Susana Raffalli: Food Bags Won’t Solve Venezuela’s Humanitarian Crisis

The nutritionist and humanitarian explains in detail why CLAP means political blackmail and unhealthy products

This interview was originally published in Spanish by Arepita, a Venezuelan daily newsletter. This version includes additional context

In 2016, the government of Nicolás Maduro created the Local Committees for Supply and Production (CLAP) to distribute boxes and bags as a response to food shortages in the country. But the CLAP food bags, widely distributed in low-income areas, soon became sullied by corruption, political use and clientelism:  “CLAP bags are treated as charitable alms and not as part of liberation from hunger, and this undermines the human dignity of those who receive them”, Michael Fakhri, United Nations Special Rapporteur on the Right to Food, recently said. In fact, human rights organization PROVEA has described CLAP bags as “food extortion” and “one of the most obvious violations of the right to food.”

On March 13, the Maduro administration ordered meat and chicken to be added to CLAP bags. But what at first glance seems like an increase in the distribution of protein, turned out to be the opposite: the meat distributed will be canned. That is, ultra-processed foods whose harm to health has been proven in multiple studies will be added alongside the canned bologna from Turkey, and other components in a bag loaded with carbohydrates (and other little things, such as social control). We spoke with Susana Raffalli , one of Venezuela’s most renowed nutritionist specialized in food security management, humanitarian emergencies and disaster risk:

—What should the CLAP bag have to satisfy the nutritional needs of a family, in contrast to what it currently distributes?

—The CLAP bag is not suitable for any type of food. Massively distributing food is something that is contraindicated and inappropriate to do. In contexts in which the food market is supplied, nourishment is accessible and people are able to work or produce their food. Distributing food is counterproductive because you demobilize people, discourage their autonomy and their own ability of working to eat with free self-determination. You discourage the local economy.

Distributing food at scale should only be reserved for extreme emergency situations, in which the emergency completely devastated the usual sources of nourishment: markets and families’ livelihoods, including their kitchens or cooking utensils. I am referring to incidents like the Vargas or Las Tejerías landslides, or an earthquake.

The obligation of the State as guarantor of the right to eat does not refer, in any case, to the obligation to feed. We, as holders of the right to food, do not have the right to be fed: we have the right to exercise our nutrition with freedom and self-determination, through our own means. The obligation of the State is to promote, respect and regulate so that this happens in the best way, guaranteeing sources of work, decent wages consistent with needs, a healthy and integrated food market, and promoting food production.

That mission of the State took a backseat. The State preferred to become a seller of subsidized food to poor people. The other function of the State, in which it should focus on feeding citizens, is that of those citizens who are in a situation of dependency and who, due to their situation, cannot feed themselves. I am referring to the population that is in prisons, in hospitals, to people on the street. In Venezuela things were reversed. The State is feeding the bulk of the population and leaving the population that is in a situation of dependency and that is under its tutelage and care very poorly fed, and they are going through horrible situations. It is a great paradox.

That’s why I can’t give a suggestion for the [CLAP] stock to be better, because the stock shouldn’t exist in any way. It is unimprovable as a food program because it has never had a food objective.

What could be done, from the point of view of the State, is to reactivate services for the distribution of food specially formulated for nutritional purposes to vulnerable population groups. The best example was routine well-child examinations. In these services, when it was detected that the child was moving away from a normal nutritional status, they were assigned a ration of Lactovisoy, which today could be a ration of Nutrichicha or another fortified food, for example. But that ceased to exist, because it does not generate votes, nor any type of political return.

—What is the relationship between the content of these bags and the malnutrition recorded in Venezuela in recent years?

—There is no relationship that I can say is direct. What can be said is that the CLAP bag, from a nutritional point of view, provides a group of foods that are extremely poor in terms of their contribution of essential nutrients. Mainly in terms of high biological value and high quality proteins. They are deficient in iron, vitamin A and functional nutrients that, above all, children and pregnant women require to cover their basic nutrition needs. It is a set of products, with a very high proportion of empty carbohydrates, which provide nothing other than energy.

In the end, the people who are feeding on this, eat and this calms their hunger. Therefore, this population is neither hungry nor in a state of thinness (which is acute malnutrition), leading to two types of malnutrition that are not evident until their symptoms manifest. I am referring to hidden hunger, such as anemia. Unicef, in its latest State of the World’s Children, and FAO, in its latest report on the Situation of Food Security in the World, report that in Venezuela, 30% of women of reproductive age live with anemia. This means that these women live without hunger because they consume foods from the CLAP bag, but they do not have iron.

The same thing happens with children. To grow harmoniously and develop their cognitive abilities, they not only need calories and proteins: they need functional nutrients, such as phosphorus, magnesium, zinc, iron. These are obtained from very high-quality proteins, in eggs, legumes, milk, fruits. Or it is acquired by fortifying highly consumed foods, which is the case of corn flour, for example.

The second type of malnutrition that can arise is stunting. A child who does not receive enough functional nutrients can spend his childhood without ever looking thin, without even being hungry, but he does not gain the height he needs, and this reflects the fact that he does not gain nerve endings, brain mass, cognitive abilities and motor skills that he needs throughout his life.

Susana Raffalli by Andrés Kerese (Prodavinci, 2019)

I am convinced that having kept the population dependent for so many years on a group of foods with such poor nutritional value as CLAP bags, and with such a poor salary to be able to access good foods, is related to the failure in growth. And I say this with figures in hand: approximately, between 25% and 30% of the children who come to the nutrition services that we have, are coming with short stature: that is, with delay in their linear growth. Of that percentage, 80% are neither hungry nor thin, but they are children who have become too small. They are children of bad eating, bad eating from a bag that has never had complete nutritional value, except for the last few months in which Nutrichicha was included –which is a fortified food– but in a ridiculous amount, which is not enough to cover the amount of nutritional intake that these children should receive in a couple of days.

—How does the consumption of ultra-processed meats contained in these bags affect the body?

—These foods can lead to major eating disorders. The first is that, especially when they are of animal origin, they have a high content of saturated fats, which cause diseases such as overweight, increased cholesterol and other hyperlipidemias and, in this way, the increase in cardiovascular diseases associated with atherosclerosis and with the increase in blood pressure. In general, they have a very high sodium content for their preservation, and this is associated with a predisposition to high blood pressure, and some of the forms of sodium that these foods contain, such as nitrites and nitrates, have been associated with several types of cancer.

On the other hand, the second large group of diseases related to these foods are linked to the many preservatives used in these foods, such as some emulsifiers, which condition the fat and keep the food compact. This greatly alters the intestinal biota, and there is now abundant evidence that this is related to multiple neurological disorders. For example, they are related to childhood malnutrition and generalized metabolic alterations. You are not going to eat a Diablitos and get all those diseases but maintaining a constant consumption of this and pretending that the source of animal protein for an entire town is canned meat is an anti-testimony of a public food policy.

This is not only surprising, but will have consequences in the future, from a health–wise point of view. The increase in obesity and cardiovascular diseases that are developing around the massive sale of poor-quality food by the State is terrifying. It has been proven that the health cost of an adult person, due to the diseases they have, can cost the State and the public health system up to 60% more when this person is encouraged to eat badly in their first years of life.

From the State itself, the enormous effort made by professionals from the National Institute of Nutrition (INN) to promote healthy eating is demobilized. The focus of the INN’s 4S [“humanist food”] campaign is exactly the opposite of what President Maduro promotes by ordering canned meat and salt to be added to the CLAP. It is a disintegrated food policy, which contradicts itself.

—How much time and investment would it require to bring the nutrition of Venezuelan families to an optimal state? What other factors are essential?

—It can be very long or very short. It can be as short as raising families’ salaries and letting them buy what they want to eat. But for it to be possible, national supply must be guaranteed. There is an FAO indicator that speaks of the percentage of the population in a situation of potential hunger. In Venezuela, this percentage of the undernourished population is 19%. This does not refer to consumption or nutritional status, it refers to the number of people who would go without eating if the food distributed in the country were distributed equally. That is, it is the capacity that the State has to feed its people from food production. In 2017 this exceeded 30%.

Even with money, food would not be enough for everyone. If vacant lands and the agricultural park are rescued, livestock and fisheries are restored, and a lot of other things –done in phases–the performance levels of the food system in 1990 would be restored in two or three years.

From a nutritional point of view, for example, it would be quick if protein of animal origin were subsidized and food vouchers that are only for exchangeable for protein were delivered, increasing the supply of this type of food and fortified foods, doing it in the well-child control clinics and in the prenatal control clinics. With this we would guarantee a better nutritional status for acute malnutrition.

However, the malnutrition that is manifested by delayed growth in children will not even be corrected even in this generation, because height does not recover so easily. Size stops accumulating in the period you had to grow. If in that period, you spent your time eating rice and pasta and fat, you will no longer grow. Some children, and it would be very exceptional, who reach puberty in a perfect environment –drinking water, vaccines, high-quality food, well-established families – may have some recovery in their height.

But, in general, that is not what happens. Since 2014, children have grown up with a deficit: girls reach the age of five 8 centimeters shorter than a well-nourished girl; in boys it is 5 centimeters [shorter]. They are small, but the country in which they grow up is also small for them. For this to be reversed, we have to wait for the next group of children to be born: born to women who go through their pregnancies eating well, who get pregnant at a sufficient age, who have access to prenatal vitamins and nutritional supplements. And these children have to spend their first 1,000 days of life with their complete vaccination schedule, without disease, with access to nutritional supplements; spending their childhood in homes where they can eat well.

This is not what is happening now. This is an active, cumulative, and continuous nutritional deprivation. The estimate is that by doing things well – doing things very, very well– the number of children with growth retardation would take approximately 20 years to lower to the levels we had in 1999.