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A Global Perspective on Food Policy

I applaud Mark Bittman, Michael Pollan, Ricardo Salvador, and Olivier de Schutter for advocating the introduction of a national food policy in the U.S. Greater emphasis in our current farm legislation on nutrition, health, equity, and the environment is clearly warranted and long overdue. As the authors note, Americans’ access to adequate nutrition at all income levels affects educational and health outcomes for the nation as a whole. Poor nutrition thus plays a role in determining the level and distribution of economic and social wellbeing in the U.S, now and in the future. It is surprising that no one within the large circle of Presidential hopefuls has raised the topic of food, not just agriculture, as a major political issue for the 2016 election.

The U.S. is not unique. Virtually every country with an agrarian base has, at some point in history, introduced agricultural policies that support farmers and provide incentives for them to produce major commodities. At the time, governments have been able to justify these policies on several grounds: national security (avoiding excess dependence on foreign nations for food), economic growth (using agricultural surpluses as an engine of economic growth), and social stability (keeping its population well-fed to avoid social unrest). Once agricultural policies are implemented, they typically give rise to institutions and vested political interests that perpetuate a supply-side orientation to food and agriculture. In the U.S., the political institutions that govern food and agriculture have their roots in historical political precedents that date back to the 1860s, and later to the 1930s when the New Deal was promulgated. Farm interests have been entrenched in the U.S. political system for quite some time, and they cannot be easily removed.

There is a general rule for successful policies: Align incentives with objectives. A corollary to this principle is that objectives change over the course of economic development. For the United States in earlier eras, and for many developing economies in recent decades, meeting basic calorie needs has been the first order of business. This objective has been largely achieved through public investments in infrastructure (irrigation, roads), research and development, commodity support programs, incentives for private agribusiness development, and other supply-side measures.

With successful agricultural growth and rising incomes, many countries face a new set of food and nutrition challenges: eliminating “hidden hunger” (deficiencies in iron, vitamin A, calcium, zinc and other micronutrients), and abating the steady rise in obesity that results from a transition to diets rich in energy-dense carbohydrates, fats, and sugar. Hidden hunger affects some three billion people worldwide. It is prevalent among low-income households in almost all countries, impairs cognitive and physical development (especially among infants up to two years of age) and thus limits a nation’s educational and economic potential. Meanwhile, rates of obesity now surpass rates of energy-deficient hunger throughout the world, even in developing nations.

The objectives of food and agricultural policies in virtually all countries need to shift, on balance, from promoting staple food supplies to enhancing nutrition. I am not suggesting an abandonment of agriculture, but rather an enrichment of agriculture with more crop diversity to support the nutritional needs of all people. If improved nutrition is the objective, what are the correct incentives? Proper incentives will differ among countries, but will inevitably require a fundamental change in institutional structure. With a shift from supply- to demand orientation, there needs to be a transition from Ministries of Agriculture to Ministries of Food. After all, the main goals of a Ministry of Agriculture are to increase the volume of agricultural production and to improve economic growth in the agricultural sector. The main goal of a Ministry of Food, by contrast, is to enhance the nutrition and food security of the entire population.

Bittman, Pollan, Salvador, and de Schutter emphasize that replacing the U.S. Department of Agriculture (USDA) with a “U.S. Department of Food, Health, and Wellbeing” would be difficult at best. It would require unprecedented political will and cooperation among parties. The same can be said for institutional change in agricultural ministries throughout the world. Regardless of the challenges, however, nothing will change until the conversation surrounding food policies, politics, and institutions takes a major turn.

A new study by Center on Food Security and the Environment researchers finds that smallholder irrigation systems - those in which water access (via pump or human power), distribution (furrow, watering can, sprinkler, drip lines, etc.), and use all occur at or near the same location - have great potential to reduce hunger, raise incomes and improve development prospects in an area of the world greatly in need of these advancements. Financing is crucial, as even the cheapest pumps can be prohibitively expensive otherwise.

These systems have the potential to use water more productively, improve nutritional outcomes and rural development, and narrow the income disparities that permit widespread hunger to persist despite economic advancement. Only 4 percent of agricultural land in sub-Saharan Africa is currently irrigated.

"Success stories can be found where distributed systems are used in a cooperative setting, permitting the sharing of knowledge, risk, credit and marketing as we've seen in our solar market garden project in Benin," said Jennifer Burney, lead author of the study published in the Proceedings of the National Academy of Sciences.

Moving forward development communities and sub-Saharan African governments need a better understanding of present water resources and how they will be affected by climate change.

"Farmers need access to financial services—credit and insurance—appropriate for a range of production systems," said co-author and Stanford Woods Institute Senior Fellow Rosamond Naylor. "Investments should start at a smaller scale, with thorough project evaluation, before scaling up."

FSE continues to contribute to these evaluations and added eight new villages to our project in Benin last year.

Children in rural Kenya are more susceptible to disease and death the farther away they live from clean drinking water, according to Stanford researchers.

In a survey of families in Asembo – a small farming community at the edge of Lake Victoria that has high rates of chronic diarrhea, child malnutrition and child death – a research team from the Center on Food Security and the Environment found that most people live just over a quarter-mile from clean water sources. About 200 feet closer to home are ponds and springs contaminated with E. coli bacteria. Sixty-six percent of families primarily use this contaminated surface water for drinking.

A child in Asembo, Kenya sits next to her family's water storage containers.

A child in Asembo, Kenya sits next to her family's water storage containers. Photo Credit: Amy Pickering

While water is essential for farming, collecting it is time-consuming and physically exhausting in remote places like Asembo. Previous research has shown that when families must travel long distances for water, child health suffers. The harder it is to collect, the less of it a family will use. A shortage of water for cooking and drinking compromises children’s nutrition and hydration. And it limits hand washing and bathing, making children more susceptible to disease. Quality and availability of water also varies widely from source to source, and the time required to collect water can force families to use dirtier, unimproved water sources that are closer to home. 

In 2011, the FSE researchers partnered with the Centers for Disease Control Kenya Medical Research Institute (CDC-KEMRI), which was already conducting an extensive survey of household-level health indicators in the region. Combining resources with CDC-KEMRI allowed the team – led by FSE Director Rosamond Naylor, a professor of environmental earth system science, and Jenna Davis, an assistant professor of civil and environmental engineering – to use a robust set of data. The information covered about 3,000 households in a five kilometer radius and was collected on a bi-weekly basis for six months. In exploring the links between water, food and health in Asembo, FSE researchers first expanded the definition of water “access” to account for both physical distance and the quality of water sources.

Researchers take a child's measurements in Asembo, Kenya.

Researchers take a child's measurements in Asembo, Kenya. Photo Credit: Amy Pickering

Researchers then mapped the distance of each household from its nearest water source, and recorded whether the source was improved (such as a deep borewell) or unimproved (surface water like a pond, spring or shallow well). To get the most precise possible data on local water quality, the research team collected samples from each household’s water source and sent them to a local hospital lab for testing. Surveyors then collected data on each household’s water management practices, including water treatment. They measured agricultural output, dietary diversity, and perceived food insecurity, then recorded the weight and height measurements of each child in the household. Respondents also reported the frequency of recent cases of diarrheal disease among children of the household.

Results of the initial survey highlight sobering realities about water access in Asembo. Households in the survey reported average per capita water consumption of only 31 liters per day, including water used for cooking, drinking, hygiene and agriculture. The average walk time to the nearest water source was approximately 15 minutes. The average distance to the nearest improved source was 428 meters, whereas the average distance to unimproved surface water was 374 meters. Water quality tests confirmed that these sources, used by the majority of families, were highly contaminated with E. coli bacteria, while improved water sources were significantly cleaner. Thirty percent of children showed stunted growth, and 11 percent were underweight for their age.

A researcher collects a sample of stored water at a household in Asembo, Kenya.

A researcher collects a sample of stored water at a household in Asembo, Kenya. Photo Credit: Amy Pickering

Researchers found that close proximity to an abundant water source, regardless of quality, correlated with an increase in food production and diversity, as well as a lower hunger score. Having enough extra water for crop irrigation clearly improves children’s diets – particularly their access to the micronutrients essential for normal physical and cognitive development – and helps them resist disease. Households further from water sources reported lower and less diverse crop yields, as well as poorer child health indicators. Quality was also an important factor, as households with access to clean, improved water reported better child health outcomes than those relying on contaminated surface water.

The ultimate goal of the project, “Rural health and development at the food-water nexus” is to design interventions and policy incentives that help people absorb nutrients in environments where food and water are limited and disease is prevalent. In the next stage of the project, researchers will focus on links between water access and the progression of HIV, and will also investigate how improved diets from better water access can impact household income.

About the Stanford Research Team:

Jenna Davis is Associate Professor of Civil and Environmental Engineering, Higgins-Magid Faculty Senior Fellow at the Stanford Woods Institute for the Environment, and an affiliate of the Center on Food Security and the Environment.
Rosamond Naylor is the Director of the Center on Food Security and the Environment, Professor of Environmental Earth System Science, and the William Wrigley Senior Fellow at the Stanford Woods Institute.
Eran Bendavid is an infectious diseases physician and Assistant Professor of Medicine in the Division of General Internal Medicine, as well as an affiliate of the Center on Food Security and the Environment and the Stanford Health Policy center.
Amy Pickering is a lecturer in the School of Earth Sciences, and a research associate in Civil and Environmental Engineering, the Woods Institute for the Environment, and the Center on Food Security and the Environment.
Glwadys Gbetibouo is a postdoctoral scholar at the Center on Food Security and the Environment.
Katrina ole-MoiYoi is a Ph.D. student at the Center on Food Security and the Environment.

Philanthropist and software giant Bill Gates spoke to a Stanford audience last week about the importance of foreign aid and product innovation in the fight against chronic hunger, poverty and disease in the developing world.

His message goes hand-in-hand with the ongoing work of researchers at Stanford’s Freeman Spogli Institute for International Studies. Much of that work is supported by FSI’s Global Underdevelopment Action Fund, which provides seed grants to help faculty members design research experiments and conduct fieldwork in some of the world’s poorest places.

Four FSI senior fellows – Larry Diamond, Jeremy Weinstein, Paul Wise and Walter Falcon – respond to some of the points made by Gates and share insight into their own research and ideas about how to advance and secure the most fragile nations.

Without first improving people’s health, Gates says it’s harder to build good governance and reliable infrastructure in a developing country. Is that the best way to prioritize when thinking about foreign aid?

Larry Diamond: I have immense admiration for what Bill Gates is doing to reduce childhood and maternal fatality and improve the quality of life in poor countries.  He is literally saving millions of lives.  But in two respects (at least), it's misguided to think that public health should come "before" improvements in governance.  

First, there is no reason why we need to choose, or why the two types of interventions should be in conflict.  People need vaccines against endemic and preventable diseases – and they need institutional reforms to strengthen societal resistance to corruption, a sociopolitical disease that drains society of the energy and resources to fight poverty, ignorance, and disease.  

Second, good governance is a vital facilitator of improved public health.  When corruption is controlled, public resources are used efficiently and justly to build modern sanitation and transportation systems, and to train and operate modern health care systems.  With good, accountable governance, public health and life expectancy improve much more dramatically.  When corruption is endemic, life-saving vaccines, drugs, and treatments too often fall beyond the reach of poor people who cannot make under-the-table payments. 

Foreign aid has come under criticism for not being effective, and most countries have very small foreign aid budgets. How do you make the case that foreign aid is a worthy investment?

Jeremy M. Weinstein: While foreign aid may be a small part of most countries’ national budgets, global development assistance has increased markedly in the past 50 years. Between 2000 and 2010, global aid increased from $78 billion to nearly $130 billion – and the U.S. continues to be the world’s leading donor.

The challenge in the next decade will be to sustain high aid volumes given the economic challenges that now confront developed countries. I am confident that we can and will sustain these volumes for three reasons.

First, a strong core of leading voices in both parties recognizes that promoting development serves our national interest. In this interconnected world, our security and prosperity depend in important ways on the security and prosperity of those who live beyond our borders.

Second, providing assistance is a reflection of our values – it is these humanitarian motives that drove the unprecedented U.S. commitment to fighting HIV/AIDS during the Bush Administration.

Perhaps most importantly, especially in tight budget times, development agencies are learning a great deal about what works in foreign assistance, and are putting taxpayers’ dollars to better use to reduce poverty, fight disease, increase productivity, and strengthen governance – with increasing evidence to show for it.

Some of the most dire situations in the developing world are found in conflict zones. How can philanthropists and nongovernmental organizations best work in places with unstable governments and public health crises? Is there a role for larger groups like the Gates Foundation to play in war-torn areas?

Paul H. Wise: As a pediatrician, the central challenge is this: The majority of preventable child deaths in Sub-Saharan Africa and in much of the world occur in areas of political instability and poor governance. 

This means that if we are to make real progress in improving child health we must be able to enhance the provision of critical, highly efficacious health interventions in areas that are characterized by complex political environments – often where corruption, civil conflict, and poor public management are the rule. 

Currently, most of the major global health funders tend to avoid working in such areas, as they would rather invest their efforts and resources in supportive, well-functioning locations.  This is understandable. However, given where the preventable deaths are occurring, it is not acceptable. 

Our efforts are directed at creating new strategies capable of bringing essential services to unstable regions of the world.  This will require new collaborations between health professionals, global security experts, political scientists, and management specialists in order to craft integrated child health strategies that respect both the technical requirements of critical health services and the political and management innovations that will ensure that these life-saving interventions reach all children in need.

Gates says innovation is essential to improving agricultural production for small farmers in the poorest places. What is the most-needed invention or idea that needs to be put into place to fight global hunger?

Walter P. Falcon: No single innovation will end hunger, but widespread use of cell phone technology could help.

Most poor agricultural communities receive few benefits from agricultural extension services, many of which were decimated during earlier periods of structural reform. But small farmers often have cell phones or live in villages where phones are present.

My priority innovation is for a  $10 smart phone, to be complemented with a series of very specific applications designed for transferring knowledge about new agricultural technologies to particular regions.  Using the wiki-like potential of these applications, it would also be possible for farmers from different villages to teach each other, share critical local knowledge, and also interact with crop and livestock specialists.

Language and visual qualities of the applications would be key, and literacy problems would be constraining.  But the potential payoff seems enormous.

As markets around the world slump, sputter and slump again, China maintains the fastest-growing economy. But despite the country’s boom, it has fallen behind in making sure its children will be healthy, strong and smart enough to cash in on it.

About 30 percent of children living in China’s rural areas are anemic – sick with an iron deficiency that Stanford researcher Scott Rozelle and his colleagues with the Rural Education Action Project have proven leads to bad school performance. And a poor education coupled with anemia’s physical blow puts those kids at risk for lives of poverty and missed opportunities.

But things are changing. Influenced in part by the research Rozelle has conducted and presented to Chinese officials, the government recently launched a policy to improve school lunches for about 20 million children across the country.

The plan invests $2.5 billion a year during the next nine years to ensure the meals are more nutritious for elementary and middle school students. That doubles the amount spent on lunches for China’s neediest children.

“For 5,000 years it was OK to be anemic if you're never going to leave the farm," said Rozelle, an economist and senior fellow at Stanford’s Freeman Spogli Institute for International Studies who is still experimenting with ways to improve children's health in rural China and get the government to adopt the most effective methods.

"But we're looking 20 years into the future where there are much fewer farms and you need at least a high school education to make a living in the city,” Rozelle said. “If you are sick with anemia, it is going to affect your cognitive ability, educational performance and ultimately your chances of going on in school."

Rozelle began studying anemia and its links to school performance in 2008.

After conducting an initial study of about 4,000 primary school students in Shaanxi province, he found that nearly 40 percent of the children were anemic – the result of diets that consisted mostly of rice and noodles in regions where meat, fruit and fresh vegetables are expensive and often hard to come by.

Those survey results were presented to the government in a 2009 policy brief written by Rozelle and his collaborators. Officials adopted the brief, making rural primary school nutrition part of China’s official policy discussion.

A second study conducted between 2008 and 2009 found that anemia rates dropped when schoolchildren were given vitamins fortified with iron. And as their iron levels rose, so did their test scores.

An experiment followed to back up those findings, while another set of large-scale surveys across four provinces reinforced that childhood anemia was indeed a widespread problem.

The findings from those surveys and tests were packaged in another policy brief that was accepted by the government earlier this year, prompting a government directive urging more concrete action in the area of student nutrition.

Those documents, along with several presentations Rozelle has made to government officials and commissions, have culminated in a move to pour $22.5 billion into more nutritious school lunches between now and 2020. It will likely be up to local government and school officials to decide exactly what those meals will include, but Rozelle is hopeful they’ll lead to diets with more meat, vegetables and iron supplements.

“Research-based results are an important avenue for affecting policy in China,” said Chen Zhili, vice chair of the Standing Committee of the National People’s Congress and a former minister of education. “The new programs for child nutrition were only made possible by the work of groups (like the Rural Education Action Project).”

And a national policy aimed at improving nutrition and curbing anemia helps ensure that China maintains its foothold in the world’s economy and grow in a more stable, equitable way, Rozelle said.

“The social return is huge,” Rozelle said. “These kids will be able to do better in school, work harder and sustain China’s growth.”