‘Evils once recognised are half-way on towards their remedy’. This was Elizabeth Gaskell’s creed, written in a letter to a friend. She was explaining why in her novels she exposed the dreadful conditions of the impoverished working classes – women and children most of all – in Manchester in the mid-19th century. Let us hope she is right.
Skyscraper or old tin shack?
Laborious… duplicative… weak… grossly insufficient… poorly targeted… fragmented… dysfunctional. These are judgements of the ‘global architecture’ designed and built to stem world undernutrition. Some architecture! These scorching words are contained in the invited commentary by one of our associate editors, Ricardo Uauy, published in this issue(Reference Uauy1). The judgements are not personal. He is co-author of the culminating paper of a series of five on the theme of maternal and child undernutrition, published earlier this year in Lancet (Reference Morris, Cogill and Uauy2). In turn, this series is the fruit of a series of consultations involving scores of experts, with support from the World Bank and the Gates Foundation.
We also publish a letter by John Waterlow(Reference Waterlow3), whose work on behalf of undernourished children in the tropics began in 1945. The politics of undernutrition is also touched upon in this month’s Out of the Box column(Reference Cannon4). In pointing out that our profession is neglecting the wretched of the earth, John Waterlow and Ricardo Uauy both issue this journal a challenge.
We stand challenged. Yes, they are right. Public Health Nutrition does not carry a proper share of articles on undernutrition. We on the editorial board can immediately do two things about this. One is to ensure that our editorial pages, which include editorials such as this, our Out of the Box column, invited commentaries and the letters pages are better balanced. The other is to urge researchers committed to finding solutions to undernutrition to submit original papers.
In the Lancet paper and in his commentary, Ricardo Uauy and his colleagues propose that ‘The editors of academic journals with an interest in maternal and child undernutrition should meet in 2008, to develop a strategy to increase the profile and programmatic relevance of the topic and to reduce fragmentation’. There are 417 such journals and getting all to work together will be a challenge; this journal pledges to do better.
Words – and action
But for a journal, doing means words. What is most needed is action. And here it seems to me, as a public health nutritionist who spends a lot of time working in Africa and India, that as a profession we have a problem, and may even be part of the problem. Our dilemma is expressed by ‘The development set’, a doggerel poem by the missionary and world hunger specialist Ross Coggins(Reference Coggins5). One verse is
We discuss malnutrition over steaks
And plan hunger talks during coffee breaks,
Whether Asian floods or African drought,
We face each issue with an open mouth.
Perhaps our task should be limited to helping to make the world a place within which it is easier for impoverished communities to feed themselves, as John Waterlow suggests in his commendation of leaf concentrate produced by villagers on their own behalf and that of neighbouring communities. But this may engage us more as citizens than as nutritionists.
The politics of hunger
Surely also it is impossible to see why undernutition persists in the world unless a bigger picture is discerned. This includes international trade and aid used by rich countries as an extension of their foreign policies. The amount of aid of all forms that goes to impoverished countries is a fraction of the interest paid by those countries to service their foreign debt.
John Waterlow uses the word ‘controversial’ in the context of undernutrition as a global public health issue. The original fundamental reason why tens of millions of families especially in Asia and Africa are now famished is exploitation by the colonial powers. It may be uncomfortable to point out that this is not just history. Indeed, tens of thousands of mothers and children in Afghanistan and Iraq now are beyond anybody’s help. They have died as a result of invasions and insurgencies, as have hundreds of thousands of mothers and children in African countries reduced to chaos and famine by incessant wars and massacres. We may have different views on the foreign policies of the world’s most materially rich countries. But we surely all agree that the impact of these policies, as practised on many of the world’s most impoverished countries, is catastrophic.
This has been understood in the USA at the highest level. Dwight Eisenhower is the most recent US President who was a senior wartime officer. After he left the US army he reflected on the horrors of war. In his first public address after his election, on 16 April 1953, he spoke about the fundamental reasons for undernutrition. He said:
Every gun that is made, every warship launched, every rocket fired signifies in the final sense, a theft from those who hunger and are not fed, those who are cold and are not clothed… This world in arms is not spending money alone. It is spending the sweat of its laborers, the genius of its scientists, the hopes of its children.
This journal and this profession does not have the answers to undernutrition. But at least we have the responsibility to see and acknowledge the scale of the problems. This is a time to bear Elizabeth Gaskell’s essential optimistic belief in mind.
