280 Diet and Health
nutritional review of this problem concluded that exhorting the Chinese people to
consume more soy when they were voting with their purses to eat more meat
would be ineffective ‘in the context of an increasingly free and global market’.^29
Such studies can suggest that the battle to prevent Western diseases in the develop-
ing world appears already to have been lost. If the nutrition transition is weakening
health in China, the world’s most populous and fastest economically growing
nation, which has 22 per cent of the world’s population but only 7 per cent of its
land, what chance is there for diet-related health improvements throughout the
developing world?
As populations become richer, they substitute cereal foods for higher-value
protein foods such as milk, dairy products and meat, increased consumption of
which is associated with Westernization of ill health. Relatively better-off popula-
tions also consume a greater number of non-staple foods and have a more varied,
if not healthier, diet.^30 Thus we have the modern nutritional paradox: in the same
low-income country there may be ill health caused by both malnutrition and over-
nutrition; in the same rural area of a poor country both obesity and underweight
can coexist.
In policy terms the challenge is whether India, China, Latin America or Africa,
for example, can afford the technical fixes that the West can resort to in order to
improve diet-related health:^31 coronary bypass operations; continuous drug
regimes; expensive drugs and foods with presumed health-enhancing benefits;^32
and subscriptions to gyms and leisure centres. The affluent middle classes in the
developed world might be able to afford such fixes but the vast numbers in the
developing world certainly will not. Technical fixes are not societal solutions.
It could be argued that the increase in degenerative diseases is the inevitable
down-side of economic progress. The problem for policy making is how to dif-
ferentiate between protecting the already protective elements of traditional, indig-
enous diets such as legumes, fruit and vegetables, and opening up more varied
food markets, which is deemed to be good economic policy. In practice, too few
policy makers in the developing world have been prepared to fight to keep ‘good’
elements of national and local diets or to constrain the flow of Western-style foods
and drinks into their countries lest they infringe support for trade liberalization.
Thus, in stark terms, trade and economic policies have triumphed over health
interests. US-style fast foods – the ‘burgerization’ of food cultures – have been
hailed as modernity. We must now expose the production, marketing and prices of
fast food,34,35 their nutritional value and their impact on health.^36
Three Categories of Malnutrition: Underfed, Overfed,
and Badly Fed
More than 2 billion people in the world today have their lives blighted by nutri-
tional inadequacy. On one hand, half of this number do not have enough to eat;