Is Food the Answer to Malnutrition? - The Oxford Topic of Food, Politics, and Society - page 415

in terms of appearance, palatability, and other nonnutrient characteristics) in combina-
tion contribute to a higher unit cost per calories as incomes rise. This increased diversity
may also help address nutrient deficits other than calories, such as proteins, although the
evidence about income elasticities of nutrients other than calories is much less clear. The
important point we can glean from this discussion is that at least at the household level,
even the poorest households in the most underdeveloped economies will spend most of
any increment in income in ways other than increasing the quantity of food and calories
consumed. This reinforces the importance of targeted nutrition programs, beyond efforts
to raise income and reduce poverty, to reduce levels of malnutrition at a pace that is con-
sistent with achieving the Millennium Development Goals for 2015.
It is noteworthy that this household level data is consistent with the macro story of
relatively modest short-term impact of GDP growth and poverty reduction on alleviat-
ing malnutrition. Although there is strong evidence that health improves with income
(see, for example, Pritchett and Summers (1996) and Sala-i-Maartin (2005)), the accu-
mulated evidence over the past nearly 40 years suggests that even if there is rapid GDP
growth, malnutrition in developing countries will persist (Berg 1981; Reutlinger and
Selowsky 1976; Alderman et al. 2003).
At the same time, there are other important global implications of the move to “higher
quality” of food as incomes rise. Most obvious is the spectacular rise in global demand
for meat and dairy products, as well as processed food. The implications of these changes
are profound. They range from the more proximal effects on food prices for staple grains
and the supply chain that affects both the earnings of, and prices paid by, small and sub-
sistence farmers as well as net consumers of their products, to the implications for the
demand for fossil fuels and thus the potential for climate change. In addition, as I dis-
cuss later, the dietary shifts that are occurring, as populations in India, China, and else-
where adapt western diets and are integrated into the global food marketing chain of
large retailers and restaurateurs, will have direct health implications as a result of dietary
change, which will lead to increased burden associated with chronic disease.
In sum, the short-term efforts to raise incomes and promote improved food security
are not likely to be effective means of reducing malnutrition. Indeed, over the long-term,
broad-based economic growth that reduces poverty and food insecurity is crucial. But,
as illustrated by the figures on the dual burden of disease, the reality is that malnutri-
tion is widespread in environments with high levels of food security and even where
poverty is relatively low. This reflects problems such as failure of mothers to get appro-
priate care and take appropriate measures to ensure their health during pregnancy;
failure to exclusively breastfeed for children under six months of age; the late introduc-
tion of complementary solid foods; high prevalence of infectious disease; inappropriate
care for children suffering from diarrheal disease and other infections; poor hygiene
and lack of access to clean water; mothers being too busy to provide for the proper care
of their newborns and young children, and so forth. Thus, the micro and macro story
also suggests the paramount importance of nonfood-related direct measures to allevi-
ate malnutrition, ranging from immunizations and micronutrient supplementation and
fortification to other targeted health and nutrition services.