Intersection between health and nutrition

Giving scientific knowledge an indigenous face in developing countries

By Charles Dhewa

The intersection between health and nutrition continues to be a grey area for ordinary people in many developing countries. There have not been serious efforts to develop appropriate ways of sharing nutrition knowledge with the majority.

For instance, formal education systems have not done enough to move health and nutrition from being understood as a science to practical aspects of people’s daily lives. Science related to health and nutrition has only been slightly extended to society through students who enrol to study medicine, veterinary science, nutrition and other related disciplines.

In health institutions, nutrition knowledge continues to be locked in health personnel like doctors and nurses who can only share it through surgeries, clinics and hospitals when they give prescriptions to patients. It means, unless you become a patient you may not have access to some of the critical knowledge.

The public remains unaware of nutrition issues. For instance, when a relative is admitted in hospital, they bring bananas, oranges, apples and other fruits but they have little sense of what these fruits contain in terms of nutrition and what they contribute to the patient’s healing process. If they were  adequately informed from a nutrition perspective, they would bring appropriate fruits for their patients.

The curse of imported terminologies
While importing scientific knowledge may not be a bad idea, it has to be followed by rigorous ways of  simplifying science and nutrition through developing appropriate terminologies that ordinary people and consumers can relate to their daily lives.  For instance, terms like Iron, Zinc and Vitamins A to E do not have local equivalent explanations.

As a result, people wonder what is the difference between Iron as steel and Iron as nutrition or whether these are related? Another confusion is the difference or relationship between Zinc as nutrition and Zinc as roofing material. As if that is not enough, people use alphabets every day but what is the meaning of vitamin A, B, C, D and others?  These are some of unanswered questions among consumers and ordinary people. In the absence of meaningful answers, they end up living with beliefs and trust in the people giving them prescriptions. They also end up relying on religion.

On the livestock side, developing countries have range of indigenous and exotic livestock breeds.  However, there is no clarity on the nutrition differences or similarities between turkeys, ducks, guinea fowls, pigeons, indigenous chickens, broilers and layers.  People wonder whether different poultry species have different nutrition content. For instance, if a layer is cheaper in price compared to a broiler, how much of a layer’s nutrition goes into the formation of eggs?

Given the emphasis on white meat, what is the meaning of that white meat to ordinary people? What is the difference between poultry, pork and fish from a nutritional perspective?  To what extent is fish a substitute of pork?  What quantities of fish or pork would be give the same nutrition levels as other specific foods?

Enter food fortification
One of the terminologies and practices imported by developing countries without asking critical questions is food fortification. This practice is being promoted by development agencies and ministries of health. Food fortification is defined as the process of adding minute levels of vitamins and minerals to foods.

It involves addition of one or more micro-nutrients during conventional crop breeding (bio-fortification), food processing (industrial fortification) and food preparation (home fortification). This is done  irrespective of whether the micro-nutrient is present or not in the said food to increase micronutrient intake in a population.  Micro-nutrients such as vitamins and minerals, are said to be needed in the body in small quantities for protecting the body from illness and diseases.

Benefits of food fortification are said to be that it helps in addressing micro-nutrient deficiencies, improve cognitive development and future productivity, reducing health care cost and improving health and quality of life for the population. In countries like Zimbabwe which have launched a food fortification strategies, the food vehicles for industrial fortification are sugar, cooking oil, maize meal, and wheat flour.  Sugar is fortified with Vitamin A, cooking oil with Vitamin A and D.  Bio-fortification is being done through breeding staple crops to increase their nutritional value.

Unaddressed issues on food fortification
Although policy makers have embraced food fortification, ordinary people have many unanswered questions. Some of the fundamental questions include: How do consumers balance bio-fortified processed foods with raw commodities like horticulture?  Assuming maize meal is bio-fortified with the same vitamins that are naturally found in leafy vegetables and other forms of relish, is not there going to be double consumption of the same vitamins for households who consistently consume maize meal and vegetables containing the same vitamins? How does science ensure ordinary consumers are able to balance the consumption of vitamins?

Due to the way most households eat a complement of foods, over-consumption of some vitamins cannot be ruled out. If food fortification is really necessary, it should target commodities that do not have close substitutes or complementary effects.

Since bio-fortification is tantamount to changing food commodities from their natural states, how different is it from genetic manipulation towards creating Genetically Modified Organisms (GMOs)?  Why should communities not be empowered to preserve food commodities in their natural states?

Bio-fortification seems to have been imported from countries with limited food diversity due to extreme weather like severe frost in extended winters which render food production impossible. To what extent do countries like Zimbabwe that have more than 80 different kinds of natural food commodities need food fortification?  Isn’t it better to identify different nutrients in the diverse food baskets and promote their production vigorously than resort to fortifying a few commodities?

Towards nutrition sensitive food policies
Just as policy makers in developing countries are interested in national distribution of staple foods, they should shift their attention to equitable distribution of nutrition across the country. These countries continue to measure staple foods in hectares and tons while cash crops are measured in foreign currency earnings. Likewise, they should devise formulae for measuring nutrition security in which nutrition dense horticulture is dominant.

Consumer organisations tend to measure a food basket for a family of six as dominated by maize meal, margarine, bread and cooking oil. All this is translated into monetary terms.  However, such a basket does not say anything about nutrition content. It also lacks horticultural elements like vegetables, tubers and legumes. Neither does it contain small grains. In addition, it does not show how the nutrition content of these foods substitute each other, given the seasonal nature of production systems and availability of natural foods. For instance, in most farming communities, a food commodity is available in abundance at one time and the other time there is nothing at all.

African countries strive to build silos for maize and wheat but they are not building equivalent food reserves for nutrition-dense commodities (mainly horticulture-related) to ensure availability of adequate nutrition all year round for all consumer classes. The issue is often left to private players who import some commodities in times of shortages but the imported food is stocked in up markets for high and middle income. When oranges are no longer in the mass market and imported for the up market, there are no policy measures to ensure consumers have access to fruits that provide the same nutrition components found in oranges.

A powerful starting point can be making consumers aware of which types of food have different nutritional elements. Consumers can then be able to choose whether to go for a fortified commodity or for a raw commodity.  In addition, there is need for deep research to other questions like:

  • How do communities understand nutrition components of foods they produce and their consumption patterns?
  • To what extent is nutrition a major determinant of a household’s food demand and consumption patterns?
  • How will a household know that consuming one commodity translates to the same nutrition content of the other commodity?  For instance, how will a household know that consuming potatoes cane translate to the same nutrition as consuming sweet potatoes and other tubers?

Why food and nutrition requires a home-grown face
In a majority of developing countries, most foods are processed in cities and when they go back to rural areas, which are the sources of raw materials, the finished products are beyond the reach of rural consumers and smallholder farmers. A telling example is tinned beans which when value added becomes unaffordable to farmers who, ironically, grow the beans.

A rural industrialisation policy that promotes semi-processing or full processing of nutrition dense commodities is badly needed. At the moment, where some bit of processing is happening in rural areas, it is done by NGOs who work according to a project life span and selected beneficiaries. This does not promote mass production and availability of the processed foods.

On the other hand, it seems development organisations are not supporting the production and availability of nutrition baskets all year round. Their notion of community gardens tend to focus on exotic leafy vegetables like Covo, Chomoulier, Rape, Onion, Cabbage and other exotic crops. An angle for supporting smallholder nutrition gardens to produce nutrition baskets comprising diverse local vegetables, tubers and other foods is missing.

Due to the availability bias, most poor households consume indigenous crops, livestock and vegetables mainly because that is what will be available and affordable. Their consumption decisions are not informed by nutrition knowledge. In countries where nutrition knowledge has not been properly articulated, consumption patterns are also undermined by religion and other practices.  It is also critical for developing countries to align nutrition consumption to age, the working class, those doing manual work like construction workers and old people.  This could assist in addressing nutrition patterns.  Nutritional requirements cannot be the same for everyone irrespective of age, gender and occupation.

Importance of tracking processed foods and their after-effects
Very few developing have policy strategies for examining and tracking processed foods and their after effects. Given the proliferation of fast food chains and increase in the consumption of fast foods, it is important to monitor and track the nutrition content of fast foods and their related effects on consumers.

This could be a critical health concern with effects on the national health budget. People are quietly eating fast foods with no consideration for nutrition. There is no debate and dialogue on fast foods in the same heat as debate and dialogue on GMOs. Each country needs to think about informed dialogue on fast foods, exogenous foods like broilers and others. This effort should not be considered down-selling of fast foods but generating public knowledge and elevating consumer awareness.  Consumers deserve to know the pitfalls and good sides of their consumption patterns and food choices.

Instead of importing food fortification and other notions that are driven by corporate industrial vested interests, developing countries should develop appropriate policies to empower individuals and communities with reliable nutrition knowledge. Ordinary people should be assisted to get knowledge, skills and resources needed to maintain their nutrition as opposed to top down approaches like food fortification. Digital and other technologies can be used to enable individuals and communities to identify their nutritional needs and play an active role in maintaining their own nutritional well-being.

Where is the media in promoting appropriate nutrition?
Radio, television and newspapers in developing countries have not been consistent in promoting nutritious food and indigenous commodities like domestic poultry and small grains. Media coverage for these commodities has remained rather ad hoc and sporadic, based on an individual reporter’s fantasies or interests.

While there are dedicated programs like soccer and music in radio and television as well as regular pages on politics, soccer and music in national newspapers, there are no programs and pages dedicated to an important national issue like nutrition.  The mainstream media tends to follow politicians, false prophets and proponents of industrial agriculture like big hybrid seed companies and large  processing companies at the expense of actors who support local balanced nutrition.

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