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Philippines launches inquiry into formula milk firms targeting poor

Philippines launches inquiry into formula milk firms targeting poor

Health department to investigate after Guardian exposed illegal marketing methods

An investigation showed formula milk companies targeting those that can afford it least in the Philippines.

The Department of Health in the Philippines has said it will investigate the actions of four milk formula companies, after the Guardian exposed the illegal and clandestine methods used to market products to mothers.

Officials in the DOH confirmed they had called an emergency meeting and had also passed on the violations uncovered by the Guardian to the Food and Drug Authority, which holds the power to formally investigate and hand out financial punishment.

Representatives from Nestlé, Abbott, Mead Johnson and Wyeth (now owned by Nestlé) were described as a constant presence in hospitals in the Philippines, where only 34% of mothers exclusively breastfeed in the first six months of their child’s life.

The representatives reportedly hand out “infant nutrition” pamphlets to mothers, which appear to be medical advice but in fact recommend specific formula brands and sometimes have money-off coupons.

They were also found to be offering doctors, midwives and local health workers free gifts and sponsored trips paid for by milk formula companies, to win their loyalty. This is a clear violation of Philippine law. All four companies have rejected the allegations and denied any wrongdoing.

Dr Anthony Calibo, the national programme manager for infant and young feeding, and division chief for the children’s health division of the DOH, said he was “aghast with the rampant violations that this investigation shows are still happening”.

“It has been a struggle for government to crack down on all of these illicit practices of the milk companies but we thought that things had changed a bit and improved,” said Calibo, who said the DOH was now reaching out to their offices at local level to “investigate and validate these clear violations”.

“We will also be making sure the FDA looks into the matter because they are the regulatory body with the power to implement sanctions, such as fines,” Calibo added. He admitted that a lack of resources meant the DOH struggled to regulate the activities of milk formula companies and gathering evidence of violations was equally tough.

Working with Save the Children, the Guardian compiled reports from doctors, nurses, midwives and mothers which demonstrated ways in which the milk formula companies were either breaking the law, or using loopholes, to promote milk formula to mothers.

As a result, many women were found to be spending up to three-quarters of their income on formula for their babies, sometimes denying themselves food to afford it. Some were living without running water and electricity, causing problems when trying to sterilise bottles.

Nestlé, Abbott, Wyeth and Mead Johnson were found to be offering doctors, midwives and other health workers meals, cinema and theatre tickets and gambling chips, as well as all-expenses-paid sponsorship for attendance at lavish medical conferences. This is a clear violation of Philippine law.

In statements to the Guardian made after the investigation, all companies denied any wrongdoing. However, both Nestlé and Mead Johnson defended funding conference trips for doctors, even though the Department of Health confirmed it was illegal in the Philippines.

Nestlé said it would “investigate all the reported actions” and “will take fast and decisive action if any wrongdoing is found”.

“This picture does not represent Nestlé’s culture and business practices,” the statement added. “The first and most fundamental expression of our respect for mothers and babies is support for breastfeeding and compliance with the law and our own strict procedures. Nestlé strongly rejects the allegation that it does not comply with its legal obligations and the WHO code as implemented in national law.”

Abbott told the Guardian it was “committed to the ethical marketing of our products in compliance with the laws and regulations of the countries in which we do business,” and added: “The behaviour you have described is not in line with our policies. We take all reports of non-compliance seriously.”

Mead Johnson said it had ”not received notification of the violations you mention. Any reports received by Mead Johnson are investigated according to the facts and information, per our rigorous compliance programme.

“We take great care to fully comply with all established laws and regulations that govern the manufacturing, distribution and marketing of all our products. Acting responsibly is core to our purpose.”

Calibo said the new findings reinforced the need for a change in approach in the Philippines to combat what he described as the “stubborn and cunning” tactics of the milk companies. Currently the majority of violations are reported by mothers themselves, rather than the healthcare professionals being courted by the formula representatives.

“We need a different approach to empower community-based groups to be the ones to report this and inform us,” said Calibo.

“Your findings pull us all back and make us realise that the problem is still there and the monster is still at large. We really have to find a way to cage that monster.”

(OP note: The expression 'plus ça change, plus c'est pareil' is French for, 'the more things change, the more they stay the same'. It's a popular saying that is actually sometimes used in other languages and is very fitting as the article below illustrates: this type of behavior by multinationals is not new.)

Nestlé baby milk scandal has grown up but not gone away

Obesity and diabetes show that better standards in the food industry must be enforced, writes Mike Muller, author of the 1974 baby milk scandal report

For Nestlé and the rest of the global food industry, the baby milk scandal has grown up rather than gone away. The industry today stands accused of harming the health of whole nations, says Mike Muller.

At the World Economic Forum in Davos, I gave Nestlé chair Peter Brabeck, a present – an original, signed copy of The Baby Killer, the 1974 report that I wrote for War on Want.

The Baby Killer explained how multinational milk companies like his were causing infant illness and death in poor communities by promoting bottle feeding and discouraging breast feeding.

Our Swiss associates were less subtle. They titled the report "Nestlé Toten Babies" (or Nestlé Kills Babies), which a Swiss court found was libelous. On the substance of the argument, however, the judge warned Nestlé that if the company did not want to face accusations of causing death and illness through sales practices such as using sales reps dressed in nurses' uniforms, they should change the way that they did business.

That shocked the company and undermined its benevolent self-image. It also launched a long-running global campaign, proving that networked social action was possible even in snail mail days.

Nestlé boycotts spread from Switzerland and Britain to the US, where shareholder activism and court challenges against other milk companies – led by the Sisters of the Precious Blood, a religious order working under the umbrella of the Interfaith Centre for Corporate Responsibility – achieved a fine balance between grassroots organising, legal process and catchy communication.

The campaigns attracted wide-spread support from medical professionals, health authorities and civil society in developing countries. So in 1981, the UN World Health Assembly (the governing body of the World Health Organisation) recommended the adoption of an international code of conduct to govern the promotion and sale of breast milk substitutes. Global regulation of consumer industries was – and remains – a threat to business. UN resolutions are "soft law" that have little direct effect, yet often lead to hard national enforcement.

Back then, Nestlé's response was that their critics should focus on doing something to improve unsafe water supplies, which contributed to the health problems associated with bottle feeding. I spent 30 years doing just that in Mozambique, South Africa and elsewhere. So it was appropriate that water brought me together with Brabeck.

I don't like the way companies such as Nestlé promote bottled water, turning one of life's essentials into a brand that only the better-off can afford and undermining the value of public supplies in the process. But I have to acknowledge Brabeck's efforts to get business and governments to work together to manage and protect the world's vital water resources.

However, for Nestlé and the rest of the global food industry, the baby milk scandal has grown up rather than gone away. The industry today stands accused of harming the health of whole nations, not just their babies. New York mayor Michael Bloomberg has committed his own money to a campaign against unhealthy food, comparing this to his fight against the tobacco industry. The WHO faces opposition to proposals from the NGO Global Action for Improved Nutitrion to establish partnerships with industry. What started as skirmish in the nursery is turning into full-scale war on many fronts.

While the diseases are now obesity, diabetes and heart disease, the issues about the food industry's responsibility remain the same: its huge marketing budgets clearly influence peoples' behaviour, even if direct causality can't be demonstrated. Children and young adults may get fat because they do not get enough exercise. But if they are offered and encouraged to "choose" super-saturated fat diets, dosed with excessive salt and drinks laced with multiple sugars, can the industries that produce and promote those products absolve themselves from the ugly outcomes? Back in the 1970s, the Swiss judge ruled to the contrary. Today public and political opinion is again swinging in that direction.

Important questions are being raised in discussions about the new global development goals to be adopted when the UN's current Millennium Development Goals 'expire' in 2015. Should sustainable development goals focus on the unsustainable and unhealthy lifestyles of the rich as well as on the plight and basic needs of the poor? As the world searches for better measures of development than gross domestic product (GDP), counting dead babies remains an important indicator. But if infant mortality was a stark indicator of poor infant feeding practices in the 1970s, gross obesity is a parallel indicator of poor nutrition today. And action to control the products and marketing of large food companies are an obvious means to improve people's health.

So the spectre of global regulation still looms, an existential issue for the global food companies. "Ethical investors" now turn for guidance to the FTSE 4 Good index, which screens company behaviour. But there will need to be more explicit codes of practice and the political will to enforce them if shareholder action is to be effective. If global companies are to produce and promote healthier food and treat their suppliers more fairly and remain market leaders, such standards must also be enforced or cheap unregulated competition will inevitably undermine those who comply.

Critics of the global food business also face challenges. Realists know that a return to a bucolic world of trusted small-scale local food production cannot meet the needs of seven billion people today and more tomorrow. But should activists build on existing regulatory platforms by raising the bar, setting new standards and mobilising shareholders to promote a more responsible and accountable global food industry? Or should they take a more aggressive approach to monitoring and acting directly against damaging behaviour? We will probably see a mix of both strategies, making the food business a challenging place to be over the next few years.

Back in Davos, my dedication to Brabeck was simple. Reading the Baby Killer report today showed that we had made progress since the 1970s, I said. I thanked him for his support on the global water agenda, and I meant it. Of course there are many places around the world where Nestlé's operations are challenged by workers and communities, for many valid reasons. But in an imperfect world, at least some of the immediate issues are now on the table for public discussion and he has helped to put them there. I could perhaps have added the Mozambican adaptation of that old revolutionary slogan: "Victory continues – the struggle is certain". But, however accurate, that would have spoilt the moment.

OP note the second: With regards to obesity, I would object somewhat to the statement in the article above, "Should sustainable development goals focus on the unsustainable and unhealthy lifestyles of the rich as well as on the plight and basic needs of the poor?": This actually needs to be nuanced as obesity is also often a disease of poverty.
-Two-thirds of obese people currently live in developing countries. (OP: in lower income countries however obesity is more common among those with higher income.)
-See also McLaren L. Socioeconomic status and obesity. Epidemiologic Reviews 2007; 29(1):29-48. (Available for free here.)
-See also Dinsa GD, Goryakin Y, Fumagalli E, Suhrcke M. Obesity Reviews 2012; 13(11):1067-1079. (Available for free here.)
This article states, "We find that in low-income countries or in countries with low human development index (HDI), the association between SES and obesity appears to be positive for both men and women: the more affluent and/or those with higher educational attainment tend to be more likely to be obese. However, in middle-income countries or in countries with medium HDI, the association becomes largely mixed for men and mainly negative for women. This particular shift appears to occur at an even lower level of per capita income than suggested by an influential earlier review. By contrast, obesity in children appears to be predominantly a problem of the rich in low- and middle-income countries." (The HDI is used to defined a country's wealth/income.) (OP: In other words, in wealthier countries obesity is more prevalent/likely when one is poorer (for women).)

Source: ONTD_Political

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