Cali, Colombia in contrast: Feast and famine

Busy shopkeepers sell tired hikers fried chicken, sausages, potato chips, and other fast food options, most of which come prepackaged in a bag.

But some neighbors in the sprawling houses winding up the surrounding Farallones foothills don’t know where their next meal is coming from, malnourished in the opposite sense.

Colombia is suffering from malnutrition and obesity simultaneously, and the country’s third largest city is no exception.

Nestled in one of the most fertile valleys in the country, Cali is among the latest Latin American cities to join the obesity epidemic, along with Mexico City and Santiago, Chile. Micronutrient deficiency, like anemia, is all too common, reflecting poor diets.

The phenomenon is seen more acutely among women: 62% of adult women in Colombia are dealing with abdominal obesity, which is strongly correlated with cardiovascular disease, in comparison with 40% of men.

For a nation with a rich culinary tradition and bountiful natural resources, Colombians have developed quite a taste for modern food fads. Retail sales of ultra-processed food and drink products increased by 25.1% between 2000 and 2013, while only 1 in 5 Colombians eats vegetables daily. The trend is compounded by new family structures which leave less time to dedicate to cooking nutritious meals, and by poverty which leaves healthy food out of reach for many.

Latin America’s heavy burden doubled

The world’s obesity problem isn’t news. But the fact that it exists in the same cities, neighborhoods, and even individuals as those with malnutrition is perplexing to many.

While Latin America and the Caribbean has become the most overweight region in the developing world, according to the Food and Agriculture Organization of the United Nations, there are still 34 million people to reach before eradicating hunger.

It’s the poorest communities that most commonly exhibit the strange phenomenon of malnutrition and obesity living side by side.

Food deserts and disparities in the valley of biodiversity

In Cali, many consumer’s choices are limited to cheap, nutrition-poor foods. Especially in low-income neighborhoods, healthy foods are often either unaffordable or unavailable.

“For the poorest, eating fast food on the corner is cheaper than cooking,” said Jenny Peña, Master of Public Health Candidate, Universidad del Valle.

“Imagine you don’t have much money, would you buy a pound of rice with eggs, or with the same money, purchase sausages covered in cheese and salsa for a family of five? The quality may be poor but it’s delicious, and above all, cheap.”

“Many people say they eat rice and potatoes during the week and on the weekend a hamburger is a special treat.”

“In other parts of Cali, the markets are full of fresh produce and wealthier households have hired help to prepare healthier options.”

With funding from the Ford Foundation, Jenny’s team – made up of researchers from the International Center for Tropical Agriculture (CIAT), the French Agricultural Research Center for International Development (CIRAD), and her university – is using an epidemiological approach to map the root causes of the health problem, much in the way Rodrigo Guerrero, Cali’s former mayor, did to drastically reduce violence in the city. This data-driven observation will help guide public officials as they develop a tailored multi-sectoral approach for Cali.

Poverty has fallen recently in Colombia to around 29% of the population, and after decades of hardship, there are signs that Cali is seeing a revival. The city’s homicide rate, which peaked at 126 per 100,000 people in 1992, has dropped to fewer than 25 per 100,000, and unemployment is also down.

Yet Colombia remains one of the most unequal places in the world – which manifests economically and also through inequality in health and nutrition.

Leaders in government, business, agriculture and other sectors must address the persistent health disparities at the national, departmental, and local levels, as both an ethical and an economic imperative.

Solving malnutrition is more complicated than simply growing more food. For the most part, the quantity of food is not a problem: Colombia grows and imports enough.

Better nutrition is largely a byproduct of a handful of policies, many of which are not about food at all, and each of which is vital to impact.

Many of the poorest in Cali, shop in the nearest store – where the quality is often low or fruit and vegetables aren’t available or within their means – to avoid spending money on transportation.

“What’s available in the local neighborhood market determines what consumers will or will not eat,” commented Jenny.

Lack of safe, green spaces for free recreation prevent many Caleños from exercising. While new pedestrian areas – such as the Bulevar del Rio which runs along Cali’s downtown and plans for a “Green Corridor” – are steps in the right direction, many parts of the city where the health problem is the gravest, there are still no such amenities.

Poor sanitation and drinking dirty water cause gastrointestinal illnesses which prevent the body from absorbing nutrients. In Colombia’s northernmost department of La Guajira, water related illnesses, as well as drought and poor governance, has contributed to malnutrition and the death of more than 100 children this year.

If girls give birth very young, their babies are more likely to be underweight, and to lack the conditions necessary for success. According to research published in the The Lancet medical journal, malnourished children are more likely (all things being equal) to struggle in school, drop out, earn less than their better-fed peers, and die earlier. More than 14% of adolescent girls (age 15-19) in Cali are mothers or are pregnant, with higher rates of teenage pregnancy seen in lower-income populations.

Paradoxically, malnutrition can also cause obesity later in life. In the womb and during childhood, hunger trains the body to hoard fat, so the poorest are more prone to be obese as adults – perpetuating the cycle.

But few governments think about nutrition when crafting education, infrastructure, or welfare policies. If they did, the ripple effect would be impressive.

That’s why CIAT, together with the local Secretary of Health and Secretary of Social Welfare, is bringing different actors from Cali’s food system to the table. Building on EATxCali in October 2015, the first of such dialogues was held in December and included representatives from the Secretary of Education, major supermarket chains, World Food Programme, local foodbanks, school food providers, among others.

They’re helping spawn ideas to create the conditions for a well-nourished society, and prioritizing actions for the production and distribution of the right kinds of foods, for all consumers. This new tradition of cooperation is edging Cali in the right direction, towards a strategy for a more sustainable and inclusive food system and the signing of the Milan Urban Food Policy Pact.

Nutrition in Cali can be improved in all sorts of ways. Guy Henry, project leader at CIAT and long-time Cali resident, ticked off a few of the tasks: invest more in disease prevention, improve school lunches for the poorest, teach good feeding practices, educate women and girls, focus agricultural production on dietary diversity, and increase policy coherence.

Better nutrition is a stunningly good investment and, if implemented, these interventions would have a high-return for the city of Cali, and for the country as it works to put an end to 50 years of armed conflict and ensure a more just, equal, and peaceful future.

The “Cali Better Food” project is supported by the Ford Foundation, as part of a partnership with the city of Cali to promote inclusive urbanization. The Foundation’s Andean Region office has recently moved from Santiago de Chile to Bogotá, Colombia, where CIAT continues to collaborate closely to challenge inequality.