the african food system and its interaction with human health and nutrition the african food system and its interaction with human health and nutrition edited by per pinstrup-andersen published in cooperation with the united nations university cornell university press ithaca and london Copyright © 2010by Cornell University All rights reserved. Except for brief quotations in a review, this book, or parts thereof, must not be reproduced in any form without permission in writing from the publisher. For information, address Cornell University Press, Sage House, 512East State Street, Ithaca, New York 14850. First published 2010by Cornell University Press in cooperation with the United Nations University Printed in the United States of America Library of Congress Cataloging-in-Publication Data The African food system and its interaction with human health and nutrition / edited by Per Pinstrup-Andersen. p. cm. “Published in cooperation with the United Nations University.” Includes bibliographical references. isbn978-0-8014-7692-1(pbk. : alk. paper) 1. Food supply—Africa, Sub-Saharan. 2. Nutrition—Africa, Sub-Saharan. 3. Agricultural systems—Health aspects—Africa, Sub-Saharan. 4. Food industry and trade—Health aspects—Africa, Sub-Saharan. 5. Food security—Africa, Sub-Saharan. 6. Public Health—Africa, Sub-Saharan. I. Pinstrup-Andersen, Per. II. United Nations University. hd9017.a3572a35 2010 338.1´967—dc22 2010033393 contents list of figures vii list of tables ix foreword xi preface xiii acknowledgments xvii chapter 1 The African Food System and Human Health and Nutrition: A Conceptual and Empirical Overview 1 Per Pinstrup-Andersen chapter 2 The Nutrition Situation in Sub-Saharan Africa 14 Derrill D. Watson II and Per Pinstrup-Andersen chapter 3 Disease Burdens of Sub-Saharan Africa and Their Interactions with Malnutrition 34 Onesmo K. ole-MoiYoi chapter 4 Animals as a Source of Human Diseases: Historical Perspective and Future Health Risks for the African Population 58 E. Fuller Torrey chapter 5 How AIDS Epidemics Interact with African Food Systems and How to Improve the Response 77 Stuart Gillespie chapter 6 Pest Management, Farmer Incomes and Health Risks in Sub-Saharan Africa: Pesticides, Host Plant Resistance and Other Measures 109 Rebecca Nelson chapter 7 Nutrition and the Environment: Fundamental to Food Security in Africa 128 Anna Herforth chapter 8 Food Safety as a Bridge between the Food System and Human Health in Sub-Saharan Africa 161 Dorothy Nakimbugwe and Kathryn J. Boor chapter 9 Population Dynamics and Future Food Requirements in Sub-Saharan Africa 182 Barbara Boyle Torrey chapter 10 Income and Food Transfers to Improve Human Health and Nutrition 199 Harold Alderman chapter 11 The Impact of Poor Health and Nutrition on Labor Productivity, Poverty, and Economic Growth in Sub-Saharan Africa 218 David E. Sahn chapter 12 Food Systems and the Escape from Poverty and Ill-Health Traps in Sub-Saharan Africa 242 Christopher B. Barrett chapter 13 Strengthening the Role of Women in the Food Systems of Sub-Saharan Africa to Achieve Nutrition and Health Goals 261 Laura K. Cramer and Speciosa K. Wandira chapter 14 Bridging the Gap: Linking Agriculture and Health to Achieve the Millennium Development Goals 279 Joachim von Braun, Marie T. Ruel, and Stuart Gillespie references 305 contributors 353 figures 1.1 A food system 2 1.2 Interactions between food systems and human health 3 2.1 Deaths associated with malnutrition, 2002 16 2.2 Millions of people suffering from hunger globally, 2005 18 2.3 Millions of people suffering from hunger in Sub-Saharan Africa, 2005 18 2.4 Percentage of population suffering from hunger globally by developing-country region, 1991, 1996, and 2005 19 2.5 Percentage of population suffering from hunger in Sub-Saharan Africa by region, 1991, 1996, and 2005 19 2.6 Millions of underweight children, 2000–07 20 2.7 Prevalence of underweight children by region, 2007 21 2.8 Millions of low-birth-weight children, 2000–07 22 2.9 Percentage of babies born with low birth weight by region, 2000–07 22 2.10 Progress toward meeting the WFS globally, 1991–2015 26 2.11 Progress toward the World Food Summit goal in Sub-Saharan Africa, 1991–2015 28 2.12 Progress toward meeting the WFS goal in Sub-Saharan Africa, by region 28 2.13 Change in millions of hungry people in Sub-Saharan Africa, by country, 1991–2005 29 5.1 Spirals within spirals: Interactions between food insecurity, malnutrition, and HIV infection 80 5.2 The vicious circle of malnutrition and HIV 81 5.3 Adapting the livelihoods framework to HIV and AIDS 82 5.4 HIV and poverty in Africa 84 5.5 HIV and income inequality in Africa 84 5.6 The HIV timeline showing core strategies 98 7.1 The environment, food security, and food-seeking behavior 129 7.2 Average landholding size in selected African countries, 1960–69and 1990–99 134 7.3 Average annual nutrient depletion in Africa, 1993–95 136 7.4 A causal map of low agricultural productivity in Sub-Saharan Africa 137 7.5 Per capita food availability in Sub-Saharan Africa, 2003 142 7.6 Food quantities in Sub-Saharan Africa, 1987–2003 143 7.7 Pathways from agricultural diversity to dietary diversity 144 viii figures 9.1 Population growth in Africa, 1950–2005 184 9.2 Infant mortality rates, 1950–2005 185 9.3 Prevalence of undernutrition, 1970–2000 186 9.4 Childhood undernutrition, 2005 187 9.5 Total fertility rates, 1950–2005 193 9.6 Future population growth in Africa, 2010–50 195 11.1 Relationship between GDP per capita and life expectancy, 2000 224 12.1 Extreme poverty, 1981–2004 243 12.2 Extreme and ultra poverty, 2004 245 12.3 Accelerating agricultural growth in Sub-Saharan Africa, 1980–2005 259 13.1 Women’s obstacles to achieving agricultural growth 265 13.2 Policy options for strengthening women’s role in food systems 272 14.1 Number of ultra-poor people living on less than $0.50a day, 2004 282 14.2 Change in the proportion of the ultra-poor in different regions, 1990–2004 282 14.3 A conceptual framework of the linkages between agriculture and health 292 tables 2.1 Life expectancy and under-five mortality rate by region, 2000–07 16 2.2 Micronutrient deficiencies in Sub-Saharan Africa, by country, 1998–2004 24 2.3 Progress in Sub-Saharan Africa by goal (number of countries) 31 5.1 Re-viewing agriculture through an HIV lens 102 7.1 Components of the environment, how they affect human nutrition, and how they are affected by human food-seeking behavior 130 9.1 Sub-Saharan African calories available per day, 2001–03(based on food harvested) 190 9.2 Caloric requirements for Africa’s future population, 2000–50 192 A9.1 Estimated calorie requirements (in kilocalories) for each gender and age group at different levels of physical activity 198 11.1 Prevalence of underweight preschool children (0–60months) in developing countries, 1975–2005(%) 221 11.2 Infant mortality rate in developing countries, 1960–2005(deaths before age one per 1,000live births) 222 11.3 Life expectancy in developing countries, 1960–2005 222 11.4 Estimated share of people below the $1-a-day poverty line (%) 223 11.5 World and regional estimates of productivity (output per worker, constant 2000US$ at PPP) 224 12.1 Participation in the staple foodgrains market in East and Southern Africa 250 14.1 Agriculture and health linkages in the MDGs 287