The Seven Year Niche
Madam
Readers who turn to the ‘back of the book’ eager after a feast of information for a dessert of ideas, will not find ‘Out of the Box’ (OOTB) this month. After 7 years and sixty-five issues without a break beginning in January 2003, the column is no more. It is an ex-column. Yes, I will be spending more time with my family and yes, I am writing a book (which I was, anyway). Let’s now hear more voices.
A distinguished nutrition scientist once said of OOTB, published as it has been in a scientific journal owned by a learned society: ‘Excellent stuff – but very unusual’. So my first thanks, madam, are to you, and to Barrie Margetts the begetter and first editor of Public Health Nutrition, and equally to successive presidents and officers of the Nutrition Society, for sustained encouragement or remarkable tolerance, and intermittent grace under pressure. On behalf of the editorial team as well as myself, thanks also to Katy Christomanou and Carol Miller of Cambridge University Press, and to Gill Watling, our ace text editor, who adapts academic style rules when faced with references to the Bible (or is it The Bible?), the Natural Death Centre, or The Anatomy of Melancholy.
Personal thanks to John Waterlow, exemplar and mentor, for his firm and heeded reminder that undernutrition, and its social, economic, political and environmental as well as biological causes, always needs prime attention(Reference Waterlow1). Equally, special thanks to Claus Leitzmann for our work in progress on the New Nutrition Science project.
Should a nutrition journal range as far as I have tried to do? The simple answer is to quote the title of this journal. Public health is a vast enterprise, and its great times have come again(2). Another answer is to take note of what Margaret Chan, the current WHO Director-General, is saying. In an interview given in July(Reference Edemariam3) she linked climate change and declining food security with massive increases in deaths from malnutrition and diarrhoea, the likelihood of more wars, and more floods, more water contamination, and more deaths from injuries and drowning. ‘The prediction is that, within the next 15–20 years, food production in Africa will drop by 50 per cent’, she said. ‘If that’s the case, how many people will go hungry? Remember that malnourished, stunted children cannot reach their educational potential, which will have a massive social and economic impact’.
Is it the business of our profession to think about the fundamental causes of malnutrition, which so often include bad systems of governance, and to engage as citizens as well as professionals in public policy and action? I think so, yes, as do you madam, and I expect that readers of this letter believe so too. Towers, whether made of ivory or concrete, have their place, but we should limit our time in them. Likewise, boxes.
All sciences are human activities. As in law, well-constructed and presented evidence is crucial. As in statecraft, judgement and action are also essential. This is therefore a good time to commend the writings and lives of René Dubos, Robert McCarrison, John Boyd Orr and Rudolf Virchow, and to reflect on what their approaches to the responsibilities of science mean to us now. Living authors and activists who have most influenced OOTB include Mike Davis, Susan George, Tony McMichael and the mellifluous Amartya Sen.
The column has been sustained by information, support, advice, encouragement and guidance from what is now a network of many hundreds of friends, colleagues and contacts at all stages of their careers all over the world, many within the UN system, national governments, and the nutrition and allied professions, and what may seem to some to be a surprisingly large number of concerned citizens in the food, drink and associated industries.
While I travel a lot, OOTB has usually been written from Brazil. Thanks to a conference organised by Prakash Shetty at the London School in 1996(Reference Shetty and McPherson4), I realised that the future of public health, with its nutrition component, is in the South, and therefore that much new thinking was needed – as it still is. At the turn of the millennium I was working within the federal Ministry of Health in Brasília as one of a team with Denise Coitinho, Elisabetta Recine, and colleagues all over the world. One result has been the current UN Global Strategy on Infant and Young Child Feeding, modified from the original Brazilian Resolution(Reference Cannon5). So yes, I think Brazil is as good a country as any, to survey the world scene.
This is not an auto-obituary. I am still around, and with your agreement madam, these are not my last words in this journal. Here are two more observations.
First, we are now entered into a new and tremendously challenging age. All health professionals, faced as we now are with precipitate urbanisation, economic globalisation, selfish ideologies, senseless wars, corruption in public life, outrageous inequities, uncontrolled pandemics, and threats to the elemental commons – air, water, soil, fuel – need to open our minds, review all we have learned, and think ahead again(Reference Waterlow1).
Second, all actors – notably leaders in multinational bodies, national governments, civil society organisations, relevant industries, the media, in institutions including foundations and health professional bodies, and indeed people as citizens(6) – now must work out how to collaborate effectively and in good faith. In order to do so in mutual trust, some big issues need to be confronted and resolved. Not much worthwhile is easy.
As I write, the sun is setting after a nice day here in this country, that for over a century has been an international leader in public health, and that is now playing an enlightened part in world governance. Greetings. Até mais!
