WPHNA World Public Health Nutrition Association

In the UK in the 1970s, overweight was not considered to be a public health problem. Micronutrient deficiencies were prevalent – and for many they still are: about one-fifth of children are short of various B vitamins, and some seriously so. In those days I was in London doing my Masters degree. There were few ready meals and most people still cooked foods. My aim was to encourage consumption of a variety of foods. I came up with a colour theory. This is that the more colours there are on a plate, the healthier the meal. (Some smart colleague suggested that I was recommending a diet of brightly dyed confectionery!).

Over 30 years later, food systems have been and are being transformed. In his commentary in WN this month, Carlos Monteiro is certainly right to note that the main single most significant change is the massive increase in ultra-processed products. What does he mean by ‘ultra-processed’? Enquire within WN...

Courageous Africans

In September, during my most recent trip to South Africa, I spent a very enjoyable Saturday afternoon watching football and talking with Pedro Pisa, a young nutritionist from Zimbabwe now living in South Africa. Pedro was trained by Lucy Malaba before going to South Africa to do his PhD with Association founder member Esté Vorster. Despite all her own health problems, which led to her very early death, and the difficulties of living in Zimbabwe, Lucy trained her students well. Pedro, like other Zimbabweans I have met, has a sound foundation in nutrition. Standards do not have to be compromised even under difficult conditions. But few of Lucy’s former students now remain in Zimbabwe.

Many families in Zimbabwe and other African countries depend on their children who are working overseas to support them. Overseas remittances increasingly account for an increasing proportion of household income for many African families. One friend from Zimbabwe got a scholarship to study overseas, and subsequently supported his brothers and sisters through their own education.

I have just received an email from Association founder member Joyce Kikafunda , who was born and raised in a remote rural village in Uganda. Explaining why she has not been in touch lately, she writes that before she could study our website and WN, and read about the Porto congress, ‘I got family problems and was off for some time. My Mum and my brother got critically ill at about the same time. My brother is my only sibling left alive of five brothers and sisters. Unfortunately he has been diagnosed with cancer of the stomach and is now in advanced stages. Everything in my family revolves around me as the only educated member of the family. With the State having no structure to care for the elderly or the sick, this is a tough time for me’.

Such stories are common in Africa. I wonder how many of my European colleagues would, in similar circumstances, do the same as Joyce. .

Equity breeds equity

In 1970 the world’s rich countries made a pledge at the UN General Assembly to give 0.7 of their Gross Domestic Product to official development assistance (ODA) Currently just five countries – Denmark, Luxembourg, The Netherlands, Norway, and Sweden – honour this commitment (1). The UK, currently at 0.43, is projected to rise to 0.56 by 2011.

In 2007 the UN Children’s Fund (UNICEF) wrote a report on child well-being in rich countries. Countries were ranked based on performance in six dimensions: material well-being; health and safety; educational well-being; family and peer relationships; behaviours and risks; and subjective well-being (2). The Netherlands ranked top followed by Sweden and then Denmark, and Norway ranked as number 7. (Luxembourg was not included in the study). The UK was bottom, just below the USA.

Is it mere coincidence that the countries that meet their international obligations also seem best at looking after their own children? I think not. In the UK where I live, there are now outrageous inequities between the rich and poor. According to the Joseph Rowntree Foundation, 40 per cent of the extra income that has been created in the UK over the past decade has gone to the richest tenth of the population. The poorest tenth has gained almost nothing (3).

When Prime Minister, Margaret Thatcher said there is no such thing as society. I believe the UK still suffers from the policies that flowed from that philosophy, one of which is not fulfilling its promises to international development.

Trade not aid

Overseas aid is often problematic. I recently came across an organisation based in Uganda called ‘Good African’. They grow and also process coffee. This is what they say on their website (http://www.goodafrican.com/index.php/our-story/trade-not-aid.html) about aid:

‘There are many problems in using aid as a vehicle for development. This is because handouts have never been an effective way to achieve economic transformation. There are several reasons for this:

Aid is really not aid. Most aid programs are poorly structured and
constrained by conditionalities. This undermines the independence of recipient countries and the management of their economic affairs.
Aid erodes accountability. Providing aid through the governments of poor countries erodes accountability because governments become more accountable to donors than to their own citizens.
Aid leads to a chronic dependency on donors. Because poor countries are dependent on donor handouts they fail to prioritize the generation of domestic resources. This creates a chronic dependency on aid, stifles creativity, and undermines the dignity of people.

For reasons such as this, as long ago as 1968, at a meeting in Delhi of the UN Conference on Trade and Development (UNCTAD) the call was for trade, rather than aid. One aspect of this has become what is now known as the ‘fair trade movement’. The first such activities were led by civil society organisations in the USA in the late 1940s. In Europe, Oxfam started importing and selling crafts made by Chinese refugees in Hong Kong in the late 1950s. In 1964, Oxfam created the first Alternative Trading Organization (ATO).

Parallel initiatives were taking place in the Netherlands, with the establishment of the importing organisation SOS Wereldhandel (now Fair Trade Organisatie) in 1967. The ATOs established direct relations with small-scale producers in impoverished countries. Their declared policy was to pay a higher price for their products. In the early 1980s, prices for many primary agricultural commodities collapsed, and small-scale coffee producers in particular faced a hard time. In The Netherlands, a fair-trade label (Max Havelaar Keurmerk) was created, and in 1988 the first fair-trade labelled coffee was sold. This was the beginning of the second generation of fair-trade initiatives, with the labelling organisations having no economic interests in the labelled products. This model has allowed fair-trade products to be sold through conventional channels.

The trading of food commodities is grossly inequitable. Coffee is an outstanding example. This is the second most traded commodity after oil. Out of the total global coffee business, valued in 2008 at approximately $US 144 billion a year, the coffee growing countries receive a total of just $US 15 billion for their green unprocessed beans. The remaining $US 129 billion stays in the rich countries whose industries add economic value to the coffee that they import.

Thus, 1 pound (around 450 grams) of green coffee will earn a Ugandan coffee farmer approximately $US 1, while industries in the countries to which the coffee is exported will sell the same coffee roasted and packed, for approximately $US 8. Ugandan coffee farmers are losing $US 7 of added value, simply because they are not roasting and packing their own coffees. African and other coffee growing countries have been gifting this level of value to the rich world for many decades. ‘Good African’ claims to be the very first African owned company that adds value to coffee beans in-country. It now sells directly to supermarkets in rich countries.

But the so-called fair-trade movement is only one small response to the call for trade not aid. It can only ever be a small player in global markets. What’s needed is equitable terms of trade, at the highest levels.

Africa needs a fair deal

Three questions about ‘Trade not aid’ are: What does the slogan really mean? Are there different interpretations? Can it really work (whatever it is)? My interpretation of the slogan is that aid alone does not support development, and that low and middle income countries must be given more equitable access to markets for their goods, so that they can generate their own wealth to use for their own development on their own terms. Look at the facts.

In 2009 support to producers in the ironically named Organization for
Economic Co-operation and Development (OECD) countries, which actually are the rich countries, was estimated at $US 253 billion, representing 22 per cent of aggregate gross farm receipts(4). This is about three and one-half times more than the aid given to lower-income countries by OECD countries.
Every cow in Europe gets more money in European Union subsidies per day
(an average of $US 2.20) than 20 percent of the world’s population earns in daily income.
For every dollar received in aid, African countries are repaying $US 13 in
interest on foreign debt. This has often been foisted in the past on governments for no good or useful end, except to enrich the lenders and too often also the national ruling regimes (5).

Eliminating such unfair subsidies and foreign debt interest payments would make development aid much less necessary, and would allow poor countries to develop their own economies without the need for charity. But multilateral trade negotiations have not yet reached any agreement after nearly ten years of talks.

The 2009 FAO State of Food Insecurity in the World report, focused on the impact of the economic crisis on food insecurity (6). Food aid contributes only a tiny proportion of commercial imports. I bet that most people in many rich countries would not believe this. The impression is so often given that African countries are just waiting for aid and not doing anything for themselves. This is not my experience, and this is not what the relevant facts and evidence show. Africa needs a fair deal.

Barrie Margetts
B.M.Margetts@soton.ac.uk

References

The Millennium Development Goals. Report 2010. United Nations: New York, 2010.
UNICEF. Child poverty in perspective: an overview of child well-being in rich countries. Innocenti Report Card 7, UNICEF Innocenti Research Centre, 2007.
Macinnes T, Kenway P, Parekh A. Monitoring poverty and social exclusion Joseph Rowntree Foundation, 2009.
OECD. Agricultural policies in OECD Countries, 2010.
Commission on Social Determinants of Health. Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health. Final report, Geneva, World Health Organization, 2008.
Food and Agriculture Organization of the United Nations The State of Food Insecurity in the World 2009. Rome, FAO, 2009 (The 2010 report is just published, at http://www.fao.org/docrep/013/i1683e/i1683e.pdf).

John Waterlow

Details of John Waterlows’s astonishing life, career, achievements and vision, are on http://www.brookes.ac.uk/lifesci/medical/synopses/waterlow.html. (See the appreciation elsewhere in this month’s home page). Here are a couple of my own stories. When I was studying in London (as mentioned above) I read the paper he wrote for Nature in 1975 with Philip Payne on ‘The protein gap’. It was so clear and sensible – and, with the views of others, it had a great impact on global nutrition policy. Then in the 1980s he was calling for nutrition to become more professional, long before the rest of us.

I spent some personal time with him over the years. Once a group of us, including John Waterlow and Alan Jackson travelled to a meeting in Athens. We headed out for some conviviality, and in no time John was sitting down, and ouzo and a spread of delights was at our table. As we walked into the place he had spoke in Greek to the waiter and ordered the local specialty – he had spent time in Crete during the war. There was no messing, with John, with and without the comma.

Another time I was sitting next to him on a bus in Barbados. We were going to some social function. He must have been about 80 at the time. I made some rather ageist remark, and he politely but quickly put me straight. More recently he was an active correspondent to Public Health Nutrition. When I asked for advice, within a few days a typewritten note (yes, a note written using a typewriter!) would appear from John suggesting what to us were profound insights, over his small neat signature. He enjoyed reading Geoffrey Cannon’s Out of the Box column, of which Geoffrey’s column here is the successor, mostly for the gossip and behind-the-scenes stories. I am privileged to have shared some time with him. He will remain an inspiration to us all.