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26 PER PINSTRUP-ANDERSEN


pesticides and consumers from toxins in the food supply. An integrated crop- management approach would consider crop diversity and resiliency and incor- porate host-plant tolerance and resistance when possible, relying on chemical pesticides as a last resort (Nelson 2010).


• Sustainable management of natural resources. Agriculture, nutrition, and health all have important links to the natural environment. Unsustainable management of land, water, and other natural resources can lead to soil erosion, siltation in watersheds, seasonal water scarcities, and water-borne and insect vector–trans- mitted diseases, with negative effects on agricultural yields and incomes as well as on nutrition and health. In contrast, sustainable management of land and water and preservation of biodiversity can help improve health and nutrition not only directly but also indirectly by maintaining agricultural yields and incomes (Herforth 2010).


• Food safety. Given the weak food control systems, poor infrastructure, lack of resources, and improper food handling common in many developing countries, food- and water-borne diseases impose a high burden on poor people, yet they are often overlooked, unreported, or ignored. Improvements should be made to food safety along the entire food chain, from production to storage, transporta- tion, and processing. Also needed are improvements in surveillance systems and in public awareness of basic hygiene and food safety measures. It is important to recognize, however, that if improving food safety raises the cost of food, it may threaten the food security of the poorest people (Nakimbugwe and Boor 2010).


These kinds of integrated approaches, as well as other poverty-reducing policies


that promote agricultural productivity, improve rural infrastructure, and strengthen domestic markets, will help create sustainable health and nutrition improvements. Approaches like these, however, take time to show impact. In the short term,


complementary programs and policies, such as income and transfer programs and primary healthcare, are needed (Alderman 2010). Many poor people who suffer from chronic hunger, malnutrition, and health problems are defenseless against income shocks caused by production, market, or employment losses. Without safety nets or some other insurance mechanism, income shocks can result in severe suf- fering, further nutrition and health deterioration, and death. Safety net programs, and the mechanisms to target them to beneficiaries, need to be context-specific and take into account what is known about how households behave, including how household decisionmaking relates to gender (see Box 1). It is important to view such programs not as unproductive handouts, but as investments in human resources and future economic growth and stability. Not only are health and nutrition intrinsically


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