1. Agriculture and malnutrition
Will Masters
Friedman School of Nutrition Science & Policy
and Department of Economics, Tufts University
Based on D. Headey and W.A. Masters, “Agriculture and malnutrition”, ch. 9 in Agricultural Development: New Perspectives in a Changing World, edited by K. Otsuka and S. Fan, forthcoming from Oxford University Press.
Research funded by UKAid through the UK Department for International Development and the Bill & Melinda Gates Foundation, via the ARENA and CANDASA projects.
ICAE 2018 session on Positioning Agriculture for the SDGs
Vancouver, BC – August 1st 2018

2. What’s ahead Foundations Data Opportunities
Malnutrition is a disease of early infancy, not a consumption choice
Causal framework starts with livelihoods and income, then prices
Technological and institutional changes cause structural shifts
Data
Stunting and farm employment
Food prices and markets
Opportunities
Agriculture, nutrition and markets

3. Malnutrition begins early, not a consumption choice
Stunting, wasting and anemia prevalence in 44 countries, 0-60 months of age
Early onset of stunting is well known, but note how anemia and wasting
both decline after 12 mo.
Anemia
Stunting
Wasting
Source: Authors’ estimates from DHS data for 44 countries, with samples sizes of 296,370 (stunting), 284,784 (wasting), and 139,356 (anemia). Estimates are based on local polynomial smoothing using the LPOLY command in Stata 14.

4. Better nutrition requires more and different foods
Source: Choudhury, Headey & Masters (2018), from DHS data (47 surveys in 39 countries, , total sample size = 67,241)
Child age (in months)
Number of food groups (out of 12) fed in previous day, 0-24 months of age
Richest 20%
Middle quintile
Poorest 20%
Even in the richest hhlds, infants reached four groups only after 12 mo.
Infants in most surveyed households did not reach
four groups by 24 mo.
WHO threshold
is 4 food groups after 6 mo. of age
Child age (months)

5. Better nutrition requires more and different foods
Source: W.A. Masters, “Rural transformation and nutrition transition: Same pathways, different speeds?" PIM workshop on Rural Transformation in the 21st Century, International Conference of Agricultural Economists, 28 July Data are from FAO Food Balance Sheets, downloaded 14 July Europe includes all of the former Soviet Union.

6. So how do health researchers see agriculture-nutrition linkages?
Causality runs in all directions, and many omitted variables
Need RCTs or natural experiments to identify effect sizes
A causal pathways diagram
The UNICEF framework
The social-ecological model
A system dynamics model

7. And how do economists see agriculture-nutrition linkages?
Causality runs in all directions, and many omitted variables
Need RCTs or natural experiments to identify effect sizes
but we can draw on a long literature of structural modeling
about agricultural production, food markets, and consumer behavior
An individual household
(here, a “net seller” of nutritious food)
A community of farm households
(here, they “export” nutritious food)
Qty. of the farm household’s other goods
(kg/yr)
Nutrition:
Diets & behavior
Price of nutritious foods
(pesos/kg)
Agriculture: natural resources and technology
Consumption
Supply
curve
Indifference curve
Production
Price in trade
Production
Consumption
Markets & policy:
Interactions between people
Agriculture: natural resources
and technology
Markets & policy:
Interactions between people
Demand curve
Production possibilities frontier
Nutrition:
Diets & behavior
Price in trade
Qty. of farm household’s nutritious foods (kg/yr)
Qty. of the region’s nutritious foods (tons/yr)

8. Agriculture-nutrition linkages as described in words for the Otsuka-Fan book chapter
Linkages from agriculture to nutrition and health outcomes
1. Real income 
Farm profits
Nonfarm earnings
2. Relative prices
Relative prices and availability of food
Price stability over time (seasonality and periodic spikes)
Price disparities in space (isolation and market access)
3. Living conditions
Time use of parents and children
Exposure to pathogens and physical risks
Empowerment of women and children
Access to nutrition-relevant goods and services

9. Income, prices and living conditions all play key roles in child stunting
In Africa, there are clear
farm-to-nonfarm and
rural-to-urban gradients
In S. Asia, all rural workers and also urban manual workers have high stunting rates
no malnutrition= 2.5%
Permanent income,
as measured by real assets
Same asset list
Source: Data shown are from Demographic and Health Surveys. Rural/urban classifications follow the DHS (national) definitions, except that all farming households are classified as rural. Circle sizes reflect the size of the sample of children in each locality-occupation class. Ideally this should measure should use sample weights, since the DHS over-samples urban areas, but since many surveys are several years old we do not apply weights in order to allow for recent urbanization trends. The 6 assets in question are a TV, motorbike, car, refrigerator, electrification, and an improved floor material. The four countries in South Asia are India, Pakistan, Bangladesh and Nepal.

10. Slides for PIM workshop at ICAE
Countries and regions differ greatly in their demographic circumstances
Number of people (billions)
China's rural population stopped growing in
the early 1990s
India's rural population
will stop growing
in the 2020s
Africa's rural population will keep growing through the 2050s
2018
Data shown are author’s calculations from UN World Urbanization Prospects, 2014 Revision, from

11. African countries have more workers in agriculture
at each level of national income
Ag’s share of the workforce
has remained much higher
in Africa than elsewhere
and did not shift down
from 1991 to 2010
Reprinted from W.A. Masters, N.Z. Rosenblum and R.G. Alemu, Agricultural transformation, nutrition transition and food policy in Africa. Journal of Development Studies, 54(5):

12. African countries have more children who are stunted at each level of national income
Africa’s stunting rates are higher than others
at each level of real per-capita income
but all benefited from innovation in maternal & child health
since the 1990s
Reprinted from W.A. Masters, N.Z. Rosenblum and R.G. Alemu, Agricultural transformation, nutrition transition and food policy in Africa. Journal of Development Studies, 54(5):

13. Slides for PIM workshop at ICAE
Another approach to structural change is through Lorenz Curves
If harvested land area were distributed equally among all rural people, the Lorenz curve would be a diagonal line
Thinner, lighter curve is 1970
From 1970 to 2010, the global distribution of harvested land area per rural person became more unequal
Thicker, darker curve is 2010
at the top, among land-rich countries
India and China switched places in the global distribution of farmland/rural person
Source: W.A. Masters, W. Bell and K. Lividini, Inequities in global agriculture, dietary intake and health outcomes (working paper, forthcoming).

14. Slides for PIM workshop at ICAE
Diet quality (e.g. consumption of protein)
has become more equal
China rose from below to above the global median
This will be replaced by a figure from Keith so that all food visuals come from GENuS
Source: W.A. Masters, W. Bell and K. Lividini, Inequities in global agriculture, dietary intake and health outcomes (working paper, forthcoming).

15. Slides for PIM workshop at ICAE
Consumption of animal-sourced foods has become much more equal
African countries (in light green) are among those with the least access to animal-sourced foods
This will be replaced by a figure from Keith so that all food visuals come from GENuS
Source: W.A. Masters, W. Bell and K. Lividini, Inequities in global agriculture, dietary intake and health outcomes (working paper, forthcoming).

16. Slides for PIM workshop at ICAE
Consumption of vitamin A
has also become more equal, but only among higher-intake countries
But increased equality in vitamin A consumption has occurred only in vitamin-A rich countries
Countries with below-median consumption have had no increase in their share of global vitamin A
Keith
Source: W.A. Masters, W. Bell and K. Lividini, Inequities in global agriculture, dietary intake and health outcomes (working paper, forthcoming).

17. One barrier to nutrition convergence is that more nutritious foods may be more costly in poor countries
Source: Data are extracted from Headey, et al. (2017b). Red lines show LOWESS curves to allow for non-linear functional forms. Individual observations are marked by the following regional groupings: Sub-Saharan Africa (SSA), Latin America and Caribbean (LAC), South Asia and East Asia (ASIA), Middle East and North Africa (MENA), all other countries in Europe, North America, and Australasia (Other).

18. Price premiums for the most nutritious foods
are highest in the poorest countries
Source: Data are extracted from Headey, et al. (2017b). Red lines show LOWESS curves to allow for non-linear functional forms. Individual observations are marked by the following regional groupings: Sub-Saharan Africa (SSA), Latin America and Caribbean (LAC), South Asia and East Asia (ASIA), Middle East and North Africa (MENA), all other countries in Europe, North America, and Australasia (Other).

19. Price premiums for more nutritious foods
have more seasonality than the cost of energy
Monthly variation in cost of nutrient adequacy vs daily energy in Tanzania,
Blue bars are a least-cost diet for energy plus 17 nutrients
Orange bars are a least-cost diet for just daily energy
2011 US dollars per day
Note: Data shown are coefficient and 95% confidence interval on calendar month indicators, relative to May. Orange bars for cost of calorie adequacy (CoCA) not significantly different from zero.
Source: Bai, Naumova and Masters (2018), Seasonality in Food Prices and the Cost of a Nutritious Diet in Tanzania. Working paper, forthcoming.

20. Price premiums for fortified infant cereals
may be especially important for child nutrition
Source: Data are extracted from Headey, et al. (2017b). Red lines show LOWESS curves to allow for non-linear functional forms. Individual observations are marked by the following regional groupings: Sub-Saharan Africa (SSA), Latin America and Caribbean (LAC), South Asia and East Asia (ASIA), Middle East and North Africa (MENA), all other countries in Europe, North America, and Australasia (Other).

21. The market for infant foods is really weird
For multinational brands,
prices are higher in poorer countries
Local generics have similar prices in all countries

22. The actual content of fortified cereals
is unpredictable and often below standards
Tested composition of 108 samples from 22 developing countries, relative to zinc and iron content of WFP SuperCereal+
Less than 1/5th (17%) of samples meet
or exceed zinc & iron benchmarks
Most (63%) are below both benchmarks
These differences turn out to be uncorrelated with what’s on the label about ingredients or nutrients, packaging quality or price
Source: Masters, Nene and Bell (2016) in Maternal & Child Nutrition

23. The actual content of “fortified” cereals
is often far below what infants need
Modeled deficit (or surplus) of nutrients by age
Age
(in months)
Inadequate fat at months
Inadequate iron at 6-9 months
Inadequate zinc at 6 months
Boxes show 25th-50th-75th percentile; whiskers extend to +/- 1.5 IQR; circles show outliers.
Source: Masters, Nene and Bell (2016) in Maternal & Child Nutrition

24. Research could potentially lead to
new quality standards
December 20, 2016

25. Positioning agriculture for the SDGs in nutrition
Conclusions:
Positioning agriculture for the SDGs in nutrition
Foundations
Malnutrition is a disease of early infancy, not a consumption choice
Causal framework starts with livelihoods and income, then prices
Technological and institutional changes cause structural shifts
Data
Rural demography drives land/labor ratios
Less stunting, dietary equality shows progress is possible
Price gaps reveal room for gains from trade
Improving nutrition calls for higher standards, not just low prices
Opportunities
Agriculture to raise the floor of living standards
Nutrition to improve maternal and child health
Product standards and other policies to improve marketed foods