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National and International Issues in Food Policy
by Jean Mayer , President, Tufts University
As a scientific discipline, nutrition is either very old or very young.1 As an empirical body of knowledge, it is old. Clearly, there was a job of selecting of plant and animal foods which went back at least ten thousand years since the beginning of fixed agriculture and probably much longer than that. Written records about the relationship of foods and health go back at least to the Ebers Papyrus, which in particular pointed out that certain diseases of the eyes were cured by the consumption of liver. Actually, that use is often misunderstood, as is the fact that lemon juice was prescribed in the 18th century to protect the sailors of the British Navy against scurvy, or for that matter, that rickets was treated with cod liver oil since the beginning of the 19th century. Those cures worked. But that does not imply that the concept of vitamins, of elements otherwise missing in the diet, was familiar to the people who used them. Those preparations were used very much the way the extract of cinchona bark from which quinine was later extracted was used to deal with malaria. These were specifics for certain diseases, not food elements which cannot be synthesized by the body but have to be provided preformed. The specifics were effective, but they were part of prescientific nutrition.
Scientific nutrition began only 200 years ago with the experiments of Lavoisier. We can divide scientific nutrition (and the rest of this lecture) into three parts. First came an understanding of the organism as an engine. The understanding of the energetic aspects--the caloric aspect of nutrition, if you want--started in the 1780s, with a very famous set of experiments conducted in 1789 by Lavoisier on his assistant, M. Seguin, and later on another assistant, M. du Pont, who came from Nemours. Lavoisier was guillotined during the Revolution. When he saw what happened to his boss, du Pont de Nemours removed himself to the U.S., where he created a chemical company which, as you all know, has done very well since. Lavoisier's experiments established clearly that there was a similarity, indeed, an identity between the phenomenon of combustion and the phenomenon of respiration and that respiration was the oxidation of foods by the individual; that what one observed was in fact a machine, an engine, burning food in order to function, to maintain its body temperature, to move, to grow. The values Lavoisier obtained with what seems to us now very primitive equipment were in fact extraordinarily accurate. All of which shows that if you have a fine scientist, as Lavoisier was, who is very careful, it is remarkable what degree of accuracy one can obtain under what appear to be rather adverse conditions.
A large part of the 19th century was devoted to elaboration of these pioneering experiments. The energy expenditures of the body, or if you want, the caloric needs under various conditions, the caloric content of foods, and the caloric equivalent of various forms of exercise were determined. These experiments produced the tables of calories in foods and calories expended in activities that all of you have seen and which are excerpted frequently in the lay press.
Meanwhile, the second area of nutri tion developed: understanding of the organism as a chemist, but not a perfect chemist.1,3,4,5 The body has to be provided with some outside elements. Indeed, the concept of elements whose absence causes disease came not from consideration of vitamins (this occurred 60 or 70 years later), but from consideration of minerals, in the work of Sir Humphrey Davy and others which showed that a number of minerals were present in the body. The first clear demonstration that the absence of a mineral, namely iodine, caused a deficiency disease, in this case, goiter, came early in the century from Prout and from Coindet, who showed that you could cure or prevent goiter by providing the body with iodine.
This was the beginning of the concept that missing elements in the diet were possible causes of disease. Iron deficiency was the second to be demonstrated. The proof that essential elements were not necessarily minerals but could be organic elements was developed as recently as the 1920s and '30s. Because my father was himself a physiologist, I can be said to be, in a sense, in the family business. As a result, I may be the only person left in the world who has known personally every discoverer of every vitamin: Mellanby and McCollum, who discovered vitamins A and D; the various discoverers of the various B vitamins; Glen King and Szent-Gyorgyi, who discovered and isolated vitamin C; Henrik Dam who discovered vitamin K; all the way to the discoverers of the last vitamin, B12, isolated in 1948 in crystalline form and shown to contain cobalt. A number of us who are still working knew Professor Rose, who in 1935 isolated the last essential amino acid, threonine. "Essential" elements, then, are those molecules that the body must have but cannot produce--which must be provided by the diet.
The essential amino acids and the essential fatty acids were discovered in the '30s and '40s, and as far as we know they and the vitamins complete our understanding of what is necessary in the diet; at any rate, we are able to maintain animals for a number of generations with synthetic diets that contain these nutrients. There may well be undiscovered molecules that have important nutritional properties, but the fact is, knowing enough to maintain mammalian organisms practically indefinitely, we can feel secure in setting requirements. What we did not know, however, as late as World War II is that what is in the diet is as important in the long run as what is not in the diet.6,7
Investigations of the impact of Ancel Keys and his collaborators, demonstrated not only that the presence of large amounts of sugar in the diet caused dental cavities (a conclusion Aristotle had already reached, observing the results of consumption of large amounts of dried grapes and figs) but also that large amounts of dietary saturated fat were accompanied by very much increased prevalence of cardiovascular disease, of heart attacks in particular, and that the higher prevalence of strokes. That, and a better understanding of the role of obesity, of how food intake is regulated--an exquisite mechanism which does not function at a very low level of activity, and therefore in sedentary animals and people is prone to cause overweight--gave us a better understanding of those "diseases of civilization" which are responsible for the bulk of mortality in industrialized societies.
More recently, evidence that the presence of certain macro-constituents in the diet is linked to the prevalence of cancer (in particular a higher fat content linked to a higher prevalence of cancer of the breast and colon) and that a number of carcinogens, both natural and in food additives, are present in the diet has given a new dimension to the fight against cancer. Now, given this much greater knowledge of the role of nutrition in health, if you believe, as I do, that greater knowledge brings greater responsibility, clearly, what was excusable even as late as the 19th century, in terms of having millions of people malnourished without intervention on the part of governments or the international community, is no longer excusable.
In the U.S., there was some beginning of intervention by the government during the Great Depression, when "the poor," instead of just being the traditional "underclasses," suddenly comprised a number of middle-class people who "through no fault of their own" could no longer feed their families. The distribution of commodities was organized, soup kitchens were opened, and some school lunch programs were begun.
A greater shock, I think, and a stimulus to doing more about the nutrition of the general public, were the results of medical examinations when the draft was instituted. The large proportion of Americans who did not meet the physical qualifications for military service was a great shock to a great many people. Many were rejected because at the age of 20 they had no teeth. Many others were rejected because of physical abnormalities known to be linked to nutritional deficiencies--in particular to vitamin D deficiencies such as rickety rosary, knock knees, bow legs, and other bony deformations. During the War, at least, there was some acceleration of the social programs which had been developed during the Depression. In the '50s, however, in the great torpor which engulfed the nation during the Eisenhower years, a great many of those programs were put in abeyance, and by the '60s had disappeared.
In the '60s, when the civil-rights movement began, a number of us who were interested in nutrition decided that there must be a nutritional rights counterpart to civil voting rights.7,8 We set up a number of surveys of reported hunger areas across the nation. They became a major survey, published in 1968 as a book called Hunger in America and shown twice on prime-time television by CBS under the same title. We created a large umbrella organization of the groups working on the problem, including most of the women's religious groups, the PTA, the Red Cross, a number of unions--the International Ladies Garment Workers Union, the UAW, the Municipal Employees Union, the Butchers Union. I became chairman of the organization, which we called the National Council on Hunger and Malnutrition in the U.S., and which had a combined membership of about 64 million people. The Council put pressure on the Congress, which created a Select Committee under the chairmanship of Senator George McGovern. Speaking for the Council, I was the first witness at the hearings.
After a number of hunger marches on Washington, the President, Mr. Nixon, called for a White House conference on food, nutrition, and health, which I was asked to organize. We took advantage of this conference not just to look at the problems of poverty, but to look at other problems which had been neglected-- the links between nutrition and health, and consumer concerns. There were two reasons for doing this. The first was that they were obviously important problems: for instance, the mortality from cardiovascular disease had increased yearly since 1900. Clearly, with the newly-emerging knowledge of the link of cardiovascular disease with dietary fat and salt, with overweight, lack of physical activity and so on, something could be done about it. The second was the observation that some of us had made that only if you also involved the middle class in a reform effort involving the poor would you have a chance to get something done.
The conference was very large: 5000 people attended, 3000 were on task forces, and it came up with 1800 specific recommendations. I had obtained from the President the promise that, first, we would have a small conference two years later to see what had not been done so that corrective measures could be taken and, second, that a number of key people, key participants in the conference, would be appointed to government posts where they could have an input in making things happen. Indeed, two years after the 1969 conference, 1650 of the 1800 recommendations had been put into effect.
As a result, the food stamp program expanded, serving 11 million recipients two years after the conference in 1971. Participation, as had been intended, rose and fell inversely with the economy. In 1980, the program served over 20 million. The number of school lunches tripled and several million school breakfasts were served. Summer food programs were created, because clearly, kids should eat in the summer as well as during the year.
Incidentally, it was interesting that the way in which those programs were sold was not by pointing out that youngsters needed to eat in summer as well as in the winter, but by pointing out that if domestic tranquility was sought and one wanted to avoid cities burning in the summer, then one needed to keep the children and the youngsters busy when school was out, and if one was going to have programs to keep everybody busy during the summer, they had to be fed while those programs were being run. That was the argument by which the kids were fed--not the physiological argument. But it worked.
A number of programs were created for the elderly. In 1969, you must remember, the majority of the poor were the elderly, who were not covered by Social Security. To be retired was to be poor, and very often to be immediately underfed. The situation is very different now. We created congregate feeding for the elderly and Meals-on-Wheels for the shut-ins, and of course the elderly were eligible for food stamps as well, although the problem of getting them to apply for food stamps--people who had never received help throughout their lives was particularly difficult because they would not go to welfare offices. We experimented with having the food stamps distributed by the Post Office, by the banks, by any means which would not make food stamps look like welfare, because otherwise many elderly poor would not apply for them.
What also dates back to the conference is the idea of standard packaging, food packages of limited numbers of sizes rather than every possible size; unit pricing, which means that you do not have to bring a slide rule in order to figure out which is more expensive, 11 ounces at such and such, or 7 1/2 ounces at this or that; also, open dating, ingredient labeling, nutritional labeling, and numerous other consumer measures of that sort. A review was begun of the safety of food additives on the so-called GRAS list, the ones "generally recognized as safe." The result was that some of the more potentially dangerous additives were eliminated.
Finally, the conference generated an enormous increase in the general public's interest in nutrition. Of course, dietary changes alone are not responsible for the fact that since 1970 cardiovascular mortality (which as I said had gone steadily up since 1900) has dropped by over one-third. There are factors other than nutrition involved: increase in exercise, better control of blood pressure, a decrease in cigarette smoking (at least among men), more people sensitized to go into a hospital immediately when they begin to feel twinges in their chest or their left arm, and improvements in surgery. But clearly, there have been some profound changes in dietary patterns since 1969--a decrease in saturated fat consumption, an increase in consumption of polyunsaturated margarines and oils, decreases in what had been a rising consumption of eggs, beef, and pork, and some decrease in salt intake. These are foods that people like, and clearly have cut back on not because they have suddenly lost a taste for eggs or beef, but because they think they need to for health reasons. One can say that the nutrition education movement initiated by the White House Conference has been very effective.
By 1978-79, surveys which looked at the same areas surveyed in the '60s in Appalachia, northern Maine, big cities, and so on, found that poverty was still there. But while there were still individual examples of malnutrition, malnutrition as a large social phenomenon had basically disappeared. The food programs had worked, had done what they were supposed to do.9 Then came the Reagan years.
In the first four years of the Reagan Administration, $12 billion worth of food programs were cut off by the combination of an Administration which used the budget to cut social programs and a Congress so bemused by the electoral success of the President that there was essentially no opposition. Hunger reappeared. The mayors of big cities started bellowing because all their discretionary funds went to feed people who again were hungry, soup kitchens had to be reorganized in all the cities, a large number of churches had to begin feeding centers, and the situation, though not as bad as in the '60s, was bad enough. We had retrogressed at least one-third, perhaps one-half toward where we had been.10,11,12 At that point, the Congress finally swung into action and voted back about $8 or 9 billion worth of food programs, so that while we are not quite where we were in 1980, we are much better off than we were in 1984.
Let me show you how ridiculous some of those economies are. Our School of Nutrition at Tufts and other groups have done studies of the WIC program, a special program for pregnant women, infants, and children which was started in the early '70s. At this point, the program reaches about 3.6 million of some 8 million women who are eligible. These are essentially very poor pregnant women, most of them teenagers. We have incontrovertible evidence that every dollar spent on WIC saves three dollars the same year in health costs. That is not very surprising. Women who are not fed properly during pregnancy have about 30- 40% more low birth weight infants. It costs one to two thousand dollars a day to keep an underweight infant in an incubator. You can buy a lot of food for that, and you can see how not feeding pregnant women can be extraordinarily expensive. Infants born underweight are also more likely to have physical defects or to be mentally retarded. In Massachusetts, for instance, the lifetime cost of maintaining a retarded person is $2.5 million. It can be said--forgetting all humanitarian considerations, on financial terms alone--that one of the stupidest ways to try to save money is not to feed pregnant women.
I may say the same thing about not feeding children. It is interesting that we are still spending a little over a billion dollars a day on national defense. This is not irrelevant to my next point.
A big difference between poverty in 1989 and the poverty in 1969 is that the poor are no longer preeminently the elderly. The elderly now constitute a much smaller fraction of the poor. The great majority of the poor now are children. Between 1989 and the year 2000, about one-third of American children are going to be eligible for food stamps, whether they receive them or not. Those are children of women with no husbands and very low salaries, or--for the first time in American history--children with two parents both of whom work and whose combined pay still does not go over the poverty line. It is true, as has been said, that eight million jobs have been created since 1980, but the great majority are low-paying jobs like serving hamburgers and french fried potatoes at McDonald's. Even if both parents have jobs like this, it still leaves them under the poverty line. What everybody knows about the homeless people--but forgets--is that they are homeless mainly because the cost of housing has shot up. That leaves an enormous number of people who are not homeless, but who are spending a very, very large part of their income on housing. In 1969 it was generally accepted that the average American spent one-third of his income on housing. For people at or below the poverty line, the proportion was 50%. Today, over 80% of the income of people below the poverty line who still have homes goes into housing--but it means that almost everything else, including good nutrition, is squeezed out. We should worry not just about the relatively few people who are homeless, but about the millions of people who have a home, but who can afford nothing but a roof over their heads. That group includes millions of children. The majority of the food stamp recipients at this point in the U.S. are children. Incidentally (for those people who worry so much about national defense), not supporting these children, who will make up the great majority of the groups from which the armed forces are going to be recruited, is unlikely to improve either their physique or their patriotism.
Alot of people are becoming very worried about the new problems of poverty: what needs to be done to the various poverty programs, how they need to be corrected, what recommendations could be made about the existing programs, possibly for new programs. In the consumer area, the problem of food safety is particularly troubling. Americans are very concerned about food safety, and they have some reason to be. For one thing, it is not clear who is responsible for ensuring the wholesomeness of our foods. For some foods, it is the Department of Agriculture, for others it is the Food and Drug Administration; the EPA is responsible for some aspects of food safety, but some important foods like fish seem to escape control in general. It is not very clear what the relationship is between the 51 food and drug administrations of the 50 states and the District of Columbia and the Federal authorities. On top of this, a number of important food companies have recently been bought by tobacco companies, about which the one thing we know is that their management doesn't care whether their customers get cancer or not, not exactly the most reassuring thing you can say about the food supply. Nobody is quite sure how the food supply is monitored, or how the nutrition level of the American people is to be monitored. Nobody is clear who is responsible for nutrition education.
The Surgeon General finally promulgated a report on diet and health which is not a bad report, but could have been written word-for-word 30 years ago.13 There are many other federal and state responsibilities that should be reexamined.
Now let me say one word about our international food programs. We live under a certain delusion which is easy to understand. The average American thinks of the United States as a very generous country which is and has been the bulwark of the world against starvation, and which does more than anybody else to help the poor of the world, in particular, feed themselves. This used to be true. The Marshall Plan after World War II was something unique in history and we can all be extraordinarily proud of what our country did. We can be just as proud of Point Four, of Food for Peace, of a number of initiatives our country took in the '50s, the '60s, and even the '70s. But all this is a long time ago.14,15
In 1989, almost no industrial country gives as small a proportion of its GNP to food and development aid to poor countries as the U.S. The United States is last among industrial countries--tied with Austria. Scandinavia, France, and Britain give several times the amount of aid we are giving. Even Japan, not traditionally the most altruistic country in the world, is much more generous on food and development assistance than we are at present.
Not only that. To make matters worse we and the Soviet Union are by far the largest arms salesmen in the world. We are not alone; practically everyone sells arms to the Third World, not only Soviets and the U.S., but the French, the British, the Brazilians, the Israelis, the Germans, everybody. But the U.S. and the Soviet Union sell far more than anyone else. To give you an idea of the order of magnitude, the amount of weapons sold to Africa last year represents a total of $5 billion more than all the combined aid to Africa from all sources--from everybody. That famous debt of African countries is very largely a debt incurred by governments buying weapons and, inasmuch as there has been essentially no foreign war in Africa, those are weapons used by governments to amuse their armed forces and to terrorize their own people.
Meanwhile, yes, when things get too bad we send some of our surplus food, usually quite late, to some countries without, incidentally, paying too much attention to whether food could not have come from a surplus from some other part of Africa.16 This could have been done in the last big sub-Saharan famine, and would clearly have encouraged food production in southern Africa. We need to do very much better than that. The Green Revolution works. To realize to what extent it works, just remember that in 1972-73 people were speaking about India as a basket case, wondering how that nation could ever feed itself, and some people were saying we should not help the Indians because that would only prolong the agony. Now with 200 million more Indians, India is a food exporter because their production has exploded, thanks to better varieties of wheat and rice, and to modern agriculture.
Practically all of Asia, except areas still torn by war and its consequences like Cambodia and Vietnam, East Timor, maybe North Korea, is growing enough food. Some parts of Latin America are doing as well. Africa is the big exception. There is almost no research on genetically improved African crops, and we have not helped to create the essential infrastructure of roads to join the different parts of Africa together. Africa still has a few roads and railroads going from the coast to limited areas of the interior, but there are very few means of transportation from one part of Africa to the other. We have not encouraged the type of education which would give African countries the managerial and technological revolution which could bring increased production, and we have nothing to be very proud about.
There are several reasons for our lack of initiative. The first is that as a country we seem to have decided we don't want to pay taxes for anything. Not to educate our own children, let alone to feed the poor in the U.S. or abroad. We have also a government structure which makes the Secretary of Agriculture the same person who is responsible for getting rid of our food surpluses and for doing technical assistance to increase production abroad, which is a little too much to ask of one individual. There are a lot of reasons why things don't work. Population increase alone is not responsible for the problems but it makes the problems and the solutions more difficult. We have an administration which refuses to participate in most population control programs for fear that abortion might be an element, and as a result does nothing to help birth control, which of course increases the probability of abortion being practiced. Clearly at this point, we have no policy as regards food assistance. The Agency for International Development (AID), ought to be one of the most vital, most vigorous branches of government. Instead, it is a tiny, neglected part of the State Department. We continue to spend a billion dollars a day on nuclear weapons we cannot use without committing suicide and on conventional weapons. It seems to me there is one thing that Vietnam and Afghanistan have demonstrated or should have demonstrated both to us and to the Russians. That is that even an enormous superiority in conventional weapons does not guarantee victory. At this point we need a change of mind, a change in priorities, a conversion if you want. If you believe with me that greater knowledge brings greater responsibility, we have the knowledge that is needed to feed our own people and to feed the world. We have very little excuse not to do both.
Footnotes
- Mayer, J. Human Nutrition: Its Physiological, Medical and Social Aspects. Springfield, Illinois: Charles C. Thomas, 1972:1-10.
- Lusk, G. The Elements of the Science of Nutrition. 4th ed. Philadelphia: W.B. Saunders, 1931.
- McCollum, E.V. The Newer Knowledge of Nutrition. lst ed. New York: MacMillan, 1918. History of Nutrition. Boston: Houghton Mifflin, 1957.
- Asimov, I. The Search for the Elements. New York: Fawcett Publishing Company, 1966.
- Frieden, E. "The Chemical Elements of Life." Scientific American, 1972, 227:52.
- Mayer, J. Overweight: Causes, Cost and Control. Englewood Cliffs, New Jersey: Prentice-Hall, 1968.
- Mayer, J., ed. U.S. Nutrition Policies in the Seventies. New York: W.H. Freeman and Company, 1972.
- Mayer, J. Human Nutrition: Its Physiological, Medical and Social Aspects. Springfield, Illinois: Charles C. Thomas, 1972:629-666.
- Kotz, N. Hunger in America: The Federal Response. New York: The Field Foundation, 1979.
- Hughes, M.A. Poverty in Cities. A Research Report of the National League of Cities, Washington, D.C., 1989.
- Brown, J.L. and Pizer, H.F. Living Hungry in America. New York: MacMillan, 1987.
- The Executive Panel, Ford Foundation Project on Social Welfare and the American Future. The Common Good. New York: Ford Foundation, 1989.
- Koop, C.E. The Surgeon General's Report on Nutrition and Health. Washington, D.C.: U.S. Government Printing Office, 1988.
- Brown, L.R., et al. State of the World, 1989. New York: Worldwatch Institute, W.W. Norton & Company, Inc., 1989.
- Sivard, R.L. World Military and Social Expenditures. Washington, D.C.: World Priorities, 1989.
- Mayer, J. Fifteenth McDougall Lecture. Rome: Food and Agriculture Organization, 1987.
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