Diet, Nutrition and Chronic Diseases: An International Perspective

The agricultural revolution of the 16th and 17th centuries in Europe followed by the industrial revolution produced radical changes, racial changes in food cultivation, distribution and availability. Recent technological advances in food processing and increases in per capita income, especially in industrialized nations, have led to profound changes in dietary preferences. One notable change since the early part of this century is the dramatic and rapid increase in consumption of fats and refined sugars - the "affluent" diet - coupled with a substantial drop in complex carbohydrate intake. The improved food supply and food security practically eliminated starvation, guarded against micronutrient deficiencies, and led to improved nutritional status and increase life expectancy. The longer term adverse health effects of the high-fat "affluent" diet, however, have become apparent in the last few decades through the emergence in industrialized countries of chronic diseases such as coronary heart disease, carovascular disease, various cancers, obesity, and non-insulin-dependent diabetes mellitus.

Fortunately, widescale scientific consensus that dietary factors can precipitate chronic diseases and recognition that modest changes in lifestyle and diet can achieve a substantial reduction in disease risk have prompted public health action in most industrialized nations.

The last two decades - possibly as a result of such action have witnessed a major reduction in cardiovascular disease mortality in the United States, Australia, and much of Western Europe. In contrast, the emerging democracies of Central and Eastern Europe, where the "affluent" diet is presently in full vogue, continue to exhibit record increases in mortality from cardiovascular-and other diet-and lifestyle-related diseases. Similar adverse trends are also emerging in developing nations - that are gradually adopting the "affluent," western, diet.

What can be done to halt or reverse these trends? The Central and Eastern European region and the developing nations of Asia, Latin America, and Africa now face the challenge of implementing public health policies that, on the one hand, guarantee adequate nutrition for the undernourished, and on the other, protect the population from the scourge of diet-related chronic diseases.

Dr. Sushma Palmer, Director, Central European Center for Health and Environment. Presented at the Third International Conference on Health and Environment; Global Partners for Global Solutions.

MINDFUL OF THE COMMONS IN THE DEVELOPMENT OF MARKET ECONOMIES

In the democratization throughout the former USSR and East Europe, there are many critical themes now under discussion such as market economies, privatization, welfare system, and Western aid. As an anthropologist, I want to point out that there is another issue that commands special attention in that usually zigzag developing processes - the Commons.

"The Commons" is a concept coined and popularized by G. Hardin, an ecologist. Its essence consists in those resources that are needed but could not be provided individually, such as those communal, natural, and environmental resources (i.e., fisheries, forests, irrigation systems, grazing lands, wildlife, highways, oil pools, etc.). The thesis of "The Tragedy of the Commons" reveals the prevalent deteriorating situations in many parts of the world, and denotes dynamic complex human relationships associated with the sharing and management of those resources. Like many other countries, East Europe and the former USSR also faced those problems in the past, and are encountering, perhaps, more difficulties and worsening situations in their respective societal developments toward democracies and market economies, especially in light of the current ongoing transition period.

But human society can no longer afford the costs of the destruction and disaster resulted from the neglect of mismanagement of those limited resources. Scientists and practitioners have been seeking a variety of solutions to the problems with the Commons, which include private enclosure, communal collaboration, and public regulation. However, each of the proposals has its utilities and limitations in different circumstances. For example, privatization can promote formation and growth of market economies, but also can create such troublesome issues as those of "land ownership" in East Europe; some form of public regulation from time to time leads to the multiplex social problems, while certain others are sometimes crucial in managing some specific types of the resources. The Western countries in their modernization processes have gained the valuable experiences and lessons from which the other countries can learn so as to avoid or at least minimize the high prices paid in the courses.

In my opinion, the definition of "Western aid" has to be expanded in this very sense, and must be given new dimensions. The aid and assistance should be provided to both short-term relief undertakings and long-term conservation projects. The concrete advice and useful information regarding the issues need to be offered in order to protect "common goods" and "public interests" and reinforce "environmental consciousness" in these countries. Moreover, it is practically important to identify and foster the indigenous ways of sharing and administering of common property resources embedded in the cultures. As the anthropologists demonstrate, there are various creative, vital forms of the management at the grassroots levels, which are qualitatively different from those derived from the totalitarian regimes or dogmatic ideologies.

Although there exist lots of transition troubles in the former UUSSR and East Europe, the issue of the Commons has to be dealt with in an attentive way, before it is too late.

Honggang Yang

The Carter Center of Emory University

SOURCE: The American Lung Association