Papers by Deborah Johnston
Review of African Political Economy, 2015
Despite biomedical innovation, HIV incidence remains high in some African countries. HIV-related ... more Despite biomedical innovation, HIV incidence remains high in some African countries. HIV-related cash-transfer projects propose a solution. However, the author raises concerns about their success from a political economy perspective. Where structural change is invoked by these projects, it is too narrowly conceived. Some cash-transfer projects focus solely on ‘nudging’ choices about risky sex, without considering the wider set of factors that increase HIV incidence. Consequently, the promise of HIV-related cash transfers is dangerously exaggerated. Instead they obscure the underlying causes of high HIV prevalence, by focusing on individual behaviour and a limited, neoliberal-friendly menu of options.
SRPN: Nutrition (Topic), 2015
Existing reviews on agriculture and nutrition consider limited evidence and focus on impact size,... more Existing reviews on agriculture and nutrition consider limited evidence and focus on impact size, rather than impact pathway. This review overcomes the limitations of previous studies by considering a larger evidence base and exploring time as one of the agriculture-nutrition pathways. Agricultural development plays a role in improving nutrition. However, agricultural practices and interventions determine the amount of time dedicated to agricultural and domestic work. Time spent in agriculture—especially by women—competes with time needed for resting, childcare, and food preparation and can have unintended negative consequences for nutrition.
Diets are changing globally, as agricultural and food systems have become globalised and created ... more Diets are changing globally, as agricultural and food systems have become globalised and created new forms of food production, distribution, and trade. Understanding how patterns of globalisation affect the welfare of populations is a key development question, but we know little about the way that the globalisation of food and agriculture systems affect different individuals or groups. By looking at schoolchildren in Accra, this study explores food security in the context of inequality and dietary change. We use a novel approach based on triangulation of primary data on food consumption and a synthesis of secondary literature on food trade, food policy and urban food environment. Thus, we bridge a divide between micro-level analyses of food consumption and macro-level studies of food systems, and seek to contextualise children’s food consumption patterns in the broad picture of global dietary change. We find that socio-economic status is a critical dimension of food security and foo...
PLOS ONE, 2018
Household air pollution from burning solid fuels is responsible for an estimated 2.9 million prem... more Household air pollution from burning solid fuels is responsible for an estimated 2.9 million premature deaths worldwide each year and 4.5% of global disability-adjusted life years, while cooking and fuel collection pose a considerable time burden, particularly for women and children. Cleaner burning biomass-fuelled cookstoves have the potential to lower exposure to household air pollution as well as reduce fuelwood demand by increasing the combustion efficiency of cooking fires, which may in turn yield ancillary benefits in other domains. The present paper capitalises on opportunities offered by the Cooking and Pneumonia Study (CAPS), the largest randomised trial of biomass-fuelled cookstoves on health outcomes conducted to date, the design of which allows for the evaluation of additional outcomes at scale. This mixed methods study assesses the impact of cookstoves on primary school absenteeism in Karonga district, northern Malawi, in particular by conferring health and time and resource gains on young people aged 5-18. The analysis combines quantitative data from 6168 primary school students with in-depth interviews and focus group discussions carried out among 48 students in the same catchment area in 2016. Negative binomial regression models find no evidence that the cookstoves affected primary school absenteeism overall [IRR 0.92 (0.71-1.18), p = 0.51]. Qualitative analysis suggests that the cookstoves did not sufficiently improve household health to influence school attendance, while the time and resource burdens associated with cooking activities-although reduced in intervention households-were considered to be compatible with school attendance in both trial arms. More research is needed to assess whether the cookstoves influenced educational outcomes not captured by the attendance measure available, such as timely arrival to school or hours spent on homework.
Food Security, 2018
Agricultural input subsidies, a form of social protection, are often considered an important mean... more Agricultural input subsidies, a form of social protection, are often considered an important means of improving agricultural productivity in low-and middle-income countries. However, their effectiveness and efficiency remains contentious with respect to productivity, economic and consumer welfare measures, as well as food and nutrition security. This is exacerbated by a weak evidence base, including no review focused on the impact of agricultural input subsidies on food security and nutrition. Further, where studies have considered nutritional outcomes of agricultural input subsidies interventions, this has often been in regard to changes in consumption of the targeted staple food, measured in terms of calorie consumption or a similar measure of changes in energy availability, ignoring other aspects of malnutrition, including impacts on dietary diversity. This wider consideration of impacts on dietary diversity is important, given the increasing recognition in nutrition policy of the importance of dietary diversity. We address this gap in the literature with a review of the evidence on the impact of agricultural input subsidies programmes on food and nutrition security in low-and middle-income countries, mapping this evidence against a conceptual framework of the mediating pathways. Keywords Agricultural input subsidy • Social protection • Nutrition • Health 2 Methods This project involved the following steps: 2.1 Development of a conceptual framework We adapted the conceptual framework of Dorward et al. (2015), taking into account other relevant frameworks in this area (UNICEF 2010; Kanter et al. 2015), to include key pathways from AISs to nutrition and nutrition-related health. 2.2 Systematic review The systematic review was based on the following inclusion criteria: "All full-text publications, published or grey literature, with English abstracts are included in the study that describe, correlate, quantify or model the impact of agricultural input subsidies on nutrition and/or nutrition-related health in low-and middle-income countries." Given that a systematic search protocol identifying articles related to the impact of specific AISs on a range of outcomes in LMICs had already been undertaken by Dorward et al. (2015), we decided that it would be relevant to our purposes of our review, with the addition of extra search criteria. Thus, we adapted the Dorward et al. (2015) review by restricting the results of their review to publications addressing nutrition and nutrition-related health outcomes. The Dorward team identified relevant studies among both published and unpublished literature, by searching scientific databases (3ie Systematic Review Database; Ageconsearch
Review of African Political Economy, 2015
The political economy of HIV Given all the positivity and self-congratulation over HIV in the int... more The political economy of HIV Given all the positivity and self-congratulation over HIV in the international policy world, it might be hard to remember how many lives have been destroyed and continue to be devastated by this illness. Looking to UNAIDS headlines, we hear of plans for an 'AIDS-free generation in Africa', 'ending the epidemic by 2030' and 'eliminating stigma and discrimination'. In this case, the boldness of the goals is partly driven by what Michel Sidibé, Executive Director of UNAIDS, called 'game-changers' in his World AIDS Day message in 2011. Biomedical revolutions seem to have radically altered the environment for HIV transmission: antiretrovirals (ARVs) and drugs to reduce mother-to-child transmission promise to cut HIV transmission rates, as does male medical circumcision. Of course, the hopeful messages of UNAIDS are tempered with warnings about expenditure shortfalls and calls for funding. With austerity as the watchword in the world's wealthy countries, the problem of gaining sufficient pledges, and then turning those pledges into money, is harder than ever. In this special issue, the debate piece by Alan Whiteside throws the question of funding into sharp relief. To what extent is the end to HIV in sight, when the costs of providing ARVs under the present approach are potentially 'crippling' for high-prevalence countries? Whiteside questions the HIV-free narrative, highlighting the 'treatment tension' that exists as the absolute number of those living with HIV rises and ARVs continue to be costly. Two of the debate pieces in this issue, by Whiteside and by Sophie Harman, remind us that, along with the external money that has been central to the HIV response, there have been new fractures in state power and in the organisation of health systems. Harman argues that the positive progress narrative on HIV overlooks several limitations to the global response. Funding is a major issue given the cost of treatment, HIV continues to be transmitted, and stigma persists. At the same time, the governance of HIV/AIDS has seen competition among international institutions, an expansion of the market into health care and the co-option of many civil society organisations. More specifically, Harman argues that health systems have been fragmented, distorted and an extra layer of bureaucracy added. More than this, the contributions to this special issue fundamentally call into question the biomedical approach. The problem is even more serious than one of a crisis of funding and a fracture of the state and the health service. While biomedical interventions promise to change HIV transmission, there are doubts about whether they will be able to affect 'the social roots of this disease' (Hunter 2010, 225). A clear reading of international public health history, from malaria to measles, shows us that technical fixes to health problems tend to leave the social and economic determinants of health, and the relationships that underpin them, untouched. For this reason, technical fixes can be far less successful than public health policy makers predict-even disastrous for the population they intend to help.
Food and nutrition bulletin, 2013
Concern about food security and its effect on persistent undernutrition has increased interest in... more Concern about food security and its effect on persistent undernutrition has increased interest in how agriculture could be used to improve nutritional outcomes in developing countries. Yet the evidence base for the impact of agricultural interventions targeted at improved nutrition is currently poor. To map the extent and nature of current and planned research on agriculture for improved nutrition in order to identify gaps where more research might be useful. The research, which was conducted from April to August 2012, involved developing a conceptual framework linking agriculture and nutrition, identifying relevant research projects and programs, devising and populating a "template" with details of the research projects in relation to the conceptual framework, classifying the projects, and conducting a gap analysis. The study identified a large number of research projects covering a broad range of themes and topics. There was a strong geographic focus on sub-Saharan Afric...
Review of African Political Economy, 2015
Neoliberalism is the dominant ideology shaping our world today. It dictates the policies of gover... more Neoliberalism is the dominant ideology shaping our world today. It dictates the policies of governments, and shapes the actions of key institutions such as the WTO, IMF, World Bank and European Central Bank. Its political and economic implications can hardly be overstated. Yet there are obvious problems with the neoliberal project. This book is a perfect introduction to neoliberalism that is ideal for anyone seeking a critical perspective. It explains the nature, history, strengths, weaknesses and implications of neoliberalism from the point of view of radical political economics. Short, self-contained chapters are written by leading experts in each field. The books is organised in three parts: the first section outlining neoliberal theory, the second exploring how neoliberalism has affected various policy areas, and a third looking at how neoliberal policies have played out in particular regions of the world. Using a broad range of left economic perspectives, from post-Keynesian to...
Malaria control and sustainable development are linked, but implementation of 'multisectoral&... more Malaria control and sustainable development are linked, but implementation of 'multisectoral' intervention is restricted by a limited understanding of the causal pathways between poverty and malaria. We investigated the relationships between socioeconomic position (SEP), potential determinants of SEP, and malaria in Nagongera, rural Uganda. Socioeconomic information was collected for 318 children aged six months to 10 years living in 100 households, who were followed for up to 36 months. Mosquito density was recorded using monthly light trap collections. Parasite prevalence was measured routinely every three months and malaria incidence determined by passive case detection. First, we evaluated the association between success in smallholder agriculture (the primary livelihood source) and SEP. Second, we explored socioeconomic risk factors for human biting rate (HBR), parasite prevalence and incidence of clinical malaria, and spatial clustering of socioeconomic variables. Thir...
There is a resurgence of interest in time use research driven, inter alia, by the desire to under... more There is a resurgence of interest in time use research driven, inter alia, by the desire to understand if development interventions lead to time constraints for participants, especially when targeted to women, by increasing their work burdens. This has become a primary concern in agriculture-nutrition research. But are time use data useful to explore agriculture-nutrition pathways? We develop a conceptual framework of the micro-level linkages between agriculture, gendered time use and nutrition and analyse how time use has been conceptualised, operationalised, and interpreted in agriculture-nutrition literature on low- and middle-income countries. We argue that better metrics, but also conceptualisations and analytics of time use are needed to understand gendered trade-offs in agriculture-nutrition pathways. In particular, the potential unintended consequences can be grasped only if the analysis of time use shifts from being descriptive to a more theoretical and analytical understan...
The main authors of this report are Christopher Cramer, Deborah Johnston, Carlos Oya and John Sen... more The main authors of this report are Christopher Cramer, Deborah Johnston, Carlos Oya and John Sender. The main research team was supported by a research officer, Bernd Mueller. Research supervisors in Ethiopia were: Reta Belda Hailu, Haileyesus Andualem, Adisalem Mesfin, Muluken Elias, and Tewodros Worku. In Uganda the research benefited greatly from the work of Bbosa Samuel; Turinawe Benoni Emmanuel also worked as a research supervisor.
The Oxford Handbook of the Ethiopian Economy
Ethiopia has an integrated approach to addressing nutrition. However, greater clarity is needed o... more Ethiopia has an integrated approach to addressing nutrition. However, greater clarity is needed on the wider impact of policy on food and nutrition. We focus on the interrelationship between economic policy and nutrition policy (defined as including all food- and nutrition-relevant policy). While Ethiopia’s policy has had notable successes, particularly with addressing stunting, two key challenges remain. First, some indicators such as wasting and anaemia in children under five have shown far less improvement. Second, the bottom quintile of children has seen far more limited general improvement than the population as a whole. We argue that the focus of government policy needs to shift from food availability to broader issues of food acquisition and particularly food affordability, which is mediated through food prices and waged employment. Of particular concern is the rising price of animal-source products and other non-staple foods, which may be related to the challenges of address...
Social Indicators Research
This paper takes as its starting point the analytical distinction between a ‘difference-making’ a... more This paper takes as its starting point the analytical distinction between a ‘difference-making’ approach and a ‘production approach’ to poverty, both of which relate to the causes of poverty and how it is measured. Although asset indices have been criticized for merely addressing correlates of poverty, we maintain that it can in fact provide an understanding of households’ conditions of reproduction and in turn, reflect upon relational aspects of poverty. We draw on household surveys in two selected villages in Bangladesh and use an asset index as a proxy for overall level of welfare. The asset scores were able to distinguish across sharecropper households but could not distinguish across landholdings, except in one site. Moreover, the asset scores show how migration can have transformative effects on welfare outcomes and at the same time constitute a fragile and uneven process that does not reap benefits to all. We demonstrate how the asset index, albeit an imperfect measure, when carefully constructed, can in fact shed light on the structural causes of poverty.
Cambridge Journal of Economics
With malnutrition recognised as a key public health issue, attention has been placed on how indiv... more With malnutrition recognised as a key public health issue, attention has been placed on how individuals can make better decisions to attain food and nutrition security. Nevertheless, food practice entails a complex set of decisions that are not fully understood. This paper interrogates the focus on food choice by investigating how socio-economic relations shape practices of food provisioning. Given the surge of behavioural approaches in development economics and our focus on a middle-income country, we contextualise food choice in the transformations of the conceptualisations of decision-making in development economics. We draw on mixed-method evidence on food consumption practices among schoolchildren in Accra, Ghana. We find that the food decision-making process is complex in that it entails multiple moments and people, and embodies contradictory motivations. Decisions are negotiated outcomes reflecting social relations of power among the actors involved. Socio-economic inequality...
Campbell Systematic Reviews
The protocol was developed by Carlos Oya (CO) and Florian Schaefer (FS) with inputs from Deborah ... more The protocol was developed by Carlos Oya (CO) and Florian Schaefer (FS) with inputs from Deborah Johnston (DJ), Dafni Skalidou (DS), Evans Muchiri (EM), Claire Stansfield (CS) and Kelly Dickson (KD). CO is the lead principal investigator and DJ is co-PI. DS, EM and FS will conduct the information retrieval, with the help of research assistants. CS will provide expert advice on information retrieval and the process will be coordinated by DS. KD and relevant staff at EPPI-Centre will provide capacity building on relevant software. Screening decisions will be made by DS, EM and FS with oversight from CO and DJ, who will resolve any conflicts. Initial screening for relevance will also be undertaken by research assistants. Qualitative study coding will be undertaken by DS, EM and FS with help from research assistants and inputs from CO and DJ. Critical appraisal will be undertaken by DS, EM and FS, and cross-checked by CO and DJ. EM and FS will calculate effect sizes, with inputs from CO. CO and DJ will lead on final report writing, and will provide oversight and leadership throughout. POTENTIAL CONFLICTS OF INTEREST Carlos Oya and Deborah Johnston were investigators in a DFID-funded research project which, among other aims, assessed the effects of Fairtrade certification on wages and work conditions of workers employed by a range of agricultural producers, including smallholder farmers, as the first study that collected data on wage workers employed by smallholder members of Fairtrade-certified
The Journal of Development Studies
Diets are changing globally, as agricultural and food systems have become globalised. Understandi... more Diets are changing globally, as agricultural and food systems have become globalised. Understanding how patterns of globalisation affect welfare is a key development question, but we know little about the way that the globalisation of food systems impacts different groups. This study explores food security and consumption among schoolchildren in Accra. We use a novel approach based on triangulation of primary data on food consumption and a synthesis of secondary literature on food trade, policy and urban food environment. Thus, we bridge a divide between micro-level analyses of food consumption and macro-level studies of food systems. We find that socioeconomic status is a critical dimension, with poorer children more vulnerable to food insecurity and narrow dietary diversity. However, the consumption of packaged and processed foods, often sugar-rich and nutrient-poor, cuts across wealth groups. We argue that the urban food question today is defined by two intersecting phenomena: inequality and dietary change. The urban poor continue to face the fundamental challenge of adequate food access amidst a food environment that provides consumers with unhealthy and cheap food options. Therefore, food policy needs to regulate imports of cheap, unhealthy and enticing food.
Global Challenges
and inadequate diets and repeated and chronic infections affects millions of households, particul... more and inadequate diets and repeated and chronic infections affects millions of households, particularly in low-and middle-income countries. In the same countries burdened by high rates of undernutrition there has also been a rapid growth in diets composed of inexpensive refined flours, fats, salt, and sugar, contributing to an epidemic of overweight, obesity, and associated diseases such as diabetes and cardiovascular disease. Across both rural and urban communities, many diets are also lacking essential micronutrients for health and development. Historically, action in the health sector to reduce undernutrition has involved "nutrition-specific" interventions such as education to encourage breast feeding and food supplements for infants. In 2013, the Maternal and Child Nutrition Series in the Lancet [2] estimated that a set of these actions, if fully implemented in regions with undernutrition, would reduce undernutrition by not more than 25%. In recent years, to address the remaining burden of undernutrition, attention has therefore turned to other forms of intervention, such as "nutrition-sensitive" actions to improve livelihoods and changes in agriculture and food systems to improve diets and food safety. Agriculture and food systems have also come under increasing scrutiny as causes of food-borne diseases, particularly in low-and middle-income countries. [3] Many low-and middle-income countries have seen dramatic improvement in the production of agricultural staples over recent decades, particularly cereals, driven by policies directed at national economic growth and food security. Many in the agriculture sector assumed that producing more staple foods would mean less hunger and improved nutrition and health. However, the evidence for such improvement arising from agricultural development is limited-even for agricultural interventions intended to improve nutrition. [4,5] This lack of evidence has generated intense interest today in understanding the processes by which agricultural and food system change affects the composition, quality, and safety of diets, and how this can in turn improve nutrition and reduce disease associated with poor diets and unsafe food. The multiple burdens of persistent undernutrition and micronutrient deficiencies, along with the rapidly growing rates of overweight, obesity, and associated chronic diseases, are major challenges globally. The role of agriculture and the food system in meeting these challenges is very poorly understood. Achieving food security and addressing malnutrition in all its forms, a Sustainable Development Goal, requires an understanding of how changing food systems affect health outcomes and the development of new tools to design and evaluate interventions. An interinstitutional programme to address this interdisciplinary research challenge is described. Over the past seven years, the Leverhulme Centre for Integrative Research on Agriculture and Health has built a portfolio of successful and innovative research, trained a new cadre of interdisciplinary researchers in "Agri-Health," and built an international research community with a particular focus on strengthening research capacity in low-and middle-income countries. The evolution of this programme is described, and key factors contributing to its success are discussed that may be of general value in designing interdisciplinary research programmes directed at supporting global development goals.
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Papers by Deborah Johnston