Globalisation has devalued a lot of our products. Burgers are not a sugary product. The social cost of it is not counted. The public health cost of it is not counted… They keep on putting pressure on the people that he had to commit suicide. India is facing a health crisis. Mass produced, unhealthy foods have slowly been saturating the food market, especially in big cities, ever since India embraced neoliberal globalisation in the 1990s. Fast food is big business in India. But as profits go up, so too do food-related illnesses like diabetes, which affects more than 70 million people in India. That’s more than the entire population of France or the UK. Indian food is famous the world over. Fragrant curries, spices, pickles, hand-made breads…. but diets and food habits in India are changing. And this change means new investment opportunities for food multinationals, whose brands can be seen everywhere from traditional bazaars to air conditioned malls in the suburbs. But not everyone welcomes the impact processed foods are having on India’s food culture and public health. We’re here in East Delhi, at Badam Sigh’s food stall. He makes traditional Indian food. Freshly made naan, dal, mixed vegetables. Everything smells and looks amazing. I have been cooking now for around 15-20 years. See, this is called naan. This is a stuffed naan with a potato filling. It is baked in a tandoor oven. It tastes best when you eat it just as it comes out. Do you want to try it? So good. A short distance from Badam Singh’s stall, we met Dharmendra Kumar, founder of NGO Janpahal, who advocates for street food vendors. Like, you see a lot of evictions in cities taking place against the street vendors. So the idea is to make street vendors go out of their business, and bring in superstores. Are there cases where multinational corporations have been involved in trying to lobby for these evictions? Yes, yes, yes. Superstores have been lobbying, not directly for evictions, but the idea is to make the city friendly to the middle class. So that they can come, park their cars. Without street food vendors, the working class cannot survive in cities. I would like to tell you something. The coming of foreign companies, like those selling burgers or chow mein, to our India have impacted our business to a great extent. Previously our business was doing really well, but after these companies arrived our business has taken a hard hit. The Indian government is not only welcoming these companies but actively courting them with flashy events and promotional videos… Imagine if India reaches its optimum processing potential. To reach this potential, multinationals are promised huge subsidies on setting up costs, and zero-tax on profits for five years. It’s tough for them; now they have a new competitor, which is giant, which is so big and is just so powerful. But unfortunately the government policy is supporting the processed food industry. But what we are not looking at is what is fresh, what is natural, what is seasonal, and what is local. We spoke to campaigner and writer Radha Holla about the threat that this increase in processed food poses to the Indian diet. This is a barracuda. The other is beans – green beans – which we just stir fry with tempering of a little lentils and mustard seeds and red chili and sprinkle a little coconut on top. And what about the impact of globalisation on the whole, on Indian food production? There is this great thrust of multinationals, bringing in, not just junk food but also so-called healthy food at twice the cost but having half the nutrition… So many of our foods are disappearing. Our traditional breakfasts are increasingly being replaced by Kellogg’s, Chocos, you know, cornflakes. But what about something like this, you know, which has much more protein than a glass of milk would probably have. And it’s usually eaten with a green chutney, which gives you some amount of vitamin A and some amount of iron. So much cereal. I think one of these costs at least 6 euros. Where’s the Coco Pops? It’s about 10 euros actually. Heinz Beans, Ocean Spray, Hob Nobs. 5 Euros for a Hob Nobs. Got Tropicana, Maggi, Jamie Oliver… Oh my God, that’s ridiculous. Made by Indian immigrants in England and then exported back to India. That’s crazy. So globalisation has devalued a lot of our products; has brought in a whole lot of new products which are replacing our traditional foods, and where the rich are concerned, there’s so much emphasis on creating status symbols which these people are supposed to meet. And that includes McDonalds, KFC, you know. In its native U.S., McDonalds is marketed as an affordable option for eating out, rather than a status symbol. But here in India, it attracts a different crowd. It’s one of like, a very pocket friendly outlet where students like us can go, so we visit this quite often. Mostly to hang out with the friends. Do you find it affordable? Yes, it is, it is. And we like chicken a lot, so chicken burger. Do you think it’s affordable? Yes, it’s affordable, cheap. Not for everyone. Basically, in Indian culture, for the lower middle class family it is not affordable, for the upper middle class family it is affordable. Do you think it’s had an affect on your health? I don’t know, maybe you can see. For a month, like, I stayed alone, so I used to have McDonalds, and then pizza, burgers and all that. I never got sick or something like that, so it’s good. There’s a Dominos, KFC, Burger King. Feels like I could be anywhere in the world right now. Seems like affluent crowd, as well. What will I order first? 6 hot and crispy chicken drum sticks. I’ll have a pepperoni. Now on to Burger King. I’m a bit scared with how today’s going to end up. Can I please have one large french fries and a water? You don’t have water? I really need water before this. Ok so, here I’ve got six pieces of KFC chicken drumsticks, Domino’s pepperoni pizza and Burger King fries. It all looks the same but actually research has shown that fast food in India contains much more fat, sugar and salt than the same fast food found in Europe This box of KFC drumsticks have four and half times the saturated fat. Burger King fries have seven times as much sugar, and it’s the same story at McDonalds, where a chicken sandwich has more than twice the sugar. This pizza costs 10 euros. It would take someone on minimum wage about four days to be make the money for that. It tastes like cardboard. Processed foods in India now account for a third of the total food industry. The All India Food Processor’s Association represents multinationals like Pepsi and Nestle – we asked its president why India’s fast foods contain such high levels of fat, salt and sugar, comprared to other parts of the world. From where has this data come that it is three times in salt? Well, actually the nutrition information provided on the website. From where? Which website? Of Burger King itself. We would not subscribe to these views without confirming, why I will tell you. There are so many planted stories, we ignore them. A food which is sold and consumed in a particular country – the manufacturer will put the salt in that according to what the population wants that salt level to be. If he serves them the bland food, they don’t take it. So it’s not his fault, it’s not the regulator’s fault. It’s the consumer’s fault. It is the consumer’s requirement. Consumers making their own decisions about what they eat sounds good, but these foods are designed to be addictive. The Indian diet is traditionally low in sugar. But a burger, fries and Pepsi from Burger King has three times more sugar than the WHO’s recommended daily intake. These sugars are so well hidden, that even industry representatives don’t seem to know about them. Burgers don’t have sugar. There are some sugars in them, yes. Listen, now I do not know what is your approach then. If you say burgers have sugar and therefore it is bad. I think it’s a misnomer. Burgers are not a sugary product. They are not supposed to be. But adding sugar to savoury products is becoming the new normal and excess sugar intake is one of the key triggers of food-related diseases like type 2 diabetes. India is now known as ‘the diabetes capital of the world’ It has one sixth of the global population, but half of the planet’s ‘diabetes burden’, a term used to indicate the combined physical and financial cost of the disease. We met with Dr. Mira Shiva, founder of the All India Drug Action Network, to ask about the links between big business and bad health… Now you see all over, you see a lot of processed food by the big companies just flooding, with trans fats, too much sugar, too much salt and in those non biodegradable plastic packets. The ecological cost of it is not counted. The social cost of it is not counted. The public health cost of it is not counted. Most of the food processing industry are basically increasing ill health. And the relationship of non-communicable diseases with public health hazards has been pointed out by WHO and by everybody. Clear, very clear. So then you create a big market, so they are creating the market of ill health. Our research found that diabetes in India has nearly tripled since its neoliberal transformation in the 1990s – and will double again by 2045. At the same time, investment by foreign companies also boomed, from $25 million to $42 billion. A comparison of the graphs shows a correlation. And the WHO found that consumption of processed foods is associated with the global escalation of non-communicable diseases. Especially the non-communicable diseases like diabetes and hypertension and all – the complications require hospitalisation. And unlike in malaria and TB, you know, you have, you give treatment for some time. For non-communicable diseases you have to give for the rest of your life. You know antihypertensives you have to take, anti-diabetic drugs you have to take, which are very, very costly. So in economic terms, you sell your buffalo, you sell your land, you pull out your fixed deposit, whatever it is, that is hitting very badly. For the 450 million Indians living in poverty, private healthcare isn’t an option and they have to rely on overcrowded public hospitals and clinics. But there is another way to get free healthcare in India… So he’s checking for diabetes? This is for diabetes. We’re checking for diabetes, we’re checking for uric acid. Dr. Muzzammil Khan holds these health camps twice a month. Patients are screened for lung disease, heart problems, diabetes, and other conditions. So he’s highly diabetic. He needs proper medicine, proper diet, proper counselling. So what medicine will he be prescribed? What’s the next step? The first thing I’ll prescribe him is strict diet control And then I’ll give him a medicine to start with, metformin with glimepiride. This is, he’s from Cipla, he’s doing a smoke check for the people. Cipla is India’s biggest pharmaceutical company. So, I was surprised to see their sales reps carrying out health tests – and they weren’t the only ones. What are all the companies, like what representatives do you have here? I have Cipla, I have Lupin, this is Torrent. This is Uric Pharmaceuticals, Franco is there, I told you. And then there is Pastoral Pharma. Overall, about 23 companies. 23 pharmaceutical companies? I found it misleading that sales reps were wearing white coats normally reserved for doctors. One of them, from Franco India, told us that they were also counselling patients and supplying drugs. Which, to me, sounded a lot like diagnosis and prescription. For more clarity, we went to speak to Amitava Guha, who worked in the pharmaceutical industry for 40 years and now works at the Centre of Indian Trade Unions. We asked if the sales reps should be allowed to do this. They should not, they should not. And this is highly illegal also. So you cannot go for any diagnoses or any clinical analysis. You are not trained for that. They should not go. If somebody has gone it was pressured by their employers. See, health camps are basically organised by the pharmaceutical companies. They will give free medicine, they’ll also pay for pathological testing of the patients, but finally it will give a result of prescribing their own drugs. Vivek Gupta was a marketing manager for Abbott, a US pharmaceutical giant. He organised health camps to test for diabetes, but was fired after he raised concerns over the drugs they were selling. And were you carrying out these tests? My representatives were carrying out the tests, who was reporting to me. Were they medically trained? They’re not trained under these camps. It is the job of a doctor or somebody who is trained to do that job. If there is a wrong diagnosis, it’s dangerous for a patient. So this wrong result will force these people to take medicine for which they’re not supposed to take. And as you know, all medicine has got side effects. But wrong diagnoses are not the only danger posed by the pharma companies, it’s also the drugs themselves. Fixed Dose Combination drugs, or FDCs, are created by combining two or more drugs into a single pill and giving it a new brand name. The possibilities of combinations are virtually endless, and more brands means more opportunities for profit. The Indian regulator says combinations don’t have to be tested, because they are made from already approved drugs. But India’s five most popular FDCs for diabetes are illegal in the UK and Canada, and only two are allowed in the U.S. This is my yoga master, yoga trainer, and this is me just last year. And this is all the awards I’ve got. Abbott Industries have been called out for using ineffective drugs, how do you in this clinic make sure – guarantee that your drugs are effective and have past the tests? The company, Lupin, is number one company and CIPLA. A brand is a brand. For example Levis, now you can’t expect Levis to make you second-grade things, like jeans. So this is a brand. They will not make anything wrong If it’s a big name, it’s a big name. And they won’t pollute their name, they will not spoil their name. He’s from Cipla, he’s doing PFT. How many of the combination drugs do you sell? How many combinations? Very few. For which? For diabetes? For diabetes there are three four, five, ten, five are widely used. Only metformin and glimepiride is commonly existing. Otherwise pioglitazone. Otherwise they are not making any. Pioglitazone, voglibose are in… Maximum two to three – very few, otherwise metformin, pioglitazone, glimepiride. But you said five, no? Four or five. I’m sorry, I know you’re saying two or three, but I’m just wondering for that specific company. He’s also, he couldn’t understand your question. Dr. Khan and a pharmaceutical rep from Cipla I spoke to, both said that they sell FDC drugs, fixed dose combinations, although they seemed confused about exactly which ones and how many they were selling. It’s quite controversial because hundreds of these FDCs have been banned by the Indian government in recent years. And I’m just on the websites of companies we saw at the health camp like Lupin, Cipla and Mankind. And they’re all selling the same FDC diabetes drugs. This one example contains Glimepiride, Metformin and Pioglitazone and that’s just one banned combination that they continue to sell on their website or through online pharmaceutical stores. So basically, potentially harmful drugs that are banned in the U.S. and EU, are being sold by international Pharma companies to patients here in India. But how dangerous are these drugs? We asked Dr. Mira Shiva… Two concerns. Efficacy and the lack of safety. And some of the drugs, of these fixed dose combinations, if you are malnourished and you already have hepatitis and things like that. And then you’re giving drugs which are hepatotoxic, toxic to the kidney or toxic to the liver. That person is going to have complications ten times more. Back at the camp, it didn’t seem as though the sales reps were advising on side-effects, nor diet and exercise. It was mostly about the brands. This is our original brand Metformin, it has been launched in 1963 in India. And after detecting the diabetes, detecting the high blood sugar – the medicines for the needy patients, poor patients are provided free, free of cost. So they give it for free, you give it out for free and they don’t pay anything? Social Corporate Responsibility is the word used in the big companies. They have some responsibility towards the social cause. I heard of this, that companies show these expenses in their books as Corporate Social Responsibility. But ultimately the whole objective is not about Corporate Social Responsibility, it is about how you are building on those brands. Because when you do these camps, after that when you go for a review of these camps, they will always correlate with the sales. So this marketing technique give rise to unethical business practices. For promotion they will do any damn thing. And many of them are combinations because combinations are promoted under high marketing pressure. Pressure is immense on the people who are working in sales in the pharma industry right now. They are more into getting more and more profits. Even Abbott itself there is one guy who committed suicide. He was from my division only, I had brought in the knowledge of the higher management, that things are not happening right in our division. I think if the company has listened to me, this guy should have not have lost his life. Because things got to that level, they keep putting pressure on people. that he had to… at some point of time, he had to commit suicide. Abbott India says their working conditions are “devoid of…undue pressure”, and they denied that employees were running diagnostic tests or that camps were being used to increase sales. Our investigation tells a different story: pharmaceutical giants marketing untested drugs; doctors allowing them to sell directly to patients; and sales reps killing themselves from the pressure. It wasn’t clear how much of this was happening at Dr. Khan’s camp. What was clear was the competition – 23 companies doing tests, many selling exactly the same drugs. many selling exactly the same drugs. Why there is marketing and promotion required for pharmaceuticals? It is not required for essential commodities, for example for bread, for rice, and other things. It is not required. But marketing is required for generating artificial demand. The market economy based system, marketing is a must for almost everything, and medicine more so. There was a time when pharma industry was there to relieve suffering of people, sufferings of the people, but now the whole motive of the pharma industry is to drive maximum profit from people’s sufferings. The world’s first multinational corporations were the British and Dutch East India Companies. They were responsible for 300 years of ravaging India’s resources and exploiting its people. Today, the descendants of the East India companies – like McDonalds, Nestle and Abbott – continue to exploit India by degrading its food culture, marketing unhealthy products and making guinea pigs of India’s sick. But while the government is rolling out the red carpet, there are people who are speaking out. What is knowledge? Knowledge has come down, over more than a millennia, it’s come down. It’s got translated and people have chosen to eat that which has kept them healthy. Our ancient food culture and the livelihoods of so many of people is going to be threatened with this. See, the products that come from abroad into India, that are being sold in India, are being used by our children, consumed by our children. But children cannot discriminate between which of these are harmful to them, which are beneficial. The food giants should take not little but quite a lot of responsibility for the increasing ill health, and just for some people to make profit so that other people should fall ill. That’s really not acceptable at all.