2012 June blog
Rio de Janeiro, Brazil. What an easy choice to make, as my hero for the month. This is Inês Rugani, mastermind of our World Nutrition Rio2012 congress, which has been anticipated on this website for two years now, and is celebrated on this month's home page. It is also appraised this month in the columns written by two leading congress participants, Reggie Annan, now back in Kumasi, Ghana, and Claudio Schuftan, now back in Ho Chi Minh City, Vietnam. So including me, the three commentators are from the three continents of the global South, and this begins to tell our tale.
Rio2012: What next. Congress funding
At last, independent
As you know well by now, Rio2012 has been a collaboration between the Association and Abrasco, Brazil's national public health civil society organisation. Host for the congress has been Rio's state university. It could even be the first international nutrition conference whose income has been totally from registration fees and public funds. Not a centavo has come from conflicted industry. This has been made possible by the Brazilian government at state and municipal as well as federal level, for in Brazil public institutions and goods are still recognised and treasured. Special support has come from the Brazilian federal Ministry of Health.
For me, Rio2012 began with a challenge, from Michael Latham, David Sanders and Arne Oshaug, at different times. They, I and others have over the years been standing up at international nutrition conferences and denouncing the gross overt and covert presence of conflicted industry, notably the transnational corporations collectively known as Big Snack (1,2).
The responsibility here is mainly that of the programme committees and professional organisers who encourage the aggressive presence and influence of conflicted industry. Many senior nutrition professionals no doubt like it this way, because they don't see any problem with Big Food and Big Snack, or else because of their own links with industry. An international conference these days may offer packages to the transnationals at a price equivalent to around $US 50,000 (for 'silver' status), $US 80,000 ('gold'), or $US 100,000 ('platinum') a pop. Such deals are now considered normal, just as they are in the medical world with its relationships with Big Pharma.
Personally I have no problem with inviting some speakers from conflicted industries to speak at conferences, as long as they come and speak as personally invited industry representatives expected to give an account of their corporation's policies and practices (3). But that's not what happens now. Time and again, public affairs and such-like executives from transnationals that fund conferences are paraded on platforms as if they are public health advocates. Worse, executives from transnational front and representative organisations set up so as to be formally not-for-profit (4), speak at conferences as if they are philanthropists. Worse yet, quite often whole sessions seem to have devised by conference organisers together with their conflicted industry sponsors, as a travesty of 'public-private partnerships' (5).
No need for fancy venues
Make the venue a university and engage the professors and students, said Michael Latham. So we did. Here is just one section of the opening plenary
So what Michael, Arne, David, I and others have dreamed of down the years, has been the creation of an independent conference, entirely free of 'support' from conflicted industry, that would be a success in itself and also a beacon for other conference organisers. No need to hold such a meeting in fancy hotels or commercial conference centres, Michael often said. Make the venue a university. Engage its governing body and its relevant heads of department, teaching staff, and students. Position the conference in the environment most likely to create positive energy and enthusiasm. Encourage speakers to pay their own way.
That's what Inês Rugani, now head of the Instutute of Nutrition at the State University of Rio de Janeiro, with all her professional and volunteer colleagues and assistants, has done. You get a glimpse of the result for Rio2012 in the picture above. This shows just one section of the 1,800 participants from over 50 countries, during the opening plenary sessions. The great hall was chocabloc. Most participants were obviously early in their careers, with an average age of around 30-35; and maybe three-quarters were women.
References and notes
- Monteiro C, Gomes F, Cannon G. Can the food industry help tackle the growing burden of under-nutrition? The snack attack. American Journal of Public Health 2010, 100 (6): 975-981.
- Monteiro C, Cannon G. The impact of transnational 'Big Food' companies on the South: A view from Brazil. PLoS Medicine. At press; on-line Tuesday 3 July.
- But not in industry-purchased and -controlled breakfast, lunch, evening and other sessions, as is now normal in nutrition conferences.
- These are sometimes known as 'BINGOs' ('business interest non- government organisations') as distinct from 'PINGOs' ('public interest NGOs'). Acronyms often make political discourse seem to be merely technical (like, don't say 'cancer', say 'NCDs'). Besides, these rather silly terms are wrong. Industry front and other representative bodies are not non- government organisations. They are industry organisations.
- The agenda of all the 'public-private partnerships' to which I have been close enough to judge, have obviously been set by industry, with their representative and supportive organisations audaciously identified as 'civil society'. Genuine civil society organisations are at most a token presence. It's clear who really is in charge. Characteristically UN agencies and national governments supply venues, act as grateful hosts, get dined and wined, are photographed with their big business 'partners', jet about, and publish and promote the policies and decisions steered by industry.
Rio2012: What next. Interactivity
Our heavy hitters
Heavy hitters at Rio2012: speakers Walter Willett and Carlos Monteiro (left,
right) and moderator Philip James (centre) after the first plenary session
Here above is a picture I have always wanted to take. Here are three of the giants of modern nutrition, all founder Association members, all committed to the application of science to the improvement of public health and public goods. Left is Walter Willett, head of the department of nutrition at the Harvard School of Public Health. Centre is Philip James, founder of the International Obesity Task Force and chair of the WHO study group responsible for its '797' report on diet, nutrition and the prevention of chronic diseases. Right is Carlos Monteiro, head of the centre for epidemiological studies in health and nutrition at the University of São Paulo School of Public Health.
Their plenary session on the second day was 'From traditional foods to ultra-processing: policies for healthy eating'. Like all the plenaries the session was interactive. In this case the speakers were complementary. 'Walter's Last Slide' has become a legend. He projected it, and there was a pause and a gasp and then among the 1,500 or so participants in the great hall, an eruption of recognition, stamping, whistles, cheers, applause. Carlos summarised his grand thesis, very familiar to World Nutrition readers. Then Phil did a superb job of putting both speakers on the spot, as if on a live television show.
In a later parallel session Phil also became a hero. As meeting chair he got up to sum up the presentations… and the lights went out in the room. Phil thought – as he told me – how wonderful, this is a test I have never been faced with before. Plus he realised that it would be dangerous if people tried to exit the steeply banked lecture room. So he started to speak in pitch blackness. Then somebody in the back of the room had a torch in her pack and shone the light on him, and so apparently disembodied, they saw his face continuing to speak, as in a Samuel Beckett play. After ten minutes or so the lights went on. Everybody in the room applauded, cheered, whistled, stamped. They loved him for showing he understands conditions in the South.
This story ends with a picture of a participant taking pictures of speakers
on the platform at plenary sessions on the final day. Very Brazil, very Rio
Rio2012: What next. The outside world
Malden Nesheim and Marion Nestle on FabTours in the midst of Rocinha, Rio's biggest favela, during our walking tour organised by Fabio Gomes
My good friend and colleague Fabio Gomes, who is a carioca (native of the city of Rio) made an offer of a tour of Rocinha, Rio's biggest favela, on 1 May, the day after the final congress ceremony. He explained that most favela tours are by jeep, as if on safari to see rhinos and hippos. We would not do this. In the morning we would take the subway from the Catete station to the Siqueira Campos station, then the Gávea bus into the heart of Rocinha. This is Rio's biggest favela, maybe 150,000 people packed into the amphitheatrical hill below Gávea mountain. It's an informal city. You've seen aspects of it on television – drug lords, police with machine guns, firefights, executions, mass murders.
All true, but there are other and everyday aspects. Walter and Gail Willett are up for it. So are Marion Nestle, and Malden Nesheim, former Cornell Provost So am I, and others including a group of scientists from Cuba whose purpose in Rio includes completing plans for the federation of Latin American Nutrition Societies (SLAN) congress in Havana this November. We have an awesome day, ending with feijoada facing the ocean in Copacabana. It turns out that the Cubans already have me down to speak in Havana. That's nice.
Rocinha public health messages. This one urges parents to have their children vaccinated against infantile paralysis. 'Parabéns!' means 'congratulations!'
Taking and giving PLoS medicine
Phil James and I share a wry joke about the reception we get when back from a conference in another continent. 'Oh hello' people say. 'Did you have a nice time?' Well yes… but it's not exactly like we've been sunbathing. The week after getting back from a conference, is when you most feel the need for a rest and a tan, instead of a heaving e-in-tray.
Also, conferences have a way of coinciding with other imperative work. Thus, last October Carlos Monteiro and I drafted a commentary for PLoS Medicine on the transnational penetration of the global South with ultra-processed fatty sugary or salty calorie-dense ready-to-eat or to-heat products. From time to time PLoS journals commission guest editors for series of their choice. This one was on Big Food. Guest editors Marion Nestle and David Stuckler chose us to tell the story of a country on the receiving end of Big Snack penetration. This means not merely rocketing rates of obesity and chronic diseases, but also the erosion and eventual collapse of the meal, family cohesion, long-established food systems, local economies, and regional and national culture and identity. Teaching the world to snack branded products has a lot of consequences.
Impact factors and peer reviewers
Like you no doubt, I have mixed feelings about the peer review system. Much depends on the nature of the contribution. Thus leading journals commonly do not subject invited commentaries to external peer review. Also, much depends on the nature of the reviewers, and we have all read horror stories about masterpieces being blocked by envious rivals or even jealous husbands. No no, nothing like that happened to us, the PLoS process is supercharged professional. Elaborated into four separate stages, it was a challenge that eventually worked well. Earlier this year we were externally examined by four peers. Is what they said supposed to be a secret? Would I be journalistic if I said anything here? Perhaps so. So let's just say that one review was a privilege, meticulous and constructive, and another two were supportive. So we reworked the piece with more rigour and less rhetoric and submitted the usual covering note, rebuttal, and revision. We were also aware that PLoS Medicine has a current impact factor of 13.05 which, once I was published there, might get me a rise, were I an academic.
Silence for some while… but then, on the very eve of Rio2012, the editors got into gear, told us that the Big Food series was in production, as a second stage asked us for another revision, and gave us a week to respond, with final completion and sign-off absolutely necessary on yes, you have guessed, the final day of Rio2012. And I was already on 17/24! Carlos is great in these situations. Obdurate. No slacking! None of that sleeping stuff! Now that the whole job is done, I have to admit that I was thinking even at the time, usually around 03.00, that (a) this is a good process (b) possible only under impossible pressure. The final final stretched final deadline was four hours after I got back home after Rio2012, for a final final final consultation with Carlos. Very well…
Road from Rio
Gonzo truckstops I have known
The barbecue at Barrakin, on the road from Rio to the Petropolis summit.
As soon as I get there for a meal I know I am back in my chosen country
After the final day of Rio2012 I took the highway north-west, back home. This snakes up through the Mata Atlântica (Atlantic forest) with its staggering vistas of successive peaks, past the town of Petropolis, built for the Emperor in the nineteenth century period when the Portuguese world empire was ruled from Brazil, whose capital was then Rio. After Petropolis the route bends round bare hills stripped to plant coffee, before the Great Depression starting in 1929 ruined that world trade. Then it crosses the Rio state line to where I live in the inland state of Minas Gerais, where the Brazilian gold and diamonds once came from, before the lodes were mined out and Iberian power crumbled.
Origins of Brazilian cuisine
On the way up through the forest I usually have a meal at the gonzo truck-stop Barrakin. When I sit down and soak up its atmosphere on a sunny day, I feel that I really am coming home. Being there also makes me think about the social and environmental aspects of food systems at local level, and how these can support communities who otherwise would have inadequate livelihoods.
Here is why. Brazil's long-established and traditional food systems have three main historic origins. These are the indigenous people, the slaves from Africa, and the colonists from Portugal and also Spain and later other countries. The Portuguese culinary influence itself derives from centuries of vast journeys of discovery and conquest throughout the world including to what became Brazil by ship, and then the equally epic inland bandeirante explorations by horse or mule or on foot (1). This explains why Brazilian cuisine is so salty: on long journeys by sea or land, travelling light, animal food was necessarily salted and dried. The habit of preferring salty or salted food persists.
Bandeirantes means, literally, 'banner-carriers'. These were explorers-cum- marauders who as from the 17th century, travelled with or without permission in large savage gangs into the interior of Brazil from its coastal areas, especially from around São Paulo, in search of native slaves, diamonds and gold. They pushed thousands of kilometres far west of the Tordesillas line, often through very rugged territory, to the Andes and more or less to the modern boundaries of Brazil. Often half-native themselves, their living off the land also has influenced Brazilian food culture.
The story of the tropeiros – drovers – is similar. They were traders. Starting at the same period of history as the bandeirantes, they travelled on horses or mules and sometimes with pigs or cattle from settlement to settlement, bringing supplies and news. Feijão tropeiro, made with dried beans, dried or cured salted meat, mandioca (cassava) flour, and salt, and with locally gathered greens, eggs and fresh meat, cooked over a fire in an iron pot, remains a favourite Brazilian dish (1).
The gonzo truck-stop
Bandeirantes have passed into history. The modern equivalent of tropeiros (who still do business in remote Brazilian backlands) are truck-drivers (2). This helps to explain my enthusiasm for Barrakin. Most countryside stops on the highways of Brazil are mere motor and motorist filling-stations. They mostly offer sweet and savoury snacks and now also alas, packaged 'long-life' ultra-processed products made by Brazilian subsidiaries of Nestlé, PepsiCo and other transnationals.
Not Barrakin. Physically it's a collection of buildings probably built by the families who live on the plot, fronted by the smoky barbecue you see above. What visitors don't see are the families who live within the forest who first built their huts there anything up to 150 years ago, without any formal rights, but who now are not disturbed by big landowners. They grow their own food and sell handicrafts by the side of the highway. They also supply their aipim (cassava) to Barrakin, which is then chipped and fried to order as delicious aipim frito (fat cassava chips). The families also supply daughters and sisters who wait on what must now be about 40 tables, or else who barbecue sausages or cheese, offering these on long skewers. The closest Barrakin gets to dietary guideline territory is its toothsome vinaigrete, a dish in itself, made from raw onion, tomatoes, cucumber and herbs marinated in vinegar, perfect to go with the aipim frito. Plus ice-cold beer. Also somewhere in the forest there is a family with a still, and any trucker can fortify himself with a couple of half-tumblers of neat local artisanal cachaça (liquor distilled from sugar-cane) before storming on up and around the mountain highway U-turns.
The combination of sharp bends, bald tyres, bad brakes, side winds, and no doubt sometimes also cachaça, accounts for the number of trucks that quite often crash over sideways and block the highway, usually without killing anybody. On the mountain this infuriates motorists, who may be stuck for two or five hours, and delights local residents, who come out of the forest and loot the booty strewn over the road, for eating, drinking, smoking, riding, driving or building. At such times Barrakin becomes a heaving party. The families who own its plot have also build a tank for carp, and a small swimming pool with showers, as you can see below.
Somebody should write a book about Barrakin before the local occupiers are made an offer for their prime site which they don't refuse. It's what you don't immediately see there, that is most interesting and valuable, starting with the fact that it provides a source of income and also a sense of community and neighbourhood to the families who live within the forest. It's a sign of an informal society within the established order of a mostly industrialised country, still to be experienced in other parts of Latin America, and in Africa and Asia, where relationships still mean more than law.
Barrakin also reminds me again that there's more to food and health than prevention of disease, important though this is. In my last column I wondered whether our topic should not be called 'nutrition' (which refers mostly to the body) but instead 'nourishment' (which refers also to the mind, heart and spirit) (3). The locally-sourced, prepared and cooked food and drink at Barrakin is definitely so-so to no-no from the nutritional point of view, but it is wonderfully nourishing.
Fun at Barrakin. Its owners have built a small swimming pool that everyone including children of the families who live in the forest can use and enjoy
Notes and reference
- There's a recipe for Feijão tropeiro in Michael Bateman's book Street Café Brazil (London: Conran/Octopus 1999). It specifies olive oil rather than lard, presumably for dietary guideline-type reasons, but otherwise is OK.
- The equivalent in the US are the teamsters who then, after mechanisation, became truck-drivers.
- Cannon G. Nourishment of the heart, and other stories [Column] Website of the World Public Health Nutrition Association, April 2012. Obtainable at www.wphna.org
What Gabriel said
So yes, I admit that I had a break on the road back home from the conference. Storming in, I showered, changed, unpacked, powered up, found that the internet connection was OK hooray, got ready and steady for Carlos… and then my 8 year old Gabriel came into my study. He was cool. He did not sob or raise his voice. Now look here Daddy, he said. You have been away for two weeks. I have been missing you. Now you are on your computer. Again. I want you to play with me now, and I know what you are going to say, you are going to say not now. I am not happy. This is not good enough.
Shame on me; I felt about three inches tall. Give me 30, I said. Look, here's the alarm clock. Once it rings I am all yours, but I have to get the final PLoS draft off to Carlos. Gabriel is now interested in global insta-communication, which helps. He sat down at my previous computer and told me to say 'Ja!' when I was done Then I have to pray that Carlos was on the end of the skype line, which he was, and we agreed the final PLoS Medicine edits, mostly excellent clarifying tweaks, many thanks to the editors, and then the alarm rang. Gabriel looked sceptical. No no I said, I'm done, I am all yours. Phew.
The next day Carlos and I hear that all was accepted for publication in PLoS Medicine – subject to a fourth stage of copy-editing, but don't you worry – and will be on-line on 3 July. Hooray!
Rio2012: What next. Tim Lang, Michael Pollan, and…
Writers who inspire us
Writers who inspire us. Tim Lang (left) with a banana, thinking about food miles; and (right) Michael Pollan bringing in his family's food close to home
In April and May World Nutrition carried a series of short communications mostly from Association members and Rio2012 speakers, asking them to give glimpses of the state of our world by answering six questions. One simply asked them to state what writer they most recommend. Last month I promised to anatomise the answers and see what themes emerge. Here we are. The original question was biased in three ways. First, to ask for the name of a writer suggests that the answer should be an author, rather than somebody best known as a contributor to learned journals. Second, Association members and Rio2012 speakers are already inclined to take a broad view of nutrition, and do not see it only or even mainly as a biological discipline. Third was a predictable flaw in the exercise: many of the 29 contributors insisted on naming more than one writer.
And the winners…
Overall, three writers stood out, and you know who two of them are, from the pictures above. Four contributors chose our very own Carlos Monteiro, exceptional in that he is best known as a writer of papers and commentaries (1-5). These were Barry Popkin, Harriet Kuhnlein, Inês Rugani, and Jean-Claude Moubarac. Jean-Claude, who came to Brazil from his native Canada to work with Carlos, says: 'Right now, I strongly recommend Carlos Monteiro for his recent papers and commentaries on the new classification of food based on the nature, extent, and purpose of food processing. His new thesis about the importance of food processing in public health nutrition is groundbreaking'.
Four contributors chose Michael Pollan (6-8). These were Barrie Margetts, Boyd Swinburn, Isabela Sattamini, and Ricardo Uauy. Of these, Boyd, Isabela and Ricardo chose only Michael Pollan. Three of them clearly see him as a hero of our times, courageous, challenging, comprehensive. Boyd says: 'Being able to cut through the cacophony of nutrition research to come up with 'Eat food, mainly plants, not too much' is brilliant – if only more academics had that level of incisive thinking'. Isabela says: 'This might be difficult for some scientists to accept, but Michael Pollan is a journalist and author who talks about food and nutrition better than anyone I have ever read. He gets to the point very well and, better than this, has the ability to write in clear language, in a very accessible way that can reach all types of public.... He sees the social side of nutrition, valuing cooking and conviviality, and also the importance of balance, in every choice'. Ricardo says: 'He has the courage to fight the prevailing views, despite the low odds of winning. To navigate against the wind, is the real challenge. Courage is tested when you are swimming contrary to the current. If you are convinced enough you have to be willing to go at it alone if necessary'. If the winner was judged in terms of the enthusiasm of his supporters, Michael Pollan was way out in front. He was also my hero of the month this February.
And the winner… A total of six of our contributors chose Tim Lang (1). These were all contributors who chose more than one writer: Barrie Margetts, Barry Popkin, Inês Rugani, Mark Lawrence, Roger Hughes, and Sabrina Ionata. Of Tim, Roger Hughes says: 'He is a great writer, a great thinker, and very inspirational'. Tim was my hero of the month last November; I wrote that he is 'in the line of British radical academics…who have intriguing early careers, combine scholarship with action, are well aware of history, have an instinctive as well as trained commitment to justice and equity, serve indefatigably on committees including in bad times, and who think, speak and write vividly and memorably'.
And the others…
Of other writers, Raj Patel, author of Stuffed and Starved, was chosen twice, by Marion Nestle and (among his four choices) Barrie Margetts, as was our very own Urban Jonsson. The other 'home' choices were Michael Latham by Urban Jonsson; Marion Nestle by Barrie Margetts; Boyd Swinburn by Inês Rugani, and me by Roger Hughes, for these columns. Merci. Other writers chosen by just one contributor included Paul Roberts (Inês Rugani), Josué de Castro (Catherine Geissler), Paulo Freire (Fabio Gomes), Amartya Sen (Carlos Monteiro), Colin Tudge (me), Pierre Bourdieu (Shiriki Kumanyika), Clive Hamilton (Christina Black), Gilles Bibeau (Jean-Claude Moubarac), Ben Goldacre (Sarah Kehoe), Richard Wilkinson (Philip James), Olivier de Schutter (Sabrina Ionata), Harriet Friedman (Renato Maluf), Philip McMichael (Renato Maluf), John Stuart Mill (Geof Rayner), James Vernon (Tim Lang). You can find references to the work of all these writers in the short commentaries immediately accessible at the beginning of this item.
Some of the writers selected – Marion Nestle, Boyd Swinburn, Carlos Monteiro, Michael Latham – are academically qualified in nutrition science. What is most striking though, is that many of the rest, whether academics or not, are people who often have become convinced of the elemental importance of food and nutrition from their knowledge of other fields, such as economics, history, sociology, anthropology, philosophy, agriculture, evolution, or from their engagement in movements such as the struggle for human rights, equity and justice. In other words, they are not so much interested in nutrition, as in what states of nutrition signify. Maybe people who come to nutrition from another and broad perspective, are able to see the meaning of nutrition more clearly than people trained in the topic who then discern the big picture. Food for thought…
- Monteiro C. Nutrition and health. The issue is not food, nor nutrients, so much as processing [Commentary]. Public Health Nutrition 2009, 12: 729-731.
- Monteiro C, Gomes F, Cannon G (2010) Can the food industry help tackle the growing burden of under-nutrition? The snack attack. American Journal of Public Health 2010, 100: 975-981.
- Monteiro C, Levy R, Claro R, Castro I, Cannon G. A new classification of foods based on the nature and extent and purpose of food processing. Its use to characterise food systems and dietary patterns. Cadernos de Saúde Publica November 2010; 26 (11): 2039-2049.
- Monteiro C. The big issue is ultra-processing.[Commentary] World Nutrition, November 2010, 1, 6:237-269.
- Monteiro C, Levy R, Claro R, Castro I, Cannon G. Increasing consumption of ultra-processed foods and likely impact on human health: evidence from Brazil. Public Health Nutrition 2011, 14: 5-13.
- Pollan M. The Omnivore's Dilemma.The Search for a Perfect Meal in a Fast-Food World. London: Bloomsbury, 2007.
- Pollan M. In Defense of Food. An Eater's Manifesto. New York: Penguin Press, 2008.
- Pollan M. Food Rules. An Eater's Manual. London: Penguin Books, 2009.
- Lang T, Heasman M. Food Wars: The Global Battle For Mouths, Minds and Markets. London: Earthscan, 2004.
- Lang T, Barling D, Caraher M. Food Policy: Integrating Health, Environment and Society. Oxford: Oxford University Press, 2009
- Rayner G, Lang T. Ecological Public Health. Reshaping the Conditions for Good Health. London: Routledge/Earthscan, 2012
Acknowledgement and request
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: Cannon G. At last, independent, and other items. [Column] Website of the World Public Health Nutrition Association, June 2012. 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.
Reviewers of this column are Fabio Gomes, Carlos Monteiro and Claudio Schuftan.