Intended for healthcare professionals

Rapid response to:

Head To Head

Should we welcome multinational companies’ involvement in programmes to improve child health?

BMJ 2015; 350 doi: (Published 17 June 2015) Cite this as: BMJ 2015;350:h3046

Rapid Response:

Re: Should we welcome multinational companies’ involvement in programmes to improve child health?

[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

26 June 2015
Adrian G Sutton
Child & Family Psychiatrist (retired): Medical Educationalist
Universities of Manchester, UK & Gulu, Uganda
90 Woodifrod Road, Bramhall, Cheshire, SK7 1PB