Is always helpful to remember what we are doing at nutrition conferences, and what is their purpose. So if you have not already, I ask you to read the September and October editorials in World Nutrition: ‘Conferences: What for?’(1) and ‘Conferences: What for.’(2). And I will continue some themes from my column last month (3).

Experience is stronger than words. Our attitudes are more effective than our speeches. What we say is more authentic when we have experienced what we are talking about. This does not mean we have to develop cancer to become an expert on cancer, nor that we have to move to a poor community to become an expert on poverty. Knowledge derived from scientific paradigms, and traditional and popular wisdom, are complementary.



What was the attitude of participants at the Porto congress, to the presence of Coca-Cola Iberia (picture above), with its absurd slogan ‘we take care of your hydration’? My guess that some of us were bothered, confused, or outraged, and that some of us were indifferent or found it – and its products – pleasant or convenient. What would be the proportion of participants in any of these categories? What would you guess?

If in congresses we act in ways that are inconsistent with what we write and say, how can we expect to be any kind of a force for good health in the world? If congress organisers think they are so short of funds that they have to take money from conflicted industries, whose products are bad for public health, how can they expect to make a difference for the better? If our nutrition students and young nutritionists are being trained to repeat claims such as ‘industry is part of the solution’ and ‘bad foods do not exist, every food has its place in a balanced diet’ what next in future conferences? Free cigarettes? Offers of whisky? The arms trade?

At their stands in conferences, conflicted food and drink industry buy off participants – old as well as young – with toys and cheap colourful gifts. But the stories we buy are much more costly. We hear that we cannot tackle public health nutrition problems without industry’s help. Really? Has public health really benefited from the support of food and drink manufacturers of conferences? Why do you think industry sponsors public health and nutrition conferences? Obviously, to claim that they are ‘part of the solution’. Conflicted industries tout themselves as part of the solution to the problems they themselves have created, such as the replacement of traditional diets with processed products.



It’s evident to me now that most (not all) change for the better in public health nutrition comes from outside the profession. See the picture above. It shows a young nutritionist drinking Coca-Cola^TM in the Infante room at the Porto congress venue. Is she really interested on helping public health nutrition to progress? The problem here is not just drinking a Coca-Cola^TM. The problem is a health professional having a Coca-Cola^TM during a world congress on public health nutrition. By this act she is complicit in the financing of the marketing of sugary drinks for children, she is supporting the environment that has created the obesity pandemic. She has become an advertisement for Coca-Cola^TM in a potent context.

References

1. Anon. Conferences: What for? [Editorial] World Nutrition, September 2010, 1, 4: 178-184. Obtainable at www.wphna.org
2. Anon. Conferences: What for. [Editorial] World Nutrition, October 2010, 1, 5: 204-210. Obtainable at www.wphna.org
3. Gomes F. Six hours of words from our sponsor, and other items. [Column] Website of the World Public Health Nutrition Association, October 2010. Obtainable at www.wphna.org
    

Agrobiodiversity
Yes we have blackberries



In October, with the themometers down to 20oC and lower in the orchard I frequent in Maricá, Rio de Janeiro, it is time to harvest blackberries. Yes, we have blackberries in Brazil. The one in the picture above didn’t need any pesticide or fertiliser. It is a gift from nature. It is almost impossible to arrive back home with a full pot after harvesting them from the orchard. For each one I collect, I eat three!

The verse this month quoted below supports my colleagues Geoffrey Cannon in his celebration of the sexy dimension of nutrition (1). The almost indescribable experience of blackberries was transformed into song by the Brazilian composers and musicians Alzira Espíndola, Paulo Salles and Itamar Assumpção:

Finally
(Finalmente)

My whole life I've waited for now
(A vida toda eu esperei por agora)
To feel your body’s scent so close.
(Sentir o teu perfume assim tão de pertinho)
That smell of yours that’s found in nature,
(Esse teu cheiro que existe só na flora)
In those flowers that also contain thorns.
(Naquelas flores que também contém espinhos)

My whole life I've waited for this glory
(A vida toda eu esperei essa glória)
To kiss you, to bite your lips, your red mouth,
(Beijar mordendo esses teus lábios de fruta)
The colour of blackberry, the colour of the dawn.
(Boca vermelha cor de amora cor da aurora)

References

1. Cannon G. Burger, shake, fries and statin, please, and other items. [Column] Website of the World Public Health Nutrition Association, September 2010. Obtainable at www.wphna.org

Food and drink processing
What for, and for whom?

During my discussions with Association founder member Walter Willett, on the occasion of the Porto debate between Carlos Monteiro and John Lupien on food processing (since Carlos won 35-0),Walter said to me that healthy diets can include a fairly high proportion of ultra-processed foods and drinks, I mentioned this last month. Afterwards he and I continued the discussion. He points out that countries with colder weather need more food to be processed, while he also agrees that ultra-processing has devastating effects on health and the planet. Some processing is necessary, but it should always where possible be minimal and benign.

In his WN commentary this month, my colleague and good friend Carlos Monteiro develops his thinking about ultra-processing. The issue, as he stresses, is not processing as such. Some processing is essential and some is beneficial or benign. The issue is that an increasing proportion of food supplies all over the world are made up from ultra-processed products.

A share of the food and drink in temperate countries has always needed to be processed, in some form. But where is the value – profit aside – of pushing more and more ultra-processed foods and drinks into tropical countries? I am reminded of a remark by my colleague and friend the food sociologist Claude Fischler, He once told me he will never understand why Brazil and other hot countries have imported the hooded and cloaked and booted obese figure of Santa Claus to our sunny Christmas. Well, one of the reasons is that Santa Claus as we know this Christmas symbol nowadays, was redesigned and rebranded by the Coca-Cola Company to sell more of its product worldwide, in hot and also cold seasons and countries. More on this is coming up in Geoffrey Cannon’s December column.

References

1. Gomes F. Six hours of words from our sponsor, and other items. [Column] Website of the World Public Health Nutrition Association, October 2010. Obtainable at www.wphna.org

World nutrition
Parabéns Carlos!



Here is our Association Council member Carlos Monteiro, being congratulated by Pan American Health Organization director Dr Mirta Roses-Periago. From Porto Carlos flew to Washington DC. There he received the Abraham Horwitz Award for Excellence in Leadership in Inter-American Health. The award, created in 1975, established to honour creative public health leaders in the Americas, is named after a distinguished former PAHO director(1).

I bring you this news to congratulate Carlos and also to highlight some features from his speech. Carlos called on the national minsters of health present at his award ceremony, as well as PAHO. to act firmly and radically to protect public health nutrition in the Americas, and to face two major interrelated problems: chronic undernutrition in childhood, and obesity in childhood and at all ages. You can access his speech here.

During his speech, Carlos gave examples of good policies and programmes, including the sharp reduction of chronic undernutrition in children in Brazil. He showed that the reasons include increased purchasing power in impoverished populations, the improvement of the education of women, improved access to safe and clean public water supplies, and universal access to basic primary health care services, including before and after the birth of children. He showed brilliantly that public policies and actions can reduce chronic undernutrition in a quite short period of time, as in Brazil.

Moving to obesity, he started by saying he wouldn’t mention the absolute figures, as he made for child undernutrition, because he didn’t want ‘to give this speech a gloomy tone.’ He then stressed that ‘in various countries of the Americas excess weight is already the norm’. He highlighted two major reasons for the global failure to control obesity. ‘The first one is to believe that the problem can be faced by a diagnosis and treatment strategy. Obesity treatment, besides being expensive, is inefficacious’. The only way is prevention. The second reason for failure is to assume, wrongly, that the reason for the increase in obesity are individual decisions.

Citing the WHO Global Strategy on Diet, Physical Activity and Health (2) he reminded his audience that this agreement made by all WHO member states stresses that information and education campaigns focused on behaviour changes can only be effective when they are feasible. ‘It is necessary that the environment... be more propitious to the consumption of fresh foods than to the consumption of highly processed and energy dense foods’ he said. But these days it’s the other way round.

He proposed to PAHO and to national health authorities two of the most powerful strategies to confront obesity effectively. These both confront the transnational food and drink companies. The first one – and now Carlos raised his voice – ‘is the regulation of the aggressive publicity for of sugary drinks and ultra-processed foods, particularly focused on children and adolescents.’ (I’ll come back to this below). The second way is the taxation of unhealthy food products, from which revenues could be used to finance campaigns and to subsidise production of fresh foods including fruits and vegetables Bravo! Well done my friend!

References

1. http://www.paho.org/english/PAHEF/horwitz.htm
2. World Health Assembly 57.17. Global strategy on diet, physical activity and health. Geneva: World Health Organization; 2004. Obtainable at http://www.who.int/gb/ebwha/pdf_files/WHA57/A57_R17-en.pdf

Legislation
Food regulation. Who loses, who wins?

When in his PAHO speech of acceptance, Carlos Monteiro suggested food marketing regulation as one of the most effective measures to tackle obesity, he gave as an example, the Brazilian food regulation proposals. I have already been telling this story (1-3).

In 2006, the Brazilian National Health Surveillance Agency (ANVISA) convened a national debate on the regulation of food advertising through a transparent and democratic process. This involved from the beginning all the actors involved. A public consultation was open to all, including consumers, policy makers, industry and regulated sector representatives as a whole. From this debate was born the first systematised and organised national initiative in Brazil to protect public health nutrition against the massive hugely funded push by transnational and big national food processors for the population to consume unhealthy ultra-processed products.

The regulation was published on 29 June this year. Industry was given 180 days to comply. Meaning, that in Brazil, from next month, 26 December, advertisements of food and drinks high in sugar (15 grams or more per 100 grams, or 7.5 grams per 100 millilitres), high in saturated fat (5 g or more/100g, or 2.5g/100 ml), high in trans fat (0.6g or more/100g or 100ml; high in sodium (400 mg or more/100g or 100ml) were to be regulated.

As shown on television, radio, newspapers, magazines, outdoors, websites, and the internet generally, such advertisements were to be followed by explicit written or verbal warnings about their risk to health. The regulation also requires the regulated sector to attach the warnings to toys, gifts, free samples, discount coupons, and charity campaigns associated with those foods.(4) So will this be the last Brazilian Christmas with junky food marketing free of the true information and protection consumers and children deserve? We have hoped so. I say ‘were to be’ because there are still plenty of obstacles in the way.

Industry fights back

From the very beginning, before the proposed regulation was officially published, the the food and drink manufacturing industry, the marketing industry, and the gifts/toys industry made it very clear that they were not interested in providing information to consumers through the specified warnings. They are against any sort of statutory regulation. This was evident in their last statements at the public hearing during the consultation process, which in effect were: ‘See you in court.’(2).

The conflicted industries gave up arguing technical aspects. They focus on two major points: public opinion, and the legal competence of ANVISA as the regulatory agency. They support the media with their advertising, and so the media editorial pages have been full of propaganda against the regulations. Plus they have published and advertised a formal letter designer to convince viewers, listeners and readers that their right to commercial free speech was being denied. They say: ‘We are confident therefore that the usurpation of power now in progress will not prosper.’(5) ‘We’ here are:

Brazilian Association of Advertisers
Brazilian Association of Advertising Agencies
Brazilian Association of Radio and Television
Brazilian Association of Food Industries
Brazilian Association of Manufacturers of Soft Drinks and Non Alcoholic Beverages
Brazilian Association of Pay TV
National Association of Magazine Publishers
National Newspaper Association
Outdoor Centre
National Federation of Enterprises of Cinematographic Exhibiters
National Federation of Advertising Agencies
Interactive Advertising Bureau
Open Word Institute

Who is usurping what? Looking at the signers of that letter you can try to figure out where public health nutrition could possible get space to show Brazilian citizens and consumers the good news of having a food marketing regulation. Open TV? No. Pay TV? No. Radio? No. Magazines? No. Newspapers? No. Outdoor? No. Cinema trailers? No. Internet? Yes! Flyers in the streets? Maybe, but environmentally unhealthy.

Can industry be part of the public health solution? Maybe in the USA and in Europe. That’s for others to judge. But I can tell you that industry is not interested in becoming part of the solution in Brazil and other ‘emerging economies’. They are the problem. In the USA and Europe, multinational food companies pledge not to advertise to children. Although they are still not honouring all their pledges, they are at least publicly declaring they intend to do it. In Brazil, you don’t see anything like this.

Additionally, as indicated in the letter above, specific food and drink companies never expose themselves and their brands. They hide behind associations such as the Brazilian Association of Food Industries, and the Brazilian Association of Manufacturers of Soft Drinks and Non Alcoholic Beverages. This is highly significant. At the International Congress on Obesity held in Stockholm last xxxxxx, I asked Derek Yach of PepsiCo what are the Pepsi plans to restrict the marketing of sugary drinks in lower-income countries such as in Latin America, as pledged for the US and the EU (6,7). He said that Pepsi policies are global. No, he did not say that PepsiCo has no intention of restricting its marketing in Latin America, or Asia or Africa. No, you do not see PepsiCo signing the industry letter above and declaring they are against the Brazilian statutory regulation.

But wait; take a closer look at the letter’s signatories. There they are: the Brazilian Association of Food Industries, and the Brazilian Association of Manufacturers of Soft Drinks and Non Alcoholic. Who is behind them? Of course, PepsiCo, Coca-Cola, Nestlé, Kraft Foods, and others, hiding their names and brands behind association names. Clever stuff. They are evading the scandal breaking news: ‘Giant food companies pledged not to advertise to children in the US and EU, are impeding food marketing regulation in Brazil’.

Can public health protection be illegal?

After publication by ANVISA of the regulation, the pressure from the conflicted industries was intensified. As they said they would, they have heavily invested in lawyers. They have hired the most influential jurist on constitutional law, Luís Roberto Barroso, to claim that the regulation was unconstitutional. Dr. Barroso’s interpretations of the Brazilian constitution are commonly used by judges to support their decisions. So it has been easy for him to suggest to the judge in this case, an interpretation of the Brazilian constitution leading to a verdict that would benefit his client, the Brazilian Association of Food Industries. Thus, Dr. Barroso requested the judge, Gilda Sigmaringa Seixas, to suspend the regulation. His argument has been that article 220, paragraph 4 of the current Brazilian constitution says that ‘The commercial advertisement of tobacco, alcoholic beverages, pesticides, medicines and therapies will be subject to legal restrictions, in terms of section II of the preceding paragraph and shall contain, whenever necessary, a warning about the harms resulting from their use’(8). His ingenious argument has been that since unhealthy foods and drinks are not mentioned, they cannot be regulated!

Judge Seixas has granted the suspension. This is not a definitive decision so the regulation can still get into effect.(9) But after the verdict, you can readily imagine what side got virtually all the supportive publicity in the Brazilian media.

In order to preserve the regulation, ANVISA now needs to convince the judge that the rational interpretation is that because the paragraph 4 of article 220 does not include unhealthy foods, the regulation is the opportunity for the Brazilian government to amplify the protection of population health.

This is also ANVISA’s opportunity to remind Judge Seixas, and the nation, that regulation of heavily marketed ultra-processed foods and drinks will help save millions of Brazilians from obesity, and from diabetes, cardiovascular diseases, various common cancers, and other chronic diseases. These are in large part caused by excessive production of unhealthy food and drink products, and consumption that is in large part driven by excessive and aggressive advertising and promotion. Plus, what does the new Brazilian president think of all this? We will see.

References

1. Gomes FS. Marketing of unhealthy food to young children: Brazilian David
   and multinational Goliath. [Letter]. Public Health Nutrition 2009; 12:1024.
2. Gomes FS. Marketing of unhealthy food to young children: Brazilian Goliath skulking. [Letter] Public Health Nutr ition 2009; 12:2250-1.
3. Gomes F. What’s the matter?, and other items. [Column] Website of the World Public Health Nutrition Association, April 2010. Obtainable at www.wphna.org
4. Agência Nacional de Vigilância Sanitária. Resolução-RDC nº 24, from June 15th, 2010. Obtainable at http://portal.anvisa.gov.br
5. Associação Brasileira de Anunciantes e outros. Em defesa do Estado de Direito. (accessed in Oct 6th, 2010) Obtainable at http://www.abia.org.br/anexos/AF-COMUNICADOANVISA.pdf
6. EU-Pledge. Food and drink companies pledge to change advertising to children. Obtainable at http://www.eu-pledge.eu
7. Better Business Bureau. Children’s food and beverage advertising initiative. Obtainable at http://www.bbb.org/us/children-food-beverage-advertising-initiative
8. Brasil. Constituição da República Federativa do Brasil, 1988. Obtainable at http://www.senado.gov.br
9. http://portalexame.abril.com.br

Joke of the month
Sugary water

In my last afternoon at the Porto congress, I went to a confeitaria (bakery store) and found another industry prank, as you can see in the picture below. Pleno Tisanas^TM is advertised on its package as similar to water. It recommends you to drink as much as feel like. ‘Pleno Tisanas / To drink whenever you feel like. Like water.’ (‘Pleno Tisanas / Para beber sempre que lhe apetece. Tal como água.’) So I went to their website to see the details of the product and they describe it as a ‘very soft and natural infusion, low calorie, that transforms the need for liquid intake into moments of refreshing pleasure.’ (1).



Guess what though! I didn’t know that in Portugal water contains sugar. The perpetrator of this fable is LACTOGAL, Produtos Alimentares SA, a Portuguese food industry, manufacturer of the Pleno Tisanas^TM . It also manufactures the sugary Fresky^TM Laranja (orange) drink served in the lunch boxes given to participants at the Porto congress on the last day, together with a processed meat sandwich (see below).So it goes – until public health nutrition congresses stop being penetrated by the manufacturers of processed food and drink products.




Reference

1.  http://www.lactogal.pt/presentationlayer/marcas_06.aspx?marcaid=51&detalhe=1

Request and acknowledgement

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.

Please cite as: Gomes F. Six hours of words from our sponsor, and other items. [Column] Website of the World Public Health Nutrition Association, Novenber 2010. Obtainable at www.wphna.org

The opinions expressed in all contributions to the website of the World Public Health Nutrition Association (the Association) including its journal World Nutrition, are those of their authors. They should not be taken to be the view or policy of the Association, or of any of its affiliated or associated bodies, unless this is explicitly stated.

This column is reviewed by Geoffrey Cannon. My thanks to Juan Rivera, Walter Willett and Geoffrey Cannon, for the energising meetings we had in Porto and for the great opportunity to share ideas I also thank Walter Willett for the follow up on our discussion on ultra-processed foods. My congratulations again and my many thanks to Carlos for the great dinners and talks we shared, and for pushing and inspiring us all to push the public health nutrition agenda forward. Regarding the Brazilian food marketing regulation story I owe a thousand thanks to the brave Brazilians that have been deeply dedicated to its approval and implementation. I thank Catarina Prima and Sueli Couto for inspiring the November's 'Joke of the month'.

fabiodasilvagomes@gmail.com