Susan Greenhalgh on Coca-Cola in China

A fundamental finding of the public health science on obesity is this – you can’t exercise your way out of a bad diet.

As obesity rates skyrocketed in the 1990s, public health experts pointed to sugary soda as the main culprit and advocated for soda taxes as a way to decrease the consumption of what Michael Jacobson called “liquid candy.”

This set off alarm bells in the junk food industry and Coca-Cola mobilized its academic allies in the United States and around the world to create what Harvard University’s Susan Greenhalgh calls soda-defense science – a science that advocated for exercise first over diet – or as one soda mantra put it – count steps, not calories.

Greenhalgh is the John King and Wilma Cannon Fairbank Professor of Chinese Society Emerita at Harvard University. 

She is the author of Fat-Talk Nation: The Human Costs of America’s War on Fat (Cornell University Press, 2015) and most recently the book Soda Science: Making the World Safe for Coca-Cola (University of Chicago Press, 2024).

How did you get onto the question of the impact of Big Food on our public policy?

“I’ve been very interested in the obesity epidemic for a long time – for ten or fifteen years,” Greenhalgh told Corporate Crime Reporter in an interview last week. “I was living in southern California when the obesity epidemic was discovered more than 20 years ago now. It became a major political issue between 2000 and 2015. It was in the news all the time. There was moral discussion about how people were so lazy, they weren’t getting enough exercise, they were eating all the wrong food. They were blaming people’s health problems on themselves.” 

“In southern California, people were totally obsessed with having the perfect body. So all of those issues were really hyped in that area.” 

“I wrote a book – Fat-Talk Nation: The Human Costs of America’s War on Fat (Cornell University Press, 2015) – documenting how young people were just victims of all this discussion about the obesity epidemic. For young kids, identity is what is most important. They were being told they were biologically flawed if they had an extra pound of two. And their primary identity was based on their weight category.” 

“It became obvious that a lot of the blaming and shaming was coming from corporations – both those selling exercise products and those selling foods.”

“I wanted to do a related project in China. I wanted to look at corporate corruption. The role of American corporations was just a speculation. It was a hunch that American corporations might have been trying to protect their products in this gigantic market of the People’s Republic of China.”

“I went to China not having any idea of what I would find. It was an open-ended project on asking – how did China begin to get an obesity epidemic, how did they handle it? I was looking at the science and policy, tracing changes from around the year 1990.” 

“Once I got the timeline in China clear, I then began looking at what was happening in the United States and started to make global connections.”

The bottom line conclusion for soda science is that physical activity is the answer to obesity.

“Yes, that’s one. The other one is – soda tax never.” 

“They would claim that exercise, or physical activity, is the primary solution to obesity. But one of soda science’s creators would say – but diet is important – in order to make people think that they were also paying attention to diet. As a matter of fact, almost all of the scientific work went into elaborating the exercise argument.”

“The second claim that soda science made was that soda tax is not necessary.”

“Even as other public health experts – like Michael Jacobson and Kelly Brownell – were calling for soda taxes. And the WHO said that soda taxes have shown benefit in lowering the increase in obesity.” 

“But the soda scientists never mentioned soda taxes. And through a silent exclusion, the implication was that soda taxes are not necessary.”

You say that soda scientists continued their research for fifteen years until it was exposed. When you say exposed, you mean – the New York Times started writing about it?

“Yes. And also, the primary funder was publicly chastised and shamed because of that reporting in the New York Times. As a result, Coca-Cola announced that it would no longer fund exercise science or any science in the field of obesity research. People still make those soda science claims. But since Coke was the major sponsor of that science, when Coke pulled out, the private effort to support it ended in the fall of 2015.”

Your book is divided into two parts. The first part of the book looks at the rise and fall of soda science in the United States. The second part deals with how soda science took over China.

How did you uncover Coca-Cola’s influence on China?

“I had read as much as I could find on obesity in China. And there wasn’t very much. This was in 2013. I read it in Chinese and in English. In China, I then started interviewing people who had published on this topic, starting with the ones who had published most. All roads led to a woman named Chen Chunming. She turned out to be the main character. She was the head of the International Life Sciences Institute (ILSI) in China. ILSI was the food industry’s main scientific non profit. They were making industry funded science for industry’s benefit. It had branches around the world.” 

“Chen was head of the ILSI branch in China. I knew nothing of ILSI at the time. I asked Chen where she got the money for her research and programs. And she said, it came from the big food companies in the United States and elsewhere outside of China. I was stunned. I asked her how they could do objective science if the food companies were funding them. And she said – they all understand our science is objective, it’s completely disinterested.” 

“For Chen, the question of industry funding science was a non-question. I just couldn’t believe it. And I spent ten years trying to figure out what she meant. The fact is, in China’s political environment, the state has a pro-market policy. Ever since the reform era, the state became pro-market. Let foreign companies in. Develop the markets in China. Let the market inform public policy. That was just the mindset that everybody had.” 

“The government had two norms – industry should fund science, but industry must not bias science. Now of course, those are inconsistent, they are contradictory. But the Chinese hold those two norms in their mind. They don’t want to look at the fact that industry funding of science is going to shift the science.”

“I began to look into this. I asked the obesity scientists. And they all said – no big deal, that’s not a problem in China. The government doesn’t care. ILSI just works this way. 

How did Coca-Cola get its way in China?

“Coca-Cola was the founding company of ILSI, way back in 1978. Coca-Cola has been the major force behind ILSI, even though ILSI had some 500 companies that were members in 2015. But Coke was arguably the dominant company. A Coke vice president had the top role in ILSI most of the time since its founding.” 

“Fast forward to China. China opened its doors to the world economy in 1978. Guess which is the first company allowed to do business in China in the reform era? Coca-Cola – and that was with the authorization of China’s top leader Deng Xiaoping. Coca-Cola has had a partnership with a China state owned enterprise. And that state owned enterprise – COFCO – the China Oil and Foodstuffs Corporation – has been in partnership with Coca-Cola to create the bottling companies and sell the product in China.” 

“Coke has been there since the 1970s. It has done a brilliant job of advertising its products. The experts in China were very impressed with Coca-Cola. There was no suspicion that Coke might be promoting its products and promoting its line about exercise in order to boost corporate profits at the expense of the health of the Chinese people. The experts I spoke with were wildly enthusiastic about the company. They saw all of the corporate responsibility projects that Coke sponsored – like exercise programs for school children.”

“In the United States, many people are concerned about corporate greed and corporate overreach – like the Corporate Crime Reporter. In China, there is not that mindset. During the time covered by this project, 1990 to 2015, large foreign companies were generally considered good, not dangerous or risky.”

How did Coca-Cola affect public policy in China?

“Coke is the major actor in ILSI. In China, the ILSI branch was located in the Chinese Center for Disease Control and Prevention under the Ministry of Health. Chen Chunming was the head of the ILSI branch in China – she was a scientist working at ILSI and she was the previous high level official in the Ministry of Health. When she joined ILSI China, she formally quit her government position. But then she took it right back up again in a de facto way. She established ILSI China in the CDC within the Ministry of Health. She had great connections with all of the officials in the Ministry of Health.”

“She was able to personally create China’s two most important policies on obesity. The first one was fairly neutral. The second one was what they called a patriotic health campaign promoting healthy lifestyles around the country. They introduced that in 2007. And it has been carried out every year since. That strongly promotes exercise as a major solution to the obesity question.” 

“Coke and ILSI took advantage of the peculiarities of China’s political system, a system where scientists are subordinate to the state. They work in state run organizations. The head of ILSI, who was a vice president of Coke, when he learned that the China head of ILSI would be located in the Ministry of Health, he was ecstatic. He said – let them do it their way. And sure enough they did.”

“Coke infiltrated the China Ministry of Health in order to get its favored policies adopted.”

Once China imposed its open door policy to junk food – let’s call it that – what happened to the obesity rate?

“The open door policy to Coke and other companies started in 1978, and childhood obesity began to rise. The child health experts I spoke with tied it directly to children going to McDonald’s, drinking sugary soda.  People didn’t necessarily love the ultra processed junk food, but it was a taste of global culture. And they loved it. Obesity has been constantly rising since then.” 

“There were public health organizations in China that tried to talk about soda taxes. One was the Chinese Nutrition Society. ILSI managed to push them aside. ILSI had the money and it was located right there in the Ministry of Health. Nobody could challenge it.”

Does anybody in China today recognize that to have this open door policy for the junk food companies was a mistake?

“There is a younger group of obesity and chronic disease specialists in China. They published a major three part series in the Lancet in 2021 on obesity in China. They were hyper critical of China’s open door to junk food companies policy. They are very critical. And they track how consumption of these junk foods has steadily increased in China, how sugar consumption in China is higher than in other countries.” 

“They have to tip toe carefully because they can’t directly criticize the Chinese government. But they suggest that the food industry having such a big role in China needs to be reconsidered. That’s the best that has happened so far.” 

“I published three articles from 2019 to 2021 in medical journals with findings about how China’s policy has changed. And I’m hoping that we might be able to get my book translated into Chinese.” 

How did Coca-Cola recruit Chen Chunming from the Ministry of Health?

“In 1978, the first year China opened to the world economy, a Coca Cola vice president, Alex Malaspina, visited China with a colleague of his. He asked everybody he knew. He was looking for a well connected scientist who might work with ILSI and eventually form an ILSI branch in China. And the names came back and he chose Chen Chunming.” 

“At that time, in 1978, Chen was a researcher at one of the Ministry of Health research units. And in China, virtually all scientists were state scientists – they worked in state organizations. Then between 1978 and 1993, ILSI worked with Chen and a colleague of hers on a number of nutrition related projects. Then in 1993, Chen decided that it was time to set up an ILSI branch in China. Her office was in the Ministry of Health.” 

Does ILSI still exist today?

“As a result of my articles which exposed what had been going on, ILSI China has closed shop. ILSI itself — the global organization — is under a lot of pressure from public health experts around the world. In 2022, ILSI underwent a major reorganization. It dropped a number of its branches, including ILSI China. And it is exploring new ways of funding so that corporations are not directly funding its research. And in 2021, Coca-Cola has severed all ties with ILSI.”

“Chen passed away in May 2018.” 

[For the complete q/a format Interview with Susan Greenhalgh, see 38 Corporate Crime Reporter 34(10), Monday September 9, 2024, print edition only.]

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