When a southern Mexican state effectively outlawed sales of sugary drinks and sweets to children to protect public health, the ban made international news. But few people in Oaxaca – even some fizzy drinks distributors and shop owners – are aware of the rule and the authorities have not enforced the potentially unpopular measure, despite tens of thousands of deaths nationally a year linked to sugary beverages, as obesity and diabetes rates soar.
Oaxaca might be known as the culinary capital of Mexico, but like elsewhere in the country, diets have shifted towards ultra-processed foods and higher meat consumption – as well as sugary drinks. Today the state has the highest rate of child obesity in Mexico and the second highest among adults.
The ban on selling fizzy drinks to children, announced in 2020, was earmarked to be implemented within a year, but there has been inaction. Campaigners say the ban would probably face stiff opposition from industry if it was imposed.
The human toll of non-communicable diseases (NCDs) is huge and rising. These illnesses end the lives of approximately 41 million of the 56 million people who die every year – and three quarters of them are in the developing world.
NCDs are simply that; unlike, say, a virus, you can’t catch them. Instead, they are caused by a combination of genetic, physiological, environmental and behavioural factors. The main types are cancers, chronic respiratory illnesses, diabetes and cardiovascular disease – heart attacks and stroke. Approximately 80% are preventable, and all are on the rise, spreading inexorably around the world as ageing populations and lifestyles pushed by economic growth and urbanisation make being unhealthy a global phenomenon.
NCDs, once seen as illnesses of the wealthy, now have a grip on the poor. Disease, disability and death are perfectly designed to create and widen inequality – and being poor makes it less likely you will be diagnosed accurately or treated.
Investment in tackling these common and chronic conditions that kill 71% of us is incredibly low, while the cost to families, economies and communities is staggeringly high.
In low-income countries NCDs – typically slow and debilitating illnesses – are seeing a fraction of the money needed being invested or donated. Attention remains focused on the threats from communicable diseases, yet cancer death rates have long sped past the death toll from malaria, TB and HIV/Aids combined.
'A common condition' is a new Guardian series reporting on NCDs in the developing world: their prevalence, the solutions, the causes and consequences, telling the stories of people living with these illnesses.
Tracy McVeigh, editor
“Femsa, which bottles Coca-Cola in Mexico, has enormous power,” says Alejandro Calvillo, director of Consumer Power, a campaigning association. “It operates more than 20,000 Oxxo convenience stores across the country, as well as gas stations and many other businesses.
“The regulation is very difficult to implement,” Calvillo says of the Oaxaca policy, adopted by nearby Tabasco. “It was primarily about sending a message.”
Coca-Cola is the most popular refresco in Mexico. “Siente el sabor (Feel the taste),” read billboards across the country, while the national football team is sponsored by the brand, whose lobbying power appears unrivalled.
A president was previously a regional head of the company, and the most recent ex-head of state, Enrique Peña Nieto, posed with a can bearing his name. Coca-Cola “employs strategies to prevent, delay or weaken the regulations that restrict its activities”, the political magazine Proceso alleged last year. Coca-Cola said its practice of hiring former government officials was about “attracting and retaining the best talent”.
Mexico is now fourth in world rankings of the consumption of soft drinks per capita. It was first until the sugar tax was implemented, with 137 litres consumed per person every year.
Karen Akins, director of El Susto, a 2019 documentary that detailed the techniques used to promote Coca-Cola – the most accessible product in many parts of Mexico – says while making the film she met people who consumed large amounts of fizzy drinks who were unaware they had type 2 diabetes. “People who were blind or had limbs amputated often have no idea that it was due to their high blood sugar level,” she says.
Amid the worsening public health crisis, the current federal government seems to be taking a different tack, after continued criticism of neoliberal policies such as the North American Free Trade Agreement, which appears to have contributed to the national obesity rate rising from a fifth of the population in 1996 to three-quarters today.
Mexico’s deputy health secretary, Hugo López-Gatell, denounced fizzy drinks as “bottled poison” in 2020 as Covid took hold. “Obesity, diabetes and hypertension are silent diseases that can lead to major complications,” he said. His warning came weeks after president Andrés Manuel López Obrador implored his compatriots to avoid junk food as the obesity risk became increasingly clear.
In 2017 the village of Yalálag, deep in the mountains three hours east of Oaxaca City, banned the sale of potato chips in stores and barred distributors. In 2020, it was one of many communities to seal itself off from outsiders and during the pandemic deliveries were stopped. The ban effectively extended to sugary drinks and other unhealthy foods for several months.
Gradually, however, it all found a way back in and the stores have returned to their normal stock. “The children are our future but we are going to have serious problems if we continue down this path,” says Vidal Aquino, the former councillor who introduced the crisp ban. “Obesity, diabetes and cancer are spreading from the cities in Mexico to all corners of the country.”
But the unique experiment had an impact. A public health campaign urging locals to avoid processed food has begun to bear fruit, as the rudimentary health system comes under strain from largely preventable type 2 diabetes. One in six Mexicans live with diabetes – up 10% between 2019 and 2021, according to the International Diabetes Foundation.
“There is more awareness not to consume soft drinks or fast food due to the illnesses they can bring, especially at a time of weakness during the pandemic,” one municipal official said. “This year the health secretary proposed both to not let in the distributors and for them to fund the disposal of packaging in Oaxaca.” But, they claimed, “no support has been offered”.
Outside Yalálag, Coca-Cola has faced more scrutiny since the sugar tax in 2014 – watered down under alleged pressure from drinks manufacturers – and the requirement since 2020 for large-font warning labels on high-sugar products.
In April, more than 10,000 units of products, including Coca-Cola, were withdrawn from shops in Mexico City by the government for failing to abide by the labelling rules. In August, the supreme court voted down a 2019 ban passed by Oaxaca on plastic bottles on the basis that it infringed on federal powers, after two companies linked to Coca-Cola Femsa successfully appealed. State lawmakers wanted to reduce environmental pollution – just 3% of 300m tonnes of plastic is recycled nationally.
“Coca-Cola does campaigns promoting their work in communities when it is one of the companies that generates the most plastic waste and extracts the most groundwater,” La Jornada newspaper said last month. Lori Dorman, from Berkeley Public Health, was quoted as saying: “Big soft drink companies have copied big tobacco’s strategies and tricks to distract the public from their dangers.”
In 2018 Coca-Cola reduced the sugar in its main product in Mexico by 30%. That came more than a century after it allegedly removed cocaine from the drink (Coca-Cola denies cocaine was ever an ingredient, though the DEA claims it was) as its addictive qualities became more widely understood – an extract of the coca leaf is still what gives the beverage its distinctive taste.
In 2015 Coca-Cola shot a controversial advert that it later pulled amid allegations of racism and of “trying to impose an alien consumer culture”. In the advert, white actors delivered plastic bottles as gifts to jubilant locals after building a Christmas tree.
Across Oaxaca, which has the most Indigenous language speakers of any Mexican state, Consumer Power has been working with organisations to highlight the risks of highly processed foods. “We are generating a revaluation of the local foods that are necessary for us to recover, and taking notice of our important links to the Earth,” Unitierra de Oaxaca, food education organisation, said in October.
State lawmaker Magaly López Domínguez, who introduced the prohibition of junk food (comida chatarra) for children in Oaxaca, says it is a “disgrace” that the health department has done “absolutely nothing” to enforce legislation.
“The authorities are effectively defending the interests of large transnational companies,” she says. “Their impotence makes me want to cry. It’s as if they cannot do anything to prevent the world’s billionaires from continuing to enrich themselves at the cost of the health of our children.”
But López Domínguez is glad that public consciousness appears to be shifting. “It seems to me that today there are many more people who distrust junk food companies.”
A Coca-Cola spokesperson told the Guardian: “Our goal is to have a positive impact on the communities in which we operate. We believe businesses like ours can play a leading role in finding solutions for some of society’s most critical challenges. In Mexico, we are committed to working hand in hand with local and federal authorities, civil society organisations and communities in the country to drive positive change in key areas such as recycling, water management and encouraging moderate sugar consumption.”
The company said it did not market products specifically at children under 13. A national reforestation plan it participated in from 2008 until 2020 planted 77m trees in Mexico, it said.
Back in Yalálag, Aquino – who does not let his eight-year-old daughter have sugar – says there could be a domino effect if people who avoid processed foods and drinks showed their better health to others.
“Change starts in the home with oneself and with family and friends,” he says. “You have to talk about it and encourage others. Together we can make a change.”
