because milk and milk products are such a good source and are in wide use. This is not the case in the LDCs. There calcium comes from cereals, leafy vegetables, and to a smaller extent animal products. If cereals are the principal food item and the principal source of calories, calcium intake can be increased by consumption of substantial amounts of pulses and nuts as well. As with vitamins, the ability to meet calcium requirements will be closely linked to the ability to meet calorie and protein requirements. OTHER NUTRITIONAL DEFICIENCIES While other nutritional deficiencies exist in the LDCs, they do not appear to constitute a major barrier to development. Rickets, the childhood form of osteomalacia, is due to vitamin D deficiency, but can be prevented by sufficient exposure to sunlight. It has not been a major health problem in recent years. Vitamin C, necessary to prevent scurvy, can be found in many vegetables, including potatoes and members of the cabbage family, as well as in citrus fruits. Foods containing vitamin C can be found in most countries of the world. It may occasionally be necessary or desirable to fortify food products or supplement diets with a synthetic form of this vitamin. In some underdeveloped countries there is a problem of endemic goiter (thyroid enlargement due to iodine deficiency). A very good source of iodine is seafood, but this is eaten in relatively small amounts in many LCDs. Iodization of salt is the most common preventive measure against goiter, but in some countries there are technical problems connected with this process. Iron deficiency anemia is apparently quite common in Africa and Latin America, even though the iron intake in these areas has been found to be far in excess of the dietary standards suggested for the United States. Obviously this is a research field in which further information is required. The same thing can be said for other nutrients, vitamins and minerals, for which requirements cannot be estimated at the present time, either for the world or for specific countries.49 Some so-called "trace elements"-minerals required in very tiny amountscan easily be overlooked, yet they are vital to health and even to life.50 It has been suggested that they may not be consumed in large amounts in the LDCs, and that research is required on this subject. Dietary Deficiencies, Public Health, and Economic Development One aspect of the problem of dietary deficiencies in the underdeveloped world that has perhaps not received the attention given to the protein gap, is the devastating and cumulative effect of disease on the entire problem of nutrition. Malnutrition, especially protein deficiency, lowers resistance to disease. Acute infection may precipitate nutritional deficiencies because infectious diseases accelerate the metabolism of the victim. (Each Fahrenheit degree of fever raises the metabolic rate by 7 percent.) What is more important, however, is the specific effect on protein metabolism. In the normal, steady metabolic 49 Ibid., page 67. 50 Paul R. and Anne H. Ehrlich. "Population, Resources, and Environment." (San Francisco, W. H. Freeman, 1970), page 346. state, the amount of nitrogen excreted by an adult equals the amount of his intake. But during acute or chronic infectious states the individual suffers a negative nitrogen balance, exhausting protein faster than he can take it in, even with a thoroughly adequate diet. If the diet is inadequate, so often the case in the LDCs, an individual may never achieve a nitrogen balance. His diet will never satisfy his requirement for protein, and indeed, the gap between requirement and intake will continue to enlarge. The various yardsticks suggested by different governments, international organizations, and private groups appear to be predicated on the good health of the population in the LDCs. It would seem important to take some approximate account of the impact of disease as it affects these standards. For example, respiratory tuberculosis increases basic requirements about 20 percent, while malaria and dysentery, in their acute stages, increase metabolic requirements 20 to 40 percent. In addition, worms and other parasites reduce the caloric efficiency of ingested foods, and use up small amounts of iron and protein. In the case of malaria and yaws, a drain of calories and protein is accompanied by a distinctive side effect: Highest incidence of these diseases occurs during the planting season; agricultural workers suffering one of these ailments may miss a planting (or harvesting) season. An epidemic of either disease can thus seriously deplete the food supplies of the country or region in which it occurs. Protein deficiencies are reported to do permanent damage, especially to small children. It has long been known that they contribute to dwarfing or delayed physical maturity, even if an original insufficiency had been overcome. Now it appears that protein deficiency in infancy or early childhood can result in permanent brain damage. Furthermore, studies in Central and South America have found a strong correlation between nutritional levels and physical and mental development in preschool and school-age children. In Santiago, Chile, a comparison was made of two groups of slum children and a group of middle-class children. One group of slum children was put on a supplemented diet, and received medical care. This group soon resembled the middle-class group both in physical and mental development, although apart from the food, the environment of the two groups of slum children was very similar. "Of the malnourished children, only 51 percent reached the normal range of development, compared with 95 percent of the supplemented group and 97 percent of the middle class group. "52 In another study, a group of children who had had marasmus (often defined as protein and calorie deficiency) as infants, and then had been given medical care and supplemental food, were all found to have an intelligence level considerably below normal 3 to 6 years later. Finally, although the results of animal studies can be applied to humans only with considerable caution, studies on rats suggest that malnourished mothers may produce children whose brain development is impaired. Accordingly, the higher the incidence of disease, the more difficult the task of the developing country seeking to provide its people with 51 This subsection down to this point is based on the remarks of Dr. Herbert Pollack at the "Symposium on the Food/People Balance," sponsored by the National Academy of Engineering, April 29, 1970, and pages 3 and 4 of the summary report of its Panel on World Nutritional Resources. 52 Ehrlich and Ehrlich. "Population, Resources, Environment," op. cit., page 77. In adequate diet. The greater the number of malnourished infants and toddlers, the smaller proportionately, and perhaps absolutely, will be the eventual number of those qualified to carry out the more sophisticated tasks of economic development. This is a discouraging prospect for the developing countries, and for the United States and other developed countries which seek to assist them. IV. THE POLITICS AND DIPLOMACY OF FOOD The preceding section indicated that a solid base already exists, with many opportunities for further advances, in the technology of food production. Whether it is possible administratively, economically, politically, socially, and diplomatically to achieve an end to malnutrition by exploiting this technology is much more uncertain. The humane and diplomatic interest of the United States in this outcome is of long standing. This section of the study discusses the dimensions of the U.S. effort directed toward this end. Evolution of U.S. Technical Assistance to Agriculture in the LDC's The food relief program in the famine areas of Europe during and after World War I was the first U.S. experience with large-scale international relief operations. Although these programs had the single nonpolitical objective of feeding hungry people, they called for special administrative machinery, and considerable international cooperation. Further and broader experience was gained when foreign assistance operations were organized again, during and after World War II. During that war, materials and food supplies were sent to allies under the authority of the Lend-Lease Act. Assistance was made available to the civilian populations of occupied areas. When the United Nations Relief and Rehabilitation Administration (UNRRA) was organized in 1943, the United States provided the bulk of its support. Immediately after the war the Congress responded to pleas to relieve distress in Europe by enacting several short-term relief programs. The legislation establishing these programs contained safeguards against political misuse of relief supplies, such as that which had occurred in both Poland and Yugoslavia with UNRRAfurnished items. The United States also took a leading role in the creation of the International Bank for Reconstruction and Development (World Bank) and the International Monetary Fund, both of which began operations in 1946. These agencies were envisioned as the principal multilateral monetary instruments through which the U.S. could assist in rebuilding the war-ravaged countries and in stabilizing their currencies. Today these agencies, especially the World Bank, figure importantly in world development projects, and are giving considerable emphasis to those relating to the food/population question. During the early postwar years, leaders in the United States expected that with appropriate assistance the developed countries receiving Marshall Plan assistance would be able to get back on their feet, and once more would be able to feed themselves, either through domestic production or by import. The severe stringencies that existed after World War II were simply viewed as an emergency situation, and not as arising from any persistent food/population imbalance. However, Marshall Plan assistance went also to the underdeveloped world, since an important feature of the program was "the carrying out of what was in fact a large-scale technical assistance program in the overseas territories of the participating countries." 5 President Truman publicly recognized the needs of the less developed countries in the fourth point of his 1949 inaugural address, calling for a "bold new program for making the benefits of our scientific advances and industrial progress available for the improvement and growth of underdeveloped areas." 54 The ensuing program of technical assistance, known as the Point IV program, launched the United States into direct involvement with the problems of developing nations, now the main focus of all foreign aid. The United States was also involved indirectly, through contributions to U.N. technical assistance and through bilateral assistance to those countries with colonial dependencies. U.S. FOOD AID TO DEVELOPING COUNTRIES The United States moved into the field of technical assistance to the developing countries at a time when food shortages had become a worldwide problem. There had been famine in India following a crop failure in 1943, and in 1952 starvation threatened both India and Pakistan. The struggle between the Chinese Nationalists and the Chinese Communists had disrupted food production over wide areas of the Chinese mainland, and there was famine among the refugees from that conflict. The Arab countries were inundated with refugees from Israel, and lacked sufficient food resources to handle the influx. At this time when the LDCs were desperate for food, U.S. food surpluses were beginning to accumulate. No machinery existed for transferring this surplus abroad. Furthermore, although it seemed both morally and polítically sound for the United States to set up such machinery, it needed to be done without adversely affecting the food production and commercial trade of other countries. The solution devised for this problem was the Agricultural Trade and Development Act of 1954, popularly known as "P.L. 480.” ❝*** to make This Act declared that the policy of Congress was "* maximum efficient use of surplus agricultural commodities in furtherance of the foreign policy of the United States." To achieve this objective the law provided that "surplus agricultural commodities in excess of the usual marketings *** may be sold through private channels, and foreign currencies accepted in payment therefor." 55 The foreign currencies thus acquired could be used, among other things, "for promoting balanced economic development and trade among nations." Some of the "soft currency" earned by the United States in this manner has been spent in the countries of origin to cover maintenance costs of U.S. embassies, for example, or military installations. A substantial part of it, however, has either been loaned or granted to the receiving countries to be used in development projects. 53 William Adams Brown, Jr. and Redvers Opie. "American Foreign Assistance" (Washington, The Brookings Institution, 1953), page 433. 54 "Public Papers of U.S. President Harry S. Truman: 1949" (Washington, U.S. Government Printing Office, 1964), page 117. 55 Section 2, Public Law 480, 83d Congress. Also section 104 (e) 68 Stat. 454, approved July 10, 1954. See "Agricultural Trade Development and Assistance Act of 1954 and Amendments." Compiled by Gilman G. Udell, Superintendent, Document Room, House of Representatives (Washington, U.S. Government Printing Office, 1971), pages 1, 3. |