Nutrition

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The Long Reach of Famine in Gaza

Childhood growth is a mirror for “the material and moral condition” of a society.           

   – Dr. James Tanner, pediatrician and auxologist (1986:3)

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In 2015, Lital Keinan-Boker and colleagues published a study in The Israel Medical Association Journal that examined whether the Holocaust during WW2 had impacted the long-term health of older Israeli adults (mean age 69 years). They were working within the framework of the Developmental Origins of Health and Disease (DOHaD) paradigm, a body of evidence that shows that an array of stressors including malnutrition early in life (prenatally and/or during infancy) can increase risk for various chronic diseases in adulthood.

The study design compared people who were born between 1940–1945 in Nazi-occupied countries in Europe (which they categorized as the ‘exposed’ group; n=653) to those in Israel to Europe-born parents (‘non-exposed’; n=433). After adjusting for confounding variables, Keinan-Boker et al concluded that those born in Europe during WW2 were significantly more likely to have dyslipidemia, type 2 diabetes, hypertension, and cardiovascular disease. As they wrote, “The results of the current study on fetal and early childhood exposure to malnutrition and hunger and the subsequent long-term outcomes are in accordance with previously published data from research on non-Jewish populations.”

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Links Between War & Famine: From the Chevauchée to Yemen, S. Sudan, Ukraine, and Syria

“Armed conflicts lead to hunger and reduced food production and economic growth in developing and transition countries. Reciprocally, food and economic insecurity and natural resource scarcities–real and perceived–often precipitate violence.”

-Marc Cohen and Per Pinstrup-Andersen (1999)

Recent images coming out of war-torn Yemen are heartbreaking. After three years of fighting between Houthi rebels and a Saudi-led coalition (backed by the US, UK and France), an estimated eight million people are near starvation. The war has exacerbated the nutritional situation in what was already one of the poorest countries in the region, causing infrastructure to crumble and unemployment rates to skyrocket. A blockade of Yemen’s ports has also led to a rise in food prices and to a lack of medical supplies, leaving people dependent on insufficient amounts of food aid.

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A malnourished infant in Yemen, with a low upper arm circumference (source: BBC).

This has been building for a while. Nearly two years ago, a BBC report cited statistics from the UN that 370,000 children in Yemen were starving. Even infants, who may be buffered from difficult economic conditions via breastfeeding, were not spared as many mothers were too malnourished to produce milk.

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Growth of Recently Arrived Refugee Children in the U.S.

A recent paper in the journal PLoS One examined growth patterns of 982 refugee children (age 0-10 yrs) from 35 countries who were resettled in the state of Washington (Dawson-Hahn et al 2016). Using height and weight measured at the time of their overseas health examination, the authors calculated rates of stunting (low height-for-age), wasting (low weight-for-height), and overweight/obesity as markers of a child’s nutritional status. These statistics were also compared to low-income children in Washington.

To me, the most important part of the results was that rates of substandard growth were quite high among refugees. Overall, refugee children aged 0-5 years old were more likely to be wasted and stunted, and less likely to be obese in comparison to low-income children in Washington.

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Figure 1 from Dawson-Hahn et al

 

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The Biology of Forced Displacement

“Seeking asylum is not illegal under international law and people have a right to be treated humanely and with dignity.”  – UNHCR

“We crossed the Mekong to get to Thailand at night, so no one would see us. We had always lived in the mountains (of northern Laos), so we did not know how to swim. When we came to the river, we used anything to help us float – bamboo, bicycle tubes. But at night, it is easy to get lost. Someone in our group said: ‘Remember, if you get lost when you’re going down the river (with the current), don’t panic. Thailand is on your right.’ ”

 

 

Every refugee has a story. The one above was told to me by a Hmong man I met in French Guiana in 2001. I went to learn about the experiences of the people there and how they had adjusted to being resettled half a world away, from Southeast Asia to a French ‘overseas department’ in Amazonia. They were actually doing quite well at the time, living as independent farmers who had been given land by the government years earlier.

Hmong men in French Guiana going hunting by bike.

Hmong men in French Guiana going hunting by bike.

They also retained a good degree of cultural continuity. While most are fluent in French, the majority of the 2,000+ Hmong in the country lived in rural, semi-isolated, ethnically homogenous villages. This gave them a buffer of sorts, allowing them to acculturate on their own terms. As they often put it, they were “free to be their own boss,” free to be Hmong, and most said they were happy with life in French Guiana. This combination of traits – economically self-sufficient, culturally distinct, mostly content, living in a rural overseas department – is not the typical refugee story. In fact, because of that relative uniqueness, the French Guiana Hmong have drawn attention from media outlets such as the BBC and the NY Times.

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Developmental Plasticity and the “Hard-Wired” Problem

“Development is the missing link between genotype and phenotype, a place too often occupied by metaphors in the past … But a strong emphasis on the genome means that environmental influence is systematically ignored. If you begin with DNA and view development as “hard-wired,” you overlook the flexible phenotype and the causes of its variation that are the mainsprings of adaptive evolution.” (Mary Jane West-Eberhard, 2003: 89-90)

“Genes, unlike gods, are conditional. They are exquisitely good at simple if-then logic: if in a certain environment, then develop in a certain way… So here is the first moral of the tale: Don’t be frightened of genes. They are not gods; they are cogs. (Matt Ridley, 2003: 250)

 

Plasticity: actor Christian Bale at two points in time. Same genes, different phenotypes.

Plasticity: actor Christian Bale at two points in time. Same genes, different phenotypes.

In his book The Triple Helix, Richard Lewontin told the story of the molecular biologist and Nobel laureate Sydney Brenner, who – while speaking at a conference – predicted that one day we would be able to “compute” an organism (2002). All we would need are two things: the organism’s full genome and powerful enough computers that were up to the task.

The idea is seductive. Genes are sometimes seen as self-sufficient molecules, almost existing in a vacuum, that contain all the information necessary to code for proteins. From there, it’s not a very big logical leap to think that if you had the genome, you could enter the code in some database, hit “run,” and then watch some digitized version of the organism unfold.

In fact, scientists are doing something much like this for the tiny roundworm C. elegans with the project OpenWorm. Yet even for a relatively simple organism such as this, with only about a thousand cells in total, there are reasons to be cautious. As The Economist warned in its write-up of OpenWorm: “Attempting to simulate everything faithfully would bring even a supercomputer to its knees.” However, this isn’t due solely to the limits of computing power (what if we had a super-duper computer!?). Rather, it’s a matter of how the question is framed.

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How War Gets Under Our Skin

beinghuman.org front page

I wrote this piece on BeingHuman.org about how war (and the world in general) gets under our skin. It looks at the Hmong example, as well as examples from a few other wars around the world (the Dutch Hunger Winter, the Biafran famine, and the Khmer Rouge period), and how these experiences get into our bodies. 

 

http://www.beinghuman.org/article/how-world-gets-under-our-skin

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Unbending rigor is the mate of death,
And wielding softness the company of life:
Unbending soldiers get no victories;
The stiffest tree is readiest for the axe.
Tao Te Ching: 76

 

Early in life, our bodies are like unmolded clay, ready to be shaped by our experiences. For some of us, that matching process can create problems. If circumstances change, we could end up poorly adapted to our adult environment. A child born into harsh conditions, though, may have to take that risk in order to make it to adulthood at all.

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War as a Public Health Problem

The surgeon Gino Strada, who has worked in war zones around the world, once referred to war as “the biggest tragedy in public health.” It is debatable whether this empirical claim is true, but by re-framing the issue in this way we can see war with fresh eyes and as more than a conflict between political entities. Rarely, if ever, is war a matter that affects solely competing militaries. Recent images from Syria, Gaza, and Israel are the latest reminders of the impact of war on civilians. See these compelling photo essays here and here.

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Aside from the obvious culprits of death, injury, and post-traumatic stress disorder, there are many ways that war can affect public health. As early as February of this year, food shortages were reported in Syria. One displaced woman told a reporter: “I can guarantee you this, people will starve to death.”

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Food shortages in Syria. From CNN (Feb 21, 2012).

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Inequality, Health Disparities, & Obesity

An October poll of 1,000 likely voters found that Americans are increasingly concerned about income inequality. When asked: “How Big a Problem is Income Inequality in the US?,” the majority (74%) replied that it was either a big problem or somewhat of a problem. Predictably, there were differences in opinion by political ideology, but a majority of liberals (94%), moderates (81%), and conservatives (55%) answered that inequality was at least somewhat problematic. However, as is true of many polls, it was not specified exactly what people found unsettling about it. I suppose there are many reasons that people might find increasing inequality (and climbing rates of poverty) to be troubling, but I wanted to focus here on inequality and health, particularly on obesity.

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First, what do we mean by poverty? I remember watching an interview on PBS with the economist Jeffrey Sachs years ago (transcript here – thank you, Google), where he distinguished between two types of poverty. The first was an extreme form, which he called the type of “poverty that kills.” The other type was more of a poverty of inconvenience or jealousy. I don’t want to over-interpret Sachs’ meaning. It was a passing phrase in an interview from ten years ago, and his primary focus was on alleviating the extreme poverty faced by more than a billion people in the world living on $1 per day (see Sachs 2005). Elsewhere, Sachs has lamented that the media have ignored poverty in the United States at a time when “the U.S. has the greatest income inequality, highest per capita prison population and worst health conditions of all high-income countries.” His credentials in fighting poverty are unassailable. But I cite the old interview here because I think his descriptions (‘poverty that kills’ vs. ‘poverty of jealousy’) might resonate with many people today, and not necessarily in a good way.

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Extreme poverty: scavenging at a garbage dump in Phnom Penh (abcnews)

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Killer Ghosts & Broken Hearts: The Mystery of Sudden Unexplained Death in Sleep in Asian Men

One of the strengths of a biocultural perspective in anthropology is its broad approach to understanding human biology and health (Wiley and Allen 2008). Such a framework seems particularly appropriate when looking at the fascinating phenomenon of SUDS (Sudden Unexplained Death During Sleep). Though SUDS first appeared in the medical literature 1917 in the Philippines, where it is referred to as ‘bangungut’ (Guazon 1917), it was largely forgotten until the late 1970s when it regained notoriety as an important cause of mortality among Southeast Asian refugees in the United States, particularly among young men (Baron et al 1983).

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War and child growth: Iraq & WWII Germany

At the population level, childhood growth is often seen as a marker of health and the quality of the environment. When populations get taller in a few generations, this is likely due to some improvement in local conditions (better nutrition, less infection, cleaner water supply, etc.). Conversely, when linear growth declines, it is usually because local conditions (ecological, economic, political) have deteriorated. Two recent working papers illustrate how this pattern applies to war conditions.

Destruction of Dresden, 1945

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