Browsing by Subject "Kosten-Wirksamkeits-Analyse"

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Micronutrient malnutrition and the impact of modern plant breeding on public health in India: How cost-effective is biofortification?
(2006) Stein, Alexander J.; Qaim, Matin
Millions of people worldwide suffer from micronutrient malnutrition or ?hidden hunger?. The related deficiencies can have devastating consequences for the life, health and well-being of the affected individuals, but they may also perpetuate a vicious circle of undernutrition, low economic productivity and poverty. Hence, in many developing countries vitamin and mineral deficiencies are public health problems of primary concern. While economic development and rising incomes can only address undernutrition in the long run, conventional approaches also have weaknesses of their own. Therefore, ?biofortification? may be a promising intervention. The idea is to breed food crops for higher micronutrient content, which can be done through cross-breeding or genetic engineering. Targeting staple crops that fortify themselves has several advantages: the enriched crops simply follow the normal food chain and are eaten by the poor in bigger quantities. Moreover, the underlying germplasm of micronutrient-rich crops only needs to be developed once and can then be used around the world ? and farmers can grow and reproduce biofortified crops year on year and share the micronutrient-dense seeds. Therefore, the initial investments in R&D of biofortification can be followed by a continuous stream of benefits that accumulates over time and space, which suggests that biofortification can be a very cost-effective intervention. However, a more rigorous and comprehensive assessment of biofortification is still outstanding. This book has been written to narrow this knowledge gap and to offer a sound basis for future research and policy decisions regarding biofortification ? covering both, crops that are produced through conventional breeding and genetically modified organisms (GMOs). For this ex ante evaluation of biofortification, an impact assessment of five different crops (iron-rich rice and wheat, zinc-rich rice and wheat and beta-carotene-rich Golden Rice) has been done for India to determine their effectiveness. The main contribution of this study lies in the development of a methodology that reproduces the whole sequence of effects between the cultivation of the micronutrient-rich crops and their ultimate health impacts, taking into account various micronutrient levels in the crops, different rates of adoption and acceptance, and the ensuing improvements in individual nutrition status. To this end in this book the disability-adjusted life years (DALYs) framework has been refined and applied to determine the disaggregate burden of disease of iron deficiency anaemia (IDA), zinc deficiency (ZnD) and vitamin A deficiency (VAD) in India. The assessment of the potential impact of the biofortified crops has been complemented by an economic evaluation, because mere effectiveness is a poor guide to policy making when resources are limited. Therefore, a cost-effectiveness analysis (CEA) and a cost-benefit analysis (CBA) have been carried out for each of the crops to determine their efficiency and their overall social profitability. The attributable costs of the R&D for the crops as well as the costs for related dissemination and extension activities within India have been juxtaposed to the expected health benefits. The resulting cost-effectiveness measure ($/DALY saved) has been compared to alternative micronutrient programmes and to benchmarks of international organisations for assessing public health interventions. By attaching a minimum value to each DALY saved, the benefits of biofortification were translated into monetary terms to calculate a lower bound of the social rates of return of the crops. These economic indicators could then be compared to those of other agricultural technologies. While conventionally bred biofortified crops are less contentious, genetically modified crops (GM crops) and, thus, the transgenic Golden Rice are controversially discussed in the ongoing debate about plant biotechnology. Therefore, related issues are discussed in more depth in special sections of this book, where the validity of common claims about Golden Rice is scrutinized. The study concludes that biofortification has the potential to help control vitamin and mineral deficiencies in a lasting and sustainable way ? even though the commitment and the support of key stakeholders may be necessary to achieve its full impact. The various economic analysis have also shown that biofortification promises to be a very cost-effective, efficient and socially profitable intervention, both if compared to alternative public health measures and if compared to other agricultural innovations. Nevertheless, to control micronutrient deficiencies, the importance of a more comprehensive strategy is underlined; in such a strategy other micronutrient interventions like targeted supplementation, fortification, dietary diversification, nutrition education and poverty reduction may all have a role to play.