Can nutrition be promoted through agriculture-led food price policy? A systematic review


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Alan Dangour from the London School of Hygiene and Tropical Medicine (LSHTM) presents findings from a systematic review on the role of agricultural policy that directly manipulate food prices and its affects on under- and over-nutrition. Only 4 studies met the inclusion criteria suggestion limited evidence in this domain. This was presented at the joint LSHTM, LIDC and IDS event called 'Synthesising evidence across health and development' held at Woburn House on 19 September 2012.

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Can nutrition be promoted through agriculture-led food price policy? A systematic review

  1. 1. Can nutrition be promoted through agriculture-led food price policy? A systematic review Dangour AD, Hawkesworth S, Shankar B, Srinivasan CS, Morgan E, Watson L , Mehrotra S,Haddad L, Waage J
  2. 2. Rationale• Agricultural growth is crucial for development and poverty reduction• Agriculture and health are linked via complex direct and indirect pathways• Increasing the availability and affordability of food may reduce undernutrition rates• Changing food consumption patterns are a major driver of the rise in non-communicable diseases• No systematic review of effect of agricultural policies on nutrition and health outcomes
  3. 3. Framework Income Employment Assets LivelihoodsAgriculturaldevelopmentpolicies Commodity Quantity/ Nutrition/ price/ quality of food health availability consumption outcomes ?
  4. 4. Research question• Do agricultural development policies that directly affect the price of food, influence rates of undernutrition and / or nutrition- related chronic diseases?• Primary outcomes – Undernutrition / Nutrition-related chronic disease• Secondary outcome – Consumption
  5. 5. Agricultural / food system policies• Commodity policies – Output price, input subsidy, irrigation and water, crop technology, land reform, mechanisation• Trade policies – Trade liberalisation, export, cash crop, foreign direct investment, procurement• Public distribution systems – Consumer subsidy and distribution, marketing support, food aid
  6. 6. Food price policies• Identified policies – Policies that affect output prices at farm-level – Trade liberalisation policies that impact trade tariffs and restrictions – Consumer subsidy and distribution policies that subsidise the price of food for consumption• Directly impact the price of food• Large resource flows and high-level interest
  7. 7. Data sources• Electronic databases – Medline, Econlit, Scopus, Agricola, Agecon, Eldis• Grey literature – E.g. FAO, World Bank, USDA websites• Hand-searching and author contact
  8. 8. Inclusion criteria• Data collected post-1990• English language• Multivariate quantitative analysis – Simple associations/correlations excluded – Commentaries/narrative reviews excluded• Ex ante simulation and ex post evaluation
  9. 9. Findings – primary outcome• 1 study reported on undernutrition – Increase in price of rice/sugar/oils provided by PDS in India had no effect on child weight (ex post)• 3 studies reported on NCDs – Increase in price of bread/sugar/oil provided by PDS in Egypt decreases BMI (ex post) – Removal of EU policy that maintains high price of fruit and veg would reduce CVD and cancer incidence and increase life expectancy (ex ante) – Removal of US farm subsidies for grains would reduce adult weight (ex ante)
  10. 10. Findings – secondary outcome• 65 studies reported on “consumption”• 3 ex post studies – Participation in Indian PDS that provides rice/sugar/oil increases energy and nutrient intake – No evidence for any change in child weight• 62 ex ante studies – Most modelled impact of trade liberalisation policies on consumption – Conflicting evidence
  11. 11. What’s new?• First systematic review of cross-disciplinary evidence linking agricultural policy with health• Identified surprising paucity of evidence especially on undernutrition• Suggestion that food price related policies may influence chronic disease outcomes• Some evidence to support the hypothesis that this is through changes in consumption• Highlights the need to build health outcomes into agricultural policy design and evaluation
  12. 12. Key messages• By linking currently distinct disciplines and sectors new insights can be gained• Agricultural policies may be a driver of population health but uncertainty remains• Potential power of food prices to affect health is large – strong rationale for more research• Cross-disciplinary thinking and methods needed to enhance understanding