Geof Rayner (Independent Researcher)
Some decades ago, in a statement which further reinforced his reputation for economic dryness and right-wing ideological rectitude, the US economist Milton Friedman mischievously asserted that the new fad of corporate social responsibility (CSR) was not just pointless but diversionary: the true economic function of every business was simply to make money. If managers wanted the company ‘to do good’, he opined, they should pay for it themselves. In 2006, the year that Friedman died, Tony Blair, in what was to become his sole Prime Ministerial speech on public health, took the opposite tack. The originator of ‘the third way’ argued that since the “ideological attack on profit” was now discredited, business had to prove that its desire for profits could be aligned with the social good. That is to say that non-financial company goals should be given full prominence. In his speech Blair went on to highlight a further societal shift. In contemporary Britain, he argued, the old public health challenges had gone, it was the individual and their choices that had taken centre stage in health promotion. Blair’s remarks foreshadowed both the Conservative-led coalition’s public health ‘responsibility deal’ and his emphasis on individual causation in health brings choice into the political limelight. Today, I argue, not only is CSR found wanting but the already specious argument for individual causation in health has taken a reactionary, indeed repressive turn. As we go into the later stages of the election campaign it is the latter, which is coming to the fore.
There’s little denying the impact of obesity on public health – although some still do. Consider these facts: around two-thirds of men and women in the UK are obese or overweight. Their condition, associated with more than 30 diseases, is a pathway to poor health and for some to an early death. The situation in Britain may be on par with the worst in Europe. In truth though it is not just a British or European or US problem, it is everywhere, and no society has so far successfully reversed the trend. Certainly the USA is in the lead, with some predictions that the entire population will be obese by 2048. If other diseases – think of Ebola – present a picture of existential risk, obesity is the visible, very living sign of avoidable chronic illness, particularly in the young, where it is a harbinger of a difficult future life. It was apparently this aspect to the worry around obesity – and its financial consequences – that set the context to Blair’s 2006 speech.
To people working in public health the issue of obesity is, by definition, a public health problem. Blair’s speech gave the opposing view. As with other non-communicable diseases (he mentioned smoking, alcohol abuse, diabetes, sexually transmitted infections), Blair argued that it was doubtful whether obesity could be seen as a public health problem at all. Unlike the big health challenges of the past obesity was volitional, in effect self-caused: the result of “individual lifestyle.” Though a man of the centre-left, Blair’s analysis differed little from right wing press pundits of the day. Boris Johnson, later to become Mayor of London, bluntly declared obesity to be the sufferer’s ‘own fat fault’. But if Johnson thought State action to combat obesity would only made matters worse, Blair gave the older utilitarian position that failure to act spread the costs across society.
Blair was correct, at least in that single respect (Johnson, as Mayor, later promoted a London food policy, in effect an about turn) but they both shared a similarly individualistic diagnoses, which many people working in the field think of as not only as being superficial but also as discriminatory. Fatness does seem self imposed. But consider for a moment the opposite scenario – that of low body weight, the cause of many chronic ailments in the past. Just over a century ago, as revealed by the Royal Commission on the Poor Laws (1905), and through physical assessments of Boer War recruits, underweight was showed as unarguably linked to poverty. Today no thinking person would moralise about underweight or low stature – although they did then, putting it down to genetic inferiority. For most of human history, the ruling condition has been food insufficiency – the analysis of which underpinned Malthusian economics. The conditions of the struggle for survival included ever-present food shortages leading the explanation for why humans have such weak controls over satiety. We now live in an entirely new food environment, one of cheap and massively available carbohydrates, fats, sugar and salt. Food (and drink) containing these ingredients are ceaselessly pushed by the food industry because, simply put, they are enormously profitable. The tenor of Blair’s or Johnson’s views is that such arguments may have applied in the past but not today and not for overweight. But to accept the individual cause thesis would also be to accept that every one of those afflicted by overweight became so in defiance of the social norms of slimness, that this population-wide shift had occurred over an extremely short period of time, around three decades, and did so outside of any kind of social pressure. And we would have to believe that individual cause applies to every society – obesity is rising worldwide, irrespective of food culture.
Rather than debating its ‘truth ‘ (although we will look at this in a moment) the more important question is ‘why has this story arisen and why it has appeal?’ The late French sociologist, Pierre Bourdieu, once suggested that neoliberal society presents a strong story linked to the justifying power of markets and the supreme role of the individual. The marketplace is arbiter of values and rewards individuals are repositories of human capital seeking to maximise their market presence. To extend his point to body weight – obesity is not disapproved of just on moral grounds it represents human capital foregone. An insight into the narrative power (another late French sociologist, Michel Foucault, referred to it as bio-power) of individual cause is that it even influences those professionals who care for the people with weight problems. In a study of over 620 primary care doctors in the USA, half viewed obese patients as awkward, unattractive, ugly, and noncompliant while one-third characterised these patients as weak-willed, sloppy and lazy. Such moralising of disease recalls Daniel Defoe’s reports on the plague, when collective immorality, identified as its cause, was denounced from pulpits across the land.
The power of the ideology is acceptance of individual causes by those afflicted. At any point in time one in three women in the USA or Britain are on a diet, what amounts to the triumph of hope over experience. One systematic review of dieting research showed that between one-third and two-thirds of dieters later regained more weight than they had lost. It is not the diet but belief in dieting that is resilient. In part this is also a feature of the neoliberal story. It assumes that human behaviour is under fully conscious control, a belief that defies not only behavioural research but also the reality of our own lives. The first generation of behavioural scientists, like William James, pragmatist theorist and founder of functional psychology, sought explanations in the power of habit. James saw habit as ‘the giant flywheel of society’, not only a moral and social force, but an ideological one which held the ruling class in control and subordinate groups accustomed to their lot. Of course individuals matter, but only to a degree. We are all connected to the conditions (social, cultural, biological) of our environment, whether we use this word (brought into its modern use by Scottish historian Thomas Carlyle), the Germanic equivalent Unwelt or Bourdieu’s attempted update Habitus.
Blair’s analysis was soon countermanded by his own chief scientific advisor. The Foresight Obesity project, bringing together more than a score of scientists and social scientists, argued that individual behavioural factors played only a minor role compared to what they called the ‘obesity system’, the world of causation outside of individual volition, much of which operated subliminally or because of societal design (as with preference for car use over cycles, for example). How therefore can corporate responsibility make a difference to obesity? This was entirely unclear from Blair’s speech. In terms of food and nutrition what is clear is that the food industry does have the power to make changes for better, but it is equally clear that self-interest is more powerful once again. The world of food is hardly recognisable from that of a century ago, and even less so from Malthus’s day another century earlier. People do not, in the main, grow their own food. The variety available today is vast. Those that do produce food – the farmers – are a shrunken minority, a tiny part of the food industry, which is the country’s largest employer. In fact it might be better to characterise consumers as part of, rather than separate from, the food industry. They are the end point in the food supply chain and their consumption patterns are shaped and to a degree formed by the supply chain. The industry determines: the range and kinds of food that are offered, food cultures shaped over decades of pricing and marketing strategies and through the design and engineering of new foods as well as the grooming of tastes, sensation and symbolism. While in simple metabolic terms, obesity is explained by the energy formula of calories ‘in’ and calories ‘out’, further analysis – as undertaken by Foresight – reveals vast systematic complexity operating in the background. Coca Cola, for example, did not become the world’s biggest brand – after all its chief product is only brown, sugary water – without mastering its supply chains and shaping the precise importance of taste, consumer desire, symbolism and habit, and then marketing it remorselessly, together with Pepsi, spending more on advertising and sponsorship than the entire budget of the World Health Organisation.
So, to repeat the question, what would genuine CSR mean? Perhaps a real act of real corporate responsibility would be to end altogether the mass marketing of fizzy, sugary drinks and shift the business model to the provision of clean, piped water making it available to the millions of people who are without it. But this is not to be expected any day soon.
CSR will always offer far less than what is needed and be configured around perceived interests and led by the desire for continued profitability. At the same time as the World Health Organisation was formulating its Global Strategy for Diet, Physical Activity and Health, the proponents of a sugary diet, eagerly represented by the US government and the Brazilian government, among others, were explicitly working against it. This organisation relies upon the support of governments over which organisations like Coca Cola have considerable influence. And so a dilemma at the level of a global institution is passed down to civil servants in the world’s health ministries who are encouraged to deal sensitively with powerful food and drink groups.
Even so, many say, CSR, even if hedged by profitability requirements, can play a useful role. In Bangladesh, the Danone company eschews any interest in profits while trying to engage local people in dairy production. Other companies, like Unilever, have claimed the high ground of product and supply chain sustainability; even Coke’s great rival Pepsi has committed itself to much healthier product formulations at considerable investment cost. Are these examples indicators of real progress? One is tempted to say yes, but this might only be true because expectations are so low. In fact, it has been suggested that the interest in CSR is waning, especially since the 2008 economic meltdown.
The main pressure group for CSR in Britain is Business in the Community, exemplified through its yearly awards process. In 2014 BITC’s awards were issued to a record 159 companies plus 82 organisations. Doubtless many CSR activities have a worthwhile aspect, but in terms of public health, the track record has been distinctly weak. More than a decade ago Walkers Crisps (a division of Pepsico), and its media partner News International received an award for their Free Books for Schools cause-related, government approved, marketing scheme. Schools were encouraged to collect vouchers from crisp packets. When I wrote to the then (Labour) minister criticising the scheme the ministerial reply stated that there were no unhealthy foods, only unhealthy diets, as if this formula – which appeared to written by a food company PR department – settled the matter. BITC is unlikely to repeat that award, denounced as bad value by the Consumers’ Association/Which, because, shortly after, Cadbury’s efforts to repeat it with chocolates was a disaster, with the company openly mocked by the Financial Times. Even so, the purveyors of sugary drinks have not entirely fallen from favour with BITC. In 2013 it gave Coca Cola an award for recycling during the London Olympics. No one won an award for the promotion of tap water.
In the wake of WHO’s dietary strategy, Tim Lang and myself examined the CSR policies of the largest global food companies and except for a few cases found the responsibility cupboard to be largely bare. In some cases, like Cadbury’s, the commitment to CSR was very strong, but it failed to be matched by improvements to their own products. The then Labour Secretary of State for Health, Alan Milburn, called for action by the food industry to cut fat, sugar and salt in food, threatening regulation if they failed to do so. After leaving office he became an advisor to Pepsico.
More recently, as part of a European Commission study led by SIFO, the Norwegian consumer organisation, a group of researchers, including myself, scanned all the countries of the EU to see what CSR policies were being applied in national settings that might have an impact on obesity. There were many, although on closer inspection, it was difficult and in many cases impossible, to gauge their impact or even to discern any commitment to measuring impact. Even EU-supported schemes, like EPODE (Ensemble Prévenons l’Obésité des Enfants), originating in Northern France, produced only limited evidence of success, confined to the towns of their origination. In many cases, EPODE being one, initiatives have been hampered by the restrictions imposed by commercial partners. Nestlé and Ferrero, partners to EPODE, have plainly restricted its scope with the argument that the project should remain neutral on food types. Some schemes were effective because businesses claimed indirect benefits (healthier menus for company staff, in Denmark) or a direct benefit (a national campaign of water drinking, pushed by a bottled water supplier, owned by Danone, in Poland). All well and good, but very limited.
In England the Responsibility Deals have become mired in controversy. In the case of alcohol product pricing was ruled out of the picture and in the case of food the eagerness to produce widespread company involvement meant that nothing could be ruled out and therefore anything could be included. From day one, the food responsibility deal failed to set up an effective evaluation system, as its originators, the Conservative Party research department, had claimed it should. In the larger picture Responsibility Deals formed an accompaniment to Nudge, the expressedly neoliberal formula for deregulating government.
Blair’s 2006 speech concluded with the aspiration that in ten year’s time the health debate would be as much about personal responsibility as collective responsibility. This state has already come upon us, and then some. In February, as the 2015 General Election approached, David Cameron brought individual assignment of blame for obesity alongside other dependent behaviours, into the election discussion, presumably drawing upon opinion polling which showed that the public (or at least 60% of them) accepted the ‘own fat fault’ argument (a figure which roughly approximates with the number in the population who are overweight or obese). What his speech actually included was a watered down version of the briefing given to the press and presented in The Times, as “Obese people without jobs will be forced to diet or lose their benefits” The link could be made to immigrants, ‘welfare’ claimants, etc. The message was all too easily understood. In contrast, CSR was never going to be an election story, the issues being too vague to nail down.
Back in the 1960s, the esteemed French-American biologist Rene´Dubos warned about the future of nutrition in terms of an evolutionary mismatch between the then emerging industrialisation of the human diet and our resistant ‘old’ bodies requiring much simpler food drawing upon our genetic heritage. His concern was with the feeding of entire societies, with issues of individual choice more or less irrelevant and with the implication of the need for a cultural revolution in food. Where are such arguments today? Provocatively, one source (among many) has been the RAND Corporation of Santa Monica, USA, an organisation hardly known for political radicalism. Set up as a military think tank in the early 1950s (supported by the Douglas Aircraft Corporation) it now produces more PhD social science researchers than any other institution in the USA. Its leading thinker on obesity is Deborah Cohen. Cohen argues that the powerful mechanisms of food marketing on the one hand and consumer vulnerability on the other can only mean that regulatory regimes for food must get tougher. Following Milton Friedman, to speak of CSR in food, is a diversion but contra Friedman action by the individual or the market is a diversion too. As with smoking, now subject to intense regulation, in order that we might avert further exacerbation of the obesity crisis, an entirely different model of the food system must develop. To be realistic, this too, at least in the US context, is unlikely as the state, it appears, has given up. And yet public health progress has always been reliant on the state and the failure of the state, or the aligning of the state and political system, with the demands of the food industry is now a major obstacle.
This depressing note leads us to consider the views of the political revolutionary Karl Marx. Marx of course had nothing to say about obesity. But he thought that overproduction and the mismatch between human need and the market would usher in radical change. In effect, he thought that capitalism would collapse due to the weight of its own internal contradictions. If we were to rewrite this slightly for the 21st century, and limit it to bodies and nutrition we might come up with a new formula: that modern capitalism might still collapse but this time due to the contradictions of its own weight.
Geof Rayner is the author, with Tim Lang, of Ecological Public Health: Reshaping the Conditions for Good Health, Routledge 2012 and the Metabolic Landscape: Perception, Practice and the Energy Transition, with Gina Glover and Jessica Rayner, Black Dog Publishing 2014. He is a former expert adviser to the Department of Health on obesity and an Honorary Research Fellow at City University.