Understanding the need for the Food Labeling Modernization Act of 2021

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By Sally Greenberg, NCL Executive Director

Many of us are trying to follow the advice of health authorities to cut back on sugar consumption, and food companies are responding with new versions of products promising “less,” “reduced,” and even “zero” amounts of added sugars.

But in the spirit of reducing added sugars — not surprisingly — more and more food producers are turning to artificial and synthetic substances, sugar alcohols, and new-fangled substances many people have never heard of like Luo Han Guo Extract (also known as “Monk Fruit”). This situation with artificial sweeteners has gotten more complicated since we last took a look at this issue.

Today more label claims are implying that the reformulated product is healthier than the original, without disclosing that the sugar content has been reduced by replacing it with artificial sweeteners. One reformulated oatmeal is labeled “Apples & Cinnamon Lower Sugar” and claims it has “35 percent less sugar.” That may sound like a good thing, but the new version is actually higher in calories than the original. Similarly, the reduced sugar version of one peanut butter brand has 1/3 less sugar, but has more calories per serving than its original counterpart.

Senior Members of Congress, including Representatives Frank Pallone (D-NJ) and Rosa DeLauro (D-CT), who chair the committees that have jurisdiction over the FDA and its budget, have introduced legislation to fix the problem, namely the Food Labeling Modernization Act of 2021, H.R. 4971 (FLMA). The FLMA, S. 2594, is sponsored in the Senate by Richard Blumenthal (D-CT), Ed Markey (D-MA), and Sheldon Whitehouse (D-RI).

The measure includes provisions aimed at increasing transparency, encouraging responsible product reformulation, and countering misleading claims. For example, the FLMA would require that a food containing any artificial or natural non-caloric sweeteners must prominently disclose the presence of such ingredients on the front labels of food packages. This would help ensure that food manufacturers do not simply replace sugar with questionable alternatives like artificial sweeteners, sugar alcohols, and other sweetening agents, making “new and improved” food products appearing to be more healthful than their regular versions.

The FMLA would also require the FDA to establish a program for front-label symbols indicating a food is high in sugar. NCL supports that effort, but consumers deserve the full story. We don’t want to see unintended consequences of sugar warning labels leading food companies to seek ever more alternative sweeteners; if they are going to be used, those alternatives should be clearly disclosed on the front label, as the FLMA would provide, so consumers can make fully informed purchasing decisions.

The FMLA also directs the FDA to improve food labels in other ways:

  • The bill improves transparency by mandating that caffeine levels be listed. Consumers who are pregnant, have certain health conditions, or take certain medications or supplements often need to limit or avoid caffeine. At the present time, there is no way of knowing how much caffeine is in many foods. The bill would address that problem by requiring prominent disclosure of caffeine content.
  • The bill would require that FDA establish clear and consistent standards for popular marketing terms like “natural” and “healthy.” That’s a welcome requirement.

In sum, the FLMA would bring food labeling into the 21st Century. The National Consumers League supports these important reforms and hope that this legislation gets the full support of Congress.

Vaccines to protect all

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By Sally Greenberg, NCL Executive Director
With co-author Marla Dalton, Executive Director and CEO, National Foundation for Infectious Diseases

COVID-19 has had profound implications on individual health and well-being and the U.S. healthcare system at-large. During the pandemic, we have seen routine vaccination rates decline significantly across all populations, putting individuals at risk of contracting vaccine-preventable diseases. The pandemic has also brought significant public attention to vaccines and now, perhaps more than ever before, many see the value of life-saving vaccines as one of the most effective public health prevention tools available to keep us safe and help end the pandemic.

The National Foundation for Infectious Diseases (NFID) and the National Consumers League (NCL) are committed to educating people about how to live healthier, safer lives. NFID is focused on educating the public and healthcare professionals about the burden, causes, prevention, diagnosis, and treatment of infectious diseases across the lifespan, and the mission of NCL is to protect and promote social and economic justice for consumers and workers in the United States and abroad.

NFID's Marla receiving her vaccine

NFID’s Marla Dalton receiving her flu vaccine.

Both organizations recognize the tremendous benefits that vaccination provides for both individuals and entire communities. While fall and winter raise the need for annual vaccination against influenza (flu), and the current pandemic has led to the need for COVID-19 vaccines and boosters, we must not overlook the importance of routine vaccines that may have been missed during the pandemic. Vaccines are for people of all ages and there are specific vaccines recommended for children, adolescents, adults, and older adults 65+ to protect against serious and potentially deadly diseases.

NCL and nearly 150 other partner organizations are proud to participate in the NFID Keep Up The Rates campaign, to share messages to encourage all individuals to receive recommended vaccines that may have been delayed during the pandemic. Since the campaign launched in 2020, Keep Up The Rates has engaged national experts and leading public health organizations to reach populations most at risk of delaying vaccinations or experiencing complications from vaccine-preventable diseases.

Sally Greenberg getting vaccinated.

Keep Up The Rates recently released resources to educate healthcare professionals and consumers about vaccine coadministration—receiving multiple vaccines at the same time. When you bring your car in for an oil change, a good mechanic takes care of other routine maintenance to make sure your car runs safely. Protecting your health is not much different, so when you receive a COVID-19 vaccine or a flu vaccine, we encourage you to make sure that you are protected against other serious but preventable diseases. A new PSA and infographics are available to help share that messaging with all relevant audiences.

The COVID-19 pandemic has demonstrated that protecting public health is more important than ever. Just as we must always protect the rights of consumers and workers, we must also encourage measures that promote better health and a safe environment for all.

During ‘Striketober,’ standing up for a USPS that benefits consumers and workers

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By Eden Iscil, Public Policy Associate

Workers across America are taking action to hold employers accountable for low pay and poor working conditions. In what’s being called “Striketober,” 10,000 John Deere employees, 14,000 Kellogg’s workers, and 24,000 Kaiser Permanente staff have gone on strike. Additionally, 60,000 film and television workers belonging to IATSE threatened to withhold their labor, resulting in a deal for more favorable contracts. At NCL, we support workers advocating for better conditions and compensation. 

While it is generating fewer headlines, the actions of US Postal Service employees are just as important for consumer and worker welfare. Recent postal worker employee protests in Minneapolis highlight the indispensable public service these workers provide to millions of Americans daily. Those protests were prompted by a visit from Postmaster General Louis DeJoy, who is infamous for his 2020 attempt to degrade mail services at the same time that COVID-19 necessitated mail-in voting for millions of Americans. Importantly, DeJoy has come under renewed scrutiny for his 10-year plan, which would lead to significantly delayed mail deliveries. 

Given the importance of delivering mail promptly, we urge Congress and the Biden Administration to take a more active role in preventing Postmaster General DeJoy’s continued attacks on the Postal Service. Millions of Americans rely on the Postal Service for delivery of life-saving medication, receipt of their veterans and Social Security checks, and other important mail. Unfortunately, the impacts of DeJoy’s 10-year plan are likely to disproportionately affect rural communities and older Americans.   

We know such policies are harmful to everyday Americans from the many times they were previously attempted. Following DeJoy’s plans for a mail slowdown in 2020, veterans were forced to find alternative access to their medications and 350 million pieces of mail were delayed. We need to challenge such regressive policies that are implemented at an enormous cost to consumers. 

The threat that DeJoy’s recommendations pose to efficient U.S. mail delivery has been known since the summer of 2020. Congress and the Administration must act to get USPS back on the right track. 

Jeanette Contreras portrait

¿Buscando cobertura médica? Healthcare.gov open enrollment begins November 1

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By NCL Director of Health Policy Jeanette Contreras with contributions by NCL Intern Grace Mills

The 2022 open enrollment period for the Health Insurance Marketplace is about to begin! Consumers can enroll in a health plan on Healthcare.gov beginning November 1.

As we commemorate Hispanic Heritage Month, the National Consumers League (NCL) wants Latino consumers to better understand their health coverage options through the Health Insurance Marketplace. Latinos make up approximately 18 percent of the U.S. population and represent the largest minority population (62.1 million). However, it is concerning that 22 percent of non-elderly Latinos are uninsured – the highest uninsured rate of any racial group in the United States.

Under the American Rescue Plan, more consumers are now eligible for increased tax credits that further reduce the cost of monthly premiums. An estimated 69 percent of uninsured Latino adults can access a zero-premium plan and 80 percent can access a plan that costs less than $50 a month. Additionally, consumers can use the Healthcare.gov platform to find out if they or their dependents can qualify for Medicaid or the Children’s Health Insurance Program. Here is what you need to know to make sure that you and your loved ones are insured during 2022.

  • The open enrollment period starts on November 1, 2021, and runs through January 15, 2022. In order for your coverage to start on January 1, you must enroll by December 15, 2021.
  • Your income will determine what you will pay for your health coverage plan.
  • Applications will be accepted online, by calling 1-800-318-2596, or through a certified enrollment partner. Learn more about the different ways to apply.

This year, the Centers for Medicare and Medicaid Services (CMS) has issued $80 million in grants to fund Health Care Navigators across the country that are trained and certified to assist consumers with enrolling in a health plan. While agents and brokers are also available, Navigator Grantees are often a trusted source of information in their communities and can offer culturally competent enrollment assistance. Consumers can find local in-person assistance or an agent/broker in their area by clicking here.

¿Buscando cobertura médica? La inscripción abierta de Cuidadodesalud.gov empieza el 1 de noviembre

¡La inscripción abierta para el Mercado de Seguros Médicos por el año 2022 empezará muy pronto! Los consumidores pueden inscribirse en un plan de salud por medio de CuidadoDeSalud.gov empezando el 1 de noviembre.

Para conmemorar el Mes de la Herencia Hispana, la Liga Nacional de Consumidores (“NCL” por sus siglas en inglés) desea que los consumidores latinos conozcan sus opciones de cobertura de salud a través de los Mercados de Seguros Médicos. Los latinos constituyen el 18% de la población de los Estados Unidos y representan la población de minorías más grande (de 62.1 millones). Sin embargo, nos preocupa que solamente el 22% de los Latinos adultos (que no son mayores) no tienen cobertura de salud y representan la tasa más alta sin seguro médico de todos los grupos raciales en EE. UU.

Bajo el Plan de Rescate Americano (conocido como “American Rescue Plan” en inglés), más consumidores están elegibles por los créditos fiscales que reducen el costo de sus pagos mensuales. Aproximadamente, el 69% de los Latinos (no asegurados} pueden acceder a un plan sin costo alguno y el 80% pueden acceder a un plan que cueste menos de $50 por mes. Además, los consumidores pueden usar la plataforma CuidadoDeSalud.gov para ver si ellos o sus dependientes califican para Medicaid o el Programa de Seguro de Salud Para Niños (conocido como “CHIP” por sus siglas en ingles). Aquí está lo que necesitan saber para que usted y sus seres queridos tengan cobertura médica durante el 2022.

  1. El período de inscripción empieza el 1 de noviembre del 2021 hasta el 15 de enero del 2022. Para tener cobertura empezando el 1 de enero del 2022, necesitas inscribirte para el 15 de diciembre del 2021.
  2. Lo que tú pagarías por un plan de cobertura médica dependerá de tu ingreso anual.
  3. Se aceptarán solicitudes: En-línea, llamando al 1-800-318-2596, o cualquier sitio web de inscripción, que esté certificado. Para obtener más información sobre las diferentes formas de como inscribirse use este enlace: https://www.cuidadodesalud.gov/es/apply-and-enroll/how-to-apply/

Este año, Los Centros de Servicios de Medicare y Medicaid ha dado un subsidio de $80 millones para financiar los navegadores de salud a través del país que están calificados y certificados para ayudar con la inscripción en un plan de salud. Mientras que los agentes y corredores también están disponibles, los navegadores son una fuente de información en las comunidades latinas y ofrecen a sus comunidades asistencia confiada sobre la inscripción. Los consumidores pueden encontrar asistencia en persona o con un agente/corredor en donde viven, usando el enlace: https://ayudalocal.cuidadodesalud.gov/es/#/

Intern Spencer Cramer

Redesigning our communities to fight health disparities

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Intern Spencer CramerBy Spencer Cramer, NCL Health Policy Intern

Spencer is a student at Brandeis University, where he is studying Politics and Health: Science, Society & Policy.

The COVID-19 pandemic has fostered a better understanding of how a public health emergency can devastate different groups of Americans already negatively impacted by health problems. These health disparities, which are differences in health outcomes based on factors such as race, ethnicity, or socioeconomic status, are deeply influenced by “social determinants of health.” Social determinants of health are factors in our environments and societies that have a large impact on someone’s health status, independent of their personal choices or lifestyle.

These social factors are the main contributors to health disparities, which represent one of the ugliest faces of inequality in America today. An example of how social determinants of health and health disparities are inextricably linked can be seen in the maternal mortality crisis, where Black women are more than three times more likely to experience a pregnancy-related death than white women. This disparity can be attributed to institutional racism, lack of access to maternal health services, and the aggregate stress of dealing with discrimination on a daily basis.

Even more illuminating, one of the best predictors of health outcomes is a person’s zip code. In many major U.S. cities, the gap in life expectancy between the highest and lowest zip codes is 20+ years. Similar gaps can be seen between different cities and states. Additionally, it is clear that locations with predominantly low-income populations and many people from racial or ethnic minority groups generally experience worse health outcomes than wealthier, white areas. Geographic location is an excellent predictor of health status for a couple of reasons. Our society still has a tremendous amount of segregation, as people of the same race, ethnicity, and socioeconomic background tend to live near each other. This means that the health inequities facing these groups become disproportionately concentrated in certain neighborhoods.

Another reason for these geographic health disparities is how under-resourced the physical neighborhoods are. Poorer and heavily minority neighborhoods are less likely to have parks, green spaces, quality grocers, and health services, and they are more likely to be afflicted by environmental pollution and other societal abuses. Urban planning has a huge impact on public health. Ensuring that we build our cities to equitably distribute public services and amenities will be a critical strategy in addressing social determinants of health and eliminating health disparities.

One way to create healthier communities for all would be to increase the amount and quality of green spaces like parks or urban forests. A large body of research suggests that urban green spaces provide a wide variety of health benefits to residents ranging from increased opportunities for exercise, cleaner air, and improved mental well-being. Urban trees are proven to be particularly important for removing pollutants and addressing other environmental risks, while improving many different health outcomes. Unfortunately, green spaces, parks, and urban trees are concentrated in whiter, richer, and healthier neighborhoods. Investing in parks and green urban spaces in disadvantaged communities can go a long way towards boosting health outcomes and increasing economic opportunities for those residents.

Perhaps nothing is more important for a community’s health than access to quality, nutritious, and affordable food. Unfortunately, millions of Americans live in food deserts, areas where there is little supply of nutritious, whole foods. Again, food deserts predominate poorer neighborhoods and racial and ethnic minority communities. Living in a food desert means that people cannot access healthy or substantial food at an affordable price, inadvertently resorting to more expensive, lower nutrition food from places like convenience stores. Poor diets driven by this lack of food access cause tons of health problems and are a key driver of health disparities. As a society we often associate diet with personal choice. However, people living in food deserts usually have no option other than to eat low-quality food, and subsequently suffer from the health consequences. Ensuring that all neighborhoods and communities can easily access healthy food at affordable prices will surely help to reduce disparities in areas such as obesity, diabetes, heart disease, and others. What we eat everyday has an astronomical impact on our health, so we must make equitable access to good food a priority when creating healthier communities.

Similarly, many of the same neighborhoods plagued by food deserts also suffer from a stunning lack of access to health and medical services. Many healthcare resources are concentrated in areas with higher insurance rates, especially places with high rates of private insurance, leaving neighborhoods with many uninsured or Medicaid-eligible residents without needed health providers. The health consequences caused by the uneven distribution of health services can be devastating and can result in the delay in crucial preventive health screenings. To address this, we can provide incentives, like additional funding or student loan forgiveness to health care providers who practice in underserved communities, and implement public policies to achieve an equitable geographic distribution of medical resources.

A final factor that leads to these health inequalities between zip codes is pollution. It is certainly no secret that environmental pollutants are often horribly damaging to human health. They can cause diseases ranging from asthma to cancer, and are devastating for any community that they afflict. And of course, pollution has a disparate impact on lower-income and predominately minority communities. Developers frequently choose to build factories and other waste-producing sites in these communities because their residents have fewer resources and less political and social capital to advocate against them. Nobody should be subjected to residing in the midst of toxins and waste.

This will require a massive shift to clean energy, responsible development, and safer waste disposal. We can create more health equity by eliminating the health costs brought upon poor and minority communities by pollutants. Designing our neighborhoods and cities with a focus on public health and health equity will help to close the gaps in health outcomes between different zip codes, and should be one of our top priorities as we battle health disparities and social inequities.

April Verrett, President of Service Employees International Union Local 2015

Earlier this year, I rolled up my sleeve…

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SEIU President April VerrettBy Guest Blogger April Verrett, President of SEIU 2015

…for my COVID shot. I was tired of feeling like the virus was winning. I was sick and tired of feeling at the mercy of the whims of this unrelenting, mutating disease. I was angry that this pandemic was beating the hell out of us. So despite any fears and reservations I had about a new vaccine, I was ready to fight. And I wanted to lead by example and show that the vaccine was safe, effective, and the best way to fight against COVID-19.

That shot was more than just a way to protect myself. Like so many have noted, wearing masks and getting vaccinated are comparable to the solidarity and community spirit our grandparents and great grandparents displayed during WWII, where the nation united and everyone did their part. That’s why our Union members referenced the iconic WWII “Rosie the Riveter” image when they launched their “We Can Do It!” vaccination campaign earlier this year. Our Union helped tens of thousands of our long-term care providers, their families, and their vulnerable clients access vaccinations across the state.In the style of the famous Rosie the Riveter poster, a person is pictured wearing mask, flexing arm, and showing vaccination bandage, saying We Can Do It

I was so relieved months earlier when the vaccine became available to essential workers in California. The more than 400,000 long-term care providers I represent every day—primarily women of color—were among the first in line. Often, their communities were the hardest hit by the pandemic. Black and brown neighborhoods throughout the state consistently suffered the highest illness and death rates.

COVID took deadly aim at our members and their elderly, sick and disabled clients. They lost many of the fragile people they cared for while they themselves struggled on the terrifying font lines of the war against COVID, often without the PPE to protect themselves. These caregivers suffer lingering trauma from seeing the ravages up close in nursing homes and private homes up and down the state. Like my sister Christine, a nurse assistant at a nursing home in Bakersfield, where they lost 19 of their patients and more than a hundred of her colleagues fell ill with COVID. It breaks my heart that this is not a unique example. I heard story after story like Christine’s.

There’s one thing that slowed this devastation and protected our members and the vulnerable people they care for: vaccination. Our members see firsthand that it’s the best weapon available to rein in this pandemic, protect against infection and hopefully slow the development of dangerous variants. It’s simple: where vaccination rates are higher, rates of infection, hospitalization and death are lower. Counties across the nation again experiencing at-capacity hospitals are, sadly, the counties that have resisted the vaccine.

I’ve never seen as much misinformation thrown at our members and our communities as I’ve seen around COVID vaccines. So, we recently started a follow-up ‘We Can Do It!’ effort to dispel the dangerous—life-threatening, really—myths about vaccination.

This summer, as employers and local and state governments began to look at ways to urge more vaccination, SEIU 2015 member leaders formed a working group to ensure that Union members would have a voice in any policy, including vaccine mandates. This group developed a set of principles to guide employers and partners in our state’s continued vaccine rollout, such as making sure the vaccine is readily available and accessible, that sick days are provided for the frequent resulting flu-like symptoms and that it’s carefully scheduled to avoid staffing shortages. Days after outlining this guidance, our Governor mandated all healthcare workers to get vaccinated. Our members overwhelmingly support vaccination, but they also want to ensure that it’s accomplished thoughtfully and respectfully for our members who remained concerned.

We can do it. Together, we will defeat COVID-19.

April Verrett is President of SEIU 2015, the largest union in California, representing more than 400,000 long-term care providers (home care, skilled nursing facility, and assisted living center workers) throughout the state. Its members are as diverse as the state’s population, but united in their commitment to caring for California’s most vulnerable: seniors and the disabled. In October, Verrett will receive an award from NCL named for our first Executive Secretary Florence Kelley. To learn more about the evening of awards, click here. 

Diverse research for a diverse America: The value of equitable, real-world research

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By Sally Greenberg, NCL Executive Director

While the COVID-19 pandemic has led to hardship for all Americans, it is clear that people of color have been disproportionately burdened. Across the health care continuum, addressing this disparity has become part of the broader conversation about the history of systemic racism and the underlying social determinants of health that negatively affect the mental, physical, and economic health of individuals and entire communities.

The pandemic has underscored persistent health disparities, and there is growing recognition that representation in research and clinical trials can have a profound impact on health outcomes. A lack of representation from racially and ethnically diverse groups in research and clinical trials have typically led to gaps in data, missing the opportunity to assess the full impact of various treatments and drugs across a range of populations. The collection and use of real-world research and data to inform the potential use, risks, and benefits of medical products and treatments can ultimately lead to better health outcomes, particularly for those who have been underrepresented in the past.

Existing efforts to improve inclusion

Efforts to expand diversity and representation in medical research are underway in Congress. Policymakers are encouraging the incorporation of Real World Evidence (RWE) in drug development through the recent Cures 2.0 draft legislation released by Reps. Diana Degette (D-CO-1) and Fred Upton (D-MI-6). While the status quo limits us from effectively reaching underserved populations, the proposed legislation would allow studies that include RWE for some drugs after they have been approved. At the heart of this issue is a growing appreciation that the same therapy can affect different populations in different ways, which is why Cures 2.0 supports collecting data that more accurately reflects the unique experiences and needs of patients across diverse populations.

Recognizing the potential for RWE in maternal health

The lack of representative research in the field of maternal health is undeniable, and its implications are staggering. The dismal state of maternal care in the United States reflects how our health care system has failed women of color, including by not adequately studying treatment options to prevent maternal morbidity and mortality. The need for RWE is clear when you consider the persistent disparities in health outcomes that plague minority communities.

Preterm birth and its disproportionate impact on women of color is a stark illustration of the need to make progress on representative research in maternal health. Preterm birth is the second-largest contributor to infant death in America today. Despite the tremendous physical, emotional, and financial toll that preterm birth continues to take on our country — disproportionately so on women and families of color — not enough therapeutic tools currently exist to prevent it.

Today, “17P,” the only FDA-approved treatment to help reduce the likelihood of spontaneous, recurrent preterm birth in the United States is at-risk of being withdrawn from the market in all its forms, including the branded product and five generic versions. Unfortunately there is conflicting evidence from two different clinical trials, one representative of a diverse U.S. population and another studied in a largely white population in Europe. It’s not a straightforward comparison. If 17P is withdrawn, the women most affected by preterm birth, predominantly women of color, would be left without an FDA-approved treatment option.

The FDA is considering the path forward, including additional data collection through leveraging RWE from past patient use. The success of the first (approval) trial for 17P in the impacted communities signals the importance of RWE. Continued access to 17P is, at its core, a matter of health equity. Black women must not yet again be left vulnerable to a system that historically has overlooked them.

NCL Public Policy Intern Tom Pahl

The complete picture: The need for alcohol labeling

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NCL Public Policy Intern Tom PahlBy Tom Pahl, NCL Policy Intern

Tom Pahl is a 2021 graduate of Skidmore College, where he received a Bachelor of Arts degree in Political Science.

Just about every consumable food and drug product has a label with information about the contents—from over-the-counter medications, dietary supplements, sodas, and chips to the candy bars we nab from a convenience store. And consumers rely on these labels to make sound purchasing decisions. Surveys show that about 77 percent of Americans use the standardized Nutrition Facts label required by the Food and Drug Administration (FDA). Yet, there is one type of consumable product where we don’t have this option: alcoholic beverages.

It is not an overstatement to say that alcoholic beverages have been part of human civilization since early humankind. Archeologists trace the first wine drinks to China around 7000 BC. Additionally, beverage alcohol has a fabled history in the United States, underscored by the so-called “noble experiment” called Prohibition from 1920-1933. In fact, Prohibition is the reason that regulation of most alcoholic beverages—including content labeling—is the responsibility of the Treasury Department’s Alcohol and Tobacco Tax and Trade Bureau (TTB).

Yet, the Federal Alcohol Administration Act, passed in 1935, created an exception to the rule. When alcoholic beverages contain more than 7 percent alcohol by volume, a standard measure known as ABV, TTB requires alcohol labeling. However, below 7 percent ABV, alcohol labeling falls under the purview of the FDA. This means different requirements for grape wine, sparkling or carbonated wine, fruit wine, saké, wine coolers, cider, and de-alcoholized or partially de-alcoholized wine. The requirements also apply to beers not made from malted barley, but instead malted barley substitutes, or made without hops like kombucha and gluten-free beer.

Why does this matter? Because alcoholic beverages regulated by FDA have the same standardized Nutrition Facts label as a soft drink (along with the ABV). This includes hard ciders and sparking wines that have taken the world by a storm in the past few years. In contrast, TTB allows the manufacturers of all other alcoholic beverages to “decide” whether to include nutritional labeling and, guess what? Surprise, surprise, the vast majority have no nutritional labels. Even more confounding, in any refrigerator, a bottle of beer and a bottle of hard cider made by the same company—to wit, Sam Addams beer and Angry Orchard Cider, made by the Boston Brewing Company—the beer has no nutritional information and the cider is fully labeled, proving that unless companies are required to label, they don’t do it!

It is true that TTB requires beer, spirits and wine makers to put specific information on product labels – including the type of alcohol, the alcohol content (ABV or proof), the net contents of the beverage, the coloring materials used, whether the beverage contains allergens, and the country of origin. As important as they are, these facts have nothing to do with health and nutrition and this information is more important than ever before due to the epidemic of obesity in the United States (almost 20 percent of men and 6 percent of women consume more than 300 calories from alcohol per day, according to the Centers for Disease Control and Prevention) and higher rates of diet-related diseases.

We know that when required by FDA, alcohol beverage manufacturers have figured out how to put a complete alcohol content label on their products. National Consumers League, along with other consumer organizations and public health groups, will continue to press TTB to issue a final rule requiring a mandatory Alcohol Facts label on all beer, wine and distilled spirits products. In 2021, consumers deserve the kind of robust labeling we see on other foods and which consumers understand, use, and need to make informed buying choices.

Addressing vaccine hesitancy with community-driven messaging

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Nissa Shaffi

By Nissa Shaffi, NCL Associate Director of Health Policy, featuring an interview with Jens Dakin, Managing Director of AM LLC

After months of vaccine review and approval informing an arduous national vaccination campaign, nearly half of the country has been fully vaccinated against COVID-19. However, despite these efforts, we’ve narrowly missed the national goal of 70 percent of Americans receiving at least one dose by July 4. Even though there is overwhelming evidence in support of the COVID-19 vaccines and their safety, vaccine hesitancy still looms.

On July 8, the NCL health team met with Jens Dakin, Managing Director of Strategic Engagement at AM LLC. AM LLC is a health and research informatics firm that provides public health related, mission critical services in information, communications, and technology to federal, state, and local government clients. Since March 2020, AM has partnered with government agencies to control, isolate, and mitigate the spread of COVID-19 through various community engagement and vaccine quality assurance measures. Below is a snapshot of our conversation.

Nissa: For over 120 years, the National Consumers League has advocated for consumer protections in health care. A big part of our work involves fostering vaccine confidence. We do this through direct consumer engagement, testifying before federal vaccine committees, like the CDC and FDA, and our Script Your Future campaign, where we engage with pharmacy students to increase vaccine uptake. We would love it if you could tell us a little about AM Trace work in vaccine confidence.

Jens DakinJens: Thank you, and nice to meet you both. AM was founded about 10 years ago to provide services to the federal government in research, communications, and healthcare IT. When COVID-19 spread to the US there was a lot of effort by the federal and state governments to keep people safe with COVID-19 threat mitigation, and then to get people to take the vaccine. AM now provides capabilities in five critical services to state and local governments, including staffing and training of public health personnel, technology support infrastructure, public awareness outreach campaigns, stakeholder collaboration. We work with key public servants to help increase capacity pertaining to COVID operations.

Spencer: When you first enter a community, how do you get your foot in the door and begin to understand the specific needs of the community so you can begin to build your campaign strategy?

JD: Ultimately, we don’t like to enter a community cold. We undertake lots of research before hitting the ground to understand the demographics and the local context. It is important for us that our local partners know the area, the people and have the access we need. Whether it’s an African American community, or a White, rural Republican-leaning county, we can make some educated guesses, but we certainly cannot make assumptions about the individuals without the local data and insight. This initial research frames how we empathize and engage with the community, allowing us to develop more credible messages that will resonate better. We don’t tend to advocate mass media campaigns, especially now when there is a need to persuade the vaccine holdouts, because the mass campaigns haven’t worked with them.

NS: On mass vaccination campaigns, I recently came into contact with an old friend that has become increasingly anti-vaccine and cited vaccine lotteries and giveaways as suspect. Do you think that these mass efforts are causing more harm than good?

JD: I believe that they have achieved what they set out to do. They have worked to an extent, to get the people who want to be vaccinated, vaccinated. Unfortunately, there is now considerable distrust in government authority in our society – much of it caused by the spread of misinformation and disinformation. Your friend views her belief as completely rational based on the information she has. For the vaccine holdouts, the message needs to come from a trusted voice and delivered in a non-intrusive way. What we are seeing working in some cases is developing a series of different “micro-interventions”, in the form face-to-face conversations, a series of emails or chats on a group message board. We can even learn lessons from deradicalization programs that have helped to sway people away from the path towards terrorism, where we listen, understand, and engage with empathy.

NS: I really like the idea of “micro-interventions”. Is there a designated period of time you allow yourself in a particular community to test these messages and strategies to see if they land before moving on from that group?

JD: We have to test and adjust all the time. This is an evolving situation. You really just need to remember that when you convince someone to get vaccinated, you’re potentially saving their life. If you keep building that relationship with the community, that can end up going a long way. This is why it’s so important that our local messengers, or canvassers, are all from the communities we are engaging within.

NS: Could you provide some examples of success stories as a result of these interventions?

JD: In NYC, AM’s teams have spoken with over 180,000 residents and as a direct result of our personalized messaging campaigns and direct engagement within [mainly minority] communities, encouraged over 50,000 people to book vaccination appointments. In Anchorage AK, AM’s teams identified, contacted, and built relationships with individuals living in both urban and rural communities with the goal of addressing vaccine hesitancy and booking vaccination appointments. During a single 6-week span of all the unvaccinated people they spoke with, they arranged for nearly 20 percent of them to get vaccinated.

NS: Who do you use in community outreach to build these relationships?

JD: We don’t tend to use professional canvassers. We prefer to recruit and train local canvassers specifically from their community. We speak with the community and individuals to find out who the local influencers are – who they trust. We meet with them and ask them to work with us because need them to become our message multipliers within that community.

NS: The COVID-19 vaccine development and approval process has been as novel as the disease itself. We’ve had the privilege of witnessing science unfold in real time, and along with that, comes a lot of trial and error, as we’ve seen with the momentary pause in the J&J vaccine and the new cases of myocarditis in pediatric populations. How do you mitigate the derailment of messaging, which have been extensively tested, by rise in these developments?

JD: Well, we know that with these holdouts, and these “wait and see” groups, science and facts won’t sway them. The issue is not necessarily about vaccine information, there is a lot of information out there. So, if you’re using science to try to convince people who are ideologically entrenched in one belief or another, they might not understand what you’re trying to say which will turn them off, or they may come up with counter arguments or “counter-facts” that support their own beliefs. They may also exist in information silos, or information echo chambers, that feed them information which confirm their biases. So no, using science will often not work with hold out groups. Which is why we need to find more innovative methods that focus on more accessible and personal benefits of vaccination.

NS: AM trace has a great vaccine confidence toolkit for community leaders which mentions the importance of decision autonomy for patients in vaccine confidence. With public sentiment headed towards vaccine mandates, to possibly issuing vaccine passports– do you see any challenges with that? How can advocates help reduce weariness around these initiatives in a way that is aligned with an individual’s constitutional rights?

JD: As communicators, we should not have any say in developing policy. Whether vaccine mandates are right or wrong, is not an issue I will discuss here. What I will say is that for those employers and institutions who are mandating it, when developing their campaign is that words matter, and the messaging and messengers matter. Employers need to understand that their ‘single’ workforce is made up of many separate communities each with their own concerns and beliefs. You need to understand the behavioral and emotional context that people exist in order to have the best chances of success. The toolkit you mentioned provides communication planners with an overview of what to consider when developing behavior change campaigns. It works very well in the COVID-19 context.

NCL Health Policy Intern Spencer Cramer contributed to this blog.

Don’t forget to take advantage of Healthcare.gov Special Enrollment Period

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By Special Guest Kelley Schultz, Executive Director, Commercial Policy, America’s Health Insurance Plans and NCL Director of Health Policy Jeanette Contreras

More than 2 million Americans nationwide—1.5 million in healthcare.gov states, and an additional 600,000 individuals in states that run their own exchanges—have signed up for coverage during the 2021 Marketplace Special Enrollment Period that extends through August 15. Earlier this year, President Biden launched a new special enrollment period for the 36 states using healthcare.gov—and states that run their own marketplaces followed suit—to help people get health coverage and peace of mind.

Millions of Americans still have the opportunity to enroll in new health insurance plans through the healthcare.gov marketplace, whether they’re uninsured or currently enrolled and wish to switch plans.

The American Rescue Plan Act of 2021 temporarily increased the availability and generosity of the Affordable Care Act’s premium subsidies. As a result, 3.7 million Americans are eligible for expanded financial assistance to make premiums more affordable, including people who didn’t qualify for financial assistance before.

This Special Enrollment Period is a crucial opportunity as the country comes out of the COVID-19 pandemic and the financial hardship experienced by many—a quarter of U.S. adults say they or someone in their household has been laid off, with even more seeing reduced pay. The expanded opportunity for people to enroll in marketplace health plans with enhanced affordability is a major development that will provide much needed assistance to Americans who have faced economic stresses over the past year.

The deadline to enroll in coverage during the healthcare.gov Special Enrollment Period is August 15. States that run their own exchanges may have different deadlines, so consumers should check when their state’s special enrollment period ends. Additionally, current enrollees should return to healthcare.gov to check to access enhanced subsidies to lower their monthly premium and see if they can get additional savings by switching to a high-value plan with lower cost sharing.

The relief bill extended subsidies to 3.7 million people to help lower their monthly premiums and out-of-pocket costs, including people with incomes over 400% of the Federal Poverty Level ($51,040 for an individual or $104,800 for a family of four). Anyone with incomes below 150% of the federal poverty level ($19,140 for an individual or $39,300 for a family of four) is eligible for a high-value plan with a $0 premium and a very low deductible.

These increased subsidies make quality health insurance coverage more affordable for millions of Americans who are encouraged to visit healthcare.gov or their state exchange to see how they can sign up. Health coverage will start on the first day of the month after you select a plan, so it is important that enrollees consider this timeline while making their decisions.

Some SEP resources:

  • For help selecting a plan in any number of languages, you can access a navigator in your area here.
  • More information about the health insurance marketplace and the Special Enrollment Period can be found here.
  • Use a decision tree tool to see if you are eligible for the special enrollment period and get other fast facts here.