<div dir="ltr"><div class="gmail_default" style="font-size:large"><br></div><div class="gmail_quote">From: <b class="gmail_sendername">Bev Snell</b> <span dir="ltr"><<a href="mailto:bev@burnet.edu.au">bev@burnet.edu.au</a>></span><br><br><br><div dir="ltr"><span style="font-family:'Helvetica Neue';color:rgb(51,51,51)">This mornings MJA (Medial Journal Australia) Insight included this piece. </span><p class="MsoNormal"><span style="font-family:'Helvetica Neue';color:rgb(51,51,51)">It is copied here to save </span><font face="Helvetica Neue" color="#333333">you looking for it. Sorry - It is a bit long but important</font></p><p class="MsoNormal"><font face="Helvetica Neue" color="#333333"><br></font></p><b><span style="font-size:13.5pt;font-family:'Helvetica Neue';color:rgb(51,51,51)">MJA Insight<span></span></span></b>
<p class="MsoNormal"><b><span style="font-size:9pt;font-family:'Helvetica Neue';color:rgb(51,51,51)"><a href="https://www.doctorportal.com.au/mjainsight/2018/28/big-formula-follows-big-tobacco-playbook/?utm_source=MJA+InSight&utm_campaign=bf6928be43-EMAIL_CAMPAIGN_2018_07_20_05_11&utm_medium=email&utm_term=0_7346f35e23-bf6928be43-42154993" target="_blank">https://www.doctorportal.com.<wbr>au/mjainsight/2018/28/big-<wbr>formula-follows-big-tobacco-<wbr>playbook/?utm_source=MJA+<wbr>InSight&utm_campaign=<wbr>bf6928be43-EMAIL_CAMPAIGN_<wbr>2018_07_20_05_11&utm_medium=<wbr>email&utm_term=0_7346f35e23-<wbr>bf6928be43-42154993</a><span></span></span></b></p><p class="MsoNormal"><b><br></b></p>
<p class="MsoNormal"><span style="font-family:'Helvetica Neue';color:rgb(51,51,51)"><b>23 July 2018<span></span></b></span></p><p class="MsoNormal"><span style="font-family:'Helvetica Neue';color:rgb(51,51,51)"><b>Big Formula follows Big Tobacco Playbook</b></span></p>
<p class="MsoNormal"><span style="font-family:Times"><b>Authored by</b></span><br></p>
<p class="MsoNormal"><span style="font-family:Times;text-transform:uppercase"><font color="#000000">ALYCE WILSON<br>
MARIAM TOKHI<br>
LISA AMIR</font><font color="#d32f2f"><span></span></font></span></p>
<p class="MsoNormal"><span style="font-family:Times"><span style="text-decoration:none"><font color="#000000"><a href="https://www.doctorportal.com.au/mjainsight/2018/28" target="_blank">Issue 28 / 23
July 2018</a></font></span><span></span></span></p><p class="MsoNormal"><span style="font-family:Times"><span style="text-decoration:none"><br></span></span></p>
<p class="MsoNormal"><span>BREASTFEEDING needs all the protection,
promotion and support it can get. Yet these three words were at the centre of a
breastfeeding resolution fiasco earlier this year. At the World Health Assembly
in May, the United States made deliberate attempts to dilute a resolution on
breastfeeding and <a href="https://www.nytimes.com/2018/07/08/health/world-health-breastfeeding-ecuador-trump.html" target="_blank"><span style="color:rgb(0,153,255);text-decoration:none">specifically
sought to remove the wording that countries should “protect, promote and
support” breastfeeding</span></a>. The US threatened the original sponsor of
the resolution, Ecuador, with trade sanctions and military aid withdrawal if
the resolution passed unchanged. Fortunately, Russia stepped up to sponsor the
resolution and it passed largely unscathed.<span></span></span></p><p class="MsoNormal"><span><br></span></p>
<p class="MsoNormal"><span>The actions of the US have outraged the
health sector, reminding us of the risks of corporate interference in public
health guidelines, policies and programs. Media and commentators around the
world have expressed surprise at these actions, yet <a href="https://www.ncbi.nlm.nih.gov/pubmed/23034164" target="_blank"><span style="color:rgb(0,153,255);text-decoration:none">formula manufacturers have been
active in aggressively marketing the substitution of mothers’ milk with
commercial alternatives for many years</span></a>.<span></span></span></p><p class="MsoNormal"><span><br></span></p>
<p class="MsoNormal"><span>Rates of breastfeeding in Australia and
internationally are low. The <a href="https://www.aihw.gov.au/reports/mothers-babies/2010-australian-national-infant-feeding-survey/contents/table-of-contents" target="_blank"><span style="color:rgb(0,153,255);text-decoration:none">Australian
National Infant Feeding Survey in 2010</span></a> found that while over
90% of women initiate breastfeeding, only 15% exclusively breastfeed their
babies to 5 months. In low income and middle income countries, <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01024-7/abstract" target="_blank"><span style="color:rgb(0,153,255);text-decoration:none">less than 40% of
infants under 6 months are exclusively breastfed</span></a>. In high income
countries, there is a significant gap in breastfeeding patterns between the
rich and poor; <a href="https://www.mja.com.au/journal/2008/189/5/socioeconomic-status-and-rates-breastfeeding-australia-evidence-three-recent" target="_blank"><span style="color:rgb(0,153,255);text-decoration:none">breastfeeding
rates show a clear gradient with higher initiation and duration in higher
income brackets</span></a>. </span></p><p class="MsoNormal"><span><br></span></p><p class="MsoNormal"><span><span style="color:rgb(0,153,255);text-decoration:none"><a href="https://www.nhmrc.gov.au/guidelines-publications/n56" target="_blank">Australian
guidelines</a> </span>recommend that babies are exclusively breastfed to around
6 months of age when solids are introduced and breastfeeding continued until
the age of 12 months and beyond, if both mother and infant wish. We recognise
that there are certain circumstances when breastfeeding is not possible, and
the safe use of infant formula is essential. Establishing and continuing
breastfeeding may be challenging for many mothers and babies. New mothers
deserve encouragement and support to feed their babies. However, the evidence
is clear: breastfeeding is a far superior option on a number of fronts and
should be strongly promoted as such. Unfortunately, marketing strategies used
by the formula industry can weaken and distort this message.<span></span></span></p><p class="MsoNormal"><span><br></span></p>
<p class="MsoNormal"><span>Breastfeeding provides children with the
best start in life and is a key contributor to improved infant and maternal
health outcomes. Authors of <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01024-7/abstract" target="_blank"><span style="color:rgb(0,153,255);text-decoration:none">the recent <i>Lancet </i>series</span></a> conducted
meta-analyses that indicated that breastfeeding provides children with
protection against infections and malocclusion, increases in intelligence and
likely reductions in overweight and diabetes. For nursing mothers, there were
benefits in terms of protection against breast cancer and potential protection
against ovarian cancer and type 2 diabetes. Breastfeeding can also help with
family planning with improved birth spacing. The benefits for children in low
and middle income countries are significant. Diarrhoeal diseases and lung
infections are among the major causes of death in children under 5 years of
age. Improving breastfeeding rates could nearly halve diarrhoeal episodes and
cut respiratory infections by a third. Breastfeeding also has economic
benefits, achieved not only through health care cost reductions and lives saved
but also through the benefits of improved cognitive development leading to greater
economic productivity. Internationally, if all infants under 6 months of age
were exclusively breastfed, <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)01044-2/abstract" target="_blank"><span style="color:rgb(0,153,255);text-decoration:none">we could prevent
823 000 annual deaths in children under 5 years and an estimated US$302 billion
annually in economic losses from cognitive deficits</span></a>.<span></span></span></p><p class="MsoNormal"><span><br></span></p>
<p class="MsoNormal"><span>The pervasive marketing and availability
of infant formula is a critical factor in lagging breastfeeding rates. Big
Formula operates in the same playground as Big Tobacco. The aggressive tactics
employed by the infant formula industry to promote their products and expand
their markets <a href="https://worldnutritionjournal.org/index.php/wn/article/view/155" target="_blank"><span style="color:rgb(0,153,255);text-decoration:none">mirror those
used by the tobacco industry</span></a>. These tactics include:<span></span></span></p>
<ul style="margin-top:0cm" type="disc">
<li class="MsoNormal"><span>interfering with political and
legislative processes;<span></span></span></li>
<li class="MsoNormal"><span>overstating the economic importance
of the industry;<span></span></span></li>
<li class="MsoNormal"><span>manipulating public opinion to
improve their appearance;<span></span></span></li>
<li class="MsoNormal"><span>engineering support through “expert”
front groups;<span></span></span></li>
<li class="MsoNormal"><span>discrediting evidence-based science;
and<span></span></span></li>
<li class="MsoNormal"><span>intimidating governments with legal
action.<span></span></span></li>
</ul>
<p class="MsoNormal"><span>The Hong Kong Infant and Young Child
Nutrition Association (HKIYCNA) appears to be a society of health professionals
and claims to “improve the nutritional wellbeing of infants and young children
in Hong Kong”. Yet, HKIYCNA is a front group for six baby food companies –
Abbott, Danone, FrieslandCampina, Mead Johnson, Nestle and Wyeth – and has
openly lobbied in opposition of the code on marketing of breast milk
substitutes</span></p>
<p class="MsoNormal"><br></p>
<p class="MsoNormal"><span>With <a href="https://www.nytimes.com/2018/07/08/health/world-health-breastfeeding-ecuador-trump.html" target="_blank"><span style="color:rgb(0,153,255);text-decoration:none">infant formula
sales plateauing in high income countries</span></a>, we can expect to see increased
lobbying efforts specifically targeting low and middle income countries, which
have been identified by infant formula producers as key growth markets. Yet
again, Big Formula is following in the footsteps of Big Tobacco. Tobacco
marketing has been reported to be <a href="http://www.who.int/bulletin/volumes/93/12/15-155846/en/" target="_blank"><span style="color:rgb(0,153,255);text-decoration:none">substantially
higher in low and middle income countries</span></a>, and the infant formula
industry will not be far behind. Research has shown that the <a href="https://www.ncbi.nlm.nih.gov/pubmed/26314734" target="_blank"><span style="color:rgb(0,153,255);text-decoration:none">marketing of breast milk substitutes
has a deleterious impact on the breastfeeding practices</span></a> recommended
by the World Health Organization. Marketing in low and middle income countries
is less regulated than in high income countries and infant formulas are
directly marketed to consumers via the mass media and print advertisements;
with the use of internet marketing and social media on the rise.<span></span></span></p><p class="MsoNormal"><span><br></span></p>
<p class="MsoNormal"><span>Free samples, incentives and benefits are
provided to health workers and services to promote infant formula products.
Misleading and even false health claims have been used by the infant formula
industry with attempts to portray formula as “more modern” and “even better”
than breast milk. The billboard advertisement shown above suggests improved
cognition with their product “360° brain plus”. Earlier this year, <a href="https://www.scmp.com/news/world/europe/article/2131672/nestle-faces-fire-misleading-baby-milk-tactics-hong-kong-and" target="_blank"><span style="color:rgb(0,153,255);text-decoration:none">Nestle came
under fire for violating breast milk substitute marketing guidelines</span></a> with
products in Hong Kong and Spain advertised as having an “identical structure”
to breast milk and “inspired by human milk”.<span></span></span></p>
<p class="MsoNormal"><span>The recent events at the World Health
Assembly reveal the depth and extent of interference that the infant formula
industry is willing to take to protect their $70 billion industry. Any health
commitments which may limit their ability to indiscriminately promote their
products will be challenged. Women and their families deserve better.<span></span></span></p><p class="MsoNormal"><span><br></span></p>
<p class="MsoNormal"><span>One approach may be to view breastfeeding
through a food security lens. <a href="https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-015-0029-6" target="_blank"><span style="color:rgb(0,153,255);text-decoration:none">Food security
for infants and young children relies on high rates of breastfeeding</span></a>.
Political attention and policy coordination may be strengthened by viewing
breastfeeding within a food security framework. A right-to-health approach
demands that women are given the best opportunity to breastfeed without the
undue influence of the industry. </span></p><p class="MsoNormal"><span><br></span></p><p class="MsoNormal"><span><span style="color:rgb(0,153,255);text-decoration:none"><a href="https://www.bmj.com/content/361/bmj.k2252" target="_blank">Governments need to ensure</a></span> responsible
advertising of infant formula, challenge countervailing narratives from the
industry, address globalised supply changes for breast milk substitutes and
have effective legislation in place to reprimand unacceptable behaviour.
Workplaces need to have supportive policies and practices that enable women to
return to work and continue breastfeeding. Women need to be supported at all
levels of society with structures in place and a culture that enables them to
breastfeed anywhere, anytime.<span></span></span></p><p class="MsoNormal"><br></p>
<p class="MsoNormal"><span><a href="http://www.who.int/life-course/news/events/world-breastfeeding-week-2018/en/" target="_blank"><span style="color:rgb(0,153,255);text-decoration:none">World
Breastfeeding Week</span></a> is celebrated in the first week of August;
and this year’s slogan is “Foundation for life”. Let’s take this opportunity to
provide babies and their mothers with a supportive breastfeeding environment
which indeed enables them to provide a foundation for lifelong good health and
wellbeing.<span></span></span></p><p class="MsoNormal"><span><br></span></p>
<p class="MsoNormal"><b><i><span>Dr Alyce Wilson is an aspiring public
health physician with a background in public health nutrition. She works in
research and international development in maternal, child health and nutrition
and lectures medical students on nutrition.</span></i></b><span><span></span></span></p>
<p class="MsoNormal"><b><i><span>Dr Mariam Tokhi is a GP and global public
health researcher focusing on women’s and children’s Health. She works in
community medicine in north-west Melbourne.</span></i></b><span><span></span></span></p>
<p class="MsoNormal"><b><i><span>Associate Professor Lisa Amir is a GP and
lactation consultant. She works in breastfeeding medicine at the Royal Women’s
Hospital in Melbourne and in private practice. She is a Principal Research
Fellow at the Judith Lumley Centre, La Trobe University, Australia.</span></i></b><span><span></span></span></p><p class="MsoNormal"><b><i><span><br></span></i></b></p>
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