Resilient food systems. Zoonoses transmission. Food safety in fresh-food markets. As the COVID-19 pandemic swept across the globe, phrases that had most often been found in research papers suddenly emerged on the front pages of newspapers and in trending topics on social media. Countries, corporations, and consumers alike struggled to understand not only how to cope with the threat of the disease itself, but also with meeting basic needs, such as food security, nutrition, and health, as lockdowns and mobility restrictions reshaped the world in very unequal ways, seemingly overnight.
As a consortium working across five flagship research areas to address some of the world’s greatest challenges in nutrition and health, the CGIAR Research Program on Agriculture for Nutrition and Health (A4NH) was uniquely prepared to support policymakers and partners in low- and middle-income countries in their COVID-19 response and recovery efforts and to contribute research evidence on ways to build back better toward a more equitable, food secure, and sustainable future.
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Work leading up to the 2021 United Nations Food Systems Summit has drawn international attention to the challenges and opportunities of food systems at all levels: global, regional, national, and local, with particular focus on those in low- and middle-income countries. A4NH’s Food Systems for Healthier Diets research flagship brings useful expertise to this conversation, having taken a national perspective with a focus in four countries: Bangladesh, Ethiopia, Nigeria, and Viet Nam. The team works across the food system, taking a demand-driven perspective, filling gaps in critical areas such as consumer behavior and the food environment (the part of the food system where consumers interact with the food they will eat), while also looking at how different parts of the system interact and impact one another. This flagship is led by Wageningen University & Research, with support from the Alliance of Bioversity International and CIAT, the International Food Policy Research Institute (IFPRI), and the International Institute for Tropical Agriculture (IITA).
The concept of a food system, made up of interconnected processes across the full range of commodities rather than a set of disparate value chains, has changed the way policymakers, researchers, the private sector, and other stakeholders think about diets, nutrition, agriculture, and a host of other critical issues and reframed how we approach our global development objectives. A4NH’s food systems work, central to its research portfolio, emphasizes the importance of ensuring healthy and sustainable diets when thinking about how to transform food systems. The research and evidence generated by the program, in close collaboration with national partners in key focus countries, have helped inform and shape thinking in the field. In 2020, to ensure access to and uptake of this work, the program launched the Food Systems Resource Center, providing stakeholders an entry point into food systems research, as well as a new blog, the Food Systems Idea Exchange, sharing insights and perspectives on aspects of food systems thinking from a consumer perspective.
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The food environment, or where consumers interact with the food system to choose the foods they will eat, comprises a critical component of the food system, including informal and formal markets. Through food availability and access, advertising and promotion, and considerations about convenience, preparation, and time, the food environment has significant impact on diet and nutrition outcomes, yet research in this area is often lacking. In 2020, FSHD researchers worked to fill this evidence gap, releasing studies about eating choices and obesogenic behaviors in girls and women; school-based nutrition interventions in Viet Nam; and urban food environments and adolescents in Addis Ababa, Ethiopia; as well as a strategic brief informing stakeholders about supporting consumer choices toward healthy, sustainable, and safe diets in low- and middle-income countries.
Food-based dietary guidelines (FBDGs) provide context-specific advice and principles for healthy diets and lifestyles, rooted in sound evidence and responding to a country’s particular situation and considering a wide range of factors. A4NH researchers have been working with the Ethiopian Public Health Institute and other partners in Ethiopia to develop the country’s first set of FBDGs and corresponding outreach material, with significant progress made in 2020. The first version of the FBDG visualization, designed to make the guidelines easily recognizable and understandable for a wide range of audiences, has been tested and revised to incorporate feedback, and is now ready for approval, while teams are working to respond to demand for guidelines specific to pastoralists. At the same time, the government has included FBDGs in its new National Food and Nutrition Strategy. According to the ongoing initiative for developing a national food system roadmap, Ethiopia needs FBDGs to put a healthy diet into practice.
With more than 2 billion people worldwide not getting enough essential vitamins and minerals in their daily diets, micronutrient deficiency (or “hidden hunger”) is a pressing, though less visible, form of undernutrition that can leave people vulnerable to a range of impairments in physical and cognitive development, disease, and even death. HarvestPlus leads A4NH work on biofortification, seeking to enhance micronutrient content in common staple crops to improve micronutrient consumption in low- and middle-income countries around the world. In addition to developing and scaling up the production and dissemination of these enhanced crops, HarvestPlus is working to build and communicate the evidence base on how biofortified crops improve micronutrient status and health and to support policy and advocacy efforts to sustain their impact. One key objective is to “mainstream” nutrient trait targeting in global and national staple crop development programs.
The foundation for scaling up biofortification is scientific research on nutritional efficacy and effectiveness that supports prioritization and investment decisions. A published study in 2020 expanded the evidence on vitamin A-biofortified cassava. Preschool children in Nigeria were given foods made from biofortified cassava for three months, and their vitamin A status significantly improved compared to children who ate foods made with nonbiofortified cassava during the same period. This builds on a 2015 study that showed the positive impact of biofortified cassava in Kenyan school-age children. Separately, HarvestPlus convened a global consultation on a recent meta-analysis indicating zinc supplements delivered in low doses and in long duration—akin to how biofortification works—can improve risk factors for type 2 diabetes and cardiovascular disease. The experts endorsed research to assess the impact of biofortified zinc wheat varieties on biomarkers of zinc status and type 2 diabetes in adults—an exciting new avenue for biofortification research given the rapidly increasing “double burden of disease” in low- and middle-income countries.
The COVID-19 pandemic upended lives, food systems, societies, and economies worldwide during 2020, and continues to do so in 2021. For smallholder farming families, many of whom live from harvest to harvest, threats to food and nutrition security and livelihoods were immediate. HarvestPlus teams worked closely with country and global partners to rapidly adopt new practices to reach farming families and allow them to continue to access and plant biofortified seed, receive training and technical support, and stay connected to crop markets where they could sell any surplus harvest. For example, in Nigeria, lockdowns and curfews in several states put millions of farmers at risk of missing a critical crop planting season. Supplies of seed and inputs for farmers were dwindling, and prices were rising. Crop aggregators, processors, and other customers could not reach farms. HarvestPlus worked with business, government, and NGO partners to mobilize a comprehensive response.
While national governments and multilateral agencies focused on addressing the immediate challenges posed by COVID-19, many also took measures to accelerate the scale-up of biofortified crops and foods over the longer term. These actions were a recognition of biofortification’s value in bolstering the micronutrient resilience of those most in need, especially during periods of shock. In India, on World Food Day 2020, Prime Minister Narendra Modi publicly endorsed biofortification as a sustainable and cost-effective response for alleviating malnutrition and “dedicated to the nation” 17 recently developed biofortified seed varieties. His government also committed to integrating biofortified crops and foods in India’s large-scale public support programs such as the Midday Meal Program. Tanzania’s government issued comprehensive guidelines for biofortification practices in seed, crop, and food value chains to catalyze activity throughout the food system.
From foodborne disease to aflatoxins to heavy metal and chemical contamination, consumers in low- and
middle-income countries are increasingly concerned about the safety of their food. Their demand for safe food grows as food systems themselves grow more complex, from harvest to transport to processing to storage to points of sale. Policymakers, farmers, market agents, and others need food safety research, evidence, and policy support more than ever, and A4NH researchers are meeting that demand. Through the work of the program’s third flagship, Food Safety, they are working across contexts and situations to develop the evidence and bring the support needed to ensure consumers everywhere have access to safe food. This flagship is led by the International Livestock Research Institute (ILRI) with support from IITA and IFPRI.
In 2020, the COVID-19 pandemic drew the world’s attention to an issue that has long been a focus of A4NH research: the growing threat of zoonotic diseases — diseases transmitted between animals and humans. Interest in the origins of the COVID-19 virus, and implications for food safety in informal markets especially, provided several opportunities for A4NH research engagement, particularly into the impacts of the pandemic on retailers and consumers and the safety of animal-source foods. Researchers also contributed expertise for strategic documents for various stakeholders and engaged with the media as expert sources. While some food safety and food handling work had to be delayed due to the pandemic, ongoing work in informal markets in Viet Nam and Cambodia was adapted and continued.
Since 2003, A4NH researchers from IITA have worked to develop and scale up Aflasafe® products, country-specific natural biocontrol products that are effective in mitigating aflatoxin across Africa. In 2020, Malawi became the tenth country where Aflasafe products are registered, bringing the total number of registered Aflasafe products to 14. Registration is a critical part of scaling-up efforts. Another critical component of scaling up is engagement with the private sector; the companies that manufacture and distribute Aflasafe products make them available to thousands of farmers in nine African countries. To better facilitate this process, the team has developed a series of guides for private sector-based commercialization of Aflasafe and other agricultural technologies.
As food systems in low- and middle-income countries grow more complex and diets diversify, consumers are becoming more concerned about the safety of the food they are eating, especially perishable products such as milk, meat, fruits, and vegetables. In India, A4NH researchers from ILRI have been working with the Government of Assam state to design and test food safety interventions that have led to changes in the government’s posture toward the informal dairy and pork sectors. One such intervention in informal dairy value chains is now being scaled up by the government and the World Bank in 16 districts, while an intervention in informal pork value chains is being scaled up in 13 districts. The interventions are expected to benefit millions of consumers.
Agriculture and nutrition are linked in many ways, yet all too often when it comes to designing or implementing policies and programs, a disconnect exists between the two. To help build bridges across the sectors and develop multisectoral solutions that can address malnutrition in all its forms, A4NH’s fourth flagship, SPEAR, helps stimulate an enabling environment for partnerships, programs, and policymaking. Researchers in this flagship work directly with governments, bringing knowledge, evidence, and support to those working to improve initiatives and foster connections at the intersection of agriculture, nutrition, and health. This flagship is led by IFPRI with support from the Alliance of Bioversity International and CIAT and the Institute of Development Studies.
Traditionally, efforts to combat malnutrition in low- and middle-income countries (LMICs) focused on maternal and child undernutrition and micronutrient deficiencies, while problems of overweight and obesity and interventions to address them, were concentrated in high-income countries. As rates of overweight and obesity climb in LMICs, however, these countries are increasingly facing a “double burden” of malnutrition. To respond, A4NH researchers are encouraging a broader, more comprehensive view of the nutrition challenges facing people throughout the lifecycle. Their work explores how to develop and implement new cross-cutting solutions, including double-duty actions that can simultaneously handle multiple forms of malnutrition, to address the changing nature of malnutrition problems in LMICs and do no harm.
A4NH has served an important role in bringing stakeholders together to share experiences and learn across contexts. A critical area for improvement in nutrition that benefits from this work is the use of data in understanding challenges and targeting and tracking outcomes. In February 2020, A4NH researchers in the Transform Nutrition West Africa platform convened stakeholders in a regional Data Forum, resulting in a Call to Action for strengthening nutrition data value chains that is directed to national and regional governments, donors, UN agencies, implementing partners, and researchers. A4NH researchers also played a key role in convening such a conversation in India, as the Partnerships and Opportunities to Strengthen and Harmonize Actions for Nutrition in India (POSHAN) program hosted a September conference together with 19 partners to explore data and monitoring needs to support the scale-up of nutrition interventions there. POSHAN and partners drafted and pledged their Commitment to Action to support government and societal efforts in response to the unprecedented challenge of COVID-19.
Policymakers, donors, project designers, and other stakeholders need to make informed decisions about which agriculture, nutrition, and health interventions are appropriate in a particular context. Comparing costs and outcomes is essential to this effort, yet evidence on the cost-effectiveness of multisectoral interventions, policies, and programs is scarce. A4NH researchers from IFPRI and ILRI, together with colleagues, have been working to build the knowledge and evidence base in this regard, with projects ranging from community-based childcare centers in Malawi to maternal and child health and nutrition programs in Guatemala and Burundi. Their research provides not only data but also insights into contextual considerations that will be essential to those considering how best to structure investments in critical nutrition and health interventions.
The COVID-19 pandemic has shed light on the critical and inextricable links between human, animal, and environmental health. The threat of zoonotic diseases, which spread from animals to humans, only grows as people and livestock live in closer proximity to wildlife, while agricultural intensification transforms landscapes and livelihoods and brings about new interactions with the potential for unintended consequences. A4NH’s fifth flagship, Improving Human Health, is working at this critical interface, bringing agricultural and human health researchers together to consider problems the sectors share but rarely come together to solve. These efforts can help identify evidence of positive and negative impacts of agriculture on disease as well as interventions to reduce disease risk and improve health. The flagship is co-led by the London School of Hygiene & Tropical Medicine and ILRI, with support from IITA.
The world has grown increasingly aware of the complex interlinkages between human, animal, and environmental health. Assessed together, these comprise the “One Health” approach, addressing the emerging challenges that occur where these domains intersect in a multisectoral, multidisciplinary way, so as to enhance health for all. Building on One Health work conducted under A4NH, in 2020, ILRI, which co-leads A4NH work on Improving Human Health, launched the One Health Research, Education and Outreach Centre in Africa (OHRECA). Under OHRECA, work is being carried out on preventing emerging infectious diseases, controlling neglected zoonoses, ensuring safe food, and reducing antimicrobial resistance. OHRECA will continue the increasingly critical One Health work begun under A4NH after the program ends in 2021.
Rice is linked with malaria in Africa because African vector mosquitoes are exceptionally efficient at transmitting the parasite (hence 85 percent of global malaria mortality is in Africa), and because these mosquitoes breed prolifically in rice fields. Researchers from A4NH and the CGIAR Research Program on RICE have studied this link and found a potential clash between agriculture and health: the agriculture sector’s plans to increase rice production could interfere with the health sector’s plan to eliminate malaria. To ensure agricultural development can be part of the public health solution, rather than part of the problem, in 2020 researchers brought together agronomists with expertise in growing rice and entomologists with expertise in the ecology of mosquitoes in African rice fields. This created an opportunity to inform the direction of rice development investment strategies to mitigate any unintended negative consequences for human health.
While COVID-19 captured many news headlines in 2020, researchers also had their attention on the pandemics of the future, and how to prevent them. Zoonotic diseases — those illnesses, like COVID-19, that are caused by pathogens that move between people and animals — make up 60 percent of known infectious diseases and three-quarters of emerging infectious diseases. As the population increases in many low- and middle-income countries, humans and animals will be pushed into living increasingly closer together, creating further openings for transmission of pathogens. To address a critical knowledge gap related to zoonoses and provide policymakers with a better understanding of the nature of potential future disease outbreaks, A4NH researchers from ILRI joined colleagues at the United Nations Environment Programme in publishing a groundbreaking report that examines the root causes of COVID-19 and other zoonoses.
For development policies, programs, and initiatives to be successful, they must pay attention to gender and equity. These issues stretch across agriculture, nutrition, and health, and failing to incorporate them can result in unintended consequences for those most in need. A4NH recognizes how critical this work is, and structured its Gender, Equity, and Empowerment work to cut across all research flagships to help researchers throughout the program better understand and address these important considerations in their work. They can then carry those lessons forward to help inform stakeholders ranging from policymakers to farmers to development organizations to community groups to other researchers and ensure that addressing gender and equity remains central to development efforts worldwide.
CGIAR launched the Generating Evidence in New Directions for Equitable Results (GENDER) Platform in 2020, with A4NH research serving a foundational role in the Methods module, the Platform’s home for research and innovation on methods and tools to improve the quality of global gender research and interventions. Key among the A4NH contributions are the Women’s Empowerment in Agriculture Index (WEAI) suite of tools, including the project-level WEAI (pro-WEAI), as well as the Reach-Benefit-Empower-Transform (RBET) framework that aims to help understand whether and to what extent agricultural development projects contribute to women’s empowerment. This and other work begun under A4NH and the CGIAR Research Program on Policies, Institutions, and Markets (PIM) will be pivotal to shaping and furthering CGIAR’s work on gender and equity under the new research strategy.
WEAI, developed by A4NH researchers and colleagues under the Gender Agriculture and Assets Project as part of PIM, has provided critical insights and measurements, revealing areas of disempowerment and enabling development program designers to address those areas. Though valuable, WEAI was somewhat limited in that it focused on the production dimension of agriculture, while women are engaged in and face empowerment challenges throughout the entirety of the value chain, including processing, trading, and markets. Launched in 2020, the new project-level WEAI for Market Inclusion (pro-WEAI+MI) enables researchers to better understand and address empowerment challenges throughout the full value chain.
As the world prepares for the UN Food Systems Summit in 2021, attention is focused on identifying problems plaguing food systems at global, regional, national, and local scales, and developing “game-changing” solutions to address these challenges. Yet different people interact with food systems in different ways, at different points along the value chain, and not all those interactions are equal. They are shaped by geography, income, skill, and, crucially, gender and age. To truly change the game, solutions must address the unique inequities and challenges facing women and youth. In 2020, A4NH researchers made significant contributions to the study of equity in food systems transformation. Researchers from the Alliance of Bioversity International and CIAT and Wageningen University & Research conducted a scoping review looking specifically at gender equity in the food environment, or the point in the food system where consumers interact with the food they will eat. Researchers from IDS explored the experiences youth have with the food system, both as consumers and as agents of change.