Health and Medicine

FSI’s researchers assess health and medicine through the lenses of economics, nutrition and politics. They’re studying and influencing public health policies of local and national governments and the roles that corporations and nongovernmental organizations play in providing health care around the world. Scholars look at how governance affects citizens’ health, how children’s health care access affects the aging process and how to improve children’s health in Guatemala and rural China. They want to know what it will take for people to cook more safely and breathe more easily in developing countries.

FSI professors investigate how lifestyles affect health. What good does gardening do for older Americans? What are the benefits of eating organic food or growing genetically modified rice in China? They study cost-effectiveness by examining programs like those aimed at preventing the spread of tuberculosis in Russian prisons. Policies that impact obesity and undernutrition are examined; as are the public health implications of limiting salt in processed foods and the role of smoking among men who work in Chinese factories. FSI health research looks at sweeping domestic policies like the Affordable Care Act and the role of foreign aid in affecting the price of HIV drugs in Africa.

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Promotion of smallholder irrigation is cited as a strategy for enhancing income generation and food security for sub-Saharan Africa’s poor farmers, but what makes this technology a successful poverty alleviation tool? In the short run, the technology should pave the way for increased consumption, asset accumulation, and reduced persistent poverty among users. Over the longer run, it should lead to institutional feedbacks that support sustained economic development and nutritional improvements. Our conceptual model and review of case studies reveal the importance of three sub-components of irrigation technology—access, distribution, and use—and the ways in which the design of the technology itself can either bridge, or succumb to, institutional gaps. These critical features are illustrated in an experimental evaluation of a solar-powered drip irrigation project in rural northern Benin, which provides a controlled study of technology impacts in the Sudano-Sahel. The combined evidence highlights the technical and institutional requirements for project success and points to two important areas of research in the scale-up of any small-scale irrigation strategy: the risk behavior of water users, and the evolution of institutions that either support or obstruct project replication over space and time.

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Jennifer Burney
Rosamond L. Naylor
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Blaming leaders in America and abroad for not doing enough to combat climate change, former United Nations Secretary-General Kofi Annan said continued failure to tackle the problem will result in worldwide hunger, social unrest and political turmoil.

“Without action at the global level to address climate change, we will see farmers across Africa – and in many other parts of the world including here in America – forced to leave their land,” the 2001 Nobel Peace Prize winner told a crowd of about 1,400 people at Stanford’s Memorial Auditorium on Thursday. “The result will be mass migration, growing food shortages, loss of social cohesion and even political instability.”

Citing numbers from the World Bank, Annan said rapidly rising food prices since 2010 have “pushed an additional 70 million people into extreme poverty.” He called a lack of food security for nearly 1 billion of the world’s population “an unconscionable moral failing” that is also a stumbling block to a strong international economy.

“It affects everything from the health of an unborn child to economic growth,” he said.

Annan’s talk, “Food Security Is a Global Challenge,” was delivered as part of a daylong conference on global underdevelopment sponsored by Stanford’s Freeman Spogli Institute for International Studies. The event drew the world’s leading experts in the field and featured panel discussions that explored the connections between global security and food supplies, health care and governance. Keynote speeches were delivered by Annan and Jeff Raikes, CEO of the Bill & Melinda Gates Foundation. Former Secretary of Defense Robert Gates also planned to deliver a talk to a private audience.

The conference marked the launch of FSI’s Center on Food Security and the Environment.

“With this facility, and the creative thinkers and inquisitive minds for which Stanford is famous, you are well-equipped to undertake research which advances our knowledge and helps to shape our response to the many global challenges we face,” Annan said. “And with the resources at your disposal, you also have the capacity to actively engage to influence policy, implement solutions and thus improve the lives of the most vulnerable people on the planet.”

Annan also lauded government initiatives such as America’s Feed the Future program that focus on alleviating global hunger. He recently met with Secretary of State Hillary Clinton, Secretary of Agriculture Tom Vilsack and Raj Shah, head of the U.S. Agency for International Development, to discuss ways to address food insecurity.

“If we pool our efforts and resources, we can finally break the back of this problem,” he said.

But he challenged wealthier nations to do more than pay lip service to the problem.

“We need to make sure that promises of extra support from richer countries are kept and involve fresh funds rather than the repackaging of existing financial commitments,” he said.

Annan, who is the chair of the Kofi Annan Foundation, the Africa Progress Panel, and the Alliance for a Green Revolution in Africa, said Africa represents both the greatest problem and the greatest promise when it comes to food security.

The continent is home to 60 percent of the world’s uncultivated arable land, but cannot produce enough food to feed its own people, he said. But if Africa can grow just half the world’s average yield of staple crops like wheat, corn and rice, it would end up with a food surplus.

Transforming Africa into one of the world’s biggest crop producers will take more than supporting farmers, he said. It entails sound environmental stewardship.

 “I hope this is an area where the Center on Food Security and the Environment can make a major contribution to finding solutions,” Annan said.

Without those solutions, the future is bleak.

In Sub-Saharan Africa, where global warming brings the threat of persistent drought, current crop production is expected to be cut in half by the end of the century and 8 percent of the region’s fertile land is expected to dry up.

“Those arguing, here and elsewhere, for urgent action and a focus on opportunities to green our economies still find themselves drowned out by those with short-term and vested interests,” Annan said. “This lack of long-term collective vision and leadership is inexcusable. It has global repercussions, and it will be those least responsible for climate change – the poorest and most vulnerable – that will pay the highest price.”

Annan's speech was sponsored by FSI, Stanford in Government and the Stanford University Speakers Bureau.

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Former U.N. Secretary-General Kofi Annan delivers a keynote address on food security and climate change during FSI's global underdevelopment conference on Nov. 10, 2011.
Ben Chrisman
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Despite an increase in food production and incomes worldwide, one in seven of the world’s 7 billion people is hungry.

Upheavals in food prices and the global economy, combined with a growing population’s demands for food and energy, are widening the gap between rich and poor. And that rift is creating new challenges to feed the hungry – most of whom live in remote, rural areas – without depleting the planet’s natural resources.

Stanford’s Center on Food Security and the Environment (FSE) is dedicated to addressing these challenges. Started as a research program in 2006, FSE is celebrating its launch today as a full-scale research center. The celebration is part of a larger conference hosted by the Freeman Spogli Institute for International Studies (FSI) focused on links between international security, food and health care. The institutional elevation signifies the growing importance of food security issues at Stanford and worldwide. And it positions FSE to become the leading academic institution in the field of food security.

“Food security has quickly risen as a critical global issue comparable to international security, global health, and democratization, and will remain a pressing issue in the years head,” said Rosamond L. Naylor, director of FSE. “We’re looking at how to raise people out of poverty so they can afford more food, how to stabilize prices so food isn’t too expensive, and how to grow more food without destroying the environment.”

In an introduction given at FSE’s Global Food Policy and Food Security Symposium Series last winter, Stanford President John Hennessy remarked, “Stanford was founded on the idea that its teaching and research could have a broader impact on society, and the area of food security certainly has that kind of possibility.”

“Our work on hunger, rural poverty, and the environmental impact of food production is critical not only to the future of our lives here in the United States but to the lives of people around the world,” said Hennessey. “We will need to bring together teams of experts from different disciplines if we are going to make important contributions to this work.”

FSE’s dual affiliation with the Freeman Spogli Institute for International Studies and the Woods Institute for the Environment supports these collaborations, and is a key factor to the center’s expansion. The center is led by Naylor and its deputy director, Walter P. Falcon. Both share a long history at Stanford studying international agricultural economics.

Naylor received her PhD from Stanford’s Food Research Institute in 1989, and is now a professor in the department of Environmental Earth System Science. Her interdisciplinary approach to teaching has resulted in popular courses such as the World Food Economy (which she co-teaches with Falcon,) and Human Society and Environmental Change. Naylor was appointed the William Wrigley Senior Fellowship in 2008 in recognition of her multidisciplinary, cutting-edge research and long-term commitment to combating global hunger and environmental degradation.

Falcon, the Helen Farnsworth Professor of Agricultural Policy, Emeritus, served as the director of Stanford’s Food Research Institute from 1972 to 1991. Falcon’s leadership role continued as FSI’s director from 1991 to 1998. Between 1998 and 2007, he co-directed the Center for Environmental Science and Policy out of which grew the Program on Food Security and the Environment.

FSE is now engaged in over 15 major projects with $11.5 million in grant and program funding under management. Productive food systems and their environmental consequences comprise the core of the Center’s research portfolio.

“Roz Naylor and Wally Falcon have worked tirelessly to promote the center’s mission and to secure the funding needed to support the center’s growth,” said FSI Director Coit D. Blacker. “It is gratifying to see FSE’s research and scholarly agendas receiving a resounding vote of confidence from the University as well as some of the world’s leading foundations, agencies and individual donors.” 

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President of women's farming group in Dunkassa, Benin shares carrots from her garden grown with the help of a solar-powered irrigation system.
Jennifer Burney
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473 Via Ortega
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George and Setsuko Ishiyama Provostial Professor
Senior Fellow, Stanford Woods Institute for the Environment
FSE Affiliated Faculty
Screen_shot_2011-10-21_at_12.14.24_PM.png MS, PhD

Dr. Lambin's research is in the area of human-environment interactions in land systems. He develops integrated approaches to study land use change by linking remote sensing and socio-economic data. This includes research to better detect subtle land changes based on time series of Earth observation satellites at multiple scales. He aims at better modeling causes and impacts of deforestation, dryland degradation, agricultural intensification, and conflicts between wildlife and agriculture around natural reserves. He also studies responses by rural communities to environmental changes. He focuses on land use transitions - i.e., the shift from deforestation (or land degradation) to reforestation (or land sparing for nature) that is taking place in some forest countries or drylands. This research identifies the conditions for a sustainable land use by rural communities. He also conducts projects on the impact of land change on vector-borne disease, through integrated analyzes of interactions between people, vectors, animal hosts and land. His research is mostly focused on tropical regions.

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Policies promoting ethanol and biodiesel production and use in the U.S., Europe, and other parts of the world since the mid-2000s have had profound—and largely unintended—consequences on global food prices, agricultural land values, land acquisition, and food security in developing countries. They have also created regional opportunities in the form of agricultural investments, crop yield growth, and booming farm economies. Rising incomes in emerging economies are generating increased demand for transportation fuels, thus stimulating further growth of the global biofuel industry. This seminar will explore the politics, economics, and global food security implications of the expanding biofuel sector. Several policy questions will be raised, including the role of biofuel mandates on food prices, the role of trade policies for stabilizing food prices in an era of increasingly tight demand, and the role of land policies and institutions for feedstock production and income distribution in the developing world.

Siwa Msangi, Senior Research Fellow in the Environment and Production Technology Division at the International Food Policy Research Institute (IFPRI) will provide commentary. Msangi's work focuses on the major socio-economic and bio-physical drivers affecting agricultural production and trade, and their impacts on nutrition, poverty and the environment. Dr. Msangi manages a research portfolio that includes the economic and environmental implications of biofuels, and has coordinated the project Biofuels and the Poor in partnership with FSE.  

Biofuels videos: Roz Naylor talks food security and energy with Near Zero

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Stanford University
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Senior Fellow, Stanford Woods Institute and Freeman Spogli Institute for International Studies
William Wrigley Professor of Earth System Science
Senior Fellow and Founding Director, Center on Food Security and the Environment
Roz_low_res_9_11_cropped.jpg PhD

Rosamond Naylor is the William Wrigley Professor in Earth System Science, a Senior Fellow at Stanford Woods Institute and the Freeman Spogli Institute for International Studies, the founding Director at the Center on Food Security and the Environment, and Professor of Economics (by courtesy) at Stanford University. She received her B.A. in Economics and Environmental Studies from the University of Colorado, her M.Sc. in Economics from the London School of Economics, and her Ph.D. in applied economics from Stanford University. Her research focuses on policies and practices to improve global food security and protect the environment on land and at sea. She works with her students in many locations around the world. She has been involved in many field-level research projects around the world and has published widely on issues related to intensive crop production, aquaculture and livestock systems, biofuels, climate change, food price volatility, and food policy analysis. In addition to her many peer-reviewed papers, Naylor has published two books on her work: The Evolving Sphere of Food Security (Naylor, ed., 2014), and The Tropical Oil Crops Revolution: Food, Farmers, Fuels, and Forests (Byerlee, Falcon, and Naylor, 2017).

She is a Fellow of the Ecological Society of America, a Pew Marine Fellow, a Leopold Leadership Fellow, a Fellow of the Beijer Institute for Ecological Economics, a member of Sigma Xi, and the co-Chair of the Blue Food Assessment. Naylor serves as the President of the Board of Directors for Aspen Global Change Institute, is a member of the Scientific Advisory Committee for Oceana and is a member of the Forest Advisory Panel for Cargill. At Stanford, Naylor teaches courses on the World Food Economy, Human-Environment Interactions, and Food and Security. 

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Rosamond L. Naylor Speaker
Siwa Msangi Senior Research Fellow Commentator International Food Policy Research Institute
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Pinstrup-Andersen, H.E. Babcock Professor of Food, Nutrition and Public Policy and J. Thomas Clark Professor of Entrepreneurship at Cornell University will talk about new evidence on the linkages among agriculture, nutrition, and health, with a special emphasis on sub-Saharan Africa. Currently lost in debate—growing more food does not necessarily lead to better nutrition or health unless other things are put in place. Pinstrup-Aandersen is a world-renowned specialist on undernutrition, health, poverty, and food, and in 2001 was named World Food Prize Laureate.

Eran Bendavid, Assistant Professor of Medicine (infectious diseases) and CHP/PCOR Associate, will provide additional commentary. Bendavid was trained at Harvard Medical School, and is currently a FSE collaborator on a rural health and development project that examines the links between food production, health, water and nutrition in sub-Saharan Africa.

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Per Pinstrup-Andersen H.E. Babcock Professor of Food, Nutrition and Public Policy, J. Thomas Clark Professor of Entrepreneurship Speaker Cornell University

Encina Commons, Room 102,
615 Crothers Way,
Stanford, CA 94305-6019

(650) 723-0984 (650) 723-1919
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Professor, Medicine
Professor, Health Policy
Senior Fellow, by courtesy, Freeman Spogli Institute for International Studies
Senior Fellow, Woods Institute for the Environment
eran_bendavid MD, MS

My academic focus is on global health, health policy, infectious diseases, environmental changes, and population health. Our research primarily addresses how health policies and environmental changes affect health outcomes worldwide, with a special emphasis on population living in impoverished conditions.

Our recent publications in journals like Nature, Lancet, and JAMA Pediatrics include studies on the impact of tropical cyclones on population health and the dynamics of SARS-CoV-2 infectivity in children. These works are part of my broader effort to understand the health consequences of environmental and policy changes.

Collaborating with trainees and leading academics in global health, our group's research interests also involve analyzing the relationship between health aid policies and their effects on child health and family planning in sub-Saharan Africa. My research typically aims to inform policy decisions and deepen the understanding of complex health dynamics.

Current projects focus on the health and social effects of pollution and natural hazards, as well as the extended implications of war on health, particularly among children and women.

Specific projects we have ongoing include:

  • What do global warming and demographic shifts imply for the population exposure to extreme heat and extreme cold events?

  • What are the implications of tropical cyclones (hurricanes) on delivery of basic health services such as vaccinations in low-income contexts?

  • What effect do malaria control programs have on child mortality?

  • What is the evidence that foreign aid for health is good diplomacy?

  • How can we compare health inequalities across countries? Is health in the U.S. uniquely unequal? 

     

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Eran Bendavid Commentator
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More than two-thirds of the population in Africa must leave their home to fetch water for drinking and domestic use. It is estimated that some 40 billion hours of labor each year are spent hauling water, a responsibility often borne by women and children. Cutting the walking time to a water source by just 15 minutes can reduce under-five mortality of children by 11 percent, and slash the prevalence of nutrition-depleting diarrhea by 41 percent.

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This paper was prepared for Stanford University’s Global Food Policy and Food Security Symposium Series, hosted by the Center on Food Security and the Environment, and supported by the Bill and Melinda Gates Foundation.


Sub-Saharan Africa (SSA) is home to two-thirds of the world’s ultra-poor today. This paper offers current thinking on the structural causes of the spatially concentrated, persistent ultra-poverty that has plagued Africa for a generation and some key entry points for facilitating Africans’ escape from persistent ultra-poverty.

The increased recognition of persistent ultra-poverty has rekindled long-dormant interest in poverty traps. The essence of a poverty trap is that there exists one or more low equilibrium level(s) of well-being in which people appear caught unnecessarily. Small adjustments fail to move people out of those equilibria sustainably. Rather, systems must change, major positive shocks must occur, or both. And in the absence of systemic change, recurring adverse shocks only drive more people into the trap.

The ultra-poverty trap that characterizes much of rural SSA today is intimately caught up with (i) the bidirectional interrelationship among hunger, ill-health, low productivity, weak institutions and natural resources degradation, all of which become manifest in low incomes, (ii) poor initial conditions associated with health and nutrition, especially early in childhood, but also with the state of infrastructure and the natural resource base on which rural livelihood disproportionately depend, and (iii) uninsured risk exposure, which is especially severe in rural areas and in agriculture. The closely coupled nature of these problems adds substantially to the challenge of addressing any one of them on its own and thereby makes integrated strategies essential. 

The available theory and evidence suggests that the policy focus must fall squarely on stimulating a smallholder food productivity revolution. Toward that end, the paper concludes by identifying and explaining key entry points for assisting the escape from persistent ultra-poverty in sub-Saharan Africa.

  1. Build and protect the productive asset endowments of the ultra-poor
  2. Improve the productivity of the ultra-poor’s current asset holdings
  3. Improve risk management options for the ultra-poor
  4. Facilitate favorable transitions out of agriculture

Although the topic of persistent ultra-poverty would seem to lend itself to a pessimistic ending, the future for Africa is actually rather hopeful. The East Asian experience demonstrates that mass, rapid escape from persistent ultra-poverty is feasible. Real agricultural output growth rates are accelerating in SSA, nearly doubling from the 1980s rate so that per capita food output is growing again, helping reduce rural poverty rates in countries enjoying increased agricultural productivity. Finally, the  policymaking and donor communities are now appropriately focusing on how best to stimulate investment incentives, productivity growth, risk management and productive transitions out of agriculture. These broad foci are appropriate and reasonably well-grounded in both theory and empirical evidence.  

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The challenges of reducing global hunger and poverty are different today than they were 30 years ago. Current challenges include price volatility associated with increased integration of food, energy, and finance markets; the steady progression of climate change; poorly defined land institutions; and a failure to break vicious cycles of malnutrition and infectious disease. Farmland speculation is occurring globally—often at odds with rural poverty alleviation—and food insecurity remains a pressing issue with the estimated number of chronically malnourished people hovering around one billion. Given these patterns, food and agriculture are becoming increasingly ingrained in international security and policy discussions. This paper explores several ways in which the traditional field of agricultural development needs to expand to address the broader issues of international security and human welfare. It focuses on five key interrelated issues: the macroeconomic and energy contexts of agricultural development; climate change; deforestation, land access, and land markets; farming systems and technology for the ultra-poor; and food-health linkages with a specific focus on infectious disease. Recommendations for investments in capacity building, revised curricula, and development projects are made on the basis of evidence presented for each issue. It is clear that academic programs, government agencies, development and aid organizations, and foundations need to dismantle the walls between disciplinary and programmatic fields, and to find new, innovative ways to reach real-world solutions.

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Food Security
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Rosamond L. Naylor
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Food and agricultural policy experts Prabhu Pingali and Philip Pardey will each speak on trends in productivity and investments in technology, survey of constraints to productivity, incentives and investment, and opportunities to raise productivity.

The Green Revolution - past successes, unfinished business, and the way forward

Pingali will review strategic components of the Green Revolution and its achievement and limits in terms of agricultural productivity improvement and broader impact at social, environmental and economic levels, including its impact on food and nutrition security. Lessons learned and the strategic insights these provide will be reviewed as the world is preparing a "redux" version of the Green Revolution with more integrative environmental and social impact combined with agricultural and economic development. Pingali will also point to core research & policy gaps that can enhance further spread and sustainable adoption of productivity enhancing technologies.

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Prabhu Pingali is the Deputy Director of Agricultural Development at the Bill and Melinda Gates Foundation. Formerly, he served as Director of the Agricultural and Development Economics Division of the Food and Agriculture Organization (FAO) of the United Nations. Pingali was elected to the U.S. National Academy of Sciences as a Foreign Associate in May 2007, and he was elected Fellow of the American Agricultural Economics Association in 2006. Pingali was the President of the International Association of Agricultural Economists (IAAE) from 2003-06. Pingali has over twenty five years of experience in assessing the extent and impact of technical change in agriculture in developing countries, including Asia, Africa and Latin America.

 African Agricultural R&D and Productiivity Growth in a Global Setting

Given the continuing importance of agriculture in most African economies, an in-depth understanding of the past and likely future productivity performance of African agriculture is key to assessing the overall economic growth and development prospects of the region. African agriculture operates in increasingly interconnected global commodity markets, so the relative productivity performance of African vis-à-vis rest-of-world agriculture is also relevant. This talk will present new evidence on African agricultural productivity performance and place that evidence in relation to the evolving pattern of agricultural productivity growth worldwide. Technological change is a principal driver of productivity growth, and new, updated evidence on the trends in R&D investments that give rise to these technological changes will also be presented and discussed. The productivity effects of R&D play out over comparatively long periods of time demanding a long-run look at these developments.    
 

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Philip Pardey is Professor of Science and Technology Policy in the Department of Applied Economics, and Director of the University of Minnesota's International Science and Technology Practice and Policy (InSTePP) center. His research deals with the finance and conduct of R&D globally, methods for assessing the economic impacts of research, and the economic and policy (especially intellectual property) aspects of genetic resources and the biosciences. He is a Fellow of the American Agricultural Economics Association and a Distinguished Fellow of the Australian Agricultural and Resource Economics Society.

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Prabhu Pingali Deputy director, Agricultural Development Speaker Bill & Melinda Gates Foundation
Philip Pardey Professor of Science and Technology, Applied Economics Speaker University of Minnesota
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