Can we feed the world in the 21st century?
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In a recent speech, Stanford professor Rosamond Naylor examined the wide range of challenges contributing to global food insecurity, which Naylor defined as a lack of plentiful, nutritious and affordable food. Naylor's lecture, titled "Feeding the World in the 21st Century," was part of the quarterly Earth Matters series sponsored by Stanford Continuing Studies and the Stanford School of Earth Sciences. Naylor, a professor of Environmental Earth System Science and director of the Center on Food Security and the Environment at Stanford, is also a professor (by courtesy) of Economics, and the William Wrigley Senior Fellow at the Freeman Spogli Institute for International Studies and the Stanford Woods Institute for the Environment.
"One billion people go to bed day in and day out with chronic hunger," said Naylor. The problem of food insecurity, she explained, goes far beyond food supply. "We produce enough calories, just with cereal crops alone, to feed everyone on the planet," she said. Rather, food insecurity arises from a complex and interactive set of factors including poverty, malnutrition, disease, conflict, poor governance and volatile prices. Food supply depends on limited natural resources including water and energy, and food accessibility depends on government policies about land rights, biofuels, and food subsidies. Often, said Naylor, food policies in one country can impact food security in other parts of the world. Solutions to global hunger must account for this complexity, and for the "evolving" nature of food security.
As an example of this evolution, Naylor pointed to the success of China and India in reducing hunger rates from 70 percent to 15 percent within a single generation. Economic growth was key, as was the "Green Revolution," a series of advances in plant breeding, irrigation and agricultural technology that led to a doubling of global cereal crop production between 1970 and 2010. But Naylor warned that the success of the Green Revolution can lead to complacency about present-day food security challenges. China, for example, sharply reduced hunger as it underwent rapid economic growth, but now faces what Naylor described as a "second food security challenge" of micronutrient deficiency. Anemia, which is caused by a lack of dietary iron and which Naylor said is common in many rural areas of China, can permanently damage children's cognitive development and school performance, and eventually impede a country’s economic growth.
Hunger knows no boundaries
Although hunger is more prevalent in the developing world, food insecurity knows no geographic boundaries, said Naylor. Every country, including wealthy economies like the United States, struggles with problems of food availability, access, and nutrition. "Rather than think of this as 'their problem' that we don't need to deal with, really it's our problem too," Naylor said.
She pointed out that one in five children in the United States is chronically hungry, and 50 million Americans receive government food assistance. Many more millions go to soup kitchens every night, she added. "We are in a precarious position with our own food security, with big implications for public health and educational attainment," Naylor said. A major paradox of the United States' food security challenge is that hunger increasingly coexists with obesity. For the poorest Americans, cheap food offers abundant calories but low nutritional value. To improve the health and food security of millions of Americans, "linking policy in a way that can enhance the incomes of the poorest is really important, and it's the hard part,” she said.” It's not easy to fix the inequality issue."
Success stories
When asked whether there were any "easy" decisions that the global community can agree to, Naylor responded, "What we need to do for a lot of these issues is pretty clear, but how we get after it is not always agreed upon." She added, "But I think we've seen quite a few success stories," including the growing research on climate resilient crops, new scientific tools such as plant genetics, improved modeling techniques for water and irrigation systems, and better knowledge about how to use fertilizer more efficiently. She also said that the growing body of agriculture-focused climate research was encouraging, and that Stanford is a leader on this front.
Naylor is the editor and co-author of The Evolving Sphere of Food Security, a new book from Oxford University Press. The book features a team of 19 faculty authors from 5 Stanford schools including Earth science, economics, law, engineering, medicine, political science, international relations, and biology. The all-Stanford lineup was intentional, Naylor said, because the university is committed to interdisciplinary research that addresses complex global issues like food security, and because "agriculture is incredibly dominated by policy, and Stanford has a long history of dealing with some of these policy elements. This is the glue that enables us to answer really challenging questions."
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Brett Carter
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blcarter@stanford.edu
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Brett Carter is an Associate Professor in the Department of Political Science and International Relations at the University of Southern California, a Hoover Fellow at Stanford University's Hoover Institution, and a Faculty Affiliate at Stanford's Center on Democracy, Development and the Rule of Law. He received a Ph.D. from Harvard University, where he was a fellow at the Harvard Academy for International and Area Studies.
Carter studies politics in the world's autocracies. His first book, Propaganda in Autocracies: Institutions, Information, and the Politics of Belief (Cambridge University Press), draws on the largest archive of state propaganda ever assembled — encompassing over eight million newspaper articles in six languages from nearly 60 countries around the world — to show how political institutions shape the propaganda strategies of repressive governments. It received the William Riker Prize for the Best Book in Political Economy, the International Journal of Press/Politics Hazel Gaudet-Erskine Best Book Award, Honorable Mention for the Gregory Luebbert Award for the Best Book in Comparative Politics, and Honorable Mention for the APSA Democracy & Autocracy Section's Best Book Award.
His second book, in progress, shows how politics in Africa’s autocracies changed after the fall of the Berlin Wall and how a new era of geopolitical competition — marked by the rise of China and the resurgence of Russia — is changing them again.
Carter’s other work has appeared in the Journal of Politics, British Journal of Political Science, Perspectives on Politics, Journal of Conflict Resolution, Security Studies, China Quarterly, Journal of Democracy, and Foreign Affairs, among others. His work has been featured by The New York Times, The Economist, The National Interest, and NPR’s Radiolab.
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CDDRL Visiting Scholar, 2020-2021
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Everything that Can Go Wrong in a Field Experiment
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Join Global Development and Poverty Initiative (GDP) for a stimulating discussion on the opportunities, obstacles, and unforeseen events encountered while conducting field research in the developing world.
The panelists will share stories of challenges and successes from their own experiences and will offer insights on conducting effective research in the field.
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Jenna Davis
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Professor, Department of Civil and Environmental Engineering
Jennifer (“Jenna”) Davis is a Professor in the Department of Civil and Environmental Engineering and the Higgins-Magid Senior Fellow at the Woods Institute for the Environment, both of Stanford University. She also heads the Stanford Program on Water, Health & Development. Professor Davis’ research and teaching is focused at the interface of engineered water supply and sanitation systems and their users, particularly in developing countries. She has conducted field research in more than 20 countries, including most recently Zambia, Bangladesh, and Uganda.
Higgins-Magid Faculty Senior Fellow, Stanford Woods Institute for the Environment
Katherine Casey
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Stephen P. Luby
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Faculty Lead, Center for Human and Planetary Health
Professor of Medicine (Infectious Diseases)
Professor of Epidemiology & Population Health (by courtesy)
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Senior Fellow at the Woods Institute for the Environment
Faculty Affiliate at the Stanford Center on China's Economy and Institutions
Prof. Stephen Luby studied philosophy and earned a Bachelor of Arts summa cum laude from Creighton University. He then earned his medical degree from the University of Texas Southwestern Medical School at Dallas and completed his residency in internal medicine at the University of Rochester-Strong Memorial Hospital. He studied epidemiology and preventive medicine at the Centers for Disease Control and Prevention.
Prof. Luby's former positions include leading the Epidemiology Unit of the Community Health Sciences Department at the Aga Khan University in Karachi, Pakistan, for five years and working as a Medical Epidemiologist in the Foodborne and Diarrheal Diseases Branch of the U.S. Centers for Disease Control and Prevention (CDC) exploring causes and prevention of diarrheal disease in settings where diarrhea is a leading cause of childhood death. Immediately prior to joining the Stanford faculty, Prof. Luby served for eight years at the International Centre for Diarrhoeal Diseases Research, Bangladesh (icddr,b), where he directed the Centre for Communicable Diseases. He was also the Country Director for CDC in Bangladesh.
During his over 25 years of public health work in low-income countries, Prof. Luby frequently encountered political and governance difficulties undermining efforts to improve public health. His work within the Center on Democracy, Development, and the Rule of Law (CDDRL) connects him with a community of scholars who provide ideas and approaches to understand and address these critical barriers.
Director of Research, Stanford Center for Innovation in Global Health
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Seminars
Health Plus: Spillovers from Foreign Aid for Health in Africa
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About the Topic: Foreign aid for health in low- and middle-income countries has increased five-fold over the past 25 years. Between 2005 and 2010, health aid made up more than 30% of all health spending in low-income countries. Global health is also an increasingly important component of U.S. foreign aid, rising steadily from under 4% of all U.S. non-military aid in 1990 to 22.7% in 2011. There is growing evidence for the role of health aid in improving health among recipient countries, but is that it? In this talk I will address the arguments for and against health as a focus of aid efforts and present initial evidence on the role of health aid on human capital and economic development.
About the Speaker: Eran Bendavid is an infectious diseases physician and an Assistant Professor of Medicine in the Division of General Medical Disciplines and a Stanford Health Policy affiliate. His research interests involve understanding the relationship between policies and health outcomes in developing countries. He explores how decisions about foreign assistance for health are made, and how those decisions affect the health of those whom assistance aims to serve.
He received a B.A. in chemistry and philosophy from Dartmouth College, and an M.D. from Harvard Medical School. He completed his residency in internal medicine and fellowship in infectious diseases at Stanford.
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Stanford University
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The American Calculus of Military Intervention
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Military interventions have traditionally been a source of controversy in the United States. But America’s appetite for the dispatch of armed forces has been diminished greatly by factors that have primarily emerged in the 21st century. These include, most painfully, the protracted campaigns in Afghanistan and Iraq that have made US political and military leaders more cautious about waging wars to end tyranny or internal disorder in foreign lands.
Debates on military intervention are complicated by the network of political, security and economic interests that must be balanced when contemplating this option. In this IISS commentary, Karl Eikenberry, the William J. Perry Fellow in International Security at CISAC, talks about how four factors have heavily influence the current calculus.
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Health care aid for developing countries boosts life expectancy, study finds
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Foreign aid for health care is directly linked to an increase in life expectancy and a decrease in child mortality in developing countries, according to a new study by Stanford researchers.
The researchers examined both public and private health-aid programs between 1974 and 2010 in 140 countries and found that, contrary to common perceptions about the waste and ineffectiveness of aid, these health-aid grants led to significant health improvements with lasting effects over time.
Countries receiving more health aid witnessed a more rapid rise in life expectancy and saw measurably larger declines in mortality among children under the age of 5 than countries that received less health aid, said Eran Bendavid, MD, an assistant professor in Stanford Medical School's Division of General Medical Disciplines and lead author of the study. If these trends continue, he said, an increase in health aid of just 4 percent, or $1 billion, could have major implications for child mortality.
“If health aid continues to be as effective as it has been, we estimate there will be 364,800 fewer deaths in children under 5,” he said. “We are talking about $1 billion, which is a relatively small commitment for developed countries.”
The study was published online April 21 in JAMA Internal Medicine. The study’s co-author, Jay Bhattacharya, MD, PhD, is an associate professor of medicine.
Bendavid and Bhattacharya are core faculty members at Stanford’s Center for Health Policy and Center for Primary Care and Outcomes Research at the university's Freeman Spogli Institute for International Studies.
Does it work?
Bendavid noted that there is much debate around foreign aid. Critics question whether it’s used effectively and reaches its intended recipients. They often argue that it discourages local development and displaces domestic resources that might otherwise be devoted to health. So the researchers devised a statistical tool to address the basic unanswered question: Do investments in health really lead to health improvements?
Bendavid said there are many reasons to suspect the answer would be no, though the findings proved just the contrary, with health-related aid leading to direct, beneficial outcomes.
“I think for many people, that will be surprising,” he said. “But for me, it fits with other evidence of the incredible success of public health promotion in developing countries.” In a previous study, for instance, he found that hundreds of thousands of lives were saved through the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR, in which the U.S. government invested billions of dollars in antiretroviral treatment and other AIDS-related prevention and treatment initiatives.
In the latest study, the two investigators used data from the Creditor Reporting System of the Organization for Economic Cooperation and Development, the world’s most extensive source of information on foreign aid. While aid programs for health grew during the 36-year study period, the largest period of growth occurred between 2000 and 2010, they found.
Stepped-up investments
It was during this decade that many governments and private groups stepped up their investments in health, including PEPFAR; the World Bank; the Global Fund to Fight AIDS, Tuberculosis and Malaria; the Gates Foundation; and the GAVI Alliance, among others, he said.
As a result, while health aid in 1990 accounted for 4 percent of total foreign aid, it now amounts to 15 percent of all aid, he said. And it’s become an important part of health budgets in recipient countries, accounting for 25-30 percent of all health-care spending in low-income countries, Bendavid said.
The researchers found that these funds were used effectively, largely because of the targeting of aid to disease priorities where improved technologies — such as new vaccines, insecticide-treated bed nets for malarial prevention and antiretroviral drugs for HIV — could make a real difference.
They observed the greatest health impacts between 2000 and 2010, when donor investments were at their peak. During the decade, under-5 child mortality declined from a mean of 109.2 to 72.4 deaths per 1,000, or 36.8 fewer deaths among those children in the countries that received the most health aid, the researchers found (a 34 percent reduction). In the countries receiving the least, under-5 mortality fell from 31.6 to 23.2 deaths per 1,000, or 8.4 fewer deaths per 1,000 live births (a 26 percent reduction), the researchers reported.
Life expectancy increases
During that period, life-expectancy figures also grew faster in countries with a greater infusion of health aid, Bendavid said. Life expectancy rose from 57.5 to 62.3 — an increase of 4.8 years — among the countries receiving the most aid. Among the countries receiving the least health aid, life expectancy increased by 2.7 years, from 69.8 to 72.5 years.
Bendavid said previous experience has shown that, on average, life expectancy has increased by nearly one year every four years in developed countries. But health-aid programs literally cut in half the time it took to reach this goal in developing countries. “In that same four-year span, they increased life expectancy by two years, rather than one year,” he said.
He said the results are not surprising if one considers some of the new health technologies made available to developing nations as a result of foreign aid. Childhood vaccines, including those for diphtheria, tetanus, polio and measles, have all but wiped out what used to be among the top killers of young children in the developing world. Health aid directed to providing insecticide-treated malarial bed nets also has been credited in recent studies with reducing malarial deaths among young children, he noted.
Among both adults and children, aid that has expanded the availability of antiretroviral drugs in the developing world has had a major impact on reducing deaths and improving overall life expectancies, he said. For instance, in a study published in 2012, Bendavid and colleagues found that PEPFAR’s health aid resulted in more than 740,000 lives saved between 2004 and 2008 in nine countries.
The researchers also found that the benefits of aid have a lasting effect: The telltale signs of aid’s relationship to reducing under-5 mortality were detectable for three years following the distribution of aid. The correlation between health aid and longer life expectancy overall was detectable for five years after the aid was distributed.
With aid commitments flattening amid the economic downturn, Bendavid said donors will have to be that much smarter in how they invest future dollars, focusing on the most cost-effective interventions and technologies.
“To date, there has been little consideration of how to use development aid in the most cost-effective manner,” he said. “That will have to change now that the funding level has reached a plateau.”
The study was funded by the George Rosenkranz Fellowship for Health Policy Research in Developing Countries and by the National Institutes of Health (grant K01AI084582).
Information about Stanford’s Department of Medicine, which also supported the work, is available at http://medicine.stanford.edu.
Ruthann Richter is the director of media relations at the Stanford School of Medicine.
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n Afghan child receives polio vaccination drops during an anti-polio campaign in Kabul March 24, 2014.
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