Rajul Pandya-Lorch, Heidi Fritschel, Zhenya Karelina, and Sivan Yosef, IFPRI
The agriculture, nutrition, and health nexus came to prominence in 2011. With 1 billion people continuing to suffer from food insecurity, and with vitamin and mineral deficiencies compromising the nutrition and health of billions of people, the international ddevelopment community began to ask how much more could agriculture do to improve human well-being if it explicitly included nutrition and health goals? What kind of changes could maximize agriculture’s contribution to human health and nutrition, and how could improved human health and nutrition contribute to a more productive and sustainable agricultural system?1
Although the agriculture, health, and nutrition sectors all seek to improve human well-being, agriculture has rarely been explicitly deployed as a tool to address nutrition and health challenges. With agriculture moving higher on the global agenda, in part because of volatile food prices, there is growing recognition that it is an opportune time to bring together the agriculture, nutrition, and health sectors and unleash the potential of agriculture—as a supplier of food, a source of income, and an engine for growth—to sustainably reduce malnutrition and ill-health for the world’s most vulnerable people (see Box 6).
Agricultural Research Takes on the Nutrition and Health Challenge
John McDermott, CGIAR Research Program on Agriculture for Improved Nutrition and Health
Malnutrition and disease are widespread and persistent global challenges. Agriculture is central to both, but agricultural growth alone has been insufficient to achieve targets for reducing malnutrition and improving health, such as United Nations Millennium Development Goal 1 on underweight children or Millennium Development Goal 4 on child mortality. One-third of children in South Asia are underweight, and more than 33 percent of childhood deaths in low-income countries are linked to undernutrition, most significantly in rural Sub-Saharan Africa. To enhance the agricultural contribution, the Consultative Group on International Agricultural Research (CGIAR) has developed a program to research agricultural actions for improving human nutrition and health.1
This new research program, launched in January 2012, has four interlinked components. One integrates agriculture, nutrition, and health programs and policies, while the other three components focus specifically on developing agricultural solutions that improve nutrition and health:
- Production and distribution of more nutritious staple crops, biofortified with pro-vitamin A, iron, or zinc, to address the most severe micronutrient deficiencies
- Improvement of value chains to increase foods’ nutritional value from production to consumption, including food-value-chain analysis and development done by other CGIAR programs
- Reduction of the risk of agriculture-associated diseases by enhancing food safety and controlling zoonoses as well as emerging diseases, and by mitigating diseases associated with agricultural intensification
Research outputs will contribute to development impacts along three pathways: improving the nutritional quality and food safety of food value chains, providing knowledge and technologies to improve the performance of agriculture-nutrition-health development programs, and providing knowledge and evidence for improved policymaking and investment decisions.
For better nutrition and health for the poor, agricultural researchers will need to work closely with nutrition and public health researchers and link with food-value-chain actors, development program implementers, and policy-makers. Behind these partnerships will be a fundamentally new perspective on agrifood system research and development, including
- looking beyond food production to processing, distribution, and consumption through deeper engagement with the private sector and other value-chain actors;
- taking a more integrative view through joint efforts of agriculture, health, and social development sectors using new metrics and tools for joint planning and assessment; and
- focusing on the perspective of the poor—by, for example, assessing livelihood and risk tradeoffs rather than using the standard hazard-avoidance perspective.
This new agricultural research program will focus on South Asia and Sub-Saharan Africa. Through investing in new tools, approaches, and evidence to usefully guide agricultural policy and practice, the CGIAR expects to have a major impact on enhancing agricultural contributions to global, regional, and national efforts to accelerate better nutrition and reduce agriculture-associated disease burdens among the poor.
1 - For more information on the CGIAR Research Program on Agriculture for Improved Nutrition and Health, see International Food Policy Research Institute, “Agriculture for Improved Nutrition and Health (CRP4),” www.ifpri.org/ourwork/division/agriculture-improved-nutrition-and-health-crp4. [Back]
Creating Momentum and Building On It
Early in the year, about 1,000 leaders and practitioners in the sectors related to agriculture, nutrition, and health came together at an international conference called “Leveraging Agriculture for Improving Nutrition and Health,” organized by IFPRI and its 2020 Vision Initiative in New Delhi (http://2020conference.ifpri.info/). At this conference, participants took stock of available knowledge on the interactions among agriculture, nutrition, and health; explored opportunities for enhancing nutrition and cutting health risks along the value chain; identified key levers and incentives for leveraging agriculture; and assessed critical research and action gaps. Ultimately, they catalyzed a process to reimagine how to make these linkages work better to enable more nutrition- and health-friendly agricultural investments (see Box 7).
IFPRI’s 2020 Conference: Tracking the Outcomes
Robert Paarlberg, Wellesley College and Harvard University
The 2011 “”Leveraging Agriculture for Improving Nutrition and Health” Conference, organized by IFPRI and its 2020 Vision Initiative, had significant useful effects on participants, in addition to informing global discourse and potential new initiatives. Conferees learned how to advance an integrated approach to agriculture, nutrition, and health more effectively in their respective workplaces. While most conferees arrived already believing the sectors should be viewed and managed jointly rather than in isolation, their attendance strengthened these opinions—as shown by pre- and post-conference surveys. Conferees gained valuable new information and connected to a wider set of cross-sector networks.
The 2020 Conference also produced measurable impacts on public and professional discourse. Between October 2010 and May 2011, the international journalists invited to the conference wrote 33 stories about the conference, and 25 other media stories were published in English, French, and German. Significant institutional reporting on the conference included 22 stories presented in various donor and stakeholder outlets. This media coverage helped increase the visibility of conference themes. Google searches at regular intervals revealed a significant uptick in the Internet presence of the conference’s central theme; the average number of retrieved web pages containing the phrase “linking agriculture, nutrition, and health” increased from about 9,300 in the preconference period to more than 13,500 in the post-conference period.
Finally, surveys and interviews revealed that this New Delhi conference inspired or supported a range of important initiatives, including follow-on meetings and consultation; efforts to contact government decisionmakers on agriculture, nutrition, and health issues; new initiatives by donors; and even some provisional programmatic and institutional change. One immediate, tangible impact was a decision by the Canadian International Development Agency to give an additional US$6–10 million grant to the HarvestPlus project on biofortification. In addition the conference further strengthened the agriculture, nutrition, and health themes in the new CGIAR Research Program on Agriculture for Improved Nutrition and Health, an international initiative to create a network of educational institutions working in the areas of agriculture, nutrition, and health. China’s State Food and Nutrition Consultation Committee vowed to create a food safety and nutrition development institute as well.
The durability and extent of such changes during the longer term will depend in part on whether IFPRI commits resources to sustained leadership in the areas of agriculture, nutrition, and health outreach and policy research.1
1 - The information in this box is based on R. Paarlberg, 2020 Conference “Leveraging Agriculture for Improving Nutrition and Health” New Delhi, India, February 10–12, 2011: Interim Report on Short-Term Impact (Washington, DC: International Food Policy Research Institute, 2011). [Back]
Several development agencies have begun to design or redesign their programs to better tap these links. For instance, Feed the Future, the United States’ multibillion-dollar global hunger and food security initiative, explicitly seeks to accelerate inclusive agriculture sector growth and improve nutritional status through sustainable country-owned development programs. The United Kingdom Department for International Development has substantially scaled up its support for nutrition programming and research and is including agriculture, food, and nutrition security research as part of its program in South Asia.
In Sub-Saharan Africa, the New Partnership for Africa’s Development and the Global Alliance for Improved Nutrition signed an agreement to develop a five-year joint program to fully integrate nutrition security into the Comprehensive Africa Agriculture Development Program (CAADP) framework. Representatives from the ministries of agriculture, nutrition, and health and other counterparts from 17 West African countries came together at a CAADP workshop in Dakar in November 2011 to examine how nutrition can be integrated into national agricultural development plans, with special attention to addressing country-specific nutrition problems. In October 2011 President Yoweri Museveni launched the Uganda Nutrition Action Plan (2011–2016), developed by the Uganda National Planning Authority in collaboration with several ministries, with a strong message to the public on what foods to grow to avoid malnutrition. Malawi organized a groundbreaking national conference in September 2011 that brought together policymakers and planners in the agriculture, nutrition, and health sectors to coordinate and integrate their activities to help agriculture in Malawi contribute to the health and nutrition of the population.
In late 2010 a road map was produced for the Scaling Up Nutrition (SUN) movement—a broad partnership of international and donor organizations.2 The movement gathered considerable momentum during 2011 when the road map began to be translated into action. By January 2012, 24 high-burden countries had committed to the SUN movement and begun setting nutrition goals and targets. More than 100 organizations around the world have endorsed it. The movement supports national governments in developing and operationalizing nutrition-sensitive national plans and aligns financial and technical support for nutrition. A large part of the SUN movement's approach consists of incorporating specific pro-nutrition actions into other areas such as food security, agriculture, and health.
Other initiatives included the United Nations high-level meeting on noncommunicable diseases in September 2011. This meeting involved only limited participation by the agriculture sector, but the declaration that resulted from the meeting noted the need for a whole-of-government approach that includes the agriculture sector. With its report Bringing Agriculture to the Table: How Agriculture and Food Can Play a Role in Preventing Chronic Disease, the Chicago Council on Global Affairs provided clear analysis and recommendations on how agriculture can contribute to better health.
Despite opportunities to improve health outcomes through the agriculture nexus approach, involving the health sector in the discussions has been challenging (see Box 8). One of the key barriers to collaboration between the agriculture and health communities is a lack of common metrics. Therefore, in May 2011, IFPRI and the Leverhulme Center for Integrative Research on Agriculture and Health brought together health and agriculture experts to find common ways of measuring the health outcomes of agriculture interventions.
Building on the momentum of the 2020 Conference, the Consultative Group on International Agricultural Research (CGIAR) developed a major new research program called “Agriculture for Improved Nutrition and Health,” which was launched in January 2012 with the overarching aim of improving the nutrition and health of poor people by exploiting the many synergies between agriculture, nutrition, and health (see Box 6).
Public Health and Agriculture: Working Together
Kabba T. Joiner, Helen Keller International
The agriculture and health sectors have long been separated by fundamentally different societal functions and institutional organization. However, both health and agriculture representatives made a marked effort to bring the two sectors closer together in 2011, forming some promising links between agriculture and health organizations. Programs that have emerged more recently in Sub-Saharan Africa include the Baby Friendly Community Initiative in The Gambia, Millennium Villages in Mali, Gardens for Health in Rwanda, and Agriculture for Children’s Empowerment in Liberia.
Agriculture can make both direct and indirect contributions to health. Growth in agriculture leads to increased rural income, which is positively related to better health status when community health infrastructure is financed by profits from agriculture. Sustained agricultural development can indirectly lead to significant progress in rural health. In particular, if women’s incomes grow, they use healthcare services more frequently, which improves maternal and child health.
Agriculture can contribute to public health directly through improved agricultural products. In general, improving diets—by improving food products—reduces the burden of chronic diseases. Integrating the agriculture and health sectors also improves food safety by making it possible to establish better surveillance systems from farm to table. But more can be done than just growing better-quality crops. For a long time, agriculture was not considered a primary weapon in the elimination of micronutrient malnutrition. Food systems were developed with little attention to balanced nutrient requirements that support good health and well-being. Now HarvestPlus and other organizations are addressing this issue through the breeding of mineral- and vitamin-rich crops, such as orange-fleshed (that is, carotene-rich) sweet potatoes and high-iron pearl millet.
Collaborations between the agriculture and health sectors can lead to substantial improvements in diet quality in developing countries, but they can flourish only if certain human and institutional challenges are overcome. Representatives from both sectors need to
- take cross-sectoral action at the community level;
- increase funding in units of the health sector that can work with agriculture;
- create formal arrangements, assign responsibilities, and develop skills for intersectoral negotiation and decisionmaking;
- establish reliable communication and links among researchers, policymakers, and practitioners in both sectors;
- ensure mutual consultation in priority setting and activities like data collection; and
- strengthen human capital in both sectors by reviewing curricula or by exchanging staff and sharing facilities.
Decisionmakers in agriculture and health should push for more innovation and cross-sectoral participation to produce better outcomes. They must go off the beaten path in order to maximize the benefits from their collaboration.
Linking Agriculture, Nurition, and Health
In many ways, the links among agriculture, nutrition, and health are already at work, but the synergies may not always be optimal. Agriculture is the primary source of food to meet people’s need for energy and essential nutrients. But to get access to food, people do not necessarily need to produce it themselves; they can also buy it. The agricultural system may help increase people’s access to food by allowing them to produce more food (if they farm themselves) or by lowering food prices or raising their incomes (if they purchase food). By improving their access to food, agriculture has the potential to greatly improve people’s nutrition and health. At the same time, some agricultural conditions and practices can lead to disease and poor health for both farmers and consumers.3 For example, agricultural practices may increase farmers’ risk of becoming infected with animal diseases, expose farmers to dangerous pesticides, or introduce toxins into foods.
In many agrarian countries, agricultural growth is more effective in reducing undernutrition than growth in other sectors. However, the composition of agricultural growth, the distribution of this growth, and the conditions under which such growth takes place all matter. Growth in agricultural subsectors where poor people are engaged, such as staple crops, contributes more to reducing poverty and increasing calorie intake than growth in, for instance, export crops. Later in the development process, growth in other sectors besides agriculture becomes more important in improving food and nutrition security. Yet neither agricultural growth nor nonagricultural growth alone is sufficient to reduce child undernutrition or micronutrient malnutrition—complementary programs in nutrition, health, water and sanitation, and behavior change communication also need to be implemented and targeted to vulnerable populations, especially women and children.4
The links among agriculture, health, and nutrition often work differently for men and women. In many parts of the world, men and women spend money differently: women are more likely to spend the income they control on food, healthcare, and education for their children. Increased equality between men and women can translate into greater agricultural productivity. If this productivity is accompanied by more income and strong bargaining power for women, it can result in better health and nutrition.
Opportunities to improve nutrition and reduce health risks exist all along the agricultural value chain. A value-chain approach to development can incorporate nutrition goals and thereby make nutritious foods more available and affordable for the poor. This approach starts by looking at every component of the food supply chain from field to fork—including production, postharvest processing, marketing, and trade—and determining where value for nutrition can be integrated. The food value chain also involves many hazards—microbiological, physical, and chemical hazards, as well as occupational hazards—that pose challenges for producing and consuming safe food. Policymakers are increasingly using risk analysis to help them decide on regulatory and other actions to reduce health risks along the food value chain.5
Many interventions are being tried to understand and deal with these challenges. Examples include biofortification (the breeding of new varieties of food crops with improved nutritional content); schemes to increase household production and consumption of micronutrient-rich vegetables, fruits, and animal-source foods; local production of foods for school feeding programs; and projects to integrate agriculture, nutrition, and health services.6 So far, however, there is little concrete evidence on how agriculture–nutrition linkages work. One crucial task then is to compile the evidence base on these links. Many more studies are needed on the nutritional impacts of agricultural interventions, more nutrition-relevant data need to be generated and collected, and nutritional indicators should be included in evaluations of agricultural programs.
The 2020 Conference highlighted four important sets of tools that could help to leverage agriculture for better nutrition and health. Economic levers include, at the broadest level, agricultural growth or overall economic growth (with the caveat that growth alone is not enough to solve the nutrition problem). “Fat taxes” and “thin subsidies” have the potential to influence people’s economic access to healthy foods in industrial counties, but more targeted approaches to improving poor people’s diets may be more appropriate in developing countries. Social levers involve bringing people together across sectors and within communities to jointly work toward improving nutrition and health. Governance levers require government leadership at all levels—from national to provincial to local. Changes in policies and programs are not enough to get people in different ministries and institutions to work together—it is important to devise incentives to get them to do so and to devote the time and resources necessary to work across sectors. Science and technology levers require not only allocating more resources to general agricultural research and development to keep the pipeline for innovation, discovery, and dissemination full, but also targeting more resources specifically to nutrition- and health-relevant research, such as work on nutrient-rich vegetables and other crops and livestock.
A number of recurring themes7 emerged during the 2020 Conference and are engaging the international community:
Improve investments by making existing ones more nutrition- and health-friendly, prioritizing and scaling up successes, and generating new ones that exploit the links among agriculture, nutrition, and health.
- Don’t wait to act but move ahead based on available information and common sense.
- Communicate better to build awareness, raise interest, provide options, and attract “champions” to promote action.
- Fill the knowledge gaps on what type of agricultural growth is best for nutrition and health and what types of governance arrangements and partnerships are needed at the local, regional, and global levels.
- Focus on education by developing multidisciplinary university-level education programs that inculcate broader thinking among future leaders in agriculture, nutrition, and health, and break down the “silos” between the sectors.
- Build the evidence base by collecting relevant data in a timely fashion, improving tools and methods, and investing in monitoring and evaluation.
- Collaborate across sectors by creating mutual accountability and looking for ways to work together while not losing the advantages of deep sectoral expertise.
- Use all available levers for change, including economic, social, governance, and science and technology levers that can maximize agriculture’s contribution to nutrition and health.
- Correct market failures by using public policies such as investments, subsidies, education, trade, and tax policies, as markets alone may not achieve socially optimal agriculture, nutrition, and health outcomes.
- Look at food systems, not just agricultural systems; consider all the stages from field to fork; and be sensitive to the sustainability of natural resources.
- Proactively engage the health sector and find ways to reach out and include the health sector in agricultural activities.
- Recognize that women are at the nexus of the three sectors and direct policies and programs to women to simultaneously strengthen agriculture and enhance nutrition and health.
The nexus approach is spilling over to other sectors. The food-water-energy nexus gained a great deal of attention in late 2011 with the Bonn2011 Nexus Conference (see Box 9). In an increasingly interlinked global environment, a nexus approach to agriculture offers considerable potential to improve nutrition and health, to manage natural resources more sustainably, to improve people’s livelihoods, and to support more inclusive economic growth. Looking ahead, it is important to build an evidence base that will improve understanding and help identify viable opportunities to strengthen linkages across sectors and achieve mutually beneficial outcomes.
Food, Water, and Energy: Understanding the Nexus
Claudia Ringler, IFPRI
During the last few years, the cross-sectoral linkages on the supply side of agriculture have become more apparent as key agricultural inputs have grown scarcer and more expensive. Key among these linkages are those of agriculture and food with water, land and energy resources, and environmental/biodiversity outcomes. The food-water-energy nexus has come to the forefront in discussions at several international forums in the run-up to the Rio+20 United Nations Conference on Sustainable Development that will take place in Brazil in June of 2012. One such forum, the Bonn2011 conference on “The Water, Energy, and Food Security Nexus: Solutions for the Green Economy,” concluded that “achieving water, energy and food security, and consequently reducing hunger and eradicating poverty, is a central future challenge that is possible to overcome, even under difficult and challenging global economic conditions.”1
Much work has been done on water and food interlinkages. Water supply is essential for food production, which depletes about 80 percent of global freshwater withdrawals annually. Population growth, economic growth, urbanization, and industrialization have fueled increasing water scarcity, putting as much as half of all global grain production at risk of insufficient water resources by 2050.2 Increasingly it is not only water availability that is being compromised, but also water quality. Investments in the sector have been insufficient in most developing countries to meet growing demand for clean and safe water.
Less is known about the interlinkages between energy and food and among energy, water, and food. However, the growing interdependence of food and oil prices as a result of increased energy use in agriculture and the growing share of foodcrop use as biofuels have made the need for joint policy development apparent. Higher energy prices have driven up food prices and reduced the availability of land and water for food production (due to competition from expanded biofuel production). At the same time, poor people’s access to sufficient food, water, and energy remains unacceptably low, particularly in Sub-Saharan Africa and South Asia.
These linkages thus demand holistically developed programs and policies. This is particularly crucial because food production will need to increase substantially in the next four decades to meet growing demand. To achieve food security without compromising sustainable water and
energy supplies, improved policies, institutions, and investments should include the following principles:
- develop clear national food and nutrition policies that take into account the consequences for water and energy;
- reduce water, food, and energy subsidies that lower resource-use efficiency and have adverse impacts on the poor and the environment;
- maximize complementarities between public and private stakeholders in food, water, and energy provision;
- promote resource-use-efficient technology development and dissemination, particularly technologies the poor can afford;
- promote tenure security for both water and land;
- focus and strengthen crop and other agricultural research at the food-water-energy nexus (for example, drought-tolerant, high-yielding,
nutrient-use-efficient crops); and
- create markets and trade solutions that ensure least-cost input flow for farmers and consumers.
If food, water, and energy connections remain unaddressed, global food security will not be achieved, particularly for the rural poor.
1 - The Water, Energy, & Food Security NEXUS Resource Platform, “Bonn2011 Conference,” www.water-energy-food.org/en/whats_the_nexus/bonn_nexus_conference.html, accessed March 15, 2012. [Back]
2 - For an overview of IFPRI’s data on the food-water-energy nexus, see Veolia Water, Finding the Blue Path for a Sustainable Economy, White Paper, www.veoliawaterna.com/north-america-water/ressources/documents/1/19979,IFPRI-White-Paper.pdf, accessed March 15, 2012.[Back]
1 - International Food Policy Research Institute, Agriculture, Nutrition, and Health: Exploiting the Linkages, IFPRI 2020 Conference Brochure (Washington, DC, 2010). [Back]
2 - United Nations System, Standing Committee on Nutrition, SUN Road Map Implementation, http://www.unscn.org/en/scaling_up_nutrition_sun/. [Back]
3 - International Food Policy Research Institute, Leveraging Agriculture for Improving Nutrition and Health: Highlights from an International Conference (Washington, DC, 2011). [Back]
4 - S. Fan, R. Pandya-Lorch, and H. Fritschel, “Overview,” in Reshaping Agriculture for Nutrition and Health, edited by S. Fan and R. Pandya-Lorch (Washington, D.C.: International Food Policy Research Institute, 2012). [Back]
5 - Ibid.; C. Hawkes and M. Ruel, Value Chains for Nutrition, IFPRI 2020 Conference Brief 4 (Washington, DC: International Food Policy Research Institute, 2011). [Back]
6 - IFPRI, Leveraging Agriculture for Improving Nutrition and Health: Highlights from an International Conference. [Back]
7 - IFPRI, Leveraging Agriculture for Improving Nutrition and Health: The Way Forward (Washington, DC, 2011); IFPRI, Leveraging Agriculture for Improving Nutrition and Health: Powerpoint at a Glance (Washington, DC, 2011). [Back]