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. Food processing and
regulation |
Fighting mad and fighting fat |
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
Food
manufacturers: Pepsi-Co. Food aid |
Who is saving the children? |
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.
Zilda
Arns. Pastoral da Criança |
A legacy for the world’s
children |
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.
Alimentação Sustentável. Clara
Brandão |
Nutritional power to the people |
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.
Evolution. Lifespan. |
Three score years and ten, and
then? |
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!
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.
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
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