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Saving Our Lunch

Déjà vu all over again.

That might be Yogi Berra's response to the current concerns about food security. If you are old enough, you may remember Paul Ehrlich's book The Population Bomb that forecast widespread famine due to population growth. Hundreds of millions of people would die of starvation. In 1967, the U.S. President's Science Advisory Committee wrote, "The scale, severity and duration of the world food problem are so great that a massive, long-range, innovative effort unprecedented in human history will be required to master it."

The Rockefeller and Ford foundations took on this challenge and established an international agricultural research system. Norman Borlaug, "Father of the Green Revolution," developed new, high-yield, disease-resistant varieties of wheat. (High-yield rice was developed as well.) These new varieties, along with improvements in agricultural sciences, led to remarkable increases in grain production. For example, wheat yields increased from 2 to 6 metric tons per hectare in only 40 years. In contrast, it had taken over 1,000 years for wheat production to increase from 0.5 to 2 metric tons per hectare. Borlaug is credited with saving a billion lives and won the Nobel Peace Prize, the Presidential Medal of Freedom and the Congressional Gold Medal for his work.

The population surge happened, but the global famine did not-a technological deus ex machina literally saved our lunch!

The public health agenda is clear: We need more sustainable ways of producing food, and societies with unfettered access to calories have to relearn what to eat.

Fast forward to 2014. We find that the world today is even more complex than it was back in the late 1960s. Undernutrition is still a major concern in poor countries, and the challenge of feeding 10 billion or so people by the end of this century is daunting. Agricultural productivity has not increased everywhere, notably Africa. The Green Revolution, dependent on use of inorganic fertilizers and modern pesticides produced with fossil fuels, would not now be called "green." As income levels rise, economic disparities grow. Those at the top of the economic ladder adopt a Western, high-meat diet, often delivered through fast-food outlets. Overnutrition is leading to epidemics of obesity. Diabetes is, paradoxically, an issue in many countries where undernutrition is common. More than half of the world's population now lives in cities, removed from the farms that produce food.

The impact of separating production from consumption was brought home by a former executive chef of the Baltimore City school system who once told me, "I have 80,000 kids who think that fruit is a flavor." Worsening this gulf are "food deserts" in many U.S. cities where people never see fresh foods and have access only to calorie-dense, nutrient-poor foods. A few years ago, I was visiting City Hall in Baltimore and noticed a bountiful urban garden outside. As I surveyed the unfenced plot of peppers, beans and tomatoes, I asked the gardener whether theft was a problem. She said unfortunately not, people did not even understand that the vegetables were food. Instead visitors continually asked her the names of the plants. Americans have forgotten what real food is.

In the U.S., food is cheaper now than ever before. In 1929, for example, Americans spent 20 percent of their disposable income on food at home, compared to 6 percent in 2012. Overweight and obesity are now the new norm. Concentrated animal feeding operations mean that we have achieved new levels of efficiency in food production, but they come with the unintended consequences of environmental degradation and human consumption of pesticides and antibiotics (used to increase fruit and vegetable production and weight gain in animals). These external costs are not reflected in the record-low food prices.

E.V. McCollum, who discovered vitamins A and D, and was a professor at our School from 1917 to 1946, taught us that what we eat and when we eat it over the life course is a major determinant of the health of individuals and populations. Forty years after the Green Revolution began, today's public health agenda is clear. We need to develop more sustainable ways of producing food, continue to improve nutrition in undernourished populations, and make diets healthier for those at the top of the economic pyramid. Young children must get the calories and nutrients that they need for optimal development but not be force-fed into obesity. Societies with unfettered access to calories have to relearn what to eat.

However, changing what we eat is more complex than it sounds. It involves not just personal choice but also changing methods of food production and delivery systems so that the right choice becomes the default choice. A new "Green Revolution" that relies on sustainable methods of food production will require partnerships of farmers, agronomists, development agencies and policymakers. Interventions to change the norms of what we eat must be culturally appropriate, and take into account the context of nutritional needs within the population. Such interventions will require partners who understand human and plant biology, behavior, economics and policy. This type of multidisciplinary, population-based effort is a centerpiece of public health, and public health has led the way in raising and solving challenges to food security.

Forty years ago, the Green Revolution did the impossible. Now we must do it again.

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