Urban nutrition in the tropics: a call for increased attention to metropolitan population in the developing world

Noel W. Solomons
INCAP, Guatemala City, Guatemala

Rainer Gross
Federal University of Rio de Janeiro, Brazil

The origins of the priorities expressed in world-wide nutritional activities are diverse. In the area of nutritional investigation, they can be set by tradition, by the emergence of new and interesting technology, or by trends and fashions in biological concepts within the professional community. For programmes of public health (diagnostic screening and intervention) in nutrition, policy-priority decisions are based on perceived relevance, political expediency for the national government, the global strategies of international development agencies, or simply accumulated habit. It is our perception that nutritional activities have traditionally been invested, and continue to be invested, in rural problems and rural populations. It is our premise, based on the obvious demographic shifts and the realities of current population distribution in developing countries, that an imbalance in the focus of efforts and interests has developed. This is reflected in the persistence of an inordinate concentration on and concern with rural nutritional issues and the relative neglect of urban problems.

It is not necessary to document here the pattern of emphasis on rural nutrition in developing countries since the end of World War II and the founding of the United Nations. Nor is it our purpose to deny the importance of studying and reaching the agrarian peasant, pastoral nomad, or tribal groups who truly constitute the world's "poorest of the poor." Rather, we focus on some new facts that should be factored into the nutrition equation for developing countries. In 1950, 47 per cent of the developed and 83 per cent of the developing world's people lived in rural areas; at that time there were no cities anywhere with more than 10 million inhabitants, and the grand capitals of industrialized nations-Tokyo, London, New York, Paris -were the great metropolises of the day. By the year 2000, it is projected that more than half the world's population will be living in urban or pert-urban (metropolitan) areas. In Latin America at the turn of the millennium, 80 per cent of the population will be metropolitan. Today Mexico City and Sao Paulo are the giant cities, and by the year 2000 these and nine others-aft in the developing world-will have more than 20 million residents each.

Implicit in this demographic reality is the potential for problems of under-nutrition, over-nutrition, and nutrient imbalance. The leading edge of this phenomenon has already been documented in the context of the rapid change in food habits of Mexican children and adolescents migrating from rural pueblos to the Distrito Federal [1]. The contribution - of soft drinks and convenience (junk food) snacks to daily intake increased dramatically. A calorie-dense, micronutrient-poor diet was the immediate result.

Ironically, two computerized software packets recently prepared for nutritional survey work in developing countries classify the grades of under nutrition from anthropometric data but do not have a parallel capacity to classify obesity

The world-wide nutrition community is showing increasing interest in urban nutrition issues. For example, the Dutch Foundation for the Advancement of the Knowledge of the Nutrition of Mother and Child in Developing Countries announced as the theme for its grant-in-aid programme for 1986-1987 "Nutrition of preschool children (O to 3 years) in urban communities." The Food and Agriculture Organization of the United Nations has established a programme concerned with the food supply to large cities, the first project of which was established in Sao Paulo, Brazil, in 1985. A recent book [2] cites 115 publications over the past two decades-review articles and original investigations-related to urban malnutrition in developing countries. In August 1985 at the thirteenth International Congress on Nutrition, held in Brighton, England, a workshop on tropical urban nutrition received outstanding interest and participation. In October of the same year, the first seminar on research on urban nutrition in Brazil brought participants from Sao Paula, Brasilia, and Rio de Janeiro together in Rio to share experiences and plan future collaborations. Noteworthy was the positive attitude manifested by officials of the Brazilian government.

What is now needed is not an abandoning of attention to rural malnutrition but a changing balance to reflect the growing relative importance of urban nutrition in the tropics.

The need to enlarge the circle of concerned nutritionists from both the developed and the developing world has motivated these comments. Input from the disciplines of both experimental and applied nutrition will determine the movement toward greater recognition of and attention to the nutrition of metropolitan populations in developing nations.

The biases against working in urban areas must be addressed. it is certainly not tenable to argue that the issue of urban nutrition lacks relevance. Fear of hostility and aggression from city slum dwellers and frustration with the demographic instability of the populations studied must be confronted and examined. The inclination of many nutritionists to be preoccupied with the most economically disadvantaged and under-fed populations in developing countries should be moderated: as urbanization generates a middle class, diet-related aspects of their life-style deserve attention. Nutritionists must also concern themselves with the ways of cities and urban populations: collaboration with professionals traditionally concerned with cities, sociologists and urban planners, should be sought. National and international meetings on nutrition and health should include issues of urban nutrition in colloquia, seminars, and other forums.

Finally, support must be sought and provided for research on public-health interventions and scientific research in urban areas of developing countries. The 115 citations found by Schurch and Favre 12] represent an average of slightly fewer than six publications per year over two decades. This production needs to be increased dramatically during the next five to ten years.

REFERENCES

1. M.T. Cerqueira, "Effects of Urbanization and Acculturation on Food Habits: Studies in Mexico," in P.L. White and N. Selvey, eds., Malnutrition: Determinants and Consequences (Alan R. Liss, New York, 1984).

2. B. Schürch and A.-M. Favre, Urbanization and Nutrition in the Cord World (Nestle Foundation for the Study of Problems of Nutrition in the World, Lausanne, Switzerland, 1985.