274 Diet and Health
connection with spina bifida (neural tube defect syndrome), the overall impact of
nutritional science in policy making has been negligible. Its response to the current
epidemic of heart disease has been ‘health education’ – advice, leaflets and exhorta-
tions to change behaviour – explaining it as caused by modern life-styles, rather than
by preventable dietary deficiencies. Almost as soon as the Productionist paradigm
was put in place worldwide in the last half of the 20th century, global campaigns
were needed to address the increase in degenerative diseases. However, the necessary
policy instruments were not in place to tackle the health impact of long-term shifts
in diet. The UN bodies which noted the evidence of new patterns of ill health were
merely intergovernmental bodies who lacked any administrative power and influ-
ence to act on the global and national level. Commercial interests, on the other hand,
had no such limits and could pursue their global ambitions, selling foods and a life-
style around the world without regard to their consequences, and being able to
defend their actions as being in the public interest.
Instead, the developed world now must confront one of the most challenging
food and health disasters ever to face humankind: an epidemic of obesity with lit-
tle prospect of an end in sight and the prospect of a new wave of diet-related dis-
eases in its wake. It has little in its armoury with which to combat the causes of
obesity, now affecting significant numbers of children and with even graver impli-
cations for future population health. Health education is ineffective; consumerism
is part of the problem, but politically it is nearly sacrosanct.
Meanwhile, hunger and insufficiency continue, ironically, to prevail. As a 1995
FAO review of the global picture starkly put it: ‘[H]unger ... persists in developing
countries at a time when global food production has evolved to a stage when suf-
ficient food is produced to meet the needs of every person on the planet.’^10 Over-
consumption and under-consumption coexist. There is gross inequality of global
distribution and availability of food energy. The same review asserted that Western
Europe, for example, has in theory 3500 kilocalories (kcal) available per person per
day and North America has 3600, while sub-Saharan Africa has 2100 and India
has 2200. By 2015 the FAO calculates that 6 per cent of the world’s population
(462 million people) will be living in countries with under 2200kcal available per
person. And by 2030, in the most optimistic scenario, in sub-Saharan Africa 15
per cent of the population will be undernourished. Numbers of the undernour-
ished look set only to decline much more slowly than suggested by targets, for
example those of the World Food Summit of 1996.^11
The transnational nature of these patterns of diet-related disease demands
public policy attention. The enormity of this human health problem cannot be
overemphasized. Diseases associated with deficient diet account for 60 per cent of
years of life lost in the established market economies.^12
Scientists categorize diseases into two broad groups: communicable (carried
from person to person or via some intermediary factor; these include diseases such
as malaria, food poisoning, SARS); non-communicable (acquired by life-style or
other mismatch between humans and their environment, such as cardiovascular
disease and cancers). Table 13.2 indicates that in the developed world, deaths