From Demographic to Nutritional Transition
Historical research on hunger and nutrition has taken on different historiographical orientations. Economic history and historical demography have been traditional approaches when carrying out research on hunger and nutrition, and are considered to be factors that influence the productivity, disease and mortality that condition the demographic evolution, growth and decrease of a population. The concept of nutritional transition has been recently introduced by economy historians to express the importance of nutrition and diet as a meaningful factor in the changes in living standards during the social development of Western societies in the 20th century. The idea of a nutritional transition has added a new perspective to the process of modernisation experienced by Western societies in the 19th and 20th centuries. Prior to that, the concept of demographic transition had been proposed and generally introduced into historiography as a useful historiographical tool since the middle decades of the last century. The process of demographic transition helped to explain the changes identified in the internal structure of the populations during the modernisation period, as a consequence of changes in mortality, fertility and life expectancy.
Later, the idea of an epidemiologic transition underlying demographic changes pointed to specific transformations in the patterns of dominant diseases, morbidity and mortality rates. The notion of epidemiologic transition paved the way for a more general health transition accompanied by a transition of risks resulting from the spread of medical technologies, the urban/rural divide, agricultural/industrial societies, labour structure, health care organisation, sanitary campaigns, life expectancy and other social transformations affecting the levels of health and the way in which disease, as a social reality, appears at a specific time and place.
With the aim of explaining the transition followed by industrialised societies, economy and demography historians suggested in the 1990s the idea of a nutritional transition, which would have taken place simultaneously to the demographic and epidemiologic transitions, directly related to the availability of foodstuffs and the changes experienced in the composition of diets among the different social groups. Obviously, the idea of a transition to modernisation from any other form of traditional society, as defined by historiography, implies the acceptance of a common pattern in the process of evolution of any society regarding the changes experienced by the structure of the population, the standards of health and the dietary habits. All countries, since the end of the 18th century, would have followed the same evolution at different speeds, something that could be accepted for the greater picture but which had to be discussed for each particular factor and context. To a great extent, those models of transition were proposed not only to explain past and present issues, but also to foresee and successfully face future challenges. The picture they showed aimed to draft economic, social and health policies in order to reduce deficiencies and inequalities in the standards of living of the Western population after World War II, especially in poor regions.
Since transitional patterns include a prospective target as a practical tool to analyse future tendencies and shape new political strategies to improve nutritional and living standards, the definition of factors influencing social development - apart from the level of income and economic growth - has become increasingly essential. Demographic and health problems after World War II in countries with slow economic growth pointed out the necessity of taking into consideration any variable factor influencing the health status of the population, with the evolution of the income level proving insufficient to explain the transitional processes. Housing, environmental conditions, access to foodstuffs, the amount and composition of the diet, medical technologies, hygiene, levels of education and cultural habits appeared as complementary factors. This was confirmed by the inability of more simple indicators such as the levels of income and economic growth to explain the evolution of health improvements. A wider approach that
included not only simple economic factors was required and at least three groups of factors were considered as influencing the evolution of health: environmental and cultural conditions; the health care service/system and social assistance organisation; and techno-scientific improvements, not only in medical therapy and prevention technologies but also in food production, agricultural modernisation, industrialisation of food production, distribution channels, global access and dietary habits.
Considering the fact that all these factors have changed over time and that they vary across countries, different patterns of transition have been accepted, which means that the idea of a nutritional transition that includes all such factors appears to be more complex nowadays than the previous approach based on demographic, epidemiologic and sanitary features. However, demographic, epidemiologic, sanitary, risk and nutritional transitions were proposed in different contexts according to the availability of records on the evolution of mortality and birth rates, causes of death and disease, access to foodstuffs and composition of the diet. Usually, such records were reported for a very specific group of developed countries and forecasts were made about the future evolution of the population, health and diet in other countries with more deficient statistics and also in poor countries that lack reliable records. Is this type of projection a solid instrument to analyse and foresee what is going on in those countries?
It is worth highlighting the political dimension of the transitional patterns proposed by recent historiography as a reference for political strategies aimed at reducing tensions, managing demographic pressure and facing foodstuff crises during the inter-war years and the period after World War II. Those models served as a reference for programmes of stabilisation during the Cold War, a period characterised by demographic expansion and a shortage of food in many regions. At the same time, we should keep in mind that a decolonisation process was taking place mostly in Africa and Asia. In this context, Theodor W. Schultz proposed, for the first time, the idea of a nutritional transition in his book Food for the World. The book summarised the conclusions of a famous meeting held in Chicago before the end of the war in order to discuss the situation of the global food market and the prospects for the production of foodstuffs during the post-war years. This influential meeting was to give impulse to the creation of the Food and Agriculture Organization (FAO).
In this meeting, Frank W. Notestein discussed the importance of the world demographic situation. He focused the challenge on the possibility of a slow reproduction of the Western demographic evolution in other countries and continents by anticipating the capacity to accelerate changes in countries with low economic growth if certain policies were implemented. Based on few demographic records, he identified the demographic situation in different countries, making a projection of the evolution of the population in large regions in the world, as well as the demands for foodstuffs derived from it in future times. The definition of a demographic transition, conceived as a global process, was soon introduced into the academic sphere and served as a tool of analysis for international and national agencies. Initially, mortality was the nuclear factor considered, but fecundity soon occupied the central place, since the need to stop and control the growth of the population in industrialised countries was pressing.
In the early 1970s the idea of an epidemiologic transition stressed the importance of concepts such as social dominant diseases, death causes and fertility rates as influential factors for social change. The idea of an epidemiologic and sanitary transition was defined after World War II in industrialised countries, which were characterised by a decrease in overall mortality, child mortality and infant mortality as a consequence of a reduction in infectious diseases accompanied by a rise in life expectancy. Non-infectious diseases and accidents emerged as major social health problems. In societies where traditional plagues had been controlled (mainly through better feeding, sanitation systems, housing and medical preventive technologies), chronic infectious diseases such as tuberculosis, typhoid fever, malaria and venereal diseases were substituted as socially dominant diseases by cancer, heart attacks, strokes and traffic and industrial accidents as main causes of death and invalidity. Obviously, the higher life expectancy had an influence as well on the growing importance of degenerative diseases and vascular accidents.
Epidemiologic and health transitions are considered to be paths followed by all societies, regardless of their pace of evolution. However, they were probably faster on continents other than Europe, as a consequence of the implementation of medical technologies and immunisation campaigns. But predictions failed as a result of the critical ending of the Cold War, and the effects of the globalisation process led to a delay in the evolution of Eastern European countries and to a terrible situation in Africa. A new crisis broke out: new emergent virus diseases, such as AIDS, and life expectancy fell dramatically in wide regions of the planet.
The nutritional transition pattern proposed by economic historians and demographers added the crucial importance of nutrition and diets to explain social change. The radical effects of structural and cyclical famines that affected populations during the Ancien Regime have been widely acknowledged by traditional historiography. Those famines were the cause of the high mortality rates and the main factor behind the demographic catastrophe, contributing to the stagnant population model. The demographic and epidemiologic transition did coincide with a reduction in hunger and famine, as well as the agricultural expansion and the shaping of a global food market. Records on food consumption, the content and variety of diets, food availability, dietary habits, as well as other aspects such as the height of the population and the labour structure, contributed a great deal of information about the effects of nutrition and diet over the population and the several diseases associated with nutritional deficiencies.
Recent research on the nutritional transition in non-Western countries has shown the quick spread of changes in diet in many countries in Asia, Africa and America. From a purely demographic and economic perspective, any nutritional deficiency, malnutrition, overfeeding, industrial production of foodstuffs and regulation of food quality have become a matter of concern under critical situations in which high rates of demographic growth and nutritional deficiencies threaten millions of lives. Nutrition requires not only a healthy diet based on enough food, but also social, cultural and economic policies.
The evolution of the level of income, and the economic growth experienced by many countries and world regions, are not sufficient arguments to explain the social change identified by historians under the concepts of demographic, epidemiologic, health and nutritional transitions during the second half of the 20th century in Europe. In a complementary way, it is essential to consider, as a main factor, the role of the social agents: international institutions, experts, scientists, practitioners, governments, industry, propaganda, housewives and cooking habits. All of them play a part in the reduction of social inequalities. The evolution of the levels of income - though an important factor - represents just one of the multiple factors that influence health, nutritional status and diet.
The European pattern of social change that we have named nutritional transition adopted different shapes and chronologies in the different countries. In the case of Spau^ it achieved a degree of modernisation during the course of the 20th century, consolidating the process of nutrition and diet transition by the 1970s. Other countries went through the process faster. The problems associated with a deficient diet and malnutrition had been overcome, with obesity emerging as a new threat. Like in most European countries, the nutritional transition from scarcity to overfeeding started in the 1920s and 1930s. But in the case of Spain, chronic malnutrition affected large sectors of the population as a consequence of the Civil War (1936-1939) and the post-war years.
In the late 1940s the nutritional landscape of the Spanish population was still a poor one, as we shall discuss in a further chapter. A low calorie and protein intake, marked by low quality proteins of vegetable origin and a shortage of calcium and vitamins, made up the overall picture. In this particular case, the decade of the 1950s was a crucial stage. In the late 1950s and early 1960s the Escuela de Bromatologia [School of Bromatology] in Madrid carried out research into the Spanish diet and concluded that a small part of the population still had an insufficient calorie intake, whilst 40 per cent of the population consumed too many calories. The total protein intake was adequate, mainly of vegetable origin, although significant deficiencies were still present regarding the intake of vitamins. Agricultural labourers and industrial workers were identified as the social groups that had the worst diet. In fact, the rural surveys carried out during the 1960s showed that the consumption of proteins was no longer deficient but in rural areas the majority of proteins were of vegetable origin, a low intake of calcium affecting most of the population.
According to current research, by the end of the 1960s the population in Western European countries was able to meet their energy, protein and most of their micronutrient requirements, and their caloric profile reflected almost perfectly the recommendations of international organisations. Carbohydrates accounted for 53 per cent of the caloric intake, proteins 12 per cent, and lipids 32 per cent. Between 1940 and 1960 the European nutritional picture shifted from the existence of significant nutritional deficiencies caused by the economic crisis, war and post-war periods, with an insufficient protein intake and severe mineral and vitamin deficiencies, to a tendency characterised by an excessive dietary intake of calories, sugar and fats. The situation worsened with the rise of a more sedentary lifestyle and its subsequently reduced energy needs. Meanwhile, the caloric intake increased at the expense of simple carbohydrates, leading to a significant rise in obesity and diabetes. The consumption of meat per person showed the most spectacular increase, particularly pork and poultry.
These changes in the diet of Europeans during the middle decades of the 20th century have been analysed in recent historical contributions, some of them taking into consideration the plurality of agents involved in the nutritional transition process. These include the role played by living conditions, research on anthropometric indicators, cultural factors such as body image or the impact of education, advertising and propaganda, local and state policies, institutional strategies and other studies addressing issues related to food policy.
This recent research gives an insight into the effects of industrialisation, increasing urban growth, women’s entry into the labour force and evidence of the changes in dietary habits. The availability of foodstuffs varied widely as a consequence of technological innovations and industrialisation in agriculture. Milk, chocolate, oil, wine, fruit and vegetables and other products all added to the growing impact of the food industry.
The previous arguments show that nutrition has increasingly become an interdisciplinary field of historical research. Traditionally, it was oriented in two main directions. One regarded several aspects of public health, considering the population’s nutritional state to be the most important issue. From this perspective, the content of the diet in rural and urban contexts, its change and evolution, and the detection of malnutrition and deficiency diseases, have contributed to the understanding of the nutritional transition and its demographic and epidemiologic impact. From this viewpoint, the production, circulation and spread of scientific knowledge, and the role of expertise and the nutritional education of the population, clearly became more and more important, especially in terms of the history of public health. This trend included not only health and demographic features, and social and institutional spheres, but also the role of cultural habits and social values from a more dynamic and anthropological perspective.
The other main historiography trend comes from economic history and focuses on agricultural policies, food production and consumption, distribution and availability of foodstuffs and their influence on the economy, trade and the market. This orientation also included research into socio-economic factors, standards of living, the role played by food and nutrition in the diet, studies of anthropometric indicators such as a synthetic index of well-being that tries to express the quality of the nutritional state, or analyses of the influence of socio-cultural factors, such as body image or the impact of advertising, among others.
At the same time, the diversity of experience and the importance of the local context have been shown to be among the most significant features of the variability in the nutritional transition process. In addition to anthropometric studies intended to show the relationship between height, weight and the environmental conditions that determine nutrition,32 the differences that had long been observed between urban and rural settings were noted as indicative of wider access to food in urban centres. Difficulties were also reported in the consumption of animal proteins, particularly milk and dairy products, in some European regions.33
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-  Cusso Segura, X., “Estado nutritivo de la poblacion espanola, 1900-1970: analisis delas necesidades y disponibilidades de nutrientes”, Revista de Agricultura e HistoriaRural, No. 36, 2005, pp. 329-358; Cusso Segura, X., Garrobou, R., “La transicionnutricional en la Espana, pp. 69-100; Langreo, A., Pujol Andreu, J., “Evolucioneconomica agroalimentaria”, Como viviamos: alimentos y alimentacion en la Espanadel siglo XX, Madrid, Lunwerg, 2007, pp. 41-66; Nicolau Nos, R., Pujol Andreu, J.,“Los factores condicionantes de la transicion nutricional en la Europa Occidental:Barcelona, 1890-1936”, Scripta Nova: Revista Electronica de Geografiay CienciasSociales, No. 12, 2008, pp. 256-265.
-  Simon Perez, H.J., Escudero, A., “El bienestar en Espana: una perspectiva de largoplazo, 1850-1991”, Revista de Historia Economica, No. 2, 2003, pp. 525-566.
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