Stanford researchers have determined that more than 15 million children are living in high-mortality hotspots across 28 Sub-Saharan African countries, where death rates remain stubbornly high despite progress elsewhere within those countries.

The study, published online Oct. 25 in The Lancet Global Health, is the first to record and analyze local-level mortality variations across a large swath of Sub-Saharan Africa.

These hotspots may remain hidden even as many countries are on track to achieve one of the U.N. Sustainable Development Goals: reducing the mortality rate of children under 5 to 25 per 1,000 by 2030. National averages are typically used for tracking child mortality trends, allowing left-behind regions within countries to remain out of sight — until now.

The senior author of the study is Eran Bendavid, MD, MS, an assistant professor of medicine and core faculty member at Stanford Health Policy. The lead author is Marshall Burke, PhD, an assistant professor of Earth System Science and a fellow at the Freeman Spogli Institute’s Center on Food Security and the Environment.

Decline in under-5 mortality rate

The authors note that the ongoing decline in under-5 mortality worldwide ranks among the most significant public and population health successes of the past 30 years. Deaths of children under the age of 5 years have fallen from nearly 13 million a year in 1990 to fewer than 6 million a year in 2015, even as the world’s under-5 population grew by nearly 100 million children, according to the Institute for Health Metrics and Evaluation.

“However, the amount of variability underlying this broad global progress is substantial,” the authors wrote.

“Mortality numbers are typically tracked at the national level, with the assumption that national differences between countries, such as government spending on health, are what determine progress against mortality,” Bendavid said. “The goal of our work was to understand whether national-level mortality statistics were hiding important variation at the more local level — and then to use this information to shed light on broader mortality trends.”

The authors used data from 82 U.S. Agency for International Development surveys in 28 Sub-Saharan African countries, including information on the location and timing of 3.24 million births and 393,685 deaths of children under 5, to develop high-resolution spatial maps of under-5 mortality from the 1980s through the 2000s.

Using this database, the authors found that local-level factors, such as climate and malaria exposure, were predictive of overall patterns, while national-level factors were relatively poor predictors of child mortality.

Temperature, malaria exposure, civil conflict

“We didn’t see jumps in mortality at country borders, which is what you’d expect if national differences really determined mortality,” said co-author Sam Heft-Neal, PhD, a postdoctoral scholar in Earth System Science. “But we saw a strong relationship between local-level factors and mortality.”

For example, he said, one standard deviation increase in temperature above the local average was related to a 16-percent higher child mortality rate. Local malaria exposure and recent civil conflict were also predictive of mortality.

The authors found that 23 percent of the children in their study countries live in mortality hotspots — places where mortality rates are not declining fast enough to meet the targets of the U.N. Sustainable Development Goals. The majority of these live in just two countries: Nigeria and the Democratic Republic of Congo. In only three countries do fewer than 5 percent of children live in hotspots: Benin, Namibia and Tanzania.

As part of the research, the authors have established a high-resolution mortality database with local-level mortality data spanning the last three decades to provide “new opportunities for a deeper understanding of the role that environmental, economic, or political conditions play in shaping mortality outcomes.”  The database, available at http://fsedata.stanford.edu, is an open-source tool for health and environmental researchers, child-health experts and policymakers.

“Our hope is that the creation of a high-resolution mortality database will provide other researchers new opportunities for deeper understanding of the role that environmental, economic or political conditions play in shaping mortality outcomes,” said Bendavid.  “These data could also improve the targeting of aid to areas where it is most needed.”

The research was supported by a grant from the Stanford Woods Institute for the Environment. 

Advances in high-yield agriculture achieved during the so-called Green Revolution have not only helped feed the planet, but also have helped slow the pace of global warming by cutting the amount of biomass burned - and the resulting greenhouse gas emissions - when forests or grasslands are cleared for farming. Stanford researchers estimate those emissions have been trimmed by over half a trillion tons of carbon dioxide. The paper is being released this week in the Proceedings of the National Academy of Sciences.

Advances in high-yield agriculture over the latter part of the 20th century have prevented massive amounts of greenhouse gases from entering the atmosphere - the equivalent of 590 billion metric tons of carbon dioxide - according to a new study led by two Stanford Earth scientists.

The yield improvements reduced the need to convert forests to farmland, a process that typically involves burning of trees and other plants, which generates carbon dioxide and other greenhouse gases.

The researchers estimate that if not for increased yields, additional greenhouse gas emissions from clearing land for farming would have been equal to as much as a third of the world's total output of greenhouse gases since the dawn of the Industrial Revolution in 1850.

The researchers also calculated that for every dollar spent on agricultural research and development since 1961, emissions of the three principal greenhouse gases - methane, nitrous oxide and carbon dioxide - were reduced by the equivalent of about a quarter of a ton of carbon dioxide - a high rate of financial return compared to other approaches to reducing the gases.

"Our results dispel the notion that modern intensive agriculture is inherently worse for the environment than a more 'old-fashioned' way of doing things," said Jennifer Burney, lead author of a paper describing the study that will be published online by the Proceedings of the National Academy of Sciences.

Adding up the impact

The researchers calculated emissions of carbon dioxide, methane and nitrous oxide, converting the amounts of the latter two gases into the quantities of carbon dioxide that would have an equivalent impact on the atmosphere, to facilitate comparison of total greenhouse gas outputs.

Burney, a postdoctoral researcher with the Program on Food Security and the Environment at Stanford, said agriculture currently accounts for about 12 percent of human-caused greenhouse gas emissions. Although greenhouse gas emissions from the production and use of fertilizer have increased with agricultural intensification, those emissions are far outstripped by the emissions that would have been generated in converting additional forest and grassland to farmland.

"Every time forest or shrub land is cleared for farming, the carbon that was tied up in the biomass is released and rapidly makes its way into the atmosphere - usually by being burned," she said. "Yield intensification has lessened the pressure to clear land and reduced emissions by up to 13 billion tons of carbon dioxide a year."

"When we look at the costs of the research and development that went into these improvements, we find that funding agricultural research ranks among the cheapest ways to prevent greenhouse gas emissions," said Steven Davis, a co-author of the paper and a postdoctoral researcher at the Carnegie Institution at Stanford.

To evaluate the impact of yield intensification on climate change, the researchers compared actual agricultural production between 1961 and 2005 with hypothetical scenarios in which the world's increasing food needs were met by expanding the amount of farmland rather than by the boost in yields produced by the Green Revolution.

"Even without higher yields, population and food demand would likely have climbed to levels close to what they are today," said David Lobell, also a coauthor and assistant professor of environmental Earth system science at Stanford.

"Lower yields per acre would likely have meant more starvation and death, but the population would still have increased because of much higher birth rates," he said. "People tend to have more children when survival of those children is less certain."

Avoiding the need for more farmland

The researchers found that without the advances in high-yield agriculture, several billion additional acres of cropland would have been needed.

Comparing emissions in the theoretical scenarios with real-world emissions from 1961 to 2005, the researchers estimated that the actual improvements in crop yields probably kept greenhouse gas emissions equivalent to at least 317 billion tons of carbon dioxide out of the atmosphere, and perhaps as much as 590 billion tons.

Without the emission reductions from yield improvements, the total amount of greenhouse gas pumped into the atmosphere over the preceding 155 years would have been between 18 and 34 percent greater than it has been, they said.

To calculate how much money was spent on research for each ton of avoided emissions, the researchers calculated the total amount of agricultural research funding related to yield improvements since 1961 through 2005. That produced a price between approximately $4 and $7.50 for each ton of carbon dioxide that was not emitted.

"The size and cost-effectiveness of this carbon reduction is striking when compared with proposed mitigation options in other sectors," said Lobell. "For example, strategies proposed to reduce emissions related to construction would cut emissions by a little less than half the amount that we estimate has been achieved by yield improvements and would cost close to $20 per ton."

The authors also note that raising yields alone won't guarantee lower emissions from land use change.

"It has been shown in several contexts that yield gains alone do not necessarily stop expansion of cropland," Lobell said. "That suggests that intensification must be coupled with conservation and development efforts.

"In certain cases, when yields go up in an area, it increases the profitability of farming there and gives people more incentive to expand their farm. But in general, high yields keep prices low, which reduces the incentive to expand."

The researchers concluded that improvement of crop yields should be prominent among a portfolio of strategies to reduce global greenhouse gases emissions.

"The striking thing is that all of these climate benefits were not the explicit intention of historical investments in agriculture. This was simply a side benefit of efforts to feed the world," Burney noted. "If climate policy intentionally rewarded these kinds of efforts, that could make an even bigger difference. The question going forward is how climate policy might be designed to achieve that."

David Lobell is a Center Fellow at the Freeman Spogli Institute for International Studies and at the Woods Institute for the Environment. The Program on Food Security and the Environment is a joint project of the Woods Institute and the Freeman Spogli Institute. The Precourt Institute for Energy and FSE provided funding for Jennifer Burney's research on agriculture and energy.