Is Food the Answer to Malnutrition? - The Oxford Topic of Food, Politics, and Society - page 411

of community-level factors affecting the nutritional environment, ranging from public
investments in schools and latrines to the efforts to control communicable disease to
public information campaigns regarding healthy food choices. Education also enters the
model, both directly and through its impact on how inputs are used to affect nutritional
outcomes. Likewise, individual characteristics, such as gender and age, are also repre-
sented in the model. There are also “unobservables,” such as genetic makeup or innate
healthfulness that influence nutritional outcomes. Some of these unobservables are ran-
dom. Others, however, may be correlated with observed factors that represent a major
challenge for modeling this production function.
There are several salient features of this production function that merit closer con-
sideration. First, the vector of nutrients is one of a long list of inputs that affect nutri-
tional outcomes. Too often, consumption of food, and even nutrients, is confused with
nutritional status. This is a serious mistake that has contributed to considerable confu-
sion in terms of the relationship between food security and intake, on the one hand, and
nutritional outcomes, on the other. In fact, as expanded on below, the conflating of food
consumption, or nutrient inputs, as described earlier in the production function, with
nutritional outcomes has often led to distortions and inefficiencies in policies that are
purportedly designed to reduce malnutrition. It is not uncommon for policymakers to
talk about improving nutrition, when they really are focused on food consumption, or
even worse, food availability or production. Thus, the concept of food security is two
steps removed from nutritional outcomes: (1) food security is about access, not actual
consumption of food. Behaviors at the household or individual level may contribute to
inadequate nutrient intake in a food secure household; and (2) as pointed out, even if
food security translates into increased or adequate nutrient consumption, it is just one
of many inputs that determine nutritional outcomes.
Second, although the nutrition production function can be estimated at any specific
point in time, as noted earlier, it is a dynamic construct and characterized by consider-
able path dependency. That is, this production function is not fixed, and changes over
the life course. And similarly, a properly specified nutrition dynamic production func-
tion incorporates the fact that current nutritional status depends on all current and
prior inputs.
The reason that I emphasize this point is illustrated by appreciating the role of pre-
natal events in terms of nutritional health across the life course and generations. In the
short-term, the impact of prenatal health and, thus, nutrition of the fetus is critical in
determining the nutritional status of the newborn and during its first couple of years
of life. The fact that stunted mothers, for example, are far more likely to have stunted
children suggests that far greater attention be accorded to the provision of prenatal
care and the prevention of maternal morbidity. However, the problem of malnourished
mothers giving birth to underweight children who are more susceptible to the ravages of
undernutrition is not the entire story. There is now a great deal of evidence that chronic
nutrition-related diseases such as obesity, diabetes, and cardiovascular diseases that
appear late in life are, in part, a consequence of nutritional deficits in utero and early
in life. More specifically, increasing attention has been given to the Barker hypothesis,