The Case for Equity-based Policy Processes - Rod Lew
Rod Lew, Executive Director of Asian Pacific Partners for Empowerment, Advocacy and Leadership (APPEAL), discusses how the negative health impacts of sugary beverages can be best understood in the context of a long history of racism and structural oppression as well as toxic relationship building between industry and marginalized communities. Building on this, Rod makes the case for systems change and calls for equity based policy processes in SSB taxes and building community power through reinvestment to challenge the negative health outcomes caused by sugary beverages. From APPEAL's work on tobacco, Rod also draws parallels between the tobacco industry and the beverage industry in their tactics regarding claims of regressivity in opposition to taxes on their products and threats to their profits.
This episode of In Praxis is a part of Season 2: Sugar Sweetened Beverage Taxes. Learn more about Praxis’ work around SSB taxes on our Centering Community & Equity Through Sugary Drink Tax Investments page.
The information, opinions, views, and conclusions proposed in this episode are those of our podcast guests.
You can also tune into this episode on Anchor, Spotify, Apple Podcasts, Google Podcasts, and Stitcher. Below is a transcript of the episode, edited for readability. You can also watch this episode on YouTube with subtitles for accessibility.
The Case for Equity-based Policy Processes – Rod Lew
Podcast Transcription
It's really important to recognize that there's a whole history of our communities being impacted by racism, and that's even before you even talk about public health, and that performs the foundation of how our communities see certain issues and can participate in policy change.
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[In Praxis Intro] You are listening to In Praxis, a podcast by The Praxis Project created to support, hear from, and uplift the stories coming out of the ecosystem of basebuilding organizing. An ecosystem that includes frontline basebuilding groups and the folks who help support their important work. In this season of In Praxis, our hosts, Julian Johnson and Kourtney Nham, focus on sugar sweetened beverage taxes. We have compiled interviews from advocates working on issues surrounding the reduction of sweet and sugary beverages as well as the taxation of these products. Participants of this podcast are community members, public health practitioners, health department representatives, and concerned parents that span across the country. In each episode, you will hear about their phenomenal work as well as their perspective on the health effects of sugary consumption, and in what ways policy can be used to combat this and lead to reinvestment in our communities.
Kourtney Nham: Hi everyone, I’m here with Rod Lew. Today we're going to be talking a little bit about sugar sweetened beverages and strategies to address their consumption. So Rod, do you mind taking a few moments to introduce yourself and telling us a little bit more about yourself to get us started?
Rod Lew: Yes hi. My name is Rod Lew I am the executive director of APPEAL Asian Pacific Partners for Empowerment Advocacy and Leadership, and we are a national health justice organization particularly focused on the Asian American, Native Hawaiian, and Pacific Islander communities.
Kourtney Nham: Great! So just to kick us off, I was wondering if you could tell us a little bit about how you first got involved in working on issues of health.
Rod Lew: Well, our organization has been around for 25 years, so I’ve been working since the inception of APPEAL. Health has always been an issue that has been important to me both in my educational career as well as the beginning of my profession, but it really first became apparent when I traveled internationally and began to see a lot of the health issues that I was seeing in many different countries and then coming back to the United States and realizing a great amount of health disparities that were impacting particularly communities of color.
Kourtney Nham: Yeah, so I guess expanding on that, I’m wondering if you could tell us about the first time you realized that sugary drinks in particular were part of a health problem and maybe give us some more context and insight about how this work fits into what you do at APPEAL and your history working for health justice.
Rod Lew: Well, my interest in sugary drinks and food actually happened before I started with APPEAL, and that's when I read a book called Food First written by Francis Moore Lappé and Joseph Collins talking about the myth of hunger throughout the world. It really brought the attention specifically to how food is a political issue, and then beginning to learn that sugary drinks was also a political issue and that there was an industry behind sugary drinks—the beverage industries—that were pushing these products particularly to marginalized communities. Our work at APPEAL has really focused a lot on tobacco control, and the role that tobacco industry plays in marketing to our communities. So, I think this was a very important parallel to see with sugary drinks—that some of the same tactics were being used by the beverage industry as had been used with the tobacco industry.
Kourtney Nham: So, I guess building off of that, is there is there something in particular that made you decide to invest your energy in reducing the conception of sugary drinks? I know you mentioned the parallels between the beverage industry and the tobacco industry. I’m curious what role that played in choosing to do this work.
Rod Lew: Well, I think one piece of information is that something like 75 of all heart disease is tied into three different factors: smoking, physical inactivity, and diet. So, three out of those three are ones that we have dedicated our support to, and the realization that the industry is connected to all three of those issues is pretty significant. That's why as an organization, APPEAL is very focused on corporate accountability to make sure that this predatory marketing is um restricted in our communities.
Kourtney Nham: So, do you have a first activity that you first remember doing that sort of started to address the health effects of sugary drink consumption?
Rod Lew: It's a little bit hard to track down one specific activity, but I can remember convening a group of experts from the Asian American, Native Hawaiian, and Pacific Sslander communities to talk about food and active living. This was one of the first times that we'd really done this nationally and had a conversation about not only what food means to our communities but how it was being used against us. The examples of sugary drinks sodas came into that conversation, and it was clear that that was a piece that we really needed to have more attention focused on.
Kourtney Nham: That sounds really interesting. I’m curious if you don't mind if you could expand more on that conversation that you had at the convening, and more broadly about how food is being weaponized against communities and obviously how sugary drinks play into that—I love to hear more.
Rod Lew: Well. I think it's important to first start by saying that within the Asian American, Native Hawaiian, and Pacific Islander communities, there's not very much data available for specific subgroups. So, we have a sense of what's happening in our communities but it's not backed up by research and documentation—research and documentation that can eventually lead to funding for programs. So, we kind of know that there are certain things that are happening in our community, such as poor diet inactivity, that will lead to harmful diseases like heart disease stroke, and so on. We realize that it's important to kind of hone in on what can be strategies to address that. Some of those strategies are specific to sugary drinks both in terms of educating about the harmful effect being able to collect the adequate data that's disaggregated among subgroups and beginning to develop strategies that look at not only individual behavior but that begin to look at changing norms changing policies. That's where the soda tax policy comes into play.
Kourtney Nham: Yeah, definitely thank you for sharing that, and I totally agree I think data desegregation especially with the API community is so crucial and so important. You started touching on this a little bit in your response, but I’m wondering if you could talk a little bit more about the strategies you've used to reduce sugary drink consumption and other strategies that you've used in the work that you do.
Rod Lew: Well, certainly we're involved with the statewide coalition in California to work on a sugar sweetened beverage tax. That's an example of a kind of a higher-level policy that will have great positive impact on our communities. But we're also having to be aware of where our community's readiness is to engage in policy change, and I think if you look across the board at communities they're dealing with many different issues. In this time of COVID, it's COVID and racism and jobs and other health issues, like access to health care. So, sometimes it's hard to focus on very specific issues like sugary drinks. So, I think there's a lot of education that needs to take place to provide the opportunity to build capacity of our communities, to organize around sugary drinks and sugary drink policies… so, I think we're having to also be aware that the beverage industries have been giving money to communities of color for many, many years, and we have to be very aware of building our community leadership's understanding of how that harms our community. Finding ways that we can talk about the impact of sugary drinks, as well as the role the industry plays in marketing to our communities. That's sometimes a difficult conversation to have with organizations that might have received beverage industry [monies] in the past or are currently receiving it.
Kourtney Nham: That's such an interesting point, and I hadn't realized that was something that was happening. By I guess building on that thread, and keeping in mind all the complexities that we have to hold in our communities, and specifically communities of color, I wanted to pivot towards health equity. There's been a few different initiatives to improve health these days that are trying to center health equity, and I’m curious if you could tell us some ways that health equity can be centered in soda tax policy, particularly and in this work, and of those ways, are any of them that you suggest better than others.
Rod Lew: Well, I think there are four different components within that question that you ask that are very important. One is who's vulnerable; two, where's the money gonna go to if it does result in revenues; three is what kind of systems change is going to be implemented; and four is how do you build community power. I think the very first one when I talked about who's vulnerable is really important to recognize that there's a whole history of our communities being impacted by racism, and that's even before you even talk about public health. That performs the foundation of how our communities see certain issues, and it can participate in policy change. So, I think history is a really important thing to look at. I think the history of beverage industries and soda with our communities is another piece that's very important to look at. So, there are certain companies like Pepsi-Cola, who have hired communities of color to work in their factories, where other times there may not have been other companies doing the same for our communities. So, there's a relationship that has been formed unfortunately that has resulted in us being in the bind that we are in. But I think the important piece around soda tax policy is the process that you engage communities in developing a structure and a plan and talk about how resources get allocated. If you would, we could describe that as kind of an equity-based policy process. Then the last two, which really relate to how we define health equity. So, defining health equity as systems change and building community power need to very much be integrated into what gets funded out of that program or what is the actual policy language that works towards eliminating or reducing soda use within our marginalized communities.
Kourtney Nham: Yeah, definitely. Thanks for sharing that, and to pivot again, the beverage industry is really aggressive and persistent in the way that they resist policies that might limit their sales especially when it comes to things like soda taxes. So, as I’m sure you're aware, the beverage industry comes out really strong with a lot of messaging around this to bolster their side, for example, they make a lot of arguments about regressivity that a soda tax will hurt people with lower incomes as well as other things. So, I’m wondering if you have any ideas about what is a good counter message against this industry staple, and what is one that really centers health equity.
Rod Lew: Well, I think the regressivity issue is an important one to talk about, because we've heard those arguments in many places. Our answer to that really is that the diseases which result from heavy use of sugary drinks are also regressive, and that's what we're trying to eliminate is the diabetes and other health issues that come up with heavy sugary drink use. We've run across this example in tobacco control where in the state of Minnesota, we had developed a leadership program called LAMP, where we had provided an opportunity for five different priority populations to gather and build expertise around policy change. When the tobacco tax was introduced as a possibility and hit the governor's desk, the governor was concerned about the same issue around regressivity, and so some of the LAMP fellows who were from communities of color, LGBTQ communities, came back and said, “yes, we understand that the diseases that result from tobacco are even more reggressive, and we want you to support this, because we believe that the programs that will develop as a result of this plus the change in prevalence due to a higher tax, will be a much more positive impact on our communities.” And I think the lesson from this that's really important around a sugary or soda tax is that the allocation the funding that gets created from these revenues needs to go back to the communities, particularly around preventing sugary use, health programs, water programs, things that will help the overall health of the communities.
Kourtney Nham: Yeah, I think that's a great parallel that you drew between the beverage industry and tobacco and kind of what is a good counter message for that. Going off of that, another thing that the beverage industry really likes to do is refute existing research and evidence against sugary drinks, and they make a lot of claims about how sugary drinks are the wrong target. Advocates on the other side in response to this have a need to present robust research showing why this rhetoric and their claims are incorrect, so my question is what is the most pressing research need you see for the advocates to continue to advance in our efforts to oppose industry claims.
Rod Lew: Well, I think there's a couple things to say about that, and the first is similar to the tobacco industry, the beverage industry puts a lot of resources and money into their own research teams that oftentimes misrepresent issues and can actually misinform people about the real harmful effects of long-term and heavy use of sugary drinks among our communities. So, I think that's the first piece. The second thing is I think there just needs to be some more research showing, similar to tobacco, of how tobacco tax or sugary tax can reduce prevalence, as well as provide opportunities and resources to develop effective programs within our communities to counter both the messaging that the industry makes but also to become healthy and well communities.
Kourtney Nham: I would love to contextualize this question specifically around the work that you do and work APPEAL does. I’m curious I know you mentioned earlier the need for desegregated data specifically in API communities and that being part of the research need or the gap in the data there. I’m wondering if there's anything else that you feel specifically within the communities that you work in, where research could be used or bolstered to help address this issue.
Rod Lew: Well, I think the recognition that our communities are very diverse and then oftentimes the data is grouped for Asian Americans with Native Hawaiian, Pacific Islanders, and if you separate out Native Hawaiians and Pacific Islanders, you can see some very, very high rates of diabetes, tobacco use, COVID… so, that's really an important piece to kind of underscore around the data disaggregation. But the other piece is that our community is very complex, and so looking at the data altogether will hide some of these factors. It will also kind of be difficult if you were to just look at where place matters as a strategy only or looking at where there's the most diagnosed diabetes cases, because again in our communities which are very dispersed across regions, it may not show up that way, as well as our communities tend to have under diagnosed diabetes rates. So, I think those are some of the things to kind of really look at. The other piece I wanted to mention is generally around health equity research. We don't know very well what are good health equity indicators for an institution like a health department who may be charged with overseeing a complete program how to advance health equity. This I think is a really important research area that we need to kind of find out what are those process measures that can help an institution be able to know that they're actually making an impact around health equity. Really, we can do the tax that's only the beginning steps of actually implementing programs and policies and then ensuring that the enforcement of those policies are not harmful to our communities of color.
Kourtney Nham: Thank you for sharing that I really appreciate the contextualization specifically within Asian American and Native Hawaiian, Pacific Islander communities as well as the broader question about how we measure health equity and there needing to be research around that. That that was great. I’m wondering if you could talk a little bit about what will look like when advocates win, and what I mean by that is what is the end game. What is kind of the ideal outcome that you see would come out of this work that you're doing.
Rod Lew: Well, I think one and outcome is that sugary drinks will no longer negatively impact our communities of color, which means that there's little to no use of sugary drinks and that there are good policies in place that limit the marketing and selling of those products to our communities. Another end game success would be that we realize health equity, so that we're not only addressing the one issue around sugary drinks but we're addressing the underlying root factors, which help to exacerbate health disparities. Those include what would normally call the social determinants of health, so health care access housing and a variety of other factors. But in terms of victories, I can say that we've experienced this to a certain extent in tobacco control with the passing of proposition 56, the tobacco tax. We've seen it happen. We celebrated, and we're now in a process of trying to implement programs. So, I would say that there are victories along the way that we need to shoot for and certainly the passage of a sugary drink [tax] with a health equity lens is a huge victory, if we ever get there, but I want us also to be prepared that there is a lot of work even after that happens. We need to create strong communities to be engaged in this work, we need to work in institutionalizing health equity in many of the mainstream institutions like health departments, so that when we are ready to go that we are more likely to be successful at achieving all the goals that we have together.
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Kourtney Nham: I’m here again with Rod Lew from APPEAL. I had a chance to speak with Rod a bit last year about his work around sugar sweetened beverages, and we're just taking some time to follow up with him a few months after his initial interview and just dive a little deeper into some of the things that we discussed last time specifically regarding strategies. So yeah, Rod, if sounds good to you I can I can head into the first question.
Rod Lew: That would be great, Kourtney, thank you.
Kourtney Nham: Awesome. So, this is the question we asked last time but we'd just love to hear a little bit more about what you have to share: could you tell me a little bit more about the different strategies you've used to reduce sugary drink consumption?
Rod Lew: Yes. APPEAL has developed a variety of different community-directed, equity-centered models for developing policy change, whether it's through commercial tobacco control or whether it's on sugared sweetened beverages. I think what's important is that the community is engaged in all aspects of that process, from the beginning identifying the readiness of communities to engage in policy change given the current environment that exists in communities, building community power such as through our community leadership program, or our policy change framework, which really addresses multiple levels of policy change as well as prioritizing community engagement at all levels. Something that we would describe as an equity-based policy process.
Kourtney Nham: That's perfect thank you so much for sharing. Last time you mentioned the need for a quote, “equity-based policy process,” and structuring planning and allocation, and I was wondering if you could expand more on what an equity-based policy process really is, and looks like, and why it's so important.
Rod Lew: I often think that sometimes we focus on the goal of policy being the main goal for what we're trying to achieve, and in some ways it's true because we want to have a tobacco tax passed or we want to have a soda tax passed, and that is ultimately something that will benefit all communities. But sometimes we miss the piece of engaging communities, and particularly marginalized communities, from the very beginning. That's really important because not only are you then going to be able to bring communities along for your policy issue, but it's helping to build capacity of communities and marginalized communities to really engage in something that is a skill, something that is a priority that needs to happen within marginalized communities, for the long run. So, that whether you're successful in this policy or not that the communities has built their capacity to better engage in other policy issues. So, it could simply be a checklist to determine how a process has engaged communities by asking questions like: did we include communities of color in the planning process, did we create language in a bill or legislation that prioritizes communities of color most impacted by sugary drinks, is there resources to be allocated that not only address sugary drinks but also uplift communities in their work overall related to health equity, how do we make sure that there is accountability in the health equity that is being implemented with this work. So, all those things are examples of what we would describe as the equity-based policy process—again ensuring that communities are engaged from step one to the end of implementation of a policy.
Kourtney Nham: Yeah, I think you put that beautifully. It's not just about the end goal/the outcome, it's really about every step along the way, and building sustainability. So, thanks for that. I know in our last interview the last time we chatted you mentioned a few times the really complex relationships that the beverage industry has historically formed with communities of color with regards to funding and employment and how this can sometimes impact the readiness of communities to engage in policy change as well as make those conversations a little bit more complicated. I was wondering if you have any suggestions around how to navigate these difficult conversations with communities while really holding those nuances that you talked about.
Rod Lew: I think we first need to understand history, and the long history of marginalized communities of color being targeted by the tobacco industry and by the beverage industry, with products that are harmful to our communities. Understanding that history and the length of it will help us be able to realize that some of our communities are entrenched with the funding that has been given to communities of color. While it's important for us to move our communities away from that in as many creative and educational ways that we can, we don't also want to attack our communities for being somewhat dependent on beverage monies. So, I think there's a multi-pronged approach that needs to take place for us to understand the dependency on some of these funds and finding alternative routes to be able to fund some of the programs that we have. Recognizing that to model to our younger individuals in our community not to rely on these fundings, we have to take some very difficult steps in refusing certain beverage money, because in the long run, if the industry is using that to keep us from supporting a certain policy that may raise for example taxes on sugary drinks, then it's really buying silence from our communities. We need to release ourselves from that bind.
Kourtney Nham: That was really helpful and obviously it's a very complex and nuanced topic to have to navigate, so I appreciate your insight on that. Well, those are the three main kind of follow-up questions that I had prepared for you, but I want to open the space to see if there's anything else that you'd like to share that you feel wasn't covered in this short conversation or from our conversation last time.
Rod Lew: I’d like to come back to the really important equity issue around data, because data and data disaggregation is actually an equity issue, particularly for Asian Americans and also Native Hawaiian, Pacific Islanders. I mentioned before that it's really important to disaggregate. Really, Native Hawaiian, Pacific Islanders, are a completely separate racial ethnic group and should not be lumped in the same category as Asian Americans. In fact, it does a disservice to the issues that they need to address, as well as the strategies in terms of addressing prevention and policy change for that community. But even for the Asian American community, there needs to be disaggregation by subgroups. It's important to recognize that depending on how the data is collected, there's a real importance of underscoring that Asian Americans overall have a much higher rate of undiagnosed and under-diagnosed diabetes. So, if you base a policy on the number of cases or neighborhoods that have the highest rates of diagnosed diabetes and fund those groups, you will completely miss Asian Americans and Native Hawaiian, Pacific Islanders and other groups that may be more under diagnosed. So, it's really important that data and data equity be discussed and incorporated in any policy issues that are being worked on.
Kourtney Nham: Definitely. Thank you so much for circling back around on that I couldn't agree more that data equity is so important. When you don't have it certain groups get invisiblized in this process, which is really detrimental. So, thank you so much for that. Again, it was really great checking in with you and following up. I really appreciate all the wisdom and expertise that you bring to this work.
Rod Lew: Thank you, Kourtney. It was a pleasure talking with you.
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[In Praxis outro] Thank you for listening to this episode of In Praxis. We hope you all enjoyed it. Make sure to visit our website, www.thepraxisproject.org, where you can check out additional episodes of other guests as well as learn more about our work.
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