Researcher finds Coke’s fingerprints on health policy in China

A complex network of research funding, institutional ties, and personal influence allowed Coca-Cola, through connections with a nonprofit group, to exert substantial influence over obesity science and policy solutions in China, nudging government policy into alignment with the company’s corporate interests, a Harvard study has found.

Professor Susan Greenhalgh’s study reveals not just efforts by the food industry to influence public policy, but also the impact of those efforts. It is described in a pair of Jan. 9 articles published in The BMJ and the Journal of Public Health Policy.

“There have been decades of work on how Big Pharma and Big Tobacco have tried to influence science and dictate policy, but the research on Big Food and Big Soda is just now emerging,” said Greenhalgh, the John King and Wilma Cannon Fairbank Research Professor of Chinese Society. “I don’t know of any other work that has documented this type of impact, especially on the policy of an entire nation.

“When I reviewed China’s policies, I could see them using the very same language Coke did,” she added. “For example, they talk about energy balance and making physical activity part of medical treatment or balancing eating and moving … their policy aligns very well with Coke’s interests, and it’s out of alignment with some of the policies advocated by the World Health Organization.”

Greenhalgh found a U.S.-based, industry-funded nonprofit known as the International Life Sciences Institute (ILSI) at the heart of efforts to steer Chinese policy. Created in 1978 by then-Coca-Cola vice president Alex Malaspina, ILSI now has 17 branches worldwide, including one in China, where the organization’s roots run deep.

The nonprofit’s Chinese branch — officially known as ILSI Focal Point in China — wasn’t established until 1993, but its founder, Chen Chunming, had been connected to the U.S. operation since 1978, Greenhalgh says, when Malaspina visited the newly reopened nation in search of local partners.

“Coke wanted to get its solution onto the public health agenda at the earliest possible moment and influence the global discourse on obesity.”

Susan Greenhalgh

Chen, a nutritionist, founded and was the first president of the agency that eventually became the China CDC. She maintained deep ties to China’s public health sector, including the Ministry of Health, even after establishing ILSI-China, Greenhalgh said, which allowed her to work behind the scenes to exert significant policy influence.

In an effort to understand how that influence may have shaped policy in China, Greenhalgh turned to an archive of ILSI-China newsletters from 1999 to 2015. The papers detailed nearly all of the organization’s scientific and policy activities, ranging from research funding to conferences to policy work.

ILSI-Global first asked its branches to put obesity on their agendas in 1999, Greenhalgh found. Up until 2003, about half of ILSI-China’s work dealt with measurement issues — the organization created a series of China-specific thresholds for body mass index — and advanced at least some prevention efforts aimed at nutrition, but none centered on physical activity.

In 2004, that began to change. It was then, Greenhalgh said, that Coke started to position itself as an advocate of “healthy active lifestyles,” and to promote the message that all food and drinks could be part of a healthy diet. To avoid obesity, the argument went, physical activity was key.

The change was almost immediately reflected in ILSI-China’s activities, Greenhalgh discovered. Between 2004 and 2009, a third of obesity activities sponsored or co-sponsored by ILSI-China focused on physical activity. Between 2010 and 2015, the proportion nearly doubled. Meanwhile, obesity activities focused on nutrition declined to just one in five.

That same shift, Greenhalgh said, was reflected in stories that appeared in ILSI newsletters. Before 2003, the group published no stories suggesting physical activity could combat obesity. From 2010 through 2015, though, 60 percent of articles backed that idea, and fewer than one-quarter focused on diet.

After a series of investigative reports by The New York Times in 2015, Coke pulled back on its aggressive promotion of the science of physical activity. Even so, ILSI structure remains in place and the programs it supported are now well established, ensuring that the soda company’s influence is still a factor in Chinese policy.

Greenhalgh conducted extended interviews with obesity and public health experts in China to gauge their concern on possible industry bias. Most were unfazed.

“The vast majority said there was no conflict of interest,” she said. “There were a tiny handful who believed that whenever corporations are funding science it will inevitably be biased, but they were very much in the minority, and most asked me not to use their names because they were afraid of possible consequences … because the political culture in China is very business friendly and pro-West.

“Western science and especially American science is considered to be the best in the world, and what happens is these companies present themselves as scientifically and technically advanced and generous because of their social responsibility programs,” she added. “So the feeling is what’s not to love about Coca-Cola?”

Ultimately, Greenhalgh said, one of the reasons ILSI — and by extension Coke — was able to so effectively redirect Chinese policy on obesity is that no one else was conducting research.

“Basically the story is that the government didn’t care about chronic diseases … but ILSI cared because these companies were pushing the agenda,” she said. “The fact is that ILSI-China was the only entity that had any money and interest in, and they had it because of corporate funding, because Coke wanted to get its solution onto the public health agenda at the earliest possible moment and influence the global discourse on obesity.”

The narrow focus on physical activity as a path to reducing obesity doesn’t fit with expert views on the problem, Greenhalgh said.

“In the past, there were a handful of scholars who felt that … the obesity epidemic was actually an epidemic of inactivity,” she said. “But today there are very few people in the field of chronic disease who believe that, and increasingly people are recognizing that while you have to stay active, when it comes to reducing obesity, diet is more important.”

Coke and ILSI responded to the findings in separate statements.

“ILSI does not profess to have been perfect in our 40-year history,” the group’s statement read. “Not surprisingly, there have been bumps along the way. This is why ILSI has analyzed best practices and has committed to ensuring scientific integrity in nutrition and food-sector research.”

Coca-Cola said that it is creating more transparency by no longer providing the bulk of funding for scientific studies, adding that it has sought to introduce new sugar-free products in China to combat obesity.

“We recognize that too much sugar isn’t good for anyone,” the company said.

Greenhalgh said she hopes to examine the impact of ILSI globally and is working on a book that will explore the organization’s work in China in greater detail.

“It was only because of my background in science and technology studies, which encourages me to look deep down into how science is done and take it apart, that I was able to find this,” Greenhalgh said. “I was shocked when I discovered this. I had no idea.

“When you read the literature, there’s not much about how Coke is influencing obesity science and policy in the U.S., but the literature that does exist shows Coke’s efforts,” she continued. “This shows their impact, so I was just stunned.”

This research was supported with funding from the National Science Foundation, the Harvard University Asia Center, and the John Simon Guggenheim Memorial Foundation.