Reflections from 2 days at the 3rd International Congress on Hidden Hunger

This week I was at the 3^rd International Congress on Hidden Hunger in Stuttgart, organised by the University of Hohenheim.  There were about 300 participants, drawn mostly from nutrition and agriculture; academia, civil society and business.  Hidden hunger means micronutrient malnutrition and we think that at least 2 billion people—in all countries—suffer from these deficiencies and we don’t know much about how quickly they are declining.  Not fast enough for sure.

Chatting with the German Academic Exchange Students (DAAD)

I gave 2 presentations: on food systems and diets and on the role of business in improving the consumption of safe nutritious foods.

Some takeaways from me:

The quality of presentations was high, but it was not always clear who the audience were: researchers or practitioners?  Diversity of audience is good, but not necessarily within the same session.  Often I felt that presentations could not build on each other because of this diversity of audience.

The latest research on RUTF and Home Fortification from Bangladesh is fascinating—and practical. There were two very interesting Bangladesh studies from ICDDR,B: one on ready to use therapeutic foods (RUTF) and one on Home Fortification (HF).  The first, on RUTF, was presented by Dr Tahmeed Ahmed but is not yet published. The conclusion from the study was that the promotion of locally produced RUTF is not in contradiction with efforts to improve infant and young child feeding strategies, do not lead to obesity and do not lead to commercialisation of foods for severely malnourished children.  These are 3 common perceptions about RUTF in Bangladesh and this scientific study provided evidence to the contrary.  The second paper, presented by Haribondhu Sarma, concluded that home fortification (HF) has not been well implemented in Bangladesh. When I asked whether there was something inherent about HF that made it difficult to implement, I was told no.  What is needed is greater care in generating demand for HF and working out how to ensure regular supply of HF to those who most need it.  GAIN works in both these areas and so these findings are really helpful to guide our efforts.

How to prioritise nutrition interventions in a given context?  Rolf Klemm from HKI gave a nice presentation on the challenges of implementing Vitamin A supplementation, Home Fortification and Enhanced Homestead Farming.  He concluded that all of them have implementation challenges, some similar, some unique to the intervention.  We should not be surprised--there are no design-proof nutrition interventions. Rolf presented only 3 interventions and I asked him how governments could prioritise across the dozens and dozens of interventions they could undertake? Which should be done first?  Rolf mentioned the LiST tool (Lives Saved Tool) as one guide but this seems like quite a blunt instrument (for example it does not take into account politics and capacity) and incomplete (it only covers a subset of interventions).  We need something more practical to help governments (and all stakeholders) to prioritise and sequence actions.  

Zero-sum tendencies persist in the micronutrient world.  This tension was simmering below the surface.  The most frequent question was: don’t fortification and bio fortification take away from efforts to generate a diverse diet?  My view on this is that needs, opportunities and capacities have to drive the balance of approaches, with government in the driving seat.  All approaches are important, at different levels, in different contexts, at different times.

There were too many environment-free nutrition papers. There was also a tension between those concerned with the environment and those concerned about nutrition.  For example, are we talking about reducing micronutrient malnutrition at any cost to the environment?  These two communities do not connect easily, but they have to.  They need to because the diet choices that affect nutrition outcomes also affect the use of water and energy and the emission of greenhouse gases.

A company’s BMS poor conduct will take away from the good nutrition work that other parts of that company may be doing.  In a coffee break I had an interesting conversation with an employee of one of the big BMS companies.  I had just presented some ATNI data on how poor the Code compliance of big BMS companies was.  This employee worked in a section of the company that focused on children over 4 years of age and politely made it clear to me that the employee’s team had nothing to do with BMS.  But clearly the failure of the  company’s willingness/ability to comply with the Code was damaging the perception of the work of done by the employee’s team.  Employees who work in companies that violate the Code can be quiet and powerful advocates of change from within.

I am grateful to Prof. Hans Biesalski at the University of Hohenheim, the Chair of the event, for the invitation to participate in the 3^rd Congress and I look forward to the 4^th in 2019.  I very much hope it focuses more on some of the following issues: environmental trade-offs, double burden issues and how to get hidden hunger higher on the political agenda.

Universality and the SDGs: transforming development as we know it?

The SDGs have been in place now for 18 months. But already there is some disquiet over the attention that is being paid to them by some countries.  

The BOND Annual Conference took up this theme and one of the sessions, which I chaired, asked the panelists “how do we make the SDGs matter more?” It was framed as how are the SDGs connected and how do we leverage the opportunities they bring?  But really it was about how to make the SDGs matter more.

The SDGs are really different from the MDGs.  The SDGs focus on sustainability, on all people within a country and on all countries.  Many of the SDGs talk about ending a problem e.g. “ending malnutrition” rather than halving its rate. Plus the process of generating the SDGs was much more inclusive than the process that generated  the MDGs. This is all great.

But for the audience and the panel the key distinction was the fact that the SDGs apply to all countries—that they are “universal”. 

This means that it is not DFID that reports on the UK’s performance in meeting its own SDG targets, but the Prime Minister’s Cabinet. 

Universality opens up lots of opportunities:

* An understanding of how difficult it is to achieve lasting change in, say, the UK or the USA or the Netherlands within the strictures of typical 3-4 year funding cycles

* An appreciation of how intrusive and disrespectful the metrics culture can be in terms of naming and shaming high income governments, businesses and NGOs that do not meet their commitments

* Learning across contexts that seemingly have no connection (what about addressing the unaffordability of safe nutritious food in some neighbourhoods of Leeds, Lagos, Lima and Lahore?)

* Connecting and engaging the global and local realities of trying to improve development outcomes.  What do the SDGs mean to someone living in Geneva or Washington DC as well as rural Mozambique and slum dwellers in Dhaka?

But is there a risk from this universality? If those who work on international development perpetuate the divide with domestic development then, I think, yes. If these two worlds remain separate there is a real risk that one will cannibalise the other for attention and resources. If, for example, we draw attention to poor school outcomes in deprived areas of the UK without drawing out commonalities and contrasts with, say, deprived parts of Africa then we run the risk of losing resources for development but we also lose a sense of context and humanity, not to mention opportunities to foster a sense of solidarity.

True universality of the SDGs should challenge international development actors to bridge the easy “us and them” dichotomies. It should disrupt our thinking and organisation sufficiently that we gradually move from international development driven by aid to global development driven sustainably by domestic resources—public and private.

The Access to Nutrition Spotlight Falls on India: What Does it Reveal?

I'm a big fan of the Access to Nutrition Index (ATNI).

The Index was conceived of at GAIN and partners and became independent a few years ago.  Its first report was in 2013 and I blogged about it favourably then.

Now comes the next logical extension of the Index--a country spotlight index.

The first spotlight is in India, where 1/6th of the world's population lives and are governed by a national and international set of food system regulations.


I really like the spotlight report (although I have only read the 60 page executive summary!).

The report selects the 10 largest Indian food and beverage manufacturers and evaluates them on three key dimensions:

* Corporate profile (company nutrition commitments, policies, practices and disclosure--analysis done by Sustainalytics based on publicly available documents supplemented by information provided by the companies upon request)

* Product profile (assessing nutrition quality of company products, based on food types and labels--analysis done by the George Institute for Global Health in Australia)

* Breastmilk Substitute (BMS) compliance (with The Code and Indian Milk Substitutes/IMS act--done in Mumbai by Westat in partnership with the Delhi Centre for Media Studies)

Indian company scores on product and corporate profiles

Key findings (from my perspective):

1. The Indian companies do well relative to the Indian multinational subsidiaries when it comes to product profiles (they derive larger shares of their sales from more nutritious products based on the Health Star Rating system which accounts for positive components such as fruits and vegetables and more negative ones such as salts, sugars and fats).

2. The Indian multinationals do better on corporate profiles, having access to their parent multinational capacities in this area.

3.  The 8 companies that are assessed on BMS behaviour (only 2 --Nestle India and Amul--overlap with the 10 largest food and beverage companies) comply, in large part, with the Code and IMS.  The exceptions seem to be (1) for products that are "parallel imports", i.e. to be consumed in other countries and (2) in marketing online sites, inviting mothers to sign up to information -- which is not subject to the same level of scrutiny.

As usual the report has clear recommendations for companies and for governments.

As I've noted before I think the overall score adjustment for BMS compliance performance should be multiplicative rather than deductive (because of the multiplier lifetime effects of undermining nutrition in first 1000 days) -- it would be an interesting analysis to see if this changes rankings.

Of course, the true test of ATNI scores is whether they are used to change behaviour.  The most important type of behaviour from a business perspective is whether the ATNI score affects investor/creditor behaviour.

At GAIN we are looking to see if we can work with ATNI to develop scores for companies in some of the key countries we work in.  For example can we use ATNI scores to screen investments in companies from our Marketplace for Nutritious Research and then use ATNI score improvements as one factor in the decision of formal lenders to transact with companies.

The public private space in nutrition desperately needs to become more transparent and accountable.  This is how trust is built up and more effective resource allocation decisions can be made.

ATNI is one important contribution towards doing this--but we need more.