Blogs posted for BMJ, Public health issues in Asia

Heads: Hong Kong babies lose. Tails: the formula companies win

It’s been a busy couple of years in Hong Kong for the international baby formula companies. As soon as the Department of Health announced it had set up a Taskforce on Hong Kong Code of Marketing of Breastmilk Substitutes in June 2010, the industry quickly mobilized to get ahead of any potential for their self-interests to be threatened.

The Hong Kong Infant and Young Child Nutrition Association, set up by the industry in May 2011, may sound like it has the interests of Hong Kong’s children rather than profits at heart. But it has since harnessed every opportunity to promote its member’s interests, and this year a so-called crisis of supply for local parents has been a bonanza for the industry, giving them many opportunities to promote their products through media assurances that they will support government efforts to maintain stable supplies.

In a clear effort to get ahead of any potential restrictions on advertising, in the unlikely event that the Hong Kong Code should ever become anything more than a suggestion for voluntary action, for the past two years the international formula manufacturers have been plastering their tacky images of ‘brainy’ children across public transport and TV screens. It is impossible to watch the terrestrial TV stations or take a bus or underground train in Hong Kong without seeing their advertisements.

But overshadowing their own marketing efforts is a bigger force that as been at play this year: massive demand for their products from mainland Chinese shoppers and parallel importers who have flocked to the city to buy formula, in favour of buying home-grown brands.

Domestic Chinese manufacturers are still feeling the impact of the melamine scandal that killed six children and sickened thousands more in 2008. Freelance parallel traders look to make a bit of extra cash hauling bulging luggage trollies from Hong Kong back to the mainland, having cleared the pharmacy shelves of formula in the bordering areas. They have been a thorn in the side of local residents who bemoan the impact on their lives and there have even been tense scuffles and protests.

This demand for imported formula came on the back of equally burgeoning demand for Hong Kong’s maternity ward services. Hong Kong-born babies obtain right of abode, regardless of the abode status of their parents. Giving birth in Hong Kong was a neat way for mainland parents to circumvent the implementation of the One Child Policy or to have a back-up plan in case they don’t like the educational and health options for their children open to them back home: right of abode confers access to free, high-quality healthcare and education in Hong Kong.

The doubling of demand for maternity beds in 2011 when nearly 44,000 women mainland women gave birth in Hong Kong without any concomitant change to supply, outraged the local population, and Chief Executive C Y Leung took the arguably unconstitutional step of barring all mainland births unless the father is a Hong Kong permanent resident.

It was against this backdrop that in March 2013 the government introduced a limit on formula exports of two 900g tins with the aim of protecting supplies for local women. The government also announced it was engaging with the formula manufacturers to ensure that local demand could be met.

What a windfall for the formula industry: the fact that the Hong Kong government helping them to avoid formula sales to mainlanders in Hong Kong cannibalizing their business over the border is a side benefit. The real benefit is the tremendous endorsement of its product from the government’s top health officials.

The message they were sending to parents is: here is a product that’s so precious, so invaluable to the well-being on our Hong Kong babies, that we will guarantee your supply. All this endorsement came without a single word from either the Food and Heath Bureau or the Department of Health about the real risks associated with formula feeding. This policy was also at the expense of the government’s own evidence-based policy of promotion breastfeeding. No amount of advertising dollars can buy you that kind of credibility. And given that Hong Kong’s lifetstyle habits are often emulated over the border, the ripple effect of this credibility into the mainland market is potentially enormous.

It seems the party is coming to an end, however. Secretary for Food and Welfare Ko Wing-man, speaking on a radio show on September 24 2013, said that the government was pondering abandoning the two-tin limit, if they were reassured that there was enough supply for local mothers.

Currently the industry is required to maintain 1.65 million cans of baby formula a month for local parents: all this formula for the babies and young children of a seven-million strong population. The formula industry’s spokesperson said the industry would welcome lifting the quota and that it had no problem maintaining the required level of stock.

So for Hong Kong’s legion of formula-fed babies, it seems that it’s heads they lose, tails the formula industry wins. Meanwhile the government’s guardians of public health continue to squander the opportunity to reach out to new and prospective parents with information about breastfeeding and warnings about the risk of using formula. The government quietly ignores its own stated public health goals for the support of big business and a quiet life without complaints from parents.

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