Nutrition is an integral part of people's "basic needs" and is considered a human right. Good nutrition is increasingly perceived as an investment in human capital that yields returns today as well as in the future.
There is evidence to suggest that improved nutrition could have a substantial impact on welfare and economic growth. In 1990 the global loss of social productivity caused by four overlapping types of malnutrition - stunting and disorders related to iodine, iron and vitamin A deficiency - amounted to almost 46 million years of productive disability-free life.80 A growing body of literature suggests that there is a strong output response to improved nutrition on the part of farm households. Moreover, nutrition raises returns on investments in education and health care. Consequently, nutrition interventions are found to have a positive effect on welfare and economic growth. Taken together, these findings provide strong evidence that public investment in improved nutrition should constitute a top priority for developing countries.
Nearly 30 percent of the world's population currently suffers from one or more forms of malnutrition, including intra-uterine growth retardation, protein-energy malnutrition (PEM) and a lack of micronutrients. Worldwide, 826 million people are undernourished, or chronically food-insecure, facing a shortfall in their basic daily energy requirements of between 100 to 400 kilocalories (kcal).
The consequences of an inadequate diet are not always visible, as most undernourished people are thin but not emaciated. However, undernourishment leads to a lower nutritional status, or undernutrition, to which the body adjusts by slowing down its physical activity and, in the case of children, growth. Undernutrition also increases susceptibility to disease, causes listlessness and limits children's ability to concentrate.
The extent of micronutrient deficiencies is also staggering:
The growth performance of children is a commonly used measure of the nutritional status of a whole community. This is because, from a nutritional standpoint, children under five years of age represent the most vulnerable segment of the population. Widely used anthropometric indices are: height-for-age, which essentially measures long-term faltering in growth; weight-for-height, which reflects body proportion and is sensitive to acute growth disturbances; and weight-for-age, which represents a convenient synthesis of both linear growth and body proportion.83
Table 4
PREVALENCE OF UNDERNOURISHMENT IN DEVELOPING COUNTRIES
Region/subregion |
Undernourished population, 1996-98 |
Trends in the share of undernourished in total population | ||
1978-81 |
1990-92 |
1996-98 | ||
(Millions) |
(Percentage) | |||
DEVELOPING COUNTRIES |
791.9 |
29 |
21 |
18 |
Asia and the Pacific |
515.2 |
32 |
21 |
17 |
East Asia |
155.0 |
29 |
16 |
12 |
Oceania |
1.3 |
31 |
26 |
29 |
Southeast Asia |
64.7 |
26 |
18 |
13 |
South Asia |
294.2 |
38 |
27 |
23 |
Latin America and the Caribbean |
54.9 |
13 |
13 |
11 |
Caribbean |
9.6 |
19 |
26 |
31 |
Central America |
11.7 |
20 |
17 |
20 |
South America |
33.6 |
14 |
14 |
10 |
Near East and North Africa |
35.9 |
9 |
8 |
10 |
Near East |
30.3 |
10 |
11 |
13 |
North Africa |
5.6 |
8 |
4 |
4 |
Sub-Saharan Africa |
185.9 |
38 |
35 |
34 |
Central Africa |
38.5 |
36 |
37 |
50 |
East Africa |
79.9 |
35 |
44 |
42 |
Southern Africa |
34.5 |
33 |
45 |
42 |
West Africa |
33.0 |
42 |
22 |
16 |
Source: FAO | ||||
There is widespread undernutrition among children, and hence among communities in developing countries in general. Nearly 156 million children under five in developing countries suffer from PEM and about 177 million are malnourished as measured by stunting.84 The situation is particularly serious in sub-Saharan Africa and South Asia. About 17 percent of infants85 suffer from intra-uterine growth retardation in developing countries, which is an indication of widespread poor nutrition among pregnant women. A low birth weight constitutes a high risk for serious morbidity and mortality during infancy and adulthood, as well as for reduced work capacity and strength.86
Vitamin A deficiency is the primary cause of preventable, severe visual impairment and blindness in children. The most vulnerable are pre-schoolchildren and pregnant women in developing countries. Moreover, about 39 percent of pre-schoolchildren and 52 percent of pregnant women are anaemic, 90 percent of whom live in developing countries.
Reductions in the prevalence of PEM among infants and young children have been very uneven over the last 20 years. Indeed, in Africa between 1980 and 2000, the prevalence of PEM among children rose by 2.3 percent. Asia achieved the largest reduction, with 38 million or 14.9 percent fewer children suffering from PEM in 2000 than in 1980. Overall, the number of children suffering from PEM in developing countries fell by only 26.1 million, or 10.7 percent, between 1980 and 2000, so substantial improvements are still needed.
Table 5
ESTIMATED PREVALENCE OF UNDERWEIGHT, STUNTED AND WASTED CHILDREN IN DEVELOPING COUNTRIES, 1995-00
Region/country group |
Underweight1 (weight-for-age) |
Wasted1 (weight-for-height) |
Stunted1 (height-for-age) |
(Percentage) | |||
Sub-Saharan Africa |
31 |
10 |
37 |
Near East and North Africa |
17 |
8 |
24 |
South Asia |
49 |
17 |
48 |
East Asia and the Pacific |
19 |
6 |
24 |
Latin America and the Caribbean |
9 |
2 |
17 |
Developing countries |
29 |
10 |
33 |
Least-developed countries |
40 |
12 |
45 |
1 Defined as <-2 standard deviation (SD) from the median of reference value. | |||
The link between nutrition and physical activity is well established. Dividing the energy available to a person by their basal metabolic rate (BMR)88 yields a measure of that person's physical activity level. In The Sixth World Food Survey,89 FAO used this measure to calculate "minimum" and "average" energy requirements.
While this aspect of nutrition and labour productivity is uncontroversial, the same cannot be said when links are made between economic outcomes and nutrition. Much of the empirical work to date has focused on agriculture, and it attempts to link farm output, profits, wages or labour allocation choices to indicators of nutritional intake, such as calories, and/or nutritional outputs, such as weight-for-height, the body mass index (BMI)90 and height.
Widely cited work by Strauss91 links the average calorie intake per adult in a household to the productivity of on-farm family labour in Sierra Leonean agriculture. For his sample, Strauss calculates that, on average, a 50 percent increase in calories per consumer equivalent would increase output by 16.5 percent, or 379 kg. For an increase of 50 percent in hours of family labour or in the area of cultivated land, this compares with an output response of 30 and 13 percent, respectively. Significantly, Strauss' findings show that the lower the calorie intake is, the more significant the output response is to increased calorie intake. For example, based on a daily intake of 1 500 calories per consumer equivalent, a mere 10 percent increase in calorie intake would increase output by nearly 5 percent.
Findings from Ethiopia, presented in Croppenstedt and Muller,92 show that a 10 percent increase in weight-for-height and BMI would increase output and wages by about 23 and 27 percent, respectively. They also find that height, an indicator of a person's past nutritional experience, is a significant determinant of wages, with a person who is 7.1 cm above the average height earning about 15 percent more wages. These findings have to be contrasted with the effect of other productivity-augmenting investments, such as education. Nutrition would appear to compare well with the 4 percent increase in cereal output attributed to an additional year of schooling in a rural Ethiopian household.93
Poor nutritional status not only reduces a person's output, it may also prevent them from carrying out certain tasks. A study on Rwanda found that those who are poorly fed have to choose activities that are physically less demanding - and less well paid.94 A low BMI and poor nutritional status may also limit productivity indirectly through absenteeism and reduced employment opportunities. Moreover, to carry out certain activities, undernourished people may have to put their muscle mass and heart rate under much greater strain than well-nourished people. This implies that, while their output is the same, the energy they expend is not, and this may lead to health problems in the long term.
There is also an increasing awareness of the role of micronutrients in people's nutritional status. It is well established that iron-deficient anaemic children usually have poorer levels of development than non-anaemic children. In adults, iron deficiency negatively affects work capacity and productivity as well as contributing to absenteeism. Basta, Soekirman and Karyadi95 found that among Indonesian rubber plantation workers, those with anaemia produced 80 percent of the amount produced by non-anaemic workers.
Iodine deficiency during pregnancy negatively affects child growth and mental development, and in extreme cases it causes cretinism. The costs are a loss of IQ, time required for care, and reduced labour supply and labour capacity when older. There is also some evidence that iodine deficiency during adulthood reduces productivity and work capacity.96
Inadequate consumption of protein and energy as well as deficiencies in key micronutrients such as iodine, vitamin A and iron are also key factors in the morbidity and mortality of children and adults. A staggering 55 percent of the nearly 12 million deaths each year among children under five in the developing world are associated with malnutrition.97 Malnourished children also have lifetime disabilities and weakened immune systems.98 Moreover, malnutrition is associated with disease and poor health, which places a further burden on households as well as health care systems.
Disease affects a person's development from a very early age. Gastro-enteritis, respiratory infections and malaria are the most prevalent and serious conditions that can affect development in the first three years of life. It is estimated that children under the age of five in developing countries suffer from 3.5 episodes of diarrhoea per year and between four and nine respiratory tract infections in their first two years of life.99 Infections affect children's development by reducing their dietary intake; causing a loss of nutrients; or increasing nutrient demand as a result of fever.
Malnutrition also plays a significant role in morbidity among adults. The link between morbidity from chronic disease and mortality, on the one side, and a high BMI, on the other, has been recognized and analysed in developed countries primarily for the purpose of determining life insurance risk. A study on Nigerian men and women has shown mortality rates among chronically energy-deficient people who are mildly, moderately and severely underweight to be 40, 140 and 150 percent greater than rates among non-chronically energy-deficient people.100
A lack of micronutrients also contributes significantly to the burden of disease. Iron deficiency is associated with malaria, intestinal parasitic infestations and chronic infections. Chronic iodine deficiency causes goitre in adults and children and also affects mental health. Vitamin A deficiency significantly increases the risk of severe illness and death from common childhood infections, particularly diarrhoeal diseases and measles. In communities where vitamin A deficiency exists, children are on average 50 percent more likely to suffer from acute measles. A UN report states that improvements in vitamin A status have been demonstrated to lead to a 23 percent reduction in mortality among children aged one to five.101
Nutrition has a dynamic and synergistic relationship with economic growth through the channel of education, and the evidence shows that the causality works in both directions:
This dual causality is complex and varies over the life cycle of a family. In utero, infant and child nutrition affects later cognitive achievement and learning capacity during school years, ultimately increasing the quality of education gained as a child, adolescent and adult. Parental education affects in utero, infant and child nutrition directly through the quality of care given (principally maternal) and indirectly through increased household income. Human capital development, primarily through education, has received merited attention as a key to economic development, but early childhood nutrition has yet to obtain the required emphasis as a necessary facilitator of education and human capital development.
Considering the importance of nutrition in human development, there is a relative dearth of studies focusing on the role of the different aspects of malnutrition on cognitive achievement among children in developing countries. Nevertheless, there is sufficient empirical evidence to indicate that early childhood nutrition plays a key role in cognitive achievement, learning capacity and, ultimately, household welfare. Specifically, available studies102 have shown that:
Children are most vulnerable to malnutrition in utero and before they reach three years of age, as growth rates are fastest and they are most dependent on others for care during this period. However, nutrition interventions, such as school feeding programmes, among children of school age are also important for strengthening learning capacity.
School lunch
Good nutrition and higher education levels are mutually reinforcing
FAO/17011/G. BIZZARRI
Many, if not most, of the studies showing the impact of nutrition on education have methodological problems, particularly those based on socio-economic studies. In particular, socio-economic analyses are often biased upward, attributing too much impact to nutrition and, in all cases, results must be qualified. It is therefore difficult to estimate the monetary costs associated with the impact of hunger and malnutrition on school performance. Nevertheless, Behrman103 cites three studies suggesting that, by facilitating cognitive achievement, child nutrition and schooling can significantly increase wages.
In general, demonstrating a direct causal link between poor nutrition and cognitive achievement requires the use of experimental design trials, of which there have been surprisingly few in both developed and developing countries. Despite these drawbacks, systematic evidence supports the argument that policy interventions in early childhood nutrition are crucially important for human capital development. Behrman concludes that, while the link between health and educational attainment is not as robust as most studies suggest, and specific cost-benefit analysis is difficult to carry out, policies supporting nutrition make good sense and the empirical basis for this is as sound as that of many other conventional assumptions in economics.104
The impact of nutrition on labour productivity, health and education ultimately filters through to higher levels of overall economic growth. As illustrated in Figure 15, a clear association can be observed between per capita GDP and dietary energy supply (DES) per capita. However, the nature of this relationship, where the cause and effect mature over long periods, makes it difficult to identify the precise impact of improved nutrition on economic growth, and vice versa:
A recent study, carried out for FAO by Arcand,105 indicates that nutrition has a positive impact on economic growth. Arcand's results suggest that raising the per capita to 2 770 kcal per day in countries where it is below that level would increase their per capita GDP growth rate by between 0.34 and 1.48 percentage points per year. Improved nutrition affects economic growth directly through its impact on labour productivity and indirectly through improvements in life expectancy. The latter is determined as a long-term phenomenon, while in the short term it is energy intake that is relevant. This result confirms findings by Bloom and Sachs,106 who looked at the roles of demography and geography in economic growth and found that life expectancy at birth is associated with an increased rate of growth. Arcand's work shows that DES has the strongest impact in countries with the highest prevalence of food insecurity, but that this impact tapers off when moving to countries with a low prevalence of food insecurity.
Neither Bloom and Sachs nor Arcand, however, control for the problem arising from the reverse causality where growth has an impact on nutrition. Their estimates of the impact of life expectancy and malnutrition on growth may thus be biased. Other studies have reversed this causality and controlled for endogeneity. Pritchett and Summers107 show that differences in growth rates explain 40 percent of cross-country differences in improved mortality rates over the last three decades, while Smith and Haddad108 show that about half of the decline in child malnutrition from 1970 to 1995 can be attributed to income growth.
Nobel Laureate Robert Fogel,109 based on historical longitudinal studies of single countries, argues that improvements in nutrition and health account for half of the economic growth that occurred in the United Kingdom and France in the eighteenth and nineteenth centuries. Using an accounting approach with concepts from demography, nutrition and health sciences, Fogel stresses the physiological contribution to economic growth over the long term. Reductions in the incidence of infectious diseases along with changes in the composition of diet, clothing and shelter increase the efficiency with which food energy is converted into work output. Many of these thermodynamic and physiological benefits accrue from public sector investments made up to a century earlier. In the case of the United Kingdom, Fogel shows that a combination of increases in the labour force participation rate, the availability of calories for consumption by workers and thermodynamic efficiency led to a 0.5 percent annual increase in per capita income, or half of the United Kingdom's annual growth rate between 1790 and 1980. Arora110 has obtained similar results for eight other industrial countries. However, using adult height as a measure may generate problems with causality.
Human capital is a key determinant of household, community and national welfare. In utero, infant and childhood nutrition plays a key role in facilitating human capital development, through its impact on adult labour force participation and productivity, on improved health and developing cognitive achievement and learning capacity. The available evidence has clear policy implications.
Malnutrition plays a significant role in morbidity and mortality among infants, children and adults. Targeted action against maternal and infant malnutrition is fundamental, with investments needed in health, education and sanitation. Improved protein and energy intake as well as reduced iodine, iron and vitamin A deficiencies generate widespread health benefits for individuals as well as society. The largest impact derives from improvements in the health of women, which not only benefits families and communities today but will also have a major impact on the health and productivity of the next generation. Women's health is important for wage earning as well as for the performance of many household tasks. With regard to education, particular attention must be given to assuring equal access for girls.
Despite the controversies over methodology, there is clear evidence of the linkages between economic growth and nutrition. Increases in the rate of economic growth lead to increased public and private spending on health and education and on the quality and quantity of food consumed, thus improving nutritional outcomes. Conversely, improved nutrition feeds back into economic growth through improvements in human capital formation and productivity. The implication is that, while economic growth is necessary for improved nutritional outcomes, public sector investment in nutrition as well as in education and public and individuals' health is crucial for long-term economic growth.
1 For a more detailed discussion of production developments within the regions, see Part 2, Regional review.
2 This report is based on information available as of February 2001. Current information on the cereal market can be found in FAO's Food Outlook report, issued every two months.
3 For further information concerning this revision, see FAO. 2001. Food Outlook, 1 (February).
4 The narrow definition of agriculture includes only agriculture (crops and livestock), agricultural services and input provision, fisheries, forestry and development of land and water resources. The broader definition also includes (in declining order of importance): rural development and infrastructure, environmental protection, research, training and extension, regional and river development, manufacturing of inputs and agro-industries.
5 Unless otherwise indicated, economic estimates and forecasts in this section are drawn from IMF. 2000. World Economic Outlook, October 2000. Washington, DC.
6 The IMF category of "advanced economies" includes developed market economies and newly industrialized economies in Asia.
7 The exact composition of the group of exporters is as follows: Sub-Saharan Africa: Benin, Burkina Faso, Burundi, Cameroon, the Central African Republic, Chad, the Democratic Republic of the Congo, Côte d'Ivoire, Djibouti, Ethiopia, the Gambia, Ghana, Guinea-Bissau, Kenya, Madagascar, Malawi, Mali, Mauritius, Mozambique, Rwanda, Somalia, the Sudan, Swaziland, Togo, Uganda, the United Republic of Tanzania and Zimbabwe. Asia and the Pacific: Mongolia, Myanmar, Papua New Guinea, Sri Lanka and Viet Nam. Latin America and the Caribbean: Argentina, Belize, Bolivia, Brazil, Colombia, Costa Rica, Cuba, Dominica, the Dominican Republic, Ecuador, El Salvador, Guatemala, Guyana, Haiti, Honduras, Jamaica, Nicaragua, Panama, Paraguay and Uruguay. Near East and North Africa: Afghanistan.
8 The composition of the group of importers is as follows: Sub-Saharan Africa: Burundi, Cape Verde, Comoros, the Democratic Republic of the Congo, Djibouti, Eritrea, Ethiopia, the Gambia, Guinea, Guinea-Bissau, Lesotho, Mauritania, Mozambique, the Niger, Rwanda, Senegal, Sierra Leone, Somalia and the Sudan. Latin America and the Caribbean: Cuba, the Dominican Republic, Haiti, Nicaragua and Panama. Asia and the Pacific: Bangladesh, Cambodia, the Democratic People's Republic of Korea, Maldives, Nepal and Samoa. Near East and North Africa: Afghanistan, Egypt, Iraq, Jordan, Lebanon, Morocco and Yemen.
9 The outcome of the Uruguay Round negotiations on agriculture was reviewed in The State of Food Agriculture 1994 and a more thorough discussion, including the impact of the negotiations and resulting Agreement on Agriculture, was presented in The State of Food and Agriculture 1995. Comprehensive documentation of the Uruguay Round negotiations concerning agriculture can also be found in T. Josling, S. Tangermann and T.K. Warley. 1996. Agriculture in the GATT. London, Houndmills and New York, Macmillan.
10 Other WTO agreements that are also of relevance for agricultural trade, such as the Agreement on the Application of Sanitary and Phytosanitary Measures and the Agreement on Technical Barriers to Trade, are not discussed here.
11 As set out in the Agreement on Subsidies and Countervailing Measures, Article 8.2, in other sectors only those non-specific subsidies (to an enterprise or industry) that also meet other acceptable objectives are non-actionable. See S. Tangermann. 2000. Agriculture on the way to firm international trading rules. Paper prepared for the University of Minnesota Law School Conference on The Political Economy of International Trade Law, honouring Professor Robert E. Hudec, 15-16 September 2000. University of Minnesota, Minneapolis, USA.
12 Agreement on Agriculture, Article 20(c).
13 Most of the relevant documents (including those cited in notes 15 to 79) are published on WTO's Web site at www.wto.org. However, access to the country proposals and recommendations submitted as part of the analysis and information exchange process is restricted.
14 The Cairns Group comprises both developed and developing agricultural exporters. It includes Argentina, Australia, Bolivia, Brazil, Canada, Chile, Colombia, Costa Rica, Fiji, Guatemala, Indonesia, Malaysia, New Zealand, Paraguay, the Philippines, South Africa, Thailand and Uruguay.
15 WTO. 1999. Preparations for the 1999 Ministerial Conference. Communication from Australia, p.1. WT/GC/W/156; Preparations for the 1999 Ministerial Conference. Negotiations on agriculture. Market access - tariffs. Communication from Australia. WT/GC/W/199; and WTO. 2000. WTO negotiations on agriculture. Cairns Group negotiation proposal - market access, G/AG/NG/W/54.
16 WTO. 2000. Proposal for comprehensive long-term agricultural trade reform, submission from the United States. Committee on Agriculture, Special Session, 23 June 2000. G/AG/NG/W/15.
17 Ibid.
18 WTO. 1999. Preparations for the 1999 Ministerial Conference. EC approach on agriculture. Communication from the European Communities. WT/GC/W/273.
19 WTO. 1999. Preparations for the 1999 Ministerial Conference. Agriculture. Communication from Korea, WT/GC/W/170.
20 WTO. 2000. Statement by Japan, Committee on Agriculture, Special Session, 29-30 June 2000. G/AG/NG/W/27.
21 WTO. 2000. Preparations for the 1999 Ministerial Conference. Negotiations on agriculture. Communication from Japan, WT/GC/W/220.
22 WTO. 2000. WTO negotiations on agriculture. Cairns Group negotiation proposal - market access, p.2. G/AG/NG/W/54; and op. cit., note 16.
23 A comprehensive insight into the economics of quota administration and its treatment within WTO is given in D.W. Skully. 1999. The economics of TRQ administration. International Agricultural Trade Research Consortium, Working Paper 99-6. Available at: www.umn.edu/iatrc.
24 Op. cit., note 18.
25 Op. cit., note 20. See also op. cit., note 19.
26 Op. cit., note 21.
27 Agreement on Agriculture, Article 5.
28 WTO. 2000. Statement by the European Community. Committee on Agriculture, Special Session, 29-30 June 2000. WT/AG/NG/W/24.
29 WTO. 2000. Statement by India. Committee on Agriculture, Special Session, 29-30 June 2000. G/AG/NG/W/33.
30 Op. cit., note 16; op. cit., note 29; and WTO. 2000. Statement by Argentina. Committee on Agriculture, Special Session, 28-29 September 2000. G/AG/NG/W/39.
31 Op. cit., note 10. See also WTO. 2000. European Communities proposal - export competition. G/AG/NG/W/34.
32 WTO. 2000. Statement by Mauritius, Committee on Agriculture, Special Session, 28-29 September 2000. G/AG/NG/W/52.
33 WTO, 2000, op. cit., note 31.
34 Op. cit., note 16.
35 Op. cit., note 32.
36 WTO. 1999. Preparations for the 1999 Ministerial Conference. Negotiations on agriculture, export restrictions and taxes. Communication from Australia. WT/GC/W/237. See also op. cit., note 16.
37 WTO. 1999. Preparations for the 1999 Ministerial Conference. Negotiations on agriculture. Communication from Japan, WT/GC/W/220.
38 Op. cit. , note 21.
39 WTO. 1999. Preparations for the 1999 Ministerial Conference. Negotiations on agriculture. Domestic support. Communication from Australia. WT/GC/W/177.
40 Op. cit., note 8.
41 WTO. 2000. Statement by the United States. Committee on Agriculture, Special Session, 28-29 September 2000. G/AG/NG/W/49.
42 WTO. 1999. Preparations for the 1999 Ministerial Conference. Negotiations on agriculture. Communication from Switzerland, WT/GC/W/261.
43 Op. cit., note 20.
44 WTO. 2000. Agreement on Agriculture: special and differential treatment and a development box. Proposal to the June 2000 Special Session of the Committee on Agriculture by Cuba, the Dominican Republic, Honduras, Pakistan, Haiti, Nicaragua, Kenya, Uganda, Zimbabwe,
Sri Lanka and El Salvador. WT/AG/NG/W/13.
45 WTO. 1999. Preparations for the 1999 Ministerial Conference. Negotiations on agriculture. Domestic support - concerns of transition and post-transition economies. Communication from Bulgaria, Czech Republic, Hungary, Latvia, the Slovak Republic and Slovenia. WT/GC/W/217.
46 Op. cit., note 18.
47 WTO. 1999. Preparations for the 1999 Ministerial Conference. Negotiations on agriculture. Communication from Norway, WT/GC/W/238.
48 Op. cit., note 42.
49 Op. cit., note 18.
50 Op. cit., note 37.
51 Positive or negative externalities in production arise when production of a good produces benefits or costs to other producers or consumers.
52 Public goods are goods that cannot be withheld from single individuals without being withheld from everybody (prime examples include national defence, police protection and street lighting). For this reason, they cannot be expected to be provided by private entrepreneurs (who would not be able to request payment for the public good by the beneficiaries). The provision of public goods, therefore, normally requires public sector intervention.
53 Op. cit., note 37.
54 Op. cit., note 18.
55 Op. cit., note 42.
56 Op. cit., note 47.
57 Op. cit., note 37.
58 Op. cit., note 16.
59 USDA. 1999. The use and abuse of multifunctionality. Washington, DC, Economic Research Service, USDA. (The emphasis is quoted.)
60 Decoupled payments are not linked to the level of current production.
61 A comprehensive list of measures and instruments that are considered to meet these conditions is presented in USDA, op. cit., note 59.
62 WTO. 1999. Preparations for the 1999 Ministerial Conference. Communication from Australia. WT/GC/W/156.
63 The concept of the multifunctional role of agriculture is discussed here within the framework of non-trade issues that might affect the current round of multilateral trade negotiations on agriculture. Within the specific context of FAO, the Organization is guided by The Strategic Framework for FAO: 2000-2015, adopted by the 30th session of the FAO Conference in 1999. Paragraph 76 of the Framework states that "as FAO's Members have noted that there is currently no consensus on the meaning of the concept of the multifunctional character of agriculture, nor on a role for FAO with respect to work on it, they agree that the Organization should pursue and further develop its work on sustainable agricultural and rural development".
64 Op. cit., note 37.
65 Op. cit., note 44. See also op. cit., note 29.
66 Op. cit., note 29.
67 Op. cit., note 59.
68 Ibid.
69 For a more comprehensive discussion of exemptions for developing countries under the Agreement on Agriculture, see S. Tangermann and T.E. Josling. 1999. The interest of developing countries in the next round of WTO agricultural negotiations. Paper prepared for the UNCTAD Programme on Developing a Proactive and Coherent Trade Agenda for African Countries. Parts of the paper are published in UNCTAD. 2000. A positive agenda for developing countries: issues for future trade negotiations. New York and Geneva.
70 Op. cit., note 44.
71 Op. cit., note 29.
72 Ibid.
73 Op. cit., note 44.
74 Op. cit., note 29; and WTO. 2000. Special and differential treatment for developing countries in world agricultural trade. Submission by ASEAN. G/AG/NG/W/55.
75 Op. cit., note 29, including sources cited therein. See also WTO, 2000. Op. cit., note 74.
76 Op. cit., note 16.
77 WTO. 2000b. Statement by Australia on behalf of the Cairns Group. Committee on Agriculture, Special Session, 29-30 June 2000. G/AG/NG/W/21.
78 WTO. 2000. Statement by Canada. Committee on Agriculture, Special Session, 29-30 June 2000. G/AG/NG/W/23. See also WTO. 1999. Preparations for the 1999 Ministerial Conference. Negotiations on Agriculture. Market access - general. Communication from Australia. WT/GC/W/184.
79 See WTO. 1999. Preparations for the 1999 Ministerial Conference. EC approach to duty-free market access for least-developed countries. Communication from the European Communities. WT/GC/W/195.
80 World Bank. 1993. World Development Report. Washington, DC, Oxford University Press.
81 Unless indicated otherwise, the data in this section have been drawn from WHO's Web site at: www.who.int/nut/pem; and FAO. 2000. The State of Food Insecurity in the World 2000, Rome. Available at www.fao.org/docrep/x8200e/x8200e00.htm.
82 For surveys of the role of nutrition in child development, see: UNICEF. 1998. The State of the World's Children 1998: Focus on Nutrition. Oxford, UK, Oxford University Press (available at: www.unicef.org/sowc98/sowc98.pdf); and R. Martorell. 1999. The nature of child malnutrition and its long-term implications. Food and Nutrition Bulletin, 20(3): 288-292.
83 WHO Working Group. 1986. Use and interpretation of anthropometric indicators of nutritional status. Bulletin of the World Health Organization, 64: 924-941.
84 Calculations are based on Tables 2 and 5 in UNICEF. 2001. The State of the World's Children 2001 (available at: www.unicef.org/sowc01/tables/.
85 Ibid. Data refer to full-term babies who weighed 2.5 kg or less at 37 or more weeks of gestation.
86 Martorell, op. cit., note 82.
87 For surveys, see J.R. Behrman. 1993. The economic rationale for investing in nutrition in developing countries. World Development, 21(11): 1749-1771; P. Dasgupta. 1993. An inquiry into well-being and destitution. Oxford, UK, Clarendon Press; and J. Strauss and D. Thomas. 1998. Health and nutrition, and economic development. Journal of Economic Literature, Vol. XXXVI(2): 766-817.
88 The BMR, calculated for a particular body weight, disaggregated by age and sex, corresponds to the "minimal rate of energy expenditure compatible with life" over a 24-hour period, i.e. an immobile, resting and fasting state in a comfortable environment.
89 FAO. 1996. The Sixth World Food Survey. Rome.
90 With regard to adults, the generally accepted anthropometric indicator of nutritional status is the body mass index (BMI), which indicates the ratio of a person's weight to the square of their height. The BMI is a simple and relatively inexpensive indicator for assessing whether a person is deficient in energy intake. A BMI of between 18.5 and 25 is recommended by FAO and WHO as the threshold for determining healthy adults. For a thorough discussion of the use of the BMI as a measure of malnutrition, see FAO. 1994. Body mass index (BMI): a measure of chronic energy deficiency in adults. By P.S. Shetty and W.P.T. James. FAO Food and Nutrition Paper No. 56. Note that there is controversy over the recommended thresholds.
91 J. Strauss. 1986. Does better nutrition raise farm productivity? Journal of Political Economy, 94(2): 297-320.
92 A. Croppenstedt and C. Muller. 2000. The impact of farmers' health and nutritional status on their productivity and efficiency: evidence from Ethiopia. Economic Development and Cultural Change, 48(3): 475-502.
93 S. Weir and J. Knight. 2000. Education externalities in rural Ethiopia: evidence from average and stochastic frontier production functions. Centre for the Study of African Economies Working Paper No. 2000.4. UK, Oxford University.
94 A. Bhargava. 1997. Nutritional status and the allocation of time in Rwandese households. Journal of Econometrics, 77: 277-295.
95 S.S. Basta, M.S. Soekirman and D. Karyadi. 1979. Iron-deficiency anaemia and the productivity of adult males in Indonesia. American Journal of Clinical Nutrition, 32: 916-925.
96 See J.M. Hershman, G.A. Melnick and R. Kastner. 1986. Economic consequences of endemic goiter. In J.T. Dunn, E.A. Pretell, C.H. Daza and F.E. Viteri, eds. Towards the eradication of endemic goiter, cretinism and iodine deficiency. Washington, DC, Pan-American Health Organization (PAHO), Scientific Publication No. 502. See also the studies cited in Behrman, op. cit., note 87.
97 UNICEF, op. cit., note 82.
98 Ibid.
99 S. Grantham-McGregor, L. Fernald and K. Sethuraman. 1999. Effects of health and nutrition on cognitive and behavioral development of children in the first three years of life. Part 2: Infections and micronutrient deficiencies: iodine, iron and zinc. Food and Nutrition Bulletin, 20(1): 76-99.
100 UN-ACC Sub-Committee on Nutrition/IFPRI. 2000. Fourth Report on the World Nutrition Situation: Nutrition Throughout the Life Cycle. Geneva.
101 Ibid.
102 For surveys see Behrman, op. cit., note 87; J. Behrman. 1996. The impact of health and nutrition on education. The World Bank Research Observer, 11(1): 23-37; S. Grantham-McGregor, L. Fernald and K. Sethuraman. 1999. Effects of health and nutrition on cognitive and behavioral development in children in the first three years of life.
Part 1: Low birth weight, breastfeeding and protein-energy malnutrition. Food and Nutrition Bulletin, 20(1): 53-75; Grantham-McGregor, Fernald and Sethuraman, op. cit., note 99; and Martorell, op. cit., note 82.
103 Behrman, op. cit., note 87.
104 Ibid.
105 FAO. 2000. Undernourishment and economic growth: the efficiency cost of hunger. By J. Arcand. FAO Economic and Social Development Paper No. 147. Rome.
106 D. Bloom and J. Sachs. 1998. Geography, demography and economic growth in Africa. Harvard Institute for International Development (mimeo).
107 L. Pritchett and L. Summers. 1996. Wealthier is healthier. Journal of Human Resources, 31(4): 841-868.
108 L. Smith and L. Haddad. 2000. Explaining child malnutrition in developing countries: a cross-country analysis. Research Report No. 111. Washington, DC, IFPRI.
109 R. Fogel. 1994. Economic growth, population theory and physiology: the bearing of long-term processes on the making of economic policy. American Economic Review, 84(3): 369-95.
110 S. Arora. 1998. Health and long-term economic growth: a multi-country study dissertation, Ohio State University, USA, cited in PAHO. 2000. Investment in health and economic growth: a perspective from Latin America and the Caribbean. Paper prepared for XXXV Meeting of the Advisory Committee on Health Research, Havana, Cuba, 17-19 July 2000.
