A brief history of food production & Foraging societies

A brief history of food production

Every new find of hominid remains in East Africa reignites the controversy about the origin of our species, but at least one conclusion remains unchanged: we have come from a long lineage of opportunistic foragers, and for millions of years both the natural diet and the foraging strategies of hominids resembled those of their primate ancestor (Whiten and Widdowson, 1992). Larger brains improved the odds of their survival but to secure food, hominids relied only on their muscles and on simple stratagems as scavengers, gatherers, hunters, and fishers helped by stone implements, bows and arrows and by fibrous or leather lines and nets. Controlled use of fire needed to prepare cooked food may have come first nearly half a million years ago, but a more certain time is about 250000 years ago (Goudsblom, 1992).

Childe’s (1951) idea of Neolithic Revolution has been one of the most unfortunate caricatures of human evolution: there was no sudden shift from foraging to sedentary farming. Diminishing returns in gathering and hunting led to a gradual extension of incipient cultivation present in many foraging societies, and foraging and agriculture commonly coexisted for very long periods of time (Smil, 1994). Similarly, there were no abrupt changes in the way most traditional agricultures produced food; some places experienced prolonged stagnation, or even declines, in overall food output, others have undergone gradual intensification of crop cultivation that has resulted in higher yields and more secure food supplies. Even then, traditional farming was able to produce only monotonous diets and it remained highly vulnerable to environmental stresses. Only modern agriculture, highly intensive and fossil fuel-based, has been able to produce enormous surpluses of food in all af uent nations and to raise most of the world’s populous developing countries at least close to, and for most of the Chinese even well above, subsistence minima.

Foraging societies

The great diversity of the preserved archaeological record makes it impossible to offer any simple generalizations concerning prehistoric diets. Modern studies of foraging societies that have survived in extreme environments (tropical rain forest, semideserts) into the 20th century have provided very limited insight into the lives of prehistoric foragers in more equable climates and more fertile areas. Moreover, these societies have often been affected by contacts with pastoralism, farmers or overseas migrants. Given the unimpressive physical endowment of early humans and the absence of effective weapons, it is most likely that our ancestors were initially much better scavengers than hunters (Blumenschine and Cavallo, 1992). Large predators often left behind partially eaten carcasses and this meat, or at least the nutritious bone marrow, could be reached by enterprising early humans before it was devoured by vultures and hyenas.

 Fishing, collecting of shellfish, and near-shore hunting of sea mammals provided diet unusually rich in proteins and made it possible to live in semi permanent, and even permanent, settlements (Price, 1991). In contrast, both gathering and hunting were surprisingly unrewarding in species-rich tropical forests where energy-rich seeds are a very small portion of total plant mass and are mostly inaccessible in high canopies, as are most animals, which are also relatively small and highly mobile. Grasslands and open woodlands offered much better opportunities for both collecting and hunting. Many highly nutritious seeds and nuts were easy to reach, and patches of large starchy roots and tubers provided particularly high energy returns. So did the hunting of many grasslands herbivores which were often killed without any weapons, by driving the  herds over precipices. This hunting was intensive enough to explain the disappearance of most large herbivores from preagricultural landscapes (Alroy, 2001).

There is no doubt that all pre agricultural societies were omnivorous and that although they collected and killed a large variety of plant and animal species only a few principal foodstuffs usually dominated their diets. Preference for seeds and nuts among gatherers was inevitable; they are easy to collect, and they combine high energy con-tent (13–26 MJ/kg) with relatively high protein shares (commonly above 10%). Wild grass seeds have as much food energy as cultivated grains (15MJ/kg), and nuts have energy densities up to 75% higher. All wild meat is an excellent source of protein ( 20%) but the esh of small and agile animals (e.g., hares or monkeys) contains very little fat ( 10%) and hence has very low energy density (5–6 MJ/kg). Consequently, there has been a widespread hunting preference for such large and relatively fatty species, such as mammoths and bison's (containing 10–12MJ/kg). Even so, except for maritime hunters of fatty fish (salmon) and mammals (whales, seals), lipids usually supplied no more than 20% of food energy in preagricultural societies.

The extremes of daily intakes of animal protein among the remaining foraging populations studied after 1950 range from more than 300 g/capita among Inuit feeding on whales, seals, fish, and caribou to less than 20 g a day for foragers in arid African environments subsisting mainly on nuts and tubers (Smil, 1994). Eaton and Konner (1997) used nutrient analyses of wild plant and animal foods eaten by recent gatherers and hunters in order to estimate the dominant composition of prevailing preagri-cultural diets. They concluded that compared to the typical recent US intakes they were more than twice as rich in fiber, potassium, and calcium, but contained less than one-third of today’s sodium consumption.

Prehistoric survival modes and diets were extremely diverse but this fact has not prevented some anthropologists making inadmissible generalizations. Undoubtedly, for some groups the total foraging effort was low, only a few hours a day, and this fact, confirmed by some modern field surveys, led to the portrayal of foragers as “the original af uent society” (Sahlins, 1972). This conclusion, based on very limited and highly debatable evidence, ignored the reality of much of the hard, and often dangerous, work in foraging and the frequency with which environmental stresses repeatedly affected most foraging societies. Seasonal food shortages in  actuating climates necessitated the eating of unpalatable plant tissues and led to weight loss, low fertility, high infant mortality, infanticide and often to devastating famines (Smil, 1994).

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Food supply

The world’s recent edible crop harvests prorate to about 4700 kcal/day per capita, but nearly half of the cereal production, worth about 1700 kcal/day, is fed to animals, and postharvest crop losses amount to some 600 kcal/day (Smil, 2000). This leaves about 2400 kcal/day of plant food and with some 400 kcal/day from animal foods (including aquatic products) the average per capita availability adds up to roughly 2800 kcal/day, well above a generous estimate of average needs of 2200 kcal/capita. Similarly, the world’s mean daily protein supply of 75 g/capita is well above the needed minimum. An egalitarian global civilization would thus have no problems with adequate nutrition. Equitable distribution of available food among the planet’s more than 6 billion people would provide enough protein even if the global food harvests were to be some 10% lower than they are today.

 In the real world these adequate global means hide, as do other global averages, large inter- and intranational differences. All Western nations enjoy uniformly high per capita food availabilities averaging about 3200 kcal/day. Their mean per capita supply of dietary protein is about 100 g/day, including about 55 g from animal foods. No elaborate calculations are needed to conclude that the average per capita food supply is more than adequate in all af uent countries. Because the actual requirements of mostly sedentary populations are no more than 2000–2200 kcal/day it is no exaggeration to label the resulting food surpluses (at least 1000–1200 kcal/day and up to 1600 kcal/day) as obscene.

After all, even when leaving aside the large energy and protein losses in animal feeding, at least 30% of all food available at the retail level in Western societies is wasted! Average Western diets in general, and the North American one in particular, also contain excessive amount of lipids, which now supply 30–40% of all food energy compared to the average of less than 20% in developing countries and to shares below 15% in the poorest societies (FAO, 2001). Surfeits of food energy and lipids are the two key nutritional factors implicated in the increase of obesity and diabetes and in a high frequency of cardiovascular disease (see Chapters 9–11). Fortification of many foodstuffs (from our to juices) with vitamins and minerals and a fashionable use of dietary supplements (including recurrent megadose manias) by increasingly health-conscious segments of the aging population would suggest that there are very few micronutrient deficiencies. This is, unfortunately, not true as clinical and biochemical studies in the US show that intakes of calcium, iron, and zinc are not adequate in some groups (Pennington, 1996).

 Given the obviously high incidence of overweight and obesity it is not surprising that hunger and malnutrition in af uent nations have received so little attention, but their extent is far from negligible (Riches, 1997). Poppendieck’s (1997) estimates that 22–30 million Americans cannot afford to buy enough food to maintain good health have been questioned, but even the most conservative estimates acknowledge that 10–20 million poor Americans could not feed themselves adequately without assistance, and that far from all of them are actually receiving it. The coexistence of undernutrition and widespread obesity is thus one of the most peculiar features of America’s current nutritional situation.

Japan, which is highly dependent on food imports, is the only high-income country with per capita food supply below 3000kcal/day (the rate has been steady at about 2900 kcal/day for nearly two decades). Specific features of the country’s food con- sumption include the already noted world’s highest per capita intake of aquatic products, exceptionally high intakes of soybeans (eaten mostly as beancurd), and very low con-sumption of sugar. Average food availability in China is now almost as high as in Japan (close to 2800kcal/day), but in spite of impressive post-1980 diversification (Fig. 3.4) its variety and quality is still much lower. Moreover, unlike in a highly egalitarian Japan, China’s mean hides large differences between coastal and interior provinces.

 India and Indonesia in the late 1990s were, respectively, at about 2400 and 2600 kcal/day. This would have provided adequate nutrition for everybody only if the two countries had a perfectly egalitarian access to food; in reality, highly skewed income distribution makes India the country with the largest number of undernour-ished people (FAO, 2000). Many sub-Saharan African countries average less than2200 kcal/day, some even less than 2000 kcal/day, and these obviously inadequate food supplies are re ected in the world’s shortest life expectancies at birth. Even when adequate in terms of total energy and protein, typical diets in most developing coun-tries are monotonous. And, unlike in af uent nations where nearly all traces of sea-sonal food supply have been erased by international trade, diets in many poor countries still strongly re ect the seasonality of plant harvests or fish catches.

200

                                 Grain

175

150

50

                                                                                                        Meat

25                                               Fruit

                                                                              Aquatic products

0

1970 1980 1990 1999

Figure 3.4

Dramatic changes in China’s average per capita food supply brought by Deng Xiaoping’s post-1980 economic reforms exemplify a rapid dietary transition in a modernizing country. Based on data from State Statistical Bureau (1980–2000); these figures exaggerate actual meat consumption (see the text for details).

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Increased demand for animal foods

As described in the previous section, af uence changed this consumption pattern but intakes of animal foods are badly skewed in favor of high-income populations. Industrialized nations, amounting to only a fifth of the global population total, now produce a third of hen’s eggs, two-fifths of all meat, and three-fifths of all poultry and cow’s milk. Animal foods now supply around 30% of all food energy in North America and Europe, around 20% in those East Asian countries that have reached apparent satiation levels (Japan, Taiwan) and far below 10% in the most food-deficient coun-tries of sub-Saharan Africa (FAO, 2001). This means, as already noted, that the daily food supply of rich nations now averages about 55g of meat and milk protein per capita, compared to just 20g in the developing world, and the actual gap is even larger for hundreds of millions of subsistence peasants and poor urbanites surviving on diets virtually devoid of any animal foods.

With meat and dairy intakes being up to an order of magnitude higher in af uent nations than in many poor countries this means that extending the current per capita supply means of developed countries (i.e., above 250 kg for milk and close to 80 kg for meat) to all of today’s low income countries (i.e., to 4.7 billion people), as well as to the additional three to four billion people that will be added in those countries dur-ing the next two generations, would call for an impossibly large expansion of feed production. The three important questions are then as follows. Should such a goal be seen as being at least theoretically desirable? What are the chances that developing countries would move as rapidly, and as far, toward the af uent (Western) consump-tion pattern as their limited resources will allow? And to what extent can we improve the prevailing feeding efficiencies?

Only the first question has an easy answer. There is no need to present a massive sur-vey of current nutritional understanding or to engage in polemics on behalf of, or against, vegetarianism, a nutritional choice that most people will not consider following voluntarily in any case, or high-level carnivory. What is abundantly clear is that humans do not need high levels of animal food intakes either to lead healthy and productive lives or to achieve average population longevities in excess of 70 years, and that no other known existential benefits are predicated on consuming at least as much meat and dairy products as the developed countries do today. Moreover, as recent experiences with some consequences of animal feeding and rearing have demonstrated (European mad cow disease and foot-and-mouth epizootic leading to large-scale slaughter of cattle and sheep, and Asian bird viruses resulting in mass killings of poultry) the scale and the very nature of meat-producing enterprises may actually be a threat to human health, or at least a costly inconvenience. In contrast to these fairly indisputable conclusions the pace and the extent of dietary transition is much harder to predict.

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Dietary patterns

No other factor will determine the future demand for animal foods as much as the degree of westernization of diets in developing countries in general, and in populous Asian nations in particular. Informed discussion of this prospect must start by acknowledging the fact that, in spite of broad similarities, there are substantial differ-ences in meat and fat intakes among Western countries. This means that there is no generic Western diet to which the developing countries might aspire. Although all major indicators of quality of life are very similar for all of the af uent nations of Western Europe, per capita supplies of meat differ by about 40%: Norwegians get less than 60kg/year, French almost 100kg/year (FAO, 2001). And whereas Greeks con-sume less than 5 kg of butter and lard a year per capita, the Finnish mean is close to 15 kg. Such comparisons make it clear that the European pattern, although very similar in total energy and protein intakes, spans a range of distinct categories from the Mediterranean to the Scandinavian diets.

Taking such differences into account, Seckler and Rock (1995) suggested that two different patterns of food consumption should be considered when forecasting the future composition of food intakes in developing countries. They define what they call the Western model as the daily mean supply of more than 3200 kcal/capita with more than 30% of food energy coming from animal foodstuffs. But a great deal of evidence confirms that another model – what they label the Asian–Mediterranean pattern, with overall food energy availability below 3200 kcal/capita and with animal products sup-plying less than 25% of food energy – appears to be a more powerful attractor for many developing countries.

Food balance sheets of the last two generations show that animal food intakes in the economically most successful developing countries have not been moving rapidly toward the Western consumption pattern. Egypt and Turkey have basically the same proportion of meat in their typical diets as they had 30 years ago. Japanese meat intakes have stabilized at around 40kg, as did the Malaysian average. Official output statistics would appear to put China into a different category and forecasts based on these numbers see China as a gargantuan meat-eating nation, but a closer look shows that the country will not move rapidly toward the Western attractor. China’s official output statistics, and hence also FAO food balance sheets based on them, credit the country with per capita output of about 47 kg meat in 1999, but the China Statistical Yearbook puts actual per capita purchases of urban households at 25 kg (unchanged in a decade!) and the meat consumption of rural families at less than 17 kg, up from about 13 kg in 1990 (National Bureau of Statistics, 2000). This means that the eventual doubling of average nationwide per capita meat consumption would result in a rate only marginally higher than the current value claimed by official statistics.

Forecasts of China’s future meat consumption have also been affected by simplistically extrapolating Taiwan’s experience. The island’s very high average per capita meat intake (about 80 kg) is not only the highest in Asia, it is even higher than the British mean, and its very low direct cereal consumption (less than 110 kg) is below the OECD’s mean of some 130 kg (FAO, 2001). Moreover, differences of scale between the two countries (1.2 billion vs. some 20 million of people) and the still very limited purchasing power of most of China’s peasants are two other factors militating against a further rapid rise of China’s per capita meat consumption.

Finally, it must be noted that the total consumption of meat, although still slowly rising in the US, has been declining in Europe (for example, in Germany it is down by 15% since 1980), which means that the Western pattern is actually shifting gradu-ally toward the alternative attractor. Consequently, there is a fairly high probability that tomorrow’s developing world, although definitely demanding higher animal food intakes, will not look toward yesterday’s French, Dutch, or US example. Widespread assumptions that rising disposable incomes will be readily translated into rapidly, and virtually universally, rising demand for meat may not come to pass. Whatever its actual level may be, lower than anticipated demand for animal foods would be much easier to meet, especially once a concerted commitment is made to improve the efficiency of feeding as much as practicable. But whatever the pace and the extent of coming dietary changes may be, the increasing carnivory could have a much lower demand on agricultural resources and could also result in much reduced environmental impacts if we were to feed the animals much more efficiently.

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Investing in agriculture

For most people the idea of investing in agriculture conjures the images of extending credit to farmers or building new irrigation schemes but the most important investments needed to assure high agricultural productivity are in maintaining viable agroecosys-tems. Although modern agriculture has eliminated many environmental limits and insulated itself from many environmental interferences through fertilization, irrigation, use of pesticides and breeding of better cultivars, crop production remains embedded within the dynamic complexities of the living biosphere and depends critically on reli-able provision of many natural services and on the maintenance of essential ecosystem structures. These necessities range from having sufficiently friable soils containing large amounts of organic matter and protected against excessive erosion to promoting practices that will minimize nutrient losses from fertilizer applications and increase water use efficiencies in irrigation as much as practicable.

 Achieving these goals is a matter of complex management that can be effective only when we use the best understanding of how agroecosystems operate. For example, the first necessity (maintaining desirable soil structure) requires the use of appropri-ate tillage methods (including minimum tillage practices), recycling of crop residues and animal wastes, regular crop rotations, and where possible also planting of legu-minous cover crops (Agassi, 1995). Without these measures soil bacteria and inverte-brates could not thrive, high organic matter content able to maintain soil structure would decline, soil would not be able to hold moisture and would be prone to erosion losses that would eventually lower its productivity. Similarly, reducing nutrient losses requires measures ranging from repeated soil and plant testing and split applications of fertilizers to selecting appropriate cultivars and regular planting of cover crops (Smil, 2001). These practices require a great deal of understanding and ongoing per-sonal commitment by individual farmers but most of them now rest on fairly well-understood principles.

 In contrast, new methods of more productive farming will require further inten-sification of agricultural research and technical innovation. Not surprisingly, many observers of the current agricultural situation argue for substantially increased public support of basic and applied agricultural research (Pinstrup-Andersen, 2001), and there is no shortage of studies to show the efficacy of this approach. For example, Huang and Rozelle (1996) showed that innovation accounted for almost all of the growth in agricultural productivity in China during the latter half of the 1980s and in the early 1990s. Avery (1997) stressed that only further intensification of crop produc-tion can save the remaining tropical rainforests, and hence most of the world’s existing biodiversity, from eventual destruction. Virtually every assessment of future agricul-tural needs prepared by the FAO or by specialized crop research centers (International Maize and Wheat Improvement Center, International Rice Research Institute) notes that returns to public investments in agricultural research and extension are very high and urges that future funding should be increased. In spite of this well-proven reality research funding remains inadequate throughout the developing world.

Given this state of affairs it is even more worrisome that the developing world may not be able to take full benefit of one of the most important scientific advances of the past generation, our increasingly effective ability to confer desirable traits on plants and animals by means of genetic engineering. Of course, an argument could be made that the rich countries, with their obscene surplus of food, have really no need to use arcane techniques in order to further boost their crop and animal production. But a common view that genetic engineering is a tool of multinational companies geared toward the rich world’s markets and that developing countries have no chance to benefit from biotechnology is wrong. As Wambugu (2001) argues, small-scale farmers have profited by using hybrid seeds and transgenic seeds simply add more value to these hybrids.

This is a very important point that needs constant stressing to scientifically illiterate critics. All but a few of our currently planted crops are products of extensive breeding modifications and today’s world could not feed itself without using these hybrid and high-yielding cultivars. Traditional breeding has made a fundamental difference to the agricultural productivity of the 20th century; current harvests would be impossible without hybrid corn (introduced in the 1930s), HYV of rice and wheat (first released during the 1960s) and hybrid rice (developed in China during the 1970s). Hybrid corn, the planting of which began slowly in Iowa in the early 1930s, has transformed US corn harvests since World War II and is now benefiting both small- and large-scale corn producers throughout the developing world. Hybrid rice, which can boost aver- age yields by 15–20%, has been finally adapted to tropical climates and is now being accepted throughout Asia (Virmani et al., 1996).

Genetic engineering is thus only the latest, and the most powerful, tool of agricultural innovation. Admittedly, it is also a tool with considerable potential for adverse effects and unwanted complications but this reality should not be the reason for banning the  effort and walking away from the prospect of immense future benefits. After all, this combination of risks and benefits is nothing unique to genetic engineering. Modern society constantly confronts such dilemmas and has found ways to deal with them. Perhaps the most apposite example is that of drug companies and the billions of users of prescription medicines who must weigh the benefits against a range of potentially even fatal side effects. Careful research and testing and responsible regulation are the answers, not a ban on the drugs. Genetic engineering alone will not solve food short- ages that are now experienced by hundreds of millions of people but it could become the most powerful tool in that quest.

I will note just a few of the recent bioengineering advances whose potential for producing larger and better harvests or more desirable animals is self-evident. Broader-leafed rice can deprive weeds of sunlight, thus reducing the need for apply-ing herbicides or for laborious weeding. Rice with higher vitamin A and iron content can be the most cost-effective, as well as the most practical, way to end two of the most persistent micronutrient deficiencies in rice-eating countries. Millions of poor tropical families cultivating sweet potatoes in their fields and kitchen gardens would benefit from a transgenic cultivar resistant to feathery mottle virus which can reduce the yields by up to 80% (Wambugu, 2001). And, to give perhaps the most impressive example from animal farming, transgenic pigs able to produce phytase (the enzyme needed to digest phytate phosphorus in their feed) in their saliva will void manure with phosphorus content reduced by up to 75% (Goloran et al., 2001). This impres- sive achievement will reduce one of the principal causes of aquatic eutrophication, algal growth and fish kills in affected waters.

Seeing genetic engineering as the solution to the world’s food problems would be naïve. Refusing to proceed with careful research and regulated applications might be one of the most shortsighted human choices ever made as the technique has potential not only for increased and improved food production but also for enhanced environ-mental protection. Well-conceived bioengineering research, together with the stress on environmentally sound farming and higher efficiency in the use of all farm inputs, should be one of the key ingredients with which to build greater food security for tomorrow’s developing world.

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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: www.cargill.com)

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

ingredients

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).

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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).

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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.

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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

Science

                                                                       Increased

                                                                                 production Distribution Health

Capital

Figure 4.1 Food’s impact on health – the mid 20th century model.

Science                                          Increased

                                                      Production                 Distribution

Health

Health

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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