In his 2019 book “Upheaval: How Nations Cope with Crises and Change”, Jared Diamond starts by interrogating the word ‘crisis’. Coming from the Greek noun ‘krisis’ and the verb ‘krino’ there are several meanings — to separate, decide, a turning point. Crises differ in terms of the way they emerge, their scale, duration, and impact. Some come as a shock, some are slow-burn — though in reality this distinction may be blurred once we look below the surface.
The COVID-19 pandemic is a sudden-onset crisis, while climate change is slow-burn (albeit linked to increasing shocks like floods and droughts). The biggest cause of global ill-health and premature mortality – malnutrition — is also slow-burn. All three crises are massive in scale, they overlap and interact, and they share many drivers. In 2019, a Lancet Commission delivered an incisive analysis of the global syndemic of obesity, undernutrition, and climate change. This was a year before the pandemic. COVID-19 has since added another crisis into this toxic mix.
Crises heighten our awareness of time, and they generate new understandings or worldviews, often elevating neglected issues to centre-stage.
Equity is one such issue.
The COVID-19 pandemic not only exposes inequities of different forms, it amplifies them. We have seen this clearly in the experience of Black, Asian and Minority Ethnic (BAME) communities in the UK and elsewhere, who are disproportionately exposed to the virus, and more likely to become seriously ill or die. A similar situation plays out with regard to climate and malnutrition crises. Syndemics are fuelled by inequity.
Equity was the central theme of the 2020 Global Nutrition Report. The introductory chapter succinctly unpacked the concepts of inequity and inequality, highlighting the core ingredients of unfairness, injustice and social and political exclusion.
But we also need to take account of another dimension – time. What we do (or don’t do) now — as individuals, organizations and governments – has immense implications for future generations.
This is the subject of a powerful new book by Roman Krznaric “The Good Ancestor: How to Think Long-term in a Short-term World”. While many activists are driving a decolonization agenda in global health, Krznaric argues that we have also colonized the future. Starting in the 18th century, Britain colonized Australia, considering it to be ‘terra nullius’ (‘nobody’s land) ignoring indigenous peoples’ claims. We are now behaving in a similar way with time. Political and economic systems consider the future to be tempus nullius (‘nobody’s time’). Our time horizons have collapsed inwards, driven by short-term dopamine-triggered feedback loops.
Krznaric distinguishes between the marshmallow brain — routinely hijacked by the digital distraction industry that has weaponized smartphones and social media platforms to steal time – and the acorn brain, that thinks long-term, considering the intergenerational consequences of actions taken today.
His analysis of intergenerational injustice and the ‘dark art of discounting’ is compelling. As a method for weighing up the costs and benefits of investment decisions over different time spans, discounting has spread from finance into many spheres of development, including public health and climate-related policymaking.
Why, Krznaric asks, are the lives and well-being of future generations considered to be of ever-declining value? Using a ‘progressive’ 1.4% discount rate, adults alive two generations from now would be assigned the value of half a human today – an ‘iconic expression of the colonization of the future’. Why isn’t the welfare of a child born 100 years from now treated as equal to the welfare of a child born today? Are we to accept that future generations will continue to be disenfranchised, like slaves and women in the past?
Intergenerational inequity plays out in different ways. Politically, it came to the fore, for example, in the 2016 Brexit referendum, when young people (overwhelmingly pro-Remain) accused the older generation (overwhelmingly pro-Leave) of stealing their futures.
So, what does this have to do with nutrition?
A growing body of research in the last few decades has shone a light on the way in which malnutrition persists through the life cycle – and even across generations. Epigenetics is showing that what we do now has major implications for the health of future generations. A recent review states:
“Early insults during critical periods of brain development, both pre- and postnatal, can result in epigenetic changes that may impact health and behavioral outcomes over the lifespan and into future generations. There is ample evidence that these early stages of brain development are sensitive to various environmental insults, including malnutrition, childhood trauma and drug exposures. The notion that such changes, both physiological and behavioral, can also carry over into subsequent generations has long been recognized, especially in the context of experimental studies. However, epigenetic mechanisms capable of explaining such phenomena were not available until relatively recently.”
Nutritional disadvantage, driven by inequitable factors and processes, can last for many decades.
Meanwhile, as we continue to learn more about long-term consequences, the ultra-processed food industry continues to exploit the short-term, addictive and impulsive traits of our marshmallow brains — one of the main reasons why obesity has rocketed in the last two decades. In evolutionary terms, we’re still very close to hunter-gatherers who were adapted to consuming food whenever and wherever they could. What used to be a survival mechanism to bridge over times of scarcity, however, has become a maladaptation to the obesogenic environments we now live in.
What to do?
Following the Global Nutrition Report’s call, we need to develop and invigorate a pro-equity nutrition agenda that includes intergenerational justice.
Security is a start point. How can anyone ‘think long’ or plan for the future if they cannot even nourish their families today? Food, health and nutrition security are foundational pillars for building a future – at all levels.
Second, nutrition researchers and activists need to become politically adept in analysing and challenging political and governance systems that colonise the future. For too long, the nutrition community considered politics and political economy as beyond their remit. We have a special challenge given that the full benefits of addressing malnutrition will take many more years than a politician’s term in office.
Third, institutional mechanisms that ‘look long’ and consider interests of future generations need cultivating – especially youth movements, such as the Scaling Up Nutrition (SUN) Youth Leaders for Nutrition. A Lancet Planetary Health commentary, released alongside International Youth Day last week, argues: ‘It is time to democratise [planetary health], balance the asymmetrical power structures, and leverage fearless voices challenging the status quo’. The authors outline a pragmatic roadmap based on three pillars: governance structures enabling young people’s participation, funding that supports inclusion and compensation of young people from all backgrounds, and capacity building for young people.
Another example of long-termism, as highlighted in the Lancet syndemic commission report, is the Iroquois concept of ‘seven generation stewardship’. This urges the current generation to live and work for the benefit of the seventh generation into the future. To this end, the Commission proposed the establishment of a ‘Seven Generations Fund for Traditional Peoples’ Science’.
Nutrition advocacy that emphasizes the foundational aspects of nutrition, and its central role within holistic strategies for achieving the Sustainable Development Goals will be more important than ever. In this context, #BuildBackBetter has become a bit of a cliché in 2020. Many also question use of the word ‘back’. Why go back to economic systems that target short-term gains, and profit over people? Why not go forward?
The SDGs rightly focus on sustainability and on equity – leaving no-one behind. In this context, the title of the postponed ‘Nutrition for Growth’ summit is looking ever more dated. Yes, we know that $1 invested in nutrition generates $16 in returns. The economic investment case needed to be made a decade ago, and it’s been made. Now we need to make the case in terms of nutrition’s pivotal role as a driver of sustainable and equitable development. ‘For Growth’ is just not a compelling rationale any more. The world has changed.
Finally, we face a challenge of public perception that can perhaps be best illustrated by a mythical fable about frogs and hot water (don’t try this at home!). If you drop a frog into boiling water it hops straight out. If you drop a frog into tepid water and heat it to boiling, it will not react until it’s too late. The COVID-19 pandemic is a rapid-onset global emergency that has generated an unprecedented sense of crisis and a large-scale response. The climate and nutrition crises, on the other hand, are slow-burn crises that proceed incrementally, month by month. They kill many more people than COVID-19 but they do not generate a sense of crisis that leads to action on the scale and intensity required. It’s reflected also in the terminology – the notion of climate ‘change’ is a little like referring to an earthquake as a ‘land movement’!
So, the overarching challenge is to generate a sense of urgency that leads to concerted large-scale action. One opportunity lies in showing the connections (through data and research) within the syndemic. During the southern African HIV epidemic in the 2000s, a similar approach was taken with nutrition, following research that showing that antiretroviral therapy did not work well unless people were adequately nourished. A recent example comes from the UK where evidence of the higher risks of COVID-related hospitalization and death of people who were obese led quickly to a strategy (flawed, but a start) to address obesity.
At long last, equity – including transgenerational justice – is central to the nutrition agenda.
There’s much work to be done.
It’s about time.