INCOME, NUTRITION AND HEALTH

[Stanley]

INCOME, NUTRITION AND HEALTH

At first glance, making the case for a connection between income, nutrition and health looks like a 'no-brainer'. It stands to common sense. However, one of the surprises I got when I looked at this as part of my studies in Inter-War history was that while the connection looked obvious, proving it was a different matter. Understanding why it was so difficult can give valuable insights about society, government policy and some of the consequences of inequitable distribution of wealth.
Before we examine the connection between the three factors, let's make an assumption that there is a connection and try to identify what the pressures are within society which govern the responses of the capital holders to any perceived problem in the balance of society caused by damage to society from a worsening of the factors. In bald terms, the regulation of the labour supply. In Feudal times the management aim of the magnates was to maintain the labour supply at a level that gave a slight labour surplus because without this reservoir of labour the land could not be worked efficiently and in the end the magnates themselves would suffer. In other words, pure self-interest.
Perhaps the best example of this balance of interest was in the mid 14th century when the Black Death killed a minimum of a third of the peasantry (and the magnates and clergy as well of course). The immediate result was a shortage of labour and competition between land-owners to attract workers. There was wage competition and in some areas, particularly in the Midlands and South, the villages of a lord who refused to pay the going rate for labour were deserted as the workers did the unthinkable and migrated to where they got the best deal. The Statute of Labourers (1351) was the legislative response to heal this breach in the feudal system but was never a success. Equilibrium was only regained after the putting down of the Peasant's Revolt and, though not appreciated at the time, the gradual increase in the labouring population which, in conjunction with improved systems of land tenure and farming methods raise food production to a sustainable level.
One more example of this pressure for change was the 'Physical Efficiency' debate of the late 19th century when, during recruitment for soldiers for the Crimean War, it was realised that in the most advanced industrial society in the world, the physical condition of the men who should have been eligible for service was so bad that the majority could not be recruited. This, plus a rising tide of epidemics such as Cholera and Typhus brought home to the government the need to improve the conditions of the working poor. This had many beneficial results including provision for 'rational leisure' by creating public parks and great sanitary improvement schemes to improve living conditions. One significant element of the spending on sewage, cleansing and mains water was an outcry from the capital owners who lived above the crowded slums that spending their rates on 'Municipal Socialism' was scandalous. The key thing here is that they had not realised that in terms of their health, the most efficient course was to eliminate the worst black spots. I might even suggest later that this short-sighted thinking is still with us.
Therefore, my basic assumption is that the government/capital owners will only move in favour of improvements if they clearly see it is to their own advantage. Some may see this as cynical but I would dispute this. It is realism, humans do not embrace any change until they are certain it is to their advantage.
Right, having admitted my starting position, let's examine the three factors, income, nutrition and health. When Dr Constantine suggested the title he specified nutrition but I have to start by examining the link between resource and shortage of food because in earlies times when famine stalked the land it wasn't money but the availability of food that governed how you ate. Too little food and you starved. It was well understood that starvation could reach a point where death ensued but at this time nutrition in the modern sense was unknown. Food was food, if you had it you lived, if it was absent you died. Looked at in these terms, the connection was well understood and the monasteries, local lords and better off neighbours did what they could to help those who were suffering. This was described as Christian charity and may well have been just that but in the end the net effect was to help maintain a breeding pool of necessary labour.
In later years when the first social researchers were trying to quantify what the position of the poor actually was their measure of nutrition was the amount of food necessary to maintain physical efficiency. This measure was based on standard diets and compared with those provided in institutions like workhouses, the armed forces and prisons. There was an unspoken assumption that diet was connected with health but they had no scientific tools to quantify exactly what the connection was. The closest they got was that, all other things being equal, a better than adequate diet seemed to lead to better than average health.
Despite increasing attention to the question of the relationship between nutrition and health this was the position until 1936 when Dr M'Gonigle and his co-author J Kirby published 'Poverty and Public Health' (Gollancz). M'Gonigle was Medical Officer of Health for Stockton-on-Tees in 1927 when a large slum clearance scheme in the centre of town meant that half the slum was demolished and 720 inhabitants moved to a new housing estate while the remaining half stayed in the slum property. Over the next five years he kept track of the health and morbidity of the two populations and came eventually to the surprising conclusion that the health of the people who remained in the slum was better than that of the lucky 720 who had been moved to the new housing. M'Gonigle asked himself why this should be and eventually found the cause. He showed that a variety of factors had combined to lower the income on the estate, these ranged from higher rents and expenditure on public transport fares to get to work to greater expenditure on furnishing the new homes to a higher standard than would have been expected in the slum. An early example of 'keeping up with the Joneses' The consequence was that expenditure on food had fallen resulting in a lower standard of nutrition and this had been accompanied by worsening health outcomes. For the first time we had a concrete example of the linkage between income, nutrition and health supported by well-researched evidence.
Forgive me for mentioning that a notable contribution to the book was 'A Banker's Dictum'. This quoted a speech made by Mr Colin Campbell at the annual meeting of the National Provincial Bank in 1936 in which he suggested that the government should divert funds being used for export bounties and subsidies for producers to improve the feeding of the under-nourished. At least one man had taken the lesson to heart and was advocating the use of resources by capital holders to finance greater spending on enabling people to eat a full diet and thereby making an increase in the trading of foodstuffs that he estimated as being £200 million which would revive British farming without harming overseas trade or shipping. This wasn't charity, it was sensible investment.
It's also worth mentioning that a contributory factor to the fog surrounding assessments of public health was the misuse of government statistics during the inter-war years. National averages were quoted as evidence that government policy was working and the nation was getting healthier. In order to massage these 'facts', local variations which proved there were still pockets of deprivation were ignored by the government's Chief Medical Officer of Health. For evidence of this please find Dr Charles Webster's paper 'Healthy or Hungry Thirties?' (In Rare Texts on the Oneguyfrombarlick website) This essay is the revised form of a paper given at the Modern Medicine Seminar in Oxford, November 1979, and circulated for the Annual Conference of the Society for the Social History of Medicine, July 1980. In it, Dr Webster shows how the data was deliberately manipulated for political ends.
At the same time, other researchers, notably Jack Drummond (The Englishman's Food. A history of five centuries of English diet.' 1936) were using the advances in the science of nutrition to advocate balanced diets taking advantage of all that had been learned about the new 'Vitamins', proteins, fats and sugars. His work in this field was the basis of his later work during WW2 as Scientific Adviser to the Ministry of Food from 1940 to 1946. His effectiveness in this role is still recognised today, all the evidence points to the fact that the population of Britain came out of the war better fed and healthier than they went in in 1939 and this despite the most severe food rationing of modern times. I was born in 1936 and take comfort from the fact that I am one of what has been described as 'The last healthy generation'.
So, by 1946 I think we can be certain that the connection between income, nutrition and health had been proven. However, history doesn't stand still. If Sir Jack Drummond was alive today, what would be his assessment of where we are now with all the advantages of modern resources and research? (If you're interested in this I suggest you read 'The Vitamin Murders' by James Fergusson (2007) which examines the murder of Jack Drummond, his wife and daughter, in France in 1952 and the post war history of pesticides and vitamins.)
The awful truth is that despite all our knowledge and resource, diet is worse today than at any time since 1946. The modern syndrome of 'The Western Diseases' is seen by many as a consequence of this deterioration. The connection between income, nutrition and health is not as clear cut as it was in 1936. Broadly speaking, income and resources have never been more plentiful but the latest research into nutrition, particularly lipids is pointing more and more strongly to deterioration in the quality of food. How could this happen?
My version of it is that in the immediate post war years after WW2 the government had a choice, they could continue monitoring food supplies and sticking to the nutritional guidelines that had brought us through the war or they could accede to what was undoubtedly popular demand, throw resources into agriculture and get rid of the hated rationing system as soon as possible. In simple terms, given the choice between quality and quantity they bet the farm on quantity. Agricultural productivity soared and the use of pesticides, herbicides and artificial fertilizer raised yields at the expense of soil quality. The proportions of vitamins and perhaps even more importantly, micro-nutrients in food fell. At the same time we saw a revolution in the food industries as they realised that the route to profit was adding value by processing, extending shelf-life by eliminating what they saw as 'bad fats' such as natural butter and lard. The natural consequence to this, exacerbated by the growth of advertising and the rise of the supermarkets has meant that 90% at least of the shelf space in a modern shop is taken up by artificial foods ranging from margarine to ready meals and pot noodles. The modern housewife has been persuaded that she is 'time poor' and there is no shame in paying exorbitant prices for ready prepared food. This has also led to an explosion in fast food outlets. Where this was once confined to pie and fish and chip shops, we now have every variety of food under the sun ready made for us and something that was hardly ever seen when I was young is now common-place, people 'grazing' on the street. Global food chains of supply mean that there is more chance of adulteration of basic foods than at any time since the 19th century, see the current problems with horse-meat.
If my assessment is correct, what is the government doing about it? The answer is very little. The food industries are, in economic terms, the largest single element of the economy. As such they control large capital stocks and can influence government by lobbying. The government is still issuing outdated guidelines on diet that totally ignore the latest research and do no harm to the processor's sales. We are still assured that fat is bad and carbohydrates good when the opposite is true. There is no dedicated government body monitoring nutrition research and the suspicion is that what food agencies we have are in thrall to the processors. I can see echoes of the misuse of statistics that Dr Webster identified in the inter-war years in the wilful way the government seems to ignore reality at the moment. They take a simple thing like obesity and warn against it but at the same time do nothing about the industries like soft drinks who are one of the major sources of calories in the diet. Other governments ban trans-fats and hydrogenated oils but all we do is 'issue guidelines'. If you begin to get the impression that I am angry you are right.
By 1936 we had the evidence that there was a proven connection between income, nutrition and health. Ten years later, in 1946, we had firm evidence of how effective strong controls of diet could be. By 1956 we were starting down the road where we ignored everything we had learned and all the evidence points to us now entering a world of malnutrition again, and this at a time when resources are more plentiful than ever. When Dr Webster gave me permission to transcribe his lecture and publish it on our website he said that it was high time we re-learned the lessons because he could see the same thing happening again. Political advantage was worth more than truth. I believe the same can be said for the way we manage nutrition today. It is more expedient to keep the large capital holders happy than pursue the best quality food.
When Mr Campbell stood in front of his shareholders in 1936 and advocated a change in government policy on the grounds it would be more efficient and save money he was a lone voice. Perhaps we need more like him today pointing out that allowing the 'Western Diseases' to get a foothold by ignoring current scientific research is a sure way to an unhealthy population and never-ending increases in the demands placed on the NHS, it damages the economy. We thought we had slain this dragon before WW2 but I am afraid it is alive and well but in a different guise.

SCG/24/04/13
2462 words

[Stanley]

Thanks Lads. It's another of my NOPs for my old mate Steve. Got to keep the brain cells functioning!

[Stanley]

Bumped.

[Stanley]

This article is still absolutely current and should be heeded by anyone who cares about public health. The key fact is that we are more badly nourished as a nation now than we were 77 years ago in 1946. Incredible but true.....