In recent decades, much attention has been given to providing effective communication strategies regarding nutritional risk, with the aim to avoid unnecessary alarm to consumers [1
]. Effective risk communication has become rather challenging, with the most recent example being food-related concerns about the risk of colorectal cancer (CRC) associated with the consumption of red and processed meat [3
]. Red meat consumption, both raw and processed, has been associated with several diseases, from diabetes mellitus to coronary heart disease [5
] and cancer [6
]. Nevertheless, this has become a sensitive topic, especially after the World Health Organization (WHO) classified processed meat as Group 1 (carcinogenic to humans) and red meat as Group 2A (probably carcinogenic to humans) [3
]. Mass media immediately disseminated the WHO announcement, which was widely cited in the most influential press agencies and commentaries.
There is no doubt that the WHO recommendation about safe levels of processed meat intake is sound and based on empirical evidence. WHO classified “processed meat as carcinogenic to humans (Group 1), based on sufficient evidence in humans that the consumption of processed meat causes colorectal cancer”. This claim was based on more than 800 studies involving more than a dozen cancer types, using data from different countries and accounting for different diets and lifestyles [3
]. However, the mechanism through which their message reached the consumers was distorted, with potential unforeseen direct and potentially harmful indirect consequences. Communication of the carcinogenicity of processed meat consumption was made official in the WHO–IARC (International Agency for Research on Cancer) press release, disseminated at the public opinion level through an intense campaign aimed at raising awareness on the risks associated with red and processed meat consumption. The core of the WHO communication strategy has been structured around the “level of evidence” of the association between processed meat consumption and CRC, which is the reason for the Group 1 classification [3
]. Group 1 includes agents for which there is sufficient evidence of carcinogenicity in humans. However, the groupings are constructs that refer to the level of evidence, not to the magnitude of risk of neoplasm related to the agent under study. Groupings are based on strict criteria of evidence of causal association between the agent and malignant neoplasms. However, the magnitude of such causal association is not included in the criteria for including an agent in Group 1. For example, two different agents, both included in Group 1, are agents for which there is sufficient evidence of association with neoplasms, but the magnitude of association could be completely different for each.
The interpretation of such concepts is not straightforward, and we cannot rule out that the concept of “level of evidence” has been mistaken for that of “magnitude of association”. Table 1
shows some extracts from selected influential international newspaper headlines and news reports showing different degrees of bias in the interpretation of the WHO announcement.
Regarding the actual figures that are the basis of the discussion, IARC estimated that every 50-g portion of processed meat eaten daily increases the risk of CRC by approximately 18% (1.18, 95% CI 1.10–1.28) [3
]. However, the estimated relative risk of current smoking (which belong to the same group as processed meat) for squamous cell cancer in men is 45.6 (95% CI 34.3–60.6) [9
]. The levels of risk are completely different in terms of both individual and general public health impact [10
The relationship between media influence and consumer reaction is not a new topic in sociology. In a seminal paper [11
], their interaction was characterized in five common steps: (i) spreading sensational news about the potential risk factor; (ii) public concern increases along with the media coverage; (iii) public response begins, usually with a shift in consumption patterns; (iv) the alarm gradually decreases as attention switches away from the issue, leading to a new equilibrium. Additionally, it is widely recognized that even risk events with minor physical consequences often elicit strong public concern and produce extraordinarily severe social impacts [12
]. These two theories, when applied in the case of the WHO announcement, suggest that even though the risk of cancer is real, the lack of careful risk communication strategy might have unintended negative impacts [2
]. We have already learned from previous food scares that consumers do react and modify their patterns and preferences, often in a sharp manner [13
]. For example, in 1996 there was an announcement by the WHO regarding Creutzfeldt–Jakob disease in humans and bovine spongiform encephalopathy (BSE) in cattle. This resulted in enormous media attention and had an immediate negative impact on the UK beef industry [14
]. This was reflected in actual consumer behavior, where beef consumption dropped by 17% in 1996, a 10% greater decrease than expected [14
Food scares shape consumption preferences, even when there is no sufficient evidence about the real causal mechanism between the contaminant and health risk. Genetic modification (GM) of food has been given a great deal of media attention (in both the United Kingdom and in Europe more generally), particularly in early 1999 [16
]. The WHO states that the GM foods currently available on the international market have passed safety assessments and are unlikely to present risks for human health. In addition, no effects on human health have been shown as a result of the consumption of such foods by the general population in the countries where they have been approved. However, in 1998 more than 1000 UK schools took genetically modified foods off their menus, and genetically modified foods were banned from restaurants and bars in the House of Commons. Furthermore, most of the major UK supermarkets have eliminated genetically modified ingredients from their own brand products in response to consumer concern [16
]. Similarly, despite the benefits of reducing red and processed meat consumption, the adoption of an aggressive communication strategy could lead to a wide range of scenarios, which should be carefully taken into account.
In this paper, we explore the potential counter-effects of such communication campaigns, raising the idea of a potential balloon effect, reflected in sectorial economic shock and contraction of sales as a foreground for future public health implications. Indeed, the literature suggests that, depending on the demand elasticity, processed meat stigmatization might induce a significant shock to the industry and lead to the displacement of workers, temporary unemployment, and instability, which all potentially lead to adverse health outcomes.
Our analysis combines real data and parameters found in recent literature to simulate a realistic scenario highlighting the potential benefits and costs of a WHO-announcement-solicited food scare. We simulated the consequences of risk communication to analyze the impacts of a reduced consumption of processed meat on the yearly number of cancers, juxtaposed with the adverse health effects deriving from job loss/displacement due to the sectorial economic shock caused by a shift in demand pattern.
The aim of the present study was to analyze, through a simulation approach, the benefits of reduced processed meat consumption on CRC cases and the potential impact of such a reduction on the processed meat market, in terms of adverse health effects deriving from job loss/displacement. The hypothesis underlying the study was that sensational communication about the risk associated with processed meat consumption would have severe unintended effects on the health outcomes of the workers employed in this sector due to a potential market shock, as demonstrated by previous studies in the field [9
]. An example of this situation is the case of BSE, which strongly impacted the world meat economy in the 1990s. In countries with meat-intensive production, such as Northern Ireland, 5135 full-time job equivalents were threatened by a reduction in demand for beef, accounting for approximately 0.6% of total regional employment [9
]. The literature also shows that these types of scenarios may have important public health issues. In the short term, the most significant burden lies in the costs associated with mental health, such as the purchase of psychotropic drugs and hospitalizations due to mental health problems [28
] and hazardous behavior (alcohol and illegal substance abuse) [33
]. Hazardous behavior due to job loss, excessive stress, smoking, and alcohol consumption are linked to circulatory disease and hospitalization due to traffic accidents [37
]. Smoking is strongly associated with lung cancer and several other cancers [9
], and both psychological distress and alcohol abuse are associated with suicide [25
]. In the long term, the effects of job loss and unemployment can result in an increased mortality, especially for older workers. Indeed, mortality rates in the year after displacement are 50%–100% higher than would otherwise have been expected, and this effect persists even after 20 years [34
]. Another recent meta-analysis has assessed the association between unemployment and all-cause mortality among working-age persons, and they found that unemployment is associated with a 63% higher risk of mortality [35
]. Hence, it would not be unlikely that, within the framework of a persistent economic crisis [36
], a contraction in the demand for red and processed meat might lead to a reduced market share of the processed meat industry, with subsequent long-term effects on public health.
The hypothesis about the potential association between CRC and processed meat consumption is a matter for criticism for two main reasons. The first one is represented by the risk communication modalities themselves, which could have been misleading. Risk communication has been extensively studied due to its critical impact on the general population [2
]. It represents a complex issue influenced by several factors, including characteristics of the public, of the message itself, and trust of the institution communicating the risk [1
]. It was not the purpose of the present work to provide an excuse of the theories of risk communication and its related issues. However, it is essential to point out a few critical elements that seem to be involved in the risk communication of the carcinogenicity of red and processed meat, forming the basis of the present study. It has been shown that several mechanisms may be involved in producing unintended effects of risk communication campaigns. An example of such mechanism is the phenomenon of “social amplification risk” [39
]. This is a complex phenomenon involving different social agents. Briefly, when a new research finding is published, mass media communicate it to the public. However, the risk representation of the researchers might be not the same as that of the mass media, which may exaggerate the risk when communicating it to the public to make the scientific finding appear more newsworthy [40
]. This process may lead to secondary, unintended effects [39
]. The second reason for criticism is that the WHO-IARC communication was based on research that would normally be subject to criticism and revision, as has been demonstrated by the recent work of Kruger and Zhou [43
]. Such work highlighted the fact that the IARC claimed that the association between CRC and red meat is supported by strong mechanistic evidence, citing heme as one red meat component responsible for the carcinogenic process. However, Kruger and Zhou concluded that studies in the field do not provide sufficient evidence about the role of heme on the risk of CRC.
The results of the present study highlight that there might be a substantial interaction between the potential benefits of an awareness campaign in terms of reducing CRC incidence and the potential long-term costs encountered by an important industrial sector in terms of increasing mortality due to job losses and other unintended economic consequences. Considering this framework and the results provided by the simulation study, it is essential to carefully plan risk communications, taking into account their potential psychological and social implications, since they may result in secondary consequences that may have a negative impact on the market [1
Clearly, the aim of WHO was to provide material for consumers to help them make informed decisions regarding their food choices. However, separating the concepts of level of evidence (a complex epistemological construct) from that of the magnitude of the risk (which is a complex probabilistic concept referring to the size of the effect of the agent on the outcome of interest) is a difficult cognitive exercise [44
]. Understanding these concepts and separating them (since they are independent from each other) requires specific training. Thus, the most likely understood message by the average consumer was, potentially, that eating processed meat was “as dangerous as smoking”. resulting in a misleading risk representation. The risk misrepresentation (and exaggeration) could reasonably lead to more extreme decisions, such as eliminating eating processed meat altogether, instead of the intended ones, such as a conscious reshaping of eating habits and individual lifestyle choices. Even though this represents a simple setting simulation study, it should make us reflect upon the need to carefully identify an optimal approach to communicate nutritional risks. Indeed, if the perception of the producers and consumers is that the level of risk of processed meat is comparable to that of smoking or asbestos exposure, it would not be surprising that some consumption pattern reshaping might happen. In Europe, which still suffers from a major economic crisis and which is slowly but consistently moving towards a more flexible labor market, some markets might face a marked decline. The literature shows that market shocks and job losses do not come without adverse consequences to individuals’ health and their propensity for risky behaviors.
To overcome these issues, the development of risk communication guidelines for media professionals has been suggested [45
] to promote clear risk communication, so that secondary consequences can be avoided. Because many newspapers reported that the classification of processed meat was in the same group as tobacco and asbestos, we argue that the meaning of this message might not have been properly assimilated by the general public. It is clear that even if these two factors are found to be carcinogenic on the basis of analogously strong and consistent empirical evidence, the levels of risk have completely different repercussions on overall public health.
What type of consequences could we imagine in this context? Although we do not have any empirical constructs that could provide a robust answer to this question, we simulated possible outcomes using findings from recent literature. Our scenarios are hypothetical but reasonable and show an important balance between the benefits of a lower CRC incidence and the costs in terms of adverse health effects related to a potential market shock for such a large industry. What makes a society better off? A gain of 406 yearly saved CRC cases is definitely a good. However, what if that gain generates some medium-term externalities that may result in 27 deaths attributable to job loss?
The interconnectedness between different segments of society in such a long-term scenario remains speculative. In an ideal world, one should prevent adverse health impacts, as well as any adverse socioeconomic consequences of interventions, and a correct knowledge and interpretation of the “magnitude of risk” by all stakeholders is of primary importance.
The scenario here simulated suggests caution when performing large-scale, important health risk communications, since inappropriate modalities might generate undesirable side effects and related consequences. This is particularly true when the magnitude of risk is modest, as is the case for most nutritional risk factors, and when it is not immediately and completely clear whether the overall benefits will be higher than the potential costs.
We emphasize that risk communication represents an important part of risk management. Accordingly, all the potential externalities should be examined and considered before launching large-scale and sensationalistic awareness campaigns, given the potential for the unintended consequences of such campaigns.