The Nutrition Transition

Evolution is transition. Fueled by ideas, war, scientific breakthroughs, and chance, the relationship of humans with their environment is in constant change, in an endless quest for equilibrium.

The Nutrition Transition

Data from the past decade and projections for the next 20 years (Murray and Lopez, 1996) indicate a continuing rise in the contribution of no communicable diseases to mortality rates in developing countries, where a large proportion of the global poor lives.

The Nutrition Transition

Robert W. Fogel and Lorens A. Helmchen, The growth in material wealth has been matched by changes in body size over the past 300 years, especially during the twentieth century.

The Nutrition Transition

Per capita availability of calories more than doubled in this period in France, and increased by about 50% in Great Britain, where caloric supply was 30% larger than that in France at the beginning of the period.

The Nutrition Transition

The role of genes in the human adaptation to rapid environmental changes has been postulated for many decades, but only with advances in molecular genetics can we identify with some clarity the interactions between genes and environmental components such as diet.

Selasa, 30 Agustus 2011

Food policy

Food policy poses special challenges to public policy. Key features of the contemporary food system, sometimes, to the detriment of health outcomes, are a focus on profits as a primary driver, value-adding, brand image, market share and “efficiency”. Meanwhile in political discourses, health issues are often combined or confounded with safety, rather than recognized as specific population-based indicators. Con icting policies are common, particularly when government subsidies undermine food policies with a potential benefit to public health. An example can be found in policies over fish. Although nutritionists generally encourage consumption of fish, environmental considerations urge if not caution then reduction. Whereas 5% of humanity consumes.
Table 4.2
Largest food corporations, by turnover, 1998 (from FT 500,
Financial Times
, 28 January
1999, excepting Cargill, website:
Sales Profits Chief products Employees

Table 4.3 Some features of the 20th century food revolution
Sector Feature Example Comment
Agriculture Labor efficiency Decline of animal power, Decline in farms, rise
                                                                     replacement by fossil power in size of holdings
Processing Value-adding Sugar and fruit extract added “New adulterations”
to fermented milk
Distribution Creation of entire new Chill systems of storage More long-distance
                                                  sector in modern food food transport
supply chains
Retail Transfer of sales force Electronic Point of Sale Key to supermarket
from direct customer (EPOS) systems using efficiency and
contact laser scanners of “barcodes” logistics control
Catering Bought-in ready-made Soups, gravy mixes De-skilling of cooking
Marketing Search for new niche Low calorie drinks Coexistence of niche
markets by use of using artificial sweeteners and mass markets;
advertising market fragmentation

45% of all meat and fish, the poorest 20% consumes only 5%. North American cod banks are severely depleted and subject to fishing bans, and according to the FAO, 69% of world fish stocks are in a “dire condition”. The FAO sees the problem as the world “having too many vessels or excessive harvesting power in a growing number of fisheries,” yet governments are subsidizing the fish industry an annual $14–20 bn, equivalent to 25% of sector’s revenues (World Trade Organization, 1999).
Food production has changed dramatically over the 20th century. New products, processes (both on and off the land), distribution (supply chain management), and marketing (e.g., advertising) have had major impacts on health, environment, and culture. A spiral has occurred in which changing supply chain features have both fed and reacted to changing aspirations and food culture. Table 4.3 gives illustrations of some key features.
The food economy unfolding worldwide has some features in common. It is characterized by:
•Value-adding – the pursuit of “difference”, i.e., a feature (e.g., packaging, taste, image) to differentiate between one product and another;
•Company mergers and acquisitions leading to high levels of concentration in the food economy;
•Quality, which may be defined cosmetically (by how the food looks or can be sold);
•Brand value – name and marketability are to market success;
•The search for new markets – or “new” to the dominant Western food companies, who desire to open previously untapped markets such as the former Soviet Union, China and India;
•Trader power – with complex supply chains, there appears to be a rule whereby whoever dominates the relationship between primary producers and processors, on the one hand, and end consumers, on the other, is sovereign
Table 4.4
Some policy options
Fragmented policy Systemic solutions
Intensification Diversification
Cost externalization Cost internalization
Marginalization of health  Health central to economics
Food miles More local food
Productionism Sustainability
Individual health Ecological public health
Integrated policy Technical fixes
Short term Long term
Consumerism Citizenship
Health focus mainly on food safety Policy linkage between safety, nutrition and
                                                                                    sustainable food supply

·         A two-tier food economy characterized by large transnational corporations with enormous power on the one hand, and a plethora of small and medium-sized enterprises restricted to local or subnational markets on the other;
·         Social fragmentation – the coexistence of over- and under consumption (see Table 4.4).

Rabu, 24 Agustus 2011

Food inequalities

Many health disparities are the result of differences in diet availability and intake. History suggests that food insecurity is not inevitable and that maldistribution of food is a classic illustration of the social determination of health. In both war and peace, equitable public policy can decrease infant mortality and increase overall human health. That the toll of diet-related inequalities is so sobering is a political challenge. There is, of course, some good news but 800 million children globally are undernourished and an estimated two billion people show the effects of poor diet (UNICEF, 2000). Deficiencies of both macro- and micronutrients are well documented, as is the fact that women, children, and older people are at greatest risk.
A self-perpetuating cycle of health and income inequalities re ects inequalities in housing and education, leading to greater exposure to environmental hazards such as unsafe food, and contaminated air and water. Such life hazards are associated with rapid urbanization, which can reduce rather than enhance the range of good dietary ingredients and increase the likelihood of ill-health through pollution and accidents, which in turn reduces the opportunities for income and education of children. It is the task of public policy to break such negative cycles.
 From the end of World War II, food policy on inequalities was fractured by a clash of analyses about the way forward. On one side stood those arguing for policies of national or possibly regional self-reliance. On the other stood those arguing for greater  ow of trade and cross-border food security.
A key thinker in the 1940s was John Boyd Orr, who became the first Secretary General of the Food and Agriculture Organization (FAO) when it was created in 1946 (Orr, 1966). He tried to bridge the two policy camps, arguing that those that could grow food, should and those that could not, should be fed by others. The problem was that countries that needed to import food had to export hard goods, commodities, or other commercial crops to generate foreign exchange. Boyd Orr argued that countries should set “targets for tomorrow”. In today’s parlance, he argued for multilevel governance, a combination of local, national, and international targets that should work to the common good for health (Orr, 1943). The approach is worth rehearsing, not just for its historical significance, but because it attempted, over half a century ago, to address some problems in food policy that still exist today. In relation to countries such as the UK, i.e., with pockets of real deprivation amidst wealth, Boyd Orr argued as follows.
•Countries should set targets within a new global system and foster intergovernmental cooperation to help each other over good times and bad, to ease out booms and slumps in production.
•Targets should be based on nutrition and agricultural science.
•Targets should be set to achieve health. Premature death from undernutrition was inexcusable; investment in better food would yield health and economic gains and savings.
• Agriculture should be supported to produce more. Agriculturally rich countries, such as the UK, ought to emulate the advanced agricultural economies such as the USA where targets had been set to raise production of fruit and vegetables (up by 75%), milk (up by 39%), eggs (up by 23%), etc.
• Industry should be geared to produce tools to enable agricultural productivity to rise, e.g., new buildings, tractors, equipment.
• Trade should be encouraged to meet the new markets. Trade would ease the over-productive capacity of some world areas and match them with underconsumption in other areas.
•International cooperation would have to follow the (proposed) UN Conference on Food and Agriculture.
•New organizations would have to be created such as a new International Food and Agricultural Commission, National Food Boards to monitor supplies, Agricultural Marketing Boards, Commodity Boards.
This was visionary indeed and was the position Boyd Orr argued with passion in the post-war reconstruction period. But this mixed approach to food policy – part market, part state action – which was rejected by some at the time, was marginalized entirely by the 1980s. Retrospectively, the 1974 World Food Summit may be seen as the high water mark of the appeal of state-led, national policies of self-reliance. The new neo-liberal orthodoxy from the 1980s replaced this central role of the State with an emphasis on market-driven growth. In the process, the definition of food security was altered in two important ways.
Firstly, a new focus had emerged from researchers who placed more stress on subnational or local and domestic food security. They argued that countries might have an overall sufficiency of supply, when at the household or local level, there could be deficiencies; what was needed, argued the researchers, was attention to the microlevel.
Four core foci emerged (Lang et al ., 2001):
• sufficiency of food for an active healthy life;
• access to food and entitlement to produce, purchase or exchange food;
• security in the sense of the balance between vulnerability, risk and insurance;
• time and the variability in experiencing chronic, transitory, and cyclical food insecurity.
Accompanying this focus on the micro- and household level of food security, were new macroeconomic frameworks for achieving food adequacy. According to the new position, economic goals should aim for sufficient purchasing power to ensure that citizens ate adequately. Considerations of national or regional food security would be rejected. What mattered was not how much food a nation, state or locality produced but whether the people could afford to purchase their needs on the open market. If they could not, the market needed to be opened to imports and at the same time income generation within economies needed to be maximized. This import–export model triumphed at the 1994 General Agreement on Tariffs and Trade (GATT).
If the pursuit of food self-reliance was killed in the 1980s, the GATT buried it. However, as often happens in public policy, when a policy regime celebrates its triumph, a replacement or opposition can already be waiting in the wings. This has happened with the import–export neoliberal approach. Largely driven initially by environmental considerations, the 1990s saw the increasing articulation of new models. One might be termed appropriate localism. This position suggests that meeting environmental goals of sustainability by producing more diverse foods locally, both empowers people and protects their capacity to feed themselves (Pretty, 1998). Another position is associated with the work of Nobel Laureate Amartya Sen, who with Jean Dreze, has articulated a view that people experience hunger when a political culture denies them “entitlement” (Sen,1981a, 2000). Social legitimacy is a precursor to adequate food, but social legitimacy can be made or broken by policy choices.
The amazing gap between rich and poor within and between societies is well documented. There are 1.2 billion people living on US$1 per day (UNDP, 2000). Mean-while, the top 200 billionaires doubled their wealth in 1994–98 and just three of their number have more wealth than the combined Gross National Product (GNP) of all least developed countries, a total of 600 million people (UNDP, 1999). Michael Jordan, a US athlete, was paid US$20 million for endorsing Nike trainers, more than the entire workforce was paid for making them (Klein, 2000). Although our focus here is on the nutrition transition experienced by developing or recently developed countries, it is important to remember that even in rich countries, policies can determine the variation in rates of diet-related health inequalities. In the European Union, for instance, rates of diet-related ill-health vary considerably (Lang, 1999a). The UK has the worst indices and, despite being wealthy, has a disproportionate share of European Union low income (Societe Francais de Santé Publique, 2000). In the period 1979–97, inequalities in income and health widened due to macroeconomic policy choices under the Conservative Government. According to the New Labour government’s own health inquiry, the poorest decile in the UK experienced both real and relative income decline (Acheson, 1998). As in other countries with far lower incomes, the UK’s lower socioeconomic groups have a greater incidence of premature and low birthweight babies, heart disease, stroke, and some cancers in adults. Risk factors including lack of breast feeding, smoking, physical inactivity, obesity, hypertension, and poor diet are clustered in lower socioeconomic groups (James et al ., 1997).

Selasa, 16 Agustus 2011

Sustainable consumption: constraint on consumerism?

Over the last decades of the 20th century evidence mounted about the deleterious effect of contemporary food and agricultural policies. These include:
• pollution and chemical contamination from pesticide (over-)use (Conway and Pretty, 1991);
• falling water tables from over-irrigation and intensive crop production (de Moor, 1998);
• drinking water quality (McMichael, 1999);
• loss of biodiversity (Gardner, 1996);
• degraded soil (Oldeman et al ., 1991; McMichael, 2001);
• wasteful use of land and sea (World Resources Institute, 1993).
There is now considerable concern in agricultural policy on whether the earth’s food infrastructure can feed populations. The Worldwatch Institute has pointed to evidence of slowing of yield increases, declining crop diversity, declining fish stocks, and the impact of climate change (Gardner and Halweil, 2000). The challenge of meeting sustainability goals is not just a matter for ecology, but also society. Key trends include urbanization, rising meat consumption and civil wars, which upset agricultural capacities. The growing debate about sustainable consumption raises additional long-term questions about the “pull” exerted by consumerism. What are the implications of continued changing consumer demands for more meat, fish and use of nonrenewable resources, such as in packaging?
A foretaste of what could follow in the wake of the nutrition transition, if developing countries adopt the entire Western intensive approach to food production and consumption exemplified by hygienic packaging, can be appreciated by looking at what the “advanced” economies do. The global packaging industry is worth an annual $100 billion and in some developed countries, packaging accounts for between 10% and 50% of end food costs. The USA’s packaging industry manufactures 32 billon kilograms of plastic food packaging each year, and its population of 280 million people throws away 60 million plastic bottles each day, less than 3% are recycled. If the USA is a world leader in such waste, the UK with a population of 60 million also manages to use 15 million plastic bottles per day, of which less than 3% are recycled. Where does this waste go? The choice is either to bury it in landfills or to recycle it.
The European Union has now set the ambitious goal of recovering 50% of all plastic waste and of recycling half of that. But the recycling currently means that shiploads of plastic waste are taken to China for sorting by cheap labor (Vidal, 2001). Such solutions are probably unsustainable. That what is required is more than palliatives, but rather a structural rethink, is given further weight by the enormity of carbon emissions. The UK’s food, drink, and tobacco industries produce 4.5 million tons (Mt) of carbon a year, and also deposit 6 Mt of waste in landfill sites each year (DETR, 1998). A policy debate about the relative health value of packaging is urgently required.
A similar challenge for health is raised by the rapid urbanization of global populations. In policy terms, the questions are: firstly, how are the populations of cities to be fed? Secondly, who is to do it? In 1900, approximately 5% of the world’s people lived in cities with populations greater than 100 000. By the 1990s, an estimated 45% – more than 2.5 billion people – lived in large urban centers. And by 2025, that proportion is likely to be 61% of the world’s population (Howson et al ., 1998). This is likely to be accompanied by a considerable growth of the urban poor. As the population in cities continues to expand into the 21st century, the demand for food to feed urban people will grow. The FAO estimates that in a city of 10 million people, 6000 tonnes of food may need to be imported on a daily basis (FAO, 1998). By the year 2025, there will be a huge increase in the numbers of people in the south living in cities. Between 1950 and 1990, the world’s towns and cities grew twice as fast as rural areas (World Bank, 1999). In 1950, only two cities had more than 8 million inhabitants, London and New York (Harrison, 1992). It is estimated that over the next 20 years, 93% of urban growth will take place, whereas the majority of the population in the continents of Africa and Asia will remain in the rural areas.
Urbanization poses a special challenge for building a sustainable route to development. If just one feature associated with the nutrition transition – meat consumption –were to be replaced by a greater emphasis on increasing availability and consumption of vegetables and fruits, patterns of production would have to be markedly different. To reduce the use of nonrenewable energy via transportation, more local cultivation would be desirable. The UN Habitat 2 conference in 1996 concluded that urban or peri-urban agriculture will have to make a come-back, after decades of declining policy focus (UNDP, 1996). In fact, for half a century, the emphasis in global food policy, and certainly in the Western model of agriculture, has been specialization and intensification. Despite this policy marginalization, in 1993 15–20% of world food was produced in urban or peri-urban areas and was worth US$500 million (WHO-E, 1999).
In cities such as Kathmandu where 37% of urban gardeners already grow all the vegetables consumed, and Hong Kong, where 45% of demand for vegetables is supplied from 5–6% of the land mass, a practical alternative to long-distance food exists. The new global movement of urban agriculture (Pretty, 1998), which tends to be encouraged on ecological and community self-reliance grounds, is beginning to receive public health encouragement. The WHO European Region, concerned about diet-related diseases, has recently produced an ambitious and far-sighted policy document (WHO-E, 1999). This notes that up to 80% of Siberian or Asian cities are already involved in urban agriculture, and that in 1997 in Poland, for example, 500 000 tonnes of vegetables and fruits (one-sixth of the national consumption) were produced on 8000 council “employees” gardens. In Georgia, home-produced food accounted for 28% of income and in Bulgaria in 1998, 47% of people were self-sufficient in vegetables and fruit and 90% of urban families make preserves for winter (WHO-E, 1999).
     To orthodox Western food economists, a policy emphasis on local urban or peri-urban food smacks of an irrational return to a mythical halcyon past. But the case for thinking through the connection between what is produced, grown, processed, and consumed And how this happens sits at the heart of the new food policy challenge. The issue is not just quantity but quality. An illustration is the huge amount of nonrenewable energy (fossil fuels) used in transporting food increasingly long distances, as the food supply chain intensifies, concentrates, and specializes. To neoliberals, that a developing country could produce, for example, dessert apples and export them to the UK would be a good thing. The fact that the UK has a good climate and could grow its own is secondary. In 1993, 685 000GJ (equivalent to 14 million liters of fuel) was used to transport 417 207 tonnes of imported apples (Garnett, 1999). Four out of five pears and two out of three apples are now imported into the UK (Hoskins and Lobstein, 1998). In 1995, by foods such as these, the UK was a net importer of “ghost hectares”; in other words, its food needs were produced on 4.1 million hectares of other countries’ land, as well as its own (MacLaren et al., 1998).
In the period 1975–91/93, food transported on UK roads increased by 30% and the distance traveled by the UK’s total food supply increased by approximately 60% (Hoskins and Lobstein, 1998). The distance traveled for shopping in general rose by 60% in that period, and travel by car more than doubled. With the citing of food shops (supermarkets) in ever larger stores, consumers had to use cars to get their food. So the net result is that the “modern”, “efficient” food economy externalized environmental costs (Raven and Lang, 1995). The western model of food shopping is not appropriate as a sustainable consumption paradigm, yet that is the cultural dimension behind the nutritional transition –a change of lifestyle with consequences for ecological as well as human health.

Sabtu, 06 Agustus 2011

Food governance

Since the 1994 GATT, the developing world has fractured with some developing countries benefiting, while others do not. Sub-Saharan Africa, in particular, has been a net loser. Dissent about the new global institutions of governance symbolized by the GATT’s creation of the World Trade Organization surfaced at the WTO talks in Seattle, USA, in December 1999, with demonstrations following in Washington DC, Melbourne, Gothenborg, Prague, and Genoa. Although much interest has focused on wider political and economic issues, there are important considerations for the issue of the nutrition transition and the food–health connection. Two considerations are central: firstly, whether the neoliberal model enshrined in the GATT is appropriate for the ecological and human health challenges of the 21st century and, secondly, whether, health issues are adequately championed in global governance.