Disciplinary Perspectives on Agriculture–Nutrition Linkages

Severe forms of protein–energy malnutrition still occur, but they are associated most commonly with devastating natural disasters and civil unrest. With the exception of sub-Saharan Africa, progress in combating chronic undernutrition is also occurring. The prevalence of vitamin and mineral deficiencies has also declined in nearly all countries, although the pace is slow for some micronutrient deficiencies, particularly iron-deficiency anaemia. Nevertheless, the prevalence rates of micronutrient malnutrition remain high, with devastating consequences for health, cognition, and productivity. Much remains to be done, particularly in reducing iron, zinc, and vitamin A deficiencies, which up to the present have largely been attacked by using a medical model that relies on the distribution of supplements. Supplements are effective but are expensive in terms of the support devoted to repetitive use of scarce health manpower. Fortification can work in some places. Education and awareness of the public is crucial. The public must not be considered only as the target of imposed interventions. Civil society must become engaged in the process, with the goal of their becoming demanding consumers, participating in the action to achieve micronutrient adequacy. Sustaining the progress that has been achieved will depend on underpinning the medical model with foodbased approaches that address multiple nutrient and phytochemical needs for optimal health. Agriculture, by investing in the Green Revolution, can rightly be credited for its contribution to reducing food shortages and the protein–energy malnutrition problem. A similar opportunity exists now for agriculture to invest in developing more micronutrient-dense staple crops, while not neglecting continued research on the production of livestock and small animals, fish, vegetables, and legumes. Some historic landmarks with respect to micronutrient defi ciencies Five decades ago, international agencies and public health officials recognized severe protein–energy malnutrition as a problem worthy of attention and expenditure of resources. Four decades ago, classic signs of deficiencies of vitamins, such as vitamin A, and of minerals, such as iron and iodine, were added to the list of scourges frequently associated with protein–energy malnutrition and deserving of special medical attention. Three decades ago, a “doomsday” mentality gripped the world because pundits predicted that global food shortages were inevitable, given the explosive growth in population that was occurring, primarily in the developing world. Two decades ago, perceptions began to change as evidence accumulated that some interventions were having positive impacts. In 1990, just one decade ago, commitments to accelerated actions were initiated at several UN agency-initiated conferences: » the 1990 UNICEF-sponsored World Summit for Children with a call for “a reduction in severe and moderate malnutrition among children under 5 by half the 1990 rate by the year 2000,” including elimination goals for micronutrient malnutrition; » the 1992 World Health Organization/Food and Agriculture Organization (WHO/FAO) International Conference on Nutrition that reinforced earlier goals and extended to “elimination of death from famine”; » the 1996 FAO-sponsored World Food Summit that endorsed earlier goals and declared “the commitment to achieving food security for all, and to an ongoing effort to eradicate hunger in all countries, with an immediate view to reducing the number of undernourished people to half its present level no later than 2015.” Changing perceptions Progress through the last half-century in addressing global food, nutrition, and health problems obviously The author is President of the International Union of Nutritional Sciences and Scholar-in-Residence at the Institute of Medicine, National Academy Sciences, in Washington, DC. Barbara A. Underwood