World Nutrition Volume 6, Number 9-10, September-October 2015
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World Nutrition Volume 6, Number 9-10, September-October 2015
Journal of the World Public Health Nutrition Association
Published monthly at www.wphna.org/worldnutrition/
WN Project Phoenix
If the time is not now, it will come
Raj Patel
University of Texas at Austin
Email: rajpatel@utexas.edu
Access April 2015 Update on Project Phoenix here
Access May 2015 Update special on Project Phoenix here
Access June 2015 Update special on Project Phoenix here
Access June 2015 Mark Wahlquist, Claus Leitzmann, others, on Project Phoenix here
Access July-August Update special on Project Phoenix here
Access this issue commentary on Project Phoenix here
Project Phoenix team note
The WN Project Phoenix initiative concludes this month with a commentary beginning to
outline a whole new science fit to face the facts of this century. Here, world food policy
authority and author Raj Patel, biologist and author Colin Tudge, two of the WN editorial
team, and WN family member research scientist Anthony Fardet, make substantial
comments on the nature and future of nutrition. Their emphases are different. They share
one overall judgement. This is that the current convention is not absolutely wrong, so much
as out of date – obsolescent and irrelevant, as specified in two of the Project Phoenix
indictments. This amounts to what Thomas Kuhn in his Structure of Scientific Revolutions
sees as a time ripe for a ‘paradigm shift’, to a new general theory of what works well in a
world whose circumstances have changed, or when new knowledge forces a new integrated
and effective way of thought and action. We agree. The new way is aptly seen as the phoenix
arising from the ashes, able to fly. This thinking also shapes WN policy now and in future.
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The crisis of nutrition science is part of a greater whole. The chaos inherent in the farcical and tragic
impasse between the central European powers and the government of Greece is a current example of
the still-dominant dogma that now must be replaced by sane, real and fair systems of governance
I write in response to the series of indictments published in WN since April (access
them above, and see the final commentary in this issue). I became a nutrition
professor only this June, and have absolutely no place contributing to a discussion in
a journal as prestigious as this, about the rebirth-through-fire of a discipline in which
I’m barely a novice, writing among colleagues whose commitment to nutrition
reflects decades of work. I do, however, have a history of working within professions
whose houses are on fire.
If there’s some small corner I might add to the discussion of how nutrition rises
from the ashes, it’s through some experience of coping with the grief of one’s
discipline in flames.
The five stages of grief
The Kübler-Ross model proposes five stages of grief. These are denial, when the
shock of trauma has yet to register; anger, characterised by rage against the order of
things; bargaining, in which deals are struck with a higher power to restore a
loss; depression, when attempts to return to the past have proved futile; and acceptance,
the bittersweet moment in which life continues, the scars of the past a permanent
and fading reminder of loss.
Every discipline I’ve touched has at some point seen itself as making a deep and
lasting contribution to the improvement of human affairs. All are, or have been, in
grief at recognition of the impossibility of their task.
Let’s begin with the discipline in deepest denial: economics. It still believes in an
enlightened neutral position from which it can dispense good advice – and no
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economic colleagues, there’s a deep connection between the tyrannies inflicted on
Greece and the calculi of supply and demand. Occasional papers like ‘Do good
economists make bad citizens?’ are read as class assignments before Christmas, rather
than a deep critique of prevailing assumptions and personnel of the profession.
Accomodation or revolution
Moving on, I’ve seen anger during my employment in the non-government
organisation world, and as a student of sociology. Both are caught between the
demands to make the world better, and the funding arrangements of capitalism that
keep these approaches penned within a world they abhor. And those are the good
NGOs and sociologists. The bad ones merely bargain with the established order, to
make capitalism more survivable while doing nothing to move beyond it. Within
sociology, the equivalent bargain has resulted in criminology, the boom industry of
modern American social studies. If there’s an analogue in nutrition, it could be that
corner of the discipline that provides calorie counts for Coca-Cola, found in small
print on the side of packages.
For depression, my current position in public affairs might fit - a slow churn of datadriven reports describe what ought to happen in public policy, even as the insane US
political system makes reasonable discussion increasingly less relevant.
Is there a discipline in a state of acceptance? I was, briefly, a student of mathematics.
I wonder whether the modern discipline would look the way it does, had it not been
initially developed as a tool to describe the divine, the orbits of the stars and of all life
below them. I suspect there’s a Pythagorean moment that every field of study needs
to pass through, one in which soaring aspirations are dashed, one in which the
conditions that incubated the field in turn become the objects of study, to be
examined and destroyed.
Perhaps Pythagoras isn’t quite right – perhaps it’s Oedipus.
Nutrition as a servant of power
Take a hard look at the conditions of the birth of nutrition science. Chinese
nutritionists served temples and emperors, as did European ones, Galen in particular.
The modern science of nutrition emerges through thinkers like James Lind, whose
18th century discoveries about lime juice helped the British navy avoid scurvy, or
Staphen Babcock and Edwin Hart, whose single-grain experiments a century ago
helped create the concentrated animal feeding operations that now produce so much
cheap meat and expensive health problems.
Nutrition has always served the powerful.
The ability of a reborn nutrition to criticise power, particularly in capitalism’s
ecology, matters. In its new incarnation, to give a concrete example, public-private
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A last call to prepare for action at a later better time, made by the US labour organizer Joe Hill
before his execution exactly a century ago. If the time for transformation is not yet, now prepare for it
partnerships wouldn’t be the objects of envy or competition within the discipline, but
subjects of study – and scorn.
This is the kind of acceptance that I’d like to see nutrition embrace. I fear that this
day is some time in the future, and in the meantime, we must – in the words of
martyred labour activist Joe Hill - mourn, and organise.
Patel R. WN Project Phoenix. If the time is not now, it will come
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WN Project Phoenix
Shifts to a holistic paradigm
Anthony Fardet
Centre de Recherche de Clermont- Theix-Lyon (INRA), France
Email: anthony.fardet@clermont.inra.fr
My theme in response to the WN Project Phoenix series (access these above) is
‘defining a new paradigm so that a more efficient preventive nutrition arises from the
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ashes of nutritionism’. Today, nutrition science is undoubtedly in transition. As
emphasised by Gyorgy Scrinis(1), David Jacobs and Linda Tapsell(2), and later by
myself and Edmond Rock (3), the ‘nutritionism’ paradigm, which is to say
reductionism, has largely prevailed. This attends to foods only as sums of nutrients.
This is not to say that nutritional reductionism is useless. It has indirectly saved very
many lives, notably by elucidating the mechanisms of vitamin deficiencies. But
reductionism is too prominent, to the point of being a dogma. Now its deleterious
consequences are obvious.
Thus, reductionism has enabled and encouraged the fractionation and recombination
of food ingredients in energy-dense, poorly satiating, ultra-processed food and drink
products. If these were consumed occasionally in small amounts there would be no
problem. But in many countries such products have become predominant,
constituting in some urban populations the basis of their diet(4), contributing to the
decrease of healthy life years. People in such countries may on average live longer
than their parents did – but increasingly in a diseased state.
Diet seen as a whole
Aims of the Brazilian Food Guide
Food enjoyment,
cultural diversity,
conviviality,
interaction with nature,
autonomy:
all enhanced
,
Water, soil, air,
biodiversity,
landscape, forests:
preserved, protected
Pollution, emissions,
use of resources,
waste, garbage,
all reduced
Food and
meal-based
diets
Healthy weight
Less nutrient deficiencies
Less diabetes, heart disease, cancer
Less medical, surgical treatment
Longer, better lives
The new Brazilian food guide sees diet as a whole in all its aspects. As illustrated here, in the
segments from top, left, these include the social, environmental and personal dimensions and benefits
Based on this finding and awareness, I propose five shifts amounting to a new
paradigm for a new preventive nutrition to increase healthy life years. This has much
in common with the philosophy of the new Brazilian food guide, the benefits of whose
recommendations are projected in the diagram above.
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1 Shifting from a dominant reductionist approach to a holistic approach in nutrition
research, which means considering nutrition as a holistic discipline with all its complex
dimensions(3, 5).
2 Shifting from dominant curative nutrition to a more focused preventive nutrition, notably
by studying more states of good health, not only searching for a differential effect
between healthy and ill subjects(6, 7). Indeed, the healthy state has never been seriously
characterised. By doing so, we will be able to elaborate new nutritional recommendations
to maintain stable healthy states within the range of natural variation.
3 Ranking foods in epidemiological studies according to their degree of processing, to reach
more solid scientific evidence as regards association with chronic disease risks(8, 9),
notably based on a classification such as NOVA (10). Indeed, increased prevalence of
chronic disease risk is associated with a high consumption of ultra-processed food
products(11, 12), not with food groups as such, like fruits, vegetables, dairy. This is well
illustrated by the Western and Mediterranean diets, the former being characterised by a
high quantity of ultra-processed products and higher risk of chronic diseases, and the
latter by a high quantity of minimally-processed products and a lower risk of chronic
diseases.
4 Defining food health potential based not only on nutrient density but also on food
structure properties, vital to satiety, the synergy of nutrient physiological actions, and
nutrient bioavailability(13-15), Nutrient composition is not sufficient. Food structure
indices should now be developed, according to the extent which food is broken down,
(16) and degree of satiety (17).
5 Shaping the framework or design of human interventional studies. When these are based
and derived from a pharmacological approach or design (7) they do not correspond to
real life and are not really applicable in preventive nutrition. New and future intervention
studies should be of ‘real life’ situations, including quality of life, emotional factors,
energy input and output (physical exercise), and also environmental impacts.
Acceptance and use of a holistic paradigm for epidemiological studies, and for
characterising food health potential, is now necessary and indispensable. Nutrition
education, based on food health potential according to degree of processing,
including the role of food structure and nutrient density, should be promoted in
primary and high schools and universities. In this way populations will be well-armed
against the pressure of corporate advertising of harmful products.
A holistic vision of diets should encompass their global health effects, and their
environmental impacts and socio-economic and cultural aspects. The definition of
what is a healthy diet should not be dogmatic and normative, implying only one type
of diet. By adapting to specific local or regional realities, it should respect cultural
habits, religious beliefs, environment, the pleasure of eating, and also the well-being
of farm animals. Healthy and sustainable diets are plant-based; dietary energy from
food of animal origin should amount at most to one-sixth of total intake (18).
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References
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Scrinis G. Nutritionism. Columbia University Press, 2013.
Jacobs DR, Tapsell LC. Food, not nutrients, is the fundamental unit in nutrition.
Nutrition Reviews 2007, 65: 439-450. Access pdf here
Fardet A, Rock E Towards a new philosophy of preventive nutrition: from a
reductionist to a holistic paradigm to improve nutritional recommendations.
Advances in Nutrition 2014, 5, 430-446. Access pdf here
Monteiro CA, Moubarac JC, Cannon G, Ng SW, Popkin B. Ultra-processed
products are becoming dominant in the global food system. Obesity Reviews 2013, 14,
S2: 21-28.
Fardet A. New approaches to studying the potential health benefits of cereals: from
reductionism to holism. Cereal Foods World 2014, 59: 224-229.
Fardet A, Rock E. The Healthy Core Metabolism: a new paradigm for primary
preventive nutrition. The Journal of Nutritional Health & Aging 2015. DOI:
10.1007/s12603-015-0560-6.
Fardet A, Rock E. The search for a new paradigm to study micronutrient and
phytochemical bioavailability: from reductionism to holism. Medical Hypotheses 2014,
82: 181-186.
Fardet A Are technological processes the best friends of food health potential?
Advances in Nutrition and Food Technology 2014, 1: 103.
Fardet A. Foods and health potential: is food engineering the key issue? Journal of
Nutritional Health & Food Engineering 2014, 1 : 1-2.
Moubarac J-C, Parra DC, Cannon G, Monteiro CA. Food classification systems
based on food processing: significance and implications for policies and actions: a
systematic literature review and assessment. Current Obesity Reports 2014, 3: 256-272.
Monteiro C, Cannon G, Levy RB, Claro R, Moubarac J-C. The big issue for
nutrition, disease, health, well-being. World Nutrition 2012, 3: 527-569.
Moubarac JC, Martins APB, Claro RM, Levy RB, Cannon G, Monteiro CA).
Consumption of ultra-processed foods and likely impact on human health. Evidence
from Canada. Public Health Nutrition 2013, 16: 2240-2248.
Fardet A. A shift toward a new holistic paradigm will help to preserve and better
process grain product food structure for improving their health effects. Food &
Function 2015, 6: 363-382.
Fardet A. Food health potential is primarily due to its matrix structure, then nutrient
composition: a new paradigm for food classification according to technological
processes applied. Journal of Nutritional Health & Food Engineering 2024, 1: 31.
Fardet A. Nutrients, nutrition, nourishment. See and enjoy food whole. World
Nutrition 2015, 6: 269-279.
Bornhorst GM, Ferrua MJ, Singh RP. A proposed food breakdown classification
system to predict food behavior during gastric digestion. Journal of Food Science 2015,
80: R924-R934.
Holt SH, Miller JC, Petocz P, Farmakalidis E. A satiety index of common foods.
European Journal of Clinical Nutrition 1995, 49: 675-690.
Agrimonde. Agricultures et alimentations du monde en 2050 : scénarios et défis
pour un développement durable (note de synthèse). INRA & CIRAD, 2009.
Fardet A. WN Project Phoenix. Shifts to a holistic paradigm
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WN Project Phoenix
From facts to wisdom
Colin Tudge
Wolvercote, Oxford, UK
Email: colin@colintudge.co.uk
Access Colin’s profile here
‘Facts alone ar wanted in life’, asserted the ferocious Dickensian schoolteacher Thomas Gradgrind.
Only now is nutrition and biological science generally freeing itself from such rigid narrow confines
Apparently people are asking, ‘Has nutritional science run its course? Have we
answered all the main questions and should we move on?’
Of course not, is the short answer. In similar vein, Lord Kelvin (allegedly!) suggested
at the end of the 19th century that physics was all done and dusted, apart from
polishing up the odd coefficient. Then Albert Einstein came up with relativity and
Max Planck made the observations that kicked off quantum theory, and physics, and
indeed the whole world, were never the same again. There was still a lot to do even
within the classical, Newtonian framework of the 19th century. More to the point,
physics (and science, and all philosophy and art) were about to undergo what the
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American philosopher of science Thomas Kuhn has called a ‘paradigm shift’: a
complete change of perspective.
Within ‘conventional’ nutrition too there is still a lot to be done. But the perspective
of the whole science – indeed of all biology – is shifting. What we have seen so far, as
Winston Churchill said of World War II in 1941, is merely the end of the beginning.
Cryptonutrients
The past few decades have seen at least three huge developments within nutritional
science itself. The first is the rising interest in what the pharmaceutical industry calls
nutraceuticals, and the food industry calls functional foods – though stripped of all
their commercial baggage they are properly called ‘cryptonutrients’.
These include what surely will prove to be many thousands of materials obtained
from food in minute quantities that are not exactly essential to health, in the way that
vitamins are, but which in some people at least are beneficial. Very obvious examples,
already well commercialised, are the plant sterols that often seem to lower blood
cholesterol. (Relative) lack of plant sterols will not incapacitate or kill people in the
short to medium term, as deficiency of vitamin C or A will do, but it might on
average knock a year or two off people’s livws, and line them up for chronic arterial
disease that they might otherwise have avoided, and generally reduce their vigour.
Thus, in action, a cryptonutrient is somewhere between a vitamin and a tonic.
If there is such a thing as a cryptonutrient, and there surely is, there could be many
thousands of them. Furthermore, they will not operate in isolation, any more than any
other nutrient or drug can do. Always, therefore, we will be looking at cocktail effects;
and then the number of possible combinations approaches infinity. The effects on
health will be elusive (how can you tell if a person’s life has been lengthened or
shortened by a small percentage? None of us come with doppelgangers to act as
controls) and will vary from person to person, so it is very difficult to gauge the effect
of any one cryptonutrient.
Given that there are probably many thousands, and a virtual infinity of combinations,
there is not enough time left in the universe to pin down with anything resembling
certainty what they all do, even if we spent the global gross national product on the
research. So some scientists of the hard-nosed type may be wont to give up on
cryptonutrients (except perhaps for commercial purposes). But biologically speaking,
their existence and their significance is perfectly plausible, and indeed is to be
expected.
Our physiology is much older than is the human species. Much of it is inherited from
our pre-human ancestors, going back to our fishy days and before that to our
protozoan and even to our prokaryote days. The evolutionary history of each and
every one of us stretches back for nearly four billion years. Through all that time our
ancestors have adapted to everything the world threw at them (either that, or endured
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and possibly died) and that would have included billions of recondite molecules
produced not least by other organisms, many of them pharmacologically potent.
Our ancestors must have evolved mechanisms to cope with whatever was potentially
toxic, and – for evolution is marvellously opportunistic – in many cases would have
turned whatever came their way to their own advantage. The classic example is
oxygen. This is horrendously active, and the mother of all toxins for creatures not
adapted to it, but is now essential to all the forms of life that we presume to call
‘higher’. Without aerobic respiration we’d still be living in swamps. (But still we have
to load our bodies with anti-oxidants).
So on such albeit arm-waving evolutionary grounds alone, it seems that
cryptonutrients must be a fact of life. God only know what, over time, our ancestors
have been exposed to, and what they have become adapted to.
Yet for logistic reasons– there are too many of them, and their effects are very
difficult to pin down and undoubtedly vary from person to person – our knowledge
of cryptonutrients must always be broad brush; either that, or confined to a very
short shortlist of the more conspicuous kinds that can be turned to commercial
advantage. The best we can say in practice is that animals, including us, ought to seek
out a diet that is as various as possible.
Wild animals know this of course. Lions relish the guts of their prey and may leave
the steaks for the vultures, while cattle and sheep given the chance eat a huge variety
of herbs – and browse! – and when plied exclusively with custom-bred pasture and
fed with nutrients and supplements measured to the nearest gram they still grow sick.
They miss the variety, though the variety is full of unknowns. (There is at least
anecdotal evidence that cattle allowed access to wild vegetation are less susceptible to
bovine tuberculosis).
Gut biota
A second revelation has been the role of microbes in human nutrition and health in
general. Dietary fibre turns out to be important largely because of its effects on the
gut flora, which in turn among other things profoundly affect the nature of various
organic molecules, including bile salts, that are reabsorbed from the gut and re-cycled.
Nature these days is full of articles describing the response of the flora in the gut and
on the skin, to changing diets and other circumstances, and the knock-on effects are
only beginning to be glimpsed. That cattle and other ruminants – and indeed all
herbivores – depend absolutely on their gut flora has long been appreciated (though
far from fully understood) but now it is obviously true of all species. By the same
token, soil scientists now appreciate more and more that the organic farmers were
right all along. The structure of the soil and the health of plants depends at least as
much on the microbes that live in it as on the inorganic radicals that conventional
agriculturalists take more seriously, that farmers are encouraged to add.
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This elephant is not dead, but drunk, having raided a beer factory. Fermentation is a fascinating
food process. It can enhance nutritional quality, and create delicious including psychoactive products
Microbes, in short, are emerging as the universal intermediaries between macroorganisms like us and oak trees, and the physical world. They are key players in our
personal ecospheres. Antisepsis has its place beyond doubt, but the attempt to
sterilise the whole world that pervaded both medicine and agriculture through much
of the 20th century can now be seen to be counter-productive, or at least was taken
much too far. My Granny used to say, ‘Eat a peck of dirt before you die’, and she was
surely right; advice reflected not least in the modern vogue for dosing patients on
faecal extracts. Eating dirt can be risky, of course, if unsupervised, but so can too
much cleanliness. All in all, the microbiology of nutrition is a huge and exciting area.
The streams of cryptonutrients and of microbiology converge in the endlessly
complex realms of fermentation. Fermented foods include some of the most
important and most delectable of all our provender (bread, cheese and all the other
fermented milks, booze, pickles from chutney to sauerkraut, tempeh, miso, and so on
and so on) and also some of the most toxic.
The line between delectation and putrescence can be very narrow. Wild animals too
benefit from fermented foods – from the many famous tales of drunken elephants
(they raid palm wine factories and sorghum beer breweries), to Keats’s drowsy
autumn wasps zonked on mouldering pears. I reckon too, teleologically speaking, that
dogs bury bones not simply for storage but to increase their pharmacological value.
Who knows what cryptonutrients and antibiotics and all the rest may reside in a
stinky skeleton.
What is ‘truth’?
Thirdly, in all biology, I am struck by the rise of the idea of narrative, with its often
anthropomorphic undertones, into respectable discourse. The biology I studied at
university in the early 1960s was obsessively hard-nosed. It seemed to be assumed (as
many still maintain) that science was leading us inexorably towards omniscience.
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Buoyed up by logical positivism, it was taken to be obvious too that all other sources
of knowledge were inveterately flaky, and were best ignored. As Thomas Gradgrind
insisted in Dickens’s Hard Times, ‘Now, what I want is, Facts… Facts alone are
wanted in life. Plant nothing else, and root out everything else’. A fact was perceived
as whatever could be directly observed and measured. Mathematical extrapolation
would take care of the rest.
In biology, in this vein, the great enemy was anthropomorphism. We were not
allowed to ascribe human-esque concepts to non-human beings. In the experimental
psychology course, the concepts of thought or emotion were banished. Animals were
just machines that responded to stimuli, as Descartes asserted in the 17th century;
and we humans, were somewhat more complicated machines. ‘Stick to Facts, Sir!’, as
the redoubtable Thomas had put the matter.
Now the attitude has become more nuanced. What is a fact, exactly? (In a court of
law it’s what the judge says it is. The rest is ‘inadmissible’). How can we be certain of
anything? More broadly, it seems that everything we know or think we know is a
story that we tell ourselves – a narrative; and what we take to be ‘true’ is a story we
happen to find convincing. More specifically, it becomes more and more obvious that
the old Cartesian view of animals as just responsive machines does not work. Like us
– like all organisms in fact, conscious or not – they make sense of the world by telling
themselves stories, and are in this crucial sense intelligent.
Intelligent beings, whether human beings or oak trees, differ from mere machines
because they do not simply react according to the Newtonian laws of physics, to the
stimuli with which they are confronted. Their responses are highly selective. They
ignore some stimuli altogether (just as high court judges do) – oak trees and
mushrooms have a great sense of what is irrelevant and what really counts – and they
infer far more from some stimuli than the stimulus itself seems to warrant. In other
words they treat all incoming data as grist to their own internal narrative. Machines
do not.
The wisdom of uncertainty
This principle is very evident in the science of nutrition. Thus it has been clear for
many decades (even when I was at university) that the feeling of hunger does not
depend only on the amount of sugar in the blood. There are all kinds of other
physiological and sensory cues, including extraneous sights and smells. But what
perhaps matters most of all is expectation and attitude. Fasting is an obvious example.
Many aboriginal peoples are forced to fast for some weeks of each year, and to get
through it they seem simply to decide that they don’t want to eat. When there isn’t
any food, that may seem straightforward enough, but fasting westerners can adopt the
same technique even though surrounded by petits fours and croquembouche.
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The conscious mind tells the body that food is forbidden and the body obliges by not
asking for any, or sometimes may decide for itself. Either way, something we may
vaguely call ‘mind’ mediates food intake, and to an unknown extent determines our
response to the food we do consume. ‘We are what we eat’ is not quite true. The
metaphor is altogether too mechanical. What we eat or decide not to eat can be seen
as a sub-plot of our own internal narrative, or as part of our body’s grand dialogue
with the world at large (in which our conscious minds may play very little part).
The concept of cryptonutrients and the renewed appreciation of microbes are internal
shifts in the science of nutrition that present huge challenges and possibilities. The
general realisation that life is too complicated to analyse exhaustively, and that the
future is innately unpredictable, is a true paradigm shift that affects all science. It
knocks on the head forever the 18th century Enlightenment conceit that we are
edging inexorably towards omniscience. The idea that all our understanding in the
end is narrative, a story that we tell ourselves, including the insights of science, is both
chastening and exciting. Life remains mysterious, and always will be.
The paradigm shift extends, or should extend, to all of life. For these past 200 years
or so westerners have tended to put science on a pedestal, to look to it as the source
not only of remarkable insights, which it does provide, but also of wisdom, which it
does not. Thus politicians and tycoons speak of ‘science-led policy’, by which they
mean for example that if some trial shows that some genetically engineered crop
grows better in some circumstances than ‘conventional’ crops do, and is potentially
profitable, then we should put political weight (and taxpayers’ money) behind it.
But if they could only see that science itself deals in partial truths and innate
uncertainties, and is itself a narrative, they surely would put it more into perspective.
They surely would see that the people who have been living and coping with innate
uncertainty for 10,000 years – traditional farmers – are telling a richer narrative,
precisely because, however extensive their knowledge, in the end they know they
must trust their intuitions. Cooks do the same – and physicians too. They know they
must work with uncertainty. They are guided by science but in the end they rely on
intuition.
So the science of nutrition stands where all sciences ought to stand. Not pretending
to omniscience. Not seeking to override all other sources of knowledge. Accepting its
own innate limitations, and content to contribute its own special insights to the
general wellbeing of humanity and the biosphere. That is a far more realistic agenda
and much to be preferred.
Tudge C. WN Project Phoenix. From facts to wisdom
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Food and nutrition insecurity
Let’s get serious
George Kent
University of Hawai’i, USA
Email: kent@hawaii.edu
Access July-August 2015 Guest editorial Thomas Pogge on world hunger data here
Thomas Pogge’s WN guest editorial World hunger books are cooked (1) is right on target.
The goalposts for ending hunger have been moved repeatedly, usually to the
disadvantage of the hungry. I add three points.
1.
The annual report on The State of Food Insecurity in the World and the agencies
that produce it, the Food and Agriculture Organization of the United Nations and
the Committee on World Food Security, ignore the food security of infants and
young children.
The Lancet reports that about 45 per cent of all child deaths are related to malnutrition
(2), which means currently there are about three million nutrition-related deaths of
children each year. It is a problem in high-income as well as low-income countries.
One study estimates that in the US alone, optimal breastfeeding would prevent more
than 900 deaths per year (3). These children die and therefore do not show up in the
food insecurity numbers. The malnourished children who don’t die are not
mentioned either. Thus the category of people most vulnerable to food insecurity is
ignored.
2
There should be more discussion about why these data are collected. How
are they to be used, by which agencies, using what tools and resources?
A serious plan is one that can be expected to achieve its purpose. It is not that the
plans for ending hunger have been tried and failed, but rather that there have been
no serious plans for ending or sharply decreasing hunger in the world. The problem
is illustrated by the approach taken for achieving the Millennium Development
Project’s goals relating to hunger (4). Reading that would not lead one to confidently
expect that the project’s goals would be achieved
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Given its mandate, FAO ought to take a strong lead in facilitation of plans to end
hunger in the world. It has not done so, understandably. As Thomas Pogge suggests,
the powerful countries that support FAO are not that interested in ending hunger in
the world. They do care about the hunger problem, but not enough. If the countries
that are the FAO’s major drivers are not particularly interested, there really is not
much FAO can do.
3
We should reflect on how hunger data might be used. After all, it is through
use that data become truly meaningful.
Pursuing a goal requires steady monitoring and feedback, not just an occasional
social audit. Monitoring tells you where you are and allows you to compare that with
where you want to be. To get your boat to a chosen port, you need a navigator and
some means for steering. If navigators find they are going in the wrong direction or
not going at all, do something different (5).
If there were serious plans for ending hunger, the purpose of data collection would
be to guide action in an identifiable way. There is little value in collecting data when it
does not enable and empower specific actors who control relevant resources.
Any serious plan for ending hunger should be about finding ways to strengthen the
capacities for monitoring and steering at global and at national and subnational
levels, including the community level. All hunger is local. In strong communities, no
one goes hungry (6). Monitoring is most meaningful when it guides steering.
Maybe the best way to end hunger globally is to end hunger locally, everywhere, by
building local communities’ capacity and motivation for taking care of their own.
Global and national agencies could help to make that happen, through a coherent
integrated plan based on supporting local action by local people. Given the dismal
historical record with other approaches, this is worth a try.
References
1
2
3
4
5
6
Pogge T. World hunger books are cooked. [Food and nutrition insecurity] [Guest editorial]
World Nutrition July-August 2015, 6, 7-8, 555-557.
Black R, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, Ezzati M.
Maternal and child undernutrition and overweight in low-income and middle-income
countries. The Lancet 2013, 9890, 427-451.
Bartick M, Reinhold A. The burden of suboptimal breastfeeding in the United States:
a pediatric cost analysis Pediatrics. 2010, 125, 5, 1048-1056.
Millennium Project. Halving Hunger: It Can Be Done. London: Earthscan, 2005.
Kent G. Steering an ungainly ship. Economic &Political Weekly 2012, 47, 37, 32-34
Kent G. How to end hunger. Food systems, agriculture, society. World Nutrition 2015, 6, 3,
170-183.
Kent G. Let’s get serious.[Food and nutrition insecurity]
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Food and nutrition insecurity
Let’s be proportionate
Claus Leitzmann
University of Giessen, Germany
Email: claus@leitzmann-giessen.de
Access July-August 2015 Editorial on professional integrity here
Access July-August 2015 Guest editorial Thomas Pogge on world hunger data here
The WN editorial and guest editorial (accessible above) are important contributions
to the much needed debate about the appropriate course of action regarding data
collection in general and its statistical interpretation in particular.
Recently the increasing numbers of forged data even in reputable scientific peer
reviewed scientific journals was a popular and welcome topic in and for the media.
This reprimand is a necessary occasional purgative, but now it has reached a
dimension that leaves the impression that all and any publication contains unreliable
information. It is the typical pendulum effect that by now may have reached its
highest amplitude. Although the accusations should be taken seriously, all honest
researchers are placed under strong suspicion. Let us be fair to this majority.
As far as the global number of malnourished and hungry people is concerned, there
cannot be reliable numbers. Anyone who is familiar with the infrastructure of
economically poor countries has experienced the frustration to get reliable data as
soon as it covers an area larger than a village or two. And does it really make a
difference to the willingness of economically affluent countries whether they are
asked to support efforts to help in reducing the misery of 800,000 or 900,000
hungry? These numbers are beyond realistic comprehension for most people.
My experience is anyhow that it is the individual dramatic case presented in the
proper setting that motivates decision makers to help and the population in general
to support financial and material actions. So let us not get carried away and keep
a sense of proportion.
Leitzmann C. Let’s be proportionate. [Food and nutrition insecurity]
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Mother and child nutrition. UNICEF
Business as usual
Ted Greiner
Hanyang University, Seoul, South Korea
Email: tedgreiner@yahoo.com
Access June 2015 UNICEF report on scaling up nutrition here
I see UNICEF's new strategy on scaling up nutrition for mothers and their children
(access this above) as an update that responds to changing realities. It correctly
identifies the major current problems as stunting and overweight. Scarce resources
should be focused in that direction, as well as adolescent girls, as the document says.
Like many others, I argued for years that 2-5 is actually the most privileged age. Most
important is the 1000 days, then adolescent girls, then schoolchildren, especially
boys, who tend to be worse off with respect to parasitism and underweight than
school-age girls.
It's sad but reflective of current reality that when UNICEF lists all the important
partners and agencies it works with and through, the UN Standing Committee on
Nutrition is not even mentioned. I fear these days that saying one is involving all the
‘stakeholders’ and ‘partner’ is a cover for engagement in so-called ‘public-private
partnerships’. As far as I know, transnational and other corporations are not yet
actually contributing much money in useful ways. All who work in the public interest
should oppose all this kind of partnering, which potentially gives food product and
nutrient corporations access and influence in policymaking settings that ought to be
regulating their behaviour.
In theory there would be no objection if non-conflicted companies (say those
producing paper or shoes) directed charitable funding toward nutrition instead of
something else. But we all know it rarely works that way.
There are limitations in the ways UNICEF is able to work. I also recognise that
treatment of severe acute malnutrition may be useful for fundraising, and that it is a
real need, one which has been relatively neglected. Still, UNICEF's current and
planned heavy focus on the use of ready-to-use therapeutic food (misleadingly calling
it ‘community based’ when ‘home-based’ is more accurate in most cases) is
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problematic. After all, this does not respond to either of the major problems to
which UNICEF says it will give top priority --stunting and overweight!
SUN rises
One of the World Bank's early arguments for the project that became Scaling Up
Nutrition (SUN) was that we nutritionists had to present a cohesive front, focusing
on the things we agree on, if we wanted governments and donors to listen to our call
for increased attention to the issue.
That's probably true, and probably was a non-politically intended message. But, as
with the Millennium Development Goals, the lowest common denominator ends up
meaning that most of the structural basic causes of malnutrition, and some of the
underlying causes too, tend to get relatively ignored, with product-based approaches
aimed at immediate causes getting ever-increasing attention. Those of us who object
to this have no political influence in a climate dominated by ‘neo-‘liberalism’,
together with alarming widespread ignorance of its very existence as a leading force
and political ideology.
All that said, as with documents issued by SUN, the authors of documents like this
new one from UNICEF, know how to weave in all the right words and phrases.
Who can object to ‘rights-based’, ‘community-oriented’, ‘capacity building’,
‘evidence-based approaches’? The crucial question will be whether those phrases in
turn guide budgetary allocations, or at least are able to empower those who want to
implement more human rights-based approaches. or if they will remain windowdressing, providing a cover for continuing with business as usual.
Greiner T. Business as usual.(Mother and child nutrition, UNICEF)
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