27 September 2013

How to get agriculture and nutrition more in sync? Focus on the fundamentals

I was at the CGIAR Science Forum this past Wednesday in Bonn.

The title of my presentation was: Bigger Impacts of Agriculture on Nutrition-What Will it Take?

My emphasis was on the fundamentals.

We spend a lot of time wondering about how to make agricultural interventions and policies more nutrition-sensitive, and this is sensible, but transformation will only be achieved when we understand how to change our expectations for agriculture's contributions to improved nutrition status.

We only change expectations for agriculture by focusing on things like:

* reframing outcomes--agriculture is not about food production, but about income production, and where markets are poor, and people cannot buy or sell products, it is about producing diets for own consumption
* understanding the current state of attitudes and knowledge about nutrition of agricultural policymakers
* painting a picture of what an agricultural commitment to nutrition actually looks like
* investing in training that brings agriculture and nutrition together--the CGIAR should be investing in training for its agricultural policymakers and scientists and in supporting national agricultural research centres in doing the same--there are not enough universities sending out a stream of professionals into this world how are literate in both issues
* not being too precious about evidence of impact. Use RCTs or quasi experimental methods where they make sense, but use other types of evidence where they most make sense.  For sure the agriculture community must up its game on impact and learning, but an over reliance on RCTs is a recipe for missing the wood for the trees
* being creative about co-location of agriculture and nutrition activities. Work by Hazell and Fan in the late 90s showed that the impacts of agricultural investment on poverty are highly contingent on location--impacts on nutrition are probably the same
* creating space for women to become engaged--and that means men have to change their behaviour as well as women forcing their way in
* developing tools that make it easier for the agricultural private sector and the public health sectors to come together to improve profits and nutrition--see an IDS-GAIN tool here

Agriculture does have the potential to dramatically accelerate stunting declines. We must realize that potential, because nutrition specific programmes on their own will, at best, reduce stunting by 20%. To realize that potential we need to build an enabling environment for agriculture. We know what to do--it’s up to us to make it happen.

26 September 2013

The UN General Assembly's Challenge: To Build a High Level Development Goal Framework from the Ground Up

So, the UN General Assembly (UNGA) meetings are over.  The press release is out and the reactions will no doubt roll in.

For those who are not in NYC to catch the whispers and rumours (I am not there), the key documents are the UN press release, Ban Ki Moon's A Life of Dignity for All (July 2013) presented to the UNGA, a Letter from the Co-Chairs of the UNGA's Open Working Group on Sustainable Development Goals (July 2013), and, of course, Participate's new report on how positive change can happen and the lessons for the next set of Development Goals.

The press release is not that exciting (are they ever?). The release calls for the next goals to "balance the three elements of sustainable development – providing economic transformation and opportunity to lift people out of poverty, advancing social justice and protecting the environment".  This is good--the advancing social justice is surely there because of the strong efforts of civil society. But these 3 have long been uncomfortable bedfellows, each with their own constituency, so what makes us think they can come together under the existing institutional infrastructure?  Any UN report on development goals would be so much more powerful if it told us that the UN itself will realign--institutionally and organisationally--behind such goals. 

To be fair, the Secretary General's report does talk about institutions needing to be "fit for purpose"--I just hope the UN is included in that.  The SG's report is good in that it not only talks about rights (which UN document would not?) but it translates that into inclusive growth, empowering women, tackling exclusion and inequality.  In fact it lists 14 areas in which progress needs to happen--but I think with too much of an emphasis on ODA and not enough on domestic resource mobilisation (mentioned twice in a 20 page document).

The Open Working Group Letter documents its progress since March 2013.  The OWG is currently in stocktaking and consultation mode.  This ends in February 2014 and drafting begins in March 2014 for a report to the 2014 UNGA in September, with the big set-piece at the UNGA in September 2015.  The progress report states that "poverty eradication remains the overarching objective of the international community and needs to be central to a proposal on sustainable development goals".  This will reassure some who felt that the SDGs would focus in an unbalanced way on the environment. 

The big elephant in the room in all of this is the quality of economic growth.  We tend to judge growth in terms of its quantity, not its quality.  Does it lift people out of poverty? Does it wreck the environment?  Does it increase inequality? These are not questions we ask regularly enough and the IMF and the World Bank certainly do not--they should, and they should generate answers too.

To get a sense of the potential synergies and tradeoffs between economic opportunity, social justice and environmental sustainability, where best to look? 

People living at the margins--they have to integrate and deal with the harsh tradeoffs we can't imagine and are oblivious to.

MyWorld is an interesting and useful people-focused exercise, polling millions about their priorities for development, but like all ranking exercises it tends to atomise the debate.  For example, "a good education" comes up as the number one priority for most countries, but how important are other priorities in the list, such as a responsive government, absence from violence and gender equality, to achieving a good education?  Pretty important I would say. 

Participate is another such initiative and one IDS is involved in.  If MyWorld simplifies, Participate reminds us of the complexities. Complexity is not something policymakers like (and maybe something researchers love), but I like the complementarity of the two approaches--sometimes simplicity is needed, sometimes complexity needs to be appreciated.

The new Participate report stresses the how rather than the what. It helps to tell hundreds of everyday stories about how structural issues can pile misfortune upon misfortune and what the triggers for change look like, stressing people's own agency.

The challenge for the Open Working Group will be to build a high level picture, which respects different contexts and views (whose goals count?), from the ground up.

Quite a challenge, but not nearly as big a challenge as those faced by the billions living on less than $2 a day.

19 September 2013

Introducing the 14 Nominees for the 2013 Nutrition Champions Awards

A while ago I mentioned that the Transform Nutrition Research Consortium, in support of the Scaling Up Nutrition Movement, invited nominations for unsung Nutrition Champions.

Nutrition requires coordinated action across different sectors and from national to community levels and strong leadership is essential to effectiveness.  Yet we rarely recognise and celebrate that leadership.  This award aims to begin changing that.

The Nutrition Champions call led to the nomination of 56 eligible candidates (full list available on the Transform Nutrition website).

Fourteen were shortlisted by the review panel (7 from Africa, 5 from Asia and 2 from Central America).  Their remarkable stories can be found here.

The 3 selected champions will be announced at the Scaling Up Nutrition Global Gathering meetings at the UN General Assembly in New York next week. 

Each nomination was reviewed based on:

1. The extent to which their achievements and actions have helped accelerate reductions in undernutrition, either directly or indirectly.

2. The degree to which their achievements and actions have transformed thinking or action e.g. changed the degree and type of attention to undernutrition, changed public attitudes, institutional structures, or policy-relevant decisions that may have been associated with high levels of undernutrition in the past.

3. The sustainability of their achievements – or their likely durability -- in terms of longevity, legacy and impact.

The panellists were:

Shams El Arifeen, Director of the Centre for Child and Adolescent Health ICDDR,B Bangladesh and Transform Nutrition Research Director
Bibi Giyose, Senior Food& Nutrition Security Advisor, New Partnership for Africa’s Development (NEPAD)
Anna Lartey, Director of Nutrition at FAO and IUNS president
Ellen Piwoz, Interim Deputy Director, Nutrition Lead for the nutrition team in the Family Health division of Global Health Program. Bill and Melinda Gates Foundation (and Transform Nutrition Consortium Advisory Group member)
Emorn Wasantwisut, Senior Advisor, Institute of Nutrition, Mahidol University, Thailand

17 September 2013

Boyd Swinburn and Obesity Policy: Mosquitoes Don't Have Lobby Groups

Yesterday's highlight of the International Congress on Nutrition was a presentation by Prof. Boyd Swinburn (Deakin University in Australia)  the role of policy in combatting overweight and obesity in high income countries.

Why a highlight?  Well, first Boyd (who I had not met before) is a terrific presenter--a depth of knowledge, communicated in just enough depth, and all with a fine sense of humour.  It was also a highlight because so many of the issues he raised are issues close to my heart, but which I cover in a undernutrition low income context.

At some times it felt like we had been separated at birth.

Boyd divided the policy space up into big P policy (political commitment) and small p policy (specific rules and regulations).  He also divided things up into direct small p, policy that tells people what they can and cannot do, and indirect small p, policy that incentivises behaviour (e.g. tax).  He noted that the "nanny state" criticism is misplaced because there are very few direct policies directed towards obesity.

The big revelations came when he started telling us that the obesity policy community don't focus enough on what he called the "back of the house" issues such as leadership and governance, capacity and resources, knowledge and evidence, and accountability mechanisms.  This is precisely what Lancet paper 4 (Gillespie and Haddad et. al.) outlines and calls for--but for undernutrition in low income countries.

The other big parallel was with his involvement in the collective effort called INFORMAS to assess the commitment of governments to do something about obesity--assessing policies, programmes and legislation--eerily similar to the HANCI index assessing commitment of governments to reducing hunger and undernutrition.

There were three parts of his presentation that were particularly troubling:

First, a study that tells the tale of two towns in California that tried to tax soda (carbonated sugar drinks).  Their mayors put these propositions to the electorate.  The beverage companies spent $150 per voter to demonise the tax, and it lost by 2/3 to 1/3. 

Second, he told us about a study  by G. Jenkin in Obesity Reviews 2011 12(12) which analysed the fate of public health task forces in Australia as they get converted into policy.  The public health task forces typically make recommendations that are in line with collective responsibility (the other end of the spectrum is individual responsibility as advocated by industry). The government then usually describes and responds in ways that move a little more towards the individual responsibility extreme.  The government solution, when put forward is further towards individual responsibility.  The eventual action, when put into law is pretty much what the industry wants or can live with.  Why is this so different from infectious disease, asks Swinburn?  Simple, mosquitoes don't have lobby groups.

Third, he and his colleagues have modelled the cost effectiveness of different policies for obesity control and reduction.  They concluded that the ones most favoured by the Australian government were the ones that were the least cost effective. (I missed the reference).

Boyd definitely has no problem bracketing Big Tobacco and Big Food.  But while we don't need tobacco, we need food, right?  Well we do not need highly processed refined foods which are high in sugar, salt and fats.  But there are no externalities (external effects on others that are not captured in the market) in Big Food, right?  Well, there may be fewer individual externalities but there are many collective externalities, think of health insurance, health care, lost productivity etc.

I asked him what will be the triggers to a step change in public policy--he thought it would be cities going broke because they could no longer afford the health care costs.  As he said, few governments prioritise health over business.  Perhaps we are approaching the point when health becomes a serious constraint on business.  That would be an interesting question to address whether in under or  overnutrition in low and high income contexts. 

It is time to reunite these relative strangers.

16 September 2013

Development Speak: This Year's Model

It is Fashion Week in London again, and it is time to have a semi serious look at words and terms currently riding high in development land.

1. Resilience. The biggie.  Everyone is glomming on to it.  What does it mean?  Bouncing back? Bouncing back better?  Avoiding the drop in the first place?  And whose resilience counts?  (sorry, I couldn't resist).  Resilience probably has a lot to offer, but we need to make sure it actually does.  

2. Transformative. Something that changes the rules of the game.  But often it just means "our stuff is so important it must be transformational".  I am involved in a research program called Transform Nutrition and the transforming filter is an important one to select activities, but it is easy to forget to use it.

3. Multi-stakeholder Platforms.  Put visions of your favourite train station aside, this is about creating spaces for people to come together.  Very good, but remember the power of the different players will be different and the vision of a platform is something that is level.  The risk is that the platform is more of a steep slope--one that ends up with everyone sliding to the feet of the most powerful.

4. Scaling Up.  Not just about rolling out or multiplication.  Rolling out always runs the risk of petering out.  Multiplication ends up with fuzzy photocopies of the original idea.  Scaling up needs to be thought through carefully, planned for and resourced with skills and money.

5. Political Economy. Often used as "whatever I cannot fit into a quantitative model" but it is the study of how political policies interact with economic processes. Working with my political science colleagues at IDS it is clear that it has structure and a long and storied intellectual tradition. Resist the temptation to use it as a dustbin for failed economic analysis.

6.  Mixed Methods. Often used as "I don't have a clue what method to use yet and I will figure it out as I go along".  Again, mixed methods can be done brilliantly or they can be done haphazardly and without rationale.  Reviewers, whenever you see this, dig deeper.  (I could say the same for "statistical model".)

Fashions change--what will be next?

Sustainable Diets: An Idea in Need of a Movement?

When I first heard about sustainable diets, I was a sceptic.

But I am gradually beginning to think that there is something substantive to the idea and so I was happy to chair a couple of sessions on it, organised by the Daniel Carosso Foundation, at the International Nutrition Congress currently taking place in Granada, Spain. (The speakers were interesting and eloquent--session agenda below.)

Sustainable food and diets: From theory to evidence – Based successful practice
The sustainable food and diets
Barbara Burlingame, Food & Agriculture Organization of the United Nations, Roma, Italy
Global state of the art in high income countries
Jennie Macdiarmid, Aberdeen University, Aberdeen, UK
Global state of the art in low and middle income countries

Evidence-based successful practices: Sustainable food and diets in the field
Chair: Lawrence Haddad, Sussex University, Brighton, UK
Perspectives and expectations in food and diets policies
Tim Lang, London University, London, UK
Perspectives and expectations in Africa food and diets policies
Joyce Kinabo, Sokoine University of Agriculture, Morogoro, Tanzania
Case studies from the field: engaging communities
Jessica Fanzo, Columbia University, New York, USA

Roundtable, Research gaps & policy challenges
Chair: Lawrence Haddad, Sussex University, Brighton, UK
Speakers: Thomas Allen, Bioversity International, Roma, Italy
Tim Johns, Mc Gill University, Montreal, Canada
Eileen Kennedy, Tufts University, Boston, USA
Sarah E. Lewis, The Sustainability Consortium, Arkansas, USA
Tony Long, WWF European Policy Office, Brussels, Belgium

So why sceptical?  Sustainable diets are healthy, affordable and have an environmental footprint that does not do harm to future generations. Nothing to be sceptical about there: this economics-environment-health triangle has been around for ever.  The scepticism comes from the interventions advocated to achieve it, simply because there is not much obvious evidence around on how to do this. 

So I would like to see an attempt to collect the non-obvious evidence, things that have worked in other areas to achieve these win-win-win outcomes.  There is a lot of work on health-environment linkages, economic-environment linkages and nutrition-economics linkages.  Someone needs to put them together. This will help us identify the opportunities for reframing or repositioning existing interventions and policies and will help us innovate on new ones.

But this is not enough--in addition we need research that highlights the potential impacts of changing production, distribution and consumption choices on the environment and the tradeoffs of these with health.  For example, bananas have a very low carbon footprint compared to asparagus because the latter are airfreighted and the former are shipped.  But bananas have low beta carotene content.  Many of the tradeoffs will be unanticipated, but many can be predicted. Once we have a topography of "impact points" in different contexts, we can begin thinking about which impact points are potentially amenable to interventions and policy.

But because there are so many players, sectors, and interests in the sustainable diet area, the danger is that non strategic choices are made. 

So I would like to see 5 things happen to take the sustainable diet ideas to the next level:

1. Consciously become a movement.  A movement advocating for the goal, but not yet for a particular solution.  Movements are hard to start but once they do they generate momentum and energy.  Movements also provide a big tent for all players to come together.  The Scaling Up Nutrition movement is a useful example.

2. Organise the evidence.  Do it around a common conceptual framework and a definition that is easy to remember.  Do this in a way that is authoritative and does not look like it is promoting anyone's institutional agenda.  This could be via a series of peer reviewed review articles backed up by an institutional arrangement akin to a more modest version of the International Panel on Climate Change (IPCC).

3. Educate policymakers and others.  Propose the metrics.  Tell them about the trends, the causes, and the consequences.  Make it clear which interventions work, which might--and which do not. Finally educate on the different policy approaches and the options within them, and try to get them more comfortable with complexity.

4. Agitate.  Work the system.  Write the op-eds, canvass the parliamentarians, work with the old media and art communities, work with new media to highlight success stories and disastrous excesses, work with universities to valorise innovative courses, convince the donors to fund across sectors, and work with the journals to become more issue oriented.  Don't let the issues die.

5. Be political.  This agenda is inherently about tradeoffs.  That means some people will sometimes win and some people will sometimes lose. Promote transparency in those tradeoffs, hold actors to account, understand the different agendas and motives, don't be ideological about the private or public sectors. 

In this way the sustainable diets idea can be sustained.   

09 September 2013

Laggard, Diehard, Hazard and Wayward: Tales from the policy pubs

So, what's new in the policy publications this week?  Here are a few things that caught my eye:

Laggard: This is the title of an article in by Mohamed A. El-Erian in Foreign Policy.  It is about the IMF in advance of next month's Annual Meetings in Washington D.C.  The title is a play on words (the IMF's Managing Director is Christine Lagarde) and it refers to the IMF's inability to reform itself.  The article bemoans the domination of the IMF by European politicians and, as well as being unfair, it notes how this representation leads to dangerous conflicts of interest (e.g. delaying action on Greece until too late).  The article ends up saying that no-one has both the appetite for a fight and the ability to win one.  All a bit depressing really.

Diehard: This is in relation to a new book on Jeffrey Sachs by Nina Munk (OK she calls him The Idealist).  It is not clear to me what the book is meant to be.  It is clearly a story of the Millennium Villages (a story yet to be concluded) but also a portrayal of Jeff Sachs himself.  As I have said before, I admire Jeff Sachs' determination to do something other than pontificate (as most of us do), and his drive, focus and self confidence.  Time will tell if his diehard stance on the MV was the best way to spend well over $100 million. But I was left wondering why the book was written--it is neither critique nor  hagiography.  (Incidentally the book mentions the 2011 blog in Development Horizons "Jeff Sachs: the LVP of the MVP?")

Hazard:  Foreign Policy's Sin Special edition focuses, among other things, on syrup.  Specifically on high fructose corn syrup. This sweetener is produced by the US in huge quantities as a result of farm subsidies, and is used by the food industry as a cheap sweetener.  Mexico has now passed the US as the country with the highest incidence of obesity (over one third) and there is a study from the Minnesota based Institute for Agriculture and Trade Policy linking the spike in Mexican obesity to the passage of the 1994 NAFTA bill which allowed junk food to flood in from the USA.  As the US slowly wises up to the fast food industry (and a particularly funny episode of Parks and Recreation comes to mind) obesity will continue to be exported to lower income countries with weaker public health regulation--a really worrying trend.

Wayward:  This refers to an article in Prospect referring to the summer's protests in Brazil.  It is clear that much of Brazil's middle class feel that their political class have just lost their way.  One of my Brazilian friends told me that people in Brazil are fed up with Swedish style taxes and Nigerian style services (which might be harsh on Nigeria).  Lula's Workers Party have not escaped blame, having been tainted by a huge corruption scandal, the build up of a huge bureaucracy and an unwillingness of those in power to distribute wealth.  A lot more than the World Cup is riding on the performance of Brazilian politicians over the next 12 months--if they do not deliver on health, education and infrastructure there will be no football in Rio in 2014. 

03 September 2013

The UK's Contribution to the next Global Development Goals: No need for Soul Searching

By Lawrence Haddad

Last week the Government suffered a hard power defeat when parliament voted against military action in Syria at this time. This, some senior Government ministers said, should lead the UK to do some “soul searching” about its role in the world. At the UN General Assembly in New York in two weeks time, the Government has the opportunity to register a major soft power success; one that would signal much to the rest of the world about the role the UK can play in global affairs. A key item on the 68th Session’s agenda is to discuss how to accelerate progress on the Millennium Development Goals and to agree a timetable and process for the establishment of new global Development Goals.

David Cameron's Government has already proved its ability to contribute significantly to the process of developing new global Development Goals. The report of the Secretary General’s High Level Panel, co-chaired by the UK, Liberia and Indonesia was widely praised for its vision, clarity and comprehensiveness and it provides a good starting point for the discussions that will continue over the next 20 months. The Prime Minister has also been staunch in his defence of the UK's aid spending. Government spending on aid is at 0.7% of Gross National Income, and in spite of heavy pressure from the “bongo bongo land” crowd the PM has held firm in his commitment. I was in the audience at the June Nutrition for Growth event in London and he convinced me that development is something he really cares about.

The Government's nerve needs to hold for the remainder of this Parliament because a lot is at stake. First, there is a real sense of momentum right now, and as the Millennium Development Goals Report of 2013 (pdf) shows, progress in development outcomes is strong in every region. This needs to be maintained to further encourage development champions fighting for progressive change within their countries. Second, the West is slowly emerging from its economic slowdown and while this will not lead to large increases in aid, it will help these countries to be more outward looking—an essential prerequisite for the collective action needed to solve key development issues such as climate change, tax flows, trade and the control of cross border flows of arms and narcotics. Third, many countries in sub-Saharan Africa and South Asia are feeling confident in their strong macroeconomic economic performance, are generating economic opportunities, attracting investment and are becoming increasingly influential. It is clearly in the UK’s narrow as well as broader national interests to stay at the forefront of progressive global change.

For the UK Government, holding its nerve on the international development agenda will not be easy with an election a mere 20 months away. First, as a 2012 YouGov-Chatham House survey reports (pdf), spending levels on international development remains unpopular with the electorate. Second, the nationalist UK Independence Party's recent rise, if sustained, will put additional pressure on the Government to lower its commitment to international development. Third, the vote on Syria will be interpreted by some as a victory for a Britain that should shun the outside world.

The benefits to the UK's leadership in thinking and action on global development are many. Some are intangible: the soft power that we bank as a result of our commitment to working with others, the relationships we build up in an increasingly interconnected world, the know-how we gain that gives us a competitive edge, the boost to a pluralistic culture that gives our nation such richness, and the identity that reaffirms it is right to work to support others who are less fortunate than we are. But these intangibles are not the reason many of us commit to international development. We need to see the tangible benefits that the UK brings to the table.

The Nutrition for Growth event in June was one of many examples. At that event, 4 billion dollars were raised to help 165 million infants to escape malnutrition. That money will not go into Ray-Bans, Ferraris and F-18s, it will go into breastfeeding promotion, the fortification of flour with iron, the iodization of salt, the distribution of vitamin A capsules to children suffering from eye problems, the distribution of rehydration solution to children with chronic diarrhoea and vomiting, programmes to get rid of parasitic worms living in the guts of tens of millions of children--the list goes on. These types of interventions address the cause as well as the symptom because they help children do better in school (their brains have not been damaged in the first 2 years of life) and earn more money later in life. Estimates show that children that avoid malnutrition early in life are 33% more likely to escape poverty 40 years later. Without UK leadership that funding would not have been raised.  Funding that will help prevent malnutrition in millions of infants.

So what does the UK government need to do at the General Assembly in New York?

First, convince its UK partners that it remains strong on development. The UK has some of the most effective NGOs, civil servants, researchers and think tanks in development and they are better able to do their job with an inspirational and committed Government. Second, rally the other Western nations to stay focussed on global development. There are lots of domestic and international distractions and the recent G8 summit was not exactly an overwhelming success. Third, continue to play the delicate role of making significant contributions to thinking about the global Development Goals while being part of a collective endeavour.

What are those significant contributions to thinking about the next global Development Goals? As some of our work at IDS has shown, make sure the Goals can be designed by everyone, ensuring that the less powerful and the less frequently heard are listened to—these are their Goals too. Make sure the goals are for everyone within a country, especially the most destitute, but also for the generations to come—this means focusing more on equity and more on sustainability. Make sure the goals are for each country—the language of developed and developing countries is an anachronism.

When it comes to global development, we all have a stake and we all have responsibilities—we really are all in this together. There’s no need for soul searching, just action.