The Community Tool Box is an excellent resource from the University of Kansas for implementing community-based initiatives with community input and support. I’ve been spending a lot of time on this site while creating a course in Community-Oriented Primary Care (COPC) for NextGenU.org (with the help of Nick Druar and the invaluable input of COPC expert Dr. Jaime Gofin). I am more than impressed with the wide variety of research and innovation that went into this online resource kit and we could not create this free and accredited course without it.
This is not a critique of The Community Tool Box.
But as I was cruising along in my reading, happy to see so much support for community participation, I saw a grey box giving an example of the importance of recognizing the realities of the communities involved. The box said:
“In an example from business: Magic Johnson, the Hall-of Fame basketball player, owns a string of movie theaters in African-American neighborhoods. In talking to theater managers, he found that drinks – the standard Coke/Sprite/root beer – weren’t selling at the concession stands. Johnson immediately ordered that sweeter drinks – orange soda, fruit punch – be added, and concession sales shot up. He knew, from his own experience, that sweeter drinks reminded patrons of the Kool-Aid they had drunk as kids.”
I was bombarded by flags as red as the Kool-Aid I imagined twirling around in square plastic jugs, ready to stain the tongues of children. This post is about one of those red flags.
After researching the insidious sales methods of various corporations that undermine public health efforts, I immediately thought this was kind of a weird example to have when talking about health. The junk food and drink industry has recently been targeted by those concerned with the rise in non-communicable diseases like type II diabetes around the world (I blogged about this here), yet somehow the links between soft drinks and health, particularly in impoverished areas, continue to be relatively ignored. Although it’s now common knowledge that sugar drinks are not good for us, global health initiatives are lagging behind in making the connection obvious, especially big organizations with lots of power (e.g. The Gates Foundation & The Global Funds teamwork with Coca-Cola, also detailed in this blog series on corporate power).
Why didn’t The Community Tool Box catch this one?
In the United States, the pleasure associated with a cold can of Coke on a hot day or the pleasant nostalgia experienced over Kool-Aid are difficult for many to deny. They have meaning in our lives because of this sense of pleasure and the associations they evoke. The sale of pleasure: of meaning and experience bottled into a glass, is a part of the insidious nature of power.* We might know the drinks are bad for us, choosing to enjoy them anyway, but we don’t even notice the influence of the multinational corporations behind these sugary beverages on global health (The Coca-Cola Company and Kraft Foods/Mondelez International). Of course, pleasure is dependent on shared cultural associations. Part of selling U.S. products overseas is also selling the “Western” experience. This includes, among many other things, the privileging of the individual and his/her own personal “pursuit of happiness” and responsibility for his/her own health.
Following this cultural assumption, most type II diabetes prevention programs focus on individual responsibility and risk while the scientific research often focuses on genetic susceptibility. Health promotion initiatives encourage individuals to avoid “junk food” and exercise (these methods are often those supported by the corporations themselves, pushing the blame onto individuals). Social determinants are often (although not always) ignored, such as access to safe outdoor spaces to exercise in, availability of affordable healthy food, histories of colonialism, and the chronic stress of poverty.
But no one takes down the Coca-Cola advertisements.
The boundaries between health initiatives and development practices are often blurred when it comes to talking about global health and global aid. Because development often involves and perhaps even implies business initiatives, corporate influence is everywhere. When talking about global health, we shouldn’t just be talking about biological influences and medical techniques. And adding social determinants, considering ecology, and tracking political influences are also not enough. We have to recognize less-obvious influences in our lives: greater structural pitfalls, visual culture, or even the international sale of the “pursuit of happiness.” We have to start to deconstruct the things below the surface: critically, daily, and collectively.
*(Thanks to social theorist and philosopher Michel Foucault and subsequent theorists for some insights on this theory).
