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NUTRITION ISSUES IN DEVELOPING COUNTRIES FOR rHE 1980s AND 1990s PROCEEDINGS OF A SYMPOSIUM Food and Nutrition Board Commission on Life Sciences National Research Council NATIONAL ACADEMY PRESS Washington, D.C. 1986

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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. This report has been approved by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The Research Council was established by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy's purposes of furthering knowledge and of advising the federal government. The Research Council operates in accordance with general policies determined by the Academy under the authority of its congressional charter of 1863, which establishes the Academy as a private, nonprofit, self-governing membership corporation. The Research Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in the conduct of their services to the government, the public, and the . It is administered jointly by both Academies and the Institute of Medicine. The National Academy of Engineering and the Institute of Medicine were established in 1964 and 1970, respectively, under the charter of the National Academy of Sciences. - scientific communities The work on which this publication is based was supported by the National Research Council Fund--a pool of private, discretionary, nonfederal funds that is used to support a program of Academy-initiated studies of national issues in which science and technology figure significantly. The Fund consists of contributions from a consortium of private foundations including the Carnegie Corporation of New York, the Charles E. Culpeper Foundation, the William and Flora Hewlett Foundation, the John D. and Catherine T. MacArthur Foundation, the Andrew

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W. Mellon Poundation, the Rockefeller Poundation, and the Alfred P. Sloan Poundation; the Academy Industry Program, which seeks annual contributions from companies that are concerned with the health of U.S. science and technology and with public policy issues with technological content; and the National Academy of Sciences and the National Academy of Engineering endowments. Copies available from: National Research Council Food and Nutrition Board 2101 Constitution Avenue, NW Washington, DC 20418 . . . 111

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FOOD AND NUTRITION BOARD KURT J. ISSELBACHER (Chairman). Harvard Medical School and Department of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts RICHARD J. HAVEL (Vice Chairman), Cardiovascular Research Institute, University of California School of Medicine, San Francisco, California HAMISH N. MUNRO (Vice Chairman), U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts WILLIAM E. CONNOR, Division of Endocrinology, Metabolism, and Clinical Nutrition, Department of Medicine, Oregon Health Sciences University, Portland, Oregon PETER GREENWALD, Division of Cancer Prevention and Control, National Cancer Institute, National Institutes of Health. Bethesda, Maryland M. R. C. GREENWOOD, Department of Biology, Vassar College, Poughkeepsie, New York JOAN D. GUSSOW, Department of Nutrition Education, Teachers College, Columbia University, New York, New York JAMES R. KIRK, Research and Development, Campbell Soup Company, Camden, New Jersey BERNARD J. LISKA, Department of Food Science, Purdue University, West Lafayette, Indiana REYNALDO MARTORELL, Food Research Institute, Stanford University, Stanford, California WALTER MERTZ, Human Nutrition Research Center, Agricultural Research Service, U. S. Department of Agriculture, Beltsville, Maryland v

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V1 FOOD AND NUTRITION BOARD MALDEN C. NESHEIM, Division of Nutritional Sciences Cornell University, Ithaca, New York RONALD C. SHANK, Department of Community and Environmental Medicine and Department of Pharmacology, University of California, Irvine, California ROBERT H. WASSERMAN, Department/Section of Physiology, New York State College of Veterinary Medicine, Cornell University, Ithaca, New York MYRON WINICK, Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University, New York, New York J. MICHAEL McGINNIS (Ex Officio), Office of Disease Prevention and Health Promotion, Department of Health and Human Services, Washington, D.C. ARNO G. MOTULSKY (Ex Officio), Center for Inherited Diseases, University of Washington, Seattle, Washington Staff SUSHMA PALMER, Director, Food and Nutrition Board

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COMMITTEE ON INTERNATIONAL NUTRITION PROGRAMS MALDEN C. NESHEIM (Chairman), Division of Nutritional Sciences, Cornell University, Ithaca, New York ALAN BERG, The World Bank, Washington, D.C. WILLIAM P. BUTZ, Bureau of the Census, Department of Commerce, Washington, D.C. CUTBERTO GARZA, U.S. Department of Agriculture Children's Nutrition Research Center, Houston, Texas MARCIA GRIFFITHS, Manoff International Incorporated, Washington, D.C. REYNALDO MARTORELL, Food Research Institute, Stanford University, Stanford, California GRETEL PELTO, Departments of Nutritional Sciences and Anthropology, University of Connecticut, Storrs, Connecticut PER PINSTRUP-ANDERSEN, Nutrition and Consumption Program, International Food Policy Research Institute, Washington, D.C. Staff VIRGINIA MIGHT LAUKARAN, Program Officer LINDA MEYERS, Staff Officer (until February 1986) . . V11

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PARTICIPANTS KURT J. ISSELBACHER (Chairman, Food and Nutrition Board), Harvard Medical School and Department of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts ABRAHAM HORWITZ (Chairman, Committee on Inter- national Nutrition Programs), Pan American Health Organization, Washington, D.C. SOL H. CHAFKIN, Local Initiatives Support Corp., New York, New York LINCOLN C. CHEN, The Ford Foundation, New Delhi, India JOHN KENNETH GALBRAITH, Harvard University, Cambridge, Massachusetts RICHARD JOLLY, UNICEF, New York, New York PAUL LUNVEN, Food Policy and Nutrition Division, FAD, Rome, Italy HALFDAN MAHLER, World Health Organization, Geneva, Switzerland JOHN W. MELLOR, International Food Policy Research Institute, Washington, D.C. JOHN C. WATERLOW, London School of Hygiene and Tropical Medicine, University of London, London, England 1X

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PREFACE This symposium, which was held on December 9, 1985, at the National Academy of Sciences in Washington, D.C., explored the critical issues for nutrition in developing countries. The purposes of the meeting were to examine the economic and environmental determinants of nutri- tional problems and determine priorities for resolving them and to explore prospects for the future. The symposium was organized by the Committee on International Nutrition Programs (CINP) of the Food and Nutrition Board (FNB), which is an element of the National Research Council's Commission on Life Sciences. The committee, which hats existed since the i950s, has prepared assessments on many important tonics in inter , , _ national nutrition, including priorities and directions for programs, policy, and research. To permit a broad and interdisciplinary view of international nutrition issues, the participants were drawn from the fields of nutritional sciences, agri- cultural economics, and public health and included persons who are active in research or in agencies that have a role in international nutrition programs. Halfdan Mahler examined the relationship of nutrition programs to primary health care. John Galbraith discussed histori- cal processes in the economic development of the western nations and drew parallels to the agricultural economics of the developing nations. John Mellor analyzed food consumption and production trends in the developing nations. John Waterlow outlined priorities for the nutritional sciences over the next two decades and the potential for biological research to assist in alle- viating malnutrition. Lincoln Chen examined the role of international agencies in solving nutrition problems of developing countries. FNB is grateful to the committee for assembling such a distinguished roster of speakers and particularly to Abraham Horwitz, the symposium chairman and former chairman of CINP. The idea for the symposium was developed by Sol Chafkin and Jean-Pierre Habicht, both former members of CINP and FNB. --a ~ rip r-A X1

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X11 PREFACE The CINP and the FNB are grateful to Virginia Hight Laukaran, who prepared the proceedings for publication; to Sushma Palmer, Director of the FNB staff, and Linda Meyers, formerly of the FNB staff, who, assisted by Marianne La Veille, organized the sym.posium; and to Susan Barron, of the FNB staff, and Michelle Daniel, who were responsible for preparing the manuscript. The Food and Nutrition Board hopes that the presenta- tions and discussions that are recorded here will stimu- late the application of current knowledge and the growth of new methods to alleviate the food and nutrition problems that persist in many parts of the developing world. Kurt J. Isselbacher, Chairman Food and Nutrition Board