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PODCAST

The Leading Voices in Food

E201: Junk Food Politics – the price of outsized corporate influence

Hosted by: Kelly Brownell (Duke)
April 10, 2023


Processed food industries are thriving in developing countries, despite government commitment to eradicating non-communicable diseases, prevention programs aim at reducing obesity, type two diabetes, and sugary beverage consumption. What’s more, political leaders in some countries are reluctant to regulate the marketing and sale of these products, particularly among vulnerable groups, like children and the poor. Like me, you might be asking yourself: why? Our guest today is the author of a new book, “Junk Food Politics: How Beverage and Fast Food Industries Are Reshaping Emerging Economics.” His name is Professor Eduardo Gomez, Director of the Institute of Health Policy and Politics, at Lehigh University.

Dr. Eduardo J. Gómez is an Associate Professor and Director of the Institute for Health Policy and Politics at Lehigh University. A political scientist by training, his research focuses on the politics of global health policy, with a focus on emerging middle-income countries. He is the author of three books, the latest being Geopolitics in Health: Confronting Obesity, AIDS, and Tuberculosis in the Emerging BRICS Economies (Johns Hopkins University Press, 2018). Dr. Gómez has published his research in a myriad of peer-reviewed journals, as well as policy journals and major news outlets. His new book, Junk Food Politics (Johns Hopkins University Press, 2023), critically examines the rise and political influence of soda and ultra-processed food industries in developing nations, with a focus on NCDs among children and the poor. He is also leading several other major research projects focusing on the politics of NCDs, such as type-2 diabetes and obesity, in Mexico, Brazil, and Indonesia. Dr. Gómez is also a Commissioner for the Rockefeller Foundation and Boston University Commission on the Social Determinants of Health. His research has received external funding support from the Rockefeller Foundation, Oxfam, George Soros, and Tinker Foundations.

Prior to his arrival at Lehigh, Dr. Gómez was an Associate Professor (UK Senior Lecturer) at King’s College London, Assistant Professor at Rutgers University, and pre-doctoral visiting scientist at the Harvard School of Public Health. He has also previously worked for the RAND Corporation, the World Bank, and the Inter-American Dialogue. Dr. Gómez is also a veteran of the United States Air Force and is a former Term Member of the Council on Foreign Relations. He received his PhD political science from Brown University, MA in International Relations from the University of Chicago, and BA in Foreign Affairs from the University of Virginia. 

Interview Summary

Let’s begin with a basic question, what prompted you to write the book?

Great question. It really started, I remember almost the day, when I came across this article written by the New York Times in 2016. This article started to talk about the rise in influence of the sugar industry in the US, and how they were shaping evidence about the connection between the consumption of sugar and heart disease. For many years in the past, that connection was never emphasized when it came to national dietary recommendations. This New York Times article really revealed how powerful and influential these industries were in shaping the evidence and policies on the linkages between sugar and heart disease, and our consumption of these products.

At the same time, I was doing research on obesity policy in Brazil, comparing Brazil to the US, and why Brazil was doing better in the areas of nutritional information, prevention, and awareness about childhood obesity. I also saw that obesity cases were still increasing in Brazil despite these prevention efforts. At the time, I was also starting to work in Mexico and saw similar policies in Mexico being implemented on prevention and awareness, and national dietary guidelines. But still, we saw a rise in obesity, a rise in adolescent diabetes. So those two things – the evidence about how industries manipulate data and dietary guidelines – and then how luncheon programs are really not achieving their goal of reducing childhood obesity in adolescent diabetes. Those puzzles really motivated me in writing this book to really delve deeper into this question. That really required not a journal article, but a book that would do an in-depth historical case study analysis of several countries, and to document and do interviews on how these industries are working with government. And, how government also works with industries in this area of trying to address childhood obesity, and type two adolescent diabetes.

So how did you go about collecting data for the book?

I did a qualitative comparative method, which is a bit different, as you know, from most people working in public health and epidemiological studies about childhood obesity and diabetes. That entailed a comparative historical analysis of several similar case studies. I chose cases in the emerging economies that, I think, reflected the biggest problems with obesity and diabetes in their region. But the goal of the comparison, was really to accentuate similarities between cases, and, also, the vast differences and uniqueness of the cases. I then went about doing the research through document analysis of several different sources, books, articles, policy reports, media news, talking about the issue, both in the English language, and also in the countries of Brazil and Mexico, the Spanish and Portuguese language. I did interviews with activists and researchers in several of these countries, although not all of them. I think bringing together all the different qualitative evidence was very effective in trying to thoroughly address this issue. It’s a topic that has not been discussed that much. Bringing together the multiple evidence pieces took a long time.

It produced a wonderfully rich book with lots of interesting information from different sources around the world. I, for one, really appreciate what you’ve done. So in the book, you have very detailed case studies, as you mentioned, of a number of countries, in particular countries such as Mexico and Brazil, India, Indonesia, China and South Africa. Let’s talk about a few of these countries, and then, perhaps, we can return to something that you alluded to a moment ago. That there are quite striking similarities across the countries. So what did you learn about Mexico?

I had lived in Mexico for several years doing research there, and the fast food culture and industry, and the consumption of soda, is extremely high. Compared to the US, Mexico’s per capita daily consumption of soda is highest, arguably, in the world. Coca-Cola played a major role in that. Coca-Cola was in Mexico for many, many years, and the NAFTA Free Trade Agreement facilitated the arrival of Coca-Cola, and of many other kinds of ultra-processed foods and industries, into Mexico. Mexico is one of the world leaders in childhood obesity and type two diabetes. The government did, for many years, a good job of raising awareness to this issue. The National Institute of Public Health in Cuernavaca, for example, did fantastic work elevating the issue, convincing the government that something needed to be done about this ongoing health problems, especially among children and the poor.

But what I found is while there was legislation being implemented, it was, a lot of times, delayed, and those policies that were created, such as limiting the presence of sodas within schools, were not really effectively enforced. A lot of parents reporting to schools that their children were still consuming soda products. Of course, everyone knows about the soda tax that was implemented in 2014 in Mexico, becoming the first in the world to have a national soda tax. That’s been a very effective effort. But there are several years in which this was debated and delayed, and for many years industries resisted improvements to the food label, which was, eventually, recently accomplished. But all of this started to point to the power and influence of major industries and their interest group.

One thing that I learned in this case is that industries also engage in several partnerships with government to try and take away the focus from regulations and improving food labels, for example. And one partnership is working with government to introduce the importance of exercise in schools. And it’s something that we’ll see, also, in the case of China. And so that has taken attention away, in addition to the lobbying efforts, and funding science and research sort of questions, from the efficacy of a soda tax. But one thing that was very important is that presidents also matter, and their relationships with industry. One president that really stood out was President Vincente Fox, who was a former Coca-Cola executive for the region. And that relationship facilitated industry’s influence within government, and in connecting with politicians in influencing policy over years. But then later, subsequent presidents, like President Enrique Pena Nieto, worked with Nestle to address hunger eradication programs in Mexico.

So these partnerships with industry, while they are admirable in trying to eradicate hunger, they also, at the same time, bring legitimacy to these industries. This facilitates their ability to influence policy. Those was some of the key lessons that I found in Mexico.

So moving to a different part of the world, and, of course, to a different political system, what did you learn about China?

China has seen a burgeoning growth in consumption of soda, and also fast food chain establishments. We’ve also seen a huge increase in childhood obesity, and adolescent type two diabetes. But was really striking about this case, is that the government has done a great job, not only of increasing awareness about the challenge, but emphasizing the importance of exercise as a primary way to try and address the issue and why this particular approach. Instead of regulation limiting sales and access to foods for children and the poor, in trying to emphasize this idea of exercise. Now I found that through the International Life Sciences Institute (ILSI), Coca-Cola, and other industry, had an influence. The ILSI found partners within the Ministry of Health, who created the ISLI of China, and through these partnerships, in these connections between I-S-L-I and major health officials, the idea of emphasizing exercise as a solution started to infiltrate, and really shaped government legislation. I cite the excellent work by Susan Greenhalgh at Harvard, who documented a lot of how this was happening. At the same time, we saw industries partnering with government, and government officials emphasizing sports and exercise as an approach. But surprisingly, there was really no effort to introduce regulations on advertising and marketing. Similar to what we’ve seen in the US, no effective food regulations or mandates on quality of sugar and products. That really was startling, given the huge problem that China’s having with childhood obesity. But again, government partnerships with industry on eradicating poverty and achieving economic growth, certainly doesn’t help, and overlooks the need to introduce regulations, and sees industry as a partner in trying to achieve China’s broader efforts on poverty reduction and economic development.

We’re certainly starting to see some themes emerge in the stories that you’re telling. So let’s go to the third continent. What did you find in South Africa?

South Africa is a very interesting case, where, again, like these other countries, you’ve seen a rise in obesity and type two diabetes. It’s been very challenging because culturally, being overweight has been seen as a sign of health for some. Being thin, being associated with diseases, such as HIV, AIDS, or tuberculosis. So, one of the major hurdles that governments, and activists, have also been trying to address, is information about the health implications of being overweight. And then also the increasing public’s knowledge about type two diabetes. Similar to the other cases, you saw government efforts, beginning in 2015, to address the national obesity issue. But there are very, very few effective policies introduced, such as regulations on advertising and marketing. These have basically been introduced as plans and ideas, with no concrete efforts yet. The government relied on self-regulation, where industries pledge not to market their products to children, and to be more responsible in that. Also, there have been no regulations on sales of these foods in and around schools, and no improvements in labels. Why has that been the case? Again, industry has been very involved through policy partnerships, working with government to emphasize, again, exercise. Companies, like Nestle, have done a very good job in providing nutritional education and training to schools. While admirable, these partnerships have distracted the government from pursuing needed regulations, and trying to address these issues, seeing that these industries are partners, and seeing no real need to introduce these regulations. But again, at the same time, presidents matter. You’ve had presidents with very strong connections to industries. The current president, for example, having been in consulting profession, direct ties to fast food industry. And they’ve seen these industries as a critical partner in addressing economic development, but especially job security, and job growth, and seeing them as a need to be there in prospering. But, at the same time, you’ve also seen a civil society that is starting to emerge, but has been challenged by industry’s relationship with other nutrition researchers and activists, and not being able to work and create a broader mobilization effort to address this issue. %he activist community is just now starting to emerge. They don’t have as many allies in society that they can work with. As we saw in China, that civic activist movement has been just very slowly emerging. That’s been limiting as well.

These comments, so far, are consistent across countries. Focusing on physical activity, for example, diverting attention away from industry influences and regulations that might affect them, weakening regulations, and things like that. What do you see as the main themes that are weaving through this picture?

There are several themes. One is policy partnerships – industries partnering with government, and how this helps industry convince policy makers that regulations are not necessary. Those studying commercial determinants of health and nutrition, we all know this, but this has been especially prominent in the emerging economies. Another, is corporate social responsibility activities. There have been so many cases, wonderful efforts, that major soda and food industries are doing to increase education, nutritional awareness and training, even food regulation, and quality of food For example, with street vendors. But again, these CSR activities are taking away, and distracting from the need for regulations, while, at the same time bringing legitimacy, and social legitimacy, community legitimacy, to their product. Another major theme is that these corporate social responsibility activities, for example, sponsoring or providing support to NGOs, that contributes to dividing society. So, when industries partner with certain activists, or NGOs, that question the importance of particular policies, or libertarian principles, of having the right to eat whatever food that you want, whenever industries partners with these researchers and activists, it takes away from the number of activists, real activists, working on the issue can partner with. There are many cases where I interviewed activists are saying that, they don’t have as many allies that they can work with, because of these other people. These nutrition researchers working with industry. So that was a major issue that came across. Another was institutions. Institutions matter very much, specifically, their ability to include civil societal interest in ideas. In the case of Brazil, I talk about Consell, a national council that was within the office of the presidency. And under the previous Lula administration, civil society had access to the office of the presidency in providing nutritional information, and recommendations for policy. Under the Bolsonaro administration, the Consell Institution was no longer present. But now it has reemerged again. That was the one case where institutions really mattered in guaranteeing access to activists. In all the other countries, these kinds of institutions were not present. A final theme is that presidential politics and policy matters considerably. We often point the finger to industries, you know, blaming them for everything, but this book really shows that we also need to blame presidents for not being more careful in the kinds of partnerships they engage in with industries. Even though their intentions may be admirable in trying to eradicate hunger, eradicate poverty, achieve economic job growth, by partnering with soda and food industries, they’re also providing legitimacy to them, and providing excuses, not really to pursue regulations that may harm their prosperity. Those were the main themes that came out in the book.

So a number of things have been tried around the world to counter industries influence. What do you think are some of the most promising?

The most promising are effective regulations on advertising and sales of products. And there are very, very, very few great examples, but one, Chile, has seen amazing progress in introducing restrictions on the advertising of foods, by law, eliminating the usage of cartoons on cereal boxes, something that, of course, we haven’t achieved yet in the US. That’s been very effective in addressing this issue. I think that these sales and advertising regulations are just the most difficult to achieve, but can really get to the root of the problem, which is decreasing children’s awareness, and interest, in food products. Another is incorporating civil society within institutions. The more the governments can provide a venue for activists to have presence within the Ministry of Health, and to actually introduce policy ideas, that can be very effective. I think that that’s been, with the exception of Brazil for several years, absent in all of the countries that I looked at in my book. I think that’s something that needs to really be taken more seriously. And then another, is investing in civil society, providing more funding for nutrition researchers, activists, and NGOs, that are trying to raise this issue about childhood obesity, but also the commercial determinants of health. That is still much needed area. The Bloomberg Foundation has done great work in Mexico, but we need a lot more in other emerging economies, and lot more support for these activists. These are efforts that can really help to address this issue.

I’m happy you mentioned the Bloomberg Foundation, because, thanks to them, a number of these things have been evaluated, which really helps other countries be informed about what might be effective, and on what might not be. Are there things that are not being done that you would think might be considered?

I do think that it’s time that presidents around the world, and other health officials leaders, question their partnerships with industry. Question if it’s really effective. I believe that there should be more of an effort to not have industry involved in nutrition policies, non-communicable disease policies, and, especially, policies that focus on childhood obesity. I think the case of China really showed that that can be a major problem. I think that one, political leaders need to take more leadership in reevaluating the effectiveness of these partnerships, and if they’re appropriate. Another is that laws on regulations of conflict of interest need to be well established. Really, in none of the cases that I looked at are there federal laws and regulations on if industries can contribute money to nutrition conferences, sponsoring of nutrition conferences. In Brazil, they are now starting to address this, but in other countries, this has not really been addressed yet. This is unacceptable when there are industries that have conflict of interest, and are supporting nutrition scientists and researchers. One of the things that really needs to be done is increasing government, or foundation, support for nutrition scientists in these emerging economies, so they are not interested in working with industry. Finally, there just needs to be a lot more of a government commitment to civic inclusion in these kinds of policies. We all know the civil society matters. Of course, government officials will always say, of course, you know, we’re listening to civil society. But the evidence on to what extent activists have access to national institutions and policy, is very, very scarce. I’m just not convinced that governments are doing enough to include activists into their national policy discussions in these emerging economies. With the exception, I think, of Mexico, now, hopefully, with Brazil, the other emerging economies that I talk about in the book really have not achieved, and I think that needs to be addressed. These are the issues that really need to be addressed going forward.

 

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