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The World Public Health Nutrition Association – the Association for short – is an independent civil society organisation committed to the protection and improvement of nutrition and public health, worldwide. The scope of this work is indicated in our aims and objectives, posted on our website every month. Thus: 'With our members, we encourage policy-makers and decision takers, at all levels from global to local, to promote equitable and sustainable access to adequate, enjoyable, appropriate and nourishing food. This is essential for population health and well-being, and also for social, cultural and economic integrity, and to conserve the living and physical world'. Hence the news stories and the columns we run every month on our website, and the imaginative, challenging or illuminating commentaries and discussions we publish here in WN.

This is one of our two main tasks. We are also a representative professional body committed to strengthening the discipline of public health nutrition as taught and practiced. Thus, again to quote our aims and objectives: 'We work to ensure a well trained, resourced and organised profession, aware of the environmental, social, political and economic as well as the biological and personal determinants of disease, health and well-being, and what these imply for research, advocacy, policy, and action'. Hence the news from and profiles of our members carried on our website.

Thus also the commentary that follows this editorial by Roger Hughes, Roger Shrimpton, Elisabetta Recine and Barrie Margetts, on ways to enhance and empower the teaching and practice of public health nutrition, in part by giving its professionals more qualifications and credentials and thus more status, influence and credibility. This initiative will succeed, provided that current and future Association members engage energetically. It is potentially of special importance for scientists, managers and field workers from less resourced and impoverished countries. They often have to struggle to make their voices heard, at a time when almost all material and human resources go to the treatment of disease, and when resources for public health and for nutrition are increasingly scarce.

Our hard times

The more effective that public health nutritionists are, the better for them, and for what they stand for. But we need to recognise that all professionals committed to the protection and enhancement of any and all aspects of public health, are now working in bad times. What still remains our world's dominant political and economic ideology, actively pursued by the most powerful international financial and trade organisations and by the governments of most countries, has as a central principle the privatisation of public goods, including the institutions designed to protect public health. This involves the demolition of international and national regulations and standards designed to protect the public interest, in favour of freedom for private industry to make profits wherever and however they can. There is nothing wrong with making profits. Societies need successful industries in order to prosper. In our field the problem comes when the activities of industry thwart the needs of public health and are antagonistic to public goods.

In effect, governments that advocate or accept privatisation of public health, or have had it forced on them as a condition for external loans, have ceded one of their principal duties. This over-rides any process that could be described as democratic. Worse, the current global financial crisis, caused in part by the 'casino capitalism' that is a product of the privatisation ideology, means that for many governments, sustained investment in public health is practically impossible. The prospects are gloomy and ominous.

Three evident results are the undermining and sometimes even the collapse of publicly funded primary health care facilities; widening inequities between and within nations; and a growing number of populations and communities throughout the world that are severely impoverished, often mired in debt, and unable, try as they may, to support themselves.

The aid agencies of wealthy countries, transnational and other big corporations, foundations, and civil society organisations, can and do support or undertake public works, famine relief, agricultural reform, and in our field the supplementation and fortification of food supplies, on a substantial scale, as do relevant UN agencies. This is vital work. But it is not adequate. Compared with the protection that should be assured by governments adequately funded with public money committed to look after their own populations, it's hard to see how it can amount to more than patchwork.

The shrunken and even calamitous state of many public institutions is not a phenomenon confined to Africa, Asia, and parts of Latin America. Substantial proportions of the populations also of North America and Western Europe are unskilled, unemployed, impoverished, and dependent on 'benefits' and other handouts from national governments some of which are close to the abyss of bankruptcy. In these circumstances, now usually forecast to get worse, there are not a lot of obvious reasons for public health nutritionists to be cheerful.

Our proud history

Nutrition is – or should be – a proud profession. Much has been achieved, both before and after the emergence of nutrition as a modern discipline less than 200 years ago. Crucially, there are lessons for us to learn now, from an examination of history, ancient and recent. One lesson is that what is now termed 'public health nutrition' – the protection and enhancement of the nutrition and thus the health and well-being of populations – has usually and rightly dominated the practice of nutrition. Clinical nutrition, as a biological discipline largely contained within a medical framework, is concerned with the health of individuals and groups of individuals, and is a more precise science. But by its nature and as its name implies, clinical nutrition has less impact on population health. Indeed, it is not directly concerned with public health or with its social, economic, environmental and other drivers. In some respects it can be seen as a branch of conventional medicine.

There is another lesson from history, as we try to make sense of our work in the context of the privatisation of public health. The records show that beginning thousands of years ago, and throughout more recent historical times, wise rulers have had as a prime concern, the quantity and quality of the food supplies of their people. Their own success and survival has often depended on their ability to organise and sustain adequate and appropriate food systems. It seems likely that learned and wise advisors earned high positions in such societies. Leaders who did not or could not protect the health and well-being of their people, which included as a first priority ensuring that food systems and supplies were adequate and sustained, tended to fail, and often were overthrown or executed. Empires fell when their food systems failed (1).

Food and nutrition adequacy, quality and security has been and remains one of the crucial priorities of gatherer, hunter, pastoralist and peasant societies, and most of all perhaps, communities migrating from one part of the world to another. A substantial part of the Christian Bible's Old Testament is preoccupied by food and nutrition, and specifies rules for what can and cannot be consumed, at least some of which may well have made sound sense at that time (2). Over 4,000 years, from the time of the building of the Egyptian great pyramids, to that of the modern planning of institutional food and nutrition, minimum standards for the food and nutrition of groups such as students, soldiers, prisoners and workers, have been devised and carefully measured and monitored (3).

An outstanding example of responses to the need for food and nutrition security and quality, has been the provisioning of soldiers and workers at times of war – hence Napoleon Bonaparte's well-known adage 'An army marches on its stomach'. Conventional histories that are focused on military process and glory overlook the fact that the outcomes of many wars, as well as long journeys of exploration and conquest, have been determined by whether or not adequate nourishing food supplies could be sustained (4).

The impact of nutrition in modern times

Three giants of public health nutrition in the modern age, whose vision changed history. Left to right, Justus von Liebig, John Boyd Orr, Tu Giay

There is also a lesson to learn from the history of modern nutrition. The rise of nutrition science in its modern form, from the early 19th to the mid 20th centuries, was usually driven by the felt need of the rulers and leaders of Europe and then the US to improve population health, for idealistic and also practical reasons. From the start, nutrition as taught and practiced – and most important, as resourced – was public health nutrition. Here are three of many examples. The great German biochemist Justus von Liebig (1803-1873, above left, commemorated on a German postage stamp), was the man of science who above all others in his time, saw nutrition as a biochemical discipline. He was supported and funded by the governments of his day, because his discovery of protein as a growth promoter for plants, animals and humans, and his emphasis on its importance, was seen as crucial to the politics and economics of the European Powers (5). Big strong young people are more effective both as workers and as soldiers.

John Boyd Orr (1880-1971, centre above), the founding director-general of the Food and Agriculture Organization of the United Nations (FAO) believed that the one secure way for nations to prosper and to eliminate starvation and gross malnutrition in their populations, was to be self-sufficient in food production. He won a Nobel Peace Prize. Earlier in his career, aware that Germany lost the First World War largely because the civilians crucial to the war effort were exhausted because of food insecurity and undernutrition, he was an architect of the state-controlled British food policy in the Second World War, which ensured that everybody had adequate and nourishing food.

Another example of history being shaped by nutrition scientists is provided by the story of the Vietnamese agronomist Tu Giay (1921-2009, right above), a former president of the Vietnamese nutrition society. As part of the strategy masterminded by General Giap, commander-in-chief of the North Vietnamese armies, Tu Giay devised a pocket-book given to all soldiers in the field. This showed them among other things which wild foods were good to eat and which were poisonous, and how to cook underground without making smoke. Victory over the foreign invading forces was due to the astounding resilience of the Viet Cong forces, most of whom were short and light by what are now generally recommended standards.

There is a common theme to these three and many other such stories, as there is from the time before the rise of nutrition as a modern discipline; and therein lies the lesson for us now. Nutrition knowledge and science flourishes when – and probably only when – its translation into rational policies and effective actions is consistently accepted as crucial by governments at the highest level, and all relevant institutions and programmes are adequately supported with public money. This should always be so, for when food systems go wrong, and food supplies are inadequate, societies themselves become insecure.

This is how things are now. As Association member Claudio Schuftan has pointed out, riots, uprisings, revolutions and wars are often triggered, and their outcomes influenced, by severe food shortages and therefore nutrition inadequacy, when these cause not only mass despair but also anger. This remains true. But the excruciating problem we all now face as citizens as well as professionals, is that in most parts of the world, decisions that drive and shape food systems have been taken out of the hands of elected politicians. In this respect, governments are not able to govern.

Places in the SUN

So what difference can public health nutrition practitioners make, in these sombre times? One vital way forward is outlined in the commentary that follows this editorial. In all circumstances, sunny or dismal, it is essential that technical and practical knowledge and standards are as high as practically possible, and are updated and reviewed regularly. The internet, and indeed the Association's own website, creates limitless opportunities for professionals, again especially in less-resourced parts of the world, to network, to be aware of current best practice, to learn from the experience of colleagues in other parts of the world, to increase their knowledge, and to enhance their judgement. Channelling this vast mass of information through an attested scheme that ensures competence and high standards has the potential greatly to strengthen the profession.

Another reason to be hopeful is the Scaling Up Nutrition (SUN) initiative. This, as said last month and previously, is engaging more and more public health nutrition and allied professionals all over the world. SUN is ambitious and highly-geared. It has the backing of very senior politicians in the US and other powerful governments, leaders of relevant UN agencies and the World Bank, and senior executives of major foundations and leading civil society organisations. Its vision is once and for all effectively to address undernutrition, hunger, food and nutrition insecurity, and their consequences, particularly in least resourced and most impoverished countries.

As stated on behalf of SUN recently (6): ' The international nutrition community has accumulated extensive evidence concerning the burden, consequences and effective interventions related to undernutrition; countries and their partners have acquired extensive knowledge and experience concerning the management of multi-stakeholder platforms and the capacities needed for scaling up; and global momentum is building for a renewed effort to translate these assets into large-scale improvements in the nutrition of high-burden countries. The coming years will be crucial for expanding and sustaining the commitment, the capacities, and the coordination for these efforts to succeed'.

Public health nutrition professionals, and those from allied and other professions committed to the alleviation of undernutrition in impoverished countries, now have in SUN a new powerful direction. World Nutrition will have more to say about SUN in general and in action, during this year. In these dark days perhaps we can discern a new dawn. So what difference can we make? Probably less than we may hope. Possibly more than our circumstances suggest. How much more, depends on how prepared we are actively to work towards the fulfilment of our mission.

Notes and references

1. Diamond J. Collapse. How Societies Choose to Fail or Survive. New York: Viking, 2005. Also, it's commonly thought now, that the fundamental reason for the fall of Greece and then of Rome in ancient times, was the increasing infertility and aridity of the lands on which these empires depended for staple foods.
2. Modern commentators on the Old Testament dietary rules tend to make fun of them. Certainly, some Biblical admonitions are taboos which seem to be more about control than nourishment. But taboos persist. For example, most Europeans now will not eat the meat of dogs, which is relished in China. We also should not be too quick to assume that pre-scientific rules have no sound rationale.
3. And sometimes turned out to be inadequate. Also, standards for prisons and workhouses were often deliberately designed to be sub-minimal, as part of the punishment, and mistakes were often made in the dietaries for schools and other institutions. They still are.
4. On the 'home front' as well. It is now generally agreed that the German will to continue fighting in 1917 and 1918, was sapped by the inadequate quantity and quality of the food supplied to the civilian population, many of whom were employed to sustain the war effort.
5. Watson P. The heroic age of biology. [Chapter 13]. In: The German Genius, Europe's Third Renaissance, the Second Scientific Revolution and the Twentieth Century. New York: Simon and Schuster, 2010. At the time when von Liebig was most influential, there was no quarrel between Prussia (the dominant force within what became Germany) and Britain; and his champions ensured that he influenced British agriculture, food and nutrition policy.
6. Lateef A, Beckmann D, Nabarro D, Shekar M, Taylor A, Walt G. Building momentum to scale up nutrition. Food and Nutrition Bulletin 2011, 32, 3: S53-S55.

Acknowledgement and request

Readers are invited please to respond. Please use the response facility below. Readers may make use of the material in this editorial if acknowledgement is given to the Association, and WN is cited

Please cite as: Anon. World Nutrition. What difference we can make. [Editorial] World Nutrition, February 2012,3, 2: 26-32. 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.

2012 February. WN2. Editorial
What difference we can make

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