To What Extent do Western Concepts of Ill-Health Limit Policies and Projects Aimed at Improving the Health of Those in the Developing World

Executive Summary Current health policies on malnutrition and HIV infection are focused in achieving the Millennium Development Goals (MDGs) of the United Nations. Specifically, these goals include reduction of malnutrition incidence since 1990 by 50% and reversal in the trend of HIV epidemic by 2015. This essay aims to critically analyse these two policies in achieving their respective aims and objectives and the factors that contribute to the success of these policies. A brief discussion on the Western concepts of ill-health and how these relate to the concepts of ill-health in developing countries is also made. Results of the analysis show that engaging communities and allowing them to take ownership of strategies to prevent malnutrition is effective in reducing incidence of malnutrition. The Scaling Up Nutrition (SUN) campaign illustrates how developing countries could positively respond to healthcare policies introduced by developed countries. However, not all developing countries are nearing or have achieved the 50% reduction in malnutrition incidence. Lack of community involvement has been shown to affect the progress of the SUN campaign. The same principle of community-based interventions is also used on the policy for HIV infection. Success rate for HIV policy is high with millions of affected individuals accessing healthcare services compared to only 400,000 in 2004. This would show that policies to increase treatment have succeeded. However, prevention of HIV infection remains challenging. Analysis would show that engaging in risky sexual behaviour is a critical factor in developing HIV infection in Sub-Saharan Africa. Changing the behaviour of a target population is established to be difficult. While community-based interventions and participation have contributed to the success of these policies, analysis would reveal that there is a need to increase the technical competencies of the stakeholders in the communities. This would ensure sustainability of programmes long after external aid has stopped. The differences in the concepts of ill-health also appear to influence the success of policies in developing nations. It is also argued that achieving all the aims and objectives of the policies might not necessarily solve the problem of malnutrition and HIV infection. Both conditions have multiple underlying causes and addressing all these would take considerable time and effort. In conclusion, policies have made great strides in improving nutrition of children and mothers and decreasing the incidence of HIV infection. Concerted effort from various stakeholders is still needed to make changes sustainable. Introduction The main aim of this brief is to critically analyse the policies, ‘Reducing Hunger and Malnutrition in Developing Countries’ (Department for International Development, 2013) and the global policy on HIV/AIDS Epidemic (KFF, 2013). Both healthcare policies are designed to improve the health and well-being of mothers and young children and those suffering from HIV/AIDS in developing countries. The first part describes these two policies while the second part discusses the Western concepts of ill health and how these limit policies and projects aimed at developing countries. The third part provides a theoretical assessment of the policies. A discussion on the underlying assumptions and views of healthcare in terms of belief structures and philosophy will be included. The fourth part presents the practical problems with implementation. Finally, a conclusion will summarise the main points raised in this essay. Recommendations will also be made at the end of this brief. Policies on Malnutrition and HIV/AIDS The ‘Reducing Hunger and Malnutrition in Developing Countries’ (Department for International Development, 2013) aims to help individuals gain access to nutritious diet, ensure that food is distributed fairly across the world and mitigate environmental risks and damages that could influence food production. In line with the Millennium Development Goals (MDGs), the policy has set out several objectives that should be achieved by 2015. This includes reducing malnutrition since 1990 by 50%. Meanwhile, the ‘Global HIV/AIDS Epidemic’ policy (KFF, 2013) aims to stop and reverse the spread of HIV/AIDS. This is consistent with the United Nation’s MDGs that by 2015, the HIV/AID epidemic will be controlled and incidence will decline. It is estimated that a total of 18.9 billion USD have funded HIV/AIDs preventive and treatment programmes in 2012 (KFF/UNAIDS, 2013). Although there is a global decrease in the trend of this epidemic, incidence of HIV/AIDS is still high in middle and low-income countries (UNAIDS, 2013). Most of those suffering from this health condition do not have access to healthcare services, treatment and management (UNAIDS, 2013). Importantly women and young girls are more susceptible of the infection compared to men (British HIV Association, 2012). Of the 35 million individuals believed to be suffering from the condition, 3.3 million of these are children (UNAIDS, 2013). Majority (71%) of persons living with HIV/AIDS reside in Sub-Saharan Africa (Health Protection Agency, 2012). The objectives of this policy include decreasing HIV prevalence amongst the young population aged 15-24 years; increase condom use especially in high-risk sex; increase the proportion of young people with correct knowledge on HIV/AIDs infection; and increase the proportion of individuals with advanced stages of the disease gain access to antiretroviral medications. Western Concept of Ill-Health Western concepts of ill-health could limit the policies on malnutrition and HIV/AIDS when introduced in developing nations. First, definitions of ‘ill-health’ could vary between Western and developing countries. There is variation in how ill-health is perceived even amongst professional, academic and the public (Wikman et al., 2005). Ill-health is also viewed differently across disciplines. For instance, the medical model of health has been accepted for several years in Western healthcare in the past (Wikman et al., 2005). This model states that ill-health is caused by pathogenic microorganisms or underlying pathologies (Dutta, 2008). However, even this concept has changed within healthcare systems. Today, many healthcare professionals have recognised that ill-health is not only caused by pathogenic organisms but social determinants of health such as poor nutrition, unemployment or stress could all influence ill-health (Dutta, 2008). Wikman et al. (2005) acknowledges tha t ill-health could be understood by using a multi-perspective approach. Concepts of ill-health are also considered as historically and culturally specific (Blas and Kurup, 2010). This means that ill-health varies across culture and time. For instance, in Western culture, obesity is considered as ill-health (Blas and Kurup, 2010). In other countries, obesity is viewed as socially acceptable since this is a sign of wealth. In Western culture, findings of scientific publications are used to underpin health policies against HIV (Bogart et al., 2011). Use of condoms to protect against HIV infection is viewed as acceptable. In some African countries, use of condoms is seen to reduce one’s masculinity (Willis, 2003; MacPhail and Campbell, 2001). Importantly, anal sex in some of these countries is practised to avoid pregnancy or viewed as a cleansing method against the virus for HIV/AIDS (Bogart and Bird, 2003). Hence, these differences in the concept of ill-health could influence the uptake of global health policies in developing nations. To illustrate t his argument, the policies on malnutrition and HIV/AIDS will be critiqued. A discussion how western concepts of ill health influence the uptake of these policies in the developing countries would also be done. Analysis and Discussion Attention on acute and chronic malnutrition is unprecedented in recent years (Shoham et al., 2013). The involvement of the UK, through its policy for malnutrition and hunger, with other countries in the scaling up nutrition (SUN) campaign has brought significant changes on the lives of children who are malnourished. The policy on malnutrition is underpinned by the philosophy on health equity and social determinants of health (Ezzati et al., 2003). Western concepts of ill-health focus on the social determinants of ill-health as a factor in promoting malnutrition in developing countries. For example, unemployment of parents, low levels of education, early years, poverty, homelessness are some social determinants of health strongly suggested to promote malnutrition amongst children (Marmot and Wilkinson, 2005). Uptake of policies for malnutrition in developing countries might be limited if these determinants are not properly addressed. Farmer (2003) explains that cultural beliefs on foo d, poor knowledge on the nutritional value of food and food production practices have long contributed to malnutrition in many countries. Policies on malnutrition might no be effective if these do not address the root causes of malnutrition, which are poverty, poor knowledge on food nutrition and poor farming practices (Farmer, 2003). Power structure also plays a role in how policies are implemented. Farmer (2003) stresses that unless the poor are empowered and their rights protected would true development occur. In recent years, there have been improvements in the lives of the poor, specifically on nutrition status. Marmot and Wilkinson (2005) emphasise that presence of poverty and unemployment could all influence health. However, there is evidence that in some developing countries, malnutrition policies have gained success. An analysis would show that involvement of the community plays a crucial role in ensuring success of these policies. For example, Shoham et al. (2013) report that the community based management of acute malnutrition (CMAM) approach contributed to its success in some 65 developing countries across the world. Communities are mobilised and they gain ownership of the programme. Individuals help in detecting uncomplicated severe acute malnutrition (SAM) and refer children to established out-patient centres. Complicated cases are referred as in-patients in the health sector staff. While the UNICEF (Nabarro, 2013) reported that 10% of the 20 million suspected cases of SAM have been treated through the scaling up nutrition campaign, other target countries have not kept up with the campaign. Policies that have gained acceptance in developing countries are those that empower communities to take actions for their own health. Empowering women through education has been shown to lead to more positive changes in the health of children ages 5 years old and below (Farmer, 2003). Policies that increase the educational levels of women were shown to reduce erroneous perceptions on the causes of malnutrition (Wikman et al., 2005). Shoham et al. (2013) observe that failure to implement the CMAM approach and educating women on malnutrition limits the success of malnutrition policies in communities. A number of studies (Bhutta, 2013; Black et al., 2013; Pinstrup-Andersen, 2013; Nabarro, 2013; Loevinsohn and Harding, 2005) have shown the effectiveness of engaging communities and empowering them to improve the nutritional status of women and children. While factors such as engaging communities and allowing them to take ownership of programmes have been shown to promote uptake of policies, there are still factors that limit policy uptake. These include failure to address the social determinants of health such as poverty, low levels of education, poor support of the children during early life years and unemployment (Loevinsohn and Harding, 2005). It has been shown that when these factors are present, malnutrition is also high (Pinstrup-Andersen, 2013). There is also a need to understand the perceptions of women and children on food and nutrition to better understand why malnutrition continue to exist in a number of developing countries. Meanwhile, the policy on HIV/AIDS also promote health by engaging communities in implementing projects aimed at preventing HIV transmission (KFF, 2013; British HIV Infection, 2012; Department for International Development, 2013). To date, HIV infection epidemic has stabilised and the number of individuals receiving treatment has increased to 9.7 million in 2012 (UNAIDS, 2013). In contrast, only 400,000 individuals with advanced HIV infection receive treatment in 2004. A closer analysis of the cause of HIV infection would still point to risky behaviours of those engaging in unprotected sex and injecting drug users as factors that promote HIV infection (KFF/UNAIDS, 2013). This is a cause of concern since there is still the prevailing cultural belief in a number of African countries that use of condom is unmanly (Willis, 2003; MacPhail and Campbell, 2001). Connolly et al. (2004) argue that changing behaviour of the target population is most difficult. Consequences of HIV infection extend to unborn children of mother infected with HIV (UNAIDS, 2013). To date, there have been various interventions to prevent HIV infection. These include behaviour changes, increase in HIV screening, male circumcision, use of condoms, harm reduction amongst in injecting drug users and blood supply safety (UNAIDS, 2013). Amongst these strategies, changing behaviour remains to be an important intervention that could prevent further spread of the virus. Experts suggest that risky sexual behaviour could only be changed through the use of different health models. For example, the health belief model could be used to inform the target population on the risk of HIV (Health Protection Agency, 2012). In addition, facilitators to behaviour change, such as decreasing stigma on HIV infection, increasing access to healthcare services could help individuals adopt less r isky sexual behaviour (Greeff et al., 2008). Patients with HIV often perceive stigma from their own healthcare workers (Kohi et al., 2006; Holzemer and Uys, 2004). This could impact not only the quality of care received by those with HIV infection but might also limit them from gaining further medical treatment. On the other hand, reducing malnutrition by 50% since 1990 has not been achieved in most countries yet (UNICEF, 2014). This is important since the United Nations aims to achieve this target by next year. Food production is continuously affected by stronger typhoons and turbulent weather patterns (KFF, 2013). Droughts appear to be longer, affecting agriculture and livestock production (KFF, 2013). Specifically, the UNICEF (2014) acknowledges that the most vulnerable groups to increasing weather disturbance brought by climate change are the poor people. This is especially challenging in the light of the MDGs since decreases in food production in developing countries could further have an impact on the nutritional status of the women and children (Bryce et al., 2008; Taylor et al., 2013). Climate change has important implications on policies for malnutrition. Even if community-based initiatives are strongly in place and individuals have learned to produce their own food, changes in weat her patterns could impact agriculture activities. The UNICEF (2014) has highlighted this issue and using current experiences, community rehabilitation after a typhoon or drought would mean increased challenges in addressing malnutrition amongst the poorest of the poor. Even if all objective are achieved, there is no full guarantee that malnutrition will be completely eradicated in developing nations. To date, there are best practices (SUN, 2013) showing that community involvement and partnership with government and non-government organisations could arrest severe acute and chronic malnutrition. A number of developing countries, especially in the Sub-Saharan Africa are still struggling with malnutrition despite external aid. The same observation is also made in this region on HIV infection where the poorest amongst the poor remain to be most vulnerable to the infection (SUN, 2013). Hence, it would be necessary to investigate the real cause of malnutrition and HIV infection in developing countries. There are multiple underlying causes of malnutrition and all interact to increase the risk of children for malnutrition. First, poverty has been highlighted earlier in this essay as an important factor for development of malnutrition (Horton and Lo, 2013). This essay also argues that maternal level of education is a significant factor in the nutrition of children (Black et al., 2013). The World Health Organization (2011) acknowledges that children born to mothers with at least a high school education enjoy better health compared to children with mothers who have lower educational levels. This observation is consistent across literature (UNICEF, 2014; Black et al, 2013) and illustrates the importance of increasing the education level of mothers. In Sub-Saharan countries that often experience conflicts, malnutrition is often caused by displacement of families and children from their homes and livelihood to evacuation centres with minimal food support (UNICEF, 2014). Apart from conflicts, recent effects of climate change have also changed the way developed countries respond to problems of food security (Taylor et al., 2013). As shown in the UK policy for hunger and malnutrition, funds are also directed to innovations and research on how to respond to environmental damages caused by climate change (UNICEF, 2014). It should be noted that changes in weather patterns, flooding and drought could have a great impact on food security and sustainability (Department for International Development, 2013). In comparison with the policy on HIV infection, the policy on hunger and malnutrition would have a greater impact on the health of the nation. It has been shown that improving nutrition during the first 1000 days of a child’s life could lead to better health outcomes, higher educational attainment and productivity later in adult life (Bhutta, 2013). Malnutrition during a child’s first two years of life could have irreversible effects on the child’s health (Bhutta, 2013). This could lead to stunting, cognitive impairment, early death and if the child reaches adulthood, difficulty in finding a job (Nabarro, 2013). The number of children and mothers suffering from malnutrition is also higher compared to individuals suffering from HIV infection. However, HIV infection could also have an impact on maternal and child health since infected mothers could transmit the virus to their unborn child (KFF, 2013). Women with HIV also suffer more stigma compared to their male co unterparts (Sandelowski et al., 2004). Recommendations and Conclusion In conclusion, the two policies discussed in this brief reveal strategies in preventing and treating malnutrition and HIV infection. Responses of developing countries to these strategies differ. Countries where communities are involved in the implementation of strategies are generally more successful in addressing these health problems. This would show that community involvement play a crucial role in the uptake of Western policies in developing countries. However, the lack of success in some countries might be attributed to the differences in the concept of ill-health between affluent and developing countries, socio-economic context of poor countries and difficulty in changing one’s health behaviour. Finally, this essay suggests that a more holistic approach should be taken in addressing the social determinants of health to ensure that children have access to nutritious food and HIV infection is prevented. References Bhutta, Z. (2013). ‘Early nutrition and adult outcomes: pieces of the puzzle [Online]. The Lancet, 382(9891), pp. 486-487. Black, R., Alderman, H., Bhutta, S., Gillespie, S., Haddad, L., Horton, S., Lartey, S., Mannar, V., Ruel, M., Victoria, C., Walker, S. & Webb, P. (2013). ‘Maternal and child nutrition: building momentum for impact’. The Lancet, 382(9890), pp. 372-375. Blas, E. & Kurup, A. (2010). Equity, social determinants and public health programmes. Switzerland: World Health Organization. Bogart, L., Skinner, D., Weinhardt, L., Glasman, L., Sitzler, C., Toefy, Y. & Kalichman, S. (2011) ‘HIV misconceptions associated with condom use among black South Africans: an exploratory study’, African Journal of AIDS Research, 10(2), pp. 181-187. Bogart, L. & Bird, S. (2003) ‘Exploring the relationship of conspiracy beliefs about HIV/AIDS to sexual behaviours and attitudes among Afrian-American adults’, Journal of the National Medical Association, 95(11), pp. 1057-1065. British HIV Association (2012) Standards of care for people living with HIV in 2012, London: British HIV Association. Bryce, J., Coitinho, D., Darnton-Hill, I., Pelletier, D. & Pinstrup-Andersen, P. (2008). ‘Maternal and child undernutrition: effective action at national level’. The Lancet, 371(9611), pp. 510-526. Connolly, C., Colvin, M., Shishana, O. & Stoker, D. (2004) ‘Epidemiology of HIV in South Africa- results of a national, community-based survey’, South African Medical Journal, 94(9), pp. 776-781. Department for International Development (2013). Policy: Reducing Hunger and malnutrition in developing countries, London: UK Legislation [Online]. Available at: https://www.gov.uk/government/policies/reducing-hunger-and-malnutrition-in-developing-countries (Accessed: 25th March, 2014). Dutta, M. (2008) Communicating health: A culture-centred approach, London: Polity Press. Ezzati, M., Vander, H., Rodgers, A., Lopez, A., Mathers, C. & Murray, C. (2003) ‘The comparative risk collaborating group. Estimates of global and regional potential health gains from reducing multiple major risk factors’, Lancet, 362, pp. 271-280. Farmer, P. (2003) Pathologies of Power: Health, Human Rights, and the new war on the poor, Berkeley and Long Angeles: University of California Press. Greeff, M., Uys, L., Holzemer, W., Makoae, L., Dlamini, P., Kohi, T., Chirwa, M., Naidoo, J. & Phetlhu, R. (2008) ‘Experiences of HIV/AIDS Stigma of persons living with HIV/AIDS and nurses involved in their care from five African countries’, African Journal of Nursing and Midwifery, 10(1), pp. 78-108. Health Protection Agency (2012) HIV in the United Kingdom: 2012 Report. London: Health Protection Services, Colindale. Holzemer, W. & Uys, L. (2004) ‘Managing AIDS stigma’, Journal of Social Aspects of HIV/AIDS, 1(3), pp. 165-174. Horton, R. & Lo, S. (2013). ‘Nutrition: a quintessential sustainable development goal’, The Lancet, 382(9890), pp. 371-372. KFF/UNAIDS (2013). Financing the response to AIDS in low- and middle-income countries: International Assistance from Donor Governments in 2012. Washington: KFF/UNAIDS. KFF (2013). The Global HIV/AIDS Epidemic [Online]. Available at: http://kff.org/global-health-policy/fact-sheet/the-global-hivaids-epidemic/#footnote-KFFUNAIDS (Accessed: 25th March, 2014). Kohi, T., Makoae, L., Chirwa, M., Hozemer, W., Phetlhu, D., Uys, L., Naidoo, J., Dlamini, P. & Greeff, M. (2006) ‘HIV and AIDS violates human rights in five African countries’, Nursing Ethics, 13(4), pp. 404-415. Loevinsohn, B. & Harding, A. (2005). ‘Buying resultsContracting for health service delivery in developing countries’. Lancet, 366(9486), pp. 676-681. MacPhail, C. & Campbell, C. (2001) ‘I think condoms are good but, aai, I hate those things’, Social Science & Medicine, 52(11), pp. 1613-1627. Marmot, M. & Wilkinson, R. (2005). Social Determinants of Health. Oxford: Oxford University Press. Nabarro, D. (2013). ‘Global child and maternal nutrition- the SUN rises’. The Lancet, 382(9893), pp. 666-667. Pinstrup-Andersen, P. (2013). ‘Nutrition-sensitive food systems: from rhetoric to action’. The Lancet, 382(9890), pp. 375-376. Sandelowski, ., Lambe, C., Barroso, J. (2004) ‘Stigma in HIV-positive women’, Journal of Nursing Scholarship, 36(2), pp. 122-128. Shoham, J., Dolan, C. & Vostelow, L. ENN (2013). The management of acute malnutrition at scale: A review of donor and government financing arrangements. Summary Report [Online]. Available at: http://scalingupnutrition.org/ (Accessed: 24th March, 2014). SUN (2013). Scaling up nutrition in practice: Effectively enjoying multiple stakeholders [Online]. Available at: http://scalingupnutrition.org/ (Accessed: 24th March, 2014). Taylor, A., Dangour, A. & Reddy, K. (2013). ‘Only collective action will end undernutrition’. The Lancet, 382(9891), pp. 490-491. UNAIDS (2013). Report on the Global AIDS Epidemic 2013. Washington: UNAIDS. UNICEF (2014). The State of the World’s Children 2014 In Numbers: Every child counts [Online]. Available at: http://www.unicef.org/sowc/ (Accessed: 25th March, 2014). Wikman, A., Marklund, S. & Alexanderson, K. (2005) ‘Illness, disease, and sickness absence: an empirical test of differences between concepts of ill health’, Journal of Epidemiology & Community Health, 59, pp. 450-454. Willis, J. (2003) ‘Condoms are for whitefellas: barriers to Pitjzntjztjzrz men’s use of safe sex technologies’, Culture, Health & Sexuality: An international Journal for Research, Intervention and Care’, 5(3), pp. 203-217. World Health Organization (2011). Global Health Observatory (GHO): Underweight in Children [Online]. Available at: http://www.who.int/gho/mdg/poverty_hunger/underweight_text/en/ (Accessed: 25th March, 2014).

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Today, according to the National Institutes of Health, Type 2 diabetes accounts for at least 30 percent of all new childhood cases of diabetes in this country†(Zinczenko 392). He argues that, if the fast food companies are regulated so that they are responsible for their food contents, by providing proper labels, than consumers will make informed food choices. Contrary to Zinczenko, Balko argues that what one eats should be a matter of personal responsibility. To Balko’s credit, I believe that people should take personal responsibility for their health by adding a sensible diet and exercise to their routines. Where I differ from Balko is when he says that government restrictions on food are a result of people making poor food choices. According to Balko, â€Å"a society where everyone is responsible for everyone else’s well-being is a society more apt to accept government restrictions† (397). I think Balko’s argument in this regard, is a selfish one, and is an attempt to exempt the rich from paying their fair share of taxes that would otherwise benefit the poor or some middle families who cannot afford the high cost of health insurance. Both Zinczenko and Balko seem to agree on the rising health costs that are somehow a result of fast food, these two authors seem to differ on reasons. Zinczenko argues that health care cost is on the rise because of diseases caused by fast food due to the failure of fast food companies to provide labels and that consumers should not be blame for it. However, Balko argues that it is so that, we allow the â€Å"government to come between us and our waistline† (396). Balko states that, the more the government continues to fund health issues that are direct attribute of poor food/health choices, the more people will continue to dine on fast food and engage not in an effective diet and exercise regimen. (398) The growth of the fast food industry and the rate at which fast food is consumed is so fast, and its accompanying risks of obesity and related cardiovascular diseases have become a societal epidemic. Zinczenko blames the fast food industries for the spring in the rate to which obesity have grown in the United States. Even though Zinczenko is right about the rising rate of obesity, and that the consumption of fast food forms part of its etiology, the thesis of his argument cannot be proven and therefore cannot form the basis for his claims against the fast food companies since there are other contributing factors regarding the cause, onset, and progression of obesity. Obesity is also biologically linked. These biological attributors include: genetics, hormones, enzymes, and vitamins and minerals. Some people have fat in their genes that, no matter what they do, they are just fat. Others have issues with hormonal imbalances and or inadequate enzymatic actions that would aid in the adequate digestion and absorption of certain foods. Fast food is just one of the many environmental attributes associated with obesity. So Zinczenko can accurately make his case against the fast food industries for providing labels so as to enable consumers make informed food choices and not a case of obesity. Sometimes, people are too fast to pass judgment on others, especially people that are obese. I am equally guilty of the accusation myself. I work as a nurse at a nursing home facility and, in most cases, when staff member comes to me complaining of headache, first thing I say to them is; let’s check your blood pressure and, God forbid, the blood pressure is elevated, or if that person just look fat to me, my next comment is, it is because of all the junk you eat. My judgment, though may be incorrect, is based on the fact that most of these staff members are single parents, live in inner cities, and have a total commute time of two hours to and from work. Not to mention, some of them have more than one job. However, these people are being made to feel guilty about something that is totally out their control. In most instances, their wages aren’t even enough to meet up with their rents and utilities bills. Fast food comes handy in such instance where one can spend ten dollars and get ten cheeseburgers to feed a family of three to five versus going to the grocery store where each healthy ingredient is almost equivalent to the price of the entire dinner comprising of fast food. People fall back on fast food because it is cheap. Zinczenko explains that his parents were split up and that he had to live with his mother who worked long hours just to make the monthly bills. â€Å"Lunch and dinner, for me, was a daily choice between McDonald’s, Taco Bell, Kentucky Fried Chicken or Pizza Hut. † (Zinczenko 391). In Zinczenko’s case, his lifestyle is altered because fast food is his only option since his family is dysfunctional. His single mother has to work very hard to pay bills and provide him a meal. It doesn’t matter the kind of meal. A meal is a meal, especially for someone who doesn’t have the time to prepare a home cooked meal. The people afflicted with fast food related obesity are not to blame for what they eat because they have very little or no options regarding what they eat due to all of the above reasons. However, to Balko’s point, while people may not have the option about what they eat, they have the option to control how they eat. Zinczenko states in his essay that fast food is â€Å"the only available options for an American kid to get an affordable meal†, and so, he urges his readers not to â€Å"blame the Eater† (392). But as with Zinczenko, we are well aware of the role fast food play in our lives. We understand that, though fast may be one, or the only available meal choice that we have, the way we eat can help us determine the role these foods play in our lives. Zinczenko supports his argument about the role food play in his life by giving information about his pre-college weight. â€Å"By age 15, I had packed 212 pounds of torpid tallow on my once lanky 5-foot-10 frame† (392). Even Zinczenko believes that, consumers are as equally responsible for the way they eat. However, he maintains his argument that the fast food companies bare the greater responsibility. In conclusion, both the eater and the producer are responsible for fast food related obesity, but I believe that the fast industries should bare the greater responsibility. Fast food companies must provide their consumers with proper food labels that enable them to make inform decision about what they eat. Label should not be falsified or misleading, like in the example giving by Zinczenko about the misleading label on the â€Å"chicken salad† (393). He refers to the salad as not healthy and that it is a caloric death- trap aimed at eaters who will not suspect it. Although Balko makes some really good points, his objectives seem to me as a means to an end. Zinczenko cautions that there are few or no alternatives to what we eat and that things have to change. Balko cautions that allowing food regulations for labels means letting the government between you and your waistline. In either case, we as a people have a responsibility to consider what and how we eat.