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“We have created a world where diabetes is the natural consequence.” — Dr. Harold Goldstein
WHEN THE FIELDING SCHOOL-based UCLA Center for Health Policy Research released a study last year finding that nearly half of California adults have either prediabetes or undiagnosed diabetes, many were surprised by the magnitude of the problem. Harold Goldstein (MSPH ’89, DrPH ’97), executive director of Public Health Advocates, the Davis, CA-based organization that commissioned the study, wasn’t among them.
As far back as 1999, the year he founded Public Health Advocates (then called the California Center for Public Health Advocacy), Goldstein was publicly warning that without major changes, the state would soon see people in their 30s and 40s with heart disease and diabetes. Pointing to factors such as the preponderance of fast food, oversized meal portions and the free flow of sugary drinks, he continues to argue: “We have created a world where diabetes is the natural consequence.”
From the beginning, Public Health Advocates took aim at the childhood obesity epidemic, promoting state and local policies that would foster environments more conducive to healthy eating and physical activity — particularly for children and in low-income communities, where access to both healthy foods and exercise opportunities is often limited. “People might think they make their food and activity choices based only on their personal preferences, but that ignores the fact that those preferences and decisions are embedded in the world in which they live,” Goldstein says. “If I’m at a meeting, sitting at a table with a bunch of gourmet cookies, I don’t have the option of eating a banana. My choice is whether to eat a cookie or not, and of course I will — that delicious sugar and fat are as likely to seduce me as anyone. That’s pretty well programmed into our biology.”
More than merely making that case to the public, Goldstein’s intention for Public Health Advocates is to promote healthier environments as an advocacy organization “that plays hardball” at the state and local levels of government. That positioning has been essential to the organization’s leading role in taking on powerful and well-funded interests in an attempt to curtail the consumption of soda and so-called junk food. The effort began with a six-year struggle that culminated in 2005 with the signing by then-California governor Arnold Schwarzenegger of first-in-the-nation laws banning the sale of soda and junk food in public K-12 schools.
Public Health Advocates and others pushing for the soda and junk food bans believed they had a strong case based on both the health dangers and the premise that minors shouldn’t be held responsible for making important health decisions on their own — especially considering the influence of advertising and peer pressure, and given that they are often captive audiences to what is served in the school cafeteria and vending machines. “Schools had become a common place for the food and beverage industry to market their products because they knew that kids establish their eating habits early,” Goldstein says. “So the industry fought like heck to keep us from getting these laws passed.”
Goldstein’s early work in pushing for the legislation included collaborations with leaders from six low-income Los Angeles communities in raising awareness among local elected officials on issues of children’s nutrition and physical activity, along with concerns about the quality of food offered in the schools. In his role as executive director of Public Health Advocates, Goldstein also brought together a panel of experts to develop the nation’s first nutritional standards for school-age children. Meanwhile, Public Health Advocates worked with partners to marshal support for the legislation. Goldstein estimates that 200 organizations signed on as backers.
Then there were the hardball tactics. Goldstein notes that the California School Boards Association (CSBA) originally opposed the legislation on the grounds that schools relied on money raised from selling soda and candy bars and that the policy was an issue of “local control.” CSBA eventually changed its stance and wound up cosponsoring the legislation — in part, Goldstein says, because “we were battering them in the media year after year.” The same pressure was applied to legislators. A week before the final vote on the bills, Public Health Advocates released a study showing obesity rates by legislative district. The result: Reporters covering the study turned up the heat on the elected officials by pointing out the troubling findings affecting their constituents and asking how they planned to vote.
In the end, Goldstein says, “the combination of solid data, great media coverage, strong partnerships and champions in the Legislature we had nurtured for six years allowed us to beat the deep-pocketed corporate interests that were fighting us tooth and nail.”
California’s actions proved influential. After a number of states passed similar laws, sugary soda and junk food are now banned from all U.S. public K-12 schools as a result of the federal Healthy Hunger-Free Kids Act, enacted in 2010. Meanwhile, Public Health Advocates followed up on the school ban to successfully push for the nation’s first statewide menu-labeling law, requiring calorie counts to be displayed on menus in chain restaurants; similar provisions were later included in the Affordable Care Act. Goldstein’s organization has also played a pivotal role in starting the movement to institute soda taxes. Although efforts to pass a statewide tax have stalled, four cities in California and others around the world have done so, and the World Health Organization recently endorsed taxing sugary drinks to lower consumption and reduce obesity. Among its other advocacy efforts, Public Health Advocates is pushing for legislation to require that warning labels be placed on sugary beverages.
One of Public Health Advocates’ allies in the California State Legislature on the soda issue, Senate Majority Leader Bill Monning (D-Carmel), calls Goldstein a dedicated public health advocate who doesn’t shy away from a challenge. “Given the powerful and multi-factored forces that adversely impact health,” Monning says, “we are lucky to have Harold Goldstein and Public Health Advocates working every day to bring science-based analysis and advocacy to the public commons.”
Goldstein credits the mentorship he received at the Fielding School — particularly from the late Ruth Roemer, a member of the FSPH faculty for more than four decades and founder of UCLA’s health law program — with preparing him for his career as a public health advocate. “I was enormously fortunate during my time at UCLA to have people who believed in me,” he says. “I couldn’t be doing this work if it weren’t for the education, mentoring and genuine love and caring I got from my professors at UCLA.”