103Book reviews / Food Policy 26 (2001) 97–105

Such mapping of the political terrain is basic to building effective advocacy effortsand for teaching how to engage the political process. It is also an agenda for nutritionpolicy research.

Nancy Milio (PhD, FAPHA, FAAN)*Professor of Health Policy and Administration School of Public Health,

Professor of Nursing The University of North Carolina at Chapel Hill,School of Nursing, Chapel Hill NC27599, USA

E-mail address:nancyFmilio@unc.edu

PII: S0306-9192(00)00027-0

Scaling Up, Scaling Down: Overcoming Malnutrition in Developing CountriesT.J. Marchione, (ed.) 1999, Gordon Breach Publishers, Amsterdam, The Netherlands

A very useful book. This collection of chapters avoids the common failing ofreading like a jumble of disconnected perspectives. Instead the editor has conjuredup a volume that on the whole is as good as its many good parts. One reason forthis success is the book’s sharp focus on malnutrition as a unifying theme rather thanon alternative rubrics such as ‘food insecurity’ or ‘hunger’. Keeping malnutrition tothe fore allows many issues to be covered but ensures that a common thread runsthrough the diverse macro-level analyses and micro-level case studies.

Entwined with the common thread are two important themes. The first is the argu-ment that an end to Cold War politics has ushered in a ‘new era’ of developmentthat requires us to review and reassess the problem of malnutrition. Starting with aconventional update on macro statistics and policy goals the book moves on quicklyto explore links between nutrition outcomes and determining sociopolitical, healthand economic processes. Such processes have been re-cast (it is argued) by globaliz-ation, liberalization and increasing democratization. This has two important cor-ollaries: on the one hand, nutrition has been ‘liberated’ from the confines of labora-tory and conventional donor lexicon. Dovetailing with the growing developmentfocus on community participation and empowerment, nutrition has ‘gone public’.Successes in community assessment and diagnosis, capacity building for community-level action, and community advocacy all reflect a quiet revolution. In this modelnutrition represents a body of empirical scienceand a set of sociopolitical realitiessimultaneously. Informative examples are offered from Haiti (the Hearth model),Vietnam, Bangladesh, Togo, South Africa and elsewhere (although the degree ofreplicability is not always self-evident, especially for poorer countries with less donorvisibility and support).

On the other hand, malnutrition is increasing recognized as a cross-disciplinaryagenda—a problem to be solved (to paraphrase the late Jean Mayer) rather than a

104 Book reviews / Food Policy 26 (2001) 97–105

discipline to be studied. The ‘new’ agenda for action brings together coalitions ofpractitioners at all levels (from the international summit arena to the village hearth),and across many sectors of research and action. The book cautions against ‘neo-liberal’ reliance on economic growth or trade to resolve nutrition problems—com-munities have to take a lead in defining and meeting their needs but often thatrequires cooperation with (improved) public institutions. Just as the limits and con-straints of public action need to be clearly spelt out, so too should the limits andconstraints of anonymous market forces. That said, no single public institution orsector of activity can alone tackle the scale and scope of malnutrition. This is nota call for returning to the do-it-all ‘integrated’ multi-sectoral development modelsof decades past, rather for better definition of responsibilities and accountability forall sectors.

A second major theme running through the book is that achieving desired goals,even in the ‘new’ context of public action, will not be easy. There is a laudablestreak of realism in most of the chapters; there are no ‘silver bullets’ anywhere tobe seen. National politics, vested interests and staff morale are shown to be keyconstraints that warrant strategies for action in their own right; removing constraintsto service delivery is as important as designing new services to deliver. Donor agencyconcerns are not ignored—the need to “show results” is identified as an importantdeterminant of how ‘international’ goals are set. And it is acknowledged that advo-cacy and social activism can be hi-jacked for personal or group gain-devolution ofpower to the “grass-roots” may in itself not meet the ethnical standards of commonjustice and decency so often used in the rhetoric of empowerment.

The solutions proffered by this volume are less than revolutionary. Common senseanswers are suggested based on patience, training and human capacity building atall levels, stakeholder ownership, policy and institutional transparency, more pati-ence, the development of a community-level “culture of inquiry” that reshapes prob-lems and solutions in terms of local perceptions and demands, applied research intoreal problems, the removal of political and institutional constraints, and yet morepatience. Why these solutions will succeed better in the ‘new era’ than in the old isnever clearly elaborated.

Indeed one of the more obvious deficiencies of the book is the assumption thatthings have changed fundamentally in the last decade, and that such change willmanifest itself quickly even in remotest Chad, Guatemala or Mongolia. There aremany countries in which malnutrition has increased in the past decade, rather thanimproved, and many earlier success stories that have proven to be unsustainable evenunder the ‘new’ economic and political regimes of the 1990s. The fact that all ofthe case studies derive from countries in which donor and national concern for foodand nutrition security is relatively high suggests a need for complementary casestudies from countries in which the context for action is much less favorable. Further-more, the book pays limited attention either to acute malnutrition in the context ofhumanitarian emergencies—do community participation models work in the contextof inter-ethnic animosity?—or to the Latin American experience of community activ-ism and institutional developments in post-structural adjustment contexts.

But these few limitations should not detract from the many strengths of the volume

105Book reviews / Food Policy 26 (2001) 97–105

and the strong contribution made by the authors. Professional application from manydisciplines will be needed over the long run to overcome what is an entrenched prob-lem.

Donors, national governments, researchers and, yes, even non-governmentalagencies should pay heed to the underlying message that business as usual is notjust out-of-date, it is now out of line. The nutrition agenda cannot be divorced fromlab-based research or from macroeconomic or environmental policy priorities.Human justice is at the core of that agenda, and as such it requires a level of commit-ment that cannot be encapsulated in pill form for consumption once a day beforemeals.

Patrick WebbDirector, Food Policy and Applied Nutrition Programme,

School of Nutrition Science and Policy,Tufts University, 126 Curtis Street,

Medford MA 02155, USAE-mail address:patrick.webb@tufts.edu

PII: S0306-9192(00)00028-2