Ethics @ Work: Fat with hunger

Poor are loosening their belts across the world.

jp.services1 (photo credit:)
(photo credit: )
Two weeks ago I repeated an assertion I have made many times: that with all due respect for the contribution of organizations providing food for the needy, Israel's poverty problem has little to do with nutrition, and rising rice prices are not going to threaten Israelis with malnutrition. Since this is a highly complex issue, I want to devote this column to the relationship between poverty and nutrition in wealthy countries. Poverty and food deprivation are intimately connected in our culture and language. We call cutting down on expenses "belt-tightening," we refer to "starvation wages," and so on. In poor countries - even today - hundreds of millions of people struggle to provide enough quality calories for their households. However, in rich countries the opposite has long been true. The poorest citizens have the highest rates of overweight. I don't know exactly how long this has been so, but the first mention I have seen is the "fat with hunger" phrase in Michael Harrington's extremely influential 1962 book The Other America: Poverty in the United States. Harrington wrote that "tens of millions of American are, at this very moment, maimed in body and spirit, existing at levels beneath those necessary for human decency. If these people are not starving, they are hungry, and sometimes fat with hunger, for that is what cheap foods do." Now the phenomenon has spread beyond wealthy countries. A World Health Organization publication states: "Once considered a problem only in high income countries, overweight and obesity are now dramatically on the rise in low- and middle-income countries, particularly in urban settings." I haven't seen any figures for Israel, but I've done a basic calculation using just a spreadsheet program and figures from the Health Ministry's comprehensive 2003-2004 Health Survey and education figures from the Statistical Abstract. The data seems to confirm that among young- and middle-aged Israelis, overweight is much more prevalent among those with lower education, which in turn is significantly correlated with lower income. (The relationship does not hold for older Israelis.) Almost fifty years after Harrington's hypothesis that "cheap foods" cause obesity, it remains the principle culprit in the professional literature. It has, however, acquired a scientific name (which Moliere would no doubt appreciate): the "energy density" explanation. Foods with fewer calories per gram (low energy density) are the most expensive per calorie. Let's see where we can take this line of reasoning. Poor people consume more calories because they can't afford quality foods which cost more per calorie? Do poor people also travel more miles because they can't afford cars which cost more than buses per mile? Or perhaps they purchase more cars than rich people, since they are limited to buying economy vehicles which cost less than SUVs per vehicle. Sorry, "energy density" advocates - no matter how you look at it, fewer calories cost less than more calories. My guess is that the underlying relationship is between education and obesity. More educated people care more about their health, have more knowledge about how to protect it, and in general have more self-control. They also have on the average more income (whether due to cause or effect). A number of studies (including mine) have found an inverse relationship between education and obesity. It used to be that poorly educated people more than made up for this by burning calories in manual occupations, but that is seldom the case today. (An additional factor is that eating is a low-cost but high-calorie form of recreation - when compared to an activity such as going to the opera). Which gets back to my original point. While there are exceptions, poverty in Israel and other developed is primarily measured not in the staples of a subsistence economy, like calories and shelter, but in the staples of a developed economy, like education and health counseling. These will be little impacted by world food prices, but greatly impacted by the policy decisions made by us and our government.