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The Double Burden

Imrana Qadeer

By Stuart Gillespie and Lawrence J. Haddad
Sage Publications, New Delhi, 2003, pp. 235, Rs. 235.00


Written by Stuart Gillespie and Lawrence J. Haddad of the International Food Policy Research Institute and published in the year 2003, this book attempts to deal with a major problem of “the double burden of malnutrition in Asia’. The publishers have made a genuine attempt to make it accessibile by pricing it at Rs. 235.00, a level almost unknown for academic publications these days. However, despite their attempts at fairness of distribution, this book falls far short of being either scientific or realistic in dealing with this major issue, that blights the lives of millions throughout the world. In fact the approach that it adopts is more likely to mislead already misled policy makers, seated in the power centres of the world, outside and within the zones of poverty and hunger!   Divided into seven chapters, the book begins by assessing the problem of malnutrition in Asia and then discusses the importance of direct action on nutrition, developing capacity for nutrition actions, as well as ‘indirect action’ and ‘relevant actions’. These four chapters are followed by another three on the contextual dynamics, the meaning of nutrition interventions, and finally, outline ways forward in policymaking.   The organization of the chapters is revealing in itself, since despite a seeming awareness of the complexities of the issues, the authors move forth in defining the problem in a manner that is largely removed from its social context and firmly located in a clinical and disaggregated mode within a biomedical perspective. This approach is as inappropriate as the lumping together of all the countries in the region, with their various histories and development strategies on food, as ‘Asia’ which even the World Bank’s health policy makers would find lacking in credibility. The gulf between the reality of the political economy of the region and the perspective put forward by Gillespie and Haddad, is also visible in the title of the text itself “the double burden of disease—a term that has been popularized by vested interests to locate centre stage, non-communicable disease, pushing back the day-to-day realities of starvation, hunger, under-nutrition and the visible presence of infectious disease arising out of poverty and inequality”.   By overemphasizing the emergence of obesity in the region as a major issue and by reducing the critical issue of under-nutrition to low birth weights at birth and stunting in under-fives alone, the authors not only ignore a large population of those who ...

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