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The argument in this paper, that a global food deficit is not a problem, that if one sees the world as a whole there is possibly sufficient food for all, is a surprising statement. What concerns me is that the unit of analysis and the unit for economic policy-making are still too general.
Solimano and Jeria discuss strategies for development and their relationship to nutritional problems, but do not indicate why the process of development in Latin America, for example, has not succeeded in substantially raising nutritional levels. The paper suggests that it is a problem of income distribution. If this is so, then it is necessary to distinguish the levels of analysis. All of the Latin American countries have experienced growth in their aggregate population levels, but it is evident that in the majority of these countries, those who have benefited from growth of the GNP have been higher up in the income pyramid, and those who have benefited least are those in extreme poverty.
Therefore, if the strategy for development is bringing about an increasing concentration of income for a few, at least in relative terms, then certainly there is no reason to expect improvements in nutritional status among the poor. From the point of view of industrialization, it does not matter whether growth is oriented toward the interior through import substitution or toward the exterior through promotion of exports. In both cases the distribution mechanisms act to slant to an extreme degree the relationship between production and distribution in the market economy. Where there is a modern sector, everything that links production and distribution directs income in favour of a very small group independently of the type of economic structure.
Another aspect that it is necessary to understand is that Latin American economies are characterized by a critical and dramatic rural urban conflict, aggravated by the fact that the countries have low average incomes. Conflict between the rural areas and the city can be resolved, or at least in some way avoided, when countries have higher levels of income because it is possible to introduce price policies. But when countries are poor, cheaper food obviously means lower incomes for the rural areas. How can this problem be resolved in a strategy for development.
It seems to me that there are still issues to study regarding target groups. Little progress has been made in this area, which has great implications for the cost of programmes. I believe that if the groups are identified selectively and precisely, the cost of the programmes would be more tolerable. Giving milk to the entire population in order to reach those children who do not have access to milk is not the same as providing it in schools comprised of poor children.
In the studies I am carrying out in a rural area of Peru, I find that many of the literacy programmes for rural zones have failed. I have asked the reason for this failure in various communities because all of the questionnaires I reviewed indicated a high rate of illiteracy, especially among rural women. The answer was quite obvious. Families were too poor to spend any time away from work to send even their children, much less their wives, to a literacy programme. This is a very clear example of the futility of merely sending teachers to the rural areas; even sending of supplements is futile if there is not a sound income distribution policy.
My final comments refer to relationships that appear in various parts of the Solimano Jeria paper. It appears to me that the principal relationship is between income and nutrition. Economists know what happens with consumption of goods and services when real income is increased, but we do not know how much income is spent on food or if there is a possibility of an adverse effect on nutrition when more real income becomes available; i.e., a change in the consumer's food choices might diminish the nutritional content of the diet. Only in this case would the nutrition problem be added to the problem of income distribution. What evidence do we have that this adverse effect exists or not' This is a question that must be investigated.
As the rural population usually forms the base of the income pyramid in all of the Latin American countries, a nutrition programme must necessarily focus on rural families. One might say that if the rural families increase production, they will consume more food. However, it is not obvious that, when real income is increased because more potatoes are available one year than in the year before, more potatoes will be consumed. This depends on whether or not it is considered desirable to eat more potatoes. Or, in the case of increased milk production, does it necessarily follow that children will be given more milk? One conclusion coming from studies of income and expenditures in rural areas is that the milk produced in the countryside is not, for the most part, consumed by the campesinos. For them, milk is a luxury food they feel they must sell; they are too poor to consume it themselves.
Finally, in the case of the behaviour of the family unit in cities, when a family has a higher income, will it buy more food or spend the extra income on televisions or less important products? What is needed is a theory of consumption, or a theory of consumer behaviour, that establishes that what the consumer does is very much determined by the consumption pattern of other members of society. While there is such a pronounced inequality in incomes and such distinct differences in life styles, it is too optimistic to hope that the really poor urban families will first try to acquire a basket of foods with better nutritional content and avoid all the pressure that comes from the consumption patterns of the privileged classes.
I, too, would like to comment on the subject of world food sufficiency. This is real only if we consider total production in relation to the number of inhabitants. The concept of the advocates of production that more food is necessary is very useful at certain policy levels, but the truth is that in t976 the world production of grain was 1,650 million tons. If we divide this among the world population, it provides 3,500 calories and 100 grams of protein per person per day. This includes only grains, not root crops or other foods. Nevertheless, these grains are very unevenly distributed. The United States produces and consumes 20 per cent, and the richest 15 per cent of the population consumes 50 per cent of these grains. In reality, those rich countries that produce and utilize great quantities of grain use it to feed animals. In the United States, for example, availability is 1.2 tons per person per year, but only 8 per cent is consumed directly as grain; the remaining 92 per cent is eaten indirectly in the form of poultry, eggs, milk, and other animal products. A great quantity of food products is wasted while 85 per cent of the world population has only 50 per cent of the grain required, a situation that is barely within the limits indispensable for sustaining life. There is not a lack of food in the world, there is a lack of food among certain population groups in the world.
Regarding the question of the importance of malnutrition on a global scale, it is very difficult to define malnutrition because the severely malnourished are already dead. Those who lose the equilibrium between their consumption and expenditure die, and some 15 per cent of the world's population are not able to survive in their poverty.
We have conducted a longitudinal study in which we observed, from birth, all those children born in 1968 in one village and compared them with children born in the same village in 1970 who were given food supplements. The first thing we found among the children born in 1968, who were not given food supplements, was that they adapted themselves to a lower consumption of food. They learned not to eat. These children are consuming 320 calories at three months of age, not 450, and later, at 18 months of age, they are consuming practically the same amount, or have increased their intake by only 50 calories. They have adapted by reducing their growth, by lessening their physical activity, by decreasing their interaction with the environment -by becoming apathetic human beings. Those who do not adapt die. There are certain ages at which these children appear to be normal. For example, if they live long enough to enter school, they look like normal children-smaller, less active, more susceptible to illness-but they play football and sing in the school chorus. They have adapted to the situation and it is difficult to say that they are malnourished.
What per cent of the world's population is in this predicament? This is what must be asked, not who is malnourished, because the severely malnourished have already died. Those who have adapted are the survivors.
This is a concept that Bengoa elaborated upon also, in speaking of the damaged survivors. My impression is that this is the majority of the world, and the figure of 75 per cent of those living in underdeveloped countries seems to be essentially correct.
This 75 per cent have adapted to this state of disequilibrium, but these people do not function normally. It is in the person who has to function in society, work, produce, develop, think, co-operate with others in a functional context, that the limitations are found, and there emerges the effects of what we call poor nutrition or chronic malnutrition, or a person who is at the limit of his capacity.
How are we going to solve this problem? More and better food is needed during infancy in order to avoid this negative adaptation, because the children born in 1970 in this village who received good food supplements have developed and grown better. They are active and their lives are different. I believe that the nutritional problem of this 75 per cent of the population is a current one, but in part it is a problem that has passed. For a person who has already suffered this process of adaptation and has learned to survive and to eat little, the problem of malnutrition is more a legacy from the past.
It has been said that to solve nutrition problems there must be higher incomes and lower prices in order to give the population access to food. Is this possible in the underdeveloped countries, where food is distributed from the top down and penetrates to the lowest levels of the pyramid as a function of the price of food and as a function of income? An expensive food like meat penetrates the highest part of the pyramid and then practically disappears. The same is true for milk. Giving more income to the population or lowering food prices would not be a solution because there would then not be sufficient food. It would be illogical to suppose that if meat costs were reduced by half and incomes were doubled everyone would have meat. There exists a level of rationing of the population according to income and to the supply of articles. One possible solution is to make the article more abundant in order for it to be available to the lower income groups, but in underdeveloped countries something always happens to block this tendency. The product is monopolized, or the producers note that if they hold onto the product they can get higher prices. There is a series of factors in these countries that always prevents penetration of those sectors that we wish to feed-the malnourished population.
The other possibility would be rationing. I remember in Nicaragua that there was once a minimum diet law, but as there was no decree for a maximum diet, and no rationing to reduce consumption by the wealthier sector, it was totally impossible to provide enough for the lower classes. If a minimum, but not a maximum, policy is used, then these will not be sufficient food. This approach has been tried various times in Latin America, but it seems to me that, in the present context, it cannot be done.
As another alternative, national food policies have been developed to try to improve consumption by the low-income sectors without affecting the equilibrium of supply and demand, or the policies of prices and incomes, and without altering the sociopolitical structure, not even by rationing. What viability do these food policies have? I believe they offer a field for action. I compare the situation of that population that I have called the "adapted to eat little" to people who are on the edge of an abyss. Some of them are falling (those 15 per cent who die), and the others continue travailing on the edge for some time, depending on whether or not they get sick, whether there is food available, or whether there is a drought, but nevertheless there are circumstances that permit them to look over the edge of the abyss.
I think that if they could move even one metre away from this abyss, many would not fall and would have greater security and a better life. This would not be so difficult or so costly. The experience I had of seeing the diet consumed in China shows that it is no more than 20 or 30 per cent better than the Mexican diet. In the north of China where I visited, the people consume wheat, Chinese bread that incorporates beans, vegetables with a little meat, and at times a little fish. It is a very well-balanced diet and it does not cost over 20 to 30 per cent more than the diet of the poor in Mexico, or the rest of Latin America.
I think they would be able to draw back from the abyss with a 20 or 30 per cent improvement in the diet, and this is not by any means impossible. A socio-political solution by our governments is necessary so that the decision is made and the effort supported. The underdeveloped countries have been living in the mirror of the United States and other rich countries, believing that a good diet is the kind consumed there: a large quantity of meat, a litre of milk per person per day, two eggs every day. This mirror has distorted our food policies. I believe that the policies in China, to give eggs and milk to children under five years of age, and to distribute meat in small quantities with vegetables, eaten with bread and beans, would provide a sufficiently good diet to allow for the well-being of people.
Elsewhere Kertesz speaks of options, calling the first option the nutritionists' earlier ideas of doing certain things to improve the diet or educating people about the value of soy products. A second option is subsidies and the introduction of technologies to protect the vulnerable groups. A third option would be to improve salaries and prices, to try to institute specific employment policies. A fourth and, in his opinion best, option would be to change the socio-political structure and really give access to power to the masses of the poor.
I think national food policies can take a little from each option. I have always insisted that we, the nutritionists, have more fear of proposing progressive actions than the politicians themselves have. For example, in the nutrition programme of Brazil, those who planned it worried far more about proposing radical methods than the politicians did. Of the 70 million dollars allocated for Northeast Brazil, nutritionists spent a considerable amount on research using obsolete methods, because they thought that many of the things could not be done. I am not speaking only of Brazil, for I believe that in many countries, from a socio-political viewpoint, the nutritionists are hiding behind the social structure of the country and that the politicians would allow much more to be done. We could do much more than we have been doing, it can be much less expensive than previously thought, and the results can be much more impressive than many people now believe are possible.
The points made by Chavez regarding the magnitude of caloric deficits compared to global food supply are concerned with the essential problem of distribution of food to the interior of countries and among countries. This raises again the problem of determining the objectives of different strategies for economic development.
The economic development of Latin American countries in the 1970s was a highly concentrated type that excluded many people. It was concentrated in the sense that the economic resources remained in a very few hands, and these were the people who determined the mode of production and excluded the marginal population that does not have access to the benefits of development. Our paper raises the point that, even in countries that have had a high rate of economic growth, there has not been a high rate of improvement in the level of nutrition and health. Certainly, a paper could be written on income distribution and development strategies, but the objective was only to raise this crucial element as part of the discussion, as a red light that indicates some of the problems relating economic development to nutrition and health.
The income distribution between and within sectors is very important and requires analysis. The process by which statistics are collected actually by-passes those groups that we believe to be the most vulnerable, and we do not have reliable information on the target groups who are supposed to be benefiting from development plans.
It is certain that there is much that can be done through direct programmes to solve specific problems in specific regions. But, in my opinion, the results will depend on whether the government model for the entire country is concerned with raising the standards of living of the people, or with levels of production growth and the balance of macro-economic variables. There is much that can be done through food distribution. It can be seen as a substitute for distribution of income or as a complement. I am inclined to think that direct programmes are effective in the long run to the extent that they are accompanied by effective distribution of income to improve consumption.
I wish to refer to the points presented by Figueroa in terms of his experience with rural populations. He spoke of the population pyramid and priorities, asking if these sectors will consume more food when real income increases, and whether or not they will really consume what they produce. One example he used was that of milk. I can add another aspect coming out of a study that we are carrying out in Panama. Families are substituting the food that is delivered to them for the food they should be producing. A food package that is calculated to serve as a supplement for a period of 15 days is consumed in five days, on average, with a range of two to eight days.
Second, when it was decided to implement this programme, based on results of a national study that had been done in 1967 by the Government of Panama and INCAP, it was concluded that the average caloric deficit was of the magnitude of 25 per cent of daily requirements, and therefore the supplement made up for this 25 per cent. But when one evaluates the possible nutritional effects of such a programme, the range of the deficit is, by gross estimates, between 10 and 50 per cent of the calorie requirements. This area needs more study and is linked to the use of appropriate indicators. Does the sensitivity of present indicators permit a good evaluation of the impact of intervention programmes?
Chavez raised the subject of the relationship between direct interventions and rationing to provide for those with insufficient income, and asked whether such programmes would eventually compensate for the deficiencies brought about by inadequate food consumption.
What has been seen in many countries, especially when new foods are introduced or existing foods are enriched, is that generally such foods are consumed by population groups that are already sufficiently fed. Those groups are the ones who have access to them, based on income and existing mechanisms for distribution and marketing. The big questions are really whether the food will reach the target group, and what food is most suitable to deliver to them and in what form, considering the socio-cultural patterns of these communities.
Finally, concerning the example given by Chavez of his experience in China, I agree that what must be done is relatively easy. The difficulty is in the decision-making process, and the context in which such decisions are made. I have never liked to transplant the Chinese example to other countries, because the Chinese experience means nothing in a different political and social context.
Besides, what is required is a careful examination of the consistency between policy formulations and possible actions, and here is where problems arise, because generally the political, social, and institutional factors cannot be touched, or their modification is beyond the capabilities and/or will of those who implement such policies.
Economists can contribute some ideas on questions that concern nutritionists. The first of these is how to make income and salaries compatible with prices. This is essential because the countries of the Third World cannot continue with the disparities of buying power in relation to prices. The second question is connected with the first, and that is how to make maximum prices to the producer compatible with minimum prices to the consumer. I should also like the economists to help us resolve the problem of simplifying studies of the elasticities of demand in relation to income and prices. The studies proposed by economists are usually so detailed that the elasticity of demand for each article of food is analyzed-a very costly procedure. This may be necessary periodically, but there should be a simpler method that would permit us to evaluate changes in habits and consumption as a function of changes in income and prices at shorter intervals.
Another factor related to price policies is that it is the custom in Latin American countries for the lower classes to purchase by units of money, not by measure or weight. The demand would be constant because people continue to buy 20 cents' worth of rice or 30 cents' worth of sugar, obtaining a smaller quantity for the same money when prices are higher. The elasticity that might exist when purchases are by kilos would not be the same as when purchases are by units of money.
One problem that concerns nutrition specialists is that we say to those responsible for price policies in a country: "Take nutrition into account, among other considerations," but what do we recommend? A policy that discriminates in favour of 10 or 12 basic foods that represent 90 per cent of the calories consumed by the population? Or is it better to have a policy discriminating in favour of the remaining 10 per cent because this remainder represents 70 per cent of the total food budget of the family? That is to say, these 10 foods contribute 90 per cent of the calories, but they cost at the most some 20 per cent of the total food expenses. But there can be another criterion discriminating in favour of food for vulnerable groups-children, for example. There are at least two or three criteria and possibly all must be taken into account.
A point that we have not touched upon is a concept developed by Joy and Payne in England. They suggest that the nutritional problems are different within a country according to areas of agricultural production, ecological conditions, or urbanization. They maintain, for example, that sugar cultivators have problems that are quite different from those of coffee growers, and those of coffee growers are different from those working on banana plantations. This functional classification means that food and nutrition programmes should be planned to take care of problems in each area, and that it is neither appropriate nor recommended that there be a national policy equal for all when the problems are so diverse in the different socio-economic sectors of a country. I believe this has some validity, and that it would be worthwhile to take it into account when dealing with food price policies. Even within one country a food price policy, for example in favour of milk, may enormously benefit one region but would not favour, or could even worsen the situation in another.
I have always been against the search for one indicator that would lump together items as heterogeneous as education, housing, health, and nutrition. Possibly it is true that the problem in nutrition consists of making a 20 per cent improvement in the food intake of the poor, but double or triple the quality of poor housing is still poor housing. Doubling or tripling the minimum wage in certain Latin American countries would have little effect. Salaries would have to be raised 10 or 20 times to improve living standards for the poor. It seems to me that reliance on one indicator could be a risky mechanism that politicians would be able to use as an escape from identifying the specific social nature of the problems.
There is a consensus that malnutrition and poverty are not restricted to a minority of the world's population. They afflict at least half of the people in developing countries. i would like to know what the cost would be for a really effective form of intervention, be it subsidy or supplementation. The usual intervention is a very small programme, a "showcase" that reaches a small number of people, and this serves very well for case studies. But if we are to bring to the problem all that is necessary to solve it, what does this mean in terms of cost and in terms of the economic system? If we set up a food distribution system that would reach 50 per cent of the population, what would the effect be? To do this we would have to put together resources of such magnitude that a change in social structure is strongly implied. If we intend to address the problem in a way that is not merely symbolic, it means an effective change in the system, in the mode of production and distribution, and in the power structure within the system.
I can give you an idea of the costs involved with reference to the Dominican Republic. In terms of a massive food policy, the first problem is that over a 10-year period the agricultural economy would have to grow by 8 to 10 per cent in basic foods alone. This would mean overcoming all the restrictions in the production system in an agricultural economy that has been stagnant. It means, in terms of redistribution of wealth, that the 25 per cent of the population that possesses 75 per cent of the income would have to give up 25 per cent so that 75 per cent of the population would have 50 per cent of the income. It means a change in the structure of land tenure in order that 50 per cent of the agricultural producers would have access to more than a quarter of the land suitable for production. A middle-range plan that would not greatly change political and social structures means that the Dominican society, if it wants a massive food policy, would have to pay a bill on the order of $150 million, or three-quarters of the GNP. Why? Because of land use, the basic infrastructure, and the social and economic costs.
I would like to find a way to integrate these problems analytically. For example, figure 2 in the Solimano-Jeria paper presents a causal model, but that is not, in fact, what it is, for theoretical and empirical reasons. The theoretical reason is that it is trying to explain what the philosophers call a "counter factual"-that is, an absence and not a presence. It does not explain a social process but rather the absence of another social process. I think that this is a problem not only with this model, but with the study of development in general. The theory of development is often a theory of the absence of development. I recommend Gwatkin's paper on nutritional planning and physical well-being in Sri Lanka and Kerala. Both the country and the region have low mortality levels in comparison to those in other Asian countries. It is well known that Sri Lanka depends heavily on its tea export for income. Cuba depends on exportation of sugar for a major portion of its income. Therefore, to say that food and nutrition problems arise when countries rely on a single export crop for income is probably erroneous, because malnutrition does not exist, or exists to a lesser degree, in Sri Lanka and Cuba.
It is clear that nutrition and food price policies have much to do with social and economic organization. It is also clear that ecological factors are very important in certain zones. I would like to give an example of the integration of approaches, looking at the peasant economy as a system that is, in part, one of auto-consumption and in part one of commercialization. The problem is knowing whether what is sold in the market is a sub-product of decisions made concerning auto-consumption, or whether that which is consumed is what remains after selling.
When farmers want to produce food for their own consumption and also sell it on the market, they look for plants with strong resistance to disease. I would like to know what their nutritional characteristics are. Why do campesinos in certain zones produce beans but not wheat? There is also the question of how much energy is required for producing various kinds of crops.
Agriculture is far more labour-intensive in peasant economies than in a capitalist country. But, we also see that the peasants are integrated into the market through intermediaries. If the prices they receive from those middle-men decrease, they must work even harder and, therefore, have greater food energy needs in order to maintain their standard of living. In El Salvador production has increased throughout the economy, even for the smallest producers of grain, but the incomes continue to decrease because the economy in general is exploiting these people and they must work progressively harder in order to maintain their standard of living. As Chavez observed: peasant producers integrated into the market may have lower living standards than those who are less integrated within the market system. This is due precisely to the relationship between the work they do and their food energy needs, the type of product, and the type of integration into the market.
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