Escaping Hunger, Escaping Excess.

AuthorGardner, Gary

The big myth of malnutrition is that it's a problem of poor countries. But in world at once rich in food and filled with poverty, malnutrition now has many faces -- all over the world.

TODAY, ETHIOPIA AND ITS neighbors are once again in the grip of an unrelenting famine, which has left more than 16 million people on the brink of starvation. After a massive international mobilization to aid this region in the 1980s, the Horn of Africa has become synonymous with famine and malnutrition. But across the Atlantic Ocean, another county is currently facing an epidemic that has left not tens of millions, but more than 100 million people malnourished--a quarter of them morbidly so. This growing problem receives little attention as a public health disaster, despite warnings from health officials that malnourishment has reached epidemic levels and has left vast numbers of people sick, less productive, and far more likely to die prematurely.

In this country--the United States--55 percent of adults are overweight and 23 percent are obese. (Definitions of obesity and overweight are not arbitrary, but are based on the internationally accepted standards. See map, pages 30-31.) The medical expenses and lost wages caused by obesity cost the country an estimated $118 billion each year, the equivalent of 12 percent of the annual health budget. Being overweight and obese are major risk factors in coronary heart disease, cancer, stoke and diabetes. Together these diseases are the leading killers in the United States, accounting for half of all deaths.

Misconceptions of hunger and overeating abound worldwide. We tend to think of hunger as resulting from a desperate scarcity of food, and we imagine it occurring only in poor counties. However, in those nations in Africa and South Asia where hunger is most severe, there is often plenty of food to go around. And even food rich nations are home to many underfed people.

Meanwhile, as the concept of malnutrition stretches to encompass excess as well as deficiency, wealthy nations are seeing rates of malnourishment that rival those in desperately poor regions. And overeating is growing in poorer nations as well, even where hunger remains stubbornly high. In Colombia, for example, 41 percent of adults are overweight, a prevalence that rivals rates found in Europe. While hunger is a more acute problem and should be the highest nutritional concern, overeating is the fastest growing form of malnourishment in the world, according to the World Health Organization (WHO). For the first time in history, the number of overweight people rivals the number who are underweight, both estimated at 1.1 billion.

Because myth and misconception permeate the world's understanding of malnutrition, policy responses have been wildly off the mark in addressing the problem. Efforts to eliminate hunger often focus on technological quick fixes aimed at boosting crop yields and producing more food, for example, rather than addressing the socioeconomic causes of hunger, such as meager incomes, inequitable distribution of land, and the disenfranchisement of women. Efforts to reduce overeating single out affected individuals-- through fad diets, diet drugs, or the like--while failing to promote prevention and education about healthy alternatives in a food environment full of heavily marketed, nutritionally suspect, "supersized" junk food. The result: half of humanity, in both rich and poor nations, is malnourished today, according to the WHO. And this is in spite of recent decades of global food surpluses.

Malnutrition has become a significant impediment to development in rich and poor countries alike. At the individual level, both hunger and obesity can reduce a person's physical fitness, increase susceptibility to illness, and shorten lifespan. In addition, children deprived of adequate nutrients during development can suffer from permanently reduced mental capacity. At the national level, poor eating hampers educational performance, curtails economic productivity, increases the burden of health care, and reduces general well-being. Confronting this epidemic of poor eating will have widespread benefits, but first the myths that obscure the causes of malnutrition must be dispelled.

The Scarcity Myth

IN THE EARLY 1980s, the world was flooded by news of hunger and death from the Horn of Africa. By 1985, nearly 300,000 people had died. But international observers paid little attention to the fact that in the midst of famine, these countries were exporting cotton, sugar cane, and other cash crops that had been grown on some of the country's best agricultural land. While only 30 percent of farmland in Ethiopia was affected by drought, ubiquitous images of emaciated people surrounded by parched land have served to reinforce the single largest myth about malnutrition: that hunger results from a national scarcity of food.

Indeed, for more than 40 years the world has produced regular and often bountiful food surpluses--large enough, in fact, to prompt major producing countries like the United States to pay farmers not to farm some of their land. Indeed, the Food and Agriculture Organization (FAO) estimates that 80 percent of hungry children in the developing world live in countries that produce food surpluses. And only about a quarter of the reduction in hunger between 1970 and 1995 could be attributed to increasing food availability per person, according to a study by the International Food Policy Research Institute (IFPRI).

This is not to say that scarcity might not one day become the principal source of hunger, as population growth and ongoing damage to farmland and water supplies shrink food availability per person in many countries. Countries like Nigeria and Pakistan, which are on track to double their populations in the next 50 years, have already seen stocks of surplus food erode steadily in the 1990s. And countries such as India, which overpump groundwater to prop up agricultural production, will be hard pressed to maintain self sufficiency once aquifers run dry or become uneconomical to pump. But for the billion or so people who are hungry today, the finger of blame points in other directions.

Hands down, the major cause of hunger is poverty--a lack of access to the goods and services essential for a healthy life. Where people are hungry, it's a good bet that they have little income, cannot gain title to land or qualify for credit, have poor access to health care, or have little or no education. Worldwide, 150 million people were unemployed at the end of 1998, and as many as 900 million had jobs that paid less than a living wage. These billion-plus people largely overlap with the 1.1 billion people who are underweight, and for whom hunger is a chronic experience. And nearly 2 billion more teeter at the edge of hunger, surviving on just 2 dollars or less per day, a large share of which is spent on food.

Hunger, like its main root, poverty, disproportionately affects females. Girls in India, for example, are four times as likely to be acutely malnourished as boys. And while 25 percent of men in developing countries suffer from anemia, a condition of iron deficiency, the rate is 45 percent for women--and 60 percent for those who are pregnant. This gender bias stems from cultural prejudices in households and in societies at large. Most directly, lean rations at home are often dished out to father and sons before mother and daughters, even though females in developing countries typically work longer hours than males do. Gender bias is also manifest in education. Inequitable schooling opportunities for girls lead to economic insecurity: women represent two-thirds of the world's illiterate people and three-fifths of its poor. With fewer educational and economic opportunities than men, women tend to be hungrier and suffer from more nutrient deficiencies.

Any serious attack on hunger, therefore, will aim to reduce poverty, and will give special attention to women. The IFPRI study on curbing malnutrition found that improving women's education and status together accounted for more than half of the reduction in malnutrition between 1970 and 1995. Such nutritional leverage stems from a woman's pivotal role in the family. A woman "eats for two" when she is pregnant and when she is nursing; pull her out of poverty, and improvements in her nutrition are passed on to her infant. But there's more: studies show that provided with an income, a woman will spend nearly all of it on household needs, especially food. The same money in a man's pocket is likely to be spent in part--up to 25 percent--on non-family items, such as cigarettes or alcohol.

From this perspective, microcredit initiatives, such as those of the...

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