In 2012, the Bank of America identified “Global fight against obesity” as a mega investment theme, whereas many companies believe in “Ride the obesity wave and supersize your income”. Are these companies making a profit by increasing our waistlines, or through our increased waistlines?
The most important trade and health argument follows a basic economic assumption: trade liberalization increases growth and development, which reduces poverty, which leads to improved health that in turn improves growth. Economics does not speak to equity, but rather to development. And one aspect of development is increased purchase of food and drink, whether healthy or unhealthy. Can we measure quality of life in terms of development?
MARKETING AND HEALTH CARE
Food and capitalism
Buying and selling is the essence of capitalism. In Nepal’s context, it is widely seen that children’s food preferences are molded by advertisements (particularly noodles and fast foods) even before they learn to tie their shoe-laces, a phenomenon apparent across groups that have been most exposed to advertising. In Nepal, the marketers have clearly succeeded in their aim of building up brand consciousness and loyalty from as early as possible. The rise in obesity and non-communicable diseases among the younger populations in Nepal is a result of such unhealthy dominance of corporate marketing in our lives. Highly processed corn-based food products with lots of chemical additives are major sources of weight gain.
But from a conventional growth perspective, the irresistible and addictive instant foods are good news. Growth in the fast food sector introduces more jobs, politicians get voted for creating jobs and get huge donations from the instant-food industry, advertising agencies get paid for advertising and making these highly processed products addictive, health care industry makes a fortune by treating the resultant diseases and cleaning up the mess by becoming janitors instead of janissaries, so why would anyone complain?
A huge conflict of interest between the public and the corporate industries has nonetheless created a loophole that allows industries to exercise their influence. The wealthy owners of fast food industries have the opportunity and power to assemble teams of their liking. Moreover, many food retail sectors are controlled by international markets, which are constantly fluctuating. Fickle tastes of the consumers leads to an unpredictable demand for different raw materials which may be contrary to the products available from natural agricultural cycles, and which may end up changing the way farmers work, and distorting natural cycles. An example could be an increase in the demand of genetically modified foods.
The “Omnivore paradox” presented by Fischler states that while we look for new foods to satisfy our palate and fulfill the nutrition needs of the body, we are also afraid of new foods because we do not know what they contain and what dangers they might bring. With respect to fast food, they satisfy our hankering for new food, though we don’t know where these foods come from, or when and how they were produced. In fact, we know very little about them. But why don’t we bother to find out? Even though it is accepted that food plays a major role in many chronic diseases, we allow food industries to directly market to our children.
How industry is influencial
Obesity epidemic and the rise of non-communicable diseases as a result of over-consumption of processed foods could present opportunities for many players, particularly multinational companies such as pharmaceutical companies that sell pills to reduce weight, and health care institutions that sell weight loss programs, among others. Traditionally, the role of private sector in health services and in improving health equity has been ideologically and empirically contested, with the weight of evidence highly critical of unregulated private markets. As stated by Dr. Marcia Angell, ex-editor of New England Journal of Medicine, the custom of drug companies gaining entry into teaching hospitals by bestowing small gifts on house officers has reached new levels of munificence. Trainees receive free meals, posh dinners, and other substantial favors from drug companies virtually every day. Although these gifts are too inconsequential to count as bribes, it must be understood that the costs of these industry sponsored trips, meals, gifts, and conferences are simply added to the prices of drugs and devices, a price which, ultimately, will be borne by the patients. Health officials have become accustomed to receiving gifts and favors from these industries, which in turn use their courtesies to influence their continuing growth at the expense of public health. No wonder, the medical status-quo relies heavily on medication and surgery, at the exclusion of nutrition and lifestyle.
In fact, the reason for this is that the nutrition training of doctors is inadequate. Several scientific articles have been published till date documenting a lack of nutrition training in medical schools, even in the United States. A report commissioned by the United States National Research Council found that physicians on average receive only 21 classroom hours of training on nutrition during four years of medical school, and a bulk of these hours are taught in the first year of medical school. Nutrition is taught under basic biochemistry, and may include information about nutrient metabolism, biochemical reactions, and certain vitamins and minerals. To put it more precisely, Nutrition is not taught in relation to public health problems like obesity, cancer, heart diseases, diabetes, etc. Although it is unfair to generalize, it would be safe to conclude that most medical students and house officers, under the constant tutelage of industry representatives, learn to rely more on drugs and devices than they probably should. This is not surprising, since a health-care system in which marketing plays such a large role is unlikely to be effective or lead to better treatment.
The relationship between the health care industry, corporate marketing, and the current situation of health in Nepal is a result of unregulated and uncontrolled dominance of corporate marketing. In future health policy reform, the state’s obligation should not be dominated by commercial interests, or by the marketing practices of the health care industry. Otherwise, the long-term burden of short-sighted indiscretion will be incalculable.
The author is a PhD student in Preventive Medicine and Epidemiology, University of Oslo