 Hi everyone and welcome to another issue of the People of Health Dispatch and today we're very happy to be talking about something that's coming up in the first week of August, so the World Breastfeeding Week. And we're here with Petty Randall and David McCoy, two of our favorite health activists and experts working on this issue to talk a bit about what's going on in the commercial milk formula industry and what activists around the world should be doing to improve the situation that we're seeing. So welcome, welcome Petty, welcome David, thank you for joining us today. Yeah, thanks very much, wonderful to be here. And so, you know, just to keep the conversation off, I was thinking that maybe we can start with the basics. So can you tell me a bit more about the World Breastfeeding Week so you know what's going to happen this year, what's going to be the focus on, why is it actually important for us to keep an eye out for the events and for the actions that will go on then? Oh well, it's fantastic to have this every year that the World Alliance for Breastfeeding Action organizes it and it's a bigger alliance than IBFAN, I come from IBFAN, which is focused very much on the marketing and World Alliance for Breastfeeding Action is bigger in terms of reaching out to many more organizations. And I think it's great that they're doing this at this year on maternity protection for women who work outside the home. It's clearly something that needs to be done and we need to remember that. But we must remember that for the research still shows that for many women just getting breastfeeding going is a real problem. You know, you have such bad information and patchy information and support going out to women that women don't have a happy experience often. Once they have that, and once things are right and they're getting the right support, women will fight like mad to do it. But it's very important that all those support and that the society is supportive of breastfeeding. We don't have that in many countries, certainly not in the UK. So these lack of skills in supporting women on the hostile atmosphere can really cause a problem. So it's very, very important in terms of actually child health, mental health, you know, family health, if we can start children off correctly and make society supportive of this, it would be a really good thing. All I would add is to emphasize the importance of this and to say that the scientific evidence showing the superiority of breastfeeding compared to artificial formula feeding is growing. And we have better and more knowledge about the gap between breastfeeding and formula feeding. So it was important 20 years ago and it's even more important given what we know today. So yeah, it's important also to remember that breastfeeding is protective of women's health as well and not just something of crucial importance to the child. Exactly. And I would just like to add on that that as we hurtle towards, you know, an emergencies becoming the norm as this weekend has shown almost like it's simply awful that people are waking up to the climate emergencies. Well, why are we not talking about breastfeeding in terms of infant and young child health where it's a lifesaver if you're in a flood or if in fine you have to run and you have to do things. How are you going to make up a bottle? And so the lack of attention to this, I think will become more and more evident that we are losing a huge skill and that is so important for child survival and just getting forgotten. So it's very, very important in terms of emergency preparedness and an emergency response. Aside from normal, as David has said, it's actually all the evidence is pointing that way that the more and more we know about breastfeeding, the more and more we understand why it's so important. All this evidence about ultra-processed foods and whatever we're just waking up to it about how we've been sold a really, really awful alternative. And Patti, actually Yip Thanh and Baby Milk Action, so essentially you've been working on collecting and analyzing evidence about transnational corporations influence and well maybe it's better to say their attempts to circumvent the international code of marketing of breast milk substitutes, but not only the code also the WHO resolutions that go to support it. And for the past years, I think that we've seen additional evidence pouring in on how this is happening and how the industry is actually not backing up from doing that. So I know it's a thing to ask maybe, but when we look at the past period, what would you say were the most important events, what was the most important evidence that you have seen appearing? Well, one of the things that strikes me is that at least WHO and UNICEF now after initially when we were talking about the 80s and when we brought it in and we've we've kept going with the code, keeping it on the agenda and having resolutions every two years. So we've got 20 resolutions now that strengthen and close down the loopholes that the companies have always used. If you look on the Nestle website, you'll see you just have the code, the 1981 code. And even then it's not searchable, it's a PDF just as the WHO one is a PDF as well. It should be searchable and none of the resolutions. They don't want to talk about the resolutions because the resolutions talk about conflicts of interest and they expand and clarify the code. And these are the things that keep it on the agenda. And so the companies try and dodge and, you know, move around and as we see even in other forums like the Committee for Food Security, they only wanted to talk about the 1981 code, not anything else. And all those things point back to that. So you will see that, that they are moving towards sponsorship, buying up everything, buying up the UN, buying up everything. Just that is the way the companies have always worked. They see somebody who's critical and then swoop in and then offer the money and or some wonderful grant or some other thing. So that has always been the real problem. So you have companies invited into the policy setting programme and that to me is the major, major problem. And even at the Congress, WHO knows that they've got to do it. They were tempted in 2020 to sunset the code and we objected and it's now still on the agenda. But that is always the thing. It's very political to actually, for the World Health Assembly, to address marketing. It's not an easy subject. And so it's easy for them to move it away. And what we're saying, whether you're talking about tobacco, whether you're talking about NCDs or baby milks, whatever, the marketing is like a virus. We say that and you need a vaccine that's evolving to solve it. You can't just leave it once as it was in 1981. You need to keep addressing it. David, you were among the lead daughters of a recent Lansing series on breast feeding. So I think that what Patty just said gives a good introduction to the content of that series. Could you maybe highlight some of the most important findings and explain a bit how this situation evolved? Sure. Yeah. I think we published a series of three papers in the Lancet earlier this year. And I think maybe I could talk about six or seven key points or key findings from the research and evidence that was collated. I mean, the first point to say is that commercial milk formula sales are rising. And despite the code, despite the fact that in some countries we are seeing a reduction in, or rather we're seeing a rise in breast feeding rates, but overall at a global level, we're seeing a rise in commercial milk formula sales. This includes the sale of commercial milk formulas that are being targeted at older children and also increasing volumes of specialized milks that are being targeted at mothers as well as so-called specialized milks for children exhibiting particular symptoms. The point about this though is that rising sales mean rising profits. Rising profits means greater financial power that the corporations have. Greater financial power also translates into greater political power and the ability to lobby governments and other actors. So one of the things that we did in the Lancet series was to try and understand how is it and why is it that commercial milk formula sales are rising and what is it that allows these companies to accrue ever greater amounts of economic and political power. We've tried to emphasize the way in which the companies are marketing via the health sector and there are industry documents that describe health professionals as the primary customer of these companies. So that says a lot about the marketing strategy of these companies. The other thing to talk about is that accompanying the marketing strategy is also a sophisticated political strategy going back to some of what Patty was talking about that there is a very sophisticated strategy designed to influence decision makers and policymakers in order to ensure that there is a friendly environment in which they can operate. An environment where regulation is not as strong as it needs to be where companies are allowed to evade tax and therefore accrue ever greater amounts of profit which again gets translated into being able to command a greater share of the market, grow their markets and again grow their political power as well. So we have tried in this Lancet series to focus attention on these political and economic factors that are important in shaping what happens at the level of the mother and the child and the healthcare worker on the ground. We've also tried to look at the claims made by the companies that this is an industry that can benefit countries in economic terms. They talk about the jobs that they create. They talk about the investment that they bring to certain countries that manufacture this milk formula. We've had a good hard look at that in this Lancet series and one of the things that we've concluded is that their claims about their economic performance and the economic benefits that they bring to countries is completely exaggerated and that in fact what we see is that many of the costs of formula feeding are in fact externalised and borne by the poorest communities by the poorest countries. We also see the environmental damage that accompanies commercial milk formula being something that is carried by the public sector and by people in general. It's externalised to all of us. These are costs that are not carried by the companies and we see that the profits that are being accrued are being sucked up and being enjoyed primarily by shareholders in the global north. So we can see this industry also through the lens of neocolonialism, sucking up profits from people, from ordinary members of the community, whereas the profits are being enjoyed by a wealthy few in the global north. And then just the final point to again going back to this week's or sorry this year's focus on maternity protection is to say that the series, the Lancet series emphasised just how unfair it is on women particularly the poorest women in the poorest countries having to take on a disproportionate burden of care work which is often unpaid and also women working in the formal and informal employment sectors suffering from pay and wage discrimination all of which militates against the ability of young women to be able to find the time and the energy to provide breastfeeding to their children. So you know there's a huge problem here with the way that women are treated in the economic sector that needs to be addressed as well. David will know that I was mightily relieved with this latest Lancet series because it used to be breastfeeding top the list for all these the solutions that would help help survive child survival suddenly it went right down to you've got all these sort of micronutrient interventions which of course feed right into what the corporates want I mean it's absolutely what they want you to believe that the local foods the real foods the breastfeeding they're a bit bit worrying you know you can't quite be sure that you've got enough and so I'm really thrilled that the Lancet looked at that looked at the way that companies have this power it was actually having the Lancet series and having a really good debate that we could refer to in the discussions and say do you see what's happening the the big powerful exporting countries are stopping the poor countries from actually protecting their children and actually it was significant in March that we we had a big victory that's saying actually the code applies to these products too and that countries can actually ban the promotion of these products very important for us that has been 11 years of struggle to try and get it and we couldn't do it so thanks to to those who came forward in in the Lancet after so many years to to get this on the on the table that this these are the things that truly affect what's happening to women and families at the grassroots people just don't talk about it otherwise so thanks very much yeah looking back at this year it's been quite quite worrying for me you know to hear all the time about how much the commercial milk formula industry was making while we're over the over again hearing about food shortages and the difficulties that people are having in actually accessing safe and nutritious food so you know it's not we can go from the famines in Africa we can also look at the formula shortage in the US which is very related to what we're talking about here but also about the growing numbers of children in the UK who cannot afford a meal a day so you know I think it's it's very disturbing information that we've got over the past year or a bit more and so maybe as a conclusion I was hoping to hear from you you know about the perspectives do you think that this can change at some point and you know what what can we do to to make that change happen yes things can change and if you've got really good strong leadership at the national level and committed leaders both in government and within the health system you can promote and protect breastfeeding because as Patty was saying earlier mothers want to do what's best for their children and they will do do everything they can to do that and if just even a little bit of support can make a big difference so there are countries which have been able to kind of shift the trend away from you know falling breastfeeding rates to rising breastfeeding rates so it's important to recognize that it is possible to to make an impact but it requires leadership and it requires commitment from governments and and leaders within the health system because it's important that health systems and health professionals you know resist the temptation also of developing inappropriate partnerships with industry and as David was saying we need strength courageous leaders and governments to do that but they're up against it now we've got this case in the Philippines now the company's coming in under a CSR CSL corporate social responsibility trying to get rid of the the code the the strong law in the Philippines I can't believe it using that you know idea that they're somehow helping and we have to wise up about this we have to get the population to be a little bit more suspicious and looking a little bit deeper because they don't and and they think that you know when a company says that they're wonderful and they have this so skilled with their PR now it's absolutely very difficult to find and and look into why somebody is telling you something corporates do not have any any sort of duty duty or responsibility for citizens in the countries they are do not have human rights should not be granted human rights you know we need governments to look after their own citizens and be empowered to do so and then maybe we'd get somewhere thank you Patty and thank you David