Transforming political will into action for nutrition

Nutrition perspectives from the 2013 Global Food Policy Report

Student eating vegetables as part of national school feeding program in Laos.

The year 2013 saw a major step forward in global attention to nutrition. Several processes converged: the Scaling Up Nutrition (SUN) movement continued to drive the momentum, with 47 countries now having signed up; The Lancet released a new Maternal and Child Nutrition Series of four state-of-the-art evidence reviews; the “1,000 Days” advocacy movement succeeded in mainstreaming the concept in development discourse; and the history-making Nutrition for Growth summit led to pledges of over $23 billion for nutrition-relevant actions.

It was the year when the political dimension of the challenge became better understood and better addressed. Malnutrition is political because it’s multicausal in nature and requires a multisectoral response because economic or technical solutions will not suffice, because there is no Ministry of Nutrition, and because the multiple benefits of addressing nutrition will not all be manifested within a politician’s term in office. The fact that stunting is so ubiquitous in some countries as to be virtually “invisible” (along with other forms of “hidden hunger”) can also prevent the development of grassroots pressure for change from community groups and civil society. With limited pressure to act, and with limited data to hold them to account, politicians often choose “business as usual” which usually translates into nutritional stagnation.

The final Lancet paper sought to open up the black box of the political economy of malnutrition and unravel the pathways of influence and commitment-building. In a review of the nutrition-relevant policy process literature three core issues were found to be important:

  1. Ensuring horizontal and vertical coherence (between sectors and, at different levels, within sectors);
  2. Optimizing the use of information and evidence to shape both policy and pro-nutrition narratives; and
  3. Strengthening nutrition-relevant capacity to support policy change.

Political will does not fall from the sky—it needs to be proactively built. And even in cases where it has been engineered effectively, this is only part of the challenge — translating commitment into effective action on the ground is an even greater hurdle. Progress has been made with the first part of this challenge, but now the focus needs to shift to where the rubber hits the road. Incentivizing, delivering, and sustaining the right mix of actions in the right places is the core challenge for 2014 and beyond.

The cost of such action has always been much lower than the long-term costs of inaction. Significant pledges of increased funding toward combatting hunger and malnutrition have been made in recent years, but more will be needed – from public, private and from innovative new sources of funding.

As attention shifts increasingly toward implementation, issues of governance, accountability, and capacity (“the elephant in the room”) become ever more important. A different type of politics now comes to the fore – the politics of delivery – shaping the complex web of incentives, rules, and power relationships that link nutritionally vulnerable populations to service providers and different layers of government.

This will be the new heartland, where the nutrition community now needs to demonstrate progress.


Political will to do what?

Stuart Gillespie’s points are all well taken. But to resort to Field’s old “underbelly” metaphor, the question is what all this new political will has been mobilized to do exactly? To what extent will it undertake to deal with the time consuming and PR-impoverished task of addressing weaknesses in capacity? When addressed, will education and training efforts aim to create Alan Berg’s “nutrition engineers” or people with only theoretical scientific knowledge?

So far the signs are not promising. SUN, like the Millennium Development Goals, has been successful in mobilization even the USA by being non-political. Most importantly, this has involved inviting Big Agriculture and Big Food to the policymaking forums/tables where they have not been welcome in the past, either at international or national levels. It is hard to imagine what benefits are expected to accrue from such “partnerships” if indeed the intention is to avoid conflicts of interest or merely giving large transnational corporations, many of whom are highly complicit in harming nutrition via infant formula or junk foods, a way to score extremely low-cost public relations points.

The recent 2013 addition to the Lancet nutrition series by Black et al identified 10 high priority interventions. Given the way complementary feeding is being interpreted in recent years (local foods are inadequate to solve the problem), the only one of those 10 that would not involve the import of fortificants and/or other products from the rich countries is breastfeeding. Even breastfeeding in recent decades focuses not on empowering communities, families or mothers themselves, but on improving the work of modern health care professionals (eg the Baby Friendly Hospital Initiative).

Thus the community based nutrition approaches which Stuart and others focused so brilliantly on when the United Nations System Standing Committee on Nutrition was still active (now dead in the water as punishment for NOT being willing to indulge in collaboration with industry) will likely not see much emphasis as these currently committed billions role—few of which are likely to cross developing country borders.

response from author

Many thanks Ted, and good to hear from you….

1 I fully agree with you on the persistently neglected issue of capacity (as discussed in the paper: “the elephant in the room”) and on the need to revisit community-based programming. On this, Barrie Margetts and I recently completed a paper on capacity (to be published in SCN News 40) and there was a very useful workshop in Rome last week that revisited the need for Berg’s “nutrition engineers” and a massive ramp up in capacity strengthening at all levels (organizational and systemic, not just individual). The two Rogers (Shrimpton and Hughes) have produced some extremely useful papers on this too.

2 Thinking more about related issue of community-based programming and looking back at the work of the SCN in the late 80s/early 90s – two (of many) workstreams underway then, led by John Mason, were on a) identifying the nuts and bolts of “successful” nutrition programmes (highlighted in the 1989 Managing Successful Nutrition Programmes symposium report) and b) applying a wider angled lens and trying to understand “How Nutrition Improves” at a country level…..looking at the whole gamut of policies, programs and other drivers of nutritional change. 8-10 country case studies were brought out using a pre-defined structure, along with the synthesis that sought to distil broadly applicable lessons. Later, the SCN brought out more case studies. In addition, UNICEF (led by Urban Jonsson with the NISA initiative in S Asia) reviewed “successful” programs and so did others (including AED/LINKAGES). I really believe we need more experiential learning like this now. Through Transform Nutrition, we plan to develop some “stories of change” this year and next wherein local partners apply several tools (for stakeholder mapping, political economy analyses, scaling up, capacity assessment etc) systematically to try to untangle what’s been happening or not happening over the last 5-10 years in selected countries. This can be done retrospectively and it can be done prospectively. I also think it would be really interesting to go back to the nutrition programmes deemed successful in the 80s and 90s and ask three questions: what happened next, why….and what’s happening now?

3 The third issue you raised, picked up by Arun Gupta and Roger Shrimpton in their email responses to me was the Big Food/Big Agriculture challenge. This tends to take over in such exchanges, so I will just mention that yes, we made a mistake in our paper in the Lancet clarified in our “author’s reply” in that we (of course) never intended to imply that the role of the private sector should be evaluated by the private sector. That was an error caused by a change in title of that table that altered the meaning of the content of that particular cell in the table. The correct statement was in the text of the paper where we state that independent evaluations are needed. One such review on this by Transform Nutrition will be ready in a few months (and just to be clear, TN has no links whatsoever to the food industry). I hope the discussion of conflict of interest does not…. again…. overshadow everything else that needs to be addressed.

Best, Stuart