Saying "Nuts" to Hunger

By Jeffrey Sachs, Jessica Fanzo and Sonia Sachs

We read with concern this week's (September 5) New York Times magazine article "The Peanut Solution," since it is likely to propagate a very serious misunderstanding about the solutions to global hunger, and especially about the role of specially fortified foods such as Plumpy'Nut, the main focus of the article. We commend journalist Andrew Rice for writing an interesting piece on an important and under-covered topic. Nonetheless, it is extremely important to correct certain ideas left dangling by the article.

The article describes a special peanut-based fortified "ready-to-use therapeutic food" (RUTF) with the brand name Plumpy'Nut, which is produced under a patent held by the French company Nutriset. This peanut-based and micronutrient rich paste has proven to be effective in addressing acute malnutrition in famine conditions resulting from crop failures, war, and other causes. Plumpy'Nut can save famine-stricken children in an advanced stage of wasting (severe low weight for height) and at a high risk of death.

This severe form of acute malnutrition affects around 20 million children under five years of age each year and contributes to around 1 million child deaths per year. Plumpy'Nut has the advantage that it is a way of treating serious acute malnutrition on an outpatient basis (at home) rather than requiring an in-patient treatment (in a hospital). It also requires no additive water that can introduce bacteria and other contaminants. At a reported $60 per child for a two-month course, Plumpy'Nut is far less expensive than alternatives involving hospitalization.

It is critical, however, that we not confuse the many types of hunger and malnutrition (poor nutrition) around the world. Plumpy'Nut is not a miracle cure for global hunger or for global malnutrition. Plumpy'Nut addresses only one kind of hunger -- acute episodes of extreme food deprivation or illness, the kind mainly associated with famines and conflicts. Plumpy'Nut is not designed for the other major kind of hunger, notably chronic hunger due to long-term poor diets. Nor is it designed to fight long-term malnutrition that is due to various kinds of chronic micronutrient deficiencies, such as iron, zinc and vitamin-A deficiencies.

The chronic kind of hunger is by far the most prevalent kind of hunger in the world, though it is more hidden and less recognized by the American public. As part of the UN Millennium Project, which one of us (Jeffrey Sachs) directed on behalf of then-UN Secretary General Kofi Annan, the Hunger Task Force found that chronic undernourishment accounts for more than 90 percent of global hunger, while acute undernourishment (starvation) addressed by Plumpy'Nut accounts for less than 10 percent. Of course, the acute episodes are far more widely known to the US public because those are the ones seen on TV in the context of wars, droughts, and other upheavals.

For the vast majority of the world's hungry, the main solutions lie in more productive local agriculture (higher food output per acre), a more diverse mix of nutritious crops, and much greater public awareness regarding feasible and low-cost approaches to a healthy diet. Plumpy'Nut has little role to play in circumstances of chronic hunger. Nonetheless, some people are apparently promoting its as a cure-all.

The article quotes the owner of the sole US Plumpy'Nut manufacturer suggesting that her product is the solution to global hunger. Here is how the article describes the pitch:

There are over a billion people in our world that are malnourished,' Salem said. 'It's a shocking statistic. The good news is there's a very simple solution.' And that, she said, was Plumpy'nut. 'It's really revolutionary, because it doesn't need to be mixed with water or refrigerated,' Salem continued. 'And the most miraculous part is, it will transform a child from literally skin and bones to certain survival in just four to six weeks.

Navyn Salem is right about the therapeutic value of Plumpy'Nut and her efforts should be commended in ensuring this product gets to children in need, but her statement, as reported, can be seriously misconstrued. Of the billion or so people in our world suffering from undernourishment, Plumpy'Nut is appropriate only for a small fraction. Most of the chronically under-nourished need not a solution to acute under-nutrition through food aid but regular access to a long-term, balanced healthy diet. Ms. Salem and we agree on this combination approach: RUTF's for acute under-nutrition, and regular access to a balanced healthy diet and adequate health care to overcome chronic under-nutrition.

Plumpy'Nut comes into relevance when an emergency has struck. And while the $30 per child per month is a very low cost for saving the child, it would in any event be an impossibly high cost for a "solution" to hunger based on food aid! Suppose that the billion hungry people in the world were put on a permanent Plumpy'Nut diet (a totally misguided idea) at a cost of $30 per month, or $360 per year. The result would be a direct cost of some $360 billion per year, an absurdly high cost compared to the real solutions of improved local agriculture, improved household dietary practices, and expanded access of the poor to basic healthcare.

The article agonizes over the patent status of Plumpy'Nut. We have two observations. First, it is absurd to think that a patent should legitimately give a monopoly right to use a fortified peanut-paste to fight acute hunger. The ingredients are simple: peanut paste, vegetable oil, powdered milk, powdered sugar, vitamins, and minerals. The nutritional values of peanuts and the other ingredients have been known for ages, and only the worst misuse of patent law would grant a broad monopoly claim to such knowledge.

Second, as the article mentions, but does not adequately emphasize, it is a standard solution of global intellectual property law that urgent public health needs supersede patent rights. Poor countries should exercise their full right of "compulsory licensing" and other legal protections to produce or to import urgently needed low-cost nutritional supplementation in the face of famines, just as they do to obtain low-cost AIDS medicines. Of course, any RUTF should ensure quality control in the preparation, packaging, and shipment of the foodstuffs. Nor should UNICEF, the world's leading and highly effective organization on behalf of the world's children, give any comfort to a private company seeking undeserved and ultimately life-threatening price markups for basic and widely held nutritional knowledge, especially since those price-markups demonstrably limit UNICEF's and others' ability to deliver emergency foodstuffs to all of the children in acute need.

We also note that Nutriset cannot claim that it expended vast R&D outlays to come up with Plumpy'Nut. It would be fine public policy to award Nutriset a one-time public payment to cover and even exceed its past R&D costs, but the public-health community should insist on the right of any producer to bring to the market low-cost, quality-controlled, peanut-based, fortified, ready-to-use foods in response to famines and other food emergencies.

Our recommended solutions therefore include the following. In cases of acute malnutrition, UNICEF and other agencies should promote locally produced, quality-controlled, ready-to-use fortified foods and should resist claims of patent protection that impede local production or low-cost imports, as needed. In cases of chronic undernourishment, rich and poor governments in partnership should promote improved agriculture and dietary diversity.

The general public should be helped to understand the difference of acute and chronic hunger, so that both are addressed appropriately. And we will need more scientific research in future years to secure even more nutritious crops, and to develop varieties that can withstand the more extreme climate change that is on the way. Of course, slower population growth in poor and hungry countries must also be a key part of any long-term equation.

Jessica Fanzo is a Senior Scientist of Nutritionist at Bioversity International in Rome. Dr. Sonia Sachs is a pediatrician and health coordinator for the Millennium Villages Project.

 

 

 

Follow Jeffrey Sachs on Twitter: www.twitter.com/jeffdsachs

Comments

[Itsbeenalongday]

08:36 PM on 09/13/2010

Delivery of Plumpy nut is like sending bottled water to Pakistan. The cost is a thousand times what it needs to be and the only ones who can afford it are the major donors. Petraeus is looking to cut down on corruption in military purchase, he should be taking a look at this idea as well.

[LJIESQ]

07:20 PM on 09/10/2010

Never mind that peanuts are poisonous as they contain aflatoxin which cannot be removed.

[Abay Alem]

03:31 AM on 09/11/2010

It is simple to detect out peanuts with aflatoxins before processing. Such peanuts can be identified and removed.

[LJIESQ]

07:43 PM on 09/11/2010

so you think. Also, the nicest looking ones go into bags, and the nastiest most contaminated ones go into peanut butter. happy death.

[Itsbeenalongday]

08:37 PM on 09/13/2010

That is a feature of the Caveman diet, if it must be cooked to remove the toxins, it is off the diet.

[skippypicasso]

10:13 PM on 09/09/2010

Russia turned out great for the oligarchs and organized criminals.

[timetocookdinner]

03:59 PM on 09/08/2010

I don't know enough about this product, world hunger, or any of these issues to weigh in with an opinion about this program. But I have to say that in the last couple of weeks I have been wondering what has happened to the peanut farmers because where my generation grew up on peanut butter and jelly sandwiches in our school lunches, my children eat very little peanut butter because it is almost completely banned at their schools (yes, the whole school!) due to some of the students having severe peanut allergies.
I'm glad that these peanut farmers have found an alternative outlet for their products but I wonder, how long until the populations we are exporting this product to start showing the same pattern of severe, life-threatening allergies in some of the children?

[scktt]

11:13 AM on 09/08/2010

The production of PlumpyNut itself should also be placed in the context of the aid it provides. I have seen only one plant producing a similar product, in Zambia. All of the ingredients are either grown or readily available throughout most of Sub-Saharan Africa, yet when crisis strikes the finished products need to be imported at great cost.
I would imagine that, with assistance, the cost of PlumpyNut could be greatly reduced vis-a-vis localized production. This process would dissipate patent issues and also serve as a job creation mechanism abroad.

[Abay Alem]

03:14 PM on 09/08/2010

There are some local production efforts like in Ethiopia, Malawi, and Senegal but to your surprise the price never come down and at times it is even expensive than the one sent from France. It is being franchised like CoCaCola for a product that can be produced at household level. Expanding and localizing the production of PN is in the right direction. However, the cost is exceptionally high for life saving product(i.e about 4,000 USD per ton) I think the battle to make PlumpyNuts like the retroviral drugs should be boosted up in all fronts by national governments, UN, NGOs, donors and civil society.

[Abay Alem]

09:02 AM on 09/08/2010

The bottom line is poor countries has the potential to produce enough food for themselves and for the rest of the world if assisted with good and faire trade policies coupled with critically needed support in terms of technology transfers and introduction of the right technology to boost crop production and diversification such as improved seeds & seedlings of fruits and vegetables, fertilizer, small scale irrigation schemes, technical support to extension work etc. It is NOT JUST and faire to be obsessed with patent rights of PlumpyNut, a life saving product and make profit out of poor people.

If we spend 60 USD per child per year, which is the amount required to treat a child with sever acute malnutrition in two months period, in poor countries in agriculture, small-sclae irrigation, health, water, education, basic infrastructure, micro-enterprise and ICT, there is good evidence that we can transform the livelihoods of the local community. We can, thus, see a much better, striving and JUST world free from the suffering and pain related to hunger! This is within our reach if there is a political commitment nationally and globally.

[andycan]

01:39 AM on 09/08/2010

Mr. Sachs, have you ever totalled the people who died of hunger in Bolivia, Poland and Russia as a result of the "strucutural adjustment" you imposed on these economies?

[JScott]

01:38 AM on 09/08/2010

Yup it's the corporate food solution and you just know they'll find other ways to insinuate it into everyone lives so that humans are dependent on it-soylent red, soylent yellow, soylent green anyone.

[Clemmieo]

09:06 PM on 09/07/2010

When I first read about Plumpy Nut a few years ago, I was left with the distinct impression that it was only being trumpeted as a short-term solution for infants and very young children, and that it did give the children all the nourishment they needed in lieu of no other food being available to them. That is a good thing. But it just makes common sense that it cannot be for an older population. And it is certainly no excuse to stop finding ways and means to get food and nutrients to those millions who are starving or only getting enough food to barely subsist.

[ThatsTheTheWayItIs]

06:48 PM on 09/07/2010

As a patent inventor, I believe "intellectual property" is an oxymoron.

I didn't file for the patent, my company did and of course owned it, now owned by Moto.
Patents are now the worst impediment to human progress.

[merlinspinoza]

06:05 PM on 09/07/2010

Dr Sachs is an intelligent man

in a comment to treehugger.com about the disappearance of bees [ i am tempted to allude to disappearances in the cold war ]
i said th e planet the total habitat and its content including people is at critical systems stage ;tinkering with details [ to adchieve significant gains ] is no longer possible or affordable

it [ survival] requires system wide evolution to higher states of consciousness and releif from stress in evryone EVERYBODY simultaneously

that requires the absolute assertion : ONLY just near 1% of the population learning the TM program
[[ tm.org + global country of world peace projects ]can save us

[hclinton]

05:32 PM on 09/07/2010

AS long as these nations continue to spend their $ are weapons and corruption there is no way to solve the problem. Before we donate as a country weapons have to be 0 % of their budget and and end to lavish life styles

[RueChevalier]

05:08 PM on 09/07/2010

"For the vast majority of the world's hungry, the main solutions lie in more productive local agriculture (higher food output per acre), a more diverse mix of nutritious crops, and much greater public awareness regarding feasible and low-cost approaches to a healthy diet."

An organization called IMPACT (Make Poverty History) has the following words on their website:
"There is enough food on planet earth to feed its entire population 3 times over. The third world is plagued by malnutrition. The west is plagued by obesity and associated problems. The only thing standing in the way of a solution to both plagues is greed."

We don't need to grow / manufacture more food. We need to share the food we already have.

[Dee Amschler]

07:13 PM on 09/07/2010

The west is plagued by obesity largely because of what we grow - at least as much so as how much the average person eats. My doctors constantly tell me to eat MORE and eat MORE OFTEN - but I can't do that and eat HEALTHY FOOD. That's the crux of the matter for quite a lot of poor people in western nations - especially the US. We can buy lots of crap foods like ramen, mac 'n' cheez (as in the kind where the "cheez sauce" is made using day glo orange powder), and hotdogs but don't expect us to come anywhere near 3 meals per day for an entire month on what we have for a food budget (unless you count ketchup + hot water = "tomato soup" as a "meal") if we start buying lean meats, whole grains, fruits, vegetables, dairy, etc. like even WE know we SHOULD be eating. So we stick with filling foods that have lots of calories and are cheap thanks, in large part, to farm subsidies...

[fireincarmation]

08:04 AM on 09/13/2010

Some whole grains are dirt cheap if you know where to get them, like oatmeal, barley, etc bought from the farm supply store.

[newtom]

04:11 PM on 09/07/2010

So now world hunger is a for-profit business? Sad.

[MJinCanada]

07:52 PM on 09/07/2010

Has been for a while. I forget which company it was that spent loads of money (I think it was government grant money) on developing a variety of rice higher in Vitamin A (though not high enough for health). However, it would have been far more practical to plant a few rows of carrots in the spots unsuitable for rice.

[Hannah Laufer-Rottman]

03:38 PM on 09/07/2010

In support of this article and... because hunger is everyone's business, I would like to introduce Facing Up to Hunger, a Palms for Life Fund project designed to engage a wide audience to look at world hunger from the perspective of its root causes and concrete solutions. While the main root cause of hunger is poverty, we address the two problems most directly responsible for global hunger: food availability and food production. The idea is to work with small groups of communities on their most immediate food production needs and then over time, develop more sustainable food security solutions. Simple investments in one or more of the following areas will be very effective:

1) Basic irrigation systems
2) Agricultural tools and equipment
3) Fertilizers
4) Seeds
5) Food storage

Projects need to be implemented by reputable local organizations in order to achieve maximum impact (let's get local!!) while also building and scaling up local capacities. A contractual relationship with the participating communities needs to be established to ensure mutual commitments and to protect investments.

In the United States
Facing Up to Hunger also advocates for change in the type of response that is provided to the approximately 50 million American people currently affected by hunger. The road to end hunger in America is ultimately beyond the traditional means of charity and philanthropy. It will be achieved by social and structural change and through recognition of every person's basic human right to food.

Hannah Laufer-Rottman (www.palmsforlifefund.org)

[uneeda]

07:11 PM on 09/07/2010

absolutely sound

[MJinCanada]

07:56 PM on 09/07/2010

I like that sort of thing.

World Vision has starter (restarter) farm kits for people who have lost everything because of war, drought or other disasters. I bought some as a Christmas gift for my dad, a retired farmer. He didn't need anything but company for Christmas and kind of liked the idea of 10 other farmers getting a fresh start. (He started farming in 1929 -- he could relate to someone needing seed grain.)