Comments on the Rome document for ICN-2 from Sight and Life:
· Overall, would like to see more clarity around the outcomes for the meeting.
· Would also like to see more specificity/direct linkages to clarify the relevance of the outcomes for developing country policymakers.
· Clause 2, RE: “micronutrient deficiencies have not improved,” though there is still work to be done, we’ve made tremendous progress. Take vitamin A as an example. In 1999, only 16 percent of children were receiving the necessary two annual doses of vitamin A; by 2007, that figure had more than quadrupled to 72 percent. Today, in some countries, 100 percent coverage has been achieved.
· Clause 3. Causes of malnutrition described are too narrow and just food-focused not considering care and health.
· Clause 6. Refer to other initiatives/commitments, such as Scaling up Nutrition, Nutrition for Growth, World Health Assembly, Zero Hunger.
· Clause 7. Refer to WHA targets for 2025.
· Clause 9. A food system has many entry points and does not have a base (agriculture). In the food system, each actor and sector has a function and the whole is greater than the sum of its parts because of the synergy created among well-functioning parts. When one part is unable to contribute to 100% capacity, the system as a whole compensates for this lag.
· Sustainable and equitable food system by definition are resilient; endurance and remaining productive is inherent in the definition of sustainability, thus term resilient is redundant.
· Clause 10. Consumption of a diverse and balanced diet, such as vegetable oil and animal source foods, leads to a healthy intake of saturated fats. Food processing technologies that convert naturally occurring fats into forms (i.e., trans fat) that are detrimental for health should be avoided.
· Not all people can access a balanced diet because of lack of knowledge and resources. The nutrient profile (density) of food can be a lens used to examine the healthiness of our food system. Food fortification shall be considered as a cost-effective and safe approach to increase nutrient density of foods.
· Clause 11. Advanced packaging technologies should be considered to reduce food spoilage and wastage.
· Clause 12. Policies should encourage private-public-partnerships to co-create public goods such as improved nutrition and health.
· Private sector role in facilitating a nutritious food system is evident
· Clause 13. Rural livelihoods need improvements, including access to quality health services, education, safe water, sanitation, improved housing (i.e., non-dirt floors, non-leaky roofs), and social protection programs.
· Clause 15. Nutrition interventions must be evidence based. Nutrition assessments are required to understand what the nutritional gaps are (lack of energy, protein, micronutrients) or essential fatty acids) and cost-effective interventions (e.g., fortification, supplementation) should be designed to fill these nutrient gaps. Supplementation with micronutrients and provision of food supplements shall be provided for the most vulnerable, women and their children.
· Clause 17. Advancing the nutrition agenda in political circles will require a multisector approach via task forces, technical advisory groups. Effective strategies for multisector alignment, financial management, and shared objectives need to be tested and implemented.
· Advancing the nutrition agenda also requires a reframing our nutrition story. We need science that will help us explain how the health and education systems affect nutrition outcomes. A nutrition lens in addition to the development lens is needed too.
· Political commitment is not completely lacking at country level. Would be beneficial to highlight that greater commitment is needed while at the same time acknowledge and highlight country success stories, noting that political commitment can translate into positive difference on nutrition outcomes.
· Clause 20. We urgently need a systematic approach to scaling up of interventions and this can be achieved through implementation science. Many of the evidence-based interventions work under tightly controlled conditions, but we lack knowledge in taking them to scale.
o There is also a need to recognize and effectively support human capacity to take programs to scale, including leadership training for policy makers and program managers. Organizational behavior theories, rewards and compensations and certifications systems, continuing education and mentorship programs need part of our discussions for improving capacity in nutrition.
o We require new assessment tools suitable for the field for rapid and reliable assessment of the (micro)nutrient status of populations.
Klaus Kraemer