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Book review

Social and Cultural Perspectives in Nutrition. Diva Sanjur. Division of Nutrition Sciences, Cornell University, Ithaca, N.Y., USA. 336 pp.

Diva Sanjur's new book speaks to an issue raised nearly four decades ago by Margaret Mead, a legend in social anthropology and distinguished pioneer in the development of nutrition social science, who, in the context of her work with the Committee on Food Habits of the US National Research Council, advocated that those concerned with improving nutrition should study attitudes, practices, beliefs, and ideas with regard to food habits and take them into account when designing programmes to help people improve their diet.

The book also touches repeatedly on another point made by Dr. Mead at a conference on Malnutrition and Food Habits, held in Mexico two decades ago: that the nutrition worker, rather than asking how to change food habits, would find it more productive to ask how food habits are formed. Sanjur proceeds simply and effectively to suggest ways and methods by which nutritionists might discover how food habits are formed and changed.

Chapter 1 points out, among other things, that the nature of food intake is heavily influenced by social, economic, political, and cultural processes. Whereas culture is a learned experience and resists change, it can also be unlearned. In chapter 2, in addition to discussing people's attitudes toward food (food preferences, food aversions, and food fads), Sanjur vividly describes physical and cultural determinants of food habits. In chapter 3, she summarizes facts about social and technological forces that influence present dietary patterns.

A very important and crucial issue of the relationship between purchasing power and food consumption habits is discussed in detail in chapter 4, which those nutritionists who have wrongly believed that malnutrition in Third World countries will be eradicated as per capita income increases would be well advised to read closely. Despite all the current talk about transferring income from rich to poor countries to achieve economic and social justice, the transfer of such income, if it ever comes about, may not benefit the poorest of the poor in many Third World countries.

It may be a shock for the 25 poorest countries in the world to learn that the United States, the richest country in the world with the highest level of per capita income, has also the closest to equal income distribution, while in these poor countries national income distributions show the greatest inequality. The subsidized or free basic services available in these poor countries are for both rich and poor. The rich often have easier access to such free services than the poor do, so that free services, like medical education, do not really make the poor better off. The book very properly stresses that an increase in per capita income may not necessarily result in improved food intake and better nutritional status unless the poor share in the benefits of economic growth.

Government policies and programmes that emphasize increased purchasing power for the urban and rural poor over maximization of growth in national income in developing countries may be expected to have a greater impact on the nutritional problems of these countries in the short term. Food subsidy is a well-known method of income redistribution to enable the poorest of the poor people to share the benefits of economic growth. Food subsidies, for example, have been shown to reduce malnutrition over a short period in China, Cuba, and Sri Lanka without nutrition education campaigns.

Chapter 5 deals with food preferences as a determinant of food behaviour, and chapter 6 deals with food ideology systems, including cultural food classification systems. The characteristics of the South American "hot-cold" ideology are discussed in detail. Sanjur points out that cultural groups, whether in a village or in a highly urbanized and technologically developed community, exhibit practices and customs related to their belief systems, some of which are beneficial to the health and nutrition of the group and some of which are harmful. No culture or socio-economic class within a culture has a monopoly on wisdom or absurdity.

All aspects of food consumption surveys are dealt with in chapters 7 and 8. The author gives emphasis to the collection of food consumption information as one of the most demanding aspects of a nutritional status survey because of the intimate nature of food habits. Chapter 9 deals with several case studies of food habit behaviours among different ethnic groups living within their own communities or in a pluralistic society. The final chapter, 10, deals thoroughly with methods to achieve changes in food habits.

Protein-energy malnutrition is the most widespread and most threatening form of nutritional disorder. It affects both the poorest and the richest countries in that protein-energy malnutrition in its severest forms occurs as kawashiorkor and marasmus in poor countries, while obesity is the form occurring in affluent countries. Obesity has been a problem of recent years, whereas kwashiorkor and marasmus are problems that are as old as humanity.

The book describes food culture ideologies (e.g., the hot" cold classification) that have contributed to the perpetual existence of kwashiorkor and marasmus in primitive communities. It also calls for nutritionists to find out what socio-cultural pressures have led people in the developing countries to change their food habits to the point of becoming obese. Unless these socio-cultural pressures are considered, intervention programmes dealing mainly with symptoms and signs of obesity (such as nutrition education or the proliferating money-making clubs and clinics providing exercise and special diets) will not have a long-term effect. Nutrition "miseducation" pressures from constant advertisements by various food industries in the mass media and what seem to be the dynamic socio-cultural changes in certain food habits to produce new forms of malnutrition like obesity demand constant research activities to detect the ever-changing co-determinants of food intake, so that appropriate preventive measures may be formulated in time.

The book highlights some of the most important ways to combat malnutrition, such as:

- improvement of income distribution in low-income countries;
- taking into account socio-cultural contexts when designing nutrition intervention programmes.
- improvement and intensification of communication in nutrition education;
- identifying and changing harmful cultural food habits (especially the more recent ones) that can easily be unlearned without disturbing the socio-cultural pattern;
- further research on why and how food habits are formed in a dynamic society, to enable nutritionists to formulate ways to modify or change the most harmful ones;
- establishment of systematic central nutrition planning that will make changes in dietary practices effective.

Seventeen years ago Margaret Mead said, "Up to the present, behavioural scientists continue largely to ignore the biochemical and physiologic aspects of the study of food habits, and nutritionists still tend to treat cultural and psychologic factors as relatively unimportant influences." This statement, unfortunately, still applies today, though perhaps to a lesser degree. Perhaps the most important appeal in this book is the call for nutrition specialists, physicians, agriculturalists, public health specialists, scientific officers, psychologists, anthropologists, political scientists, sociologists, planners, ecologists, economists, statisticians, educators, etc., concerned with nutrition to make better attempts to pull their forces together when conducting research and when designing and implementing nutrition intervention programmes in order to achieve a synergistic effect in their joint efforts to combat malnutrition.

Diva Sanjur's work will be important for teachers and students in the area of national and international nutrition, as well as field workers seeking to improve the quality of human life, economic planners and policy-makers. It should be made available in medical, nutrition, and social science libraries in developed as well as developing countries.

Valerian P. Kimati
Department of Paediatrics and Child Health
University of Dar es Salaam, Tanzania
Former UNU Fellow and Visiting Scientist
MlT/Harvard International Food and Nutrition
Policy and Planning Program

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