ParkLives (continued): Responding to the response
Post date: 21-Jun-2016 08:51:29
This article is the latest in a series about the Coca-Cola sponsored physical activity programme, ParkLives. A few weeks ago I wrote the first article about the scheme only to find out the following week that it was coming to my home town this summer. I then wrote another article which was picked up by the local paper. Since then I have had many conversations in person and had various comments posted online and so this week’s blog is written in response to these comments.
“Coke is not the problem, lack of physical activity and wider calorific intake is.”
There’s a wealth of studies that have addressed this question and it won’t take long for both proponents and advocates of this argument to find good quality studies in support of their conflicting views. This conflicting evidence base is problematic as it can make it difficult and daunting for both policy makers and the public to feel they have confidence in the “facts”. Conflicting findings in science are common and might not even mean that the science is wrong in either case, it just demands that we then use techniques of synthesising the evidence such as systematic reviews and meta-analyses. These can help but confusingly, there are even issues with these complex methods as they are only as good as the studies that they are reviewing. We need to interrogate the various biases in the production of the evidence more and it’s at this stage that we start to see some themes in the research that suggest we need to exercise caution on this topic.
Consistently, analysis of the research outputs in this area show that studies funded by the big food companies are biased in their findings (Lesser et al, 2007; Massougbodji et al, 2014). For example, it’s been shown that studies that are funded by the big food companies are five times more likely to conclude that there is no association between sugar intake and poor health than those that are not funded by the big food companies (Bes-Rastrollo et al, 2013). Further muddying the waters, there are organisations such as The British Nutrition Foundation that despite this, support the view that sugar intake doesn’t cause obesity, diabetes or cardiovascular disease. A quick chat with your local dietetics contact and a look at the groups that fund the BNF might suggest however, that the BNF also have certain biases that they should address having sustaining members that include Coca-Cola, PepsiCo and Tate & Lyle.
So what's the problem with conflicting science? A common discussion that I find myself having with clients is, “I don’t know what to believe anymore [hands up in the air & shoulders shrug], one day it’s good for you, the next day it’s going to give you cancer….I’ll just keep doing what I’m doing until it affects me”. Conflict and confusion cause a form of cognitive overload that makes many people just give up trying and who benefits from that, the big food companies. I wouldn’t suggest that Coke don’t fund research but how they are able to do this, and how this gets reported and used is an issue. If this research suggests that sodas are not the cause of major illness they win, if it simply creates multiple narratives that make it difficult to interpret then they will also benefit..
"The “nanny state” is intruding into our lives enough already and if some people choose to get fat, then they can face the consequences on their own and it won’t affect me."
The upstream allegory is explained nicely in this short video and outlines how we have a choice as a society; catch as many people as possible down the river or try and do something to stop them falling in the river in the first place. We would all hope that as a community, via councils and central government, the state would catch us when we need it, but to do this would it make sense to train more people as fishermen/women or to put up railings where the most amount of people are falling into the river?
The cry of, “nanny state” is a commonly applied liberal tradition that claims that certain interventions infringe on personal freedom by stopping people from pursuing their own choices. It’s coincidentally also a cry that is often used by many of the industry supported lobby groups that have existed around the sugar tax and tobacco laws. Nanny state arguments are a well trodden path in public health and it’s explored in more depth in books like “Public Health Ethics” by Stephen Holland. There are a series of philosophical arguments to be explored, one of which is our definition of what “freedom” actually means to us. Holland, for example, uses the example of a lady who is really keen to work but has a physical condition that prevents her from doing so. She is “free” to work, however the reality is that she can’t physically make a full day in her job. In this case, if the state had a medical solution in its gift (ie surgery or medication) then we would expect the state (at least in the UK) to act, giving this person the “freedom” to work and contribute to society. If we have this expectation of the state, we should also be consistent and allow for the authorities to have responsibility for our health in other domains and implement other interventions for the benefit of our long term wellbeing. A more nuanced approach would be that of libertarian paternalism where we could ensure that people still have choices, but they are presented with a range of choices and those that are going to have the best outcome for the individual in the long run are made as easy to choose as the less “healthy” choices.
Calls of nanny state suggest that public organisations should leave us to it however, the scenario of the ParkLives scheme shows that often there is no such thing as an inconsequential choice of action. It would seem there are three situations possible; the council could take an active protective role and prevent the scheme coming to Plymouth, they could remain neutral neither supporting or promoting the project but allow it to happen, or they could actively collaborate in its provision thereby supporting the new provision and the marketing of the Coke brand. They seem to have gone for the latter. Creating additional opportunities for Coke to market their products doesn’t seem as though it represents any amount of paternalism or duty of care that is going to help us make the best decisions for our own health in the long term. To revisit the upstream allegory, it might be analogous to suggest that the local authority are bussing more kids to the park that is right next to the river, and they haven’t put up a fence yet either.
In response to the idea that it won't affect me (or any individual not connected with this scheme), I would personally rather not be working an extra year or two so I can contribute the necessary tax money required to fund the NHS to look after the amount of people that could have diabetes in the future.
"We all have free choice"
In a rational world we would all have incontrovertible facts at our finger-tips, then weigh up the costs and benefits of an action and make the choice that is best for us. There are however, many examples of how the human mind doesn’t work like that and how we have a series of cognitive biases and shortcuts that help us get by but which don’t always allow us to make the best decisions for our long term well-being all the time. Why else would marketing departments claim to be of any use if they couldn’t influence our decision making?
Marketing is used to create demand, build brand loyalty, and change social environments to increase the likelihood of future consumption. The tactics used and mentality of the marketeers has been shown to be ruthless over the years and is outlined in books such as “God, country, and Coca-Cola” by Mark Pendergrast and this article in the Washington Post where a former Coke executive slams ‘share of stomach’ marketing campaigns.
Throw in a dose of social norms, the ubiquitous availability of a product, physical addictions to sugar, and habituated use and over time the degree to which we truly have free choice is clearly less and less.
"Marketing and sponsorship is OK, in fact it is essential for activities to take place"
So imagine I concede, let’s agree that it’s OK for Coke to sponsor physical activity schemes as they won’t happen otherwise and anyway, it won’t make people buy more coke. I don’t think I'm being facetious or adopting an exaggerated “slippery slope” argument to suggest that if this works, we could try and get one of our local schools sponsored. Money is tight, it won’t make the kids buy Coke and who would mind if we had The Coke Academy School of Plymouth? What about a hospital? Maybe a ward, The Coke Diabetes Unit?
I think I may have reached the point of facetiousness with the last one. Despite that, all examples are built on the same premises; funding is tight, sponsorship won’t make more people drink Coke, and even if it did, Coke is not really a problem to this population and their health. If any of the examples I have given seem wrong then I would like to know what makes any of them sound right or a special case from the others.
In response to the point that activities wouldn’t happen it the sponsorship wasn’t forthcoming from Coke, I would point out, as I already have done, that there are lots of great activities taking place in almost exactly the place and time and these have been running for years up to this point and appear to be quite self-sustaining. My driving passion is the use of physical activity for health reasons and that means that I’m less bothered about active people changing sports or activities and more interested in getting those that are not active active and that is a clear distinction that needs stressing in evaluations of such projects.
"Marjon should get their own house in order first and there are other problems that are worse"
I agree that the shop on campus at my University is a source of disappointment and frustration for me almost every time that I walk through it. It represents a significant problem in our society that chocolate and fizzy drinks are so easy to come by, and that any time I step into a convenience store and look around my kids and I are bombarded with logos and bargain multi-buys. I will try and influence this situation over the coming months.
It is however a different issue than ParkLives coming to Plymouth. The suggestion that my University doesn’t provide any community events is not true as we have hundreds of school children on campus through the year, our students go out into the community as part of their courses and work experience and I have worked with hundreds of adults with various chronic conditions. I could try and get the University to sponsor the ParkLives activities rather than Coke and I’m happy to discuss this if it is of interest. If that were to happen though, cynics might suggest that through my advocacy, my University and I are capitalizing on an opportunity to market our degrees to teenagers through the use of sport and physical activity at a time when they are vulnerable to our influence. But if that is a point, then surely I have a point in highlighting the dangers of allowing Coke access to our young people for the same reason.
Reading & References
Bes-Rastrollo, M., Schulze, M. B., Ruiz-Canela, M., & Martinez-Gonzalez, M. A. (2013). Financial conflicts of interest and reporting bias regarding the association between sugar-sweetened beverages and weight gain: a systematic review of systematic reviews. PLoS Med, 10(12), e1001578.http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001578
Holland, S. (2015). Public Health Ethics. John Wiley & Sons.
Lesser, L. I., Ebbeling, C. B., Goozner, M., Wypij, D., & Ludwig, D. S. (2007). Relationship between funding source and conclusion among nutrition-related scientific articles. PLoS Med, 4(1), e5. http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0040005
Massougbodji, J., Le Bodo, Y., Fratu, R., & De Wals, P. (2014). Reviews examining sugar-sweetened beverages and body weight: correlates of their quality and conclusions. The American journal of clinical nutrition, 99(5), 1096-1104. http://ajcn.nutrition.org/content/99/5/1096.short
Nestle, M. (2015). Soda politics: taking on big soda (and winning). Oxford University Press, USA.
Pendergrast, M. (2013). For God, country, and Coca-Cola: The definitive history of the great American soft drink and the company that makes it. Basic Books.