2020.05.01.2
Files > Volume 5 > Vol 5 No 1 2020
CARTA AL EDITOR / LETTER TO EDITOR
Anthropologists Respond to The Lancet EAT Commission
Authors: The Nutrire CoLab, listed in alphabetical order,
Diana Burnett; Megan A. Carney; Lauren Carruth; Sarah Chard; Maggie Dickinson; Alyshia Gálvez; Hanna Garth; Jessica Hardin; Adele Hite; Heather Howard; Lenore Manderson; Emily Mendenhall; Abril Saldaña-Tejeda; Dana Simmons; Natali Valdez; Emily Vasquez; Megan Warin; Emily Yates-Doerr
Available from: http://dx.doi.org/10.21931/RB/2020.05.01.2
The Lancet Commissions are widely known as aspirational pieces, providing the mechanisms for consortia and networks of researchers to organize, collate, interrogate and publish around a range of subjects. Although the Commissions are predominantly led by biomedical scientists and cognate public health professionals, many address social science questions and involve social science expertise. Medical anthropologist David Napier was lead author of the Lancet Commission on Culture and Health (2014), for example, and all commissions on global health (https://www.thelancet.com/global-health/commissions) address questions of social structure, everyday life, the social determinants of health, and global inequalities.
Founded in Stockholm in 2013 (and funded by the Stordalen Foundation, Stockholm Resilience Center and the Wellcome Trust), the EAT Foundation published Food in the Anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems in January 2019. Led by Walter Willett (Professor of Epidemiology and Nutrition at Harvard Chan School of Public Health) and co-authored by 36 scientists from 16 countries around the world, the Commission aimed to use scientific targets to address how to feed the world within environmental limits. Concerned about the critical role of the food system in climate change, deforestation, biodiversity loss, water consumption and poor health, the Commission combined medical and environmental science knowledge to deliver a unified framework to quantify a sustainable food system for the future.
The final report brings to its readers -- public health professionals, policymakers across sectors, academics, journalists, the public -- a refreshing conversation about how to improve the health of populations and the sustainability of the planet.1 The authors propose multiple strategies to improve people’s health through transformed global food systems. These strategies include defining a “healthy reference diet” for all populations to follow, re-orientating agricultural priorities away from producing high quantities of monocultural agriculture, applying a coordinated global food governance system, and halving food loss and waste.
Yet, the narrow way in which the EAT-Lancet Commission describes strategies to tackle broken food systems and poor population health requires revision. For instance, the Commission frames premature death as primarily a consequence of individual dietary and lifestyle choices, repeating the term “healthy diets” nearly 100 times. Interventions aimed at changing individuals’ behaviors, and so addressing such choices, fail to address the more fundamental challenges of structural inequalities. The Commission promotes the language of sustainability, but the repeated and dominant focus on “healthy diets” as a means to achieve this “frame[s] health as an issue of personal responsibility and deflects societal responsibility for restructuring economic, political and food systems.”2 Moreover, the Commission overlooks the socio-cultural practices of the people who will be eating these healthy diets, and the complexities of nourishment that are at the heart of kinship, social life, and caregiving. We encourage those who read the Commission’s report to consider individual and structural factors in conversation, and so to focus on what it means to nourish populations.
By prioritizing and promoting “healthy diets” over other ways of nourishing, the Commission defines the problem as one of individual behavior and education rather than inequality within food systems and across societies. This is a critical misstep which, if enacted, would exacerbate the very problems the strategies seek to address.3–6 For example, since the beginning of Spanish colonization in Mexico, European foods were presented as morally and nutritionally superior to traditional foods. European foods became crucial to the colonial enterprise, continuously disrupting Indigenous and traditional foodways. These histories, which play a central role in the now far-reaching spread of chronic disease,7,8 demonstrate how ineffective and potentially harmful diet-focused interventions can be.2,4 In arguing for the urgency of a “universal, healthy reference diet” (447), the Commission may repeat this pattern under the guise of environmental sustainability.
Nutrient supplementation, as suggested by the Commission, represents another commonly misplaced intervention. Public health nutrition fortification campaigns have not effectively reduced global rates of stunting, and randomized trials of nutrient supplements consistently demonstrate that supplemental feeding alone will not make people taller and healthier.9 Nutrition research increasingly points to recurrent infectious diseases, which are shaped in large part by infrastructures that include water systems and universal health coverage, as a key determinant of severe and acute malnutrition.8
Diseases associated with malnutrition and obesity often reflect intergenerational histories of poverty and dispossession and resulting stress and trauma.8,10 Focusing on what foods and how many calories people consume erases environmental and economic exposures that shape diets and health across the life course.8 This focus also assumes that different kinds of foods, including fresh foods, are readily available and affordable. This is not always the case. Further, access to fresh foods is but one piece of a larger problem.8,10–12
Shifting attention and the language of policy responses from “healthy diets” to nourishment, which stems from the Latin word nutrire -- to feed and to cherish -- encompasses both food and care. Nourishment better captures ways to think empirically about how food environments are shaped, constrained, and confined. It draws attention to cultural factors and how these vary in different local contexts.5 Concern for nourishment also insists upon holding corporations that shape the global food system accountable by addressing the political and economic foundations of food environments.2,5,12,10
Ultimately individuals have little control over why they eat what they do.6,13 The concept of nourishment directs public attention towards sustainability in food, soil, air, water, bodies, and communities. This approach is in direct opposition to consumption-oriented economic development. This shift deprioritizes interventions and innovations that target individual behavioral change, instead pushing to change governmental and corporate policy to ensure people have the support and resources they need to nourish their loved ones.
Shifting attention and the language of policy responses from “healthy diets” to nourishment, which stems from the Latin word nutrire -- to feed and to cherish -- encompasses both food and care. (Photo by Gastón Saldaña)
REFERENCES
1. Willett W, Rockström J, Loken B, et al. Food in the Anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems. Lancet. 2019;393(10170):447-492. doi:10.1016/S0140-6736(18)31788-4
2. Gálvez A. Eating NAFTA: Trade, Food Policies, and the Destruction of Mexico. Berkeley: University of California Press; 2018.
3. Carruth L, Mendenhall E. “Wasting away”: Diabetes, food insecurity, and medical insecurity in the Somali Region of Ethiopia. Soc Sci Med. 2019;228(March):155-163. doi:10.1016/j.socscimed.2019.03.026
4. Howard HA. Canadian Residential Schools and Urban Indigenous Knowledge Production about Diabetes. Med Anthropol Cross Cult Stud Heal Illn. 2014;33(6):529-545.
5. Yates-Doerr E. The Weight of Obesity: Hunger and Global Health in Postwar Guatemala. Berkeley: University of California Press; 2015.
6. Dickinson M. Feeding the Crisis: Care and Abandonment in America’s Food Safety Net. Berkeley: University of California Press; 2019.
7. Saldaña-Tejeda A. “Why should I not take an apple or a fruit if I wash their underwear?” Food, Social Classification and Paid Domestic Work in Mexico. J Intercult Stud. 2012;33(2):121-137.
8. Valdez N. Redistribution of Reproductive Responsibility: On the Epigenetics of “Environment” in Prenatal Interventions. Med Anthropol Q. 2018;32(3):425-442.
9. Dewey K. Reducing stunting by improving maternal, infant and young child nutrition in regions such as South Asia: evidence, challenges and opportunities. Matern Child Nutr. 2016;12(Suppl Suppl 1):27-28.
10. Mendenhall E. Rethinking Diabetes: Entanglements of Trauma, Poverty, and HIV. Ithaca and London: Cornell University Press; 2019.
11. Warin M, Zivkovic T. Fatness, Obesity and Disadvantage in the Australian Suburbs: Unpalatable Politics. New York: Palgrave; 2019.
12. Carney M. The Unending Hunger: Tracing Women and Food Insecurity Across Borders. Berkeley: University of California Press; 2015.
13.. Hardin J. Faith and the Pursuit of Health: Cardiometabolic disorders in Samoa. New Brunswick: Rutgers University Press, 2019.
Autores: The Nutrire CoLab, en orden alfabetico,
Dr. Diana Burnett
School of Arts and Sciences, University of Pennsylvania
Email: [email protected]
Assistant Professor Megan A. Carney
School of Anthropology, University of Arizona
Email: [email protected]
Assistant Professor Lauren Carruth
School of International Service, American University, Washington, DC.
Email: [email protected]
Associate Professor Sarah Chard
Sociology, Anthropology, and Health Administration and Policy
University of Maryland Baltimore County
Email: [email protected]
Assistant Professor Maggie Dickinson
Stella and Charles Guttman Community College
City University of New York
Email: [email protected]
Professor Alyshia Gálvez
Professor of Food Studies and Anthropology
The New School, New York.
Email: [email protected]
Dr. Hanna Garth
Anthropology, University of San Diego
Email: [email protected]
Assistant Professor Jessica Hardin
Rochester Institute of Technology, New York
Email: [email protected]
Dr. Adele Hite
Communication, Rhetoric, and Digital Media
North Carolina State University
Email: [email protected]
Associate Professor Heather Howard
Department of Anthropology, Michigan State University
Email: [email protected]
Lenore Manderson AM, PhD FASSA FWAAS MASSAf
ORCID: 0000-0002-7883-1790
Distinguished Professor of Public Health and Medical Anthropology
School of Public Health, Faculty of Health Sciences
University of the Witwatersrand, Johannesburg, South Africa and
Honorary Professor, Institute at Brown for Environment and Society, Brown University, USA
Adjunct Professor, School of Social Sciences, Monash University, Australia
Associate Professor Emily Mendenhall
Edmund A Walsh School of Foreign Service
Georgetown University
Email: [email protected]
Dr. Abril Saldaña-Tejeda (Corresponding author)University of Guanajuato, Mexico
Email: [email protected]
Associate Professor Dana Simmons
Department of History, University of California
Email: [email protected]
Assistant Professor Natali Valdez
Women's and Gender Studies Department
Wellesley College, MA
Email: [email protected]
Dr Emily Vasquez
Department of Sociology, Columbia University in the City of New York
Email: [email protected]
Professor Megan Warin
School of Social Sciences, University of Adelaide
Email: [email protected]
Assistant Professor Emily Yates-Doerr
Faculty of Social and Behavioural Sciences, University of Amsterdam
College of Liberal Arts, Anthropology, Oregon State University
Email: [email protected]
CARTA AL EDITOR / LETTER TO EDITOR
Antropólogas Responden a la Comisión Lancet EAT
Autores: The Nutrire CoLab, en orden alfabetico,
Diana Burnett; Megan A. Carney; Lauren Carruth; Sarah Chard; Maggie Dickinson; Alyshia Gálvez; Hanna Garth; Jessica Hardin; Adele Hite; Heather Howard; Lenore Manderson; Emily Mendenhall; Abril Saldaña-Tejeda; Dana Simmons; Natali Valdez; Emily Vasquez; Megan Warin; Emily Yates-Doerr
disponible en: http://dx.doi.org/10.21931/RB/2020.05.01.2
Las Comisiones Lancet son ampliamente conocidas como piezas aspiracionales, proporcionando los mecanismos para que los consorcios y redes de investigadores organicen, cotejen, interroguen y publiquen en torno a una serie de temas. Aunque las Comisiones están dirigidas predominantemente por científicos biomédicos y profesionales afines de la salud pública, muchos abordan cuestiones de ciencias sociales e implican experiencia en las mismas. El antropólogo médico David Napier fue autor principal de la Comisión Lancet sobre Cultura y Salud (2014), por ejemplo, y todas las comisiones sobre salud global (https://www.thelancet.com/global-health/commissions) abordan cuestiones de estructura social, vida cotidiana, determinantes sociales de la salud y desigualdades globales.
Fundada en Estocolmo en 2013 (y financiada por la Fundación Stordalen, el Centro de Resiliencia de Estocolmo y el Wellcome Trust), la Fundación EAT publicó Food in the Annthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems en enero de 2019. Dirigida por Walter Willett (Profesor de Epidemiología y Nutrición en la Escuela de Salud Pública Harvard Chan) y en coautoría con 36 científicos de 16 países de todo el mundo, la Comisión pretendía utilizar objetivos científicos para abordar la forma de cómo alimentar el mundo dentro de los límites ambientales. La Comisión, preocupada por el papel clave del sistema alimentario en el cambio climático, la deforestación, la pérdida de biodiversidad, el consumo de agua y la mala salud, combinó los conocimientos sobre ciencias médicas y ambientales para ofrecer un marco unificado para cuantificar un sistema alimentario sostenible para el futuro.
El informe final trae a sus lectores -- profesionales de la salud pública, responsables políticos de todos los sectores, académicos, periodistas, público en general- una conversación refrescante sobre cómo mejorar la salud de las poblaciones y la sostenibilidad del planeta. 1 Los autores proponen múltiples estrategias para mejorar la salud de las personas a través de sistemas alimentarios globales transformados. Estas estrategias incluyen la definición de una "dieta de referencia saludable" para todas las poblaciones a seguir, la reorientación de las prioridades agrícolas lejos de la producción de grandes cantidades de agricultura monocultural, la aplicación de un sistema coordinado de gobernanza alimentaria mundial y reduciendo a la mitad la pérdida y el desperdicio de alimentos.
Sin embargo, la forma estrecha en que la Comisión EAT-Lancet describe las estrategias para abordar los sistemas alimentarios rotos y la mala salud de la población requiere una revisión. Por ejemplo, la Comisión enmarca la muerte prematura como principalmente una consecuencia de las opciones dietéticas y de estilo de vida individuales, repitiendo el término "dietas saludables" casi 100 veces. Las intervenciones dirigidas a cambiar el comportamiento de las personas, y así abordar esas decisiones, no abordan los desafíos más fundamentales de las desigualdades estructurales. La Comisión promueve el lenguaje de la sostenibilidad, pero el enfoque repetido y dominante en las" dietas saludables" como medio para lograr esta "estructura de la salud como una cuestión de responsabilidad personal y desviarla responsabilidad social de reestructurar los sistemas económicos, políticos y alimentarios". 2 Por otra parte, la Comisión pasa por alto las prácticas socioculturales de las personas que van a comer estas dietas saludables, y las complejidades de la alimentación que están en el corazón del parentesco, la vida social y el cuidado. Animamos a quienes lean el informe de la Comisión a que consideren los factores individuales y estructurales en la conversación, y así a que se centren en lo que significa nutrir a las poblaciones.
Al priorizar y promover las "dietas saludables" sobre otras formas de nutrir, la Comisión define el problema como uno de comportamiento y educación individuales en lugar de desigualdad en los sistemas alimentarios y en todas las sociedades. Se trata de un paso en falso crítico que, de ser promulgado, exacerbaría los mismos problemas que las estrategias tratan de abordar. 3–6 Por ejemplo, desde el inicio de la colonización española en México, los alimentos europeos se presentaron como moral y nutricionalmente superiores a los alimentos tradicionales. Los alimentos europeos se convirtieron en cruciales para la empresa colonial, interrumpiendo continuamente los alimentos indígenas y tradicionales. Estas historias, que desempeñan un papel central en la dispersión de enfermedades crónicas que ahora se extiende de gran alcance,7,8 demuestran lo ineficaces y potencialmente dañinas que pueden ser las intervenciones centradas en la dieta. 2,4 Al abogar por la urgencia de una "dieta de referencia universal y saludable" (447), la Comisión puede repetir este patrón bajo el pretexto de la sostenibilidad medioambiental.
La suplementación con nutrientes, como sugiere la Comisión, representa otra intervención comúnmente malentendida. Las campañas de fortificación nutricional de salud pública no han reducido efectivamente las tasas mundiales de retraso en el crecimiento, y los ensayos aleatorios de suplementos de nutrientes demuestran consistentemente que la alimentación suplementaria por sí sola no hará que las personas sean más altas y saludables. 9 La investigación nutricional apunta cada vez más a las enfermedades infecciosas recurrentes, que se configuran en gran parte por infraestructuras que incluyen los sistemas hídricos y la cobertura sanitaria universal, como un determinante clave de la desnutrición grave y aguda. 8
Las enfermedades asociadas con la desnutrición y la obesidad a menudo reflejan historias intergeneracionales de pobreza y despojo y el estrés y el trauma resultantes.8,10 Centrarse en qué alimentos y cuántas calorías consumen las personas elimina las exposiciones ambientales y económicas que dan forma a las dietas y la salud a lo largo de toda la vida. 8 Este enfoque también supone que los diferentes tipos de alimentos, incluidos los alimentos frescos, son fácilmente disponibles y asequibles. Este no siempre es el caso. Además, el acceso a alimentos frescos no es más que una parte de un problema mayor. 8,10–12
El cambio de la atención y el lenguaje de las respuestas políticas de las "dietas saludables" al alimento, que proviene de la palabra latina nutrire -- para alimentar y apreciar- abarca tanto la alimentación como el cuidado. La nutrición captura mejor las formas de pensar empíricamente sobre cómo se moldean, limitan y confinan los ambientes alimentarios. Llama la atención sobre los factores culturales y cómo varían en diferentes contextos locales. 5 La preocupación por el alimento también insiste en hacer que las corporaciones que dan forma al sistema alimentario mundial den cuentas al abordar los fundamentos políticos y económicos de los entornos alimentarios. 2,5,12,10
En última instancia, las personas tienen poco control sobre por qué comen lo que hacen. 6,13 El concepto de alimento dirige la atención del público hacia la sostenibilidad en los alimentos, el suelo, el aire, el agua, los cuerpos y las comunidades. Este enfoque se opone directamente al desarrollo económico orientado al consumo. Este cambio desprioriza las intervenciones e innovaciones que apuntan al cambio de comportamiento individual, en lugar de presionar para cambiar la política gubernamental y corporativa para asegurar que las personas tengan el apoyo y los recursos que necesitan para nutrir a sus seres queridos.
El cambio de la atención y el lenguaje de las respuestas políticas de las "dietas saludables" al alimento, que proviene de la palabra latina nutrire -- para alimentar y apreciar- abarca tanto la alimentación como el cuidado. (foto por. Gastón Saldaña)
REFERENCIAS
1. Willett W, Rockström J, Loken B, et al. Food in the Anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems. Lancet. 2019;393(10170):447-492. doi:10.1016/S0140-6736(18)31788-4
2. Gálvez A. Eating NAFTA: Trade, Food Policies, and the Destruction of Mexico. Berkeley: University of California Press; 2018.
3. Carruth L, Mendenhall E. “Wasting away”: Diabetes, food insecurity, and medical insecurity in the Somali Region of Ethiopia. Soc Sci Med. 2019;228(March):155-163. doi:10.1016/j.socscimed.2019.03.026
4. Howard HA. Canadian Residential Schools and Urban Indigenous Knowledge Production about Diabetes. Med Anthropol Cross Cult Stud Heal Illn. 2014;33(6):529-545.
5. Yates-Doerr E. The Weight of Obesity: Hunger and Global Health in Postwar Guatemala. Berkeley: University of California Press; 2015.
6. Dickinson M. Feeding the Crisis: Care and Abandonment in America’s Food Safety Net. Berkeley: University of California Press; 2019.
7. Saldaña-Tejeda A. “Why should I not take an apple or a fruit if I wash their underwear?” Food, Social Classification and Paid Domestic Work in Mexico. J Intercult Stud. 2012;33(2):121-137.
8. Valdez N. Redistribution of Reproductive Responsibility: On the Epigenetics of “Environment” in Prenatal Interventions. Med Anthropol Q. 2018;32(3):425-442.
9. Dewey K. Reducing stunting by improving maternal, infant and young child nutrition in regions such as South Asia: evidence, challenges and opportunities. Matern Child Nutr. 2016;12(Suppl Suppl 1):27-28.
10. Mendenhall E. Rethinking Diabetes: Entanglements of Trauma, Poverty, and HIV. Ithaca and London: Cornell University Press; 2019.
11. Warin M, Zivkovic T. Fatness, Obesity and Disadvantage in the Australian Suburbs: Unpalatable Politics. New York: Palgrave; 2019.
12. Carney M. The Unending Hunger: Tracing Women and Food Insecurity Across Borders. Berkeley: University of California Press; 2015.
13.. Hardin J. Faith and the Pursuit of Health: Cardiometabolic disorders in Samoa. New Brunswick: Rutgers University Press, 2019.
Autores: The Nutrire CoLab, en orden alfabetico,
Dr. Diana Burnett
School of Arts and Sciences, University of Pennsylvania
Email: [email protected]
Assistant Professor Megan A. Carney
School of Anthropology, University of Arizona
Email: [email protected]
Assistant Professor Lauren Carruth
School of International Service, American University, Washington, DC.
Email: [email protected]
Associate Professor Sarah Chard
Sociology, Anthropology, and Health Administration and Policy
University of Maryland Baltimore County
Email: [email protected]
Assistant Professor Maggie Dickinson
Stella and Charles Guttman Community College
City University of New York
Email: [email protected]
Professor Alyshia Gálvez
Professor of Food Studies and Anthropology
The New School, New York.
Email: [email protected]
Dr. Hanna Garth
Anthropology, University of San Diego
Email: [email protected]
Assistant Professor Jessica Hardin
Rochester Institute of Technology, New York
Email: [email protected]
Dr. Adele Hite
Communication, Rhetoric, and Digital Media
North Carolina State University
Email: [email protected]
Associate Professor Heather Howard
Department of Anthropology, Michigan State University
Email: [email protected]
Lenore Manderson AM, PhD FASSA FWAAS MASSAf
ORCID: 0000-0002-7883-1790
Distinguished Professor of Public Health and Medical Anthropology
School of Public Health, Faculty of Health Sciences
University of the Witwatersrand, Johannesburg, South Africa and
Honorary Professor, Institute at Brown for Environment and Society, Brown University, USA
Adjunct Professor, School of Social Sciences, Monash University, Australia
Associate Professor Emily Mendenhall
Edmund A Walsh School of Foreign Service
Georgetown University
Email: [email protected]
Dr. Abril Saldaña-Tejeda (Corresponding author)University of Guanajuato, Mexico
Email: [email protected]
Associate Professor Dana Simmons
Department of History, University of California
Email: [email protected]
Assistant Professor Natali Valdez
Women's and Gender Studies Department
Wellesley College, MA
Email: [email protected]
Dr Emily Vasquez
Department of Sociology, Columbia University in the City of New York
Email: [email protected]
Professor Megan Warin
School of Social Sciences, University of Adelaide
Email: [email protected]
Assistant Professor Emily Yates-Doerr
Faculty of Social and Behavioural Sciences, University of Amsterdam
College of Liberal Arts, Anthropology, Oregon State University
Email: [email protected]
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