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Bringing Agriculture to the Table
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Transcript of Bringing Agriculture to the Table
September 7, 2011
IFPRI SEMINARWASHINGTON, DC
RACHEL NUGENT, PHDUNIVERSITY OF WASHINGTON
DEPARTMENT OF GLOBAL HEALTH
Bringing Agriculture to the Table
Bringing Agriculture to the Table • September 19, 2011
Some intellectual history Links between agriculture and health focused on pesticide
exposures for workers, other exposures to downstream and downwind communities, BSE, H1N1, food residues, mycotoxins and food safety etc.
Nutrition and health has a long history of deficiency-related specific interventions (Vit A, Folate, zinc, etc.) and scattered longitudinal research linking nutrition interventions with physical and cognitive human development
IFPRI project and workshop on healthy agriculture produced briefs in 2002 (range of topics), and 2005 CGIAR research platform initiative created projects at several Centers (e.g. CIP, ILRI, and Ruel and Hawkes at IFPRI)
3rd generation began with IFPRI conference in New Delhi, February 2011, ag and health broadly conceived to include a fuller range of agricultural and health outcomes
Bringing Agriculture to the Table • September 19, 2011
Agriculture, nutrition and health links
Bringing Agriculture to the Table • September 19, 2011
Where do we stand now?IFPRI conference accomplished:
Dozens of ANH topics 900+ Attendees, 65 Countries High level attention, new CIDA funding for
HarvestPlus Began to “change the conversation”
NCD HLM intended to Raise awareness among UN member countries Propose actions to prevent and control NCDs Engage broader stakeholders on NCDs, including
non-health sectors and non-public actors
Bringing Agriculture to the Table • September 19, 2011
Why a UN High Level Meeting on NCDs?Political and Advocacy background
Countries led by CARICOM began in 2007 Civil society organizing coalitions by 2008 Private industry joined
NCDs impose substantial and growing burdens Health costs apparent in Asia by 1980s Demographic transition combined with epi transition Economic costs being felt widely
Status and Expectations Not going to mimic the HIV/AIDS 2001 summit Low level of funding (<3% of all DAH)
Bringing Agriculture to the Table • September 19, 2011
Health costs: The epidemiologic transition is spreading
NCDs cause 63% of mortality worldwide 80% of NCD deaths occur in LMICsAge-standardized death rate much higher: 29%
of NCD deaths occur before age 60 (13% in high-income countries)
Burden of nutrition-related diseases 9 of top 20 mortality risks in 2000 (Ezzati et al Lancet
2002)Double burden of malnutrition
Half of risks related to over- and half to under-nutrition
Bringing Agriculture to the Table • September 19, 2011
Danaei G et al. Plos Medicine 2009
-50 50 150 250 350 450
Smoking
High blood pressure
Overweight-obesity (high BMI)
Physical inactivity
High blood glucose
High LDL cholesterol
High dietary sodium (salt)
Low dietary omega-3 fatty acids (seafood)
High dietary trans fatty acids
Alcohol use
Low inatke of fruits and vegetables
Low dietary polyunsaturated fatty acids
Deaths attributable to individual risks (thousands) a
Cardiovascular
Cancer
Diabetes
Respiratory
Other NCD
Injury
Both sexesMen and
Women
(age 30+ yrs)
GBD Results: USA
Bringing Agriculture to the Table • September 19, 2011
Independent of calories or obesity, dietary quality is a major risk factor for chronic diseases, including CVD, diabetes, and common cancers. Dietary quality also influences risk of weight gain.
For chronic diseases, dietary quality is best defined by foods and diet patterns, not nutrients.
Existing global data on relevant dietary intakes, and corresponding global and regional impact on chronic diseases, is very limited.
New GBD has systematic and comparable estimates of: Quantitative causal effects of major dietary risks. Global, regional, and national data on key dietary intakes. Assessment of the global, regional, and national impact of specific dietary risk
factors on chronic diseases.
Results will inform priorities and policies for prevention of millions of CVD, diabetes, and cancer events worldwide.
New GBD results for dietary risk factors
Bringing Agriculture to the Table • September 19, 2011
NCDs affect younger people in LMICs
9
Age-standardized deaths per 100,000 from non-communicable diseases in selected countries
NCD deaths occur at an earlier age in lower-income countries than higher-income countriesSource: World Health Organization. (2011). Global Status Report on Non-communicable Diseases 2010. Geneva, Switzerland: World Health Organization.
Burkina Faso Bangladesh Brazil U.K.0
100
200
300
400
500
Male Female
Bringing Agriculture to the Table • September 19, 2011
Economic Costs of NCDs
10
Costs of diagnosing, treating, and long-term management of NCDs could overwhelm low-resource health systems
ECONOMIC COSTS OF NON-COMMUNICABLE DISEASES
OBESITYIn China, total costs related to overweight and obesity areequivalent to 4 percent of the country’s GDP, and by theyear 2025 these costs are projected to reach 9 percent.
DIABETESA recent study shows that health spending on diabetes care alone ranges from 6 percent of all health expenditures in China to 15 percent in Mexico.
CVDFull implementation of CVD prevention comes at $7 up to $30 per capita. The total estimate for CVD prevention in 18 high-prevalence countries is $110.8 billion
TOTAL NCD COSTSHarvard SPH estimates costs above $30 trillion from now to 2030. $35 trillion represents 7X the current level of global health spending.
Bringing Agriculture to the Table • September 19, 2011
Food Marketing
Advertising and communications agencies
A food system should offer choicesfor a healthy, balanced diet
11
Reaching that goal involves a wide range of actors, each with their own goals and function in the food systemAgriculture
Agribusiness and Extension Services (seeds, crop protection, farm machinery), farmers (including smallholders and subsistence farming), agricultural laborers
Secondary Food Storage and Processing
Importers, exporters, donors and international institutions, food
and beverage manufacturers
Food Wholesaling and Retailing
Street vendors, supermarkets, restaurants, fast food companies, public institutions (schools, prisons)
Primary Food Storage, Processing and Distribution
Packers, millers, crushers, refiners, farmers
collectives, distributers
Bringing Agriculture to the Table • September 19, 2011
Aligning Agriculture and Health to Prevent NCDs
12
Value ChainApproachesan enhanced version of a supply chain, a value chain reveals possibilities for achieving social, environmental, and health goals in the production process.
Develop & UseMutual MetricsProgress indicators that can be shared by the agriculture and health sectors to help align outcomes e.g.,
• the volume of fresh and fruits vegetables delivered in a timely fashion to consumer markets; or
•The substitution of healthier oils for palm oil in processed foods.
Bringing Agriculture to the Table • September 19, 2011
Where do we need more research?
13
Quality and diversity of diet, measurement and methods
Options for food reformulation and changes in intensive food processing
Causal linkages across agriculture, nutrition and health outcomes
Policy options, especially cross-sectoralImpacts of policy on diet and nutritionRelationship of poverty to agriculture and
diet
Bringing Agriculture to the Table • September 19, 2011
Deaths Attributable to Major Risk Factors in 2000
0 1000 2000 3000 4000 5000 6000 7000 8000
High blood pressure
Tobacco
High cholesterol
Underweight
Unsafe sex
Low fruit and vegetable intake
Overweight and obesity
Physical inactivity
Alcohol
Unsafe water, sanitation, and hygiene
Indoor smoke from solid fuels
Iron deficiency
Urban air pollution
Zinc deficiency
Vitamin A deficiency
Contaminated health care injections
Occupational airborne particulates
Occupational risk factors for injury
Lead exposure
Illicit drugs
Mortality in thousands (Total 55.86 million)
High-mortality developing
Lower-mortality developing
Developed
Ezzati et al Lancet 2002