Coming soon! You can get sick… then get your medicine from the same cart

by Sasha Alyson

“Today at the European Development Days, The Coca-Cola Company and its Foundations, in partnership with the Global Fund to Fight AIDS, Tuberculosis and Malaria, the U.S. Agency for International Development and the Bill & Melinda Gates Foundation, announced the latest expansion of ‘Project Last Mile’ with innovative programs to strengthen local health systems in Liberia and Swaziland.”
–Press release issued by the Global Fund(1)

For nearly two decades the Global Fund to Fight AIDS, Tuberculosis and Malaria has played an important role fighting three diseases, particularly in Africa. It has raised more than $45 billion from the U.S. government, the Gates Foundation, and others, so that otherwise unaffordable medicines could reach people who needed them. The organization claims “32 millions lives saved through the Global Fund Partnership.” Although many of these funds would have been put to similar use through other agencies if the Global Fund hadn’t existed, it was the Global Fund that did the work, rallied support, and maneuvered some turbulent political waters to prevent many deaths.

At the same time, however, the Global Fund was actively helping to spread a new epidemic, which is expected to claim far more lives than AIDS, tuberculosis, and malaria combined. This is the less-visible epidemic of Non-Communicable Diseases (NCDs). Through its partnership with Coca-Cola, the Global Fund strengthens a company which aggressively seeks to expand into new markets, undermining health of children and adults alike, in single-minded pursuit of profits – with a large chunk of those profits going to people like Warren Buffett, who didn’t really need them.

The Global Fund’s partnership with Coca-Cola goes back to 2010, and the Global Fund repeatedly congratulated itself for its savvy – everyone knew Coca-Cola had superb distribution, wasn’t it clever of the Global Fund to take advantage of Coke’s expertise in delivery systems?

Well, perhaps they weren’t the clever ones. It wouldn’t be surprising if Coca-Cola — aggressively trying to expand its market, shine its image, and pull health officials into its corner — suggested the idea. Let’s look at each of these.

Expansion: After decades of steady growth, soda consumption leveled off and is now dropping. Years of work by health departments, civic organizations, and concerned individuals is bringing results, and Big Soda is worried. A generation ago, developing countries were an afterthought; the big money was at home. Now Coke and Pepsi have become downright frantic about pushing their product abroad. And the wealthy countries aren’t enough; where health departments, media, and civic organizations are starting to fight back. They are targeting the global South. Mexico has the world’s highest per-capita consumption of Coke.

Image: The last decade has brought a development that deeply frightens Coke and Pepsi: The soda tax. Lawmakers in more than 30 countries have decided to fight an unhealthy trend by taxing sugary drinks. And it’s working. It reduces consumption; brings in funds… and also produces another health benefit; it stigmatizes soft drinks. Now they are in a special category, along with tobacco and alcohol, which society agrees is harmful. In 2019 South Africa became the first African country with a soda tax. (Morocco passed a similar law, but under pressure from a well-funded industry opponents, has backed down.) Getting aligned with a health initiative gives Coca-Cola an edge as it fights soda taxes in other countries.

Government relations: U.N. agencies and large NGOs routinely offer thinly-disguised bribes (“here’s a mobile phone, so we can keep in close contact with you”) to win favor with bureaucrats whose permission they need to run their programs. Coca-Cola must be careful here; the Foreign Corrupt Practices Act bans corporate bribery. But now, the Global Fund has created a partnership in which an American behemoth, clawing for more, works closely with the very health officials who should be guarding the gate. There will be countless opportunities for Coke to take these officials on fact-finding trips, to provide coveted electronic equipment under guise of public health measures, to hire part-time consultants. When you’re selling flavored sugar water at a premium mark-up, you’ve got plenty of cash to spread around to be sure everyone remains servile.

Would the Coca-Cola company and its affiliates stoop so low? Heck, how would I know? All I know is what they’ve done in their own backyard, where there are stronger laws, health departments, civic organizations, and even a few surviving media watchdogs who call attention to corporate self-serving when it goes overboard.

Here’s what one watchdog has uncovered. Save the Children once supported a tax on soft drinks. PepsiCo gave it $5 million and Coca-Cola talked about giving it more. Save the Children promptly decided soda taxes weren’t such a good idea. CEO Carolyn Miles explained that this decision had nothing to do with the money.(2)

Surely money played no role on another occasion: Coca-Cola gave nearly $3 million to the American Academy of Pediatrics, which on its “” website praised Coke for its commitment to “better the health of children worldwide.”(3)

And Coca-Cola put up $1.5 million to create the “Global Energy Balance Network,” with a University of Colorado professor propped up as its public face, which sought to emphasize exercise, rather than healthier diet, as the key to controlling obesity. We know about this because the New York Times exposed it. GEBN, worthless after its ties were known, soon shut down. We don’t know what else Coke is doing now, but which hasn’t been exposed yet.(4)

Will Coca-Cola behave more honestly in Liberia and Swaziland?

A boy's open mouth shows black nubbins where many of his teeth should be, one result of sugar being pushed into the diets of children in societies where the consequences are often not understood..
The most prevalent NCD often is not mentioned with the others: Tooth decay. I took this photograph about 30 meters from a soft drink machine, in a rural village where fifteen years ago, all the children had beautiful, healthy teeth.

For years, global health experts have lamented the irrational way that funds are apportioned. When the Lancet tallied spending by the four largest donors, including the Bill & Melinda Gates Foundation, it found that funding per death showed enormous variation: $3.21 for non-communicable diseases (NCDs), $20.30 for nutrition, $197.80 for tuberculosis, $646.70 for malaria, $1029.10 for HIV/AIDS.(5) There are good reasons for some variation: Facing a potential epidemic, increased spending now may prevent many more deaths in the future. But nothing explains this scale of difference. Besides, it is non-communicable diseases that are becoming epidemic.(6)

The Big-Four NCDs are cardiovascular disease, diabetes, cancer, and chronic respiratory disease. Already, these four cause more deaths than all other causes combined. By 2030, the The World Health Organization anticipates that NCDs “are projected to cause nearly five times as many deaths as communicable diseases worldwide.” Yet they get one-half of one percent of the funding, per death, of malaria.

Why do NCDs get so little attention and funding from so many big global health organizations? A report from the U.N. and WHO, which notably DOES give attention to these diseases, offers one clue: NCDs “could be significantly reduced and prevented, with millions of lives saved and untold suffering avoided, through proven and affordable measures…. The knowledge and technology to fight the onset and effects of non-communicable diseases already exist.”(7)

In short, this job won’t need exciting innovation, new technology, or TED speeches. It won’t need heroes. There won’t be anything to patent and sell at a big mark-up. It needs a lot of people on the ground, rolling up their sleeves and getting to work.

Furthermore, you’ll make powerful enemies. Fund a vaccine and you’re a hero. Challenge the right of Big Tobacco and Big Soda to push their toxins on the rest of the world, or of Big Pharma to let people die while they pile up runaway profits, and the industry giants will fight back.

A third factor is that NCDs are often known as “lifestyle-related diseases,” largely caused by poor diet, smoking, and sedentary behavior. NCDs were once associated with richer countries but as Western products, advertising, technology, and influence spread, so did these diseases. To focus on NCDs is to expose the downsides of globalization and Western marketing power. If you’d rather not think about all that, then malaria is a safer topic. We can all be against malaria.

The Global Fund could have said to Coca-Cola “No, Africa doesn’t need another epidemic.” Instead, it helped Coke pursue its goals.

This reflects the way that aid agencies work, and even those that bring genuine benefits, such as the Global Fund, easily fall into into the same thinking. They focus on their own goals without much thought about whether the country and health infrastructure will be more prepared for the next epidemic. In this case, the Fund seems not to have even noticed that it was contributing to that epidemic.

Everyone whose life is saved will be grateful. But we also have to look at the long-term picture and hidden costs. Even if Coca-Cola truly has useful expertise, is that worth the cost of making it look like a true friend of the people?

And just what expertise did Coca-Cola have that was so indispensable? Aid organizations always arrive in the global South believing that locals can’t do the job, that foreign expertise is needed. Local people have often come to believe this too. But they are the ones who know the situation best. In this case, just how hard did the Global Fund try to develop local expertise, when Coca-Cola was right there, so eager to dive in? Bill and Melinda Gates are two of Coke’s biggest boosters, and also give to the Global Fund. Did anyone actually look very hard to see if delivery could be improved, without bringing in Coca-Cola?(8)

Here is a microcosm of the aid industry. They give with one hand, then with the other they pick your pocket or stab you in the back, whatever works out well for them. They always call the shots, they decide what they’ll give, what they will take back, and then they cluck about how bad things are over there, but no problem! They will be happy to continue helping…. and they’ll define “help.”

This is karma colonialism at work.

Notes and Sources

  1. Press release from the Global Fund to Fight AIDS, Tuberculosis and Malaria, 8 June 2017
  2. “Save the Children Breaks With Soda Tax Effort,” by William Neuman, New York Times, 14 Dec. 2010.
  3. “Coke Spends Lavishly on Pediatricians and Dietitians,” by Anahad O’Connor, New York Times, 28 Sept. 2015.
  4. “Coca-Cola Funds Scientists Who Shift Blame for Obesity Away From Bad Diets,” by Anahad O’Connor, New York Times, 9 August 2015
  5. The Lancet study is from 2008, and I’d prefer a more recent spending breakdown, but have not found one. I have not seen evidence that the proportions have significantly shifted toward NCDs.
  6. In what it called a “watershed event,” the U.N. announced in 2011 presented a challenge of “epidemic proportions.” Then, lest anyone worry that the U.N. might propose a suitably strong response, Secretary-General Ban Ki-moon issued a statement that surely required several revisions to make it as feeble as possible. According to the U.N. report, “He called on corporations that profited from selling processed foods to children, including the media, marketing and advertising companies, to act with the utmost integrity.”
  7. “Prevention and control of non-communicable diseases,” United Nations, 19 May 2011. (The report is distributed from the WHO website.)
  8. Eight years after offering to come in to train and give advice to African manager, Coca-Cola is still coming in to train and give advice to African managers. It sounds as if Coca-Cola, like the aid industry, likes the benefits that it gets from its role, and would like to continue. Forever.

Top photo and headline: Coke cart photo by Rod Waddington (Creative Commons license CC-BY-2.0) The title is intended to be metaphoric, not literal. Coca-Cola is — at this writing — only acting in an advisory role, not as actual distributor.

Related stories

Left: Why not just give them the money? Cash transfers — just giving aid money directly to those you wish to help — has a proven track record. Why does the aid industry dislike this approach?
Right: Celebrities and Saviours: A UK charity vows to hire African filmmakers … but it continues using celebrities to get attention. That creates a focus on feel-good solutions — which often won’t get the job done.

Left: High-level hypocrisy. Coca-Cola pushes a harmful product on vulnerable children. How can Warren Buffett be a trustee for the world’s biggest health foundation, and also Coke’s biggest investor?
Right: Cellphones and literacy. UNESCO took money from big tech to publish a deceitful report that benefited the company that gave it the money. If an African president had done that, what would we call it?

Other stories about karma colonialism

Left: Chocolate hands. You can buy chocolate hands at shops in Antwerp. So what? Well, one of the colonial era’s great atrocities involves Belgians chopping off the hands of Africans.
Right: Gender parity in education. The aid industry tells us that girls are short-changed on education, especially in Africa. They’re twisting the data, to bring in the dollars. The U.N.’s own numbers show a very different story.

Left: “Sometimes I feel like a sign board.” A Kenyan professional, working at a Western NGO, tells what it’s like: Pointing the way for an ever-changing succession of ex-pats who are paid much more, but don’t know what to do.
Right: What would make a better future? There are ways that wealthier countries can genuinely help others, if they want to. Give the aid money directly to the poor, for example. Here are ideas.