Feast and famine - trends in nutrition

More than 20 years on from the first ever International Conference on Nutrition, its successor (ICN2) is due to take place in Rome this week.

The nutrition challenges facing the world have changed enormously. Undernutrition rates have dropped while obesity has skyrocketed - now killing more people than undernutrition. Diabetes has become one of the top 10 causes of death globally, while increasingly volatile/erratic weather has brought with it new threats to global food supply.

ICN2's official purpose is to finalize the wording, and plan the implementation of, the Rome Declaration on Nutrition, which will be signed at the conference by governments from across the globe.

At the 19-21 November conference, the outcome of which will set the path of nutrition policy for the coming years, the limelight will be dominated by heavyweights such as UNICEF, the World Health Organization (WHO) and the Food and Agriculture Organization (FAO).

Yet IRIN wanted to give a platform to other voices from the frontline of the fight against malnutrition, speaking to a range of stakeholders - from local government officials to global experts - to ask them what they want ICN2 to deliver, the biggest obstacles they face in their countries to nutrition scale-up, and what should be done to improve global nutrition."

"More accountability is needed"

Lawrence Haddad, UK, senior research fellow at the International Food Policy Research Institute and co-chair of the Global Nutrition Report.

"The big worry I have is of all the recommendations [of the ICN2's framework for action document], there is only half a page on accountability. In other words there are all these lovely commitments and recommendations but who is going to lose their job if none of this happens? Who is going to face consequences? And who is going to be rewarded? I feel like the accountability section is pretty weak.

"Also there is nothing on spending targets for nutrition. That is one of the big gaps - governments not spending enough on nutrition. Donors are spending about $1.5 billion a year out of $140 billion official development assistance (ODA). Not much really, considering child malnutrition is responsible for 45 percent of under 5 deaths.

"The ICN documents are also really complacent about the role of nutrition in the 2030 Sustainable Development Goals [SDGs]. There are 17 goals and 169 targets in the SDGs and nutrition is mentioned in one of the SDGs. That is pathetic.

"This stuff isn't rocket science, it is about being really clear about what the commitments are, being really clear about who is responsible for delivering on them and being really clear on the time frame. Then you have to figure out what the sanctions are for delivering or not delivering them. I would like to see a document from ICN2 saying: 'This is how we are going to track all this stuff.'"

"Search for holistic nutrition solutions"

Caroline Abla, Washington, DC, director of nutrition and food security, International Medical Corps

"The increasing nutritional problems related to obesity and non-communicable diseases such as diabetes are important to include given the problems we have seen in recent disaster responses - including the Syria one. For example, there is already a tentative SDG target on childhood obesity but it needs to be broadened to include the non-communicable diseases and other vulnerable groups such as adolescents.

"The last draft of the Framework of Action from ICN2 focused a great deal on food and food systems. While that is important, we need to place more emphasis on other nutrition and nutrition-sensitive issues such as WASH, ECD [Early Childhood Development], etc."

"Not just a developing world problem"

Roger Mathisen, Vietnam, emergencies/nutrition consultant in Southeast Asia

"I think the biggest issue to tackle at ICN2 is for developed countries to not only see themselves as donors, but that they [also] have an important role to play at home in also implementing the recommended policies and plans to address the double burden of malnutrition.

"Having worked [on] policy change in developing countries for many years, some of the most frequently asked questions from policymakers [in those countries] are: 'Why have developed countries not got this policy in place? Why are data and monitoring reports from developed countries lacking for this issue?' This is about practicing what you preach and have committed to globally. All countries should be held equally accountable.

"Such policies include national codes on marketing restrictions [ ] of breastmilk substitutes from infancy, to baby foods and other energy-dense foods and beverages high in sugar, fat, alcohol or salt, targeting the population. Moreover, this should cover import and export policies and price policies to promote quality and save foods."

"Malnutrition increases other diseases"

Francois Venter, South Africa, deputy executive director of the Wits Institute for Sexual & Reproductive Health, HIV and Related Diseases (WHI) and Associate Professor in the Department of Medicine, University of the Witwatersrand, in Johannesburg

"For a long time we have known how important nutrition and sanitation are in the fight against HIV and AIDS but they have consistently been pushed down the development agenda.

"I am extremely frustrated by how little importance is given to nutrition in the public health sector. What is the point of having amazing programmes with all the latest drugs and innovations when patients are going to bed hungry?

"I would give up a whole generation of HIV drugs and innovation if I could guarantee that my patients were going to be properly nourished. There is too much rhetoric in the nutrition field and I think public health practitioners need to start going back to basics and start focussing on provision of adequate nutrition.

"Post-2015 we need to have a clearer focus [on] nutritional goals, not faddy ideals like changing the percentage of fat or processed food, but actually goals around how many people are going to bed hungry. We need clear objectives that will have meaningful impacts, not vague recommendations that can all too easily be hijacked by commercial considerations."

Arumugam Selvarani, Sri Lanka, government child health officer, Ampitya Division, Bandulla District, Uva Province

"Big conferences [like ICN2] should address. the impact of good mental health on a child's physical progress. We know that if a child is not happy mentally then his growth can be affected. But we need clear guidance to give our patients - that if the father and mother fight all the time, [there can be a negative impact on physical growth]."

"More finance for direct nutrition"

Aboubacar Mahamadou, Niger, national coordinator for REACH Partnership and a government nutrition adviser

"We are getting closer to finding answers to our nutrition problems [after recent gains made thanks to international and national initiatives], and [getting better at] coordinating multiple interventions. Some challenges that remain include multi-sector coordination, especially nutrition financing. We should think about innovating funding mechanisms for nutrition similar to the vaccine alliance, GAVI.

"A second challenge is the implementation of 'direct nutrition' and 'nutrition sensitive' interventions given their cost. This challenge is particularly important for Niger's case. The country is vast (1.3 million square kilometres) and sparsely populated with less than 15 inhabitants per sq km.

Vedanayagam Tabendaran, Sri Lanka, district social service officer, Divisional Secretariat, Kilinochchi District, Northern Province, which primarily works with war-affected communities

"We have good knowledge on how to prevent diseases, but we need more assistance in accessing remote locations. There is never enough funds to get people to remote villages. We get to these places once a month. That is not enough to monitor populations. It is easier and effective when health professionals get to areas of need rather than trying to get the people to the health professionals. A little bit more emphasis on mobility of health workers will go a long way."

"Nutrition advances need economic solutions"

Vinod Paul, head of the department of paediatrics at the All India Institute of Medical Sciences, New Delhi, India, and director of the World Health Organization Collaborating Centre on Newborn Health for the South East Asia Region.

"India's challenge is really to use economic development to improve [the] nutritional status of our children. We are making some progress with our socio-economic development. The challenge is how to translate economic growth and acceleration of development in terms of nutritional improvements."

Vedanayagam Tabendaran, Sri Lanka, district social service officer, Divisional Secretariat, Kilinochchi District, Northern Province.

"People in my district are poor. Most still live in temporary houses, so it is very difficult to get them [to] focus on health and nutrition, which for them are secondary until they [have some income]. When there are government-sponsored [nutrition] programmes or others funded by NGOs, then people will come, but assistance is going down.

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