Developing Countries, Developing Problems
Friday, January 20th, 2012By Benjamin Tennenbaum, courtesy of the University of Chicago Undergraduate Law Review

Hunger is no longer the sole nutritional problem facing the developing world. 1996 marked a pivotal year for the World Food Programme (WFP): it was the last year when more than seven million tons of food aid was donated by the Programme for non-emergency related aid. 2006 was the last year more than one million tons of related aid was donated and delivered. The numbers keep falling—year after year less food aid is donated and distributed by the WFP to people who need it, even as the economic crisis swells the ranks of the hungry.
Yet since 1980 a historically rich-world phenomenon—obesity—has reared its ugly head in nations previously considered too poor for obesity to be a problem. It isn’t only in consumption that developing countries are now mirroring the developed. Heart disease, diabetes, and other chronic diseases that more typical middle-aged Westerners develop are spreading throughout the developing world as fortunes rise. Developing countries are experiencing developed-world problems.
The World Health Organization (WHO) regards health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Health is under attack, but the international community is doing too little to bulwark health because weak international interests are continually trumped by national ones.
Many countries around the world have limited access to cheap, affordable, healthy, and nutritious food. The European Commission in a September, 2011 report on trade raises fears over heightened protectionism among G-20 members, and agricultural products are no exception. In 2011 Ukraine raised export duties on grains, between 9 and 14 percent increases; Algeria banned exporting cereals like wheat and barley and flour; Kazakhstan banned the export of buckwheat; the Russian Federation tightened grain exports in the wake of a devastating drought. In developing regions like Central Asia or Sub-Saharan Africa, where regional agricultural net producers buttress net importers, insular exportation policies greatly harm those reliant on cheap imports. There are no export restrictions on the Twinkie and many other less-than-essential foodstuffs. Instead of fostering healthy trade and doing away with trade restrictions, policies like these make it more difficult to purchase healthy and cheap food. As a consequence, the WFP and other global assistance funds donate less and less cheap and healthy food, and poorer consumers buy less cheap food.
During economic hardships the international community seems to forget “the right of everyone to an adequate standard of living for himself and his family, including adequate food,” declared in Article 11 of the United Nations Covenant on Economic, Social and Cultural Rights, choosing instead to hold back giving. The European Charter on Counteracting Obesity, signed in 2006 by all 53 members of the European region of the World Health Organization, serves as a good start for developing regional goals to combat obesity, which can lead to a reduction in other non-infectious diseases related to an unhealthy weight. Supranational efforts spearheaded by the European Union like the European Platform for Action on Diet, Physical Activity and Health are good steps, but do not take action in reducing European obesity levels; instead of passing meaningful reform to promote habits, legislators call for more talk and less action.
While these are important initiatives, and more pan-national dialogue will lead to greater awareness, fitness does not garner the same calls for reform that a unified monetary policy does. There is an astonishing absence of law pertaining to preserving health. In the developing world, where citizens cannot afford to buy healthy food, the percent of a population that is overweight is significantly higher. While certain outliers exist among developing countries—only 4 percent of India’s population is overweight—Middle Eastern countries tend to be both more overweight and obese than their European counterparts. The Pacific Islands, where weight used to be a sign of affluence, have been hit the hardest: Nauru has the dubious distinction of being the fattest nation in the world, with more than 79 percent of its population obese. When obesity, which costs the US alone $123 billion in direct and indirect costs, is compared with other economic activities, it would seem imperative that something must be done. Obesity and diabetes cost the Pacific Island of Tonga $1.95 million per annum. While this may seem a small sum, this figure represents nearly sixty percent of the health budget and six percent of gross domestic product (GDP).
$7.3 trillion will be lost in output by 2025 from heart disease, cancer, diabetes, and lung disease according to the World Economic Forum. And yet there remains no effective mechanism on an international level to combat non-communicable diseases (NCDs). On a national level there has been some success albeit limited—with Scandinavian countries leading the way. Sweden has introduced voluntary labels informing consumers about the nutritional content of food items, helping consumers make healthier choices. Finland has studied the eating habits when free vegetables or a free salad was added in a meal.
School lunches—the Finnish study was conducted in a university cafeteria—play an integral role for children. What children eat at an early age lays the foundations for successive eating habits. A school in the Little Village neighborhood of Chicago, Illinois has staked out new ground by banning home-packed lunches; only school-prepared lunches are allowed, unless students are medically-required to eat certain foods. This policy helps students from backsliding at an early age into unhealthy eating habits. Julian Ruiz, a second-grader at Little Village Academy, confesses: “sometimes I would bring the healthy stuff, but sometimes I would bring Lunchables.” While Julian may not be totally ignorant of what is healthy, the schools should nonetheless be praised for taking the initiative to reinforce healthy behavior.
The Chinese government has unique abilities to make healthy changes for their citizens. Chinese culture places a great deal of power into the hands of the community. The central government, realizing the scope of diversity in China, has decided to engage the community in tackling eating habits. Through the National Plan of Action for Nutrition for China, the government—utilizing such diverse bureaus as health, agriculture, and State Planning—will attempt to “alleviate hunger and food shortages; […] prevent, control, and eliminate micronutrient deficiencies; and to improve the general nutritional state of the people and prevention nutrition-related chronic disease [15,000 deaths per year, or 70 percent of mortality in China] through proper guidance to consumption behavior, improvement of dietary patterns, and promotion of healthy lifestyles.”
By setting price controls to make unhealthy foods more expensive or even ban them outright, and administering gargantuan publicity campaigns that can reach any corner in China, the Chinese government has immense power to reduce obesity—power unrivaled anywhere else. However, because of China’s scope, little has been accomplished. It must be noted that Beijing had historically been hesitant, even hostile, towards creating broad-reaching social programs like those of the developed world (e.g., some form of retirement insurance or socialized medicine). This reluctance could lead to a uninformed and unhealthy aged population, and only recently have steps been taken to provide social benefits.
Here in the United States, the courts have recently backed initiatives to make consumers better informed about their decisions. In New York State Restaurant Association v. New York City Board of Health (2009), the US Court of Appeals for the Second Circuit upheld a statue issued by the New York City Board of Health mandating the prominent display of caloric information for food purchased in restaurants, sparking a national trend. Outside of the United States and Western Europe, there is very little evidence to support much legal action to curtail hidden caloric information or fast food-related media aimed at children.
One huge factor in preventing and treating NCDs around the world is readily-available generic medicine, bringing the power to save hundreds of millions from pharmaceutical companies to the developing world. During most of the Twentieth Century, developing countries lacked access to sophisticated drugs manufactured in the developed world because of high costs and little cash. Acquired immune deficiency syndrome (AIDS) medication is notoriously expensive, limiting its market to the wealthy infirm. African governments, valuing human life over copyright laws, threatened to manufacture essential drugs cheaply and illegally to prevent a public health crisis.
The public relations storm that ensued, along with other outcries against other expensive treatments led to the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), a World Trade Organization (WTO) international agreement that set down for the first time the minimum standards for many forms of intellectual property. TRIPS spells out how “members [of TRIPS] may exclude from patentability inventions [… that] which is necessary to protect ordre public or morality.” This groundbreaking agreement paved way for the Doha Declaration in 2001, which further emphasized the flexibility of TRIPS member states in getting around patent rights to essential medicines. While acute diseases, spurring on national emergencies, are listed for public health crises, given current trends in the prevalence of NCDs, the Doha Declaration may experience revisions unforeseen ten years ago, and what exactly constitutes a public health crisis will come under fire. Countries may manufacture without consent drugs to treat obesity-related conditions as well as fighting AIDS.
This drive for individual expression, whether it is showing wealth by eating unhealthy foods in a country where a great many people do not have the ability to make ends meet, or to ignore copyright law for the good of many at the expense of a few shareholders, lies at the very heart the conflict to uphold of the universal idea of health laid down by the World Health Organization. The Supreme Court of the United States has further emphasized the “freedom of information,” but freedom now means producers can advertise to the general public potentially harmful products: cigarettes. In Lorillard v. Reilly, the Supreme Court mandated removing tobacco advertising limitations designed to protect Massachusetts children. The Court explained this decision by citing smoking as a lawful activity and that tobacco companies had an interest in providing accurate information about their product. The law sends a mixed message about the freedom to live in an environment where harmful interests daily interact with people to produce health issues. The Supreme Court strikes down most efforts to create a paternalistic intervention to prevent unhealthy lifestyle choices that would undermine personal freedom and responsibility, highlighting the tension between protecting public health and protecting personal responsibility. The developed world is not setting the best example for others to follow. If tobacco can be advertised when small children are watching, McDonald’s can target with equal impunity small children.
The global economic downturn had made it more difficult for those living in poverty to gain access to adequately-healthy food. The endemic threat posed by NCDs has been addressed by global strategies and charters, United Nations summits, and other international movements, gently guiding nations towards reducing obesity levels. The problem is that generating international law to combat non-communicable diseases must not oppose national law and initiatives and vice versa, reducing economic clannishness and protectionism, and thereby lowering global food prices and allowing more people access to food.
Governments around the world must take steps to make healthy food available to all those who need it, especially giving food aid to developing nations; and pharmaceutical companies must, even in hard times, make readily available essential medicine to poverty-stricken countries who can benefit from this the most. Lipitor, Avandia, Plavix, Viracept, Norvir, Sustiva, and many other drugs that treat high cholesterol, prevent blood clots, and control HIV respectively, and many other expensive, time-tested drugs will within five years become first-time generic or Rx-to-OTC. While there is no pill to cure obesity, its effects can be controlled. The pressure to litigate and reapply patents will be strong, but governments, especially the United States, must take a firm stance and allow these medications to slip into the public domain. Even if readily available, cheap medication is not seen as the best solution to solving the spread of chronic, non-communicable diseases.
Even though it has been more than sixty years since the WHO set down its standards of health, they ring as true today as they did following the hemoclysms of the first half of the twentieth century. Supranational organizations that exert considerable economic influence, such as the European Union, have the power to change the social status quo, encouraging and even mandating healthier lifestyle “paths.” Basic foodstuffs are abundant worldwide but are astonishingly poorly distributed. The temptation to purchase cheaper, less-healthy foods where possible is ever present, but surely the economic loss presented by NCDs outweighs the pain of pain of passing on the fries and a shake. National political units must take note of what it means to be healthy and encourage healthy habits to defray costs in the long run. Cracking down globally on tobacco was a good first step for many countries. Will there ever come a time when Twinkies cannot be consumed within two hundred feet of a school anywhere?





