editorial
Donald
planning
day dreams
S. McLaren,
M.D.,
Ph.D.
“It must be possible for an empirical scientific be refuted by experience.” Karl
R. Popper,
“The
Logic
of Scientific
system
to
Discovery.”
For nutrition, more than for most other areas contributing to human health and well being, application has tended to lag far behind advances in knowledge. Disorders related to either deficiency or excess of nutrient intake are inextricably bound up in the whole bundle of the way of life. Problems of food supply with all their complexities are clearly related to, but should not be confused with, those of malnutrition (1). The current tendency to talk of Food and Nutrition problems in a single breath may on the surface appear to imply an integration of approach. In practice, it more often leads to the ignoring of deep-seated differences in responsibilities and interests of the areas of agriculture and health. These conificts are acted out at national level in the respective governmental departments, but in the United Nations System the dilemma is compounded where, in addition to FAO and WHO, the strong interests of UNICEF and more recently those of the World Bank bring further confusion. At this level a difficult situation has undoubtedly been made worse by the low standing Nutrition has in the academic world and the consequent poverty of expertise available to these agencies. They can claim no credit for the initiation of the Green Revolution and their strong backing of such inappropriate measures as the ill-fated protein-rich food mixtures (2) and mishandling of applied nutrition programs have brought only discredit. In these patently discouraging circumstances it is perhaps understandable that, in The American
at the United
1
Journal
of clinical
Nutrition
31: AUGUST1978,
the heady atmosphere preceding the World Food Conference in 1974, the technical agencies concerned should decide to abandon their previous practice of dealing piecemeal with pressing problems at their Ninth Joint Expert Committee on Nutrition and adopt as their topic “Food and Nutrition Strategies in National Development” (3). The report of this meeting has been widely circulated and concerning as it does primarily the developing countries will have considerable influence there. It has nevertheless, as far as I am aware, hitherto at’racted no detailed criticism in academic circles. I have commented previously on some of the inadequacies of United Nations technical reports in general (4). The latest meeting of this particular series appears to me to have the additional defect of creating a potentially dangerous departure from prior practice. Previous Expert Committees have addressed themselves to technical aspects of nutritional problems, most particularly those affecting developing countries. The Eighth Report, for example, dealt with Protein-Calorie Malnutrition and Food Fortification. Those participating had had many years of practical experience in the topics discussed and had contributed considerably to the extensive literature cited. There remain many technical nutrition problems for expert committees to discuss and report on with profit. To have chosen the present subject is to pander to the obsessive concern with policy making and planning evident in nutrition as in other circles in recent years. The point has been made 1 From the Department of Physiology, School, Edinburgh, Scotland.
pp.
1295-1299.
Printed
in U.S.A.
The
Medical
1295
Downloaded from https://academic.oup.com/ajcn/article-abstract/31/8/1295/4655821 by California Digital Library user on 01 January 2019
Nutrition Nations
1296
MCLAREN
The writing is very uneven, giving the impression that various sections were written by different specialists. The report lacks coherence; ideas are not propounded, developed sequentially, and synthesized, and the reader is soon lost in a verbal morass. Outright repetition has often resulted, in one instance even on the same page (p. 12). A useful section on “the evaluation and surveillance of nutrition programs” is isolated from the main text and appears as an annex where it is divested of relevance. Many complex and sometimes controversial issues are glossed over by bald statements, with the practical implications ignored. Here are a few examples: How can “key indicators” for “at risk” groups be “food supply, demand and prices” (p. 7)? The causes of the recent food crisis (p. 8) are grossly oversimplified and a reference to the Green Revolution involving multinational corporations and “aid” receives no analysis. What does “500 million people are underfed” (p. 8) mean? What is the evidence for “deterioration of nutritional status in many countries” (p. 9)? How is “the present and projected magnitude of the problem” (p. 9) to be measured? Protein-calorie malnutrition is recognized on p. 9 as being the most widespread and important childhood nutritional problem in all developing countries but analysis of the reasons for this is avoided. On page 10 and subsequently the reasons for such clearly fundamental factors as “inadequate diets”, “displacement from the land” and “socio-economic inequalities” are not discussed. Many of the proposals made by the committee are totally unrealistic. By this I mean that they are merely enunciated without any consideration being given as to how they might be implemented, of whether the necessary methodology exists and of the limitations imposed by practical realities. For example, on pp. 16 and 51 “a ranking order for alternative contributions to social welfare”, is proposed and cost-benefit analysis is stated to be essential. Have these ever been done? And with what results? Again, if there is “no substitute for strategies and measures which increase the real incomes of the poor” and “the most essential need is to increase the opportunities for productive employment” (p. 23) it sounds like mere wishful thinking to go
Downloaded from https://academic.oup.com/ajcn/article-abstract/31/8/1295/4655821 by California Digital Library user on 01 January 2019
more strongly; “In our day the mania for planned, controlled, contrived, subsidised experiment which, like war, appeals to the masses because of its exorbitant cost and its unanimous call for many democratic hands, is a syndrome of man unhinged in more ways than one” (5). The Report is only 64 pages long but as it makes very turgid reading, and I have yet to find a colleague who has read it through, I had better outline its contents. The meeting was asked to review the scope and objectives of a national food and nutrition policy, to provide practical guidelines particularly for developing countries and to identify areas of training and research. Past approaches are referred to in less than three pages and dismissed out of hand, without any attempt at critical analysis, as being “piecemeal” (p. 10). A new approach is called for that consists of the integration of food and nutrition planning into national development programs. The strategy for this is stated to consist of three elements: 1) most fundamental, a strategy for rural development to foster productivity and improve the pattern of income distribution; 2) improve the quality of diet available to all income groups, and 3) a complex of measures that have a more direct impact on nutritional status and health of vulnerable groups. Pages 22 to 40, under the heading “An approach to food and nutrition planning”, deal successively with economic, agricultural, food policy, dietary and health aspects, and the complementary of these ‘lements of a strategy. Apart from a fmal list of research and training needs, the rest of the report describes the planning process and its implementation. The small literature cited emanates, with two exceptions, from United Nations or United Nations-related meetings, and none of the references is an experimental study. The report is devoid of hard data and contains not a single case study to back up the approach the committee recommends. The single reference (p. 21) to a project that reputedly had “no useful impact” is unreferenced. An “argument from silence” suggests that none of the “experts” has actually experienced from start to finish the planning process upon which they herein advise others. Why were the achievements in China ignored?
NUTRITION
PLANNING
“
THE
UN
1297
The report rightly refers to certain factors that are not generally appreciated. These indude the recognition “that growth measured simply in terms of increase in per capita GNP has frequently been accompanied by the aggravation of poverty and malnutrition” (pp. 14-16), “that the technologies that are borrowed will be poorly adapted to the needs of a developing country” (p. 26), and the interesting admission that “the undue emphasis on protein and the so-called ‘protein gap’ led to undesirable approaches in national and international efforts in the field of food and nutrition” (p. 33). However, throughout the report, there is evidenced a disturbing unwillingness of the committee to grapple with the true causes of world hunger and malnutrition. Nearly a quarter of a century spent in Asia, Africa, and the Middle East working on nutritional problems has given me quite a different understanding of the nature of the forces at work. These are described much better than I could hope to in several recent books, notably two written by young journalists, with profuse references and containing a wealth of detailed information from around the world to back up their arguments (9, 10). They provide, to my mind, overwhelming evidence on the harmful effects that the activities of multinational agribusiness corporations, the major governments, multilateral development organizations, and third world governments and elites are having on the poor, not only in developing countries but throughout the free world. Further, what Gunar Myrdal has to say in his chapter on “The soft state” regarding exploitation, vested interests, and corruption should make clear just how superficial the report’s analysis of the problem is (11). The report, ignoring these realities, abounds in such platitudes as “Agricultural progress implies changes in the behavior of millions of individual farmers” (p. 29); existing programs, such as roads, land, registration, irrigation, or ranching schemes “will need to be appraised. They may themselves be sufficient, or they may warrant expansion, redesign, or curtailment” (p. 44); “full integration of nutrition with other basic health, agricultural and educational programs” (p. 52); “knowledge about food and nutrition problems and possible solutions must reach
Downloaded from https://academic.oup.com/ajcn/article-abstract/31/8/1295/4655821 by California Digital Library user on 01 January 2019
on to say that “a new approach to the identification of development programs will produce measures to achieve these ends” (p. 23). How is a more gradual but widespread modernisation of the agricultural sector” (p. 28) to be brought about? Section 5.3 claims to outline a bureaucratic system that will ensure “that the planning process takes a realistic view of the nutritional problem, the factors governing its emergence, and the measures available for tackling it” and is accompanied by a complicated flow diagram that displays the organizational structure proposed. It is difficult to understand how this halcyon dream could have been accepted when the harsh reality is so very different, as we can learn from a book edited by one of the committee members (6). It is there acknowledged that there is “a tendency for all the professionals to be engaged on overall planning, while the ministries whose actions the plan is supposed to coordinate follow their own devices” (p. 136), that “where the procedures of annual budgeting are left largely undisturbed the ‘planning process’ tends to become an academic exercise” (p. 128) and that “Exasperated economists in planning ministries not infrequently view the situation as follows: their minister (the minister of planning) genuinely wants to do what is needed to ensure an improved rate of growth. But he is obliged by reason of the need to stay in power to compromise with all sorts of conificting political interests” (p. 109). A serious fault in the report is the introduction, without definition, of numerous psuedotechnical terms, some of which appear to have been coined by committee members, and which form an integral part of the treatment of the whole subject. They include “state of malnutrition” (pp. 7, 9), “requirements targets”, “low opportunity cost”, “poor problem perception”, “desired price levels” (all p. 11), “divisible innovations” (p. 28), “quantitative and qualitative studies” (p. 43), “need indicators” (p. 51), “integrated packages”, “hierarchy of deprivation”, and “taxonomy of deprivation” (all p. 58) and so it goes on. Term-coining and flow diagram drawing seem to have become a preoccupation of nutrition planners (7, 8), each doing his own thing with a dearth of critical interaction.
AT
1298
MCLAREN
organized structure, our ignorance is great and our irresolution greater. What Ziman (15) says of sociology applies equally to nutrition. Although it is “often genuinely scientific in spirit, the ‘methodological problem’ has not been surmounted, there is not yet a reliable procedure for building up interesting hypotheses that can be made sufficiently plausible to a sufficient number of other scholars by well devised observations, experiments or rational deductions.” Elsewhere (16) he illustrates this by observing that in a study of “scales or indices in sociological literature used to measure various phenomena, of 2080 different measures used only 589 were used more than once, and only 47 more than five times.” Popper points out that most social institutions have just grown, and depend largely upon the efforts of individuals. He states as one of the most crucial points in Spinoza’s political theory the impossibility of knowing and controlling what other people think. Spinoza described tyranny as the attempt to achieve the impossible and to exercise power where it cannot be exercised. But this is what holistic planners are trying to do, says Popper, when they say they are tackling the problem of transforming men. This Utopian engineering is impossible and leads to piecemeal improvization and to unplanned planning. The committee fell into just this error when it ultimately stated: “Malnutrition is unlikely to be eradicated by a single round of such measures, however, and priorities will need to be asserted which specify the ranking order of desirability of different increments of improvement” (pp. 50, 51). What alternative approach, then, lies open to us in the field of social action with our present rudimentary ability to understand and control the determinant factors in any situation? For Popper it is “piecemeal social engineering.” The word piecemeal often has a pejorative meaning and it is only so used in the FAO/WHO report where it is assumed that piecemeal measures in the past failed, if failed they did, because they were piecemeal and for no other reason. But the word should be used only in its strictest definition of “piece by piece”, “part at a time”. The piecemeal social engineer recognizing “that we cannot make heaven on earth but only improve matters a little, also realizes that we can only
Downloaded from https://academic.oup.com/ajcn/article-abstract/31/8/1295/4655821 by California Digital Library user on 01 January 2019
equally effectively top government decision makers and the needy population” (p. 55). There are three examples of what I would call “sins of commission” which I fmd inadmissable in an official document such as this. The first is the sanction given to the principle of “triage” on p. 35 by reference to “postponement of programs directed to those who are the most deprived”. It would surprise me if those responsible have not been rapped severely across the knuckles for letting through this statement that contravenes the United Nations’ Charter. Then there is the cynical remark on p.54 “The measures which will be most acceptable will be those which secure their benefits at the least possible cost to others-especially those with power.” The whole problem of having to deal with powerful and corrupt elites is thus brushed aside. Thirdly, I fmd objectionable the frequent advocacy by the committee of self perpetuation (especially p. 56). One is reminded of the criticism of the promoters of the “Great Society” programs in the United States that they denigrated their real achievements in order to justify more funding and public support (12). Having said all this there remains a further, and to my mind most serious, criticism of this report and of the present approach to nutrition planning in general. Here the initial fault lies with the agencies which sponsored the meeting. By relating the topic to national development an holistic approach was implicit. Some noted scientists were on the committe and their endorsement of this has harmed the cause of Nutrition. The crucial question is whether holism is appropriate in the present context. As I have pointed out elsewhere (13) Sir Karl Popper has explained (14) how the “whole” in holistic literature has two senses: 1) totality of all properties and relationships and 2) special properties which make something appear an organized structure and not a “mere heap”. This latter sense has been especially developed by the Gestalt school of psychology. He goes on to show how holists fail to recognize the difference, believing that they can tackle social problems in entirety (sense 1)) on the precedent of Gestalt psychology (which applies only to sense 2)). In the present context the holistic approach is perfectionist and inappropriate; there is no
NUTRITION
PLANNING
3. Joint
4.
5.
6. 7.
8. 9.
10.
...
References 1. MCLAREN. D. S. World hunger: tions. Lancet 2: 86, 1963. 2. MCLAREN. D. S. The great protein 93, 1974.
some fiasco.
misconcepLancet
2:
11.
THE
1299
UN
FAO/WHO
Expert
Committee
on
Nutrition.
Ninth Report, Nutrition Strategies in National Development. WHO Technical Report Series No. 584. Geneva: World Health Organization, 1976. MCLAREN. D. S. Expert committees. Nature 237: 119, 1972. TRUESDELL. C. Cited by Ziman, J. M. The Force of Knowledge: The Scientific Dimension of Society. Cambridge: Cambridge University Press, 1976, p. 240. SEARS, D., AND L. Joy. Development in a Divided World. Harmondsworth: Penguin, 1971. Joy. J. L., AND P. R. PAYNE. Nutrition and national development planning. Food Nutr. 1: 2, 1975. BEATON. G. H. Defming a food and nutrition policy. Food Nutr. 1: 8, 1975. GEORGE. S. How the Other Half Dies: the Real Reasons for World Hunger. Harmondsworth: Penguin, 1976. LAPPE. F. M., AND J. COLLINS. Food First: Beyond the Myth of Scarcity. Boston: Houghton Mifflin, 1977. MYRDAL. G. The Challenge of World Poverty: A World Anti-Poverty Program in Outline. New York:
Pantheon, 1970. 12. KAHN. H., AND B. BRUCE-BRIGGS. Things to Come. New York: Macmillan, 1972, p. 29. 13. MCLAREN. D. S. Nutrition planning: the poverty of holism. Nature 267: 742, 1977. 14. POPPER. K. R. The Poverty of Historicism, (2nd ed). London: Routledge and Kegan Paul, 1960. 15. ZIMAN. J. M. Public Knowledge: The Social Dimension of Science. Cambridge: Cambridge University Press, 1968, p. 26. 16. ZIMAN. J. M. The Force of Knowledge: The Scientific Dimension of Society. Cambridge: Cambridge
University
Press, 1976, p. 291.
Downloaded from https://academic.oup.com/ajcn/article-abstract/31/8/1295/4655821 by California Digital Library user on 01 January 2019
improve them little by little.” Popper’s criticism of holism, he says, does not exclude cooperation between various branches of a science in tackling a piecemeal problem. But this is very different from the plan to grasp concrete wholes by a method of systematic analysis. After this bad bout of day dreaming, let us see a return to the drawing board, not for more flow diagrams and verbal acrobatics, but for realistic piecemeal measures and sensible planning. I firmly agree with the view of Alan Berg, Senior Nutrition Advisor to the World Bank (personal communication): “Nutrition planning has become something of an industry, an end in itself, and is now about to drown of its own methodological complexities Is it not possible to have something between holism, at least as currently reflected in the everything-is-relatedto-everything-else school of nutrition planning and, on the other hand, the kind of straightforward single set solutions we were exposed to in the late 1960’s?”
AT
Donald
planning
day dreams
S. McLaren,
M.D.,
Ph.D.
“It must be possible for an empirical scientific be refuted by experience.” Karl
R. Popper,
“The
Logic
of Scientific
system
to
Discovery.”
For nutrition, more than for most other areas contributing to human health and well being, application has tended to lag far behind advances in knowledge. Disorders related to either deficiency or excess of nutrient intake are inextricably bound up in the whole bundle of the way of life. Problems of food supply with all their complexities are clearly related to, but should not be confused with, those of malnutrition (1). The current tendency to talk of Food and Nutrition problems in a single breath may on the surface appear to imply an integration of approach. In practice, it more often leads to the ignoring of deep-seated differences in responsibilities and interests of the areas of agriculture and health. These conificts are acted out at national level in the respective governmental departments, but in the United Nations System the dilemma is compounded where, in addition to FAO and WHO, the strong interests of UNICEF and more recently those of the World Bank bring further confusion. At this level a difficult situation has undoubtedly been made worse by the low standing Nutrition has in the academic world and the consequent poverty of expertise available to these agencies. They can claim no credit for the initiation of the Green Revolution and their strong backing of such inappropriate measures as the ill-fated protein-rich food mixtures (2) and mishandling of applied nutrition programs have brought only discredit. In these patently discouraging circumstances it is perhaps understandable that, in The American
at the United
1
Journal
of clinical
Nutrition
31: AUGUST1978,
the heady atmosphere preceding the World Food Conference in 1974, the technical agencies concerned should decide to abandon their previous practice of dealing piecemeal with pressing problems at their Ninth Joint Expert Committee on Nutrition and adopt as their topic “Food and Nutrition Strategies in National Development” (3). The report of this meeting has been widely circulated and concerning as it does primarily the developing countries will have considerable influence there. It has nevertheless, as far as I am aware, hitherto at’racted no detailed criticism in academic circles. I have commented previously on some of the inadequacies of United Nations technical reports in general (4). The latest meeting of this particular series appears to me to have the additional defect of creating a potentially dangerous departure from prior practice. Previous Expert Committees have addressed themselves to technical aspects of nutritional problems, most particularly those affecting developing countries. The Eighth Report, for example, dealt with Protein-Calorie Malnutrition and Food Fortification. Those participating had had many years of practical experience in the topics discussed and had contributed considerably to the extensive literature cited. There remain many technical nutrition problems for expert committees to discuss and report on with profit. To have chosen the present subject is to pander to the obsessive concern with policy making and planning evident in nutrition as in other circles in recent years. The point has been made 1 From the Department of Physiology, School, Edinburgh, Scotland.
pp.
1295-1299.
Printed
in U.S.A.
The
Medical
1295
Downloaded from https://academic.oup.com/ajcn/article-abstract/31/8/1295/4655821 by California Digital Library user on 01 January 2019
Nutrition Nations
1296
MCLAREN
The writing is very uneven, giving the impression that various sections were written by different specialists. The report lacks coherence; ideas are not propounded, developed sequentially, and synthesized, and the reader is soon lost in a verbal morass. Outright repetition has often resulted, in one instance even on the same page (p. 12). A useful section on “the evaluation and surveillance of nutrition programs” is isolated from the main text and appears as an annex where it is divested of relevance. Many complex and sometimes controversial issues are glossed over by bald statements, with the practical implications ignored. Here are a few examples: How can “key indicators” for “at risk” groups be “food supply, demand and prices” (p. 7)? The causes of the recent food crisis (p. 8) are grossly oversimplified and a reference to the Green Revolution involving multinational corporations and “aid” receives no analysis. What does “500 million people are underfed” (p. 8) mean? What is the evidence for “deterioration of nutritional status in many countries” (p. 9)? How is “the present and projected magnitude of the problem” (p. 9) to be measured? Protein-calorie malnutrition is recognized on p. 9 as being the most widespread and important childhood nutritional problem in all developing countries but analysis of the reasons for this is avoided. On page 10 and subsequently the reasons for such clearly fundamental factors as “inadequate diets”, “displacement from the land” and “socio-economic inequalities” are not discussed. Many of the proposals made by the committee are totally unrealistic. By this I mean that they are merely enunciated without any consideration being given as to how they might be implemented, of whether the necessary methodology exists and of the limitations imposed by practical realities. For example, on pp. 16 and 51 “a ranking order for alternative contributions to social welfare”, is proposed and cost-benefit analysis is stated to be essential. Have these ever been done? And with what results? Again, if there is “no substitute for strategies and measures which increase the real incomes of the poor” and “the most essential need is to increase the opportunities for productive employment” (p. 23) it sounds like mere wishful thinking to go
Downloaded from https://academic.oup.com/ajcn/article-abstract/31/8/1295/4655821 by California Digital Library user on 01 January 2019
more strongly; “In our day the mania for planned, controlled, contrived, subsidised experiment which, like war, appeals to the masses because of its exorbitant cost and its unanimous call for many democratic hands, is a syndrome of man unhinged in more ways than one” (5). The Report is only 64 pages long but as it makes very turgid reading, and I have yet to find a colleague who has read it through, I had better outline its contents. The meeting was asked to review the scope and objectives of a national food and nutrition policy, to provide practical guidelines particularly for developing countries and to identify areas of training and research. Past approaches are referred to in less than three pages and dismissed out of hand, without any attempt at critical analysis, as being “piecemeal” (p. 10). A new approach is called for that consists of the integration of food and nutrition planning into national development programs. The strategy for this is stated to consist of three elements: 1) most fundamental, a strategy for rural development to foster productivity and improve the pattern of income distribution; 2) improve the quality of diet available to all income groups, and 3) a complex of measures that have a more direct impact on nutritional status and health of vulnerable groups. Pages 22 to 40, under the heading “An approach to food and nutrition planning”, deal successively with economic, agricultural, food policy, dietary and health aspects, and the complementary of these ‘lements of a strategy. Apart from a fmal list of research and training needs, the rest of the report describes the planning process and its implementation. The small literature cited emanates, with two exceptions, from United Nations or United Nations-related meetings, and none of the references is an experimental study. The report is devoid of hard data and contains not a single case study to back up the approach the committee recommends. The single reference (p. 21) to a project that reputedly had “no useful impact” is unreferenced. An “argument from silence” suggests that none of the “experts” has actually experienced from start to finish the planning process upon which they herein advise others. Why were the achievements in China ignored?
NUTRITION
PLANNING
“
THE
UN
1297
The report rightly refers to certain factors that are not generally appreciated. These indude the recognition “that growth measured simply in terms of increase in per capita GNP has frequently been accompanied by the aggravation of poverty and malnutrition” (pp. 14-16), “that the technologies that are borrowed will be poorly adapted to the needs of a developing country” (p. 26), and the interesting admission that “the undue emphasis on protein and the so-called ‘protein gap’ led to undesirable approaches in national and international efforts in the field of food and nutrition” (p. 33). However, throughout the report, there is evidenced a disturbing unwillingness of the committee to grapple with the true causes of world hunger and malnutrition. Nearly a quarter of a century spent in Asia, Africa, and the Middle East working on nutritional problems has given me quite a different understanding of the nature of the forces at work. These are described much better than I could hope to in several recent books, notably two written by young journalists, with profuse references and containing a wealth of detailed information from around the world to back up their arguments (9, 10). They provide, to my mind, overwhelming evidence on the harmful effects that the activities of multinational agribusiness corporations, the major governments, multilateral development organizations, and third world governments and elites are having on the poor, not only in developing countries but throughout the free world. Further, what Gunar Myrdal has to say in his chapter on “The soft state” regarding exploitation, vested interests, and corruption should make clear just how superficial the report’s analysis of the problem is (11). The report, ignoring these realities, abounds in such platitudes as “Agricultural progress implies changes in the behavior of millions of individual farmers” (p. 29); existing programs, such as roads, land, registration, irrigation, or ranching schemes “will need to be appraised. They may themselves be sufficient, or they may warrant expansion, redesign, or curtailment” (p. 44); “full integration of nutrition with other basic health, agricultural and educational programs” (p. 52); “knowledge about food and nutrition problems and possible solutions must reach
Downloaded from https://academic.oup.com/ajcn/article-abstract/31/8/1295/4655821 by California Digital Library user on 01 January 2019
on to say that “a new approach to the identification of development programs will produce measures to achieve these ends” (p. 23). How is a more gradual but widespread modernisation of the agricultural sector” (p. 28) to be brought about? Section 5.3 claims to outline a bureaucratic system that will ensure “that the planning process takes a realistic view of the nutritional problem, the factors governing its emergence, and the measures available for tackling it” and is accompanied by a complicated flow diagram that displays the organizational structure proposed. It is difficult to understand how this halcyon dream could have been accepted when the harsh reality is so very different, as we can learn from a book edited by one of the committee members (6). It is there acknowledged that there is “a tendency for all the professionals to be engaged on overall planning, while the ministries whose actions the plan is supposed to coordinate follow their own devices” (p. 136), that “where the procedures of annual budgeting are left largely undisturbed the ‘planning process’ tends to become an academic exercise” (p. 128) and that “Exasperated economists in planning ministries not infrequently view the situation as follows: their minister (the minister of planning) genuinely wants to do what is needed to ensure an improved rate of growth. But he is obliged by reason of the need to stay in power to compromise with all sorts of conificting political interests” (p. 109). A serious fault in the report is the introduction, without definition, of numerous psuedotechnical terms, some of which appear to have been coined by committee members, and which form an integral part of the treatment of the whole subject. They include “state of malnutrition” (pp. 7, 9), “requirements targets”, “low opportunity cost”, “poor problem perception”, “desired price levels” (all p. 11), “divisible innovations” (p. 28), “quantitative and qualitative studies” (p. 43), “need indicators” (p. 51), “integrated packages”, “hierarchy of deprivation”, and “taxonomy of deprivation” (all p. 58) and so it goes on. Term-coining and flow diagram drawing seem to have become a preoccupation of nutrition planners (7, 8), each doing his own thing with a dearth of critical interaction.
AT
1298
MCLAREN
organized structure, our ignorance is great and our irresolution greater. What Ziman (15) says of sociology applies equally to nutrition. Although it is “often genuinely scientific in spirit, the ‘methodological problem’ has not been surmounted, there is not yet a reliable procedure for building up interesting hypotheses that can be made sufficiently plausible to a sufficient number of other scholars by well devised observations, experiments or rational deductions.” Elsewhere (16) he illustrates this by observing that in a study of “scales or indices in sociological literature used to measure various phenomena, of 2080 different measures used only 589 were used more than once, and only 47 more than five times.” Popper points out that most social institutions have just grown, and depend largely upon the efforts of individuals. He states as one of the most crucial points in Spinoza’s political theory the impossibility of knowing and controlling what other people think. Spinoza described tyranny as the attempt to achieve the impossible and to exercise power where it cannot be exercised. But this is what holistic planners are trying to do, says Popper, when they say they are tackling the problem of transforming men. This Utopian engineering is impossible and leads to piecemeal improvization and to unplanned planning. The committee fell into just this error when it ultimately stated: “Malnutrition is unlikely to be eradicated by a single round of such measures, however, and priorities will need to be asserted which specify the ranking order of desirability of different increments of improvement” (pp. 50, 51). What alternative approach, then, lies open to us in the field of social action with our present rudimentary ability to understand and control the determinant factors in any situation? For Popper it is “piecemeal social engineering.” The word piecemeal often has a pejorative meaning and it is only so used in the FAO/WHO report where it is assumed that piecemeal measures in the past failed, if failed they did, because they were piecemeal and for no other reason. But the word should be used only in its strictest definition of “piece by piece”, “part at a time”. The piecemeal social engineer recognizing “that we cannot make heaven on earth but only improve matters a little, also realizes that we can only
Downloaded from https://academic.oup.com/ajcn/article-abstract/31/8/1295/4655821 by California Digital Library user on 01 January 2019
equally effectively top government decision makers and the needy population” (p. 55). There are three examples of what I would call “sins of commission” which I fmd inadmissable in an official document such as this. The first is the sanction given to the principle of “triage” on p. 35 by reference to “postponement of programs directed to those who are the most deprived”. It would surprise me if those responsible have not been rapped severely across the knuckles for letting through this statement that contravenes the United Nations’ Charter. Then there is the cynical remark on p.54 “The measures which will be most acceptable will be those which secure their benefits at the least possible cost to others-especially those with power.” The whole problem of having to deal with powerful and corrupt elites is thus brushed aside. Thirdly, I fmd objectionable the frequent advocacy by the committee of self perpetuation (especially p. 56). One is reminded of the criticism of the promoters of the “Great Society” programs in the United States that they denigrated their real achievements in order to justify more funding and public support (12). Having said all this there remains a further, and to my mind most serious, criticism of this report and of the present approach to nutrition planning in general. Here the initial fault lies with the agencies which sponsored the meeting. By relating the topic to national development an holistic approach was implicit. Some noted scientists were on the committe and their endorsement of this has harmed the cause of Nutrition. The crucial question is whether holism is appropriate in the present context. As I have pointed out elsewhere (13) Sir Karl Popper has explained (14) how the “whole” in holistic literature has two senses: 1) totality of all properties and relationships and 2) special properties which make something appear an organized structure and not a “mere heap”. This latter sense has been especially developed by the Gestalt school of psychology. He goes on to show how holists fail to recognize the difference, believing that they can tackle social problems in entirety (sense 1)) on the precedent of Gestalt psychology (which applies only to sense 2)). In the present context the holistic approach is perfectionist and inappropriate; there is no
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References 1. MCLAREN. D. S. World hunger: tions. Lancet 2: 86, 1963. 2. MCLAREN. D. S. The great protein 93, 1974.
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Ninth Report, Nutrition Strategies in National Development. WHO Technical Report Series No. 584. Geneva: World Health Organization, 1976. MCLAREN. D. S. Expert committees. Nature 237: 119, 1972. TRUESDELL. C. Cited by Ziman, J. M. The Force of Knowledge: The Scientific Dimension of Society. Cambridge: Cambridge University Press, 1976, p. 240. SEARS, D., AND L. Joy. Development in a Divided World. Harmondsworth: Penguin, 1971. Joy. J. L., AND P. R. PAYNE. Nutrition and national development planning. Food Nutr. 1: 2, 1975. BEATON. G. H. Defming a food and nutrition policy. Food Nutr. 1: 8, 1975. GEORGE. S. How the Other Half Dies: the Real Reasons for World Hunger. Harmondsworth: Penguin, 1976. LAPPE. F. M., AND J. COLLINS. Food First: Beyond the Myth of Scarcity. Boston: Houghton Mifflin, 1977. MYRDAL. G. The Challenge of World Poverty: A World Anti-Poverty Program in Outline. New York:
Pantheon, 1970. 12. KAHN. H., AND B. BRUCE-BRIGGS. Things to Come. New York: Macmillan, 1972, p. 29. 13. MCLAREN. D. S. Nutrition planning: the poverty of holism. Nature 267: 742, 1977. 14. POPPER. K. R. The Poverty of Historicism, (2nd ed). London: Routledge and Kegan Paul, 1960. 15. ZIMAN. J. M. Public Knowledge: The Social Dimension of Science. Cambridge: Cambridge University Press, 1968, p. 26. 16. ZIMAN. J. M. The Force of Knowledge: The Scientific Dimension of Society. Cambridge: Cambridge
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improve them little by little.” Popper’s criticism of holism, he says, does not exclude cooperation between various branches of a science in tackling a piecemeal problem. But this is very different from the plan to grasp concrete wholes by a method of systematic analysis. After this bad bout of day dreaming, let us see a return to the drawing board, not for more flow diagrams and verbal acrobatics, but for realistic piecemeal measures and sensible planning. I firmly agree with the view of Alan Berg, Senior Nutrition Advisor to the World Bank (personal communication): “Nutrition planning has become something of an industry, an end in itself, and is now about to drown of its own methodological complexities Is it not possible to have something between holism, at least as currently reflected in the everything-is-relatedto-everything-else school of nutrition planning and, on the other hand, the kind of straightforward single set solutions we were exposed to in the late 1960’s?”
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