Is Public Health Outreach All Sunnyside Up or Is It A Shell Game?


Craig Klugman

Publish date

Tag(s): Legacy post
Topic(s): Ethics Privacy

by Craig Klugman, Ph.D.

Last week, I received an automated phone call from my local grocery chain saying that I had purchased some hardboiled eggs that were part of a recall and I should return the eggs for a full refund.

My initial reaction was that the call was a wonderful public health outreach program. The company that processed and distributed the eggs issued a recall after 7 people were infected with Listeria monocytogenes (4 were hospitalized; 1 died). A CDC investigation ( found that all of the infected patients had eaten hardboiled egg products from one processing plant. Besides a posting on the CDC website, major news outlets covered the recall and most markets pulled hardboiled egg products from their shelves. And just in case someone did not get the message, some grocery chains called their customers to let them know. These actions are a great example of an effective public health campaign to inform the public of a problem that might impact them and let them know what actions to take. After all, the goal of public health is to reduce morbidity and mortality and the phone calls may have saved some lives.

After being impressed at this action, my thoughts moved in another direction: Did the grocery store call every person who had shopped there (a very large number of people and how did the chain get their phone numbers) or did it just target people who had bought the recalled products (and how would it know who that was)? When I opened my fridge, I saw a bag of hardboiled eggs—not one of the brands discussed in the news, but clearly one that was covered. Without the call, I might have eaten these (and probably would have been fine, but I’m not a big gambler). This realization then led to a second question: Does this mean that the grocery store knows everything I buy at the store? I did pay with a credit card so is the credit card processor or issuer and the store communicating about me? Suddenly, the public health success story started feeling a little creepy.

Like over 142 million other people (, I use a loyalty card when I shop at the grocery store. By typing in a number (or scanning a card), I get benefits such as sales pricing, points that can be used toward purchases, or even discounts on gas. But you do not get something for nothing in a capitalist marketplace. In exchange for a modest discount, a store gets my private information: what I buy, what I no longer buy, how often I shop, how much time I spend in the store, how much I spend, what I purchase, what do I prefer to purchase, where do I live, income of people in my area, do I use in-store services, and more. The reasons are practical for the store: to more accurately know what they need to order, to know when they can hike prices (or lower them), to offer targeted promotions. Yes, the store knew what eggs I had purchased and on what date. The store may even have known why (I like the extra protein with my morning yogurt).

While this might seem innocuous—it is nice to get discounts on things you use or on new products that might be of interest to you—there is a dark side in giving away your private information ( What if you buy a lot of alcohol—the store may know of your substance abuse problem. Would they be a co-dependent if they sent you coupons for alcohol?

From a public health perspective, there’s a lot of benefit to these loyalty programs beyond informing people of recalls. Perhaps the person with high alcohol purchases is sent information on rehab programs. Someone who buys cigarettes could be sent information on smoking cessation. The store also knows if you make poor eating choices, are trying to eat better, or are struggling with your weight (I certainly would not want to count up the number of bakery chocolate chip cookies I have bought there). Might ice cream come with a side of available nutrition counseling?

Or does this cross a line—getting coupons to try products is fine, but information about changing my habits is not? Sometimes your buying patterns reveal information about you before you are aware. Many years ago, Target sent coupons for baby food and clothes to one household ( The male head-of-household was incensed to receive coupons for such things and talked to the store manager. They figured out that the coupons were addressed to the man’s high school daughter who was not yet aware that she was pregnant. By tracking the buying patterns of the daughter, Target knew she was pregnant before anyone else did.

Stores are also selling this information to anyone who will purchase it. Maybe your health insurer is buying information on your eating habits. Or your boss who might suddenly encourage you to participate in a wellness program after seeing your bakery bills. This discussion is to point out that giving away your private information for something as seemingly unimportant as your grocery store purchases can be combined with other data to build a picture of your health or other likely habits which might be information that you wish others did not have.

In the tech age, it’s important to remember that data about our habits and actions is the most lucrative commodity. Information about your buying patterns may be more profitable than the food you buy in the store. We are not the consumer, but rather are the product being repackaged and sold. While the benefit of getting $1.50 off that purchase with no effort (not even clipping coupons) seems like an easy gain, you get that discount at a cost. Essentially, that discount is payment for them collecting your information. In the marketplace, this might be an even trade (clearly the stores think it is adequate payment). In a world where privacy is being undermined at every turn, we all have to be more careful before signing up for things where we give away our information. Despite the benefits of the public health outreach in this situation, it may not be worth the cost to my individual liberty.

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