A Conversation with Charlotte DuFour – United Nations Food and Agriculture Organization

As a Nutrition, Food Security, and Livelihoods Officer at FAO, Charlotte DuFour has been working for the last several years to mainstream multi-sectoral approaches to improve nutrition, primarily by strengthening linkages between agriculture and nutrition in both national and international policies and programs. We invited her to speak to us on the topic of nutrition sensitive agriculture, a concept that emerged from the Scaling Up Nutrition movement and was popularized by an article in the 2013 Lancet series on maternal and child nutrition. As authors Ruel and Alderman explain:

“Targeted agricultural programmes and social safety nets can have a large role in mitigation of potentially negative effects of global changes and man-made and environmental shocks, in supporting livelihoods, food security, diet quality, and women’s empowerment, and in achieving scale and high coverage of nutritionally at-risk households and individuals.”

That makes for a great list of positive impacts which, as students of agriculture and nutrition policy, we all care deeply about. But let’s hold up for a moment here to ask, what evidence supports these claims? As Masset and Haddad and others have found, the evidence to support the nutritional benefits of investing in agriculture have so far been scarce. In fact, it’s one of the bread and butter issues here at the Friedman School. In 2014, two of our professors, Eileen Kennedy and Patrick Webb, collaborated on an article addressing the very topic: Impacts of agriculture on nutrition: Nature of the evidence and research gaps. Their review concluded that, although the evidence base is weak, this is mainly due to the lack of comparable, well-powered studies with rigorous experimental design.

But, as they say, absence of evidence is not evidence of absence. From Charlotte, we were excited to hear first-hand what FAO is doing to put a nutrition sensitive agricultural principles into practice, and what kinds of successes she has seen in scaling up the approach. Her talk was an illuminating two hours we wished we could have turned into four.

Setting the stage

Charlotte’s presentation began with a brief overview of the State of Food Insecurity in the World, with an eye towards how recent trends in FAO measures of undernourishment stack up against global targets. In her coverage of this, she highlighted an important discrepancy between progress reducing the prevalence of undernourishment, as compared to reductions in the absolute number of hungry people in the world. As shown the graph below, the MDG 1 goal of halving the proportion of hungry people in the world between 1990 and 2015 was very nearly accomplished, while the 1996 World Food Summit target of reducing the number of hungry people was woefully short, by about 265 million.

Capture1

Of course, much of this discrepancy can be explained by population growth, which increased by around 1.9 billion people globally over this time span. However, according to FAO figures, around 780 million people in the world remain hungry. In other words, food insecurity continues to be a major global challenge of our time that will only become more difficult as the world population continues to grow.

As we saw next in Charlotte’s presentation, the challenges of global hunger are compounded by overnutrition (overweight and obesity), as well as micronutrient deficiencies, known as hidden hunger. For many, the resulting “triple burden” of undernutrition, overnutrition, and micronutrient deficiencies – and the overlapping distributions of these phenomena in the world – indicate that rethinking strategies for combating malnutrition is critical if we want to make headway in combating the problems they create in society.

Overlapping burdens

From Charlotte’s perspective, a comprehensive approach to addressing all forms of malnutrition necessitates taking into account the myriad ways that food systems impact nutritional outcomes. Although there are many definitions of food systems out there, Per Pinstrup-Andersen provides a reasonably simple one: “the aggregate of all food-related activities and environments (political, socio-economic, and natural) within which these activities occur.”

As we learned in the talk, a food systems approach compels us to go beyond a narrow view of the role of food security in pathways leading to nutrition. Using the diagram below, Charlotte showed us her take on the UNICEF conceptual framework, which has been used by the nutrition community for over 25 years to depict the multi-level causes of malnutrition.

food systems

As you can see, more than half of the framework is dominated by the right hand and center factors of HEALTH services and CARE practices, suggesting that FOOD plays a relatively smaller role. But as the green boxes show, food systems influence factors of nutrition at every level. A broad multi-sectoral approach runs counter to the persistent idea that nutrition falls strictly under a health paradigm. Charlotte sees the medicalization of the nutrition sector as one reason that these interactions were ignored for so long. By looking at the food system more holistically, there is an opportunity to analyze how any number of broader phenomena, – influences such as climate change, urbanization, or humanitarian crisis – can be tied to poor nutrition outcomes. Charlotte believes we should address these trends through nutrition sensitive programming, and she is not alone.

Applying a Food Systems Perspective

Increasingly, practitioners in the field of food security are adopting a food systems lens, which reflects the growing consensus that, in order to meet nutrition specific objectives, nutrition sensitive objectives must also be ensured. This may sound like a fairly straightforward logic, but putting a food systems perspective into practice is not so simple. As Charlotte explained, one reason for this is that, operationally speaking,  food systems are driven by context. At any given location or scale, they are defined by diverse characteristics like livelihood strategies, natural resource wealth, or market dynamics.

This complexity has made it hard for many traditional actors in the nutrition sector to get on board with the idea of nutrition sensitive programs. She has found that public health practitioners may even look down on agriculture to nutrition programming, even if they do understand the linkages, because the community lacks a set of best practices that can be universally applied to activate explicit impact pathways. As she put it, the medical model benefits from the fact that human physiology is relatively common from place to place. “You can give someone a vitamin A capsule and be relatively certain of the effect it will have.” This is not the case with nutrition sensitive agricultural interventions, and not just because there are so many other variables that can intervene, but also because the outcomes themselves are less certain, and may even compete with one another. In case we were still in the dark, she provided the great example of water management practices, which might just as easily result in increased pollution of water sources as in health improvements.

Flipping the Equation

While part of her job entails trying to convince health practitioners about what agriculture can bring to nutrition Charlotte says she focuses more on convincing agricultural actors why they should care about nutrition outcomes. The beauty of this approach is that it sidesteps the need to disentangle the tortuous pathways through the food system that lead to positive nutrition outcomes. Charlotte believes that practitioners should orient themselves with a perspective of do no harm, asking the question: How can agricultural projects that lead to negative outcomes be prevented? This was the starting place for a set of key recommendations FAO developed for improving nutrition through agriculture and food systems.

These recommendations, also known as “guiding principles” include 10 ways agricultural programs and investments can strengthen impacts on nutrition, as well as 5 ways food and agriculture policies can have a better impact:

10 ways

5 ways

We wrapped up this part of the discussion with a run-down of some of the challenges and opportunities she sees in applying these principles.

Challenges:

  • Incomplete information systems. Although there is good data on nutritional requirements and agricultural production, detailed dietary intake information that can be used to link the two are often missing.
  • Trade promotion policies are tricky because they can both support or hinder improved nutrition. Because of power imbalances, trade often results in an unequal distribution of benefits.
  • Bilateral donor investments in agriculture may pit national and/or multinational private interests against one another, and mix private companies into the public sphere, eroding national sovereignty and agency.

Opportunities:

  • Food based social protection programs that offer support in the form of food vouchers, school meals, and cash transfers can be used to stimulate demand for certain foods and incentivize production.
  • Promoting diversity of food staples, including incorporation of land races and wild relatives.
  • New forms of nutrition education and marketing that promote healthy consumption patterns.

Examples from the Field – Ag2Nut in Practice

After a heavy load of theory, it was finally time to look at a couple of examples of how nutrition sensitive agriculture principles have been applied in the field. To demonstrate nutrition sensitive agriculture programming, Charlotte presented an overview of the Land Husbandry, Water Harvesting, and Hillside Irrigation Project in Rwanda, also known by its pithier acronym, LWH. This flagship program of the Rwandan Ministry of Agriculture is funded by the World Bank and was designed with technical support from FAO’s Investment Center. Visiting the project, Charlotte and her colleagues found that a number of the design features provided traction for enhancing impact on nutrition. For example, by building a suite of services – including health insurance – into agricultural cooperative membership, smallholder farmers were better protected against disruptive health crises and had better access to health care. Women’s groups established “keyhole” gardens designed to optimize vegetable production in a small space, and have access to nutrition education provided by the Ministry of Health nutrition community workers. These activities are fully in line with the Ministry of Agriculture’s Nutrition strategy, for which FAO provided technical assistance.

After hearing about this case study, it was easy to look back at the list of principles and see what Charlotte meant about how they reflect an attempt to ensure that food systems are designed in a way that avoids doing harm. However, meeting the standards of the guiding principles does require injecting nutrition goals into the ag sector, or as Charlotte put it, “we have to find a way to convince the ag sector that they own a stake in nutrition.”

This can be really tricky when, in reality, agriculture is largely driven by private sector actors who bear some of the blame in creating many of the nutrition related health burdens faced by people from all strata of societies across the world. Based on her experience, Charlotte believes this challenge is surmountable if good policies can be implemented that build synergies across sectors. In the course of her career, she has built her confidence alongside her capacity to act as a convener and a facilitator. She gave us some good advice in this area, reminding us that where it is not possible to set the agenda, it may be possible to influence it. To do this, she told us, you have to know who the players are, you have to develop some political savvy, and above all else, you have to be legitimate.

In her second example, Charlotte told us about a successful workshop organized by FAO wherein a group of African ministry officials were gathered to discuss nutrition policy as part of AU-NEPADs Comprehensive Africa Agriculture Development Programme (CAADP). The key to the success of the workshop, she said, was using peer-to-peer influence to galvanize interest in nutrition among the Ministries of Agriculture. As part of the workshop, Charlotte asked the CAADP representatives to present their own country success stories in promoting nutrition through agriculture. As she tells it, this approach benefited from the sense of ownership experienced by each country representative who presented. Following a particularly brilliant presentation by the CAADP Rep from Malawi, the excitement quickly became contagious. Each delegation’s presentation stimulated the rest to reflect and discuss how they could achieve similar impacts in their own countries. Eventually many brought those ideas home to put into practice. Slowly, these kinds of efforts are changing the agenda from the inside out.

One of the best parts, she says, was realizing that part of the demand can be built around the idea that improving nutrition matters. It’s a goal we can all relate to, and that people who create agriculture policy can feel good about promoting. And, it doesn’t have to stop with nutrition as an end in itself, rather, nutrition can be a means to achieve even bigger virtues like equity, health, and resilience.

Reflections and Take Aways

Our conversation with Charlotte came at an opportune time in the course of the semester. Each of the four speakers we heard from before her had provided us with valuable critical perspectives on the role of large institutions from the outside, looking in. Many of their critiques suggested that, not only is small-scale, community-driven engagement is an essential  ingredient of sustainable development, but that large bureaucratic entities may actually create challenges for smallholder farmers.

Just as we were beginning to question whether there is a role for large multinational agencies in promoting the values we care about, like social welfare, food justice, and sustainability, Charlotte’s talk reaffirmed the idea that large organizations like FAO can, and do, play an important role in complementing community based development efforts.

Ultimately this came down to three important observations:

  1. UN Agencies like FAO occupy a different operational space than organizational actors working at the community level
  2. Size affords these organizations the ability to convene key policymakers and provides influence that can be used to set the policy agenda
  3. Policy interventions shape the environment in which people, communities, and development organizations interact

In our talk with Charlotte, I don’t think I was alone in my sense of surprise at encountering someone so incredibly real and lucid. It didn’t match up with the anonymous, jargonistic, bureaucrat we might have expected to encounter on the other end of a skype call from the offices of a large UN headquarters. The practicality of her work also gave me pause to stop and recognize the myopia of my grad school experience. It was incredibly reassuring to see that she is not academic researcher, at least not primarily, but nonetheless she gets it. She can talk the talk about data needs and switch between science and policy concepts as though she were trained with the best, right here at Friedman.

Most importantly, she proved to us that she’s out fighting the good fight, and it’s the same one many of us hope to join one day soon. Despite the fact that nutrition sensitive agriculture is a hard concept to capture in a word, let alone a paragraph, I left the conversation convinced that the approach does have a place in that fight. So for those who care about sustainable agriculture, and who care about improving nutrition, which we do, it is great to know there is lots of work to be done. Let’s get hopping!