Farming for Health. Agriculture & Human Health United: a Global Imperative Ross M. Welch USDA-ARS U.S. Plant, Soil and Nutrition Laboratory Cornell University.

Farming for Health. Agriculture & Human Health United: a Global Imperative Ross M. WelchRoss M. WelchUSDA-ARSUSDA-ARSU.S. Plant, Soil and Nutrition U.S. Plant, Soil and Nutrition LaboratoryLaboratoryCornell UniversityCornell University

Annually, What Global Risk Factor is Annually, What Global Risk Factor is Responsible for Causing the Most Human Responsible for Causing the Most Human

Deaths?Deaths?

A. Unsafe sex (HIV-AIDs, etc.)

B. Unsafe water, sanitation, hygiene

C. War and genocide

D. Terrorism

E. Malnutrition

Malnutrition -Malnutrition -will be responsible for 3,000 deaths will be responsible for 3,000 deaths globally, mostly women, infants and globally, mostly women, infants and children, children, during this lectureduring this lecture!!

•Globally, one in three people are Globally, one in three people are malnourishedmalnourished•This global crisis is happening now!This global crisis is happening now!•These deaths are preventable! These deaths are preventable! •What is the root cause of these deaths?What is the root cause of these deaths?•What can we do to prevent them from What can we do to prevent them from happening in a sustainable way?happening in a sustainable way?

Some WHO Major Risk Factors Causing World Deaths in 2000

0 5,000 10,000 15,000 20,000 25,000 30,000 35,000

Malnutrition

Tobacco

Unsafe sex

Alcohol

Unsafe water,sanitation, hygiene

Occupational safety

Ris

k F

acto

r

Number of Deaths (X1000)(World Health Report, 2002)

Some Major World Risk Factors Causing DeathsSome Major World Risk Factors Causing Deaths

Malnutrition accounts of ≈ 30 million deaths per year (about 1 death per second)

Why Does Agriculture Exist?Why Does Agriculture Exist?

• To produce food and fiber and provide livelihoods to farmers and profits to the agricultural and food industries alone?

• Why do we need “food”? – Nutrients!• Agriculture is the primary source of all essential

nutrients required for human life! • Farmers are nutrient providers!• If food systems, based in agriculture, cannot

provide all the essential nutrients in adequate quantities to sustain human life during all seasons, diseases ensue, societies suffer and development efforts stagnate.

Death

Figure from WHO, 2000

Agricultural technologies can be directed Agricultural technologies can be directed at improving the “healthiness” of foods to at improving the “healthiness” of foods to meet human needs, but this require the meet human needs, but this require the use ofuse of

Holistic Food System Perspectives Holistic Food System Perspectives to Assure Sustainable Impactto Assure Sustainable Impact

Holistic Food Systems ModelHolistic Food Systems Model

Food Systems, Diet Food Systems, Diet and Diseaseand Disease•Global food systems are failing to provide adequate quantities of essential nutrients and other factors needed for good health, productivity and well being for vast numbers of people in many developing nations.

•Green revolution cropping systems have resulted in reduced food-crop diversity and decreased availability of many trace elements & micronutrients.

•Nutrition transitions (double burden of malnutrition) are causing increased rates of chronic diseases (e.g., obesity, cancer, heart disease, stroke, diabetes, osteoporosis) in many nations.

•Holistic, sustainable improvements in the entire food system are required to solve the massive problem of malnutrition and increasing chronic disease rates in developed and developing countries.

•Agricultural systems are a major factor affecting human health

• Agriculture’s primary focus has been on production alone, with little concern for nutritional or health-promoting qualities of products.

• Nutritionists tend to emphasize unsustainable medical approaches to solve malnutrition problems

– supplements

– food fortificants

•Simplistic views are the norm – looking for “silver bullet” approaches for solutions

•Agriculture and human health have never been generally recognized as closely linked disciplines

Global Food Systems’ ProblemsGlobal Food Systems’ Problems

Air, Water & Energy

(3)

Protein

(amino acids)

(9)

Lipids-Fat

(fatty acids)

(2)

Macro-Minerals

(7)

Trace Elements

(17)

Vitamins

(13)

Oxygen

Water

Carbohydrates

Histidine

Isoleucine

Leucine

Lysine

Methionine

Phenylalanine

Threonine

Tryptophan

Valine

Linoleic acid

Linolenic acid

Na

K

Ca

Mg

S

P

Cl

Fe

Zn

Cu

Mn

I

F

Se

Mo

Co (in B12)

B

Ni

Cr

V

Si

As

Li

Sn

A

D

E

K

C (Ascorbic acid)

B1 (Thiamin)

B2 (Riboflavin)

B3 (Niacin)

B5 (Pantothenic acid)

B6 (Pyroxidine)

B7/H (Biotin)

B9 (Folic acid, folacin)

B12 (Cobalamin)

The Known The Known 5151 Essential Nutrients for Sustaining Human Life Essential Nutrients for Sustaining Human Life**

*Numerous other beneficial substances in foods are also known to contribute to good health.

The Ugly Face The Ugly Face of “Hidden of “Hidden Hunger”Hunger”

Zinc Deficiency

Vitamin A Deficiency Iodine Deficiency

Iron Deficiency

Ca DeficiencyRickets

Micronutrient malnutrition Micronutrient malnutrition Causes.…Causes.…

• More severe illness• More infant and maternal deaths • Lower cognitive development• Stunted growth• Lower work productivityAnd ultimately - • Lower GDP, e.g. an estimated >5% annual

loss in Pakistan• Higher population growth rates

(Map from USAID)

Global Micronutrient Global Micronutrient DeficienciesDeficiencies

> 3 billion people afflicted

> 200 million children affected

Map from WHO

Prevalence of Vitamin A DeficiencyPrevalence of Vitamin A Deficiency

Other Malnutrition ProblemsOther Malnutrition Problems

Se deficiencies

Scurvy (vitamin C)

Beriberi (thiamine/B1)

Rickets (both vitamin D & Ca deficiencies)

Pernicious Anemia (cobalamine/B12)

Folic acid

Change in Prevalence of Iron Change in Prevalence of Iron Deficiency GloballyDeficiency Globally

1960

1990

2000

0

10

20

30

40

50

60

70

Year

Fe

Def

icie

ncy

(% o

f gl

obal

pop

ulat

ion)

Data from WHO, 2002

5.0

5.5

6.0

6.5

7.0

50

60

70

80

90

100

% A

nem

ic W

om

en

(b

elo

w 1

2g

/dL

blo

od

)

1970 1972 1974 1976 1978 1980 1982 1984 1986 1988Year

% Anemic Women

Dietary Iron Density

South Asia

Die

tary

Iro

n D

ensi

ty (

mg

Fe

per

kc

al)

Dietary Iron Density and % Anemic Dietary Iron Density and % Anemic Women in S. AsiaWomen in S. Asia

Most Important Food Crops Most Important Food Crops GloballyGlobally

rice + wheat + maize = 56%

(From Garvin et al., J. Sci. Food Agr. 2006)

Historical Trends in Iron, Zinc & Selenium in Grain of Historical Trends in Iron, Zinc & Selenium in Grain of Hard Red Winter Wheat Varieties in USA (1873 to 2000)Hard Red Winter Wheat Varieties in USA (1873 to 2000)

Data from National Research Council, NAS, 1996

>1000

>650

>1000

Comparative Nutritional Comparative Nutritional Quality of Fonio to White RiceQuality of Fonio to White Rice

Very high biological value of protein; rich in methionine and cystine

Rich in mineralsOne of the world's best tasting cereals

World's fastest maturing cereal

(FAO data, 1999)

% Changes in Cereal & Pulse % Changes in Cereal & Pulse Production & in Populations Production & in Populations Between 1965 & 1999Between 1965 & 1999

0

50

100

150

200

250

% I

ncr

eas

e in

Pro

du

ctio

n (

fro

m 1

965-

199

9)

0

50

100

150

200

250

% I

ncr

eas

e in

Po

pu

lati

on

(fr

om

196

5 to

199

9)

Cereal Production Pulse Production Population

Ind

ia

Pa

kis

tan

Ba

ng

lad

es

h

Wo

rld

De

ve

lop

ing

Na

tio

ns Ind

ia

Pa

kis

tan

Ba

ng

lad

es

h

De

ve

lop

ing

Na

tio

ns

De

ve

lop

ing

Na

tio

ns

Percent of People in USA Not EatingPercent of People in USA Not EatingAdequate Intakes of Various Nutrients Adequate Intakes of Various Nutrients

93

56

44

31

14

12

8

5

5

5

5

3

3

3

0 20 40 60 80 100

Vitamin E

Mg

Vitamin A

Vitamin C

Vitamin B6

Zn

Folate

Cu

P

Thiamin

Fe

Se

Niacin

Riboflavin

Inadequate Intakes < EAR (% )

Moshfegh et al., NHANES 2001-2002.

Food Guide PyramidFood Guide Pyramid

Changes Needed in U.S. Agriculture to Changes Needed in U.S. Agriculture to Meet Dietary GuidelinesMeet Dietary Guidelines

From Quantity to QualityFrom Quantity to Quality• Agriculture is no longer driven only by supply-side forces

and stimulus of support policies (commodity agriculture)• Now becoming demand-driven controlled by consumer food

preferences• These demands seek distinctive elements of food value• Quality characteristics of foods can be fostered by farmers• Profitable farms will shift form raw material producers to

become genuine producers of “food” capturing some of the final value of the products consumed – (e.g., Gerard’s Bakery, Mountain View Harvest

Cooperative)• “Quality agriculture” is the future of sustainable farms from

an economic prospective– e.g., high-selenium durum wheat grain– e.g., packaged lettuce (1989 - $18 million; 2003 - $2.1

billion at the same production level).

(J. McInerney. 2002. The production of food: from quantity to quality. Proc. Nutr. Soc. 61: 273-279)

Table to Farm: A New Agriculture ParadigmTable to Farm: A New Agriculture Paradigm(National Academy of Sciences Workshop - Exploring a vision: Integrating knowledge for food and health, 2003)

Rouse, T. I. & Davis, D. P. Exploring a vision: Integrating knowledge for food and health. A workshop summary. Board on Agriculture and Natural Resources, Division on Earth and Life Studies, National Research Council of the National Academies of Sciences. 1-88. 2004. Washington, D.C., The National Academies Press.

WHO Global Strategy on Diet, Physical WHO Global Strategy on Diet, Physical Activity & HealthActivity & Health

5757thth World Health Assembly 2004 World Health Assembly 2004

Agricultural policy and production have great effects on national diets (i.e., health).

Governments can influence agricultural production through many policy measures.

As emphasis on health increases and consumption patterns change, Member States need to take healthy nutrition into account in their agricultural policies.

International Obesity Task Force, International Obesity Task Force, Global Prevention Alliance (2006)Global Prevention Alliance (2006)

• Nutrition criteria should be included in agricultural policy

• Agricultural policy should undergo health impact assessment

• Support should be provided for agricultural programs aimed at meeting WHO dietary guidelines

New 2006 Mandate for the Food & New 2006 Mandate for the Food & Agriculture Organization, UNAgriculture Organization, UN

• Extended to encompass entire food chain – from farm to plate – food chain approaches

• Assistant Director-General, Louise Fresco– “We are witnessing a ‘paradigm shift’ away

from tonnes, calories and hectares towards issues of quality – quality of life, quality of environment, quality of nutrition”

– Puts improved nutrition & health goals into production agriculture goals

UNICEF & the Asian Development UNICEF & the Asian Development Bank – China (2006)Bank – China (2006)

• Agriculture forms the foundation for development of the food and nutrition industry globally

• Agricultural structural adjustments should be guided by nutritional science for better quality, safety and nutrition

• Include nutritional value as an important criterion to assess in agricultural production

Routs to Better NutritionRouts to Better Nutrition(The World Bank)(The World Bank)

The World Bank, Directions in Development. Repositioning Nutrition as Central to Development.A strategy for large scale action (2006)

“… the HarvestPlus program is a promising initiative in which the international agricultural and research centers have begun to develop new breeds of staple foods that are rich in key vitamins and minerals using a new approach to fortification termed biofortification.”

Copenhagen Consensus 2008 Copenhagen Consensus 2008 ChallengesChallenges

• Air Pollution • Conflicts • Diseases • Education• Global Warming• Malnutrition and Hunger (includes “Hidden

Hunger”)• Sanitation and Water • Subsidies and Trade Barriers Terrorism • Women and Development

Linking Agriculture to Human Linking Agriculture to Human Health: The Norway ExampleHealth: The Norway Example

• Necessary policy reorientation was made to increase available micronutrient-rich foods within local food systems

• Implemented agricultural and food production policies in a national nutrition plan of action

• Provided economic incentives for producer and consumer in support of healthful diets

• Resulted in sustained improvement in life expectancy and a reduction in deaths from cardiovascular disease and other chronic diseases

From: FAO/WHO. Vitamin and mineral requirements in human nutrition, 2nd ed. 2004

•Field Site Selection – (e.g., soils high in Se, Zn, etc.)

•Agronomic Practices macronutrient fertilizers

–nitrogen, phosphorus, potassium, sulfur, calcium, magnesium

–effects protein, fats, vitamins, antinutrients, etc. micronutrient & trace element fertilizers

–Zn, Se, Co, Ni, I, Mo, Li, Cl - effective in increasing amount in plant seeds and grains

–Fe, Cu, Mn, B, Cr, V, Si - not very effective in increasing seed or grain levels

farming system (no-till, organic matter, soil amendments)

•Cropping systems – design to maximize nutrient output crop rotations - effects micronutrient content use nutrient-dense varieties of food crops (HarvestPlus) diversification – soil health and human health

•Utilize indigenous plant foods and diversify food systems

•Genetically modify food crops to improve nutrient output and the “healthiness” of crops from farming systems

Agricultural Approaches to Agricultural Approaches to "Healthier" Food Crops"Healthier" Food Crops

HarvestPlus BiofortificationHarvestPlus BiofortificationProgram StrategyProgram Strategy

Develop micronutrient-dense staple crops using the best traditional breeding practices and modern biotechnology to achieve provitamin A, iron, and zinc concentrations that can have measurable effects on nutritional status of target populations

The Importance of BioavailabilityThe Importance of Bioavailability

• Bioavailable amount of a trace element in a meal, not the total amount, is the critical factor for human health

• Most staple plant foods (cereal grains and legume seeds) fed alone contain very low levels of bioavailable Fe (e.g., about 5%) because of the antinutrients they contain (phytate, polyphenols, etc.)

• Increasing the bioavailability of Fe from 5% to 30% would have the same effect as increasing total amounts of Fe in staples by 6 fold

Agriculture's Agenda For Better Agriculture's Agenda For Better HealthHealth

•Make human health and well being an explicit goal of agricultural systems in addition to productivity & environmental goals

•Re-diversify cropping systems & design for maximum nutrient output

•Make more use of indigenous nutrient-dense edible plant species, small livestock, & fish

•Use agricultural practices (e.g., fertilizers) that increase the nutritionally improved & “healthy” crops output of farming systems. “Traceability” and guaranteed quality is a key to profits

•Breed for and select for nutrient-dense staple food crops having nutrient efficiencies

•Genetically modify food crops to increase nutritional & health promoting quality factors

•Redefine sustainable agriculture to include adequate nutrient output and “healthy foods” for healthy & productive lives

Sir Albert HowardSir Albert Howard

• • • “related subjects as agriculture, food, nutrition and health have become split up into innumerable rigid and self-contained little units, each in the hands of some group of specialists. The experts, as their studies become concentrated on smaller and smaller fragments, soon find themselves wasting their lives in learning more and more about less and less. The result is the confusion and chaos now such a feature of the work of experiment stations and teaching centers devoted to agriculture and gardening. Everywhere knowledge increases at the expense of understanding.The remedy is to look at the whole field covered by crop production, animal husbandry, food, nutrition, and health as one related subject, and then to realize the great principle that the birthright of every crop, every animal, and every human being is health.” – March, 1945 In: Rodale, J.I. 1945. Pay Dirt, Farming & Gardening with Composts. Rodale Books, Inc., Emmaus, Penn. p. vii.

“Western civilisation is suffering from a subtle form of famine – a famine of quality.”– November, 1947

What can you do?What can you do?• Become informed • Promote food-based system approaches to finding

sustainable solutions to malnutrition • Advocate for a food systems program at Cornell

University and at other universities• Tell a friend/student/colleague about the critical role

agriculture plays in human health• Advocate for more nutrition education in elementary

schools, high schools & medical schools• Advocate for close ties between nutrition and

agriculture, agriculture and health, health and nutrition at all levels in global food systems

• Advocate to include human nutrition & health as part of sustainable agriculture goals