patrick webb, tufts university, keynote presentation: "agriculture and nutrition. what do we...

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1 Science Forum 2013 Agriculture and Nutrition: What do we know, and what do we still need to know? Patrick Webb 23 September 2013, Bonn, Germany

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Science Forum 2013 (www.scienceforum13.org) Keynote plenary Patrick Webb, Tufts University, keynote presentation

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Page 1: Patrick Webb, Tufts University, Keynote Presentation:  "Agriculture and nutrition. what do we know, and what do we still need to know?"

1

Science Forum 2013

Agriculture and Nutrition: What do we know,

and what do we still need to know?

Patrick Webb

23 September 2013,

Bonn, Germany

Page 2: Patrick Webb, Tufts University, Keynote Presentation:  "Agriculture and nutrition. what do we know, and what do we still need to know?"

The tines, they are a changin’….

Copyright 2013 by S. Karger AG

Page 3: Patrick Webb, Tufts University, Keynote Presentation:  "Agriculture and nutrition. what do we know, and what do we still need to know?"

“Higher calorie intake has improved nutrition and health.”

CGIAR (1996) Annual Report 1995-96

� “Merely producing more food does not ensure food

security or improved nutrition.” (Herforth (2012) World Bank)

� “Agriculture interventions do not always contribute to

positive nutritional outcomes.” (FAO 2012)

Page 4: Patrick Webb, Tufts University, Keynote Presentation:  "Agriculture and nutrition. what do we know, and what do we still need to know?"

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Starting at the end…

1. Effective agriculture-nutrition research needs honesty

(about feasible contribution to nutrition), engagement

across sectors, and rigor (outcome-appropriate methods).

2. Only possible with agriculture researcher involvement in

public health dialogue, priority-setting, integrated research.

3. Expanded research agenda: highest impact may be in

‘novel’ domains (food system hygiene, agriculture

programmes as platforms for delivery of other services).

Page 5: Patrick Webb, Tufts University, Keynote Presentation:  "Agriculture and nutrition. what do we know, and what do we still need to know?"
Page 6: Patrick Webb, Tufts University, Keynote Presentation:  "Agriculture and nutrition. what do we know, and what do we still need to know?"

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a) Discussion of potential for

agriculture to contribute to,

accelerate, and enhance coverage

of improved nutrition outcomes

b) Search for evidence that it can…

Page 7: Patrick Webb, Tufts University, Keynote Presentation:  "Agriculture and nutrition. what do we know, and what do we still need to know?"

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Lancet 2013

� All forms of undernutrition combined responsible

for 45% of avoidable child deaths.

� 165 million children stunted in 2011.

� 20% stunting ascribed to in utero conditions

(small for gestational age) – which means reaching

pregnant women and pre-pregnant girls is priority.

Page 8: Patrick Webb, Tufts University, Keynote Presentation:  "Agriculture and nutrition. what do we know, and what do we still need to know?"

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Lancet 2013

� 10 targeted interventions implemented at 90%

coverage cuts stunting by 20%, mortality by 15%.

� But…“coverage rates for [many] interventions are

either poor or non-existent.”

� Cost: US$9.6 billion per annum.

� Even at 90% coverage, 80% of stunting remains!!!

Page 9: Patrick Webb, Tufts University, Keynote Presentation:  "Agriculture and nutrition. what do we know, and what do we still need to know?"

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0.1

.2.3

.4.5

dens

ity

-6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6height-for-age z-score (stunting)

Mountains Hills Terai

Source: DHS 2006

Children below 5 years (n=5,237)

by agroecological zone(from left to right, means = -2.27, -2.02, -1.89)

Height-for-age Z-scores (stunting) Nepal, 2006

and Shively (2013)

Page 10: Patrick Webb, Tufts University, Keynote Presentation:  "Agriculture and nutrition. what do we know, and what do we still need to know?"

Masset et. al. (2011)

� 7,000 studies considered.

� Only 23 qualified for final inclusion (i.e. having

credible counterfactuals and rigor in methods).

Masset et al. (2011/12):

a) Positive impacts on farm output/productivity.

b) “Poor evidence of impact on households’ net income.”

c) “Little evidence…on changes in diets of the poor.”

d) No studies assessed quality of whole diet (substitutions).

e) 9 studies tested impact on Vitamin A (only 4 were positive).

f) “No evidence of impact on stunting, wasting.”

Page 11: Patrick Webb, Tufts University, Keynote Presentation:  "Agriculture and nutrition. what do we know, and what do we still need to know?"

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1. Productivity 2. Empowerment

� Source of food

� Source of income

� Stability of food

prices

�Resource control

�Women’s time

�Women’s nutrition

Mechanisms

A doubling of per capita income from agriculture is

associated with 15-21% point decline in stunting.

Page 12: Patrick Webb, Tufts University, Keynote Presentation:  "Agriculture and nutrition. what do we know, and what do we still need to know?"

New crop

technology

Higher

productivity

Higher household

income, sales,

consumption

Transfer of labor

and inputs

Net return/day of

labor X3

Net rise in real

income 13%/hh

10% income rise

= 4.8% rise in

calorie supply

Child nutrition improved

(but less than expected)

10% rise in calories =

2.4% fall in children

underweight

Source: von Braun et al. (1989)

Page 13: Patrick Webb, Tufts University, Keynote Presentation:  "Agriculture and nutrition. what do we know, and what do we still need to know?"

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1. Productivity 3. Diet Quality2. Empowerment

4. Food system safety 5. Delivery platforms

� Source of food

� Source of income

� Stability of food

prices

�Resource control

�Women’s time

�Women’s nutrition

� ‘Whole diet’

diversity

� Inputs to

processed foods

� Sources of anti-

nutrients

� Source of human and

environmental

pathogens

� Integration with multi-

sector interventions

� Value chain foundations

Mechanisms

Page 14: Patrick Webb, Tufts University, Keynote Presentation:  "Agriculture and nutrition. what do we know, and what do we still need to know?"

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Lancet Paper 3 (Ruel and Alderman 2013)

“Poor-quality evaluations prevent firm conclusions

on the impact of agriculture programs on nutrition.”

“Evidence of the effectiveness of … agricultural

programmes on maternal and child nutrition, with

the exception of vitamin A, is limited.”

Page 15: Patrick Webb, Tufts University, Keynote Presentation:  "Agriculture and nutrition. what do we know, and what do we still need to know?"

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Page 16: Patrick Webb, Tufts University, Keynote Presentation:  "Agriculture and nutrition. what do we know, and what do we still need to know?"

Source: Masset et al. 2011

Tradeoffs;

opportunity

costs of timeDiet quality (animal

source foods, whole

diet diversity; anti-

nutrients in meals)

Food safety

(mycotoxins;

cytokines)

Environmental enteropathy

(gut microbiota; shared

pathogens)Do no harm

(malaria, bird flu,

pesticides)

Agriculture and

Livelihoods

Nutrition and Health

Empowerment,

income control

Page 17: Patrick Webb, Tufts University, Keynote Presentation:  "Agriculture and nutrition. what do we know, and what do we still need to know?"
Page 18: Patrick Webb, Tufts University, Keynote Presentation:  "Agriculture and nutrition. what do we know, and what do we still need to know?"

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What do we still need to know? - Lancet

1. Rigorous cost-effectiveness assessment of large scale

nutrition-sensitive programmes (not just gardens).

2. Careful assessment of intermediary outcomes along

impact pathways.

3. Programme entry/technology adoption barriers.

4. Feasibility and desirability of integrating interventions

from several sectors, versus co-location.

5. Documented scalability of biofortified crops.

Page 19: Patrick Webb, Tufts University, Keynote Presentation:  "Agriculture and nutrition. what do we know, and what do we still need to know?"

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What do we still need to know? - Hawkes/DFID review

1. Complete links in chain (from ag. to nutrition outcomes).

2. Cost-effectiveness of interventions/investments.

3. Population sub-groups (incl. the poorest, rural non-farm).

4. Indirect effects on nutrition (pathogens, agric. safety).

5. Value chain roles in linking agriculture and nutrition.

6. Agriculture/food/trade policy effects on nutrition.

7. Incentives for effective nutrition-sensitive policies.

Page 20: Patrick Webb, Tufts University, Keynote Presentation:  "Agriculture and nutrition. what do we know, and what do we still need to know?"

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What do we still need to know? - Food Security Learning Framework

1. Cost-effective approaches that result in demonstrated

improvements in diets and nutrition.

2. Effect mediators of those approaches by context.

3. What combinations of sector actions most effective.

4. Value chain and agriculture policy impacts on nutrition.

5. Assessment of actual mechanisms to having impacts on

diets and nutrition.

6. Incentives for effective governance of nutrition sensitive

actions to impact nutrition nationally.

Page 21: Patrick Webb, Tufts University, Keynote Presentation:  "Agriculture and nutrition. what do we know, and what do we still need to know?"

CGIAR Independent Science and Partnership Council (2012)

Strengthening Strategy and Results Framework

Page 22: Patrick Webb, Tufts University, Keynote Presentation:  "Agriculture and nutrition. what do we know, and what do we still need to know?"

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Ways forward

� As stewards of scarce resources, we must understand and

document investment impacts (and explain how and why).

� Much more high quality research needed (beyond agronomy,

ag. econ., resource management); requires evidence-capture

that passes the bar of future meta-analyses (but not just RCTs!)

� Need less claiming/modeling of “potential” impact, more

demonstration of actual net impacts.

� Must link agriculture with public health research to fill

knowledge gaps on ‘dose-response’, effect modifiers, cost-

effectiveness, inter-sectoral processes, etc.