Sabtu, 23 Juli 2011

New models for old

As was outlined above in the discussion on Boyd Orr, the dominant model for food policy dates back to the post World War II period. The model centered on an analysis that
                                                                                 production Distribution Health
Figure 4.1 Food’s impact on health – the mid 20th century model.
Science                                          Increased
                                                      Production                 Distribution
Capital                                                                 education       
Figure 4.2 Food’s impact on health – the mid to late 20th century model.
underproduction was the primary policy failure. If science could only unleash nature’s productive capacity and if capital investment could be suitably made, then farming could increase output and nutritional deficiencies could be alleviated. As long as there was efficient distribution and a welfare safety net to “catch” failures in personal income, then improved public health would surely be the outcome. The model is schematically represented in Fig. 4.1. By the 1980s, with rising evidence of degenerative diseases, another “box” was inserted into the package in the form of health education (Fig. 4.2).
The problem with this approach was that it made a number of assumptions which events proved to be unwarranted. Firstly, it assumed that increased supply would improve health when in fact rising incomes, urbanization, and changed nature of sup-ply allowed (or arguably encouraged) the rise of degenerative diseases such as coronary heart disease, the diet-related cancers, diabetes, and obesity – all the diseases associated with and highlighted in the nutrition transition.
Secondly, the model assumed that the era of contagion was over when in fact theopening up of food systems removed barriers to the spreading of diseases. Thus, if food traveled across continents and if processors and retailers purchase globally, new opportunities and routes for cross-contamination and spreading of diseases were created. Key causes of disease include Salmonella, Campylobacter, Escherichia coli, and new ones such as bovine spongiform encephalophathy (BSE). Thirdly, changes in the nature of production and distribution opened new chances for diseases to spread further and faster. Tourism, for instance, turns more than 600 million people each year into disease carriers.
Food Policy
Figure 4.3
WHO European Region model for food and health policy (reproduced from WHO Regional Committee for Europe, 2000, with permission).
Fourthly, the model assumed that the “old” banes of food policy, such as adulteration and contamination, would be consigned to the history books when in fact they have changed. Some forms of contamination and adulteration have been successfully controlled whereas new ones such as contamination from pesticides, additives, and nitrates have been introduced or greatly enhanced.
 What is now required is a much more complex and multidimensional model. The 51 member states of the WHO European Region in 2000 agreed to a new simple model (Fig. 4.3). This suggests that to meet health goals, public policy should give equal emphasis to building three pillars: nutrition, food safety, and sustainable food supply. Unless they are equal, the roof – health – under which all humans can shelter would tilt and not last. This model is highly appropriate to present this new message, being simple and intelligible. But it can be argued that in reality, the model ought to be more multifactoral; there should be many more pillars and understanding required needs to include many sciences. Figure 4.4 shows a more appropriate model, even though this might be hard to sell to politicians, who famously are both busy and need to be “sold” simple messages.
If public policy is to be built on a comprehensive rather than a partial analysis, it should integrate the goals of achieving individual, population, and ecological health.


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