It is very impressive to see the interest aroused by this discussion until the final hours... I would first like to thank all participants for the number and quality of contributions. I think it shows to what extent, coming from very different countries and backgrounds, we are all strongly involved in the fight against malnutrition, against all forms of malnutrition, and therefore against the deep inequalities that continue to impede many children, women and men from ensuring "a fulfilling and dignified life free of fear”.
I would like to address four points:
Thank you again for having brought your own points of views and experiences to the discussion. I look forward to continuing this lively dialogue on the way to the ICN2 and after.
Nutrition is a fundamental human need and working together to achieve it is such a meaningful activity. During the course of the on-line discussion, it was heartening to see many examples of the way people can pull together to further food security and nutrition. Overarchingly, the conversation has pointed to the need for a diverse range of actors to be engaged: farmers organisations, NGOs, academics, private sector, and individuals too.
We have seen evidence of the strengths each sector brings to delivering nutritional programs. These include specific activities taken by non-governmental actors in their respective businesses or organisations, which in turn can lead to collaborations that become more than the sum of their parts. From a private sector perspective, it may mean not only improving the nutritive content of an existing product but also being part of partnerships that deliver integrated solutions on household nutritional security. The private sector is at its best in leveraging market-based solutions to address some of the most intractable problems in addressing poverty and sustainability. We heard great examples of the role universities can play in analyzing needs, also of farmers organisations in managing resources sustainably, and civil society groups on-the-ground. Each group bringing their own skills to bear on the problems of nutrition is a potent solution.
So, many thanks to all of you for your insights and the passion you bring to feeding the world's people better. Onward to more engagement and more action.
The 2006 World Food Summit (WFS) defined the concept of food security as when “all people at all times, have physical, social and economic access to sufficient, safe and nutritious food which meets their dietary needs and food preferences for an active and healthy life.”
This definition included nutrition relative to the previous concept. Nutrition in developing countries is not valued as highly as it should be. In the developed world, nutrition is vital to the development of human capital. In recent years, diabetes, high blood pressure; stroke, heart diseases, and cancer have been on the rise. They have replaced malnutrition and transmittable diseases as major public health problems. This goes in accordance with the paper, “The Agriculture, Food and Health Challenge” that was released in 2009 by Inter-American Institute for Cooperation on Agriculture (IICA).
In recent times, developed countries have introduced several measures to help eradicate the harm to public health as a result of poor nutrition. In Guyana, for example, stakeholders inclusive of small farmers are advocating for a reversal of the current trend of consumption. Shifts from processed foods, beverages, and other such food products lose much of their valuable nutritional capacity rendering them less wholesome to foods produced organically.
Fresh food and fruits are abundant in Guyana. However, a major challenge to small farmers is getting that food to the people who want it. In a sense, this is a typical case of market failure. The inability of sellers and buyers to meet or food to reach to those who desire it most is not occurring. This results in a natural case where the food which actually reaches the market is sold at higher prices resulting in lesser consumption. This tragedy has harmed both famers and consumers. Opportunity is here created for all stakeholders’ government, civil society, and the private sector to work together and bridge the gap.
It has been estimated that on average Guyanese do not consume 2 serving of fruits per day. Such estimates reflect less than half of what is required. The majority opt for aerated beverages over water, or fruit juices. One should note that manufactured fruit juices are not as healthy as they may appear; the sugar level and the amount of preservatives added often neutralize the vitamins that were there to begin with. Yet Guyanese prefer those products over the local juices available.
With these choices that consumers tend to make, it is not surprising that outcome is ill health. Many of the consumers of these processed foods are children, teens and young adults, when one takes a good look at what happening, it is deplorable. In another 10 years when these children turn into adults, the rate we are currently seeing they are likely to have a number of health related issues. This is not a future we would like to have.
Some of the measures that can be taken to help prevent these inevitable outcomes are; reshaping the way the population sees agriculture and its products. This refers to educating the public of the blatant blunders in their judgment as it comes to food consumption. The media plays a central role in this aspect. Advertisements and programs can be broadcast to expose the nation to the better ways of living and should also reveal the detrimental effects that not reforming can have on them all. This would enable the population to greatly change their skewed perspective of what agriculture is and the benefits of fresh agriculture produce. Many are under the impression that consuming local products is a sign of being inferior to the high class of society. This false impression should be washed away form the minds of the people through sensitizing programs.
Government can have a program which is aimed at strictly sensitizing the public of their nutrition and what they can do about it, to improve it. Schools and women should be major targets because children are easier to mold than adults, women are the ones who often do the cooking and therefore if they are educated in better nutritional practices it will better the entire family. Families are what make up communities. The spill off effect of such a simple feat would lead to such major improvements in nutrition. Agriculture pays a major role in better nutrition; after all the products which are consumed all stem from the agriculture sector. Educate the population about better nutrition and the agriculture sector is bound to flourish.
We need to re-shape food markets for the benefit and health of the poor
We need to decide what kind of food and nutrition systems we want to build, and then talk about how to use policy and programmes to build them. A number of other contributors have asked about real world examples and cases. This post refers to several, from IDS’s work on markets and nutritious food.
First, we should recognize that food and diet are not the sole determinants of nutrition. And markets aren’t the only way people access food. Hundreds of millions of smallhold farming households grow much of their food. This household production is, in some cases, an important source of nutritious diets; it’s also where the majority of ‘nutrition-sensitive agriculture’ programmes have focused.
But we can’t ignore markets. The majority of the world is already buying their food, and this will increase in the short or medium term. Yet, at present, most markets are failing colossally to provide access to healthy foods for poor populations (in both North and South), and we see the growing ‘double burden’ of over/undernutrition.
I want to highlight 3 challenges facing efforts to promote the role of the private sector in nutritious foods:
Food markets are usually not efficient
The starting point is that the vast majority of markets for food don’t function well; they are riddled with market failures. There’s lots of debate about the effects of financial speculation on global food markets. But in most countries, even domestic markets have huge problems. Especially common is the so-called ‘credence problem’. This happens when consumers can’t distinguish between a nutritious form of food, and a nutrient-poor alternative. The result is that food producers (whether large or small) have no incentive to make healthier foods. (A good example is infant weaning foods in many countries.)
The implication is that, so long as people are buying food, we need various forms of regulation and other mechanisms to address these problems.
Formal businesses – when they sell nutritious food – don’t sell it to the poor
We don’t have the numbers to generalize, but based on a number of case studies, it appears that most of the businesses explicitly making nutritious food products are selling them to middle- and upper-income consumers. This is true both of medium-size domestic companies and multinationals. There are examples where ventures have set out to sell products to ‘bottom of the pyramid’ populations, but we’ve seen in a number of cases that they have had to shift strategy and focus on the wealthy, in order to recover costs (this was case for Grameen Danone Foods in Bangladesh). Again, this calls for attention to the policy environment and the structure of incentives.
The exceptions are products sold to public agencies, such as WFP, which distribute them to vulnerable populations. The best-known example is Plumpy’Nut, a Ready-to-Use Therapeutic Food. But when you take the same (or very similar) products and try to sell them in consumer markets, things are radically different, and it’s unclear whether consumers will be willing to pay for them, and whether companies will be able to fend off competition from non-nutritious competitors. (For an excellent review of this issue, see Lybbert 2011, UNSCN News 39)
Informal markets are crucial providers for the poor
In an earlier contribution, Aliya Bakry (and others) point out that the huge range of actors contained within the ‘private sector’. Much of the discussion about how to encourage businesses to produce nutritious foods focus is on multinational corporations, or large domestic companies. But the potential of these actors has only been proven in a few areas (most notably, in national-level fortification of staple foods like flour). Yet, most of the world’s poor already rely on informal food markets. (OECD data indicate that informal markets are growing in all regions.) These markets produce, transport and provide foods at low cost, and they are especially dominant for nutrient dense and fresh foods. Informal markets also face important problems (including the problem of credence goods described above). They involve large numbers of individuals and small businesses, and are difficult for policy to coordinate.
Are there models we can learn from about what might improve food markets for the poor? There are interesting cases to look at. For example, in Ghana, UNICEF and the government helped spark a large number of informal businesses selling weaning foods aimed at infants. This market expanded rapidly and organically, but it also lacks transparency for consumers to know what they are paying for. In Mozambique, donor-funded projects tried to build local markets for orange-fleshed sweet potato, aiming to convince consumers it was worth paying slightly more for the more nutritious orange variety, and to convince traders to buy and promote them.
We need serious debates about what kind of food system can deliver nutritious foods to the people who currently don’t have access. For this foreseeable future, this means we need to address problems with markets. We need more positive cases of ways to do this. What businesses will do depends on the structures and incentives embedded in markets. Improving food markets for the poor needs to be a central issue for policy in this debate.
Dear Moderator and friends
I like to draw attention to, why investment from the private sector will only go some of the way to ending undernutrition. It covers two broad arguments. Firstly, when considering how the private sector could contribute to improved nutrition outcomes, it dispels two common misconceptions: the first is that all that is needed is a production-based model with a minor tweak towards nutritionally enhanced harvests. The second is that all countries and regions in the midst of the global nutrition crisis are equally attractive for private sector contributions. The reality is that by eliminating food availability through increased yields we will only take a minor step towards eradicating undernutrition (Smith and Haddad; 2000). Secondly it emphasizes that new investments have so far been very biased towards agriculture and have not been mirrored by investments in other sectors such as nutrition, health, education or rural infrastructure. The G8’s ‘New Alliance’, which has food security and nutrition as its headline goals, is regarded as the flagship programme to catalyze investments from the private sector. Examining the six country frameworks that so far have been published, it appears that few private sector investments are planned for nutritious crops and foods. More than half of the 111 planned private investment projects focus on non-food crops and only four mention specific, nutrient-dense food products to be sold locally (Robinson and Humphrey, IDS Blog 2013).
The first misconception is that increased production of nutritionally rich crops will be a major step in combatting the global nutrition crisis. While evidence exists suggesting that improved agricultural can lead to improved food security and nutrition outcomes, evidence also exists proving that this will not happen automatically and that regulated, multi-sector interventions are needed to ensure that the increased food resources are distributed evenly at household level and that food of the right quality is accessible by all. To maximise availability at the household level, production models need to be adjusted with three key policy measures in mind:
The second misconception is that private sector interest in development is equal to the interest shown in public private partnerships (PPP). The encouraging theme of the World Economic Forum in 2010 (Realizing a New Vision for Agriculture and Nutrition: A Roadmap for Private Sector Stakeholders) did result in some support towards the resolution of problems related to water quality, hygiene, disease prevention, livelihoods and commodity supply chains. However it is probably reasonable to state that private sector food companies have yet to become pro-active towards the needs of the very poor and malnourished who may be perceived to be outside their future customer base. The above analysis of the New Alliance confirms this trend.
The groundbreaking work which led to the development of Ready To Use Therapeutic Foods (RUTF) to treat Severe Acute Malnutrition (SAM) through the CMAM approach has given frontline medical professionals a product which can be used under clinical or community supervision in controlled dosages to save the lives of many. Considering the caseload of 19 million children in need of these products globally, this is surely an interesting investment proposition. However there are apparently some major blockages to engaging business actors to invest in it.
To attract new actors to contribute to efforts to improve nutrition, it is of paramount importance to narrow the current funding gap and the unpredictability of the current market place. Funding for RUTF is more forthcoming in response to emergencies: 60% of current investments involving the treatment of SAM with RUFTs are in short-term, emergency settings, rather than in protracted crises. Increasing the funding for nutrition in chronic crises where there are on-going baseline needs would be more conducive to private sector investments (ACF’s Aid for Nutrition Series 2012-13) and would potentially attract new actors.
Not only does funding need to be increased and delivered more consistently, but the supply chain also needs to be reformed. One of the key challenges is that the sustainable provision of RUTF by external actors is only possible if UNICEF plays a pivotal role. Governments, donors and civil society organisations should explore and trial innovative financing to provide long-term, sustainable and predictable funding for the full package of direct nutrition interventions which is aligned with complementary initiatives in health, food security and agriculture. The vacuum of private sector interest in undernutrition can only hope to be closed when a credible costing to improve nutrition by an external actor is integrated with national nutrition plans.
Equally, donors within the SUN Movement are taking very different approaches to tackling undernutrition. While the EC is the primary funder of the Secretariat, DFID’s support appears to focus on advocacy and the stimulation of partner government involvement rather than the supply of digestible nutrients. In contrast, USAID’s approach through the Feed the Future initiative is to improve food security by boosting harvests, nurturing agricultural development and expanding business opportunities. In some respects this is a return to development through market economics and livelihood improvement rather than a direct move to addressing malnutrition on the ground or through its health and social drivers. Despite the positive messages printed in their policies, such inconsistency between major donors is sending mixed messages to potential private investors.
An additional barrier to private sector investment in nutrition is the limited potential for additional stocks of RUTF. It is unlikely that a new PPP for RUTF would be successful as the current producers of the product are operating well below their available capacity. An alternative would be to direct the capacity of the private sector to the manufacture of Ready To Use Supplementary Products (RUSF) which could be used address Moderate Acute Malnutrition (MAM). MAM is much more widespread and there is a much greater potential to develop new, innovative types of RUSF. Therefore the private sector could play a very positive role here by working with the public sector to ensure the institutional supply of products to address MAM and by potentially providing the consumer with the product free of charge.
The development of products and services for the treatment and prevention of MAM probably offers the greatest potential for the private sector in nutrition programmes. Private sector investments would to reduce the need for treatment and free up the resources of governments to target the underlying causes of undernutrition within the health, food security and education sectors. This will also require a rethink of how civil society operates and the role of NGO’s play in addressing MAM.
Finally we should consider whether there is a preference for local or multinational companies to invest, bearing in mind that multinational companies are likely to contribute the most financially. While global or regional private partnership initiatives would contribute significant value to the distribution of products around the world, they would also undermine the desired objective of integrating the manufacture of RUTF within national governments where it is needed. Also there must be a transparent agreement between the private sector, civil society and government at national level which defines the extent to which external engagement is in the interest of all parties. This is especially the case when foreign exchange is needed for the purchase of milk powders, micronutrients and packaging.
The lack of funding, stability and strategy to tackle acute malnutrition and to produce RUTF therefore requires initiatives to be started at government level and progressed by engaging in discussions with affected civil society. These challenges are unlikely to be fixed by the private sector.
If the private sector is to play a new and positive role in addressing undernutrition, governments and civil society must be clear on where and how to encourage the development of future markets. Discussions must outline where the gaps in funding are and how new investment could free resources in other areas where private sector investments have not been forthcoming. Furthermore, given that there is unequal progress in different sectors and regions, donors must be able demonstrate that there is a real need to tackle undernutrition beyond emergencies. This would create long-term markets which interested companies could enter. In 2008, the first Lancet series concluded that the approach to tackling nutrition crises was fractured. Since then much energy has been expended to improve coordination and increase the evidence-base. If future efforts to address hunger are dictated by disjointed and biased private investment, we are in danger of losing much of this progress.
By 2050, the global human population is expected to exceed nine billion. Currently, 12.5% of the global population, or one in eight people, are undernourished – the vast majority of whom live in developing countries, where the prevalence of undernourishment is estimated at 14.9%. With the global demand for food, feed and fibre set to nearly double, there is an urgency about how to feed the world. Producing 70% more food for an additional 2.3 billion people by 2050 while combating poverty and hunger; using scarce natural resources more efficiently and adapting to climate change are the main challenges facing world agriculture.
Responding to these challenges will take investments in innovation, research and development, in affordable technologies and in smallholder farmers, who are essential to stable, productive and equitable agricultural development. In many regions fewer people will be living in rural areas and even fewer will be farmers. Making farms more productive and more resilient through sustainable intensification systems ‐ increasing crop yields with improved nutrition levels and resistance to disease and climate change, while using less water, pesticides and fertilizers and lowering greenhouse gas emissions is critical.
Such enormous tasks cannot be faced without a true partnership involving governments, academic and scientific communities, non-governmental organizations, communities, farmers as well as the food industry itself. Policies and practices aimed at advancing the goals of sustainable agriculture, improving the livelihoods of smallholder farmers, securing the stability of rural communities and helping ensure the future of the world’s food supply certainly cannot be implemented without a proper involvement also of the food industry.
As the World Health Organization Global Strategy on Physical Activity and Health suggests, reducing the risk factors for chronic disease on a global basis will demand collaboration among many different groups. The success of the Global Strategy can only be based on a comprehensive approach with active participation by all involved, including government, the food and beverage industry, civil society and other public- and private-sector stakeholders.
The UN Declaration of 16 September 2011 on the prevention and control of non-communicable diseases (http://www.un.org/ga/search/view_doc.asp?symbol=A/66/L.1 ):
- recognizes “the need for the efforts and engagement of all sectors of society to generate effective responses for the prevention and control of non-communicable diseases”;
- acknowledges “the contribution and important role played by all relevant stakeholders, including, where and as appropriate, the private sector and industry, in support of national efforts for non-communicable disease prevention and control”;
- commits to “advance the implementation of multi-sectoral, cost-effective, population-wide interventions in order to reduce the impact of the common non-communicable disease risk factors”;
- commits to “develop, strengthen and implement multi-sectoral public policies and action plans to promote health education and health literacy, including through evidence-based education and information strategies and programmes in and out of schools, and through public awareness campaigns”.
To sum up:
1) the Food Industry is an essential partner to help reach the goal of an improved nutrition worldwide and, therefore, it should be properly involved in a whole-of-society effort towards reaching such a goal. Of course, proper “rules of engagement” could usefully be defined for such an involvement.
2) The best way to improve nutrition is not through regulations and restrictions, but rather through nutrition education and literacy, especially through evidence-based education and information strategies and programmes (in and out of schools) and targeted public awareness campaigns.
3) Multi-sectoral, cost-effective, population-wide interventions should be the preferred tool to be used. As an example, please refer to the EPODE experience: http://www.epode-european-network.com/ and http://www.epode-international-network.com/
The title of this discussion calls out for a clarification of terminology. The “private sector” embraces a large continuum of companies, from the very small enterprise to the large multinational. It is clear that at the two extremes of this continuum, these two types of companies don’t play the same role, don’t affect the market in the same way and in what concerns us here don’t relate to nutrition and health in the same manner. Hence, I think it is obviously misleading to put all these companies in the same basket and to call on the civil society to “collaborate” with them indistinguishably is pure decoy.
I would like to refer to the excellent paper published in February 2013 in the prestigious journal The Lancet: Moodie et al. 2013. Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries. The Lancet NCD Action Group. The Lancet, vol 381, Issue 9867, pages 670-679, 23 February 2013.
I invite the participants of this discussion to read this excellent article and I cite here its key messages:
“• Transnational corporations are major drivers of non-communicable disease epidemics and profit from increased consumption of tobacco, alcohol, and ultra-processed food and drink (so-called unhealthy commodities)
• Alcohol and ultra-processed food and drink industries use similar strategies to the tobacco industry to undermine effective public health policies and programmes
• Unhealthy commodity industries should have no role in the formation of national or international policy for non-communicable disease policy
• Despite the common reliance on industry self-regulation and public–private partnerships to improve public health, there is no evidence to support their effectiveness or safety
• In view of the present and predicted scale of non-communicable disease epidemics, the only evidence-based mechanisms that can prevent harm caused by unhealthy commodity industries are public regulation and market intervention.”
As clear from the conclusions of The Lancet NCD Action Group, some constituents of what’s quite loosely called “the private sector”, namely in the field of nutrition and health, the producers and distributors of ultra-processed foods, should be rigorously controlled by the States; in this control, the civil society can play a role. The illusion of “public-private partnership” need in the same way to be demystified.
I have been following the debates in the Forum and I would like, in the name of FIAN International, the human rights organization for the Right to Adequate Food, to support the positions expressed by the representative of PHM, Claudio Schuftan.
In addition to what he wrote, I would like to convey FIAN´s concern on the lack of participatory, transparent and coherent governance of international nutrition initiatives since the UN Standing Committee on Nutrition excluded civil society representation participation, and was recently reduced to the facilitator of the UN platform of SUN.
Unfortunately, the CFS itself, despite some efforts, has been unable to effectively take into account all the dimensions of nutrition into its Food Security and Nutrition mandate, especially due to the non-participation of WHO and UNICEF (and other nutrition related UN agencies) in it, and due to the fact that the governmental participants in the CFS normally come from the Agricultural Ministries and not from the broad food and nutrition area.
We are also concerned that the CFS has not been invited to take a proactive role in the preparation of the International Conference on Nutrition 2, to take place in 2014. How can the ICN 2 discuss issues relevant to promoting nutrition and overcoming the most relevant nutritional problems in the world today (malnutrition, micronutrient deficiencies, the double burden, NCDs, the role of food publicity for children, regulation of TNCS involved in the food system, etc.) without an adequate participation of the CFS members? And especially who will be in charge of guaranteeing the implementation of the recommendations of the ICN 2, with a dismantled SCN and a non-involved CFS?
We hope the ICN2 preparatory meeting in November 2013, will open a space for these discussions.
To discuss national initiatives is very important but to discuss how to guarantee policy space to the most affected countries, through human rights compliant public regulation of the interference of powerful actors ( among them the G8 and TNCs) is even more important.
Flavio Luiz Schieck Valente MD.MPH.
I do take strong exception to Robynne's statement that: "...the question set out a ‘private-sector’ – ‘civil-society’ dichotomy, but we all know that real life doesn’t work like that. Just look at the wide range of academics, farm organisations, private companies and others involved since the discussion began on-line and it’s easy to see that this division seems somewhat artificial and not necessarily helpful".
Indeed, real life does work like that. The dichotomy is there, and it is marked. The fact that in our consultation we have had inputs from the sectors Robynne mentions is certainly no proof that the division is somewhat artificial and not necessarily helpful. This is a dangerous blanket statement. Does anybody have a doubt about the negative effects Big, Food, Big Beverage and the baby food industry are having on nutrition the world over? ...and this is just one example. What about corporate land grabbing? Multinational, family owned and corporate international oligopolistic grain traders? Speculators in futures markets?
Ho Chi Minh City
In fact NGOs and Private organizations play major role in education,awareness creation,model kitchen/nutrition garden development and demonstration.
It was the traditional wisdom of ancient inhabitants in warm humid tropics to grow plants and crops of family choice and make family self sufficient in food and nutrition. A kitchen garden has fruits,vegetables,spices and herbs,tuber crops and ornamentals to decorate family deity.
No outside labour was used, only family labour is used. Kitchen wastes are converted to manures and methane cooking gas.Irrigation water comes from adjescent well and ponds.The ancestors have prior knowledge on light/shade requirement of crops.Every available space is utilized including bio fences using chekkurmanis,basella,Ceylon spinach. Amaranth rich in iron and fibre was grown through out the year. Fruits like guava, bilimbi, tamarind, gooseberry, litchi, rambutan etc were grown based on temperature requirement of fruit trees. Spices like black pepper,ginger,turmeric,clove,nutmeg etc were also grown. Tubers like potato,Chinese potato,cassava,sweet potato and yams were also cultivated. With change in time technologies like hydroponics, aero ponics and aqua ponics to meet nutrition requirement of family have come up. I have a series HORTICULTURAL SCIENCES published by New India Publishing Agency New Delhi(www.bookfactoryindia.com).I compliment FAO for initiating such a discussion.
Dr K V Peter
Links and resources:
Earlier FSN Forum ICN2 discussions: