This column might have been called A Tropical View, for it has been written since I moved to Brazil. Or The Other Way Up, for it is only since the European voyages of conquest half a millennium ago that maps were standardised with the north on top. What seems wrong or real depends on where we are coming from. Here I reflect on how where we are affects what we assume, think, say, write and teach. First though, some warm poop.
Don't be shy!
Lately I have been hunkered down on a day (and night) job and my international journeys have been electronic only. On one topic I have received a cascade of emails saying ‘have you heard?’ and ‘you won't believe this, but’ and ‘I always knew something was rum, and…’ By now I expect you also have heard…
This is why in my early mornings I find myself humming the Coasters Lieber/Stoller 1958 smash hit ‘Yakety yak/Don't talk back!’, as I make myself a vitamina (homespun smoothie) from liquidised banana, guava, papaya, ginger, cinnamon, multimistura and guaraná, with water from our rustic earthernware filter. And why I ask this poser: What is the connection between the nutrition label I am perusing now, on a can of Coca-Cola Minute Maid™ guava-flavoured drink, and the announcement by PepsiCo of its appointment of the former WHO Executive Director of Non-Communicable Diseases and Mental Health, with the resplendent title of PepsiCo Director for Global Health and Wellness?
Easy. Neither mentions sugar. What's behind this silence? The manufacturers of products containing added sugar are shy about this amazing commodity – at once a preservative, bulking aid and sweetener, and essential in combination with cosmetic chemical additives to make fat palatable in very many gut-busting processed foods. It is uniform, stable, compact, does not rot, and packs and travels well: it is as close as any foodstuff can be to metal. It has been the foundation of many mansions in the Americas, and a fuel for the ‘industrial revolution’ and the British EmpireReference Mintz1. As derived from cane, sugar has been the most profitable edible cash crop for hundreds of years. Sugar refiners and manufacturers have been and are the beneficiaries of stonking subsidies. Perhaps in gratitude, Big Sugar magnates have become donors of grandiloquent benefactions, such as the Tate Gallery in London, and also of leading public servants, like Lord Jellicoe, who in the 1980s moved from being chairman of Tate & Lyle to become chairman of the UK Medical Research Council.
Sugar is the invisible ingredient in processed foods and drinks. I deduce that the global strategy, as secret as the formula of Coke™, is to make us think it is normal for food and drink to be sweet. Manufacturers are not obliged to state what proportion of the carbohydrates in their products are from starch and what from sugars, unless they choose to make associated health claims. So they don't. Nutrition labels usually do not distinguish between the amount of sugars naturally present in the ingredients (like guavas) and the amount of sugars added. Indeed, usually there is no mention of sugar at all. The label just lists ‘carbohydrate’. This is useless informationReference Cannon2.
Why, is because Big Sugar, a transnational industry since the transcontinental slave trade began in the 17th centuryReference Blackburn3, has made sure in its dealings with regulators that the volume of added sugars in processed foods and drinks remains a mystery. Big Sugar is not just the refiners of sugars and syrups. It also includes those powerful food manufacturers whose profits depend on sugars and syrups, including the soft drinks giant Coca-Cola; and PepsiCo, who announced their hiring of Derek Yach (hence my hum) in early February.
Catch 'em young!
Apparently he will be working with the William J Clinton Foundation public–private–people Alliance for a Healthier Generation (doncha love these heart-warming titles) in order to promote the School Beverage Guidelines devised by Cadbury Schweppes, Coca-Cola and PepsiCo. These guidelines, found at www.ameribev.org, are the act of a quasi-cartel determined to keep joint control of their vast markets. They include some mutually restraining proposals especially for drinks vended in schools for young children. They do not mention s*g*r.
Vending machines in schools are big business. As quoted by Marion NestleReference Nestle4, a PepsiCo executive said way back in 1998 that contracts with schools for vending machines were ‘pretty high stakes business’, and a Coca-Cola executive said Coke would ‘continue to be very aggressive and proactive in getting our share of the school business’Reference Cherkassky5. The next year a PepsiCo executive said ‘marketing to the 8 to 12 year-old set is a priority’Reference Hays6. In 1994 a US Senate hearing reported a school food service director saying that cola drinks marketed in schools wrecked school lunch programmes. Coca-Cola had provided her under-resourced school with cash, bicycles, computers and catered events, in return for exclusive rights to install its vending machines. She said: ‘Without government regulations, Coca-Cola will always win’7.
Some time later, Coca-Cola, PepsiCo and Cadbury Schweppes (by then a US-controlled company) decided on a united front – just as rival prospectors whose rigs gush from one underground sea of oil, realise that it's wise to stop hiring guns to blast one another to bits and instead combine, wear suits and ties, and get into politics. The greatest act of product placement has been the positioning of US presidents as Coke or Pepsi people. Next time you see a film of a US president in an informal setting, check out the props, none of which are there by chance. I am not of course suggesting that any executive of any US soft drink company has ever engaged in any illegal activity of any kind.
From 1970 to 1997 production of sugared cola and soda drinks in the USA increased from 22 to 41 gallons per person a year, which is well over a 12 oz bottle or can a person a day. By the turn of the millennium people in the US were drinking 13.15 billion gallons of carbonated drinks a yearReference Zorn8, and US children were consuming the same volume as adults – often moreReference Harnack, Stang and Story9.
Do talk back!
Do sugars matter? (By ‘sugars’ here is meant all caloric sweeteners added to foods and drinks, also sometimes known as extrinsic sugars, added sugars or refined sugars, including syrups made from cane, beet and corn.) Well, it depends on where you get your information from, and on who funds and controls those sources of information.
A WHO statement on soft and cola drinks says among other things: ‘The high and increasing consumption of sugars-sweetened drinks by children in many countries is of serious concern. It has been estimated that each additional can or glass of sugars-sweetened drink that they consume every day, increases the risk of becoming obese by 60%’10. This is from the technical report Diet, Nutrition and the Risk of Chronic Diseases, produced under the aegis of Derek Yach when he was the responsible WHO Executive Director. Big Sugar was displeased, and the US Department of Health and Human Services mounted an effective campaign to trash the report and to neuter the WHO Global Strategy on Diet, Physical Activity and Health of which the report is the scientific foundationReference Cannon11, Reference Mooney12.
I attended the final meeting of the World Health Assembly in May 2004, at which the Strategy was eviscerated, as a junior delegate from the International Union of Nutritional Sciences. I asked delegates who formed the final drafting group to speak out in favour of retaining explicit clauses. I became aware that the halls were swarming with flacks for meat, fat, sugar, soft drinks, booze and salt. I was told that a bunch of consultants had been hired by WHO to secure ‘stakeholder’ public–private–people alliances, as required by Kofi Annan and the UN Millennium Development Goals.
In the midst of this mêlée, Derek, as I knew him then, who perhaps felt that I and others who wanted to protect the original wording of the Strategy were gaining traction, marched up and confronted me. ‘Loose Cannon! Loose Cannon!’ he hissed. Before I had time to ask which version of the Strategy he wanted me to support, the one with or without guts, and also to explain that I had not been manufactured to fit in his warship wherever it steamed, whoosh, he was gone.
So all this makes his move to PepsiCo rather intriguing. It seems that he is expected to work with civil society organisations, such as the International Obesity Task Force, whose leaders he knows well. At the end of 2006 the UN System Standing Committee on Nutrition published the Sydney Principles developed by IOTF, designed to reduce commercial promotion of foods and beverages to children13. These are not impressed by the approach taken by Coca-Cola, Cadbury Schweppes and PepsiCo. Principle 3 is: ‘Be statutory in nature. Only statutory regulations have sufficient authority to reduce the volume of marketing to children and the negative impact that this has had on their diets. Industry self-regulation is not designed to achieve this goal’.
Curiously, the Sydney Principles and their preamble refer to ‘energy-dense, nutrient-poor foods and beverages’ (what's wrong with ‘drinks’?) and ‘the foods and beverages that are promoting obesity’, also without mentioning s*g*r. This might seem even-handed, but what else apart from sugars and also fats is the issue? Are the junior high-school vending machines in Sydney stocking tubes of Fosters? Are those in New Mexico and New York vending bottles of mescal and Jack Daniels™?
Well, the good people at IOTF, who include my respected colleagues Tim Gill, Shiriki Kumanyika, Tim Lobstein, Jaap Seidell and Boyd Swinburn, will have thought carefully about how to pitch their admirable campaign. They may well consider the School Beverage Guidelines to be what they term ‘new marketing methods’, designed by the transnational soft drinks companies to give the impression that they are the men in white, the good guys (you know, the ones without strabismus or moustaches) who, with some prestidigitation, swapping canned fizzy sugar for canned fizzy water, can maintain their joint lock on vending machines in schools.
Expect a picture of Derek Yach shaking hands with William J Clinton, and a story about new moves initiated by the good people from industry to protect the health of schoolchildren. Meanwhile let's hope he is talking back to his boss Antonio Lucio, who sports another resounding title as PepsiCo Chief Innovation and Health & Wellness Officer, and that he will promote the WHO and IOTF stance on the marketing of cola and soft drinks to children to the masters of the universe at Coca-Cola and Cadbury Schweppes as well as within PepsiCo. Do not, however, hold your breath.
There again… perhaps he is playing a long game. Having revolved round the doors of public health academia, to UN agency senior executive, to transnational industry representative not after retirement but with 15 years of hard and effective work to come, has he made an adroit sideways move that will strengthen his candidacy for a master of the universe post, as head of a UN agency, in a few years' time? After all, following the appointment of former US Agriculture Secretary Ann Veneman as head of UNICEF, the website www.wfp.org tells us that former US State Department international food trade deals enforcer Josette Sheeran has become Executive Director of the UN World Food Programme. Another hum… ‘Heaven knows, anything goes’. And ‘I'd like to teach the world to sing/In perfect harmony’. Sorry sorry, wrong product…
Rooms and views
Now for a riff. Trust that its relevance to public health nutrition will become evident.
Is our work and are our ideas affected by the view from our office window? I think so. Could it be otherwise? Perhaps this is why so many offices are standardised: large rooms divided into cubicles; small rooms furnished with similar-type chairs, desk, cupboard, shelves. The only difference in the last twenty years is computers instead of typewriters. Offices are sanitised, too; in the evening other workers come with vacuum cleaners, chlorine and bin-liners, leaving a whiff of dust and Vim in the air.
But views? Usually our ideas cannot be affected by the view from our office window, because even if there is a window it has no view, and even if it has a view, there is nothing outside to engage the senses or emotions. And who in any organisation is most likely to have an office whose window has an interesting view, even if this is only of street life or of workers inside glass-fronted buildings in the next blocks? Yes, you got it – the boss, who wants to be nourished. Bosses often also require living plants in their office. These give them ideas. Views encourage points of view.
I am influenced by Georges Perec, who wrote a novel that never uses the letter ‘e’, who made an inventory of everything he ate and drank in 1974Reference Perec and Sturrock14, and who, like Eugène Marais, constructs natural philosophy from observation of particular things usually taken for granted or which seem to have no meaning. So today as I write and on other recent days I have looked out of the window of the house where I am working, and looked around the room I am using as an office, and reflected on how what I see, and sense in other ways, outside the house and inside the room, tells me – and may tell you – about public health nutrition and (as we say) points arising.
Ants and vultures
I am the first to rise. The sun has risen over the hill in front of my window, and the sky and the surface of the saltwater canal by which this house is placed, glow pink.
In tropical countries you share your space with bichinhos – little creatures. Now I am watching a very small ant carrying a crumb of broa (plain corn cake) twice its size that I must have dropped on the keyboard of my new trusty Acer Aspire 5610 last night. It seems I dropped it around the ‘end’ or ‘enter’ keys, because she (formiga, Portuguese for ‘ant’, is feminine) is climbing up, along, down, up, along, down, up, along, the k j y t % $ # 3 keys. But what for, and where to? Then I see a thin file of same economy-size ants moving to and fro across the cloth on this table I am using as a desk. They seem to be carrying nothing. Is ‘my’ ant the bringer of food for all of them? And where are they going? My attention is on my ant. If I avoid the keys she is on, she and I can work together. I help her over ! and esc, coax her on to a card, and drop her and her load of nourishment, in her world the equivalent of a sack of rice, within the file of ants. Boa sorte! Good luck!
I am somewhat Jain about ants and bees. They teach us about us. Wasps also. Outside my study window in our other house, a wasp is completing her nest. (Vespa is also feminine, but in any case it is the female of the species that builds.) Here in Brazil, wasps are serious business, half as big again as temperate species, with a barb like a miniature kukri, the Malaysian dagger. I lean out of the window and take snaps of her and the nest she is building, and I like to think she knows I respect what she is doing, because she seems to pose. Lizards too; I enjoy the family that live on the top of my bookshelves and eat mosquitoes, about which I have no Jain feelings. If I find lizard poo on my keyboard in the morning, that's my fault, for not closing the lid of my Aspire before retiring.
And now back to the Rio state littoral and Cabo Frio by the side of the canal das Ostras, where I am now. Later in the morning I look out and on the other side of the canal see a bunch of black birds bigger than crows, flapping and foraging. Urubu: vultures, smaller than the African flesh-eaters with wingspans of a metre or more, but they do the same job. Some animal has died.
Later I watch Jalder, the plasterer in our gang of builders, as he walks out into the canal during his lunch break, and casts his net. There are two species of saltwater fish here, both with names given by the long-gone original people, whose palaeolithic ancestors left their marks on rocks overlooking the bay where much later Amerigo Vespucci landed. Parati, after which the town on the southern Rio littoral is named, leap out of the water for flies or (so I like to think) joy. Carapicu are the preferred catch; these are fried whole like sprats or sardines. The other day one of the fisherman living in a hut on unused land opposite, waded across to our house and showed the children here how he kept the caught fish alive in a pocket of his net. He sells to a restaurant somewhere in town, maybe to the bistro in the old quarter, by the church whose priest climbs a ladder to the pulpit, whose owner and chef plays bebop.
Fishers and people
I suggest that what we see from the window of the room where we read and work affects what we think and write, and who we are. Take my ant. Informed by the work of Eugène MaraisReference Marais and de Kok15, it is evident that the organism is not the one insect I see, nor only the line of her companions, but the entire community. The same is true of bees, as we may realise by watching their behaviour centred on the hive, or by contemplating the structure and nature of the honeycomb.
We humans are not utterly removed from these insect worlds. The concept of the unique identity of the human individual – the invention of Martin Luther and John Calvin and others, which was then built into natural philosophy by René Descartes, and then became the founding doctrine of the states whose leading religion is salvation not by works but by faith – is an error. Individualism, first noted by Alexis de Tocqueville in his journeys as a Yankee ideology, misunderstands human nature.
Take the local fishermen. They know the tides and what affects their catch. If, as is rumoured, a factory emitting chemical pollutants is planned to be built on the saltwater lagoon whose waters feed our canal, they would become the expert witnesses called by the residents whose houses are on the canal. Here in Brazil an execrable state secondary-school system has perpetuated an illiterate class very many of whom are intelligent, whose culture is oral, and who are very articulate. These are the people who are almost always ignored by visiting scientists from the big cities or overseas, whose job is to fix food security and nutritional adequacy. And now? The fishermen tell us the water is clean, and they know, because they make a living. We and the fishermen depend on one another – or we better had. Here, in the sense of community, is where public health begins.
