1. Agri-Food, Nutrition and Health: Capturing the Synergies Dr. Ballayram Food Economist Caribbean Food and Nutrition Institute/ Pan American Health Organization CARIBBEAN WEEK OF AGRICULTURE October 17-23, 2010 Grenada

2. Objectives To articulate the importance of the Agri-Food- Nutrition-Health Link To identify synergies in a multi-sectoral approach to food, nutrition & health Focus on Key actions on how to advance the agri- food-health agenda

3. A fundamental set of questions:  What is the aim of:  increasing agricultural investments and productivity?  agricultural and rural development?  Developing agro-processing?  Etc, etc…..? A Plausible Answer:  Ultimately the aim is to improve the material well-being of the population  We can do this many ways—increase income, employment...  We can do it also by good nutrition and health—w/o conflicting other aims

4. Agri-Food-Health Link Acknowledged at Highest Policy Levels  1996 Bahamas Declaration of the region’s Ministers of Agriculture  2006 Caribbean Commission on Health and Development  2007 Heads of Government Declaration of Port of Spain  2007 St Ann’s Declaration of Caribbean Ministers of Agriculture at Runaway Bay, Jamaica  2009 Heads of Government “Liliendaal Declaration”  These Declarations all aim at addressing the region’s main food and nutrition problems of obesity, NCDs and micronutrient deficiencies, and mandated an integrated, multi-sector approach for the achievement of food and nutrition security—with key role assigned to agriculture

5. DETERMINANTS OF NUTRITION & PATHWAYS LINKING AGRICULTURE AND NUTRITION FOOD AVAILABILITY & SAFETY FOOD ACCESSIBILITY FOOD CONSUMPTION NUTRITIONAL & HEALTH STATUS Local Production Imports SES Income Price Distribution Food Preparation Age, Gender Nutrition Education Disease Status Genetics Physical Activity Health Policy Urban Development Transportation Globalization Poverty Agri/Food Policy Incentives/ Investments

6. WHAT IS THE PROBLEM ?

7. The shape of things to come The Economist, Dec. 2003

8. 1950 0 19701990 50 25- 10 - % of Total death s Chronic Diseases Infectious Diseases/ Undernutrition  Epidemiological transition in the Caribbean  Linked to Nutrition transition  Part of the development/modernization process

9. Main Causes of Death in the Caribbean 1980 (%) 1.Heart Disease* - 20 2.Cancer * - 12 3.Stroke* - 11 4.Injuries - 8 5.Hypertension* - 6 6.ARI- 5 7.Diabetes*- 4 *Food/Nut related = 53% 2000 (%) 1.Heart Disease * - 16 2.Cancer * - 15 3.Stroke * - 10 4.Diabetes * - 10 5.Injuries- 7 6.HIV/AIDS- 6 7.Hypertension * - 6 *Food/Nut Related = 57%

10. Cost of Nutrition-Related diseases  NCDs are twice as costly to treat compared to other diseases  Direct cost of treating everyone with diabetes and hypertension in the region:  US$691 million/annually (2% of GDP or 66% of current expenditures on Public Health)  Cost of diabetes and hypertension attributable to obesity is US$ 336 million annually (1 % of GDP or 32% of current expenditures on Public Health)

11. Cost of Nutrition-Related diseases (con’d)  If nothing is done the developed countries nutrition/health experience could be a good proxy of where we will end up  In the USA:  half of the citizens suffer from one or more chronic disease  75 cents of every dollar spent on health care is on NCDs  80% of costs major public health programs is on NCDs  for the 7 most common chronic diseases, 80 percent of expenditures are for indirect cost while 20 percent is for direct cost

12. What is our Goal for Consumption of Foods in the Caribbean? Deficits: (1) Staples (8%); (2) legumes (4%); (3) Vegetables (6%); Excess: (1) Food from animals (5%); (2) Fats/oils (4%); (3) Sugar (9%) QUESTION: HOW DO WE MOVE FROM CURRENT TO GOAL? Where we are NOW Where we want to GO

13. HOW CAN WE EAT HEALTHY FOODS WHEN……….. Our domestic agriculture policy lacks adequate incentives for the production of indigenous staples, fruits and vegetables? Our food import encourages the consumption of high energy dense, processed foods? Many schools canteens and vendors promote high energy dense foods with little nutrient value? Our local and cable networks heavily advertize fast foods, especially on children’s programs?

14. CAPTURING SYNERGIES IN THE AGRI-FOOD-NUTRITION-HEALTH LINK

15. Food Trade Crisis mitigation Import substitution Dietary Guidelines to combat obesity/NCDs School Feeding Linkages Among Food Security - Related Policies

16. MULTI-SECTORAL APPROACH TO AGRI-FOOD-HEALTH PUBLIC SECTOR PRIVATE SECTOR NUTRITION/HEALTH FOOD RELATED AGENCIES AGRI EDU TRADE FIN OTHERS MANUFACTURERS PROCESSORS FOOD ESTABLISHMENTS FARMERS DISTRIBUTORS FAO IICA CARDI CTA UWI CARICOM

17. Multi-Sector Approach & Policy Coordination Agri Food/Nutrition Health Agri/Trade Health Education Social Welfare Food Industry/ distribution Stakeholders

18. CONCLUSIONS  Agri’s role transends food availability only…can be leveraged to enhance nutrition and health  At the policy level there is the urgent task to establish NUTRITION/HEALTH-oriented food policies—national/regional levels  Establish and promote national food and nutritional goals for agriculture and the food systems to deliver adequate and nutritionally appropriate quantities of food  This would require:  Multi-sectoral approach/collaboration to addressing the region’s main public health problems;  Fully-funded Food/Nutrition/Health promotion campaign  Support to facilitate the passage through to Cabinets, of National Plans of Action for Food and Nutrition Security (NPANS)