March 2014 Innovation Lab Asia Ted Talk
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Transcript of March 2014 Innovation Lab Asia Ted Talk
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1
The Contribution of Agriculture to Nutrition:
Thought Experiments and Experimental Thoughts
Patrick Webb
Innovation Lab Directors Council and Partners Meeting
Kathmandu, Nepal
March 2014
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Chronic malnutrition rates have not declined significantly over the years despite increased income from high value crops. New approach to resolution of problem is required.
USAID/Update (Guatemala Portfolio Review 2013)
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10 known targeted nutrition interventions could reduce stunting by 20%.
Bhutta et al. (2013) Lancet Series
Scaling up evidence-based targeted interventions: 30 million fewer children under the age five would be stunted representing a 20% reduction.
Horton (2010)
So what do we do? that is evidence-based?
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A doubling of per capita income from agriculture is associated with a 21 percent reduction in stunting.
Webb and Block (2012) Proceedings of the National Academy of Sciences
Doubling per capita income is associated with reduced stunting of 14.8%.
World Bank (2012)
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Up to 43% of observed growth faltering [stunting] can be explained on the basis of long-term intestinal lesions.
Lunn et al. (1991) Lancet
Best linear approximation to the true average causal effect of village-level sanitation [on children's height] is likely to be a large fraction of 0.45 (45%).
Spears (2013)
37% of stunting explained by aflatoxin levels. Gong et al. 2002. Brit. Med. Jou.
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Poverty reduction
- 15%
Agriculture income 22%
WASH/EE 10-43%
Open Defecation 23-40%
Aflatoxins - 25-40%
Nutrition interventions
11-30%
A thought experiment
15%?
20%?
35%?
25%? Value
chain/diet quality
20-30%?
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Agriculture-nutrition pathways
Policy & program mechanisms
Neglected biological mechanisms
1
2
3
But a) Optimal packages for nutrition impact unknown b) Translation from trials to scale poorly documented c) Cost-effectiveness of packages unmeasured
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8
Sunaula Hazar
Nutrition Innovation Lab field sites (21+4)
Multi-Sector Nutrition Plan
Johns Hopkins University/NTAG/NARC
Heifer/Virginia Tech/Tufts/HKI
Tufts/Pathan Academy/Suaahara/HKI Harvard/IOM
Field Trips!
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1 Agriculture-Nutrition Pathways
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Source: Shively et al. 2014
Crop Yields
Child nutritional status
Crop yields in Nepal and child nutrition (stunting), by district
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Crop Diversity
Diet Diversity
Crop D
Diet D
< x
4
> x
Crop D
Diet D
Crop D
Diet D
Crop D
Diet D
Crop D
Diet D
Crop D
Diet D Crop D
Diet D
Crop D
Diet D
Crop D
Diet D
Crop D
Diet D
Crop D
Diet D
Crop D
Diet D
Crop D
Diet D Crop D
Diet D Crop D
Diet D
Crop D
Diet D
Crop D
Diet D
Crop D
Diet D
Crop D
Diet D
Crop D
Diet D
Crop D
Diet D
Johns Hopkins University/NTAG/Tufts
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12
Neglected biological mechanisms
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13
16
17
22
32
34
9
11
4
11
5
15
67
66
74
63
60
46
5
2
3
1
1
1
4.6
7.5
4.0
5.6
6.3
5.2
0% 20% 40% 60% 80% 100%
Nepal
India
Bangladesh
Sri Lanka
Pakistan
Myanmar
Percentage contribution to total protein
Animal source Legumes and pulses
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Policy & program mechanisms From Efficacy to Effect: Whats Happening in Between?
What bundle of agr/WASH/SBCC/value chain activity has real
(measurable) impacts on nutrition?
What combinations work most cost-effectively per unit of nutrition gained?
Can we empirically measure quality of implementation and governance for nutrition impacts?
3
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14
Conclusions Nutrition labs offer unique research platform on which to build
Longitudinal panel and cohort designs Providing program-relevant empirical data Providing frontier biosciences findings linking ag-nutr Testing/validating new diagnostic tools Never forgetting cost in relation to scaled effects
Collaboration with other labs, missions, partners desired!
Cost-efficacy of food and agriculture-based nutrition enhancing interventions has not been rigorously evaluated.
Pinstrup-Andersen (Nov 2014) ICN+22 prep meeting
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Many collaborators (Asia and Africa):
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