Jody Harris

Agriculture and nutrition in India: mapping evidence to pathways.

In India, progress against undernutrition has been slow. Given its importance for income generation, improving diets, care practices, and maternal health, the agriculture sector is widely regarded as playing an important role in accelerating the reduction in undernutrition. This paper comprehensively maps existing evidence along agriculture–nutrition pathways in India and assesses both the quality and coverage of the existing literature. We present a conceptual framework delineating six key pathways between agriculture and nutrition. Three pathways pertain to the nutritional impacts of farm production, farm incomes, and food prices. The other three pertain to agriculture–gender linkages. After an extensive search, we found 78 research papers that provided evidence to populate these pathways. The literature suggests that Indian agriculture has a range of important influences on nutrition. Agriculture seems to influence diets even when controlling for income, and relative food prices could partly explain observed dietary changes in recent decades. The evidence on agriculture–gender linkages to nutrition is relatively weak. Sizeable knowledge gaps remain. The root causes of these gaps include an interdisciplinary disconnect between nutrition and economics/agriculture, a related problem of inadequate survey data, and limited policy‐driven experimentation. Closing these gaps is essential to strengthening the agriculture sectors contribution to reducing undernutrition.

Value Chains and Nutrition: A Framework to Support the Identification, Design, and Evaluation of Interventions

In this paper we explore how a value chain framework can inform the design of interventions for achieving improved nutrition. Conceptually, there are three main channels for value chains to improve nutrition: (1) through increased consumption of nutritious foods (a demand side pathway); or (2) through increased incomes from value chain transactions (a supply side pathway) or (3) through increased nutrition value-addition in the chain transactions. These three pathways are interlinked and involve complex dynamics that are not straightforward to understand.

If They Grow It, Will They Eat and Grow? Evidence from Zambia on Agricultural Diversity and Child Undernutrition

Abstract In this article we address a gap in our understanding of how household agricultural production diversity affects the diets and nutrition of young children living in rural farming communities in sub-Saharan Africa. The specific objectives of this article are to assess: (1) the association between household agricultural production diversity and child dietary diversity; and (2) the association between household agricultural production diversity and child nutritional status. We use household survey data collected from 3,040 households as part of the Realigning Agriculture for Improved Nutrition (RAIN) intervention in Zambia. The data indicate low agricultural diversity, low dietary diversity and high levels of chronic malnutrition overall in this area. We find a strong positive association between production diversity and dietary diversity among younger children aged 6–23 months, and significant positive associations between production diversity and height for age Z-scores and stunting among older children aged 24–59 months.

Diet Quality in Developing Countries

Dietary quality contributes to an individual’s nutrition and health status, with a high-quality diet providing the right nutrients in the right amounts for health and well-being. Attainment of a high-quality diet is particularly problematic among poor populations in low-income countries where diets are dominated by starchy staple foods, and nutrient-dense animal source foods, fruits, and vegetables are often unavailable or unaffordable. The measurement of dietary quality is also more difficult in these contexts, where a lack of resources and research capacity makes the collection and analysis of detailed quantitative dietary data for research or program planning difficult. Dietary diversity (DD), the number of foods or food groups consumed, is a key dimension of dietary quality, with diverse diets increasing the likelihood of adequate intake of essential nutrients. This chapter updates a 2003 review of DD indicators (J Am Diet Assoc 96:785–791, 1996) and summarizes new evidence regarding their potential use as a proxy for dietary quality in developing country contexts. The review concludes that new evidence confirms that DD indicators are useful, simple indicators for assessing diet quality among children and adults in developing countries.

Gender Implications of Poor Nutrition and Health in Agricultural Households

For most of the rural poor, their most important asset is their own physical capacity for work. This depends crucially on individual nutritional and health status. This chapter summarizes the evidence on gender differences in vulnerabilities to poor nutrition and health, and their potential effects on the productivity of men and women in farming households. Adopting a life-cycle perspective, the chapter examines the implications of four key health and nutritional disorders—undernutrition, iron-deficiency anemia, HIV, and malaria—for the productivity and well-being of men and women in agriculture. These disorders have both direct and interacting impacts, with the nature of the disorder and the context in which it is found determining its exact impacts and the strategies required to cope with nutrition and health shocks. In each case, the impact on the productivity of women is different from that on the productivity of men for biological, social, and cultural reasons. The author discusses several promising policies and interventions to prevent and mitigate some of the negative impacts of specific disorders discussed above on women’s agricultural productivity and production. The chapter concludes by proposing further research on understanding the complexities of women’s time use and trade-offs in coping with ill health and poor nutrition in agriculture, and on evaluating the most promising policies and programs to protect poor women and enhance their productivity in agriculture and income-generating activities.

3rd Annual Conference of the Leverhulme Centre for Integrative Research on Agriculture and Health (LCIRAH), Developing methods in agriculture and health research, London, 13-14 June 2013

Agriculture and health interact in complex ways via food systems and nutrition, creating positive and negative synergies, which differ according to economic, political and environmental contexts, but particularly affecting the lives of vulnerable populations in low-income countries. Research in these subjects has historically proceeded in relative isolation, with different disciplines applying distinct methods to generate knowledge and inform sector-based policy and practice. This segregated working is not beneficial if research is to inform the design and implementation of programs and policies that aim to fully and sustainably address the nexus of agriculture and health. Encouragingly, policy and programmatic initiatives, as well as research endeavours, have been increasingly attentive to the linkage of agriculture and health as a method for improving nutritional status and health (Masset et al. 2012). More and better multi-sectoral action will be necessary, however, to reduce the harms and enhance the benefits of the agriculture-health relationship, and research increasingly needs to engage with this complex picture if findings are to remain relevant to policy and practice. In response to this interdisciplinary challenge, the Leverhulme Centre for Integrative Research on Agriculture and Health (LCIRAH) was established in 2010 with a grant from the Leverhulme Trust to develop “unifying approaches and methodologies for understanding the relationship between agricultural production and population health, and the factors which drive them both”an agri-health research agenda (www.lcirah.ac.uk). Since its inception, LCIRAH has hosted three international conferences endeavouring to bring together experts from different sectors to share perspectives and explore integrated inter-disciplinary approaches to global agri-health challenges. In 2011, the first conference, organised with the International Food Policy Research Institute (IFPRI), had a strong focus on agri-health metrics, with scholars presenting work on ways in which metrics and methods can cross disciplines to fill knowledge gaps. The conference found a potentially huge benefit in promoting the understanding and utilization of different methods across disciplines to move the agri-health research agenda forward. The second conference, in 2012, J. Harris :M. Bruce : E. Cavatorta : L. Cornelsen :B. Hasler : R. Green : E. H.Morgan : S. Stevano :H. L.Walls :K. Cunningham Leverhulme Centre for Integrative Research on Agriculture and Health (LCIRAH), London, UK

Urbanization and the Nutrition Transition

Diets are changing with rising incomes and urbanization— people are consuming more animal-source foods, sugar, fats and oils, refined grains, and processed foods. This “nutrition transition” is causing increases in overweight and obesity and diet-related diseases such as diabetes and heart disease. Urban residents are making the nutrition transition fastest— but it is occurring in rural areas too. Urban food environments—with supermarkets, food vendors, and restaurants—facilitate access to unhealthy diets, although they can also improve access to nutritious foods for people who can afford them. For the urban poor, the most easily available and affordable diets are often unhealthy.

Changes in the policy environment for infant and young child feeding in Vietnam, Bangladesh, and Ethiopia, and the role of targeted advocacy

BackgroundThere is limited literature examining shifts in policy environments for nutrition and infant and young child feeding (IYCF) over time, and on the potential contribution of targeted advocacy to improved policy environments in low- and middle-income countries. This study tracked changes in the policy environment over a four-year period in three countries, and examined the role of targeted nutrition and IYCF advocacy strategies by a global initiative.MethodsQualitative methods, including key informant interviews, social network mapping, document and literature review, and event tracking, were used to gather data on nutrition and IYCF policies and programs, actor networks, and perceptions and salience of nutrition as an issue in 2010 and 2014 in Bangladesh, Ethiopia, and Vietnam. Theoretical frameworks from the policy sciences were used to analyze policy change over time, and drivers of change, across countries.ResultsThe written policy environment improved to differing extents in each country. By 2014, the discourse in all three countries mirrored international priorities of stunting reduction and exclusive breastfeeding. Yet competing nutrition priorities such as acute malnutrition, food insecurity, and nutrition transitions remained in each context. Key actor groups in each country were government, civil society, development partners and the private sector. Infant formula companies, in particular, emerged as key players against enforcement of IYCF legislation. The role of a targeted IYCF advocacy and policy support initiative was well-recognized in supporting multiple facets of the policy environment in each country, ranging from alliances to legislation and implementation support. Despite progress, however, government commitment to funding, implementation, and enforcement is still emerging in each country, thus challenging the potential impact of new and improved policies.ConclusionTargeted policy advocacy can catalyze change in national nutrition and IYCF policy environments, especially actor commitment, policy guidance, and legislation. Implementation constraints – financing, capacity and commitment of systems, and competing priorities and actors – are essential to address to sustain further progress. The lack of pressing political urgency for nutrition and IYCF, and the uncertain role of international networks in national policy spaces, has implications for the potential for change.

What it takes: evidence from a nutrition- and gender-sensitive agriculture intervention in rural Zambia

ABSTRACT The Realigning Agriculture for Improved Nutrition (RAIN) project was designed to address child undernutrition through a multisectoral approach which integrated agricultural diversification to improve access to nutritious foods, the promotion of gender equality and women’s empowerment and nutrition behaviour change communication to improve infant and young child feeding (IYCF) knowledge and practices. This paper presents the intention-to-treat impacts of the RAIN project on women’s empowerment, IYCF knowledge and practices and child anthropometry. Findings on programme impacts on agricultural production, household food security and dietary diversity and maternal and child dietary diversity are reported elsewhere. The RAIN project had positive effects on women’s empowerment, IYCF knowledge, child morbidity and weight-for-height z-scores, but had little impacts on IYCF practices, and no impact on stunting. Strengthening programme implementation and fostering higher participation rates could support greater impacts on child nutrition outcomes.