Beer, Coke and Phone Cards, but No Health Care?

Last week, New York Times columnist, Nicholas Kristof, wrote a piece about families in the developing world spending more on beer, cigarettes and elaborate festivals, than on their children’s education. He pointed out some interesting dilemmas when it comes to where the finances of the family are spent. Why, after a hard day’s labor and living such a difficult life, shouldn’t a father or mother be able to enjoy a beer with their peers in the evening?

However, lacking in Kristof’s analysis was a look at the flip side of that equation. Why is it that beer, soda, cigarettes and phone cards are ubiquitous in the most remote regions of the world, but those same areas often lack basics like health care?

I’m seeing this first-hand in Tanzania at the moment, on a trip for Pathfinder International. On a 10-hour-drive on Saturday from Arusha to a remote area called Shinyanga, we went miles on a rutted dirt road without seeing anything, when suddenly, a small wooden shack with a mud roof appeared — a phone card provider (in countries like Tanzania you pay for minutes on your cell phone via phone cards). Was there a clinic in site? Or even any kind of provider who could help with medical needs? Probably not.

Once in Shinyanga I was amazed at the amount of advertising — all for beer, soda or phone cards. Even the local district hospital sign indicating where people can find care is a billboard for Coke. This is a town where every Sunday the electricity is shut off from 8am to 6pm. This is where the homes are made of mud bricks with grass roofs (one of our staff at Pathfinder saw a goat on the roof happily munching away on some fresh grass growing on the roof). This is where patients with HIV and AIDS routinely lack medicines to fight opportunistic infections because the hospital or pharmacy are out of stock. You may not be able to get medicine, but not to worry, you can go have a soda or a beer.

What’s frustrating to me is that clearly there are ways to get these goods to retail outlets regularly. Are there ever stock outs of soda? Doubtful. If there is a way to ship soda and beer to remote regions, why not condoms? Contraceptives? Medications? Medical supplies? One could argue that there is demand for these other goods — and Kristof’s column would be a good example. But there is also a demand for health care.

It’s too bad we can’t put condoms on soda bottles, HIV messages on the back of phone cards or even take advantage of these shipping opportunities to throw a few boxes of medical supplies in with the other goods.

Certainly, as Kristof argues, we need to educate families about the importance of investing in their children’s futures and funnel more funds to women (who spend more of the household income on improving the family). But we also need to rethink supply and demand, as well as distribution. We need to find out how these goods are in constant supply and then ensure that what people really need to save their lives, make it into those channels, as well.


Tanzania: Sala Lewis


Rose F.
Rose F7 years ago

Molly, you are so right. We also value our entertainers, and athletes more than our teachers. We do not set a great example of children first. If we did we would have clean energy, free health care, quality education and free secondary education.

Colm Fay
Colm F7 years ago

one thing that these products have, that unfortunately healthcare doesn't have, is an element of aspiration. by drinking coke, smoking cigarettes or using a cell phone, people in these communities create the positive perceptions within their societies. the challenge to social marketers is to give healthcare, sanitation and clean water this same element of prestige. To do this, we need to understand a lot more about how and why these cultures make the choices that they do. We tend to focus on internal determinants of behavior change - educate and individual, show them the benefits to their health of using a particular prophylactic or therapy, put programs in place so that they will understand the risks to their health and well being. What we ignore are the external determinants of behavior change - questions like how do people perceive me, what will make people respect me, what will encourage customers to come to my small business. These are arguably more powerful than top down methods of behavior change, but my opinion is that to be successful, you must strike a balance between both aspects. It is not Coca-Cola's fault that people choose to buy a soda instead of a condom. All they have done is listen to what people want and have taken the time to understand what motivates them and drives their behavior to further their organization's aims. Capitalism isn't the problem here, in my view its a very under-utilized component of systemic healthcare solutions.

Philippa P.
Philippa P7 years ago

Mankind's priorities must change if we are to survive.

Claire M.
Claire M7 years ago

To the corporate mentality humans are nothing more than natural resources to be harvested for their money. It does not matter what happens to them, only that a projected number moving in the positive direction on reports of potential profit are achieved.

androniki koutsoureli
NIKY NINA7 years ago

here lies the stupidity of our coke,beer and phone cards...greedy multi-national corporations and unconscious human beings...i think it's hopeless...

Marie K.
Marie K7 years ago

The district hospital is not in the town. The hospital is a long trek away, and when you do get there, they often are out of whatever medicines you need.

Alan G.
Alan G7 years ago

This reflects the priorities of capitalism.

Molly N.
Molly N.7 years ago

I agree with Lili P.-obviously our societal 'norms' are VERY different from the people in Tanzania... but it's this same mentality that despite being poor, or of 'limited means' one still wants to wear brand name clothing.
Americans don't have access to moderately priced doctor visits a.k.a. heath care (even though we have modern indoor plumbing, central heating and usually garbage pick up) & we're supposed to be surprised that consumerism is "King" in Tanzania?
It doesn't make it any better but if a society doesn't value education or some other worth while pursuit, how can we judge them, when our young people don't value education anymore??

Lilli P.
Lilli P7 years ago

Interesting article ... points to ponder ... but how to replace the coke, cards and beer with healthcare and should we deny these poor people their few pleasures in life?

carole a.
.7 years ago

The answer to your question is that American giant multi-national corporations could care less. If there's no profit for them, they are not humanitarian. I live in a foreign country and would not dream of telling people how to live their lives.