2012 December blog
Havana, Cuba, and now just arrived back in Brazil. This month, writing now a week or so after the XVI SLAN conference, my hero is a man of whom I was only vaguely aware before I arrived at José Martí International Airport outside Havana. Yes, this is José Martí.
Good nutrition and land reform
For Cubans, José Martí is a definition of his country's aspirations and identity. He is as much the national hero and martyr as is Che Guevara. His own attempt to liberate Cuba, in his day from Spanish rule, ended very soon after he and his companions came ashore in 1895. He was killed in his 43rd year, in the first battle. Fidel Castro, who came ashore a little over 60 years later, has always acknowledged José Martí as his inspiration.
Very good, you may be thinking, but how does this relate to nutrition and to public health? José Martí, shown above and below, and other liberators, are relevant to our work. A reason is land reform, with the purpose of giving freedom for family and co-operative farmers to grow what's natural in the land in which they live, to feed their communities and their families and to nourish their country. This was and remains the great issue in Cuba, whose economy since the Spaniards came saw and conquered half a millennium ago, has depended on sugar, tobacco and coffee.
José Martí: from left, birthplace; campesino leader and teacher; soldier and man on horseback (in Central Park, New York City); and Cuban national hero
The first three pictures show José Martí's birthplace, and then him as a campesino and an educator committed to land reform. Primarily a lawyer, writer, poet and educator, he is also commemorated as a warrior on horseback as shown in the fourth picture, a statue on the south side of New York City's Central Park. These give an idea of why his image is on coins as shown in the fifth picture, and why the national 1 peso banknote, the equivalent of the $US 1 dollar bill with the picture of George Washington, depicts him.
But his main place in history is as a philosopher committed to reasoning out right ways to live. Cuba's astounding record in public health medicine in the tradition of Rudolf Virchow, my hero last month, which yes includes nutrition, above all begins with José Martí.
Cancer. Study, treatment, control, or prevention?
Richard Horton of The Lancet. Michel Coleman of the London School, a
lovely man. Richard Peto from Oxford - lancet? No, very like a bludgeon
What was I doing in Lugano, as mentioned in last month's column? Glad you asked. Franco Cavalli, a former president of the Union for International Cancer Control, who I got to know first in 2007 at a conference in Rio, in his role as supremo of the World Oncology Forum, invited me. The deal was that the world's 100 top experts would, for two days, debate 'Are we winning the war against cancer?' Thanks to the beneficence of an Italian foundation, we all travelled business class. No thanks to TAP (short for Take Another Plane) I nevertheless arrived wasted, in the midst of the first of a number of splendid receptions.
Knowing nothing about oncology, I asked Franco if in my interventions, I could focus on prevention and on the World Cancer Research Fund sense of 'stopping cancer before it starts'. Absolutely, he said, and other participants also did. There was also a move against focus on treatments with super new drugs that cost a billion to develop, and which apparently prolong life for anything between two months amd zilch, but which are super-interesting to study.
To know Michel Coleman (middle, above) of the London School of Hygiene and Tropical Medicine, who as Professor of Vital Statistics has a quiet sense of humour, is to respect him. He gave an awesome presentation, revealing the origin of the military metaphors now associated with cancer. The reason was that Richard Nixon 'scaled up' (to use a current buzz-phrase) cancer in the context of the Vietnam war and maybe had got into the habit of talking about surgical strikes, not to mention collateral damage. How strategic hamlets fitted into his narrative, I can't say.
Anyway, the day after his presentation, Michel, with exquisite timing, stuck up his hand and suggested that maybe the war was not being won, but perhaps 'war' could be lost. Quick as a flash Richard Horton, editor-in-chief of The Lancet (left, above), who at this final stage was acting like a super-interventionist talk show host, asked for a vote, which was around 90-5 in support of Michel (I think there were a few abstentions). So 'war' is over.
The WOF proceedings are a bit hush-hush until next February, so I won't say much more, except to be a bit indiscreet about Richard Peto (right, above), who compared with Michel Coleman is as a bludgeon to a rapier (I almost wrote 'lancet'). Apart from infections, he is focused almost entirely on smoking as a cause of cancer. Anything else? Trivial. Will the final WOF declaration, statement and ten points to be published in February in The Lancet and The New York Times, mention any aspect of nutrition? Don't hold your breath.
Staying with The Lancet, Angelo Stefanini of the People's Health Movement, the Italian equivalent of a diamond geezer (a lovely fellow), sent me and colleagues an infuriated email this morning. He pointed to The Lancet 1 December number, and its 'A manifesto for the world we want' after the current term of the Millennium Development Goals ends in 2015, which Richard Horton must have approved, if not drafted. Access it at http://www.thelancet. com/journals /lancet/article/PIIS0140-6736(12)62092-3/fulltext?elsca1=ETOC-LANCET&elsca2 =email&elsca3=E24A35F.
On chronic non-communicable diseases the sole vision is 'Managing and treating cardiovascular disease, cancer, diabetes, and chronic respiratory disease will need continued action, as will mental health and neurological conditions such as epilepsy and dementia, which still get marginalised in global policy debates' . Angelo comments, rather mildly: Big Food itself would not be able to produce a more normalising, de-politicised…statement!' Quite. Odd.
Fundamental and elemental public health
There's more to nutrition than nutrition
Let me explain the headline of this item. Having been invited to present at SLAN Havana, and also having some experience as a conference co-organiser of what it feels like when speakers drop out close to the event, I wrote a crafty note to Santa Jiménez, the splendid chair of the scientific programme committee. I suggested either one of two additional themes should a slot happen to become vacant, one of which was 'Nutrition or nourishment?'
Two slots did fall vacant, so I was asked to go for both (the other topic is another story), which is how I ended up with five presentations. This meant I saw nothing of Cuba outside the hotels where I and also colleagues and chums were staying, the Palace of Conventions, and the drive from and to José Martí airport. Bah! It's what's known as John Lennon Syndrome. Asked at the height of Fab Four Mania what Los Angeles, or Tokyo, or Frankfurt, was like, John said 'the presidential suite in the Sheraton Hotel, Los Angeles, Tokyo, and Frankfurt, and the gigs'.
What we are about
José Maria Bengoa on the magic wheel that returns nutrition to the Greek dietetic tradition (left), and (right) my outline of what nourishment means
Anyway. Here above are two slides from my presentation relevant to the theme here, on 'Nutrition or nourishment?' I started by pointing out that since its beginnings as a science, nutrition has been mainly concerned with human growth, and with the understanding, treatment and prevent of physical disease. Nobody contradicted me.
Whereas, I said, in the tradition going back to Classical Greek times (right hand slide above) nourishment includes physical and also mental, emotional and spiritual good health and well-being. At the end I asked for a vote, and everybody in the room stuck up their hands for the bigger picture, envisioned by José María Bengoa (left hand slide above) as 'the ideas that the Greeks held about dietetics – as the dominion of life itself'. Nobody voted for nutrition as principally a biological science. Carlos Monteiro, who was in the room participating, pointed out that my sample was biased. He was right, if the population was all SLAN participants, or all readers of this column. But my population was the 100 or so SLAN participants who chose to come and join in a discussion on the scope and limits of their work.
I mention Carlos here also because of all nutrition scientists now alive and active, I have learned most from him in the context of living and working in the global South, as is evident from a big World Nutrition commentary this month. Carlos is a very remarkable person, as indicated by his Association member's profile. He has been a tenured professor at the University of São Paulo for over 30 years. Before that, as a young physician at the time of Brazil's military regime, he served deprived communities and families in and around Porto Nacional, in what is now the Northern state of Tocantins.
Fundamental and elemental nutrition
One of Carlos's most crucial insights circles back to José Martí and Rudolf Virchow. Rates of undernutrition, related to food insecurity and showing as hunger and eventually clinical disease, have been high in Brazil, most of all in the North-Eastern and North regions. Now they remain a public health issue, but are low. Why? As a meticulous epidemiologist, Carlos tracked the factors. The main reasons include sustained schooling especially of girls, improved sanitation including clean safe water supplies, and income transfer schemes. That is to say, communities and families increase and improve their diets when they are enabled to make the choices they already know are right.
In Carlos's list of factors, nutrient supplementation or nutrition education, in isolation, did not figure. To quote José Martí, in a passage in which he surely refers to people in general: 'An ignorant man is on the way of becoming an animal, whereas an educated and responsible man is on the way to becoming God'.
This also circles back to the topic of my presentation, and to why José Martí and other enlightened educators speak to us, whatever work we profess. Another good friend and esteemed colleague of mine, Urban Jonsson, a former chief of nutrition at UNICEF in New York, occasionally states in nutrition conferences that of all the people he needed to raise the quantity and quality of nutrition in Iringa, Tanzania, where he worked decades ago, the one group that was of little or no value were nutritionists. That is of course an annoying thing to say, and I think he is right. What I take him to be saying, is that nutrition in isolation is ineffective, and that the state of a people's nutrition can be raised and sustained only by nutrition in context.
Which is to say, that properly understood, nutrition fundamentally is a social, economic and environmental as well as a biological and behavioural science. Even deeper, it is an elemental science. To raise up deprived, exploited and ravaged populations, we need to think about earth (land) and also fire (energy), air and water. Or, to state this in another way: in the full sense of the word, nutrition is political.
Brazilian backlands. Illustrations of fundamental nutrition, which includes basic education, and elemental nutrition, which includes clean safe water
Here I illustrate the point with photographs taken in the backlands of Brazil. The first, on the left above, was taken in 1999 in Araguatins, in Tocantins, just after dawn. It is of children cycling to school. They are adults now. Does the provision of elementary and now also secondary education in remote parts of Brazil, enable children to grow up with a real chance to know what is good to eat, and to have sufficient income to choose what is good for their families? Obviously yes.
The second picture was taken in 2007 in the Amazonian forest close to Belém, also in the North of Brazil. We had stopped nearby a cluster of homes, for reasons indicated in the story below. At the back of one house there was a big pool, and I took pictures of children swimming and larking about. Does the provision of what is another public good, which is safe clean water, also a foundation of nutrition? Obviously yes. It is only when we address such fundamental and elemental questions, that we can claim to be addressing the basic issues of nutrition.
Gifts from Cuba
Both these examples also circle back to Cuba. The country now has one of the best stories anywhere in the world, for universal education, basic primary health care, and family physicians – and to fair, the beginnings of this achievement predated the 1959 revolution. I learned some of this when for a while a decade ago, I was living in Tocantins, where in its backlands there were around 70 dedicated Cuban community physicians 'donated' by the Cuban government, giving impoverished communities basic care and treatment, building their trust, and learning Portuguese.
When communities are cared for and their children stay at school, families have more access to and knowledge of healthy food, and also are more likely to have safe water supplies. Such truths are sometimes forgotten when nutrition is taught and practiced. This is what I said during discussion after my presentation at SLAN.
Enter the President of Enjoyment
Was Derek Yach (left) defenestrated from his top suite? And will his Pepsi
boss Indra Nooyi, here at the World Economic Forum, now bite the dust?
Last month I wondered why after five years, Derek Yach (above, left) formerly a WHO high-up executive director responsible for global nutrition and health policy, has now left his later executive post as Pepsi-Co senior vice-president, global health and agriculture policy. And moreover, why he is now doing what to an outsider seems like a much less awe-inspiring job with the Vitality Group. This is a South African-owned firm that seems to be selling workplace health to corporations in return for truckloads of cash. Whether Vitality health includes kicking cola drink vending machines out of places of work, I can't say. But Derek has chameleon qualities, as must any transnational executive or official.
Derek, me, Ricardo, and '916'
Last month I mentioned that I recommended to Derek Yach at the 2001 International Conference on Nutrition in Vienna, that the chair of what became the 2003 WHO/FAO '916' report on Diet, Nutrition and the Prevention of Chronic Diseases, should be Ricardo Uauy. Derek then had the power to make such decisions, and Ricardo was indeed appointed to the super-prestigious position, and in 2005 became IUNS president.
Of course this had nothing to do with me, I added last month. Well,,, maybe not so. On arrival in Havana I bumped into Ricardo the day before SLAN started, and we reminisced, and he told me that Derek offered him the appointment at the 2001 ICN. Just fancy that!
What's up, or should I say down? In our world, Derek is himself an intriguing topic. But last month I speculated that the context of his departure is the failure of the PepsiCo boss of bosses Indra Nooyi (above right), who hired Derek, to move Pepsi's 'fun for you' products into the so-called 'better for you' category, and the 'better for you' products into the audaciously termed 'good for you' category.
Indra bottles it
What happened beginning around three years after Derek slung his gun with Pepsi, was that 'Wall Street', meaning the financiers who drive corporations' share prices and market values, were giving Pepsi the thumbs-down. They were reinforced by the bottlers, a powerful independent bunch totally reliant on sales of soda. They were infuriated by Indra Nooyi banging on about rejigged Pepsi products – ultra-processed snacks, mostly – as being healthy, while as they saw it, neglecting the core brand, Pepsi-Cola itself. Their general attitude, indicated in the US trade press, is that Indra was not concealing her desire to 'serve her country' – meaning a top job in the federal government – and that PepsiCo's business is not health but wealth. Too true. So they gave her the Black Spot.
Last February Indra bottled out, and announced at a summit with Wall Street financiers that 8,700 employees were being fired, and that advertising and marketing would be boosted by 15 per cent or $US 500-600 million, mainly for Pepsi soda itself, and also classic 'fun for you' snack products.
So did Derek walk the plank, bite the dust, drop through the trap? Was he, to use the US euphemism, Let Go? Or did he merely see the Writing on the Wall, which being interpreted, said Health Sucks?
Gagging for Gaga
But I was altogether too tentative last month, and have been slow on the uptake. The real story is not about Derek. It is about the new commercial strategies of PepsiCo and other transnationals in response to what they foresee as long-term continued finance, fuel and food crisis and chaos.
When armies are at war, the last thing that bothers the troops is getting fat or having a heart attack. It's much the same when populations are in states of transition, confusion or depression, or struggling to stay employed, or to feed their families, or to avoid eviction. Their felt needs become more basic and immediate. It's the ancient Roman bread and circuses syndrome, of which today's equivalents are burgers and Barca, sugar and Star Wars, latte and Lady Gaga – and soda and superheroes.
Armed with this unoriginal insight, I googled 'pepsico' this, that and the other, together with 'pictures' and here is one of the first images I found. It shows how PepsiCola is being marketed in the global South, in order to approach and exceed the 'double-digit' growth of 10 per cent or more extra sales every year. Here is Exhibit #1: an advertisement for Pepsi-Cola in India:
Indian sporting stars MS Dhoni and Ranbit Kapoor persuading the youth of India that it's cool to drink Pepsi-Cola and suggesting that they drink it too
Call me a kill-joy if you will, but I think it's disgusting that PepsiCo is putting across the message to the children and young people of India that it's smart and cool and sporting and healthy to drink Pepsi-Cola. One of the striking things about this image is the in-your-face aggression in the way the bottle is thrust out.
These are not snaps. Many $US 000s are spent on the studio shots, and many $US 000,000s are spent on getting the stars, their teams, and their controllers, to wear the gear and thus be living advertisements for what is, apart from colours and flavours and gas, sugared water. Advertisements for Pepsi-Cola in the global North are softer and more subtle. Out in India, transnational corporate publicity – not just PepsiCo, of course – is red in tooth and claw. Savage and ruthless.
Now from the most populated country in the world, to China, the second most populated country in the world. The advertisement below is also an indictment of the current authorities in China, who have allowed an iconic image of heroic struggle against tyranny, as seen by the leaders of the People's Republic of China, to be perverted into what almost feels like worship of soda:
A travesty of images of Chinese revolutionary youthful fit and slim vision
and fervour, here being used to advertise a super-sized sugared fizzy drink
Call me a dull dog if you will, but I think it's horrible to pervert images of the rise of a nation against the odds in such a way, and in this case betrayal by the Chinese authorities of the period in which China became independent, whatever the failures and atrocities of the Communist government under Chairman Mao. To get a bearing on my point here, think of the image of the US marines planting the Stars and Stripes on Iwo Jima hill, or of a flight of Battle of Britain pilots, or Australian soldiers at Gallipoli, being used in this way. Not even a corporation of the clout of Coca-Cola or PepsiCo would dare to do that, besides which any such campaign would be countered with outrage. But China, that's different, for the corporations originating in North America and Europe that are driving for double-digits.
Very cleverly, this advertisement would have been cheap, unless it came as part of a package whereby Pepsi China paid the authorities an eye-watering fee in return for ripping off an iconic image of the revolution. Any deal would take the form of for example, agreement to build a Pharaonic-size Pepsi bottling plant in an outlying province, and thus retrain and employ thousands of destitute farmers who otherwise might slit their wrists, sell their daughters, or migrate to city slums and see their sons become doormen or drug-dealers and their daughters maids or call-girls.
But sporadic national campaigns are small change for transnationals, and also contrary to their nature. Think Disney. Indeed, think Coca-Cola, whose branding has remained constant globally. And more recently, think DreamWorks and their creations. To be transcendent, transnationals need to tap into the brains of young and vulnerable people in India and China, and Bolivia, Russia, Ghana, Indonesia, Tanzania, Egypt, Mexico, Somalia, Iran, Iraq, Saudi Arabia and Afghanistan, as well as the US, UK and Germany, with the same message, to be tweeted, facebooked, texted, with images and music and a main-line slogan.
Drugs, cigarettes and hard liquor aside, the best vehicle for global immersion in a brand has to be fizzy hyper-palatable sugared water, with the hit it gives. Success would cost a lot of cash. But remember, Indra Nooyi announced in February that she had moved a great big stack of chips to the centre of the gaming board. She had diverted $US500-600 million to pushing Pepsi primary products, and as she spoke, she already knew how the money would be spent.
My time in the belly of the beast
A time in the Brazilian jungle. The Coca-Cola truck blocking our progress
(left), and (right) a Pepsi marketing exec in search of the low-hanging fruit
There are two contexts to the revelation that climaxes this story. The first is, as I was warned when five years ago I accepted Derek's invitation to advise Pepsi on 'righteous development' in Brazil, that it's the distribution and marketing boys that control transnationals. If they don't like the visions of chief executives, the vision will be as a soap-bubble, quivering in the air and then – phut!
Five years ago Derek rang me up and asked me to remind him of the righteous food vision, centred on Brazilian tropical fruits, that I had discussed within the Brazilian federal ministry of health some years before. Thus it was that later that year we, together with a Pepsi marketing executive, found our car blocked by a Coca-Cola truck that had destroyed a dirt road in the jungle outside Belém. (See left, above). I found out later that the reason the drivers kept on ducking out of sight as I took pictures, was because apparent in their cab was the drink they favoured, which was PepsiCola, and they thought I was a spook from Coke.
The trip was frustrating, because the marketing executive, who kept on telling me 'here's the thing', was not interested in righteousness. He also kept on talking about 'low-hanging fruit', a metaphor here applied to actual fruit, which meant raw material that could be branded and on sale the next year. This is why I photographed him (see right, above) handling the very delicious low-hanging cupuaçu fruit, in an experimental orchard created by the dedicated researchers who work for Brazil's national tropical fruits station, our destination on the day our passage was blocked by the Coke truck.
The eventual meeting towards the end of the year at the five-star Cesar Park hotel close to São Paulo international airport, with Derek and his then immediate boss, who left PepsiCo very soon afterwards to run a credit card company, was a fiasco. For a while afterwards I telephoned Derek and asked so what now. Things are developing, he said. Things are exciting, he said. Things are promising, he said. Once he said 'I have survived'. As I had surmised, the 'things' had nothing to do with righteous food.
The next context is the life's work of Robert Jay Lifton, now venerable but still I believe active. His first famous book was Why They Collaborated, which explained why the Chinese Communists found it so east to convert US soldiers captured during the Korean war, into devotees of Maoism. The reason generally was that people in the US, young people most of all, had no deep-rooted beliefs. It was easy to plant ideas in them. At that time Lifton had already made the same observation of Japanese young people. Living in a country whose traditions had been deracinated by the US occupation, and thus by Hollywood, Disney – and burgers and Coke – they had no rooted character, and wore personalities and related behaviour as if these were mere fashion, like clothes. This fragility could express itself in outrageous attention-seeking actions.
From this, Lifton developed his most resonant theory, of Protean Man, the modern or post-modern kaleidoscopic or chameleon personality that is indefinitely plastic, changing shape and nature under any sort of pressure or pleasure. This is an iconic text for advisors to politicians and entrepreneurs, because it implies that any organisation with enough power and money can shape populations to its ends, so that they vote or buy whatever message or brand that is most potent or exciting. You will now be thinking that this is leading to the use PepsiCo is putting the $US 500-600 million set aside to push its primary product, and you would be right.
Enter the President of Enjoyment
Here is Brad Jakeman, Pepsi President of Enjoyment, with his partner at
his 50th birthday party, and then addressing the 2012 Aspen Ideas Festival
On the PepsiCo campus in New York state, there is its Beverage Lab, run by Brad Jakeman, who previously worked for Activision Blizzard, Macy's, Citibank, and Ogilvy and Mather. Brad is an image man. What you think of Citibank has a lot to do with what Brad thinks you should think – established, warm and friendly, part of the story that has made America great. Brad is a bullshit artist. He works at the highest level, so far not yet for a political party. Now his big canvas is sugared water. He joined PepsiCo in early 2011, and is now – honest, this is true – Pepsi's President of Enjoyment, and also its Chief Creative Officer. He joined at a time when the Pepsi main Board knew that all the 'better for you' and 'good for you' narrative was not working. Scope! $US 500-600 million of scope, and a free hand!
So here comes the big one, Exhibit #3.After a mass of market research, which he terms 'the most exhaustive and rigorous consumer-insights-led process', including 'immersions' in Argentina, Australia, the United Arab Emirates and Russia, Brad and his cohorts in the Beverage Lab came up with a rather obvious master plan. This is that Pepsi needed to become a global brand with a global image, focused on fun. Bottler Jeff Minges is excited and says that Brad is showing the moxie (guts, nerve) of a truly global corporation. Brad came up with the line that whereas Coke is timeless, Pepsi is timely.
Nikki Minaj, the voice of Live For Now. Her colour fits in any culture, she's
a travesty, and (see the picture second from left), she also has serious booty
This all needed a voice. The ideal would have been Michael Jackson, the completely ambiguous singer and dancer. Madonna would not do, because she is white, old, and has her own ideas. Lady Gaga could have been a candidate. Brad's choice is Nikki Minaj, and the reason is obvious from the picture strip above. Any young or impressionable customer can pin any idea on her. Even more astounding, Brad has resurrected Michael Jackson, as you can see below.
Michael Jackson, back from the dead to sing for his soda. He too is part of
The Live For Now global campaign now masterminded by Brad Jakeman
The whole campaign is knit together with the slogan to make Pepsi timely: 'Live For Now'. The concept is that Pepsi will be part of the kit of all cool customers, from Turkmenistan to Fiji to Uruguay to Lesotho to Iceland to the Democratic Republic of the Congo. China and India also, for sure. The US and the UK less so, because consumer-insights-led processes show that folks in these countries are burped out – these markets are saturated, flooded. How in Brazil I could have missed the Live For Now home page, shown below, I can very well imagine. I am old, and set in my ways, and eat meals.
Acknowledgement and request
Conflicting or competing interests: My consultancy with PepsiCo in 2007 would count as a conflicting interest, but the statute of limitations has now passed. Reviewers of this column are Fabio Gomes and Claudio Schuftan. Readers may make use of the material in this column if acknowledgement is given to the Association, and WN is cited. Please cite as: Cannon G. José Martí. The right to nutrition, and land reform, and other stories. [Column]. Website of the World Public Health Nutrition Association, December 2012. Obtainable at www.wphna.org.
All contributions to this website are the responsibility of their authors. They should not be taken to be the view or policy of the World Public Health Nutrition Association (the Association) or of any of its affiliated or associated bodies, unless this is explicitly stated.