Five sub-sessions
Chair: Dr. Shaikh Mohammad Bokhtiar, SAARC Agriculture Centre (SAC) & SAC Governing Board, SAARC
Speakers and presentations
Sigrid Wertheim-Heck, Aeres University of Applied Science Almere
Food Safety and Nutrition for the Urban Poor - Exploring the Social Justice Policy Dilemma of Consumption
Recording
Helen Walls
The Role of Evidence in Nutrition Policymaking in Ethiopia: Institutional Structures and Issue Framing
Recording
William A. Masters, Tufts University (on behalf of Kafui Adjaye-Gbewonyo IFPRI/HarvestPlus)
Agricultural Trade Policies and Child Nutrition in Low- and Middle-Income Countries: A Cross-National Analysis
Recording
Keith Lividini, HarvestPlus/IFPRI, Tufts University
The Impact of Agricultural Specialization and Trade on Inadequate Nutrient Consumption over Time
Recording
Mehroosh Tak, SOAS/LCIRAH
Linkages Between Public Investments, Agriculture and Dietary Diversity in Rural India
Recording
Q&A
Recording
Food Safety and Nutrition for the Urban Poor - Exploring the Social Justice Policy Dilemma of Consumption
Sigrid Wertheim-Heck, Aeres University of Applied Science Almere
Introduction
This paper addresses the challenge of equitable development in health-inducing food accessing opportunities in urban Asia. It goes in detail on the impact of urban food safety governance, which promotes formalised modern retail outlets over more traditional outlets, on the dietary intake of the urban poor. Based on citizen background inequalities - income and gender - the paper examines the quality and diversity of the diet - in terms of food safety guarantees and nutrition composition - in relation to time-spatial and social-cultural dimensions of accessing food.
Methods
Building on empirical evidence from Hanoi, Vietnam, the study addresses food accessing capabilities by linking (i) food retail infrastructures - discussing the retail typology, assortment on offer, food health and safety claims, and price levels - with (ii) the food shopping practices and preferences of 400 women of reproductive age. It then proceeds with mapping the actual food practices with (iii) the measured dietary intake of this same group of women.
Data were collected with a retail outlet census and two household questionnaires administered on non-consecutive days to women responsible for household food provision. The first questionnaire was on food safety and shopping practices, followed by a nutrition questionnaire including a quantitative 24-hour recall and knowledge and attitudes. A sample of 400 poor women of reproduce age was randomly selected using a pre-defined door-to-door sampling method.
Findings and Interpretations
Our results reveal a minimal level of diet quality is maintained through traditional and importantly informal market channels with 74 percent of daily energy and 80 percent of daily vitamin A, zinc, iron and calcium intakes came from foods purchased from traditional food retail outlets. However, these channels do not provide for formal food safety guarantees, most commonly found in modern retail channels. Women were shown to be practically de-capacitated of shopping in supermarkets. Further the research uncovered that modern channels offer a higher percentage of ultra-processed foods than traditional channels, and are mainly frequented for purchasing less/unhealthy foods. Although, only 7 percent of the foods consumed came from supermarkets, 60 percent of the ultra-processed foods consumed were purchased from modern retail outlets.
Conclusions
This paper uncovers a conflicting duality in governing food security that requires urgent attention. The struggle with food safety is a well-recognized problem throughout Asia. Across Asia, similar transformations in urban food retailing are observed, that push modernization and ban traditional vending structures as remedy for recurrent food safety incidences. Our research demonstrates how these one-dimensional ideal-type policies risk to jeopardize dietary quality for the urban poor through two pathways: depriving access to nutritious foods and stimulating less healthy diets.
The paper suggests that the dual public responsibility for ensuring access to nutritious and safe foods requires an inclusive retail diversity approach. In preventing the shaping-up of nutrition desserts for the urban poor, food safety policies should recognize the importance of allowing for a versatile and hybridized food retail environment to evolve.
We argue that, in converging the apparent competing priorities of food safety and nutrition for the urban poor, there is a need for intervention studies that consider dynamic societal interactions, allowing for co-creation, involving consumers, producers, retailers, and policymakers within the local food business ecosystem to identify options for inclusive and healthy retail diversity.
The Role of Evidence in Nutrition Policymaking in Ethiopia: Institutional Structures and Issue Framing
Helen Walls
Introduction
Malnutrition is the single greatest contributor to the global burden of morbidity and mortality, with most cases arising in low- and middle-income countries. However, the multi-sectoral nature of nutrition policymaking adds considerable complexity to the implementation of effective programs. This raises questions about why or how relevant policy change may come about within different country settings. This paper examines multi-sectoral nutrition policymaking from the health sector perspective, focusing on sectoral perspectives and the role and use of evidence. The Ethiopia case study provides a unique example of the challenging nature of multi-sectoral nutrition policymaking, even with a strong coordinating infrastructure.
Methods
The paper draws on findings from 23 in-depth semi-structured interviews held in December 2014 with stakeholders from key health sector organizations and a related documentary analysis, coinciding with the end of the first National Nutritional Plan (which ran from 2008-2013). Key participants were identified though purposive and snowball sampling strategies. We endeavored to conduct interviews with health policy actors representing a diverse range of perspectives, including government representatives, aid providers, multilateral organizations, and academic researchers. Interviews focused on key themes including: the structures and functions of evidence use within the Ethiopian health sector, the institutional mechanisms for evidence uptake, and investigation of the roles of evidence in influencing recent or important health policy decisions in the country. Consent was obtained at the initiation of each interview, with respondents given options on levels of anonymity desired. Ethical approval was provided by the London School of Hygiene & Tropical Medicine, and research permission obtained from the Ethiopian Public Health Institute. The interviews were nested within a wider review of the use of evidence in health policymaking in Ethiopia. Key policy documents were reviewed in order to compile an official view of the challenges and opportunities in the area of nutrition multisectoral policy.
Findings and Interpretations
The framing of policy issues greatly influences the types of evidence considered policy-relevant. Malnutrition has historically been framed in Ethiopia as an acute issue, but this is changing, with greater consideration of overweight/obesity and noncommunicable diseases, as well as undernutrition and micronutrient deficiencies. However, overweight/obesity-related concerns are still less evident in policy documents, in terms of space accorded these issues and the setting of performance indicators.
Some interviewees critiqued ‘downstream,’ less structural approaches to addressing nutrition, for example a micronutrients approach instead of ‘an integrated dietary approach.’ Others described how reasons driving policy action in agriculture often differ from those in health, reflecting a general challenge of enacting structural policy changes when doing so requires agreement with other sectors over policy goals.
While multi-sectoral plans to address malnutrition are in place, respondents suggested nutrition being seen as predominantly a health sector issue was reinforced by the nature of evidence collected. As they described, evidence such as under-five mortality, rates of diarrhoea and infections, and prevalence of overweight/obesity do not have the same importance to other key stakeholders required for sustainable, effective, policy action. Other stakeholder institutional logics may be based around a different normative position or set of goals.
Conclusions
This paper focuses on health stakeholder perspectives, and thus can only explore some of the issues involved with multi-sectoral policymaking to address malnutrition. Despite this, it illuminates three issues. First, it helps explain the problems in the coordination of mandates and evidence, and suggests likely areas for continuing challenge. Second, we have argued that there is still a lack of clarity about the role of upstream interventions, and despite a framework for integrating targets, this may be worsened by the tension with some agricultural sector targets. Third, despite the improvements in the evidence base, we argue that further evidence is needed to inform nutrition policymaking in Ethiopia, and that more evidence is needed to inform policy in non-health sectors on nutrition-specific interventions.
Despite Ethiopia’s strategic framework and its progress in achieving some nutrition targets, it shares the challenge of countries elsewhere in addressing nutrition as a multi-sectoral issue. It also provides a useful case of institutional logic and how assumptions about the type and role of policy-relevant evidence for nutrition policy action may not hold across sectors. This study of nutrition policymaking in Ethiopia highlights the complex interaction of evidence within different conceptualisations of policy problems and responses.
Agricultural Trade Policies and Child Nutrition in Low- and Middle-Income Countries: A Cross-National Analysis
William A. Masters, Tufts University (on behalf of Kafui Adjaye-Gbewonyo IFPRI/HarvestPlus)
Introduction
Child undernutrition can have serious consequences, including mortality, impaired cognitive development, reduced educational and economic potential, and increased chronic disease risk. Despite efforts to reduce undernutrition, it remains a global challenge with nearly a quarter of young children being stunted. Increasingly, governmental and non-governmental organizations have acknowledged the potential for agriculture to influence nutrition. Likewise, there is growing interest in the role of trade in health and diets. However, there is a lack of rigorous research examining the links between agricultural trade policies and nutritional status. This cross-country study explores whether policies affecting tradable agriculture are associated with child nutrition.
Methods
Data on government distortions to agricultural prices were linked to 61 Demographic and Health Surveys from 22 countries between 1991 and 2010 in a repeated cross-sectional design. The sample included 212,258 children aged 6 to 35 months. Country fixed-effects linear regression models that control for all time-constant, country-level factors were run to examine the association between changes in five-year average rates of assistance to tradable agriculture and changes in child nutritional status (height-for-age, weight-for-age, and weight-for-height Z-scores). Child, maternal, household, and time-varying country covariates were included in the models, and interactions with parental occupation (non-agricultural, self-employed in agriculture, earning wages in agriculture) and proportion of tradable agriculture were added to examine potential differential effects.
Findings and Interpretations
Five-year average nominal rates of assistance to tradable agriculture in this sample ranged from -72.0% to 45.5% (range: 117.5 percentage points) with a mean of -5.0%. Fixed-effects regression analyses showed that a 10-percentage point increase in five-year rates of assistance to tradable agriculture was significantly associated with improved height-for-age (0.02, 95% CI: 0.00-0.05) and weight-for-age (0.05, 95% CI: 0.02-0.09) Z-scores in the overall sample. For all nutritional outcomes, increases in nutritional status were greatest among children who had at least one parent earning wages in agriculture, and this difference was significant for weight-for-age and height-for-age Z-scores. In addition, positive associations between rates of assistance to tradable agriculture and weight-for-age and weight-for-height Z-scores were stronger when countries had a lower percentage of tradable agriculture; however, this effect decreased as the share of tradable agriculture increased.
Conclusions
The results of this analysis suggest that government assistance to tradable agriculture may have medium-term impacts on child nutritional status, and this may potentially operate through income pathways, given the stronger association among children with a parent earning wages in agriculture. However, such assistance may also be less important to nutrition as the share of trade in agriculture increases and agricultural economies becomes more globalized. Further research is needed to confirm these results and to better understand the role that agricultural policies may play in child nutrition.
The Impact of Agricultural Specialization and Trade on Inadequate Nutrient Consumption over Time
Keith Lividini, HarvestPlus/IFPRI, Tufts University
Introduction
From 1990 to 2016, the total burden of nutritional deficiencies in DALYs lost is estimated to have fallen by over 12 percent, with the remaining burden of 61 million DALYs falling disproportionately on children under 5 years of age in Sub-Saharan Africa and South Asia. This paper addresses the role of agricultural specialization and trade globally in the fight against nutritional deficiencies. There is some evidence of convergence in the number and types of foods consumed across countries, which suggests that global food trade may have contributed to reductions in inadequate nutrient consumption over time.
Methods
The primary data source is the Global Expanded Nutrient Supply (GENuS) Model in which national nutrient supplies for 23 nutrients were estimated by calculating and matching the per capita edible food availability of 225 foods to regional food composition tables. The GENuS model is used for this study to determine how changes in production and trade from 1961 to 2011 have interacted relative to national nutrient requirements to affect the prevalence of inadequate nutrient consumption for 152 countries.
Nutrients will be mapped to their primary food sources. Annual population demographics will then be combined with age and sex-specific nutrient requirements to determine total annual national nutrient requirements. Quantitative techniques for data visualization will then be used to illustrate trends in the contributions of food production and trade to consumption of various nutrients and for meeting national nutrient requirements.
Regression methods will be used to test the hypotheses that specialization in production and trade have brought countries closer to their nutrient requirements over time; that much of the progress toward meeting nutrient requirements has been through the greater availability of animal source foods; and that progress toward meeting nutrient requirements has been dampened due to changing population demographics in some countries.
Findings and Interpretations
We expect to find that changes in production and trade have brought countries closer to their nutrient requirements over time. We further expect that the effect of trade has been greater specifically since the 1990s in which agriculture was included in the reform agenda of the Uruguay Round of multilateral trade negotiations. The Uruguay Round included the Agreement on Agriculture which established a set of rules and disciplines specifically geared toward reducing trade-distorting support from governments. We also expect to find- particularly for developing countries- a specific effect from animal source foods. This is because developing countries have been increasing their net imports of temperate-zone commodities, which include meat and dairy, since the 1960s. Finally, because nutrient requirements change with age, we expect to find that changes in age-specific demographics result in slower progress toward meeting national nutrient requirements where production and trade have only kept pace with per capita food consumption.
Conclusions
The outcomes of the study will be valuable to multiple stakeholders including government policymakers and donors that are responsible for crafting legislation on food trade policies, allocating budgetary resources for appropriate micronutrient intervention and for funding micronutrient intervention research. The results will provide valuable insights as to the importance of trade for supplying essential nutrients globally.
Linkages Between Public Investments, Agriculture and Dietary Diversity in Rural India
Mehroosh Tak, SOAS/LCIRAH
Introduction
India is home to a quarter of the world’s chronically undernourished population, and the prevalence of micronutrient deficiency is high. Rural public capital expenditures in agriculture, roads, and education have the potential to promote diet diversity by making a range of foods, particularly perishable nutritious foods, widely accessible. Even though the Indian government spends large sums on the development of rural infrastructure and agriculture, it remains a neglected aspect of the agriculture-nutrition research agenda, and relatively little is known about the linkages between public expenditure in nutrition-relevant public capital and dietary diversity.
Methods
Based on a system of equations (SEM), the study estimates impact of public expenditures in infrastructure and public capital on dietary diversity in rural India. Based on a review of existing literature we first construct a framework conceptualizing the pathways between public expenditure and dietary diversity with a focus on state-level factors. Subsequently, the paper constructs and exploits a rich household consumption expenditure dataset from 1970-2012 containing four measures of dietary diversity (DD) for Indian states. DD data are combined with cross-sectional time-series data on economic growth, infrastructure and public expenditures to build a panel dataset. The model is jointly estimated with a system of seven equations and marginal effect of every million rupees spent on five categories of state expenditures is estimated on dietary diversity. As a robustness check, we replicate the analysis on all four indicators of dietary diversity including dietary diversity score (12 food groups), entropy and simpson indices and share on non-cereal consumption in food basket. We also conduct a path analysis to better understand both direct and indirect mechanisms through which such expenditures can improve consumption of more diverse and healthy diets. We rank different categories of public expenditures based on their impact on dietary diversity.
Findings and Interpretations
The analysis confirms the nutrition sensitivity of public expenditures in most public capital in India. It is found that state expenditures that support diversification of agricultural production diversity, market density, road density, and female literacy have played a positive role in the diversification of rural Indian diets. Governmental spending agricultural R&D is found to have the largest association with dietary diversity of 0.032 food groups. This is followed by state spending in food storage and warehousing (0.019 food groups increase), transport (0.01 food groups increase) and education (0.003 food groups increase). In contrast, irrigation spending is associated with a decline of 0.01 food groups. This may be because public expenditures in irrigation promote specialisation of agricultural production.
Conclusions
The paper investigates linkages between public expenditures, infrastructure, and dietary diversity in rural India in the face of high economic growth and alarming rates of malnutrition. In particular, the diet diversity implications of government expenditures on agricultural R&D, food storage and warehousing, irrigation, transport, and education are reviewed using a structural equation framework. The structural models find support for the hypothesis that public expenditure in irrigation has been largely geared towards boosting staples in diets, while neglecting micronutrient-rich foods such as fruits, vegetables, and pulses. Simultaneously, other expenditures made by the state, such as in agricultural R&D, food storage and warehousing, transport, and education were found to be nutrition-sensitive. We also find that the expenditures that support diversification of agricultural production and market density play a positive role in diversification of rural Indian diets. The findings make a case for renewing interest in state expenditure in rural public capital via diversification of production and access to diverse foods as a pro-nutrition strategy in a country marred by micronutrient deficiencies and chronic malnutrition.
