Friendly promoters are handing out leaflets they present as educational material about nutrition and branded certificates for children who behave for the doctor. How did Coca Cola get into public hospitals in Argentina? Who will get rid of it? Soledad Barruti asks these questions for MU La Vaca. Translation by Nadia Belén Bandura.
The visitors from Coca Cola came to Penna Hospital three years ago. For Doctor Fernando D’Ippolito, the business program coincided with a special moment in his life: recently graduated, he was ready to face whatever his new profession might bring, and had the sharp focus of a new arrival that helped him put his theoretical training up against the realities of being a doctor. He was doing his residency in general medicine as he wanted to work in the field he is in today: primary care for families who cannot afford access to health services since, basically, they have nothing, no gas, no safe water, no fresh food, no streets where buses or ambulances can circulate.
D’Ippolito soon realised that he had come to the perfect place. A few blocks from the hospital is Villa 21-24, the most important slum in the City of Buenos Aires. Eight blocks where 60,000 people live, wedged between Barracas and Pompeya. His work opened up like a kaleidoscope to suit the needs of the community: accident & emergency, hospital stays, outpatient facilities, and even supervising the nutrition courses and workshops that he was sure could improve people’s health
“This is among the most urgent problems: food and its consequences. We are dealing with children who have cheese puffs and juice for lunch, and follow it up with a hotdog, cookies, and fizzy drinks. If they’re lucky, they’ll have some real food at night,” D’Ippolito says, with a tone of voice that reflects something he surely did not have three years ago: exhaustion. Not resigned, but with no strength to turn on his enthusiasm; that private tragedy that hits when you are faced with something worse every time. “I couldn’t explain why but I have numbers that make it clear: since I started with this initiative, people weigh more, not less; they suffer because they cannot address their diabetes or high blood pressure. They try hard, they do their utmost, but they soon lose heart. Even more so if they are children.”
Effort and frustration. That is what the doctor saw over and over, especially when he had to do one of the most simple and, at the same time, most important practices of pediatricians: monitor the height and weight of children.
It was in one of those practices, on a normal day of the week, when he came across the company’s representative for the first time. She was a young girl and brought gifts. In a public hospital like Penna, where there is always something missing, someone who brings something, no matter what, is welcome. “If I understood correctly, she was a nutritionist, and, as health visitors do, she hander over the materials only after asking for an official stamp and signature before.”
What were the materials that the company delivered? Prescription pads with the brand logo as letterhead. Coca Cola in red and, at the bottom, the typical white for the doctor to prescribe… what? An antibiotic? A sedative? A diet?
“But there is something even worse: take a look,” D’Ippolito says, showing the ‘good behavior award’. “This certifies that …. was asked by the doctor to 1. Stick out his/her tongue, 2. Cough or 3. Take a deep breath; AND HE/SHE DID IT WITHOUT CRYING NOR COMPLAINING.” This is what the award says: with the blanks to be completed, the instructions and the capital letters; with a smiling heart and the brand logo in italics, followed by the signature of the professional who completes it. “When I received it, I was really alarmed,” he says. “I was alarmed because it is a brand directly associated with the conditions we try to heal as doctors, such as child obesity, and because they were awarding a certificate that congratulates obedience to a behavior command. It is Coca Cola telling a child how to behave.”
Today, the remains of that first delivery are not the only branded materials that can be found in the hospital. At the entrance to the Accident & Emergency ward, which receives 120,000 patients a year, Coca Cola left a 2016 calendar that includes other forms of advertising that, inevitably or strategically, reach that demographic the company assures it is not targeting: children under the age of 12. Among the typical actions of corporate social responsibility (CSR) –take care of water, recycle packaging, work with the communities where the company establishes its plants– the booklet also presents the inter-school dance contest, “Baila Fanta”, and football tournament, “Copa Coca Cola”. These two events have been organised for years, since they are useful for the brand to highlight the message it most strongly embraces: you need to move. It doesn’t matter if a little coke bottle has 66 grams of sugar, if children dance, jump, chase a ball, then some think that they burn the calories, that they do not gain weight, and, the next day, that they can keep on drinking it.
An active, healthy lifestyle. A happy lifestyle. That is what the company points out in the education program with which it has been able, since 2008, to enter public schools in 16 provinces, reaching an estimated 620,000 children. The program is called “Dale, juguemos” [Come On, Let’s Play!] and is undertaken by the brand through the Fundación Alimentaria, with support from the Olympic Committee and the Argentine Federation of Cardiology. “With the consent of provincial education authorities, teachers were trained and sports equipment was donated for use at break time. The school authorities and its teachers are the ones who implement the program. In accordance with our global guidelines of responsible marketing, this program is done without presenting the image of our brands to the students,” Francisco Do Pico assures. Do Pico shifted, a year ago, from being communications officer at Monsanto a similar seat in Coca Cola, where it seems that they do not believe that something that is said to be done “for Coca Cola Argentina” has brand exposure.
It’s unbelievable. “Though no more unbelievable than what I found out later,” D’Ippolito says, opening the door to a mystery that no one seems willing to solve. “Coca Cola representatives come to the hospital almost every month. We don’t know who allows them to come nor the purpose of their visits: they hand out leaflets, talk to the doctors, collect signatures and stamps. Perhaps they are conducting market or statistical analysis. Or maybe they are looking for partner hospitals, how can we know?”
We asked them. “Coca-Cola Argentina exclusively provides information about the ingredients of its products. The main aim of meeting health professionals is to listen to them and respond to their concerns regarding the products and ingredients of the company’s portfolio, always by means of information based on available scientific proof, explained by health professionals,” Do Pico asserts, but not before pointing out that these people are not health visitors because, for Coca Cola, “the role of health visitors is to promote prescription drugs, in order to achieve their medical prescription. As such, health visitors are contracted by pharmaceutical laboratories.”
Penna, Fernández, Gutiérrez, Garrahan, Güemes and Italiano Hospitals. Coca Cola has access to all of them, and every doctor, mainly the pediatricians that are normally the most required, calls the company’s nutritionists, their visitors. Everyone who came across them is surprised and deem it almost offensive at first (‘Coca Cola entering hospitals!’). But in the end they accept that, as these are kind people only asking for a couple of minutes from those on whom they depend on for their salaries, doctors will open their doors and lend them a bit of the time they do not have.
“I receive them out of respect, because I would feel sorry for them if they stayed outside. But I did never understand the purpose of the visit: why this company in particular, Coca Cola, is interested in talking to health professionals when we will obviously not recommend its beverages to children,” says one professional.
“They talked to me about sodium in water,” says another.
“To me, about sugar.”
“To me, about corn syrup.”
“To me, about aspartame.”
“To me, about happiness.”
“To me, about hydration.”
And more things like that. Trying to understand the most controversial marketing strategy of this time is not easy. But it is almost entertaining.
The first time that Vanesa Miquel encountered this issue was through a colleague that had contracted by Coca Cola. As a nutritionist, she understood the whole picture: the enticing job opportunity in a difficult context and how perfect it is for the company if it turned out to be satisfactory. So she did not hesitate. As a professor at the University of Concepción del Uruguay in Rosario, she thought that the best thing to break the cycle, one that every year has people getting ill a bit earlier in their lives, would be to show it to her students. “I taught them using the marketing material, which is amazing to develop critical thinking over both the content and the purpose of the brand, as well as the professional ethics that are exposed in these leaflets.”
What the nutritionists gave to the doctors, what Do Pico calls “information based on scientific proof”, are leaflets and booklets that summarise the company’s view on different issues, with reference to supporting documents.
There is, for example, ‘The Science of Sugar’: 24 pages of contentious issues such as sugar and high fructose corn syrup, increasingly highlighted as being responsible for pandemics of obesity and type 2 diabetes that, in many countries, reach half of the population and, in others, will do in just a matter of time. But they are presented with a dialectical cunning that can lead to extraordinary conclusions. “Carbohydrates – sugars, starches and fibres found in fruits, vegetables, cereals and dairy products– play an important role in a healthy diet (…) Beverages sweetened with caloric sweeteners provide calories –energy– found in sugars that are simple carbohydrates. Carbohydrates are essential nutrients for life.”
If A is similar to B, and B is a bit similar to C, then, is A the same as C? Definitely, the booklet asserts on every page.
The Pan American Health Organisation discourages the intake of food with sweeteners and many scientific journals publish research studies showing that non-caloric sweeteners not only fail to reduce sugar consumption, but they also include substances such as aspartame, cyclamate or acesulfame-K that may cause similar problems like weight gain. But Coca Cola shows the doctors a bright and colorful collage which vehemently denies new paradigms. In other presentations, the bet is on hydration: the importance of addressing it before thirst comes (which many times, they say, is already too late) and of quenching it with beverages that are better if they are flavored, since children “drink between 45 and 50% more fluids than if it is just water.”
“They do it with references, that’s what surprised me,” Miquel says, “it is a clever move by the brand: they make their own reading of diverse scientific publications in order to advertise.” Without doubt, this strategy, with Coca Cola even creating institutes and associations, is the most questionable.
Like every health advisor, the Coca Cola visitors, a name they would rather not use, have goals: a number of professionals to talk to, relationships to create and materials to hand out which, in turn, should be distributed by doctors to their patients in order to improve nutritional education. This is why pediatricians’ offices in Argentina’s public hospitals have piles of infomercial sheets and, of course, leads to other questions: how it is possible that these people had access, that they took some of the doctors’ time, that they can leave these materials?
“It is madness”, Sergio Auger, another doctor, says. He was director at the Santojanni Hospital until December and, since then, has been the coordinator of hospitals at the Health Ministry. “For someone to visit a public hospital like that, there has to be a written agreement with the management. It is not as though anyone can enter the hospital with a cart to offer his or her products.”
Does Auger know of any such agreement? “No. During my time as director, no one from that company ever came to offer things at the hospital. I am not even aware of an existing regulation in the ministry that allows these things. And if they were to propose it to me, I wouldn’t allow them access.”
Is there any agreement between Coca Cola and the public sector in Argentina? No, Do Pico asserts. What about others?
“There isn’t any agreement.”
“If there is, no one wants to disclose it.”
“I think they can enter the hospital without any problem.”
“They see lights inside and they just come in.”
The latest report on non-communicable diseases by the Health Ministry (published in February 2016) places obesity among one of the most serious problems faced by the country, which has the regional record for obese children under the age of five. It argues that weight gain is associated with the intake of ultra-processed food and the consumption of sweetened beverages. On the latter, the report asserts:
The biggest company is, of course, Coca Cola, which in broad daylight passes freely through hospitals, wanders through medical offices, and tries to convince doctors not only that the company is not behind the problem, but that it is also practically the remedy.
Will Jorge Lemus, the health minister who authorises the publication of such a powerful report, allow this type of promotion to continue?
Translated by Nadia Belén Bandura for The Indy.
This article originally appeared as ‘Coca Cola y el marketing que enferma: Tuve tu veneno‘ on lavaca.org, a communications co-operative founded in 2001, and produces a web page, monthly magazine MU, and radio programmes that can be reproduced freely. Our home is the cultural centre ‘MU Punto de Encuentro’, at Hipólito Yrigoyen 1440, Congreso, Buenos Aires.