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Despite massive efforts over the past 60 years, since the start of the Green Revolution, there are still far too many chronically hungry people in the world. Last year, the Food and Agriculture Organisation of the United Nations estimated that more than a billion people were hungry, partly as a result of sky-high food prices.

That would be bad enough, but at the same time the World Health Organisation (WHO) estimates that more than a billion people are seriously overweight. And then there are believed to be two billion people – mostly young women and children – who suffer from a lack of essential micronutrients such as vitamin A and iron.

The problem is not simply one of lack of proteins or calories. It is about the lack of diversity in the diet, because dietary diversity is one guarantee of an adequate supply of essential micronutrients. Without diversity in their diet, people can have enough to eat and yet still suffer the hidden hunger of malnutrition.

There is very good evidence from several studies, mostly in the rich world and also increasingly from developing countries, that a diverse diet protects people from several non-communicable diseases and is associated with a longer, healthier life and greater productivity.

Non-communicable diseases, such as obesity, type 2 diabetes, heart disease and cancers, were long thought of as diseases of affluence, but they are growing fastest in low- and middle-income countries, where 80 per cent of the deaths from these diseases occur. They account for 70 per cent of all adult deaths in the Western Pacific Region, and the Food Summit held in Vanuatu in April 2010 cited “declines in traditional food crops, increased dependence of imported foods and growing vulnerability to climate change” as among the most important reasons.

Current approaches to the problems of malnutrition are clearly not working. It is time for a fresh set of solutions, based on using agricultural biodiversity not simply as a source of traits for scientific breeders but as a component of healthy diets and resilient food systems.

Many levels

Agricultural biodiversity exists at many levels – in ecosystems, among species, and among different populations, or varieties, of the same species.

For example, in Kenya people traditionally ate more than 200 different species of leafy vegetables. In almost all cases, these species are much more nutritious than the cabbages and kales that are often the only green vegetables on sale in cities. However, they have also had to cope with a barrage of obstacles to their wider use – they are perceived as backward, supplies were erratic and unhygienic and younger adults, especially in the cities, had no idea how to prepare them.

Working with a range of partners Bioversity International trained farmers to grow traditional leafy vegetables and worked on quality control and supply chains. Supermarkets were brought in to help make the produce available in cities, and colourful recipe leaflets showed how to prepare them. Celebrities from entertainment and government endorsed traditional foods publicly and on mass media.

The result was an increase in deliveries to markets from about 30 tonnes a month to about 400 tonnes a month over three years. More telling, supplies in supermarkets and open-air markets, where traditional leafy vegetables are now much more common, regularly run out by early afternoon, indicating that there is still considerable unmet demand. Incomes have increased between two and 20 times among the farm families supplying these vegetables.

An expanded follow-up is now looking at 20 villages in Kitui district, east of Nairobi. Ten control villages are being compared with 10 matched intervention villages, where a whole range of activities designed to promote agricultural and dietary biodiversity are being undertaken. There is preliminary evidence that dietary diversity has increased in the houses, markets and restaurants of the intervention villages, and while it is very early days yet to see improvements in health, there are already hints of lower levels of anaemia.

It is important to note that the work in East Africa is not intended to be replicated directly elsewhere with the same species and the same interventions. Indeed, I would not expect it to work in other countries and other cultures. It is the methods and the ideas behind this food-based approach that are intended to be globally applicable – and Bioversity has other successful projects on Andean grains in Bolivia and Peru and nutritious millets in India and Nepal.

Similar food systems approaches based on locally available agricultural biodiversity are making headway in the Western Pacific Region. One is in Pohnpei (formerly Ponape) in the Federated State of Micronesia (FSM), where the Island Food Community of Pohnpei has been a leader in promoting the nutritional value of local fruits and vegetables using a whole range of innovative approaches.

Specific varieties of Pandanus fruit, for example, are much richer in vitamin A precursors than others, and a poster helps people to choose them and plant the best varieties. The community also worked with the FSM to issue a set of stamps promoting karat bananas, which are also very rich in pro-vitamin A. Every stamp carries a message explaining that karat is an ideal food for babies older than six months, in addition to breast milk.

Encouraging results

Many of the bananas of the Pacific are richer in vitamin A precursors than any other varieties of the plant. However, the knowledge that they exist has prompted Bioversity research in Cameroon in West Africa to look for high provitamin-A bananas there, with encouraging results. Considerable work remains to be done to make these an integral part of a food-based approach to vitamin A deficiency, but such an approach is likely to be the most sustainable solution.

Indeed, the food-based approach is long overdue for re-examination. When the WHO and other organisations first began to sound the alarm about micronutrient deficiencies, they specifically said that dietary diversity embedded in a food systems approach was the preferred option for tackling the problem. This original emphasis was slowly overtaken by a much more medicalised approach, which saw each deficiency as a disease to be cured by the administration of a specific supplement.

A recent analysis by Professor Michael Latham of Cornell University has pointed to what he calls “The Great Vitamin A Fiasco” with claims that this sort of reductionist intervention has done almost no good and may well have done harm, not least by blocking funding for more sustainable approaches. Critics have responded strongly to Professor Latham, who has also has brought out supporters and, perhaps most importantly, re-opened the debate.

While not in itself evidence for the medical “capture” of the treatment of malnutrition, it is salutary to realise that the pharmaceutical companies who manufacture vitamin A supplements were subjected to the largest fines ever issued in the US and the European Union, for price-fixing.

The medical establishment currently sees three approaches to tackling malnutrition – supplements, fortified foods and biofortified staples. This is echoed in the cost-benefit analyses of economists. The Copenhagen Consensus, for example, identified tackling malnutrition as one of the most pressing problems for humanity, with the highest return on investment of all the problems that it looked at. It did not, however, even consider food-based approaches, because there have not been enough detailed studies to enable comparison with the more medical approaches. In this way the medical establishment maintains its pre-eminent position.

The original food-based solutions advocated by the WHO and others need to be reassessed, not least because placing a greater emphasis on food and diet as a whole will enable medical interventions to be used where they are most needed and most effective. Both are needed in a balanced approach, with greater weight given to food-based approaches than at present.

In pursuit of this, Bioversity’s nutrition program is working to build the evidence base of what works on the ground, and how that can best be applied to other places and other cultures. Policy-makers need to understand that there are alternative approaches to tackle malnutrition, and that they often have multiple benefits beyond improving nutrition and health.

Virtuous circles

There are many virtuous circles that improve the resilience and stability of farm systems, adaptability to changing circumstances, such as climate change, household incomes and productivity, and long-term sustainability.

Most efforts to tackle malnutrition in the recent past have adopted a reductionist one-at-a-time approach to specific disorders. These will still be needed in the future, but a shift to more food-based approaches offers more comprehensive solutions to a range of interlinked problems.

Hunger and undernutrition are part and parcel of almost all development goals, influencing – and in turn being influenced by – health, income, education, gender equity and the environment. Implementing such approaches will require effort and funding, and – more than that – collaboration and coordination among different sectors that have not been used to working with one another.

This is hard. The benefits, however, will be seen in long-term improvements that will be self-sustaining, as healthier communities engage in a diversified and less destructive agriculture that offers a nutritionally superior diet, which in turn keeps communities healthier – all with profound effects on economic development.

Bioversity International is the operating name of the International Plant Genetic Resources Institute (IPGRI) and the International Network for Improvement of Banana and Plantain (INIBAP).

Dr. Emile Frison, Director General of Bioversity International has spent most of his career in international agricultural research for development. Dr Frison leads Bioversity and its partners in the formulation of a strategic vision in which nutrition and agricultural biodiversity play an important role in the overall goal of reducing hunger and poverty in a sustainable manner. He also leads the CGIAR System-Wide Genetic Resources Program and is a member of the CGIAR Genetic Resources Policy Committee.  In 2007, he was appointed as Extraordinary Professor by the Catholic University of Leuven, Belgium. Dr Frison is also a Member of the Executive Board of the Global Crop Diversity Trust.