Here is the face of a whole-body wood sculpture, found among cobwebs in the back of a junk shop in downtown Rio six years ago. The master craftsman is Mestre Expedito of Teresina, Paiuí, whose life’s work is carving saints. It’s of St Sebastian, the patron saint of Rio, whose full name is São Sebastião do Rio de Janeiro. This is because the Portuguese came into Guanabara Bay imagining it was a river (hence ‘Rio’) on the Feast of St Sebastian, on 20 January (hence ‘Janeiro’). Not many people know this, even in Brazil. He has a special place in my study. Now I show him to celebrate the news that the 2012 World Congress on Public Health Nutrition Congress will be held in Rio. As you can see, he is all fixed up for skypery, for there’ll be plenty of that as the Congress is prepared.

David Kessler is one of the most intriguing US public health movers and shakers. In this picture, taken as he was sworn in at the age of 39 as Commissioner (big boss) of the US Food and Drug Administration, he looks more like 25, and he also looks startled. So was US industry. After battles with the food, drink, cigarette and drug manufacturers and associated trades, with all the pressure involved, he lasted six and a bit years, from late 1990 to early 1997. He then went on to be dean of the Yale and then of the University of California (San Francisco) medical schools, and… well, at the end of 2007 this phase of his career also ended dramatically. Now among other things, he is the author of The End of Overeating: Taking Control of Our Insatiable Appetite. Published in the USA last year, UK publication date is right now – 1 April.

His book is a polemic against the chemicalisation of industrialised food systems. The gist of what he has to say has already been said, for example by Eric Schlosser in chapter 5 of Fast Food Nation, and Michael Pollan in chapter 5 of The Omnivore’s Dilemma. But, no offence, those authors are journalists. David Kessler has been inside the belly of the beast as a very senior US government official, and has heavy-hitting academic credentials. He also is mad as hell, as a US citizen whose weight has yo-yoed most of his adult life, and who decided to find out why.

He says that foods that contain a lot of sugar, fat and salt make you want to eat more. These ‘three points of the compass’ (as food technologists put it) ‘stimulate neurons, cells that trigger the brain’s reward system, and release dopamine, a chemical that… makes us want to eat more’. But we are not talking fruits or fresh meat here. This is all about added sugar, fat and salt, made into what Michael Pollan calls ‘edible food-like substances’ formulated by highly qualified technicians whose lives are devoted to creating products that fool the body’s appetite regulation system. ‘Sugar, fat and salt are either loaded into a core ingredient (such as meat, vegetables, potatoes or bread), layered on top of is, or both’. The results depend on sophisticated use of additives. These include emulsifiers, stabilizers, firmers, gellers, aeraters, anti-cakers, improvers, thickeners, thinners, binders and buffers, and fabulous cocktails of cosmetic flavours and colours.

David Kessler brings to his sleuthing a very special authority, and his book may bring the current US authorities a little closer to a tipping point. Publishers usually ask authors of books on food and eating to end up with advice for consumers, which he provides. But I think he knows that what’s really needed is advice for citizens, on effective pressure for strict regulation of processed foods and drinks in the public interest. The US Food and Drug Administration was created a century ago by President Theodore Roosevelt, in the context of the scandal uncovered by Upton Sinclair’s The Jungle, his book on the outrageous practices of the Chicago slaughterhouse trade. Just maybe, David Kessler will impress the current US President – or the First Lady

Any writing that expresses or indicates a point of view is therefore liable to be labelled ‘selective’. Well of course it is! Damn right! But the items in this column, and in my previous ‘Out of the Box’ column in Public Health Nutrition, are not just my own selections. Lots of folks point me in intriguing directions. These include people in UN agencies, government departments, academia, and sometimes also industry. Typically they are shy and ask me not to say who they are.

Sometimes also I blunder into unexpected situations. For example, at the International Congress on Nutrition (ICN) at Durban in 2005, I was asked to be one of a number of speakers celebrating the inauguration of FANUS, the Federation of African Nutrition Societies. Lunch followed. The waiter offered me a Coke. No thanks I said, I don’t touch that stuff. Please give me some water. The waiter drew closer and quietly told me: ‘All the drinks here are made by Coca-Cola’. Water? Really? I asked him for a sample of every drink in the room. He was of course right. It was only then that I scanned the room and noticed, sitting round one table, some executives from… Coca-Cola. Ah. Aha. I see. Nice of them to supply the drinks. Folks from Coke point out that in parts of the world where water supplies are contaminated, it’s safer to drink Coke. Or water bottled by Coke. True.

This is mentioned here partly because this item now is about Pepsi-Co, and it’s always best to be balanced in any reporting of or comments on transnational corporations whose main business is cola drinks.

As I was writing this column, two little birds sent me an email asking me if I knew that Pepsi-Co had donated $US 5 million over a period of three years, to the leading international charity Save the Children, to support its work in India and Bangladesh. No, I didn’t. Actually it was the PepsiCo Foundation which, while having a separate constitution, is part of the Pepsi enterprise.

Indeed, I did know a bit about the Pepsi Foundation. They were on show at the ICN in Bangkok last October. Above is a snap of a wall of their stall at the ICN. This picture shows a line of African men holding sacks of stuff, grain maybe, apparently dropped from the sky, presumably by the UN World Food Programme (WFP). The ground looks arid. Maybe this is because of climate change, or because deep bore holes have lowered the water table. Maybe it’s because food aid discourages communities from growing their own crops.

But such speculation is not my point here. The advertisement at the Bangkok ICN gave me the impression – and perhaps also gives you the impression – that Pepsi, or rather its Foundation, is playing quite a lead part in World Food Programme work. So I was a bit surprised to find that the support referred to was $US 2.2 million, whereas the total annual income of the WFP is around $US 5 billion. Sure, every few drops in the bucket help, but as another bit of context, the 2008 annual profit of PepsiCo was $US 8.5 billion. None of this is any kind of secret. You can check it out by googling Pepsi Foundation Save The Children, Pepsi Foundation World Food Programme, and PepsiCo annual reports.

My little birds were thinking in the same terms about Pepsi and Save the Children, whose annual income in 2008 was $US 1.275 billion, and who recently received $US 70 million from the Gates Foundation. Why did they take $US 5 million over three years from Pepsi? It’s easy to see the benefit of the PepsiCo donations for PepsiCo. It’s not so easy to see the benefits for Save the Children, or indeed for the World Food Programme.

At least, that’s what my little birds think. Charles MacCormack, president and CEO of Save the Children USA, would not agree. He says, in a PepsiCo media release dated 19 February: ‘PepsiCo Foundation’s support of Save the Children’s work in India and Bangladesh will help expand critical social protection and basic nutrition and safety net programs that, in turn, will help children there survive and thrive’.

The vision of the PepsiCo Foundation is ‘to create a better tomorrow for the global community’. Given the scale of their contributions, the scale of their profits, the size of the organisations of which they are donors, and the fact that all the administration, networks, programmes and trust in Africa, India, Bangladesh and other impoverished parts of the world have been built by Save the Children and other civil society organisations, this vision does seem somewhat… well, let’s say grandiose.

Tom Phillips’s excellent obituary of Zilda Arns in The Guardian failed to explain why Dra Zilda, who was killed in Port au Prince by the Haitian earthquake on 12 January, has been so important in Brazil, as she will remain. Nominated three times by the federal government for a Nobel peace prize, presidential candidates sought her endorsement. Here you see Luis Inácio (Lula) da Silva, whose second and final presidential term ends this year, paying his respects.

Zilda Arns was not so much a health worker, as a field-marshal of health workers. In this role she may well have saved and protected more young children’s lives and health than any other public health professional, ever. She was also a formidably tough executive. Born in the south of Brazil in 1934, the 13th of 16 children, to parents of German origin, she trained as a paediatric physician. In 1982 James Grant, then director-general of UNICEF, proposed to her elder brother Dom Paulo Evaristo Arns, then cardinal-archbishop of São Paulo, that cheap and simple care could protect the lives of millions of impoverished Brazilian children. Dom Evaristo conveyed this message to his sister.

The idea became the Pastoral da Criança (roughly, ‘the ministry for children’). Under the umbrella of the socially conscious Brazilian Catholic church, and with sustained support for many years from UNICEF in Brazil, the Pastoral now has 130,000 paid workers and over 100,000 volunteers in over 4,000 municipalities (two-thirds of Brazil’s total), and works every year with 2 million children and their families and communities, at a cost of roughly $US 1 per child a month. In Brazil infant mortality dropped from around 47 per thousand in 1990 to around 20 per thousand in 2007. Brazilian public health professionals agree that the Pastoral is one important reason why, especially in the most impoverished communities. Dra Zilda had recently retired as director of the Pastoral, handing overall responsibility to her physician son Nelson. The Pastoral now works in 20 countries, mostly in Latin America – including Haiti, where in January Dra Zilda was spreading the word.

The philosophy of the Pastoral includes self-reliance. With the support and encouragement of its workers, impoverished mothers and their families and communities are shown the basics of health, nutrition, and citizenship, using methods pioneered by the Brazilian educator Paulo Freire, These are designed to empower the people and to make them as independent as their situation allows: not to be passive but active, not to go on waiting for help, but to find out how they can help themselves, and to own their lives.

In this respect the Pastoral’s nutrition programme, now known as Alimentação Sustentável (roughly, ‘Sustainable Food and Nutrition’), is especially significant. People as family and community members are encouraged to make the best of what they have already got or can find, gain or grow. This includes learning to gather fruits that grow wild, to cultivate grains and vegetables, and to prepare and cook meals using fresh cheap or free foods.

The most striking part of the Pastoral’s nutrition programme is the multimistura (multi-mixture), as celebrated by Francis Moore Lappé in the fourth chapter of her 2002 book Hope’s Edge. This was originally devised and promoted by Clara Brandão, another very remarkable Brazilian paediatric physician, in Santarém in Amazonia, and then nationally. It was then adopted by the Pastoral. Dra Clara, who for many years worked as nutrition consultant to the Pastoral, and then for the federal Ministry of Health in Brasilia, remains an inspiring force throughout Brazil.

The multimistura is given to children by Pastoral workers both to prevent and treat undernutrition, showing as specific or combination micronutrient deficiency symptoms, or as general debility, or even as marasmus.

Multimistura can be seen as an artisanal version of multi-vitamin and mineral pills, but it is more than that. The ‘classic’ mixture is a powder made from rice bran, cassava leaves, and eggshells – ingredients usually discarded as garbage – together with powdered nuts and seeds. The result is of course extremely rich in micronutrients, and also in uncounted bioactive compounds found in plant foods. Wheat bran can be used instead of rice, and sometimes the eggshells are missed out or else packaged separately as an optional addition. Google Multi-Mistura Alimentação Sustentável and you can see how it is made and how it is used, and hear testimonies to its benefits. Nor it is valuable only for children, or in situations of deprivation.

The social, economic and environmental aspects of the multimistura are fascinating. It can be manufactured by the people themselves, using simple machinery and a lot of care. In this way it, and the whole nutrition programme, sustains local economies. The picture above shows an example, made by Mãos Mineiras, a women’s co-operative in the countryside of the state of Minas Gerais. The process of collaborative manufacture and marketing also encourages family and community cohesion, as well as being a source of income. The conservation and recycling of what otherwise would be waste is environmentally friendly.

Also, the multimistura works, although some claims made for its therapeutic value have been felt to be over-enthusiastic. Has its efficacy been tested by statistically high-powered intervention trials? As far as I know, no. Who would put up the money? Besides, the community workers know what they experience, and it’s unlikely that they would agree to a trial taking up a lot of their time, in which half the cohort of children were deprived of the multimistura. Food for thought.

Dra Zilda’s and Dra Clara’s work is now rooted in many thousands of communities throughout Brazil, and Dra Clara remains a great force for public health nutrition. Any public health programme whose strength is that it is by and for the people, and not imposed from above, is liable to be seen by those in authority as subversive, even dangerous. Alimentação Sustentável is controversial, in the sense of being disliked or opposed by conventional food and nutrition professionals who are committed to ‘top-down’ methods of nutritional intervention. Zilda Arns’s genius, with the initial support of her brother the cardinal-archbishop, and then of the assembled bishops of the Brazilian Catholic church, and then therefore of powerful politicians, has been to rise above such suspicion. Secular public health professionals also don’t like the Pastoral being an arm of the church, but this is one way things work in Brazil, the country with the largest Catholic population in the world.

As a footnote of acknowledgement, my first visit to Brazil in 1999 was to investigate what is now called Alimentação Sustentável. On that occasion I spent most of my time in the Brazilian backlands. In my report I concluded that the programme works. My wife, Raquel Bittar, was formerly an executive secretary working to the governor of the northern state of Tocantins. In that capacity she was responsible for the ProVida programme, designed to protect and sustain rural and other livelihoods in impoverished communities. She is a long-standing colleague of Dra Clara Brandão, and testifies to the social, economic, environmental and also nutritional and public health benefits of Alimentação Sustentável, as used by the Pastoral and in many other settings.

The picture above shows Dra Clara, who is of Japanese ancestry, in action in the small Amazonian city of Araguaina. The woman by her side was the then mayor’s wife, the ‘first lady’ of the city. The community nutritionist on the left is holding a little girl who has recovered from marasmus. The writing on the wall tells the story – ‘health, education, nutrition, action’. The multimistura is in my view an appropriate and rational supplement. My family uses it every day, as an ingredient in dishes and drinks. So do I.

This month I am 70, not so far short of the age when men start to boast about their longevity. Yuri Gagarin, the first spaceman, did the business for the USSR on my 21st birthday, so you can check out when to send me a consoling email.

There is a professional reason why I mention this. Psalm 90 of the Bible says: ‘The days of our life are threescore years and ten, or even by reason of strength fourscore years; yet is their pride but labour and sorrow; for it is soon gone, and we fly away’.

Maybe the Bible is right. Maybe the human species is evolved so that in favourable circumstances, our lifespan extends to the time when our children are independent, and then also to later in life, so that we remain useful as grandparents of younger children and as advisors to the tribe. Then the selective advantage of remaining alive cuts out. Only those living in secure environments and/or with tough genes stagger on, irritating their families, and as a burden on the community.

This theory has always seemed rather plausible to me. It means that the main aim of professionals concerned with public health, is to foster circumstances in which the greatest possible proportion of people in any population enjoy good health and well-being until what we now call late middle age, say until their late 60s. Thereafter, according to this point of view, it is perfectly natural that quite soon afterwards most die, either after a short illness, or else simply because their inner clock has stopped. It follows that what’s most important is not extension of life, but freedom from serious disease, in youth and then adult life, until say – I hate to write this – around the age of 70. Give or take some years.

So why in many countries does the average age of death continue to rise well into the 70s and even in Japan and some other countries into the 80s? The main reason is surely medical treatment. Drugs, surgery and other interventions keep people alive for years – often many years – after their natural lifespan. In high-income countries now, the average person lives with serious diseases, debilitated or disabled, or even eventually in a prolonged state of dying, for around 15 years before they die. So often, obituaries, which I check out most days, say that X died after a long illness bravely born, or after many years ‘battling’ with cancer, and such-like phrases. Can this be right? It feels wrong to me.

My personal health is fine, thanks. Well, more or less – most weeks I have reason to hate the dentists at my secondary boarding school, whose drills were the gauge of screw countersinks. It’s midnight now, and after it’s light I’ll totter round the estate where I live, for my daily vigorous 40 minutes, and then make myself a massive vitamina with a banana, half a mango, a passion fruit, cashew nuts, ginger – and multimistura. So you can expect a few dozen more columns after this one. Salutations!

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.

The item on the PepsiCo Foundation was suggested by two Nonny Mice. The item on Zilda Arns was suggested by Association Council member Roger Shrimpton, UNICEF representative in Brazil at the time the Pastoral was formed and developed. This item was also read by Carlos Monteiro and Fabio Gomes. For acknowledgement of Clara Brandão and Raquel Bittar, see above. For work on the New Nutrition Science, my thanks as always to Claus Leitzmann. The column as a whole is reviewed by Barrie Margetts. My thanks also and always to Guardian Online, Google, and Wikipedia.

geoffreycannon@aol.com