How Mexican Public Health Advocates Fought Big Soda and Won

When Karen Akins signed up to volunteer for a medical mission to Mexico in 2008, she knew very little about the impact of type 2 diabetes on the country. She had no idea that rates of the disease had doubled between 2000 and 2006, that Mexico’s healthcare system was ill-equipped to handle chronic conditions, nor that, for a time, it was the leading cause of death there.

Akins traveled to remote rural villages where the Coca-Cola logo was painted on elementary school walls and bottles of soda were cheaper than water. There, she and her team delivered the dreaded diagnosis over and over. She learned that soda consumption had doubled among Mexican adolescents between 1999 and 2006, mirroring diabetes rates, and began to get angry about what she—and everyone else—hadn’t known.

“I was concerned about people on the ground that were suffering,” she said. So she decided to make a film about what she had learned.

About a decade later, despite having no filmmaking experience, Akins finished El Susto (The Shock), a documentary that follows Mexico’s type 2 diabetes public health crisis, tracks the soda industry’s role in that crisis, and looks at how a group of advocates and politicians challenged the industry and passed a federal soda tax there in 2013.

Since the soda tax passed in 2013, data have shown sales of the taxed drinks went down. Recent research also shows more Mexicans are drinking less soda as a result of the tax.

Akins finished the film in 2019, but the pandemic slowed the rollout. This month, it became widely available in the U.S. (and around the world) for the first time, via Apple TV, Amazon Prime, and On Demand (via select cable providers).

El Susto documents how Coca-Cola and other soda brands became ever-present throughout Mexico over time. It tracks their ubiquity even in remote, rural places (where nutrition education is often lacking), as well as their inescapable branding, and the companies’ ties to politicians, health organizations, and media outlets. It also shines a light on the dire impacts of type 2 diabetes on Mexicans—from blindness and amputations to more than 100,000 deaths annually.

At a moment when battles over soda taxes are being fought all over the world, Civil Eats spoke to Akins about what she saw through her lens and what she hoped to convey about soda taxes, public health, and Big Soda on screen.

“El Susto” refers to an Indigenous belief that shock, caused by a trauma, can cause illnesses like type 2 diabetes. Why did you decide to make it your title?

Occasionally we would test people, and when they heard that they had diabetes, they would go, “Oh, El Susto.” We kept hearing it. Later on, when I started delving into attitudes, I [realized that I] didn’t understand how prevalent the [belief] was throughout Mexico and Central America. But the film’s name works on several levels. It works on the economic level, where you’ve had an influx of processed foods that has shocked the whole culinary culture. And it also has another level of meaning: the unseemly tactics that the companies used are another level of shock and horror. I was interviewing this academic down at the University of Texas, Austin—Dr. Pilar Zazueta—and an hour and a half into the interview [I asked her about] El Susto and she got super serious and gave this unbelievable explanation. She said that this could be a way that people make sense of how their lives are being disrupted.

A mural featuring Pepsi logos at a shop in Santa Ana Zegache in Oaxaca, Mexico. (Photo credit: Thomas Aleto)

In some of the rural places you filmed, the fact that safe water wasn’t always available contributed to soda consumption. Can you speak about the ways economics and lack of infrastructure in Mexico contributed to Big Soda’s ability to become so ingrained in the culture?

There have been fairly recent cholera outbreaks in Mexico, so the fear [of drinking the local water] is not unfounded in some places. A lot of people just don’t want to take the risk, and they know that if they drink a Coke it’s going to be fine.

I’m not an expert on Mexican water policy, but there was some corruption inside the Mexican government when Vicente Fox was president, and he was a former Coca-Cola executive. He had one of his former colleagues as the head of the department in charge of water, and then they started giving out water rights to bottling companies. And maybe it was just meant to create jobs. It certainly did, but it was also taking a public resource, privatizing it, and letting people profit off of it. And then it enabled them to do things like produce bottled water and Coke and set the price of Coke at less than the water, which incentivizes drinking it. They had all kinds of tactics, including a heavy marketing presence everywhere.