Should we welcome multinational companies’ involvement in programmes to improve child health?BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h3046 (Published 17 June 2015) Cite this as: BMJ 2015;350:h3046
All rapid responses
[This is adapted from my posting on the Child HIFA DGroup discussion forum
where further contributors' responses can be viewed]
I write in support of Prof Spencer’s position asking for an open and thorough debate about the ethical principles which are involved if there are associations between health providers /educators and multinational companies, particularly where those companies may be seeking to present a philanthropic public face whilst marketing products which are implicated in having long term adverse health impacts.
I have proposed the term “Structural Grooming” to describe a process I believe is involved. Structural Grooming is the process through which the structures and policies of institutions or organisations influence, or are likely to influence, an individual or population and lead to behavioural consequences which have a reasonable likelihood of causing or significantly contributing to adverse outcomes. It can occur in pursuit of what may be considered legitimate, and even philanthropic, institutional or corporate aims and the organisations may be accepted and even esteemed for the work. It is directly analogous to “Structural Racism” in that the 'perpetrators' of Structural Grooming may have no wish to cause harm and may be outraged or shocked at any suggestion that their actions may be harmful despite their best intentions.
a good example can be found in Uganda where Coca-Cola are replacing traditional school signs with ‘billboards’ which are approximately two thirds by size CocaCola advertisement and one third naming of the school – it is easy to miss the fact that there is a school involved (I am happy to send people photos of examples). Creating an association between Coca-Cola and education, particularly implanting themselves in the minds of the children through daily exposure as they go to gain their much-esteemed education, is a very cheap form of promotion of their product for both the short and the long term. Schools with little money may welcome the new signs without being aware of the evidence accruing that the popularity of the products being advertised through this ‘philanthropic’ exercise is actually a time-bomb in health terms. Even in the UK where the knowledge of the dangers posed by the products of the soft drinks and fast food industries is in the public domain, companies are able to insinuate themselves through associations with child health such as the Ronald Macdonald Houses at children’s hospitals (which also receive some minor support from Coca-Cola).
Those involved may not realise that there is an intergenerational justice component to the debate – short term benefit in exchange for long term detriment.
Once identified, measures to counter Structural Grooming must be included in the debate about the ethics of health care providers’ and educators’ involvement with multinational companies. I am in no doubt that the direct human and economic costs of the involvement, including those indirect costs in time and money to counter the fact there is a structural grooming aspect, argue against establishing or perpetuating such links. In order to achieve this there will need to be a campaign to support those currently dependent on these organisations to achieve independence from them: any such process will need to be led by those organisations in realising that compromise risks inadvertently becoming implicit collusion.
Competing interests: Member of BMJ Ethics Committee
Nick Spence can afford to retain his principled views. He doesn’t have a child suffering from diarrhoea with no prospect of available, effective treatment. Without intending to appear disrespectful, I think he needs to 'get real'.
While I don't condone everything that multi-nationals do, I personally have to be pragmatic - and so do we all. If we were to exclude trading/dealing with businesses that had questionable or, in our opinion, undesirable traits our economies (personal and macro) would founder. We need to work with others to further our own ends (in ColaLife’s case, saving the lives of children) and, in doing so, demonstrate that there are alternative/better ways to do business together and to live together.
We need to nudge the system forward rather than excluding ourselves from it. When we do the latter we simply lose the potential benefits of collaboration and (perhaps most importantly in the long-term) lose the opportunity to influence the system, to change it for the better.
So Nick, why not join ColaLife ‘inside the tent’ and, while saving children's lives, work from there to bring about change. In my experience, working from the inside with the insights that provides is a far more effective way to achieve sustainable shifts in individual and organisational behaviour.
Go on, give it a try!
Competing interests: No competing interests
I dare say that Prof. Nick made his comments in the best possible interest. But the ‘best interest of whom’?
1. Child obesity - If children survive their early years and go on to become ‘obese’, that’s a shame, but at least they survived!
a. How many children in Africa between 6yrs and 16yrs are ‘OBESE’. Not as many as western countries, I bet!!
2. Tax avoidance - Tell me how many ‘multinationals’ do NOT work hard at reducing their tax liability. Most employ armies of financial advisers, accountants and lawyers to help reduce their tax burden.
b. So, do we give up trying to save lives because multinationals are prudent, unlike governments?
3. Child LIFE – The most precious commodity we have is LIFE, and a child’s life is the most precious. We would all rather die and give our child the chance of life, so what if a multinational doesn’t pay it’s fair share of tax, so what if a multinational produces sugary drinks. We are talking LIFE over tax, profit and obesity. LIFE must come first! What the kids do with the ‘saved’ life later on in their lives, is up to them. What we can do is give them the chance or opportunity to make that choice or decision, which they don’t have when it comes to needlessly suffering from diarrhea.
The above are ‘red herrings’ - If we align with companies which produce sugary drinks and companies who, if legally possible avoid paying tax, so what! How many children’s lives will be saved, thus reducing the burdens of governments, tax payers, charities and other organisations. Sometimes we just have to ‘bite the bullet’.
Competing interests: No competing interests