12 December 2012

The MDGs: Where Does Nutrition Fit?

At a recent nutrition meeting I realised that I don’t yet have a clear idea of where nutrition should fit into the next set of development goals.

I also realised that the wider nutrition community has not had this discussion either.

As many critical decisions will be made in the next 6 months, we need to get our act together.

So what are the options?

A preliminary set might look something like this:

1. Business as usual.

That is, the underweight indicator in the poverty and hunger MDG. This seems unsatisfactory given the ambiguity attached to underweight—improvements in it do not necessarily track healthy growth (e.g. overweight but short kids).

2. Nutrition as a separate MDG.

There is probably not enough political space for this, given that the MDG set is already health-heavy. But if there were space would this be a good thing? It would probably draw more resources to nutrition (that is what the health MDGs did, by most accounts) and heaven knows nutrition needs that. It would also be a goal that could be embraced by rich and poor countries alike, thus unifying the under and over nutrition sides of the coin and generating a truly global goal, leading the way on other goals that will have to be global. A battery of indicators would be used: stunting, wasting and a healthy range for underweight (young children) and body mass index (adolescents and adults). The World Health Assembly might be supportive of this given the stunting target they recently announced.

3. More nutrition indicators throughout the MDGs, but no MDG on nutrition.

This seems more politically feasible, but maybe less desirable for the reasons given above. If it were an option, what would go where? Stunting is a marker of chronic undernutrition, but it is also a marker for poverty and deprivation in general. It could be used as an indicator for MDG1, with the hope that its existence will bring nutrition interventions into the poverty frame as they are a proven way of moving a stunting MDG1 indicator in sustainable ways that which generate high benefit cost ratios. Did this happen with the underweight indicator? I don’t think so, but I could be wrong. But even if I am right, things might be different now with the energy of the SUN movement. Wasting could be used as an indicator of child ill-health—we know that kids with severe acute wasting are many times more likely to die as kids without. Ironically this could help the treatment of SAM be better rooted in the health sector (it does not have much traction there). Diet diversity could be an indicator of food security (quantity, indirectly and quality, directly) and of agricultural productivity (via income effects and via improved physical access to food where markets don’t work well). If we could measure resource use and ecosystem services, we could begin to think about sustainable diets.

There could be combinations of 1 and 3 and 2 and 3.

There are probably other options out there.

And then there is the case of targets and timelines: should the aspiration be to end undernutrition? To halt the increase in overnutrition? To halve both rates?

What do you think?

16 comments:

Bruce Cogill said...

Thanks Lawrence for the useful comments and suggestions. The MDG debate should look at why nutrition has been less than successful. This has been done but we are too locked into "business as usual" mode with the complexity of malnutrition reduced to sound bites and slogans. This Lancet this week published the impact of overnutrition on the global burden of disease. It is a powerful analysis that has reenforced the realization that what we are facing is a imbalance in nutrition/diet/lifestyle throughout the world. This imbalance results in trade offs for the individual and the state. By making us look at food as something that will make us healthy or kill us is taking us down paths that will be wasteful. So your MDG suggestion requires some new thinking than the medically dominated approach of treating us as sick. For nutrition to be part of other MDGs require a food systems approach with the imbalance seen as part of the issue but with other factors taken into account. Over and undernutrition together.
BTW FAO has been hosting a post-2015 MDG Online Consultation on Hunger, Food and Nutrition Security with over 100 entries at:
http://www.fao.org/fsnforum/post2015/
The report of the responses is downloadable from the site.
Thanks for the question and the insights.

Bruce Cogill said...

FAO and WFP are seeking comments on the post 2015 MDG agenda on nutrition Please leave your comments on how best to address hunger, food insecurity and malnutrition.
The outcome of e-consultation, together with the proposed CFS consultation, will feed into the high level consultation to be hosted by the Government of Spain in March 2013. Please add your thoughts to the current 100 plus entries.
The e-Consultation on Hunger, Food and Nutrition Security is:
OPEN UNTIL 21 December 2012
http://www.fao.org/fsnforum/post2015/

Scott Bleggi said...

Lawrence, nutrition should definitely be part of any post-2015 MDG discussion. In Bread for the World's 2013 Hunger Report (http://files.hungerreport.org/reports/2013/Downloads/HR13-Executive-Summary.pdf)we posit that improving the proportion of stunted children in a country is an MDG progress indicator. Not having an MDG stunting indicator is a serious oversight. We recommend a bulls-eye target of ending hunger and extreme poverty by 2040 - within a generation. Nutrition plays perhaps the critical role, and building the evidence base of successful nutrition-sensitive development actions will be key. If world leaders recognize the global momentum that nutrition has gained, SUN and individual country efforts will be leveraged and the goal to end hunger can be reached!

Lawrence Haddad said...

Thanks Bruce and Scott

Scott, thanks for the link. I have come to like the approach of eradicating stunting within a generation. I do think is is possible, certainly technically, and perhaps politically (depending on how effective we are at pushing for change)..

Bruce, I will join the conversation at the FAO/WFP consultation.. btw do you go for a nutrition goal or having nutrition indicators as proxies for other goals? Or something else?

Anna Lartey said...

Thank you so much Lawrence for bringing up these issues. Year 2015 is just around the corner and these issues should be occupying us all by now. At the time the MDGs were formulated nutrition was still stuggling for recognition. Now there is political will to have nutrition goals/indicators in the post-MDGs. The case has been made for reducing stunting as an indicator. It should surely get in. Indicators of diet quality should also get in.This time the emphasis should not only be on addressing under-nutrition. Over-nutrition has become a global issue as well. Many developing countries are going through the nutrition transition and we should be addressing nutrition in all its forms. I strongly believe we should have nutrition goals. Achieving better nutrition will help solve many of the nutrition-related health problems. The focus should be on prevention and what better way is there to prevent these conditions than to have better nutrition indicators in the post-MDGs. SUN Movement has brought momentum for addressing under-nutrition. Adding nutrition to the post-MDG goals will move the whole world into nutrition positive action.

Anna Lartey said...

Thank you so much Lawrence for bringing up these issues. Year 2015 is just around the corner and these issues should be occupying us all by now. At the time the MDGs were formulated nutrition was still stuggling for recognition. Now there is political will to have nutrition goals/indicators in the post-MDGs. The case has been made for reducing stunting as an indicator. It should surely get in. Indicators of diet quality should also get in.This time the emphasis should not only be on addressing under-nutrition. Over-nutrition has become a global issue as well. Many developing countries are going through the nutrition transition and we should be addressing nutrition in all its forms. I strongly believe we should have nutrition goals. Achieving better nutrition will help solve many of the nutrition-related health problems. The focus should be on prevention and what better way is there to prevent these conditions than to have better nutrition indicators in the post-MDGs. SUN Movement has brought momentum for addressing under-nutrition. Adding nutrition to the post-MDG goals will move the whole world into nutrition positive action.

Muhammad Amir said...

The case has been made for reducing stunting as http://www.trimnutrition.com/hcg/hcginjections.html an indicator. It should surely get in. Indicators of diet quality should also get in.

Lawrence Haddad said...

Thanks Muhammad... agree

Lawrence Haddad said...

Anna, agree with you on all your points. Many thanks for your inspiring leadership on nutrition (Anna is the new President of the International Union of Nutrition Sciences). best, Lawrence

Lara Savage said...

I agree that authorities must set a timeline and it should be done as soon as possible. They should also come up with foods that have nutritional value, not just food to suffice hunger. What's the point if they are not hungry but still lack proper nourishment.

Mina L. Irvin said...

I am also worried and very disappointed with the demographics of the WHO about nutrition of countries. The surprising part was that the first class nations like the US are not fairing well with nutrition. Though that is more based on lifestyle choices and not the lack of food unlike the developing nations. I believe that nutrition should start in the grassroots in which lies with the producers themselves.

Donna said...

Such a great and informative post. Health is such an important factor to living life. It is not easy to face life’s challenges when you are not feeling your best. Every ache, pain, and discomfort interferes with your ability to handle a situation or enjoy an experience. Health is crucial to happiness.

Dylan Warren said...

That's why the leaders should prioritize the welfare of each and every citizen they've got. Just to be sure that they are getting the nutrients they are needed.

http://www.developmenthorizons.com/2012/12/the-mdgs-where-does-nutrition-fit.html said...

It's important to take good care of our body's overall health condition. Remember any slightest injury to our body could affect our overall performance.

Bella Jamison said...

It's important to take good care of our body's overall health condition. Remember any slightest injury to our body could affect our overall performance.

Harold Khan said...

I'm torn between numbers 2 and 3, though I know nutrition should be highly prioritized. Will it be possible to be both, since neither of the two would be sure to be sufficient enough to support undernutrition?