Intended for healthcare professionals


Making China safe for Coke: how Coca-Cola shaped obesity science and policy in China

BMJ 2019; 364 doi: (Published 09 January 2019) Cite this as: BMJ 2019;364:k5050

Read all The BMJ's investigations

Chinese translation


  1. Susan Greenhalgh, John King and Wilma Cannon Fairbank research professor of Chinese society
  1. Department of Anthropology, Harvard University, Cambridge, MA, USA
  1. greenhalgh{at}

Susan Greenhalgh investigates how, faced with shrinking Western markets, the soft drink giant sought to secure sales and build its image in China

Ever since 2001, when the US surgeon general called on all Americans to fight the newly named epidemic of obesity, the soft drink industry has had a target on its back. Recent investigations have shown how it is fighting back. From blocking New York City’s ban on large drink sizes to lobbying against soda restrictions and funding exercise specialists to promote physical activity as the best solution to obesity, “Big Soda” has been defending its interests.1234 Yet with US soda sales plummeting, the industry is losing the battle.5

As the US market shrinks, the industry has set its eyes on the global south, especially rapidly developing countries like China, with vast undeveloped markets for products associated with “modernity” and “the American way of life.”56 Until recently, China’s hypermarketised political economy and pro-Western culture have enabled some multinational firms, especially politically well connected ones, to manage the risks and restrictions and prosper.

This is particularly true for Big Soda’s largest and most famous brand, Coca-Cola. China is now Coke’s third largest market by volume.7 And with its vast population, huge growth potential remains, making it “critically important to the future growth of our business,” according to former Coke chief executive Muhtar Kent.7

But Coke’s recipe for success in China relies on more than cultivating political relationships and strategic localisation of products and marketing. Through a complex web of institutional, financial, and personal links, Coke has been able to influence China’s health policies. The company has cleverly manoeuvered itself into a position of behind-the-scenes power that ensures that government policy to fight the growing obesity epidemic does not undermine its …

View Full Text

Log in

Log in through your institution


* For online subscription