Re: The e-Consultation on Hunger, Food and Nutrition Security

Hélène Delisle WHO Collaborating Centre on Nutrition changes and Development, Canada

Comments on Hunger, Food and Nutrition Security Post 2015 Development Agenda Framework

Thank you for giving us the opportunity to express our views on these topics. However, we cannot organize our comments around the three themes on which inputs were sought.
1.    Global challenges call for global approaches. There is a need for merging or at least converging or consolidating initiatives for post-2015 plan of action. At the present moment, we observe an inflationary trend. Only for insiders is the complexity of plans and consultations understandable. Several consultation processes are going on in a somewhat parallel fashion, on health, on food, on sustainable development. Responding to these separate consultations is not highly productive, and it is not known how the comments are processed. Avoiding the ‘silo’ consultations would be imperative.
The Global Forum on Food Security and Nutrition (FSN), led by FAO, launched this e-consultation led by FAO, WFP and ‘The World We Want’, on a development agenda framework. Recently, the Committee on World Food Security (CFS) launched another e-consultation on CFS Global Strategic Framework (until October 2012) also through the Global Forum on FSN. Now what is the difference between the ‘Development Agenda Framework’ and the ‘Global Strategic Framework’, if any? The report on comments on the Global Strategic Framework is 98 page-long. How is this consultation to impinge on the present consultation on Hunger, food and nutrition security in the next development agenda framework? The following are just a few more documents that would need to be taken into account if we are to integrate food systems, food (and nutrition) security, and nutrition through the lifecycle, sustainable development, and health in plans, frameworks, objectives, indicators, and targets.
•    On food security and nutrition:
-    The Zero Hunger Challenge – Comprehensive framework for action, by the High Level Task Force on Global Food Security, 2011 (as alluded to in the invited comments);
-    UNSCN Statement on Nutrition Security of Urban Populations (2012);
-    WHO, Draft Comprehensive Implementation Plan, Maternal, Infant and Young Child Nutrition (2012);
•    On sustainable development:
-    The Future we Want (2012)
-    Climate change – Food and Nutrition Security Implications (SCN News 2010)  
•    On non-communicable diseases:
-    Global Action Plan for NCDs Zero Draft (2012)
-    Draft Comprehensive Global Monitoring Framework Including Indicators and a set of Voluntary Global Targets (2012)
•    On health and social determinants of health:
-    Health in the Post-2015 Development Agenda (Consultations 2012-3)
-    UN System Task Team on the Post-2015 UN Development Agenda – Health (UNAIDS, UNICEF, UNFPA, WHO, 2012)
-    Outcome of the World Conference on Social Determinants of Health, Rio 2011
There has to be some way of integrating these, and nutrition may be a key, as it provides a link between food systems and health. All segments of food systems would have to be considered, as well as the interesting notion of ‘nutrition value chains’ for food systems. Regarding nutrition and health, the lifecycle approach should be revitalized, in order to avoid the current tendency to link undernutrition with maternal and child health, and nutrition-related chronic diseases with ‘adult’ health.

2.    Concepts have to be clear and a shared vision is needed. Food security and nutrition (security) are still not clearly defined and one wonders if consensus is achieved, in spite of a recent report on the terminology, advocating ‘food and nutrition security’. ‘Food security and nutrition’ (not nutrition security) was used in the consultation on CFS Global Strategic Framework. This makes a difference. Nutrition security implies adequate access to health services and a healthy environment. The underlying issue is the negative impact of infection on nutritional status, particularly of children. It is not so relevant for adult nutritional problems, including nutrition-related chronic diseases. ‘Food and nutrition insecurity’ still refers primarily if not exclusively to undernutrition, undernourishment, hunger. The term ‘malnutrition’ continues to mean undernutrition (and specific nutrient deficiencies, ‘hidden hunger’) and not to ‘overnutrition’ (a misnomer), at least for the general public. Furthermore, the concept of food security would have to be broadened to integrate environmental sustainability and social equity, like in the WHO-Europe’s criteria of food security. It is now established that food and nutrition insecurity are also linked with non-communicable diseases such as obesity, diabetes and cardiovascular disease. Undernutrition and micronutrient malnutrition in mothers and in infants, in particular, are a risk factor for these non-communicable diseases (NCDs) in adult life. NCDs are no longer associated with affluence, even in low-income countries, and NCDs themselves contribute to poverty. Why not consider the term ‘dysnutrition’ to encompass global undernutrition, micronutrient deficiencies, overnutrition, and dietary imbalance?
3.    A great deal is being said and written about action frameworks, but to our knowledge, no conceptual framework has been proposed to integrate food systems, nutrition and health since the UNICEF produced its causal model of 1990. Can’t this conceptual model be broadened and updated to take into account the new challenges and emerging forms of ‘malnutrition’ (nutrition-related chronic diseases), as well as the environmental issues?

4.    As we already brought up on several occasions, the key importance of high quality professional training of the workforce in nutrition, right in low and middle-income countries has to be more emphasized. If international organizations, NGOs and NGIs are not satisfied with existing university programs, they should strengthen these programs in a coordinated way, instead of having their own informal training activities, which may not be sustainable in the long run. Initial training, continuous education and international accreditation structures (to establish norms and standards) for nutrition training programs would be required. It would be difficult, for instance, to strengthen national nutrition policies and action plans and implement the Global Strategy on Diet, Physical Activity and Health unless more human resources are well trained in nutrition at all levels. Advocacy for health and nutrition promotion also calls for high-level human resources.

5.    The MDGs galvanized the efforts and helped mobilize resources. A new set of development goals is needed for post-2015. The goals that were not achieved should remain. Some others would need to be more explicit, for instance: food and nutrition security; NCDs; education and professional training. Women should continue to be the focus of at least one goal, to improve not only their health and their equality, but also their resources, their well-being and their participation in public life as citizens. We would see the relevance of goals focusing on the following:

-    Agriculture for health, equity and environmental sustainability
-    Governance
-    Protracted crises.

Hélène Delisle, Ph.D., Professor
Head of TRANSNUT, WHO Collaborating Centre on Nutrition changes and Development
Department of Nutrition, Faculty of Medicine, University of Montreal