New America Media, Commentary, Palav Babaria
Editor’s note: An American physician who worked in a rural health clinic in Haiti says multinational corporations are exporting processed foods with high-salt content that is worsening health in impoverished countries.
The Haiti that Mackenzy Brun returned to in 2005 was not the same one he left in 1987. After almost 20 years in Brooklyn, Mackenzy expected the newly paved streets that crisscrossed his small city in Haiti’s central plateau and the electric grid that inched into town in 2011. What he did not expect was the dramatic change to his grandmother’s cooking. He dreamt of her soup joumou(squash soup), legim (vegetable soup) and diri kole ak pwa (rice and beans). What he found was that the locally sourced green herbs that flavored her cooking had been replaced by a dense yellow-wrapped cube: Maggi.
Nestle, the international food conglomerate, makes Maggi. Popular throughout Europe for over a century, as trade laws loosened in the 1990s Maggi’s infiltration into the Caribbean was brisk and universal. Women walk through the local market with baskets that used to carry dark greens or plantains; now those baskets contain every variety of Maggi: shaker seasoning, chicken, tomato and beef bouillon cubes. Haitians will tell you that Maggi has become a way of life, thanks in part to its low cost, ready availability and Nestle’s extensive TV and radio campaigns. This trend can be seen the world over. Maggi can be found throughout most of Asia, the Caribbean, Africa and Europe in its various incarnations: bouillion cubes, seasoning packets, cooking sauces and noodle soups.
Nestle fortified Maggi with iron and iodine, to address nutrition deficiencies in their low-income consumers. The targeted marketing of “health and affordability” has made Maggi ubiquitous in even the most rural parts of Haiti.
What Nestle does not advertise is that a single Maggi bouillon cube contains more than 30% of the recommended daily sodium intake. Cardiovascular disease is now the world’s leading killer, largely due to increased consumption of processed foods worldwide. This little yellow cube is a dangerous actor in a place where health care is scarce, inequitable and unaffordable for most people. Marketing it as a socially conscious good to the poor – healthy and affordable — when it is just high-salt flavoring seems misrepresentative at best.
In 2008, an estimated 33.6% of men and 28.1% of women in Haiti had hypertension. (Globally, hypertension rates vary between 25 to 50%.) Cardiovascular disease was the leading cause of non-communicable disease-related mortality.
The wards of the local district hospital in Haiti where I worked as a physician and Mackenzy worked as a Creole interpreter, bear witness to this trend—more than 50% of our adult medical admissions are for cardiovascular disease and stroke. Odette, a 64-year old grandmother of six, was either never told or forgot that she was a hypertensive, coming in only when it was too late—after she’d had her paralyzing stroke. In this crumbling public hospital, where there are no cholesterol medications or blood thinners to treat her stroke and no physical therapists to aid in recovery, we wished for an ounce of prevention over an ounce of Maggi.
Jean, a 24-year old mother, arrived at the hospital almost too late—every inch of skin swollen with fluid, gasping for air. Her mother carried Jean’s 6-month old daughter; she was too ill to hold her baby. Jean was diagnosed with peripartum cardiomyopathy, a type of heart failure common throughout Haiti’s countryside—affecting young, previously healthy women in the late stages of pregnancy or after delivery. With diuretics and cardiac medications, Jean slowly improved, but she could not stay out of the hospital. At home, all of her food options worked against her, the high amounts of salt leading to more water retention, overworking her bad heart. During each of her hospitalizations, we counseled her on reducing salt to avoid worsening heart failure, including reducing Maggi.
Many think that cardiovascular disease is an affliction of the privileged, those who have enough to eat, or even too much. But as the developed world exports its processed foods, we see the impact of cardiovascular disease in places that have few health resources to deal with it. With so few options at most public hospitals in places like Haiti for advanced care and treatment, prevention is the best hope.
Perhaps it can start with companies like Nestle, which have so profoundly altered the national cuisine. Research shows that reductions in the salt content of processed food can reduce cardiovascular disease worldwide. Although Nestle has “committed to reducing sodium levels by an average of 10% between 2012 and 2015,” for a single cube of Maggi, this amounts to just 100mg of sodium. To meet World Health Organization recommendations for sodium intake, most people in the Caribbean would have to reduce sodium intake by more than 1000mg per day — an entire cube of Maggi.
As American consumers pressure food manufacturers to improve processed foods, we should make sure they do not simply shift to targeting impoverished consumers elsewhere in the world. Governments in developing countries like Haiti should also pursue stronger regulations controlling the import of sodium-rich processed foods and higher taxes based on sodium content. Mackenzy dreams of the day when his local hospital no longer sees so much preventable death and disability from cardiovascular disease. He also dreams of the day when he can eat the food his grandmother used to make, flavored with herbs instead of Maggi.
Palav Babaria, MD, MHS is a primary care physician at Oakland’s Highland Hospital. She was an internal medicine physician in rural Haiti from 2012-2013 through the UCSF Global Health-Hospital Medicine fellowship. Her writing has appeared in the New England Journal of Medicine, Los Angeles Times and New York Times.