Slide 2 Plant and Crop Sciences Seminar fitness fit·ness (f ĭ t'n ĭ s) n. Farming for fitness: The state or condition of being the economics of putting physically sound and healthy, especially as the result of exercise and proper nutrition. vitamins and minerals into staple crops A state of general mental and physical well-being. Alexander J. Stein ! This seminar is about the fitness of the poor and malnourished to simply live and work 5 May 2010, The University of Nottingham Slide 3 Slide 4 Structure Introduction • Introduction • Vitamin and mineral deficiencies (VMDs) • Health consequences of VMDs • Quantifying the burden of disease of VMDs • Socio-economic impacts of VMDs • Causes of VMDs • Micronutrient interventions • FAO (2009): 1,020,000,000 are hungry • Impact and cost-effectiveness of biofortification • Conclusions Slide 5 Slide 6 Introduction Mineral deficiencies • Increasingly also “hidden hunger” • 20+ dietary minerals & trace elements falls under the definition of malnutrition essential for proper functioning of body • Chronic lack of vitamins and minerals • Most are abundant in food or are only needed in very small amounts • “Hidden" because people feel not hungry; often no immediately visible signs of VMDs • But for some minerals deficiencies occur: - globally: iron ( Fe ), zinc ( Zn ) and iodine ( I ) ! Here the potential role of agriculture in - regionally: calcium ( Ca ) and selenium ( Se ) addressing VMDs is discussed and evaluated from an economic viewpoint - less: magnesium ( Mg ) and copper ( Cu ) www.AJStein.de
Slide 7 Slide 8 Mineral deficiencies Health consequences Number of people affected (billion) • Iron deficiency leads to anaemia and 2.0 1.8 - higher maternal mortality Difference in estimates 1.6 - lower mental development in children 1.4 1.2 - impaired physical activity and fatigue 1.0 0.8 • Zinc deficiency in children contributes to 0.6 0.4 - under-five mortality 0.2 0.0 - pneumonia & diarrhoea Hunger Iodine Zinc Iron Selenium deficiency deficiency deficiency deficiency - stunting + vitamin deficiencies = multiple deficiencies Slide 9 Slide 10 Health consequences Health consequences ! Impact of VMDs not uniform : • Iodine deficiency causes goiter and mental retardation & cretinism • They cause different functional outcomes, hit different target groups and • Calcium deficiency causes bone problems impose different levels of suffering (especially rickets in children) and may aggravate certain chronic diseases • Magnitude of some health consequences intuitive, but impact of others difficult to grasp • Selenium deficiency is associated with a • The deficiency that affects most people is heart disease that is often fatal (Keshan) and not necessarily the one representing the it increases a number of other health risks biggest overall health loss Slide 11 Slide 12 Burden of disease Burden of disease • How to measure “health loss” consistently? • Adding up DALYs gives “burden” of disease - Premature death is counted in • World Bank and WHO introduced Years of Life Lost (YLL) “disability-adjusted life years” (DALYs) - Disease is counted in • Single index taking into account the duration Years Lived with Disability (YLD) and severity of each health outcome • Burden = DALYs lost = YLL + YLD weighted • Severity captured through a disability-weight • More formally: ranging from 0 (no health loss) to 1 (death) − − − − rL rd 1 e j 1 e ij ∑ ∑ ∑ = + DALYs T M T I D lost j ij j ij ij j i j r r www.AJStein.de
Slide 13 Slide 14 Burden of disease Socio-economic impact • Ranking of major health risks (WHO 2002) • VMDs affect billions of people, cause ill health and suffering, and contribute to the Underweight global burden of disease Unsafe sex Blood pressure 10% of DALYs lost Tobacco to undernourishment • They also impose tangible economic costs Alcohol = 1st rank Lack of sanitation by hampering both individual productivity and Cholesterol Indoor smoke overall economic growth Iron deficiency Overweight 6% of DALYs lost ! Apart from a moral obligation, there is a Zinc deficiency to VMDs = 2nd rank Little fruit & veggies purely economic rationale for fighting them Vitamin A deficiency Physical inactivity Risks for injury 0m 20m 40m 60m 80m 100m 120m 140m Slide 15 Slide 16 Socio-economic impact Socio-economic impact • Controlling malnutrition (inclusive VMDs) • In the aggregate the mechanism is similar: helps break the malnutrition-poverty trap - Malnutrition reduces overall productivity, economic growth and national income Malnutrition - This keeps labor demand down, suppresses Low wages and thus perpetuates poverty... productivity - ... and it limits public resources that can be Poor diets used for nutrition and health interventions Low earnings Poverty Slide 17 Slide 18 Socio-economic impact Socio-economic impact • Fogel (2004): 30% of growth in British per • VMDs also affect cognitive abilities, hence capita income over the last 200 years due they even reduce future productivity by to better nutrition (incl. vitamins & minerals) lowering the success of schooling • World Bank (1994): deficiencies of vitamin A • Malnourished mothers have smaller babies (VA), iodine & iron can cost up to 5% of GDP that are more sickly later on in life, • Horton & Ross (2003): iron deficiency thus again reducing future productivity costs developing countries 4% of GDP ! VMDs not only affect health but also • MI/UNICEF (2004): Fe, I, VA & folate economic outcomes in many ways deficiency can cost over 2% of GDP www.AJStein.de
Slide 19 Slide 20 Socio-economic impact Causes of VMDs • But economic productivity is no end in itself • No availability of micronutrient-rich food: disasters, shortages, seasonality • Ultimate goal is human happiness and development ( Millennium Development Goals ) • Lack of access to food & health care: ! Less hunger, less poverty, more education, - poverty = low overall food intakes more gender equality, less mortality, - poverty = monotonous diets poor in micronut. more health, more environmental - intra-household distribution (individual level) sustainability, more participation: often vitamins & minerals can help! Slide 21 Slide 22 Causes of VMDs Causes of VMDs • Poor utilisation of available food: • No or low micronutrient content in crops: - low bioavailability of micronutrients - no beta-carotene in white crops (monotonous, cereal-based diets) (rice, sweet potato, cassava, maize) - micronutrient content irrelevant for people’s - cultivation of crops on mineral deficient soils food preferences (even if affordable) - depletion of soils through higher - poor food choices due to a crop production per unit area lack of nutrition knowledge - increased yields in cultivars associated • Loss of nutrients due to disease, with reduced mineral concentrations in crops e.g. diarrhoea or bleeding Slide 23 Slide 24 Causes of VMDs Micronutrient interventions Wheat cultivars released by CIMMYT from 1950 to 1992 • Various interventions to control VMDs: (Monasterio & Graham 2000) 45 1. supplementation (e.g. iron pills) Concentration (ppm) 2. fortification (e.g. iodised salt) 40 3. dietary diversification (production & 35 promotion of micronutrient-rich crops) 30 + complementary interventions (infant feeding, nutrition education, Fe concentration of cultivar 25 public health, WASH, poverty reduction) Zn concentration of cultivar 1950 1960 1970 1980 1990 Year of cultivar release www.AJStein.de
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