2 May 2017

The coexistence of hamburgers and saté in Indonesia

Isabel writes:*

Indonesia is undergoing a ‘nutrition transition’ similar to that of many other developing countries (Hanandita and Tampubulon, 2015). This nutrition transition is characterized by a shift from the ‘end of famine’ nutrition stage into the ‘overeating’ stage in which there is an abundance of high-calorie foods. What makes Indonesia an interesting case is that it is experiencing many different versions of this nutrition transition. With over seventeen thousand islands Indonesia is geographically and culturally highly diverse. Because of this diversity, islands in Indonesia are developing at different rates. This causes for the Double Burden of Malnutrition (DBM) to be present in Indonesia, i.e., simultaneous under- and over-nutrition.

The estimated national prevalence of underweight is 14.4% while overweight is projected at 17.9%. This means that a third of the Indonesian population is malnourished, and exemplifies the DBM problem Indonesia faces. Interestingly, the risk of under- and over-nutrition to occur is spatially clustered. As Figure 1 shows, under-nutrition is observed in South Sumatra, Central and South Kalimantan and the North-Coast of Java. Over-nutrition is especially detected in North Sumatra, West and East Java and Sulawesi. This is an important finding as common factors between these areas tell us more about which factors drive the DBM.

Figure 1: under- and over-nutrition
Research has shown that those districts that have a higher expenditure per capita have greater obesity rates than the ones with lower expenditures. Additionally, obesity is more prevalent in urban areas, and significantly higher among women than men. This is in line with the spatial correlation discussed earlier; those areas in which the risk of overweight was substantially higher are generally more urbanized and have higher incomes. In these areas two important developments are emerging alongside each other; urbanization has created urban lifestyles for these people which makes them reliant on less fresh foods, as well as diet Westernization occurs in these areas due to higher incomes. This causes for an increase in the consumption of more fatty, high in sugar foods.

In the end, what this tells us is that the DBM is ultimately related to inequalities among the population of Indonesia. However, this makes tackling the DBM difficult as simply attempting to reduce poverty would not necessarily improve the nutrition situation as more people would be at risk for obesity. The problem of the DBM is thus as complex as defining its geographical borders.

Bottom LineThe Double Burden of Malnutrition exemplifies that economic growth does not equal development in Indonesia. Because of the geographical and cultural diversity of Indonesia differences among development levels exist which outs itself in both undernutrition and over nutrition. Thus, despite recent economic growth, inequalities persist and nutritionally the population is not better off.

* Please comment on these posts by students in my growth & development economics course. It really helps if you highlight unclear analysis, alternative perspectives, better data, etc.


Esmee Hendriksen said...

Isabel, I really enjoyed this post and it definitely gave me new insights into Indonesia's nutrition transition and how it shows that economic growth does not necessarily go in line with a country's development, as it leads to inequality.

To add to your post, an interesting finding that The World Bank has brought up, is that people who experience malnutrition in an early stage of their lives, have a bigger risk of becoming obese when they are older. (http://www.worldbank.org/en/news/feature/2015/04/23/the-double-burden-of-malnutrition-in-indonesia) This finding thus shows how undernutrition can reinforce over-nutrition. Now, how do we solve this problem? Looking at solutions from a food production perspective, reducing poverty and thus reducing economic inequality within the country might not be able to completely solve malnutrition, as resources are scarce and food production is limited, so as the demand for food rises exponentially, supply might not be able to catch up.

However, I do think that reducing income inequality is generally a crucial part of fostering development within Indonesia. Perhaps, in order to prevent more income equality from leading to over nutrition and resource scarcity, in our policies we should pay more attention to education about nutrition. Educating young people in the underdeveloped areas about the risks of obesity and diabetes might prevent them from becoming overweight later in life, once they might become part of the middle class.

Markéta Prokopová said...

Hi Isabel! I enjoyed reading your blogpost. I think, your blog post actually brings up an interesting challenge - rising obesity and overweigh levels which unfortunately many countries are facing at the moment. The threat of rising obesity and overweight levels is very big even in developed countries (e.g. the US and the UK). The difference is however that the developed countries are not shifting from the “end of famine” nutrition stage into the “overeating’ stage”, but rather from “normal eating stage” to “over eating stage”. Nevertheless, it seems like that in “both worlds” (developed and developing) one might find similar causes for such transitions.

In your blog post you pointed out that areas with higher expenditure per capita tend to have greater obesity rates than the ones with lower expenditures. Yet, this is also a common case in developed countries, since people usually tend to consume more food than they need when they can afford it (this is exactly what happened in Czechoslovakia in 1990s). The current scientists and doctors from the developed countries also point out that obesity is also associated with urban lifestyles, limited access to fresh foods, and so called “Westernization.” So from this point of view, Indonesia does not seem to be facing any significantly different conditions.

Nevertheless, your blog post inspired me to consider whether the obesity and overweight levels could ever be used as some kind of predictor of countries’ development. It is important to take into account that obesity and overweight significantly increases the risks of developing diseases associated with obesity and overweight such as cardiovascular diseases or cancer. Moreover, according to the statistics obese (and overweight) people tend to be less productive due to their medical and physical limitations. Furthermore, there is a high probability that the obese and overweight people will be in fact creating negative externality which will burden the state. Simply stated, obesity and overweigh can in fact worsen the quality of human capital, which could further impact the economic growth and the “wellbeing of others”. Nowadays, we aim to measure various forms of wellbeing which are used as supporting indicators of development. Using the same logic and the argument (which I summarized above) I think, obesity and overweight could also be used as indicators of “development.” In sum, by having more obese and overweight people, the society tends to struggle more which would imply higher the index score, which would suggest worse human capital quality.

Arvid said...

Interesting article, particularly on the spatial clustering of the two different types of malnutrition and how they both can be linked to specific socio-economic indicators such as urbanization and per capita expenditures.

A part of your bottomline "Thus, despite recent economic growth, inequalities persist and nutritionally the population is not better off." made me think whether quality of nutrition could be modeled into a Kuznets curve. Simply put: Perhaps economic growth will initially not improve nutrition from a quality perspective, but overtime it will improve.

There has been some research done on a health kuznets curve which shows a link between income-related health inequalities and economic
development (GDP per capita). Perhaps this might also be true for nutrition seeing as Western Countries have suddenly become obsessed with 'super foods'.

Source: http://eprints.lse.ac.uk/68782/7/Costa-Font_Health%20Kuznets%20curve_2017_published_LSERO.pdf

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