Public Private Partnerships in the face of the obesity crisis: Promoting public health or potential risk?

Brazilian Consumers are Increasingly Eating Energy-Dense Nutrient-Poor Foods

Globally, obesity rates have doubled since 1980. Recent estimates count 41 million children under the age of five and 9.1 billion adults as overweight or obese. While obesity is often framed as a first world problem, rates are rapidly growing in low and middle-income countries. Overweight and obesity has doubled in Africa since 1990 and Asia is home to half the overweight and obese children in the world . We’re expecting to see 60 million obese children by 2020. In 2010, a Lancet Global Burden of Disease Study declared that for the first time, overweight and obesity was a bigger problem than malnutrition. Childhood obesity is of particular concern, not only for its impact on children’s lives but as an indicator of co-morbidities later in life including heart disease, cognitive impairment, diabetes, asthma, cancer and respiratory diseases, as well as mental diseases and reproductive disorders later in life. Aside from the human impact this rise in disease comes at massive cost with the World Economic Forum estimating an economic impact of 2 trillion dollars a year.

Diet-related diseases in low and middle income countries are being driven by the ‘nutrition transition’ which has seen more people around the world shift their diets to widely available staples: more processed foods high in salt and sugar and fat. This transition is facilitated by the perceived affordability of processed foods and the aspirations of emerging consumers who are attracted to westernised diets. While sales figures for processed food are beginning to plateau in the saturated markets of the global north, rising income rates in the global south are dishing up millions of new consumers. This has not gone unnoticed by junk food marketers who are aggressively pursuing these potential new customers.

The Sustainable Development Goals (SDGs) provide a clear mandate for the prevention and control of non-communicable diseases, particularly overweight and obesity. Yet so far, attempts to address these problems have been inconsistent and implementation of action plans has been slow. The SDGs also provide a clear call to engage in partnerships for sustainable development. However, the question must be asked: how do we balance the potential gains with the potential risks when entering into partnerships in regards to nutrition and health?

Facing increased scrutiny in light of these crises the Food and Drink Industry is shifting the focus of their Corporate Social Responsibility (CSR) programs towards health, nutrition and physical activity. Branches of CSR theory contend that corporations engage in responsibility programs inherently linked to their greatest harm and this appears to be exactly the kind of action the Food and Drink Industry is taking. Nestlé is the largest provider of health education programs in the world. As of 2015, Nestlé was running children’s health programs in 80 countries ‘to raise nutrition and health knowledge and promote physical activity among school-age children around the world’. These programs are delivered as public private partnerships with governments, NGOs, and sporting bodies. Nestlé is also a member of the EPODE network which facilitates links between private and public actors to fight childhood obesity.

In the Philippines, Nestlé have partnered with the national Department of Education to roll out the Wellness Campus program. The partnership has seen school children participate in coordinated dance activities with moves and lyrics that reflect Nestlé’s marketing materials. In particular, these programs encourage the consumption of breakfast cereals, going so far as to hold seminars for teachers on the importance of educating their students on the value of cereal. While whole-grains are healthy, most cereals manufactured by Nestlé are highly-processed, energy-dense and nutrient-poor.

A Filipino Child Participates in a Nestlé Healthy Kids Program (Image: Nestlé)

In this photograph used to promote the Healthy Kids Program a young Filipino child is presenting the answers to a series of questions while his teacher holds up a cereal box. The questions ask the students to identify ingredients and nutrients in the prop cereal as well as the manufacturer’s name and the number of the cereal brand’s consumer care line. This is teaching children how to read packets and identify the hallmarks of industrial, processed food. Furthermore teaching children the value of food in the terms of ‘calcium’ and ‘iron’ rather than say, ‘fruits and vegetables’ promotes nutritionism, a reductive and unhelpful understanding of the healthfulness of foods. Promoting boxed breakfast cereals through a global program promotes a normative diet displacing local traditional diets in favour of processed foods.

Recently, Nestlé announced the roll out of the Healthy Kids Program as a part of São Paulo’s first Nutrition and Food Security Plan. The partnership sees Nestlé assisting the São Paulo Department of Education and the Co-ordination Office for School Canteens of São Paulo in delivering nutrition lessons and cooking classes. The CEO of the Nestlé Brazil Foundation, Juan Carlos Marroquín, celebrated the announcement by saying “The city of São Paulo provides almost 2 million school meals per day. Therefore, such a public-private partnership is fundamental to maximise good nutrition and healthy eating habits to hundreds of thousands of children and teens.” Nestlé Brazil has previously been criticized for promotions such as its Nestlé Até Você a Bordo (Nestlé takes you on board), a supermarket boat that shipped 300 processed food products down the Amazon river to be experienced by new consumers out of reach of supermarket distribution channels.

An attendant checks out products on the Nestlé Até Você a Bordo supermarket boat (Image: Nestlé)

Governments are facing increasing costs in managing the burden of overweight and obesity while at the same time trying to weather increasing economic instability. This combination makes the offer of corporate sponsorship of public health programs attractive. But is it appropriate that the world’s largest manufacturer of confectionary products has input into school lunches for millions of children or to provide nutrition education programs? Policy-makers have warned that while public private partnerships can be attractive they are, by nature, transactional. Furthermore, the subliminal promotion of corporate agendas can ultimately undermine the public good intended by the partnership in the first place. Public health advocates have called for the removal of food industry actors from public health policy. Critics have raised concerns that private actors use partnerships to influence public policy and their presence undermines legitimacy of public health programs. It remains to be seen if these programs do more to serve the health of corporations’ public image than the health of children.