Nutrition For All Analysis of work programme of the UN Decade of Action on Nutrition, 2016-2025.
We at ‘Nutrition For All’ would like to thank the UN SCN Secretariat for giving us the opportunity to contribute to this living document. The Work Program is a good step in showing the open transparent nature of what Nutrition Decade aspires to be. Given the excellent submissions on this forum, the Work Program will change rapidly. We at ‘Nutrition For All’ look forward to the work programme’s evolution.
In particular, we would like to cite submissions from the Sun Movement, regarding the investment case for good nutrition and the double burden as well as country ownership, Raghaventra Guru Srinivasan, regarding the business case for good nutrition and national ownership on tax policy. We strongly agree with Sandy Thomas regarding the lack of reference to obesity and childhood obesity. Save The Children legally binding legislation and clearly reminding us of the metrics in terms of what funding is actually required. We strongly endorse the concept from Jane Sherman on a framework policy on nutrition interventions to act as a guide for Government and aid organizations under criteria such as cost effectiveness and impact. We would like to also to congratulate Jane on her outstanding submission on nutrition education. We pay special attention to Stefano Prato from the Society for International Development Kenya for an excellent and systematic set of documents. Samantha Chivers from 1000 days United states for giving us a realistic overview of funding issues with Decade Nutrition itself.
We would like to contribute to Decade Nutrition’s work program vision, elements and action areas with the following recommendations and rationales.
1. The Nutrition Landscape – Talking About All of The Problem – All of The Time:
The Nutrition landscape:
The nutrition landscape has changed so rapidly that we in the nutrition community do-not either have the words or mindset to deal with it. If we are to finally end global malnutrition it needs to be done using an inclusive and unified approach. We need to be talking about all of the problem all of the time.
Language:
We find that a barrier to a unified approach to ending malnutrition is our narrative around it. The recurring statements by the Nutrition Community which call obesity over-nutrition is confusing because we simply cannot be over nourished and malnourished at the same time. It suggests a lack of urgency and is factually incorrect.
Recommendations:
1.1 We propose two possible terms for malnutrition in its two manifestations that are both clear and accurate.
Underweight Malnutrition or Sub Asian Malnutrition and Overweight Malnutrition known as Obesity.
Rationale:
We believe that the words we use are important because it will, in particular, allow Western Nations to take owner ship of the problem. It will also allow governments to present more accurately to its people, the scale and magnitude of the problem that we are all facing.
2. Looking at malnutrition in all its forms:
The Global Nutrition Report 2015 has stated that in order to achieve the second sustainable development goal “we need to pay as much attention to the obesity epidemic as we do to under nutrition“. Given that the ultimate aim of Decade Nutrition is to support ICN2 and the SDGs and the adoption of the WHO’s global noncommunicable disease (NCD) targets by 2025. It is surprising therefore that the draft Work Program is focused on underweight malnutrition with much less emphasis on overweight malnutrition. As was pointed out by Sandy Thomas from the Global panel on Agriculture and Food Systems for Nutrition. It is also surprising to us that the WHO European union and South East Asia action plan for ending obesity in children has not been mentioned given its relevance to global malnutrition.
The Nutrition Decade needs to be a time when we radically redefine our thinking around malnutrition and food production systems. We need to understand better how we present the scale of the problem to our citizens.
Recommendations:
2.1 That Nutrition Decade focuses equally on all aspects of malnutrition
2.2 In line with the Global Nutrition Report 2016 “All national governments should establish SMART national targets for stunting, wasting, exclusive breastfeeding, low birth weight, anemia, childhood overweight, adult obesity, diabetes, and salt reduction by the end of 2017. These targets should be ambitious but achievable and aligned”
2.3 It is imperative that we find ways to make nutrition newsworthy, interesting and personally relevant to everyone. We can do this by creating an inclusive approach that has at its center citizens right to informed choice.
We must directly tackle the impacts and perpetuating cycles of over consumption to health and wellbeing and consequential climate change. We would also suggest that Stainable Development Goal number 12 has a much higher relevance to nutrition than is being suggested. Both our personal consumption and production of food is affecting our lives so negatively. We must act now with the knowledge of what 2050 will be like if we do not succeed. History's pen is watching what we are now doing.
2.4 Establish a world nutrition summit template on the climate change talks in Paris. Please find attached document and brief overview further on in the document.
3. Investment Needed – We Know What To Do:
The painful truth that every organization and institution working in nutrition faces daily, is that we know exactly what to do but we simply do not have the financial resources or the political support to do it or political will
Not only is under investment in nutrition morally incomprehensible it does not make economic sense to not invest given the clearly documented returns. Malnutrition in all its forms is costing 2 trillion dollars per year. We know 6.5 million people, half of whom are children are dying annually because of its effects. According to the World Bank we need an annual investment of 7 billion dollars. Investment over the next 10 years which will give a return of 17 times that number. Tackling malnutrition is proven to be one of the most powerful policy options available to improve our overall health and long-term prosperity. So why is this investment not happening?
Recommendations:
3.1 As a matter of priority set up an advisory nutrition funding council that will reevaluate and reenergize all possible funding and financial streams such as:
The unrealized promise of development aid reaching 0.7% GDP
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Look again at where official development assistance (ODA) is being allocated and how new rules on how it is defined, is hindering on the ground impact.
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External Debt repayments of low-income countries. Following the example of Denmark on its stance on unethical lending to Mozambique. Given the high returns on investment on nutrition it makes financial sense to Reinvest the Debt straight into nutrition. This reinvestment could be one of the flagship calls for Decade Nutrition.
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Strengthen advocacy for Investment
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Consider a Reinvest the Debt campaign
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International Monetary fund
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World Bank
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Investment funds
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Stock market
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Reinvest unhealthy food tax back into nutrition initiatives
4 Country Commitments Accountability:
“More must be done to hold countries, donors, and agencies accountable for meeting their commitments to improve nutrition." Global Nutrition Report. (2014)
Recommendation:
4.1 Governments to set legally binding targets in order to meet commitments on ending malnutrition in all its forms by 2030. To the extent we know the scale of the problem, we can set targets to reduce it by percentage year on year from now till 2030. The voluntary route is unfortunately not yielding results. Millions of people are dying on our humanitarian watch. We are now at the scale of billions of people are not reaching their full potential because their basic rights to nutrition are not being met. The malnutrition crisis should be committed to, in the same legally binding way we are committing to change our behavior on Climate Action, including cost implications which are to be directed into investment in nutrition.
We believe that these need to be key questions of the Nutrition Decade.
5. SUN Movement Mechanisms – A Template for Change:
A stated aim of Nutrition Decade is to foster a global movement to end all forms of malnutrition within existing structures. We are fortunate to have such a structure in place already in the form of the SUN Movement, which is a framework for action that is working. Its vision is to have a world free from malnutrition in all its forms by 2030. It is impossible however for the movement to achieve its stated vision, as it is continuing to concentrate on underweight malnutrition.
However, the mechanism is in place for that to change ‘SUN is open to all countries whose governments commit themselves to scaling up nutrition and to all stakeholders committed to providing support.’ (SUN ICE ToR, 4) (Mokoro, 2015: 8)
A central question for the future of the movement needs to be whether the next developmental stage requires it to become a truly global movement.
Recommendation:
5.1 SUN’s evolution needs to include a broader nutrition objective, that would also specifically address over weight malnutrition and so embrace all forms of malnutrition on an equal footing. Tailoring SUN support to different country contexts and needs. The west can take a leadership role with swift multi sectorial actions spurred on by the active membership of the SUN Movement. Citizens know if they are overweight, they do not however know that they are malnourished. This might help to generate public debate.
Rationale:
Creating a truly global multi-sectorial will help all countries and its’ citizens to face the problem ahead of us inclusively. This so far has not happened and in the view of Nutrition For All is unlikely to happen given current plans. Resources will need to be in place to facilitate such an expansion. We however feel strongly that such a move can and will be revenue positive.
6. Call to Action - Nutrition For All World Summit:
A proposal has been sent in late 2016 to a small group of people in the nutrition sector for a Nutrition For All World Summit. Inspired by the Paris climate change talks, the Nutrition for All Summit, where every country would recognize their problem in terms of malnutrition and make public commitments to its citizens. This is what Tom Arnold former SUN movement coordinator regarding the proposal for the Nutrition for All World Summit. (2016)
“There is a lot in the submission I agree with. I also admire the work you have been doing in India over many years and the credibility this brings to underpinning what you are advocating for.’’
Find attached Nutrition For All world summit proposal.
Rationale:
Over-nutrition, obesity and their associated non-communicable diseases are now widespread and increasing so rapidly that the World Health Organization refers to this phenomenon as a new pandemic. Moreover, obesity is growing in all developing regions, even in countries beset by high levels of poverty where increasingly there is a double burden on the healthcare system from Under Weight Malnutrition-nutrition and Overweigh Malnutrition.
All international conferences on nutrition focus on underweight malnutrition. A unified global response is needed and has been shown to work as is evident in the Climate Change talks. A key to the summit will be to stimulate citizen involvement. Nutrition Decade can play a key role in this. Investment in solving underweight malnutrition and overweight malnutrition would be key elements of the proposed summit.
Data Collection:
“As the world embarks on an ambitious project to meet new Sustainable Development Goals (SDGs), there is a urgent need to mobilize the data revolution for all people and the whole planet in order to monitor progress, hold governments accountable and foster sustainable development” A World That Counts 2014
Nutrition For All have developed and completed the first year trialing of the 1000 day app. It is a real time data collection monitoring and evaluation tool, that encourages stake holders to implement targeted nutrition programs around the first 1000 days of a child's life. It is bringing data monitoring into the 21st century with a intuitive, easy to use interface that is within the learning capabilities of all field workers. It relies on SMS to send and received data such as real time outcomes.
A short video outing the app is available to watch. The system cost E 120,000 to build and a lot of hard work. We are taking steps for this to become open source so that Governments can create there own versions of it and helping regain autonomy over their Nations nutrition status. We are seeking more stakeholders to conduct field trials of the 1000 day App.
How can we contribute to Decade Nutrition:
We at Nutrition For All believe that we can be a strong independent voice of advocacy with an inclusive approach. We will advocate for nutrition without prejudice and with out preconceived ideas of what is not possible. We come with a decade and a half field experience in targeted Maternal nutrition programs. And Community Management of Severe Acute Malnutrition (CMAM)
We warmly welcome all contacts regarding this submissions.
Pat J Mc Mahon
Mr. Pat Mc Mahon