'Estimates and causes of poor nutrition - meaningful disagreements among economists' Food Forum talk 7 th March 2008 Dr Deborah Johnston, Dept of Economics

Undernutrition – inadequate intake of calories from proteins, vitamins, and minerals Malnutrition Food insecurity Popular understanding of hunger

INTERNATIONAL NUTRITIONAL GOALS 1996 World Food Summit, representatives from 185 countries and the European Community - achieve universal food security, the access of all people at all times to sufficient, high-quality, safe food to lead active and healthy lives. The pledge - to cut the number of hungry people in the world by half by Echoed by the 1 st Millennium Development Goal. -Human rights -Development impact

Measurement Against International Targets FAO & WHO But timeliness of FAO Data agree only on the fact that international targets wont be reached. Significant differences. Implications for how we think about good nutrition

WHO measure of undernutrition – Prevalence of (moderately or severely) underweight children is the percentage of children under five years old whose weight for age is less than minus two standard deviations from the median for the international reference population ages 0–59 months.

FAO Estimates 1. Measures of calorie availability (NPCCA); 2. Distribution of calories (CV); and 3. Cut-off point (CCOP).

Examples of divergence: Nigeria –FAO measure – 7% undernourishment WHO measure – 31% underweight Senegal – FAO measure – 25% undernourishment WHO measure – 23% underweight Namibia – FAO measure – 9% undernourishment WHO measure – 26% underweight Kenya – FAO measure – 44% undernourishment WHO measure – 22% underweight

Reasons for divergence (1): 1.Poor data – especially for FAO Measure of availability Distribution Cut-off point Suggests that calorie availability data is weak for many poor countries

Reasons for divergence (2): 2.High or improved agricultural production does not always mean that the hungry get more food Ignores long-term productivity (e.g. Food aid) Ignores distributional issues (e.g. What is happening to poor workers, or to women or children in the farming household)

Why food secure households may contain individuals with insufficient nutrition (World Bank 2006)? Pregnant and nursing women eat poorly, are ill or do not get enough rest. Caregivers feed children too little food, or foods that are not energy dense. Caregivers do not know how to feed children during and following diarrhoea or fever. Caregivers poor hygiene contaminates food with bacteria or parasites.

Highlights important factors other than food availability: 1.Importance of distributional issues both between and within households – affected by economic and social relations 2.Importance of care in pregnancy and early years nutrition Maternal knowledge Maternal care and status 3.Access to health and sanitation services (circular link between poor nutrition and disease)

Examples of divergence: Nigeria –FAO measure – 7% undernourishment WHO measure – 31% underweight Senegal – FAO measure – 25% undernourishment WHO measure – 23% underweight Namibia – FAO measure – 9% undernourishment WHO measure – 26% underweight Kenya – FAO measure – 44% undernourishment WHO measure – 22% underweight

Determinants of nutrition (Smith & Haddad): Immediate determinants: dietary intake and health status. Underlying determinants: food security, adequate care for mothers & children, and a proper health environment (all affected by poverty). Basic determinants: potential resources, political, economic, cultural and social factors.

Policy implications: Policy focus must be on more than food availability (problems of targeting) Improved nutrition is not just a by-product of poverty reduction and economic growth. Income growth will on average reduce under-nutrition, it will only do so slowly. E.g. womens education and womens status are slow to change Need a balanced strategy of income growth and investment in more direct interventions.

CONCLUSIONS Measurement of nutrition intake v outcomes Policy issues – food availability v. nutrition security