Challenging Dogma

...Using social sciences to improve the practice of public health

Thursday, April 26, 2007

An Apple a Day is not Enough: The 5-a-Day Campaign is Falls Short to Increase the Public’s Intake of Fruits and Vegetables – Sasha Fraine


The 5-a-day health campaign encourages the consumption of five to nine servings of fruits and vegetables per day. In doing so it strives to promote healthy living and prevent diseases like obesity, cancer and heart disease. The downfall of the campaign tactic is that it relies too heavily on the Health Belief Model and neglects to look at the issue from both social and environmental perspectives. In doing so the campaign strategy does not take into consideration several factors that arise in today’s society, and fails to utilize many other approaches to public health campaigning that would more effectively reach the fast-paced, busy and preoccupied general public it targets. The campaign places a large amount of responsibility on the individual to find and apply the message; ideally people should not need reminders of how to eat healthy, but in today’s world these simple reminders, when placed directly in the line of sight, can be extremely beneficial.

The Campaign is Too Reliant on the Health Belief Model

The most commonly utilized model in public health campaigning is the health belief model, which relies heavily on the assumption that an individual’s beliefs will influence their behavior. This model combines the perceived susceptibility to a disease with the perceived severity of a disease and weighs them against barriers that may prevent a person from seeking an intervention to the behavior in which they are engaging that puts them at risk. The outcome of the actual change in behavior is dependant upon the individual’s personal intention to change their behavior (1).

Assuming that individual responsibility is enough to change the outcome of one’s health behaviors is by no means unusual. However, the use of the health belief model in this campaign assumes that the sole outcome of this intervention involving nutrition depends upon the perceived causal relationship between intention and action. It is common knowledge that fruits and vegetables are essential to good health yet so many people are not consuming the number of servings they need. What is left out of the equation are the many other contributing factors at the social and environmental level that are not being considered. When it comes to the availability of fruits and vegetables factors like cost, how easy it is to obtain them and how difficult it can be to get finicky children to acquire a taste for them are some examples of barriers at an individual level. On a grander scale factors that come into play include geographic areas where access to a local supermarket is unavailable. Without reliable means of transportation and financial resources to get to these places, it can be very difficult for many Americans to eat healthy let alone to eat a well balanced diet.

Social and Environmental Barriers

With any issue that involves an individual behavior it is important to step back, look at the big picture and try to figure out what may be preventing people from being able to change their behaviors. In the case of so many Americans, especially those who struggle to make ends meet, living in a community that has all the available resources one needs is often nothing more than a dream. In the case of families who do not live near a supermarket or own their own vehicle, they are at the mercy of the local public transportation system, which is often an unreliable and time-consuming means of travel. In situations where a system may not travel to a supermarket, people may be left to stock their cupboards at the local convenient stores and dine out at inexpensive, fast food chains. In addition to situations like this, there are other variables that are driving people to eat quickly and inexpensively.

We live in a society that is built around convenience. It seems that everything is being engineered to be on the go. In addition to drive thru fast food chains, Americans can pay for their gas at the pump with the swipe of a card. Afterwards they can drive up to the window at many convenience stores and pharmacies to complete their errands on the way home from work without ever having to get out of their car. It should be no surprise that instead of choosing a healthy salad so many choose a broccoli and cheese Hot Pocket and consider it a balanced meal.

An effective approach for the campaign to take in response to social and environmental factors would be to team up with the government. To a certain extent this has already begun. The 5-a-Day campaign teamed up with the center for disease control (CDC) to launch the new “More Matters” program in March 2007. In accordance with the launch, all fifty states and US territories have been appointed a “Fruit and Vegetable Coordinator” at the CDC. While this is an important step what should take place is a government intervention in fast food chains making it mandatory that they provide healthier options in their meal deals. The emergence of healthy foods on fast food menus has already begun to occur with a variety of salads being offered and a new option for mandarin oranges in one chain’s Kid’s Meal. Continuing to push for healthier changes at this level would have a more effective outcome than simply making more information available to the public. By making fruits and vegetables more abundant in fast food establishments, people who have no access to a supermarket and those who choose to lead a fast and convenient life are not robbed of the nutrition they need.

Failure to Utilize All Effective Available Resources

According to a study conducted in 1997, researchers concluded that the average American views over 3,000 advertisements per day on television, billboards and in print (2). Byrd-Bredbenner and Grasso stated that on average, the American child views three to four hours of television per day (2). In their study primetime television was viewed for 17.5 hours over a period of two weeks. During that time, all commercials were recorded and categorized by topic and by the percentage that contained direct health related content. During this time, 700 commercials aired to occupy a total of four hours and eighteen minutes of advertisements. Advertisements for food and beverages occupied the largest percentage of advertising at 23% (106 advertisements); consumer related factors (taste, convenience, sugar content) were used predominantly as the main selling factor of these products. Out of 106 commercials, four out of every ten advertised for a fast food item (2). These items were omitted from the remaining six categories of the food pyramid because they do not fall into one specific category. Of the remaining six categories (and the remaining 60% of advertisements not for fast food), the grain group (breads, cereals, etc) and the Fat, oil and sweet category occupied the majority of airtime with 41% each. Dairy came in second with 8% of all advertisements leaving fruits and vegetables trailing behind with a mere 6% of advertisements each (2).

While this study was conducted eight years ago, it is an excellent example of how popular advertisements today are still dominated by ads for fast food chains and soda companies. Equally as popular are advertisements for products like Lean Cuisine, Hamburger Helper, Kraft Macaroni & Cheese, and Lunchables just to name a few. Popular cartoon characters now sponsor sugary cereals, Coca-Cola gets more airtime than many cosmetic products and Jessica Simpson is convincing America to eat at Pizza Hut. Herein lies a major breakdown in the effectiveness of the 5-a-day campaign. The campaign marketers are not effectively reaching their audience because they are not putting their campaign in their direct line of vision.

An advertisement does not only makes the public aware of a new product on the market it serves as a constant reminder that it is still out there available to make life easier. Furthermore in doing so other companies are making full use of the advertisement model, a model the public health industry has not managed to take advantage of. By utilizing this model industries like Kraft are able to offer the public a promise, for example, an alternative to making lunches the night before a big day. Instead, parents and other busy individuals can save time and purchase a Lunchable, an all inclusive meal complete with entrée, desert and a beverage that easily fits into a child’s backpack as it comes nicely packed in its own box. While in recent years they have been upgraded to include healthier ingredients, the product is still limited to processed meats and cheeses, crackers and packaged sauces containing three-fourths of the daily value of sodium (3). Nowhere in the package is there one serving of fruit. Adults love the product because it makes life easier, and kids love it because they see them on television.

This is not to say that the 5-a-day campaign has made no effort to put their message out there, a simple internet search will immediately yield results from both the public health campaign itself as well as government sponsored websites and other sites sponsored by companies like Dole. One of these websites goes so far as to include two lists of “quick and easy” ways to incorporate fruits and vegetables into your diet (4). Both eye-catching and educational, simply does not reach the populations it needs to. It is unfair to assume that all families and individuals have access to a computer and the Internet. Impoverished families all over the country struggle to keep food on the table let alone to pay the Internet bill to learn about healthy choices. Among families who have the resources and access to such luxuries many are scarce for the time or simply just do not think to browse the web for a nutrition campaign even if the outcome is to their own benefit.

Conclusion: A Proposition for a More Efficient Campaign

In order to recruit a fast paced modern public that is pressed for time and on the go, a successful campaign needs to reach out and entice people to believe that what they are seeing will be worth their while. A place to start would be by creating a commercial for television. The California Cheese commercials are an excellent example of a commercial for a healthy product. It features two cows singing their Californian rendition of “Green Acres”. The tune is catchy, the theme is entertaining and the product is well known and liked. The dairy industry has the idea and now it is time for the 5-a-Day campaign to jump onto the advertising bandwagon. By placing advertisements directly in the public’s line of sight and including a less commanding message (“More Matters” versus “5-a-Day”) people will be more apt to do what they can to consume more fruits and vegetables. Another positive outcome of this tactic is that it will lead to a sense of personal empowerment.

By abandoning the strong dependency on the health belief model and incorporating the ideology behind the advertising model the 5-a-Day campaign will make catastrophic improvements in its attempt to reach the general public. What is stopping it right now from doing so is how the campaign is targeting its intended audience. It is common knowledge that fruits and vegetables are important for good health and there is enough information out there to support the claim to anyone who doesn’t believe it. By making more information available, as the campaign is currently doing on line, it is only making an impact on an individual level. While any improvement in behavior is beneficial and no doubt a great success, more needs to be done to solve the issue at the social and environmental levels. It is at these levels where small changes will go a long way to improving the behaviors of millions.


1. Siegel M. Health Behavior Models. Class notes. 22 March 2007

2. Byrd-Bredbenner C. & Grasso D. Prime-Time Health: An Analysis of Health Content in Television Commercials Broadcast During Programs Viewed Heavily by Children. New Brunswick, NJ: The State University of New Jersey. 1999. Retrieved from on 5 April 2007

3. CNN Interactive. Lunchables may be munchable- but study warns of salt. Retrieved from on 3 April 2007

4. Center for Disease Control. (2007). How to add fruits and vegetables into your diet the quick and easy way. Retrieved from on 19 April 2007.

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