program areas Digital Health

The Center for Digital Democracy (CDD) endorses the Federal Trade Commission’s (FTC) proposal to better protect health consumer and patient information in the digital era. CDD warned the commission in 2010, as well as in its 2022 commercial surveillance comments, that health data—including information regarding serious medical conditions—are routinely (and cynically) gathered and used for online marketing. This has placed Americans at risk—for loss of their privacy, health-decision autonomy, and personal financial security. The commercial surveillance health data digital marketing system also triggers major strains on the fiscal well-being of federal and private health insurance systems, creating demand for products and services that can be unnecessary and costly. The commission should “turn off the tap” of data flooding the commercial surveillance marketplace, including both direct and inferred health information. The commission can systemically address the multiple data flows—including those on Electronic Health Record (EHR) systems—that require a series of controls. EHR, or personal health record systems, have served as a digital “Achilles heel” of patient privacy, with numerous commercial entities seizing that system to influence physicians and other prescribers as well as to gain insights used for ongoing tracking. The commercialization of health-connected data is ubiquitous, harvested from mobile “apps,” online accounts, loyalty programs, social media posts, data brokers, marketing clouds and elsewhere. Given the contemporary commercial data analytic affordances to generate insights and actions operational today, information gathered for other purposes can be used to generate health-related data. Health information can be combined with numerous other datasets that can reveal ethnicity, location, media use, etc., to create a robust target marketing profile. As programmatic advertising trade publication “AdExchanger” recently noted, “sensitive health data can be collected or revealed through dozens of noncovered entities, from location data providers to retail media companies. And these companies aren’t prevented from sharing data, unless the data was sourced from a covered entity.” The FTC’s Health Breach Notification Rule (HBNR) proposal comes at an especially crucial time for health privacy in the U.S. A recent report on “The State of Patient Privacy,” as noted by Insider Intelligence/eMarketer in July 2023, shows that a majority of Americans “distrust” the role that “Big Tech Companies” play with their health data. A majority of patients surveyed explained that “they are worried about security and privacy protections offered by vendors that handle their health data.” Ninety-five percent of the patients in the survey “expressed concern about the possibility of data breaches affecting their medical records.” These concerns, we suggest, reflect consumer unease regarding their reliance on the online media to obtain health information. For example, “half of US consumers use at least one health monitoring tool,” and “healthcare journeys often start online,” according to the “Digital Healthcare Consumer 2023” report. There is also a generational shift in the U.S. underway, where at least half of young adults (so-called Generation Z) now “turn to social media platforms for health-related purposes either all the time or often…via searches, hashtags QR codes…[and] have the highest rate of mobile health app usage.” The Covid-19 pandemic triggered greater use of health-related apps by consumers. So-called “telehealth” services generate additional data as well, including for online “lead generation.” The growing use of “digital pharmacies” is being attributed to the rising costs of medications—another point where consumer health data is gathered. The FTC should ensure the health data privacy of Americans who may be especially vulnerable—such as those confronting financial constraints, pre-existing or at-risk conditions, or have long been subjected to predatory and discriminatory marketing practices—and who are especially in need of stronger protections. These should include addressing the health-data-related operations from the growing phalanx of retail, grocery, “dollar,” and drug store chains that are expanding their commercial surveillance marketing operations (so-called “retail media”), while providing direct-to-consumer delivered health services. Electronic Health Record systems are a key part of the health and commercial surveillance infrastructure: EHRs have long served as “prime real estate for marketers…[via] data collection, which makes advanced targeting a built-in benefit of EHR marketing.” EHRs are used to influence doctors and other prescribers relying on what’s euphemistically called point-of-care marketing. Marketing services for pharmaceutical and other life science companies can be “contextually integrated into the EHR workflow [delivered] to the right provider at the right time within their EHR [using] awareness messaging targeted on de-identified real-time data specific to the patient encounter.” Such applications are claimed to operate as “ONC-certified and HIPPA-compliant (ONC stands for “Office of the National Coordinator for Health Information,” HHS). The various, largely unaccountable, methods used to target and influence how physicians treat their patients by utilizing EHRs raise numerous privacy and consumer protection issues. For example, “EHR ads can appear in several places at all the stages along the point-of-care journey,” one company explained. Through an “E-Prescribing Screen,” pharma companies are able to offer “co-pay coupons, patient savings offers and relevant condition brand messaging.” Data used to target physicians, including prescription information derived from a consumer, using EHR systems, help trigger more information from and about a health consumer (think about the subsequent role of drug stores, search engines and social media use, gathering of data for coupons, etc.). This “non-virtuous” circle of health surveillance should be subjected to meaningful health data breach and security safeguards. Patient records on EHRs must be safeguarded and the methods used to influence healthcare professionals require major privacy reforms. Contemporary health data systems reflect the structures that comprise the overall commercial surveillance apparatus, including databrokers, marketing clouds, AI: The use of digital marketing to target U.S. health consumers has long been a key “vertical” for advertisers. For example, there are numerous health-focused subsidiaries run by the leading global advertising agencies, all of which have extensive data-gathering and targeting capabilities. These include Publicis Health: “Our proprietary data and analytics community, paired with the unsurpassed strengths of Sapient and Epsilon allow us to deliver unmatched deterministic, behavioral, and transactional data, powered by AI.” IPG Health uses “a proprietary…media, tech and data engine [to] deliver personalized omnichannel experiences across touchpoints.” Its “comprehensive data stack [is] powered by Acxiom.” Ogilvy Health recently identified some of the key social media strategies used by pharmaceutical firms to generate consumer engagement with their brands—helping generate invaluable data. They include, for example, a “mobile-first creative and design approach,” including the use of “stickers, reels, filters, and subtitles” on Instagram and well as “A/B testing” on Facebook and the use of “influencers.” A broad range of consumer-data-collecting partners also operates in this market, providing information and marketing facilitation. Google, Meta, Salesforce, IQVIA, and Adobe are just a few of the companies integrated into health marketing services designed to “activate customer journeys (healthcare professionals and patients) across physical and digital channels [using] real-time, unified data.” Machine learning and AI are increasingly embedded in the health data surveillance market, helping to “transform sales and marketing outcomes,” for example. The use of social media, AI and machine learning, including for personalization, raises concerns that consent is insufficient alone for the release of patient and consumer health information. The commission should adopt its proposed rule, but also address the system-wide affordances of commercial surveillance to ensure health data is truly protected in terms of privacy and security. The commission should endorse a patient health record information definition that reflects both the range and type of data collected, but also the processes used to gather or generate it. The prompting and inducement of physicians, for example, to prescribe specific medications or treatments to a patient, based on the real-time “point-of-care” information transmitted through EHRs, ultimately generate identifiable information. So any interaction and iterative process used to do so should be covered under the rule, reflecting all the elements involved in that decision-making and treatment determinative process. By ensuring that all the entities involved in this system—including health care services or suppliers—must comply with data privacy and security rules, the commission will critically advance data protection in the health marketplace. This should include health apps, which increasingly play a key role in the commercial data-driven marketing complex. All partnering organizations involved in the sharing, delivering, creating and facilitation of health record information should also be held accountable. We applaud the FTC’s work in the health data privacy area, including its important GoodRx case and its highlighting the role that “dark patterns” play in “manipulating or deceiving consumers.” Far too much of the U.S. health data landscape operates as such a “dark pattern.” The commission’s proposed HBNR rules will illuminate this sector, and, in the process, help secure greater privacy and protection for Americans.

There is a digital data “gold rush” fever sweeping the data and marketing industry, as the quest to find ways to use data to determine a person’s “identity” for online marketing becomes paramount. This is triggered, in part, by the moves made by Google and others to replace “cookies” and other online identifiers with new, allegedly pro-privacy data-profiling methods to get the same results. We’ve addressed this privacy charade in other posts. In order to better position themselves in a world where knowing who we are and what we do is a highly valuable global currency, there are an increasing number of mergers and acquisitions in the digital marketing and advertising sector.For example, last week data-broker giant TransUnion announced it is buying identity data company Neustar for $3.1 billion dollars, to further expand its “powerful digital identity capabilities.” This is the latest in TransUnion’s buying spree to acquire data services companies that give it even more information on the U.S. public, including what we do on streaming media, via its 2020 takeovers of connected and streaming video data company Tru Optik (link is external) and the data-management-focused Signal. (link is external)In reviewing some of the business practices touted by TransUnion and Neustar, it’s striking that so little has changed in the decades CDD has been sounding the alarm about the impacts data-driven online marketing services have on society. These include the ever-growing privacy threats, as well as the machine-driven sorting of people and the manipulation of our behaviors. So far, nothing has derailed the commercial Big Data marketing.With this deal, TransUnion is obtaining a treasure trove of data assets and capabilities. For Neustar, “identity is an actionable understanding of who or what is on the other end of every interaction and transaction.” Neustar’s “OneID system provides a single lens on the consumer across their dynamic omnichannel journey.” This involves: (link is external) data management services featuring the collection, identification, tagging, tracking, analyzing, verification, correcting and sorting of business data pertaining to the identities, locations and personal information of and about consumers, including individuals, households, places, businesses, business entities, organizations, enterprises, schools, governments, points of interest, business practice characteristics, movements and behaviors of and about consumers via media devices, computers, mobile phones, tablets and internet connected devices.Neustar keeps close track of people, saying that it knows that “the average person has approximately 15 distinct identifiers with an average of 8 connected devices” (and notes that an average household has more than 45 such distinct identifiers). Neustar has an especially close business partnership with Facebook, (link is external) which enables marketers to better analyze how their ads translate into sales made on and spurred by that platform. Its “Customer Scoring and Segmentation” system enables advertisers to identify and classify targets so they can “reach the right customer with the right message in the right markets.” Neustar has a robust data-driven ad-targeting system called AdAdvisor, which reaches 220 million adults in “virtually every household in the U.S.” AdAdvisor (link is external) “uses past behavior to predict likelihood of future behavior” and involves “thousands of data points available for online targeting” (including the use of “2 billion records a month from authoritative offline sources”). Its “Propensity Audiences” service helps marketers predict the behaviors of people, incorporating such information (link is external) as “customer-level purchase data for more than 230 million US consumers; weekly in-store transaction data from over 4,500 retailers; actual catalog purchases by more than 18 million households”; and “credit information and household-level demographics, used to build profiles of the buying power, disposable income and access to credit a given household has available.” Neustar offers its customers the ability to reach “propensity audiences” in order to target such product categories as alcohol, automotive, education, entertainment, grocery, life events, personal finance, and more. For example, companies can target people who have used their debit or credit cards, by the amount of insurance they have on their homes or cars, by the “level of investable assets,” including whether they have a pension or other retirement funds. One also can discover people who buy a certain kitty litter or candy bar—the list of AdAdvisor possibilities is far-reaching.Another AdAdvisor application, “ElementOne,” (link is external) comprises 172 segments that can be “leveraged in real time for both online and offline audience targeting.” The targeting categories should be familiar to anyone who is concerned about how groups of people are characterized by data-brokers and others. For example, one can select “Segment 058—high income rural younger renters with and without children—or “Segment 115—middle income city older home owners without children; or any Segment from 151-172 to reach “low income” Americans who are renters, homeowners, have or don’t have kids, live in rural or urban areas, and the like.Marketers can also use AdAdvisor to determine the geolocation behaviors of their targets, through partnerships that provide Neustar with “10 billion daily location signals from 250+ million opted-in consumers.” In other words, Neustar knows whether you walked into that liquor store, grocery chain, hotel, entertainment venue, or shop. It also has data on what you view on TV, streaming video, and gaming. And it’s not just consumers who Neustar tracks and targets. Companies can access its “HealthLink Dimensions Doctor Data to target 1.7 million healthcare professionals who work in more than 400 specialties, including acute care, family practice, pediatrics, cardiovascular surgery.”TransUnion is already a global data and digital marketing powerhouse, with operations in 30 countries, 8,000 clients that include 60 of the Fortune 100. What is calls its “TruAudience Marketing Solutions (link is external)” is built on a foundation of “insight into 98% of U.S. adults and more than 127 million homes, including 80 million connected homes.” Its “TruAudience Identity” product provides “a three-dimensional, omnichannel view of individuals, devices and households… [enabling] precise, scalable identity across offline, digital and streaming environments.” It offers marketers and others a method to secure what it terms is an “identity resolution,” (link is external) which is defined as “the process of matching identifiers across devices and touchpoints to a single profile [that] helps build a cohesive, omnichannel view of a consumer….”TransUnion, known historically as one of the Big Three credit bureaus, has pivoted to become a key source for data and applications for digital marketing. It isn’t the only company expanding what is called an “ID Graf (link is external)”—the ways all our data are gathered for profiling. However, given its already vast storehouse of information on Americans, it should not be allowed to devour another major data-focused marketing enterprise.Since this merger is now before the U.S. Department of Justice—as opposed to the Federal Trade Commission—there isn’t a strong likelihood that in addition to examining the competitive implications of the deal, there will also be a focus on what this really means for people, in terms of further loss of privacy, their autonomy and their potential vulnerability to manipulative and stealthy marketing applications that classify and segment us in a myriad of invisible ways. Additionally, the use of such data systems to identify communities of color and other groups that confront historic and current obstacles to their well-being should also be analyzed by any competition regulator.In July, the Biden Administration issued (link is external) an Executive Order on competition that called for a more robust regime to deal with mergers such as TransUnion and Neustar. According to that order, “It is also the policy of my Administration to enforce the antitrust laws to meet the challenges posed by new industries and technologies, including the rise of the dominant Internet platforms, especially as they stem from serial mergers, the acquisition of nascent competitors, the aggregation of data, unfair competition in attention markets, the surveillance of users, and the presence of network effects.”We hope the DOJ will live up to this call to address mergers such as this one, and other data-driven deals that are a key reason why these kind of buyouts happen with regularity. There should also be a way for the FTC—especially under the leadership of Chair Lina Khan—to play an important role evaluating this and similar transactions. There’s more at stake than competition in the data-broker or digital advertising markets. Who controls our information and how that information is used are the fundamental questions that will determine our freedom and our economic opportunities. As the Big Data marketplace undergoes a key transition, developing effective policies to protect public privacy and corporate competition is precisely why this moment is so vitally important.

“Big Food” and “Big Data” Online Platforms Fueling Youth Obesity Crisis as Coronavirus Pandemic RagesNew Report Calls for Action to Address Saturation of Social Media, Gaming Platforms, and Streaming Video with Unhealthy Food and Beverage Products Contact: Jeff Chester (202-494-7100) For Immediate ReleaseWashington, DC, May 12, 2021A report released today calls for federal and global action to check the growth of digital marketing of food and beverage products that target children and teens online. Tech platforms especially popular with young people—including Facebook’s Instagram, Amazon’s Twitch, ByteDance’s TikTok, and Google’s YouTube – are working with giant food and beverage companies, such as Coca Cola, KFC, Pepsi and McDonald’s, to promote sugar-sweetened soda, energy drinks, candy, fast food, and other unhealthy products across social media, gaming, and streaming video. The report offers fresh new analysis and insight into the most recent industry practices, documenting how “Big Food” and “Big Tech” are using AI, machine learning, and other data-driven techniques to ensure that food marketing permeates all of the online cultural spaces where children and teenagers congregate. The pandemic has dramatically increased exposure to these aggressive new forms of marketing, further increasing young people’s risks of becoming obese. Black and Brown youth are particularly vulnerable to new online promotional strategies. Noting that concerns about youth obesity have recently fallen off the public radar in the U.S., the report calls for both international and domestic policies to rein in the power of the global technology and food industries. The report and an executive summary are available at the Center for Digital Democracy’s (CDD) website, along with other background material.“Our investigation found that there is a huge amount of marketing for unhealthy foods and beverages all throughout the youth digital media landscape, and it has been allowed to flourish with no government oversight,” explained Kathryn C. Montgomery, PhD, the report’s lead author, Professor Emerita at American University and CDD’s Senior Strategist. “We know from decades of research that marketing of these products contributes to childhood obesity and related illnesses. And we’ve witnessed how so many children, teens, and young adults suffering from these conditions have been particularly vulnerable to the coronavirus. Both the technology industry and the food and beverage industry need to be held accountable for creating an online environment that undermines young people’s health.”The report examines an array of Big Data strategies and AdTech tools used by the food industry, focusing on three major sectors of digital culture that attract large numbers of young people -- the so-called “influencer economy,” gaming and esports platforms, and the rapidly expanding streaming and online video industry.Dozens of digital campaigns by major food and beverage companies, many of which have won prestigious ad industry awards, illustrate some of the latest trends and techniques in digital marketing:The use of influencers is one of the primary ways that marketers reach and engage children and teens. Campaigns are designed to weave branded material “seamlessly into the daily narratives” shared on social media. Children and teens are particularly susceptible to influencer marketing, which taps into their psycho-social development. Marketing researchers closely study how young people become emotionally attached to celebrities and other influencers through “parasocial” relationships.McDonald’s enlisted rapper Travis Scott, to promote the “Travis Scott Meal” to young people, featuring “a medium Sprite, a quarter pounder with bacon, and fries with barbecue sauce.” The campaign was so successful that some restaurants in the chain sold out of supplies within days of its launch. This and other celebrity endorsements have helped boost McDonald’s stock price, generated a trove of valuable consumer data, and triggered enormous publicity across social media.Food and beverage brands have flocked to Facebook-owned Instagram, which is considered one of the best ways to reach and engage teens.According to industry research, nearly all influencer campaigns (93%) are conducted on Instagram. Cheetos’ Chester Cheetah is now an “Instagram creator,” telling his own “stories” along with millions of other users on the platform.One Facebook report, “Quenching Today’s Thirsts: How Consumers Find and Choose Drinks,” found that “64% of people who drink carbonated beverages use Instagram for drinks-related activities, such as sharing or liking posts and commenting on drinks content,” and more than a third of them report following or “liking” soft drink “brands, hashtags, or influencer posts.”The online gaming space generates more revenue than TV, film or music, and attracts viewers and players – including many young people -- who are “highly engaged for a considerable length of time.” Multiplayer online battle arena (MOBA) and first-person shooter games are considered one of the best marketing environments, offering a wide range of techniques for “monetization,” including in-game advertising, sponsorship, product placement, use of influencers, and even “branded games” created by advertisers. Twitch, the leading gaming platform, owned by Amazon, has become an especially important venue for food and beverage marketers. Online gamers and fans are considered prime targets for snack, soft drink, and fast food brands, all products that lend themselves to uninterrupted game play and spectatorship.PepsiCo’s energy drink, MTN DEW Amp Game Fuel, is specifically “designed with gamers in mind.” To attract influencers, it was featured on Twitch’s “Bounty Board,” a one-stop-shopping tool for “streamers,” enabling them to accept paid sponsorship (or “bounties”) from brands that want to reach the millions of gamers and their followers.Red Bull recently partnered with Ninja“the most popular gaming influencer in the world with over 13 million followers on Twitch, over 21 million YouTube subscribers, and another 13 million followers on Instagram.”Dr. Pepper featured the faces of players of the popular Fortnite game on its bottles, with an announcement on Twitter that this campaign resulted in “the most engaged tweet” the soft-drink company had ever experienced.Wendy’s partnered with “five of the biggest Twitch streamers,” as well as food delivery app Uber Eats, to launch its “Never Stop Gaming” menu, with the promise of “five days of non-stop gaming, delicious meal combos and exclusive prizes.” Branded meals were created for each of the five streamers, who offered their fans the opportunity to order directly through their Twitch channels and have the food delivered to their doors.One of the newest marketing frontiers is streaming and online video, which have experienced a boost in viewership during the pandemic. Young people are avid users, accessing video on their mobile devices, gaming consoles, personal computers, and online connections to their TV sets.Concerned that teens “are drinking less soda,” Coca-Cola’s Fanta brand developed a comprehensive media campaign to trigger “an ongoing conversation with teen consumers through digital platforms” by creating four videos based on the brand’s most popular flavors, and targeting youth on YouTube, Hulu, Roku, Crackle, and other online video platforms. “From a convenience store dripping with orange flavor and its own DJ cat, to an 8-bit videogame-ified pizza parlor, the digital films transport fans to parallel universes of their favorite hangout spots, made more extraordinary and fantastic once a Fanta is opened.”New video ad formats allow virtual brand images to be inserted into the content and tailored to specific viewers. “Where one customer sees a Coca-Cola on the table,” explained a marketing executive, “the other sees green tea. Where one customer sees a bag of chips, another sees a muesli bar… in the exact same scene.”The major technology platforms are facilitating and profiting from the marketing of unhealthy food and beverage products.Facebook’s internal “creative shop” has helped Coca-Cola, PepsiCo, Unilever, Nestle and hundreds of other brands develop global marketing initiatives to promote their products across its platform. The division specializes in “building data-driven advertising campaigns, branded content, branded entertainment, content creation, brand management, social design,” and similar efforts.Google regularly provides a showcase for companies such as Pepsi, McDonald’s and Mondelez to tout their joint success promoting their respective products throughout the world.For example, Pepsi explained in a “Think with Google” post that it used Google’s “Director’s Mix” personalization video advertising technology to further what it calls its ability to “understand the consumer’s DNA,” meaning their “needs, context, and location in the shopping journey.” Pepsi could leverage Google’s marketing tools to help its goal of combining “insights with storytelling and drive personalized experiences at scale.”Hershey’s has been working closely with Amazon to market its candy products via streaming video, as well as through its own ecommerce marketplace. In a case study published online, Amazon explained that “…as viewing consumption began to fragment, the brand [Hershey’s] realized it was no longer able to reach its audience with linear TV alone.” Amazon gave Hershey’s access to its storehouse of data so the candy company could market its products on Amazon’s streaming services, such as IMDbTV. Amazon allowed Hershey’s to use Amazon’s data to ensure the candy brands would “be positioned to essentially ‘win’ search in that category on Amazon and end up as the first result….” Hershey’s also made use of “impulse buy” strategies on the Amazon platform, including “cart intercepts,” which prompt a customer to “add in snacks as the last step in their online shopping trip, mimicking the way someone might browse for candy during the checkout at a physical store.”Some of the largest food and beverage corporations—including Coca-Cola, McDonald’s, and Pepsi—have, in effect, transformed themselves into Big Data businesses.Coca-Cola operates over 40 interconnected social media monitoring facilities worldwide, which use AI to follow customers, analyze their online conversations, and track their behaviors.PepsiCo has developed a “fully addressable consumer database” (called “Consumer DNA”) that enables it to “see a full 360 degree view of our consumers.”McDonald’s made a significant investment in Plexure, a “mobile engagement” company specializing in giving fast food restaurants the ability “to build rich consumer profiles” and leverage the data “to provide deeply personalized offers and content that increase average transaction value” and help generate other revenues. One of its specialties is designing personalized messaging that triggers the release of the brain chemical, dopamine.The report raises particularly strong concerns about the impact of all these practices on youth of color, noting that food and beverage marketers “are appropriating some of the most powerful ‘multicultural’ icons of youth pop culture and enlisting these celebrities in marketing campaigns for sodas, ‘branded’ fast-food meals, and caffeine-infused energy drinks.” These promotions can “compound health risks for young Blacks and Hispanics,” subjecting them to “multiple layers of vulnerability, reinforcing existing patterns of health disparity that many of them experience.”“U.S. companies are infecting the world’s young people with invasive, stealth, and incessant digital marketing for junk food,” commented Lori Dorfman, DrPH, director, Berkeley Media Studies Group, one of CDD’s partners on the project. “And they are targeting Black and Brown youth because they know kids of color are cultural trendsetters,” she explained. “Big Food and Big Tech run away with the profits after trampling the health of children, youth, and families.”The Center for Digital Democracy and its allies are calling for a comprehensive and ambitious set of policies for limiting the marketing of unhealthy food and beverages to young people, arguing that U.S. policymakers must work with international health and youth advocacy organizations to develop a coordinated agenda for regulating these two powerful global industries. As the report explains, other governments in the UK, Europe, Canada, and Latin America have already developed policies for limiting or banning the promotion of foods that are high in fat, sugar, and salt, including on digital platforms. Yet, the United States has continued to rely on an outdated self-regulatory model that does not take into account the full spectrum of Big Data and AdTech practices in today’s contemporary digital marketplace, places too much responsibility on parents, and offers only minimal protections for the youngest children.“Industry practices have become so sophisticated, widespread, and entangled that only a comprehensive public policy approach will be able to produce a healthier digital environment for young people,” explained Katharina Kopp, PhD, CDD’s Deputy Director and Director of Research.The report lays out an eight-point research-based policy framework:Protections for adolescents as well as young children.Uniform, global, science-based nutritional criteria.Restrictions on brand promotion.Limits on the collection and use of data.Prohibition of manipulative and unfair marketing techniques and design features.Market research protections for children and teens.Elimination of digital racial discrimination.Transparency, accountability, and enforcement.###

The coronavirus pandemic triggered a dramatic increase in online use. Children and teens whose schools have closed relied on YouTube for educational videos, attending virtual classes on Zoom and Google Classroom, and flocking to TikTok, Snapchat, and Instagram for entertainment and social interaction. This constant immersion in digital culture has exposed them to a steady flow of marketing for fast foods, soft drinks, and other unhealthy products, much of it under the radar of parents and teachers. Food and beverage companies have made digital media ground zero for their youth promotion efforts, employing a growing spectrum of new strategies and high-tech tools to penetrate every aspect of young peoples’ lives.Our latest report, Big Food, Big Tech, and the Global Childhood Obesity Pandemic, takes an in-depth look at this issue. Below we outline just three of the many tactics the food industry is using to market unhealthy products to children and teens in digital settings.1. Influencer marketing - Travis Scott & McDonald'sMcDonald’s enlisted rapper Travis Scott, to promote the “Travis Scott Meal” to young people, featuring “a medium Sprite, a quarter pounder with bacon, and fries with barbecue sauce.” The campaign was so successful that some restaurants in the chain sold out of supplies within days of its launch. This and other celebrity endorsements have helped boost McDonald’s stock price, generated a trove of valuable consumer data, and triggered enormous publicity across social media.2. Gaming Platforms - MTN DEW Amp Game Fuel - TwitchPepsiCo’s energy drink, MTN DEW Amp Game Fuel, is specifically “designed with gamers in mind.” Each 16 oz can of MTN DEW Amp Game Fuel delivers a powerful “vitamin-charged and caffeine-boosted” formula, whose ingredients of high fructose corn syrup, grape juice concentrate, caffeine, and assorted herbs “have been shown to improve accuracy and alertness.” The can itself features a “no-slip grip that mirrors the sensory design of accessories and hardware in gaming.” It is also “easier to open and allows for more uninterrupted game play.”To attract influencers, the product was featured on Twitch’s “Bounty Board,” a one-stop-shopping tool for “streamers,” enabling them to accept paid sponsorship (or “bounties”) from brands that want to reach the millions of gamers and their followers.3. Streaming and Digital Video - "It's a Thing" Campaign - FantaConcerned that teens were “drinking less soda,” Coca-Cola’s Fanta brand developed a comprehensive media campaign to trigger “an ongoing conversation with teen consumers through digital platforms” by creating four videos based on the brand’s most popular flavors, and targeting youth on YouTube, Hulu, Roku, Crackle, and other online video platforms. “From a convenience store dripping with orange flavor and its own DJ cat, to an 8-bit videogame-ified pizza parlor, the digital films transport fans to parallel universes of their favorite hangout spots, made more extraordinary and fantastic once a Fanta is opened.” The campaign, which was aimed at Black and Brown teens, also included use of Snapchat’s augmented-reality technology to creative immersive experiences, as well as promotional efforts on Facebook-owned Instagram, which generated more than a half a million followers.

General Comment submission Children’s rights in relation to the digital environment • Professor Amandine Garde, Law & Non-Communicable Research Unit, School of Law and Social Justice, University of Liverpool • Dr Mimi Tatlow-Golden, Senior Lecturer, Developmental Psychology and Childhood, The Open University • Dr Emma Boyland, Senior Lecturer, Psychology, University of Liverpool • Professor Emerita Kathryn C. Montgomery, School of Communication, American University; Senior Strategist, Center for Digital Democracy • Jeff Chester, Center for Digital Democracy • Josh Golin, Campaign for a Commercial Free Childhood • Kaja Lund-Iversen and Ailo Krogh Ravna, Norwegian Consumer Council • Pedro Hartung and Marina Reina, Alana Institute • Dr Marine Friant-Perrot, University of Nantes • Professor Emerita Wenche Barth Eide, University of Oslo; Coordinator, FoHRC • Professor Liv Elin Torheim, Oslo Metropolitan University • Professor Alberto Alemanno, HEC Paris Business School and The Good Lobby • Marianne Hammer, Norwegian Cancer Society • Nikolai Pushkarev, European Public Health Alliance 13 November 2020 Dear Members of the Committee on the Rights of the Child, We very much welcome the Committee’s Draft General Comment No25 on children’s rights in relation to the digital environment (the Draft) and are grateful for the opportunity to comment. We are a group of leading scholars and NGO experts on youth, digital media, child rights and public health who work to raise awareness and promote regulation of marketing (particularly of harmful goods, services and brands) to which children are exposed. We argue this infringes many of the rights enshrined in the UN Convention on the Rights of the Child (CRC) and other international instruments and should be strictly regulated. Based on our collective expertise, we call on the Committee to recognise more explicitly the fundamentally transformed nature of marketing in new digital environments, the harms stemming therefrom, and the corresponding need to protect children from targeting and exposure. Without such recognition, children will not be able to fully enjoy the many opportunities for learning, civic participation, creativity and communication that the digital environment offers for their development and fulfilment of their rights. Facilitating children’s participation in this environment should not come at the price of violations of any children's rights. Before making specific comments, we wish to highlight our support for much of this Draft. In particular, we strongly support the provisions in the following paragraphs of the General Comment: 11, 13, 14, 52, 54, 62, 63, 64, 67, 72, 74, 75, 88, 112, and 119. We also note concerns regarding provisions that will require mandatory age verification: e.g., paragraphs 56, 70, 120, 122. We call on the Committee to consider provisions that this be applied proportionately, as this will certainly have the effect of increasing the processing of children’s personal data - which should not happen to the detriment of the best interests of the child. The rest of this contribution, following the structure of the Draft, proposes specific additions / modifications (underlined, in italics), with brief explanations (in boxes). Numbers refer to original paragraphs in the Draft; XX indicates a new proposed paragraph. Hoping these comments are useful to finalise the General Comment, we remain at your disposal for further information. Yours faithfully, Amandine Garde and Mimi Tatlow-Golden On behalf of those listed above [See full comments in attached document]

Contact: Jeff Chester jeff@democraticmedia.org (link sends e-mail) 202-494-7100 Katharina Kopp kkopp@democraticmedia.org (link sends e-mail) https://www.democraticmedia.org/ USDA Online Buying Program for SNAP Participants Threatens Their Privacy and Can Exacerbate Racial and Health Inequities, Says New Report Digital Rights, Civil Rights and Public Health Groups Call for Reforms from USDA, Amazon, Walmart, Safeway/Albertson’s and Other Grocery Retailers Need for Safeguards Urgent During Covid-19 Crisis Washington, DC, July 16, 2020—A pilot program designed to enable the tens of millions of Americans who participate in the USDA’s Supplemental Nutrition Assistance Program (SNAP) to buy groceries online is exposing them to a loss of their privacy through “increased data collection and surveillance,” as well as risks involving “intrusive and manipulative online marketing techniques,” according to a report from the Center for Digital Democracy (CDD). The report reveals how online grocers and retailers use an orchestrated array of digital techniques—including granular data profiling, predictive analytics, geolocation tracking, personalized online coupons, AI and machine learning —to promote unhealthy products, trigger impulsive purchases, and increase overall spending at check-out. While these practices affect all consumers engaged in online shopping, the report explains, “they pose greater threats to individuals and families already facing hardship.” E-commerce data practices “are likely to have a disproportionate impact on SNAP participants, which include low-income communities, communities of color, the disabled, and families living in rural areas. The increased reliance on these services for daily food and other household purchases could expose these consumers to extensive data collection, as well as unfair and predatory techniques, exacerbating existing disparities in racial and health equity.” The report was funded by the Robert Wood Johnson Foundation, as part of a collaboration among four civil rights, digital rights, and health organizations: Color of Change, UnidosUS, Center for Digital Democracy, and Berkeley Media Studies Group. The groups issued a letter today to Secretary of Agriculture Sonny Perdue, urging the USDA to take immediate action to strengthen online protections for SNAP participants. USDA launched (link is external) its e-commerce pilot last year in a handful of states, with an initial set of eight retailers approved for participation: Amazon, Dash’s Market, FreshDirect, Hy-Vee, Safeway, ShopRite, Walmart and Wright’s Market. The program has rapidly expanded (link is external) to a majority of states, in part as a result of the current Covid-19 health crisis, in order to enable SNAP participants to shop more safely from home by following “shelter-in-place” rules. Through an analysis of the digital marketing and grocery ecommerce practices of the eight companies, as well as an assessment of their privacy policies, CDD found that SNAP participants and other online shoppers confront an often manipulative and nontransparent online grocery marketplace, which is structured to leverage the tremendous amounts of data gathered on consumers via their mobile devices, loyalty cards, and shopping transactions. E-commerce grocers deliberately foreground the brands and products that partner with them (which include some of the most heavily advertised, processed foods and beverages), making them highly visible on store home pages and on “digital shelves,” as well as through online coupons and well-placed reminders at the point of sale. Grocers working with the SNAP pilot have developed an arsenal of “adtech” (advertising technology) techniques, including those that use machine learning and behavioral science to foster “frictionless shopping” and impulsive purchasing of specific foods and beverages. The AI and Big Data operations documented in the report may also lead to unfair and discriminatory data practices, such as targeting low-income communities and people of color with aggressive promotions for unhealthy food. Data collected and profiles created during online shopping may be applied in other contexts as well, leading to increased exposure to additional forms of predatory marketing, or to denial of opportunities in housing, education, employment, and financial services. “The SNAP program is one of our nation’s greatest success stories because it puts food on the table of hungry families and money in the communities where they live,” explained Dr. Lori Dorfman, Director of the Berkeley Media Studies Group. “Shopping for groceries should not put these families in danger of being hounded by marketers intent on selling products that harm health. Especially in the time of coronavirus when everyone has to stay home to keep themselves and their communities safe, the USDA should put digital safeguards in place so SNAP recipients can grocery shop without being manipulated by unfair marketing practices.” CDD’s research also found that the USDA relied on the flawed and misleading privacy policies of the participating companies, which fail to provide sufficient data protections. According to the pilot’s requirement for participating retailers, privacy policies should clearly explain how a consumer’s data is gathered and used, and provide “optimal” protections. A review of these long, densely worded documents, however, reveals the failure of the companies to identify the extent and impact of their actual data operations, or the risks to consumers. The pilot’s requirements also do not adequately limit the use of SNAP participant’s data for marketing. In addition, CDD tested the companies’ data practices for tracking customers’ behavior online, and compared them to the USDA’s requirements. The research found widespread use of so-called “third party” tracking software (such as “cookies”), which can expose an individual’s personal data to others. “In the absence of strong baseline privacy and ecommerce regulations in the US, the USDA’s weak safeguards are placing SNAP recipients at substantial risk,” explained Dr. Katharina Kopp, one of the report’s authors. “The kinds of e-commerce and Big Data practices we have identified through our research could pose even greater threats to communities of color, including increased commercial surveillance and further discrimination.” “Being on SNAP, or any other assistance program, should not give corporations free rein to use intrusive and manipulative online marketing techniques on Black communities,” said Jade Magnus Ogunnaike, Senior Campaign Director at Color of Change. “Especially in the era of COVID, where online grocery shopping is a necessity, Black people should not be further exposed to a corporate surveillance system with unfair and predatory practices that exacerbate disparities in racial and health equity just because they use SNAP. The USDA should act aggressively to protect SNAP users from unfair, predatory, and discriminatory data practices.” “The SNAP program helps millions of Latinos keep food on the table when times are tough and our nation’s public health and economic crises have highlighted that critical role,” said Steven Lopez, Director of Health Policy at UnidosUS. “Providing enhanced access to healthy and nutritious foods at the expense of the privacy and health of communities of color is too high of a price. Predatory marketing practices have been linked to increased health disparities for communities of color. The USDA must not ignore that fact and should take strong and meaningful steps to treat all participants fairly, without discriminatory practices based on the color of their skin.” The report calls on the USDA to “take an aggressive role in developing meaningful and effective safeguards” before moving the SNAP online purchasing system beyond its initial trial. The agency needs to ensure that contemporary e-commerce, retail and digital marketing applications treat SNAP participants fairly, with strong privacy protections and safeguards against manipulative and discriminatory practices. The USDA should work with SNAP participants, civil rights, consumer and privacy groups, as well as retailers like Amazon and Walmart, to restructure its program to ensure the safety and well-being of the millions of people enrolled in the program. ###