Not a lack of food but a lack of access.

During the last fifty years, there has been a phenomenal rise in world population. According to available projections, the world population figure for 1997 will increase by 1,297 million by the year 2015. A great part of this increase is expected to take place in those very areas of the world that are currently most hard-pressed for food. Thus, as much as 820 million of the projected 1,297 million is expected to occur in Asia. (1) Apart from this disturbing growth, the per capita requirement for food is also expected to rise, as millions who are currently trapped in poverty cross the poverty line to join the ranks of an expanding "middle class". The scope for further expansion of land resources for food production being limited, increased food production to meet growing population needs must be achieved through a significant increase in production per unit of land.

Developmental transition during the last few decades has also brought about a significant "qualitative' change in the demographic nutrition profile. As a result, there has been a progressive though painfully slow movement of the population away from poverty and towards affluence in many developing countries. This ascent to affluence has been more marked in some countries than in others. The striking immediate results of this transition have been:

An expanding pool of sub-standard survivors. These are children who in earlier years would have died but now manage to "survive" and reach adulthood.

The emergence of an expanding relatively affluent urban middle class (the first-generation rich), among whom there is an alarming escalation of nutrition-related chronic degenerative diseases.

Strategies for the achievement of nutrition security must be adapted to suit this change. "Survival" is not synonymous with good health/optimal nutrition. Strategies to ensure survival must give place to strategies to ensure child health and optimal nutrition.

The time has come when there must be a paradigm shift in national nutrition policies in recognition of this changing nutrition profile.

The earlier strategies, which were largely in the nature of "holding operations" that had helped to buy precious time and hold Malthusian fears at bay, were based on such limited goals as freedom from hunger, child survival and "safe motherhood", and are no longer appropriate. Children must "live", not just "survive"; mothers must be educated, productive and resourceful, not just safe for reproduction; and people must be optimally nourished, not just "free from hunger". Dietary excesses among the relatively affluent must be avoided and lifestyles consonant with good health must be promoted.

Food security in earlier years was largely interpreted as the achievement of adequacy with respect to energy needs. The calorie adequacy yardstick was being used to assess success, and the emphasis was on food grains. Nutrition security, on the other hand, must mean adequate access not only to energy rich cereals but to a range of foods as well, whose intake in judicious amounts could provide balanced nutrition. The attempt must be to provide "qualitative" improvements in the diets of the poor population, using foods that are well within their reach, including pulses/legumes, vegetables and fruits, milk, poultry and fish.

An integrated plan for food production should strive for augmentation of production not only from land sources but also from improved animal husbandry and better utilization of riverine and marine food sources. Nutrition security should also imply the adoption of strategies, which will ensure the cleanliness and wholesomeness of food to avoid infections and toxicants, It should also include nutrition education in order to ensure equitable intra-familial distribution of food in accordance with physiological needs, It is through this enlarged concept of "nutrition security" that we can hope to combat the emerging nutrition problems.

It has often been claimed that the green revolution and the technologies now available for augmenting food production have largely run out of steam and that it is therefore imperative that new technologies and initiatives need to be explored. While the quest for such technologies certainly needs to be encouraged, in large parts of Asia, actual food yields currently being achieved with existing technologies fall far short of the potential yields. (2)

Obviously, considerable scope for significant increase in food production using already available technologies on the shelf exists. Developing countries should give the highest priority towards more efficient implementation of these technologies. The intensive agricultural technology that had been adopted earlier as part of the green revolution had not always been pursued with appropriate precautions with regard to optimal use of fertilizers and pesticides, and periodic soil testing and soil replenishment. These past mistakes must be reversed in order that we may derive maximal gains from present technologies.

The current wastage of food due to bad storage and preservation procedures also needs to be curtailed. Nearly a third of the vegetables and fruits and a considerable proportion of cereal grains perish before reaching the point of consumption, and avoidance of this wastage must receive immediate attention.

There is considerable scope and need for the expansion of agro-based industries in villages and townships, which could create job opportunities for women and men. This could also lead to better production and more effective utilization of local food resources by the community, and reduce the present considerable loss of perishable food items.

There is increasing international recognition that programmes for achieving nutrition security must be sustainable--sustainability has been defined by the World Committee of Environment and Development as "meeting \the\ needs of present generation without compromising the ability of future generations to meet their needs". The technologies used for production in the wake of the green revolution did not always fulfil this salutary criterion. The nutritional upliftment of poor populations in developing countries must obviously be achieved by enabling them to utilize their food resources optimally and judiciously. Upliftment programmes must be food-based and not drug-based. Attempts must be made to bring about desirable and feasible inexpensive ways of achieving diet improvement using locally available foods.

Millions of people in developing countries do not enjoy nutrition security, not because adequate food is not available at the overall national level, but because they lack the economic access to these foods. They are caught in the "poverty trap". We are therefore witness to the cruel paradox of large buffer stocks of food grains on the one hand, and vast pockets of undernutrition on the other, in the same country.

The poverty syndrome has many mutually synergistic and reinforcing attributes. Family incomes are low because of widespread illiteracy and the lack of income generating skills. Low income not only denies adequacy with respect to food but also to basic health care, housing and environmental hygiene. More so, continued endemic poverty saps self-confidence and undermines the physical and mental attributes of people to the point that they acquiesce in and accept their poverty status. The populist and temporary short cut to overcoming poverty consists of thick "welfare carpets"--free giveaway programmes, which help to mitigate severe hunger in the short run, but which keep the people in poverty and further lower their self-esteem. Anti-poverty programmes that lift people out of the poverty trap help them to help themselves, lay emphasis on education, acquisition of skills and provision of basic health care, and improve transport and communication. A close association between the level of female illiteracy and the level of undernutrition in a community has been demonstrated. (3,4)

Association, however, does not necessarily reflect a direct cause and effect relationship. The very socio-cultural factors which are deterrents to female literacy could also be the ones that perpetuate social and economic stagnation. In the final analysis, nutrition security cannot be achieved in isolation in an underdeveloped society through narrow vertical nutrition programmes in the context of continuing underdevelopment. It can only be achieved as part and parcel of the overall socio-economic development of the community.

Development has two equally important dimensions which are interrelated: social and economic. The cornerstone of social development is female education and empowerment. When the mother is educated, it is usually the case that the father is also educated. The child therefore has the benefit of better parental caring and "stimulation", and the household is able to make the right choices with respect to foods within its economic reach and towards the optimal utilization of other health care resources available to them.

The quest for food and other basic necessities for survival has been the major preoccupation of mankind right through the ages. It is sad that, even with the spectacular advances in science and technology over the last several centuries, nearly half of mankind continues to be engaged in the quest for basic necessities for survival. Unlike the hunters and food gatherers of the Stone Age, the poor of today suffer nutrition insecurity not due to a lack of food around them, but due to a lack of economic access to these foods. We are witness to the cruel paradox of poverty in the midst of plenty in an inequitable world. It is true that during the last century some of the worst forms of nutritional deficiencies, like famines and florid deficiency diseases, have been largely overcome. It is to be hoped that in this century mankind will achieve the goal of a world where the basic necessities of life will be available to all, and that man's efforts will henceforth be largely directed to creative and productive pursuit s, which will contribute to the enrichment of the quality of life.

Notes

(1.) Human Development Report, UNDP, Oxford University Press, 1999.

(2.) Agricultural Statistics at a Glance, Ministry of Agriculture, Government of India, 1998.

(3.) The State of the World's Children, UNICEF, 1998.

(4.) National Family Health Survey (1992-1993). India: Summary Report. International Institute for Population Sciences, 1995

RELATED ARTICLE: New genetic technologies offer the promise of opportunities for breeding food crop varieties for resistance, tolerance to biotic and abiotic stresses, drought and salinity resistance, and even better nutrient quality. Genetic technology applied to horticulture could result in production of vegetables and fruits with improved micronutrient content and better acceptability. There are widespread concerns regarding the safety of some genetically modified foods, and some of these may prove to be genuine. These concerns relate to the possible direct effects of the transferred genes on: the recipient organisms; the possibilities of unfavourable recombination; the behaviour of these foods under actual field conditions; possible allergenicity and toxicity of these foods; the environment and bio-diversity; and nutritional quality. The need exists to collect convincing evidence of the efficacy and safety of genetically modified foods before they can gain general public acceptance, and a precautionary pa ckage for their safe and beneficial use should be developed. Ethical codes for experimentation and field-testing need to be in place, as well as national and international protocols to ensure bio-safety.

C. Gopalan, FRS, MD (Madras), D.Sc. (London), is President of the Nutrition Foundation of India and former Director and the founder of the National Institute of Nutrition, Hyderabad. He is also Director-General of the Indian Council of Medical Research and President of the International Union Nutrition Sciences.