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022 Article A008 en
022 Article A008 en
strategy
to
reduce
malnutrition
Nutrition is a basic human need, one that continues, and will
continue, to remain unfilled for vast numbers of people in the
developing world. This article discusses the need for
nutrition-oriented food policies—a promising vehicle for a
major attack on the problem.
mortality, help reduce desired family size. Bank staff in 1972 and is ployed. They thus benefit only indirectly
now Senior Nutrition from programs designed to boost the pro-
Strategy needed Adviser. Before joining the duction of small farmers. Fifth, within any
The common official response to the Bank, he was a Senior country, the extent of deficiencies tends to
problem of food and nutrition has been to Fellow at The Brookings vary substantially between regions and be-
grow more food. More recent analysis, tak- Institution, Visiting Professor of Nutrition at the tween rural and urban areas. The varia-
Massachusetts Institute of Technology (M.I.T.), and
ing account of low demand or purchasing tions that occur partly reflect differences in
worked from 1966 to 1970 on nutrition problems in
power among the poor and malnourished, India. His publications include The Nutrition
incomes and tastes. They also reflect dif-
has also emphasized the need to increase Factor: Its Role in National Development ferences in prices resulting from differ-
their incomes. The relative importance of (Brookings, 1973), Nutrition, National ences in transport, production and storage
food production and income, and the effect Development, and Planning (M./.T. Press, 1973, costs, marketing margins, and government
that improvement in either would have on as senior editor), and was responsible for the pricing policies. Often nutritional ade-
the level of nutrition in a country, have nutrition section in The World Food and quacy of diets also varies a great deal by
been projected by Bank staff from data Nutrition Study (National Academy of Sciences, season and by year. Seasonal deficiencies
available on Bangladesh, Brazil, India, Mo- 1977). tend to be severe in countries with only
rocco, and Pakistan. With the most opti- one major harvest, where price rises gen-
24 Finance & Development I March 1980
that ration and subsidy programs are much Target food programs
benefits of a 10 per cent increase in the pro-
duction of cassava would be received en- more a part of the development problem Food subsidies can be expensive, how-
tirely by the calorie-deficient group. Em- than a part of the solution. These programs ever. For example, in 1975 their share of
phasis on foods favored by the poor should are, however, one of the few ways to meet total budgetary expenditure was 21 per
extend to every aspect of agricultural strat- the basic nutritional needs of very large cent in Egypt, 19 per cent in Korea, 12 per
egy, including research, extension ser- groups of people. Experience in several cent in Morocco, and 16 per cent in Sri
vices, supply of inputs, credit facilities, countries shows that such programs can Lanka. To keep costs down, subsidies must
and marketing. effectively reach the poor and substantially be specifically aimed—or "targeted"—at
Effective programs aimed at improving reduce severe malnutrition and malnutri- the nutritionally needy. Otherwise, the
the production of small farms will gener- tion-related deaths. programs are likely to run short of funds
ally improve the diets of small-farm house- The nutritionally most successful (and fi- and supplies just when they are needed
holds, whether or not the programs di- nancially one of the most costly) food de- most, as Sri Lanka's program did in 1974.
rectly increase the production of the food mand program has been carried out in Sri Had the subsidies been directed more at
crops they consume. However, changes in Lanka. A 1970 survey shows that the rice the poor, as they are now, the increase in
agricultural cropping patterns or policies ration program (which then provided rice mortality could have been substantially re-
can sometimes have unexpected deleteri- to nearly the whole population) provided duced.
ous effects on nutrition. When a farm shifts about 20 per cent of total caloric intake and Target groups of malnourished can be
production from subsistence to cash crops, had a value equivalent to 14 per cent of in- identified in a number of ways—by in-
total income may increase but heads of come for the lowest income group. Only 5 come, by region, by season, by age, and by
households may not provide to their fami- per cent of the (adult-equivalent) popula- the staples in their diet. Income is probably
lies as much food as before, since it must tion consumed less than 1,900 calories per the best means of indicating where nutri-
now be bought at retail prices. This partic- day. In 1975, life expectancy was 66 years, tional problems on a large scale are con-
ularly affects young children and women, higher than in richer countries such as Bra- centrated. However, imposing a means test
who generally come at the end of the fam- zil, Korea, or Malaysia, and the highest in to define the target group is difficult, both
ily food line. Intensive nutrition education relation to income level of all countries for politically and administratively. Another
or plans to continue some subsistence pro- which data are available. It was 39 per cent way is by geographic area—a part of Col-
duction may be needed to avoid the dan- higher than would have been predicted for ombia's nutrition program, for instance,
gers inherent in such shifts. Similarly, when Sri Lanka's income level; infant mortality provides foods to specific age groups living
agricultural prices are increased as an in- was 67 per cent lower. in specified needy geographical regions,
centive to increase production, wages for How far is nutrition responsible for Sri regardless of income level. A promising
unskilled laborers, which are often at bare Lanka's long life expectancy and low in- but generally unexplored means of target-
subsistence levels, are generally slow to fant mortality? Sri Lanka also has a tradi- ing is by season. Countries with subsidy
rise in step, and the transitional effect on tion of assisting the poor in meeting other programs during the months when food
nutrition may be severe. It can be alle- basic needs—its literacy rate is 78 per cent, prices normally are highest will cover the
viated through wage policies, short-term health services are good, and the water periods of severest nutritional vulnerability
subsidies, or other food demand pro- supply is better than that of most other and of highest demand for expenditures of
grams. poor countries. Clearly such achievements human energy.
in meeting basic needs complement one Most target programs require rationing
Food demand programs another. But the direct relation between to avoid large-scale misuse. But when poor
Nutrition-oriented food production pro- food supply, nutritional adequacy, and the households constitute the target group, the
grams, in conjunction with steps to in- low death rate in Sri Lanka has also been need for rationing, with all the administra-
Finance & Development I March 1980 25