A Philosophical Point
Food plays important social, cultural and economic roles in every society; but always it remains the (usually sole) source of nutrients. Therefore, nutritional status and, to a great extent, health, depend on access to, quality of and diversity in food supplies. Perhaps it is the very personal nature of food use that allows these issues often to be overlooked amid efforts to enhance economies, alleviate poverty and improve public health; but, in fact, these are the very issues that connect food to health outcomes. The alleviation of diseases related to uneven food access and/or improper nutrient balance, whether they be the deficiencies of poor countries or the excesses of affluent countries, will require a new way of thinking about agriculture: as an instrument for improving human health.
Food Systems: a Useful Concept
Health and well-being, thus, depend on access to sustenance provided by the many activities concerned with the production, processing, acquisition and utilization of foods. The interrelationships and interdependencies among these various activities become apparent when they are considered against the larger scope, that of the Food System. Sobal et al (1) have offered a useful conceptual Food System model that is similar in many ways to one developed informally at an international workshop(2). This model includes sub-systems of highly interrelated activities occurring within a variety of contexts, implying, therefore, that food systems vary across the world.
It is clear that the world's food systems have evolved with little explicit
attention to the balance and quality of their nutrient outputs or to their
overall abilities to support good health. The persistence and extent of
malnutrition (affecting some 40% of the world's people, particularly the
poor in developing nations) attests to that. Many of these problems involve
diets that provide insufficient amounts of vitamins and minerals. For the
first time in many countries, these problems of under-nutrition are increasingly
seen along side of problems of over-nutrition, traditionally the province
of the industrialized countries. These diet-related problems persist in
a world that, thanks to the CGIAR-led advances in crop production, now appears
to produce enough total food to meet its current energy and protein needs.
Falling Behind Current Knowledge
Efforts to alleviate malnutrition in the developing countries have been targeted on increasing supplies of macronutrients (in particular, energy and protein) and a few micronutrients (vitamin A, iron and iodine) because deficiencies of these nutrients have been or are reponsible for the ill-health of millions of people, a fact that has been well documented. That not withstanding, it is true that millions of people in poor countries are also malnourished with respect to other vitamins (riboflavin, folate, vitamin B12) and minerals (selenium, calcium, copper and probably chromium and boron). While few program have addressed these latter deficiencies, none have undertaken to implement in poor countries recent findings of great public health relevance: the cancer-preventive effect of selenium; the heart-protective effects of folate, vitamin E and perhaps copper; and the antidiabetic effect of chromium; the reduction of bone loss by boron. Somehow, contemporary nutrition knowledge is not being translated into programs in the developing world.
Need for a New Approach
The persistence of diet-related health problems is clear evidence that the traditional approaches to dealing with them have had limited success. This raises the serious question of how to alleviate these types of problems while increasing food production in general to meet the growing food demands of the expanding global population.
Failures of food systems consistently to support good health can be attributed, in part, to their many complexities and interactions that ultimately affect nutrition and health outcomes; however, the constituent elements of food systems have generally been addressed only in isolation rather than as parts of integrated systems. This can be seen in the scientific support base for these activities, which has been constructed largely along disciplinary lines: research, training and outreach activities relating to food systems have been developed and deployed in separate and poorly interacting programs. Developing sustainable solutions to diet-related health problems (in both the industrialized and developing world) may be beyond the capabilities of individual disciplines or sectors, as these problems would appear to be best addressed using approaches that consider all relevant causal variables and conceive of objectives in multi-disciplinary terms.
This task calls for trans-disciplinary and trans-sectoral efforts that address food systems in holistic ways, i.e., from the production, acquisition and utilization of foods to the bio-physical, economic, social, public health and policy environments in which those activities are carried out. This means that human health and well-being must be viewed as explicit outcomes of food systems. While, historically, agricultural success has been measured in terms of yields and costs, food systems approaches would also include measures of impacts on human nutritional status and health, as well as environmental, economic and social sustainability. They would do this by setting among the explicit objectives of an agricultural system that of producing healthy people and, to that end, that of producing foods of sufficient quality and quantify to support human health and well being. Such a view would constitute a new paradigm, expanding the tradition view of agriculture to include the promotion of human health and expanding the understanding to sustainability to include social as well as environmental and economic dimensions.
Implications to the CGIAR
The improvement of diets (and, thus, health) is implicit to any effort to increase food production and/or decrease food production costs. This is true regardless of whether agriculture is thought of as primarily an economic engine that can improve food access, or as a means of producing better nutrient availability and balance. If that is, indeed, the case for the CGIAR, then the relavent question is not whether the CGIAR should undertake the improvement of human nutrition as part of its agenda but, rather, whether it should make that goal explicit. In other words, should the CGIAR adopt what I have called the "new paradigm" for agriculture?
It seems clear that the answer should be "yes". First, when made an institutional value of the CGIAR, it is possible that this new paradigm could facilitate more effective trans-disciplinary research, outreach and instructional approaches to the complex and costly diet-related health problems of society while also making agriculture a consumer issue. Who is better positioned than the CGIAR, with its resident multi-disciplinary expertise and existing/potential network of collaborating researchers in various NARS and research universities, to lead such an effort productively?
Making the new paradigm an institutional value would not mean creating a new program; instead, it would mean using that paradigm to re-think and to link existing programs. It would mean that CGIAR efforts would need to go beyond those that would target mainly crop yields and production costs, to link those outcomes with consumer accessibility and nutrient content and bioavailability. Such food systems-based approaches would not be focused only on major crops; instead, they would consider cropping systems (including livestock) and their abilities to support balanced human nutrition in sustainable ways. The core strategies for doing this were laid out by an international expert consensus conference in 1995 and include items already on the CGIAR agenda:
Implementing the new paradigm would probably call for the CGIAR to expand and make better use of its network of colleagues in the various disciplines of the social and biological sciences. This could be achieved in various ways including regular colloquia and formal linkages with key institutions. The time is right to develop such stronger networks, as consumer demand in many parts of the world will call for this new paradigm. This will be particularly true for centers of in agriculture and related expertise in industrialized countries, which will need to re-invent themselves in order to move from the shrinking political base of producer-centered agriculture to the growing one of the health and environmentally concerned consumer.
Final Observation
The responsibility to implement the new paradigm for agricultural research may fall to the CGIAR by virtue of its unique international leadership role. In fact, if the global goal is to find ways to make the food systems of the world provide the nutrient needs of healthy human populations, then it is a highly relevant question to ask "if not the CGIAR, then who will do this?"
Diet-Related Health Problems in the Developing World
| problem | links to diet* | people affected | impacts |
| insufficient food | calories, protein and all other nutrients | at least 840 million | lost work productivity, impaired physical and cognitive development; excess morbidity and mortality; social unrest |
low birth weight (<2 kg) |
insufficient bio-available Zn, Fe | 35% of children 0-5 yrs. | impaired physical development; excess morbidity and mortality |
| vitamin A deficiency | insufficient pro-vitamin A-rich foods | 250 million (14 M with xerophthalmia) | impaired cognitive development; excess morbidity and mortality |
| anemia | insufficient bio-available Fe | 2.1 billion (including 42% of all women) | lost work productivity; impaired cognitive development; excess morbidity |
| Goiter | Insufficient I and/or Se | 200 million cases (1.6 billion at risk) | Lost work productivity; excess stillbirths, abortions and infant deaths |
| Cretinism | Insufficient I and/or Se | 6 million births/yr | Severe neurological impairment |
| Cardiomyopathy | Insufficient Se | 400 million at risk | Lost work productivity; excess morbidity and mortality |
*Other deficiencies, notably those of energy, protein, calcium and at least some vitamins (e.g., vitamins A and C, riboflavin), also contribute to many of these and other less widespread problems of malnutrition.
1. Sobal, J., L. K. Khan, and C. Bisogni. 1998. A Conceptual Model of the Food and Nutrition System, Social Sciences and Medicine 47:853-863.
2.Combs, G.F., Jr., R.M. Welch, J.M. Duxbury, N.T. Uphoff and M.C. Nesheim (eds.). 1996. Food-Based Approaches to Preventing Micronutrient Malnutrition: an International Research Agenda, Cornell International Inst. Food Agric. Devel., 68 pp.