The Political Economy of Hunger: Volumes I-III (1990)
Edited by Jean Dreze and Amartya Sen, Clarendon Press, Oxford.
Following on from the excellent Hunger and Public Action by Dreze and Sen (see SCN News No. 5), here are three volumes of papers, under the overall title The Political Economy of Hunger, commissioned by the World Institute for Development Economics Research (WIDER), based in Helsinki.
Volume I: "Entitlement and Well-Being" deals with the background nutritional, economic, social and political aspects of the problem of world hunger. Topics covered include the characteristics and causal antecedents of famines and endemic deprivation, the interconnections between economic and political factors, the role of social relations and the family, the special problems of women's deprivation, the connection between food consumption and other indicators of living standards, and the medical aspects of undernutrition and its consequences. Several chapters also address the political background of public policy, in particular the connection between the government and the public, including the role of newspapers and the media, and the part played by political commitment and by adversarial politics and pressures.
Volume II: "Famine Prevention" focuses in particular on sub-Saharan Africa, and includes papers on the problems of early warning and early action, the politics of famine preven tion, the influence of market responses, the role of cash support and employment provision in protecting threatened food entitlements, and long-term issues of reduction of famine vulnerability. In addition to such general analyses, the book contains a number of case studies of successes and failures in famine prevention, both in South Asia and in sub-Saharan Africa.
Volume III: "Endemic Hunger", will be published soon, and will contain papers on Chinese food policy since 1949, public policy and basic needs provision in Sri Lanka, growth and poverty in Brazil, malnutrition and poverty in Latin America, undernutrition in sub-Saharan Africa, policy options for African agriculture, poverty and food deprivation in Kenya, industrial contributions to African food problems, food problems in Bangladesh, and some policy options for eliminating hunger in South Asia.
Together the essays cover a wide range of topics relating to world hunger, providing many authoritative and provocative insights and recommendations for policy-makers worldwide.
Income Sources of Malnourished People in Rural Areas: Microlevel Information and Policy Implications
IFPRI Working Paper No. 5 (1991) Edited by Joachim von Braun and Rajul Pandya-Lorch
This study, comprising 13 papers and a synthesis piece bringing together the broader findings, identifies employment and income sources of malnourished and non-malnourished rural households, traces their employment and income strategies, and identifies relevant differences in their demographic, income, and employment characteristics. The analyses are based on 13 household-level surveys conducted in the 1980s by IFPRI in low-income rural settings in Latin America, Africa, and Asia.
The research was stimulated by the preliminary insight that rural house holds, even if they are poor and/or located in so-called subsistence-oriented regions, are dependent on a variety of farm, non-farm, and non-agricultural income sources. The study finds that rural households do not depend directly for their incomes only or mostly on agriculture; in half of the survey locations, the non-agricultural income share of households is about or exceeds 50%. The study comes to several important policy conclusions:
- Malnourished rural households have diverse sources of income that vary by economic setting.The comparative analysis suggests a focus on prevention of policy-induced market failures, improved market integration through infrastructure, provision of social security including community health and sanitation improvement, and rural growth promotion.
- Rural households do not depend directly for their income on agriculture alone; in half of the survey locations, the share of household income from non-agricultural sources was 50% or more.
- Income diversification occurs in stagnating rural economies as a response to coping with risks associated with any one income source, whereas in growing rural economies it is driven by households capturing gains from specialization, enabling the rural economy to get more diversified.
- Although female-headed households tend to have generally lower incomes than male-headed households, in some cases they tend to have higher calorie intake than male-headed households.
- In major developing countries, the share of agriculture in the economy declines rapidly as economies grow, but the share of agricultural income in rural income remains high.
- Increasing rural income reduces malnutrition significantly in countries with very low per capita income.
To obtain a copy contact: Rajul Pandya-Lorch, International Food Policy Research Institute. 1776 Massachusetts Avenue, NW Washington, DC 20036-1998, USA. Fax: 202-467-4439; Cable IFPRI, Tel: 202-862-8185.
Women, Work, and Child Welfare in the Third World
Edited by Joanne Leslie and Michael Paolisso.
AS Selected Symposia Series 110; West-view Press, 5500 Central Avenue, Boulder, Colorado 80301, 265 pp. 1990
During the 1980s, two main schools of thought concerning the productive and reproductive roles of women existed. The "women-in-development" school sought to enhance women's income-earning capacity and de-emphasize child care responsibilities; on the other hand, proponents of the "child welfare" school tended to view women as instruments to produce healthy children, while down-playing the need for poor women to work. This valuable book edited by Leslie and Paolisso, shows how only recently bridges have begun to be built between these two schools leading to policy recommendations aimed at improving both the status of women and the welfare of children. This increasing collaboration has come about as the nature of women's work in developing countries has changed - with more women working away from home earning cash incomes - and as recognition of the importance to the household of female income has increased.
The book brings together work from several researchers who are trying to unify women's welfare and development concerns. Following two overview papers by Joanne Leslie and Susan Joekes, case studies are presented from Chile, Guatemala, Honduras, Kenya, Panama, Peru and the Philippines.
The net effects on a child of its mother taking up employment outside the home has been debated throughout the 1980s. Some studies demonstrate positive effects through higher incomes earned translating into enhanced food security and better nutrition. In others, the net effect is negative as time necessary for child feeding and care is eroded, suitable caregivers are not available and/or the increases in income are not controlled by the earner. Results are situation-specific and the case studies do tend to show that concepts of both work and welfare need to be disaggregated to arrive at meaningful and useful results. Regarding work - its nature, location, facilities, time spent and income earned are all highly important descriptive variables. Nutritional status is just one measure of child welfare, along with dietary intake, morbidity, cognitive development etc.
The caregiver is another important intervening variable.
There are many significant benefits of collaboration for both "welfare" and "development" fields, as described in the introductory chapter. Notions of women as either mothers only or workers only would be dispelled, allowing a better understanding of survival strategies; a more welfare-oriented focus would bring intra-household resource utilization into the picture, as well as the part that child welfare plays in a woman's choice of work. For the "welfare" school, the constraints faced by women in adopting new health practices or utilizing health services would be revealed, and the household food security gains of appropriate women's work appreciated.
The book clearly shows that there need not necessarily be a dilemma in aiming to improve both women's economic status and the immediate welfare of their children. As noted by Joanne Leslie and Mayra Buvinic in their introduction: "At the core of each study included in this volume is the question of whether women's work, particularly recent increases or changes in women's labor force participation, may have a detrimental effect on the welfare of children in the Third World. The findings vary considerably depending on the specific characteristics of women's work in the study population, the particular measure(s) of child welfare used, and the theoretical and methodological approach taken. In fact, one of the conclusions that emerges most clearly from examining the studies presented in this volume is the importance of disaggregating both the concepts of women's work and of child welfare so that research results can be interpreted more meaningfully. Key characteristics of women's work - such as type of work, location of work, time spent working, income earned, and work-related benefits - as well as key aspects of child welfare - such as morbidity, nutritional status, cognitive development, dietary intake, and caregiver - need to be defined and measured separately.... each [study] makes a serious attempt to disaggregate both concepts, to investigate specific linkages, and to reach conclusions that go beyond the simplistic assertion that women's work has negative or positive consequences for child welfare." And, among the conclusions: "...[the book] suggests the possibility of building a broad base of support for strategies that enhance both women's economic opportunities and child welfare, such as interventions to improve the health and nutritional status of women, work-based or community-based child care, and increased access to family planning."
Child Nutrition and Poverty in South India
by Barbara Harriss, 130 pp.
Concept: New Delhi, A/15-16 Commercial Block, Mohan Garden, New Delhi-110015.
This book makes instructive reading for anyone concerned with nutritional advocacy or policy-making. It deals with the political economy of nutrition in the South Indian state of Tamil Nadu during the mid-1980s. At this time, nutrition featured prominently on the agenda of the then Chief Minister. Several nutrition-oriented programmes, funded partly or wholly by the state, were under way at this time, including the (Chief Minister's) Noon Meals Scheme (NMS) and the Tamil Nadu Integrated Nutrition Programme (TINP). The Public Distribution System (PDS) which disbursed subsidized grain was also relevant, as, it soon becomes clear, was policy on alcohol.
Following Schaffer, Harriss sets out to examine food and nutrition policy with the premise that "policy is what it does". The policy process is conceptualized as having three simultaneous activities: establishing agendas (what is to be done), enacting rules of procedure and access (who should benefit) and the distribution and allocation of resources (what actually happens).
In the past, agendas have been characterized by sectoralism i.e. "if there is a nutrition problem, we need a nutrition policy". A related issue is how solutions are determined by how a problem is "labelled" or classified. For example, supplementary feeding programmes are commonly labelled as nutrition interventions, as is nutrition education and food fortification. Through such labelling, the formation of agendas in nutrition becomes exclusive and excluding -the nutritional effects of "non-nutritional" policies are not considered.
The Public Distribution System (PDS) is one such policy. Subsidized food grains are made available to middle income and poor households (who hold ration cards) through a network of fair-price shops. There are several objectives including restraining open-market grain prices, turning over buffer stocks, providing employment to rural shopkeepers. Despite the calorie content of a full cheap quota being 2,300 per household per day, the PDS is not considered a nutrition intervention. Another "non-nutritional" influence on nutrition is liquor. Alcohol consumption both reduces the potential shareable calories within a household, and represents a very lucrative revenue source for the state. Within a year of the state government coming to power on a prohibitionist ticket, prohibition was lifted in 1981, and alcohol sales rocketed from Rs. 85 million to Rs. 1,080 million within a year. Harriss points out that this money could have bought an extra 1,500 calories (from coarse grains) per household per day. In Tamil Nadu, at least, policy on alcohol is very relevant to nutrition.
The book goes on to contrast the Noon Meals Scheme with the Integrated Nutrition Programme (TINP) and describe the social impact of the PDS and alcohol policy, both at the level of the State and two contrasting villages, where 142 households were surveyed. The food-energy economy in rural Tamil Nadu is characterized, and the rules of access to these interventions examined.
Harriss employs military metaphors in assessing the Noon Meals Scheme - "if the target were the children of malnourished households then the weapon hits 3 out of 5 school aged children and 4 out of 5 pre-schoolers......the cost of this accuracy is akin to the cost of saturation bombing to root out guerrillas". Nearly 70% of beneficiaries were not in need of the nutritional supplement, while the 40% of school-aged children from nutri-tionally vulnerable households who do not benefit are from the poorest households, least able to send their children to school. The rules of access specify school-aged children and the elderly as eligible, despite a large nutrition survey in the 1970s clearly showing pre-school children, adolescents and pregnant and lactating women as most in need. The priority attached to the NMS resulted in rice being diverted from the PDS during a drought, effectively penalizing about 50% of rural households without eligible children, who nevertheless were eligible for fair-price rice.
Nutrition was on centre stage, both politically and bureaucratically, in Tamil Nadu in the 1980s, as the most basic aspect of human welfare. The State government did not hive off responsibility for nutrition to a "nutrition department" with limited powers and scope of action. The Noon Meals Scheme involved departments of revenue, agriculture, food, health and welfare. As Harriss concludes, pressures to improve its design need to be assessed in this light. This book provides a valuable insight from a nutritional perspective into the dynamics of policy formulation, the inter-play between different policies, and the political aspects of nutrition-relevant actions. As such, it should be sought by nutritional advocates and policy-makers alike.
To Cure All Hunger
Food policy and food security in Sudan
208 pp., April 1991
Simon Maxwell from the Food Security Unit at the Institute of Development Studies, University of Sussex, has edited this book with a number of other contributors. With their substantial experience of Sudan, they challenge conventional wisdom on food insecurity analysis. The book discusses famine in Sudan which in their view need never have happened if the already existing knowledge could be applied. Their conclusions have applications in other parts of the world facing famine and food insecurity.
Copies may be obtained at Pound Sterling 11.94 (including postage and packing) through contacting IT Publications Ltd, 103-105 Southampton Row, London WC1 B 4HH, UK. Tel: 0712-436 9761.
Anthropometric Standardization Reference Manual, (1991)
Abridged Edition, Timothy G. Loh-man, Alex F. Roche, and Reynaldo Martorell (Editors). Human Kinetics Books, Box 5076, Champaign, Illinois. 90 pp., 2nd edition.
While almost all reference manuals are, generally speaking, useful to those working in the related areas, this one is especially valuable. Anthropometric Standardization Reference Manual as the title implies, tackles a long-standing problem faced by many researchers and clinicians dealing with measuring human beings - that is a lack of consensus among experts on a set of standardized procedures to follow. Human anthropometry is widely used as a research tool by many investigators engaged in various areas of research. For this reason there already exists an extensive amount of data in the literature on human body's measurements. However, anyone who has ever tried to use, interpret or compare such data has experienced a painstaking and challenging task because often published data contain diverse descriptions for a set of measurements reported, different procedures followed by various investigators, and the data reported are not in comparable formats. The above manual is prepared to help with this chaotic situation. The manual's objective, as cited in the preface, is "to serve as a comprehensive set of measurement procedures, and to provide a standardized set of descriptions that can be used across disciplines, for example, epidemiology, exercise and sport science, human biology, human nutrition, medicine, physical anthropology, and physical education."
For each dimension included in this manual the purpose of the measurement under study, recommended technique (illustrated by appropriate photographs and drawings), previous description of the dimension, its reliability and sources of reference data are cited. Full reference citations are given at the end of the book. An appendix to the book gives the equipment and their suppliers. This abridged edition does not contain sections on Applications and Special Issues (such as right versus left side, measurement error, and equipment availability) which were included in the first edition of this reference manual published in 1988. The descriptions and recommended procedures contained in this recent volume cover 47 dimensions in five chapters, written in an easy-to-read manner. The notes given under the purpose of each measurement help in selecting the most suitable parameter depending on the purpose of the study, while the reliability of each measurement gives the expected between-measurer differences based on the data from the literature.
What is not given in the manual is a range of expected values for each measurement under normal conditions by age, sex, etc. to help in interpretation of obtained data. While such complementary data would be very useful particularly for the beginners in the field, this information is, nevertheless, available elsewhere.
Anthropometric Standardization Reference Manual is an authoritative source of standardized anthropometric procedures which should be widely used by those engaged in human anthropometry to help solve present constraints in collecting and reporting anthropometric data.
To order a copy please write to: Human Kinetics Books, A division of Human Kinetics Publishers, Inc., Box 5076, Champaign, IL 61825-5076. Tel:1-800-747-4457.
How to Weigh and Measure Children. Assessing the Nutritional Status of Young Children in Household Surveys, (1986)
by United Nations Department of Technical Cooperation for Development and Statistical Office, National Household Survey Capability Programme. New York.
This well designed and illustrated manual, published by United Nations, has met a critical need of health and nutrition programs all over the world. Anthropometric measurements are an important part of population surveys for assessing the nutritional status of children. They are used widely to assess the nature and magnitude of the nutrition and health problems of individuals and groups ranging from single communities to large, country-wide, population groups (e.g. national health and nutrition surveys) for diagnostic, planning and program evaluation purposes. Given its usefulness to provide child's nutritional status indicators, anthropometric measurements have also become an important component of household surveys. Such measurements are increasingly used for individual growth monitoring of children in primary health care systems. Regardless of the research or service purposes of anthropometric measurements, there is always a need to obtain accurate and reliable data on which to make proper judgements about the nature and appropriateness of children's physical growth. The quality of data obtained largely depends on the accuracy of measurement instruments and techniques.
While great emphasis has been placed on anthropometry as part of surveys or as a means for individual growth monitoring, there was no adequate training manual objectively describing the anthropometric procedures. Since there are so many steps to each measurement, unless done properly, measurement error can easily occur which may render the results invalid. Generally, there has been an underestimation of the level of effort necessary to properly do anthropometric measurements and a misconception that such measurements are "easy" to do. In the United Nations manual each step of the measurements procedures is presented in a simple to understand manner and clearly illustrated in detail with excellent photographs and drawings.
This unique publication, with over 100 photographs and 24 illustrations, is a step-wise, cookbook procedural manual describing the anthropometric measurements of weight (using widely available hanging spring dial scales), standing height, recumbent length and mid-upper arm circumference. The presentation is straight forward and simple, with attention given to small, but extremely useful details of measurement. Some basic education and training principles are incorporated in the manual; each sentence, which is 21 words or less, begins with an imperative (e.g. "Hold", "Place", "Remove", etc.) and there is only one task to accomplish per sentence. Both photographs and graphic illustrations are placed directly within the text (i.e., after every few sentences that depict the steps just described). Although there are nearly 100 pages to the manual, it is easy to read because of the clear presentation, simple language, and creative use of photographs and illustrations which make it flow.
A very useful part of the manual is the "Summary Procedures" section which is located in two places: at the beginning of the manual and as an Annex that is located inside back flap of the cover as a separate section where each of the four anthropometric procedures are described in one page summary with a graphic drawing. The annex can be removed easily for use or to be photocopied and is also available for purchase separately. Other annexes are useful, particularly for survey planners, directors and trainers, such as age assessment techniques, quality control and anthropometric standardization procedures. While the manual contains information for both the trainer and the field worker, in practice, the main body of the manual may be useful for survey planners, directors and trainers while the Annex I "Summary Procedures" is a handy tool for interviewers (enumerators, anthropometrists, measurers, etc.) in the field.
The manual is a carefully designed and well assembled guide which is a reflection of the extensive experience of its author, Irwin Shorr, a well known nutritionist who has worked in several countries worldwide on anthropometric training for large scale national and regional household surveys, growth monitoring programs, etc. He also took many of the photographs that appear in the manual from different countries and directed the remaining photography and graphic art work.
This manual, published in 1986 and available in English, French and Spanish, has had great popularity and demand from a wide range of users. It was initially distributed for free, which made it available to a number of people, but is now a priced publication. In fact, it may now be rather too expensive for new users (currently US$25.00 plus handling and shipping) which would make it hardly affordable for many potential users, particularly from developing countries where it is badly needed. If its current cost were more affordable (i.e. not greater than US$10.00), the manual would certainly be more readily available to the many potential users in both developed and developing countries.
Jose O. Mora M.D.
Senior Associate, International Science and
Technology Institute (ISTI)
1129-20th Street, NW Suite 706, Washington,
DC 20036, USA
Functional Significance of Iron Deficiency, (1990)
Annual Nutrition Workshop Series, Volume III, Center for Nutrition, Meharry Medical College Fall.
This is the proceedings of the workshop held at the Kresge Learning Resource Center, Meharry Medical College, Tennessee, from 25 to 27 October 1989.
The document is edited by Cyril O. Enwonwu, Professor of Family and Preventive Medicine and Director of Center of Nutrition. It contains the keynote address delivered by Dr N.S. Scrimshaw, and 15 other papers discussed at the workshop on the following topics: dietary habits of blacks and other ethnic minorities in the US with special reference to iron status; iron deficiency diagnosis; dietary factors influencing bioavailability of dietary iron; maternal iron deficiency and pregnancy outcome; iron deficiency: pedia-tric epidemiology; iron deficiency coexisting with sickle cell anemia; iron deficiency, thyroid function, and ther-moregulation; immunity and infection in iron deficiency; iron overload in different population groups; malnutrition, work performance and the role of iron; iron in the central nervous system; relationship of brain iron to dopaminergic neurotransmission and to the genesis of Parkinson's disease; iron deficiency: long-term effects on learning; iron deficiency and childhood lead poisoning; iron deficiency - research priorities.
For information on how to obtain a copy please contact: The Office of Public Re lations, Meharry Medical College, 1005 D. B. Todd Boulevard, Nashville, Tennessee 37208.Tel: 615-327-6037, Fax: 615-327-5958. M.L.
Alternative Agriculture (1989)
Committee on the Role of Alternative Farming Methods in Modern Production Agriculture, National Academy Press, Washington DC, 427 pp.
US Federal policies on agriculture have traditionally made a plentiful food supply a higher priority than protection of the resource base. For more than four decades, the productivity of crop and livestock farms have been increased principally through the heavy use of pesticides, drugs and synthetic fertilizers. This has led to water pollution with pesticides and nitrates from fertilizers, soil erosion, increasing pest resistance to pesticides, and unsolved problems of pesticide residues in food-stuffs.
In this important book, the Committee on the Role of Alternative Methods in Modern Production Agriculture has reviewed the dimensions and structure of US agriculture, its problems, and some of the alternatives available to farmers to resolve them. Evidence is presented to show that farmers that apply little or no chemicals to crops can be just as cost-effective in production as their more conventional counterparts. The goals of "alternative agriculture" include reducing input costs, preserving the resource base, and protecting human health. Alternative systems emphasize management, biological relationships, such as those between the pest and predator, and natural processes, such as nitrogen fixation instead of chemically-intensive methods. The objective is to sustain and enhance rather than reduce and simplify the biological interactions on which production agriculture depends, thereby reducing the harmful off-farm effects of production practices.
The Committee came up with four major findings:
i) farmers adopting alternative agricultural practices in the US were generally deriving significant sustained economic and environmental benefits;Alternative farming is not easy. It requires more information, trained labour, time and management skills per unit of production than conventional farming. On the other hand, it uses less synthetic chemical pesticides, fertilizers and antibiotics per unit of production. Reduced use of such inputs lowers production costs and lessens agriculture's potential for adverse environmental and health effects without necessarily decreasing (and in some cases increasing) per acre crop yields.
ii) as a whole, federal policies work against environmentally benign practices and the adoption of alternative agricultural systems, particularly those involving crop rotations, certain soil conservation practices, reductions in pesticide use and increased use of biological and cultural means of pest control;
iii) a systems approach to research is essential to the progress of alternative agriculture - farmers need to know the type of interactions between crop rotations, tillage methods, pest control and nutrient cycling;
iv) farmers adopting alternative methods have been innovative in developing a wide variety of integrated practices and methods suited to their specific needs, limitations, resource bases and economic conditions.
The Committee suggests that federal policies that economically penalize farmers who adopt alternative methods, need reforming. The pursuit of further crop yield increases regardless of consequent environmental degradation should no longer continue to be promoted. Despite the need for further research into the off-farm consequences of on-farm practices, this much is becoming clear.
The report comprises two parts. In part one, there are chapters on "Agriculture and the Economy", "Problems in US Agriculture", "Research and Science" and "Economic Evaluation of Alternative Farming Systems" while in the second part, eleven case studies of alternative farming experiences in the US are presented. Drawing on this material, the Committee concludes with a series of detailed recommendations on farm and environmental policy, and research and development.
The Health of the Nation (1991)
A Consultative Document for Health in England, HMSO: London, June 1991, 112 pp.
NCH Poverty and Nutrition Survey of Britain (1991)
National Children's Home, 85 High-bury Park, London N5 1UD, June 1991, 15pp.
"People may be living longer, but many still die prematurely or have the quality of their lives - especially in their later years - impaired by avoidable ill-health". This is the starting point of The Health of the Nation - a discussion document which sets out for consultation (until 31 October 1991) the British Government's proposals for the development of a health strategy for England. A health strategy is felt to be valuable in that it clarifies aims and responsibilities, focuses actions and sets a framework against which progress can be measured. Its stated ultimate purpose is to "further the span of healthy life of the people of England". The major policy objectives are to identify the main health problems, to focus equally on prevention and treatment of disease, to recognize multiple influences on health, and corresponding widespread opportunities and responsibilities for action, to recognize that concerted action requires co-operation at national and local level, within and outside the National Health Service, to secure a balance between central strategic direction and local flexibility and initiative, and to optimally use human and economic resources.
The crux of the strategy is the setting of targets in "no more than five or six" key areas. The key areas are chosen on the basis of whether the problem is a major cause of premature death, whether an effective intervention is possible, and whether targets can be set and progress monitored. Of the 12 areas that meet these criteria, about half of them are highlighted by the report. These include coronary heart disease, stroke, cancers, smoking, eating and drinking, and health of pregnant women, infants and children. Heart disease is the main single cause of premature death in England, and a possible target suggested is the reduction by 30 per cent of the total deaths below age 65 by year 2000. Other targets include similar levels of reduction within the decade.
For the area of "eating and drinking", the report states that nutritional defi ciencies "no longer present a major public health problem in England", although unhealthy dietary habits do significantly contribute to the development of heart disease, stroke and probably some cancers. Targets here (all by year 2005) include ensuring that at least 60 per cent of people derive less than 15 per cent of food energy from saturated fatty acids, reductions of adults classified as obese to 7 per cent, and reductions in the proportions of adults consuming more than "sensible" limits of alcohol to one in six men and one in 18 women.
Since the green paper was launched in July, there has been a lively and heated debate about whether the healthy diet proposed can actually be afforded by low-income families on state support. This partly came about as a result of the findings of an earlier publication (June 1991): the NCH Poverty and Nutrition Survey, which clearly concludes that a healthy diet is too expensive for some poor families in England. This is in direct contrast to the Government's assertion that nutritional deficiency is no longer a problem. It also reveals the marked lack of socio-economic differentiation in the statistics on which the strategy is based - the effects of poverty and social inequality are hardly touched on. After the NCH survey release, it was pointed out (Guardian 6 June 1991) that the Government's own figures on the diet and nutritional status of school-children in 1989 (Department of Health Report No. 36, HMSO, 1989) showed that in families receiving state support the children were significantly shorter in height than their better-off peers - clear evidence of nutritional inadequacy.
Results of the NCH survey (of 354 low-income families with under-five year old children sampled from 52 NCH centres throughout Britain in December 1990) contradict the argument that it is ignorance, not lack of money, that prevents families eating more healthily. The results starkly illustrate how difficult it is to provide a nutritionally healthy diet for children at present UK Income Support levels. The key findings speak for themselves:
- 1 in 5 parents said they had gone hungry in the last month (December 1990) as they did not have enough money to buy food, while 44% had gone short of food in the past year to ensure other members of the family had enough;The report's recommendations are clear and directed to the British government: Income Support needs raising to a level that will ensure ability to provide a healthy diet, and within this, a specific food element needs to be identified based on the cost of providing a healthy diet from corner stores (not supermarkets which require transport). Grants should be provided to purchase essential cooking facilities, qualitative standards for school meals need re-introducing, and the housing crisis in Britain addressed, as many of the poorest families live in Bed and Breakfast accommodation without kitchen facilities.
- 1 in 10 under-fives had gone without food in the last month due to lack of money;
- two-thirds of the children and over half of the parents were eating nutritionally poor diets;
- the cost difference for a family of three of a healthy compared with an unhealthy shopping basket was on average 5 pounds per week - or 20% total weekly expenditure on food of families on Income Support. It is virtually impossible for low-income families to have a healthy diet;
- poor diet is correlated with low food expenditure and there is no evidence that parents are ignorant about what constitutes a healthy diet.
Agricultural Policies in Europe
How they interface with food and nutrition policies FAO, 1991
As Nutrition Consultants' Report Series No. 84, this report by Professor J. Marsh describes the objectives of food and agricultural policy in both western and eastern Europe, gives the successes and failures of policies actually implemented, and explores the implications of adopting dietary patterns as suggested by present nutritional wisdom. The report - presented at the First European Conference on Food and Nutrition Policy held in Budapest, 1-5 October 1990 - discusses how nutritional issues may play a role in future policy formulation.
While the report is about Europe, it is also of interest to developing countries, many of which have populations already experiencing similar threats to health as those in developed countries.
Enquiries and requests for copies should be addressed to the Nutrition Planning, Assessment and Evaluation Service, Food Policy and Nutrition Division, FAO, Via delle Terme di Caracalla, 00100 Rome, Italy.
Guidelines for Control of Maternal Nutrition Anaemia
The International Nutrition Anaemia Consultative Group (INACG) has just released both French and Spanish translations of Guidelines for the Control of Maternal Nutritional Anemia, the English version of which became available over a year ago. Iron deficiency anaemia accounts for well over half the total number of anaemia cases and leads to numerous problems - increased risk during pregnancy, reduced resistance to disease, decreased work productivity from exhaustion, and potentially decreased cognitive development in children. The guidelines released by INACG outline short and long-term strategies for controlling prenatal nutritional anaemia, in support of the goal adopted at the 1990 World Summit for Children to reduce iron deficiency anaemia in women by one third of the 1990 level.
To obtain a copy contact: INACG Secretariat, International Life Sciences Institute -Nutrition Foundation, 1126 16th Street, NW, Washington. DC 20036 USA.
Vitamin A Intervention Studies (VITAL), USAID
VITAL New (May 1991, vol. 2, No. 1), has included a table on "Update and Summary of Vitamin A Intervention Studies" by country, listing known studies completed in the 1980s and those currently under way or planned. For each study included, data on the study aims, donor agency, age group and current status of the intervention (as of March 1991) are provided. This is perhaps the most complete collection of data on vitamin A intervention trials.
The Vitamin A Field Support Project (VITAL), as part of its information gathering and dissemination strategy. provides valuable information resources to those working in the area of vitamin A (see SCN News No. 6, p. 51). It publishes VITAL News three times a year by support from the Office of Nutrition, Bureau for Science and Technology, United States Agency for International Development (USAID).
To order a free copy of VITAL News write to The Managing Editor, VITAL News. 1601 N. Kent Street, Suite 1016, Arlington. Va. 22209, USA. Tel: 703-841 0652: Fax: 703-841 1597.
Micronutrients and Immune Functions, (1990)
Edited by Adrianne Bendich and Ranjit K. Chandra, Annals of the New York Academy of Sciences, Volume 587, pp. 1-319.
Given their key role in metabolism and nutrition at so many levels, it should not be surprising that micronutrient deficiencies impair immune responses. More exceptional is that, until recently. less attention than merited has been focused on this field. This book reviews the State of the Art in nutritional immunology through 24 presentations given at a conference sponsored by the New York Academy of Sciences. Five sections overview vitamins and immune function, clinical significance of.micro-nutrient status and immune functions. minerals, micronutrient interactions. infant nutrition and micronutrient safety at high levels of intake.
In line with research activity, greatest emphasis is on vitamin A, vitamin E, vitamin C, zinc and iron. But there are also two comprehensive articles dealing with selenium and copper, as well as a useful discussion of antioxidant micro-nutrients by Bendich. The interrelationships of micronutrients and immune functions is a complex field -for example while beta carotene is an effective quencher of free oxygen intermediates. vitamin A (whose major precursor is beta carotene) has a limited ability to scavenge free radicals. Iron and vitamin A are probably the two fields in which the practical implications of deficiencies on immune systems - and the other side of the picture, supplementation and the impact of control interventions - remain the most controversial. The trace element zinc has also been largely ignored until recently, and yet may well be critical in some situ ations of malnutrition as well as immune response. Iodine deficiency, though both highly prevalent and a prime goal for elimination, remains an area where more needs to be known about effects on immune responses.
It is clear from these contributions that we are beginning to piece together the sites of action of micronutrients on immune system cells. But there are still large gaps in knowledge. This book is both a very useful summary of the present position, and a pointer to future directions.
Dr N. Cohen
EPI, WHO, Geneva
Too Far to Walk: Maternal Mortality in Context, (1990)
by Screen Thaddeus and Deborah Maine, Columbia University.
This multidisciplinary literature review was undertaken within the Program on Prevention of Maternal Mortality established in 1987 in the Center for Population and Family Health of Columbia University in New York. The aim was to see what is already known which can be applied to the challenges faced by the Safe Motherhood Initiative. With information dissemination as an essential component of the programme, the findings have recently been published. The document - the first major publication from this programme - includes information useful to policy makers, programme planners and researchers.
A great deal of maternal mortality is directly caused by obstetric complications which are, in most cases, treatable with timely medical interventions. The points of departure for this activity were, therefore, the factors responsible for delayed treatment, i.e. the interval between the onset of an obstetric complication and its outcome. The docu- ment does not consider all possible factors that contribute to maternal mortality - many background factors e.g. nutritional status contributing to maternal deaths are not included. The document is framed around elements causing three phases of delay: seeking care, arrival at a health facility, and provision of adequate treatment. It contains the article abstracts, a list of journals consulted, keywords reflecting major concepts discussed in the article, and the findings of this review together with their programmatic implications for preventing maternal mortality. Giving examples of projects to reduce maternal deaths, various options for similar efforts are offered using existing resources. Also available to those interested is a computerized database, which contains short abstracts of the studies reviewed. For this, PROCITE, the bibliographic software used to enter, edit and retrieve selected articles will be required.
Programmes to reduce unnecessarily high maternal mortality will benefit immensely from this document, as will those trying to improve health care services - their accessibility, utilization, quality and effectiveness.
To order a copy of this monograph at US$8.50, or for further information please write to: The Prevention of Maternal Mortality Program, Center for Population and Family Health, Columbia University School of Public Health, 60 Haven Avenue, New York, NY, 10032, USA.
World Development Report (1991)
The central theme of the new WDR is the relation between government and markets. Lawrence Summers, the World Bank's chief economist, has talked (The Guardian 8 July) of an emerging new "market-friendly" consensus on economic development - one that nevertheless recognizes that governments need to "invest in infrastructure and provide essential services to the poor", where markets are inadequate or fail altogether. Governments should support rather than supplant competitive markets. The Bank believes per capita incomes in develop ing countries could rise by 3 per cent a year, or 5 per cent with the right mix of policies. Democracy is also stressed, as being a prime precondition for such growth. The best help the developed world can give to the development process, according to the Bank, is to roll back restrictions on trade and to address the debt crisis, with more countries being made eligible for commercial debt and debt reduction.
Human Development Report (1991)
United Nations Development Programme
The new UNDP report proposes $20 billion be spent a year to achieve universal primary education, basic health care, family planning, safe water and the elimination of serious malnutrition and abject poverty by the year 2000. The money would come from a 3 per cent cut in the military spending of industrialized countries and a freeze on developing countries' military expenditure. The ball is put in the court of powerful Western agencies and governments. Dr Mahbub ul-Haq, the report's project director, argues for human development criteria for prioritizing aid; currently less than 9 per cent of all aid is earmarked for human development goals, while total aid amounts to less than half of the officially agreed target of 0.7 per cent of donor GNP.
The report suggests an urgent need for reform in technical assistance - too much money is being spent on funding foreign experts, too little on institution-building in developing countries. Donors also prefer to fund capital-intensive schemes (requiring donor technology and expertise), rather than less-glamorous recurring social spending on non-project development.
The Human Development Index (HDI) of last year's first UNDP report has been improved on here, with both "developed" and "developing" countries being ranked with respect to a scale combining life expectancy, adult literacy and basic purchasing power. New scales measure gender disparities, income distribution and freedom, and may substantially modify a country's rank on the HDI. Dr ul-Haq hopes that eventually donors will use such an index as the basis for decisions on aid to developing countries.
Agriculture and Forestry Statistics in Computer-Readable Form
The Food and Agriculture Organization (FAO) offers standard tapes giving data in computer-readable form to users of the FAO Production Yearbook, the FAO Trade Yearbook, the FAO Fertilizer Yearbook, and the Yearbook of Forest Products. Each annual series on the standard computer file starts with the year 1961 and runs to the latest year published in the Yearbook. The FAO Production Yearbook standard file provides users with all time series reported in the "Land", the "Crops", the "Livestock Numbers and Products" and the "Means of Production"sections of the Yearbook. The standard tape also provides data on certain commodity groups not shown in the Yearbook, e.g. "Meat, indigenous, total" and "Milk, total". Annual population data are also included on the tape by country/country group. The FAO Trade Yearbook standard file provides users with all time series (52,000) reported in the "Trade in agricultural products" and "Trade in agricultural requisites" sections of the yearbook. The FAO Fertilizer Yearbook standard tape provides users with all time series (about 7000) on production, international trade, consumption and prices paid by farmers reported in the yearbook. The Yearbook of Forest Products standard tape provides users with all production and trade time series (about 40,000) reported in the yearbook.
Data on food (from AGROSTAT) - e.g. food balance sheet results - are now also becoming available on diskette for use with microcomputers.
The cost of each standard tape is US$500 (subject to revision) or the equivalent in Pounds sterling or French francs. For further information contact: Computer Service Centre, Food and Agriculture Organization of the United Nations, Via delle Terme di Caracalla, 00100 Rome, Italy.
The Impact of Development Policies on Health
A Review of the Literature
by Cooper Weil, D.E., Alicbusan, A.P., Wilson, J.F., Reich. M.R. and Bradley, D.J. World Health Organization, Geneva (1990). Sw. fr. 31/-(Sw. fr. 21.7 in developing countries)
This review considers the impact on health of development policies in five areas outside the health sector, all of which are closely linked to economic growth i.e. macroeconomic, agricultural, industrial, energy, and housing policies.
The type of adverse short-term health impacts of macroeconomic adjustment policies have been well documented in the past. The components of adjustment policies are often those which particularly affect the poor e.g. real wage reduction, food price increases, and cuts in government expenditures on social services. Several policies have been implemented in recent years in an effort to alleviate detrimental impact. In Sri Lanka, well targeted food subsidies were used; Brazil, Chile, and Zimbabwe all restructured their health care system and put more money into programmes designed to raise the standard of living of the poor e.g. the construction of more sanitation facilities. There are opportunities for avoiding negative health impacts on the poor during adjustment (see, for example, SCN News No. 6 p. 59).
Regarding agricultural policies, irrigation may be a necessary stimulant for agricultural development, but it can also contribute to the spread of disease. Today its effects on health are better understood. Pesticides can have an adverse effect on the health of both humans and their livestock through the handling and consumption of toxins introduced into food and the atmosphere. There is the added problem of disease vectors which become immune to the pesticides used to control them. An increasing need remains for the health and nutrition effects of specific agricultural interventions to be examined, and to look into whether and how local research centres have considered such linkages. Case studies focusing on how planners try to reduce risk and promote health in development of new agricultural policies would be informative.
Health problems related to developing countries' industrial policies are numer ous and worsening in many cases. Indoor air pollution, caused by the burning of certain fuels, the reduction in food prepared because of the scarcity or expense of fuels (caused by the high demands of industry), health risks from industrial power stations, including hydroelectric ones, long-term environmental degradation - these are all important concerns that need to be addressed.
Both existing knowledge and recent data on health linkages differ between the five policy areas. In some sectors there are important reviews leading to recommendations, although often these are general and have not dealt in depth with likely health costs and benefits.
The review is selective; for example, policies on population, education and transport are not examined, although these are mentioned as warranting future attention. Throughout, likely causal associations between policy choice and health outcome, as well as knowledge gaps, are identified before moving on to consider the type of policy measures that could mitigate negative health effects. Vulnerable groups are highlighted, as is the potential for constructive intersectoral collaboration, the lack of which has often restricted previous research. The review specifically does not offer an operational framework for action; rather it seeks to encourage a new awareness of development-health linkages as well as providing information for policy discussions and outlining areas for research.
The type of relationship between various development policies and health, at the level at which decisions can be made to mitigate negative impacts, is country-specific. Thus, while this book provides a valuable overview of the problem, it recognizes that true benefits accruing from the better design and implementation of development policies need country-level analyses by relevant sectors.
Food and Nutrition in the Arabian Gulf Countries,
An Annotated Bibliography. First edition 1990. Public Health Directorate, Ministry of Health. Bahrain; FAO.
This document provides information on the food and nutrition situation in the Arabian Gulf countries of Bahrain, Kuwait, Oman, Saudi Arabia and United Arab Emirates, and is of interest to researchers in human nutrition, food sciences, and related areas. The abstracts of papers and reports published from 1974 to 1989 are annotated or directly reproduced and arranged under the six main headings of: composition of foods; food consumption patterns; infant feeding practices; nutrition anthropometry; nutrition related diseases; nutrition education and communication; food control; and others.
The document is compiled by Abdul-rahman O. Musaiger, Head of the Nutrition Unit, Public Health Directorate of the Ministry of Health in Bahrain, and reviewed by E. Boutrif, with support from the Near East Regional Office of the Food and Agriculture Organization of the United Nations. As a first attempt to summarize the available literature on food and nutrition in the Arabian Gulf countries, this is a very useful compilation of the existing information for those research scientists working or interested to seek data in these areas.
For more information contact: The Nutrition Unit, Public Health Directorate, Ministry of Health, Bahrain.
Manual of Nutrition and Dietetic Practice for the Caribbean
The Caribbean Food and Nutrition Institute (CFNI) has published the Manual of Nutrition and Dietetic Practice for the Caribbean in 1990, covering the recent advances made in the field of clinical dietetics. While this is, in fact, an up-to-date version of the Diet Manual for the Caribbean published and revised in 1977 and 1980 respectively, it includes a whole lot more than the previous editions.
This manual represents the pioneering effort of a number of dedicated nutritionists, dieticians and physicians in the Region to compile diets for normal and therapeutic nutrition utilizing indigenous food. It covers dietetic issues relevant to both health and disease conditions providing a coverage of clinically relevant situations where diet has a part to play in the management of diseases and in the prevalent complications, as well as presenting practices for normal healthy living.
Copies can be ordered from: Caribbean Food and Nutrition Institute, UWI Campus, P.O. Box 140, Mona, Kingston 7, Jamaica, W.I., at US$20 and US$40 for developing and developed countries respectively. Limited supplies of materials requested by the Permanent Secretary or Chief Technical Officer in ministries in CFNI member countries will be provided free of charge. Bona fide students are entitled to purchase at half price.
Media Promotion of Breastfeeding: A Decade of Experience (1989)
by Cynthia P. Green. Academy for Educational Development, USAID.
This publication of the Academy for Educational Development's Nutrition Communication Project, reviews and summarizes breastfeeding promotion efforts in over 25 countries. It includes sample communication materials which were used to reach audiences in different cultural settings. This document is aimed at planners who wish to learn from past successes, and to avoid the pitfalls in implementation of breastfeeding promotion programmes. The report contains data from around the world showing that declines in breastfeeding can be reversed, and that the most successful programmes have been those which were tailored to women's concerns. It focuses on issues that must be addressed in promoting breastfeeding, and includes sections on market research, message strategies, and important target groups. The document, developed by the USAID sponsored Nutrition Communication Project, (a) explores the conceptual issues underlying how breastfeeding is promoted, (b) reviews the role of popular media, (c) provides guidelines on how to apply communication design principles to breastfeeding, and (d) makes practical recommendations for future programmes.
Copies are available at no charge to individuals from developing countries through the Clearinghouse on Infant Feeding and Maternal Nutrition, APHA, 1015 15th Street, N.W., Washington, D.C. 20005. Those interested from developed countries may purchase a copy for $10 directly from the Academy for Educational Development (AED), 1255 23rd Street, N.W., Washington, D.C. 20037. Tel: 202-8621900; Fax: 202-8621947.
Nutrition in Public Health, (1990)
A Handbook for Developing Programs and Services
This handbook is written to answer the recurring question: What is it that public health nutritionists really do? Thus the purpose of this book, as cited in the preface, is "to define and describe the scope of public health nutrition and the potential opportunities for nutrition services in health agency programs". A broad overview of key concepts is given in 25 chapters. With 14 annexes and a clear set-up this book should contribute greatly to the administration of public health nutrition programmes. It is edited by Mildred Kaufman, Professor and Chair, Department of Public Health, University of North Carolina, Chapel Hill, and published by ASPEN Publishers.
To obtain a copy please write to: Aspen Publishers, Inc., Rockville, Maryland, USA.
Infant and Child Nutrition, (1991)
A Manual for Health Workers, College Tutorial Press.
"This manual was primarily designed as a practical guide to health workers concerning infant, toddler and preschool feeding and nutrition. It does not attempt to document current research, although it is based on scientific knowledge currently available."
"There are many conflicting ideas and opinions concerning good nutrition during childhood, and these lead to confusion and anxiety amongst many health workers. The manual provides practical and sensible guidelines for the feeding of infants and young children. This will enable health workers, nurses and doctors, in both developing and industrialized communities, to give confident and well-informed advice to mothers." This is how the book is introduced by its author Pauline Kuz-wayo. Senior Lecturer in the Department of Human Nutrition, Medical University of Southern Africa, in the introduction section of the manual.
The manual describes in the simplest possible way some key aspects of feeding young children. It is richly supplied with clear drawings which makes the reading pleasant and comprehensive.
Copies can be ordered at R15.00 (GST and postage included) from the College Tutorial Press, 7 Glynnville Terrace, Lower Gardens, 8001, PO Box 2081, Cape Town 8000, or from local bookshops. Tel: 021-45 2041/2051/2052.
The ARF Story: A Compendium of Research on Amylase-Rich-Foods (1980-1990), (1990)
Department of Foods and Nutrition, Faculty of Home Science, University of Baroda, Baroda, India.
This compendium of research on Amy-lase-Rich Foods (ARF) has been prepared by the Department of Foods and Nutrition of M.S. University of Baroda on the occasion of the IDRC sponsored National/International Workshop on ARF Technology on 12-13 October 1990. It brings together the experience gathered on ARF Technology during ten years of research and field testing. As well as containing summaries of the research work completed or under way, the document pictorially describes simple steps for making ARF.
A decade's research at the Department of Foods and Nutrition, University of Baroda has demonstrated that ARF preparations made out of germinated grains, can, in small amounts, effectively liquify viscous gruels enabling infants (up to 24 months) to eat more (see also SCN News No. 6). The research team has been successful in transferring this technology to the mothers in slums and demonstrated its beneficial effect on child health.
For copies please write to Professor Tara Gopaldas, Project Leader, Infant Foods (India) Project, and Dean, Faculty of Home Science, MS University of Baroda, Baroda 390 002, India.
Famine and Food Security in Africa and Asia: Indigenous
Response and External Intervention to Avoid Hunger
Edited by H.G. Bohle, T. Cannon, G. Hugo, F.N. Ibrahim, Bayreuther Geo-wissenschaftliche Arbeiten, Vol. 15.
The proceedings from the First International Famine Workshop (November 1989) of the International Geographical Union Study Group on Famine Research and Food Production
Systems, have been published recently. The four sections of the proceedings include: I - Introduction; II - Famine process: vulnerability and indigenous coping strategies; III - Famine prediction: early warning systems and food crisis management; and IV - Famine prevention: food security, famine policies, and the role of research.
Copies at US$15 (DM25) may be ordered from Druckhaus Bayreuth, Theodor-Schmidt-Str. 17, D-8580 Bayreuth, Germany.
NU - News on Health Care in Developing Countries
This publication by the International Child Health Unit, Department of Pediatrics of Uppsala University, discusses current health care issues and exchanges information focusing on developing countries. It is produced three times per year, with support from the Swedish International Development Agency (SIDA), mostly in Swedish.
The first issue of NU in 1991 published in March, was a special issue devoted to a debate on population growth and child mortality. Since the discussion is international, the debate section has been published in English. The debate -introduced by Y. Hofvander, NU chief editor - started when Dr Maurice King questioned the general assumption that decreased child mortality leads to decreased birth rate, in an article entitled "Health is a sustainable state" published in the Lancet (Sept. 15, 1990). His most controversial point which aroused considerable criticism is that actions which will help children to survive, e.g. oral rehydration therapy and vaccination, should be avoided to prevent survival into a miserable life in an ecologically-disturbed environment.
In several "Letters to the Editor" in the Lancet and elsewhere his statement and conclusions have been scrutinized.
To bring out relevant facts and arguments, Dr King has been invited, in this special issue of NU. to summarize his ideas in the light of published criticism with Mr Jolly. UNICEF, responding. Also included are nine other views plus a reprint of the King's original Lancet paper.
To get a copy and for free subscription to NU please contact: The International Child Health Unit (ICH), Department of Pediatrics, Uppsala University. University Hospital, entrance 11, S-75185, Uppsala, Sweden. Tel: 018-66 5996; Fax: 018-50 8013.
Addressing the Human Dimension
In nutrition sciences, agroindustries, and international agriculture research IDRC-285e, 1991.
The need for research on food systems beyond considerations of farm production has been recognized by the International Development Research Centre (IDRC) since its inception in 1970. An area which requires further elucidation is the linkages between production and post-production processes and the means to preserve better quality food in order to feed adequately the rapidly growing world population. This recent IDRC publication is based on a paper by Dr Richard Young presented at a workshop in Rome. The workshop brought together a group of experts to develop recommendations on improving food-crop utilization and agro-industrial development. The target beneficiaries, it is suggested, should be directly involved in the research and development processes within the relevant sectors. The book. thus, focuses on people as the main component of the food systems and processes and recognizes the need to strengthen the links between farmer and consumer through multi-disciplinary research. It emphasizes the major role of small-scale agroindustries in providing employment and generating income, which is essential to eliminating malnutrition. The author believes that "the social, human, and nutritional consequences of food-processing ventures and food-system changes must be predicted at the outset through the application of relevant research". The components of such research and the means by which it may be incorporated into international agricultural research systems are then discussed in some length. The book covers the main issues related to the development of small-scale agroindustries and experiences, and gives constructive recommendations. It also cites the literature on actual research and development in these areas.
For information and to order a copy please contact: IDRC, Head Office, PO Box 8500, Ottawa, Ontario, Canada K1G 3H9.
List of Free Materials in Family Planning/Maternal and Child Health
This is compiled by P. Maglaque and C. Murphy, Programme for International Training in Health (INTRAH), the University of North Carolina at Chapel Hill. It is supplied to institutions in developing countries and to international organizations and agencies.
For copies please write to the Programme for International Training in Health, School of Medicine, the University of North Carolina at Chapel Hill, 208N. Columbia St, CB$8100, Chapel Hill, North Carolina, 27514, USA.