The links and feedback loops among agriculture, nutrition, and health (ANH) in low- and middle-income countries (MCs) are clearly hypothesized, and the empirical evidence describing, analyzing, and clarifying these links is growing by the day.1,2 Engagement in agriculture can affect nutrition and health directly, for instance through the production of diverse foods for consumption3 or exposure to harmful chemicals.4 Engagement in agriculture or food systems can generate income that may be spent on goods to enhance (or undermine) nutrition or health,5 and agricultural growth can be a source of poverty reduction more generally in some contexts.6 Agriculture and food systems set the relative prices of different foods, shaping affordability of different foods7 as well as the broader food environment that affects desirability and quality of foods.8 Each of these pathways is mediated by personal characteristics such as gender,9 which can shape issues such as engagement in agriculture or Indra household allocation of nutrition and health goods.10
The United Nations Sustainable Development Goals contain targets to improve aspects of each of these issues in developing countries, and provide a roadmap that places emphasis on “leaving no one behind” in the rush for development. Leaving no one behind implies a focus on equal outcomes but also equitable processes and avoiding structural flaws that leave out certain groups in achieving development indicators.11 What is seen in practice, however, is marginalization and structural inequities shaping unequal outcomes and limiting global progress on the goals.12 There is therefore a need to understand how issues of inequity and inequality are shaping progress on agriculture for nutrition and health in these countries.
Equity is not a new concern for social research or international development: The World Bank in 2006 focused its annual report on equity and development,13 and organizations and individuals working on human rights, justice, and inclusion have long focused on the reasons why certain groups have poorer outcomes. The concept of equity, however, is contested, with multiple different interpretations in different fields: The World Bank report defines equity simply as fairness at different levels, with economic definitions focusing on issues of distribution and equality of opportunity.13 A relatively recent review of the idea in international development policy and practice has described equity as comprising “equal life chances, equal concern for people’s needs, and meritocracy,” with inequity usually grounded in power imbalances leading to social and political exclusion.14 In sociology, the idea of inequity emerged from work to understand changing societies in rapidly industrializing Western countries in the last century, looking at the social and political structures that create differences in both opportunities and outcomes for different social groups.15 Underpinning philosophical understandings of equity are a range of traditions, from work on entitlements and capabilities,16,17 to social justice,18,19 to anti-capitalist Marxist20 approaches. Definitions generally agree on inequity being grounded in issues of power shaping structural causes of inequality, and equity requiring an inclusive process, even if they disagree on whether it is people’s needs or rights that should be upheld.21
Equity by some definition is therefore fundamental to understanding how different nutrition and health outcomes are shaped in the fields of food and agriculture in MCs, a particular sub discipline of international development research. Agriculture for nutrition and health (ANH) research has included research on issues such as gender disparities and relative poverty in assessing how engagement in agriculture affects nutrition and health outcomes, for instance.22,23 There has also been work on how differential access to agricultural assets shapes opportunity24 and how ANH interventions try to change gender norms at more fundamental levels.25 Being aware of this snapshot of equity-focused work in the ANH field, we were keen to explore the totality of this body of work, to understand different approaches that have been used over time to understand how equity affects nutrition and health through agriculture, and how that might inform an ANH research agenda going forward.
Authors of previous reviews have looked at single aspects of equity such as gender in ANH research26 and how inequities shape nutrition outcomes outside of agriculture,27 but none that we are aware of has looked at the broad issue of how equity is addressed across ANH research. Our aim, therefore, was to take stock of how ANH research is addressing issues of inequity and inequality in MCs in order to pinpoint gaps in knowledge that might be limiting action to leave no one behind in these important areas of social and economic development. The broad question driving the study was: How does ANH research address equity issues in MCs? Within this, we also wanted to understand how different disciplines understand and research equity in ANH, and how a focus on equity has changed over time.
Ours is a broad research question and therefore lends itself to the process of a scoping review, an approach to reviewing academic literature in which the topic is broad rather than defined, and in which a range of different research types might be relevant and available.28 Scoping reviews are a relatively rapid form of review, aiming to systematically gather and map the key concepts and sources underpinning an area of research and to identify knowledge gaps that researchers might choose to address in future work, but not necessarily to assess the quality of the canon of research or to draw further inference from it.29 In this article, we describe the findings of a scoping review of the treatment of equity in ANH research in MCs.
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