Глобальный форум по продовольственной безопасности и питанию (Форум FSN)

1. What are your expectations for the UN Decade of Action on Nutrition and how could it make a significant difference in improving nutrition and food security of the people in your country within the next ten years?

-focused attention/validation of nutrition as an essential global issue requiring urgent action

-acknowledgment and action that collegial and consistent with being on the same playing field. 

-acknowledgement and participation/contribution on the forms of malnutrition across the malnutrition spectrum

-continue to increase evidence and evidence-based programming here at home while also providing technical guidance and resources in other country settings (but not simply exporting protocols and standards without acting on what happening in the US)

2. What critical activities need to be included in the Work Programme for the implementation of the UN Decade of Action on Nutrition to reach the 2025 global nutrition targets? Which activities would need to be accelerated in your country to reach these targets? How could these activities be funded?

-data!!!!! Tracking prevalence and trends in malnutrition forms as well as evidenced base around initiative that can be taken to scale. 

- building local nutrition leadership capacity: clinical and community provision and programs that are nutrition specific and/or nutrition sensitive, governance (dietetics, nursing, public health, ag, research, M&E, knowledge management, policy,...

-recognizing obesity fully as the urgent form of malnutrition that it is. Conveying that message clearly and relevantly to the public and other stakeholders

3. What can be done to accelerate and improve the quality of commitments from the various actors? What role(s) should public and private actors play in monitoring their implementation?

4. How can other relevant forums, such as the CFS and the UNSCN, contribute, and how can other movements (e.g. human rights, environment) be involved in the Decade?

-so many other sectors are tied to nutrition. Open the door, provide consultations,  and examples for these sectors to make public statements and focused action commitments, creating unified messaging and translating that into action (steps in integrated programming and demonstration of proof of priniciples), even if quite small to begin. And then consider how nutrition can reciprocate- reinforcing the unifying messages. 

English translation below

Por muchos años hemos hecho el compromiso de alcanzar metas nutricionales, sin haber logrado sino modestos avances, sobre todo en los grupos de población más necesitados. La diferencia entre los avances cientificos y la solución de los problemas es abismal, lo cual nos dice que hay urgencia de pasar del conocimiento a la acción. Se han celebrado muchas reuniones en donde los expertos plantean diversas formas de actuar que no se traducen sino en contados casos de implementaciones exitosas. La pregunta es por qué?. Creo que la comunidad internacional debe volver a analizar con muchas modestia experiencias exitosas. Brasil nos ha mostrado que en menos de una década logró disminuir la desnutrición en forma exitosa, al igual que Perú y Colombia. Uno de los spectos fundamentales para el éxito es el nivel de compromiso y competencia de profesionales locales de la salud y nutrición que en forma silenciosa han cumplido con sus tareas haciendo que los niños acudan a las unidades de salud, asegurando colaciones escolares saludables, regulando la venta y propaganda de productos ultraprocesados, mejorando las condiciones sanitarias y el acceso a agua segura. Muchos de los expertos deben darse la oportunidad de conocer las realidades locales desde la perspectiva de los propios actores para poder entender por que se es exitoso en unos casos y no en otros. No podemos seguir fomentando la dependencia del desarrollo tecnológico que solo alcanza a unos pocos y que muchas veces es más costoso que los logros alcanzados. La solución esta en manos de la misma gente que una vez empoderada sabe que es lo que se debe hacer porque hay otros factores que a los nutricionistas no les interesa conocer. Debemos fortalecer la capacidad del sector salud y darle más sustento a la producción local. Por años la OMS hizo extraordinarios aportes en esta linea pero ahora estamos más en una visión reduccionista pensando que la solución esta en la entrega de un producto cuando el problema de la mala nutricion y sus determinantes es  tan compleo. Más aún cuando las fuerzas externas al problema, con todo el poder que tienen nos condiciona a consumos masivos de productos y bebidas ultraprocesados y son capaces de someter gobiernos, niveles politicos, comprar académicos, como ha salido a la luz en los ultimos años, en que se conoce que desde los años 60 y aún más antes, las transnacionales al igual que las tabacaleras han tenido tanto poder que han sido capaces de, através de la seudociencia, modular las recomendaciones que se han hecho sobre grasas y azúcares.

Lo  países cuentan con profesionales de excelencia que deben ser convocados a compartir no solo su experiencias sino tambien a elaborar recomendaciones. Ese conocimiento podrá dar verdaderos frutos  en el diseño de propuestas viables y masivas para largos segmentos de la población. Naciones Unidas, como organismo multilateral que fue creado por los países, debe facilitar estos intercambios al igual que lo hace con donantes, ONG´s y otros organismos, algunos de los cuales tienen sus propios objetivos.

For many years we have committed ourselves to fulfil nutritional goals, although progress has been limited, especially for those most in need. The gap between scientific developments and problem solving is huge, so we urgently need to turn expertise into action. Many meetings have been held in which experts propose different interventions that, with very few exceptions, are not successfully implemented.

Why? I think the international community should take another close look at successful experiences with due modesty. Brazil has shown that undernutrition can be successfully reduced in less than a decade, just like Peru and Colombia did as well. One of the key factors for success is the level of commitment and competence of local health and nutrition professionals, who have discretely fulfilled their duties by bringing children to health units, ensuring healthy school snacks, regulating the sale and advertising of ultra-processed products, and improving sanitation and access to safe water. Many experts should have a first-hand knowledge of local realities to understand the reasons behind the success or failure of an intervention. We cannot continue fostering dependency on technological development, as it only reaches a few and is usually more expensive than the actual accomplishments.

The solution lies in the hands of the same people who, once empowered, know what must be done, as there are other factors that nutritionists are not interested in knowing. We must strengthen the capacity of the health sector and provide more support to local production. For years, the WHO made extraordinary contributions in this field but nowadays we have adopted a more simplified approach by which the solution lies in the delivery of a product, despite the problem of malnutrition and its causes are highly complex.

Moreover, when external parties, with all their power, induce the population to a massive consumption of ultra-processed food and drinks and are able to subjugate governments, at all political levels, and bribe academics. A case which was made public in recent years, involved multinational corporations like tobacco companies, so powerful in the 60s -and even more before– that they were able to tailor recommendations on fats and sugars on a pseudo-scientific basis.

Countries do have excellent professionals who should be invited not only to share their experiences, but also to formulate their recommendations. This knowledge can yield real results in the design of feasible and large-scale proposals for large segments of the population. United Nations, as a multilateral organization established by member countries, should facilitate these exchanges, just as it does with donors, NGOs and other agencies, some of which have their own objectives.

   In Ethiopia, the nutrition program is coordinated by ministry of health and co-chaired by ministry of agriculture and education. There are three sub-technical committee under national coordination body: program implementing, food fortifcation, and research. National multi sectoral coordination is progressing and functioning, however sub national level is not progressing very well.

    Commitment and policy environment is crucial to bring those change significantly. Food and nutrition,  need  multi sectoral coordination at high level. There should be accountability and monitoring mechanism for implementing sectors.

    All the programs or activities should be supported with operational researches, and strong evidence; they program should be context specific and should meet countries need. Activities includes:  increasing the productivity of agricultural system, making agricultural more nutrition sensitive, promotion of the mechanism to reduce post harvest lost, develop values chain, the equitable  food distribution system, mandatory food fortification, promotion of  food diversification, and bio-fortification. Activities need to be accelerated are: start of small scale food processing technology for reduction of post harvest lost,  start of mandatory food fortification, strengthen bio-fortification program, promote consumption diversified food,  strengthen coordination mechanism among nutrition sensitive and specific sectors, and strong monitoring and evaluation. The funding should come from multisources: might  Government, Donor, private, and industry.

It is necessary to scale up agricultural practices through technology and climate smart practices, an effort to attract  youths, to achieve food security and sustainability in developing countries and in particular the Caribbean. 

There is need to increase the work force in Food and Nutrition.  Though there is an increase persons receiving degrees in the area of nutrition and /or Public Health, they are not sufficiently employed/utilized;  there is a growing need for work and workers in this sector.  Building capacity in the region for conducting impact analysis of nutrition interventions and research in nutrition that would lend support by donor agencies and validate the need for increase workforce.  

In order for progress to be made, I think the UN should enhance and consolidate its "delivering as one" framework, particularly in Africa. In Africa, particularly the most rural and deprived communities where I have worked before, the issue of food security and nutrition is beyond the food aspect of the equation. There are thorny issues of Sanitation and hygiene that impede of household's ability to absorb vital nutrients. In most of the poor communities in Ghana, for instance, the issue of insufficient nutrition is both an issue of lack of nutritious food and lack of water, sanitation and hygiene. Lack of potable water and sanitation impedes on families ability to absorb vital nutrients.  

what I expect to see in my region is:

1. An enhanced richly textured integrated program that brings together the various expertise of the UN to jointly deliver on the UN action on FSN. I was privileged to be part of a joint UN program on Human Security in Northern Ghana  which, produce tremendous results. All the dimensions of Food availability, Access, Utilization, Water, Sanitation, and Hygiene but be prioritized and tackle almost simultaneously. 

2. There should be advocacy targeting national governments to ensure that there is integrated and cross-sectoral planning by the various governmental department. Despite the clear link between food security, nutrition, and hygiene promotion, most governments departments in Africa unfortunately, still work in Siloe. If the UN agencies deliver together as one and the government departments who are supposed to own these interventions sill continue to operate in silos then there will be a little impact in the long run. My proposal is that institutions must be supported to have the capacity to also jointly plan, budget, implement, and monitor together. 

3. I will also like to see that, the campaign for food security and nutrition should go beyond household's consumption of food. I suggest there should be activities targeting open-market food vendors in villages in Africa (both cooked and uncooked food). There are two sub-issues to be addressed here - a. to tackle the problem of poorly prepared food which, most school and other school children highly patronize in the villages. It should be noted that, in most African communities local food vendors who sell cook food on the streets and other open places serve as an important source of food consumption by mostly children. However, these vendors have little or no idea of basic nutrition and hygienic practices. b. to tackle the issue of food waste. It is shocking to see the amount of food that is wasted in the open-market by these food vendors in the midst of scarcity of food in rural villages in Africa. 

1. Improving nutrition and food security of the people in (my) country within the next ten years:  Income security is the biggest barrier, because most people have physical access to food retail - this will require public policy, especially to improve incomes for households dependent on income from government sources (e.g., social assistance, disability pension).  However, Canada also has vulnerable populations and geographic regions where food insecurity exists in part due to lack of physical access to food - particularly among Indigenous Peoples and in northern and remote communities.  Distribution infrastructure and access to more local/country foods are barriers.  With respect to local food, there must be assessment of the relative value and feasibility of food produced locally vs food produced in the best 'locale'.  Geographic regions with ideal growing conditions (soil, climate - including effects of climate change, water) must be protected for agricultural use, especially in urbanized areas where there is tremendous pressure from urban sprawl (requiring governments at all levels to commit to land protection).

2.  Critical activities - intersectoral dialogue in every country, at all levels of government, with citizen engagement, with value placed on upholding food sovereignty.  Countries need national food policies that consider all the costs and benefits - health and environmental impacts, agriculture and economy.  Trade targets for export cannot be prioritized at the expense of population health and biodiversity - not sustainable at the global level.  Plant-based diets are more easily sustained - the world needs to seriously consider how population consumption habits will change, and some producers and processors will need to transition from animal-based industries.

3.  A personal opinion - there is increasing unease about monopolies in the agri-food sectors - how can we commit globally to limiting private sector monopolies to achieve balance and a reasonable degree of protection for food sovereignty among citizens?  What global indicators might be monitored?  Who could develop and enforce global food policy?

4. Protection of human rights and the environment must become entrenched beyond "movements" - these are not optional, they are essential for a globally sustainable food system!  If this awareness can be raised in the next decade, with universal agreement among governments, then that will be one mark of success.  Food and water are not simply "commodities" - they are not optional, they cannot be replaced by other "products" - and so ownership of and access to food and water must be fair and secure, a shared public responsibility to protect the right to food and water, with dignity and equity, not by charity.

A good day to all

The Decade of Nutrition is an initiative for me that is personally welcomed as the avenue whereby greater emphasis is can be placed on the issues of food sovereignity in our region. Additionally, concerning critical activities that need to be included in the Work Programme, I refer to one of the pillars of food security specifically the use and utilisation of foods: maternal and child health from a nutrition standpoint is one of the crucial areas that warrants the investment of all stakeholders. 

The problem of hunger in developing countries is very serious. In this regard, the world community needs to work together to improve the efficiency of agriculture as a result of implementation of innovative technologies. One such technology is the production of genetically modified foods. However, the expansion of production of such products should be preceded by research on their safety, to put an end to disputes about whether they are harmful or useful.

Sincerely,

Alexander Kaigorodtsev (East Kazakhstan state University)

Please find my comments below, in English and then in French. Kind regards.

English version

I would suggest that the following initiatives be pursued in order for the Decade of nutrition to have much impact:

1. Support research in order to generate the scientific evidence where it is lacking while important, and notably on the effectiveness of nutrition interventions based on food systems coupled with behaviour change communication. In the absence of such evidence, donors are unlikely to fund such programmes.
2. Strengthen capacity and workforce in nutrition : It is of foremost importance and it has to be done in close collaboration with local universities for sustainable institutional strengthening. The priority is to train community health workers in nutrition and toward this purpose, a cadre of public health nutritionists/dietitians has to be trained at university professional bachelor level and decentralized throughout countries. There is also an urgent need to demonstrate the positive impact of nutrition capacity strengthening efforts on the population’s nutritional health as evidence thereof is lacking. This brings us back to the previous item on research for generating scientific evidence.
3. Assess the impact of distinguishing between nutrition « specific » and nutrition « sensitive » actions : The nutrition-specific actions are essentially all in the health sector, whereas most nutrition-sensitive actions are in non-health sectors or multisectoral at best. The nutrition-sensitive actions are likely more effective and sustainable since they address underlying or fundamental causes of malnutrition. We can therefore question the relevance of this distinction and assess whether it is counter-productive.
4. Better define « nutrition » : This may appear as a futile exercise and yet « nutrition » would benefit from a clearer definition.  Indeed, food science and technology, agro-biology, biochemistry and metabolism are often considered as nutrition, which gives the wrong impression that nutrition is well taken care of. At present, “nutrition” is a holdall with ill-defined boundaries. It should not be called “nutrition” unless there is an explicit link with man and his food. The specific focus should be on public (health) nutrition and there would be value in going back to the definition of the « new » nutrition (although it is not new) given by Geoffrey Cannon and Claus Leitzman. In their definition, they emphasize the societal and environmental dimensions of nutrition, beyond its health dimension. This could impact positively on capacity building and training of human resources in nutrition for the benefit of the population.

French version

Je suggère que les initiatives suivantes soient poursuivies pour maximiser l’impact de la décennie d’action des Nations-Unies sur la nutrition.

1. Appuyer des travaux de recherche pour produire l’évidence ou les données probantes qui font défaut sur l’efficacité de divers types d’intervention à visée nutritionnelle encore insuffisamment investigués, en particulier les approches s’appuyant sur les systèmes alimentaires et combinées à la communication pour les changements de comportements. Car à défaut de cette évidence scientifique, il est difficile de convaincre les bailleurs de fonds d’investir dans ces approches.
2. Renforcer les capacités en nutrition : c’est indispensable et ce doit être fait avec les universités locales pour renforcer celles-ci et pour la pérennité. Il faut en priorité former des agents communautaires à l’action en nutrition et pour ce développer un corps professionnel de nutritionnistes/diététistes de santé publique au niveau de la licence universitaire à déployer de manière décentralisée dans les pays. Il faudrait aussi par la recherche démontrer l’impact positif de ce renforcement des capacités en nutrition sur la santé nutritionnelle des populations, ce qui n’est pas démontré! Et on revient là au point précédent sur la recherche pour générer l’évidence scientifique nécessaire.
3. Vérifier l’impact de la distinction des interventions spécifiques ou sensibles à la nutrition : Les interventions « spécifiques » sont essentiellement du ressort de la santé, alors que les interventions « sensibles » à la nutrition sont le plus souvent dans des secteurs autres que la santé ou à tout le moins intersectorielles. Or ces dernières sont les plus prometteuses et pérennes comment elles agissent au niveau des facteurs sous-jacents ou fondamentaux des problèmes nutritionnels. On peut donc se demander si une telle distinction n’est pas contre-productive…
4. Mieux définir la « nutrition » : Ceci peut apparaître comme un exercice futile et pourtant, la nutrition gagnerait à être mieux définie. En effet, on parle de nutrition alors qu’il s’agit par exemple de science et technologie des aliments, d’agro-biologie, de biochimie ou encore de métabolisme. Ceci donne l’impression erronée que le champ de la nutrition est fort bien pourvu. La nutrition est actuellement un « fourre-tout » aux contours trop flous. Il ne peut s’agir de nutrition s’il n’y a pas de lien direct avec l’alimentation de l’être humain. On devrait se concentrer sur la nutrition (de santé) publique et on aurait intérêt à retourner à la définition de la « nouvelle nutrition » (même si elle n’est pas nouvelle) par Geoffrey Cannon et Claus Leitzman, laquelle insiste sur les dimensions sociales et environnementales de la nutrition, au-delà de sa dimension santé. Ceci pourrait avoir un impact positif sur les initiatives de renforcement des capacités et de formation des ressources humaines en nutrition.

Hélène Delisle, Ph.D.

Professeur émérite

Département de nutrition, Faculté de Médecine

Pavillon Liliane-Stewart, Université de Montréal

Canada

I would like to congratulate all actors involved on this effort on nutrition and suggest the UN to kindly include the nutrition of the elderly as an important issue in scaling up.

Every government must be able to develop policy to promote elderly health and nutrition.

Prof Ibiyemi Olayiwola

Professor of human nutrition

Department of nutrition and dietetics.

Federal university of Agriculture Abeokuata Nigeria