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In: Ghosh PK, ed. Health, food and nutrition in Third World development. Westport, Connecticut, Greenwood Press, 1984. 61-76. (International Development Resource Books No. 6)Chronic malnutrition, in contrast to famine, is a grossly neglected but very serious problem in developing countries. Efforts must be made to acquaint authorities with the seriousness of the problems, to identify the causes of chronic malnutrition, and to develop effective programs to deal with the problem. Chronic undernourishment or subtle hunger receives little attention because 1) nutrition is a relatively new science; 2) those most seriously malnourished, i.e., poor women and children, have little power or influence; and 3) politicians are more likely to support programs with highly visible results, and the results of improving nutrition are subtle and not always immediately detectable. Attention should be directed to the problem by conducting epidemiological studies to demostrate that the growth and development of children is highly dependent on good nutrition. Indices for measuring growth and development are available and studies could be designed to show how these indices vary by social class or by geographical region. Other studies could demostrate how morbidity and mortality rates for nutrition related diseases can be reduced by improving nutrition. Weak points in the food chain which contribute to the problems of chronic malnutrition are delineated and include such factors as low agricultural production, deficient transportation systems, and the low food purchasing power of large segments of the population. Governments should be encouraged to develop national food policies, and the ministries of agriculture, health, education, and social welfare should be encouraged to play a role in combating chronic malnutrition. The protein deficit crisis in developing countries can be averted by 1) increasing the production of animal proteins, fish and marine resources, and food crops, especially protein-rich crops; 2) expanding research programs to improve the protein quality of cereals, to increase the yield of forage crops, and to develop new protein sources; 3) reducing the unnecessary loss of food by improving storage, transport, and processing procedures; 4) promoting the use of formulated protein foods and educating the public about protein production and consumption; 5) developing programs to improve the protein intake of the most disadvantaged segments of the population and to reduce the incidence of infectious diseases which prevent the full utilization of protein by the body; and 6) promoting training in agriculture, food science, and nutrition. A reduction in population growth and an increase in economic growth would also contribute toward a decline in chronic malnutrition.
Assessment and implementation of health care priorities in developing countries: incompatible paradigms and competing social systems.
Social Science and Medicine. 1984; 19(4):373-84.This paper addresses conceptual issues underlying the assessment and implementation of health care priorities in developing countries as practiced by foreign development agencies coping with a potentially destabilizing unmet social demand. As such, these agencies mediate the gap between existing health care structures patterned around the narrow needs of the ruling classes and the magnitude of public ill-health which mass movements strive to eradicate with implications for capitalism at large. It is in this context that foreign agencies are shown to intervene for the reassessment and implementation of health care priorities in developing countires with the objective of defending capitalism against the delegitimizing effects of its own development, specifically the persistence of mass disease. Constrained by this objective, the interpretations they offer of the miserable state of health prevailing in developing countries and how it could be improved remains ideological: it ranges between "stage theory" and modern consumption-production Malthusiansim. Developing countries are entering into a new pattern of public health which derives from their unique location in the development of capitalism, more specifically in the new international division of labor. Their present position affects not only the pattern and magnitude of disease formation but also the effective alleviation of mass disease without an alteration in the mode of production itself. In the context of underdevelopment, increased productivity is at the necessary cost of public health. Public health improvement is basically incompatible with production-consumption Malthusianism from which the leading "Basic Needs" orientation in the assessment and implementation of health care priorities derives. Marx said that "countries of developing capitalism suffer not only from its development but also from its underdevelopment." (author's modified)