Does Cash Cropping Affect Nutrition?
Nutrition in Times of Disaster
Food first, or agriculture for export? Does growing food protect nutrition, whereas cash-cropping cause famines? Are subsistence farmers lured into the cash economy, growing inedible crops and then finding themselves unable to feed their families? Based on recent research and new thinking, some tentative answers to such questions are now being found. In the first place, the view that households growing cash crops inevitably suffer damage to their nutrition is becoming firmly rejected. The issues depend on the context of different developing countries; on the perspective, from historical to the need for immediate decisions; and on the viewpoint, from household to national, increasingly taking account of the interdependence between countries with the debt crisis.
A symposium on “cash-cropping and nutrition” held at the ACC/SCN 14th session at WHO headquarters in Geneva, February 1988, brought together researchers and representatives of UN agencies and donor governments to debate current views. The symposium, organized by Dr P. Pinstrup-Andersen of Cornell University, drew on recent research in six countries and on an historical perspective of developments in West Africa; and on thinking in a broad policy context. Research in this area was identified as one of six priority topics by the SCN in 1983/4. The symposium, resulting in part from this previous SCN interest, was chaired by Dr P. Lunven, of FAO. The symposium's conclusions provide an improved basis for decisions ranging from the cropping priorities of individual development projects, to wider policies of structural adjustment.
What Are “Cash Crops”?
There is “an underlying ambiguity about what the term “cash-crop” refers to; a tendency to slide across levels of analysis from the household to the international economy; and a bewildering variety of issues” according to Mr S. Maxwell (Institute of Development Studies, UK); his paper tried to “bring order to a heterogeneous and notably acrimonious debate”. “Cash-crops” are typically such products as cotton, sorghum or groundnuts in drier areas; maize, cocoa, coffee, tea or palm-oil where rainfall is better; sugar-cane in many parts of the world; jute, rubber, and rice, notably in Asia. They may be food or nonfood, frequently for export, but also for domestic consumption. The broader definition of “a crop produced for sale” has come to be used. The issue is thus virtually the same as that of commercialization of agriculture in poor communities: cash crops are commercial crops.
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Now Available UPDATE ON THE NUTRITION SITUATION Recent Trends in Nutrition in 33 Countries ACC/SCN Jan/Feb 1989 This report updates and extends information published in the
ACC/SCN's First Report on the World Nutrition Situation (November 1987).
Copies can be obtained by writing to the ACC/SCN Secretariat. |
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SCN News is issued twice yearly by the Secretariat of the UN ACC/Sub-Committee on Nutrition. A description of the ACC/SCN is given on the back cover. Your contribution to future issues would be welcome. Please send us items for inclusion in “News and Views”, “Programme News” and/or “Publications”. Letters to the Editor for possible publication in future issues are also most welcome. If you wish to receive additional copies of the SCN News, or would like to suggest other names to be added to our distribution list, please write to us. Dr Abraham Horwitz Dr John B. Mason Cable: UNISANTE Geneva |
“The commercialization of agriculture is the cornerstone of economic development in many developing countries... (seen as) a means of generating and saving foreign exchange, increasing the incomes of the rural smallholder, providing employment for the landless and stimulating growth linkages with other segments of the economy,” said Dr E. Kennedy, of IFPRI in her introduction. But “critics... have argued that not only have the economic benefits not materialized but in some cases, the transition to commercial agriculture has had a negative effect on staple food production and hence household-level food security, and health and nutritional status. Many of the most contentious nutrition issues in the food crop/cash crop debate have revolved around the impact of commercial agriculture on women and preschoolers.”
The question of direct effects on farmers growing cash crops has received most of the research attention to date. But the linkages of widespread and established cash cropping to national food availability, food prices, employment and income distribution - possibly even more important in the long-run - have been relatively neglected. Social changes brought about by cash cropping have been of major importance. Yet these issues, sometimes inadequately distinguished, are central to the debate, brought to the public eye as “Food First”. They need to be definitively answered.
They need answers because otherwise development agencies risk inadvertently worsening nutrition when investing in agricultural production. A number of the studies reported at the symposium were financed by IFAD and by USAID. Answers are needed because structural adjustment programmes, commonly with IMF and World Bank support, often aim to increase foreign exchange earnings through commercial agriculture. This could conflict with efforts to ensure a “Human Face” for adjustment to protect the poor and vulnerable, especially mothers and pre-schoolers, precisely those feared to be at risk from cash-cropping. And answers are needed above all, so that, as put by Mr S. Maxwell, “cash crop policy (can be) consistent with food policy and rural development policy: the first in order to secure adequate supplies of food at appropriate prices throughout the year; the second in order to ensure participation by the poor and by women in the gains (both direct and indirect) from cash crops”.
The debate ranges from effects on individual households, both those adopting cash crops and those excluded, to effects on the national economy; it encompasses food security issues at these different levels, as well as health conditions; and it must view the social and political changes involved.
Cash Cropping Has Shaped Development in West Africa
Pervasive changes throughout West Africa resulted from commercial exploitation of agriculture. Dr T. Brun (Cornell University, US/GRAINS, Paris) gave a devastating view of how systems of production and marketing can impoverish rural people, drawing on a review of events starting in the last century. The methods used to produce crops, as much perhaps as the crops themselves, were to blame. This theme is taken up in the more recent and geographically focused case-studies from other countries.
“In less than a century, cash-cropping has spread over thousands of hectares in West Africa”, Dr Brun points out, “It occupies the most fertile and best irrigated lands”. The map (see page 4) shows the main areas of export crop production and their rail links to the ports in the 1960's.
Cash-cropping brought an era of change in W. Africa. In the early 1900's food grain carried prestige: the number of granaries was a mark of wealth. This is no longer so. The “mining” of agriculture - extraction of value as fast as possible from intensively farmed areas - moved populations and caused extensive deterioration of the land. Production initially used forced labour, moving able-bodied men from villages over initially wide areas. More recently low-paid wage labour has had similar results. Neither the production nor marketing systems put much resources back into the local farming economy. High interest debts were repaid - and continue to be - by the value of the next harvest; and much remaining cash is directly spent at harvest time. “In this way cash-cropping was directly linked to the supply of groceries and household goods. Peasants would obtain loans until the next harvest from their usual suppliers of basic commodities: rice, salt, sugar, cooking oil, fabric etc. and in turn the retailers would benefit from loans from leading foreign trading firms”.
The change from a barter to a monetary system - encouraged to help taxation - together with the mass migration of laborers and the disruption of the whole traditional local economic system, transformed a settled food producing area into one entirely different; in such areas as the Sahel, into one tragically vulnerable to drought and famine. To this day, there can be a real conflict between production of food crops and cash crops - especially with groundnuts and cotton - in terms of labour and land availability. Consumption patterns shifted from the local millet, sorghum and root crops, to imported rice and wheat, as well as sugar, alcohol, and consumer goods. So distorted had the system become that it was often cheaper to buy imported rice than local foods.
Main Areas of Export Crop Production in the 1960s.
Nor was this system always efficient, either in colonial times or with many major agricultural development schemes after independence. An early example quoted by Dr Brun is the cotton-growing enterprise called the “Office du Niger” which operated from the mid-1920's to mid-1940's. The human cost of construction of irrigation and of farm labour was enormous - in 1926 13% of the work force died from ill health and malnutrition - and cotton output was far below target. A number of more recent examples of failed large-scale enterprises are given: “In Mali, both Operation Groundnut in 1967-68 and Operation Groundnut and Food Crops (OACV) in 1973-74 have failed. The failure of this last operation, backed by substantial resources, has increased the debt burden”.
Other schemes have succeeded: “By contrast to groundnuts, cotton in Mali and to some extent in Burkina Faso is a success story. Its yields and production have increased in a spectacular way and in both countries it has brought a marked improvement in the standard of living of farmers”.
Important factors that lead to success or failure include the involvement and adequate remuneration of the farmer. Recently relative producer prices have in many areas made food grains more profitable and farmers have benefited where they have been able to switch. Cash-cropping seems worthwhile where it does not compete with food crops, especially in terms of land and peak labour demands; where prices are good, and the crops are suitable for the ecology. In contrast, some schemes to counter import needs, themselves resulting from distorted consumption patterns, have a poor record: “despite a huge capital outlay, production of wheat... from a large irrigation project has been a dismal failure”. Finally, effective organization of farmers and relation to the political process are seen as essential to success.
Four examples - two successful, where nutrition is reckoned to have benefited, and two failures - illustrate these points, summarized in Box 1 (see page 5). In these cases, success required both effective farmers' organizations and influence, and no conflict with staple food crops: under these conditions, income and nutrition benefited.
Box 1
EXAMPLES OF CASH-CROPPING SCHEMES
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Crop |
Characteristics |
Results |
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A. Cotton (Dry zone) |
Organized farmers' association. Most farmers aim to cultivate
both cotton and food crops. Cotton yields increased, income increased. |
Food intake and nutrition improved. |
|
B. Groundnut (Dry zone) |
Absence of farmers' association. Groundnut expansion in
conflict with sorghum and millet. Low groundnut yields, income not increased.
Changing back to food crops. |
Food intake not improved. |
|
C. Cocoa (Wet zone) |
Farmers' lobby influential politically. Cocoa not in conflict
with staple food production. Marked increase in income. |
Food intake improved. |
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D. Palm oil (Wet zone) |
Weak farmers' association. Although palm oil not in conflict
with basic crops, production and income stagnated. |
Food intake not improved. |
Nonetheless, the individual farmer taking advantage of cash crop production often does somewhat better than his neighbor who does not switch. But all farmers in W. Africa may be worse off than they could have been under other circumstances. So, on a micro scale, promoting cash crops can be advantageous, if done in the right way. But on a larger scale, geographically and over time, the development of societies based on undue priority to cash crops - and especially with a “mining” approach - produces grave distortions across the board, and can both perpetuate poverty and lead, for example, to the devastating famines seen in the Sahel in the last 15 years.
The theme of possible short-term gain to the individual farm household vs long-term national development is returned to later. But first, recent evidence from studies organized by IFPRI sheds important light on the question of local effects.
Case-studies of Household and Community Effects
Six projects where cash cropping was promoted have been studied in detail. Two of these - in Kenya and the Philippines - were sugar cane production and processing schemes, largely for export. Two were concerned with edible crops, not however used for local consumption: sorghum production for animal feed in Mexico, and export vegetable production in Guatemala. Finally, two schemes for irrigated rice production - where some of the product could be consumed by the producers - were studied in Gambia and Sri Lanka.
Fundamental questions concerned whether income increased and if this was translated into improved food consumption; hence whether health and nutritional status benefited. Equally important was to understand better the mechanisms involved: the role of women, time allocations and child care; timing and “lumpiness” of income, and its control within the household; food security and health conditions; and others.
Effects of doubling income on nutrition. Illustration of data from project in the Philippines: dilution of income effects, through food consumption, on child growth.
How much do Income Increases improve Nutrition?
Clearly increases in income are not all spent on more food. Nor is there an exact one-to-one relation between food available to the household and child growth. Infectious disease, in particular, could negate benefits of better eating. These relationships were illustrated by Drs Kennedy, von Braun and Bouis, of IFPRI, with results from the Philippines - as shown in figure 1. They noted that “although income has a significant effect on energy consumption, the magnitude of the effect is small. A doubling of household income would increase a preschooler's caloric intake by only 9 percent, and this in turn would improve the average weight/length Z-score by 4 percent”.
This explains why income increases may have only a small effect on nutritional status. By the time the mechanism has gone through increased income translating into higher food expenditure, then into food consumption (and more expensive food is often chosen) at household then child levels, then into child growth (activity probably increasing concurrently), the relationship is only weakly positive. (In passing, the Philippine results do show that children's food intake goes up in parallel with household food availability). So a weak influence of income on child nutrition is to be expected, once the mechanisms begin to be examined. And that was what was observed in most of the case studies.
Sugar Schemes. A sugar processing factory started operation in 1980 in south Nyanza district in Kenya. Although some sugarcane had been grown in the area, maize was previously the main crop. Large-scale sugarcane production was introduced, in two ways. Some 2,800 hectares were put down to sugarcane production as a commercial enterprise, and a further 6,000 hectares were converted to sugar-growing by small-holders - known as the “Outgrowers Scheme”. Some labour inputs were provided to small-holders by the factory, but generally the effect was to provide a commercial outlet for their sugarcane. The result was a substantial shift from maize - still grown partly on the farms - to sugarcane.
The impact of this move to cash-cropping by the “outgrowers” was studied by IFPRI, using formal survey methods and an ethnographic or anthropological approach. Early results were on the economic and nutrition situation of farm households, in 1984, a few years after introduction of the scheme. Those who had adopted sugar cane were compared with those growing mainly maize. A follow-up study is trying to trace changes in these outcomes over time. In general, both research approaches tend to rule out the possibility that cash-cropping here had caused a deterioration in nutrition among the sugar-growing farm households. If anything nutrition was improving, although it was still rather early to tell definitely. But there were some disturbing indications that farmers not adopting the cash crop - who might be those with less land endowment, so having less room for manoeuver - were falling behind and suffering nutritionally.
A parallel study in the Philippines led to similar conclusions. Here, the authors stressed that “the introduction of sugar led to a serious deterioration in land tenure patterns, which especially adversely affected corn tenant households. Preschoolers in landless households were significantly more stunted than preschoolers in households with access to land.” From their studies in Kenya and the Philippines, Kennedy et al concluded “in general, the results from the comparative analyses suggest either a neutral or slightly positive effect of cash cropping on nutritional status of children. Nevertheless, the loser/gainer patterns at each of the study sites are complex.” They warned that “these two examples illustrate the fact that even in cases where some groups benefit from commercialization, there are other groups for whom the impact may be negative.”
Sorghum for Animal Feed in Mexico. Hybrid sorghum varieties were developed in Texas some thirty years ago. Their use spread rapidly into Mexico, so that by 1980 sorghum had become the third largest crop, after maize and cotton - so much so that it is thought of as a “Second Green Revolution”. This rapid adoption took place without formal promotion by government, by aid agencies, or indeed by extension services. As de Walt and colleagues - researchers from the University of Kentucky, Mexico and Argentina - said: “Farmers simply saw a good product and adopted it”. By the early 80's sorghum, much of it grown on irrigated land, supplied three-quarters of the raw material used in Mexico's extensive animal food industry.
For their contribution to the symposium, de Walt et al applied their wider studies in four Mexican communities to assessing nutritional affects of the shift to sorghum. One important broad conclusion was that “ecological conditions, agrarian and agricultural policy, community social and cultural factors, and alternative employment sources may be more important in determining change in the nutritional status of rural populations at risk than is the process of agricultural commercialization”.
Adoption of the crop itself - sorghum - was found to have little detectable effect on nutrition. In three of the four communities, children of families producing sorghum were somewhat better off - although these families may have had better productive assets anyway. Far more important than the crop type itself was access to good land, especially irrigated land, and other productive resources. But here again the link between income and adequate child growth was relatively weak - even when food consumption patterns changed significantly with income.
Thus the authors concluded, on the one hand “if we are interested solely in the question of what effect cash-cropping in these communities has on nutritional status, we would have to conclude that the relationship is relatively unimportant”. But, on the other hand “in some sense we are guilty here of asking the wrong question. Choice of sorghum as a cash-crop over maize as a semi-subsistence crop does not appear to place the families of small farmers in nutritional jeopardy, nor does it give them an advantage. The more important questions here have to do with access to basic productive resources and the relationship between access to basic resources and rural-urban and international migration”.
The broader question on the supply side - the overall effects of displacement by sorghum of wheat (the “First Green Revolution crop”) and its possible competition with maize, the staple food - remained open, but was taken up in general terms later.
Irrigated Rice in the Gambia and Sri Lanka. Both in the Gambia, in W. Africa, and in Sri Lanka, rice is the preferred staple and is produced domestically although imports have risen in recent years. Major schemes to increase irrigated rice production have potential for benefiting both national food security, and individual households within project areas.
In the Gambia, a pump irrigation scheme some 300 km upstream on the banks of the country's major river, initiated in 1982, was studied as part of the IFPRI programme by Drs Rubin and Webb. The “Jahally-Pacharr” project was intended “to develop rice production by smallholders on 500 hectares of mechanical pump irrigation and 960 hectares of rainfed/tidalflow irrigation. The project is owned and managed by the state, with water control, seeds, fertilizer, and plowing services all being provided on a credit basis. All other farming activities are carried out by smallholders who are registered as temporary tenants of plots.”
“As it happened”, the authors report, “the rice produced with the new technology available in the Jahally-Pacharr project was not sold, but was instead treated as a new and more reliable source of food for household consumption.” The result was that income and food consumption increased, associated with “substantially improved nutritional status for children”. A notably useful effect was that seasonal fluctuations in food availability were smoothed out, reducing mothers' seasonal weight loss, with benefits for child health and nutrition. One drawback seen was that mothers working on the rice scheme would often take small children with them to the fields which may have increased children's exposure to disease.
Overall, however, the scheme seemed to benefit substantially the nutrition of families involved. This might be expected, with the rice produced directly contributing to household diets, but is important to know.
Development in the Kirama Oya (river) basin in Sri Lanka has been supported by the Norwegian government for a number of years. An Integrated Rural Development “project concentrated on raising the productivity of paddy cultivation. One component dealt with the rehabilitation and reconstitution of an old irrigation system along the Kirama river. The other entailed the introduction of modern cultivation techniques, a credit system for agricultural inputs, proper water management practices, and a system for crop insurance”.
Economic and nutritional changes were monitored by Norwegian researchers during three years of project work, 1981-84, for participants in the scheme and other households living in the area. Drought in 1981/82 affected the whole population, causing nutritional status to deteriorate. However, by 1984 it was clear that conditions of households participating in irrigated rice production were improving, compared with others, and even some landless laborers were benefiting through increased employment. In the project area, income was estimated to have increased by 88%, far higher than the price inflation rate for food - although this was substantial at 55%. Part of the positive benefit for nutrition was put down to the crop itself: rice could be used directly in the diet. Although total rice eaten did not increase significantly - the level of intake being already high - the authors reckoned the positive benefit accrued from superior quality of the rice, and retention of a higher proportion of paddy, saving money.
But the major effect was thought to be from increased income, with an indirect effect on nutrition. Rice production was thus fairly comparable to other commercial crops, and the authors looked to factors that had gone well with this particular cash-cropping project. Essentially, they ascribed the project's success to its appropriate features in the social and cultural context of Sri Lanka and its positive interaction with underlying potential for improvement - the high education levels, for example, particularly of women. Mistakes seen in other commercial agricultural projects were avoided. Women were not overburdened with new work; benefits reached the relatively poor farmer; insurance schemes and the absence of new technology helped.
The organizing concept of household food security was advocated as a more general means of assessing project design - here focusing on three factors: the availability of an adequate food basket; the “viability in procurement” (meaning absence of conflict with fulfilling other basic needs); and sustainability of access to food. The Kirama Oya project met these criteria.
Better Health Needed to Realize Nutritional Benefits of Increased Income
Several results from the case-studies showed that health of children - measured by reports of episodes of sickness - did not seem to improve with income. This observation emphasized that economic development alone is unlikely, through income, to solve nutrition problems where health care and sanitation remain poor. Indeed, an important conclusion was that investment in primary health care, and in health/nutrition education, should be included in development projects. Complementary measures are important to ensure that potential benefits to nutrition of successful agricultural projects are realized.
National Food Availability - Still “Food First”?
The detailed studies at household and community level strengthened the case that cash-cropping per se may not be damaging to those participating - indeed may benefit their nutrition. But key issues remain at a broader level: does cash-cropping lower national food availability, or anyway put it at greater risk? Does it cause social differentiation, so that some are impoverished? These relevant questions could be examined from the available literature.
But, “this... literature... is surprisingly ambivalent and surprisingly incomplete” according to Mr S. Maxwell. “On the issues it does cover, the literature is on the whole rather more favourable to the opponents of cash crops than it is to the proponents. At the national level, there is no convincing refutation of the “Food First” critique that the foreign exchange earned from cash cropping is not used to replace food lost for domestic consumption”. “National food availability”, he says, “is likely to be determined by policies on food trade. The hypothesis that foreign exchange earned from cash cropping is used for food imports remains untested. Some Food First critics have argued that food imports do not compensate for food “lost” because of cash crop production. On the other hand, other country studies show that food imports fluctuate in direct proportion to foreign exchange earnings from export agriculture. This evidence does not prove that imports compensate fully for “lost” food production, but does at least suggest a link between the two. Of course, this could be counted as part of the case against export agriculture, by showing that national food security is a hostage to international commodity prices”.
Box 2.
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From: ACC/1988/PG/1 SCN 14th Session Report 18. In response to a question raised regarding future directions in this area, suggestions made included the following: (a) Primary health care and nutritional education should be integrated into cash cropping projects. Recent evidence clearly pointed out that increased income alone was unlikely to solve nutritional problems caused by a number of factors, including lack of primary health care and poor knowledge. Efforts should be made to design integrated programmes in such a way as to alleviate the most hindering constraints. This might be done on the basis of solid information by functional group; |
Social Differentiation; who gains, who loses?
“The nutrition status of individual households” as Mr Maxwell emphasized “is determined more by their ability to acquire food than by the level of food output or its availability in the market”. Cash cropping effects on employment and income distribution are of prime importance - as are food prices, which he also examined in some detail. A vital question is “who gains and who loses” from the processes of social change associated with and, possibly, initiated by cash crops. “The economic and social transformation associated with cash crops will have a profound effect on nutrition. Indeed, this is one of the main criticisms of cash crops in the popular literature”.
Social differentiation is catalyzed by cash cropping, the history of W. Africa being one example. Extensive knowledge, even if not specific to nutrition, has been gained on these social consequences. A central conclusion is that often only those already better endowed with productive resources take up cash crops. Further, “cash crops exacerbate maldistribution because they accelerate processes of social differentiation: cash crop “adopters” (at whatever level of analysis) grow faster, sometimes at the expense of non-adopters. This growth is often favored by state policy on pricing, research, input supply, wage policy, taxation or trade”.
Individual, Short-term Benefit Conflicts with National Development?
Most nutritional information on cash-cropping to date has focused on households or communities that adopt cash-crops. Results have varied in the past, because of differing contexts. The picture becomes sharper with the new studies. Often those adopting cash crops benefit - in terms of income and nutrition. Nothing inherent in producing crops for sale - even inedible crops - necessarily makes them nutritionally bad for the producer. It depends on the situation - but there should be no reflex rejection of cash cropping from this viewpoint.
The emerging issue concerns the long-term and wide scale effects, and how cash cropping is promoted. Cash crop policy must be fitted into, made consistent with, food policy and development policy. The effects on food security must be carefully considered at levels from household, through area to national; over time, bearing in mind international and within-country terms of trade; and in relation to future vulnerability, as in the Sahel. The far-reaching social and income distribution effects have to be thought of in the context of development processes, not just as a short-run foreign exchange issue.
Successful targeting of cash crop production projects to poor farmers could in many cases be a major route to equitable development - the issue is then how to achieve this. A focus on small scale enterprises would often be a start.
So, like so much else, cash cropping policy relates to priorities, to policy objectives; to who benefits. But at least one concept, confusing in the past, is becoming clearer: for the farmer himself, there is nothing nutritionally disastrous in itself in growing crops for sale.
Where to go from here?
In synthesizing the one-and-a-half days' debate, Dr Pinstrup-Anderson brought together practical conclusions of the symposium (see Box 2). Cash cropping projects should capitalize on their potential for improving nutrition by including health and education components. A broader approach, keeping production costs down, should favor the rural poor. Better knowledge of how nutrition responds, and why, to agricultural development is needed, to guide policy and project design.
Deliberate and sustained efforts by those responsible for policies that affect nutrition - from health and agriculture to economic planning and education - to include nutritional considerations in their activities could have far-reaching benefits for the malnourished in many parts of the world.
The number of disaster victims requiring assistance for survival and in meeting their nutritional needs continues to increase. Some 20 million people now live in refugee camps. “The international community must take advantage of all available knowledge with a view to continuously improving our response (to disasters)”, said James Ingram, Executive Director of the World Food Programme, in his keynote address to the Conference on Nutrition in Times of Disaster. “The whole matter of nutrition in times of disaster is one of formidable complexity but, equally, of formidable urgency”, he stressed. The Conference aimed to provide a forum for discussing and coordinating related technical issues, especially among those involved in disaster relief activities, in order to arrive at practical recommendations to improve responses to emergencies. It was organized by WHO and UNHCR under the auspices of the ACC/SCN and the International Nutrition Planners Forum (INPF) from 27-30 September 1988. Some 150 participants from fifty countries attended.
Following discussions in plenary sessions and working groups, the conference participants agreed on a set of recommendations. These related to the issues of early warning and preparedness; assessment and monitoring prior, during and after an emergency; rations and logistics; and transition from emergency to development assistance.
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Statement of Conference on Nutrition in times of Disaster “In the last fifteen years, the continuing problem with famine and disasters, both natural and man-made, has resulted in unprecedented numbers of people depending for survival upon international food aid, sometimes for prolonged periods of time. The generosity of donor nations has been immense but, even so, the total volume of emergency resources (food and money), provided bilaterally or multilaterally through organizations such as the World Food Programme, has proved painfully inadequate to meet escalating needs. The food provided has also, at times, failed to reach intended beneficiaries due to severe logistical and security constraints in recipient countries. Consequently, the rations provided very often result in a seriously insufficient and unbalanced diet. The food shortages, along with other factors, have often had a dramatic effect, increasing disease and deaths among affected populations, particularly in refugee camps. In this context, there are alarming reports of outbreaks of certain nutritional deficiency diseases which have hitherto been considered to be under control, such as scurvy, severe anaemia and beriberi. These outbreaks may, in a large measure, be ascribed to an inadequate quantity and quality of the food available locally and/or provided by international assistance. The participants in this conference consider that a minimal standard for food provision for emergency conditions must be maintained. This requires the provision of at the very least 1900 kcals/person in the daily diet. Furthermore, such a standard diet should contain all essential nutrients at levels that have been determined necessary to maintain health and sustain life. The conference urges donor nations to increase their emergency resource allocations and to programme these according to estimates of emergency needs rather than reacting to each situation in an ad hoc manner. It urges that more of this emergency food aid be channelled through multilateral agencies. In order that nutritional standards can be met, it further urges donor nations to diversify the composition of food aid that they provide without reducing the total amount of calories allocated. Finally, it encourages both affected countries and the donor community to intensify efforts to strengthen the capacity of governments to cope with their own disasters and assure the provision of a nutritionally adequate diet to disaster-stricken populations. The meeting urges donor nations to assist the UN family in
meeting these goals. Such actions are of the greatest urgency if this toll of
lives is to be reduced” |
On other topics, here are some points recommended by the Conference.
The preparedness focus should be on response, supported by the necessary information. Relevant information should be integrated into an early warning system. But, lack of precise or complete information should not be a justification for an inadequate response. Systems for surveillance of the food and nutrition situation are usually more effective than one-time assessments and need to be in operation to provide timely warning and response.
Guidelines for the use of anthropometric data were put forward. It was stressed that nutritional indicators need to be complemented with socio-economic indicators, for which there is a need for specified methodologies under different situations. While anthropometric measures, in the context of each situation, are useful and important, evidence of food shortages, no matter how measured, is sufficient to demand intervention and should not be contingent upon evidence of “malnutrition” measured by anthropometry. Among other indicators, information on morbidity was considered as useful only in specific situations and unless already collected, of marginal value for general monitoring purposes. Mortality data were agreed not to be generally a priority for monitoring and assessment except sometimes in camp situations and possibly in the evaluation of feeding programmes.
More research into appropriate methods for rapid assessment was vital. Transition from emergency to development assistance aims to avoid dependence, to recreate assets, to create income and to foster community self-help.
The recommendations on issues of rations and logistics were wide-ranging, and those specifically related to nutrition are extracted here.
“A practical working figure for the minimum energy requirement should be 1900 kcal/person/day for a sedentary population. There is no advantage in specifying an alternative figure for energy intake as being sufficient for survival. The further mean per capita energy intakes fall below the minimum level, the more malnutrition, morbidity and eventually mortality occur, particularly in infants and young children.
The mean per capita daily energy and protein requirement for any target population can be more accurately calculated by applying age-specific values for energy and protein requirements to the demographic age/sex structure of the target population. Other important factors to take into account in calculating requirements include:
- how much of the requirement can be obtained by the affected population itself;Energy and protein- exposure to cold (an upward adjustment of 5% per 5°C below 20°C was suggested);
- additional needs for supplementary feeding of “at risk” groups;
- additional needs for activity, e.g. physical labour;
- losses during distribution: a 5% allowance was proposed for transport losses within countries with ports, 10% for land-locked countries.
The immediate priority for the choice of commodities is to ensure an adequate intake of energy and protein. The protein-energy ratio of the total basket should not fall below 12%. If necessary, this may be a priority criterion for commodity selection during the first month of a relief programme. (Some commentators pointed out that this figure may be too high - a target of 8-10% protein-energy ratio is in line with current UN recommendations.)
The level of fat intake should be such as to provide at least 10% of the dietary energy intake.
Micronutrients
Where rations are provided to the target population for more than one month, it is essential to ensure that the ration provides minimum requirement levels on the following critical micronutrients: vitamin A; thiamine; riboflavin; vitamin C; iron; folic acid.
Mechanisms for ensuring the supply of essential micronutrients include the following:
- locally procured or traded food stuffs containing the micronutrients;Food Basket- foods, fortified locally or externally with the micronutrients;
- as a last resort, pharmaceutical supplements of the micronutrients might be distributed in some situations.
Food provided should be culturally acceptable and able to be consumed in a digestible form. When whole grains are provided, milling equipment must be provided from the onset of the relief programme. Special weaning and supplementary foods for vulnerable groups must be energy dense and contain adequate essential micronutrients.
When the general ration does not contain a digestible cereal, adequate oil, and a separate protein source, (e.g. lentils or other pulses); and/or when adequate milling facilities for whole grains are not yet available, then processed food (such as CSM) may be necessary in the general ration and for supplementary feeding. Processed foods are expensive, and locally mixed supplementary foods can substitute if the raw ingredients are available.
Options for when Food Supplies are Inadequate
Field workers face certain painful decisions regarding distribution in situations where food supplies are insufficient to provide the minimum energy requirements. The primary solution is that relief agencies must strive to avoid situations where food supplies are inadequate for the survival of populations. Nonetheless such situations continue to arise and field workers may have to choose from the following options, unsatisfactory as each of them is:
Option A. Where the community and family structure is still intact and community representatives can be identified, then the community should decide how such limited food shall be distributed. The potential problems associated with this approach were recognized.The very fact that field workers may be faced with distributing grossly inadequate food supplies was seen as an avoidable tragedy, and having to consider such options as a policy of desperation. Ensuring adequate supplies is the only satisfactory solution.Option B. Where community structures have been disrupted, then field workers should distribute food selectively to those at highest risk of mortality. Such selective feeding should continue for the shortest time possible until overall food supplies are adequate.
Option C. A third alternative is that food is equitably distributed to all members of the affected population without selection of particularly vulnerable members of that population.”
A publication incorporating the full recommendations of the Conference, report of the proceedings, and the background papers will be issued in 1989.
