[Second Opinion] Unlimited rice, empty stomachs

by Gideon Lasco
Philippine Daily Inquirer

I don’t think Cynthia Villar anticipated that her comments on prohibiting “unlimited rice” will draw so much resentment and ridicule. But as she probably knows by now, “unli rice” is not just a gluttonous indulgence for Filipinos but also a compensatory recourse for those with limited means. I hope she also realizes that prohibitionism is not always the answer to our health problems.

To be fair to the senator, however, the idea of discouraging Filipinos from eating too much rice has been raised by experts for many years. In 2012, PhilRice lamented that each Filipino wastes two tablespoons of rice every day, “which, when not wasted, could result in import savings as high as P6.2 billion and could feed 2.6 million hungry Filipinos in a year.”

Her pronouncements mirror PhilRice’s lament and actually sound like something a nutritionist would say: “If possible, we should shift to brown rice so Filipinos would eat less and so that finally, we can be self-sufficient… Unlimited rice is bad for the health. We should learn how to eat more vegetables.” In this, the doctor in me heartily agrees with her.

Of course, what drew the most attention was her misguided suggestion that fast-food chains’ offerings of “unli rice” be prohibited. But now that she has backed down from it, her overall concerns remain salient. Leaving the specifics of rice sufficiency to the economists and agriculturists (which Cielito Habito discussed in his latest column here), what can we do to improve our state of (mal)nutrition?

To appreciate the magnitude of the problem, we have to bear in mind that one in three Filipino children remains stunted. Aside from making Filipinos among the shortest in the region, stunting has dire consequences for children’s health and overall development. Rice, in this context, remains very important because for many Filipinos, it is the main source not just of carbohydrates but also of protein. Ironically, while many are eating too much rice, the poor need more of it.
Instead of prohibiting unlimited rice, a more positive approach is to incentivize the offering of whole-grain (i.e., brown, red, or black) rice, which satiates the eater faster, has more fiber and vitamins, and is easier to produce (even if longer to cook). Surely, increased demand will lower prices.

Another is to go beyond rice and encourage the consumption of other kinds of carbohydrates. Granted, our very word for eating, “kain,” is linguistically and cognitively related to the word for rice, “kanin”—many Pinoys don’t feel full if they don’t eat rice. Also, our viands are prepared in such a way that their flavors are balanced by rice: Can you imagine eating kare-kare by itself?

There are alternatives, however, that can take the place of rice—though we may need to  develop more recipes for them. Despite their lowly reputation, root crops like kamote, gabi and ube are uber-healthy, not to mention easy to grow. There’s white corn, too—which UP Los Baños scientists recommend mixing with rice.

But beyond carbohydrates, a big problem is protein energy malnutrition—the lack of ulam caused by the prohibitive cost of meat and fish. In olden days, Filipinos had more diverse sources of protein: Even insects (now recommended by the World Health Organization) were part of the diet.

What may be more culturally acceptable and practical today, however, are beans and legumes. As the Food Nutrition Research Institute’s Charina Javier tells me, farmers usually plant these in between rice cropping cycles to enhance soil quality. Encouraging the public to embrace beans and root crops, alongside being “rice-ponsible” (as the Department of Agriculture puts it), will surely go a long way.

But what of the urban poor with nary a place to lay their heads, let alone plant crops? Ultimately, we must also address the structural causes of hunger and malnutrition, which include the flooding of our markets with cheap but unhealthy food, the miserable plight of our food growers, and, above all, the extreme poverty that leaves people with no choice but to eat what little — if any — food they can find.

In this age of “unli rice,” no Filipino should have to live with an empty stomach.

Originally published in the Philippine Daily Inquirer: http://opinion.inquirer.net/104983/unlimited-rice-empty-stomachs

Pantawid-gutom: Negotiating hunger in the Philippines

by Gideon Lasco, MD

TO TIDE OVER, through the sea of hunger from one island of satiety to another: such is the image conveyed by the term “pantawid-gutom”. For people who eat three meals a day, and meriendas in between, it may be a term that we rarely encounter in our everyday lives. But it means a lot for people who regularly experience what it feels to have an empty stomach.

What makes a good ‘pantawid-gutom’? The foremost and most obvious consideration is the ability to momentarily alleviate hunger. Second, it has to be easy to prepare and consume. Finally, it has to be affordable. After all, lack of funds is what keeps most people from buying better food in the first place.

Street foods are perhaps the most common form of pantawid-gutom. Doreen Fernandez surveyed Filipino street foods in the early 90's, dutifully chronicling some of their colourful names: Adidas for chicken feet, PAL for wings, Walkman for pigs’ ears. Over two decades later, these foods have been joined by pancit canton and other ‘instant’ foods such as candies and junk foods. High in oil, simple sugars, and artificial flavors, many of these foods have “empty calories” that do provide some energy, but without nutrients the body needs. Moreover, they have been implicated in the rise of non-communicable diseases like hypertension and heart disease as well as communicable ones like Hepatitis A and gastroenteritis. When people see what they eat as pantawid-gutom, they themselves recognise that these are not the ideal foods for their bodies, but given the circumstances, they would suffice.

Some also use certain drugs as pantawid-gutom. In my own research on the use of shabu (methamphetamine), I found that one of the drug’s desirable effects (for its users) is its potent ability to suppress hunger. This, and shabu’s other effects, such as giving alertness and allowing people to stay awake, makes it a particularly appealing choice for people who have to work all day and night, such as vendors and drivers, among many others. “Rugby” often used by street children, as well as the nicotine in cigarettes can have a similar effect. Much of the discourse around drugs has focused on how they are linked to addiction, peer pressure, and criminality, but often overlooked are the ways in which they are used by people to deal with their physiologic needs and everyday problems - such as hunger.

Who in our society commonly resort to pantawid-gutom? First, the urban poor, for whom access to food is as good as the money they could earn for the day - a “food insecurity” that we commonly express as “isang kahig, isang tuka” (one scratch, one bite). Children are not spared of this predicament, and the impact is particularly alarming: lack of healthy food leads to stunting and future health problems, as well as weak immune systems that contribute to more infant and child deaths.

Second, we have people who have to work for long hours without food. These include construction workers, laborers, street vendors, drivers, and many others. Often, these are people who belong to the informal sector, unprotected by labor laws. Their lack of funds and time to prepare for food impels them to eat just enough pantawid-gutom to stave off hunger until they get home.

Finally, we have overworked individuals - whether in the corporate world, in call centers, hospitals, schools, and various other institutions. They too, sometimes resort to pantawid-gutom to finish their tasks.

Drawing on the meanings of pantawid-gutom, the government named its conditional cash transfer scheme as “Pantawid Pamilyang Pilipino Program”, or ‘4Ps’. While there have been indications of positive results, its wider impact remains unclear. According to a recent SWS survey, 4.8 million Filipino families said they experienced hunger in the past month, representing 22% of our entire population.

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THE WHOLE NOTION of pantawid-gutom speaks to us of the hunger that many Filipinos experience on a daily basis, and the tactics (“diskarte”) they deploy in order to get by (“makaraos”). Sadly, many of us have been desensitised to images of children sniffing rugby, or families on the streets partaking of pancit canton and whatever else they can find. Moreover, access to healthy foods among people working in different sectors, formal or informal, have oftentimes been overlooked.

The challenge for nutritionists and policymakers is to come up and promote food alternatives that are safer and healthier, but just as accessible and affordable. Admittedly, this is not an easy task, because for food to be “instant” and “cheap”, a lot of nutritional sacrifices have to be made. But we can start with foods that already there, like protein-rich taho (sweetened snack made of soy), boiled bananas, and kamote-cue. In addition, these efforts should go hand in hand with strengthening the agricultural sector to increase yield and lower food prices. Moreover, for people who resort to pantawid-gutom out of convenience, not out of necessity, education about the health risks of an unbalanced diet can go a long way.

As for those for whom there is little choice, we are called upon to show understanding, empathy, and solidarity. Many Filipinos rely on pantawid-gutom - unsafe and unhealthy foods and even drugs - to tide them over, even as the economic gulf grows wider, and the islands of satiety seem fewer and further apart. Rather than be judgmental or indifferent to their predicament, we should examine and act on the circumstances that have led to their chronic hunger in the first place.

Quezon City
February 26, 2015