Keith Lividini * 1,2 , Winnie F. Bell 1 and William A. Masters 1 ANH Academy Week, Hyderabad

1. Nutritional inequality:The impacts of agricultural production and international trade on nutrient availability across countries Keith Lividini*1,2, Winnie F. Bell1 and William A. Masters1 ANH Academy Week, Hyderabad June 26, 2019 1 Tufts University, Friedman School of Nutrition Science & Policy 2 HarvestPlus and A4NH

2. Motivation: Many countries still have high prevalence of nutrient deficiencies Hidden Hunger Index, 2011 Average of iron-deficiency anemia, vitamin A deficiency and child stunting rates Magnitude of Hidden Hunger Mild (<15) Moderate (15-24.9) Severe (25-39.9) Alarmingly High (>40) Data not available Maps produced by Michael Diressie, HarvestPlus Source: Ruel-Bergeron, Julie C., et al. "Global update and trends of hidden hunger, 1995-2011: the hidden hunger index." PloS one 10.12 (2015): e0143497 Data shown are estimated prevalence of low serum retinol (< 0.70 μmol/L), iron-amenable anemia (Hemoglobin (Hb) < 110 g/L), and the prevalence of stunting (height-for-age Z score (HAZ) <-2

3. Motivation: How does international trade alter nutrient availability, and what does that imply for micronutrient strategy? • International trade is often restricted by national governments • Since the 1980s, many governments have removed taxes on farm exports and reduced barriers to food imports (Anderson & Masters, 2008) • Now in the 2010s, a new wave of nationalism has raised trade barriers • Trade policies respond to lobbying and advocacy • Previous work on agricultural trade focuses on food security and income • We ask how trade has affected micronutrient availability, and the implications of trade policy for micronutrient strategy

4. Conceptual framework: A social-ecological approach to global data Here we focus on how national food supplies translate to nutrient availability • Demographic and socio-cultural conditions • Population growth, age structure, urbanization and rural population density • Agroecological conditions and farm production • Land use, irrigation and fertilization, seeds, livestock and other inputs • Food production and trade • Foods available per person per day • Nutrient availability • Macronutrients and micronutrients • Health outcomes • Anthropometry, chronic disease

5. Mechanisms: Trade mediates between production and consumption • The world food system connects supply to demand across countries Quantities produced and consumed in each country depend on opportunities to trade with other countries Importing Self-sufficient (no trade) Exporting Supply Price in trade with other countries Demand Quantity produced Quantity consumed Quantity produced Quantity consumed

6. Methods: How does international trade affect nutrient availability? • Convert FAOSTAT Food Balance Sheets to Nutrient Balance Sheets (NBS) • Balance sheets show national estimates of total quantity produced, plus imports minus exports and non-food uses (including waste), to obtain total availability by country • We use USDA standard reference nutrient composition of each food category, and focus on national totals for inequality between countries; other data would be needed to address inequality within each country • Convert UN population data into nutrient requirements by country • Nutrient requirements per capita depend on demographic structure • We use European Food Safety Authority (EFSA) nutrient needs for each age and sex, with uniform levels of physical activity and anthropometry; other data would be needed to adjust for actual heights and weights or other differences in nutrient needs • Calculate long-term changes (1961 or 1970 to 2011) in nutrient production, trade and availability relative to requirements • Regional inequities are shown with color-coded maps • Compute Gini measure of inequality using global Lorenz curves across countries

7. Before we see results, some limitations: Data shown are all national totals! • Our focus is international trade and the global food system • Much of the world’s malnutrition is within countries • Disparities among households, in food access and affordability • Disparities within households, by gender and age or social status • Differences in requirements due to anthropometry, activity & disease • Data quality for national totals is subject to improvement • Quality and completeness of food balance sheet reporting into FAOSTAT • Differences in degree of household & plate waste • Differences in nutrient composition

8. Results: Farm production is unequally distributed, relative to nutrient needs Agricultural surplus (farm production - requirements, kcal/person/day) 1961 greener = larger surplus 2011 In Africa, more deficits in 2011 than 1961 In many countries more surplus in 2011 than 1961

9. Results: Food availability has become more equally distributed Food surplus (food availability - requirements, kcal/person/day) 1961 greener = larger surplus 2011 Much less insufficiency in 2011 than 1961, even in Africa

10. Results: Trade between countries has helped equalize food access Net food trade (imports - exports, kcal/person/day) 1961 green = imports red = exports 2011 In 2011, more exports from S. America, and more imports into Africa

11. Our question: How has trade between countries altered global inequality in micronutrients, such as vitamin A? Availability minus requirements Production minus requirements 1961 1961 greener = larger surplus 2011 2011

12. We use standard metrics of inequality: Lorenz curves and Gini coefficients Country labels and colors reveal how China rose to having one of the world’s most vitamin A-rich diets Proportion of all the vitamin A in the world If vitamin A were distributed equally, the Lorenz curve would be a diagonal line The Lorenz curve allows us to measure global inequality using a Gini coefficient, defined as area A/(A+B) Color coding shows geographic regions A Thinner, lighter curve is 1970 B Thicker, darker curve is 2010 Proportion of the world’s population, ranked by level of vitamin A per capita

13. Lorenz curves allow comparisons across nutrients Lorenz curves for micronutrient availability, 1961-2011 Proportion of global vitamin B12 Proportion of global vitamin A Vitamin B12 became much more equally distributed Vitamin A had little change in overall inequality Thicker, darker curve is 2010 Thinner, lighter curve is 1970 Proportion of the world’s population Proportion of the world’s population

14. Gini coefficients allow us to compare inequality trends in production and availability Gini coefficients for micronutrient production and availability, 1961-2011 Vitamin A Vitamin B12 Vitamin B12 production and availability both became much more equal since the 1980s, now similar inequality as vit. A Vitamin A production has become more unequal since the 1990s; trade has helped availability be less unequal than production

15. Summary and implications • Results for all nutrients (macro- plus 18 micronutrients) reveal that international trade has helped improve the global distribution of nutrients, with important variation over time and among nutrients • since 1980s, inequality in vitamin B12 has fallen greatly, to now having similar inequality as vitamin A • since 1990s, vitamin A has become more unequal in production and less so in availability • Trade policies could be managed to promote even more improvements in total nutrient availability, to help national food systems improve distribution within countries • Nutrient gaps not filled by international trade require local production, starting with nutrient dense foods, biofortification of staple crops, fortification of processed staples, and also supplementation • National “nutrient balance sheets” can help inform trade policies and micronutrient strategy, based on total availability by country over time

16. Thank you! Contact info: Keith.Lividini@tufts.edu Winnie.Bell@tufts.edu William.Masters@tufts.edu