Alice Evans of Cambridge University looks for lessons from a small victory in the global struggle against obesity
We in the development industry are often frustrated by lack of government transparency, disregard of the evidence, and lack of political will to address major social problems.
Such obstacles are universal. Perhaps we might learn ‘how change happens’ (to use Duncan’s title) by comparing common processes in the Global North and South.
One global challenge is obesity. In the UK, it afflicts 25% of adults and costs the NHS £5.1bn every year. High sugar intake is a major factor, but despite this demonstrable causal link, the UK Government delayed publication of Public Health England’s recent report on how to curb sugar intake. That infuriated the Health Select Committee, which raised strong concerns about government interference and ideological aversions to a proposed sugar tax.
So what’s in this top secret report? Well, one of its recommendations is that we learn from Mexico, where purchases of sugar sweetened drinks fell (slightly) after the introduction of just such a tax.
How did this come about? What is different about Mexico?
Maybe fizzy drinks weren’t all that popular to begin with? Perhaps it was less of a battle? Nope. The average Mexican drank 728 cans of Coca Cola branded drinks in 2012 alone.
Perhaps the sugary drinks industry is less influential in Mexico? Hardly. The closeness of industry and politics is embodied in Vicente Fox (President of Mexico from 2000 to 2006, and previously President of Coca-Cola Mexico). Several Mexican politicians certainly seem rather partial to the company: awarding it Mexico City’s ‘Health Conscious Organisation’ award. Indeed, Coca-Cola Mexico generously funds thousands of sporting events.
Culturally too, Coca-Cola is incredibly powerful. ‘Coke is used in religious rites; burping rids the body of evil spirits. In Chiapas highland churches, Coke bottles line the aisles and even decorate the altars’ – reports the Guardian.
Mexican civil society organisations, such as the Nutritional Health Alliance, struggled to compete with the deep pockets of the beverage industry. But help was at hand.
Having failed to ban large fizzy drinks cups in New York, Mayor Bloomberg’s charitable foundation decided to support
reform overseas. Bloomberg Philanthropies gave $16 million towards a campaign to reduce soda consumption in Mexico. Now there could be a fairer fight for hearts and minds.
Besides innovative street theatre (attracting media publicity), scary posters and subway billboards, the Nutritional Health Alliance also tried to buy airtime. Mexico’s major television networks refused, expressing concerns about upsetting importantly clients. So instead the ad – “see what the networks censored!” – was directly uploaded to YouTube, generating a quarter of a million hits. The Alliance also promoted the traditional Mesoamerican diet as healthy eating – literally ‘going with the grain’ [pun intended].
With widespread obesity imposing a growing burden on the underfunded health sector, the Mexican government became increasingly open to dialogue. The Ministry of Health appointed an expert panel to investigate the topic. Their findings were published in Mexico’s most widely read public health journal and widely shared in international scientific meetings, enabling collective discussion and reflection. Their recommendations were endorsed by Mexico’s Minister of Health.
Overtaking the U.S.A. to become the country with the world’s highest obesity rate was a shock that seems to have triggered growing government commitment to tackling obesity. This is encapsulated in the nationwide government-led media campaign entitled ‘Check yourself; Measure what you eat and Move!’.
A fortnight ago that tax was halved, despite protests from the National Institute of Public Health. Public health groups and some opposition politicians accused lawmakers of ceding to pressure from industry (which claimed that 1,700 jobs had been lost).
A stark, cautionary tale of fragile gains.
So why did this (partial) success happen in Mexico but not elsewhere? One might speculate about the under-utilised power of social media and innovative framing. Or maybe this narrative indicates the need to strengthen and work with domestic academia, especially where it is underfunded (such as neoliberal Sub-Saharan Africa).
But do these factors explain political intransigence around the sugar tax in the UK? Not obviously. Is the British public less aware of the negative consequences of sugary diets? Are public health researchers more disconnected from policy makers? Neither sounds plausible. Maybe the UK government will become more responsive when we reach Mexican levels of obesity and struggling hospitals? (Not long now…!). Is it just an ideological difference between Mexican and UK ruling elites and/or publics? Or maybe Mexico and the UK are not all that different? After all, Mexico’s sugar tax has now been watered down… (admittedly awful pun intended).
I don’t have the answer. All I know (or at least think) is that we need to transcend this bizarre North-South divide and learn from shared, global experiences: such as obesity and also urban policy, neoliberalism and gender inequality. The question of ‘how change happens’ has a global remit. The current silos around North/South research aren’t helping anyone.