by Kul Chandra Gautam
Conference on Agricultural Transformation in Asia:
Policy Options for Food and Nutrition Security
Siem Reap, Cambodia 26 September 2013
I am grateful to the International Food Policy Research Institute (IFPRI), Cambodia Development Resource Institute (CDRI), and the United States Agency for International Development (USAID) for this opportunity to share some perspectives on ensuring food security and nutrition through transformation of agriculture in the Asia-Pacific region.
We all know the old saying that “Man does not live by bread alone”. Perhaps in keeping with the times, here in this part of Asia, we would say, “People do not live on rice alone”. Of course, all human beings need food to survive, but food alone is not enough for people to thrive – and to live a healthy, productive and dignified life.
We at the South Asia Food and Nutrition Security Initiative (SAFANSI) believe that the challenge of hunger and malnutrition in South Asia, as elsewhere, requires a multi-pronged approach, including: greater availability of food; enhanced livelihoods; education; clean water and sanitation; women’s empowerment; social protection; and a special focus on infant and child care.
But above all else, genuine food and nutrition security requires a political commitment that recognizes hunger and malnutrition as violation of people’s human rights, as well as a serious impediment to national development.
The importance of political commitment was graphically highlighted by the Nobel Laureate Amartya Sen who famously argued that the Great Bengal Famine of 1943 was not caused by the shortage of food, as the granaries of Kolkata were apparently quite full, but the British Raj of the time felt no political obligation to protect the starving masses from famine.
As we know, Amartya Sen also propounds a thesis that there is no large-scale famine in a functioning democracy.
A poignant proof of this thesis can be found right here in Cambodia. This country of great ancient civilization, with plenty of fertile land, bountiful lakes and rivers, great forestry resources, and well developed agriculture for its relatively small population, suffered one of the greatest man-made tragedies of death through starvation in our own life-time.
I was here in Cambodia with UNICEF in the 1970s when the genocidal tragedy unleashed by the Khmers Rouges unfolded. Even today, the memory of that monstrosity sends chills down my spine.
Let us be clear though that while democracy may indeed help avert visible famines, as we have seen all over Asia and other parts of the world, democracy is not an adequate anti-dote to combat malnutrition, which is often invisible to the naked eye, and therefore cannot be sensationalized in election campaigns.
Conventional wisdom would have it that hunger and malnutrition result from poor agriculture, lack of food or an unbalanced diet. But we know that hunger has many dimensions. There are at least four types of hunger:
The first hunger is the most obvious, caused by the lack of food. When we speak about millions of people going to bed hungry, or when we see the heart-wrenching pictures of emaciated children dying in famines, that is the common kind of hunger we refer to.
The second hunger, which we generally underestimate in conferences focused on food and agriculture, is the “hidden hunger” for micronutrients – or tiny amounts of minerals and vitamins such as iodine, iron, and vitamin A. This type of hunger does not manifest itself in the form of a bloated belly or emaciated body. But it strikes at the core of people’s health and vitality. It seriously damages human brain, learning ability, human health, and productivity.
The third type of hunger is the need of children and women for adequate care, nurturing, and protection from infections, without which food alone cannot protect them from malnutrition.
The fourth hunger is for a safe and sanitary environment—including safe water, clean air, and sanitation – so essential for promoting health, growth and nutrition, as well as liberating women from the drudgery of these time-consuming chores.
To these, we might add the growing occurrence of obesity, largely caused by junk foods and unhealthy life-styles, which is becoming an alarming phenomenon alongside under-nutrition, even in very poor countries and communities.
Indeed, it has been noted that both under-nutrition and obesity are a reflection of the life-cycle consequences of inadequate foetal and infant growth, and the life-style related consequences of urbanization where the poorer people, including children, often eat cheap, processed foods which fill the belly and satisfy their taste buds, but harm their health.
Interestingly, some of the solutions to under-nutrition and over-nutrition are common. Optimum breastfeeding, for example, prevents both under-nutrition among children and protection from some obesity-related diseases in adulthood.
Overcoming these different types of hungers, requires a holistic, life-cycle approach to ensure that all children get a healthy start in life; that all families have essential household food security; that primary health care and basic education are universally available in all communities; and that we promote good nutrition and healthy lifestyles among adolescents and adults.
Now, how does agriculture contribute to all this?
Let us be humble that agriculture alone cannot solve most of the problems of malnutrition. Directly, it can only help tackle one of the five dimensions of malnutrition – namely meeting the requirement for food. But indirectly, a wise and comprehensive agriculture policy can help tackle several other underlying causes of malnutrition as well.
First, a wise agriculture policy helps ensure household food security so families that are dependent on farming for their own food and livelihood produce nutritious foods to ensure proper nutrition for all, especially for the most vulnerable women and children.
A deliberate focus on producing nutrient-dense foods, such as fruits and vegetables, fish, livestock, milk and eggs; increasing the nutritional content of foods through crop biofortification; improved post-harvest storage and preservation of foods to cover “lean” seasons; and educating people about nutrition and diet, are obvious areas for agriculture policy to contribute to good nutritional outcome.
Second, in most countries of Asia where agriculture is the main source of people’s income and employment, good agriculture policy can help alleviate poverty. Beyond meeting the farmers’ own basic food requirements, good agriculture policy helps people produce surplus food, and cash crops, which they can sell or barter to improve their income. With higher income, people can purchase or access better health and nutrition.
It is the surplus food produced by farmers that also helps meet the food requirements of the growing number of people, who are not engaged in agriculture, especially in urban areas.
Third, good agriculture policy, especially extension services, impart skills that empower people not only to be better farmers, but better citizens, aware of their rights and responsibilities. Tailor-made extension services, such as those focusing on women farmers, and deprived communities, can motivate people to educate their children, adopt healthy life-styles, and better protect themselves from exploitation – thus unleashing the path of good nutrition and social progress.
Good agricultural policies implemented as part of broader rural development and poverty eradication measures have significant direct as well as indirect impact on reducing malnutrition.
For far too long, nutritionists have debated about the intricacies of various nutrients and enzymes, and failed to persuade politicians and policy makers with simple and persuasive messages as to why investing in nutrition is one of the best bargains to promote national development.
We all say that nutrition requires a multi-sectoral approach, which it does. But therein lies a big problem. When something is multi-sectoral, it becomes nobody’s priority. Most sectoral ministries of governments understandably champion their own sectors. And multi-sectoral programmes become secondary and discretionary for which one can always pass the buck to another ministry.
With a few notable exceptions, there are very few Planning Commissions and Finance Ministries, or heads of government and provincial chiefs who play an enlightened leadership role in support of programmes that maybe very important, but for which there is no lobbying by powerful constituencies.
And so it is that nutrition has become a subject that is over-studied and under-acted upon.
Now, fortunately, there has been a significant change in the last decade – and a growing consensus nationally and internationally – on what needs to be done to improve nutrition; why it deserves a high priority; and some very strong evidence-based cases for investing in nutrition.
About a decade ago, the World Bank issued a seminal report on “Repositioning Nutrition as Central to Development”, drawing on evidence from many country studies that demonstrated very high cost-effectiveness of many nutrition interventions.
In 2008, the British medical journal, The Lancet, published a series of articles, again drawing on lessons learned from many projects around the world, and made the case that there was a ‘Golden 1000 days’ “window of opportunity” from pregnancy to two years of age, during which a set of specific nutrition interventions have the greatest impact in dramatically reducing malnutrition, morbidity and mortality in children, and greatly enhancing their learning and earning ability as they grow up to adolescence and adulthood.
Around the same time, a group of leading economists, including several Nobel Laureates, came up with what came to be known as the “Copenhagen Consensus” that showed that investment in nutrition, such as on micronutrients and some community-based nutrition interventions had far higher rates of economic return and social impact than investment in any other sector.
All of this culminated into a bold proposal for “Scaling Up Nutrition” – The SUN Initiative – around which there is now an emerging global consensus among governments, UN agencies, multilateral and bilateral organizations, academics and NGOs that are key players in promoting nutrition.
The SUN Initiative recommends two complimentary approaches to reducing under-nutrition – a set of about a dozen specific and evidence-based direct interventions to prevent and treat under-nutrition, and a broader multi-sectoral approach to deal with the underlying causes of malnutrition.
The SUN approach got a major boost earlier this year at the G-8 Summit in London when a commitment of nearly $4 billion was announced for a “Nutrition for Growth” initiative.
I am currently associated with the South Asia Food and Nutrition Security Initiative (SAFANSI) that is hosted by the World Bank and involves active participation of several governments and donor agencies. It was partly inspired by The SUN Initiative. It was also partly inspired by what came to be known as the “Asian Enigma”, a term coined in the mid-1990s that referred to the puzzle of why despite the “Green Revolution” and rapid economic growth, many Asian countries had double the rate of malnutrition than sub-Saharan Africa.
To understand this enigma, UNICEF commissioned three leading experts on health and nutrition with deep experience in Asia and Africa, the late Dr. Vulmiri Ramalingaswamy, Urban Jonsson, and Jon Rohde to elucidate the causes and consequences of this reality. What they reported then in 1995 was intriguing and fascinating, and is still valid today.
First, they examined, and ruled out, the ‘usual suspects’ for potential causes of malnutrition in South Asia – concluding that it was not really the high level of poverty, or the vegetarian diet, or poor agricultural performance that was the main culprit, because in those respects most African countries were worse off than Asians.
Instead they concluded that the lower status and greater neglect of girls and women, and the poorer hygiene and sanitation in South Asia which had higher level of urbanization than Africa, were more critical factors. These led to the inter-generational transmission of malnutrition through low-birth weight, inadequate breastfeeding, poorer health and nutrition of adolescent girls and pregnant women, all of which made Asian children more vulnerable to infection and malnutrition.
Even today, if we take the case of India, there are several “Puzzle States”, such as Gujarat, Kerala and Punjab where, despite high agricultural growth and high literacy rates, very high rates of malnutrition persist. At the household level, adequate income does not seem to guarantee adequate nutrition; as even among the richest quintile in India, 64% of preschool children are iron deficient and 26% are underweight.
Here in Cambodia, despite great progress in the past two decades, 40 percent of children under-5 are stunted; 28 percent are underweight and 11 percent are wasted or suffering from moderate to severe malnutrition. All these rates are higher rates than the average for sub-Saharan Africa.
Similar situation prevails in many other Asian countries. Indeed, even some countries with food surplus at the national level, including some major food exporters, have high levels of malnutrition. So let us be careful not to presume that agriculture alone can solve the problem of malnutrition or household food insecurity. We need more deliberate nutrition-focused and nutrition-sensitive agriculture policies.
I would, therefore, urge all of us involved in agricultural research, education and extension to be mindful of the limitations as well as the great potential of agriculture to contribute to food and nutrition security in designing our programmes and influencing public policy.
The world produces enough food to feed every man, woman and child on earth. Hunger and malnutrition are therefore not due to lack of food alone, but are mainly a consequence of poverty, inequality and misplaced priorities.
Let us use our collective energy and innovative genius to overcome this shameful blemish on our region, Asia, as the epicenter of the world’s worst malnutrition. Let us make this ancient land of great civilizations, rich culture and natural beauty, a land free of hunger and malnutrition as it emerges as the new economic power-house of the 21st century.