‘All Poor Everything’ – The Food System, Poverty and the Double Burden of Disease

Based on the fact that the term ‘malnutrition’ has been redefined to include undernutrition AND overnutrition, it’s safe to say that malnutrition is now a global problem. However, even though it’s no longer just about starving children in Asia and Africa, it is about obese children in Europe and America…AND Asia and Africa. Yes indeed, thanks to globalisation and the nutrition transition, poor people in poor countries with poor diets and poor healthcare are now dealing with potential obesity epidemics and all the trimmings that come with it; including the chronic diseases once associated with the more affluent parts of the world such as cancers and heart disease and hypertension. So, all of this new burden is being piled on top of an existing burden of infectious diseases associated with undernutrition, which has actually gotten worse (See A Broken Food System…). So yes, poor people in poor countries with poor diets and poor healthcare (which I will now refer to as P to the 4th power or P4, or ‘All Poor Everything’) now have to battle against a double the burden of disease with the same malfunctioning, mediocre healthcare system they’ve always had – which is apparently seventy-six doctors for every one hundred thousand people; not to mention poor infrastructure, poor sanitation, poor road systems and poor electricity supplies (Pearson and Jordan, 2010) – talk about reverse progress.

So in addition to the 800 million people suffering from what is called ‘chronic hunger’ – “not consuming enough energy to lead a normal life”; another 600 million people are consuming too much energy to lead a normal life, suffering from what is called ‘obesity’. On top of this, another two billion people are deficient in essential micronutrients. In fact, here’s a not-so-fun trivia question: What do children’s diets in India, Kenya, Senegal and Guatemala all have in common? Answer: They are all deficient in micronutrients (vitamin A, Iodine and Iron) that are oh-so important for their optimum growth.

I think that everyone can now agree (at least I hope so) that this state of nutrition chaos is all down to an incredibly messed up food system – from the policies to the production to the processing to the marketing to the purchasing to the preparing to the consumption to the wasting. Yet the link between the human food system and human health is a relatively recent one and a difficult one to make at that, as audacious as that might sound – (like which other species relies on their food system to keep them healthy?) Worse yet are the links between agriculture, nutrition and health: the food you grow becomes the food you eat, which provides the nutrients you need to keep you in good health – sounds like a no-brainer right? Well apparently it’s more complicated than that; so complicated that some of the highest incidences of chronic hunger and childhood stunting are found in agricultural regions and in the households of small-scale farmers – people that grow food for a living. Let that one sink in…

To explain this complication, I find it fitting to use a quote made by Uncle Ryan from ‘Everybody Hates Chris’ – “you can get it good and cheap but not fast; fast and cheap but not good; or good and fast but not cheap.” Indeed he was referring to passport photos for a fake ID, but it can apply to the global food system as well. For many P4 people, food is either not available or not accessible, of really bad quality, or simply way too expensive. Not only that, but in those cases where food IS available AND affordable AND of good quality; some people apparently either don’t have the knowledge of how important this food is for their health, or have neither the time nor resources to prepare it, for whatever reason; be it too busy working in a fast-paced urban environment, or limited water to wash and cook with in a rural setting.

So change is needed – and not just any change, but quick and drastic change; something radical… like a food revolution; a total reshaping of the food system. So how do we go about achieving this? Some experts recommend that this should begin with governments improving national food policies to make them more sensitive to the nutrition needs of their population. Given that undernutrition during infancy and childhood can lead to poor cognitive development, permanent IQ loss and a decreased potential for lifelong learning; perhaps the emphasis should be placed on the economic impact of poor nutrition instead – after all, everyone talks, but money usually has the first say. So it may be momentarily heart-breaking to hear that three million children die every year because of undernutrition; but the fact that that undernourished children go on to earn 20% less when they become adults compared to those that were well nourished; and that Africa and Asia stand to lose eleven percent of their Gross National Product every year due to poor nutrition; and (one more) that chronic diseases can cost the global economy $35 trillion US dollars by 2030 might motivate more of a response.

Part 2: More expert recommendations – coming soon

Source: Healthy Food for a Healthy World: Leveraging Agriculture and Food to improve Global Nutrition. Sponsored by the Chicago Council on Global Affairs


References available on request

Waste A Lot, Want A Lot More

why reducing food losses should be prioritized over boosting production

Increasing food production to meet the demands of a growing population and amidst the impact of climate events has been highly prioritized on the development agenda. Yet up to one third of the food currently produced globally is either lost or wasted. It may be the case that the best practice to ensure food security and avoid further environmental degradation would be to improve the existing food system by minimizing food loss and waste.


Food lost in Africa each year can feed up to 300 million people

It is predicted that by 2050 the world will have an additional 2.3 billion people. The vast majority of this population growth is expected to occur in the developing world, particularly in Sub-Saharan Africa (FAO, 2009). The current trend of Sub-Saharan economies growing at a faster rate than many high-income countries is also expected to continue well into 2050. As a result of this population and economic growth, alongside the threat of climate change, boosting food production has remained a priority (Larson, 2014).

Calls for increasing cereal production, both for human consumption and animal feed have been made, with demand projected to rise to one billion tonnes by 2050 (FAO, 2009). The demand for other products such as livestock, dairy and vegetable oils are expected to grow even faster than cereals, with meat production predicted to increase by 200million tonnes. All in all, the FAO has estimated that global food production would have to be up-scaled to produce 70% more food in order to meet the demands of the 9.1 billion world population expected by 2050. This would include a doubling of current food production in low and middle-income countries (LMICs).   However, the problem with this is that it would require considerably more land and water, which can have an exhausting and detrimental impact on the planet’s existing resources.

The growth of agricultural production, particularly meat and dairy can cause the further depletion and pollution of land, air and water resources; which can lead to an exacerbation of the already erratic climatic conditions. For instance, meat and dairy are very resource-intensive commodities. The livestock sector occupies 45% of the global surface area and is responsible for 8% of global human water use (Thornton et al. 2011; Joyce et al. 2012). Approximately 13 million hectares of global rainforests were cleared each year between 2000 and 2010 to make space for agricultural activities, particularly mono-crop farming and animal grazing (UN, 2012). Deforestation is one of the leading causes of carbon dioxide emissions. In total, agriculture is responsible for approximately 22% of global greenhouse gas emissions (more than the transport sector) including methane and nitrous oxide, which have a greater warming effect than carbon dioxide (McMichael et al. 2007). Thus, increasing food production in light of the impact of global warming can actually lead to further climatic changes. With regards to water, scientists at the Stockholm International Water Institute (SIWI) have predicted that by 2050 there will be insufficient water to maintain the level of intensive agricultural practices needed to meet the requirements of this future population (Jägerskog et al. 2012).

Parallel to the forecasted increase in demand for food commodities and need to boost production, is the amount of food that is currently lost or wasted. In short, food waste occurs primarily at the consumer level, where food is discarded by supermarkets and households or left to expire due to negligence. Food loss however, is defined as the “decrease in quantity or quality of food”, and usually occurs at the production end due to poor post-harvest techniques and a lack of infrastructure such as road networks (FAO, 2014). Globally, approximately 30% of annual cereal production is lost or wasted, (which totaled 2.3 billion tonnes in 2009/2010); along with 20% of the meat and dairy produced (FAO). Fruits, vegetables and tubers constitute the largest portion of wasted food at 45% (FAO).  Every year, LMICs are estimated to lose or waste in excess of 630 million tonnes of food; which is almost on par with high income countries at 670 million tonnes (FAO). This has been calculated to cost LMICs approximately US$310 billion (FAO). The Food and Agriculture Organization (FAO) estimates that the food lost in Africa alone can feed up to 300 million people; and if only a quarter of the food wasted globally was to be saved it could feed 870 million people, which is nearly all of the undernourished people in the world.

Food waste exists mainly in high-income countries, while the majority of food loss is found in poorer countries. However, with the current nutrition transition in many LMICs, food waste is expected to become more of a problem. Currently consumers in Sub-Saharan Africa were estimated to waste 6-11kg of food per year compared to 95-115kg in North America and Europe; however this is likely to increase due to a rise in supermarket chains, rapid urbanization, and diet and lifestyle changes.

Food lost at the post-harvest and processing stages of production in LMICs has been calculated at around 40% (FAO). This occurs largely as a result of financial and technical constraints, including a lack of adequate storage facilities. Thus, providing support to farmers in terms of post-harvest infrastructure such as cold storage, packaging and transportation could go a long way towards mitigating food loss. Professor Judith Kimiywe from the Department of Food, Nutrition and Dietetics at Kenyatta University in Kenya stated at the 2014 ANEC Conference in Ghana that 40% of all food loss in Africa was due to poor road networks*.

Strategies to reducing food loss in LMICs can be as straightforward as prioritizing investment in the necessary infrastructure, reducing transport distances by providing sales points closer to farmers and improving access to simple, low-cost post-harvest technologies such as plastic bags** and chlorination;*** all of which can have a significant impact on reducing food loss. Also, farmers can benefit from post-harvest handling and food management training as well as the improvement of market access and the provision of market requirement information (IRIN, 2014).

The need to reduce food losses and waste goes beyond increasing availability; as it results in the unnecessary depletion of land and water resources, not to mention energy, labour and capital (FAO, 2014). This environmental impact varies according to the level of processing and the stage in the supply chain at which food is lost. Also, small-scale farmers and poor consumers in LMICs tend to feel the brunt of food losses as it translates into a loss of income for farmers and higher food prices for consumers – thus contributing to hunger and food and nutrition insecurity. It is therefore recommended that reducing food loss and waste should be the first point of call for ensuring global food security for the future population of the world.

* for a digest of the 2014 ANEC conference email keiron.audain@gmail.com 
** Storing in sealed plastic bags with cotton liners; the cotton prevents emerging insects from perforating the plastic bag
*** The purpose of chlorination is to drastically reduce the number of microorganisms in the water and thus reduce or prevent inoculation with post-harvest diseases or contamination with human pathogens


Further Reading:

Reducing Food Losses in Sub-Saharan Africa