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).
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