Looking at nutrition with an agriculture lens
I attended the bi-annual Consultative Group on International Agricultural Research (CGIAR) Science Forum in Bonn, Germany in late September, organized by the CGIAR Independent Science and Partnership Council. This year the theme was “Nutrition and health outcomes: targets for agricultural research”. It was an impressive gathering of scientists and economists from the CGIAR system and elsewhere. Given that the conference was hosted by CGIAR, an agriculture organization, the attendance was more from the agriculture side as opposed to the nutrition side. This in itself is an accomplishment since usually it is the other way around. At least to date, nutritionists seem to be more interested in talking about the agriculture-nutrition linkage than the agriculturists. But this forum was an exception to that trend!
So, here are my two main observations from this forum. First of all, the influential Lancet 2013 Maternal and Child Nutrition papers were cited time and time again in many presentations, especially paper 3 by M. Ruel and H. Alderman on nutrition sensitive development, “Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition?”. However, what may have been cited and discussed even more were Per Pinstrup-Andersen’s comments in the same Lancet series, “Nutrition-sensitive food systems: from rhetoric to action”. The Ruel-Alderman paper recognized the huge potential that agriculture could play in improving nutrition outcomes but concluded that available evidence prevents firm conclusions on whether this is indeed the case or not. Their paper focused on evidence generated by rigorous randomized control trials (RCTs). Pinstrup-Andersen’s comments argued that a wider set of evidence should be considered (and generated going forward) because many agriculture sector wide policies cannot be studied by RCTs because treatments cannot easily be randomized and the effect pathway is long. Just think of how difficult it would be to design an RCT around a production subsidy program and his point becomes clear. At the forum, there was a lot of interest in how we can generate a broad set of evidence, beyond RCTs, which were considered by many participants to be a standard methodology in medical research but perhaps limited in its applicability in agriculture. Specifically, there was a strong call for the marrying of economic and epidemiological methodologies in tackling this challenge, which I fully agreed with.
Secondly, there was a surprisingly robust discussion on the “income pathway” from agriculture to nutrition. Usually this particular pathway is not given much attention by the proponents of nutrition-sensitive agriculture since income growth is believed to take too long to for it to matter for nutrition. Therefore, the slogan for nutrition-sensitive agriculture is to “do agriculture differently – with a nutrition lens”. The presentation that best articulated the possible importance of the income pathway was a plenary presentation by Martin Qaim from the University of Gottingen. Amongst other results, he showed that the adoption of Bt cotton in India led to not just the well-known economic outcomes (yield increase of 20-30% and profit increase of 50%) but also positive nutrition outcomes! Growing Bt cotton reduced food insecurity by 15-20% (obviously not by farmers eating the cotton but through the income effect). He also showed that vitamin A intake of adoption farmer households was 9.6% higher than non-adoption households, 4.6% higher for iron, and 4.5% higher for zinc. While we can debate about the strength of the income pathway or any other pathway, it was stimulating to hear these results and discuss them openly.
This brings me to the three messages that Patrick Webb laid out in his plenary speech on the first day: (i) effective agriculture-nutrition research needs honesty (about feasible contribution to health), (ii) this is only possible when agriculture researchers are involved in public health dialogue, priority-setting, and integrated research, and (iii) we must be open to an expanded research agenda. Highest impact may be in novel domains, which may or may not be agriculture.
I think this conference did well on these three important points. The forum was full of honest and intellectual discussions amongst a group of agriculture scientists, economists and nutritionists about how efficiently agriculture could contribute to nutrition.