85010 A Agriculture for Nutrition in Latin America and the Caribbean: From Quantity to Quality B Agriculture for Nutrition in Latin America and the Caribbean: From Quantity to Quality © Copyright 2014 International Bank for Reconstruction and Development/THE WORLD BANK 1818 H Street, N.W., Washington, D.C., U.S.A. All rights reserved Manufactured in the United States of America First printing March, 2014 ISBN 978-92-9248-496-5 Agriculture for Nutrition in Latin America and the Caribbean: From Quantity to Quality June 10, 2013 This Document is a Guidance Note for Task Managers and Decision Makers working on the agriculture sector in the Latin American and the Caribbean region and serves as a Companion to the Global Guidance Note: “Improving Nutrition Through Multisectoral Approaches”, World Bank, 2013. Table of Contents iii Table of Contents Acknowledgements ............................................................................................................. iv Abbreviations and acronyms .................................................................................................v Foreword ............................................................................................................................ vii I. Introduction .................................................................................................................... 1 A. Motivation................................................................................................................... 1 B. Agriculture and nutrition in LAC ................................................................................. 8 C. Steps towards designing nutrition-sensitive agriculture interventions in LAC............. 12 II. Opportunities for mainstreaming nutrition into agriculture in LAC ....................... 17 A. Policy level .............................................................................................................. 17 B. Agriculture program and investment level opportunities............................................ 20 C. Mainstreaming nutrition into different agriculture sector settings in LAC.................... 24 D. Country notes – Agriculture for nutrition ................................................................... 25 1. Haiti..................................................................................................................... 25 2. Brazil................................................................................................................... 32 3. Guatemala........................................................................................................... 40 III. Measuring nutrition outcomes in agriculture programs in LAC............................ 47 Annex 1. Nutrition glossary................................................................................................. 49 Annex 2. Data construction and sources............................................................................ 51 Bibliography....................................................................................................................... 52 iv Agriculture for Nutrition in Latin America and the Caribbean: From Quantity to Quality Acknowledgements This Guidance Note was prepared by a group of experts from the World Bank and the Inter American Institute for Agriculture Cooperation (IICA). The team was led by Diego Arias (Senior Agriculture Economist, World Bank), and composed of Barbara Coello (Economist, World Bank), Joaquin Arias (Economist, IICA), Asa Giertz (Economist, World Bank), Svetlana Edmeades (Senior Agriculture Economist, World Bank), Romina Bandura (Consultant, World Bank), Erika Salamanca (Project Assistant, World Bank), and Marie Chantal Messier (Senior Nutrition Specialist, World Bank). The team would like to thank the guidance of Joana Godinho, Health Sector Manager, World Bank; and Laurent Msellati, Agriculture Sector Manager, World Bank. The authors also would like to thank the inputs and comments from peer reviewers and colleagues, including Yurie Tanimichi Hoberg (Senior Economist, World Bank), Andrea Spray (Nutrition Specialist, World Bank), Leslie Elder (Senior Nutrition Specialist, World Bank), Julie Ruel-Bergeron (Nutrition Specialist, World Bank), Willem Janssen (Lead Agriculturalist, World Bank), and Cristina Tirado (School of Public Health, University of California, Los Angeles). Abbreviations and acronyms v Abbreviations and acronyms CDD Community Driven Development CESCR Committee on Economic, Social and Cultural Rights CGIAR Consultative Group on International Agricultural Research DDI Dietary Diversity Index DES Daily Energy Supply FAO Food and Agriculture Organization FCS Food Consumption Score GFSP Global Food Safety Program GAFSP Global Agriculture and Food Security Program HDDS Household Dietary Diversity Score IDA International Development Agency IFPRI International Food Policy Research Institute MDG Millennium Development Goals NTAE Non-Traditional Agricultural Exports PDO Project Development Objective PPP Public Private Partnership TTLs Task Team Leaders WDI World Development Indicators WFP World Food Program WHO World Health Organization Foreword vii Foreword Dear Colleagues: In an era of high volatility of food prices, and in trying to achieve the twin goals of shared prosperity and poverty reduction, no other topic is more front and center than nutrition. Food security is the ability of all people at all times to have physical, social and economic access to sufficient, safe and nutritious food to meet their dietary needs for an active and healthy life. Maintaining food security remains a huge challenge, despite increases in global food production in recent decades, in particular from the Latin America and Caribbean Region. Furthermore, in recent years, amid the food, fuel and financial crises, hunger and malnutrition have grown significantly in a large number of low-income countries. In Latin America and the Caribbean, not only millions of low income families, in particular in rural areas, suffer from deficiencies in micronutrients such as iron, zinc and vitamin A (which has serious implications for the health, survival and optimal cognitive development of vulnerable populations such as pregnant women and children in the first 1000 days of life), but also obesity has become a serious problem, where the rural poor in the region have comparable obesity rates as in high income countries. But agriculture and food production makes up an important percentage of the economy of the region, as well as the single most important source of income for the low income households in rural areas. The challenge is how to bridge the gap that exists in our region between being an agriculture powerhouse and yet having to tackle nutrition problems from the same households that produce the food. The Latin America and Caribbean Region has been in many ways successful in increasing agriculture production and competitiveness, as well as tackling nutrition. The new challenge of integrating nutrition and agriculture should be achievable with political leadership and inter-institutional coordination. This Guidance Note seeks to bridge some of the important knowledge gaps on how best to identify, design, implement, monitor and evaluate agriculture and food security interventions. We need to think critically and to carefully plan sustainable solutions that address the challenges of linking agriculture with nutrition interventions. Sincerely, Laurent Msellati Joana Godinho Sector Manager Sector Manager Agriculture and Rural Development Health, Nutrition and Population viii Agriculture for Nutrition in Latin America and the Caribbean: From Quantity to Quality Introduction 1 I. Introduction The right to adequate food is realized when every man, operations in LAC to mainstream nutrition outcomes woman and child, alone or in community with others, into agriculture sector policies and investments. has the physical and economic access at all times to This Note describes first the current situation in LAC adequate food or means for its procurement. with respect to agriculture and nutrition, then offers – General Comment 12 (CESCR) practical guidance to TTLs regarding the available levers for positively impacting nutrition outcomes of A. Motivation agriculture projects, and presents a series of country notes and steps to be followed in designing nutrition Mainstreaming nutrition considerations into sensitive interventions. agriculture operations could increase the availability of and access to nutritious food, Nutrition-sensitive agriculture is central to which can improve the nutrition status of ensuring food security. For over half a century, food individuals (Hoddinott, J., 2012). The international security has been on the development agenda and community has increased its efforts to highlight the the concept has evolved from focusing on production linkages between nutrition and agriculture. This targets, often in combination with national food self- Guidance Note aims to bridge the gap between the sufficiency objectives, to recognizing the importance conceptual framework and tools that were proposed in of nutrition education, accessibility, affordability and the Global Guidance Note1, presenting policy-makers availability of nutritious food. Per capita daily energy and Project Managers (Task Team Leaders – TTLs) supply (DES) and caloric intake have been used to with a set of tools and examples of initiatives and measure food security and it has long been assumed Figure 1. Share of Food Trade in LAC vs other Regions (only developing countries) 18 16 14 12 10 8 6 4 2 0 Europe & Middle East & East Asia & South Asia Sub-Saharan Latin America & Central Asia North Africa Pacific Africa Caribbean Food exports (% of merchandise exports) Food imports (% of merchandise imports) Source: WDI-COMTRADE 1 https://www.securenutritionplatform.org/Pages/DisplayResources. aspx?RID=151 2 Agriculture for Nutrition in Latin America and the Caribbean: From Quantity to Quality Figure 2.A. Reduction in Undernutrition in LAC Countries (1990-2005) 0% % Decrease in Under -10% 5 undernutrition -20% -30% -40% -50% -60% -70% -80% Brazil Nicaragua Mexico Dominican Colombia El Salvador Costa Rica Honduras Peru Bolivia Guatemala Haiti Republic Underweight Stunting LAC Average Source: World Bank, 2012c that income increases and food security go hand-in- intake does not necessarily satisfy nutritional needs, hand (see The State of World Food Insecurity2 and The and increased incomes, even in rural areas, do not State of Food and Agriculture3). It is now increasingly automatically translate into better and more nutritious recognized that this does not hold everywhere. Caloric diets (FAO et al., 2012). Although health indicators Figure 2.B. Percentage of Undernourishment (2010-2012) LAC Average Antigua and Barbuda Argentina Bahamas Barbados Belize Bolivia (Plurinational State of) Brazil Colombia Costa Rica Chile Dominica Dominican Republic Ecuador El Salvador Granada Guatemala Guyana Haiti Honduras Jamaica Mexico Nicaragua Panama Paraguay Peru Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Suriname Trinidad and Tobago Uruguay Venezuela (Bolivarian Republic of) 0 5 10 15 20 25 30 35 40 45 50 % of the population that is undernourished Source: FAO 2 http://www.fao.org/publications/sofi/en/ 3 http://www.fao.org/docrep/018/i3301e/i3301e.pdf Introduction 3 have improved in the past decades, overweight, nutrition-sensitive policies, pushing the boundaries in obesity, and diet related diseases are now spreading rethinking agriculture and nutrition linkages. rapidly (Popkin and Gordon-Larson, 2004; WHO, 2009a). Many opportunities exist in the agricultural Overall, the LAC region has seen a reduction in sector and, particularly through multisectoral undernutrition and undernourishment indicators collaboration, to avail diverse and healthy diets across (Figures 2.A and 2.B). However, countries that have income segments. been the most successful in reducing undernutrition are now facing high overweight and obesity rates (Figure With a population of 590 million and more than 3). The steady increase in overweight and obesity three quarters of it living in cities, food security is rates in the LAC region rivals today that of the U.S. an important challenge for Latin America and the and Canada and is positively correlated with income Caribbean (LAC). Favorable natural resources provide inequalities (Finucane et al., 2011). However, the a comparative advantage to the region enabling it to prevalence of children with moderate or severe wasting meet domestic demand and expand its agricultural and stunting are still high. Also, several countries in exports (Figure 1). However, despite a recent sustained the region show alarming rates of undernourishment: period of regional economic and agricultural growth, higher than 30% in Haiti and Guatemala, and higher the evolution of nutrition outcomes in the LAC region than 20% in Paraguay, Bolivia, Antigua and Barbuda, has been variable. Given the achievements of its and Nicaragua (Figure 2.B). agriculture sector, LAC should be a leader in designing Figure 3. Prevalence of Overweight and Stunting in LAC Countries (2009) Guatemala Honduras Haiti Bolivia Ecuador Panama Peru Nicaragua El Salvador Mexico Paraguay Colombia Uruguay Dominican Republic Argentina Brazil Costa Rica Chile 0 10 20 30 40 50 % of the population Overweight, 2009 Stunting, 2009 Source: Authors’ calculations (see Annex 2 for details) 4 Agriculture for Nutrition in Latin America and the Caribbean: From Quantity to Quality Countries in LAC where agriculture makes up a However, countries with more diversified rural large part of the economy (agriculture GDP as economies and higher value added per agriculture % of total GDP), score poorly in the nutrition worker have lower poverty and food insecurity status of the most vulnerable groups. Figure 4 rates. Although poverty and food insecurity are higher shows that there is a strong correlation between the in areas highly dependent on agriculture, the relationship importance of the agriculture sector (as % of GDP) and is more complex. Agriculture value added and income the prevalence of stunting. For example, Guatemala, diversification can have positive implications for food Bolivia and Nicaragua have an agricultural sector that security and rural development, as demonstrated in represents a relatively large share of their total GDP Figure 5. and yet households in these countries have the highest levels of both overweight mothers and under 5 stunting As expected, the prevalence of under 5 stunting (Garret and Ruel, 2003). Furthermore, food insecurity across LAC is negatively correlated with GDP and malnutrition are higher and highly seasonal in rural per capita (Figure 6). However, when seeking areas, compared to urban areas, which is a relevant improved nutrition outcomes, it is not sufficient fact when thinking about the role that agriculture can to focus only on increasing income. Other play in reducing malnutrition. The most recent data factors such as food access, affordability, quality and compiled by UNICEF in 2013 shows that in 82 out of diversity play an important role. Economic growth 95 developing countries for which data is available, the has been shown to play a central role in reducing prevalence of underweight children is higher in rural the prevalence of calorie deficiency in most countries areas than in urban ones. during their early stages of development, but the Figure 4. Agriculture Value Added 2011 (% of GDP) and Prevalence of Under 5 Stunting 2009 (%) 60 Guatemala % of Under 5 stunting 40 Honduras Ecuador Bolivia Panama Peru Nicaragua 20 El Salvador Mexico Paraguay Colombia Uruguay Dominican Rep. Argentina Brazil Costa Rica Chile 0 0 10 20 30 40 Agriculture Value Added (% of GDP) linear fit 95% CI Source: Authors’ calculations (see Annex 2 for methodology and data sources) Introduction 5 Figure 5. Production and Income Diversification in Rural Territories Agriculture Value Added/Worker (Average 2000-09, constant USD) Honduras Uruguay Ecuador Households highly dependent on agricultural sources 8000 80 7000 6000 5000 Paraguay Households with more income diversification Chile 4000 3000 Honduras 2000 70 1000 0 Bolivia Costa Guatemala Rica Guatemala Rural household poverty rate 60 Panama Mexico Paraguay Dominican Brazil Republic 50 Dominican Ecuador 40 Republic Mexico Paraguay Brazil 30 Export oriented Non 20 traditional products Costa Rica 10 Service-related, Chile tourism activities Uruguay 0 0 10 20 30 40 50 60 70 80 Percentage of rural agricultural employment Source: ECLAC/FAO/IICA (2013). The Outlook for Agriculture and Rural Development in the Americas: A Perspective on Latin America and the Caribbean Figure 6. GDP per Capita PPP* 2011 (current international $) and Prevalence of Under 5 Stunting 2009 (%) 50 Guatemala 40 % of Under 5 stunting Honduras 30 Haiti Bolivia Ecuador Nicaragua Peru Panama 20 El Salvador Paraguay Mexico Colombia Domican Rep. Uruguay 10 Brazil Argentina Costa Rica Chile 0 0 5000 10000 15000 20000 GDP per capita (2011) linear fit 95% CI * Purchasing Power Parity Source: Authors’ calculations (see Annex 2 for methodology and data sources) 6 Agriculture for Nutrition in Latin America and the Caribbean: From Quantity to Quality impact of increased income on nutrition declines the supply side in terms of variety, nutrient content and as the development process evolves from the early safety (FAO and UE, 2008; Fan, S. et al., 2012), as stages (see Ecker O. et al., 2012 and Figure 7 for the well as improving education and decision-making on case of India). the food consumption (demand) side. Agriculture is a key economic and social sector Therefore, GDP growth and GDP per capita of most LAC countries, providing an important are not good indicators to measure nutrition source of income for poor rural households and improvements and, on the contrary, can be a source of growth for the region’s economy. positively correlated with the prevalence of Recently, however, the rise in demand for non-food overweight. There is a positive correlation between products, such as biofuels, combined with growing the prevalence of overweight and GDP per capita demand for meat and higher market potential for food across LAC countries (Figure 8). This is showing a products in developed countries have changed the transition of the nutrition problem of the population dynamics of the sector. In order to improve the nutrition as countries move forward in their development status of the most vulnerable populations in LAC, the processes. agricultural and food systems need to be rethought to turn local agriculture and food production into a The rural poor in LAC can have overweight rates pathway to mitigate food insecurity in a sustainable comparable to those in richer countries. The manner. Expansion of income and food production correlation between living standards and overweight has been shown to be a necessary, but insufficient was found with different poverty indicators, such as condition to put an end to undernourishment and poverty rates (incomes below US$1.25 a day and malnutrition4. It will require improving food quality on below US$2.5 a day), and rural poverty rates (below Figure 7. Trend in per Capita Income and Energy Intake in India from 1974 to 2002 450.0 2500 400.0 350.0 2400 300.0 2300 250.0 Kcal US$ 200.0 2200 150.0 100.0 2100 50.0 0.0 2000 1974-75 1975-76 1976-77 1977-78 1978-79 1979-80 1980-81 1981-82 1989-90 1991-92 1994-95 1996-97 2001-02 Energy intake, NNMB Per capita income, Economic survey of India 2003-04 Source: Ramachandran, P. 2006 4 Andrew MacMillan, former FAO Director of Field Operations and fellow member of the Global Forum on Food Security and Nutrition, declared “expanding food production, alone, will never put an end to hunger and malnutrition” in a lecture at Reading University on June 11, 2012. Introduction 7 Figure 8. GDP per Capita PPP* 2011 (current international $) and Prevalence of Adult Overweight 2009 (%) 12 Paraguay Argentina 10 % of adult overweight Chile Dominican Rep. Bolivia Peru 8 Mexico Nicaragua Brazil 6 Honduras El Salvador Guatemala Ecuador Colombia 4 Haiti 0 5000 10000 15000 20000 GDP per capita linear fit 95% CI * Purchasing Power Parity Source: Authors’ calculations (see Annex 2 for methodology and data sources) US$2.5 a day). The correlation between the most per capita GDP, adult obesity is higher among women severe rural poverty (below US$1.25 a day) and with low education levels, whereas the opposite holds the prevalence of adult overweight is defined by a for countries with lower per capita GDP (Rivera et. al., U-shape curve (Figure 9). In LAC countries with higher 2004). Figure 9. Rural Poverty Level 2009 (below $1.25 a day) and Prevalence of Adult Overweight 2009 (%) 12 Paraguay 10 % of adult overweight Chile Dominican Rep. Peru Bolivia 8 Mexico Brazil Nicaragua 6 El Salvador Honduras Guatemala Ecuador Colombia 4 0 10 20 30 Rural poverty (%) quadratic fit 95% CI Source: Authors’ calculations (see Annex 2 for methodology and data sources) 8 Agriculture for Nutrition in Latin America and the Caribbean: From Quantity to Quality B. Agriculture and nutrition in LAC consequence, as well as a cause of economic inequality, thus entering in a vicious circle. Stunting Obesity Rates of child stunting in the bottom quintile of LAC’s population is among the highest in the The burden of obesity affects the most vulnerable world (Figure 10). Although the average prevalence of households in the poorest nations of the LAC child stunting decreased during the last decade in the region, with a particular concentration in urban LAC region, the rate of reduction is unequally distributed areas5. In LAC some segments of the population across countries and across households. Child stunting continue to suffer from undernutrition, while others has direct short-term private and social costs—such as exhibit excess weight gain, contributing to the mortality, morbidity, disability and monetary costs—and development of non-communicable diseases such indirect long-term costs—such as reduced cognitive as diabetes and cardiovascular diseases. In Latin abilities, late entry into the education system, higher America, the rate of diabetes was higher than the school drop-out rates, reduced economic productivity, world average in 1995 and was expected to have reduced reproductive performance and increased an estimated 42% increase between 1995 and 2025 chance of contracting metabolic and cardiovascular (Andrade, 2006). Such non-communicable diseases diseases—(Paraje, 2009; Victora et al., 2008; Strauss will have a dramatic effect on the population’s future and Thomas, 2008; Behrman and Deolalikar, 1988). health, requiring a greater share of public expenditures The disproportionate concentration of stunting in the to be directed towards overcoming this latent health lowest socioeconomic strata implies that stunting is a problem. Annual costs associated with diabetes are Figure 10. Prevalence of Child Stunting in the Poorest Quintile 1990-2005 (%) – 49 Developing Countries, 86 Observations 70.0 60.0 Quintile 1 prevalence 50.0 40.0 30.0 20.0 10.0 0.0 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 Average prevalence nationally Developing countries Latin America and the Caribbean Source: Paraje, G. 2009 5 Overweight and obesity: (i) in the world: Eberwine, D., 2002; Popkin, B., 2009; Mendez, M.A., Monteiro, C.A., Popkin, B.M., 2005; Webb, P., Block, S., 2010; Bleich, S., Cutler, D., Murray, C., Adams, A., 2007; (ii) in LAC: Andrade, F., 2006; Fraser, B., 2005; Uauy, R., Albala, C., Kain, J., 2001. Introduction 9 estimated to be more than US$65 billion for the region produce across seasons, they often drive a broader shift (Barceló et al., 2003). in diets towards non-traditional and processed foods. This shift is often reflected also in local markets and small High levels of obesity among women are related shops where similar products are often offered (Byerlee to poor diets that very often also correlate with et al., 2013). anemia. The mother’s nutritional status at the time of conception and during pregnancy is transmitted across In the LAC region, caloric availability is in general generations to the child, contributing to both under- not the main problem, as staple foods provide nutrition in childhood and obesity and related diseases sufficient energy for the population. Rather, the in adulthood (Fraser, 2005). Therefore, the double problem is a diet composed mainly of carbohydrates burden where underweight and micronutrient deficiency that lacks essential nutrients such as proteins and coexist is often present at the country, household and micronutrients. Livestock products, for instance, are an individual levels. excellent source of protein and micronutrients (vitamin B-12, calcium, zinc and riboflavin) not found in crops that The obesity problem in LAC reflects a global trend are especially important for women and children. The in shifting diets towards foods high in sugar, salt challenge is to increase the quality of food consumed, and fat. This trend is also driven in part by increases while at the same time making it affordable to the most in income, relative prices and structural changes vulnerable households in the LAC region. like urbanization, female labor force participation, infrastructure development, diversity of food markets Progress towards the Millennium Development and food environments (Cummins and Macintyre, 2005; Goal (MDG) of halving the proportion of people Rayner and Lang, 2012). Further, in LAC and, particularly who suffer from hunger is uneven in Latin America in Central America, this shift in diets seems to have been and the Caribbean. Approximately 70% of the in part supply driven by international trade agreements countries for which data is available are off track in terms and the increased availability of sugared beverages and of achieving MDG 1 (eradication of extreme poverty and highly processed snack products (Rivera et al., 2004; hunger). Efforts must be made if the region wants to Hawkes, 2006). achieve its nutrition target by 2015 (Global Monitoring Report, 2012). Given that most of the population growth The change in diets in the LAC region has been in the next 30 years will occur in urban areas, the double reinforced by changes in distribution channels burden of malnutrition (underweight–overweight) will and expansion of supermarkets. In 1990, the retail probably continue to exacerbate if nothing is done to market accounted for a maximum of 10 to 20 percent reverse this trend (Caballero B., 2005). of national food retail sales. In 2000, supermarkets had risen to occupy 50 to 60 percent of national food retail, Micronutrient deficiency approaching the 70 to 80 percent share in the United States and France. Latin America has thus seen, in just Micronutrient deficiencies are also of public health a single decade, the same expansion of supermarkets significance in LAC. According to the WHO (2009b), the that the United States experienced over five decades prevalence of vitamin A deficiency among LAC preschool- (Reardon and Berdegue, 2002). While supermarkets age children is 15.6%, and 4.4% of pregnant women by themselves may be a good source of nutritious food suffer night blindness, a consequence of preexisting compared with other forms of retailing6 and avail fresh maternal vitamin A deficiency. When looking at iron deficiency, anemia prevalence in the region is alarming: 6 See for example the food deserts in the United States that have 40% of preschool-age children, 31% of pregnant women emerged in supermarket scarce areas (USDA Food Access Research Atlas, 2013). and 23.5% of non-pregnant women suffer anemia (WHO, 10 Agriculture for Nutrition in Latin America and the Caribbean: From Quantity to Quality 2008). This means that approximately one quarter of diversified dietary intake than their urban equivalents women in the LAC region is anemic (United Nations SCN, (World Bank and World Food Programme, 2012). 2010). Anemia is the most widespread nutrition problem affecting girls and women in developing countries; it is The agro-ecological endowment and high levels a significant cause of maternal mortality and can cause of agricultural productivity have better equipped premature birth and low birth weight. A child born with the LAC region to scale up its agricultural output low birth weight is more likely to experience adverse in the future (Figure 11 and World Bank, 2012b)7. health outcomes, including neonatal and infant mortality, The region revealed a comparative advantage index in poor growth and cognitive development, and morbidity agricultural production of 2.2, where 1 represents the due to chronic diseases later in life. As much as half of all global average (Anderson and Valdes, 2008). This has children stunting occurs in utero, highlighting the critical transformed LAC into the most integrated region in importance of better nutrition for women and girls (Box 1 the world markets, in terms of both export and import and Save the Children, 2012). ratios (Figure 12 and von Braun and Diaz-Bonilla, 2008). Agricultural exports in LAC increased almost Low income, limited access to diverse diets, threefold in the period from 1995 to 2009 (World and food habits all contribute to micronutrient Bank, 2012b), and together with the recent rise in deficiencies. As seen in previous sections, micronutrient food prices, has led to a shift in the composition of intake is highly correlated with income but increased the crops grown. In recent years biofuel production income does not necessarily lead to improved nutrition. has taken a growing share of the region’s agricultural Factors such as knowledge about nutritious diets and production as it has become increasingly attractive access to diverse food across seasons are important for due to soaring energy prices. As a result of all these nutrition outcomes (FAO et al., 2012). Experience shows factors, LAC has been specializing on international that micronutrient intake can be higher among groups agricultural markets resulting in a concentration of with access to an adequate and diverse diet, regardless its agricultural exports. A recent estimation of this of income. Farmers in some countries have shown more concentration using the Gini coefficient shows an Box 1. The first 1000 days in the context of LAC “Nutrition in the First 1,000 Days” is the title of the 2012 State of the World’s Mothers report, published annually by Save the Children in commemoration of mothers’ day. The report stresses the importance of the quality of nutrition in the first 1,000 days of a child’s life in determining his future health and success. This is the period from the start of a mother’s pregnancy through the child’s second birthday. During these 1,000 days, a child’s brain and body develop rapidly and hence need the right nutrients in the correct amounts in order to avoid often irreversible damage. The report highlights that, although in LAC overall stunting prevalence is falling, stunting levels remain high in many countries (for example: Guatemala, Haiti and Honduras). It also stresses that success in fighting child undernutrition is very much dependent on political commitment, supportive policies and effective strategies. Latin American countries such as Brazil, Chile and Costa Rica are mentioned as examples of countries that are performing better on child nutrition than their national wealth might suggest. On the other hand, Guatemala, Mexico, Panama and Venezuela are included among the countries that are underperforming relative to their GDP. 7 The LAC region has the highest level of agricultural productivity within developing countries with an overall level 7 times higher than China ($3,500 and $500 in constant 2000 USD, respectively). Agricultural productivity is measured by the agriculture value added per worker (WDI). Introduction 11 Figure 11. World Area Expansion and Yield Growth (1990–2007) increase from 0.69 in 2000 to 0.73 in 2008 (World Bank, 2012b). 4 3.5 The LAC region seems to be in a nutri- 3 tional-agricultural paradox, reflected by 2.5 the quantities of food supplied to the 2 world market and the quality (nutritious percentage 1.5 value) of food accessible to the most 1 vulnerable populations at home. LAC’s socioeconomic and demographic dynam- 0.5 ics shows that the urbanization process has 0 shifted from two-thirds of the population liv- -0.5 ing in rural areas, in the middle of the past -1 century, to more than three-quarters living -1.5 in urban areas today. In more urbanized Sub-Saharan Africa Latin America and the Caribbean Southeast Asia Middle East and North Africa South Asia East Asia countries, the availability of cheap, energy- dense foods facilitates the consumption of more empty calories relative to expensive healthier food (Caballero, 2005). The prob- lem is also present in rural areas that are not yield area well integrated to local food markets and/or Source: Deininger et al., 2011 where agricultural specialization may have Figure 12. Yield Gap, Availability of Uncultivated Area, and Area Cultivated per Rural Inhabitant area (ha/rural inhabitant) El Salvador 0.35 Haiti 0.20 Peru 0.46 Honduras 0.46 Colombia 0.64 Brazil 2.25 Argentina 8.82 Uruguay 7.91 0 0.2 0.4 0.6 0.8 1 1.2 ratio of cultivated to achieved percentage total suitable area of potential yields Source: Deininger et al., 2011 12 Agriculture for Nutrition in Latin America and the Caribbean: From Quantity to Quality increased incomes but reduced the availability and af- The lack of data to better understand potential linkages fordability of a diverse diet. between agriculture and nutrition (Gillespie et al., 2012) has been a challenge and there is an immediate need to The increase in international food prices and food increase the number of surveys (including quantitative price volatility also has a direct impact on food and qualitative data covering production, consumption insecurity and nutrition in LAC. Even if, in general, and price patterns). Research in this area has identified, low-income food-deficit countries are the most based on past experiences and on-going initiatives, vulnerable to international commodity price increases, several areas of opportunity to mainstream nutrition and poor households living in net agriculture exporting agriculture. countries can also be net food-consumers (World Bank, 2011). For the poor net food-consumers, food costs C. Steps towards designing nutrition- take up a substantial part of the household’s budget. sensitive agriculture interventions So when prices rise or fluctuate, the portion taken up in LAC by essential staple foods increases at the expense of costly nutrient rich foods such as vegetables, fruits, When nutrition considerations are taken into account and pulses (Bouis, 2011). by policy makers and Project Managers in the design of agricultural policies and programs, these would be The increase of LAC’s agricultural exports has considered “nutrition-sensitive” interventions. During improved the quality of production meant for ex- project design, and after the decision to include nutrition port due to the need to conform to international activities or components has been made, explicit standards and the food-quality demand from high- nutrition objectives could be stipulated in relation to the income food-importing countries in order to enter traditional agriculture-sector project objectives such as developed markets8. However, it seems that the qual- increases in income, production volume, sales and/ ity spillovers to domestic markets and, particularly to the or productivity. Also, appropriate nutrition indicators most vulnerable households, have been very limited. should be identified in order to monitor the proposed Very few initiatives or investments have been made in activities and to evaluate the impact of the agricultural LAC to develop domestic food safety norms and regu- interventions on nutrition outcomes. lations to promote healthier and more nutritious food at the local level. Domestic consumers are, in many cases, Projects with objectives and/or activities related to unable to identify the more nutritious and safer foods. improving nutrition status or food security at the When they can actually identify them, their certifica- household level should reflect code 68 in the Bank’s tion—e.g. as organic or fair trade—transform them in an information system, the Nutrition and Food Security unaffordable good for the local population9. code that is part of the Bank’s theme and sector coding. See Box A-3 from the Global Guidance Note10 for a list Several opportunities exist in LAC’s agricultural sector to of activities that should be included under code 68. create local spillovers from increasing the quantity and Graph 1 in the previous page shows the suggested quality content of food production to improve the nutrition steps to mainstream nutrition into agriculture programs. status of the most vulnerable. TTLs and policy makers have the opportunity to simultaneously tackle LAC’s Further in line with the World Bank’s Global Guidance agriculture investment needs and nutrition challenges. Note11, the first suggested step is for the social assessment of projects to include the identification of 8 Developed countries’ non-trade barriers are mainly based on sanitary and phytosanitary criteria. 9 See for example the recent case of the Quinoa in Bolivia: http://www. 10 See footnote 1 nytimes.com/2011/03/20/world/americas/20bolivia.html?_r=0) 11 See footnote 1 Introduction 13 nutrition problems and any opportunities for including as the context and the specific constraints related to the nutrition sensitive activities in order to increase the nutrition problem faced by the groups and communities project’s nutrition impact. Depending on the proposed to be targeted by the project (some key questions are initial program’s objective and target area, a nutritional included in Box 2). The social assessment would guide profile of the most vulnerable groups (often women, specific actions to better address the nutrition problem landless households, indigenous communities, autarkic of the targeted vulnerable groups in terms of activities, communities, etc.) should be done as part of the social roles and responsibilities. This is not to say that an assessment. agriculture project should become a health project, but that it should be nutrition-sensitive to address and The social assessment should provide a diagnostic complement ongoing or planned nutrition interventions, to understand the nutrition problem at hand (obesity, as well as adjust activities to maximize their nutrition micronutrient deficiency, stunting, anemia, etc.) as well impact. Finally, an M&E system should be designed Graph 1. Steps for Mainstreaming Nutrition within the Cycle of Agriculture Programs Step 1 - As part of the agriculture program’s social assessment, evaluate the nutrition problem • What is the food insecurity issue (i.e. the nutrition problem) in the country and/or intervention area? Example: if the problem is low level of vitamin A intake, this could eventually lead to activities to promote biofortified crops rich in vitamin A; or stunting?, Zinc fertilizers can contribute to solving that problem; or anemia ? Increase in crops with high levels of iron should be introduced. • Is there any population in the area of intervention that is more at risk than others and that should be targeted? Example: Have landless rural households a lower diverse diet? Or is it the indigenous population that is at risk? Step 2 - How can the agricultural program address the nutrition problem? Case of including nutrition objectives in the PDO Can the problem be answered through an agricultural (or a multisectoral) intervention? What nutrition indicators are appropriate (see Section III )? Case without nutrition objectives in the PDO Will the policy/intervention have a positive or negative impact on the food security problem and/or on the particular group that is food insecure? Step 3 - Design and implement nutrition activities and interventions • Following the assessment and program’s objectives, find opportunities (Section B) to mainstreaming nutrition into agriculture interventions. • Design an M&E system to track and evaluate the impact of agriculture interventions in nutrition outcomes (if relevant). • Ensure that counterpart agencies have qualified personnel available (internally or externally) to supervise program activities related to nutrition. 14 Agriculture for Nutrition in Latin America and the Caribbean: From Quantity to Quality Box 2. Nutrition concerns to be addressed in the design of agricultural projects Answers to these statements or questions can guide the diagnostic regarding nutrition status and food security issues that could be incorporated during project design (as part of the social assessment). • Will the additional income be received or controlled by women? • What is the food security situation in the country and/or intervention area? e.g. access to food, diet diversity. • What’s the nutrition problem of the targeted population? Anemia, micronutrient deficiency, obesity, stunting, contaminated food and water, etc.? • Based on the nutrition problem at hand, potential interventions and activities should try to seek/promote: increased access all year long to safe, high-nutrient food; improve food diversity; improve affordability of the food basket; raise the micronutrient reserves of the soil; promote good agricultural practices and safe handling of food products. • If a change in production and consumption patterns is expected, it is important to assess the level of acceptance of new food products by families and consumers, and if existing skills for handling and cooking can be applied. • Have agricultural extension agents been trained to transmit knowledge on nutrition, food safety and good agricultural practices to farmers and, more generally, to families, or is this a possibility in the near future or during the project’s implementation? • What have been the nutrition education efforts in the project area and are local families aware of the nutrition benefits of food products and the health benefits of the safe production, processing, and handling of food? and the skills of the counterpart agency in charge of the 1. Invest in women execution and the supervision should be assessed (see Section III). Women are most often the food and care providers of rural households and in particular for children. As a result of the social assessment, the various (Cramer et al., 2010). There are already several initiatives activities (if any) to maximize the impact on nutrition of and approaches to improve and invest in women as part any given agriculture project could be grouped in the of agriculture interventions (16 IDA-financed operations following two areas: already require specific targeting to reach women), and Box 3. Non-exhaustive list of proactive actions for female empowerment to achieve positive nutrition outcomes11 • A sustainable increase in women’s income (even if small) is more likely to be invested in food purchase and children’s education, than other household expenditures. • Improve women’s access to project activities and benefits (such as extension services, credit, knowledge, common property, information, technology, inputs, productive assets and markets): Studies have shown that, once women have access to project activities (training, technical assistance, etc.), they show higher productivity and income increase more than other beneficiaries. Thus, there’s a need to raise female awareness and advocate for their rights in project activities (particularly, in land, education, training, employment and information). • Include interventions and investments in subsectors or activities where women are concentrated (for example, post- harvest activities, planting, weeding, grinding). • Contribute to increased female leadership and visibility in the community (through projects’ operational policies about decision-making processes such as quotas and participation incentives). • Ensure that women are not explicitly or implicitly excluded from project activities (take into consideration security issues, type of crop, training and meeting at nighttime and/or far from their household, etc.). Introduction 15 focusing on women can have a direct effect on the programs that aim to reach the poor and food insecure food diversity intake and nutrition status of the family. households are an important mechanism to sustain However, given the diversity of agriculture programs in local investments in food quality. Many social programs the LAC region, there is no model or set of recommended in LAC that provide support in the form of cash and/or interventions for female empowerment. However, Box 3 vouchers to vulnerable families could be an important lists some examples of actions that can improve families’ incentive to invest in food quality. The same applies for nutrition status through female empowerment. linking agricultural beneficiaries to social safety nets or schools (i.e. school feeding, food aid programs, etc.) In certain regions in LAC, women are important contributors to livestock production activities, Linking local food production to social safety nets, from feeding to selling products. Investing in rural food aid programs and school feeding initiatives women can therefore be a way of increasing the can provide incentives to the market to sustain production of livestock and animal source food (meat, agricultural investment in food quality beyond milk, eggs), which are an important piece of a healthy project closing. Creating demand for such high diet. Furthermore, a recent FAO study argues that quality nutritional food products (even if it represents women livestock keepers must be recognized as the a small percentage of the overall food consumed), major actors in efforts to stop the decline of indigenous can transform the local food supply towards higher breeds, crucial for rural food security and animal genetics quality food, creating long-term spillovers on the rest (FAO, 2012). Particular attention could be drawn towards of the society which would have already integrated and promoting and advertising the production, marketing understood the benefits, in terms of income and health, and consumption of nutritious foods grown by women of better food quality13. Furthermore, social programs groups. would also increase their expected benefits in terms of nutrition outcomes, as they would guarantee that the Women can play a key role in efforts to undertake provided support directly increases the nutrient content nutrition education. Nutrition education for vulnerable of households’ diets and preserves those households families could have a great impact in solving the nutrition from future nutrition problems. problem of the LAC region, as the primary problem is not quantity, but rather quality of the caloric intake. Given their Programs linking local food production to social direct link with the nutrition status of the family, women safety nets have already been implemented should be at the center of such nutrition education/ with success in Brazil (see Box 4), resulting in extension programs. Starting early and including cooking a drop of 37.8% in hospital admissions due to and nutrition in elementary school curricula has also undernutrition between 2002-2005 and achieving proven effective to improve knowledge and change the first Millennium Development Goal in 200614. approaches to new foods and dietary habits. The positive impacts of such system have also been highlighted in a recent pilot program conducted by 2. Increase access all year-round to IFPRI in Ecuador (see Box 5). This mechanism could be high-nutrient content food for the amplified by direct information campaigns to prioritize most vulnerable12 the consumption of local and nutritionally better food Quality food needs to be accessible all year-round in 13 The idea is to use public purchases as a vector to overcome a market order to have an impact on the nutrition status of the failure, which is not allowing the cost of investments on high quality food vulnerable population. Social safety nets and other to be translated into higher prices, desincentivizing farmers to start and/ or pursue such practices after the interventions. 14 Goal 1: Eradicate extreme poverty and hunger. 12 Adapted from Herforth, 2012 See: http://www.un.org/millenniumgoals/poverty.shtml 16 Agriculture for Nutrition in Latin America and the Caribbean: From Quantity to Quality Box 4. Brazil “Zero Hunger” Zero Hunger (Fome Zero) is a Brazilian government program with the objective to eradicate hunger and extreme poverty in Brazil. The program is coordinated by the Ministry of Social Development and Hunger Combat and puts into action the government’s strategy to guarantee the right of access to basic food. The diagnostic in the country was that hunger was more related to inadequate access to food rather than availability. As a result, Zero Hunger’s strategy focuses on basic conditions for food security: food availability and food access. Its main goal is to guarantee access to food in the proper quantity, quality and regularity according to the needs of populations living in food and nutrition insecurity, as well as to promote social inclusion in rural areas by strengthening family agriculture. The integrated action of the Ministries involved in Zero Hunger with the civil society allows a planned and articulated action with great possibilities of ensuring access to the production and consumption of healthy food. In order to achieve the human right of access to adequate food each, the State is obliged to ensure that all individuals under its jurisdiction have access to the minimum essential quantity of food. It should be noted that this quantity must be sufficient, so as to ensure that all citizens are, in fact, free from hunger. The Brazilian Congress has approved the Constitutional Amendment Project (PEC) 047/2003 to incorporate the Right to Food as a fundamental right in the national Constitution. The Right to Food has been included in article 6 of Brazil’s Supreme Law that already contemplates other social rights such as the right to work, health, education and social security. The program takes a number of forms, ranging from direct financial aid to the poorest families (Bolsa Familia) to diverse strategies such as creating water cisterns in Brazil’s semi-arid areas, creating low-cost restaurants, educating people about healthy eating habits, distributing vitamins and iron supplements, supporting subsistence family farming and giving access to microcredit. Two components are particularly interesting: 1. Brazil’s Food Acquisition Program (Programa de Aquisição de Alimentos, PAA) Created in 2003, the PAA allows the public purchase of food items for targeted family farmers, without a competitive bidding process, for distribution in the social assistance network and to build a strategic food reserve. 2. National School-Feeding Program (Programa Nacional de Alimentação Escolar, PNAE) This program aims at fulfilling the nutritional needs of students during their stay at school, contributing to growth, development, learning and scholar goals, as well as to the constitution of healthy nourishment habits. 47 million students receive a free daily meal at pre-school, elementary and high school. In order to ensure the connection between school- feeding and family farming the regulations now require that 30% of the school-feeding budget be used for purchasing family farming production. products and certifications for visibility/identification15. In other terms, promoting a profitable production and Box 5. Food vouchers in Ecuador an affordable consumption of high-quality food products An innovative pilot program conducted by IFPRI will send a very strong signal to the market and ensure and WFP in Ecuador tested the efficiency of food a behavioral change on both sides of the value chain. vouchers relative to the distribution of food or cash. Finally, this type of mechanism could be used in time The program conditioned the use of the voucher on a of emergency to ensure local food provision and diversity of nutrient-rich foods that had a large impact distribution and avoid adverse market impacts16. on several food security indicators (HDDS, 5%, DDI, 16%, FCS, 16%). Food vouchers also had a higher impact than other modalities on the diversity of food 15 To maximize the impact, other measures such as those listed under groups consumed and on the social capital, notably section “Improving the safety and quality of food brought to markets” increasing individuals’ confidence and participation in could be added. community groups. 16 Haiti has been a good example of the harm that food aid can cause to the agriculture sector when such systems are not in place to be scaled up. See: http://www.gao.gov/products/GAO-11-636 Opportunities for mainstreaming nutrition into agriculture in LAC 17 II. Opportunities for mainstreaming nutrition into agriculture in LAC Following the steps and general areas for nutrition- However, nutrition and non-communicable diseases sensitive agriculture activities outlined in the are often a low-level priority within the health agenda previous section, numerous opportunities exist to of the country. Furthermore, since agriculture sector mainstream nutrition into agriculture policies and specialists often see nutrition as a health issue, and investments in the LAC region. These opportunities not an agricultural one, the nutrition agenda within the can be grouped into policy level opportunities agriculture sector and intersectoral collaboration are often (intersectoral collaboration; nutrition-sensitive agricultural non-existent. Nevertheless, recent initiatives (such as One policies), and program and investment level opportunities Health) and crisis (such as the Swine and Avian Flu) have (agriculture R&D; programs linking farmers to markets and demonstrated the importance of the agriculture sector increasing agriculture productivity). Potential interventions for the health of the local and global population (Box 6). include preventive actions and proactive actions such as Given the important role that the agriculture sector has by promoting nutrition outcomes within agricultural projects being at the source of the food supply, it can help prevent and investments. The available levers to affect nutrition nutrition problems of the most vulnerable, while at the outcomes through agriculture interventions are numerous, same time securing their agricultural incomes. including actions at the farm level all the way to the sector policy level. The following sections offer a practical guidance to TTLs in the LAC Region to mainstream Box 6. One Health nutrition into agriculture policies and programs, providing One Health concept is a worldwide strategy for different types of levers and mechanisms that could be expanding interdisciplinary collaborations and considered by TTLs and clients. communications in all aspects of health care for humans, animals and the environment. This initiative A. Policy level allows for synergies between different sectors to achieve advanced health care, enhanced public health efficacy, expeditiously expanding the scientific The LAC Region has had extensive experience in knowledge base, and improving medical education and mainstreaming different types of concepts within clinical care. The One Health Initiative is a movement multisectoral policy dialogue and discussions with to forge co-equal, all inclusive collaborations between client countries, including Avian Flu, Climate Change, physicians, osteopaths, veterinarians, dentists, nurses and various environmental and social issues that are and other scientific-health and environmentally cross-sectoral in nature, making interventions effective related disciplines, including the American Medical Association, the American Veterinary Medical and sustainable. Below is a list of a few levers at the Association, the American Academy of Pediatrics, policy level that can be used as opportunities for the American Nurses Association, the American introducing nutrition into the agriculture sector, building Association of Public Health Physicians, the on past experiences of multisectoral work between the American Society of Tropical Medicine and Hygiene, agriculture and health sectors. the Centers for Disease Control and Prevention (CDC), the United States Department of Agriculture (USDA), and the U.S. National Environmental 1. Strengthening intersectoral Health Association (NEHA). Additionally, more than collaboration to achieve nutrition 700 prominent scientists, physicians and veterinarians outcomes worldwide have endorsed the initiative: Although nutrition cuts across several sectors, the main https://www.onehealthcommission.org responsibility often falls within the Ministry of Health. 18 Agriculture for Nutrition in Latin America and the Caribbean: From Quantity to Quality The health and agricultural sectors have well- 2. Increasing knowledge and established public institutions and Ministries, awareness of linkages between but they are often not well organized in ways agriculture and nutrition that readily allow for cross-sectoral action. Nutrition and related health problems are the result A. Capacity at the Ministries of Agriculture of several factors and require action across different sectors (social protection, health, education, water and Increase nutrition knowledge at the policy level by sanitation, agriculture, etc.). Hence, in the absence of incorporating nutrition experts and training into strong incentives to develop cross-ministerial policies agriculture policy decision-making. Most Ministries and programs for food and nutrition security, sector- of Agriculture in the region do not have nutrition experts specific silos for nutrition will end up favoring one or training on nutrition for Ministry staff. In order for pillar of good nutrition at the expense of the others. agriculture policies and programs to maximize their impact There are however examples where such intersectoral on nutrition outcomes of the targeted rural (and urban) coordination has worked (see Box 7), like in the populations, Ministries of Agriculture should actively seek outbreak of certain diseases, and in cases where to include nutrition experts within their teams, and provide agricultural extension agents have coordinated with nutrition training to agriculture policy decision makers and health extension agents. This collaboration between extension agents. Mainstreaming nutrition considerations extension programs has the potential to enlarge the in agriculture policies and agriculture public services area of coverage in terms of number of households by having access to specialized nutrition experts, can but also in terms of household members, increasing ensure that the Ministry of Agriculture takes into account the probability of achieving behavioral change in health nutrition objectives across its various departments and and agriculture practices. investments at a relatively low cost. In most cases, as with other dimensions such as gender and environment, An overall public sector coordination body mainstreaming nutrition could just involve slight (interministeral committee) is key to ensure such considerations in operational rules and policy incentives multisectoral policy and interventions. The Zero (see Section III). Hunger initiative in Brazil (see Box 3) is one of the most known coordination initiatives in LAC. Although B. Understanding the linkages between intersectoral collaboration can partly solve this problem nutrition and agriculture of lack of capacity, Ministries of Agriculture can actively and unilaterally seek to increase knowledge and Given the need for more evidence in LAC on the impact awareness of nutrition-sensitive agriculture policies of agriculture policies and investments on nutrition and investments. outcomes, data collection and impact analysis needs Box 7. Multisectoral coordination to reduce chronic malnutrition in Peru The recent national strategy to reduce malnutrition was set in a multisectoral and intergovernmental framework. The Social Inclusion Technical Assistance Project (P131029) is supporting the Ministry of Development and Social Inclusion in implementing such strategy. All the fiduciary responsibilities of the project will be carried out through the Ministry of Economy and Finance allowing for interinstitutional coordination toward the same objective of reducing chronic malnutrition. The creation of a National System of Monitoring and Evaluation will allow to condition additional resources allocation in the different local coordinations based on the performance of the results measured by malnutrition indicators. Opportunities for mainstreaming nutrition into agriculture in LAC 19 to be prioritized. Monitoring and evaluation systems A recent systematic review of agricultural interventions are crucial for tracking progress, for identifying good that aim to improve the nutrition status of children practice principles of program design that enhance shows that, among the 23 studies that were considered impact, and for guiding unit costing for scale-up. Data methodologically valid, only one included cases in are also essential to provide feedback to researchers LAC (projects in Mexico and Nicaragua that involved and policy makers to continue improving and adapting biofortified maize seeds) (Masset et al., 2012). This solutions for the most vulnerable. Up until today, shows that there is a need to increase the empirical household surveys have major gaps regarding nutrition analysis of nutrition-sensitive agriculture interventions in and agriculture as they rarely include data on feeding, the region. nutrition and agriculture outcomes; and very few of them allow linking the different sets of indicators if available at 3. Improving the safety and quality of all. Opportunities exist to improve data in order to relate food brought to markets the agro-ecological areas and nutritional and agricultural profiles of the population, such as, for example, net food Improving the food safety regulations is essential to buyer/net food seller and nutrition status. Also, food price safeguard the health and nutrition of the population. surveys should include better spatial disaggregation and Although other initiatives and efforts have been made product quality differentiation. in the area of food safety (see Box 8), it is important Box 8. Global Food Safety Program (GFSP) Globalization of the food supply means that food safety risks are shared across borders. Foodborne disease outbreaks are common in both the developed and developing world, and have serious implications for public health and agri- food trade. As such, food safety is a global public good, and addressing it requires global solutions. Why a Global Partnership? A globalized food supply chain means that food production is increasingly sourced from both developed and developing countries. In a globalized food supply chain, the concerned actors (including private sector producers, processors and retailers, regulatory agencies, consumer advocates, and technical service providers) find it difficult to combine forces to collaborate effectively to improve food safety. While several partnerships for food safety have combined private sector agribusinesses, or public sector organizations, the Global Food Safety Partnership (GFSP) aims at creating a forum where all concerned actors—private and public, consumer groups and academia, international organizations and financial institutions—would be able to participate. Therefore, the GSFP aims at bringing together global actors to collaborate on capacity building to improve the safety of the global food supply. Global Food Safety Partnership Building on the work initiated under the Asia Pacific Economic Cooperation (APEC) Food Safety Cooperation Forum (FSCF), the World Bank Group sees a unique opportunity to promote a new paradigm of capacity building for food safety as a global public good. The multi-stakeholder GFSP will support food safety capacity building around the world. The partnership will bring together stakeholders to collectively address critical capacity building gaps through the establishment of an innovative open-source knowledge-sharing community of practice. What are the main objectives of GFSP? The main GFSP program development objective is to support improved food safety systems as demonstrated by enhanced agri-food value chains and improved public health outcomes. These outcomes will be achieved through delivery of a 5-year program for training and capacity development, supported by a public-private-partnership and funded by a multi-donor trust fund. The GFSP would contribute to food security, accelerated economic growth, facilitated trade and reduced rural poverty. 20 Agriculture for Nutrition in Latin America and the Caribbean: From Quantity to Quality to ensure that adequate food safety regulations and (such as increasing the zinc content of grains through implementing institutions are in place as improvements in zinc fertilizers), the benefits to the population (if zinc nutrition quality and consumer awareness can be undone deficient) could be greater than the investment of the if problems with unsafe food arise. Similarly, guidelines additional marginal cost derived from using zinc-rich and regulations for good agricultural practices should be fertilizers. Similarly, publicly funded investment support in place and promoted by extension services to ensure to the private sector could include selection criteria the safe production of food at the pre-harvest and pre- that benefit nutrition-sensitive agricultural and food- slaughter phase. This is important, not only to minimize processing investments. contamination of foods, but also to sustain nutrient soils and clean waters, both of which are essential for Another potential policy-level incentive is through sustainable, safe and nutritious food production. Thus, a certification and labeling of foods to reward safety comprehensive food safety framework with a “from farm and nutritional content. Beyond the food safety norms to fork” approach to food safety is a necessary condition and standards that regulate the production, processing to ensure that investments in improving food quality and and marketing of foods, there is an opportunity to ensure nutritional content are sustained over time, safeguarding that the labeling of food products inform consumers against any individual case of unsafe food. about nutritional values and, thus, facilitate social marketing. This can be in the form of nutrition fact labels Provide policy incentives for the private sector that list the nutrient amount in the product, or as symbols to increase the nutritional quality of food and reflecting the relative nutrition content and dietary value. food safety. Opportunities exist for public policies to It is important to develop unified standards and monitor differentiate subsidy rates providing incentives for the the application of these labels so that they can be trusted production of nutritionally enhanced foods. For example, by the consumers. Further, with the growth of natural and several countries in LAC have policies to subsidize health food products, there is an opportunity to ensure agriculture inputs (such as fertilizers, seeds, etc.) that consumers are informed about the benefits and and adoption of improved technologies (agroforestry, meanings of the different food labels (health, organic, irrigation, soil preparation, etc.). By rewarding the natural, etc.). The identification of higher food quality adoption and/or use of nutrition-enhancing agriculture products in the market place can allow to target (i.e. with practices and technologies (i.e. zinc fertilizer, biofortified vouchers) or condition the transfers (i.e. with cash) for seeds, food fortification, etc.) (see Box 9), as well as nutritionally at risk population (see Box 10). Good Agricultural Practices, agriculture policy could induce agribusinesses and producers to improve the B. Agriculture program and nutritional content of food and to adopt practices that investment level opportunities improve food safety, creating positive externalities in consumer’s health. Although the market initially may Although this companion note is primarily discussing not pay for the benefits of improved food quality opportunities for investments and interventions in the Box 9. Promoting zinc fertilizer Recently, China has recognized the importance and current deficiency of zinc in its agricultural production. The Ministry of Agriculture (MoA) recommended zinc fertilizer in its official guide for fertilizer use. The International Zinc Association (IZA), working with the MoA and the Chinese Agricultural University (CAU), is currently carrying out crop trials involving zinc fertilizer with positive results (i.e. average yield increases between 7% and 10% across crops and provinces). Opportunities for mainstreaming nutrition into agriculture in LAC 21 Box 10. Nutrition focused marketing in Kenya Kenyan CSO (Farm Concern International) won a World Bank CGAP award for its approach of nutrition-focused marketing of African leafy vegetables, driving up the value of these horticultural products 213 percent in five years and substantially increasing incomes and awareness among farmers interested in growing them (see Ewbank et. al., 2007). agricultural sector, food policy is cross-sectoral and plant-breeding techniques should always be preferred to comprises a multitude of diverse stakeholders in the transgenic techniques. Relative to supplementation and public and private sector. Investment in nutrition-sensitive fortification, biofortification offers several advantages. agriculture and food production, therefore, does not only First, it targets food-at-risk households in rural areas. fall under traditional agricultural investment projects, Second, it is cost-effective, as after the initial investment but also provides opportunities for Community Driven in R&D, crops are available all year round. Finally, it is Development Programs (CDDs), Development Policy sustainable because it relies on staple crops that people Operations (DPOs), and private sector development are already used to eating. In LAC, Agrosalud and initiatives. Embrapa are good examples of research institutions that have been making large progress in the biofortification 1. Agriculture research and development field (see Box 11 and Box 12). Enhancing the capacity of regional and national Agriculture R&D investments also present ways to agricultural research institutions to develop identify opportunities throughout the value chain, and promote new varieties of food products to increase food quality and/or to avoid nutritional with improved nutritional content. Examples of losses and food safety risks. Traditionally, agricultural recent agriculture research and development (R&D) R&D has been focused on the agricultural production investments in nutritional quality include biofortification (i.e. pre-harvest) segment of the value chain, so today (the process by which the nutritional quality of crops is there are many areas of improvement on the remaining improved, dovetailing on efforts to enhance agronomic parts of the chain, which have shown to lead to potential traits through plant breeding). The 2008 Copenhagen high levels of private and social returns on investment. consensus concluded that biofortification was the fifth Understanding the entire value chain of the agricultural most cost-effective intervention to address hunger products (from the field to the plate) can help private and malnutrition. If micronutrient deficiencies are and public sector investments in terms of achieving well identified, the development of such crops could improved nutrition outcomes for the poorest. Often, such improve the intake of iron, zinc and vitamin A. To create R&D can be conducted in partnership with the private sustainability (i.e. availability from one year to another) sector (through PPPs). Applied research can focus on and make initial investments in R&D cost-effective, the area of post-harvest processes to address local Box 11. Agrosalud, an applied research center based in Cali, Colombia The objective of Agrosalud is the development and deployment of biofortified staple crops to reduce nutrient deficiencies and improve food security in Latin America and the Caribbean. The goal is to increase, through traditional plant-breeding, the levels of nutrients and the nutritional content of important staple crops: iron and zinc in beans, maize, rice and sweet potato; tryptophan and lysine in maize; and beta-carotene in orange-fleshed sweet potato and yellow maize. It must be noted that, in addition, these crops are bred to retain positive agronomic qualities such as high yields and disease resistance. 22 Agriculture for Nutrition in Latin America and the Caribbean: From Quantity to Quality Box 12. Embrapa, agricultural R&D in Brazil Embrapa, the Brazilian Agricultural Research Corporation, has generated and recommended more than nine thousand technologies for Brazilian agriculture, reduced production costs and helped Brazil to increase the supply of food while, at the same time, conserving natural resources and the environment and diminishing external dependence on technologies, basic products and genetic materials. One of its achievements is the creation of alternatives for soybean processes, the development of products for thermo-plastic extrusion, the identification of the grade and quality of essential oils of native plants, the development of small machinery for family agriculture and the optimization in the use of enzymes for the extraction of avocado and soy oil. One of its actual priorities is the loss reduction of fruits and vegetables in the post-harvest phase. Finally, a very interesting program was developed to incentivize school restaurants all over the country to source locally with the food promoted by the program. Also, eleven regional Embrapa offices are working on a biofortification program that aims to develop and introduce eight biofortified crops, namely: pumpkin, rice, sweet potatoes, beans, cowpeas, cassava, maize and wheat. nutrition problems and/or reduce nutrient deficiency Including nutrition in the agriculture extension curriculum and contamination risks in the value chain of the main and modules represents a marginal cost with potential food products consumed by the most vulnerable. For great benefits to bring nutrition awareness to farmers instance, milk is often consumed in school feeding and rural households (see Box 13 for an example on programs and bought locally. Fortifying milk with needed Haiti). micronutrients could be a cost effective solution to address some of the nutrition problems, also producing A parallel effort, in conjunction with the Ministries spillovers beyond the student population. Scope for of Health, could be aimed at informing and R&D can also exist to improve marketability of local raising awareness among local consumers about foods, in order to maintain a constant nutrient factor in the benefits of nutritionally enhanced foods for the logistics of the product and to maximize shelf life. the health of a family, and thus increase demand for such products. Social marketing and nutrition 2. Agriculture Extension and education could promote and advertise nutritional Information Services benefits as well as potential problems. This can be combined with marketing of local agricultural Opportunities exist to increase nutrition knowledge products to generate consumer demand for local at the local level by incorporating food security production. Labeling and recommendations from and nutrition modules into agriculture extension the Ministry of Health and/or Agriculture can also be training curricula. Extension agents (both private useful in promoting the benefits of sourcing local foods and public) often provide great coverage throughout and nutrition-enhanced foods among consumers, the territory and a direct link to farmers and rural restaurants, schools, etc. households. They are readily available delivery channels to promote nutrition among small-scale farmers and 3. Linking farmers to markets and their households, usually the most vulnerable to food strengthening the value chain insecurity. The skills taught by extension agents could be used to change behavioral habits of producers (and rural Programs that invest in helping farmers link to households) towards making their agricultural activities markets, such as Rural Alliances and Community (e.g. choice of seeds, Good Agricultural Practices Driven Development (CDD) type of projects, have including harvesting and slaughtering, post-harvest the opportunity to provide incentives to improve handling, food preparation) more nutrition-sensitive. food quality and safety in value chains by not only Opportunities for mainstreaming nutrition into agriculture in LAC 23 Box 13. Nutrition in agriculture investments in Haiti After the 2010 earthquake, humanitarian agencies in Haiti wanted to procure food locally to distribute to distraught populations but neither the quality nor the quantities needed were available in the country to suit the organizations’ needs. Most food aid was imported and distributed freely, harming national production. Therefore, the Ministry of Agriculture (MARNDR) of Haiti decided to implement policies and programs that would increase the volume and quality of the food produced to increase farmers’ income and contribute to the overall food security of the country. The MARNDR and the Bank designed the RESEPAG II project to strengthen the MARNDR’s capacity to define and implement the National Agriculture Extension Strategy, to increase access of small farmers to agriculture extension services and training on animal and plant health in priority regions (the US$50 million project was declared effective in April 2012). Nutrition is integrated into project activities in the following ways: • Nutrition status of rural households in the project area is a PDO level indicator • Creation of a nutrition unit within the MARNDR to support the development of a nutrition strategy • Training of agricultural extension agents just in the field of nutrition • Under the “Market Support Facility”, matching grants will finance activities related to: - Improving the nutritional quality of foods in post-harvest processes - Facilitating the production of nutrient dense foods through the use of biofortified seeds already present in Haiti, and zinc-based fertilizers - Training women in post-harvest activities, knowledge about market demand for food quality norms, capacity to respond to such market demands through skill and leadership building - Supporting food processing techniques such as fortification and food quality control • Development of a network of agribusinesses, mainly composed of informal female-owned microenterprises, to support the increase and improvement of agricultural production and value-added products needed to fulfill local buyers’ demand (e.g. National School Feeding Program, Household Development Agent Initiative and the World Food Organization). • Implementation of an impact evaluation to measure the appropriate impacts related to these specific interventions in nutrition. linking to markets but to food purchasing programs, (iii) provide (a) technical assistance related to complying like food aid and school feeding17. These projects and with procurement rules and nutrition expertise for local “alliances” require a clear demand for the food product to farmer groups to (b) improve food quality and supply food be produced (often in the form of a letter of intent from the assistance programs (such as food aid, school feeding, buyer). Therefore, to promote investments in food quality, and other local purchases programs). projects that help link farmers to markets could: (i) actively help farmer groups to find potential markets that value More traditional value chain approaches that increased nutritional content of food (having positive benefit nutrition and food safety involve post- spillovers into other markets and consumers); (ii) increase harvest handling and logistics. To improve food the amount and/or scoring system for those initiatives safety for marketed products, cold storage and that show a positive impact on nutrition outcomes; and transportation, together with good hygiene practices in handling and packaging, are essential. While 17 All traditional investments that aim to increase farmers’ access to some of these measures can be improved through markets such as infrastructure investment or market promotion are also knowledge and changes in routines, other require examples of ways of linking farmers to markets and strengthening the value chain. relatively large up-front investments, which are more 24 Agriculture for Nutrition in Latin America and the Caribbean: From Quantity to Quality prone to market failures, especially when agricultural illustrate the different nutrition problems and credit is scarce. Public investment project can agriculture sector country contexts, and how the therefore play a role, either by availing credit or by co- potential interventions may vary. The agriculture financing through conditional and competitive grants. sector in LAC is very heterogeneous in terms of overall Similar investments are required to maintain nutrition economic importance (agricultural GDP as % of total quality throughout the supply chain. The nutrition value GDP), social importance (agriculture income as % of of perishable products such as fruits and vegetable total income of the rural poor), competitiveness (net quickly declines after harvest, so appropriate storage, food exporter vs. net food importer), structure (small packaging, and preservation techniques are therefore vs. large-size farmers), etc. Also, nutrition indicators crucial. like obesity and stunting vary across countries, and the solutions and linkages between agriculture and C. Mainstreaming nutrition into nutrition are numerous depending on the situation. different agriculture sector In the next pages, we have focused on 3 countries settings in LAC as a way to illustrate the different situations and different opportunities for mainstreaming nutrition into Given the difficulty of grouping countries, this agriculture investments. section provides some country examples to Opportunities for mainstreaming nutrition into agriculture in LAC 25 D. Country notes - Agriculture for nutrition 1. Haiti Country Context Overweight, 2009 1 0.9 Net Food Import 0.8 0.7 Stunting, 2009 2008-2010 0.6 0.5 0.4 0.3 0.2 0.1 GDP per capita, PPP 0 Gini Index, 2011 (current international $), 2011 Agriculture, value added Rural Poverty (% of GDP), 2011 (< US $1.25 per day), 2009 National Poverty (< US $1.25 per day), 2009 Haiti LAC Average Note: All the LAC data were normalized to 1 to ensure comparability between variables and countries. • HDI ranking: 161 out of 182 countries1 Key Agricultural Actions to Address • Life expectancy: 63 years2 Nutrition Challenges in Haiti • Under-five mortality rate: 76 per 1,000 live births2 • Global ranking of stunting prevalence: 75th out of • Support diversified, nutritious and safe food 123 countries2 (where 1 is the highest prevalence production, and raise farmers’ as well as local and 123 is the lowest) consumers awareness of the nutrition side of food • Ag. GDP per Total GDP: 25%3 (GDP per capita: production to reduce chronic food insecurity. US$771) • Support farmers’ access to markets, including • Ag. employment per total employment: 50%10 food aid and school feeding programs, and food (24.15% of the agricultural labor force are women)3 preservation techniques to improve access to • Rural population: 45% of total population3 nutritious food. • Rural poverty 88%2; total poverty 55% • Support production of animal-sourced food for the local markets to reduce anemia. • Support the laboratory infrastructure to increase Investing in nutrition yields high returns: food safety for local and international markets 6-30 times its costs8. • Develop food standards such as, for example, iodized salt to address iodine deficiency. GDP growth originating in agriculture is at least twice as effective in reducing poverty as GDP growth stemming from other sectors (WDR, 2008)11. 26 Agriculture for Nutrition in Latin America and the Caribbean: From Quantity to Quality The Costs of Undernutrition • 25% infants are born with a low birth weight2. • 68% of children aged 6–24 months are not fed • Nearly half (45%) of all deaths in children under according to the three recommended infant five are due to undernutrition13. and young child feeding practices based on • The economic costs of undernutrition include diet diversity, adequate feeding frequency and direct costs such as the increased burden on the receiving breast feeding or milk products7. healthcare system, and indirect costs like the lost • One third of pre-school aged children are deficient productivity. in vitamin A; two thirds of children under-five, • Childhood anemia alone is associated with a three fourths of children under-two, and 60% 2.5% drop in adult wages4. of pregnant women suffer from anemia: 59% of children 6-12 are considered iodine deficient. Where Does Haiti Stand? • Food insecurity is highest in rural areas: For every 100 person affirming to be unable to satisfy their • 58% of all households in Haiti are food insecure5 alimentary needs in the country, 77 are located in and 49.8% are undernourished. The main rural areas, 9 in the capital’s metropolitan area and strategies that households adopt in response 14 in other cities12. Achieving food security means to lack of food or money to obtain food are ensuring quantity, nutritional quality and continuity reducing food quantity or number of meals of food access for all household members. per day, reducing dietary diversity, and adults • Food price declines at the international level after the reducing consumption for the benefit of children. food crisis were not fully reflected in local markets. • Overall food availability remains low with a total • Haiti has a high disease burden from food and food supply of 1,979 caloric per capita and day waterborne diseases. Undernourished children in 20096*. who fall sick are much more likely to die from such • 22% of children under the age of five are stunted, illness than well-nourished children. 7% of deaths 11% are underweight, and 5% are wasted2. under 5 children children is due to diarrhea. Box 1. Haiti’s Agro-Food Sector There are approximately one million farms in Haiti, averaging about 1.5 ha and divided between multiple parcels. The number of small farmers is rapidly growing and expanding on marginal land, which currently accounts for one third of the land used for farming. Haiti’s agro-environment is diverse, with about 20% of country is occupied by plains and the rest being mountainous. Forests are a natural component in the environment but also rapidly decreasing due to expanded agricultural land and the demand for wood. As a result, less than 2% of total land area is currently covered by dense forest. Similarly, watersheds are deteriorated and cause frequent floods. Agricultural production: Haiti’s agricultural production is diverse, and the sector produces both for the domestic and export markets. Exports have remained fairly stable over the past two decades, whereas imports of agro-food products have seen a four-fold increase. Fishing is important for income and nutrition in the costal areas, and occupies 50,000 people part or full-time, with demand at both local and international markets. * Anything below 2,200 kcal per capita and day in a country is considered low from a food availability perspective. 2,500 kcal per capita and day is considered a lower limit to ensure stable food access among the vast majority of a country’s population. Opportunities for mainstreaming nutrition into agriculture in LAC 27 Top 10, Production Value Avocados Plantains 5% Cattle meat 5% 17% Maize 6% Beans 7% Mangoes, mangosteens, Pigmeat guavas 8% 17% Cassava 9% Bananas Yams 14% 12% Top 10, Production Quantity Vegetables Mangoes, Rice 3% mangosteens, 3% guavas 5% Sweet Sugar cane potatoes 30% 6% Plantains 7% Yams 9% Maize Cassava 9% 18% Bananas 10% 28 Agriculture for Nutrition in Latin America and the Caribbean: From Quantity to Quality Import and Export Food Products, US$ Million Food Export Meat Import Food Import 0 200 400 600 800 1000 1991 - 93 2008 - 10 Import and Export (2010), US$ Million Beverages distilled alcoholic Fruit prp nes Coffee Mangoes, mangosteens, guavas Cocoa beans Oil essentials nes Ag. products total Food prep, flour, malt extract Food prep nes Sugar refined Milk whole evp Palm oil Chicken meat Soybean oil Wheat Sugar raw Rice Ag. products total 0 100 200 300 400 500 600 700 800 900 1000 Haiti’s farmers face numerous challenges that impact food security for both producers and consumers. Agricultural practices are basic and access to inputs such as fertilizers, quality seeds, livestock feed and even tools and equipment is limited. As a result, fertilizer use in Haiti is among the lowest in the world. Limited availability to agricultural credit poses an additional challenge to accessing inputs. Post-harvest infrastructure, including storage and post-harvest handling are underdeveloped, which cause oversupply of agricultural products in harvest seasons and post-harvest losses. They also result in poor quality of meat products and fruits and vegetables at markets. Similarly, physical access to markets is challenged by poor roads, which causes perishable products to rot on the way, to the extent that farmers are discouraged from producing fruits and vegetables. Opportunities for mainstreaming nutrition into agriculture in LAC 29 Limited agro-food processing shortens potential shelf-life of food products and limits access to food across seasons: Haiti’s agro-food industry is under-developed with poor infrastructure, poor communication, and difficulties complying with food safety standards, especially for export. Similarly, inadequate equipment, organization, and post-harvest handling, pose challenges to development of the fishing sector. Source: FAO STAT: Haiti National Agricultural Investment Plan, May 2010 Opportunities in Agro-Food Sector to pesticide management, in particular related to Address Causes of Undernutrition in Haiti water sources. • Maximize the impacts of the natural environment, Two main causes of undernutrition in Haiti are the limited considering soil characteristics, nutritional access to nutritious and safe food faced by a large content of crops and the diverse agro-ecological proportion of Haitians, and the high disease burden conditions. This can also support sustainability stemming from food and waterborne diseases. as it decreases the reliance on externally sourced inputs. Agroforestry** can be used as a method It is necessary to promote farm-to-fork approaches to to improve soil quality and to maintain marginal improve food quality and safety, as well as support safe land while availing it for food production. A recent production and handling of food products throughout the multisectoral initiative has been launched by Aba agro-food chain. At the same time that actions are taken Grangou (see below) to promote the adoption to increase food quality, the diversification of production and the use of Benzolive (MORINGA) to reduce is also needed to improve diets diversity across seasons. malnutrition. Similarly, integrated crop-livestock Finally actions should aim to contribute to the affordability farming can be used to improve soil quality and of a diverse, safe and nutritious food all year-round for maintain the natural nutrient cycle. the most vulnerable. The agricultural sector counts many • All of the above is likely to require incentives for opportunities to contribute to these solutions: the adoption of new technologies and practices as well as financing due to the limited private Food Production resources among farmers. Such programs can • Support farmers in increasing productivity and give extra points to investments that will yield quality of diverse food crops (to increase rural broader nutritional benefits. incomes and decrease prices through increased • To maximize returns from public support in this supply). regard, the focus should remain on identified • Integrate activities strengthening backyard food products produced for the domestic farming for household consumption and local markets that have been shown to have the most markets, including chicken and small ruminants, impact in rural economic development, namely into the regular work program of the extension rice, plantain/bananas, beans, legumes, root, services. dairy products, and farm chickens12. • Improve an all-year safe and diverse food supply by promoting good hygiene and storage practices Linking Farmers to Markets, Food Aid and in post-harvest handling. Also develop on and School Feeding Programs off-farm storing and processing techniques for • Invest in rural and market infrastructure to improve horticulture and livestock products. connectivity to markets, decrease post-harvest • Promote good agricultural practices for losses, encourage production of perishable food production of safe food. Such practices include ** Agroforestry means agricultural systems where trees are managed livestock management, and fertilizer and together with other crops and/or animals (FAO, 2013). 30 Agriculture for Nutrition in Latin America and the Caribbean: From Quantity to Quality products, and improve marketability of local among local and international consumers. products in urban areas. To ensure affordability for local consumers, • Support the organization of farmers to increase standards need to be developed in accordance volumes and quality of food produced, with the Haitian context in addition to any transformed and stored in order to offer international requirements. continuous supply to markets. • Develop national guidelines and standards • Help develop diverse food systems and for food product fortification and control investment in market infrastructure to locally mechanisms. procure for social programs including food • Develop systems for labeling food products to aid, school feeding programs and vouchers highlight nutrition and safety content. Successful distribution. This type of mechanism could be examples from other countries include systems used in time of emergency to ensure local food of simple symbols reflecting the content. This provision of food distribution and avoid adverse can be done in collaboration with the private market impacts***. sector, laboratories and the Ministry of Health • Today, the legislation in Haiti makes it very which already has an initiative on “Agriculture de difficult for social programs and public markets Santé Publique” (Public Health Agriculture). Make to procure the food locally. So action has to sure that an independent verification system is in be taken to either change the legislation and/ place to ensure the integrity of the system. or support farmers to comply with the law and criteria to qualify as suppliers to such programs. Ongoing Initiatives in Agriculture to • Social marketing should be developed in parallel Improve Nutrition in Haiti to promote diverse, safe and nutritious food to local demand. There are numerous on-going nutrition-sensitive agricultural initiatives and activities in Haiti. Many of Agriculture Research and Development these can be built upon or serve as models in order to • Improve micronutrient content in food products by not duplicate work and institution building. focusing R&D on developing fortified seeds of key staples and fertilizers rich in, for example, zinc. Aba Grangou is the Government cross-sectoral • Partner with the private sector to initiate fortification national strategic framework for reducing hunger and of certain food products such as milk and maize malnutrition. It is led by the President with the support of flour further up the value chain. PPPs with salt the First Lady and it’s objective is to halve the share of producers and national food standards could the food insecure population by 2016 and to eradicate enhance iodine fortification of salt in the country. hunger and malnutrition in Haiti by 2025. The program These should be accompanied with awareness works across nine ministries, seven autonomous campaigns to increase demand for iodized salt. agencies, 21 government programs, and the Haiti Red Cross. The program addresses hunger and malnutrition Regulations and Standards by improving access through social safety net programs, • Invest in food safety infrastructure such as increasing domestic food production through investing laboratories to ensure and enforce food safety in agriculture, and availing basic services such as health, standards. The development of food safety water and sanitation9. standards needs be reinforced to build trust The objective of the Strengthening of Agricultural *** Haiti has been a good example of the harm that food aid can cause Public Services Project II (RESEPAG II) is to strengthen to the agriculture sector when such a system is not in place to be scaled up. See: http://www.gao.gov/products/GAO-11-636. agriculture innovation and extension services. While the Opportunities for mainstreaming nutrition into agriculture in LAC 31 project works with the agricultural sector at large, it comprises several specific nutrition-sensitive activities. These include strengthening the institutional capacity of the Ministry of Agriculture in nutrition aspects, establishing nutrition modules in agriculture extension curriculum, and providing incentives for farmer groups (matching grants) to invest in nutrition improvements in food production. References 1. UNDP Haiti Country Profile: http://hdr.undp.org/ en/countries/profiles/HTI 2. UNICEF, 2014. State of the World’s Children. 3. FAO STAT, 2012. 4. Horton, S., Ross, J., 2003. The Economics of Iron Deficiency. Food Policy 28:517-5. 5. FAO, 2009. The state of food insecurity in the world: Economic crises – Impacts and lessons learned. 6. Addendum to the 2005 Haiti DHS, Infant and Young Child Feeding (IYCF) Practices. 7. FAO STAT, 2009. Haiti Food Supply. 8. Horton, S. et al., 2009. Scaling Up Nutrition: What will it cost? 9. SUN Haiti: http://scalingupnutrition.org/sun-countries/haiti 10. GAFSP Proposal Haiti 11. World Bank, 2008. World Development Report: Agriculture for Development. 12. Haiti National Agricultural Investment Plan, May 2010. 13. Black, R. et al., 2013. Maternal and Child. Undernutrition and Overweight in Low-income and Middle-income Countries. The Lancet, 382: 427–451. 32 Agriculture for Nutrition in Latin America and the Caribbean: From Quantity to Quality 2. Brazil Country Context Overweight, 2009 1 0.9 Net Food Import 0.8 0.7 Stunting, 2009 2008-2010 0.6 0.5 0.4 0.3 0.2 0.1 GDP per capita, PPP 0 Gini Index, 2011 (current international $), 2011 Agriculture, value added Rural Poverty (% of GDP), 2011 (< US $1.25 per day), 2009 National Poverty (< US $1.25 per day), 2009 Brazil LAC Average All the LAC data were normalized to 1 to ensure comparability between variables and countries. • HDI ranking: 85th out of 182 countries1 Key Agricultural Actions to Address • Life expectancy: 73.8 years2 Nutrition Challenges in Brazil • Under-five mortality rate: 14 per 1,000 live births2 • Global ranking of stunting prevalence: 115th • Support backyard and smallholder production out of 123 countries3 (where 1 is the highest of food in cash crop producing areas to improve prevalence and 123 is the lowest) nutrition outcomes in rural areas. When possible, • Ag. GDP per Total GDP: 5.5% (GDP per capita: include family agriculture in the supply chains of US$12,590)3 government safety net programs, to strengthen • Ag. employment per total employment: 10% local food systems. (24.5% of the agricultural labor force are women)5 • Improve shelf-life of fresh products through • Rural population: 12.7% of total population5 Rural support for the development of cold chains poverty 12% (below US$1.25 per day); total poverty and small-scale food processing, to supply 21% (6% below US$1.25 per day)4. competitive, nutritious products to urban consumers despite distance and infrastructural challenges. Investing in nutrition yields high returns: • Improve the food environment in urban areas to 6-30 times its costs10. avail a more diverse diet, and develop a labeling system for healthy vs. unhealthy foods to address GDP growth originating in agriculture the growing burden of overweight and obesity. is at least twice as effective in reducing poverty as GDP growth stemming from other sectors (WDR, 2008)11. Opportunities for mainstreaming nutrition into agriculture in LAC 33 The Costs of Undernutrition • 6.7% of the population is estimated to consume below the minimum level of dietary energy (2011 • Diabetes and cardiovascular diseases account figure)7. for 38% of all deaths in Brazil8 • Stunting among children has decreased over the • Children who are undernourished between past years and prevalence is now about 7%6. conception and age two are at high risk for • 8% infants are born with a low birth weight2. impaired cognitive development, which adversely • Malnutrition among children under five has been affects the country’s productivity and growth. more than halved since the 1990s6; 88% of all • Childhood anemia alone is associated with a households consume iodized salt2. 2.5% drop in adult wages12. • Although important gains have been achieved over • The Latin America and Caribbean region is the past decade in reducing undernutrition, obesity anticipated to lose a cumulative US$8 billion to is now becoming a problem (see Figure below). chronic disease by 20158. • 52% of Brazil’s population is overweight, 19% is obese8. Where Does Brazil Stand? • 43% have raised cholesterol, 40% have raised blood pressure, and 10% raised blood glucose8. • Poor nutrition affects rural and urban population • Daily food supply in Brazil is 3,173 Kcal per differently in Brazil. Especially in the Northeast, capita, at the level of high-income countries5. the rural population is still struggling with • Race, gender, and birth location still determine undernutrition and limited access to food; in access to adequate nutrition and clean water6. urban areas, malnourishment is a consequence • Clean water sources are problematic in rural and of nutrient-poor, energy-dense diets, resulting peri-urban areas6. in overweight and obesity, and diet-related non- communicable diseases. Brazil – Anthropometric Indicators for Population 5 to 9 Years of Age Male Female 34,8 32,0 29,3 26,7 16,6 15,0 14,7 12,6 11,9 11,8 10,9 8,6 7,2 5,7 4,3 6,3 5,4 3,9 4,1 2,2 2,9 1,5 1,8 2,4 Height Weight Overweight Obesity Height Weight Overweight Obesity Deficit Deficit Deficit Deficit 1974-1975 (1) 1989 (2) 2008-2009 Source: IBGE, Diretoria de Pesquisas, Coordenação de Trabalho e Rendimiento, Estudo Nacional de Despesa Familiar 1974-1975 e Pesquisa de Orçamentos Familiares 2008-2009; Instituto Nacional de Alimentação e Nutrição, Pesquisa Nacional sobre Saúde e Nutrição 1989. (1) Exclusively rural areas of the North and Midwest Regions. (2) Exclusively rural areas of the North Region. 34 Agriculture for Nutrition in Latin America and the Caribbean: From Quantity to Quality Box 1. Brazil’s Agro-Food Sector Brazil is one of the world’s most important agricultural producers and the sector remains very important in the country’s economy. Brazil is the world’s third largest agri-food exporter after the European Union and the United States and agricultural products account for 30% of total exports. The sector still employs about 10% of the total labor force. However, the rural population is decreasing and has decreased from about 21% to 12.5% over the past 15 years. Brazil’s agro-environment is highly diverse but land degradation and deforestation is a challenge. Large parts of the country is covered with forests and about 31% of Brazil’s land is used for agriculture (24% for pasture and 7% for cultivation). The climatic zones range from semi-arid land in the northeast, to tropical and subtropical climate in the center, and more temperate climate in the south. Brazil is well suited for agriculture but there is significant land- degradation and low soil-suitability across the country. Smallholder farms are important contributors to the sector, though belong to Brazil’s poorest. Brazil’s agricultural sector is divided between large-scale export oriented farms in the south and center-east regions, and about 4 million smallholder, or family farms of which a share is classified as subsistence farms. Although these farms face a multitude of challenges, including limited access to inputs, credits, technical know-how, and markets, they account for 70% of domestic food production and also contribute to exports. Unequal land distribution contributes to rural poverty. In particular in the northeast and in central Brazil, landless farmers and smallholders are impoverished. At the same time, non-agricultural employment is increasingly important and provides the main source of income for 30% of the rural population Brazil’s agricultural production is strongly correlated with its main agricultural exports. Reflecting a significant shift towards meat exports over the past two decades, feed and meat products along with sugar and traditional export products like coffee and oranges (for juice) dominate agricultural production. As for trade, it is interesting to note that high-value and quite specialized products such as wine, olive oil, garlic and frozen potato are among the top ten import products in value terms. Top 10, Production Value (2011) Coffee 3% Maize 3% Rice 3% Oranges 3% Cattle Meat Pigmeat 4% 23% Cow milk 9% Chicken meat 14% Sugar cane 22% Soybeans 16% Opportunities for mainstreaming nutrition into agriculture in LAC 35 Top 10, Production Quantity (2011) Rice 1% Bananas 1% Oranges 1% Cattle Meat 1% Cassava 2% Chicken Meat 1% Cow milk 3% Maize 6% Soybeans 8% Sugar cane 75% Change in Imports and Exports, US$ Million Meat Export Food Meat Import Food 0 10000 20000 30000 40000 50000 Annual 1991-93 Annual 2008-10 36 Agriculture for Nutrition in Latin America and the Caribbean: From Quantity to Quality Top Imports and Exports (2010), US$ Million Maize Tobacco, unmanufactured Sugar (refined) Cattle meat (boneless) Exports Soybeans (cake) Coffee Chicken meat Sugar (raw centrifugal) Soybeans Frozen potatoes Olive oil Flour (Wheat) Wine Imports Garlic Food Prep Nes Rice Malt Rubber (Nat Dry) Wheat 0 2000 4000 6000 8000 10000 12000 Productivity has increased significantly over the past decades but yield gaps remain and increase in production is also a result of expansion in land. Brazil’s grain production increased 245% since the late 1970s, while cultivated land increased only 35%. At the same time, yield gaps remain. Future competitiveness of the sector will depend on the ability to tackle environmental degradation and ensure sustainable use of natural resources. Deforestation, soil nutrient depletion, and soil erosion are of major concern in Brazil. A vicious cycle of deforestation in marginal areas for agricultural production (e.g. coffee, sugar, and cattle) by farmers who are unable to afford fertilizers causes nutrient depletion of soils and the need to incorporate new areas into production and thus further deforestation. Brazil production is highly at risk of being affected by climate change over the next century and it will have significant impact on food production under the current agricultural system. Temperatures are projected to increase and precipitation is expected to decrease. Not all parts of the country will be equally affected, however. Although decreased crop yields are projected for southeastern Brazil, intense rains will occur more frequently and floods will increase, as opposed to northeastern Brazil where precipitation is expected to be reduced by 15-20%. Further, rising sea levels will affect the mangrove ecosystems of Brazil. Climate change models projects that, with time, southern Brazil will no longer be suitable for grain crops such as rice, beans, maize, and soy, and that this production would instead move towards the central and western parts of the country. The rural poor are already affected by changes in weather patterns. Droughts over the past years in northeastern Brazil have resulted in up to a 25% decrease in agricultural GDP, which in turn has led to out-migration and displacement of millions of low-income rural people. Especially vulnerable have been those supporting themselves through subsistence agriculture. Source: FAO STAT Country Profile: Brazil, World Bank Climate Change Country Note; IFAD Rural Poverty Country Profile; OECD Policy Brief (2005) Opportunities for mainstreaming nutrition into agriculture in LAC 37 Opportunities in Agro-Food Sector to local populations’ all-year access to diverse diets Address Causes of Undernutrition and either though local food production or markets. Obesity in Brazil Similarly, broader policies should be evaluated from a public health aspect at the macro level. Due to the size and the diversity of the country, agricultural • Support access to improved fertilizers to avoid interventions to tackle Brazil’s nutrition problems will be further soil nutrient depletion and to improve complex and multifaceted. Although undernutrition and nutritional content in food production. stunting still exist, particularly in certain rural areas, the • Ensure access to competitive seed varieties adequate amount of calories is not the primary challenge for food producers to improve the quantity and to improve diets in Brazil, especially given the rise in quality of outputs and to ensure that they can obesity. Better understanding the local nutrition status compete on urban markets. and challenges to access nutritious and diverse diets is • Support integrated pasture management to required to develop targeted interventions. Many initiatives halt land degradation and to ensure continued of this kind are already ongoing throughout the country livestock production, also among smaller-scale and have proven effective in improving nutrition indicators farmers, without further deforestation. as well as developing and strengthening local food • Support climate change adaptation among food systems. Yet, with the past decades’ rapid urbanization producers though climate resilient seeds and and continued rising incomes, the challenge of overweight breeds, knowledge about alternative production, and non-communicable, diet-related diseases are bound and through improved water management. This to grow, emphasizing the need for innovative approaches can be done within the ongoing Climate Risk to integrate rural and urban markets. Zoning Program. • In rural areas with limited access to diverse, year- Limited Access to Safe and Nutritious Food round markets, promote diversity of subsistence in Rural and Urban Areas food production, such as backyard farming, Some of the opportunities include: (i) improve food through extension services and improved access production in rural areas; (ii) improve supply opportunities to inputs, specially for small-scale cash-crop to urban markets through improved storage and producers and subsistence farmers. processing; (iii) improve food environments in urban • Promote good agricultural practices and hygienic areas and avail space for safe and diverse markets; (iv) handling of food products to reduce food and link poor producers and consumers through existing waterborne diseases. Such practices would government safety net programs; (v) promote farm- include livestock management and fertilizer and to-fork approaches to food safety; and (vi) help small pesticide management, in particular related farmers comply with food safety standards to be able to water sources. Promote good hygiene and to supply school feeding programs. This can be done storage practices in post-harvest handling of through the following: food products. Food Production Develop more Diverse Food Markets Brazil has achieved great increases in food production • Support increased profitability for local food in recent decades, however some opportunities to production by developing market infrastructure contribute to the nutrition agenda exist: and supporting on and off-farm storage and processing of food products. This is not only • Assess nutrition impacts on the rural population important in distant areas with poor roads but from state interventions and projects; ensure crucial for reaching the urban inhabitants that now that such interventions do not compromise the account for almost 90% of Brazil’s population. 38 Agriculture for Nutrition in Latin America and the Caribbean: From Quantity to Quality Given the importance of small-scale farmers in laboratories that currently support the export the domestic food supply, developing market- sector. Enforce stricter food safety standards on channels and value chains could have significant the domestic markets for larger producers. impacts on both farm incomes and consumers’ • Develop national guidelines and standards for food access to diverse diets. product fortification and control mechanisms. • Although traditional cash crops may in many • Develop systems for labeling food products to cases be most profitable for farmers to produce, highlight nutrition content and to alert consumers opportunities exist for farmers to scale up food when products are high in sugars, salt, and production by participating in Brazil’s school saturated fats as a mean to tackle the growing feeding and safety net programs, under, or obesity burden. Successful examples from other copying the model of, Brazil’s Food Acquisition countries include systems of symbols reflecting Program (Programa de Aquisiçaõ de Alimentos, the content. This can be done in collaboration with PAA) and the National School Feeding Program the private sector and can gradually be enforced (PNAE). Provide technical assistance to farmers among processors above a certain size. Make to comply with food safety standards and other sure that an independent verification system is in procurement requirements to participate in these place to ensure the integrity of the system. programs. • Improve the urban food environment so that Ongoing Initiatives Linking Agriculture to diverse and nutritious foods are available at Nutrition in Brazil urban markets, also in areas with lower-income consumers. This can be done by developing The Zero Hunger Program (Fome Zero), adopted market-space connected to clean water, electricity, in 2003, is an umbrella program with the objective of and refrigerated storage areas for the cleaning of eradicating hunger and extreme poverty in Brazil. The space and products, and for cold storage. These program supports both production and consumption of markets should have systems for accepting food healthy food through measures such as food stamps, stamps from program such as Zero Hunger. school feeding programs, and integrating family agriculture into viable food systems. Nutrition education Agriculture Research and Development is also part of the program9. • Continue initiatives like BioFORT to develop fortified seeds in order to improve micronutrient Food Acquisition Program (Programa de Aquisiçaõ content in food products. Scope also exists for de Alimentos, PAA): Through a public sector purchasing developing mineral and nutrient-rich fertilizers for entity, the Government buys food products from small the same purpose. farmers and gives (donates) food to NGOs and public • Focus R&D on developing climate resilient seeds sector programs for food aid. and breeds for food production. • Continue initiatives such as Harvest Plus to fortify National School Feeding Program (PNAE): Through processed food products in stores. Partner with municipal-level quotas, the public resources allocated to the private sector to initiate fortification of certain buying food for school feeding require that a mandated food products such as milk and maize flour minimum level of 30% of the food is sourced locally. In further up the value chain. practice, many municipalities buy approximately 50% of their food from local small farmers. Food Regulations and Standards • Invest in food safety infrastructure such as Agriculture R&D: Embrapa, the public sector laboratories or purchase services from private Agriculture Research organization, invests resources in Opportunities for mainstreaming nutrition into agriculture in LAC 39 biofortification and best practices that improve nutrition content of food products. The World Bank supports rural poverty reduction and improved natural resource management through increased family agriculture productivity and market access in the North (Acre), Northeast (Ceará, Pernambuco, Rio Grande do Norte) and South (Paraná, Santa Catarina)6. References 1. UNDP Brazil Country Profile: http://hdr.undp. org/en/countries/profiles/BRA 2. UNICEF, 2014. State of the World’s Children. 3. Encyclopedia of the Nations: http://www.nationsencyclopedia.com/ WorldStats/WHO-status-stunting-prevalence.html 4. World Development Indicators Database, accessed on June 1, 2013. 5. FAO STAT Country Profile: Brazil, accessed on June 25, 2013. 6. IBRD and IFC: Country Partnership Strategy for the Federative Republic of Brazil for the Period FY 2012-2015, approved September 21, 2011. 7. WHO Nutrition Landscape Information System Country Profile: Brazil: http://apps.who.int/nutrition/landscape/report. aspx?iso=bra, accessed on June 30, 2013. 8. WHO, 2011. Non-communicable Diseases Country Profiles: http://www.who.int/countries/bra/en/, accessed on June 25, 2013. 9. World Bank, 2013. LAC Agriculture for Nutrition Companion Note. 10. Horton, S., et al., 2009. Scaling Up Nutrition: What will it Cost? 11. World Bank, 2008. World Development Report: Agriculture for Development. 12. Horton, S., Ross, J., 2003. The Economics of Iron Deficiency. Food Policy 28:517-5. 40 Agriculture for Nutrition in Latin America and the Caribbean: From Quantity to Quality 3. Guatemala Country Context Overweight, 2009 1 0.9 Net Food Import 0.8 0.7 Stunting, 2009 2008-2010 0.6 0.5 0.4 0.3 0.2 0.1 GDP per capita, PPP 0 Gini Index, 2011 (current international $), 2011 Agriculture, value added Rural Poverty (% of GDP), 2011 (< US $1.25 per day), 2009 National Poverty (< US $1.25 per day), 2009 Guatemala LAC Average Note: All the LAC data were normalized to 1 to ensure comparability between variables and countries. • HDI ranking: 133 out of 182 countries (2011, Key Agricultural Actions to Address down from 122 in 2008)1,2 Nutrition Challenges in Guatemala • Life expectancy: 72 years2 • Under-five mortality rate: 32 per 1,000 live births2 • Improve support to competitive supply chains of • Global ranking of stunting prevalence: 6th highest foods like meat and horticulture to link to local out of 123 countries2 markets and food aid/school feeding programs • Ag. GDP per Total GDP: about 20%1 (11.3%6) to address problems such as anemia among GDP per capita: US$2,8736 young children and pregnant women. • Ag. employment per total employment: 40%9 • Improve diversity and production based on • Rural population: 51% of total population1 household food consumption and nutrition • Rural poverty 71%6; total poverty 54%7 (7 out of decisions. 10 people of indigenous decent lives in poverty)9. • Improve the agriculture inputs used by farmers, promoting those with nutrition impact, such as biofortified seeds and fertilizers with zinc. Investing in nutrition yields high returns: • Improve nutrition along the supply chain by 6-30 times its costs4. promoting investments in food fortification and labeling systems for healthy foods to address the GDP growth originating in agriculture growing burden of overweight and obesity. is at least twice as effective in reducing • Work together with the private sector to improve the poverty as GDP growth stemming from food safety system and implement food standards other sectors (WDR, 2008)5. for iodized salt and to address iodine deficiency. Opportunities for mainstreaming nutrition into agriculture in LAC 41 The Costs of Undernutrition twice that of non-indigenous children3. Nearly 8 out of 10 indigenous children are stunted • Underweight in Guatemala (at 18%) cost the compared to 4 out of 10 non-indigenous country US$3.1 million, or 11.4% of GDP, in children. Large differentials in chronic lost productivity in 2004. This is over half the malnutrition by ethnicity may reflect social combined cost of undernutrition for all of Central exclusion or other forms of differential access America3. to services7. Indeed, supply side barriers have • Nearly half (45%) of all deaths in children under been shown to be particularly important for the five are due to undernutrition10. indigenous population8. • Children who are undernourished between • 1 in 8 infants are born with a low-birth weight2. conception and age two are at high risk for • 67% of Guatemalans aged 15 and above are impaired cognitive development, which adversely overweight, of which 29% are obese6. This is affects the country’s productivity and growth. a problem in urban areas in particular. Poverty • Childhood anemia alone is associated with a levels in urban areas are 35% compared with 2.5% drop in adult wages4. 71% in rural areas6. • The Latin America and Caribbean region is • Micronutrient deficiency is wide spread, with anticipated to lose a cumulative US$8 billion to 38% of children under-five and 22% of pregnant chronic disease by 20155. women being iron deficient, 16% of pre-school children being vitamin A deficient, and less than Where Does Guatemala Stand? half the households in Guatemala use iodized salt, causing an estimated 67,000 children being • Guatemala has the third highest rate of chronic born mentally impaired every year. malnutrition (stunting) in the world (54.5%)2. • Food insecurity is related to inadequate intake of • Indigenous children suffer disproportionately, nutritious food rather than insufficient intake of with rates of stunting and underweight almost calories. Box 1. Guatemala’s Agro-Food Sector Guatemala’s agricultural sector accounts for a significant share of the economy, employing over 40% of the workforce and contributing 10.2% of GDP and about half the country’s exports. About 70% of agricultural land is under cultivation. Agro-environmental conditions are not ideal as parts of the country are covered by mountains, and dense forests cover certain regions. Farming is largely done on steep slopes and soil erosion is a problem. Roads are not well developed, especially in the northeastern region, and parts of the countries are relatively inaccessible. This is reflected in the limited development of irrigation in many places, and farmers often rely solely on rainfall, which makes them vulnerable to unpredictable weather. Changing weather patterns with increased temperatures, decreased precipitation, and more frequent droughts and hurricanes are projected in the future as a result of climate change. Forest-covered areas are cleared for subsistence farming and natural resources, such as land and water are heavily exploited for agriculture, which has resulted in lower productivity in basic crops. This has allegedly led to more food-insecurity among poor small-hold farmers. Infrastructure is better developed and agro-climatic condition are favorable in the southeastern part of the country and has allowed farmers to diversify and to access markets. Agricultural production: Guatemala’s agricultural sector is highly export oriented. The top 10 products in terms of value are also Guatemala’s man export products, including bananas, sugar, and coffee. Horticulture is limited but meat and animal sources food makes up a significant share of production. 42 Agriculture for Nutrition in Latin America and the Caribbean: From Quantity to Quality Top 10, Production Value Tomatoes 4% Beans 4% Natural rubber 4% Bananas Cow milk 26% 5% Hen eggs 7% Cattle meat 8% Sugar cane Chicken meat 23% 9% Coffee 10% Top 10, Production Quantity Pineapples 3% Coffee 11% Sugar cane 27% Palm oil 5% Tomatoes 5% Cow milk 6% Potatoes 4% Melons (inc. cantaloupes) 4% Maize 3% Bananas 32% Opportunities for mainstreaming nutrition into agriculture in LAC 43 Change in Imports and Exports, US$ Million Meat Export Food Meat Import Food 0 500 1000 1500 2000 2500 1991-93 2008-10 Top Import and Export (2010), US$ Million Beverage Non-Alc Natural rubber Melons (inc. cantaloupes) Food Prep Exports Palm oil Rubber (natural, dry) Nutmeg, mace and cardamoms Bananas Coffee Sugar (Raw, centrifugal) Chicken meat Milk Whole Dried Tallow Imports Pastry Breakfast Cereals Soybean oil Cake of Soybeans Wheat Maize Food Prep 0 100 200 300 400 500 600 700 800 44 Agriculture for Nutrition in Latin America and the Caribbean: From Quantity to Quality It can be noted that several products are both imported and exported. The preceding figure only covers the top 10 imports and exports products, but while Guatemala for example imports significant amount of pastry in value terms, pastry is also the country’s 11th food export item. It might thus be that a number of products are for value adding industries. Guatemala’s agricultural sector has changed over the past decade. People have in part moved from on-farm labor to agricultural self-employment and to non-agricultural employment. Interestingly, farm workers in general earn more than the agricultural self-employed. Labor productivity in the sector has increased over the past years but mainly in large-scale, export oriented production. Nevertheless, access to resources is limited for the landless rural population and for households headed by women. Guatemala produces food staples, including maize, sorghum, and beans for domestic consumption, and coffee, bananas, rubber, sugar cane, and livestock for export. High-value agriculture for export has also taken off, with vegetables, fruit, and flowers. Supply-chains include contract farming with small-scale farmers. Source: FAO STAT; World Bank Poverty Assessment (2009); World Bank Climate Change Aspects in Agriculture, Guatemala Country Note (2009); Ifad, http://www.ruralpovertyportal.org/country/home/tags/guatemala Opportunities in Agro-Food Sector to Address and improve affordability of diverse diets. Improve food Causes of Undernutrition in Guatemala environments in urban areas and avail space for safe and diverse markets by linking farmers to health and Guatemala struggles with the double burden of education programs (schools, food voucher programs, undernutrition and obesity. Although the country has a etc.). Promote a farm-to-fork approach to food safety. competitive agro-food sector, high poverty rates prevail Support safe production and handling of food products in rural areas and among the indigenous populations, throughout the agro-food chain. This can be done and are the primary cause of undernutrition. Although through the following: income levels increased among the poor segments of the population in the 2000s, increases in domestic food prices Food Production exceeded that of incomes and thus extreme poverty • Support farmers in increasing productivity and grew as did the share of household income availed to quality of diverse food crops by leveling the food. Any changes in extreme poverty were also uneven, playing field of producer supports across food as it declined among the non-indigenous population but products (to increase rural incomes and decrease not in the indigenous, and in certain regions but not in prices through increased supply). others8. In addition, rural infrastructure, including roads, • Given the inadequate access to markets, does not cover much of the areas, limiting access to especially for rural on-farm laborers, strengthening markets and market diversity for both producers and backyard farming for household consumption consumers, in particular in the northeastern part of the and local markets, including chicken and small country8. Obesity, on the other hand, is common in urban ruminants. areas and caused by a more complex set of factors from • Review agriculture support policies and programs food environments and market offer, to affordability of to support all-year round diverse markets. With diverse diets compared with energy-dense processed Guatemala’s well-developed export supply chains food. In both these cases, the agricultural sector has a (bananas, coffee, etc.), high-value horticulture role in improving diets in Guatemala. could also reach local markets. Often the best quality products go directly for export, and the Limited Access to Nutritious Food rest (often those with visible flaws) end up on Opportunities: Improve and diversify food production the local market. Stronger linkages between for local markets, diversify markets throughout seasons, high-quality foods and horticulture, and local Opportunities for mainstreaming nutrition into agriculture in LAC 45 markets could be achieved by linking agriculture products by focusing R&D on developing fortified production policies and programs with social seeds of key staples and fertilizers rich in, for safety net, education and health programs with example, zinc. nutrition objectives. Support to farmers could • Partner with the private sector to initiate include access to school feeding or food aid fortification of certain food products such as milk programs, as well as investing in off-farm storing and maize flour further up the value chain. PPPs and processing techniques for horticulture and with salt producers and national food standards livestock products, especially in areas where could enhance iodine fortification of salt in the roads are poor and products more likely to spoil country. These should be accompanied with during transportation to markets. awareness campaigns to increase demand for • Promote food safety at the farm level, through iodized salt. good agricultural practices and hygienic handling of food products to reduce food and waterborne Regulations and Standards diseases. Such practices would include livestock • Invest in food safety management and management as well as fertilizer and pesticide infrastructure such as laboratories or purchase management, in particular related to water services from private laboratories that currently sources. Promote good hygiene and storage support the export sector. Enforce food safety practices in post-harvest handling of food standards on the domestic markets for larger products. producers. • Ensure full implementation of the General Law for Develop Diverse Food Markets the Fortification of Food Products. • Invest in agriculture public goods and services • Develop systems for labeling food products to (particularly in infrastructure in the northeastern highlight nutrition content and to alert consumers region) to improve connectivity to markets, to when products are high in sugars, salt, and decrease post-harvest losses, to encourage saturated fats as a mean to tackle the growing production of perishable food products, and to obesity burden. Successful examples from other improve marketability of local products in urban countries include systems of symbols reflecting areas. the content. This can be done in collaboration • Help farmers link to school feeding programs with the private sector and can gradually be by complying with quality and procurement enforced among processors above a certain standards and other criteria to qualify as suppliers size. Make sure that an independent verification to such programs. system is in place to ensure the integrity of the • Help farmers link to food aid and food voucher system. systems, to promote urban farmers markets and link health campaigns with local food Ongoing Initiatives in Agriculture to sourcing. This could help improve the urban food Improve Nutrition in Guatemala environment so that diverse and nutritious foods are available at urban markets, in particular in To address the persistent malnutrition rates in areas with lower-income consumers. Guatemala, several initiatives have been launched by the Government over the past years. Central is the Research and Development Zero Hunger Pact, which pulls together Government, • Promote R&D in biofortification and improvements the civil society and the private sector in a movement of agriculture inputs. Potential areas include the to combat hunger in the country. Importantly, the Zero improvement of micronutrient content in food Hunger Pact is cross sectoral and an Action Plan at the 46 Agriculture for Nutrition in Latin America and the Caribbean: From Quantity to Quality core of the Pact guides the Government’s initiatives. The 10. Black, R. et al., 2013. Maternal and Child. Zero Hunger Pact is committed to: (i) reduce chronic Undernutrition and Overweight in Low-income malnutrition among children by 10% over the next 4 and Middle-income Countries. The Lancet, 382: years, and by 24% over the next 10 years; (ii) reduce 427–451. the number of deaths due to acute malnutrition, and to provide maternity care and healthcare to young children; and (iii) fight poverty and exclusion as a mean to combat malnutrition, with a particular focus on rural indigenous women. The Zero Hunger Pact is coordinated by the Food and Nutrition Secretariat (SESAN), which has also developed the Zero Hunger Plan for 2012-16. The Action Plan focuses mainly on child feeding practices, including through the provision of nutrition supplements and fortified food products, and on providing vaccination to small children. However, to sustainably combat seasonal hunger and malnutrition, the Action Plan includes support to family agriculture to increase production through improved inputs and practices. The Pact has taken a step-wise approach, focusing on those municipalities where chronic and acute malnutrition is most prevalent but will, over time, scale up to cover the whole country. The Ministry of Agriculture, Livestock and Food (MAGA) has been assigned a central role in meeting the Pact’s objectives. References 1. UNDP Guatemala Country Profile: http://hdr. undp.org/en/countries/profiles/GTM 2. UNICEF, 2014. State of the World’s Children. 3. Nutrition at a Glance: Guatemala 4. Horton S. et al., 2009. Scaling Up Nutrition: What will it Cost? 5. World Bank, 2008. World Development Report: Agriculture for Development 6. World Development Indicators Database 7. CIA Fact Book: https://www.cia.gov/library/publications/the- world-factbook/geos/gt.html, accessed June 22, 2013 8. World Bank Poverty Assessment, 2009 9. IFAD: http://www.ruralpovertyportal.org/country/ home/tags/guatemala Measuring nutrition outcomes in agriculture programs in LAC 47 III. Measuring nutrition outcomes in agriculture programs in LAC The list below summarizes some of the possible recognize that a comprehensive approach is necessary interventions to mainstream nutrition into agriculture to improve overall diet and nutrition indicators in a programs in LAC, with possible respective indicators sustainable manner. As mentioned in previous sections, that could be used to measure progress in terms there’s a need to better understand the potential impact of nutrition outcomes. They have to be taken as a of agriculture investments and policies in nutrition complement of those developed in the Global Guidance outcomes, and the measurement of such activities will Note18. While each of these interventions could have a be very useful to inform future project design and policy significant impact on nutrition outcomes, it is important to making in LAC.19 Table 1. Possible nutrition sensitive interventions and example of indictors for agriculture programs (non-exhaustive list): Nutrition related Identified interventions Examples of indicators and mechanisms goals for measuring impact on nutrition outcomes19 1. Agriculture R&D Programs Increase year • Enhancing capacity of national agricultural • Availability of biofortified varieties relative to non-biofortified varieties round access to research institutions to develop and promote • Number of hectares harvested by farmers using biofortified varieties and availability nutrition-sensitive food production. • Availability of enhanced fertilizers relative to non-enhanced fertilizers of high nutrient • Establish a regulatory framework that allows content food • Number of hectares cultivated with appropriate amounts of enhanced for the development of seeds, fertilizers, and fertilizers compared with non-enhanced fertilizers. breeds and that does not limit farmers’ access to these. • Availability of/number of animals/herds replaced with for the context improved breeds • Establish a regulatory framework for • Nutrition-related indicators to measure the improvement in products fortification of food products. focused on under the R&D project, such as improved nutrition content, • PPP in R&D to develop food products decrease in contamination, or extended shelf-life throughout the supply chains in a manner that • Volume/Sales/Share of total market of fortified food produced and/or would have significant nutrition outcomes, other products developed under the project for example fortified products, improved packaging, extended shelf-life, etc. • Develop models for marketing of local crops through improved packaging, shelf-life, etc. 2. Linking Farmers to Markets and Food Purchasing Programs Increase year • Linking smallholders to the value chain of • Net sales from [livestock, milk, fish, fruits and vegetables or any round access to nutritious foods (e.g. livestock, dairy, fish, fruits production with higher nutritional value/content] and availability & vegetables or any production with higher • Number of certification/labels created to identify safe and nutritious of high nutrient nutritional value/content) and food purchasing foods in the market content food programs. • Volume and % of food from social protection programs sourced from local production • Number of farmers/volume of products included in cold-chains • Development of local markets with better linked • % of food from food aid/school feeding programs being sourced locally farmers and improved market infrastructure using nutrition sensitive techniques and inputs and food safety. • Change in diversity of products procured under such programs. • Campaigns to promote locally produced agro- food products. 18 See footnote 1 19 Except if it is mentioned, all indicators will be disentangle by gender 48 Agriculture for Nutrition in Latin America and the Caribbean: From Quantity to Quality 3. Agriculture Extension and Information Services Increase year • Develop/adapt agriculture-nutrition related • Training hours received by agriculture extension workers on practices round access to curriculum for extension/economics agents. that will impact the nutrition problem in line with the context and availability • Develop extension activities to promote Good • Training hours received by beneficiaries in order to improve the safety of high nutrient Agricultural Practices for the production of safe and nutritional content of the agricultural production/processing. content food food and for protection of agricultural soil and • Training hours received by beneficiaries in order to improve the waters. nutritional content of their meals • Development of education curriculum to • Number of hours of home economics extension services received by improve consumer’s knowledge of nutrition. beneficiaries • Inclusion of home economics specialists in the • Dietary diversity score of beneficiary households (for women and agriculture extension force, favoring particularly children) the recruitment of women. • Increase productivity of small scale nutritious • Number of times in the last week where any amount of [animal meat, food production (e.g. livestock, dairy, fish, fruits fish, milk, fruits and vegetables] was consumed by household members and vegetables). (disaggregated by gender and children) • Promote improved post-harvest handling and • Grams/day of [animal meat, fish, milk, fruits and vegetables] consumed preservation techniques on the farms. by household • Level and seasonal fluctuation of the dietary diversity score (for women and children) through the entire year and seasons • Number of times in the past 12 months the household was not able to procure nutrient rich foods [livestock, milk, fish, fruits and vegetables], specifying the reason: availability, price, etc. • Share of products with some form of value added for food safety and/or preservation/extended shelf-life before leaving farm 4. Women and Nutrition Invest in women • Improve productivity and income for women. • Income and income coefficient of variation of revenues of women • Increase income stability of women revenue. • Investments allocated to women and/or gender-sensitive activities • Increase women participation in decision • Value added of activities managed by women and/or women groups making of agriculture production and commercialization. • Increase women empowerment in the corresponding programs and agencies. Annex 1 49 Annex 1. Nutrition glossary ANEMIA: It is a condition in which the number of red blood cells or their oxygen-carrying capacity is insufficient to meet physiologic needs, which vary by age, sex, altitude, smoking and pregnancy status. Iron deficiency is thought to be the most common cause of anaemia globally. It is caused by poor diet and can be exacerbated by infectious diseases, particularly malaria and intestinal parasites. MALNUTRITION: It is defined as all forms of poor nutrition, including both undernutrition and overnutrition. OVERWEIGHT and OBESITY – ADULTS: Overweight and obesity are defined as excessive fat accumulation that may impair health. The body mass index (BMI) is an index of weight-for-height that is commonly used to classify overweight and obesity in adults. The BMI is defined as the ratio of weight in kilograms over height in meters squared (kg/m2). A person whose BMI is greater than 25 is overweight, and greater than 30 is obese. OVERWEIGHT and OBESITY – CHILDREN: Children above 2 years of age can be classified as being normal weight, overweight or obese using their BMI measures, and the international cut-off points recommended by the Childhood Obesity Working Group of the International Obesity Taskforce: between the 85th and 95th percentiles children are considered overweight, and above the 95th percentile, obese. STUNTING: Stunted growth reflects a process of failure to reach linear growth potential as a result of suboptimal health and/or nutrition conditions. Stunting is traditionally used as an indicator of nutrition status in children. It means being too short for one’s age and it is calculated by comparing the height-for-age of a child with a reference population of well- nourished and healthy children. Stunting is a cumulative indicator of nutritional deprivation since birth or conception. It is relatively independent of immediate circumstances, since height does not change much in the short term. The worldwide variation of the prevalence of low height-for-age is considerable, ranging from 5% to 65% among the less developed countries. UNDERNOURISHED: To provide insufficient quantity or quality of nourishment to sustain proper health and growth. UNDERNUTRITION: It is the consequence of insufficient food intake and repeated infectious diseases. It includes being underweight, stunted, wasted or deficient in vitamins and minerals (micronutrient malnutrition). UNDERWEIGHT: It means having too low weight for one’s age and it is calculated by comparing the weight-for-age of a child with a reference population of well-nourished and healthy children. It can be seen as a more comprehensive indicator, as both stunted and wasted children are likely to be underweight. The worldwide variation of low weight-for- age is similar to that of stunting. WASTING: It means being too thin for one’s height and it is calculated by comparing the weight-for-height of a child with a reference population of well-nourished and healthy children. Wasting is usually taken to be an indicator of short- term nutrition status, as it reflects a recent and severe process that led to substantial weight loss, usually associated with starvation or disease. Provided there is no severe food shortage, the prevalence of wasting is usually below 5%, even in poor countries. 50 Agriculture for Nutrition in Latin America and the Caribbean: From Quantity to Quality Z-SCORES: Weight-for-height, height-for-age and weight-for-age are usually interpreted by using the Z-score classification system. The Z-scores are constructed standardizing the measure as its deviation from the median of the reference healthy population for that age in months and sex, and dividing it by the standard deviation from the same reference population. The Z-score cut-off points are <-2 SD (standard deviations) to classify low weight-for-age, low height-for-age and low weight-for-height as moderate and severe undernutrition, and <-3 SD to define severe undernutrition. For example, a child whose height-for-age Z-score is less than minus two but greater than minus 3 (-2> Z >-3) is considered moderately stunted. An alternative classification uses the weight-for-height Z-scores: a child is overweight if he is more than 2 standard deviations above the corresponding child growth standards median, and he is obese if he is more than 3 standard deviations above it. Annex 2 51 Annex 2. Data construction and sources The nutrition data are nationally representative prevalence of stunting and overweight/obesity in Latin America and the Caribbean. Source: PAHO’s Health in the Americas report, 2012 edition. The food trade data comprises commodities in SITC sections 0 (food and live animals), 1 (beverages and tobacco), and 4 (animal and vegetable oils and fats), and SITC division 22 (oil seeds, oil nuts, and oil kernels). Source: UN Comtrade. GDP per capita PPP: Gross Domestic Product per capita, based on Purchasing Power Parity (current international $). Source: IMF, World Development Indicators (WDI). Agriculture Value Added (% GDP). Source: World Development Indicators (WDI). Rural Poverty (below US$1.25 a day). Source: World Development Indicators (WDI). Construction of the nutrition variables When data was not available for the needed year, the two available nearest data points were averaged to obtain the prevalence rate for the year needed. The nearest data points were selected in the following ranges for each needed year: 1990: 1989-1991: Exceptions for stunting: 1986-1995 (Colombia), 1982-1996 (Costa Rica) 1995: 1994-1996 2000: 1998-2002 2005: 2002-2006 2009: 2007-2010: Exception for stunting: 2006-2010 (Ecuador) The “last available year” for the nutrition indicators: • Overweight: 2005-2010. Except for Guatemala (2002) and Dominican Republic (2002) • Stunting: 2006-2010. Except for Haiti (2005) and Panama (2003) The “first available year” for the nutrition indicators: • Overweight: 1989-1996. Except for Haiti (2000) and Honduras (2001) • Stunting: 1989-1996. 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The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries.