The content on this page (“Sinister cycle: The sugar savior”) by Kridpuj Dhansandors is not produced by The Isaan Record staff. The Isaan Record merely provides a platform, and the opinions stated here do not necessarily reflect those of The Isaan Record.
In this Part XVI of our continuing series, Sweetness & Power, we present an opinion piece that questions the role of sugar in Thai society, especially in Isaan, a region with the highest number of people suffering from chronic diabetes in the country. Has the problem been handled the right way? Guest contributor Kridpuj Dhansandors shares his view.
PART XVI: Sinister cycle: The sugar savior
“Today, I’d like to warn you about Thai food. Whether it’s for welcoming foreign or domestic guests, shops should reduce the amount of sugar they put in the food because it has become too sweet. Thai people have become addicted to sweetness which destroys their health and leads to diabetes and other diseases. This costs a lot so if you can protect yourself, you should. I ask for cooperation from all food sellers at every level. Please try to reduce the amount of salt and sugar.”
–General Prayut Chan-ocha, prime minister and head of the National Council for Peace and Order (NCPO), June 25, 2019
Statistics from the Ministry of Public Health show that people from Isaan disproportionately suffer from diabetes. While prevalence of diabetes for Thailand as a whole is around seven percent, it is much higher for Thais over the age of 40. There are 22 million Thais over the age of 40, with a 12.6 percent prevalence of diabetes. In the Northeast, among the 7.88 million people over 40, the prevalence is 14.85 percent.
There are currently 5.54 million rai (886,400 hectares) of farmland grown in sugarcane in the Northeast feeding 20 sugar factories. The Isaan people are both consumers of sugar and sugarcane farmers, which prompts the question of whether the reduction of salt and sugar in food, as suggested by the prime minister, would be a solution to an epidemic of diabetes.
This article invites readers to think about four things concerning diabetes:
1) the narrative of the Thai Health Promotion Foundation in the fight against diabetes; 2) the question of whether sugar is addictive; 3) the state mechanisms supporting the sugar industry; and, 4) the sinister cycle of sugar and diabetes.
On the frontline against sweetness
After the 1997 political reforms, “respected citizen” Dr. Prawase Wasi founded the Thai Health Promotion Foundation (ThaiHealth) in 2001. He’s a self-styled, first-of-its-kind expert on promoting mental and physical health through food consumption and lifestyle of the people.
Dr. Prawese proposed that doctors should act as teachers of morality for the people in order for them to escape capitalism. With a three-billion baht per annum fund ($100 million USD) derived from alcohol and tobacco taxes, ThaiHealth launched its campaign for people to be “good” and able to look after their own health.
Dr. Prawase Wasi at the press conference announcing a joint campaign between ThaiHealth and the sugar company Mitr Phol Corporation, “Sustainable development of local communities,” which supports well-being across nine sub-districts, including Ban Kaeng and Khok Sa-at in Chaiyaphum’s Phu Khiao district and Ban Meng and Kut Kwaeng in Khon Kaen’s Nong Ruea district. Photo: www.thaihealth.or.th.
Dr. Prawase has became an influential figure among health-related organizations and doctors who returned to society after the fall of the Communist Party of Thailand in the 1980s and under the semi-democracy regime of former prime minister General Prem Tinsulanonda, who played a major role in laying a strong foundation for the Thai establishment. Former left-wing people interpreted Dr. Prawase’s view as saying that diabetes was a result of Western capitalism and a threat to the nation.
ThaiHealth has paid attention to the addiction to sweetness since the early years. In 2002, a campaign, “Thai kids don’t eat sweet,” was launched under Dr Prawase’s concept of “a triangle that moves the mountain.” Slogans like, “Sustain your stomach, save your health,” and, “Let’s do good for father, never eat desserts,” led by the Thai Dental Council, were implemented in 2005 in Bangkok schools before expanding to the rest of the country via the campaign’s network that urged business operators to lower levels of sugar in their products and for schools to be “soda-free” places.
As a result, some schools were able to reduce the level of sugar in food and desserts they prepared. There were competitions between classes on how much they could limit the amount of sweets consumed. Schools also held story-telling and game sessions to campaign for a reduction of sweetness, and for “snacks-free” and “ice cream-free” days. “Young ambassadors to reduce sweetness” were appointed and tasked with warning their classmates when they ate something sweet. Some provinces reported a 20-percent decline of tooth decay.
ThaiHealth joined hands with the Mitr Phol sugar company, Black Canyon coffee, and as well as Amazon cafes, Macro supermarket, and hotel operators to manufacture reduced-sugar, four-gram packets to use in meetings as part of the “snack for health” program to promote meeting participants’ health. The project was implemented among civil servants and then expanded to employees of state enterprises.
Sweetness and addiction
According to ThaiHealth, Thais consume on average 30 kilograms of sugar a year or 20 teaspoons a day, an amount higher than guidelines of the World Health Organization. This prompts the question, aside from the societal factor, of whether sugar is a chemical similar to drugs that can cause an addiction to sweetness.
A 2018 scholarly article, “Sugar Addiction: From Evolution to Revolution,” by David A. Wiss studied the system of food addiction in order to understand its relation to obesity. It found that the consumption of processed food stimulates the brain’s “reward center,” leading to behavioral motivation caused by dopamine as a neurotransmitter. Sugar in processed food influences the decision-making process, which is similar to substance abuse.
The chart shows sweetness stimulated by sugar. Sugar is consumed and enters the bloodstream, stimulating production of insulin hormones from the pancreas that reduces sugar levels in the blood. Parts of the brain affected, the limbic system and striatum-thalamus, are related to the brain’s reward center system. Photo: American Diabetes Association.
Apart from the biochemical factor, ThaiHealth has argued that the sweetness addiction mechanism began when “food consumption patterns” develops when a child is six months old. This combines with the natural development of a child where the sweetness taste buds develop faster than other taste buds. Sugar and sweetness represent love, joy, and a life reward.
“Unsweetened state” supports sugar business
During the late 1950s, Thailand’s sugar production was higher than domestic consumption and the country began exporting sugar. When sugar production began seeing a loss of profits, the Thai government intervened and set the domestic price of sugar higher than the world market price. The profit margin was then spent in subsidizing the sugar industry, causing Thais having to buy sugar at a high price.
The solution the government came up with was to push Thais to consume more sugar. Higher sugar consumption, directly and indirectly, arose when people put it in their food or when sugar became a kind of seasoning.
In early 2016, Brazil raised a case against Thailand with the World Trade Organization , targeting government intervention in setting the high price of sugar domestically and paying out subsidies. The military government at the time swept the problem under the rug by using Article 44 and suspending government intervention in sugar prices. Eventually, inside deals occurred, resulting in a drop of sugarcane price which affected farmers financially.
Isara Vongkusolkit, chairman of Mitr Phol Group, served as a member of the National Legislative Council, a committee member of the working group on modern agricultural development, and a major businessman in the military-sponsored Pracharat network. He announced that a new wave of economic policy would increase farmers’ income from 48,000 baht ($1,570 USD) per person per year to 65,000 to 85,000 baht by 2027 ($2,130 to $2,800 USD).
There is also a plan to increase sugarcane farmland from 10.53 million rai to 16.1 million rai (1,684,800 to 2,576,000 hectares) by 2026. Article 44 was also used to bypass a ministerial order of the 1975 Urban Planning Act that allowed the government to have 29 sugar factories built in Isaan. This action was carried out in disregard to the suffering of farmers. No study was done to determine the suitability of the locations of these factory in relation to food sources and ecological change in the Isaan region that spans over a million rai (160,000 hectares), all in favor of a few investors and without public participation.
In the same breath, the government’s managing of the sugar and diabetes problem appears to promote less consumption of sugar. Recently, the revenue department announced that a sugar tax of three baht per litre of beverage will be collected. By September 2021 the tax will be increased to five baht per liter.
Wit Kasemsap of the Faculty of Medicine at Ramathibodi Hospital argued a taxation of beverages that contain sugar at a level above standard is the most effective means to deal with unhealthy eating behavior and should be done along with other measures.
Chayada Pattrakom of Kasetsart University’s Faculty of Economics said a 20-percent hike on the retail price of sweetened beverages, would reduce per capita sugar consumption to 2.122 grams a day.
The views of these academics make it sound as if Thailand has found a solution to Thailand’s diabetes problem.
Three stakeholders trapped in the sweet, vicious circle
Does taxation really affect investors and those who are involved in this sinister cycle? Is this only creating an illusion of a diabetes-free future?
Three parties play a role in perpetuating this sinister cycle of refined sugar production and diabetes among the people:
First, owners and investors of sugar companies who have taken advantage of the working people. Through their linkages with the elites in power who represent the capitalist state and the penning of laws in protecting their interests. Both grew together in the face of globalization that hit Thailand at the end of the 20th century.
Second, the Thai public health system that began at a period between the reigns of King Rama IV and King Rama V. However, the grassroots citizens’ healthcare only began after the 1932 Siamese revolution through the creation of a healthcare state where medicinal and modern knowledge were used as state’s tools to control people’s lives.
It continued to the period of extensive growth following the supported funds from the US during the Cold War, along with the growth of the army and the monarchy. After the 2006 coup, there was a “sustainable economy” narrative that combined with a push for the people to take care of their health, an expected behavior determined by the state. Sugar was then vilified as a product of Western capitalism.
Third, the people, especially some who are addicted to refined sugar via the reward center in their brains. Others were laborers bound by contracts with the companies to conform. At the same time, they are also bound by the suggestions of health organizations to take care of their health and to be good citizens. The people themselves do not have many choices when it comes to food choices.
It is interesting when the richest in the country tell the people to live within their means. For the last 200 years at least, these elites worked with Western nations in changing the economy to the market system, abolishing slavery so that slaves could became citizens who paid taxes. The military regime of Field Marshal Sarit Thanarat in the early 1960s promoted the narrative of “running water, lights and roads everywhere,” luring Isaan people into capitalism, backed by the US, and changing their way of life from sustainable agriculture to industrial agriculture.
Conclusion
It would be too much to hope that the first player, the sugar industry that’s tied to the authoritarian government, would admit the fact that Thailand is facing a major nutritional crisis.
The government’s solution to the problem, as coined by the research director of the Thailand Development Research Institute (TDRI), has been “sweeping the trash under the rug.” Dealing with this crisis would require an elected government, a constitution that adheres to democracy, and a government that respects the values of the people who elected them.
The second player is the Ministry of Public Health. Even though the universal healthcare system, which has a human-focus approach, has been put in place since 2002, many challenges remain in dealing with diabetes.
The health ministry’s preventive strategy is applied through ThaiHealth who launches well-being promotion campaigns with investors and supports the monarchy. The “four-gram sugar packet” campaign is aimed at civil servants, a tiny percentage compared to the people who are under the 30-baht healthcare scheme.
The campaign, “Thai kids don’t eat sweet,” has created an army of youth who followed sustainability. They act as a nation force trained to hate sweetness and monitor it for ThaiHealth. These campaigns of “self-purifying,” whether intentionally or not, overlook the history and context of how sweetness flourished in Thailand.
The sugar tax seems like a call of ethics, not unlike the taxation of tobacco and alcohol. It obviously does not deal with the cause of the problem. The taxation covers only “beverages with added sugar” such as tea, coffee, and vegetable and fruit juices. It does not cover businesses that produce “refined sugar” or “added-sugar meals” which have been processed by companies that shared interests with the government.
Campaigning for people to protect themselves from the danger of sugar at a young age, without mentioning the businesses and investors who profit off the people. I am not so sure how these campaigns deal with the problem at its root.
The third player are the people who are on the receiving end of the industry’s selfishness and years of stagnant management of the healthcare system.
It would not be too much of an exaggeration to say that not only has public health become the government’s trash can, it has also taken part in the creation of the problem, while aiding the government to hide it, intentionally or not.
That means one ministry cannot alone tackle the diabetes problem and health and food crisis.
The country’s leader said Thais are addicted to sweet dishes but Isaan has never had a tradition of adding sweetness to food. On the contrary, the state leads the tradition of consuming sweeteners, inspired by the West, and comfortably reaps profits for investors from outside of Thailand.
It can be seen that to deal with diabetes is not only telling patients to abstain from eating sweet food or exercising 30 minutes a day, five days a week. The other two players are not being criticized as much as they should be concerning their roles in causing the food crisis that is to come.
If the people’s mistake was getting addicted to sweetness, then what is yours?
If this country belongs to the people, the taxes we pay every day, often on food with added sugar from the chain store owned by a Pracharat network member, are translated into the salaries of the dignified members of parliament every month.
We can only hope one day you see us.
