Poverty, Malnutrition, and Disease

The primary cause of low life expectancies in the less developed nations is pov- erty. In Chapter 3, we saw that wealthy Americans experience less illness and live longer than do poorer Americans. In the same way, wealthier nations have lower rates of illness and mortality than do poorer nations. The average life expectancy is 65 years in the least developed nations, 71 years in the less developed nations, and 79 years in the more developed nations—a 14-year difference all told.

In large part, poverty causes disease and death by causing chronic malnu- trition. Malnutrition causes disease and death by damaging the body’s immune system, leaving individuals more susceptible to all forms of illness and contributing to both infant and maternal mortality. In addition, malnutrition leads to numer- ous health problems, including brain damage caused by iodine deficiency, blind- ness caused by vitamin A deficiency, and mental retardation caused by anemia. For these reasons among others, malnutrition underlies many deaths in the least developed nations.

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The Roots of Chronic Malnutrition Given the link between malnutrition, illness, and death, investigating the roots of chronic malnutrition is clearly important. At first thought, we might easily assume that malnutrition in less developed nations that have not yet experienced the epidemiological transition results naturally from overpopulation combined with insufficient natural and technological resources. Yet on a global level, farmers now grow twice as much food as is needed to feed the world’s population. This bounty, however, may soon end because of population growth, changes in climate that will make it impossible to grow crops in many regions, the use of crops such as corn for fuel rather than for food, and the rise in meat eating in newly wealthy parts of Asia.

For now, however, malnutrition cannot be blamed on population density. The Netherlands, for example, is one of the most densely populated countries in the world, yet chronic malnutrition no longer occurs there. Similarly, malnutrition has largely disappeared from Costa Rica but remains com- mon in nearby Honduras, even though the latter has twice as much cropland per person.

If overpopulation, lack of food, population density, and lack of cropland don’t explain chronic malnutrition, what does? The answer lies in the social distribution of food and other resources: Malnutrition occurs most often in countries where resources are most inequitably distributed. In other words, malnutrition occurs not in countries where resources are scarce but in countries where a few people control many resources while many people have access to extremely few resources. Similarly, within each country, malnutrition occurs most often among those groups—typically females and the poor—with the least access to resources. In essence, then, malnutrition is a disease of powerlessness.

If powerlessness causes malnutrition, then eliminating power inequities should eliminate malnutrition. Evidence from China (officially known as the People’s Republic of China) and Costa Rica supports this thesis. In the past, both nations adopted socialistic strategies for redistributing resources somewhat more equitably. By giving farmland to formerly landless peasants, extending agricultural assistance to owners of small farms, working to raise the status of women, and so on, they made chronic malnutrition almost unknown within their borders. On the other hand, China has not proved immune to acute malnutrition caused by famines. According to Nobel Prize–winning economist Amartya Sen, famines occur only when (1) natural events reduce harvests and (2) nondemocratic governments (such as China’s) can ignore citizen’s basic needs because politicians know they can’t be voted out of office. “Contemporary Issues: Linking Sanitation and Malnutrition, further illustrates how power inequalities can continue to breed malnutrition, even when countries begin to develop and food becomes more widely available.

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