Mexico: How Far Have its Institutions Really Come?
The question remains if Mexico has achieved a degree of institutional development consistent with its participation in those organizations.
A Daily Publication of The Dialogue
The Mexican states of Oaxaca and Tabasco recently passed legislation to ban the sale of high-calorie packaged foods and sweetened drinks to minors, and several other state legislatures are reportedly moving in the same direction, in a bid to curb so-called lifestyle diseases such as obesity and diabetes, whose long-term risks have been laid bare by the Covid-19 pandemic. To what extent are such prohibitions successful, and what lessons can be drawn from similar measures on other products such as cigarettes and alcohol? What can Mexico do to address noncommunicable health problems in the most effective way? Are the state-level initiatives a distraction from an inadequate government response to the Covid-19 pandemic, as critics allege?
Rafael Pérez-Escamilla, professor and director at the Yale School of Public Health: “The impact of prohibition is not yet known in the area of junk food and sugar-sweetened beverages. At the very least, it sends the powerful message to parents and school officials that these products are harmful to the healthy growth and development of children and youth. It also sends the clear message from society to the food industry that the health and well-being of children and youth is no longer for sale. Mexico should invest much more on primary prevention by making sure women, infants and young children, adolescents and their whole families have access to a healthy and nutritious diet at the same time that it puts policies in place to protect them against easy access and the unregulated marketing of junk food and sugar-sweetened beverages. The state-level initiatives are not a distraction, they are in direct response to the reality of a huge problem of obesity and chronic diseases such as hypertension, heart disease and diabetes. They are fully justified because these adverse conditions are strongly driven by the excessive consumption of ultra-processed foods and sugar-sweetened beverages. Preventing sales of these unhealthy products to minors is one of several policies needed to bring the obesity epidemic under control. Others include excise taxes on sugar-sweetened beverages and junk food, clear front-of-package food labels, protection of minors against marketing of sugar-sweetened beverages and junk food and healthy school feeding programs that prohibit unhealthy foods and beverages in schools. Also, because breastfeeding is key for healthy child growth and development and prevention of chronic diseases in their mothers, it is key to regulate the marketing of infant formulas, follow-on formulas and toddler milks. It’s important to keep in mind that these policies are being enacted after years of giving the benefit of the doubt to the food industry. Indeed, in response to strong lobbying from the food industry, the government has allowed the food industry to ‘self-regulate’ for years, but these voluntary efforts have not and will never work because they affect companies’ profits.”
Santiago López, executive director of the International Council of Beverage Associations (ICBA): “The beverage industry believes in the importance of open dialogue and respects the measures taken by the authorities. We are a socially responsible industry that is actively contributing to efforts to solve the complex, multifactorial obesity challenge. This type of prohibition is unprecedented and lacks a solid evidentiary foundation. This narrow focus on a certain category of foods is not a comprehensive solution. These types of measures disproportionately affect those in the value chain of the agri-food industry who can least afford it—artisan producers and small businesses, who are already suffering severe economic consequences due to the pandemic. The biggest public health challenges we face in Latin America and the Caribbean are malnutrition—including overweight/obesity as well as undernourishment—and access to potable drinking water. It is extremely important for all stakeholders to work together to tackle these challenges, particularly given the aggravating factor of Covid-19. We support the United Nations’ call to action for all stakeholders, including civil society and the private sector, to work together on comprehensive solutions. We support public policies based on science and equitable measures. We are greatly concerned about the stigmatization of food processing and the food industry. This stigmatization lacks scientific basis and does not take into account industry efforts to contribute to the solution. In Mexico, for example, industry has reformulated over 3,000 products, reducing the content of added sugar, sodium, calories and fat. More than 40 percent of the products marketed by the beverage industry are low in calories, without calories and in reduced portions. Moreover, millions of beverages and health supplies have been donated to support vulnerable communities, hospitals and health professionals, in addition to efforts to sustain jobs in small stores and restaurants. We will continue to collaborate with all sectors, working together to provide the best solution to improve health conditions while taking care of economic recovery and communities’ resilience.”
Arturo Sarukhan, member of the Inter-American Dialogue’s Board of Directors and former Mexican ambassador to the United States: “Overconsumption of sugars is an important public health issue, and in recent years both governments and multilateral organizations have taken actions to improve access to healthy foods as one way to prevent noncommunicable diseases. However, sugar content should not be seen as the sole determinant of a healthy diet. Improvements in dietary patterns appear to have the greatest influence on reducing weight and cardiometabolic risk and represent the best opportunity for successful intervention, rather than outright prohibitions such as the ones some states in Mexico are attempting to enact in response to Covid-19. There’s no question that obesity and diabetes are a huge public health issue in Mexico: of the OECD nations, it has the second-highest rate of obesity, after the United States. But the linkage that has explicitly been drawn by the Mexican government between this issue and the number of coronavirus deaths not only has a chink in its armor; it also entails an own-goal scored by the country’s health authorities. Even before the emergence of the pandemic, we knew that obesity and diabetes were a major public health problem throughout the country. And as it spread from China to Europe, it soon became clear that along with other related comorbidities, they significantly increase the risk of severe disease and death. The government knew Mexico faced staggering numbers of obesity. Therefore, one should ask why in heaven’s name, knowing this, did it approach the coronavirus in the laissez-faire way it has, minimizing its effects and risks and downplaying the importance of face masks and physical distancing? Despite evidence and the fact that a big swath of the population was vulnerable, they forged ahead with a negligent public health strategy that only heightened those risks. Not a pretty picture—if not outright malfeasance—in the implementation of public policy.”
Núria Homedes, executive director of Salud y Fármacos: “The main contributors to noncommunicable diseases (NCDs) are smoking, unhealthy diets, sedentarism and harmful use of alcohol. Mexico ranks 130th and 72nd in the world in cigarette and alcohol consumption per capita, respectively, and has the highest global prevalence of children who are overweight or obese. The consumption of ultra-processed food has doubled in the last three decades, reaching 23 percent of the caloric intake, and sugary beverages constitute another 10 percent. The policies adopted by Oaxaca and Tabasco aim at changing two unhealthy habits, which are key to controlling future rates of NCDs in Mexico. However, embracing healthy habits requires knowledge, time, willingness to change and resources; and the effect of the pandemic in people’s daily lives and the economy might not be conducive to flattening barriers to change. State governments do not have the resources to deploy a massive education campaign, facilitate access to unprocessed or minimally processed foods and teach healthy cooking and eating on a budget. Sustainable behavioral changes are not achieved through prohibition, even when stringently enforced, which is unlikely to be the case. Those affected by the policy will find ways to bypass the prohibition, as they did when selling tobacco to minors was prohibited in the late 1990s. The food industry and the private sector have not welcomed these policies, they fear that more states will follow and are resentful of recent mandates to improve food labels. These state efforts seem unrelated to the poor government’s response to Covid but claiming a relationship could be an easy political target.”
Andrew Rudman, managing director at Monarch Global Strategies: “Federal, state and local governments absolutely have a role to play in mitigating the long-term risks posed by obesity and diabetes. Reducing the incidence of these conditions, which can be prevented or controlled through diet and exercise, requires adoption of a holistic, long-term view rather than pursuit of a quick fix that targets products instead of behaviors. Increasing the tax on soda led to reductions in consumption in several U.S. jurisdictions (such as Philadelphia and Berkeley, Calif.), but a direct relationship to a reduction in diabetes or obesity has not yet been proven. To truly change children’s consumption patterns requires that parents understand the importance of, and, far more importantly, have access to affordable and healthy alternatives. Diabetes and obesity are not caused by any single product or product category but can be exacerbated by consumption of prepared and packaged foods which are often high in salt, fats and sugar, even though they are not considered ‘junk food.’ Several staples of the modern Mexican diet (tacos, tortas and tamales) are also high in fat and calories. When considering bans or raising taxes, jurisdictions should also consider the potentially regressive impact of these policies; more affluent consumers may be able to travel to nearby jurisdictions to avoid them, while the poor cannot. Given the need for durable solutions, government leaders should consider a focus on improving access to drinking water and fresh fruits and vegetables through infrastructure investment and distribution of healthy foods, especially in so-called fresh food deserts. Adding healthy lifestyle modules to school curricula would be another potentially beneficial policy option.”
Nicolás Mariscal, member of the Advisor’s board and chairman of Grupo Marhnos in Mexico City: “Prohibition won’t eradicate the obesity problem in Mexico. Packaged food only constitutes around 23 percent of Mexicans’ calorie intake; the remaining 77 percent come from unpackaged food, including street food, according to a recent study published in The Lancet. Obesity is a multifactorial challenge that must be addressed comprehensively, and the diet must be adapted to each person’s habits and lifestyle, age, gender and many other considerations. It is a matter of education and healthy habits. Prohibition laws in Mexico do not include educational programs that could help minors and their families decide responsibly what and how much to eat. Governments must invest in teaching of healthy habits, promotion of physical activity and in providing safe places for physical exercise. Better results could be achieved if companies and parents could be part of this effort. If all sectors work together with the same goal in a collaborative way, lower obesity rates could be reached in a more effective way. According to several studies in Mexico, obesity or diabetes were not the main factors behind the fatality rate among Covid-19 patients in the country, but the treatment, or lack thereof, they received in hospitals.”
Arachu Castro, Samuel Z. Stone Chair of Public Health in Latin America at Tulane University: “In Mexico, with the overconsumption of packaged energy-dense foods and beverages and decreased unprocessed foods intake, it is no surprise that obesity and overweight affect three-quarters of adults. Among children, obesity exists in all socioeconomic groups, and chronic malnutrition disproportionately affects indigenous children, those whose mother has no schooling and those living in rural areas. Recent legislation to tax foods and beverages with high sugar, salt or fat content, and to restrict their sale to children, along with an upcoming front-of-pack labeling system, has been in the making in Mexico since before the pandemic. The impact of these types of regulations, which have been successful in Chile, will take time to curb the prevalence of obesity among adults but will help prevent the onset of obesity and chronic malnutrition among children much faster. At a time when the obesity epidemic and its associated comorbidities, such as cardiovascular disease, diabetes and cancer, have created a fertile ground for the mortality toll of Covid-19 in Mexico, more Mexicans have realized that obesity causes shorter life spans. The crisis brought by the pandemic may create the best juncture for the years-long efforts of legislators, consumer groups, and public health researchers to find the necessary social support to promote anti-obesity public health measures—and to counter the junk food industry’s heavyweight. However, Mexicans should welcome legislation to increase public spending in health and expand universal access to drinkable water, too.”
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