Kumasi. This month, I start with a new picture of the Elgro River in Potchefstroom, South Africa, where the annual African Nutrition Leadership Programme is held annually. My column continues with discussions on how alumni of the programme see its impact. Last month several colleagues wrote to tell me why they would like to see the programme continue receiving support and this month others have added their voices. As you can imagine from the picture above, many graduates of the programme have fond memories of the Elgro River, which provided the right environment for our end of day reflection during the leadership training.

Also this month: nutritionists in Ghana are rising up to protest against publicity by transnational industry which they see as against the public health interest and the nutritional well-being of their people. What are these and how may they be harmful, and how are colleagues in Ghana handling this situation? Read on.

Transnational industry. Coca-Cola

Nutritionists as advocates

Advertisements linking Coca-Cola with aspiration,, success and the good life in Africa, at the time of the World Cup in South Africa. Drink, burp, win!

In May I received a message from a colleague asking: 'are we advocates for nutrition?' It was a letter from Abdul-Razak Abizari (above), who is a lecturer at the department of community nutrition, University for Development Studies in Tamale, Ghana. He was writing to the president of the Ghana Nutrition Association raising some important issues regarding some advertisements and requesting that the letter be disseminated to all members of the Association'.

He wrote: 'I hope this mail finds you well. In the last few weeks I have, with a lot of disdain, heard and seen adverts from the Coca-Cola Company promoting the consumption of Coca-Cola with meals. The promotion is dubbed: "Liven up your meal time with Coca-Cola"... We should not sit aloof and watch this promotion go on. It is not in the interest of public health nutrition. As professionals, we promote healthy eating habits on a daily basis in our respective capacities. Certainly, Coca-Cola's promotion does not complement our efforts. Obesity and other diet-related chronic diseases are on the rise in Ghana. The promotion of such unhealthy eating behaviour is the last thing we need'.

Abdul-Razak Abizari continued: 'Some of us may have heard or seen these advertisements without giving them a second thought. Others may have not seen or heard them. Just a quick gist: the radio version talks about eating chibom (fried eggs with bread) and washing it down with Coca-Cola. The billboards show a family at dinner and each person, including children, with a bottle of coke by their side, obviously to wash down dinner with Coca-Cola...'

He went on: 'As an association one of our objectives, as stated in our constitution, is: "To be a strong advocate of nutrition issues and place at the disposal of the general public our expertise as nutritionists". Well, I think this is the opportunity for us to demonstrate our commitment to that objective. Remember there is no civil society for nutrition in Ghana. We cannot look behind us, we are the backstoppers! The objective of this mail is to start a discussion among us which I hope will generate enough heat to move us into action'.

Hard margarine for growth?

Well said! After reading this letter I felt the point was made. I expected that replies would follow. I was not surprised when two others registered their displeasure. This is what Association member Paul Aryee (above), lecturer at the school of medicine and health sciences at the same university, had to say. 'Abdul-Razak Abizari is "speaking my voice". I have been equally appalled with this and other disdainful advertisements by transnational, rich and powerful corporations who are mainly interested in the profits accruing to them from such careless and ill-thought pronouncements in our media. To say that these advertisements are distasteful to public health-minded persons is an understatement. In my candid opinion we are in for big trouble in our endeavour to protect the nutritional well-being of our people'.

He continued: 'This is an opportunity to act our talk. Well, it is important to discuss such issues dispassionately and to take a clearly defined and formidable stance as advocates for nutrition. But let me warn that it is going to be a gargantuan fight which will require us agreeing collectively as a body on what to do. The enemy is already in our midst and has a way of fighting his battles by using the fifth column. I hope you know what I mean.

'The Coca-Cola advertisement is not the only one. There is this other one that encourages mothers and parents to spread hard and highly saturated fat (in the form of Blue Band margarine, daily, "for growth". Well, it should have said for obesity and heart attacks in later life. The use of powerful marketing approaches to sell ill-health to our people should prompt us to come out with the appropriate strategies to counter such anti-nutritional propaganda. You can also have your say on this matter my friends!'

Here is what Kingsley Pereko (above), who is a lecturer in the medical school of the University of Cape Coast, wrote:

'Dear Abizari. This is a good start. I believe there are many others out there that we could take on if we mean to be real advocates of nutrition. We are also part of a civil society and our voices could raise a change. I ask that you extend this campaign not only among the association but you could put it up on the social media to get the support of the masses to overturn this unfortunate situation. You could also raise this issue by writing an article in the media to generate a public discussion'.

Well here now it is me Reggie as you see above. Congratulations to those of us who are speaking out and who are prepared to act. But I did expect more responses, I must say. Clearly this Coca-Cola advertisement is against the health and nutrition well-being of the population. It is on many billboards all over Kumasi, the second capital city of Ghana, where I live and work. It does indeed gives the impression that you cannot have a good, full or complete meal unless Coca-Cola is part of the meal. Like, Coca-Cola must accompany a family lunch or dinner. I fear that whoever designed that advertisement is succeeding with what they set out to achieve. Most people I see having lunch or eating out, have a fizzy drink, usually Coca-Cola, with it. This is becoming a mindset. This is of course the whole purpose of the odious publicity.

The fact that this advertisement is targeted at the whole family, is very worrying. Diseases caused by changing diets and ways of life are now very common in many low-income countries and Africa is not exempted. Childhood obesity is more common than probably reported, especially in towns and cities across Ghana. I see in my city that many more adults, both male and female (more females than males) who are clearly obese. If a family meal is high in fat, it is more likely to be energy-dense. Adding sugared fizzy drinks, which are predominantly sugar and water, is a worst thing to do. No, I am not saying it is absolutely wrong ever to drink fizzy drinks, neither do I imply that Coca-Cola should never be drunk. My worry is that this advertisement gives the impression that Cola-Cola family meals must served with such fizzy drinks. Moreover, to target both adults and children with such propaganda is a sign of imminent disaster.

So I am quite concerned that nutritionists and other public health professionals in my country do not seem to care much. Most do not regularly speak against practices by such multi-billion dollar corporations that damage public health. Take this case: even when somebody specifically raised such a topic, only three people contributed. Are we nutritionists and public health practitioners so busy, that we have no time to contribute to such discussions that should make a difference to the health of the population? What are we so busy doing then? It is about time for us to rise up and become a profession with a voice.

Abdul-Razak Abizari, the colleague who started this discussion, participated in our World Nutrition Rio2012 congress last April. I sense that the various discussions and debates we had in Rio has sparked something in him. I sincerely pray and hope that nutritionists and other health professionals in Ghana will rise up to become a civil society organisation advocating for nutrition. We should demand polices and actions by governments against bad practices, and hold policy-makers to account. So I say to Abdul-Razak Abizari and to Paul Aryee and also to Kingsley Pereko who contributed: keep the fire burning. If we continue, very soon more people will join so don't stop. This is a sure way to make a real difference in the health of our society.

Nutrition leadership in Africa

La luta continua!

Above are participants in the 2011 leadership training: 28 participants from
over 10 African countries. What do they now all think of the programme?

As I wrote my column for last month, and after it appeared, more participants in the African Nutrition Leaders programme have been in touch:

Robert Ackatia-Armah, Ghana (above), participated in 2009. He says: I think people should know also that the programme is a philosophy. It is analogous to building a house. A foundation that is not strong will eventually collapse when it takes the pressure of being over-used. What we have been doing in the last couple of years has been to lay a solid foundation to build nutrition leadership, mentoring, and networking principles for success in nutrition programming, government and management.

As you say Reggie, we are already beginning to see some of these solid building go up. Anna Lartey, the incoming International Union of Nutritional Sciences president, is an excellent example. So is Jane Badham at JB Consultancy. There are many more examples. I expect in the next few years we will see many seeds grown into strong plants. Students, colleagues, workers and friend who will grow and develop to be successful graduates, researchers and leaders. They will form the backbone of the transformation we are expecting on our continent and on the global stage.

Joyceline Kaganda, Tanzania, participated in the programme in 2009. She is in the picture above in the front row, third from the right. She says: 'Thank you all for sharing what the programme did for your life or contributed to your organisation. I really appreciate that I got a chance to attend the course in 2009. For sure I learned a lot that has helped me change my thinking in accommodating, compromising and making decisions.

'I am happy to share with you my recent appointment as director of nutrition education and training at the Tanzania Food and Nutrition Centre. I remember during the interview, many questions were directly linked to what I learned with the programme: issues like team building, networking, collaborating, advocacy and so on. It is my wish that such courses be also conducted in Tanzania'.

Paul Aryee, Ghana (here he is again) participated in the programme in 2010. 'Well, well, I must say I am greatly impressed by the verbosity, enthusiasm and alacrity of expressions submitted so far by ANLPers in your column Reggie. Indeed, the saying that 'the sweetness of the pudding lies in the eating' is very true! And how can you eat or rather enjoy such as sweet pudding and not want to share it? Before the programme, just like my colleagues have stated, I knew I had some leadership qualities and even perhaps a few hidden ones, but the experience of the programme and the aftermath was like the 'eureka' of Archimedes's exclamation!

'As a trainer and teacher, I am sharing and of course ensuring that I rub off every experience of the programme to students, colleagues, superiors and family and friends, and I do so at every opportunity – brightening the corner where I am. My thanks go to Johann and all the organisers'.

Anselimo Makokha, Kenya (above), participated in 2004. 'Some of the very important ways in which the programme impacted on me are not easily tangible. The issue of embracing integrity in our daily interactions with others – superiors, colleagues, students – is one very strong value that is reflected in some of us. Then there is the difficult art of listening to the views of others as we work in teams. To me, though intangible, these are valuable lessons that I carried from the training I hope many others will benefit from this training'.

Reggie Annan, Ghana, participated in 2009. Yes it's me once more. Well what can we say to these things? Some participants have referred to the leadership training as seed planting. Others think their hidden qualities have been unearthed. For some, strong personal values have been received and these are used in day-to-day activities.

Some have also risen up to be national leaders in the field of nutrition in their own countries. I like the analogy with seed planting. As we all know, life is made up of seasons.... there is a time to plant and there is a time to reap... This is true in every sense. Therefore if the training has been to plant seeds, then there will be a time to harvest the crops. We just need to wait and see what sort of harvest we will have. Still one may ask; when should we expect this harvest? This will require careful consideration. Do let us know what you think. I will continue to share with you more testimonies from participant in my future columns, Write to me and share your thoughts please.