While the challenges facing agriculture are clearly urgent, this paper questions the thrust of ‘sustainable intensification’. Sustainable intensification is reported by the author to include technology-based approaches through strategies developed without participation of small farmers. The author argues that most of the world’s food is grown by small farmers, without the use of industrial inputs, and using traditional seed varieties. Small farmers have raised their own priorities as a sustainable agriculture that builds on farmers’ own expertise and knowledge, with clear land rights, and rights for women, including agrarian reforms; agricultural research that starts by asking farmers what they need; knowledge and technologies that are based on agro-ecological principles, including compost, integrated pest management and mixed cropping; seed development based on traditional varieties; and mechanisms to protect local farmers from unfair competition from imported products.
Poverty and health
The Comprehensive Africa Agriculture Development Programme (CAADP), launched by African heads of state in 2003, offered the prospect of a new, intensified focus on agriculture throughout the continent. Ten years on, how successful has CAADP been? This paper offers a brief assessment, with its authors examining if agricultural budgets have increased, if the focus of spending has improved, and if CAADP is providing ‘fair shares’ to the millions of smallholder farmers who do most of Africa’s farming and produce most of its food. The key CAADP commitment made by African states was to allocate 10% of public expenditure to agriculture. Yet, as of 2010, only eight countries have exceeded the 10% target. Although the adoption of CAADP-aligned national strategies has played a role in increasing agricultural investment in some (though not all) countries, there are serious problems with the focus of spending, especially in the lack of adequate support to the needs of smallholder farmers, notably women farmers. The authors note that CAADP is promoting a farming model associated with the Green Revolution, which promotes the use of expensive external inputs such as chemical fertilisers, pesticides and genetically modified or hybrid seeds bought from agribusiness companies; they argue this comes at the expense of promoting sustainable agriculture approaches that are likely to benefit poor farmers much more. One of the biggest failures for CAADP-aligned national investments is that they have not recognised the potential of smallholders’ own investments or their potential to build on their ‘fair share’, the authors conclude.
Household air pollution (HAP) from solid fuel (biomass or coal) combustion is the leading environmental cause of death and disability in the world. The health effects of HAP and unsafe stoves are documented in this paper to be in seven areas (cancer; infections; cardiovascular disease; maternal, neonatal, and child health; respiratory disease; burns; and ocular disorders). Gaps in four cross-cutting areas were found that are relevant to research on HAP (exposure and biomarker assessment, women's empowerment, behavioural approaches, and programme evaluation). The authors argue that it is vital that researchers partner with implementing organisations and governments to evaluate the impacts of improved stove and fuel programmes to identify and share evidence regarding the outcomes of the many implementation programmes underway, including the socio-behavioural aspects of household energy use.
The key message of this report is that without better understanding the determinants of smallholders’ participation in agricultural markets, and formulating appropriate measures to facilitate improved participation, initiatives seeking to promote the adoption of productivity enhancing technology by smallholder producers are likely to have limited success. Smallholders’ participation in markets is crucially important for improved food security and poverty reduction. Attempts to improve smallholder productivity will have limited success if smallholder linkages to markets are not strengthened simultaneously. Limited smallholder participation in markets is not necessarily a result of a lack of commercial orientation per se, but the result of constrained choice in a risky environment. Smallholders are very heterogeneous, facing different types of constraints and opportunities, and will react differently to new market opportunities. Public policy interventions are generally needed to foster smallholder market integration, the authors argue. These interventions need to be prioritised and sequenced according to evidence-based diagnosis of the constraints faced by different categories of smallholders. Evidence-based policy-making could help minimise the risks of policy failure.
What do newer emerging external funders do in the field of agricultural cooperation in Africa? And how does this relate to the African Union’s Comprehensive Africa Agriculture Development Programme (CAADP)? This paper from ECDPM looks at Brazilian agricultural cooperation in Ghana side by side with the CAADP process in the country. It finds that while Brazil largely supports the country’s CAADP investment plan, it does not engage with the process around it. This is not necessarily the result of a conscious policy choice or bad will, but due to the fact that CAADP might not be very attractive for newer external funders as currently designed, the author argues. Yet, there are clear trends towards cooperation and joint learning between Brazil and Western external funders, which might provide some space for CAADP to play a role in facilitating these exchanges.
The Commission on Social Determinants of Health (CSDH) was tasked by the World Health Organisation (WHO) with summarising the evidence on how the structure of societies, through myriad social interactions, norms and institutions, are affecting population health, and what governments and public health can do about it. To guide the Commission, the WHO Secretariat conducted this review and summary of different frameworks for understanding the social determinants of health (SDH). Developing a conceptual framework on social determinants of health (SDH) for the CSDH needs to take note of the specific theories of the social production of health. Three main theoretical non-mutually exclusive explanations were reviewed: (1) psychosocial approaches; (2) social production of disease/political economy of health; and (3) eco-social frameworks. In turning to policy action on SDH inequities, three broad approaches to reducing health inequities can be identified, based on: (1) targeted programmes for disadvantaged populations; (2) closing health gaps between worse-off and better-off groups; and (3) addressing the social health gradient across the whole population. A consistent equity-based approach to SDH must ultimately lead to a gradients focus. However, strategies based on tackling health disadvantage, health gaps and gradients are not mutually exclusive. They can complement and build on each other.
The global food system is under acute and rising pressure - and Africa's farmers are feeling its full force. There is still more than enough food in the world to feed everyone, says the Panel in this report, but population and economic growth as well as the search for low-carbon energy sources are driving up demand for arable land, while climate change, ecological constraints and lower levels of productivity growth in agriculture are limiting food supply. While these emerging strains in the global food system offer Africa some opportunities, they also carry very large risks. Higher food prices could create incentives for African governments to invest in agriculture and raise productivity, or they could lead to a dramatic worsening of poverty and malnutrition among vulnerable populations. Africa's vast untapped potential in agriculture could become a source of rural prosperity and more balanced economic growth, or it could act as a magnet for more speculative investments, land grabs and the displacement of local communities. Carbon markets might open up opportunities for small farmers to benefit from climate change mitigation efforts in rich countries, though the benefits have so far proven limited and the future of these markets remains uncertain. What is certain is that Africa's farmers will bear the brunt of dangerous climate change, with drought and unpredictable rainfall patterns reinforcing rural poverty and undermining food systems.
Maternal and child undernutrition, consisting of stunting, wasting, and deficiencies of essential vitamins and minerals, was the subject of a Series of papers in The Lancet in 2008. In the series, researchers quantified the prevalence of these issues, calculated their short-term and long-term consequences, and estimated their potential for reduction through high and equitable coverage of proven nutrition interventions. Authors of the 2008 series identified the need to focus on the crucial period from conception to a child’s second birthday - the 1,000 days in which good nutrition and healthy growth have lasting benefits throughout life. They also called for greater priority for national nutrition programmes, stronger integration with health programmes, enhanced intersectoral approaches, and more focus and coordination in the global nutrition system of international agencies, external funders, academia, civil society, and the private sector. Five years after the initial series, the the Lancet has re-evaluated the problems of maternal and child undernutrition in this document and also examines the growing problems of overweight and obesity for women and children and their consequences in low-income and middle-income countries (LMICs). Many of these countries are said to have the double burden of malnutrition - continued stunting of growth and deficiencies of essential nutrients along with the emerging issue of obesity. The Lancet also assesses national progress in nutrition programmes and international efforts toward previous recommendations.
This informal document aims at informing policymakers how best to consider the social determinants of health in the post-2015 global thematic consultations organised under the United Nations Development Group. It illustrates the concept of the social determinants of health as applied to the thematic groups, gives examples of why health is important to each theme and shows how each theme could contribute to health. In order to reduce health inequities, the UN Platform argues that there is a need to address the wider socioeconomic and structural factors that influence how people become sick, what risk factors they are exposed to, how they access services, and how they use those services. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. Integrated policy approaches are necessary in order to address the complexity of health inequities, including through national social protection floors, which address income security and the goal to establish universal access to health care simultaneously.
Concepts of ‘what constitutes mental illness’, the presumed aetiology and preferred treatment options, vary considerably from one cultural context to another. In this study, participants from four locations in Burundi, South Sudan and the Democratic Republic of the Congo, were invited to describe ‘problems they knew of that related to thinking, feeling and behaviour?’ Data were collected over 31 focus groups discussions (251 participants) and key informant interviews with traditional healers and health workers. While remarkable similarities occurred across all settings, there were also striking differences. In all areas, participants were able to describe localised syndromes characterised by severe behavioural and cognitive disturbances with considerable resemblance to psychotic disorders. Additionally, respondents throughout all settings described local syndromes that included sadness and social withdrawal as core features. However, attributed causes varied from supernatural to psychosocial and natural. The authors conclude that local conceptualisations have significant implications for the planning of mental-health interventions in resource-poor settings recovering from conflict.