and New Agendas, Department Of Health and Human Services; Public Health Reports; 103, pp. 674-683, November 1988.

This article explores the effects of advertising on alcohol consumption and the corresponding effort to utilize preventative advertising campaigns to influence drinking behavior. The authors specifically address how ethnic populations are affected by advertising of alcohol--in particular Blacks and Hispanics. In 1988, Blacks composed about 12 percent of the U.S. population, and Hispanics numbered more than 6 percent. Despite the sizes of these two ethnic groups, relatively little research has focused on their respective use and abuse of alcohol. In general, neither the epidemiologic nor prevention efforts have addressed the wide cultural diversity within the Black and Hispanic populations. 

Studies have revealed that Black men reported higher rates of problem drinking than white men. Among Hispanic males, about 18 percent reported having one or more alcohol related problems. Prevention strategies are discussed in the literature but not from a research perspective. The authors point out that prevention strategies should be designed with strong evaluation components to determine what is effective and for whom. Careful attention must be paid to the cultural values and social norms of the target population. For example, among Hispanics, the influence of the Catholic Church should be taken into consideration. Likewise, religious beliefs and practices, the family, and cultural heritage and pride play significant roles among Blacks. I agree with the authors of this article in that preventative efforts in the form of advertisements must be tailored to the specific ethnic group in which is it suppose to target. Hopefully, as the authors point out, more research will be done on what can be done to effectively reach ethnic population about alcohol prevention, and that the consorted efforts of the alcohol industry in targeting these population will be thwarted. [Back]

 


Mattew L. Miller, The First Amendment And Legislative Bans Of Liquor And Cigarette Advertisements, 85 Colum. L. Rev. 632, pp. 632-655, (1985).

This article addresses the issue of whether liquor and cigarette ads should be banned from the media. Proponents of such bans, concerned about the effects of alcohol and cigarettes on health and society, complain that the glamorous portrayal of alcohol and cigarettes in advertising contributes to abuse. Those opposing such bans fear that inroads on such ads will threaten the economic base of the communications industry.

However, the author points out that the constitutionality of such bans is often overlooked. The author argues that bans on the advertising of potentially harmful substances such as liquor and cigarettes are unconstitutional because they violate the First Amendment rights of those who receive commercial messages. He further argues that individual autonomy is infringed upon by these advertising bans and asserts that the availability of counter speech as a less restrictive alternative requires the invalidation of nearly all such bans. 

The author concludes the article by stating his belief that all bans on advertising of liquor and cigarettes should be held unconstitutional. He believes that such bans have only been upheld in the District Courts because they have overlooked the value of the First Amendment. He believes that counter speech is the required less restrictive alternative. I can not say I agree with Mr. Miller. I believe that it is up to the citizens to determine what they want advertised in their respective communities. If they do not want certain substances advertised or want restrictions on those ads, then it is their right as free thinking Americans to lobby for such bans. I think that such bans in ethnic communities could help deter focused advertising, and could help those communities reclaim their citizens and help attain better health for their community. [Back]

 


Ahron Leichtman, The Top Ten Ways To Attack The Tobacco Industry And Win The War Against Smoking, 13 St. Louis U. Pub. L. Rev. 729, pp. 729-747, (1994).

This article examines a strategy in which to attack the tobacco industry's influx of advertising and promotions on the American public. The article points out that smoking kills more Americans each year than alcohol, cocaine, crack, heroin, homicide, suicide, car accidents, fires, and AIDS combined (citing a 1993 article in the JAMA). Tobacco is unlike any other advertised product. The industry spent more than $12.6 million per day (in 1993) using seductive imagery and high powered advertising to associate glamour, athletics, success and sex appeal with cigarettes. The author points out his belief that this form of advertising is deceptive, false and misleading. 

The author sets out his plan for attacking the tobacco industry. His suggestions include a requirement that newspaper and magazines which accept tobacco ads to provide equal space for anti-smoking groups to run pro-health messages. He also suggests restricting the kind of tobacco ads and promotions that is permitted by eliminating seductive imagery, the use of cartoon characters and sponsorship of sporting events. He claims that the only truthful images in cigarette ads would be showing dying cowboys, yellow toothed teenagers, winded athletes, and cancer patients; any other image lies. He points out that the industry has continued to target children and people of color in its advertising and promotional efforts.

I agree that more must be done to target the tobacco industry in its shameless advertising. However, I do not think it is economically feasible to require free counter ads to be placed in magazines and newspapers. This could bankrupt many newspapers and magazines because they would be required to give away for free what they could be selling to a company for a profit.

I think that the best method of attack is challenging their ads as deceptive, false, and misleading. I think that arguments can be made to support this notion. In addition, I think that banning the use of cartoon characters is well-founded. However, I believe it is up to the effected communities and citizen groups to start grass-roots movements to eliminate seductive and false advertising. Community involvement and awareness appears to be the best route to eliminating such advertising. [Back]

 


George White and Marc Lacey, Liquor Industry Takes On Activists In Political Arena Alcohol: Well-Funded Wholesalers Wield Power In Federal, State Capitals. They Also Alter MarketingStrategies, L.A. Times 1, (publication page numbers not available), December 15, 1992.

This article is the last of a two part series about liquor in Los Angeles. This article focuses on the escalating conflict about drinking's impact on the inner city. On the streets of L.A., liquor stores are being blamed for drug dealing, drunkenness, loitering and public urination. As the L.A. residents struggle to shut down liquor stores, the National Beer Wholesalers Association is trying to combat those groups. The citizen groups are upset about the marketing of alcohol in the inner city. Industry reps. acknowledge that they direct marketing efforts at minority communities, but add that such promotions re commonplace. The ethnic press is a major beneficiary of the industry's outreach. Alcohol ads are second only to cosmetics and hair products in Black-oriented publication, according to "Marketing Booze to Blacks," as study be the Center for Science in the Public Interest.

Although many financially strapped minority businesses and organizations are more willing to snatch up the industry's funding, others are beginning to question this flow of dollars. Many community groups have sprung up to combat target advertising. Numerous community and religious groups have banned together to pressure the alcohol industry to eliminate alcohol billboards and other ads and to dramatically reduce the sale hours of liquor outlets. The article points out that around the county, some companies have felt the impact of community pressure.

I think that this article is the best of all the "preventative measure" articles that I annotated. This article stresses the need and the impact of community pressure on industries that target their communities. Community involvement is the best tactic for forcing focused advertising out of affected communities, especially ethnic populations. When the focused advertising is reduced or eliminated, then the affected community has a chance to heal. In the case of harmful substances, the targeted ethnic communities will have a chance to catch up to the European-American communities in term of decent health---which will allow those communities to better obtain the economic necessities of life. [Back]

 



 
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