1. Interconnections between food production, nutrition and health in conditions of rural poverty Mike Joffe Imperial College London

2. dietary intake nutritional and health status household income

3. labour productivity nutritional and health status household income

4. labour productivity dietary intake nutritional and health status household income

5. labour productivity dietary intake nutritional and health status agricultural livelihoods land access healthcare services clean water, sanitation, pesticides, etc women’s time, education, power food availability soil fertility & climate non-agricultural livelihoods (jobs) household income pathogens

6. Poverty as a self-perpetuating cycle the cycle is intended to correspond with households’ lived experience different households will differ in its applicability and its content the outcome “variable” is perpetuation of the cycle the central concept is reserve capacity when this reaches zero, cycle interruption occurs food insecurity: variability in reserve capacity the cycle’s causal processes occur over time attention is needed to generalisability of: overall structure, component variables & links, parameter estimates – and, reasons for the latters’ variation between households and between locations

7. dietary intake nutritional and health status primary prevention impregnated bed nets protective measures against aflatoxins, chemicals, etc non-polluting fuels micronutrient-dense crops education re consumption improved infant feeding irrigation improved crops agricultural tools chemical inputs landmine clearance healthcare immunization maternity care TB treatment ART for HIV household income labour productivity

9. Thank you!

10. Poverty as a self-perpetuating cycle the cycle shows the main interrelations: BREADTH of poverty outcome “variable” is perpetuation of the cycle the central concept is reserve capacity, corresponding to SEVERITY/DEPTH of poverty when this reaches zero, cycle interruption occurs cf. food insecurity: variability in reserve capacity the cycle’s causal processes occur over time – this has implications for DURATION of poverty – it requires longitudinal assessment the cycle corresponds to households’ lived experience attention is needed to generalisability of: overall structure, component variables & links, parameter estimates – and, reasons for the latters’ variation “deterministic” links include: dietary intake & anthropometry; bed nets & malaria probabilistic links include the risk of child & adult mortality representative population; theoretical sampling

11. low dietary intake poor health status poor dietary status macronutrient deficiency micronutrient deficiency low functional health status low birth weight risk of infant/child death impaired neurodevelopment poor childhood growth low energy/strength risk of (adult) death impaired immune function diseases infections TB measles malaria HIV pneumonia diarrhea etc anemia

12. low socio- economic position fuel poverty indoor air pollution housing quality healthcare availability low level of education polluting fuels poor health status poor hygiene practices low income water sewage disposal social hierarchy lack of wellbeing other amenities poor labor conditions zoonoses e.g. bird ‘flu pesticides injury