Is Food the Answer to Malnutrition? - The Oxford Topic of Food, Politics, and Society - page 412

which basically describes the association between health in utero and the first weeks of
life with health outcomes during adulthood (see Barker (1994), and Godfrey and Barker
(2000)). The epidemiological evidence in this regard is explained by what is often
referred to as the thrifty phenotype concept (Hales and Barker 2001). It posits that poor
nutritional status in utero will contribute to impaired development and function of β
-cells and insulin-sensitive tissues. In combination, this will result in increased insulin
resistance later in life and subsequent deleterious outcomes such as diabetes and cardio-
vascular disease.
A number of recent studies have elucidated this relationship, including the work of
Almond (2006), Almond and Chay (2006), Barker (2006), and Godfrey and Barker
(2000). It is a challenge to disentangle the mechanisms or causal components of these
correlations, because issues such as genetic endowment and unobservables may partly
explain these relationships. But what is quite clear is that there are intergenerational
determinants of health status, and that fetal malnutrition is an important factor deter-
mining health deficits later in life. Although food intake, and specifically, diseases of
affluence associated with a diet high in calories, refined sugars, and saturated fats, may
affect the probability of nutrition-related chronic disease of adults, it is the interaction
of the diet in the more immediate term with health inputs that go back to the prenatal
period that will be critical in determining nutritional outcomes later in life. Again, fail-
ure to appreciate this has potentially serious implications for our understanding of the
relationship between food consumption and nutritional outcomes.
An important implication of taking this life-course perspective is that it highlights
the particular importance of nutritional outcomes early in childhood. This point has
been forcefully made in a number of recent academic and policy documents, including
a recent series of papers in he Lancet that emphasizes that the period of greatest vulner-
ability to becoming malnourished and suffering short- and long-term functional conse-
quences, is just before birth and during the first two years of life (Black et al. 2008). This
has led to a rethinking of nutritional strategies by a range of international organizations,
such as the World Bank who has refocused their nutrition initiatives on the period from
in utero through the child's first 24 to 36 months of life. Consequently, and consistent
with the nutrition production function presented earlier, the design of programs and
interventions gives primacy to inputs such as breastfeeding behavior, the quality of child
care and nurturing behaviors, the sanitary and home environment, and provision of
micronutrients through supplementation programs, all of which are of critical impor-
tance in determining nutritional outcomes of this most vulnerable group. This contrasts
with the reduction in efforts such as school feeding programs, that might be effective
incentives for getting children to enroll and remain in school, but which are unlikely to
be effective in combating malnutrition and its short- and long-term consequences.
Another lesson that can be gleaned from the production function is that the inputs in
the production of nutrition are substitutes. Likewise, changes in prices, such as for health
care and food, will affect the household choices regarding the availability of inputs, oper-
ating through the input demand functions such as those for nutrients in Equation (2).
One price, which is of particular importance and often not fully appreciated in terms of