 So I have been following Pear around physically, intellectually, unfortunately I'm still not able to reach a stature in any respect but it's always a honor but more problematic, a challenge to speak after Pear. But I'll give it a go and believe it or not Pear and I had not discussed our presentations for this meeting. So there's some degree of overlap which either will save me some time or get me distracted along the way when I realize Pear already said it. But so actually I am going to ahead of time summarize my six major points and this is a strategy to cope with the 20 minute time limit because I know when I come to the end I will have not gotten through these six points properly. So at least I'll have said my do right up front. And the six points in the first one I'll make briefly which is that in fact the reduction in malnutrition and other measures of particularly child well-being like infant mortality I think has been one of the unheralded success stories of the past 20 or 30 years. That being said there's really a very long and difficult road ahead in many respects. But the second point which I'll focus a little bit more on is that over the short to medium term and now I'm talking about five to 25 years, not looking at five generations. Nutrition and related health improvements are actually only loosely or will only be loosely related to broader measures of economic development such as income growth, poverty alleviation and food production. And I'll explain that largely through the reality that improvements in nutrition are best achieved through targeted and nutrition sensitive interventions focused on vulnerable groups. In fact I'm looking at the slide that you're not looking at. And particularly vulnerable groups defined as women in their fertile years and children during their first thousand days of life. The fourth major point I will make I will talk a little bit about the role of agriculture and food policies since Pear had already kind of delved into this issue. But I will summarize it this way 50 years ago it looked like a pretty simple and straightforward task for agriculture. Thank you. We had a shortage of food. We needed a green revolution. We figured out how to produce tons of cereals and oil seeds. We met those targets. Nobody's you know there hasn't been massive food shortages and so forth. So when people like Pear and his colleagues went to Rockefeller Foundation and started the CG there seemed to be a clearly set of achievable goals which miraculously I guess to some extent have been achieved or to a lot of people's hard work. But now the situation has gotten far more complicated and complex and I'll talk about kind of these new goals and the changing role of agriculture in this context. Now the fifth point I will talk about briefly Pear alluded to which is that while we are talking about malnutrition and hunger still there's an emerging challenge which is I think excuse the pun grossly underestimated which is the challenge of non-convenable COVID diseases that are related to obesity and overweight. And I'll make the case albeit very briefly that this challenge is going to be far more difficult far more expensive and far more challenging in many respects than the fight against what we consider traditional hunger and malnutrition. And the final point I will make again all of these quite briefly given the time allowed but I want to set in some sense an agenda as per Finns request is that one of the problems and there's only really one session in this large conference about nutrition and that reflects that I think the returns from improvements or interventions that improve nutrition are very substantially underestimated. And I'll explain why again time permitting but they focus on the physical and mental abilities of workers increase productivity and labor supply but there's some good technical reasons while why economists in the international community have underestimated the benefits of these interventions and I'll kind of end with a plea to kind of give nutrition and related health concerns more time more effort and more emphasis. So now going through these six points relatively quickly. So the picture of some information on child stunting now pair show you some information about from FAO estimates about food security progress and so forth. But you can see that there has been a pretty substantial decline over the past 20 years or so in terms of the share of children that are stunted which is arguably the best measure of malnutrition. And that's occurred in all different regions although and likewise a number of children affected has also gone down. So this is good news and certainly the trend is in the right direction but you can see we're still in this day and age some hundred million children under the age of five are still suffering from what we would consider traditional protein energy type of malnutrition manifested in stunting could also be caused by certain micronutrient deficiencies and other factors but we are making substantial progress. This is pretty good but certainly there's a very long way to go. So the question I want to ask though is what do we have to do to get there. So if one looks at this curve it's a pretty simple curve despite all the colors and the dots and the circles on it. This is the prevalence of stunting amongst preschoolers and this is by GDP and you can see that if one looks across countries as one would expect there's a declining curve meaning as countries get wealthier as their GDP per capita grows there's less and less stunting or less and less malnutrition but there's also a couple other things on this curve that are worth noting and I'm not going to go into many of them but one of which is that if you take any given level of GDP there could be a pretty wide variation in terms of levels of stunting from in case somewhere around GDP around three thousand you have levels in Sri Lanka of around I don't know fifteen percent and you have levels in Angola around fifty percent. So there's a pretty wide there's a tremendously wide divergence but of course the thing to consider when you look at this is that you're looking at a correlation at a given point in time between countries and basically the point I'm going to try to make is that this static correlation between interest in nutrition and income that we were looking at is really not very meaningful it's not a very good predictor of the path of an individual country and that what we need to look at is the effects of within country changes in income in GDP over time and how they affect within country changes in nutrition and that's a far more complex graph than the one I just showed you and what we want to know is how directly do improvements in nutrition follow from improvements in income within a country and how are nutrition improvements distributed across the income distribution within a country so that's a lot to take in and I'm gonna just show you one graph to kind of illustrate the point here and I'm gonna have to move on to the next issue but this is a graph of and I'm gonna use the case of Uganda of the growth in income in what we call growth incidence curves many of you have seen these Martin Revalian and his colleagues have been doing them for deck for years this is looks at the difference in log expenditure income and percentiles of the household income distribution and what this graph basically tells you is that across the entire spectrum of the income distribution there's been an increase in income between the years of 1988 and 2011 and that group increase in income is represented by this line please ignore the dotted lines as a standard errors okay and what this graph tells you is everybody's income is increased but the people who are at the top end of the income distribution have seen a much larger increase in their income than the people at the lower end of the income distribution okay this is a source of great concern people who are talking about inequality at this conference this is kind of what they're talking about right now I'm gonna show you the next graph and then I'm gonna try to explain why it looks different than this and again I'm only choosing Uganda I have other countries here and the next graph is something that looks kind of the same but the shape of the curve is completely different so what I'm calling this is a gradient forget that it's a lousy name but I can't think of a better thing the gradient nutrition improvement curve and it's again for Uganda during the exact same time period 1988 1988 to 2011 so we're looking again over a 20 year period so what this is doing is the x-axis is the exact same these are the percentiles of the per capita household expenditure distribution the y-axis is now not changes in income but changes in height okay and their standard eyes for the age and the gender of the kids so this graph basically tells you a very different story that we just looked at even though it's for the same country during the same time period using the same survey data but the outcome variable we're interested in here is basically child nutrition which is the outcome variable on the y-axis what this is telling you is just like with nutrition there's been generally an increase or with income increase in income over a large range of the income distribution but that improvement in it nutrition is concentrated amongst the low income households the exact opposite story that we find for income now the standard errors on the nutrition graphs are much larger and please so it looks a little less clear but I think the direction of the line is clear so I'm going to try to explain why this is the case and we late to that to my earlier point as to why nutrition improvement and income improvement do not necessarily follow from each other you can have one without the other and the nature of the growth and improvement can be very very different okay now I have a whole bunch of different of these graphs and for different countries they all tell the same story that I just told so the question comes back to my second that major message and what we want to know what we basically the empirical observation is that many countries have had a decade of more rapid expansion and income growth including the incomes for the poor but the poor's income rarely grows faster than those of the rich but for a given country nutrition improvement patterns do tend to be very different from the income improvement patterns and are usually far more optimistic so nutrition improvements have taken place in countries that have not witnessed income increases and countries that do best on income may not be doing best in terms of nutrition okay so in some the within countries the income growth patterns across the distribution differ dramatically from the nutrition patterns okay so why is that so the answer is quite simply and I'm gonna it's I'm making it far sound quite quite simple but it's a lot more complicated than I have in 20 minutes message 3 that the progress in achieving nutritional improvement is primarily going to be observed through intervention programs okay and these intervention programs there are and I'm gonna actually kind of I've got five minutes I'm gonna kind of scroll through a few highlight a few things one is that these intervention programs that are gonna work are gonna have to prioritize the nutritional determinants and outcomes not good enough to be a secondary goal so for example agricultural growth increased food production in the agricultural sector even general social welfare programs are not the types of things we're talking about okay so but the specific examples of the types of things that we need to focus on are things like social safety nets that condition transfers on prenatal visits maternal mental health services water and sanitation programs family planning programs focused on young girls and women delaying initial births women's empowerment through ccts schooling and education investments so there is a laundry list but the other aspect or the other element to that and the top of the slide is cut off is I just want to say there's also a large role for agriculture but the nature of that role has changed so there are some examples of very narrowly focused targeted food and agricultural policies like bite of fortification of vitamin a reductions and aflatoxin thought the aflatoxins a range of fortification and supplementary supplementation policies but more important there's an increased role for indirect effects of good policy but these need to focus on new and different types of considerations and what are those new then with the traditional kind of green revolution focus and they really need to focus on raising rural incomes and employment and in that regard as well as just going through this very quickly focus on women who have more limited access to technology inputs extension and output markets and also focus on investments to avoid the effects of negative shocks and environmental degradation so those that agendas clearly is much more ambitious than the original green revolution agenda but it also recognizes that the share of the labor force in agriculture and developing countries will inevitably have to decline and that labor and agriculture will have to shift from small holdings to larger-scale agriculture and this will involve many small holders gradually having to shift into different sectors to increase household incomes so the real challenge that we face in the agriculture sector is how to manage and encourage and promote this transition and again we're a little short on time so we'll save that possibly for the discussion later on okay so of course one of the unintended benefits of their unintended benefits of all sorts of good things of this dramatic increase in food production this dramatic increase in international trade and agricultural goods the transformation of the food system toward a more market oriented economy where the value chain involves much more involvement and integration into kind of international agribusiness is this issue of obesity that pair raised okay so as as I say here there are now really close to two billion adults who are obese or overweight today that number has more than doubled in the past 30 years and I think Pear actually said this that obesity and overweight are linked to more deaths at currently than they are in than the issues of underweight and the proximate causes of this are pretty clear they're increased in intake of energy dense foods that are high in fat increases sedentary lifestyles and kind of the whole modern supermarket food distribution and sales system so and Pear also alluded to this that it's not uncommon to find under nutrition and obesity existing not only in the same countries but in the same communities and in the same households it's not at all unusual to see an obese woman in the same household with a stunted child okay so that was it I didn't get my two minute warning did I I'll so I'll take four okay did I get my two minute warning three okay I've lost 30 seconds on that negotiation all right here we go so what we can see though here is that that obesity story yeah it is concentrated in high-income countries but it even in occurs in countries in the poorest regions of the world and it's increasingly a big problem in lower middle and upper middle income countries so just to take a couple nice examples China if you look at the effects of non-community if you look at the share of non-communicable diseases that it's killing people basically it is really a very small slice of the pie it's less than 15% not not all of the remaining 85% is due to nutrition but a large share of the cardiovascular disease certainly some of the cancers most of the diabetes is due to food related illness so probably you could say certainly around half of greater than half of the deaths in China right now or due alone to obesity and overweight related disease but even in a country like Egypt I'm gonna go again through just look at the red look at the blue as non-communicable diseases which is where nutrition would fit under nutrition you can see even in countries like Nicaragua Vietnam Ghana even Nagana is an example of amongst the poorest countries we could find good data on but you can see in Ghana it's still quite large but already cardiovascular disease and diabetes is somewhere around 20-25% of the causes of death okay Indonesia looks more like China did or Vietnam so the situation is somewhat weak as one looks progressively into the future I didn't show you the graph which I would not have time for that does these projections but the rapid increase in expected deaths from this is even more startling than the current deaths and I've got a laundry list of things to do about it which I'm not going to go through in deference to our chair and Rob who will follow and so I will just take one more minute to focus on my last point which is why are returns from nutrition so underestimated and why are these nutrition related interventions whether they are to reduce hunger or stem the tide of obesity so important and I've got a four major reasons I think maybe that's five and I'm not going to go through the sub story but here it is one is that at least that place is like Cornell we don't I even have economic historians on our faculty anymore we don't look at economic history and there's a very great story in economic history that a large share of the improvement in economic well-being economic well-being throughout Europe and in most countries was a result of improvements in nutrition but the second and third and fourth are more technical points and I just want to make them because most of you are economists and one is that when we look at micro evidence one of the problems is that returns to investment of new something like nutrition interventions must employ a very complicated model that views adult labor outcomes as a cumulative function of investments is that me okay good just great grab back another 30 seconds thanks must view adult labor outcomes as a cumulative function of investments in various periods of an individual life including childhood and schooling and adulthood and our models generally are not have not been up to that test we don't have these long-term types of epidemiological or randomized controlled trials to show how investments early on affect well-being late in life so we generally only look at one period returns as opposed to multiple periods and the other point is that there are multiplicity of pathway pathways by which nutrition improves economic growth and economic productivity and they range from physical and mental abilities higher expected earnings but things that we often don't think about like household and fiscal savings due to lower health care costs or things like greater savings that result from expectation of living a longer life okay and let me I'm going to skip my summary because I've overstayed my welcome but hopefully we'll have a chance to talk about some of these things later on thanks very much