Back from Visconde de Mauá, a tiny city up in the hills on the border of the states of Rio de Janeiro and Minas Gerais. I spent a weekend breathing fresh air (yes, there is still some around), drinking spring water (yes, there is still some un-bottled) and eating ripe raspberries (yes, we also have them here) freely offered by nature.

So this month I begin my column with a phrase from Eça de Queiróz, one of the most Brazilian of Portuguese writers, from his book The City and the Mountains (A Cidade e as Serras): ‘Eu sentia também que necessitava remergulhar na serra, para que ao seu puro ar … me despegasse a crosta da cidade, e eu ressurgisse humano’ Which is to say in English: ‘I also felt that I needed to immerse myself again in the mountain, so that in its pure air …I could peel off the scab of the city, and rise up again human’ (1).



Following the nutritional recommendation for diversity, not from biochemistry books but from nature’s harvest calendars, April in Brazil is a month for one of our softest and juiciest fruits: caqui. Here it is, above. It’s a special offer in the fruits section of supermarkets, and in street markets, as I write. This is the persimmon, originally native to Asia and also America. Artemus Ward says: ‘The best types become veritable sugar-plums at maturity… Their sweetness has indeed earned for them the nickname of the date-plum’. Even their seeds are soft. When we stay with nature’s calendar, we keep our meals tastier, cheaper, nourishing in every sense. The mystery is out there. Open your eyes and experiment with colour, touch and feel the softness, breathe and feel the smell touching your tongue, bite, taste the juiciness and feel the aroma coming out through your nose. Such pleasure.

In this spirit of joy and harmony with nature I’m back in the city of Rio de Janeiro to share some thoughts on the decisions and actions that are being made to feed the world’s inhabitants.

Coca-Cola Light Plus, launched in the USA and Europe in 2007, has landed in Brazil and is being promoted in supermarkets throughout the country. Check out Coca-Cola Light Plus Brazil and you will find that it is marketed as the first refrigerante (soft drink) in Brazil that contains added vitamins and minerals. Will it shut the mouths of nutritionists who say terrible things about ‘regular’ Coca-Cola – that it is sugary and practically empty of micronutrients? After all, consumer choice is sovereign, say the food marketeers.

I had a look at the label of Coca-Cola Light Plus, on its silvery can that looks like a space-ship accessory. Curiously, the added vitamins B3, B6 and B12, and minerals magnesium and zinc, are listed in the nutrition labels together with sodium. I can imagine that for some under-educated Brazilians who might look at labels this will mean to them: ‘Wow, it also comes with sodium. Great! It’s super healthy!’  The label also says that the product contains no energy, carbohydrates, protein, fat, saturated fat, trans-fats, or dietary fibre. Indeed. The artificial sweeteners are aspartame and acesulphame.

Coca-Cola is not alone. You may have noticed, wherever you live, that the biggest food and drink manufacturers continue to add synthetic vitamins and minerals to many of their products, and are formulating more and more new products also advertised as healthy because they have synthetic micronutrients added to them. There is no better example of how the exclusively biochemical perspective of nutrition can lead us nutrition professionals to condone or even to approve what are really disastrous ways of feeding populations. Looking around supermarkets, the general marketing of new products, especially to children, feels to me to be more and more like the ways in which pet food is marketed.

Is this really all about free choice? I don’t believe so. The advertising and marketing budgets of transnational food and drink manufacturers, which include ‘slotting fees’ paid to supermarkets for what Marion Nestle calls ‘prime, eye-level real estate’ (2) on the shelves, and masses of it, bear me out. Manufacturers buy their way into prominence, and taken all together their impact is to push out products whose makers don’t have such muscle, down to the bottom shelves and into the least-visited aisles. Thus are food supplies and diets shaped.

Coca-Cola originally was mainly water and sugar (then syrup), plus caffeine and its secret mix of herby and spicy flavours. (As Mark Prendergrast says in his history of the firm and the drink, (3) there has been no trace of cocaine in Coca-Cola for over 100 years). But now, with technological abracadabra, the sugar comes out, the special ingredients are reformulated, and some synthetic micronutrients go in, together with artificial sweeteners, and a colossal spend to convince customers to buy the new miracle of drink technology.

Call me old-fashioned, but I’d rather enjoy a fruit in season.  Nutrition in its full sense will never fit into a bottle, can, or pill.  Nor is nutrition just about enjoyment and health. What we eat expresses the way we interact with planet and people; indeed, the whole way we live, either passively as consumers or actively as citizens.  

This now brings me to the Pan American Health Organization and its Partners Forum for Action on Chronic Disease. This is described as ‘a catalyst for multi-sector partnerships that drive direct social, environmental, and policy action to promote health and prevent chronic diseases’. (4)

The Forum is designed as a ‘public-private partnership’ or PPP for short. (These are sometimes also termed ‘public-private-people partnerships’, or PPPPs). The term is itself persuasive, because the protection and improvement of public health depends on the involvement of all actors, including ‘the private sector’ – meaning industry. Public-private partnerships have sprung up in the last 10-15 years in the context of United Nations agencies and national governments being increasingly constrained, and the corresponding strengthening of organisations based in or largely controlled by Europe and the USA, such as the World Economic Forum, the World Trade Organization, the World Bank, and more recently the Gates Foundation.

It’s hard to say exactly what the Partner’s Forum amounts to. Reports from its meetings, such as those held in Rio last April and Washington last December, are not clear, and also are not encouraging, for all those concerned with public health. But perhaps it’s best that you look up PAHO Partner’s Forum and judge for yourself.

What you will notice, is that the Forum began as an initiative shared by the World Economic Forum, and the International Business Leaders Forum. Both these organisations have as their main concern, more and better big business. What you may then notice, is that most of the partners are, in one way or another, transnational food and drink manufacturers and allied organisations. Further, the agenda for the Forum seems to be much the same as that industry has already worked out for itself – for instance, workplace wellness, physical activity, reduction of salt, and media relations. I haven’t been able to find anything about fast food, soft drinks, fat, sugar, energy-density, advertising to children, or the use of regulation. Maybe I am mistaken. If so, there is space under this column for an explanation of what the Forum is all about.

There are some general questions to be asked, though. For example, why are industries whose products, consumed in typical amounts, are known or reliably believed to be harmful to health, interested in collaborating in order to decrease chronic diseases? Is this because they are planning to sell fruits and vegetables rather than highly processed snacks and drinks? This seems not likely.

What does seem rather more likely, is that as word gets around about partnering with PAHO and those civil society organisations engaged in the Forum, they will be seen as ‘healthy industries’ concerned to protect population health. This, while at the same time, they penetrate more and more markets in Africa and Asia – and Latin America – with the inevitable result that production and consumption of added sugars, fats and oils, salt and additives, increases in these regions, along with the replacement of meals with snacks. From the point of view of big business, this is what’s known as a ‘win-win situation’. What would this do for public health, social and community cohesion, national and local economies and self-determination, traditional cultures, and family meals? Lose-lose-lose-lose-lose-lose, I’d say.

And we have all heard the refrain that there is no such thing as a bad food; that all food and drinks can be consumed as part of a balanced diet. Industry also says that food and drink are not cigarettes. This is obviously true, in some senses. Thus, we need to eat, and we don’t need to smoke (unless ‘need’ refers to addiction). But in other senses it seems to me that certain highly processed foods and drinks are rather like cigarettes. Their risk to health is dose-responsive. Nobody now other than people associated with the tobacco trade would recommend smoking just a few cigarettes a day, if only because they are carcinogenic and addictive. The fact remains though, that the more you smoke the higher your risk. Most people would say that there’s no harm in consuming a soft drink or a convenience snack or meal say once a week, although doing so may draw you into a fast food culture and way of life. There’s a lot to be said for not touching the stuff. But the issue is the amount.

Final food for thought this month. If transnational industries agree that over-consumption of their products is an issue, as they must if they respect the science, why don’t the packets of their products say something like: ‘Consume in moderation, not more than two portions a week’?

Again and again we come back to the same basic point, which is that in all fields of public health, reliable protection depends on the careful use of law used in the public interest. Here, I bring you some bad news and some good news, as an update of the Brazilian government’s proposal to regulate food and drink marketing, by statute. The stage this proposal has now reached is that it is approved by the legal division of ANVISA, the federal government’s public health protection agency. The next stage is that the proposal goes before our legislators – Congress, and then the Senate. At any point in this process, the proposals can be attacked by interested parties and their lawyers.

The bad news is that most of the section of the proposed regulation specifically directed to protect children has disappeared. This means among other things that manufacturers in Brazil can continue to market their products using prizes and toys, including those that attract small children (5). The good news is the proposal, for the first time in our history, to have warnings on television, radio, and outdoors, included in every single advertisement of food products high in added salt and sugar and in saturated and trans fat, and also low nutrient-dense drinks.

ANVISA evidently feels that this compromise deal was the best that could be achieved. This has been in the context of strong resistance from the food and advertising industries (6). Just recently the Brazilian Association of Advertisers rolled out an advertisement on the main Brazilian TV channels, saying that advertising serves the public interest and common good, and that the one thing advertisements do not do, is require anybody to buy anything. What do you think of that?

References

1. Queiroz E. A cidade e as Serras. Porto Alegre: L&PM, 1998.
2. Nestle M. What To Eat. New York: Farrar, Straus Giroux, 2006.
3. Prendergrast M. For God, Country and Coca-Cola. Second edition. New York: Basic Books, 2000.
4. Pan American Health Organization. Partners’ Forum for Action on Chronic Disease.
5. Gomes FS. Marketing of unhealthy food to young children: Brazilian David and multinational Goliath. Public Health Nutr 2009; 12:1024.
6. Gomes FS. Marketing of unhealthy food to young children: Brazilian Goliath skulking. Public Health Nutr 2009; 12:2250-1.

You are invited please to respond, comment, disagree, as you wish. Please use the response facility below. You are free to make use of the material in this column, provided you acknowledge the Association, and me please, and cite the Association’s website.

fabiodasilvagomes@gmail.com