Here are some comments from Corinna Hawkes at WCRF International, an organisation concerned with the prevention of cancer through the promotion of improved nutrition:
Theme 1: What are some of the key lessons that have been learned during the current MDG Framework, 1990-2015?
Many lessons have been learned during this period. Here are some:
• Food and nutrition insecurity encompasses a triple burden of poor nutritional status: underweight; stunting; and overweight/obesity. These three conditions can co-exist within the same individuals, households, and communities. They may also exist independently of each other.
• All forms of malnutrition are linked with health, including the development of chronic non-communicable diseases in later life. Evidence indicates that poor nutritional status is linked with the development of noncommunicable diseases.
• Intervention in early life is critical to prevent stunting and the health conditions associated with it later in life since malnutrition has a profound effect on child growth and development during the first two years of life.
• Good nutritional status should therefore be an objective for development, rather than “hunger” alone.
• Moving out of a situation of undernutrition does not necessary lead to good nutritional status if replaced by overweight and obesity. Healthy development needs to take a different path to Western nations in this regard!
• Good nutritional status is achieved by a range of actions, including on food, health and care.
• With regard to food, improvement to the total diet is essential. Focusing on one or two specific foods or nutrients can have perverse effects.
• A strong civil society can galvanise and promote action to address malnutrition.
• Good governance, including multi-sectoral mechanisms, is essential for the effective development and implementation of actions to address malnutrition in all its forms.
• Having clear goals can motivate action.
Theme 2: What actions are needed?
Taking into account the triple burden of poor nutritional status, the following actions are needed for the post-2015 development agenda:
• Actions that address all forms of poor nutritional status. Some actions are needed to address two of three aspects of malnutrition at the same time; others are needed that target the specific form of malnutrition alone.
• Maintaining and promoting breastfeeding – evidence states that breastfeeding leads to positive nutritional outcomes in all its forms. UN recommendations on breastfeeding should be followed, implemented and monitored by all relevant actors.
• Social safety nets are needed to reduce poverty and malnutrition among poor families, including systems of ensuring adequate food intake, such as school meal provision and cash. However, it is essential that these systems include nutrition standards and/or provisions to promote healthy eating (evidence suggests these otherwise valuable programmes can be associated with excessive energy intake or unbalanced diets).
• Malnutrition should be viewed as a food systems problem, as well as one of poverty and unbalanced development. This is particularly the case now that more attention and investment is being placed into agriculture. There currently exists a considerable opportunity to promote “nutrition sensitive agri-food systems”. Actions are needed to improve the nutrition-sensitivity of “short value chains” between farmers and consumers, focused on specific, and often rural, populations e.g. initiatives to promote the production of plant-based foods and their movement into the market throughout the value chain. Given the presence of huge urban populations who purchase food that has moved through long and complex value chains, action is also needed to make “long value chains” more nutrition sensitive. This is needed to bring the triple burden and vulnerable urban populations into the frame of nutrition-sensitive agri-food systems.
• As part of this, policy actions are needed that target entire populations. For example, national governments and UN bodies should build the protection and maintenance of good nutritional status into relevant policies and agreements; the food and drink industries should make nutrition an explicit priority in all stages of food systems including product research, development, formulation and reformulation, and promotion. disincentives to the food and drink industries to mobilise and create demand for poor quality diets, such as policies to significantly reduce the marketing of high calorie, nutrient-poor foods to infants, young children, adolescents, and their caregivers.
• Overall, policies and actions will only be effective if they change the 3As – the availability, affordability and acceptability of healthy diets. Policies should thus promote a combination of supports changes in the food environment to address all 3As, plus educational strategies designed to facilitate the acceptability of healthy food choices and other food- and nutrition-related behaviours conducive to health.
• Evidence suggests that school-based approaches can be effective, but that a “whole school approach” is needed (that is, the integration of nutrition in several different forms throughout the whole school, including education on the curriculum, food served in schools, gardening etc). School gardening interventions are becoming more popular all over the world as a way of integrating many different aspects of nutrition education into one.
• Multi-sectoral (health, agriculture etc) and multi-stakeholder (civil society, government etc) action is needed to ensure good governance of the triple burden of malnutrition. For multi-sectoral and mulit-stakeholder action to happen, it is necessary to create the spaces to do so. This requires a policy spaces and governance spaces, such as national multi-sectoral councils. There is evidence that these multi-sectoral governance mechanisms have more power and positive influence when they report directly to the executive branches of government, preferably at the prime ministerial or presidential level.
• Current civil society mobilisation around nutrition has largely (and understandably) focused on undernutrition. A stronger “social movement” around all forms of malnutrition is needed to bridge gaps and cut across into the health and development agenda. Further focus is needed from civil society on overweight/obesity and nutrition-related non-communicable diseases.
Theme 3: Objectives, targets and indicators
The post-2015 development framework should include goals and indicators.
With regard to nutrition, nutrition indicators should be mainstreamed throughout the entire post-2015 framework given its interlinkages with other areas, such as health and sustainability.
The Zero Hunger Challenge and the Global Strategic Framework for Food Security and Nutrition are to be welcomed and have many strengths, but are limited in how they bring the triple burden of malnutrition together into one framework. The post 2015-agenda should be more explicit in how it addresses this triple burden in its actions, goals and indicators for food and nutrition security.
• There should be time-bound targets that take into account the triple burden of malnutrition.
• Reduction of stunting should be a key target, as should zero growth of obesity, particularly among infants and young children.
• There should also be an “indicator” on the development of food systems relevant to the triple burden of malnutrition.
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This thematic discussion is led by FAO and WFP in collaboration with “The World We Want”.
The consultation is facilitated by the Global Forum on Food Security and Nutrition (FSN Forum)
All contributions received (DOC)