Policy and Practice

Policy and Practice The links between agriculture and health: an intersectoral opportunity to improve the health and livelihoods of the poor Corinna Hawkes a & Marie Ruel a Abstract Agriculture and health are linked in many ways. First, agriculture is essential for good health: it produces the world’s food, fibre and materials for shelter; in many countries it is also an important source of livelihood among the poor. At the same time, agriculture can be linked with poor health, including malnutrition, malaria, foodborne illnesses, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), livestock-related diseases, chronic diseases and occupational ill-health. Health also affects agriculture: people’s health status influences the demand for agricultural outputs, and in agricultural communities, poor health reduces work performance, reducing income and productivity and perpetuating a downward spiral into ill-health. This paper presents an overview of the bidirectional links between agriculture and health with a focus on the developing world. It develops a conceptual framework that brings together the various links between agriculture and health into a single broad framework. The framework comprises the core components of the agricultural supply chain (producers, systems and outputs), key health concerns and the mechanisms of common interaction between the agricultural and health components: income, labour, environment and access — all key social determinants of health. These links between agriculture and health present an opportunity for the two sectors to work together to find solutions to each other’s problems. Yet the health and agricultural sectors remain poorly coordinated. Leadership from global health and agricultural institutions is needed to build policies and good governance to facilitate integration, while capacity building is needed at all levels to help translate the conceptual links into comprehensive action on the ground. Health and agricultural researchers likewise need to work more closely together to achieve common goals. Bulletin of the World Health Organization 2006;84:985-991 ميكن اﻻطﻻع عىل امللخص بالعربية يف صفحة Voir page 989 le résumé en français. En la página 989 figura un resumen en español. .990 Introduction: identifying the same time, agriculture can lead to The links between agriculture and 3 critical links between poor health. As pointed out over 15 health are thereby bidirectional: agricule years ago by Lipton & De Kadt in their ture influences health and health influee agriculture and health review of links between agriculture and ences agriculture. This bidirectionality It is well established that population health, agriculture is linked to the main offers an incentive for the two sectors to health is strongly influenced by sociee causes of death and disease — malnue work together — to orient agricultural ety and the environment. Social and trition, infectious diseases and chronic systems to benefit health, and health 4 environmental determinants of health diseases. systems to benefit agriculture. include income, employment, access to Examining health in an agricultural The recognition of the importance food and social capital, and exposure to context is therefore important because of intersectoral work to health is not agriculture presents not only opportunie new.5 It was articulated recently by the agents in air, water and soil.1,2 Although ties for improving health but also risks Bangkok Charter for Health Promotion. these determinants have been much to health. It is equally important because “An integrated policy approach,” it states, studied, one important aspect of society health affects agriculture. In agricultural is “essential if progress is to be made in and environment has as yet been inadee communities, poor health reduces ine addressing the determinants of health.” 6 equately addressed: agriculture. come and productivity, further decrease In agriculture, the emergence of joint Agriculture is essential for good ing people’s ability to address poor health animal and human health concerns health — it produces the world’s food, and inhibiting economic development such as avian influenza, and epidemics fibre, and materials for shelter, and can more broadly, while in the population at among agricultural communities such produce medicinal plants; it is also an large, malnutrition and disease patterns as that of human immunodeficiency important source of livelihood for many influence market demand for agricule virus/acquired immunodeficiency syne of the poor in developing countries. At tural products. drome (HIV/AIDS), have heightened a International Food Policy Research Institute, 2033 K Street NW, Washington, DC 2006, USA. Correspondence to Dr Hawkes (email: [email protected]). Ref. No. 05-025650 (Submitted: 1 August 2005 – Final revised version received: 18 June 2006 – Accepted: 19 June 2006) 984 Bulletin of the World Health Organization | December 2006, 84 (12) Policy and Practice Corinna Hawkes et al. Links between agriculture and health the need for integrated action with the Direct) for publications from 1980 one But by considering the different types health sector. wards, limited to those in English. The of literature together, it becomes clear Yet despite this opportunity and initial search terms were “agriculture” that the entire agricultural supply chain some awareness, the health and agricule and “health” later refined by searching has implications for health: agricultural tural sectors remain poorly coordinated: for particular health conditions and producers (i.e. both farmers and agricule health considerations play little part in agricultural practices. tural workers) are particularly vulnerable the decisions farmers make about proe to malnutrition and disease because they duction or those that agricultural mine Key health conditions: often have limited resources; agricultural istries make about policy, and likewise significance to global public systems influence human health through agricultural policies have a limited role health interactions with the environment which in the health sector.4 There are reasons The first step in the development of the affect agricultural outputs; and agricule for this disjuncture, some resulting from framework was to identify the key health tural outputs — food, fibre, materials lack of awareness, others from distinct conditions and risks, diseases and groups for shelter and some medicinal plants policy conflicts. But whatever the chale of diseases, associated with agriculture. — are essential for human health but lenges, these divisions are undermining In the currently available literature, the also present risks. Producers, systems and efforts to overcome illehealth among following health problems — all of which outputs also represent potential points of impoverished communities, and giving affect the poor in developing countries intervention to achieve greater synergies short shrift to agriculture’s role in allee — were identified as being linked in with health. viating many of the world’s most serious some way with agriculture: malnutrie health problems. tion, watereassociated vectoreborne disee Key intermediary processes: The objective of this paper is to eases, foodborne illnesses, HIV/AIDS, the social and environmental highlight the potential advantages of livestockerelated illnesses (zoonoses), determinants of health closer interaction between the health and chronic diseases and particular occupae The final step in the development of the agricultural sectors by presenting a cone tional health risks. (It is likely that other framework was to identify the common ceptual framework of agriculture–health health conditions are also linked with processes mediating the relationships links, and illustrating how these links agriculture, but they have not yet been between the agricultural supply chain operate in specific settings in the devele explored in the published literature.) and the different health conditions. oping world. The framework thus specifies and unites From the literature, it emerged that four an array of key global health concerns, interlinked social and environmental The conceptual framework: which interact when present in the same determinants of health are critical: ine how is agriculture linked context. come (amount, type, stability, distribue tion and control of), labour (amount with health? Key agricultural components: available, type, location, energy and The conceptual framework (Fig. 1) was the supply chain time expended), access to food, water, developed following a review of the The second step was to look at how age land and healtherelated services (e.g. scientific literature on agriculture and riculture is associated with these health medicines, bednets and hospitals) and health, including existing models with conditions. Scientific studies tend to environmental changes in water, air agriculture–health components, such focus on one part of the agricultural and soil. The role of the intermediary as the ecohealth approach.2,4,7–16 The supply chain (e.g. agricultural producers processes, together with the rationale search was undertaken in three databases and occupational health risks; agricule behind the identification of the health (PubMed, ISI Web of Science and CAB tural outputs and foodborne disease). conditions, is elaborated on in the next Fig. 1. Conceptual framework of the links between agriculture and health ��

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