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


Agriculture, nutrition and health links


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


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)


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


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


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


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


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.


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


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.


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

September 7, 2011

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Thank You


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

Bringing Agriculture to the Table

Education

health outcomes

health links

nonhealth sectors

nutrition interventions

healthy agriculture

range of topics

ifpri conference

summitlow level of funding