In Kenya, 11 million people suffer from malnourishment. Twenty percent of children younger than five are underweight, and nearly one in three are below normal height. In a typical day, the average Kenyan consumes barely half as many calories as the average American.

But Kenya – and other underfed countries throughout Sub-Saharan Africa – have more than enough land to grow the food needed for their hungry populations.

The juxtaposition of food deprivation and land abundance boils down to a failure of national agriculture policies, says Thom Jayne, professor of international development at Michigan State University. Governments haven’t helped small farmers acquire rights to uncultivated land or use the land they own more productively, he said.

Speaking earlier this month at a symposium organized by the Center on Food Security and the Environment, Jayne said lifting African farmers out of poverty will require a new development approach.

The focus, he said, should be on increasing smallholder output and putting idle land to work in the hands of the rural poor.

Much of Sub-Saharan Africa’s fertile land, Jayne explained, falls under the ownership of state governments or wealthy investors who leave large tracts of land unplanted.

Meanwhile, population density in many rural areas exceeds the estimated carrying capacity for rainfed agriculture – approximately 500 persons per square kilometer, according to the U.N. Food and Agriculture Organization. Above this density threshold, farm sizes become so small, farming becomes economically unsustainable.

“As farm size shrinks, it’s increasingly difficult to produce a surplus,” Jayne said. “As it’s difficult to produce a surplus, it becomes difficult to finance investments in fertilizer and other inputs that could help you intensify.”

Agricultural development policies, Jayne said, have exacerbated these problems. One Zambian fertilizer subsidy program, for example, delivered support payments to over 50 percent of farms greater than five hectares in size – but only reached 14 percent of farmers whose holdings measured one hectare or smaller.

“This was a poverty reduction program that was targeted to large farms,” Jayne said. “Where’re the allocations to R&D appropriate to one hectare farms, tsetse fly control, vet services, all the things that are going to make that one hectare farm more productive?”

He stressed that investments in small farms could reduce poverty.

“Fifty to seventy percent of the population in these countries is engaged in agriculture,” he said. “There aren’t very many levers to reduce poverty and get growth processes going except to focus on the activities that that fifty to seventy percent are primarily engaged in.”

Smallholder-based growth strategies delivered stunning results in Green Revolution-era India – while large-farm strategies in Latin American countries have largely failed to alleviate rural poverty, he said.

Symposium commentator Byerlee, a rural policy expert and former lead economist for the World Bank, agreed with Jayne. In particular, Byerlee expressed skepticism about the benefit of large land investments by foreign agricultural interests.

“The social impacts aren’t going to be very much,” he said of the large-scale mechanized farming operations favored by foreign investors.

“They don’t create many jobs,” he said. “That’s really what we should be focusing on in terms of poverty reduction – job creation.”

Byerlee also stressed the need to formalize Sub-Saharan Africa’s land tenure systems. Currently, he said, about eighty percent of Africa’s land is titled informally under “customary” rights.

“When you have this population pressure, and on top of that you have commercial pressures coming in from investors, this system is just not going to stand up,” he said. “If you had better functioning land markets, it could reduce the transaction costs for investors, allow smallholders to access land, and provide an exit strategy for people at the bottom end.”

Jayne suggested reforms and new policies should include mechanisms to help small farmers gain access to unused fertile land. He called for comprehensive audits of land resources in Sub-Saharan African nations, a tax on uncultivated arable acreage, and a transparent public auction to distribute idle state lands to small farmers.

Additionally, he said, governments can help by improving infrastructure in remote rural areas and clearing fertile land of pests – such as tsetse flies – that threaten crops and human health.

But whatever particular policies they choose to pursue, Jayne said, African governments cannot afford to ignore the problems associated with inequitable land distribution and low smallholder agricultural productivity and. Failure to implement broad-based, smallholder-focused growth strategies will result in “major missed opportunities to reduce poverty in Sub-Saharan Africa,” he said.

This was the seventh talk in FSE's Global Food Policy and Food Security Symposium Series.

As incomes rise around the world, health experts expect a more troubling figure to increase as well: the number of diabetics in developing countries.

In China and India – two of the world’s most populous nations with fast-paced economies – the prevalence of diabetes is expected to double by 2025. Between 15 and 20 percent of their adult population will develop the disease as household budgets increase, diets change to include more calories and new health problems emerge.

But China, India and other developing countries are not fully prepared to deal with the rising trend of diabetes. And a growing number of diabetics aren’t getting the care they need to prevent serious complications, Stanford researchers say.

Even with insurance, many diabetics don’t have essential medications that could help them manage their conditions. In many cases, people are spending a great deal of their household incomes to pay for their treatment, said Jeremy Goldhaber-Fiebert, an assistant professor of medicine who led the research team.

“Public and private health insurance programs aren’t providing sufficient protection for diabetics in many developing countries,” said Goldhaber-Fiebert, a faculty member at Stanford Health Policy at the university’s Freeman Spogli Institute for International Studies. “People with insurance aren’t doing markedly better than those who don’t have it. Health insurance and health systems need to be re-oriented to better address chronic diseases like diabetes.”

Findings from the study are online and will be published in the Jan. 24 edition of Diabetes Care, the journal of the American Diabetes Association. The journal article was co-authored by Jay Bhattacharya, an associate professor of medicine and Stanford Health Policy faculty member; and Crystal Smith-Spangler, an instructor at Stanford’s Department of Medicine and an investigator at the Palo Alto VA Health Care System.

Failure to adequately manage diabetes will lead to more severe health problems like blindness, heart disease and kidney failure. It also harms the otherwise healthy, Goldhaber-Fiebert said.

Diabetes often strikes people at an age when they’re taking care of children and elderly parents. To sideline these primary caretakers as dependants will lead to a heavy burden for communities and create an obstacle for economic growth, he added.

Using responses to a global survey conducted by the World Health Organization in 2002 and 2003, Goldhaber-Fiebert and his colleagues examined data from 35 low- and middle-income countries in Asia, Latin America, Africa and Eastern Europe to determine whether diabetics with insurance were more likely to have medication than those without insurance.

They also wanted to know whether insured diabetics have a lower risk of “catastrophic medical spending,” a term the researchers define as spending more than 25 percent of a household income on medical care.

“Surprisingly, diabetics with insurance were no more likely to have the medications they need than uninsured diabetics,” Goldhaber-Fiebert said. “They were also no less likely to suffer catastrophic medical spending.”

There are many reasons why health insurance may not protect diabetics in developing countries against high out-of-pocket spending. In some cases, there’s a lack of sufficient medication – such as insulin – that regulate glucose levels. Without those drugs, there’s a greater risk of complications that often lead to more hospitalizations and more expenses.

In other cases, co-payments and deductibles are too high. Sometimes, drugs and medical services to prevent diabetes complications are not covered. And doctors and hospitals don’t always accept insurance.

“Better policies are needed to provide sufficient protection and care for diabetics in the developing world,” Goldhaber-Fiebert said.

Without medications to manage diabetes and prevent secondary complications, the condition will worsen and the burden of catastrophic spending will increase, he said.

“It’s important to get ahead of the curve and prepare so there’s an infrastructure in place to deal with these health and cost issues,” he said.

While preventing diabetes in the first place would be ideal, programs and policies must be established to care for the many cases that will surely continue to exist.

“There isn’t a single country that’s managed to entirely arrest or reverse the trend of diabetes,” he said. “Programs that focus on primary prevention are extremely important, but the reality is that the developing world faces hundreds of millions of diabetes cases that are unlikely to all be prevented.”

Michael A. McFaul, a Stanford political science professor and senior fellow at the university’s Freeman Spogli Institute for International Studies, was confirmed by the Senate to be the next ambassador to Russia. 

McFaul, President Barack Obama’s top advisor on Russia and a Bing Senior Fellow at Stanford’s Hoover Institution, will succeed John Beyrle.

"Mike will bring to his new posting in Moscow the same intensity, clarity of vision and imagination that he demonstrated as President Obama's point person on Russia at the White House," said Coit D. Blacker, FSI’s director and the Olivier Nomellini Professor in International Studies. 

The Dec. 17 voice vote confirming McFaul came on the last day the Senate was in session before its winter break. Sen. Mark Kirk, R-Ill., had held up McFaul's approval over issues with U.S. policies toward Russia.

During confirmation hearings before the Senate Foreign Relations Committee in October, McFaul discussed the overall status of U.S.-Russian relations, missile defense, arms reduction agreements and trade relations.

Since the beginning of the Obama administration, McFaul has been the special assistant to the president for national security affairs and senior director for Russia and Eurasia at the National Security Council.

He served as senior adviser on Russia and Eurasia to Obama during the presidential campaign and continued to advise on foreign policy issues during the transition.

The Obama administration has achieved new momentum in relations with Russia with McFaul's involvement.

The two countries have signed the New Start arms control treaty, which calls for significant cuts in nuclear arsenals; finalized a civilian nuclear cooperation pact; forged agreement on tougher sanctions on Iran; and expanded the supply route to Afghanistan through the territory of the former Soviet Union.

The two powers now turn to the efforts to forge cooperation on missile defense in Europe and to gain Russia's admission to the World Trade Organization, as well as the challenges posed by Iran and Libya.

"This is a complex and sensitive time in the ever-evolving relationship between the United States and the Russian Federation," Blacker said. "Having an ambassador in place who gets the relationship has never been more important. For this reason above all others, Mike is the perfect choice. We are all deeply proud of Mike and all that he has accomplished."

McFaul, who has served as FSI’s deputy director and director of the institute’s Center on Democracy, Development, and the Rule of Law, received a bachelor’s degree in international relations and Slavic languages and an master’s in Slavic and East European studies from Stanford in 1986. He was awarded a Rhodes Scholarship to Oxford, where he completed his PhD in international relations in 1991.