Published in: M. Ginman, E. Väliverronen (eds.): Communicating Health and New Genetics: Workshop Proceedings, 17-18th September 2001). Finnish Information Studies 20, Åbo; Tampere; Oulu, 2002, pp. 57-84.

Communication barriers in the market for functional foods

The dilemma of using health claims in business-to-

consumer communication

Aart Jan de Heer PhD

Post-doctoral researcher Turku School of Economics and Business Administration

Department of Marketing / Innomarket Lemminkäisenkatu 14-18C

20520 Turku, Finland Email: aartjan.deheer@tukkk.fi

ABSTRACT Problems concerning the use of health claims as a tool for the marketing of functional food are discussed. Functional food is a concept, which deals with the research, production and marketing of foods with enhanced health effects. In societies with high health care costs, functional food is a promising concept since it is expected to prevent a variety of modern life style diseases. However, results from consumer surveys indicate that consumers do not primarily seem to think of food as a matter of health, but rather define their eating and drinking behaviour in terms of well-being, social relations, and traditions. Like many novel products, functional foods encounter mistrust and rejection. Usually, general acceptance of new technologies requires a long process of social legitimation. Therefore, it cannot be expected that the benefits of functional foods can be communicated to consumers through mere label information. Studies in the field of business success provide indications that developers, producers, and marketers of functional foods will have to bridge the communication gap with consumers before any sustainable market success in this product segment can be achieved. In this paper, an attempt is made to characterise the communication gap through the identification of different health claim discourses. Keywords: Communication, functional foods, health claims, marketing INTRODUCTION Functional food is a complex concept, which has been defined in many ways. A simple and widely accepted definition has been proposed by the American Dietetic Association, according to which functional food deals with “any modified food or food ingredient that may provide a health benefit beyond the traditional nutrients it contains” [1]. Further, being applied to a business context, functional food refers to an emerging industry, which synergically

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combines the research, production and marketing of foods with enhanced health effects [2, pp. 3-4]. The development of functional foods started in Japan in the 1980's, as authorities became concerned by the increased average age of the population [2, pp. 138-140]. In societies with high health care costs, functional food is a promising concept. Functional food is expected to prevent a great deal of modern life style diseases, and to enable consumers to self-care, thus diminishing the increase of public health care expenditures [3]. Regulators and nutrition scientists, however, emphasise that the efficacy and safety of functional foods must be scientifically validated [4] [5] [6]. Accordingly, any information on food labels about the relationship between food and health must be based on satisfactory scientific evidence in order to constitute an authorised health claim [7]1. The scientific load of health claims may in turn help in persuading consumers that functional foods indeed reduce the risk of specific diseases and do not cause side effects [2, p. 97] [10]. From this point of view, using health claims as a tool for marketing functional foods is salient. Currently, however, the use of health claims is not allowed in the European Union and in the USA and Japan health claims are subject to national approval systems [2, pp. 97, 125-127, 140, 154-157] [11, pp. 10-12]. Furthermore, examinations of the practical value of health claims call into question whether detailed information on the health effects of specific nutrients may actually change the food choice behaviour of consumers [12] [13, p. 154] [14]. Research on eating behaviour indicates that to consumers, food means much more than a tool for survival or keeping up fitness or increasing performance [e.g. 15, p. 61]. Food consumption has also been noticed as a part of the consumers' identity and involves traditions, social commitment, and conceptions of health, etc. [16] [17] [18] [19] [20] [21] [22]. Typically, these values change over time and vary according to factors including gender, social class, age, education, and culture [23]. Moreover, food-related behaviour is highly inconsistent as physical needs, temporary moods, attitudes, traditions, food supply situations, acquired knowledge of nutrients and food ingredients, etc. interact at different levels and to a varying extent. As a result, food consumption patterns are complex phenomena, which are hard to control or to modify by any single external action [15] [24]. The implication for functional food marketing is that the benefits of functional foods cannot simply be communicated to consumers through scientifically underpinned health information on food labels [13] [15]. Though the possibility of making health-related statements is an important juridical prerequisite of functional food marketing2, health claim strategies include restrictions, because they are based on the assumption that the complexity and versatility of consumer behaviour can be controlled by medical or medicinal statements [cf. 15].

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Functional foods are high-tech products that, because of their novelty and complexity, easily encounter mistrust and rejection [25, pp. 75, 114-116]. It seems that functional foods have to compete in the very mature market of conventional processed foods as long as their premium nature has not been accepted or conceived by the consumer [cf. 25, pp. 41-44]. Japan’s Yakult case indicates that good communications with consumers are an important success factor. Yakult’s functional dairy products have been marketed directly to consumers since 1955, and in spite of numerous imitators, Yakult has retained a leading position in many countries [25, pp. 132-133]. Yakult’s approach to marketing is, however, exceptional in the food industry. Normally, manufacturers of functional food rely on advertising strategies, where direct interaction with individual consumers plays a subordinate role [25, p. 43]. Nutrition scientists seem to take even less account of the individual consumer. They stress the importance of communication through neutral label information, which, suggests that all consumers would understand the relation between health and food in the way science does and that it would be enough to manipulate this understanding rationally. Thus, marketing through label information ignores the fact that consumers assess the relation between food and health in very different ways and that they may act irrationally in conditions where food has fulfilled its primary goal, i.e. satisfaction of hunger. The reductionist approach to communication of food science and, to a great extent, also of the food industry, is in obvious contradiction with the philosophy of contemporary marketing [25, pp. 42-43, 275-277] [26]. Today, marketing studies emphasise the importance of creating and maintaining strong relationships with key external stakeholders: customers, competitors, collaborators, and co-workers. Yakult’s success, for example, has been explained by its strong relationships with consumers [25, pp. 253-254]. The notion of relationships sheds special light on the responsibilities of the firm. Whether or not a particular stakeholder3 has legal rights or economic power, the firm may have obligations to them based on natural justice. From this point of view, business relationships are not only determined by dimensions of rational benefit, as assumed by the transaction cost theory of Williamson [28], but are also driven by ethical considerations. Typically, the ethical approach to business relationships focuses on the legitimacy and non-material values of the business idea for stakeholders. According to this logic, a business will flourish and survive as long as it reflects the stakeholders’ view of the world. This suggests that the stakeholders’ confidence and commitment to the business can be regarded as critical for the vitality of the business. The extent to which stakeholders are prepared to commit to a business does not seem to be a value, which can be predicted on the basis of rational calculations. In this matter, Raisio’s Benecol case may provide

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illustrative examples both with respect to consumer loyalty and to partner commitment. After Benecol was launched on the international market in 1999, brand loyalty of consumers to this product remained low in most countries, probably because consumers experienced this cholesterol lowering margarine as a pure medical product, which lacks the emotional attraction of conventional food brands [cf. 25, p. 49]. Concerning Raisio’s partner, McNeil Consumer Nutritionals, part of the multinational US healthcare group Johnson & Johnson, showed reluctance to introduce Benecol onto the Swedish market, despite Raisio’s eagerness to take advantage of Benecol’s good prospects until the arrival of Unilever’s cholesterol lowering Benecol-substitute Pro.aktiv [cf. 2, p. 19]. The notion of relationships being critical for successful marketing draws attention to the role of communication in business process development [29] [30]. Human communication is indispensable as a tool for creating and maintaining the social networks in which business relationships are established. Thus, analysing the communication behaviour of stakeholders may help us to understand the strengths and weaknesses in the relationships between stakeholders. Studies on the role of information in the interaction between private organisations and the business environment give indications how communication contributes to establishing strong relationships between stakeholders [31] [32] [33]. Excelling marketers in different industries seem to have in common that they make many efforts to map different views of reality and to include the customer’s way of life in their products [25, p. 253] [32] [33]. In the food sector, the retail industry is most committed to gathering knowledge about consumers. This circumstance is a consequence of the interface position of food retailers between producers and consumers. In turn, food manufacturers are in their role of mass producers largely dependent on the food retailers’ interpretations of consumer needs [cf. 25, p. 26]. This kind of dependence is, however, new for developers of functional food ingredients, who as a part of the high-tech life-science sector have a strong focus on research and development (R&D). In this professional setting, there has only been little contact with end-consumers since products constitute individual nutrients and medical applications that have been marketed in a domain-specific business-to-business context. As a consequence, ingredient developers tend to assume a business environment where stakeholders behave like experts. However, as the emergence of functional food forces life-sciences to expand to open consumer markets, communication between nutrition experts and laymen is quickly gaining importance. Functional foods are unconventional and challenging products, the successful marketing of which requires versatile and intensive communication with different stakeholders. Diffuse and inconsistent regulation practices of authorities (e.g. the blurred distinctions of drugs, dietary supplements and foods

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in the USA) [see 25, pp. 166-172], the confusing role of the media [25, p. 84] [34, p. 8], and faltering public confidence in the benefits of functional foods [12] [35] [36] [37] are symptoms that there exists a communication gap between producers of functional food and key external stakeholders (see figure 1). Ignoring this gap may threaten the future conditions of success for the whole industry. Figure 1. The communication gap between producers of functional food and the market place

Bridging the gap as indicated in the above figure requires a change in the overall communication strategy of the functional food industry and related science. Instead of considering health claims as the appropriate way of communicating with stakeholders, the industry should focus on the identification and maintenance of key relationships in the market place. In focusing on relationships, the interdependencies of the relationships also need to be mapped: good relationships with consumers are difficult to achieve without the help of the media, good relationships with regulators may give positive signals to the media, etc. Restricted communication between marketers and consumers of functional food has been an important cause of disappointing results in key consumer markets. It is interesting that, for example, in the US market for functional spreads both McNeal-Raisio’s Benecol and Unilever’s Take Control have been relatively unsuccessful, although the applied marketing strategies were based on robust mass product branding [25, p. 245]. Although Unilever is known as an experienced creator of food brands, the firm was not aware that consumers are not really willing to pay premium prices for standard products that bear health claims.

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HABERMAS’ IDEA OF THE PUBLIC SPHERE Based on the above observations, it seems that the different stakeholders in the functional food industry have their own logic. In this context, the focus will be on three stakeholder groups (science, industry and consumers) who seem to assess the value and implications of health claims in very distinct ways. These three groups build a communication sphere, in which different approaches to reality constitute a triangle of competing discourses. The notion of examining a social phenomenon like the use and acceptance of health claims in a conflict setting has been inspired by Jürgen Habermas’ theory of communicative action [38] [39]. Habermas suggests that in modern society, the empowered elite (“bourgeois”) aims at limiting the freedom of the public to take part in the social debate through a purposeful “scientisation of technology” [40, p. 82, 104]. In this way, communication can serve a repressive function in our culture when it is limited and legitimised by the needs of information rich structures, which maintain themselves through purposive-rational action [cf. 38, p. 81]. For Habermas scientific-technology “can also become a background ideology that penetrates into the consciousness of […] the population, where it can take on legitimising power” [40, p. 105]. The power of technology is according to Habermas, not vulnerable to reflection, because as a positivist structure, it maintains the force of Truth. Habermas argues that knowledge, which determines political power systems, should be derived through communicative action “governed by binding consensual norms, which define reciprocal expectations about behaviour and which must be understood and recognised by at least two acting subjects” [40, p. 94]. Thus, he postulates that the validity of social norms must be governed by intersubjective understanding by the parties. According to Habermas, this can be achieved through an egalitarian debate in a publicly controlled context, also referred to as the “rational debate” or as the “ideal speech situation”. Building on this idea, Habermas elaborated the relation between political power and knowledge in his theory of the public sphere [41]. Following Habermas, Dahlgren conceptualises the public sphere as “the realm of social life where the exchange of information and views on question of common concern can take place so that public opinion can be formed” [42, p. 8]. Through this concept, Habermas associates knowledge with discourse ethics and provides a theoretical framework within which to discuss the problems of social dialogue in democratic societies. Apart from scientific elitism, Habermas identifies two other institutional factors, which weaken the vitality of the public sphere: the invasion of advertising ethic and the penetration of public relations [41, p. 192-195]. Habermas considers these factors as tools of modern propaganda, which distort the rational debate and establish false consensus.

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According to Habermas, in order to rescue the public sphere, it is necessary to accommodate the three generic domains of human interest in which justifications for participation can be formulated: the technical, practical, and emancipatory [43] [cf. 44]. Habermas uses the three domains in order to describe a model, which identifies the relations between the different approaches to communication activity. Accordingly, he associates the orientations of human interest with their typical knowledge, medium, and science. Carr and Kemmis [45, p. 136] summarise Habermas' framework in the following table: Table 1. Habermas’ domains of human interest and the knowledge, medium, and science associated with each.

Interest Knowledge Medium Science

Technical Instrumental (casual explanation)

Work Empirical-analytical or natural sciences

Practical Practical (understanding) Language Hermeneutic or

interpretive sciences

Emancipatory Emancipatory (reflection) Power Critical sciences

The technical domain of human interest is fostered by the empirical-analytic sciences. These sciences are based on the assumption that nature is a lawful system of interconnected facts, which must be researched by means of objectifying experimental methods. Because of this approach, the focus is on instrumental activity, which aims at controlling nature. The practical domain of human interest is the realm of the historical-hermeneutic sciences. These sciences build on a subjective, interpretive method that constitutes social reality as a symbolic text comprising meaningful actions, artifacts, and events. According to this approach, the focus is on practical understanding and communication activity, which aims at establishing a common identity and coordination of action. Finally, the domain of emancipatory interest is the task area of the critical social sciences. These sciences use both objectifying (causal explanatory) and interpretive procedures in determining the causes, nature, and dependencies of social phenomena. Social sciences are driven by the emancipatory interest in achieving freedom from domination. Accordingly, they use reflective methods, which enable critical self-examination [cf. 46, p. xxx].

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Habermas argues, that actors in a healthy public sphere need unbiased and equal access to the knowledge in all three domains of interest. This constitutes the prerequisite of communicative rationality and democracy, in which understanding is based on the truth, rightness and authenticity of validity claims brought up by social actors in their speech [41]. Although Habermas regards rational communicative action a good thing, he opposes the idea of rationalisation. Since the basis of all communication is language, trust and belief often play a significant role in social validation processes. Rationalisation deals with generating trust and belief in a context of unequal access to information (information asymmetry). This occurs when aspects of the real world are made explicit [38]. As societies become more complex, rationalisation also increases, and mechanisms are developed to reduce the risks and failures related to coordinating mutual understanding. A serious consequence of this rationalisation is according to Habermas “an elitist splitting off of expert cultures from contexts of communicative action in daily life” [39, p. 330]. Expert cultures are typical of natural sciences, where a positivist tradition disavows reflection [43, p. vii]. In expert cultures, communication is typically non-social and implies purposive-rational action. As a counterweight to the emergence of expert cultures, is the increase of advertising and public relations. While experts acquire domination through the exclusivity of their knowledge, advertising and PR attempt manipulation by private or state interests of the flow of public information. In this way, citizens are transformed into consumers, dedicating themselves more to passive consumption (“consumerism”) and private concerns than to issues of the common good and democratic participation. Habermas states that, at this level, “arguments are transmuted into symbols to which again one can not respond by arguing but only by identifying with them” [41, p. 206]. Like in expert cultures, communication in advertising and PR cultures focuses on purposeful-rational action. Though advertising and PR address people, the nature of the action is instrumental and aims at strategic advantage. Thus, the social function of advertising and PR is utilitarian. According to Habermas, actors from expert and public relation cultures do not treat people as genuine persons, but as objects for successful operations [cf. 38, p. 285, 333]. As a contrast to the purposeful action of experts representing natural sciences and the strategic intentions of advertising and PR specialists from the business and mass media world, Habermas mentions the interpersonal interaction in the public sphere. Here, persons act as subjects, who do not primarily have strategic purposes, but attempt mutual understanding [cf. 38, p. 285].

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Although Habermas’ idea of the public sphere, and in particular his conceptions relating to the ideal debate have been subjected to severe critical argumentations, Habermas provides a fruitful approach for analysing conflicting interests within a socially biased context [cf. 47]. In this article, the idea of the public sphere will be applied to analyse the dimensions and implications of the communication gap between developers, producers and marketers of functional food on the one side and consumers of these products on the other side. First, the connection between food and health is discussed. Then, the assumptions, beliefs and logic in the discourses of the nutrition scientists, marketers and consumers are discussed. THE CONNECTION BETWEEN NUTRITION AND HEALTH The notion of food as a health-constructing factor is not new. Already the ancient Greek physician Hippocrates (460 - 377 BC) expressed the thought that there must be a connection between nutrition and human health. His words “Let food be thy medicine and medicine be thy food” are still considered an important tenet in Western medicine and nutrition [cf. 48]. In 1538, Paracelsus (1493 - 1541), established the idea that curing substances should be used at appropriate dosages. His observation that “solely the dose decides that a thing is not poisonous” is the cornerstone in modern toxicology [49] [50] and has also given a basic incentive to the study of chemical compounds in nutrition [51]. In spite of Hippocrates' and Paracelsus' insights, the mechanisms behind the beneficial and noxious therapeutic effects of food have remained unclear until recent times. An important step forward in the scientific development towards safer and healthier food marked the activity of Louis Pasteur (1822-1895) who discovered that microbes caused most of the common diseases and that infection could be transmitted by polluted water or contaminated food. One of Pasteur's most renowned methods to control pathogenic bacteria, milk pasteurisation, is used in the food industry, not only to semisterilise liquids but also to inhibit harmful enzyme action in beverages such as orange juice [52]. Nutritional sciences were still in their very infancy at the start of the 20th century [cf. 53]. Until the discovery of micronutrients it was unknown that minerals and vitamins were necessary to prevent diseases caused by dietary deficiencies. Diseases like beri beri, pellagra, rickets, scurvy, and xerophthalmia (a type of blindness) were considered infectious diseases. By 1900, biochemists and physiologists had identified protein, fat, and carbohydrates as the basic nutrients in food. In 1911, the Polish chemist Casimir Funk (1884-1967) discovered that food contained vitamins and that small amounts of “vital amines” (as he called them) could prevent a number of

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deadly diseases. These scientific discoveries and the resulting public health policies, such as food fortification programs, led to substantial reductions in nutritional deficiency diseases during the first half of the 20th century. The focus of nutrition programs shifted in the second half of the century from the prevention of acute deficiency diseases to controlling chronic degenerative diseases, such as cardiovascular disease, cancer, obesity, and mental health disorders [54]. This shift reflected rapid development in medicine (e.g. the invention of antibiotics in the 1940s and 1950s) and new knowledge on the relationship between nutrition and degenerative diseases [e.g. 55, p. 177]. In 1953, Ancel Keys published his controversial findings on the connection between heart disease and dietary fat [55, pp. 323-350]. A year later, in 1954, Denham Harman launched his conception of the free radical theory of aging [56], which has attracted a wide range of scientific interest for several decennia [cf. e.g. 57, pp. 2-3]. Harman found that free radicals damage proteins and the DNA of living cells, and are involved in the development in age-related disease. Harman concluded that free radicals should be neutralised, and that this was possible through enhanced intake of antioxidant nutrients, such as vitamins C and E. As a third milestone from this period may be regarded Roger Williams’ (1893-1988) concept of nutritional individuality [58]. Williams argued that people greatly vary in their individual nutritional requirements. According to his view, national nutritional standards had inherent defects and had to be adapted to the metabolic complexity and needs of real people [58] [59]. Over the last 30 years, science has discovered a host of bioactive substances in and outside food that may contribute to human health in one way or another. Especially fruits and vegetables have been identified as the carriers of these beneficial new substances, but certain bacteria have also been recognised as health-promoting agents. Today, science has a respectable, but highly incomplete understanding of important components in food [cf. 60]. Partly because of this, researchers are not inclined to dismiss any nutrients or substances they don't know about. Knowledge of beneficial effects often includes a controversial element, and therefore, the inclusion of results from nutritional research in dietary recommendations is problematic. As regular parts of a well-selected diet, bioactive components may help the consumer reduce the risk of cancer or heart disease, but in more concentrated dosage forms the effects of the components may also be the opposite. There is insufficient research that tracks the health outcomes of patients treated with a biochemical substance. Consequently, many food substances with potentially positive effects on health may also include a source for disease risks not yet identified [cf. 54]. As a conclusion, it can be stated that nutrition science has gathered a lot of valuable data on the health effects of food, but that the knowledge resulting

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from this data is incomplete, fragmented, and often also controversial. Most of the acquired knowledge consists of correlations between a disease risk and a nutritional, chemical or behavioural factor. Although statistical analyses have made it possible to discover a number of interesting causal relationships, all of these interpretations are actually biased by imperfect rational argumentation. Pomerol [61], for example, puts forward that cognitive bias has a restrictive impact on our capabilities to understand and process probabilistic data independently from a specific value context. Due to this circumstance, different expectations may lead to opposed interpretations of identical statistical data [cf. 62]. Hence, we may say that there is substantial evidence in favour of a connection between health and nutrition, but there is relatively little understanding on the nature and implications of this connection [cf. e.g. 55, p. 373]. Apart from certain inherent weaknesses in biomedical argumentation, there is also the problem that nutrition research is far from omnipotent. Currently, most diseases and cause-specific mortality peaks seem to emanate from high-risk lifestyles and bad environmental control rather than from unbalanced nutrition. Hence, the connection between nutrition and health is only one factor of interest, which must be addressed in the human battle against disease and premature death. In the short term, probably much more can be achieved by means of social and political measures than by the massive commercialisation of nutrition research. For example, illnesses caused by food contamination constitute an urgent growing public health problem, both in developed and developing countries. Although the global incidence of foodborne disease is difficult to estimate4, it has been reported that in 2000 about 2.1 million people died from diarrhoeal diseases alone [63] [64]. Another example is the growing problem of tobacco consumption. According to the WHO, there are approximately 1.25 billion smokers in the world [65]. In industrialised countries, smoking has been identified as the most important preventable cause of disease and premature death. Currently, tobacco causes 4 million deaths a year worldwide, but it is estimated that by 2020, tobacco will be the single biggest cause of death globally, accounting for 8.4 million deaths per year [66, p. x]. Other significant causes of premature death result from alcohol consumption, accidents, violence, risk-related lifestyles, etc. The relation between nutrition and health, together with behavioural and other factors that may influence the life expectancy of the average consumer, are summarised in the figure below. However, it must be noticed that the distribution of eating and health behaviours (risk avoidance, mainstream behaviour, and destructive behaviour) in the figure is hypothetical. Similarly, the accommodation of the distributions to Pareto’s 80/20 rule is more hypothetical than based on empirical evidence5.

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Figure 2. Exploring the contingencies of eating and health behaviour

THE RATIONAL BIAS OF NUTRITION SCIENCE Nutrition science is based on the idea that an optimal diet may prevent most diseases. New understanding of how individual food components affect human metabolism has resulted in the introduction of functional foods. According to the evidence from numerous clinical tests, these may help the consumer

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keeping specific health risks under better control [48] [60]. Hence, functional food exists by the grace of the notion of risk. According to Heasman [25, pp. 78-87], the assessment of risk is associated with power and is central to:

• the construction of health claims; • the development and use of biomarkers; • communication and marketing strategies about food and disease

prevention; • the place of functional food in public health policy.

Heasman points out, that experts assess risk in a highly technical way, which is not understood by the average consumer. Further, he argues that scientists do not show great interest in how the consumers should understand and manage health risks in relation to their everyday diets. Lupton [68] summarises a number of features of the technical-scientific debates about risk and mentions the following characteristics:

• a focus on how well risks have been calculated; • the level of seriousness of the identified risks; • the validity of the measured risks; • the stability and strength of predictive and explanatory models.

It is clear, that participation in these debates is not possible without advanced knowledge of biotechnology and medical research. Hence, laymen are excluded from discussions on risk assessment, and the topic is withdrawn from the public sphere. In this context, the average consumer lacks any favourable conditions for feeling committed to the experts’ conception of risk. Nevertheless, the scientific assessment of risk is presented as the basis for a health claim for a food product. Since direct interaction between consumers and science is minimal, it is interesting to note the intermediation role of the media. This role, however, is complex and problematic. Apart from some exceptions, journalists are usually laymen, just like the consumer. Hence, they often encounter major difficulties in reporting the contents of the fuzzy scientific debates for a wide public. T. Sanders [69], for example, states in an overview of food production and food safety that “public perception of risk is distorted by media reporting.” In this way, the media confuses the public more than it enlightens. Even if this practice is unintentional, it may worsen the power asymmetry between science and the public. On the other hand, any reporting, even when distorting, may also give the public incitements for critical discussion in the public sphere.

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THE DUAL MARKET APPROACH OF MARKETERS The functional food business is still very young and its market potential is still rather unexplored. In addition, the market for functional foods has appeared to be unstable and difficult to predict [cf. 25, pp. 31-33]. This can be illustrated by the fact that many brands have been withdrawn in the first years after their initial launch, either for economical reasons (e.g. Novartis’ Aviva brand was withdrawn from the UK market in 2000 after an unsuccessful start), or for reasons relating to an inappropriate use of health claims (e.g. the Danish dairy company MD was forced to withdraw its Gaio brand from the UK market in 1995 because Gaio’s claim “can help reduce cholesterol” was judged to be exaggerated and misleading). In this context the assumed important role of health claims in marketing must be questioned. Many functional foods have the character of trial products and encounter therefore mistrust or indifference from the consumer’s side. It is worth noticing, that successful and vital functional food brands like Yakult do not primarily base their marketing strategy on health claims, but on intensive and individual communication with consumers [25, pp. 216-218]. Yakult is an example of a highly technological product that has been marketed with a human face. At the other extreme, one can mention the advertising based strategy of Benecol during its first launch in the United States. Here, marketing had a strongly positivistic bias: it was assumed that the health claim information presented on the food label was enough to communicate the advantages of the product. Also the apparent (but unjustified) trust of the developers of Benecol in the market value of the product patent indicates, that their marketing strategy had an instrumental approach: not the consumer, but the product was focused. Another problem in the marketing of functional foods like Benecol has been the discrepancy between the premium price of the products and the willingness of the public to pay this price. Premium earnings are an important stimulus for the industry to introduce new functional foods, since the development of these products may have required considerable investments in research and development. Premium prices, however, also require enhanced quality in terms of the consumer’s expectations and preferences. In the Benecol case, it appeared that the promise of reduced health risk was not enough to justify a high product price [cf. 70].

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THE PLURIFORM VALUE SYSTEM OF CONSUMERS In general, consumers seem to share the nutrition scientists’ belief that there is a connection between health and nutrition. This does, however, not mean that consumers conceive the need for health risk reduction in a scientific way. For consumers, health is only one aspect of food (see introduction), and food is only one factor among the total number of potential risks (cf. figure 2). Furthermore, consumers do not behave like objects in laboratories: they make decisions of their own and may behave intuitively and inconsistently. In fact, the only rational element in human eating behaviour is hunger [71] [72], and everything beyond this criterion varies over time, and according to culture, gender, lifestyle, etc. With regard to the time factor, for example, a radical shift in the general valuation of food in the industrialised world has occurred. Until ca. 1800, the availability of food, whatever it contained, was essential, in particular during periods of frugality or famines. Since the late 17th century, the focus shifted to the taste and appearance of food. In the 19th century, when the use of the microscope increased general awareness of pathogenic micro-organisms, hygiene and safe food practices came to the fore. Only in the 20th century, after the vitamin revolution, health did become a significant choice factor [73, pp. 20-39]. Health claims are rational only for the scientist, but they become subject to critical argumentation as soon as they enter the market place. For consumers, health claims constitute only one value among others, which legitimate the decision to consume the food product or not. Consumer research indicates that important competing values include at least convenience, ethical considerations, taste, tradition, and price [25, p. 42] [74, p. 47] [75]. International survey studies indicate that consumers do not necessarily pay most attention to the health aspects of food (see tables 2 and 3).

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Table 2. Rating of food characteristics by consumers [76].

Table 2 summarises the findings of a consumer survey, which Müller and Hamm conducted in 2001 among 922 participants in the German state Mecklenburg-Vorpommern. This study indicates that consumers are first of all concerned about the directly recognisable physical properties of food (freshness, taste and appearance). Next come health-related issues, such as food safety aspects (low chemical residues) and well known food components (vitamins and minerals). At the third place is ranked the price of food. After these material values follow a number of ethical arguments, all related to the sustainability of the supply chain (good treatment of animals, reduction of pollution, no genetic modification). Somewhat surprising is the low value set to the convenience of food preparation and the food brand. The results of Müller’s and Hamm’s survey is highly consistent with the results of another consumer survey, which ranks attitudinal factors that promote the purchase of fresh produce in the USA in 1999/2000 (see table 3).

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Table 3. Primary factors when purchasing fresh produce [77].

87%

83%

74%

70%

57%

Expected taste

General appearance

Cleanliness

Degree of ripeness

Nutritional values

0% 20% 40% 60% 80% 100%

(n = ?)

Like in table 2, also according the results of table 3, consumers make their food purchasing choices primarily on the basis of taste and appearance preferences, rather than on food safety or health considerations [77]. The evidence given by the different studies is, however, fragmented and also includes in some cases contradictions. For example, the results in tables 2 and 3 are not clearly sustained by the data from an older food consumption study among 946 participants in California [78]. According to this study, consumers based their food purchasing decisions in most cases on food safety considerations (80.2%). Next important were nutritional factors (79.3%), taste considerations (75.4%) and factors relating to price (49.5%). The differences in appraisal between the first three factors are, however, very small, which may indicate that food safety, nutrition and taste are all equally important factors. 6 In most cases, the evidence must be evaluated in its context. At times when no food disease outbreaks are reported by the media, the consumers will, for example, apparently emphasise taste or appearance rather than health aspects of the food, which are taken for granted. In addition, the motivation of the consumers with regard to each product group in question must be taken into account. Above mentioned considerations indicate that the context of consumers is much more complex than which health claim strategies are designed for. Health claims may in certain circumstances have some restricted impact on the behaviour of consumers, but there is no evidence that health claims can bring

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about significant change in the everyday decision making of the consumers. Basically, the idea of prevention may even be in conflict with human nature. Most health-related behaviour of people seems to be induced by a crisis (e.g. by a heart attack), which in turn changes the basic conditions for the intake of new health information. Benecol, for example, is often consumed in connection with a post-crisis therapy, although it is marketed for its risk-reducing effects. It seems that marketing of functional food requires much more adequate understanding of the premises of consumer behaviour. The Yakult case shows that individually based, long-term communicative action with consumers is the only way to get access to the mind of the consumer. CONCLUSIONS The information environment in which functional foods are discussed is changeful, complex and conflicting at the same time. Although stakeholders in the functional food market commonly accept the view that there is a connection between health and food, there is no consensus on what this connection implies. Nutrition scientists believe they can accurately communicate their view of the connection between food and health through health claims. However, health claims confer to an ambiguous reality, which is conceptualised differently in the discourses of the involved stakeholders. Within the scope of this article, the following three major discourses must be considered:

1. a rational-scientific discourse; 2. a strategic marketing discourse; 3. a critical consumer discourse.

In the rational-scientific discourse, argumentation is primarily based on the analysis of empirically observed phenomena. In this context, the emphasis is on evidence, which, in turn, is strongly associated with Truth. Since Truth is considered to be the result of logical and objective reasoning, it is assumed to be universal and not to be subject to individual reflection. Hence, rational-scientific arguments do not take account of subjectively determined factors. The implication for health claims is that these are expected to be universally valid expressions of the association between nutrition and disease prevention. Through their strong commitment to health claims, nutrition scientists ignore (or at least neglect) the fact that food might have values, which go beyond the function of its nutrients. Together with a firm belief in the technological potential of biomedical science, this way of thinking constitutes the basis for the medicalisation of food.

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The strategic marketing discourse is either based on controlling consumer behaviour through selling strategies or on learning from consumers through relationships. In this dual discourse, the focus is on harnessing information for particular uses. Accordingly, health claims are used a tool for gaining competitive advantage. Marketers seem to have a more pragmatic approach to health claims than nutrition scientists, and may not always consider health claims as an indispensable part of a strategy for marketing functional foods. With regard to the concept of food, professional marketers are used to think of food as a complex phenomenon. For them, food addresses a constellation of values (freshness, safety, price, ethics, etc.) which must be analysed in relation to the features (preferences, expectations, lifestyle, gender, age, etc.) of the identified consumer groups. Finally, the critical consumer discourse is based on subjective interpretations of Truth. In this discourse, observed reality is never perceived as fully transparent or unambiguous, and, therefore, is always open for critical discussion. When consumers learn about health claims, they interpret them in very different ways and, most probably, try to assess them together with other individuals in a social dialogue. If this dialogue is open and egalitarian, different views get merged and individual justifications may become part of a publicly shared knowledge domain. The reached state of consensus empowers the average consumer to take part in the ongoing discussions. Any public consensus on food and health issues does, however, not mean that the public conceives the connection between health and nutrition in the same way as nutrition scientists do. For consumers, food is a part of their personal identity, lifestyle and culture. Hence, food consumption is a way of self-realisation, through which meaning is created. According to the logic of the critical discourse, the impact of health claims on food consumers cannot be predicted on the basis of the rational content of the message, but can only be assessed in relation to the value context of the consumer. Apart from being tied to different discourses, the communication between the stakeholders is also characterised by the asymmetry of information. Scientists have the expertise to examine and evaluate the effects of nutrition on health, which laymen do not have. Although the discussion on health claims for functional foods is of general interest, nutrition scientists do not seem to make special efforts to involve consumers in the debate. On the contrary, the consumers are excluded from the debate, and, thus, the topic is withdrawn from the public sphere. Since there is no direct communication between science and consumers, citizens feel disempowered and become highly dependent on the information they can obtain from the mass media. Because this information may include errors and conflicting views, the truth is easily distorted. As a consequence, an atmosphere of mistrust and confusion emerges, in which

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consumers do not feel committed to the concept of functional food (see figure 3). Figure 3 Health claims in a squeezed public sphere

The above figure illustrates the role of health claims in a society where food has become an object of inappropriate medicalisation7. In particular, the medicalisation of food addresses two egoistic needs: 1) the need of biomedical sciences for truth authority, and 2) the industry’s need for supporting a strong market economy [cf. 81]. From this point of view, health claims function as a tool for patronising, scaring and manipulating the consumer, and, as a consequence, suffocate the public sphere. Potentially important counterforces constitute consumer organisations, which are expected both to empower individual consumers and to take action against the harmful effects of advertising and to reveal unethical aspirations in science. The actual impact of consumer organisations on the position of consumers in the public sphere is, however, still rather unexplored. For the time being, the confusing impact of the media on the average consumer seems to be stronger than the beneficial role of the consumer organisations [cf. 82, p. 74]. In figure 3, the role of the regulators is to demarcate and to control the flow of health information that science and industry provide to the public. In this role, regulators try to harmonise the interests of producers with those of public stakeholders. However, there is no agreement upon whether regulatory practices improve the conditions of the health and nutrition debate in the public sphere [cf. 83].

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The idea that the public debate on health and nutrition issues is restricted and distorted gets empirical support from a Danish consumer survey, according to which two main barriers for general acceptance of functional foods are: • distrust of manufacturers’ motives and competence (credentials), and • consumers’ lack of ability to evaluate functional foods due to uncertainty

about the health effects and dosage [84, p. 7]. In order to increase the commitment of the public to functional food, it is necessary to establish a strong public sphere in the field of health and nutrition. In open societies, the future success of functional foods depends on whether nutrition scientists are able to communicate their vi ews and beliefs in the language of the public. Likewise, marketing strategies must enable genuine relationships with the end consumer. In this process, the challenge is how to make decision making transparent and to enable an open dialogue between the stakeholders [cf. 85]. REFERENCES [1] The American Dietetic Association. Position of the American Dietetic Association: phytochemicals and functional foods. Journal of The American Dietetic Association 1995; 95(4): 493-6. [2] Heasman M, Mellentin J. Signposting the way to success in strategic partnerships (Editorial). New Nutrition Business 2000; 5(10): 19. [3] The American Dietetic Association. Position of the American Dietetic Association: functional foods. Journal of The American Dietetic Association 1999; 99(10): 1278-85. [4] Hasler C M. A new look at an ancient concept. Chemistry & Industry 2 Feb. 1998: 84-9. [5] Diplock A T, Aggett P J, Ashwell M, et al. Scientific concepts of functional foods in Europe: consensus document. EC concerted action coordinated by ILSI, Europe. British Journal of Nutrition 1999; 81 (Suppl. 1). [6] Directorate General for Health and Consumer Protection. European Commission. SANCO D4. Discussion paper on nutrition and functional claims (SANCO/1341/2001). [Brussels]: European Commission, 2001. http://europa.eu.int/ comm/food /fs/fl/fl03_en.pdf 2002; January. [7] Richardson D P. Scientific and regulatory issues about foods which claim to have a positive effect on health. In: Sadler M J, Saltmarsh M. (eds.) Functional foods: the consumer, the products and the evidence . London: Royal Society of Chemistry, 1998.

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NOTES

1 Health claims should not be confounded with nutrition claims. The Codex Alimentarius Commission has drafted the following definitions of health claims [8]: “Health claim means any claim establishing a relation between a food or a constituent of that food and health, [whether it is good health or a condition related to health [or disease].” or: “Health claim means any claim which suggests that a food or a constituent of that food has an impact on health.” Examples of health claims are [cf. 11]: • “Calcium improves bone density.” (Enhanced function claim) • “An adequate intake of calcium may help to reduce the risk of osteoporosis.”

(Reduction of disease risk claim) Nutrition claims, which, in contradistinction to health claims, are allowed in the EU, have been defined by the Codex Guidelines for Use of Nutrition Claims as follows [9]: “Nutrition claim means any representation which states, suggests or implies that a food has particular nutritional properties including but not limited to the energy value and to the content of protein, fat and carbohydrates, as well as the content of vitamins and minerals.” Examples of nutrition claims are [cf. 11]: • “Rich in calcium” (Nutrient content claim) • “Contains 50% more calcium than regular milk” (Comparative claim) • “Calcium is necessary for a solid bone structure.” (Nutrient-function claim) • “The National Nutrition Council recommends a daily intake of 800mg of

calcium.” (Healthy eating pattern claim) 2 Countries in the European Community still lack a concordant legislation at this point [cf. e.g. 25, pp. 99-100]. 3 Clarkson [27, p. 106] defines stakeholders as “persons or groups that have, or claim, ownership, rights, or interests in a corporation and its activities, past, present, or future. Such claimed rights or interests are the result of transactions with, or actions taken by, the corporation, and may be legal or moral, individual or collective.

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Stakeholders with similar interests, claims, or rights can be classified as belonging to the same group: employees, shareholders, customers and so on”. 4 Probably less than 10% of all food contamination cases are known to authorities in the industrialised world, but less than 1% to authorities in developing countries [cf. 63]. 5 It is unclear to what extent empirical studies support the distributions suggested in figure 2. Generally, studies on food and health behaviour use categorisations, which result in another type of distributions. For example, the Health and Wellness Trends Report conducted by the Natural Marketing Institute [67, p. 3] mentions five categories of health/wellness consumers in the USA: (1) “Wellbeings”, for whom health is the main concern in life (17%), (2) “Food Actives”, who are dedicated to health through food (21%), (3) “Magic Bullets”, who attempt at health through the easiest means available, e.g. through supplements and OTC medicines (25%), (4) Fence Sitters, who are neutral about most health issues (19%), and (5) “Eat, Drink & Be Merrys”, who are unconcerned about health or the food they eat (18%). The report indicates further that proactive and constructive health behaviour is 25% - 55% less likely among the “Magic Bullets” and “Eat, Drink & Be Merrys” than among the “Wellbeings” and “Food Actives” [67, p. 6]. The consistency of the identified trends in the report with the real behaviour of the consumers is difficult to evaluate, as the lifestyle context of the involved consumers has not been subject to a qualitative analysis. 6 It should be kept in mind that the study of Jolly and al. [78] has a strong focus on food safety, whereas the other studies concentrate on food purchasing criteria and on general food-related concerns. This makes it difficult to compare the studies and to make any general statements on the implications of the findings in the surveys. Furthermore, there seems to be a lack of empirical evidence on how food safety, nutrition and taste are interrelated [cf. 79]. Any interpretations of the relative importance of these factors may tell more about the vision of the researcher than about the real view of the consumer. 7 Kawachi and Conrad describe medicalisation as a “process by which non-medical problems become defined and treated as medical problems, usually in terms of illnesses and disorders” [80].