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24 PER PINSTRUP-ANDERSEN


increasing or decreasing the prevalence of chronic diseases by influencing changes in the prevalence of overweight and obesity. Although much past research and debate have focused on the impact of agri-


culture on nutrition, it is important to recognize that there is a two-way causal relationship. Health and nutrition may also affect agriculture and food systems. For instance, energy and nutritional deficiencies, infectious diseases, obesity, and chronic diseases may influence food systems by lowering the labor productivity of food system workers; by reducing the adoption of improved technology and the use of inputs and credit; and by leading to suboptimal use of land, water, and other resources. Labor productivity may also be influenced by infectious diseases, such as malaria and bacterial and virus contamination, associated with water management in the food system. Improving food quality in ways that support human health will require an


integrated approach that encompasses both the agriculture and health sectors and will open new avenues of agricultural research. It will require coordinated efforts in the study of soil quality, plant varieties, crop and food engineering, food safety, climate change, plant and animal health, and food processing, among others. And because such an approach will require more diversity in the types of crops grown, with implications for all aspects of farming, it will raise new challenges for efforts to achieve sustainable agriculture.


The Poverty/Hunger/Ill-Health Trap The interactions between agriculture, health, and nutrition mean that all three sectors play a role in the poverty/hunger/ill-health trap that afflicts millions of poor people around the world. Ultra-poverty (living on less than half a dollar a day), poor health, hunger, and malnutrition are mutually reinforcing conditions that push people into a poverty trap—a “self-reinforcing mechanism that causes poverty to persist” (Azariadis and Stachurski 2007). Widespread hunger and mal- nutrition combine with prevalent infectious diseases to cause poor health. Poor health and health shocks in turn have economic and productivity implications that are particularly pronounced in rural areas, where the food system is the main source of income and employment. In fact, recent research suggests that major health shocks may be the leading cause of collapse into long-term poverty. The productivity consequences of health shocks are likely to be most severe for farmers and others who undertake hard physical work. Furthermore, the income effects of health shocks will be direct and severe among semi-subsistence farmers, who may not be able to provide the labor needed to bring the crop to harvest. The resulting poverty trap has dire implications for human well-being, cognitive development, and individual and national incomes.


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