Slide 1

AGEC 640 – Agricultural Development and Policy

Nutrition and Food Markets

September 16th, 2014

Today:Nutrition, health and human capital

(Reading: Haddad et al., 2004) Next time:

“Demand and imperfect information”

Much of agricultural policy concerns food, nutrition and health…

You have all seen demand curves and elasticities…

Slide 2

Price of food

Quantity of food consumed

P1

P2

Q1 Q2 Consumers’ income

Quantity of food consumed

Q2

Q1

Y1 Y2

“demand curve” “Engel curve” (=income-consumption curve)

price elasticity of demand:%∆Q/ %∆P income

elasticity of demand:

%∆Q/ %∆Y

We will use these curves starting Thursday, but first…

How do peoples’ nutritional needs influence these curves -- and how closely is nutrition linked to basic survival?

Slide 3

Price of food

Quantity of food consumed

P1

P2

Q1 Q2 Consumers’ income

Quantity of food consumed

Q2

Q1

Y1 Y2

“demand curve” “Engel curve” (=income-consumption curve)

price elasticity of demand:%∆Q/ %∆P income

elasticity of demand:

%∆Q/ %∆Y

Slide 4

Source: Angus Deaton, “Health, Inequality, and Economic Development.” Journal of Economic Literature, XLI(1), March 2003: 113–158. Note: Circle size is proportional to population.

To start: how does health change with income?

Slide 5

Life Expectancy at Birth, 1950-2000

35

40

45

50

55

60

65

70

75

1950-1955

1955-1960

1960-1965

1965-1970

1970-1975

1975-1980

1980-1985

1985-1990

1990-1995

1995-2000

Europe

Lat.Am.&Car.

World

India

Pakistan

Bangladesh

Africa

Source: Computed from UN Population Division, 2004 <http://esa.un.org/unpp>

How does health change over time?

Slide 6

Health is closely related to weightThe “Waaler Curve”

Reprinted from: Fogel, R.W. “Economic Growth, Population Theory, and Physiology.” American Economic Review, Vol. 84, No. 3. (Jun., 1994), pp. 369-395.

Slide 7

Source: Fogel (1994), p. 376.

Europe’s gains in BMI and health began early

Slide 8

The closest nutrition-mortality link is for infants

Source: Fogel (1994), p. 382.

Slide 9

A common metric: Z-scores

• Height-for-age (chronic stunting)• Weight-for-height (acute wasting)• Weight-for-age (body mass relative to age)

– Problematic because it depends on weight and height– Same score could signal tall + thin or short + normal

• Value compared to WHO international reference age-sex population for well-nourished children

• Typical cut-off is < - 2

Slide 10

0.1

.2.3

.4.5

dens

ity

-6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6height-for-age z-score (stunting)

Mountains Hills Terai

Source: DHS 2006

0.1

.2.3

.4.5

dens

ity

-6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6weight-for-height z-score (wasting)

Mountains Hills Terai

Source: DHS 2006

Distribution of height-for-age (left panel) and weight-for-height (right panel) for children under 5 in Nepal in 2006, by agroecological zone (from left to right, means = -2.27, -2.02, -1.89, -1.11, -0.82, -0.73)

Source: Shively, Sununtnasuk and Brown (2012)

Slide 11

Almost all shortfall in child growth occurs between 4 and 14 months of age

Source: Shrimpton, R. et al., 2001. “Worldwide Timing of Growth Faltering: Implications for Nutritional Interventions” Pediatrics 107:e75.

Mean weight-for-age z scores, relative to the NCHS reference

Latin America and the Caribbean

Asia

Africa

Slide 12

-4-3

-2-1

0ha

z in

200

6 D

HS

0 200 400 600 800ndvi for aug-sep-oct in year of birth

95% CI Mountains

Source: DHS and MODIS-NDVI

-4-3

-2-1

0ha

z in

200

6 D

HS

0 200 400 600 800ndvi for aug-sep-oct in year prior to birth

95% CI Mountains

Source: DHS and MODIS-NDVI

Plots of height-for-age for children under 5 in Nepal in 2006 against cluster average NDVI for district in Aug-Oct of birth year (left panel) and year prior to birth (right panel), Mountain zone only

Source: Shively, Sununtnasuk and Brown (2012)

Does Agriculture Matter? Yes, but…

Nepal: comparison of district-level nutrition and agriculture outcomes

HAZ < average HAZ > average

yield < average 22 21

yield > average 13 19

Slide 13

Table entries show # of districts

HAZ from 2006 DHSyields from 2004 NLSS

Negative deviants

Positive deviants

Slide 14

Lack of food is still the world’s greatest health threat!

0 20 40 60 80 100 120 140

Underweight Unsafe sex

Blood pressure Water & sanitation

TobaccoIndoor smoke from fuels

Cholesterol Alcohol

Zinc deficiency Vitamin A deficiency

Iron deficiency Low fruit and vegetable intake

Overweight

Annual loss of disability-adjusted life-years

(millions of DALYs)

Worldwide disease burden from m ajor risk factors, 2000

Source: WHO (2002), World Health Report 2002, available online at www.who.int.

Slide 15

Nutrient deficiencies are major health risksWorldwide disease burden attributable to major health risk factors, 2000

    DALYs (M) % total

Disease burden attributable to undernutrition

Underweight 138 9.5%

Iron deficiency 35 2.4%

Zinc deficiency 28 1.9%

Inadequate fruit and vegetable intake 27 1.8%

Vitamin A deficiency 27 1.8%

254 17.5%

Disease burden attributable to risk-factor exposure

Unsafe sex 92 6.3%

Smoking and oral tobacco 59 4.1%

Alcohol 58 4.0%

209 14.4%

Disease burden attributable to cardiovascular condition

Blood pressure 64 4.4%

Cholesterol 40 2.8%

Body mass index 33 2.3%

Physical inactivity 19 1.3%

157 10.8%

Disease burden attributable to environmental conditions

Unsafe water, sanitation, and hygiene 54 3.7%

Indoor smoke from solid fuels 39 2.6%    93 6.4%

Source: WHO (2002), World Health Report 2002. Online at www.who.int/whr. Data shown are from web annexes at www.who.int/whr/2002/material/en.

Some

interaction

Slide 16

Risk factors vary with income

Contribution to global burden of disease by risk factor and region

Why?

Slide 17

The role of nutrition in disease is rarely clear

Attribution of disease burden to major risk factors in high-mortality developing countries

Risk factor % DALYs Disease or injury % DALYsUnderweight 14.9 HIV/AIDS 9.0Unsafe sex 10.2 Lower respiratory infections 8.2Unsafe water, sanitation and hygiene 5.5 Diarrhoeal diseases 6.3Indoor smoke from solid fuels 3.7 Childhood cluster diseases 5.5Zinc deficiency 3.2 Low birth weight 5.0Iron deficiency 3.1 Malaria 4.9Vitamin A deficiency 3.0 Unipolar depressive disorders 3.1Blood pressure 2.5 Ischaemic heart disease 3.0Tobacco 2.0 Tuberculosis 2.9Cholesterol 1.9 Road traffic injury 2.0Subtotal for under-nutrition 24.3

Notes: Arrows are roughly proportional to attribution rates. Risk factors and diseases associated with under-nutrition are in italics. The selected risk factors cause diseases in addition to those relationships illustrated, and additional risk factors are also important in the aetiology of the diseases illustrated.

Data shown are totals for 69 countries defined by the WHO as having both high child mortality and high adult mortality. Source: WHO (2002), World Health Report 2002, Annex Table 14 (p. 232). Available online at www.who.int/whr.

Slide 18

Undernutrition is falling, except in Africa

Data and projections on childhood underweight, 1995-2015

30

25

20

15

10

5

0

1995 2000 2005 2010 2015 MDG

Africa Asia Lat. Am. &Caribbean

DevelopingCountries

World

Trends, projections and MDGs for prevalence of underweight children under 5, 1995-2015

Perc

en

t o

f c

hild

ren

Source: UN Standing Committee on Nutrition (2004), Fifth Report on the World Nutrition Situation. New York: UN SCN.

Note: Data show estimated percentage of children aged 0-5 who areunderweight, defined as <2 s.d. below median NCHS weight for age.

…but between Africa and South Asia, there is a very important puzzle:

(Based on surveys of child bodyweights) (Based on estimated food availability)

Source: UN Millennium Development Goals Report, July 2009. Online at http://mdgs.un.org.

Why does South Asia have more

underweight children

than Africa,

despite higher

estimated food

availability?not disease,

but low birth weight due to

maternal malnutrition

Some conclusions

• Nutrition is clearly a major driver of health and human capital…

• But the link between food availability and nutritional status is complicated, and depends on– inequality in access and entitlements– disease pressure and public health– market failures and policy failures

Slide 20