The Contributions of Agriculture to Nutrition: Thought Experiments and Experimental Thoughts
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Transcript of The Contributions of Agriculture to Nutrition: Thought Experiments and Experimental Thoughts
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The Contribution of Agriculture to Nutrition: Thought Experiments and Experimental Thoughts
Patrick Webb
Innovation Lab Director’s Council and Partners MeetingKathmandu, 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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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/HKIHarvard/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 >4
> x
Crop D
Diet D
Crop D
Diet D
Crop D
Diet D
Crop D
Diet D
Crop D
Diet DCrop 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 DCrop D
Diet DCrop 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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Neglected biological mechanisms2
Nepal
India
Bangladesh
Sri Lanka
Pakistan
Myanmar
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
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
Animal source Legumes and pulses Cereals
Percentage contribution to total protein
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Policy & program mechanisms
From Efficacy to Effect: What’s 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?
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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):