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ARTICLE DETAILS
TITLE (PROVISIONAL)
AUTHORS
Can nutrition be promoted through agriculture-led food price policy?:
a systematic review
Watson, Louise; Dangour, Alan; Hawkesworth, Sophie; Shankar,
Bhavani; Srinivasan, C; Morgan, Emily; Haddad, Lawrence; Waage,
Jeff
VERSION 1 - REVIEW
REVIEWER
REVIEW RETURNED
GENERAL COMMENTS
Howarth Bouis
Director, HarvestPlus
International Food Policy Research Institute
USA
29-Apr-2013
I have concerns for the implications of the results for policymaker
and donor investments, which I express in the attachment. The
authors may simply disagree with me (which in my opinion should
not influence the decision to publish), or they may want to address
my concerns in a revision of the paper. To me, it the authors' (and
perhaps the editor's) decision.
The study by Dangour et al. seeks to investigate/evaluate what the
literature says about the effect of agricultural price policies on
nutrition outcomes. The authors are to be congratulated for at least
two reasons – first, for putting together an interdisciplinary team
(more such teamwork is sorely needed) to undertake this research,
and second for emphasizing the important of role of agriculture in
determining nutrition outcomes. Too often in the past, agricultural
policies have been driven solely by productivity and poverty
reduction considerations, with a nod toward food security when
cereal prices rise in short term. The study is well executed
methodologically.
The authors start with 1,110 possibly relevant studies (from an
original pool of 14,837), set a certain standard for methodological
rigor, and find only four studies that meet that standard. It matters
little really what these four studies conclude positively or negatively
about the effect of food prices on nutrition outcomes. The sample
size is much too small.
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To whom are the authors primarily directing their conclusions? To
me this is the essential point for discussion here.
Certainly, this could be interpreted as a rebuke of sorts of the
research community. Either the research community is asking the
wrong questions, or their methodologies need to be improved, or
both. The research community needs to “raise its game,” as it
were. Either that, or perhaps the authors set the bar too
high. Others may be interested to discuss where the bar should be
set, and to investigate alternative conclusions.
However, having practiced nutrition-related food policy analysis at
the International Food Policy Research Institute (IFPRI) for the past
30 years, what I am concerned about rather is what do we
recommend to policymakers and donors who have to make policy
and investment decisions today? This year‟s budget is on the table
and the clock is ticking. Are there any clues in the literature that can
help us help them?
An exhaustive literature review is not possible in the time given to
undertake this review, so I must rely on a personal example,
hopefully to make my point clear.
My reading of the literature is that as prices of particular foods go up,
demand/intake of those foods go down, especially if one is poor,
especially if it is a non-staple food. In addition, there are also
studies that show that iron status is a function of iron intakes, among
other factors. The same goes for provitamin A intakes and vitamin A
status, and so on. Magnitudes may vary, there may be nutrient
interactions, and so forth.
For example, in Bouis, Eozenou, and Rahman (2011), we simulated
an across-the-board 50% increase in food prices, which showed that
this would lead to a 30 percent decline in iron intakes in Bangladesh,
with only a modest percentage decline in energy intakes. A study of
the Indonesian financial crisis of 1997-98 by Block et al (2004) has
much better evidence. Prices of most food groups rose by over
100%, with the minimum percentage increase for one food group
being 80%. Child hemoglobin fell by -0.75 g/dl.
Last year, a graduate student at the Delhi School of Economics put
together the trend in inflation-adjusted food price indices for India
shown below. These indices more or less corresponded to my a
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priori expectations – and are broadly consistent with price indices for
Bangladesh shown in Bouis, Eozenou, and Rahman (2010). It is
well-known that the Green Revolution resulted in long-run declines
in cereal prices. There were major investments in milk productivity in
India. Cereal and milk prices in India have fallen over the forty year
period between 1970-73 and 2009-10, although cereal and milk
prices are higher in 2009-10 as compared with 1979-82. Otherwise
there has been a 40-year increasing trend in the prices of all other
food groups. I want to do some further analysis of how this (to me)
alarming trend has affected dietary quality in India, but there has not
been time.
By chance, recently I had an opportunity to give a seminar to a
rather high level policymaker audience organized by the
Commissioner on Agriculture Costs and Prices in India (a former
IFPRI Division Director). Having no other evidence than the food
price indices below (and my 30 years of experience), I rather
passionately argued that something needed to be done to reverse
this trend in food prices if mineral and vitamin deficiencies were to
be significantly and sustainably improved. I repeated this message
in several media interviews during my short visit to India. Was it
improper of me to do so?
At this point, I am not sure if I am part of the “lack of rigor” problem
or not. There will always be scope to make research more rigorous
and this should always be pursued vigorously. In fact, at the
beginning of our careers one of the co-authors and I conspired to
show that a basic econometric flaw had led to severely upwardly
biased estimates of calorie-income elasticities, and wrong policy
conclusions (Bouis and Haddad 1992).
After 30 years, however, I have learned that today‟s rigorous
research is tomorrow‟s flawed research. Policy analysis will always
be part science, but also part art, part detective work, part drawing
out a consistent story. For example, in reference to Bouis and
Haddad 1992, simply looking at differences in bodyweights across
income groups would have made it obvious that calorie-income
elasticities could not possibly have been as high as had been
estimated (Bouis 1994).
Masset et al (2012) are perhaps on firmer ground in a previous
paper -- with a similar methodology and conclusion -- about the lack
of evidence that agricultural projects can improve nutrition. Even
there, I would urge the application of “art-detective work-drawing out
a consistent story” to see what the literature might be telling us.
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However, this detective work is much easier with respect to
agricultural prices. Food prices are an important determinant of
diet, diet is an important determinant of nutritional status. I find it
rather more interesting to tease out from the literature what the
magnitudes might be. Let us not lose sight of the fact that food
prices and income are different sides of the same coin.
With respect to specific agricultural strategies and projects, I have
my own biases about which will be shown to be cost-effective.
Hopefully more rigorous evidence will become available to help us
convince policymakers where best to invest.
References
Block, S, L Kiess, P Webb, S Kosen, R Moench-Pfanner, MW
Bloem, CP Timmer. 2004. Macro shocks and micro outcomes: child
nutrition during Indonesia‟s crisis. Economics and Human Biology,
vol 2, p.21–44.
Bouis, H. 1994. The effect of income on demand for food in poor
countries: Are our food consumption databases giving us reliable
estimates? Journal of Development Economics 44 (1): 199-226.
Bouis, H., and L. Haddad. 1992. Are estimates of calorie-income
elasticities too high?: A recalibration of the plausible range. Journal
of Development Economics 39 (2): 333-364.
Bouis HE, P Eozenou P and A Rahman. 2011. Food prices,
household income, and resource allocation: Socioeconomic
perspectives on their effects on dietary quality and nutritional status.
Food and Nutrition Bulletin Vol. 32(1): S14-S23.
Masset, E, L Haddad, A Cornelius, J Isaza-Castro. 2012.
Effectiveness of Agricultural Interventions that Aim to Improve
Nutritional Status of Children: Systematic Review. BMJ 344:d8222
doi: 10.1136/bmj.d8222 [published Online First: Epub Date].
REVIEWER
Signed electronically
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REVIEW RETURNED
GENERAL COMMENTS
Eileen Kennedy,D.Sc.
Professor of Nutrition
Tufts University
USA
09-May-2013
This is a timely and important topic. The authors highlight the
difficulties of using extant data for a meta analysis. This should
provide a template for future research in this area of agriculture
development and nutrition.
One suggestion - please add a sentence on why articles 1990 and
onward were selected.
VERSION 1 – AUTHOR RESPONSE
Reviewer: Howarth Bouis:
I have concerns for the implications of the results for policymaker and donor investments, which I
express in the attachment. The authors may simply disagree with me (which in my opinion should not
influence the decision to publish), or they may want to address my concerns in a revision of the paper.
To me, it the authors' (and perhaps the editor's) decision.
i) We have clarified the reviewer‟s question about who the primary audience is. Specifically, we now
note at the end of the introduction that
„Our immediate audience for this research is the policy evaluation research community in health,
agriculture and development. By reviewing the nature and adequacy of the currently available
evidence, we have the objective of improving the quality of evidence provided to policymakers in
these sectors.‟
ii) We agree with the reviewer the lack of rigorous and direct evidence as highlighted by our review
does not preclude the provision of good policy advice in this important area. We have made several
small adjustments to our text to qualify our assertions accordingly, and have also amended a key
paragraph in our discussion section to address this. This paragraph now reads as follows:
„There are important implications to draw from this paper. For policy evaluation researchers, our
primary audience, we highlight the value of bringing health and development research methods
together to understand complex and rapidly evolving phenomena. The systematic review presented
here indicates a clear need for future research that is rigorously implemented, with credible
counterfactuals, and that extends across the causal chain from policy introduction to nutrition
outcomes. However, this does not imply that the research community does not have a valuable role to
play in providing policy advice now, based on currently available evidence. There is strong evidence
available on segments of the causal chain shown in Figure 1. Such evidence, pieced together
carefully and supported with the intuition of experienced researchers, can help guide nutritionsensitive agriculture price policy design while a rigorous evidence base encompassing the causal
chain is built up. For policymakers we note the potential that food prices may affect nutrition and
health outcomes and suggest that as the costs of applying a nutrition lens to development
interventions are likely to be dwarfed by the benefits of doing so these opportunities should be taken
where at all possible.‟
Reviewer: Eileen Kennedy
This is a timely and important topic. The authors highlight the difficulties of using extant data for a
meta analysis. This should provide a template for future research in this area of agriculture
Downloaded from http://bmjopen.bmj.com/ on June 17, 2017 - Published by group.bmj.com
development and nutrition.
One suggestion - please add a sentence on why articles 1990 and onward were selected.
We thank Prof Kennedy for this positive review and have added the following sentence to clarify why
articles 1990 and onward were chosen:
„Descriptive analyses, commentaries and narrative reviews were excluded, as were older evaluation
studies (pre-1990) which are less relevant to the current agricultural policy, development or health
landscape.‟
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Can nutrition be promoted through
agriculture-led food price policies? A
systematic review
Alan D Dangour, Sophie Hawkesworth, Bhavani Shankar, Louise Watson,
C S Srinivasan, Emily H Morgan, Lawrence Haddad and Jeff Waage
BMJ Open 2013 3:
doi: 10.1136/bmjopen-2013-002937
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