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United Nations University programmes
Global use of the instruments of scholarship for
the conquest of hunger: The world hunger programme of the United
Nations University
Human and Social Development Programme (HSDP)
Programme on the use and Management of Natural
Resources (NRP)
by Nevin S. Scrimshaw, Ph. D., M.D.
Introduction
In 1975 a new kind of United Nations organization, the United Nations University, was established, with headquarters in Tokyo. Its purpose is to contribute to the solution of "pressing global problems of human survival, development, and welfare" through imaginative and practical use of the instruments of scholarship-research, advanced training, and the dissemination of knowledge. It has no campus, faculty, or students in the conventional sense. Instead, it was formed to organize "sustained, internationally co-ordinated networks of research and advanced training programmes, and to encourage innovative approaches to pressing global problems". Its goal is to contribute to "the continuing growth of vigorous academic communities everywhere, and particularly in the developing countries", in order to "increase dynamic interaction in the world community of learning and research".
Within the UN system the University is unique. Its governing board is made up of scholars, not representatives of governments, and it can work directly with individual scholars and institutions rather than through governments. In the official relationships of other UN agencies, universities and their faculties are frequently left out because support goes only to government ministries. Moreover, the UN University depends entirely on building indigenous competence rather than substituting for it by outside advisers. It seeks to create an international community of scholars who can contribute substantially to solving the problems of developing countries and improving the quality of life of their populations.
To give it stability, independence, and relative freedom from recurrent political pressures, the University's financial support depends on interest from endowments from countries participating in its programmes. To resist the tendency to bureaucracy, it is managed by a small head quarters group on limited leave from their own national universities or institutions. It relies heavily on advisory committees and task forces rather than on regular staff, and devotes almost all of its resources to programme activities through existing and strengthened universities and research institutes, with special emphasis on those in developing countries.
Priorities
Early in 1975, the governing body, a 24-member council of knowledgeable academicians from as many countries, serving in their individual capacities and not as representatives of their governments, selected three priority global problems for initial concentration: Human and Social Development, Use and Management of Natural Resources, and World Hunger.
It was not difficult for the University Council to identify hunger as a pressing global problem so soon after the publicity surrounding the World Food Conference in Rome in November 1974. However, it was quite another matter for the Council to determine how it might make a significant contribution to overcoming such an overwhelming problem when agencies and organizations with far greater resources were having so little apparent effect. The World Food Conference led to the establishment of the World Food Council, and after a long delay resulted in the establishment of the Fund for Agricultural Development earlier this year.
In order to identify an appropriate course of action, the University, in October 1975, convened a meeting of approximately 20 nutritionists, food scientists, agriculturists, economists, and others who had extensive experience with the food and nutrition problems of developing
University, for the Science. countries, who understood the programmes of other agencies designed to alleviate them, and who recognized the importance of helping countries to deal effectively with these problems themselves. The steps in the process of advising the University on its hunger programme were to analyse the world hunger problem, identify a role for the University, and devise a specific programme for implementation.
Nature and Causes of the World Hunger Problem
Estimates of the current magnitude of the world hunger problem depend on the criteria used, and vary from the conservative WHO figure of 500 million persons moderately to severely malnourished (1 ) to a World Bank estimate (2) of over a billion persons suffering under- or mar-nutrition to a degree influencing growth and development or health. In India alone, approximately 55 per cent of all children 1 - 5 years of age are classified as moderately or severely malnourished by WHO standards.
It is often assumed that the cause of hunger in the world is a tendency for population growth to exceed food supply. It is true that the world population has doubled from 2 billion to 4 billion since 1930, and that a fifth billion will be added before the end of the next decade. However, even with 250,000 more persons to feed every day, world food production per capita has not decreased and is not likely to do so in the immediate future. Although both population and food supply must eventually reach equilibrium, hunger and malnutrition occur in today's world because of maldistribution of food. Under present circumstances, global food production is limited by market forces that only imperfectly reflect human need. Because the world population will almost certainly double again soon after the turn of the century, there can be no let-up in the efforts to increase food production. What is required, of course, is greater food production in food-short and rapidly growing developing countries. However, the amount of dietary energy consumed by the industrialized nations populations, and the upper socioeconomic groups of developing countries, already exceeds estimated dietary requirements. A small component of this excess food is ingested and contributes to obesity and the consequent higher prevalence of diabetes, hypertension, and coronary heart disease. The greater part of it is simply wasted. The principal factor responsible for under nutrition is maldistribution of available food supplies among countries, socio-economic groups, families, and family members. Per capita availability figures, as commonly used by economists and planners, tell little about the availability of food to low-income groups.
The maldistribution of food is, of course, greatly exacerbated by natural disasters and by seasonal and annual variations in weather. In developing countries where the margin of food for survival is narrow at best, droughts, especially if extended over several years, as recently in the Sahel of Africa, will give rise to famine conditions, and floods have a similar, although less prolonged, effect. Producing more food will not solve the distribution problem unless the food is grown by the needy individuals themselves, or they have the income to purchase it, or it is distributed to them through some kind of organized programme. The latter is prohibitive in cost on the scale required.
Human factors, however, including the political shortcomings of governments, inequitable social systems, unbalanced agricultural policies, and emphasis on cash rather than food crops, are far more responsible for hunger. The sheer number of hungry and malnourished persons in the world is increasing because the number of people in low-income groups has grown, and they cannot buy or produce as much food as is desirable. World food production keeps up with effective demand, i.e. market demand, but has never been sufficient for the human needs of a large segment of the population. As some nations and some segments of the population grow in affluence, the imbalance for others is accentuated.
In a physiological sense, hunger is not only due to inadequate quantity of food, but also to qualitative deficits. The maldistribution of dietary protein is even more marked than that of dietary energy when protein quality is taken into consideration (3). Persons who can afford to do so will generally eat far more than their requirement and include proportionately more protein of animal or legume origin. Therefore, the maldistribution of total protein in the diet according to income group tends to be greater than that of calories when expressed as available protein. Whenever dietary data can be disaggregated at the level of the low-income family, it will be seen that the pre-school child and pregnant and nursing mothers suffer disproportionately.
Among the low-income-group populations, the diet will consist predominately of a cereal staple-rice, corn, sorghum, or wheat, and in some cultures, mainly in Africa, cassava and other roots and tubers-and nutritional deficiencies commonly occur. These diets do not provide sufficient concentration of available protein for normal child growth, good nutrition during pregnancy and lactation, and satisfactory recovery from stress, particularly that caused by frequent disease episodes. Iron is poorly absorbed from diets largely comprised of vegetables, and vitamin A will be deficient when the diet is lacking in both animal foods and green and yellow vegetables.
The human consequences of this maldistribution of food consumption are tragic. Poorly nourished mothers give birth to small infants whose neonatal, perinatal, and infant mortality is much higher than for infants of normal weight. Infants weighing less than 2,500 grams are treated as prematures in North America and Europe, but it is estimated by WHO that approximately one-sixth of the annual live births at term in developing countries, or roughly 22 million newborns, are below this weight. Poorly nourished mothers have less breast-milk and it is of poorer quality. This, combined with inadequate weaning practices, results in persistently slower infant growth and development, and decreased resistance to infectious disease. The combination of malnutrition, an unsanitary environment, and poor personal hygiene results in frequent diarrhea!, respiratory, and other infections that, in turn, further worsen nutritional status. The main mechanisms are reduced food intake, metabolic losses that are part of the stress response, and impaired intestinal absorption. Moreover, the evidence for an association, under these circumstances, between impaired physical development and reduced cognitive development and performance is conclusive. The synergistic interaction of malnutrition and infection also leads to much higher mortality in the 0.4-year age group.
Inadequate supplementation of breast milk and inappropriate or misused substitutes often lead to infantile marasmus. The cumulative effects of multiple episodes of infection in depleting protein status, and the relative deficiency of protein to calories in the diets given during and after such episodes, are responsible for the continued occurrence of kwashiorkor in Latin America, tropical Africa, South Asia, and some countries of Southeast Asia.
For adults, the interaction of malnutrition and infection results in increased absenteeism and poorer work performance. When calorie consumption is chronically below estimated needs, survival requires a curtailment in physical activity. While this suffices to maintain energy balance, it is not a socially desirable adaptation. When iron intake is deficient, physical capacity and work performance are significantly impaired, and diarrhea! and respiratory diseases are more frequent.
Priority Areas for the World Hunger Programme
The expert group, convened to determine what the UN University could contribute to solving these overwhelming food and nutrition problems of complex origin, considered carefully the expectation that it would give priority to increasing food production. The group noted that, despite its importance, increased food production alone would not solve the world hunger problem, and, moreover, that University resources would be of limited value in supplementing those already being devoted to this goal by other agencies of the UN system, by bilateral assistance programmes, and by the network of international agricultural research institutes that has been established.
The group emphasized, however, that at that time, post-harvest food conservation was receiving almost no attention from governments, international agencies and organizations, or from bilateral assistance programmes, and was excluded from the terms of reference of the international agricultural centres. Yet, grain losses in India are estimated to be 25 per cent in the field and 35 per cent after harvest (4). Such losses are caused by a combination of rodents, moulds, insects, spoilage, and inefficient processing. In Nigeria, sorghum losses are set at approximately 46 per cent, and fruit and vegetable losses are well over 50 per cent. Quantitative post-harvest losses of rice in Southeast Asia range from 10 to 37 per cent. Moreover, when insects infest grain or legumes, they eat the better protein, and quality falls. For such reasons, post-harvest food conservation was proposed as one sub programme area for the new UN University Hunger Programme.
The group also considered the inadequate state of our knowledge of nutritional requirements, and of the capacity of local diets to meet them, especially for the populations of developing countries. It noted that current estimates of protein requirements are mainly extrapolations from short-term studies of small groups of Caucasian university students selected for freedom from disease, living under privileged and protected conditions, and receiving a diet generous in calories. Data on energy needs are similarly inadequate. Whether ethnic differences exist in efficacy of dietary protein and energy utilization is unknown. Moreover, the effects of acute and chronic infections, and of sweat losses during work at high environmental temperatures have been inadequately explored.
The adequacy of iron intakes is influenced by the iron losses that occur with hookworm infection, Schistosomiasis, and malaria, and by reduced absorption of dietary iron in the presence of the phytates, oxalates, and fiber in predominantly vegetable diets lacking in the more readily absorbable heme-iron contained in meat. Moreover, iron deficiency, even when anaemia is not present, can impair cell-mediated immunity (5), work performance (6) and, as is just beginning to be realized, child cognitive behaviour (7).
Joint WHO/FAD expert committees have been pointing out these serious gaps in knowledge of nutrient requirements for the past 20 years, but there has been no mechanism for ensuring that the needed research would be done. Clearly, both the interpretation of dietary adequacy and the making of agricultural and educational policy require more information on energy, protein, and other nutrient needs of individuals living under conditions prevailing in developing countries, and of the capacity of local diets to meet these needs. The expert group believed that the United Nations University should give a priority to obtaining this requisite knowledge in order to guide countries in their policy and planning for the prevention of hunger and malnutrition.
The third priority problem area identified was the general lack, with a few notable exceptions, of any systematic consideration of nutrition in the policies and development plans of developing countries. Ministries of Health show little understanding of the synergistic interrelations between infectious disease and malnutrition, leading to high infant and pre-school child mortality, or of the relationship of the mortality, in turn, to family planning.
They also usually fail to include nutrition in the training of health workers. Ministries of Education pay little attention to teaching good food and nutrition practices at any educational level, and most conspicuously, nutrition training for physicians is ignored even in countries where most of the diseases they see are exacerbated or complicated by malnutrition.
Agricultural planning is dominated by quantitative considerations, and has focused primarily on cereal production and cash crops. As a result, in most countries, the production of legumes, which are a necessary source of more concentrated protein and energy to supplement predominantly cereal diets, has decreased, reducing their per capita availability, and increasing their price sharply. For families who already cannot afford protein of animal origin, the nutritional consequences are serious.
Agriculture in developing countries is frequently oriented toward profits for the indigenous elite or national and multinational corporations, and toward export earnings, rather than toward providing adequate income for rural people and food for their national needs. Because their agricultural policies do not put food, much less nutrition, first, many countries that could easily be self-sufficient in food, or even export it, are chronically deficient.
At the level of national development planning, the economists have been largely unaware of the economic as well as social costs of neglecting nutrition and health, and instead have concentrated their efforts on maximizing the gross national product and obtaining foreign exchange. The third and overriding priority proposed, therefore, was food and nutrition considerations in the socio-economic sector and in the national policies and planning of countries. Incidental to this was the recommendation for workshops to promote better understanding and interchange among professionals in the agricultural sector and those concerned with nutrition and food tech no logy .
How the UN University Can Contribute
With limited resources and only the instruments of scholarship, how could the UN University be expected to make a significant impact when the large staffs and budgets of other UN agencies and organizations seemed unable to turn the tide? Individuals with some of the longest and most intimate experience in working with WHO, FAO, and other UN bodies, as well as in developing countries, considered this a unique opportunity to apply some of the lessons they had learned and avoid some of the mistakes they had observed. They recognized that most developing countries were becoming increasingly wary of outside experts, and wanted to be able to depend on indigenous competence. They also knew that, despite many effective and dedicated individuals working as consultants in developing countries, this was no substitute for training local people, and that a discouragingly large number of consultants, however well-intentioned, made little or no contribution and were often a burden on the countries.
They believed that an international organization with no permanent staff, utilizing essentially all of its resources to help institutions in developing countries to develop the personnel and competence needed to deal with their own pressing problems, could make a significant contribution. The mechanisms proposed were the following.
First, associated institutions, primarily in the developing countries, that could provide the kind of multidisciplinary, advanced, but practical, mission-oriented training required for dealing with the hunger problem in the priority areas selected.
Second, UN University fellows selected from developing countries for their basic disciplinary competence and chosen from institutions that could provide opportunities for them to apply the experience of one or more academic years at one of the associated institutions. In addition, senior fellowships of shorter duration were proposed to enable existing or newly appointed directors or heads of departments and institutions of similar purpose, to study the organization, management, staffing, programme planning, and financing of those associated institutions most closely related in function to their own.
Third, support for applied research of direct relevance to priority problems.
Fourth, specialized workshops and small conferences to summarize current knowledge, to identify research needs, and to foster interchange among scientists working in a common priority area.
Fifth, dissemination of information of an applied nature in the priority areas, from workshops, commissioned reviews, and other activities.
Sixth, measures that would serve to build an interacting network of institutions and individuals with common purposes in each of the three sub-programme areas.
Individuals eligible for research grants were to be selected by site visits, and the quality and value of their subsequent project proposals were to be judged by peer review as a basis for award. In addition, institutional research programme grants, evaluated in the same way, were to be made to associated institutions able to conduct a series of integrated or related research projects in one or more subprogramme area.
Several aspects of these recommendations merit reemphasis. Within developing countries there are often highly trained persons in relevant disciplines who, nevertheless, have not been prepared for either multidisciplinary collaborations or problem-solving research. For such individuals, a period of training to reorient and broaden their comprehension of problems would enable them to make a greater contribution to their own countries, but also would help to keep them in their countries. The fellowships are also available for foreign nationals now in the United States and other industrialized countries with a commitment to return better prepared to make a useful contribution toward solving their own countries' problems.
No fellowship applications are accepted directly from an individual or institution, but each case is personally evaluated by site visits and interviews, and judged on institutional need and opportunity as well as ability. It was subsequently agreed that the UN University fellowship experience at associated institutions would, in some cases, be desirable for persons from industrialized countries as well, if they were committed to extended overseas service or expected to play a major role in the training of students from developing countries. In such cases, however, other funds are to be obtained for their support in order to conserve the UN University fellowship funds for developing countries.
It was also recognized that the number of institutions in the developing world prepared, at this time, to assume the kind of multidisciplinary, mission-oriented training responsibility envisaged would be limited, and, in some geographic regions, wholly lacking. This can be overcome in two ways. One way is by the gradual development of potential institutions through fellowship training for their staff, and support of a research programme. The other is by the careful selection of a few institutions in industrialized countries, with the staff experience and multidisciplinary orientation to the practical problems of less developed countries, to provide needed training until comparable institutions evolve in less developed countries.
The World Hunger Programme advisers felt that a properly developed multidisciplinary network, willing to try innovative approaches, would greatly facilitate understanding of the specific regional and local problems in the three programme areas of the University, as they occur in different ecological and cultural settings, and would assist in their solution. The goal of network development is the establishment of a community of scholars in different disciplines, sharing information and exchanging views on research and training priorities relevant to the UN University objectives, and engaging in concrete co-operative ventures for the solution of the problems.
Accomplishments of the World Hunger Programme to Date
In the fall of 1976, the first two associations were established. The first was INCAP, the Institute of Nutrition of Central America and Panama, in Guatemala City, with experience in the evaluation of human nutrient requirements and the nutritive value of local diets, in giving policy and planning advice to the Latin American countries, and in the use of agricultural wastes for animal feeding. The other, CFTRI, the Central Food Technological Research Institute in Mysore, India, was founded to develop relevant technologies for the protection of food resources through minimizing losses and wastage at various levels-with special emphasis on village storage and processing methods; to develop nutritious food products from indigenous raw materials; to provide assistance to industry and new entrepreneurs; to help start food industries, and to help solve day-to-day problems in food production and quality control. Both institutions had a 25-year record of multidisciplinary applied training, a large and highly competent professional staff, and publication records unique to the developing world.
To provide training and field experience in the specific area of food and nutrition programme planning, and development in the health and education sectors, a newer and different kind of institution, the Nutrition Centre of the Philippines (NCP), was also selected. It has primary responsibility in the Philippines for co-ordinating and advising one of the most comprehensive efforts yet undertaken by any developing country to improve nutrition, on a national scale, at the home and village level with the support of appropriate regional and national policies.
By early 1978, 49 regular fellowships had been awarded- 13 at CFTRI, 18 at INCAP and 18 at NCP, from eight Asian, six African, seven Latin American, and one Middle Eastern countries. In addition, 2 senior fellows from Indonesia and 1 from Thailand have studied the organization of both INCAP and CFTRI, and senior fellows from the Sudan, Senegal, Mexico, and Libya have done so at CFTRI alone. Additional senior fellows have been selected from Tanzania, Nigeria, India, Libya, Iran, and Thailand. In addition, 11 senior officials from six Southeast Asian countries have participated in the last week of the training programme for fellows from their countries in a condensed review of the NCP training experience. Many more potential regular and senior fellows have been identified, and the fellowship programme already appears highly useful and successful.
The task of identifying, in less developed countries, additional institutions ready to assume the kind of training responsibilities envisaged has proved extremely difficult, especially in Africa, and points up the urgent need for further institutional capacity in food and nutrition in developing countries. The UN University plans to assist the development of associated institutions in Ghana, Senegal, Thailand, Indonesia, Nigeria, Iran, and Brazil that might be expected eventually to have training functions. In the meantime, the training in post-harvest food technology, available at the original associated institutions, will be supplemented by TPI, the Tropical Products Institute, in London, and the National Food Research Institute in Tokyo, the latter for its expertise in the post-harvest technology of rice.
In the area of food and nutrition policy and planning, the Joint MlT-Harvard International Food and Nutrition Policy and Planning Programme (IFNP), utilizing also collaborators from Cornell and Columbia, will provide the academic background for fellows who will have subsequent field experience in the programmes of INCAP, NCP, or other institutions in developing countries. The Centre for Research in Nutrition (CRN) at Laval University in Quebec City, Canada, will offer training in French for fellows from Francophone developing countries.
Newly associated institutions for research are: INTA, the Institute of Nutrition and Food Technology in Santiago, Chile, with projects on iron-deficiency anaemia in children, protein-energy needs of adults, educational motivation to stimulate breast-feeding, environmental sanitation as a tool for nutritional intervention, and the prediction of groups at risk of malnutrition and ill health, using economic indicators falling in sub-programmes I and III; and IVIC, the Venezuelan Institute for Scientific Investigation, Caracas, which is undertaking development of centres in four other South American countries to measure iron availability from local diets and to identify suitable vehicles for iron fortification.
The research programmes of INCAP are also in all three sub-programme areas. Particularly valuable is the pilot study of iron fortification of sugar under way in Guatemala, and the investigations of protein and energy needs of local populations. The results of the fortification of ail refined sugar with vitamin A on a national scale in Guatemala and Costa Rica are also awaited with great interest.
To bring together agriculturalists, nutritionists, social scientists, and policy makers to discuss common policy and research problems, successful workshops have been held at the International Institute for Tropical Agriculture, Ibadan, Nigeria, in co-operation with the University of Ibadan, and at the International Rice Research Institute, Los Baños, the Philippines, in co-operation with the Nutrition Centre of the Philippines. The next is scheduled for INCAP in collaboration with the International Maize and Wheat Improvement Centre, Mexico, the International Centre for Tropical Agriculture, Colombia, and the International Institute of Tropical Agriculture, Costa Rica. Technical workshops on "Protein and Energy Requirements under Conditions Prevailing in Developing Countries," and the "Impact of Food-Price Policies on Nutrition" have been held in San Jose, Costa Rica and Mexico City, respectively.
Obviously, the World Hunger Programme of the University is still in its infancy, and the number of associated institutions, regular and senior fellows, research projects and programmes, workshops, technical meetings, and publications will increase steadily. All of these activities are determined by advisory groups and task forces made up of experienced persons from both less developed and industrialized countries.
The World Hunger Programme must also be viewed in the larger context of the over-all University mission. All three programmes of the University are concerned with the quality of life, and this, in turn, requires definition of goals and of indicators of their achievement. Too often development has been seen as economic in nature, and the perceived solution to underdevelopment is assumed to be financial and technical assistance to bring about economic development. The results of this strategy have been disappointing. The University is re-assessing the nature of development in the context of continuing mass poverty, social inequity, and external dependence.
A joint technical workshop is planned between the World Hunger and Human and Social Development Programmes of the University to bring together persons from different cultures, disciplines, and political systems to consider the appropriate goals and indicators for programmes to overcome hunger and malnutrition. A joint workshop of the World Hunger and Natural Resources Programmes on "Bioconversion of Organic Residues for Rural Communities" is planned as the first step in developing a research programme in this area. Such other issues as technology transfer, research and development for rural settings, socio-cultural differences, and education for development are of common interest to all three programmes.
A fundamental premise of the University's World Hunger Programme is that much can be done to alleviate hunger, malnutrition, and other health problems even within current economic constraints. Almost any country can afford iodization of salt to prevent endemic goiter, and the distribution of vitamin-A capsules to young children to prevent eye damage from avitaminosis-A. Iron fortification to eliminate iron-deficiency anaemia should soon be feasible. Immunization programmes to prevent whooping cough and measles are also important because these diseases so often precipitate clinical malnutrition. Still within the capability of low-income rural populations are programmes of periodic weighing of all young children and education of mothers to provide proper food before malnutrition becomes sufficiently severe to impair growth and development and lower resistance to infection. Even improvements in environmental sanitation and personal hygiene for the control of diarrhea! disease can generally be achieved within existing economic constraints.
The unqualified statements of some economists and even nutritionists that the solution to hunger and malnutrition is the abolition of poverty are as misleading as those asserting simplistically that the solution lies in increased agricultural production. A great deal could be done to improve the nutrition and health status of individuals and populations without waiting for the uncertain progress of economic development. Health workers-must respond to this challenge nationally and internationally. Moreover, as we now recognize, affluence brings with it new health problems, many of them nutritional in origin, or at least having a major nutritional component.
Harmonization of International Efforts
A question repeatedly raised concerns duplication and competition among international programmes. It is worth noting that, in the field of nutrition, the UN system has taken a major step toward harmonization of international efforts in this field by the establishment of a UN Sub-Committee on Nutrition of the Administrative
Committee on Co-ordination (ACC) of the UN system. The ACC is made up of the heads of UN agencies and organizations and meets three times a year. The Sub-Committee on Nutrition (SCN) is made up of the senior persons responsible for the nutrition activities of each agency and meets with the same frequency, along with its Advisory Group on Nutrition {AGN). The latter consists of distinguished professionals in this field, serving in their individual capacities, and is a successor to the Protein-Calorie Advisory Group (PAG) of the UN system. The administrators of bilateral programmes of Canada, Denmark, France, Japan, Norway, Sweden, the U.S., and others furnishing assistance to developing countries with food and nutrition problems, meet together in sessions that partially overlap those of the SCN. Several SCN and AGN members are also members of the UN University World Hunger Programme Advisory Committee in order to provide further assurance that the UN University's programmes complement the efforts of other agencies and organizations.
Summary
The role of the UN University lies in fostering the research needed to fill pressing gaps in knowledge, in providing appropriate advanced training, in helping to build effective and relevant institutions, and in disseminating useful knowledge. Relevant institutions of higher learning and research are a global necessity in order to inform, train, and motivate individuals who can contribute effectively to the solutions of the "pressing global problems of human survival, development' end welfare". The University's World Hunger Programme seeks to assist the development of such institutions in the developing countries where they are so urgently needed.
References
1. Joint FAD/WHO Expert Committee on Nutrition, Ninth Report, Food and Nutrition Strategies in National Development, WHO Tech. Rep. Ser. 584, FAO and WHO, Geneva, 1976.
2. Reutlinger, S. and Selowsky, M., "Malnutrition and
Poverty-Magnitude and Policy Options", World Bank Staff
Occasional Papers No. 23. Baltimore and London: The Johns Hopkins
University Press, 1976.
3. Scrimshaw, N.S., "Through a Glass Darkly: Discerning the Practical Implications of Human Dietary Protein-Energy Interrelationship", W. O. Atwater Memorial Lecture. Nutr. Rev. 35112). 321 11977).
4. Parpia, H.A.B., "Post-Harvest Losses-Impact of their Prevention on Food Supplies, Nutrition, and Development", in Nutrition and Agricultural Development, N.S. Scrimshaw and M. Béhar, eds. New York and London: Plenum Press 1 976.
5. Suskind, R. ed., Malnutrition and the Immune Response. New York: Raven Press, 1977.
6. Viteri, F.E., "Definition of the Nutrition Problem in the Labor Force", in Nutrition and Agricultural Development, N.S. Scrimshaw and M. Béhar, eds. New York and London: Plenum Press, 1976.
7. Pollitte, E., Greenfield, D., and Leibel R. Fed. Proc, 37, 487,1978. (Abstr. 1447)