1
Science Forum 2013
Agriculture and Nutrition: What do we know,
and what do we still need to know?
Patrick Webb
23 Septem...
The tines, they are a changin’….
Copyright 2013 by S. Karger AG
“Higher calorie intake has improved nutrition and health.”
CGIAR (1996) Annual Report 1995-96
“Merely producing more food ...
4
Starting at the end…
1. Effective agriculture-nutrition research needs honesty
(about feasible contribution to nutrition...
6
a) Discussion of potential for
agriculture to contribute to,
accelerate, and enhance coverage
of improved nutrition outc...
7
Lancet 2013
All forms of undernutrition combined responsible
for 45% of avoidable child deaths.
165 million children stu...
8
Lancet 2013
10 targeted interventions implemented at 90%
coverage cuts stunting by 20%, mortality by 15%.
But…“coverage ...
9
0.1.2.3.4.5
density
-6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6
height-for-age z-score (stunting)
Mountains Hills Terai
Source: DHS ...
Masset et. al. (2011)
7,000 studies considered.
Only 23 qualified for final inclusion (i.e. having
credible counterfactual...
11
1. Productivity 2. Empowerment
Source of food
Source of income
Stability of food
prices
Resource control
Women’s time
W...
New crop
technology
Higher
productivity
Higher household
income, sales,
consumption
Transfer of labor
and inputs
Net retur...
13
1. Productivity 3. Diet Quality2. Empowerment
4. Food system safety 5. Delivery platforms
Source of food
Source of inco...
14
Lancet Paper 3 (Ruel and Alderman 2013)
“Poor-quality evaluations prevent firm conclusions
on the impact of agriculture...
15
Source: Masset et al. 2011
Tradeoffs;
opportunity
costs of time
Diet quality (animal
source foods, whole
diet diversity; a...
18
What do we still need to know? - Lancet
1. Rigorous cost-effectiveness assessment of large scale
nutrition-sensitive pr...
19
What do we still need to know? - Hawkes/DFID review
1. Complete links in chain (from ag. to nutrition outcomes).
2. Cos...
20
What do we still need to know? - Food Security Learning Framework
1. Cost-effective approaches that result in demonstra...
CGIAR Independent Science and Partnership Council (2012)
Strengthening Strategy and Results Framework
22
Ways forward
As stewards of scarce resources, we must understand and
document investment impacts (and explain how and w...
Patrick Webb, Tufts University, Keynote Presentation:  "Agriculture and nutrition. what do we know, and what do we still n...
Patrick Webb, Tufts University, Keynote Presentation:  "Agriculture and nutrition. what do we know, and what do we still n...
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Patrick Webb, Tufts University, Keynote Presentation: "Agriculture and nutrition. what do we know, and what do we still need to know?"

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Science Forum 2013 (www.scienceforum13.org)
Keynote plenary
Patrick Webb, Tufts University, keynote presentation

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Patrick Webb, Tufts University, Keynote Presentation: "Agriculture and nutrition. what do we know, and what do we still need to know?"

  1. 1. 1 Science Forum 2013 Agriculture and Nutrition: What do we know, and what do we still need to know? Patrick Webb 23 September 2013, Bonn, Germany
  2. 2. The tines, they are a changin’…. Copyright 2013 by S. Karger AG
  3. 3. “Higher calorie intake has improved nutrition and health.” CGIAR (1996) Annual Report 1995-96 “Merely producing more food does not ensure food security or improved nutrition.” (Herforth (2012) World Bank) “Agriculture interventions do not always contribute to positive nutritional outcomes.” (FAO 2012)
  4. 4. 4 Starting at the end… 1. Effective agriculture-nutrition research needs honesty (about feasible contribution to nutrition), engagement across sectors, and rigor (outcome-appropriate methods). 2. Only possible with agriculture researcher involvement in public health dialogue, priority-setting, integrated research. 3. Expanded research agenda: highest impact may be in ‘novel’ domains (food system hygiene, agriculture programmes as platforms for delivery of other services).
  5. 5. 6 a) Discussion of potential for agriculture to contribute to, accelerate, and enhance coverage of improved nutrition outcomes b) Search for evidence that it can…
  6. 6. 7 Lancet 2013 All forms of undernutrition combined responsible for 45% of avoidable child deaths. 165 million children stunted in 2011. 20% stunting ascribed to in utero conditions (small for gestational age) – which means reaching pregnant women and pre-pregnant girls is priority.
  7. 7. 8 Lancet 2013 10 targeted interventions implemented at 90% coverage cuts stunting by 20%, mortality by 15%. But…“coverage rates for [many] interventions are either poor or non-existent.” Cost: US$9.6 billion per annum. Even at 90% coverage, 80% of stunting remains!!!
  8. 8. 9 0.1.2.3.4.5 density -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 height-for-age z-score (stunting) Mountains Hills Terai Source: DHS 2006 Children below 5 years (n=5,237) by agroecological zone (from left to right, means = -2.27, -2.02, -1.89) Height-for-age Z-scores (stunting) Nepal, 2006 and Shively (2013)
  9. 9. Masset et. al. (2011) 7,000 studies considered. Only 23 qualified for final inclusion (i.e. having credible counterfactuals and rigor in methods). Masset et al. (2011/12): a) Positive impacts on farm output/productivity. b) “Poor evidence of impact on households’ net income.” c) “Little evidence…on changes in diets of the poor.” d) No studies assessed quality of whole diet (substitutions). e) 9 studies tested impact on Vitamin A (only 4 were positive). f) “No evidence of impact on stunting, wasting.”
  10. 10. 11 1. Productivity 2. Empowerment Source of food Source of income Stability of food prices Resource control Women’s time Women’s nutrition Mechanisms A doubling of per capita income from agriculture is associated with 15-21% point decline in stunting.
  11. 11. New crop technology Higher productivity Higher household income, sales, consumption Transfer of labor and inputs Net return/day of labor X3 Net rise in real income 13%/hh 10% income rise = 4.8% rise in calorie supply Child nutrition improved (but less than expected) 10% rise in calories = 2.4% fall in children underweight Source: von Braun et al. (1989)
  12. 12. 13 1. Productivity 3. Diet Quality2. Empowerment 4. Food system safety 5. Delivery platforms Source of food Source of income Stability of food prices Resource control Women’s time Women’s nutrition ‘Whole diet’ diversity Inputs to processed foods Sources of anti- nutrients Source of human and environmental pathogens Integration with multi- sector interventions Value chain foundations Mechanisms
  13. 13. 14 Lancet Paper 3 (Ruel and Alderman 2013) “Poor-quality evaluations prevent firm conclusions on the impact of agriculture programs on nutrition.” “Evidence of the effectiveness of … agricultural programmes on maternal and child nutrition, with the exception of vitamin A, is limited.”
  14. 14. 15
  15. 15. Source: Masset et al. 2011 Tradeoffs; opportunity costs of time Diet quality (animal source foods, whole diet diversity; anti- nutrients in meals) Food safety (mycotoxins; cytokines) Environmental enteropathy (gut microbiota; shared pathogens) Do no harm (malaria, bird flu, pesticides) Agriculture and Livelihoods Nutrition and Health Empowerment, income control
  16. 16. 18 What do we still need to know? - Lancet 1. Rigorous cost-effectiveness assessment of large scale nutrition-sensitive programmes (not just gardens). 2. Careful assessment of intermediary outcomes along impact pathways. 3. Programme entry/technology adoption barriers. 4. Feasibility and desirability of integrating interventions from several sectors, versus co-location. 5. Documented scalability of biofortified crops.
  17. 17. 19 What do we still need to know? - Hawkes/DFID review 1. Complete links in chain (from ag. to nutrition outcomes). 2. Cost-effectiveness of interventions/investments. 3. Population sub-groups (incl. the poorest, rural non-farm). 4. Indirect effects on nutrition (pathogens, agric. safety). 5. Value chain roles in linking agriculture and nutrition. 6. Agriculture/food/trade policy effects on nutrition. 7. Incentives for effective nutrition-sensitive policies.
  18. 18. 20 What do we still need to know? - Food Security Learning Framework 1. Cost-effective approaches that result in demonstrated improvements in diets and nutrition. 2. Effect mediators of those approaches by context. 3. What combinations of sector actions most effective. 4. Value chain and agriculture policy impacts on nutrition. 5. Assessment of actual mechanisms to having impacts on diets and nutrition. 6. Incentives for effective governance of nutrition sensitive actions to impact nutrition nationally.
  19. 19. CGIAR Independent Science and Partnership Council (2012) Strengthening Strategy and Results Framework
  20. 20. 22 Ways forward As stewards of scarce resources, we must understand and document investment impacts (and explain how and why). Much more high quality research needed (beyond agronomy, ag. econ., resource management); requires evidence-capture that passes the bar of future meta-analyses (but not just RCTs!) Need less claiming/modeling of “potential” impact, more demonstration of actual net impacts. Must link agriculture with public health research to fill knowledge gaps on ‘dose-response’, effect modifiers, cost- effectiveness, inter-sectoral processes, etc.

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