FOOD 2030 - A NATIONAL REPORT WITH GLOBAL IMPLICATIONS

PREAMBLE Demand for food and energy will jump 50% by 2030 and for fresh water by 30%, as the world population tops 8.3 billion. Climate change will exacerbate matters unpredictably. The United Nations Environment Programme (UNEP) predicts widespread water shortages across Africa, Europe and Asia by 2025. The amount of fresh water available per head of population will decline sharply during that time. The issue of food and energy security rose high on the political agenda last year during a spike in oil and commodity prices, but then slipped in priority with falling prices. At present, 30-40% of all crops are lost due to pest and disease before they are harvested, and future droughts and increasing salinity will affect growth and produce.

In this issue, we highlight the British Government’s new Food Strategy, released January 5th, 2010. It is a timely document, with implications for both the UK and the rest of the world.

UK GOVERNMENT’S NEW FOOD STRATEGY
A National Report with Global Implications
On January 5th, 2010, the UK Government released its new food strategy: Food 2030: How we get there is the first of its kind in over 50 years, and the UK’s first food security assessment. The report states observes that "the natural environment and the economy are intrinsically linked", and discusses issues ranging from how to create a sustainable food system locally and globally, to the challenges of rising global demand for food and how food contributes to greenhouse gas emissions (GHG).

"We need to think differently about food," said Prime Minister Gordon Brown in his Foreword to the report, produced by the Department for Environment, Food and Rural Affairs (DEFRA). 2008 was a wake-up call to world governments, as food prices rose sharply for the first time in a generation, provoking riots in some parts of the world. Many countries have reacted to protect food supplies in the face of climate change, a growing world population, and the spectre of “sudden shocks” such as natural disasters or price spikes.

[Ed Note: In Haiti, people are already reduced to eating mud cakes (clay with little added nutritional content); the January 13th 2010 earthquake will further exacerbate this extreme situation.]

As Secretary of State for DEFRA Hilary Benn states: “…the consequences of the way we produce and consume our food are unsustainable to our planet and to ourselves… we are at one of those moments in our history where the future of our economy, our environment, and our society will be shaped by the choices we make now.” Food production, he continues, must occur “without damaging the air, soil, water and marine resources, biodiversity and climate that we all depend on". For the UK, the aim by 2030 is to ensure that consumers are informed, can choose and afford healthy, sustainable food; that this demand is met by profitable, competitive, highly skilled and resilient farming, fishing and food businesses, supported by first class research and development. Food security is ensured through strong UK agriculture and food sectors, and international trade links with EU and global partners which support developing economies.

Globally, the report calls for a fairer international trade system that addresses import restrictions and subsidies, and the support of fair trade products, will work towards food that is produced, processed, and distributed to feed a growing global population in ways which:

o use global natural resources sustainably
o utilizes a low carbon food system which is efficient in using resources – any waste is reused, recycled or used for energy generation
o enable the continuing provision of the benefits and services that results from a healthy natural environment
o promote high standards of animal health and welfare
o protect food safety
o make a significant contribution to rural communities, and
o allow for global leadership on food sustainability.

Sustainability is a central theme throughout the document, but with the onus for this left mostly up to consumers. More government regulation and intervention may be required, given that many consumers will find it difficult to change food purchasing habits; otherwise, the agribusiness will find new ways to appeal to consumers without truly changing their activities. Related target areas:

 education to help consumers know how and where food is produced and how to grow and cook it themselves;
 programmmes to provide schoolchildren with opportunities to grow food;
 the public sector would lead by example and purchase healthy and sustainable foods.

A broader understanding of sustainability is advocated that would address GHG emissions, water use, animal welfare, and supporting rural communities in the UK and in developing countries. The report suggests that the previous focus on ‘food miles’ was too narrow, as the transportation of food only accounts for 9% of the carbon footprint of a food product.

Food 2030 repeatedly links what is happening in the UK and the need to support communities in the developing world regarding resource use, improving technologies, purchasing fair trade products. Such endeavours could benefit communities by supporting farmers, improving infrastructure and supports, and mitigating the impacts of climate change. Or, such support could amount to another “Green Revolution”, benefiting the few and disadvantaging the many.

Sources:
HM Government. Food 2030: How we get there. Released Jan 2010. http://www.defra.gov.uk/foodfarm/food/pdf/food2030strategy-summary.pdf
Manitoba Alternative Food Research Alliance. Evaluating Food 2030, Jan 6, 2010. http://www.localandjust.ca/?p=432
Christine McGourty. Global crisis 'to strike by 2030'. Mar 19, 2009. http://news.bbc.co.uk/2/hi/uk_news/7951838.stm.
Tom MacMillan. Hilary’s contradiction casserole. Jan 5, 2010. http://www.guardian.co.uk/commentisfree/2010/jan/05/hilary-contradiction-casserole-can-worms.
Food Ethics Council. Food security. http://www.foodethicscouncil.org/topic/Food%20security. Accessed Jan 14, 2010.
Food Ethics Council. Food poverty. http://www.foodethicscouncil.org/topic/Food%20poverty. Accessed Jan 14, 2010.
Food Ethics Council. Hunger. http://www.foodethicscouncil.org/topic/Hunger Accessed Jan 14, 2010.

DISCUSSION: Looking back: how far have we really moved ahead? Defined at the 1996 World Food Summit, food security: “… exists when all people, at all times, have physical, social, and economic access to sufficient, safe, and nutritious food that meets their dietary needs and food preferences for an active and healthy life”. Leaders at that meeting committed to tackling hunger. By June 2009, however, the world’s hungry had increased to 1.02 billion people.

In the aftermath of high global food prices in 2008, amid growing concern about the effects of climate change on agriculture, much of the focus shifted to boosting food production. Yet, people go hungry because they cannot afford to eat rather than because there is no food available, and agricultural investment could exacerbate problems unless it is focused on reducing economic inequalities.

For examples: increasing meat and dairy consumption in the fastest growing economies will increase pressure on supplies; the roles played by financial speculation and biofuel promotion on the 2008 price hikes shows how developed country politics, consumption and spending power, not food production, adversely impact hunger globally.

Despite increasing choice and affordability of food in some countries, many people eat “what they can afford”, not what they “want” let alone what nutrition “experts” tell them they “should”. Food poverty means that an individual or household isn’t able to obtain healthy, nutritious food, or can’t access the food they would like to eat. This often results in lower nutrient intake, bad dietary patterns, hunger, low fruit and vegetable consumption and problems accessing food. The resulting poor diets lead to heart disease, obesity, diabetes and cancer, and inadequate levels of many vitamins and minerals. Obesity is now a sign of poverty in rich countries, as hunger is in poor countries.

Food poverty and economic poverty are linked. Policy-makers often view food security as a strategic issue of national security, dependent on logistics and global trade relations. At global level, how to feed a growing population that demands more resource-intensive diets, while tackling climate change and environmental degradation, are key questions of food security.

Envoi: According to a 2002 report from the UN Food and Agriculture Organization (FAO), global food production will continue to exceed population growth through 2030, but hundreds of millions of people in developing countries will remain hungry, and many environmental problems associated with agriculture will remain serious. Although growth in demand for food will be lower and population growth will slow, agricultural pressure on natural resources will continue to increase, albeit at a slower pace, and agricultural trade deficits in developing countries will increase drastically. Because most of those in extreme poverty live in rural areas, giving rural people better access to land, water, credit, health and education is essential for alleviating poverty and hunger, according to the report.

International trade plays an important role in achieving these aims, the agency says, calling for greater agricultural trade liberalization, better access to OECD (Organization for Economic Cooperation and Development) markets, the elimination of export subsidies and the reduction of tariffs. The FAO recommended openness toward international markets, investments in infrastructure, promotion of economic integration and limits on market concentration to make globalization work for the poor.

Citing Asia as a region where globalization has generally led to progress in reducing poverty, FAO notes that… " it has also led to the rise of multinational food companies with the potential to disempower farmers in many countries". "Developing countries need the legal and administrative framework to ward off the threats while reaping the benefits".

Source: World Agriculture: Towards 2015/2030 http://www.unwire.org/UNWire/20020820/28440_story.asp

HEALTH CARE IN CANADA – An Essay

Preamble: A public consultation on health care, called the Conversation on Health, took place during 2007 in the Canadian province of British Columbia.[1] Our firm made a written submission [2], and now we take the opportunity to transform the core of this into an overview of Canada’s health care, on the premise that this may be of global interest.

NOTE: The essay is written for the Canadian context, so we caution that Canada’s model is NOT readily translatable to most other countries. However, it may be a viable option for economically developed ones that still lack universal coverage.

We reserve the right to change our views on any aspect of this essay as new analysis may emerge to justify revision, and in this sense it may be viewed as a work in progress.

NEW NOTE January 25, 2013: Due to the popularity of this posting (based on our web traffic statistics) we wish to alert readers to a related article: White F, Nanan D. A Conversation on Health in Canada: revisiting universality and the centrality of primary health care. J Ambul Care Manage. 2009;32(2):141-149.  Full FREE access to that article has been arranged at the following site: http://www.phabc.org/modules.php?name=Contentpub&pa=showpage&pid=173

CANADIAN HEALTH CARE – An Overview
Canada’s health system enjoys wide public support. Its most valued features are: universality, portability and no direct fees for insured services, financed by government in accordance with the Canada Health Act (1984). The objective under the Act is "to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers."

While the Canada Health Act resonates politically, not all health modalities are equally recognized. Nor are they equal in terms of need, quality of supporting evidence, nor necessarily affordable. Choices have always have been made. Thus, even though “comprehensiveness” is one of the stated principles, in practice this particular attribute has never been a reality as it refers historically to services deemed “medically necessary” in the context of 3-4 decades ago when the provincial acts supporting universal health care were promulgated. Elements still not adequately recognized include: home care, long term care, dental care, physiotherapy and pharmaceuticals, and others. A relevant question: will universality be applied in future to services not fully financed today?
To the extent that the system delivers on equity therefore, it approaches this only for fully insured medical and hospital-based services; but where coverage is not universal, ability to pay is critical. This contrast reflects how society views health as a public good, what it considers essential, the extent of equity it seeks, and the resources it is prepared to allocate. While the Canadian experience overall has been positive, the commitment and sustainability are remain functions of social values and political will. Canada’s health care system is justifiably a source of pride, but there is still much room for improvement

Health therefore is both a complex social goal and a major enterprise in Canada, mostly now based in the public sector. While compassion and human rights lie at its base, it is also seen in terms of the social and economic benefits it provides to the entire population.

INTER & INTRA JURISDICTIONAL COMPARISONS
A systematic review of 38 studies recently confirmed that Canada’s system leads to health outcomes that are favourable overall when compared with the US private for-profit system, at less than 50% of the cost [3]. However, perhaps more relevant is WHO’s landmark study in 2000 of health systems performance in almost 200 countries, ranking the UK in 18th place, Canada at 31st, and the US (most expensive health care in the world) at 37th. Most European countries performed better than Canada, while Australia’s performance (similar socio-demographics) at 32nd place was virtually tied with Canada [4]. Several other countries also scored better than Canada eg., Singapore, Japan. In our view, rather than dismiss such comparisons (which is unfortunately a defensive reaction in some circles) Canada should study and learn from those systems which appear to be doing better, and (while staying consistent with the core principles of the Canada Health Act) be more prepared to innovate, test and evaluate new approaches. We should also show more interest in the internal comparisons being revealed from within our health and social sectors [5], specifically: why are health conditions so different for different groups within the country, and what can be done about this? The key premise here is to be guided by evidence within the social contract represented by the Canada Health Act.

When one examines overall health status of populations using objective measures, it is tempting to conclude that the health systems of countries with similar socio-economic conditions appear to vary more with regard to cost than performance, irrespective of the public-private mix. However, the type of system does appear to have a strong influence on the indicators of equity. Beyond observing the principle of universality, this is reflected in steadily improving outcomes. A new Canadian study [6] reveals that – over a 25 year period – differences between the richest and poorest quintiles in expected years of life lost amenable to medical care decreased 60% in men and 78% in women. Reductions in rates of death amenable to medical care made the largest contribution to narrowing the socioeconomic mortality disparities. Continuing disparities in mortality in causes amenable to public health suggest that public health initiatives have a potentially important but yet unrealized role in further reducing mortality disparities in Canada.

If we make the political decision that there is probably already enough money in the system, the challenge in achieving better performance necessarily must lie in improving leadership, priority-setting, decision-making and management at all levels: in particular, we must do better on health promotion, public health and preventive medicine. On the other hand, there are many in society and among the ranks of the health professions who believe that the system we have is already doing very well, and – while its underlying principles seem secure – we would adjust its design and the way it is working at our peril. Nonetheless, the existing budget is by definition aligned with the status quo, mostly a legacy of thinking of the early 1970s (when most Canadian provinces launched their particular version of “medicare”). Does it necessarily follow that this is the only formulation we are capable of, or has the time come to expand the scope of health services to more within currently underfinanced sub-sectors eg., pharmacare, dentistry?
LOOKING WHERE THE OBJECT IS LOST, NOT WHERE THE LIGHT IS BEST
When engaged in public debate about health care, as a society Canada tends to focus on the high cost items that preoccupy institutional administrators, while overlooking the powerful forces that preserve our health: healthy living environments and workplaces, primary prevention (eg., nutrition education, childhood immunization, ante-natal care, physical activity, smoking prevention), and social policies (affecting literacy, employment, crime, housing quality and community wellbeing). These are the “upstream factors”. We also become so preoccupied with acute care issues, which are crisis-prone and sometimes glamorized, forgetting not only the upstream factors, but even downstream ones (eg., long-term care, home care) whose availability determines the speed with which acute care patients may move on to more appropriate levels of care.

To the extent that health systems fail, especially with regard to addressing priority needs and the ethic of equity (universality, access, affordability), this most often results from failing to deliver on basic needs, especially for groups that lack power or recognition.

OUR SUGGESTIONS FOR THE CONTINUED STEWARDSHIP OF CANADIAN HEALTH CARE

o That federal and provincial governments continue to recognize health as a public good, recommit to the principles of universality and equity in health services delivery, and curtail private for-profit entities as an alternative in any area of core or essential services. Clearly our governments must continue to ensure that how it puts together services must be in compliance with the Canada Health Act (1984).

o The Government of Canada should be kept under scrutiny regarding the decline in its financial contributions to provincial health services, thereby contravening the Canada Health Act. The “new” federal government must be held accountable for reneging on the Kelowna Accord (investment in aboriginal peoples) and Child Care. These failures to honour prior commitments that enjoyed public support reveal a short-sighted federal political agenda that undermines important determinants of health and social equity.

o Also in the spirit of the Canada Health Act, we urge government to re-examine now what services should be core or essential, and to consider expansion of the scope of publicly financed provisions, with emphasis on the more vulnerable eg., dental provisions for children and the elderly; provisions for new parents eg., maternity leave and child care, and expand the eligibility and/or scope of pharmacare for elderly. This is particularly timely given record governmental budget surpluses in recent years.

o Health care quality and outcomes for Canadian jurisdictions generally compare favorably with those of the US. Nonetheless, the tendency of Canadians to refer to the US performance in health care and outcomes as if this is a desirable norm is misplaced. It makes more sense to learn from the experience of systems elsewhere in the world eg., western Europe, Japan, Singapore, that are better performers than the failing US model. To the extent that Canada looks to the US for systems design support or medical records contracting, this must not threaten privacy; under the current US administration even its own citizens are losing trust regarding the invasion of privacy in the name of security.

o The most critical elements of any health system needs to be public health (ie., population health provisions, including health promotion) and primary health care: to the extent that systems fail, this is often due to failure to support these components. Effort is needed to attract talented individuals to engage in these fields. The responsibility for this lies with professional education institutions, specialty bodies and professional associations, with support from relevant ministries to ensure that effective action is taken.

o There is a need for Canada to strengthen its response to the surging chronic disease burden. The international literature indicates that about half of this burden is potentially preventable through attention to modifiable behaviours eg., smoking, fitness, weight control; and about half of those who do develop these conditions can be prevented from progressing to more complicated forms through attention to secondary prevention eg., blood pressure screening; active glucose monitoring for persons with diabetes.

o When one looks at Canada’s population health internally, it is obvious that there is still a substantial amount of inequity, both regionally eg., northern regions, inner city areas, and by population group eg., First Nations. We therefore recommend that, equity must be given more prominence in the public debate and in government decision making.

References1. Conversation on Health. Government of British Columbia, Canada (2007): http://www.bcconversationonhealth.ca/EN/401/
2. Pacific Health & Development Sciences. Shaping health in BC – observations and suggestions. Submission to the B.C. Conversation on Health. http://www.bcconversationonhealth.ca/media/PacificSci_COH_Submission.pdf
3. Guyatt GH, Devereaux PJ, Lexchin J, et al. A systematic review of studies comparing health outcomes in Canada and the United States. Open Med 2007;1(1):e27–36.
4. The World Health Report 2000. June 21, 2000. Geneva. http://www.who.int/whr/2000/en/index.html
5. Hertzman C, Irwin LG. It takes a child to raise a community: population-based measurement of early child development. Human Early Learning Partnership. No 1: July 2007. http://www.earlylearning.ubc.ca/
6. James PD, Wilkins R, Detsky, Tugwell, Manuel DG. Avoidable mortality by neighbourhood income in Canada: 25 years after the establishment of universal health insurance. J Epidemiol Community Health 2007; 61:287-296. http://jech.bmj.com/cgi/content/abstract/61/4/287

WORLD DEVELOPMENT CALLS FOR INVESTMENT IN AGRICULTURE 2008

PREAMBLE: The World Development Report 2008 (reference link below) calls for greater investment in agriculture in developing countries. This annual World Bank report warns that the sector must be placed at the center of the development agenda if goals of halving extreme poverty and hunger by 2015 are to be realized.

o While 75% of the world’s poor live in rural areas in developing countries, a mere 4% of official development assistance goes to agriculture.
o In Sub-Saharan Africa, a region heavily reliant on agriculture for overall growth, public spending for farming is also only 4% of total government spending and the sector is still taxed at relatively high levels.
o GDP growth originating in agriculture is about four times more effective in raising incomes of extremely poor people than GDP growth originating outside the sector.

Said World Bank Group President Robert B. Zoellick: “At the global level, countries must deliver on vital reforms such as cutting distorting subsidies and opening markets, while civil society groups, especially farmer organizations, need more say in setting the agricultural agenda.”

In this issue we focus on Malawi as a Case Study of the role of new subsidies to enhance agricultural production, despite decades of donor proscription not to subsidize, and take note of a World Trade Organization investigation into the use by the United States of truly massive trade-distorting farm subsidies in violation of international commerce rules.

Reference : World Development Report 2008: Agriculture for Development. http://econ.worldbank.org/WBSITE/EXTERNAL/EXTDEC/EXTRESEARCH/EXTWDRS/EXTWDR2008/0,,contentMDK:21410054~menuPK:3149676~pagePK:64167689~piPK:64167673~theSitePK:2795143,00.html

Case Study - ENDING FAMINE IN MALAWI
After a disastrous corn harvest in 2005, almost 40% of Malawi’s 13 million people needed emergency food aid. Move forward to 2007, and Malawi is selling more corn to the UN’s World Food Programe than any other country in southern Africa. Farmers explain the extraordinary turnaround with one word: fertilizer.

Over the past 20 years, the World Bank and some rich nations Malawi depends on for aid have periodically pressed this small, landlocked country to adhere to free market policies and cut back or eliminate fertilizer subsidies, even as the USA and Europe extensively subsidized their own farmers. But after the 2005 harvest, the worst in a decade, Bingu wa Mutharika, Malawi’s newly elected president, decided to follow what the West practiced, not what it preached, reinstating and deepening fertilizer subsidies.

The country’s successful use of subsidies is contributing to a broader reappraisal of the crucial role of agriculture in alleviating poverty in Africa and the pivotal importance of public investments in the basics of farm economies: fertilizer, improved seed, education, credit and agricultural research. Malawi’s leaders long favored fertilizer subsidies, but reluctantly acceded to donor prescriptions, often shaped by foreign-aid fashions in Washington, that featured faith in private markets and antipathy to public intervention.

In a withering evaluation of the World Bank’s record on African agriculture, the bank’s own internal watchdog concluded in October not only that removal of subsidies had led to exorbitant fertilizer prices in African nations, but that the bank itself often failed to recognize that improving Africa’s declining soil quality was essential to lifting food production.

In Malawi, deep fertilizer subsidies and lesser ones for seed, abetted by good rains, helped farmers produce record-breaking corn harvests in 2006 and 2007. An independent evaluation, financed by the USA and the UK, found that the subsidy program accounted for a large share of this year’s increase in corn production. The harvest also helped the poor by lowering food prices and increasing wages for farm workers.

Malawi’s determination to heavily subsidize fertilizer and the payoff in increased production are beginning to change donor attitudes, say economists who have studied Malawi’s experience. The UK (DFID) contributed $8 million to the subsidy program last year. Bernabé Sánchez, an economist with the agency in Malawi, estimated the extra corn produced because of the $74 million subsidy was worth $120 million to $140 million. The US, which has shipped $147 million worth of American food to Malawi as emergency relief since 2002, but only $53 million to help Malawi grow its own food, has not provided any financial support for the subsidy program, except for helping pay for the evaluation of it. Over the years, the USAID has focused on promoting the role of the private sector in delivering fertilizer and seed, and saw subsidies as undermining that effort. But Alan Eastham, the US ambassador to Malawi, said in a recent interview that the subsidy program had worked “pretty well,” though it displaced some commercial fertilizer sales. And the World Bank now sometimes supports the temporary use of subsidies aimed at the poor and carried out in a way that fosters private markets.

In Malawi, bank officials now support Malawi’s policy, though they criticize the government for not having a strategy to eventually end the subsidies, and... say there is still a lot of room for improvement in how the subsidy is carried out. “The issue is, let’s do a better job of it,” said David Rohrbach, a senior agricultural economist at the bank. Though donors are ambivalent, Malawi’s farmers have embraced the subsidies. And the government moved this year to give its people a more direct hand in their distribution.

Source: Adapted from the article by Celia Dugger. Ending Famine, Simply by Ignoring the Experts. New York Times Dec 2, 2007 http://www.nytimes.com/2007/12/02/world/africa/02malawi.html

WORLD TRADE ORGANIZATION INVESTIGATION INTO US SUBSIDIES
GENEVA (AP) — The WTO has opened an investigation into whether the US was violating international commerce rules that limited subsidies to American farmers, three days after the US Senate approved a $286 billion farm bill. Brazil and Canada, frustrated by US resistance to cutting back on subsidies, asked the WTO to condemn Washgton for exceeding permitted levels of what it called trade-distorting handouts to American producers of crops like corn, cotton, rice, soybean and wheat. The panel is expected to issue a first ruling in 2008. The dispute system often takes years before a final decision is reached, but can force countries to change their legislation or face billions of dollars in retaliatory sanctions. The battle over farm subsidies could become a landmark dispute for the WTO because Brazil’s complaint includes payments for ethanol production. The trade body has largely steered clear of energy issues in its 12-year history.

Source: Bradley S. Klapper. Associated Press. December 18, 2007