As our world population continues to rapidly increase to a predicted 9 billion people by 2050, the types of food we grow will have a direct impact on human and environmental health. It is crucial to ensure that not only everyone has a nutritious meal to eat, but that we also are growing the food in a way that benefits both people and the planet. Our current agricultural practices are resource intensive, and harmful to our natural ecosystems. Dietary changes have a major impact on chronic disease rates as well as and environmental impact. These shifts are causing major implications. As developing countries continue to rise from the lower class to the middle class, traditional diets are being replaced with diets high in saturated fats, sugar, and processed foods. Working with developing countries to introduce culturally appropriate, healthy, affordable, and accessible foods must be a top priority.
This essay is tailored to the specific program called Gardens for Health International, which is a non-profit aiming to increase nutrition security and sustainability through education and gardening in the African country of Rwanda. While the statistics in this paper are focused on Rwanda, the concepts and programming can be applied to many other programs around the world.
The Academy of Nutrition and Dietetics’ Position Statement on Global Nutrition Securityi
It is the position of the Academy of Nutrition and Dietetics that all people should have consistent access to an appropriately nutritious diet of food and water, coupled with a sanitary environment, adequate health services, and care that ensure a healthy and active life for all household members. The Academy supports policies, systems, programs, and practices that work with developing nations to achieve nutrition security and self-sufficiency while being environmentally and economically sustainable. Food and nutrition practitioners can aid in the promotion and implementation of effective and sustainable policies, systems, programs, and practices that support individual, community, and national efforts.
Why Nutrition Security?
Calories alone are not enough to ensure proper growth and development. Over 800 million people in the world are experience calorie deficiencies, however over 2 billion people are experiencing malnutrition in the form of micronutrient deficiencies.ii The vast majority of these deficiencies stem from four nutrients: Vitamin A, iodine, iron, and zinc.iii Both calories and proper nutrient consumption are essential to sustaining a healthy population.
Adequate food and nutrition are a universal right and are essential for the physical, mental, and emotional development of children and adults. Malnutrition is claiming lives in Rwanda every year; women and children are the population that is most affected. Ten percent of women between the ages of 15 and 49 are malnourished in Rwanda.iv Since the genocide in the early 1990’s, the Rwandan Government has worked hard to rebuild the country and improve the quality of life for its citizens. While the overall GDP of the country is growing, there is still much to be done to improve the nutrition profile of the population. In rural Rwanda, the poverty rate is three times higher than its urban populations.v As many as 21 percent of Rwandan households have unacceptable food consumption and may be considered to be food insecure. Regions with the highest rates of food insecurity have children with stunting rates of over 50%. Chronic malnutrition is an issue that requires the support of nutrition professionals teaming up with other sectors to help educate and reduce these high numbers.
Why Agriculture?
Global Agriculture
The global agricultural system is primarily concerned with ensuring that sufficient food (in terms of calories) will be produced to feed the projected global population of nine billion in 2050. However, to tackle global public health problems associated with both under- and over-nutrition, healthy diets must be sufficient not just in calories but also in the balance of macronutrients, vitamins and minerals.vi Diet diversification is especially important for the most vulnerable populations – young children and pregnant/breastfeeding women. Increasing the production of nutrient-dense foods, particularly locally adapted varieties rich in micronutrients and protein, is vital for combating nutrition related chronic diseases.viii Fortification of foods, supplementation and agricultural diversification to include more nutrient rich foods are all techniques that can help mitigate micronutrient deficiencies.ix Our increasingly sophisticated understanding of the association between diet and health should now prioritize health as a key driver of future agricultural production.vii In order to reach nutrition security, more strategic partnerships between development and research communities are required.
Rwandan Agriculture
Agriculture accounts for 1/3 of Rwanda’s GDP, and is the main economic activity for a large majority of the country. Despite the fact that 85% of Rwandans rely primarily on agriculture for food and income, nutrition remains a critical barrier to achieving positive health outcomes. Malnutrition isn’t always an issue of not producing enough food, and growing more food does not always translate to healthier populations. In fact, as we see in many developed countries, we are growing foods that are considered to be lacking in major nutrients – canola, wheat (especially when processed to white flour), and corn. When aiming to improve health outcomes of a population, it’s important to consider the availability, acceptability, and affordability of nutrient-dense foods such as fresh fruits, vegetables, whole grains, and lean proteins. That being said, simply growing healthy foods is not enough. Foods must be culturally appropriate, and be coupled with education on how to properly prepare it. Healthy food does no one good if it ends up going to waste.
Why Climate Smart?
The Rwandan agriculture sector, as well as many other countries, are highly susceptible to climate and weather-related risks. Research shows that rainfall patterns are becoming more sporadic.x Flooding, mudslides, pests and droughts can all dramatically influence the outcome of crops. With our growing global populations, and increase in greenhouse gas emissions, there is growing pressure on our earth’s finite resources. Designing agriculture interventions that take into account climate-change is of critical importance for the long-term viability of populations. What we choose to grow and cultivate has a direct impact on our greenhouse gas emissions, and climate change simultaneously has an extreme impact on the environments in which we grow food. Climate smart agriculture practices bring important adaptation and productivity benefits to growers in Rwanda, including increased soil health, reduced water erosion, and increased land productivity. Incorporating climate-smart tactics can help reduce/remove greenhouse gasses and achieve a more efficient, effective, and equitable food system that addresses environmental dimensions.x
Gender Issues
Gender mainstreaming within agricultural extension and the nutrition curriculum is another key strategy for addressing rural malnutrition. Women in most households are intimately involved in the production and preparation of meals and feeding their family, and have the most direct control over nutrition. Female-headed households in India typically have a higher incidence of malnutrition and food insecurity.xi Commercialization of agriculture is a necessary component of rural development and provides a buffer against seasonal or climatic conditions. However, nutritional considerations and the role of women must be incorporated into policy to effect meaningful change in the circumstances of rural people.xii
Gardens for Health International (GFI)
Gardens for Health International is attempting to address all of the aforementioned issues into its programming. GHI has a mantra that healthy food must be part of the long-term solution to malnutrition.xiii They view the fact that agriculture is a primary source of over 3/4ths of the population of Rwanda as an opportunity to make real and lasting change. However, growing nutrient dense food is often not seen as a profitable option, and many times cash crops are grown instead of nutrient dense foods. Gardens for Health International has an ultimate objective of integrating agriculture into the clinical care of malnutrition in Rwanda, so that nutrition focused home gardens become a key strategy for addressing, and ultimately eradicating chronic malnutrition among vulnerable families. As with many other developing (and developed) countries, this will require a fundamental shift in the current treatment of malnutrition.
In the Musanze and Gasabo Districts of Rwanda, Gardens for Health offers 14 weeks of nutrition and agricultural training to families of children diagnosed with malnutrition. These families are enrolled in the program based on nutrition status indicators, such their child’s weight for age, height for age and symptoms of malnutrition. The educators who deliver the trainings come from the local communities and speak the native language, Kinyarwanda. Nutrition education has been proven to be effective if the trainers are properly equipped with the right knowledge and tools they need.xiv Even in the short time GHI has been in existence, they have already seen major successes in their approaches.
How it Worksxv
Gardens for Health International believes that the long-term solution to malnutrition must involve growing and eating healthy foods. This requires a shift in the current paradigm of conventional treatment of malnutrition away from handouts and towards self-sustaining programming that can be passed along from generation to generation. While emergency food has its place and is critically important for many, GHI believes that addressing the underlying causes of malnutrition is the only way to solve it. GHI partners with government health centers in Rwanda to provide seeds, knowledge, and support that will help enable marginalized populations to overcome malnutrition in the long-term.
Families enrolled in the program receive culturally appropriate seed packages, trees, cuttings, and animals for agriculture. Growing food and creating access to healthy options is only half the battle. That is why this agriculture support is coupled high-quality training models to help Rwandan mothers and their children to fully comprehend the importance of consuming the food they are growing. GHI trains health care workers and community leaders to help deliver the trainings. Families and field educators form lasting relationships to help lead visual demonstrations such as cooking demos, interactive programming, and song and dance.
Measureable Outcomes
Programs wouldn’t be effective without measured success, and Gardens for Health International has created a strong monitoring and evaluation team to do just that. In 2013, they saw an average of 88% attendance across their health centers.xvi Families often have to walk many miles to come to a lesson – some up to 2 hours one way. Some other outcomes include
- 61% of children were on an improved growth trajectory after only 14 weeks in the program
- 50% of families were consuming a high dietary diversity diet (up from 35% prior to enrollment)
- Health attendance rates were at 91%
- Agriculture attendance rates were at 84%
GHI is advocating with their successes to continue to spread their programming to more health centers across the country, with the help of Rwandan Ministries of Health and Agriculture, as well as multi-national stakeholders. Some partners include UNICEF, International Institute of Tropical Agriculture, and the Humid Tropics Project.
Repeating Successes
Successful programs like Gardens for Health International are combating malnutrition by taking traditional approaches a step further. By linking agriculture, nutrition and health, they are able to create a sustainable solution to increasing food access, affordability, and acceptance – as well as introduce evidence-based nutrition trainings to effectively reduce the insidious effects of nutrient-deficiency. As our global population continues to grow, and climate continues to change – it is imperative that nutrition is at the forefront of conversation and connecting the dots. Registered Dietitian Nutritionists are uniquely suited to help innovate and lead our agriculture system towards a more sustainable future. We must work cross-disciplinary with other professions to achieve healthy, well-nourished populations.
References
i Nordin SM, Boyle M, Kemmer TM. Position of the Academy of Nutrition and Dietetics: Nutrition security in developing nations: Sustainable food, water, and health. Journal of the Academy of Nutrition and Dietetics. 2013;113:581-595.
ii Caulfield LE, Richard SA, Rivera JA, Musgrove P, Black RE. Stunting, wasting, and micronutrient deficiency disorders. In: Jamison DT, Breman JG, Measham AR, et al, eds. Disease Control Priorities in Developing Countries. 2nd ed. Washington, DC: National Institutes of Health; 2006: 551-565.
iii World Health Organization. Globalization, diets, and noncommunicable diseases. Published 2002. http://whqlibdoc.who.int/publications/9241590416.pdf. Accessed January 14, 2015.
iv Rice AL, Sacco L, Hyder A, Black RE. Malnutrition as an underlying cause of childhood deaths associated with infectious diseases in developing countries. World Health Organization. 2000;78:1207–1221.
v https://www.usaid.gov/sites/default/files/documents/1864/USAID-Rwanda_NCP.pdf
vi B. S. Investing in the Future: A United Call to Action on Vitamin and Mineral Deficiencies: Global Report, 2009. Ottawa, Ontario, Canada: Micronutrient Initiative; 2009.
vii Hawkesworth S, Dangour AD, Johnston D, et al. Feeding the world healthily: the challenge of measuring the effects of agriculture on health. Philosophical Transactions of the Royal Society B: Biological Sciences. 2010;365:3083-3097.
viii Ruel MT, Alderman H, Maternal, Group CNS. Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition? The Lancet. 2013;382:536-551.
ix Nestel P, Bouis HE, Meenakshi J, Pfeiffer W. Biofortification of staple food crops. The Journal of nutrition. 2006;136:1064-1067.
x https://ccafs.cgiar.org/publications/climate-smart-agriculture-rwanda
xi Suresh Chandra Babu TH, Eija Pehu. Fostering Agriculture–Nutrition Links. Recommendations for Agriculture Extension Curriculum Reforms in India. World Bank2015.
xii Gupta H. Food and nutrition security in India: some contemporary issues. Journal of the Indian Society of Agricultural Statistics. Vol 63: Indian Society of Agricultural Statistics; 2009:209-218.
xiii Garden Health International. Gardens for Health Web site. http://www.gardensforhealth.org/ . Accessed October 16, 2015.
xiv Contento, Isobel, et al. “The effectiveness of nutrition education and implications for nutrition education policy, programs, and research: a review of research.” Journal of nutrition education (USA) (1995).
xv http://www.gardensforhealth.org/wp-content/uploads/2014/09/GHI-Annual-Report-WEB.pdf
xvi http://www.gardensforhealth.org/wp-content/uploads/2014/09/GHI-Annual-Report-WEB.pdf