04 June 2017

No Excuses for Inaction on Adolescent Nutrition

This years World Health Assembly (WHA) meetings (all the Ministers of Health attend) had a big focus on one sixth of the world’s population: adolescents.  The WHA launched the Accelerated Action for the Health of Adolescents (AA-HA!) a major report from all the key UN agencies on why we need to act now to improve adolescent health and what to do. In this context, I participated in two panels on adolescent nutrition.

My key takeaways were:

Adolescents are invisible in nutrition data.  It is ironic because adolescents are typically hard to miss: frequently opinionated, critical and emotional and deafening in their exuberance and silences. Yet in nutrition data, they are absent. Essentially, we don’t collect nutrition data on adolescent boys of 10-19 years of age or on adolescent girls in the 10-14 year age group.  This is extraordinary.  Attitudes and preferences are highly fluid in this 10-14 age group—like liquid concrete waiting to be set for life.  Also, why no interest in boys?  Yes, adolescent girls have higher micronutrient needs due to menstruation, but boys are just as important in shaping attitudes, norms and boundaries in nutrition practices—now and in the future.  This relative invisibility of adolescents to the nutrition community is all the more puzzling because iron deficiency anaemia is the number one cause of adolescent DALYs for girls and boys (see below). 


There are few nutrition interventions that are designed FOR adolescents.  Yes, there are plenty of interventions aimed at the wider population that should benefit adolescents (see here), but none are designed for adolescents particular needs save for iron-folate supplementation (IFA).  IFA seems to work when administered through schools, but not through communities (see here).  This is a problem because only 30% of adolescents in South Asia and Sub-Saharan Africa complete secondary school (see here).  Why do adolescents merit specially designed interventions?  It is primarily because of the plasticity of their attitudes and the rapid velocity with which these attitudes become relatively fixed but also the widening opportunity to act as the gap between biological maturity and social transition to adulthood increases.   The graphic below from the AA-HA! Report summarises things well.










There are even fewer interventions that are designed WITH adolescents.  Adolescents have increasing autonomy and they know what they like and don’t like and I would guess most nutrition intervention and policy wonks don’t have a clue what these likes are and how they can be leveraged and shaped.  Adolescents will have a better idea of where, why and how they can be engaged around nutrition choices.  But adolescents are also more vulnerable to risky food and nutrition options.  Adolescents will help us to think laterally and holistically about their lives, to find opportunities to work with them to influence and shape food and nutrition preferences via sports, clubs, social media, schools, music, film and comics.  Engaging with them will take us outside of our comfort zone and that is where innovation and change happens.

We are paralysed by the lack of evidence.  We are in a “lack of evidence, lack of action, lack of evidence” low level equilibrium when it comes to actions on adolescent nutrition. The consequences of trying something and getting it wrong are not negligible, but these have to be weighted against the consequences of inaction.  The adolescent window is opening and closing without any fresh thinking or action making it through the gap all while nutrition status is eroded throughout the lifecycle. Funders and development agencies need to be braver. They should support (a) the development of new approaches and actions that are grounded in formative adolescent centred research, (b) their implementation, (c) their evaluation, (d) share their results and (e) scale the promising ones.  Adolescents deserve no less.

The private sector has a big role to play, because adolescents are more engaged with the private sector than many other demographic groups: they are tied to their social media platforms (see below from Indonesia—90% of rural adolescents in Indonesia use Facebook!), they buy junk food after school, they buy street food on breaks from their factory work, they listen to commercial radio and watch commercial TV.  For example, how can we combine earnest public sector behaviour change efforts with the more calculated but creative private sector demand shaping efforts.  How can we create hybrid approaches that are greater than the sum of their parts?

The new AA-HA! Initiative from the UN is a great step forward and countries should use it as a guide to raise funds for this agenda and a guide on how to allocate those funds.  GAIN is using the above principles, working in Bangladesh, Pakistan, Indonesia and Mozambique, forming alliances for and with adolescents to generate and implement solutions to accelerate adolescent nutrition.  

Watch this space. 


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