24 September 2016

Our Food Systems = 3 billion with low quality diets. Let's start fixing it. Now.

Yesterday, at FAO, we launched the Global Panel report on “Food Systems and Diets: Facing the Challenges of the 21st Century".  About 120 people gave up their time to hear about the report. 

The Global Panel is co-chaired by John Kufuor, the former President of Ghana and World Food Prize laureate and by Sir John Beddington, former Chief Scientist to the UK Government and it is hosted well at the London International Development Centre.  The independent report was support by UKAid and the Bill and Melinda Gates Foundation.

The report basically says the following things:

1. Diet is by far the main risk factor for the global burden of disease
2. Diets are not getting better with income
3. The consequences of poor diet go well beyond poor health and undermine sustainable development
4. The food system is a big part of the problem – and a big part of the solution

5. Policymakers have many options to move food systems from villain to hero, and the report attempts to expand this set of options

6. The wide set of options and the incomplete data and evidence base make the selection of the right set of policies a real challenge

7.  New data, new tools and new ideas (all provided by the report) are needed to help policymakers develop a set of food system policy responses that are right for their diet problems

8.  Policymakers need to make more compelling arguments for why this issue is so important—so they can bring other stakeholders into the picture, and the report aims to help here.

Perhaps the biggest message from the report to policymakers is: wake up!

Diets are the main cause of illness, they are not going to get better any time soon, and the consequences of inaction are staggering.

Members of the audience corralled me after the talk.  Perhaps the most glaring omission in the report is the treatment of consumers as shapers of food systems.  It is true that we don’t spend much time in the report on nutrition education and behaviour change of consumers.  This is definitely an important area and one where we need more answers.  But we decided to focus more on the behavior change of policymakers in the public sphere and decision makers in the private sector.  They too need to change their behavior if food environments are to make it easier for people to make healthy choices.  Consumers base their purchases on culture, income, prices, food quality, taste, nutrition and desirability, but if they are priced out of healthy foods there is not too much they can do about it individually or even, perhaps, through consumer collective action. 

Anna Lartey the Director of Nutrition at FAO said we have all missed an opportunity to get a diet quality indicator and goal into the SDGs, but let’s try to get them into national goals. I agree.  If we don’t know whether food systems are diet quality friendly and if we don’t know what diets look like, then we cannot hold public and private decision makers accountable -- and that hampers change. 

These days it seems like everyone is writing reports on food systems and diet.  The Committee on World Food Security’s High Level Panel of Experts has empowered a team (which I am a member of and which is led by Jessica Fanzo) to guide CFS members in this policy area.  The challenge for this report will now be to add value to the Global Panel one.  Unfortunately this will be easy.  Why unfortunately?  Because the problem is so wide ranging there are areas that the Global Panel did not highlight (such as consumer behavior change and collective action). In addition, this area is so dynamic that new challenges, opportunities, data and evidence can be factored into the HLPE report due out in mid-2017. 

This diets and food systems problem is so big and so long in the making it is not likely to be fixed quickly, but let’s start to get serious about it now.  

20 September 2016

10 More Songs About Social Change

Folks, in this time between leaving IFPRI and moving to GAIN I thought I would indulge one of my great passions--music.

About 6 years ago I did a list of social change songs.  We often say improvements in nutrition are underpinned by social change. So now it is surely time for another list.

I picked songs that (a) I like, (b) say something about social change, (c) are not too embarrassing and (d) did not appear on the 2010 list.

Here they are.

1. "To Hell With Poverty" by the Gang of Four.  A classic from the early 80s.   A song about the hopelessness induced by living in poverty.

2.  "Philadelphia" by Bruce Springsteen -- one of the first songs to bring AIDS into the mainstream. An an amazing song.

3.  "John, I'm only Dancing" by David Bowie.  In 1971 -- a brave song about being gay in those bleak days.

4.  "People have the Power" by Patti Smith. Much prefer this to Lennon's "Power to the People".  Why? The people already have the power.

5.  "Same Love" by Macklemore and Ryan Lewis.  When Macklemore was cool, about 5 years ago.  A beautiful song (guest vocals by Mary Lambert) about love, straight or gay.

6.  "Baltimore" by Prince.  A recent song about the death of Freddy Grey, shot in Baltimore. "Nobody got in nobody's way. So I guess you could say it was a good day.  At least a little better than the day in Baltimore".  Chilling.

7.  "Isn't it a Pity" by Nina Simone.  This live version was dedicated to the just murdered MLK.

8.  "The Community of Hope" by PJ Harvey. A song about shrinking the big food deserts in the poor parts of Washington DC.  Didn't go down too well with the DC Council, I'm told.

9.  "A Change is Gonna Come" by the Fugees.  Lauryn Hill gives the full treatment to Sam Cooke's great great song.

10. "Them Belly is Full (But We Hungry)" by Bob Marley and the Wailers.  "A hungry mob is an angry mob". Policymakers take note.

And if you want to comment on these or add some, do it below!

14 September 2016

Reflections on 3 years of work with the Global Nutrition Report

On the 1st of October I step down as the co-chair of the Global Nutrition Report's Independent Expert Group and begin my work at GAIN.

I have been working hard on the GNR for nearly 3 years and I thought it would be a good time to share some reflections.  Here they are:

1.  The decision to focus the GNR on all countries and all forms of malnutrition was a good one.  Back in 2013 this was not by any means a given—there were varying views among the GNR stakeholders.  Some felt a focus on malnutrition “in all its forms” would draw attention away from undernutrition.  While this is certainly a risk, and one we have worked hard to manage, the GNR Independent Expert Group has always felt the risks of separating out different forms of malnutrition would be much greater.  The focus on all forms of malnutrition has allowed new alliances to form, new audiences and actors to be brought into the fight against malnutrition, new concepts and analyses to be drawn on and new actions to be contemplated and developed.  With 44% of countries facing a double burden of undernutrition and overweight and obesity, these connections are even more relevant.

2. The decision to make the GNR dig below nutrition status outcomes has also been important.  While the database for nutrition outcomes is weak, with much missing data, the database for things like investment, policies, legislation, coverage and commitments is even weaker.  It is hard to hold governments and other stakeholders solely accountable for nutrition outcomes as so many external factors are at play, but if the coverage of nutrition programmes is weak, if social protection and WASH programmes pay little heed to nutrition, if the breastmilk substitute code is not enshrined in legislation, if nutrition spending is low and flatlining and if employer workforces are not protected nutritionally in the workplace, then we know exactly who to hold accountable.

3.  A lot can be done with existing data.  The GNR does not collect new data, but uses existing data to track progress, gain new insights and make recommendations for action.  Perhaps it should, but there is a surprising amount that can be done with existing data:  things that are not being done.  Outcome data are available, but progress in them is not frequently enough linked to targets.  Overlaps in outcome data are not presented frequently enough.  Budget data are available, just not assembled in the right way for nutrition purposes.  Commitment data is available but not assembled and analysed.  Some data disaggregations are available but often they are glossed over in national numbers.

4.  The nutrition community has been really generous in its willingness to contribute to different GNRs.  We must have had over 250 different contributors over the past 3 years and the vast majority have been easy to work with: egos and logos have been checked at the door and we have gotten on with the work of shining a light on success and stasis.  Long may this continue.

5. The lack of analyses on why this country or that region or this actor has been successful in improving nutrition status was surprising.  We have tried to fill this gap and to encourage others (like CIFF who are supporting a set of case studies called Stories of Change) to do the same.  I believe it is vital to do more to fill the gaps.  In nutrition we need to see all the pictures: from things that work in one intervention in one region to things that have worked at a country level in several countries.  The incentives from scientific journals are to slice and dice our stories, but we have to work hard to stitch them together so we can see the woods for the trees--and especially to inspire those who are not in the nutrition echo chamber. 

6.  Despite our best efforts, it has been difficult to engage with those outside the nutrition community, and the GNR has only just begun to make progress on this.  In the first few GNRs it was important to engage and hopefully energise those within the nutrition community and try to generate some common language, statistics and messages. But it is past time to take the messages to other groups, groups that can expand commitment to nutrition to accelerate improvements (e.g. food systems, climate, early child development etc.).  How to do this?  It takes strategic alliances and that takes diplomacy and legwork.  Who has the incentive to do this? Everyone.  Who has the responsibility? No-one, as far as I can tell.  I don’t have the answer to how to do this.  It boils down to mandates and leadership.  Mandates make it easier, but leadership needs to transcend the lack of mandates.  We need people like Jim Kim and Akin Adesina, the Presidents of the World Bank and the African Development Bank, respectively, to not lose interest in nutrition—and whose job is that?  Everyone in the nutrition community.

7. The GNR has not done a great job of connecting with the private sector.  The reporting requirements are seen by some companies as too onerous, and the treatment of business in the GNR has been seen by some as too negative.  Businesses have hoped that the GNR would highlight the positive role they can play, and those suspicious of business have been concerned about whitewashing. This stalemate is a shame and is something I want to help fix in my new role at GAIN.  Business is too present in nutrition to say we won’t engage.  But its presence is not uniformly positive.  The goal of the GNR should be to help businesses to the right thing and make it harder for them to do the wrong thing.  The GNR should also help others to navigate this complex terrain of business and nutrition by promoting transparency in all dealings.  The chapter on business in the 2015 GNR has lots of potentially useful ideas on how to do this, but as far as I can tell, very few have been picked up on.  We need to work harder in this area.

8. Finally, I am reminded of how a small number of people can make a difference.  Not to blow our own trumpet too much but the core GNR team is a small one.  The independent expert group of 20 people each give us 20 days of their time a year.  We have 1.5 comms staff, and 1.5 data analytics staff, 3 co-chairs (summing to 1 full time equivalent) and 1 full time equivalent of management time.  That is 5 FTEs in the secretariat and 2 FTEs in the expert group.  Not much for a report that has been downloaded 70,000 times in 2016 alone, which has been used to influence hundreds and hundreds of decisions (we have our own examples of 60-70) and which has (we are told) changed the narrative on nutrition.  Of course the GNR team has had help: a great Stakeholder Group with 4 wonderful co-chairs over the 3 years; and support from more than 10 donors, many of whom have invested expertise way beyond the hard currency of dollars, euros and pounds. Support from – and collaboration with – partners in the nutrition community and beyond has been critical to the GNR’s reach so far.  All of these groups have supported, inspired, problem solved and championed the report in countless ways – and they have done so collectively.

I thank all of the above actors, organisations and people (and all of you reading this). Nutrition and the GNR needs you to remain restless for-- and engaged in -- change. I will commit to doing everything in my power to support the GNR from my new position at GAIN.  (More on that later.)