Food for a healthy and active life: New indicators to guide action in the agriculture and food sector

Transcription

1 Food for a healthy and active life: New indicators to guide action in the agriculture and food sector Anna Herforth, Ph.D. Independent Consultant Visiting Fellow, Cornell University Festschrift, Dec 13, 2013

2 What is access to adequate food? And what is the agriculture and food sector supposed to do about it?

3 1960s-1970s: The food shortage era Green Revolution; formation of CGIAR Although deficiency of vitamins and minerals may cause serious health problems, especially among children, the therapy is now well known and relatively easy to apply so that the magnitude of this problem is almost negligible in relation to the one created by lack of calories and proteins. World Bank, 1972 Possible Actions on Malnutrition Problems

4 Concept of food security Nature of main nutrition problems Data on malnutrition prevalence Main cause of malnutrition Data on apparent causes of malnutrition 1960s-1970s 1974 World Food Summit: availability at all times of adequate world food supplies Hunger and protein deficiency; micronutrient deficiencies Estimates made using per capita food supplies Considered to be lack of calories (and protein) Dietary energy supply (DES) and protein supply Today 1996 World Food Summit: physical and economic access to sufficient, safe, nutritious food to meet dietary needs for a healthy and active life Stunting, obesity, micronutrient deficiencies Collected in nearly all countries regularly since mid-1990s (DHS, MICS) Inadequate food, health, and care Next slide

5 Why have global indicators of food not evolved with understanding of the problem? 1970s 1980smid-90s Dietary Energy Supply Protein supply Dietary Energy Supply Undernourishment Supply of iron and vitamin A * Food Health Care Access to safe water Access to health services Immunization Breastfeeding to 3 mos Breastfeeding to 6 mos Breastfeeding to 12 mos 1998 Dietary Energy Supply Undernourishment 2013 Dietary Energy Supply Undernourishment Protein supply % calories from starches Access to safe water Access to adequate sanitation Immunization ORT use Access to safe water Access to adequate sanitation Immunization ORS use VAS coverage Exclusive BF 0-3 mos BF & comp food 6-12mos Breastfeeding 20-23mos Early initiation of BF Exclusive BF to 6 mos Intro of solid/semi-solid/soft foods 6-8mos Breastfeeding at age 2yrs Sources: UNICEF SOWC, SCN Reports on the World Nutrition Situation, FAO SOFA and SOFI reports

6 Nutrition isolationism (1980s-2008) The major lesson of the last 20 years is that reductions in malnutrition cannot be achieved only by increases in food production. UNICEF first flagship State of the World s Children report, 1980 Attention went elsewhere for a long time nutrition science incubated its story, data, and priorities

7 Long tradition of personal responsibility in nutrition science Nutrition education is and has been the main intervention to address diet quality Historical: Since deficiencies were discovered, response has been supplementation, fortification, and nutrition education Gender division: women in home economics; men in agricultural economics Arguably, for political/pragmatic reasons Allows nutrition to continue to work by itself, without getting into the messy business of food policy

8 Politically easier to avoid food [Micronutrient programs could] reduce human suffering yet do not threaten the existing economic and political structures. S Reutlinger, 1993 Echoed in Per s Lancet 2013 commentary

9 Nearly 1/3 of high stunting-burden countries have overweight + obesity rates >40% % Overweight + Obesity (all age yrs) Stunting (age <5 yrs) Data source: WHO Global Infobase Global Obesity Comparison Tool

10 165 million under 5 are stunted

11 Projected increases in diabetes to 2030 Source: International Diabetes Federation, Diabetes Atlas 5 th Ed. 2011

12 Top 10 causes of years of life lost All developing countries, 2010 Source: Institute for Health Metrics and Evaluation

13 Top contributors to Dietary risks All developing countries, 2010 Source: Institute for Health Metrics and Evaluation

14 Causes of poor diets? Consumers ultimately determine what they eat and therefore what the food system produces. Key Message of FAO SOFA 2013 (on homepage) Most nutritionists and agricultural economists have agreed with this for the last century (in deed if not in word)

15 Ecological model for diets Image source: Pelto, Dufour and Goodman. Nutritional Anthropology: Biocultural Perspectives on Food and Nutrition. Oxford University Press

16 Concept of food environment Constrains and signals consumers what to purchase What foods are available; their nutritional quality and safety What foods are most affordable, based on relative prices What foods are most convenient to obtain and prepare What foods consumers have information about What foods are most strongly marketed, including advertising or strategic placement to encourage purchase Source: Herforth, forthcoming 2014

17 Low availability and high prices of diverse diets Source: Herforth 2010 (in Pinstrup-Andersen, Ed.), based on FAO data. Note: analysis redone with 2009 data, same results

18 Share of Energy Source & Food Budget in Rural Bangladesh Non-Staple plants Fish and Meat Energy Source Food Budget Staple foods Slide Source: Howdy Bouis; FNB Mar 2011

19 Photo: Anna Herforth

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21 McDonald s Outlets, Latin America Asia/Pacific Europe Global other (excludes US) Pingali, Food Policy 2006

22 Habits and norms change over time Washington Post 11/9/2013

23 Demand from individuals, or from food industry? In high-income and rapidly growing lowincome countries, the agricultural sector has become or is rapidly becoming a supplier of raw materials for the food processing industry, rather than a provider of food for direct consumption. -Pinstrup-Andersen 2013, Lancet series on maternal and child undernutrition

24 Given the advances in the food security conversation and the nature of nutrition problems today Does it make sense to measure access to adequate food with a 1960s-era calorie availability indicator?

25 Key Recommendations for Improving Nutrition through Agriculture Food and agriculture policies can have a better impact on nutrition if they: Monitor dietary consumption and access to safe, diverse, and nutritious foods. The data could include food prices of diverse foods, and dietary consumption indicators for vulnerable groups.

26 FAO SOFI 2013 lists 30 indicators Still, few shed light on availability of and access to healthy diets.

27 Undernourishment and undernutrition Of the 21 countries that have already met the MDG1 target of halving the proportion of the population below the minimum level of dietary energy consumption, only six are on track to meet the underweight target. Source: World Bank 2013 FAO SOFI 2013

28 Share of energy supply from starches has potential Diversity of national food supply is a predictor of child undernutrition outcomes, independent of national income, calories available per capita and other socio-economic variables. Remans et al (presented at IUNS ICN) FAO SOFI 2013

29 Is it sufficient? Maybe for correlations with stunting probably not for chronic disease. Not significantly correlated with obesity rates (Remans et al., presented at IUNS ICN 2013) What is the appropriate policy response? It is not an indicator of diet quality; need household survey data for that

30 Examples of food indicators National-level food availability: what does the picture of food availability look like? % non-starches Fruit and vegetable availability falls below need in most countries in the world (Siegel et al, forthcoming) Sugar availability (sig. assoc. with diabetes prevalence Basu et al. 2013) Others possibly legume and nut availability, or Plant:Animal source protein supply ratio Local-level food environments: Percent households who cannot afford a balanced diet (e.g. Save UK Cost of Diet tool) Cost of healthy diets: on average, $21/week more than unhealthy alternatives (Rao et al. 2013) Relative prices of different food groups Food deserts -type indicators Community-level production diversity in Kenya associated with household dietary diversity (Remans et al. 2011) Household-level food security: Household dietary diversity (HDDS) access to diverse foods Food Insecurity Experience Scale (FAO Voices of the Hungry) being piloted in Gallup World Poll Individual-level diet quality: Women s dietary diversity (WDDS) cut-off being developed for early 2014 Fruit and vegetable dietary variety In Brazil, the proportion of ultra-processed foods in household food increased from 20% to 28% from (Monteiro 2010)

31 Problem identification and advocacy In addition to identifying the problems and measuring the number of people affected, information from [food security and nutrition monitoring] is also used for sensitizing the public and the decision makers in the government and donor community. Babu and Pinstrup-Andersen 1994

32 Addressing Nutrition through Agriculture is now high on agendas Agriculture s main contribution to better nutrition is food. But, how are planners to weigh potential policy options without any indicators of how the food environment looks, and what diets are like?

33 Conclusion Current global measurement of food access was made for a different world, 50 years ago. Then food shortage Now healthy food shortage (World Bank 2014) Available data make it possible to analyze core health and care causes of nutritional problems at national level, but not food causes Lesson from history: Core data collected and published can change. Post-MDGs: time to align understanding of food causes of malnutrition with globally-collected indicators Global institutions need to monitor food for a healthy and active life with data on healthy food access and dietary quality FAO (SOFI) DHS, UNICEF MICS, World Bank LSMS

34 Thank you