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LINKING AGRICULTURE, LINKING AGRICULTURE, HEALTH AND HEALTH AND

NUTRITION:CHALLENGS NUTRITION:CHALLENGS AND POTENTIALSAND POTENTIALS

IFPRI POLICY SEMINARIFPRI POLICY SEMINARWashington, DCWashington, DC

7 November, 20107 November, 2010

Kabba T JoinerKabba T Joiner

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PROBLEM STATEMENTPROBLEM STATEMENT Agric - primary Agric - primary source of livelihood and nutrientssource of livelihood and nutrients

for majority of world’s poorfor majority of world’s poor Good health - an enabling condition for the Good health - an enabling condition for the

development of human potentialdevelopment of human potential Agric - driven by Agric - driven by economic developmenteconomic development

rationale, whilst health sector aims rationale, whilst health sector aims to safeguard to safeguard human developmenthuman development

These These fundamental different societal functionsfundamental different societal functions and institutional organizationand institutional organization keep the sectors keep the sectors apartapart

Health community too tribalHealth community too tribal – “failure to integrate – “failure to integrate our science, practice and advocacy hurts our science, practice and advocacy hurts everyone, not least mothers and children” everyone, not least mothers and children” (Jeremy Shiffman)(Jeremy Shiffman)

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AGRIC LED GROWTHAGRIC LED GROWTH

Agric growth leads to Agric growth leads to higher rural incomehigher rural income, , particularly those with improved agric particularly those with improved agric inputsinputs

InfrastructureInfrastructure is positively related to better is positively related to better health and nutrition, as community health and nutrition, as community infrastructure is infrastructure is financed by agric profitsfinanced by agric profits

ProgressProgress in health and nutrition achieved in health and nutrition achieved only if progress in only if progress in agricagric development is development is sustainedsustained

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WHAT IS KNOWNWHAT IS KNOWN World’s rural poor rely on agric for their livelihood, income, World’s rural poor rely on agric for their livelihood, income,

food security, nutrition and health carefood security, nutrition and health care Women’s incomeWomen’s income contribute more to household security, contribute more to household security,

child nutrition and health care than child nutrition and health care than income controlled by income controlled by menmen

SeasonSeason income is generated and income is generated and gender gender of the provider of the provider determine impact of household income on nutritional determine impact of household income on nutritional status and health carestatus and health care

Agric rich areas have a financial advantage - Agric rich areas have a financial advantage - investments investments in community infrastructure, impact on improving health in community infrastructure, impact on improving health and nutrition statusand nutrition status

High seasonal labour - High seasonal labour - negatively affects adult nutrition and negatively affects adult nutrition and child birth weightchild birth weight

Agric intensification - Agric intensification - important role in emerging diseases important role in emerging diseases Supplementation and fortification - Supplementation and fortification - treating large numbers treating large numbers

of people – short and medium term interventions for MNDof people – short and medium term interventions for MND

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ON-GOING LINKAGES ON-GOING LINKAGES West AfricaWest Africa:: NIP for water and sanitation – SenegalNIP for water and sanitation – Senegal Millennium Villages – MaliMillennium Villages – Mali Baby Friendly Community Initiative – GambiaBaby Friendly Community Initiative – Gambia WAHO / BIOVERSITY / FAO / INFOODS / AFROFOODS collaboration – 7 West WAHO / BIOVERSITY / FAO / INFOODS / AFROFOODS collaboration – 7 West

African CountriesAfrican Countries WAHO/ HKI – Francophone West African StatesWAHO/ HKI – Francophone West African States WAHO / CILSS – Sahel states of West AfricaWAHO / CILSS – Sahel states of West Africa ROPPA / WAHO collaboration – West African StatesROPPA / WAHO collaboration – West African States Tulane University / WAHO / FDOA – child labour and health in cocoa Tulane University / WAHO / FDOA – child labour and health in cocoa

plantations in Ghana, Cote d’Ivoireplantations in Ghana, Cote d’Ivoire Agric for Children’s Empowerment (ACE) – LiberiaAgric for Children’s Empowerment (ACE) – Liberia ECOWAS Nutrition Forum – West African StatesECOWAS Nutrition Forum – West African StatesOthers RegionsOthers Regions Gardens for Health – Kenya, RwandaGardens for Health – Kenya, Rwanda Yellow Flesh Sweet Potato Trials - UgandaYellow Flesh Sweet Potato Trials - Uganda International Federation of Plantation and Agric Workers – ILO / WHO International Federation of Plantation and Agric Workers – ILO / WHO

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Global Weak links among Agric and Global Weak links among Agric and Health Organizations Health Organizations (Joachim von Braun, (Joachim von Braun,

2010)2010) FAO – info on food and agric and advice, some nutrition, FAO – info on food and agric and advice, some nutrition,

some healthsome health WFP – food assistance and some nutrition actionsWFP – food assistance and some nutrition actions IFAD – finances agric development projectsIFAD – finances agric development projects World Bank – poverty and agric, health and some nutritionWorld Bank – poverty and agric, health and some nutrition WTO – trade agreements and trade disputesWTO – trade agreements and trade disputes WHO – leadership in global health, including some nutritionWHO – leadership in global health, including some nutrition UNICEF – rights of children, including child nutrition and UNICEF – rights of children, including child nutrition and

child healthchild health CGIAR – reduce poverty and improve food security through CGIAR – reduce poverty and improve food security through

research, some nutrition and healthresearch, some nutrition and health

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CRITICAL QUESTIONS TO BE CRITICAL QUESTIONS TO BE ADDRESSEDADDRESSED

Household decisions concerning Household decisions concerning labour allocationlabour allocation / child care/ child care

Level of Level of maternal educationmaternal education Changes in nutrient content of food through Changes in nutrient content of food through crop crop

diversification / plant breedingdiversification / plant breeding Economic, political, social and environmentalEconomic, political, social and environmental

matters intrinsically related to healthmatters intrinsically related to health ““One World, One HealthOne World, One Health”” Part played by Part played by agric intensificationagric intensification in emerging in emerging

diseasesdiseases

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NEGATIVE EFFECTS OF AGRIC NEGATIVE EFFECTS OF AGRIC ON HEALTHON HEALTH

Community exposedCommunity exposed to diseases foreign to it to diseases foreign to it Increase spreadIncrease spread of water and food-borne of water and food-borne

diseases – malaria, diarrhoea, zoonotic diseases – malaria, diarrhoea, zoonotic diseases, mycotoxins, hazardous pesticides, diseases, mycotoxins, hazardous pesticides, herbicides and fertilizersherbicides and fertilizers

OccupationalOccupational hazards hazards Health impact of Health impact of landscape destructionlandscape destruction Climate changeClimate change

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HEALTH CONSEQUENCES OF HEALTH CONSEQUENCES OF UNBALANCED NUTRITIONUNBALANCED NUTRITION

(A) (A) Calories / ProteinsCalories / Proteins PEM, ObesityPEM, Obesity

(B) (B) Micronutrients - Trace elements (15) / Vitamins (12)Micronutrients - Trace elements (15) / Vitamins (12) Impaired mental and physical disabilitiesImpaired mental and physical disabilities LBW infants with IQ 5 points lower than normal infantsLBW infants with IQ 5 points lower than normal infants Increase susceptibility to infectionsIncrease susceptibility to infections Increase maternal mortalityIncrease maternal mortality High rates of neonatal deaths and still birthsHigh rates of neonatal deaths and still births Poor attention span and decrease memory retentionPoor attention span and decrease memory retention BlindnessBlindness DeafnessDeafness DiarrhoeaDiarrhoea Impaired reproductive performanceImpaired reproductive performance Delayed wound healingDelayed wound healing Heart DiseaseHeart Disease

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AREAS OF CONCERNAREAS OF CONCERN Level of Level of human and institutional capacityhuman and institutional capacity Agric not Agric not considered as a primary weaponconsidered as a primary weapon

in eliminating MNMin eliminating MNM Consumers understandingConsumers understanding importance of importance of

divers and balance diet to their health, divers and balance diet to their health, productivity and well beingproductivity and well being

Food systemsFood systems developed with developed with no no attention attention to their ability to provide the nutrients to their ability to provide the nutrients to to support good healthsupport good health and well being and well being

Health and Livestock – significant Health and Livestock – significant health health burden on the poorburden on the poor

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AREAS OF CONCERN (cont)AREAS OF CONCERN (cont) Limited human capacityLimited human capacity and and poor physicalpoor physical

facilitiesfacilities cause new and emerging cause new and emerging diseases diseases undetectedundetected

Discrete, sectoral approachDiscrete, sectoral approach lead to – lead to – misdiagnosis, incomplete and ineffective control misdiagnosis, incomplete and ineffective control strategies, lack of effective communicationstrategies, lack of effective communication

Vertical orientation by respective agenciesVertical orientation by respective agencies – – responsibilities divided according to bureaucratic responsibilities divided according to bureaucratic mandatemandate

Effects of increase female labourEffects of increase female labour in agric and the in agric and the increasing cash income in hands of menincreasing cash income in hands of men

Sustainable agric not including human healthSustainable agric not including human health dimensions until recentlydimensions until recently

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CHALLENGESCHALLENGES Effects of increase female agric labourEffects of increase female agric labour on child health on child health

and nutritionand nutrition High seasonal agric labour requirements affects High seasonal agric labour requirements affects

women’swomen’s physical energy expenditure, nutritional physical energy expenditure, nutritional status, child nutrition and birth weight, foetal status, child nutrition and birth weight, foetal developmentdevelopment

Lack of dataLack of data combining health and nutrition with agric combining health and nutrition with agric productivity at the household levelproductivity at the household level

Human and institutional capacityHuman and institutional capacity to address problems to address problems of linkagesof linkages

““Hidden Hunger” – Hidden Hunger” – changes in crop production systemchanges in crop production system contributing to MNMcontributing to MNM

Government policies and subsidiesGovernment policies and subsidies promoting cash promoting cash cropping and expansion of cereal crops without cropping and expansion of cereal crops without consideration of production of micronutrient dense consideration of production of micronutrient dense cropscrops

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CHALLENGES (cont)CHALLENGES (cont) Poverty and health related MDGsPoverty and health related MDGs Urbanization and GlobalizationUrbanization and Globalization Undertaking Undertaking cross-sectional actioncross-sectional action at community at community

levellevel Health sector that would Health sector that would need to workneed to work withwith agric agric

are underfunded, no formal arrangements for are underfunded, no formal arrangements for inter-sectoral roles and responsibilities, inter-sectoral roles and responsibilities, inadequate skills for inter-sectoral negotiation inadequate skills for inter-sectoral negotiation and decision makingand decision making

Difficulties of Difficulties of establishing reliable communicationestablishing reliable communication between sectorsbetween sectors

Building Building partnerships on mutual strengthspartnerships on mutual strengths to to better link the sectors research, policy and better link the sectors research, policy and practicepractice

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POTENTIALSPOTENTIALS Classical approachClassical approach – – What do I do? What am I What do I do? What am I

responsibleresponsible for? Is this my job?for? Is this my job? Integrated approachIntegrated approach – – What needs to be done?What needs to be done? Proceeds from agricProceeds from agric to develop health infrastructure to develop health infrastructure

and finance programmesand finance programmes Direct - Direct - increase nutritious food consumedincrease nutritious food consumed by by

householdhousehold Indirect - Indirect - increase in incomeincrease in income permitting households to permitting households to

purchase food and health servicespurchase food and health services Augmenting women’s incomeAugmenting women’s income from agric activities from agric activities

increase demand for health care servicesincrease demand for health care services Improved coordination of Improved coordination of data collection and data collection and

disseminationdissemination On the On the job trainingjob training in nutrition education to health and in nutrition education to health and

agric personnelagric personnel

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POTENTIALS (cont)POTENTIALS (cont)

Improved linkagesImproved linkages will rely on: will rely on:

* Consultation in priority setting* Consultation in priority setting

* Joint preparedness planning* Joint preparedness planning

* Community consistent messages* Community consistent messages

* Exchanging select staff and sharing facilities* Exchanging select staff and sharing facilities

* Strengthening education – review curriculum* Strengthening education – review curriculum

* Provide an appropriate institutional framework* Provide an appropriate institutional framework

* Encourage multi-stakeholder approach for * Encourage multi-stakeholder approach for improving public healthimproving public health

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BENEFITS FROM LINKAGESBENEFITS FROM LINKAGES

Increase food securityIncrease food security

Increase food safetyIncrease food safety

Reduce burden of diseaseReduce burden of disease

Reduce burden of chronic diseasesReduce burden of chronic diseases

Improved occupational healthImproved occupational health

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POLICY IMPLICATIONS OF POLICY IMPLICATIONS OF LINKAGESLINKAGES

Policies that Policies that help promotehelp promote proper storage, proper storage, transport, application and disposal of transport, application and disposal of fertilizers, pesticides and herbicidesfertilizers, pesticides and herbicides

Increase household agric revenue to be Increase household agric revenue to be used to financeused to finance greater access and greater access and improvements to health services improvements to health services (promotional activities)(promotional activities)

Improved Improved curriculumcurriculum in health, nutrition in health, nutrition and agricand agric

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““BUSINESS AS UNUSUAL”BUSINESS AS UNUSUAL”

Developing the entrepreneurial style / spiritDeveloping the entrepreneurial style / spirit* Set Priorities* Set Priorities* Focus* Focus* Measurement / Reporting – What gets measured, * Measurement / Reporting – What gets measured,

gets donegets done* Alignment* Alignment* Discipline – reduces need for much supervision* Discipline – reduces need for much supervision* Structure* Structure* Communication - sent, received and understood* Communication - sent, received and understood* Commitment* Commitment* Continuous Improvement* Continuous Improvement* Analysis – of opportunities* Analysis – of opportunities

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FUTURE AREAS FOR FUTURE AREAS FOR RESEARCHRESEARCH

OBJECTIVE OF RESEARCHOBJECTIVE OF RESEARCH – Better understand effects of agric – Better understand effects of agric development on health and nutrition and determine mechanisms development on health and nutrition and determine mechanisms to improve their linkages.to improve their linkages.

Research for ImpactResearch for Impact Coordinate ongoing and planned researchCoordinate ongoing and planned research

TOPICS FOR CONSIDERATIONTOPICS FOR CONSIDERATION Data on direct linkages between agro-forestry and healthData on direct linkages between agro-forestry and health Health impact assessment of urban sustainable agricHealth impact assessment of urban sustainable agric Chronic health problems that arise from unhealthy agric practicesChronic health problems that arise from unhealthy agric practices Assess the potential environmental, health and social impact of Assess the potential environmental, health and social impact of

any agric technology and the implementation of appropriate any agric technology and the implementation of appropriate regulatory frameworksregulatory frameworks

What factors affect utilization of agric income and how the income What factors affect utilization of agric income and how the income is disposed of?is disposed of?

How will linkages work in refugee / IDP campsHow will linkages work in refugee / IDP camps

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CONCLUSIONCONCLUSION

Need to incorporate youth in all Need to incorporate youth in all sectoral planningsectoral planning

Work towardsWork towards “VIRTOUS” “VIRTOUS” as opposed as opposed to to “VICIOUS”“VICIOUS” cycle cycle

““Not everything faced can be Not everything faced can be changed, but nothing can be changed, but nothing can be changed until it is faced”changed until it is faced”

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THANK YOUTHANK YOU

FOR YOUR ATTENTIONFOR YOUR ATTENTION