Travel through rural Pakistan and two things will strike you. One is heart rending poverty. And the other is hospitality. Visitors are greeted with warmth and selfless generosity. The poorest of the poor will immediately call for “paani” for their visitors. Paani means water in Urdu. But in the local lexicon it has come to mean a bottle or a glass of a fizzy drink – a Coke or a Pepsi or a 7Up or the likes.
And paani brooks no refusal. Visitors can demur all they want but the host is not deterred. “It’s only paani”, he says. “It can do no harm”. But it can. And it does. And the impression amongst the general public that it does not reflects an appalling failure of public policy. A failure that has caused more harm to public health than perhaps even smoking tobacco.
Clearly the companies that produce and market fizzy drinks have done a superb job. Their ubiquitous and colourful billboards stare down at you no matter where you are in the country. Their video advertisements, whether on the Internet or TV, ooze glamour and cool usually promoted by a popular pop artist.
It is nothing less than a triumph of marketing that a fizzy drink has become synonymous with “water” - the very essence of life. And, in rural Pakistan at least, has become the gold standard of hospitality. Remember that these are people so poor that they have trouble putting a single meal on the table. Paani is not cheap. Bottles for five or ten visitors can mean a whole day’s wages for a rural worker. And a high probability that his children will go to bed hungry.
For companies that produce and market these drinks there is big money at stake. The Pakistani market for fizzy drinks is approaching… wait for it… USD 8 billion per year and growing rapidly. Where there is so much money at stake, there is every reason for these companies to invoke and unleash all the marketing skills and resources at their disposal.
But this does not mean that public policy makers in Pakistan should watch all this as silent spectators. The ruinous monetary impact on the poor is only the tip of the iceberg. Over the years a growing list of scientific studies have highlighted the health risks of fizzy drinks. The list of diseases associated even with modest consumption of fizzy drinks is long and growing: Diabetes, heart disease, prostate cancer, metabolic syndrome (associated with diet drinks), and obesity. All of this can be verified easily with a few Internet searches.
Here in Pakistan, it is shocking that the rural population thinks paani is harmless. What they do not know is that each bottle of fizzy drink has 9 or 10 teaspoons of sugar. This is 100% the recommended daily intake. Add to this a variety of other exotic chemicals - some of which are confirmed carcinogens - and you have a thorny concoction. One expert likens drinking a bottle of fizzy drink to an ‘assault’ on the body tantamount to throwing a grenade in the stomach.
Researchers led by a group of scientists from Imperial College London recently completed the largest study ever to investigate the link between fizzy drink consumption and diabetes. The results published in April 2014 in a wide section of the press are shocking: Consuming just one can of fizzy drink a day leads to a 22% increase in the chance of getting Type 2 diabetes.
In Pakistan, Type 2 diabetes - also known as adult-onset diabetes - is increasing at an alarming rate. The number of people suffering from the disease has risen to above 33 million people or roughly 28% of the adult population. A recent report from the International Diabetic Federation (IDF) ranking the world’s top countries for number of adults (20–79 years) with diabetes in 2021 has put Pakistan in third place after China and India.
Diabetes is a manageable disease. But in Pakistan illiteracy, poor public health services and a general lack of awareness - as witnessed by the myth of paani being harmless - means that diabetes is often fatal. We have on our hands a medical emergency. Doing nothing is not an option.
Primarily the task at hand is raising public awareness of the risk fizzy drinks pose. Public awareness campaigns need to start immediately. Television is the ideal medium. Its footprint now covers almost all of Pakistan. What’s more PEMRA, the Pakistani media watch dog and licensing authority, has written into contracts with all TV channels that they must make available several minutes of broadcast time every hour at no cost for public service messages. This free TV time can and must be used by the health authorities to broadcast the health risks of fizzy drinks.
The task ahead is not simple. The fizzy drink companies are rich, powerful, smart and ruthless. In addition to conventional advertising, their excess, or rather obscene, profits allow them to throw money at feel good heritage and cultural events featuring some of the country’s popular performers. These activities seem intended to revive our past cultural heritage by giving it a modern touch. But in fact, their real objective is to further solidify the brand by giving it an aura of innocence and respectability. Pakistan’s popular performers would do a service to the country’s poor by boycotting such deception.
This creative, gimmicky marketing using film, music and sports stars projects fizzy drinks as healthy, refreshing and fashionable. This is as far from the truth as it can be. And as new research pours in it is becoming clear that having a fizzy drink may well do just as much or more damage to one's health than smoking a cigarette. Cigarette packets now carry a clear health warning. Cigarette ads are banned on all media – TV, billboards, social media and radio.
Is it not time that we compel the fizzy drink makers to put health warnings on their bottles, and at the same time enact a comprehensive ban on all advertising for soft drinks?
Time is running out. The longer that this outrage is allowed to continue the more people will lose their health and forfeit their lives.