Hostname: page-component-8448b6f56d-wq2xx Total loading time: 0 Render date: 2024-04-19T16:31:10.370Z Has data issue: false hasContentIssue false
  • English
  • Français

Feast and famine: Socioeconomic disparities in global nutrition and health

Published online by Cambridge University Press:  01 March 1998

I Darnton-Hill  and
ET Coyne
I Darnton-Hill*
Affiliation:
OMNI (the USAID-funded Opportunities for Micronutrient Interventions Project), managed by John Snow Inc., 1616 North Fort Myer Drive, Arlington, VA 22209, USA
ET Coyne
Affiliation:
Department of Epidemiology, Graduate School, Public Health, University of Pittsburgh, PA, USA
*
*Corresponding author: E-mail: Ian_Darnton_Hill@jsi.com
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

To review current information on under- and over-malnutrition and the consequences of socioeconomic disparities on global nutrition and health.

Design:

Malnutrition, both under and over, can no longer be addressed without considering global food insecurity, socioeconomic disparity, both globally and nationally, and global cultural, social and epidemiological transitions.

Setting:

The economic gap between the more and less affluent nations is growing. At the same time income disparity is growing within most countries, both developed and developing. Concurrently, epidemiological, demographic and nutrition transitions are taking place in many countries.

Results:

Fully one-third of young children in the world's low-income countries are stunted because of malnutrition. One-half of all deaths among young children are, in part, a consequence of malnutrition. Forty per cent of women in the developing world suffer from iron deficiency anaemia, a major cause of maternal mortality and low birth weight infants. Despite such worrying trends, there have been significant increases in life expectancy in nearly all countries of the world, and continuing improvements in infant mortality rates. The proportion of children malnourished has generally decreased, although actual numbers have not in sub-Saharan Africa and south Asia. Inequalities are increasing between the richest developed countries and the poorest developing countries. Social inequality is an important factor in differential mortality in both developed and developing countries. Many countries have significant pockets of malnutrition and increased mortality of children, while obesity and non-communicable disease (NCDs) prevalences are increasing. Not infrequently it is the poor and relatively disadvantaged sectors of the population who are suffering both. In the industrialized countries. cardiovascular disease incidence has declined, but less so in the poorer socioeconomic strata.

conclusions:

The apparent contradicitions found represent a particular point in time (population responses generally lag behind social and environmental transitions). They do also show encouraging evidence that interventions can have a positive impact, sometimes despite disadvantageous circumstances. However, it seems increasingly unlikely that food production will continue to keep up with population growth. It is also unlikely present goals for reducing protein-energy malnutrition prevalence will be reached. The coexistence of diseases of undernutrition and NCDs will have an impact on allocation of resources. Action needs to be continued and maintained at the international, national and individual level.

Keywords

MalnutritionOvernutritionObesityNon-communicable diseasesEpidemiological transitionSocioeconomic disparities in health
Type
Research Article
Information
Public Health Nutrition , Volume 1 , Issue 1 , March 1998 , pp. 23 - 31
Copyright
Copyright © The Nutrition Society 1998

References

1IFPRI. A 2020 Vision for Food, Agriculture and the Environment. International Food Policy Research Institute, Washington, DC, USA, 1995.Google Scholar
2Karp, R. Poverty and malnutrition in two countries. J. Am. Coll. Nutr. 1995; 14: 561–2.CrossRefGoogle ScholarPubMed
3Wilkinson, RG. Class mortality differentials, income distribution and trends in poverty 1921–1981. J. Soc. Pol. 1989; 18: 307–35.CrossRefGoogle ScholarPubMed
4Wilkinson, RG. Income and mortality. In: Wilkinson, RG, ed. Class and Health, Research and Longitudinal Data. London: Tavistock Publications, 1986: 88–114.Google Scholar
5Pelletier, DL, Frongillo, EA, Schroeder, DG, Habicht, J-P. The effects of malnutrition on child mortality in developing countries. Bull. WHO 1995; 73: 443–8.Google ScholarPubMed
6Duncan, BB, Rumel, D, Zelmanowicz, A, et al. Social inequality in mortality in Sao Paulo State, Brazil. Int. J. Epidemiol. 1995; 24: 359–65.CrossRefGoogle ScholarPubMed
7Cassen, RH. Economic implications of demographic change. Trans. Roy. Soc. Trop. Med. Hygiene 1993; 87: (suppl 1): 13–8.CrossRefGoogle ScholarPubMed
8FAO/WHO. World Declaration and plan of Action for Nutrition. International Conference on Nutrition, Rome: FAO, 1992.Google Scholar
9Scott, L, Shapouri, S. Income-Nutrition Relationships in Developing Countries. Food Aid Needs Assessment/GFA-5, Washington DC: USAID, 1994: 68–74.Google Scholar
10Garcia, M. Malnutrition and Food Insecurity Projections, 2020. IFPRI 2020 Brief 6, 1994.Google Scholar
11SCN News. Can Half of all Hunger be Eliminated? Meeting Assesses Progress towards Bellagio Goals. Geneva: News and Views, UN Administrative Committee on Coordination/Subcommittee on Nutrition, 1995; 12: 20.Google Scholar
12Mason, J, Garcia, M. Update on the Nutrition Situation, 1994. Geneva: UN Administrative Committee on Coordination/Subcommittee on Nutrition (ACC/SCN), 1994.Google Scholar
13WHO. Nutrition. Highlights of the recent activities in the context of the World Declaration and Plan of Action for Nutrition. Nutrition Programme, Geneva: WHO, 1995.Google Scholar
14Us Interagency Board for Nutrition Monitoring and Related Research. Third Report on Nutrition Monitoring in the United States. Executive summary. Washington DC: Life Sciences Research Office, Federation of American Societies for Experimental Biology, 1995.Google Scholar
15Grinker, J, Rush, D, Vokonos, P. Changing body habitus among healthy older men: the NAS Boston VA study of weight stability in healthy male volunteers aged 40–80 Years. In: Baba, S, Zimmet, P, eds. World Data Book of Obesity. Excerpta Medica: Amsterdam, 1990: 89–94.Google Scholar
16Darnton-Hill, I, English, R. Nutrition in Australia: deficiencies, excesses and current policies. Aust. J. Nutr. Diet. 1990; 47: 34–41.Google Scholar
17Darnton-Hill, I, de Boer, AS, Nair, NVK. Obesity in children with particular reference to the Western Pacific Region of the World Health Organization. Proc. 1st Natl. Symp. Clin. Nutr., Malaysia 1994: 1–16.Google Scholar
18Uemara, K, Pisa, Z. Trends in cardiovascular disease mortality in industrialized countries since 1950. WHO Stat. Q. 1988; 41: 155–78.Google Scholar
19Cavalli-Sforza, LT, Rosman, A, de Boer, AS, Darnton-Hill, I. Nutritional aspects of changes in disease patterns with improved economic conditions in the Western Pacific Region. Bull. WHO 1995; 74: 307–18.Google Scholar
20Darnton-Hill, I, Cavalli-sforza, LT, Volmanen, PVE. Clinical nutrition in East Asia and the Pacific. Asia Pacific. J. Clin. Nutr. 1992; 1: 27–36.Google ScholarPubMed
21Scrimshaw, NS. The new paradigm of public health nutrition. Am. J. Public Health. 1995; 85: 622–4.CrossRefGoogle ScholarPubMed
22Coyne, ET. The effect of urbanization and western diet on the health of Pacific Island populations. South Pacific Commission Technical Paper 186. Badcock, JC, Taylor, R, eds. New Caledonia: South Pacific Commission, 1984.Google Scholar
23Taylor, R, Lewis, NC, Levy, S. Societies of transition: mortality patterns in Pacific Island populations. Int. J. Epidemiol. 1989; 18: 634–43.CrossRefGoogle ScholarPubMed
24Popkin, BM. The nutrition transition in low-income countries; an emerging crisis. Nutr. Rev. 1994; 52: 285–98.CrossRefGoogle ScholarPubMed
25Paul, C. Inequalities in health and redefining values. NZ Med. J. 1993; 106: 121–2.Google ScholarPubMed
26McMichael, AJ. Food, nutrients, health and disease: a historical perspective on the assessment and management of risks. Aust. J. Public Health 1991; 15: 7–13.CrossRefGoogle ScholarPubMed
27Coyne, ET, Darnton-Hill, I. Australian Aborigines – nutrition and changing disease patterns. New Doctor 1979; 12: 32–7.Google Scholar
28Bobadilla, JL, Costello, CA. Premature death in the New Independent States; overview. In: Bobadilla, JL, Costello, CA, Mitchell, F, eds. Premature Death in the New Independent States. National Academy Press: Washington, DC, 1997: 1–33.Google Scholar
29Chen, X-S, Ge, K-Y. Nutrition transition in China: the growth of affluent disease with the alleviation of undernutrition. Asia Pacific J. Clin. Nutr. 1995; 4: 287–93.Google Scholar
30Zhao, F, Guo, J, Chen, H. Studies on the relationship between changes in dietary patterns and health status. Asia Pacific J. Clin. Nutr. 1995; 4: 294–97.Google ScholarPubMed
31Wang, H. HLA gene and clinical study of insulin dependent diabetes melltus (IDDM) in Chinese individuals. Asia Pacific J. Clin. Nutr. 1995; 4: 298–300.Google Scholar
32Collins, V, Dowse, G, Zimmet, P. Prevalence of obesity in Pacific and Indian Ocean populations. In: Baba, S, Zimmet, P, eds. World Data Book of Obesity. Amsterdam, Excerpta Medica, 1990; 29–32.Google Scholar
33Byers, T, Marshall, JA. The emergence of chronic diseases in Developing Countries. SCN News 1995; 13: 14–9.Google Scholar
34Marmot, MG, Davey, Smith G. Why are the Japanese living longer? Br. Med. J. 1989; 299: 1547–51.CrossRefGoogle ScholarPubMed
35Horowitz, JC. Toward a social policy for health. N. Engl. J. Med. 1993; 329: 130–3.CrossRefGoogle Scholar
36Montague, P. Economic inequality and health. Rachel's Environment and Health Weekly. Annapolis, MD, Environmental Research Foundation, 1996; 497.Google Scholar
37Davey, Smith G, Neaton, JD, Wentworth, D, Stamler, R, Stamler, J. Socioeconomic differentials in mortality risk among men screened for the Multiple Risk Factor Intervention Trial: I. White men. Am. J. Public Health 1996; 86: 486–96.Google Scholar
38Davey, Smith G, Wentworth, D, Neaton, JD, Stamler, R, Stamler, J. Socioeconomic differentials in mortality risk among men screened for the Multiple Risk Factor Intervention Trial: II. Black men. Am. J. Public Health 1996; 86: 497–504.Google Scholar
39Syme, SL. Individual vs community interventions in public health practice: some thoughts about a new approach. Health Promotion Matters: Vic Health 1997; 2: 2–9.Google Scholar
40Link, BG, Phelan, JC. Editorial: understanding sociodemographic differences in health – the role of fundamental social causes. Am. J. Public Health 1996; 86: 471–2.CrossRefGoogle ScholarPubMed
41Lang, T, Ducimetiere, P. Premature cardiovascular mortality in France: divergent evolution between social categories from 1970 to 1990. Int. J. Epidemiol. 1995; 24: 331–9.CrossRefGoogle ScholarPubMed
42Popkin, BM, Sahasporn, P, Keyou, G, Zhai, F. Body weight patterns among the Chinese: results from the 1989 and the 1991 China Health and Nutrition Surveys. Am. J. Public Health 1995; 85: 690–4.CrossRefGoogle ScholarPubMed
43Kington, RS, Smith, JP. Socioeconomic status and racial and ethnic differences in functional status associated with chronic diseases. Am. J. Public Health 1997; 87: 805–10.CrossRefGoogle ScholarPubMed
44Editorial. The big idea. Br. Med. J. 1996; 312: 985.Google Scholar
45Cohen, MJ, Reeves, D. Causes of Hunger. International Food Policy Research Institute, IFPRI 2020 Brief 19, 1995.Google Scholar
46Waterlow, JC (with contributions by Tomkins, AM, Grantham, McGregor SM). Protein-Energy Malnutrition. London: Edward Arnold, 1992.Google Scholar
47ACC/SCN. Update on the Nutrition Situation 1996. Geneva: United Nations Administrative Committee on Coordination/Subcommittee on Nutrition, 1996.Google Scholar
48Bicego, G, Ahmad, O. Infant and child mortality. Demographic and Health Studies (DHS) Comparative Studies no.20. Maryland: Macro International, 1996.Google Scholar
49Barker, DJP. Fetal and infant origins of adult diseases. Br. Med. J. 1992; 301: 1111.CrossRefGoogle Scholar
50 :Rowe, PM. Lessons about NIDDM from the pima Indians. Lancet 1996; 347: 1320.CrossRefGoogle Scholar
51Penning de Vries, FWT, van, Keulen HRabbinge, R, Luyten, JC. Biophysical Limits to Global Food Production. International Food Policy Research Institute, IFPRI 2020 Brief 18, 1995.Google Scholar
52Brown, LR, Kane, H, Ayres, E. Vital signs. Worldwatch Institute. London: Earthscan Publications, 1993.Google Scholar
53Goldburg, RJ. Old MacDonald had a fish (EDF Letter). Environmental Defense Fund 1997; xxviii: 7.Google Scholar
54Royal Society of London and the US National Academy of Sciences. Population Growth, Resource Consumption, and a Sustainable World. London and Washington, DC, 1992.Google Scholar
55UNDP. Human Development Report 1997. United Nations Development Programme. New York: Oxford University Press, 1997.Google Scholar
56World Resources Institute. World Resources: a Guide to the Global Environment 1996–97. Oxford: Oxford University Press, 1996.Google Scholar
57McMichael, AJ, Hales, S. Global health promotion: looking back to the future. Aust. NZJ. Public Health 1997; 21: 425–8.CrossRefGoogle ScholarPubMed
58Hill, K, Panda, R. The Recent Evolution of Child Mortality in the Developing World. Arlington, VA: BASICS, 1997: 1–12.Google Scholar
59Mason, JB, Gillespie, SR. Policies to Improve Nutrition: What was Done in the '80s. SCN News. Geneva: United Nations Adminstrative Committee on Coordination/Subcommittee on Nutrition, 1990; 6: 7–20.Google Scholar
60Lakka, TA, Kauhanen, J, Salonen, JT. Conditioning leisure time physical activity and cardiorespiratory fitness in sociodemographic groups of middle-aged men in eastern Finland. Int. J. Epidemiol. 1996; 25: 86–93.CrossRefGoogle ScholarPubMed
61Walker, SP. Nutritional issues for women in developing countries. Proc. Nutr. Soc. 1997; 56: 345–56.CrossRefGoogle ScholarPubMed
62Editorial. Structural adjustment too painful? Editorial. Lancet 1994; 344: 1377–8.CrossRefGoogle Scholar
63Mackay, J. The State of Health Atlas. London: Simon & Schuster, 1993.Google Scholar
64UNICEF. World Declaration on the Survival, Protection and Development of Children. The World Summit for Children. New York: UNICEF, 1990.Google Scholar
65Lupien, JR. Implementing the ICN World Plan of Action for Nutrition. Plenary Lecture at the Thrasher Foundation/Cornell University/FAO/UNICEF International Workshop on Food-based Approaches to Preventing Micronutrient Malnutrition. Salt Lake City, Utah, USA, 1995.Google Scholar
66Webb, P. A Time of Plenty, a World of Need: the Role of Food Aid in 2020. International Food Policy Research Institute, IFPRI 2020 Brief 10, 1995.Google Scholar
67Logie, DE, Woodruffe, J. Structural adjustment: the wrong prescription for Africa? Br. Med. J. 1993; 307: 41–4.CrossRefGoogle ScholarPubMed
68Winichagoon, P, Tontisirin, K, Attig, GA. Essential Elements in the Process of National Nutrition Development. Mahidol University. Thailand: INMU special publication, 1994, no. 7.Google Scholar