From bowel movements to social movements, the nutrition workshop I attended this week at the Bill and Melinda Gates Foundation had it all. A group of about 40 top researchers met to exchange knowledge and ideas about how to accelerate declines in infant stunting (low height for age for those -9 months [in utero] to 24 months of age). There were gastroenterologists, doctors, epidemiologists, biologists, nutrition scientists, and me, the sole economist. We moved through the disciplines and the light they each shed on how to promote infant growth and prevent its faltering.
On measurement, we concluded that height for age is the best proxy for the things we really care about for infants—immune system development and brain development. This is different from the MDG 1 indicator—underweight—but we decided that recommending this be changed before 2015 would be counterproductive—the nutrition community would just look indecisive.
On achievements – we recognized that nutrition specific interventions (those that have nutrition improvement as the key goal) could currently deal with approximately one third of stunting and that (potentially) nutrition sensitive interventions (such as agriculture [the topic of my presentation], cash transfers, and sanitation) would need to contribute more and that they have the potential to do so.
On country experiences of sustained nutrition reduction, we heard about the good (Brazil and Mexico) and those waiting for nutrition lift off despite strong income growth (India, Ghana). Political movements were the key to success, lack of leadership the block for those waiting on the launch pad.
The priority action point (determined by a vote) was to strengthen the capability of individuals, organizations and institutions to (a) make the existence of undernutrition more uncomfortable to those in power and (b) do something to accelerate undernutrition reduction. Without drivers from civil society making a lot of noise about undernutrition and without leaders able to take the initiative to do something about undernutrition, all the other actions will be weakened.
The priority research issue (also voted in) was to rigorously design, implement and evaluate integrated, holistic and comprehensive interventions for nutrition. I wondered how equipped the nutrition research community is to achieve this ambitious goal. This requires politics, anthropology, communication and management skills being added to the mix. And even then we have to work across disciplines—and strangely enough boundary spanning is not one of the nutrition community’s strengths.
The workshop will no doubt influence the Foundation’s future work and, hopefully, the priorities and ways of working of many others. I enjoyed it. It reconnected me to a community I am very fond of and an issue I care passionately about. The workshop was organized superbly—a great mix of participation and decisiveness.
The Foundation could do much more of this kind of expectation setting and recalibrating of key topics—they have the independence and clout to influence the field, and this nutrition team were very keen to listen, learn and reflect.