Review: El Susto, by Karen Akins

Abstract

In recent years, public health has taken aim at sugary beverages, the pleasurable drinks clever media campaigns have led consumers to associate with happiness. On the surface, the issue is understood as one of personal will and motivation. Decreasing—or better yet, eliminating—our consumption of these empty calories is associated with decreased risk of diabetes and certain cancers, as well as decreased incidence of tooth decay. This may seem to call for a simple behavioral change, but lowering sugary beverage consumption is a goal laden with economic, social, and even racial undertones, ripe for analysis and debate. Karen Akins, a former activist who first encountered the ruinous effects of diabetes in Mexico as a medical mission volunteer in 2008, takes on this complexity in her first documentary, El Susto, using Mexico as a case study.Akins blends multiple perspectives, using narration to thread across interviews, footage of daily life, celebrations, and political and industry events, as well as commercials and other forms of popular culture. The film brings together the many voices involved in this debate: researchers, politicians, the business sector, the food industry (Coca-Cola), and civil society. Importantly, she gives voice to the Mexican population suffering the brunt of chronic health illnesses. Imagery of the dire health consequences (amputations, blindness, death) is effectively juxtaposed against the profit-driven perspectives of the industry and the politicians who have supported the industry through recent decades.El Susto begins with El Día de los Muertos—the Day of the Dead—Mexico’s celebration of the passing from one world to the next. The film uses the celebration as an initial anchor to talk about type 2 diabetes, which is the main cause of death in the country, despite greater media attention being given to violent deaths and the drug cartels. Bottles of Coca-Cola sit conspicuously between flowers and other trinkets that adorn the beautiful altars built for the celebration. Family members recount the departed’s love for the fizzy beverage, a love that they also share, even when associating Coca-Cola with their own diabetes diagnosis and the death of their loved one. Yet the narrator centers the perceived causes of diabetes on the concept of “el susto.” Susto translates as a fright, a sudden scare, or a sensation during which one’s soul momentarily leaves the body as a result of grief, traumatic events, earthquakes, kidnappings, and so on—events too common in Mexican society. According to the film, 76 percent of Mexicans believe that sustos cause diabetes. Yet, as the viewer soon learns, the core of the problem is not sustos but the politics, corruption, and trade agreements that have allowed Coca-Cola to become such an important part of everyday life in Mexico.Akins brings to full view the consequences of the North American Free Trade Agreement (NAFTA), industry power, and resource allocation on public health, echoing important recent scholarship, such as Alyshia Gálvez’s Eating NAFTA (2018) and Marion Nestle’s Soda Politics (2015). The film presents the roots of Coca-Cola’s global influence, along with contemporary views from the company’s strategic events and political rallies, where industry tactics are laid out along with its influence in policymaking. Beyond Coca-Cola, viewers are also presented with larger issues contributing to Mexicans' love for sugary beverages: water access and safety, health care access, and the health care system’s lack of capacity to address chronic diseases, leading to greater risks of complications, disabilities, and death from mostly preventable conditions. In doing so, Akins provides evidence of how profit and the well-being of the rich have been prioritized at the expense of the poor, who more often than not are marginalized Indigenous communities in the country. Fortunately, Akins also presents solutions, showcasing Mexico’s civil society and researchers’ efforts to create impactful change, focusing on the passing of sugary beverage taxes in 2014 (which also included a tax on junk foods). The showcase is largely uncritical, praising both Mexico’s victory in passing the tax and civil society efforts to call attention to local industry influence. The policy victories—the sugary beverage tax and the recently passed front-of-package labels—are laudable, but they sustain a focus on behavioral change that places the burden for health solely on the individual. Are there ongoing efforts to improve the health care system? Water access? Socioeconomic and racial inequities? These are a few key aspects that merit further exploration.El Susto is a valuable contribution to motivate deeper conversations about transnational companies and the role of government to safeguard its citizens’ health. The film could be incorporated into classes that tackle issues around food access, nutrition, food justice, and even migration. The film can also be viewed as a needed call for action to push for government regulation of food marketing and of industry involvement in research and policy, both of which are significant, but often overlooked, influences on individual and community health.