This document summarizes a seminar given by Rachel Nugent on the links between agriculture and health. Some key points from the seminar include: - The relationship between agriculture and health has focused on issues like pesticide exposure, food safety, and how nutrition interventions can impact development. - Recent conferences and projects have sought to broaden the view to consider the full range of agricultural and health outcomes. - Non-communicable diseases (NCDs) impose large health and economic burdens globally, especially in low and middle income countries. Dietary risks are major contributors to NCDs independently of obesity. - There is a need for more research on the quality and measurement of diets, food reform

1. Bringing Agriculture to the Table IFPRI Seminar Washington, DC Rachel Nugent, PhD University of Washington Department of Global Health

2. Some intellectual history Links between agriculture and health focused on pesticide exposures for workers, other exposures to downstream and downwind communities, BSE, H1N1, food residues, mycotoxins and food safety etc. Nutrition and health has a long history of deficiency-related specific interventions (Vit A, Folate, zinc, etc.) and scattered longitudinal research linking nutrition interventions with physical and cognitive human development IFPRI project and workshop on healthy agriculture produced briefs in 2002 (range of topics), and 2005 CGIAR research platform initiative created projects at several Centers (e.g. CIP, ILRI, and Ruel and Hawkes at IFPRI) 3rd generation began with IFPRI conference in New Delhi, February 2011, ag and health broadly conceived to include a fuller range of agricultural and health outcomes

3. Agriculture, nutrition and health links

4. Where do we stand now? IFPRI conference accomplished: Dozens of ANH topics 900+ Attendees, 65 Countries High level attention, new CIDA funding for HarvestPlus Began to “change the conversation” NCD HLM intended to Raise awareness among UN member countries Propose actions to prevent and control NCDs Engage broader stakeholders on NCDs, including non-health sectors and non-public actors

5. Why a UN High Level Meeting on NCDs? Political and Advocacy background Countries led by CARICOM began in 2007 Civil society organizing coalitions by 2008 Private industry joined NCDs impose substantial and growing burdens Health costs apparent in Asia by 1980s Demographic transition combined with epi transition Economic costs being felt widely Status and Expectations Not going to mimic the HIV/AIDS 2001 summit Low level of funding (<3% of all DAH)

6. Health costs: The epidemiologic transition is spreading NCDs cause 63% of mortality worldwide 80% of NCD deaths occur in LMICs Age-standardized death rate much higher: 29% of NCD deaths occur before age 60 (13% in high-income countries) Burden of nutrition-related diseases 9 of top 20 mortality risks in 2000 (Ezzati et al Lancet 2002) Double burden of malnutrition Half of risks related to over- and half to under-nutrition

7. GBD Results: USA Men and Women(age 30+ yrs) Danaei G et al. Plos Medicine 2009

9. For chronic diseases, dietary quality is best defined by foods and diet patterns, not nutrients.

10. Existing global data on relevant dietary intakes, and corresponding global and regional impact on chronic diseases, is very limited.

11. New GBD has systematic and comparable estimates of:

12. Quantitative causal effects of major dietary risks.

13. Global, regional, and national data on key dietary intakes.

14. Assessment of the global, regional, and national impact of specific dietary risk factors on chronic diseases.

16. Economic Costs of NCDs Costs of diagnosing, treating, and long-term management of NCDs could overwhelm low-resource health systems ECONOMIC COSTS OF NON-COMMUNICABLE DISEASES OBESITY In China, total costs related to overweight and obesity are equivalent to 4 percent of the country’s GDP, and by the year 2025 these costs are projected to reach 9 percent. DIABETES A recent study shows that health spending on diabetes care alone ranges from 6 percent of all health expenditures in China to 15 percent in Mexico. CVD Full implementation of CVD prevention comes at $7 up to $30 per capita. The total estimate for CVD prevention in 18 high-prevalence countries is $110.8 billion TOTAL NCD COSTS Harvard SPH estimates costs above $30 trillion from now to 2030. $35 trillion represents 7X the current level of global health spending. 10

17. A food system should offer choicesfor a healthy, balanced diet Reaching that goal involves a wide range of actors, each with their own goals and function in the food system Agriculture Agribusiness and Extension Services (seeds, crop protection, farm machinery), farmers (including smallholders and subsistence farming), agricultural laborers Secondary Food Storage and Processing Importers, exporters, donors and international institutions, food and beverage manufacturers Food Wholesaling and Retailing Street vendors, supermarkets, restaurants, fast food companies, public institutions (schools, prisons) Primary Food Storage, Processing and Distribution Packers, millers, crushers, refiners, farmers collectives, distributers Food Marketing Advertising and communications agencies 11

19. The substitution of healthier oils for palm oil in processed foods.12

20. Where do we need more research? 13 Quality and diversity of diet, measurement and methods Options for food reformulation and changes in intensive food processing Causal linkages across agriculture, nutrition and health outcomes Policy options, especially cross-sectoral Impacts of policy on diet and nutrition Relationship of poverty to agriculture and diet

21. Rnugent2@uw.edu www.thechicagocouncil.org Thank You

22. Deaths Attributable to Major Risk Factors in 2000 Ezzati et al Lancet 2002