24 March 2017

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

This week I was at the 3rd 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 3rd Congress and I look forward to the 4th 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.

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