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19th century direct action. Rudolf Virchow took to the Berlin barricades in 1848 (left), and (right) John Snow inactivates the Broad Street pump in 1854

This editorial is about the place of direct action in the service of public health. Two 19th century examples are illustrated by the pictures above. In 1848 Rudolf Virchow, a pathologist who became a founding father of modern epidemiology, took to the barricades in the streets of Berlin (left) as part of the 1848 European revolt of oppressed workers and peasants. His action in defiance of the Prussian armed forces, was in protest against the immiseration and disease suffered by communities in Upper Silesia, whose conditions he had been charged to investigate. The rising was put down, yet its tricolour shown in the picture is now Germany's national flag.

The equally committed physician John Snow (right), convinced that outbreaks of cholera in London in 1854 were caused by sewage, defied the private water boards, took the law into his own hands, and removed the handle of Soho's Broad Street pump. He also is now seen as a father of modern epidemiology in the public interest.

In the mid-19th century the fight for transformation of public health and protection of public goods, often in part was just that – literally, direct action that could and sometimes did involve civil disobedience.

The peasants uprising

This month World Nutrition publishes an account of La Via Campesina. This is the worldwide coalition of small, family and co-operative farmers that claims 150,000 members coming from around 150 organisations. It is the best known and most energetic representative worldwide movement fighting for food sovereignty, which is to say the right of farmers and growers to determine their own food systems. La Via Campesina is now recognised by relevant UN agencies. An early account of its mission and work (1) is available here.

Its work and its stance are relevant to public health nutrition for at least two reasons. The first reason is that inadequate food means deficient nutrition. Sustained food and nutrition security in vulnerable populations, depends on agriculture suited to local climate, terrain and other conditions, as signalled by the UN General Assembly's decision that 2014 is the International Year of Family Farming.

The second reason is that La Via Campesina campaigns include direct action. Sometimes this is symbolic, as shown in the small picture above of patented hybrid seeds being burned in 2010 by Haitian farmers. Or sometimes the action may challenge or break current laws. It may take the form of disruption of official world trade, climate and other summits, or protests against government policies on land ownership, during which its demonstrators provoke police retaliation that may include arrest, violence and imprisonment.

An arresting idea

But is this relevant? Few public health professionals committed to the improvement of nutrition these days, go in for direct action. As an illustration, here is a true story, with some inessentials altered. Once there was a public interest organisation specialising in food and nutrition policy. Supported with funding from its national ministry of food, one of its projects was a consultation with government officials and industry representatives on nutrition labelling. This involved much reading of background papers, regular meeting agenda and notes expertly prepared by civil servants, occasional polite disagreements from industry with civil society positions, and vice versa, and the building of consensus statements which nobody fully supported other than the officials who wanted the job done.

A member of the council of the public interest organisation was uneasy about this work, which she saw as a muzzling tactic. Was it not possible that the funding from government was – perhaps not consciously – encouraging consensus of a type that might be more reassuring and less candid than it should be? So to see what colleagues thought, at a council meeting she made a proposal, which went something like this. Let's select a number of top-selling branded food products and identify their contents. Then let's prepare dramatic warning labels, some the size of the product containers, and others the size of campaign posters. We will need say six stalwarts for each of say four big central supermarkets, armed with labels and gluepots. We alert the television news media, organise sympathisers to rally round, synchronise the storming of the supermarkets, stick as many warning labels on the products as we can before being stopped, pay for some products, take them into the street, and get interviewed for the prime time news by reporters who then ask our planted 'bystanders' what they think. So, what do you say?

There was silence for a while, and then somebody said words to the effect of: 'That would cause trouble. The manufacturers and the supermarkets wouldn't like it. We might even get arrested'. This of course was the whole idea! Nothing was done.

But why is direct action, which can indeed involve deliberate challenges to and even breaking of existing laws, now seen as inappropriate or irrelevant in the world of public health nutrition?

Social movements are needed

'George Alleyne, the former director of the Pan American Health Organization, thinks that a social movement is needed to respond adequately to the pandemic of non-communicable diseases' (2). This comes from a recent commentary in the British Medical Journal by its former editor Richard Smith. He continued: 'But how do you create a social movement, and can they change the world?'

He thought that yes, social movements can succeed. As an example he cited the movement to abolish the slave trade as sanctioned in Britain. Its methods included 'national organisations with local chapters, campaigns writing to political representatives, report cards on how those representatives have voted, investigative reporting, petitions, marches, badges, boycotts, logos, fliers, books of evidence with readings in bookstores, newsletters, use of the media'. He also cited the sugar boycott of 1792, which collected half a million signatures, and inaction by the authorities which prompted the poet Robert Southey to call tea 'the blood stained beverage'.

Curiously though, what Richard Smith did not mention is action that goes beyond marches and boycotts, of types that some people identified with the established order would identify as anti-social. For it may well be that most or maybe even all successful social movements committed to radical reform of any type, have been led by or have included people who have advocated and enacted civil disobedience, which is to say, direct actions that deliberately challenge current laws and regulations.

Early 20th century direct action: Force-feeding of a suffragette in 1913 (left),
and (right) Mahatma Gandhi's 1930 Salt March. Both involved law-breaking

The types of action exemplified by Rudolf Virchow and John Snow continued into and throughout the 20th century. Two early examples are shown above. In Britain beginning in 1912, the suffragettes, campaigners for votes for women, chained themselves to railings, set fire to letterboxes, and smashed windows, as a result of which (left) they were liable to be imprisoned, where they went on hunger strikes and were force-fed. Mohandas (Mahatma) Gandhi led the 1930 Salt March in defiance of the British Raj laws monopolising production of salt (right), as a result of which he was imprisoned. These direct actions were an essential part of the movements that eventually secured full citizenship for British women, and gained Indian independence from British rule.

Later 20th century direct action: Rosa Parks bussing in a 'whites only' seat in Alabama, in 1955 (left); Greenpeace challenging Arctic oil drilling (right)

Later in the 20th century this lesson has been learned and acted upon by civil society organisations and movements of various types. Examples include the US civil rights movement, catalysed in the mid 1950s by the decision of Rosa Parks, a seamstress living in Montgomery, Alabama, to break the law by sitting in a bus seat reserved for white people (left, above). Her action and arrest inspired Martin Luther King, then a young minister working in Montgomery. Other examples include the sit-ins of the UK Committee of 100, the militant branch of the Campaign for Nuclear Disarmament, and the New York Stonewall demonstrators who galvanised the Gay Liberation Front. Within the environmental movement the best-known example are the campaigns of Greenpeace against whaling and deep sea oil drilling (right, above). Typically, such direct action may not succeed at the time, but it makes an impression without which nothing much at all is likely to change for the better.

La Via Campesina manifestations. A 2010 Haiti march against Monsanto
(left), a banner (centre), 2012 confrontation with riot police in Manila (right)

This leads to the topic of this month's WN commentary. La Via Campesina literally translates as 'The Peasant Way'. Since its foundation in 1993, it has mobilised activists to protest against global trade laws that accelerate growth of transnational corporations and that impoverish its members. Some of its impressive and organised manifestations are of the types listed by Richard Smith, such as the 2010 demonstrations in Haiti against hybrid seeds owned by the transnational corporation Monsanto (left, above). Others involve challenge of laws and confrontation with riot police, designed for example to disrupt official global trade summits, or to denounce corporate land-grabbing, as in 2012 in the Philippines (right, above).

His way, José

And food? The La Via Campesina leader José Bové became world-famous as a result of trashing a McDonald's outlet in his native France in 1999. He has been imprisoned more than once for such actions. The following information is extracted from an anti-Bové statement (3). 'In 1988 he was one of the leaders who organised a protest called "Ploughing the Champs Elysees" in Paris against the European set-aside policies. In 1990 he led protests and hunger strikes demanding more government subsidies for sheep farmers. In 1991 he picketed the airport of Lazac and prevented the French prime minister's plane from landing. In 1995, he joined Greenpeace on the Rainbow Warrior to protest nuclear trials. Also in 1995, he led protests attacking French government offices smashing windows, setting fires and charging local police office gates with tractors. Since 1997 he has been implicated in the destruction of a Novartis seed production facility, and his group are also said to have hijacked shipments of biotechnology-grown corn'.

As a result of the McDonald's event, in 2002 José Bové was sent to prison with a sentence initially of three months, which after furious denunciations from his admirers, rumoured to include then French president Jacques Chirac, was reduced. In 2001 he published a manifesto against malbouffe (junk food) (4).He gained almost half a million votes as a presidential candidate in 2007, and is now a member of the European parliament.

José Bové, French cheese producer, in handcuffs on his way to prison (left), on his political platform (centre), and at the Cannes Film Festival (right)

Where's the action?

The question asked here in this month's WN editorial, and implied by our commentary, is: why do public health nutritionists (other than those working within the People's Health Movement and the global breastfeeding networks) rarely if ever think of using direct action methods to raise consciousness of, for example, childhood obesity and the advertising of ultra-processed products to children?

After all, as already suggested, it may well be that in situations of gross inequity or injustice, significant and sustained progress in improving and protecting public health and public goods always involves an element of direct action. Would John Snow be remembered now if he had confined his zeal to committee meetings? Would Mohandas Gandhi now be acknowledged as the father of Indian independence if he had gone no further than organising petitions? It seems unlikely.

Tim Lang, professor of food policy at City University in London, has often said that 'nutrition needs a Nutpeace' – a radical organisation whose methods are modelled on Greenpeace. In part perhaps this actually already exists – in the shape of La Via Campesina, as witness José Bové's direct actions against malbouffe.

The great 19th century US emancipator Frederick Douglass said: 'Power concedes nothing without a demand. It never did and it never will. Find out just what any people will quietly submit to and you have found out the exact measure of injustice and wrong which will be imposed upon them, and these will continue till they are resisted'. This does seem to be an evidence-based claim. So why is there no militant action in which parents and nutritionists are joined, against the obviously outrageous advertising of malbouffe to children on television and the internet? Why did no group summon national news media to witness the pasting of vivid warnings on top of the labels of ultra-processed products in selected big city supermarkets? Why are the World Alliance for Breastfeeding Action and the International Baby Food Action Network (note the 'Action') practically alone among civil society organisations, in being prepared to confront food manufacturing corporations whose policies and practices conflict with the interests of public health? Are public health nutrition professionals too polite for the good of their cause?

References

1. Borras S. La Via Campesina. An Evolving Social Movement. The New Politics Project. Amsterdam: The Transnational Institute, 2004. http://www.tni. org/sites/www.tni.org/files/download/campesina.pdf
2. Smith R. Learning from the abolitionists, the first social movement. British Medical Journal 345:e8301 doi:10.1136/bmj.e8301. Published 19 December 2012.
3. Petition on-line. Make José Bové serve his term. http://www.petitiononline.com/cinagro4/petition.html. Undated.
4. Bové J, Dufour F. The World Is Not for Sale: Farmers Against Junk Food. London: Verso, 2001