Obesity, hunger, and agriculture: the damaging role of subsidies
http://www.100md.com
《英国医生杂志》
1 Swedish National Institute of Public Health, 103 52 Stockholm, Sweden
Correspondence to: L Sch?fer Elinder liselotte.elinder@fhi.se
Globally, we are producing more food than the population needs. Subsidising overproduction in Europe is affecting the health of people in both Africa and Europe
Being overweight is becoming the norm rather than the exception in most developed countries, and obesity is a serious health problem worldwide.1 Many people see obesity as a lifestyle issue. However, behavioural interventions to prevent obesity in both adults and children have generally been ineffective,2 indicating strong influences beyond individual control. Considerable resources are currently invested in developing drugs to prevent and treat obesity. However, from a societal perspective, prevention of obesity through diet and physical activity should be given priority for both economic and ethical reasons.1 3 Chopra and DarntonHill recently suggested that we need a global strategy on food similar to the Framework Convention on Tobacco Control.4 Their suggested actions are mainly aimed at reducing demand for food. But we argue it is equally important to tackle the oversupply of food, driven by agricultural subsidies.
European common agricultural policy
The societal changes causing the worldwide increase in body mass index include mass production of heavily marketed, energy dense foods, globalisation of trade and taste, technological developments in the workplace, a sedentary lifestyle, and the reduction in active transport.5 6 Improvements in agricultural productivity over the past decades have facilitated a massive increase in dietary energy intake.
Actually, the main problem for the agricultural sector in many developed countries is overproduction.7 Several studies have suggested that overproduction of food followed by excessive consumption is the prime cause of the increase in body mass index in the United States and elsewhere.8 9 Continued subsidy to stimulate production of food through agricultural policy is therefore paradoxical. Obesity and associated noncommunicable diseases cause costs for health care and lost productivity, and overproduction in agriculture causes environmental degradation. But these negative effects are difficult to influence through behavioural intervention because consumers do not bear the full costs. The World Health Organization has noted this problem, and its global strategy on diet, physical activity, and health recommends that "Member states need to take healthy nutrition into account in their agricultural policies."10
The dairy sector in the European Union is an example of how agriculture subsidies can lead to negative health effects in Europe as well as in developing countries. The European Union spends almost 2bn (￡1.4bn, $2.4bn) a year to maintain production levels at 20% above the domestic demand and at prices twice as high as on the world market.11 Without subsidies, production would quickly adapt to the level of demand. However, for historical reasons, and because of strong lobbying, milk production in the European Union is highly protected.
Surplus milk is converted to the storable products skimmed milk powder and butter. Butter mountains are expensive to maintain and create negative publicity. Therefore, export subsidies and domestic consumption aids are granted in order to dispose of it. Export subsidies for milk products undermine the milk sector in many developing countries such as the Dominican Republic, Kenya, India, and Jamaica.12 Domestic consumption aid for butter at a yearly cost of 500m is granted to one third of all butter produced in the European Union, corresponding to 1.5 kg of butter per European citizen a year. This butter is sold with subsidies to the food industry, which turns it into mainly ice cream and cakes (fig 1).13
Fig 1 Quantities of European Union butter receiving consumption aid from 1995 to 2003.13
The European school milk scheme is another outlet of surplus milk.11 Higher subsidies given to milk with a higher fat content has led to only 5% of Swedish school children drinking the recommended skimmed milk with their school lunches (Swedish National Food Administration, unpublished figures). In theory, a child who drinks full fat milk instead of skimmed milk receives an extra 1.5 kg of saturated fat each year from school milk alone.
Increasing dietary energy supplies worldwide
Figures from the Food and Agriculture Organization show that global per capita dietary energy supplies are rising and forecasted to grow for at least another 25 years (fig 2).14 A decreasing global population growth rate in combination with a strong growth in agricultural productivity has given us access to more and better food at declining real prices, in fact the lowest in history. People around the world can purchase more calories today for the same money as western Europeans could decades ago at a similar gross domestic product level. This is, of course, positive for the 850 million people who still suffer from hunger and malnutrition worldwide. However, the main reason for hunger is not a lack of global food supplies but lack of access to food, conflicts, natural and human disasters, animal and plant pests, and unfair international trade in combination with a lack of political will to eradicate it.15
Fig 2 Development of per capita dietary energy supply from 1964 until 203014
A daily energy intake of 9.2 MJ (2200 kcal) is regarded as necessary to avoid malnutrition, while more than 11.3-12.5 MJ a day will lead to obesity in people with a sedentary lifestyle.15 Income inequalities, the level of poverty and health care, and the fact that obesity shifts from the rich to the poor as income rises will determine the socio-epidemiological distribution of malnutrition, obesity, and non-communicable diseases in each country.16
In a climate of tough competition, sections of the food industry develop new and healthier value added foods at higher prices, benefiting mainly higher socioeconomic groups. But what is produced is eventually eaten by someone. Fat, sugar, and cereals are cheap and constitute the raw materials for energy dense and nutrient poor foods, which lead to passive overeating and obesity.5 17-19 Therefore, as long as the supply of energy dense foods is not reduced, the prevalence of obesity and social inequalities in health is likely to continue to increase. As a first step to reverse the obesity epidemic, agricultural market support promoting the overproduction of food has to be phased out.
The overproduction of food by developed countries also has detrimental health effects in other countries. The use of export subsidies by rich countries and tariffs on imported food is a serious obstacle for growth of the agricultural sector in developing countries.15 Agricultural growth has an important role in alleviating poverty and malnutrition because it increases food availability locally, creates employment, stimulates the rural economy, and reduces the cost of food for poor consumers.20 According to the Food and Agriculture Organization, rural development and agriculture are key to reducing poverty and hunger and reaching the millennium development goals.
Agricultural subsidies coupled to production should be phased out
The 2003 reform of the common agricultural policy, the main aim of which was to bring supply in line with demand, was a step in the right direction. It partially decoupled financial support from the amount of foods produced. However, the results of quantitative analysis by the Organisation for Economic Cooperation and Development indicate only modest (less than 1%) reductions in production of most commodities such as wheat, coarse grains, oilseeds, beef, pig meat, and poultry.21 Only rice production is expected to decrease significantly. Milk production in the European Union is expected to increase slightly until 2014-5 because of increases in the quota (the amount of milk eligible for subsidies). There are consequently no plans to phase out consumption aid for butter (Swedish Board of Agriculture, personal communication). Subsidised export is assumed to decrease by 4% for wheat, 6% for cheese, 8% for skimmed milk powder, and 17% for butter. This will result in falling prices on the European market and more energy available for consumption. Economists expect European consumption of butter to increase by 0.7%, cheese by 1.5%, and wheat by 0.3% by 2008. In other words, it is assumed that the population will contribute to solving the problems of the common agricultural policy by eating more. Clearly, the policy reform is a failure from the perspective of preventing obesity.
The public health sector must now engage in reform of the common agricultural policy. Health effects have been neglected despite article 152 in the Amsterdam Treaty saying that public health should be promoted by all EU policies. The ongoing discussions concerning the reform of the fruit and vegetable sector are an opportunity not to be missed.
The resources ploughed into agriculture in developed countries are enormous. The total transfers to agriculture in countries in the Organisation for Economic Cooperation and Development for 2003 amounted to $350bn (￡194bn, 288bn),7 half of which comes from taxpayers and half from consumers. Eliminating all agricultural policy distortions could produce global annual welfare gains up to $165bn according to the Food and Agriculture Organization because production would move to countries with comparative advantages.14 The global cost of not eradicating hunger—in terms of conflicts, recurrent emergencies, international crime, the drug trade, terrorism, clandestine migration, and the premature death of those who are hungry—is enormous.15 To this should be added the cost of environmental damage from agriculture, which might be even higher.
Summary points
Current dietary energy supply is more than sufficient to alleviate starvation worldwide and is forecasted to grow for another 25 years
Agriculture subsidies coupled to production distort the balance between supply and demand, leading to overconsumption and obesity
Overproduction of food in rich countries using trade distorting measures undermines the agricultural sectors in developing countries, hindering the eradication of hunger and poverty
Phasing out of agricultural producer support in developed countries is the first step in the fight against both obesity and hunger
In comparison, the estimated cost for food for the 850 million people who currently are food insecure is $10.4bn a year, while the annual cost of ensuring sound nutrition and health in developing countries is estimated to be $70-80bn in addition to the $136bn currently spent.15 The official development aid needs for achievement of the millennium development goals have been estimated to be $135bn for 2006 rising to $195bn in 2015.22
Two steps towards better health
Phasing out of market support for agricultural producers in developed countries is necessary as a first step in the fight against obesity, poverty, and hunger worldwide. In addition, the money saved in taxes could be used for ensuring sound nutrition and health in developing countries and for reaching the millennium development goals. Agricultural market support paid from taxes can be defended only if the food is undersupplied—that is, if the market fails—which was the case when the common agricultural policy was founded in the late 1950s.
But even if subsidies are phased out, global supplies will probably continue to be higher than "healthy" demand for many years to come. The food industry will fight for its markets and try to expand them. Therefore, as a second step, internationally binding conventions like the one on tobacco are needed. These should include issues such as marketing of energy dense foods, availability to children, labelling, and tax and price measures, as suggested by Chopra and Darnton-Hill.4 Such conventions will require governments, WHO, and the Food and Agriculture Organization to take a strong role. However, government failures must be corrected before market failures can be tackled. Before we brake, we should take the foot off the gas.
LSE has worked at the National Institute of Public Health in Sweden since 1998. Her main areas of interest are nutrition, physical activity, obesity, policy development, health impact assessment, and agriculture policy. Sources of information are reports from the European Commission, the WHO, OECD, FAO as well as the scientific literature.
Competing interests: None declared.
References
World Health Organization. Obesity: preventing and managing the global epidemic. Geneva: WHO, 2000. (WHO technical report 894.)
Mulvihill C, Quigley R. The management of obesity and overweight, an analysis of reviews of diet, physical activity and behavioural approaches. London: Health Development Agency, 2003.
Visscher T, Seidell J. The public health impact of obesity. Annu Rev Public Health 2001;22: 355-75.
Chopra M, Darnton-Hill I. Tobacco and obesity epidemics: not so different after all? BMJ 2004;328: 1558-60.
World Health Organization. Diet, nutrition and the prevention of chronic diseases. Geneva: WHO, 2003. (Report No 916.)
Swinburn BA, Caterson I, Seidell JC, James WP. Diet, nutrition and the prevention of excess weight gain and obesity. Public Health Nutr 2004;7(1A): 123-46.
Organization for Economic Cooperation and Development. Agricultural Policies 2004. At a glance. Paris: OECD, 2004.
Putnam J, Allshouse J, Scott Kantor L. US per capita food supply trends: more calories, refined carbohydrates, and fats. Food Rev 2002;25(3): 2-15.
Silventoinen K, Sans S, Tolonen H, Monterde D, Kuulasmaa K, Kesteloot H, et al. Trends in obesity and energy supply in the WHO MONICA Project. Int J Obes Relat Metab Disord 2004;28: 710-8.
World Health Organization. Global strategy on diet, physical activity and health. Geneva: WHO, 2004.
Sch?fer Elinder L. Public health should return to the core of CAP reform. EuroChoices 2003;2(2): 32-5.
Oxfam. Milking the CAP. How Europe's dairy regime is devastating livelihoods in the developing world. Oxford: Oxfam, 2002.
European Commission. Thirty-fifth report on intervention measures in the milk and milk products sector 2003. Brussels: EC, 2004.
Food and Agriculture Organization of the United Nations. World agriculture: towards 2015/2030. Summary report. Rome: FAO, 2002.
Food and Agriculture Organization of the United Nations. The world food summit five years later. Mobilizing the political will and resources to banish world hunger. Rome: FAO, 2004.
Monteiro C, Moura EC, Conde WL, Popkin BM. Socioeconomic status and obesity in adult populations of developing countries: a review. Bull World Health Organ 2004;82: 940-6.
Prentice AM, Jebb SA. Fast foods, energy density and obesity: a possible mechanistic link. Obes Rev 2003;4(4): 187-94.
Schulze MB, Manson JE, Ludwig DS, Colditz GA, Stampfer MJ, Willett WC, et al. Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. JAMA 2004;292: 927-34.
Pereira MA, Kartashov AI, Ebbeling CB, van Hom L, Slattery ML, Jacobs DR Jr, et al. Fast-food habits, weight gain, and insulin resistance (the CARDIA study): 15-year prospective analysis. Lancet 2005;365: 36-42.
Irz X, Lin L, Thirtle C, Wiggins S. Agricultural productivity growth and poverty alleviation. Dev Policy Rev 2001;19: 449-66.
Organization for Economic Cooperation and Development. Analysis of the 2003 CAP reform. Paris: OECD, 2004.
Sachs JD, McArthur JW. The millennium project: a plan for meeting the millennium development goals. Lancet 2005;365: 347-53.(Liselotte Sch?fer Elinder, associate pro)
Correspondence to: L Sch?fer Elinder liselotte.elinder@fhi.se
Globally, we are producing more food than the population needs. Subsidising overproduction in Europe is affecting the health of people in both Africa and Europe
Being overweight is becoming the norm rather than the exception in most developed countries, and obesity is a serious health problem worldwide.1 Many people see obesity as a lifestyle issue. However, behavioural interventions to prevent obesity in both adults and children have generally been ineffective,2 indicating strong influences beyond individual control. Considerable resources are currently invested in developing drugs to prevent and treat obesity. However, from a societal perspective, prevention of obesity through diet and physical activity should be given priority for both economic and ethical reasons.1 3 Chopra and DarntonHill recently suggested that we need a global strategy on food similar to the Framework Convention on Tobacco Control.4 Their suggested actions are mainly aimed at reducing demand for food. But we argue it is equally important to tackle the oversupply of food, driven by agricultural subsidies.
European common agricultural policy
The societal changes causing the worldwide increase in body mass index include mass production of heavily marketed, energy dense foods, globalisation of trade and taste, technological developments in the workplace, a sedentary lifestyle, and the reduction in active transport.5 6 Improvements in agricultural productivity over the past decades have facilitated a massive increase in dietary energy intake.
Actually, the main problem for the agricultural sector in many developed countries is overproduction.7 Several studies have suggested that overproduction of food followed by excessive consumption is the prime cause of the increase in body mass index in the United States and elsewhere.8 9 Continued subsidy to stimulate production of food through agricultural policy is therefore paradoxical. Obesity and associated noncommunicable diseases cause costs for health care and lost productivity, and overproduction in agriculture causes environmental degradation. But these negative effects are difficult to influence through behavioural intervention because consumers do not bear the full costs. The World Health Organization has noted this problem, and its global strategy on diet, physical activity, and health recommends that "Member states need to take healthy nutrition into account in their agricultural policies."10
The dairy sector in the European Union is an example of how agriculture subsidies can lead to negative health effects in Europe as well as in developing countries. The European Union spends almost 2bn (￡1.4bn, $2.4bn) a year to maintain production levels at 20% above the domestic demand and at prices twice as high as on the world market.11 Without subsidies, production would quickly adapt to the level of demand. However, for historical reasons, and because of strong lobbying, milk production in the European Union is highly protected.
Surplus milk is converted to the storable products skimmed milk powder and butter. Butter mountains are expensive to maintain and create negative publicity. Therefore, export subsidies and domestic consumption aids are granted in order to dispose of it. Export subsidies for milk products undermine the milk sector in many developing countries such as the Dominican Republic, Kenya, India, and Jamaica.12 Domestic consumption aid for butter at a yearly cost of 500m is granted to one third of all butter produced in the European Union, corresponding to 1.5 kg of butter per European citizen a year. This butter is sold with subsidies to the food industry, which turns it into mainly ice cream and cakes (fig 1).13
Fig 1 Quantities of European Union butter receiving consumption aid from 1995 to 2003.13
The European school milk scheme is another outlet of surplus milk.11 Higher subsidies given to milk with a higher fat content has led to only 5% of Swedish school children drinking the recommended skimmed milk with their school lunches (Swedish National Food Administration, unpublished figures). In theory, a child who drinks full fat milk instead of skimmed milk receives an extra 1.5 kg of saturated fat each year from school milk alone.
Increasing dietary energy supplies worldwide
Figures from the Food and Agriculture Organization show that global per capita dietary energy supplies are rising and forecasted to grow for at least another 25 years (fig 2).14 A decreasing global population growth rate in combination with a strong growth in agricultural productivity has given us access to more and better food at declining real prices, in fact the lowest in history. People around the world can purchase more calories today for the same money as western Europeans could decades ago at a similar gross domestic product level. This is, of course, positive for the 850 million people who still suffer from hunger and malnutrition worldwide. However, the main reason for hunger is not a lack of global food supplies but lack of access to food, conflicts, natural and human disasters, animal and plant pests, and unfair international trade in combination with a lack of political will to eradicate it.15
Fig 2 Development of per capita dietary energy supply from 1964 until 203014
A daily energy intake of 9.2 MJ (2200 kcal) is regarded as necessary to avoid malnutrition, while more than 11.3-12.5 MJ a day will lead to obesity in people with a sedentary lifestyle.15 Income inequalities, the level of poverty and health care, and the fact that obesity shifts from the rich to the poor as income rises will determine the socio-epidemiological distribution of malnutrition, obesity, and non-communicable diseases in each country.16
In a climate of tough competition, sections of the food industry develop new and healthier value added foods at higher prices, benefiting mainly higher socioeconomic groups. But what is produced is eventually eaten by someone. Fat, sugar, and cereals are cheap and constitute the raw materials for energy dense and nutrient poor foods, which lead to passive overeating and obesity.5 17-19 Therefore, as long as the supply of energy dense foods is not reduced, the prevalence of obesity and social inequalities in health is likely to continue to increase. As a first step to reverse the obesity epidemic, agricultural market support promoting the overproduction of food has to be phased out.
The overproduction of food by developed countries also has detrimental health effects in other countries. The use of export subsidies by rich countries and tariffs on imported food is a serious obstacle for growth of the agricultural sector in developing countries.15 Agricultural growth has an important role in alleviating poverty and malnutrition because it increases food availability locally, creates employment, stimulates the rural economy, and reduces the cost of food for poor consumers.20 According to the Food and Agriculture Organization, rural development and agriculture are key to reducing poverty and hunger and reaching the millennium development goals.
Agricultural subsidies coupled to production should be phased out
The 2003 reform of the common agricultural policy, the main aim of which was to bring supply in line with demand, was a step in the right direction. It partially decoupled financial support from the amount of foods produced. However, the results of quantitative analysis by the Organisation for Economic Cooperation and Development indicate only modest (less than 1%) reductions in production of most commodities such as wheat, coarse grains, oilseeds, beef, pig meat, and poultry.21 Only rice production is expected to decrease significantly. Milk production in the European Union is expected to increase slightly until 2014-5 because of increases in the quota (the amount of milk eligible for subsidies). There are consequently no plans to phase out consumption aid for butter (Swedish Board of Agriculture, personal communication). Subsidised export is assumed to decrease by 4% for wheat, 6% for cheese, 8% for skimmed milk powder, and 17% for butter. This will result in falling prices on the European market and more energy available for consumption. Economists expect European consumption of butter to increase by 0.7%, cheese by 1.5%, and wheat by 0.3% by 2008. In other words, it is assumed that the population will contribute to solving the problems of the common agricultural policy by eating more. Clearly, the policy reform is a failure from the perspective of preventing obesity.
The public health sector must now engage in reform of the common agricultural policy. Health effects have been neglected despite article 152 in the Amsterdam Treaty saying that public health should be promoted by all EU policies. The ongoing discussions concerning the reform of the fruit and vegetable sector are an opportunity not to be missed.
The resources ploughed into agriculture in developed countries are enormous. The total transfers to agriculture in countries in the Organisation for Economic Cooperation and Development for 2003 amounted to $350bn (￡194bn, 288bn),7 half of which comes from taxpayers and half from consumers. Eliminating all agricultural policy distortions could produce global annual welfare gains up to $165bn according to the Food and Agriculture Organization because production would move to countries with comparative advantages.14 The global cost of not eradicating hunger—in terms of conflicts, recurrent emergencies, international crime, the drug trade, terrorism, clandestine migration, and the premature death of those who are hungry—is enormous.15 To this should be added the cost of environmental damage from agriculture, which might be even higher.
Summary points
Current dietary energy supply is more than sufficient to alleviate starvation worldwide and is forecasted to grow for another 25 years
Agriculture subsidies coupled to production distort the balance between supply and demand, leading to overconsumption and obesity
Overproduction of food in rich countries using trade distorting measures undermines the agricultural sectors in developing countries, hindering the eradication of hunger and poverty
Phasing out of agricultural producer support in developed countries is the first step in the fight against both obesity and hunger
In comparison, the estimated cost for food for the 850 million people who currently are food insecure is $10.4bn a year, while the annual cost of ensuring sound nutrition and health in developing countries is estimated to be $70-80bn in addition to the $136bn currently spent.15 The official development aid needs for achievement of the millennium development goals have been estimated to be $135bn for 2006 rising to $195bn in 2015.22
Two steps towards better health
Phasing out of market support for agricultural producers in developed countries is necessary as a first step in the fight against obesity, poverty, and hunger worldwide. In addition, the money saved in taxes could be used for ensuring sound nutrition and health in developing countries and for reaching the millennium development goals. Agricultural market support paid from taxes can be defended only if the food is undersupplied—that is, if the market fails—which was the case when the common agricultural policy was founded in the late 1950s.
But even if subsidies are phased out, global supplies will probably continue to be higher than "healthy" demand for many years to come. The food industry will fight for its markets and try to expand them. Therefore, as a second step, internationally binding conventions like the one on tobacco are needed. These should include issues such as marketing of energy dense foods, availability to children, labelling, and tax and price measures, as suggested by Chopra and Darnton-Hill.4 Such conventions will require governments, WHO, and the Food and Agriculture Organization to take a strong role. However, government failures must be corrected before market failures can be tackled. Before we brake, we should take the foot off the gas.
LSE has worked at the National Institute of Public Health in Sweden since 1998. Her main areas of interest are nutrition, physical activity, obesity, policy development, health impact assessment, and agriculture policy. Sources of information are reports from the European Commission, the WHO, OECD, FAO as well as the scientific literature.
Competing interests: None declared.
References
World Health Organization. Obesity: preventing and managing the global epidemic. Geneva: WHO, 2000. (WHO technical report 894.)
Mulvihill C, Quigley R. The management of obesity and overweight, an analysis of reviews of diet, physical activity and behavioural approaches. London: Health Development Agency, 2003.
Visscher T, Seidell J. The public health impact of obesity. Annu Rev Public Health 2001;22: 355-75.
Chopra M, Darnton-Hill I. Tobacco and obesity epidemics: not so different after all? BMJ 2004;328: 1558-60.
World Health Organization. Diet, nutrition and the prevention of chronic diseases. Geneva: WHO, 2003. (Report No 916.)
Swinburn BA, Caterson I, Seidell JC, James WP. Diet, nutrition and the prevention of excess weight gain and obesity. Public Health Nutr 2004;7(1A): 123-46.
Organization for Economic Cooperation and Development. Agricultural Policies 2004. At a glance. Paris: OECD, 2004.
Putnam J, Allshouse J, Scott Kantor L. US per capita food supply trends: more calories, refined carbohydrates, and fats. Food Rev 2002;25(3): 2-15.
Silventoinen K, Sans S, Tolonen H, Monterde D, Kuulasmaa K, Kesteloot H, et al. Trends in obesity and energy supply in the WHO MONICA Project. Int J Obes Relat Metab Disord 2004;28: 710-8.
World Health Organization. Global strategy on diet, physical activity and health. Geneva: WHO, 2004.
Sch?fer Elinder L. Public health should return to the core of CAP reform. EuroChoices 2003;2(2): 32-5.
Oxfam. Milking the CAP. How Europe's dairy regime is devastating livelihoods in the developing world. Oxford: Oxfam, 2002.
European Commission. Thirty-fifth report on intervention measures in the milk and milk products sector 2003. Brussels: EC, 2004.
Food and Agriculture Organization of the United Nations. World agriculture: towards 2015/2030. Summary report. Rome: FAO, 2002.
Food and Agriculture Organization of the United Nations. The world food summit five years later. Mobilizing the political will and resources to banish world hunger. Rome: FAO, 2004.
Monteiro C, Moura EC, Conde WL, Popkin BM. Socioeconomic status and obesity in adult populations of developing countries: a review. Bull World Health Organ 2004;82: 940-6.
Prentice AM, Jebb SA. Fast foods, energy density and obesity: a possible mechanistic link. Obes Rev 2003;4(4): 187-94.
Schulze MB, Manson JE, Ludwig DS, Colditz GA, Stampfer MJ, Willett WC, et al. Sugar-sweetened beverages, weight gain, and incidence of type 2 diabetes in young and middle-aged women. JAMA 2004;292: 927-34.
Pereira MA, Kartashov AI, Ebbeling CB, van Hom L, Slattery ML, Jacobs DR Jr, et al. Fast-food habits, weight gain, and insulin resistance (the CARDIA study): 15-year prospective analysis. Lancet 2005;365: 36-42.
Irz X, Lin L, Thirtle C, Wiggins S. Agricultural productivity growth and poverty alleviation. Dev Policy Rev 2001;19: 449-66.
Organization for Economic Cooperation and Development. Analysis of the 2003 CAP reform. Paris: OECD, 2004.
Sachs JD, McArthur JW. The millennium project: a plan for meeting the millennium development goals. Lancet 2005;365: 347-53.(Liselotte Sch?fer Elinder, associate pro)