Since the American Heart Association changed its charter in 1988 to permit product endorsements, an arrangement it had prohibited from its founding in 1924, it has raised millions of dollars from such sources as the National Cattlemen's Beef Association, the Kellogg Co. and Conagra.
The heart association, a non-profit group, says the money supports research and education programs and helps spread its message promoting heart health. But critics are asking whether such arrangements confuse the public into thinking that a food endorsed by the group is better than one that is not. They also ask whether in the long run these arrangements are detrimental to charitable organizations by undermining their stance of objectivity.
Brigid McHugh Sanner, the heart association's senior vice president for communications and advocacy, said she had no comment on specific criticisms because she had not seen the data. She objects, though, to the word "endorsement."
"We don't endorse products," she said. "We would like to have certification on as many foods as possible. None of this constitutes an endorsement."
The American Heart Association is not the only non-profit group to face concerns over corporate links. In August the American Medical Association withdrew its plan to endorse health care products, such as blood-pressure monitors made by Sunbeam Corp., after an avalanche of bad publicity. Even some of the group's members feared that the endorsement, the first in its history, could cause conflicts of interest.
The heart association charges varying fees for the use of its name. For $2,500, a company like Kellogg can put the association's heart-check symbol on, for example, a package of Fruity Marshmallow Krispies. The yearly renewal charge is $650.
That fee is paltry compared with the $450,000 it cost the Florida Department of Citrus for an exclusive promotion and advertising contract with the association that lasted from 1994 until early this year. The agreement precluded any similar citrus trade association from using the heart association's endorsement.
The cattlemen's association paid $25,000 for its arrangement with the heart association, which promoted lean cuts of beef. Conagra's ads for its Healthy Choice products in the Wall Street Journal offer a nutrition tip and promote the association, which agreed not to disclose how much it received from Conagra. For an agreement with Conagra in 1992-93, it received $3.5-million for a TV program on nutrition.
An association brochure says the heart-check certification program, established in 1992, is "designed to help consumers easily select foods in the grocery store that can be part of a balanced, heart-healthy diet." The association has so far certified 636 products. To be designated "heart healthy," a product must meet nutrient requirements established by the Food and Drug Administration or U.S. Department of Agriculture: It must be low in fat, saturated fat and cholesterol. The heart association also requires written assurance from the company that its nutritional labeling is correct.
All foods are eligible except those manufactured by a tobacco company or its subsidiaries. That excludes all products from Nabisco (a unit of RJR Nabisco Holdings Corp.) and Kraft, Post and Jell-O (all owned by Philip Morris). So Post's Raisin Bran cannot carry the heart-check symbol, while Kellogg's Raisin Bran can. And does.
Dr. James T. Bennett of George Mason University asks whether the heart association's arrangement with the Florida citrus group means that "California citrus won't help you with heart disease; only Florida can." Bennett, a political economist, calls such endorsements "ludicrous."
Bennett's sentiment was echoed by Dr. Michael Jacobson, the executive director of the Center for Science in the Public Interest, a Washington advocacy group. An endorsement "deceives people into thinking one product is better than another," he said.
For companies that want an exclusive agreement with the American Heart Association like that of the Florida citrus growers, the cost is $55,000 a quarter or $200,000 a year. Without exclusivity, the cost is $25,000 a quarter or $90,000 a year.
No matter the form of the endorsement, Jacobson said, "this is dangerous territory for non-profits."
"The risk is if they get money from the dairy industry, will they be able to criticize the industry if the occasion arises?" he said. "I think it's virtually impossible for a charity to bite the hands that feed it."
Bennett was particularly critical of the relationship between the cattlemen's association and the heart association. The heart association also presented a "Champion of Heart" award to the group for its "contributions that have allowed AHA to further its fight against heart disease and stroke." In exchange for "a very nice, healthy grant," Bennett said, the cattlemen have a plaque to display from the heart association.
"They are compromising themselves, particularly when word gets out that they are getting big bucks," he said of the association. "Over time they will lose their credibility. They become a shill for corporate interests and there is no way you can dress that up as charitable activity. It is unethical."
As soon as non-profit groups are seen as an arm of industry, "it's going to hurt their fund-raising, their stature," he added.
Sanner said research done by the association indicated the opposite.
"We've done a number of marketing studies specifically about the certification program and we find the public is not confused about what the certification mark means," she said. But she added that the association has not done any surveys to gauge the public's reaction to the other promotional partnerships that have been forged with the food industry.