My column this month celebrates JK Galbraith (pictured above). It has one main and two related themes. The first is whether we should be guided by numbers or values. Next, is why the social science of economics has now generally shrunk into a doctrine focusing on the mathematics of money, which can be termed 'economism'. This crucially affects our understanding of the cost of consumption of unhealthy food, and the cost of consequent diseases. It also affects official notions of 'development', policies that govern agriculture, and approaches to malnutrition. Then, I point out the slipping and sliding of key words and terms between technical and ordinary language meanings.

Nutritionism

Quantity and quality

From time to time I have been told that my place in the professional community would be more assured if I became a Doctor. But the PhD theses I have occasionally proposed have been identified as qualitative rather than quantitative, and so classified – a false distinction, in my view – not as science but as art. What is usually expected in academic nutrition is lots of crunched numbers, derived by methods comparable with other studies. Such reduction of nutrition, together with the identification of food with its chemical components, is well characterised as 'nutritionism' (1, 2).

This approach I respect as producing substrate, but it is not my bag. My interest is in what nutrition means. This requires human judgement which, however soundly based on quantitative evidence, is an art. To give an analogy with architecture, while it's necessary to know the breaking point of steel girders of any specified gauge, what matters most is the whole building, and its function and beauty. What's needed in our world now, in which public health nutrition needs to be and seen to be relevant, is big picture stuff. Like, a bit less about the effect of the fortification of breakfast cereals on the serum folate levels of Serbian teenagers, and a lot more about issues like, will food and water shortages be the causes of the next world wars and if so, what's the plan. This, I am pleased to say, has been generally agreed by the organisers of our Rio2012 congress, of whom I am one – see this month's home page.

My hero – JK Galbraith

And so now I come to economics and to my hero for this month. Here is one of his statements: 'To appreciate the causes of present deprivation and famine, we must first be aware of a major error in our view of economic development... Our mistake is in believing that the advanced industrial countries... are a guide and model for the poor countries... It is an error that arises from the failure of the older industrial countries to understand their own history or to appreciate the sources and well-springs of their own development and modern well-being'. This is John Kenneth Galbraith, who died in 2006 at the age of 97 (3), contributing 25 years ago to a US National Research Council think-in on the nutritional future of 'developing countries' (4). Like John Maynard Keynes, he was always clear that economics is an art as well as a science, always requiring human judgement. Numbers are a tool, which by themselves cannot do the job. He went on to explain that the foundation for the rise of the US as a nation was not industry. It was agriculture of a type that was 'both socially stable and economically efficient'.

He advocated small and family farms: 'The owner-operated farm is an agricultural design that combines efficiency with social tranquillity'. His conclusion was: 'Agriculture has its own design, given not by ideology, but by the practical accommodation to agricultural need and circumstances'. Of nations that are primarily agricultural, he said: 'We make a grave and foolish mistake when we carry over to agriculture the ideological concepts and debate relevant to the mature industrial world , and in doing so delay or abort the very development we seek'.

References and note

1. Scrinis G. Sorry marge. Meanjin 2002, 61, 4: 108-116.
2. Pollan M. In Defense of Food. An Eater's Manifesto. New York: Penguin, 2008.
3. This column, and World Nutrition, has recently suggested that on the whole it's best to be short and small, and Thomas Samaras says that short people live longer. In the interests of balance, we report that the long-lived JK Galbraith's height was 6 foot 8 (2.03 metres).
4. Galbraith JK. Economic policy as an historical process: the meaning for agriculture and nutrition. In: Food and Nutrition Board/ National Research Council. Nutrition Issues in Developing Countries for the 1980s and 1990s. Washington: National Academy Press, 1986.

Economism

The meaning of 'development'

As an interjection, colleagues who reviewed earlier versions of this column said that they could not tell when it was being satirical and when it was being serious. So as a guide, the above graphic in the form of a slide, showing one of the principles of the New Nutrition Science, is serious (1).

OK. Now then. Not many people know that my preliminary degree includes success in an examination in economics. It is now time to admit that this result, a surprise to my tutors Thomas Balogh and Paul Streeten, was due to me staying up the night before the examination, mugging up JK Galbraith's brilliant essay on the great US and therefore global bust of 1929 (2), the one and only book on economics I then knew of that could keep me awake and attentive. This was also the time of first publication of The Affluent Society (3), and here later I learned the meaning of 'gross national product' and 'gross domestic product'. Both these technical terms refer to the monetary value of a country's production and consumption or, more or less, in a word, its turnover. Thus, if a million workers dig a hole and then fill it up again, they will boost their country's gross national and domestic product.

According to the conventional wisdom of the dominant group of economists, which continues to bamboozle politicians, the higher turnover of any country, the more economically developed it is, which is in a sense true by definition, but then – whoops! – the word 'economic' is dropped. Here is the trick, to use a word denoting value, like 'developed', 'developing', and – a term now tactfully not much used – 'undeveloped'. The proper course would be to use a value-free technical term (4). The term 'developed' is loaded, because in its ordinary and not technical meaning, clearly it's best to be developed.

But now imagine a country with an ancient civilisation, no wars, wonderful art and literature, philosophies of life shared by the whole population that enhanced their well-being, rational agriculture, enlightened education, beautiful cities, parks, woods and forests, clean air and water, secure employment for communities and people with all types of skills, happy families, and little crime or disorder. As natives, residents, and even sensitive visitors know, there are still some parts of some Asian counties that retain some of these hard-won blessings. Some can also be discerned within parts of Africa and Latin America, and some continental European countries also. However, if the population is not turning over much cash, and in particular people are not shopping (5), countries such as this are by definition 'undeveloped' or, if capital was beginning to flow, 'developing'.

Money as a root of evil

'Development', by means of 'growth', has become an imperative. It is a tenet of capitalism, as it was of the form of dictatorial statism misnamed 'socialism' practiced by successive governments of the USSR. Faith in 'growth' and 'development' is so strong, and so irrational, as to amount to a kind of millenarian religion. One of its effects, whether under Stalin or successive Republican US presidents, is to squeeze, bankrupt or evict small, family or subsistence farmers, who turn over little money, and push them into cities, and often into slums. The treasure of small farmers is not cash but land – if they are fortunate enough to have secure ownership of the land they tend. They produce food, much of which may well be exchanged for other goods, without much or sometimes even any significant use of money. For them farming is not merely a business, it is their way of life. When the same lands have been cultivated by the same family for many generations, farming is also a communion with their ancestors. Such farmers are of course productive in any sane sense. But by the conventional definition, any society whose products are not much converted to money is 'undeveloped'.

It was JK Galbraith who taught me that the term 'development' as now used everywhere about any society, is actually all about money. The more money that is turned over, the more 'developed' a country is. Anything goes. Anything! Production and consumption, in three of Galbraith's riffs, can be of silk shirts, kitchenware, chamber-pots and orange squash, or food, gasoline and pinball, or comic books, alcohol, narcotics and switchblade knives. 'The head of a distillery, a drive-in theatre, or a dog track is a producer… As such he enjoys a position in the community as one of its supports and pillars and sources of its wealth', he says (3). 'Development' is, well, developed, by 'more elegant cars, more exotic food, more erotic clothing, more elaborate entertainment – indeed… the entire range of sensuous, edifying, and lethal desires', many of which, as he observes, have been invented or amplified by advertising.

Thus, economics is reduced to a focus on money. This, an exact parallel with the reduction of nutrition to nutrients, is not economics, but only one part of it, which should be a means to much greater ends. Its right name is 'economism' (6).

Given dwindling natural resources and rocketing populations, an ideology that gives prime value to the circulation of more and more money, and so which pushes populations to get and spend more and more, is clearly mad. Such forces are driving the human race towards being trampled by the horsemen of the Apocalypse that, so it is said, Christ showed to John the Divine, which include humanity overwhelmed and destroyed by famine, disease, and war. But there – and here – it is.

My specs

Here is a parable and its interpretation. The week before I drafted this commentary, I played my part in stopping Brazil becoming a high-income, 'developed' country. Here is how. I needed new glasses (spectacles). One was needed for general use, because of a new prescription. The other ones, used for reading – and writing – were broken, because I had sat on them and snapped an arm at the hinge. The first shop we visited was recommended (and owned) by the optometrist. Nice location on a main street, fittings like those of a jewellery shop, young women in pink outfits lined up behind the counter, lots of choice. We sat down. No, said pink woman, repair would be impossible, unfortunately. Two styles were nice, and I then looked at the (very discreet) price tags, and the names branded on the arms. Brand 1 had a price the equivalent of $US 500, Brand 2, that of Giorgio Armani, cost the equivalent of $US 650.

My general policy is not to pay to be an advertisement. So we then went to another shop also on a main street selling non-branded glasses, and bought a frame which to me looked much the same, for the equivalent of $US 7. We then went to an old-fashioned shop in the same area that was a little out of the way, not owned by an optometrist, where the women behind the counter were not chic and wore their own clothes, and got my other specs welded invisibly in 40 minutes by their local craftsman for the equivalent of $US 8. Result, expenditure not of $US 1,150, but $US 15.

The point of this story is that if everybody who can afford to pay more in Brazil chooses to pay less, or to barter, the ambition of the Brazilian government that the country becomes 'developed' – or 'fully developed' – will be impeded. Thus, according to the economism doctrine that equates development with turnover of money, citizens who want Brazil to gain a permanent seat on the UN Security Council can do their bit by buying Armani spectacles. Mothers of newborns can also join the march towards full development by refusing to breastfeed, for breastmilk is given no economic value and thus does not contribute to 'development' (7), in favour of buying baby formula and then bottled weaning foods, which scaled up nationally are terrific contributors to development indices.

Notes and references

1. Claus Leitzmann and I are the founding co-convenors of the New Nutrition Science project. Its philosophy is encapsulated in The Giessen Declaration. Many thanks to the members of all the workshops in which the NNS principles have been hammered out – this part of the project is still work in progress, in its final stages. The graphic shown above includes the NNS spiral emblem, in the form of the symbol drawn for us by the Beijing calligrapher Ying Huang Bi, and in the shape of a path within Christ Church College, Oxford.
2. Galbraith JK. The Great Crash 1929. New York: Houghton Mifflin, 1997. [First published 1954]
3. Galbraith JK. The Affluent Society. London: Hamish Hamilton, 1958.
4. This isn't a habit only of economists. As I have pointed out before, nutritionists use the charged terms 'stunted' and 'wasted' to label children who are small and thin, below agreed cut-off points, including when they show no sign of disease or debility. Hm.
5. Did George Bush tell the American public to 'go shopping' in the first public statements he made in rapid response to 9/11? No, not in so many words. But both he and Tony Blair, the then UK prime minister, in their responses to 9/11, told people to travel and shop as ways to be patriotic and normal, and to keep the economy going and avoid depression. In rapid response to 9/11, Bush also urged US citizens to: 'Do your business around the country. Fly and enjoy America's great destination spots. Get down to Disney World in Florida. Take your families and enjoy life'. As an immediate response to an attack on the USA that killed more people than Pearl Harbour, and far more civilians, this seems a bizarre as well as insensitive thing to say, until you realise that without spending to generate production, the US, the UK, and other 'market economies', may well turn out to be houses of cards. Remember the massive financial wobble of 2008? Yes, you do. Is it imaginable that we will one day fairly soon, be in the midst of an uncontrollable great crash? Yes, it is.
6. The alternative term is 'econometrics' which is already used more or less in the sense proposed here, but not much outside the academic community. Hence 'economism', which has a nice symmetry with 'nutritionism'.
7. The development nutritionist and economist Alan Berg, who worked for the World Bank for many years, almost 40 years ago proposed that breastmilk should and could be given a monetary value. Breastfeeding is however a drag on the profits of baby formula manufacturers, and nothing has come of the proposal. See Berg A. The crisis in infant feeding practices. [Chapter 7, and also Appendix C] The Nutrition Factor. Its Role in National Development. Washington DC: The Brookings Institute, 1973.

Killer habits, obesity, economics

Patriots! Smoke, drink, get fat!

JK Galbraith was a brilliant writer and speaker. He also was the proud owner of a sense of irony. This took several related forms, such as being sardonic about serious issues, making jokes about his fellow economists, not always allowing his readers to be sure of his own opinion, and playing with paradoxical observations. All this and similar qualities got him into a lot of trouble, and also made him the most widely and eagerly read writer on how the theory and practice of 'the dismal science' of economics shapes world affairs and our own lives. But, like John Maynard Keynes, the economist – and statesman – he most admired, he is now sidelined. This is a grave and foolish mistake. For those of us who are most concerned about the future, for our children and grandchildren and for the planet, among all economists after Keynes, his is the most valuable, profound and sane – while also playful – voice. So let's look a little more closely at current economism dogma.

Do your bit. Smoke!

In paradoxical mode, he might have enjoyed making the case for smoking being good for national economies, which it is, as measured by economism (1). Perhaps he did. Here is how it goes. First, the tobacco trade, with slavery, sugar and other trades, together with a policy of stamping out industry in colonies, created the wealth that fuelled the Industrial Revolution and thus the hegemony of the European Powers (2). True. Smoking continues to be the main source of livelihood for millions of growers and manufacturers, not to mention countless hard-working retailers who keep their shops open late to support their families, and who also sell newspapers, birthday cards, chewing gum and lottery slips, and in other ways provide solace for sad and lonely customers. True.

Second, in countries where tobacco is taxed, as it almost always is, the more smokers and the more smoking, the more money there is for the government to build schools, renew dilapidated city centres, raise old-age pensions, and do all the other public-spirited things that governments are supposed to do. Revenue from the taxation of tobacco may raise anything between 3 and 9 per cent of national government incomes from all sources. True.

Third – and much more important – smoking kills. Here is where the argument tends to provoke emotional reactions, because according to the economism ideology that pretty much runs the world these days, suffering and death from smoking is good for business and also for welfare states. Any lethal habit that is fairly likely to kill people on or around the time of retirement from paid work, boosts national economies, as now defined (1). Pensioners, being normally by definition unproductive, and often living in poverty and therefore not spending much money, are a drag. True, smoking does frequently disable and kill people in their productive years rather than around the time they retire, and death from lung cancer caused by smoking is relatively quick (unlike disablement from emphysema caused by smoking, which can precede death by decades). But the increased proportion of people in many countries who have stopped smoking, or who never smoked, has undoubtedly increased governments' pension and other social security burdens, now commonly seen as intolerable, and one of the most serious crises of materially rich countries. People who continue to live for 20, 30 or more years after retirement, are an economic disaster. True.

So what would a hard-headed Spartan-style government, that did not buy into the notion that every single human life was sacred, and that accepted the economism conventional wisdom, do? It would grant all its citizens a slap-up feast on their 65th birthday to which all their nearest and dearest were invited, and then shoot them. Short of this, smoking does a pretty good job (2).

A more measured response is that smoking, which is reckoned to kill around 10 million people every year, costs vast amounts of money in medical and other professional treatment. True. Whether this amounts to more than the revenue from tobacco taxes, and also the money saved by reduction in the number of pensioners, is moot. But here comes the killer point. Money spent on the treatment of disease is not of itself bad for national economies as conventionally gauged. It is good business for the medical profession and the drug and pharmacy industries. Anything that boosts spending is good for national economies, as defined by economism (1). Thus, the same points apply to the turnover of money caused by spending on automobiles, gasoline, landfills, pollution, and then clearing up the messes caused

Do your bit. Gorge!

The same point applies to obesity. This was pointed out in a much cited article written some years ago (3). This quotes Tomas Philipson of the University of Chicago as saying: 'The obesity problem is really a side-effect of things that are good for the economy… For many corporations, and even for physicians, Americans' obesity has also fattened the bottom line'. In 2006, revenue from the US obesity industries was estimated at over $US 300 billon, including over $US 130 billion for fast-food restaurants, over $US 120 billion for medical treatment, and around $US 2 billion for dieting books – all adding up to around 3 per cent of the US annual gross domestic product.

Obesity has also contributed to clinical and even public health nutrition now being a boom profession, with masses of professors and journals devoted to the study of obesity. Further, William Weis of the University of Seattle was quoted as saying: 'Put simply, there is a lot of money being made, and to be made, in feeding both oversized stomachs and feeding those enterprises selling fixes for oversized stomachs…And both industries -- those selling junk food and those selling fat cures -- depend for their future on a [high and rising] prevalence of obesity'. So there you have it. Finish up your super-size burger, and then drain your Big Gulp. No slacking!

Bold practitioners of economism do make these points, about smoking, drinking alcohol, obesity, pollution, or (see below) warmongering. Others may feel a shy of doing so, because as well as being obviously outrageous, they show that much getting and spending is really not development in the sense of progress, and undermine the whole economism enterprise. Money is not the measure of all things.

Notes and reference

1. Readers of this column in draft have asked me if this item is serious. The answer circumvents the question. It depends on what is counted, in making the accounts for national economies. If all that is counted is money, the economism argument that smoking and obesity are good for business is strong, and the point about pensions is particularly strong. The counter argument in money terms, is that if people did not spend money on smoking (or drinking, for that matter), and on behaviour that made them obese, they would be spending more money on other things. Maybe, maybe not. But public health advocates need to be very careful before asserting that healthy populations save money. It does not follow that what is good for health is therefore good for wealth, if 'wealth' is defined merely in terms of the getting and spending of money. This is not necessarily what numbers, whether reliably derived, or extrapolated or otherwise guessed at, will show. However, if 'wealth' is defined more broadly, to include factors that can't easily be quantified, or that are values and as such impossible to encapsulate in numbers – well-being, for example – the whole picture changes. This is why JK Galbraith might well have enjoyed the points being made here. They amount to an indictment of the doctrine of economism, whose ideology, which continues to control the policies of the governments of dominant countries, is that the measure of wealth is money. With smoking and obesity, the economic case against, depends on counting 'externalities', some but by no means all of which can be quantified.
2. Similarly, war is good for business, in that it massively increases production and, in an efficiently run country, also employment. Private industry specialising in the manufacture of ever-more ingenious weapons of mass destruction are liable to make spectacular profits. This is true for the competing and winning sides. It is not true for losing sides whose infrastructure is obliterated. But the progress of Germany, and then South Korea and Vietnam, towards 'development', had wars that devastated these countries as a prelude. Whether this will also apply to Iraq and Afghanistan remains to be seen. The continued perception that Osama bin Laden threatened the USA, as a miniature version of the perception that the USSR could destroy the USA, enriched the US economy, as conventionally defined. Agreement that Osama bin Laden was alive, continuing to mastermind Al Qaida networks that any moment – or so many supposed – could rain mass death on schools, created an enormous amount of business, as any foreigner encountering immigration at US airports senses. If agreement that he is dead has the effect of reducing the US army, security systems, and other aspects of 'the war on terror', this will be bad for business and will depress relevant economies. Cynics inured to the boom created by the US-USSR stand-off, will expect more terror scares.
3. Rosenwald M. Why America has to be fat. A side-effect of economic expansion shows up in front. Washington Post, 22 January 2006. The passages cited here are also contained in Paul Roberts's book The End of Food (New York: Houghton Mifflin, 2009).

John Kenneth Galbraith

Things are not always as they seem

The World Health Organization has just issued yet another report on chronic diseases (also known as NCDs) (1). As is usual these days, it seeks to push diabetes, heart disease, cancer, and so on, up the international policy-makers' agenda, by claiming that the more chronic diseases there are, the greater the damage to national and therefore global economies. But it shies away from justifying the prevention and treatment of chronic diseases in terms of intangibles such as human rights, security, order, well-being, and decency. Instead, it moves into the world of numbers and specifically of conventional economism theory and modelling, which (see above) assumes that the more production and consumption, and therefore the higher any 'gross domestic product', the better. In other words, it defines 'economy' narrowly, in terms of money turnover.

Thus: 'In 2010, the World Economic Forum placed NCDs among the most important and severe threats to economic development, alongside the current financial crisis, natural disasters and pandemic influenza (Estimated losses in national income from heart disease, stroke and diabetes in 2005 were US$ 18 billion in China, US$ 11 billion in the Russian Federation, US$ 9 billion in India and US$ 3 billion in Brazil. One macroeconomic analysis demonstrated that each 10% rise in NCDs is associated with 0.5% lower rate of annual economic growth According to this estimate, the expected 50% rise in NCDs predicted in Latin America by 2030 would correspond to about a 2.5% loss in economic growth rates. An Institute of Medicine study in the United States in 2010 found that NCDs cost developing countries between 0.02% and 6.77% of GDP… From 2005 to 2015, China and India are projected to lose International $ (I$)12 558 billion (0.93% of the GDP) and I$ 237 billion (1.5% of the GDP) respectively, as a result of heart disease, strokes and diabetes'.

Funny, you might think, and with reason, that the World Economic Forum (WEF), the front for protecting the power and profit of transnational industries, directly and now indirectly as funders of governments, is now keen on heart attacks and cancer. You might also think it is peculiar that the World Health Organization is relying on WEF estimates, and thus its take on public policy.

Development as disease

Now for the tendentious WHO and WEF claim. In any real and not foolish technical sense, any country with few resources whose people are afflicted with diabetes, cardiovascular disease, new forms of cancer, and other disabling and deadly diseases, in early life, or during their working life, and who also have no money for treatment, is indeed in danger of economic as well as all sorts of ruin, just as a number of southern African countries now are wrecked by HIV-AIDS. Such countries are not 'developing' in any ordinary common sense meaning of the term, they are deteriorating. This also applies to the great mass of the population of countries with lots of resources but with vicious inequity, where a large proportion of the population has been trashed and driven into poverty and despair, the most blatant example of which is Russia. Alcoholism in Russia among men, with all its consequences, is indeed depressing the nation, in any sense.

But as already indicated earlier in this column, in countries whose governments can pay for 'health care', and where people do have or can raise money for treatment, the causes and the treatments of chronic diseases and general debility that start to destroy people in middle age and in particular after retirement from work, is terrific for business. It does not make the country poorer, according to the conventional wisdom, but richer – more 'developed'.

This may seem odd, and indeed it is odd, but look at it from the economism point of view. The amount of money circulating in a country increases. People have more disposable income. They then spend quite a lot of this money on ready-to-eat or ready-to-heat energy-dense fatty sugary or salty ultra-processed products, and the more health-conscious among them join fitness centres. Good. More development. They then are diagnosed with diabetes, or high blood pressure, or heart disease, or (say) breast or colon cancer. Better. Yet more development, in the form of money spent on consultation fees and medical and surgical treatment, more employment for the medical profession, and better business for the drug industry. In a country with vicious inequities, such conspicuous getting and spending breeds a class of bandits and robbers, against which rich citizens built fortified houses with armed guards. Expensive security systems in countries with high crime rates are terrific for development.

All those who spend money in ways that make them sick, and then spend money on treatment, are doing their bit for national development. In this scenario, chronic diseases do not contribute to national poverty, but to national wealth, and the assumptions, calculation and claims made by the World Health Organization are wrong – dead wrong, one might say.

So why are the transnational corporations that run the World Economic Forum now so interested in chronic diseases? This, as they say, is a good question.

Reference

1. World Health Organization. Global Status Report on Non-Communicable Diseases 2010. Geneva: WHO, 2011

Acknowledgement and request

You are invited please to respond, comment, disagree, as you wish. Please use the response facility below. You are free to make use of the material in this column, provided you acknowledge the Association, and me please, and cite the Association’s website.

Please cite as: Cannon G. The meaning of 'development', and other items. [Column] Website of the World Public Health Nutrition Association, June 2011. Obtainable at www.wphna.org

The opinions expressed in all contributions to the website of the World Public Health Nutrition Association (the Association) including its journal World Nutrition, are those of their authors. They should not be taken to be the view or policy of the Association, or of any of its affiliated or associated bodies, unless this is explicitly stated.

This column has been reviewed by Claudio Schuftan, Barry Popkin and Fabio Gomes. My thanks also to Google, Wikipedia, and Guardian On-Line. The idea for 'economism' comes by analogy from Gyorgy Scrinis, who first coined 'nutritionism'.