The Covid-19 crisis has had several unexpected effects, including renewed attention to food security concerns. Earlier understandings of food security in terms of production self-sufficiency have given way to importing supplies since late 20th century promotion of trade liberalization.

Jomo Kwame Sundaram

Transnational food business
Disruption of transnational food supply chains and the devastation of many vulnerable livelihoods by policy responses to the Covid-19 pandemic have revived interest in earlier understandings of food self-sufficiency. But, even if successful, winding back policy will not address more recently recognized food challenges such as malnutrition and safety.

All too many food researchers have been successfully compromised, e.g., with generous research and travel funding, by food and beverage businesses to discourage criticisms of their lucrative business practices.

It is important for authorities to make sure that food is produced safely for consumers. The authorities should not only be concerned when food exports are blocked by foreign importers for failing to meet phyto-sanitary standards.

Is food safe for consumption? Are toxic agro-chemicals putting consumers at risk? Are anti-biotics, used for animal breeding, putting animal and human health at risk of antimicrobial resistance? Are food processing practices compromising consumers’ nutrition?

Malnutrition threat looming larger
The world has to deal with three major types of malnutrition, i.e., dietary energy undernourishment, or hunger; ‘hidden hunger’, due to micronutrient deficiencies of vitamins, minerals and trace elements; and diet-related non-communicable diseases (NCDs).

Many of the poor typically lack means to improve their condition, with the poorest often lethargic, due to not getting enough to eat, or not being able to gain sufficient nourishment from food due to gastrointestinal diseases, typically due to poor sanitation and hygiene.

Although hunger and starvation have reportedly been declining in recent decades, dietary energy undernourishment has been falling more slowly than poverty although the poverty line is supposedly defined by an income level to avoid hunger.

The nutrition situation in the world remains worrying as other manifestations of malnutrition — including stunting, obesity, diabetes and anaemia — have been growing, or declining slowly at best, according to available official evidence.

Micronutrient deficiencies
Micronutrient deficiencies threaten human health and wellbeing, but rarely get much public policy attention. ‘Hidden hunger’ is due to diets lacking essential micronutrients — vitamins, minerals, trace elements — vital for the body to develop and function well.

Wan Manan Muda

Insufficient vitamin A, iron, calcium and zinc seem to be the major micronutrient deficiencies of public health importance. All too many people are anaemic, with especially serious consequences for women of reproductive age.

In many countries, iodine deficiencies have been successfully tackled by iodizing salt, while vitamin A is typically tackled with costly supplements for children under five. Such hidden hunger is usually better addressed by dietary diversity to consume food with the needed micronutrients.

Biofortification can help, but for this to work well, close collaboration is needed between nutritionists and dieticians on the one hand, and scientists working to improve food crops and animal-source foods on the other.

Child undernutrition
Most parents are not aware that the ‘first 1000 days’, from conception until the child is two, is most critical for child development. Maternal and infant malnutrition start during pregnancy, especially with pregnant mothers suffering micronutrient deficiencies or diet-related NCDs.

We can and must do much more to enable and promote ‘exclusive breastfeeding’ for the first six months of every child’s life. Various work and maternity leave arrangements as well as childcare facilities should be made available to enable widespread adoption of such practices.

While international measures suggest that wasting, stunting and underweight among children are declining all too slowly, child undernutrition remains high, with national shares still rising in many, including middle income countries.

Child stunting not only adversely effects children’s physical development, but also their cognitive development. How can societies and economies progress if future generations continue to be handicapped from the outset.

Non-communicable diseases
The crises of obesity, diabetes and other diet-related NCDs in middle income countries remains alarming, with NCDs among the leading causes of premature death and disability. The prevalence of overweight, obesity, diabetes and related morbidities has increased in most countries.

Overweight and obesity are risk factors for NCDs, such as diabetes, cardiovascular diseases and cancers, which reduce the quality of life and productivity, unnecessarily raising health costs, both private and public.

Often, people are not aware of the consequences of eating much more carbohydrates, calories or ‘dietary energy’ than they normally use or need. Over-eating — often wrongly termed over-nutrition or over-nourishment — often leads to diet-related NCDs and their consequences.

Various non-infectious diseases are due to what we have eaten or drunk in excess, especially processed sugars. Excessive consumption of ‘starchy’ foods or carbohydrates raises blood sugar levels which cause diabetes and other problems including excessive weight gain. Thus, sugar ‘addiction’ directly contributes to various malnutrition problems.

Meanwhile, excessive salt consumption contributes to hypertension or ‘high blood pressure’ which, in turn, causes various other health problems. Meanwhile, deep fried food has become the most popular type of ‘fast food’, concealing possible staleness or even ‘rotting’, as more prepared meals are increasingly purchased and consumed, not prepared at home.

Balanced, healthy diets
The consequences of not eating properly need to be widely understood. Healthy eating requires dietary diversity. Healthy diets should be adequately diverse, to ensure consumption of various foods. Consuming a variety of nutritious foods can supply all the nutrients people need.

We all need macronutrients (carbohydrates, protein, fats), without overeating staples like rice or bread, or fatty, sugary and salty food, and micronutrients, especially vitamins and minerals.

Governments, employers, family and peer pressure can help encourage better eating. Food regulations and meal arrangements can thus improve eating practices, behaviour and habits.

When people better understand the effects of their food behaviour, and have relevant, easily comprehensible and actionable knowledge and information, many will try to improve their food behaviour. But misleading ‘information’ from food and beverage companies and advertising firms is widespread and influential in popular culture.

The problem is made worse by popular, even iconic figures who dispense misleading ideas, even half-truths, as part of their own discourses and narratives, often without meaning to do harm, but as part of their own efforts to gain or retain popularity, legitimacy and authority.

Various media and popular culture — at the workplace, at worship and at home — as well as peers, family and friends greatly influence food behaviours. Women, typically the main caregivers, are particularly important, often choosing the food purchased, prepared and consumed.

Transforming food systems
Food systems need to be repurposed to better produce and supply safe and nutritious food. Ensuring that food systems improve nutrition is not just a matter of increasing production. The entire ‘nutrition value chain’ — from farm to fork, from production to consumption — needs to be considered to ensure the food system better feeds the population.

Food systems have to improve production practices, post-harvest processing and consumption behaviour. Resource use and abuse as well as environmental damage due to food production and consumption need to be addressed to ensure sustainable food systems.

Governments must realize that improving nutrition is crucial for economic and social progress. No country can achieve and sustain development with a malnourished population. Without healthy people, future productivity and progress will be severely compromised.

Good nutrition and food safety are necessary for healthy societies and future progress. Governments should use the Covid-19 induced reconsideration of food security in relation to supply chains to better address malnutrition and safety issues.

Food security initiatives prompted by pandemic considerations should promote food system changes that will encourage more sustainable and healthy diets. This opportunity to strengthen food systems must also prioritize nutrition, food safety and dietary diversity.

Professor Wan Manan Muda is Visiting Professor at Alma Ata University in Jogjakarta, Indonesia. He was Professor of Public Health and Nutrition at Universiti Sains Malaysia, and long active in Malaysian university reform efforts.

School feeding programme in Togo. Credit: WFP/João Cavalcante

By Jomo Kwame Sundaram and Wan Manan Muda
KUALA LUMPUR, Malaysia, Jan 21 2020 (IPS)

If well planned, coordinated and implemented, a government funded school feeding programme for all primary school children can be progressively transformative. Such a programme, involving government departments and agencies working together, can benefit schoolchildren, their families, farmers and public health, now and in the future.

Jomo Kwame Sundaram

Such a scheme should comprehensively supply adequate food for all, especially schoolchildren, and improve their nutrition, thus overcoming hunger and malnutrition besides improving the children’s physical and mental development, and school learning, attendance, participation and performance.

School meals, well planned by nutritionists and dieticians familiar with local food practices and alternatives, using safe food grown by family farmers free of toxic agrochemicals, and hygienically prepared, will significantly improve the nutrition, health and wellbeing of the children.

3-pronged approach

A comprehensive and ambitious three-pronged approach to school feeding would go a long way to address contemporary malnutrition, of both micronutrient deficiencies of minerals and vitamins as well as overweight, obesity and other diet-related non-communicable diseases (NCDs).

Nutrition education for schoolchildren must promote an adequate, balanced and comprehensive understanding of health and nutrition. Teachers and the media will need to effectively share better knowledge of nutrition, health and wellbeing, and related food behaviours, dietary lifestyles and healthy living.

The programme should enable children to learn, from an early age, about food, its production, safety, preparation, consumption and effects on the human body.

Menus served can be rotated every two to four weeks to enhance dietary variety. Strict implementation and enforcement can help ensure that only healthy food is available in schools.

Learning from relevant experiences everywhere, good implementation and appropriate enforcement can also inculcate values of responsibility, equity, concern, empathy, cooperation and hygiene.

Nutritious school meal programme

A nutritious school feeding programme — properly designed and supervised by well-informed nutritionists and dieticians to meet school children’s micronutrient (vitamins and minerals) needs, and 25-30% of their macronutrient needs, such as carbohydrates and proteins — can go a long way.

Wan Manan Muda

The programme should meet much of the children’s dietary needs besides promoting knowledge of health and nutrition as well as healthy food habits. Menu planning should be aligned with the country’s dietary guidelines and international best practices for healthier school meals.

Meal requirements should adopt minimum standards, as stipulated in the country’s Recommended Nutrient Intake (RNI) or Recommended Dietary Allowance (RDA), but modified to increase consumption of fruits, vegetables and whole grains, and to set minimum and maximum calorie intake levels.

Programme success is often partly due to active parental involvement, especially to ensure school food hygiene, safety and quality.

Children in such programmes generally have significantly better scores for both cognitive and physical development. Participating students significantly reduced their body mass indices (BMIs) even if they snacked outside school.

Agrarian transformation

The procurement policy for the school feeding programme offers a unique opportunity for agrarian transformation. Food procurement for the programme can be used to induce farmers to safely produce more nutritious and healthy food, especially vegetables and fruits.

With the promotion of international trade and export orientation, not many farmers produce food, typically staples, often due to subsidies from governments, aid programmes and sometimes consumers. Many of those growing cereals often remain among the poorest farmers as they cannot compete with industrially produced cereals, often imported from abroad.

Instead of large transnational companies, family or ‘homestead’ farmers should be the main source of food procured for school meal programmes. With sufficient, appropriate agricultural research and extension, the programme can not only provide safe, non-toxic and nutritious food for children, but also increase farmer incomes.

If well designed and implemented, it can strengthen or revive farmer cooperatives and organizations to better serve the farmers’ and the nation’s needs as locally grown food supplies can be more easily regulated to ensure safe and healthy food supplies.

In many countries, from Brazil to China, the quality, safety and nutrition of food supplies on local markets have improved as farmers produce more than necessary to meet procurement contract requirements for school meal programmes.

Scheme implementation

Three types of school feeding programmes have different implications and consequences:

• (1)

Universal

• programmes in which all schoolchildren get free meals without conditions or requirements.

• (2)

Targeted

• programmes in which only selected children to qualify for free meals, such as those from destitute families, or severely undernourished children, due to stunting and wasting, although qualification requirements are often abused.

• (3)

Local

• programmes in which all children in a designated area receive free meals, e.g., rural areas, poor urban areas, post-disaster zones,

et al

.

The experiences of Japan and other societies show that only universal programmes can achieve all the objectives of such initiatives. Unlike targeting, the universal approach reduces the shame associated with receiving free meals, encouraging more children to participate with dignity.

Most middle-income countries and some low-income countries can well afford such universal programmes, which benefit countries in several significant ways, if well designed and implemented with broad popular participation, including both parents and farmers.

Two decades into the 21st century, all too many people still associate being ‘overweight’ with prosperity, health and wellbeing, mainly because being thin has long been associated with being emaciated due to hunger, undernourishment and malnutrition.

Overweight and obesity can easily be assessed by anthropometric measures, including the body mass index (BMI) and waist circumference. But BMI thresholds for overweight and obesity may differ by ethnic group or country.

Wan Manan Muda

Obesity pandemic
In 2014, McKinsey Global Institute estimated 2.1 billion overweight people, including the obese, then almost 30% of the world’s population. The related economic burden was estimated to be over US$2 trillion, a close third to civil conflicts and smoking.

By 2016, an estimated 1.97 billion adults and over 338 million children and adolescents worldwide were categorized as overweight or obese, following the rapid increase in overweight, including obesity, in recent decades.

An estimated 6% of children under 5 years of age were overweight in 2016, up from 5.3% in 2005. Similarly, the prevalence of overweight and obesity among adults rose by 27% between 1980 and 2013.

The situation in many middle-income developing countries is especially dire as higher incomes and more food consumption have reduced hunger while worsening other forms of malnutrition, including ‘hidden hunger’ or micronutrient deficiencies. The resulting health condition of much of the population generally imposes heavy costs for themselves, their families and their nations, while reducing their incomes.

Role of the brain
Obesity is typically due to nutrient imbalances where food ingested is stored as fat, instead of being utilized for energy and metabolism. Epidemiological evidence suggests ‘high fat’ and carbohydrate diets contribute to obesity, and the relationship between dietary fat and the degree of obesity.

Jomo Kwame Sundaram

A recent study found that high-fat diets stimulate inflammation in the brains of mice, triggering physical changes in such cells, and encouraging the mice to eat more and become obese. As this happens before the body displays signs of obesity and body weight changes, it implies that high-fat diets induce the brain to want to eat more.

Thus, it is possible that high-fat diets may not just affect humans physically, but also alter food intake neurologically. Hence, it is detrimental when food rich in fat and carbohydrates is easily available, encouraging even more eating.

Health threats
Many factors contribute to obesity, including lifestyle, diet, individual genetics and gut bacteria. Besides high fat and carbohydrate diets, immune system activity can also contribute to obesity, although details remain unclear.

The presence of large numbers of fat cells changes micro-biomes inside the body, causing the body to respond negatively. Worryingly, obesity has been closely linked to various chronic diseases including cardiovascular disease, diabetes and other metabolic disorders.

Recent research also clarifies how they affect various diseases of the brain, including Alzheimer’s, a neurological disorder associated with changes in brain cells more prevalent among the obese.

Such evidence continues to grow. Therefore, high fat diets have not only contributed to the developing world’s overweight and obesity pandemic, but may also have caused damage to brains and brain functioning.

Prevention better than cure
Changing diets, food consumption and human behaviour have all contributed to the nutrition transition and obesity pandemic.

While the developing world makes slow progress in overcoming hunger, or dietary energy undernourishment, much more needs to be done to educate the public about problems of malnutrition besides macronutrient deficiencies.

Micronutrient deficiencies, or ‘hidden hunger’, as well as diet-related non-communicable diseases also need to be addressed.

Already, those associated with overweight and obesity have been growing rapidly to pandemic proportions in recent decades, mainly due to dietary and other behavioural changes.

The authors recently co-authored Addressing Malnutrition in Malaysia available at: www.krinstitute.org

Smoking-related diseases are the major causes of premature death worldwide. Every year, six million smoking-related deaths are reported worldwide. If current smoking trends persist, 8 million deaths can be expected by 2030, of which four-fifths will occur in lower- and middle-income countries.

Start them young
Many studies show that smoking is typically learned and started during adolescence. Owing to nicotine addiction, the earlier someone starts to smoke, the higher the likelihood he or she will continue the habit into adulthood, and the smaller the likelihood of stopping smoking.

Jomo Kwame Sundaram

The first Global Youth Tobacco Survey (GYTS) in 2003 found that 20.2% of 13-15 year-old school-based adolescents were already smoking. Prevalence was much higher among males (36.3%) compared to females (4.2%). Subsequently, the 2009 GYTS reported reduced prevalence (18.2%) of current cigarette smoking among adolescents, mainly due to less male smokers (30.9%) while female smokers increased (5.3%).

Electronic cigarettes new threat
Many studies have reported increasing e-cigarette usage worldwide. E-cigarettes were touted as a means to help smokers stop smoking. However, studies suggest no difference between e-cigarette users and non-users in rates of successfully quitting.

As the vaping epidemic spreads, health risks associated with nicotine rise dangerously. Young people are vaping in record numbers in many parts of the world. “Adolescents don’t think they will get addicted to nicotine, but when they do want to stop, they find it’s very difficult,” notes Yale neuroscientist Marina Picciotto.

Despite many research reports highlighting its dangers and marketing tactics to hook teenagers and young adults, the number of vaping users continues to climb. And while it is possible to buy liquid or pod refills without nicotine, it is much harder to find them.

Many observers, including policymakers, overlook or underestimate the role of nicotine, a key ingredient in the vapours inhaled. Most teens do not realize that nicotine is deeply addictive. Studies show that young people who vape are much more likely to move on to cigarettes, which cause a broad range of diseases.

Wan Manan Muda

The mesolimbic dopamine ‘reward’ system is a more primitive part of the brain which positively reinforces behaviour needed to survive, such as eating. As the mechanism is etched into the brain, it is hard to resist. When a teen inhales vapour with nicotine, the drug is quickly absorbed through blood vessels lining the lungs, reaching the brain in about 10 seconds. There, nicotine particles fit ‘well’ into receptors on nerve cells (neurons) throughout the brain.

Why nicotine cravings persist
“Nicotine, alcohol, heroin, or any drug of abuse works by hijacking the brain’s reward system”, according to Yale addiction neurobiologist, Nii Addy. The reward system was never meant for drugs, but evolved, enabling nicotine to biochemically interact well with natural neurotransmitters which activate the muscles in our body.

Once nicotine binds to the receptor, it signals the brain to release dopamine, a well-known neurotransmitter which generates a ‘feel-good’ feeling. Dopamine is part of the brain feedback system signalling that “whatever just happened felt good”, training the brain to repeat the action.

Unlike other drugs such as alcohol, nicotine quickly leaves the body once it is broken down by the liver. And once it is gone, the brain craves nicotine again. Craving, due to the drug that causes the dopamine rush, makes it difficult for addicted youth to quit nicotine.

Recent research, including human brain imaging studies, shows that “environmental cues, especially those associated with drug use, can change dopamine concentrations in the brain”. Simply seeing a person one vapes with, or visiting a school toilet where teens vape during the school day, can unleash intense cravings, making it difficult not to relapse.

Physical changes caused by nicotine
Nicotine also causes physical changes to the brain, some temporary, while others could be long-lasting. Cigarette smoking research has long shown that acetylcholine receptors in the brain increase with continuous exposure to nicotine, intensifying cravings.

But the receptors decrease after the brain is no longer exposed to nicotine, implying that such changes are reversible. Animal studies also show nicotine adversely affecting brain functions, relating to focus, memory and learning, which may be long-lasting.

According to Picciotto, nicotine can cause a developing brain to increase connections among cells in the cerebral cortex region in animals, which would cause cognitive function and attention problems, if also true for humans.

Vaping vs regular cigarettes
Comparing the pros and cons of vaping versus smoking is complicated. On the one hand, unlike regular combustible cigarettes, e-cigarettes probably do not produce 7,000 chemicals, some of which cause cancer. However, aerosol from vaping devices contains lead and volatile organic compounds, some of which are linked to cancer, while the long-term health effects of vaping are still unresearched.

E-cigarettes have not been approved by the US Food and Drug Administration (FDA) as smoking cessation devices. But according to the US Centers for Disease Control and Prevention (CDC), e-cigarettes may be better for adult smokers if they completely replace smoking.

The ‘pod mod’ is a newer, popular vape device outcompeting many other e-cigarettes. The nicotine in these pods is two to ten times more concentrated than most ‘free-base’ nicotine in other vape liquids. A single pod from one vape manufacturer contains 0.7 mL of nicotine, about the same as 20 regular cigarettes.

Despite its highly addictive nature, people can successfully quit nicotine, particularly with personalized approaches under the guidance of suitably trained physicians. For young people, early intervention could significantly improve the quality of the rest of their lives.

To learn more, visit yalemedicine.org

Professor Wan Manan Muda was professor of nutrition and public health at Universiti Sains Malaysia. Jomo Kwame Sundaram was an economics professor and United Nations official.