The Association for Nutrition welcomes this opportunity to comment on the first draft of the ‘WHO/FAO Work Programme of the UN Decade of Action on Nutrition, 2016-2025’.
Q1. Does the work programme present a compelling vision for enabling strategic interaction and mutual support across existing initiatives, platforms, forums and programmes, given the stipulation of Res 70/259 that the Decade should be organized with existing institutions and available resources?
The collective vision of ‘a world where all people at all times and at all stages of life have access to affordable, diversified, safe and healthy diets’ is compelling and fully supported by the Association for Nutrition. This draft work programme presents the rightly aspirational aim of the Nutrition Decade providing a clearly-defined time-bound operational framework that utilises and works with existing structures and available resources. We support the acknowledgement of the need for open, inclusive, accountable and transparent activities; communication at all levels is essential for the successful implementation of actions to achieve the commitments made at ICN2, in the 2025 Global Nutrition and diet-related NCD targets and in the 2030 Agenda for Sustainable Development.
Q2.What are your general comments to help strengthen the presented elements of the first draft work programme of the UN Decade of Action on Nutrition?
We fully support the guiding principle that the Nutrition Decade will be fully inclusive, as malnutrition is a global issue with 45% of the cases of under-five mortality attributable to under-nutrition. The number of countries simultaneously experiencing the complex burden of different forms of malnutrition is an increasingly common issue and highlights the need for multifaceted action by professionals who are suitably trained in nutrition science.
The Global Nutrition Report 2014 included a conceptual framework highlighting the fundamental role enabling (an) environment for nutrition improvement has in obtaining the ultimate goal of achieving benefits from improved nutrition status. A key facet for achieving this is the provision of professionals with the knowledge and skills to support and address the nutrition issues in their locality. The World Food Programme has also noted >80% of the world’s most food-insecure live in countries prone to natural disasters with high-levels of environmental degradation, and the need to build resilience of vulnerable people to disaster risk and climate change. These findings reiterate the fact nutrition professionals are vital in improving the knowledge, capacity and skill required for addressing complex situations and essential in empowering current and future generations to undertake practices that improve their nutritional status.
However scientific papers published by Association for Nutrition Registrants have demonstrated substantial gaps in knowledge and skill exists in countries of great need. In particular, registrants involved in the MDGs and SUN movement have highlighted the particular inadequacy in professional capacity in nutrition in Africa. For example, Ellahi et al (2015) found limited nutrition training was available in Africa compared to identified level of need. In this review of nutrition training provision, serious questions were raised in regards to programme structure, curricula content, standardisation, knowledge and practical/ interpersonal skills. These, combined with the fact that nutrition support in many countries is provided by health or support workers, rather than nutrition professionals, creates a potential bottleneck to ensuring evidence-based delivery of interventions and action.
Jackson and Ashworth3 (International Malnutrition Task Force) have also highlighted the need for capacity building and the emphasis required on the prerequisite of nutrition training and education and the potential establishment of Communities of Practice to address the, ‘current piecemeal, scattered capabilities that are not fit for purpose’.
All six Action Areas are underpinned by the need for evidence based nutrition policy and practice, both at strategic and frontline levels. This can only be guaranteed if nation states have a qualified, trained and trusted workforce. Therefore we feel that this needs to be strengthened throughout the draft work programme.
Q3. Do you feel you can contribute to the success of the Nutrition Decade or align yourself with the proposed range of action areas?
The Association for Nutrition has longstanding experience in researching, developing and validating nutrition competency requirements not only for nutrition professionals but also for those working or volunteering in health & social care, catering and fitness & leisure capacities, who alongside nutrition professionals carry a responsibility to use, translate or provide nutrition advice to the public. This work, undertaken with the support of UK’s Department of Health & Public Health England, has extended our reach into the quality assurance of nutrition training provisions for these wider workforces.
The Association for Nutrition can contribute to the success of the Nutrition Decade through input and support relating to the development of international standards to enable nations to ensure action is supported by qualified, trained and trusted workforces. Our registrants also have the expertise to deliver training, support and research for the Nutrition Decade from a policy to frontline delivery, on both a national and international level.
Q4.How could this draft work programme be improved to promote collective action to achieve the transformational change called for by the 2030 Agenda for Sustainable Development and the ICN2 outcomes? What is missing?
The draft work programme would be strengthened by the provision for a set of standards by which all nation states can measure and ensure those delivering actions are suitably qualified and competent in nutrition to deliver evidenced-based support and activities, providing the ability to undertake comparisons of delivery across nation states. Setting and monitoring against these standards also has the potential to create education development and subsequent empowerment of individuals gaining skills and knowledge to support improved health as noted in Action 3 para 30.
Q5. Do you have specific comments on the section on accountability and shared learning?
The Association for Nutrition supports the transparent reporting of progress and the use of an open access database, which would enable nutrition researchers to explore this rich dataset for further research and investigations to further this area of knowledge.
Dr. Glenys Jones