17 September 2018

Food Safety and Healthy Diets: Docking, Colliding or Passing in the Night?

I have been working on food security and malnutrition for 30 years and food safety issues have almost no visibility. I realised that I also am woefully ignorant personally about this topic. This is very strange – as I learned last week – on both counts.  As the presentations at the Pontifical Academy of Sciences – GAIN technical workshopin the Vatican made clear, food safety threats are on the rise as food systems modernise but the capacity to control those risks lags behind.
It is clear that food safety is a necessary but not sufficient condition for healthy diets. But many people with my background do take it for granted. We should not and this is why.
First, if, for example, we want food systems to make good things like vegetables and fruits more available, affordable and desirable there is a real risk that the price we will have to pay is greater consumption of pesticides.  That’s a price no one should have to pay. The most nutritious foods we want to promote like dairy, fish, fruit and vegetables are more susceptible to food borne diseases than, say, highly processed biscuits, snacks or sugar.
Second, food “unsafety” can generate large numbers of Disability-Adjusted Life Year (DALYs) lost. The World Health Organization (WHO) estimates that “600 million – almost 1 in 10 people in the world – fall ill after eating contaminated food and 420 000 die every year, resulting in the loss of 33 million healthy life years (DALYs).”
Third, food safety scares do not need to generate large burden of disease figures to have devastating effects on lives. For example the livelihoods of the poorest farmers can be wrecked due to the distrust generated by such scares and by the potentially exclusionary food safety standards that are put in place long after the damage has been done.
So what are the pros and cons of trying to link thinking and action in food safety with healthy diets?
On the positive side, food safety issues could enter into bigger food system conversations, to rise up the policy agenda and recruit more advocates. Food safety has to be alert to changing threats generated by climate change, new technologies, climate change and urbanisation. The healthy diets community worries about these issues a lot—they could help make those lateral connections. For the healthy diets community, the food safety community could teach us about systems thinking in food. Food safety is only as strong as the weakest link in the chain and food safety experts worry about all of them and, I suspect, understand better the unintended consequences of changing one part of the food system for other parts.
What are the downsides of closer collaboration? For the food safety community there is the risk of becoming lost within the food system/healthy diet debates and budgets. There is already some sensitivity because past attempts to link with the food security community resulted in food safety becoming the minor partner.  For the healthy diet community the risk is that food safety may appear to present an added layer of complexity in what is already a complex space.
But I would urge both communities to find ways of moving closer together.  Consider the following:
  • Individual foods can be safe, but in certain diet combinations they are deadly, generating massive DALY burdens (see the country profiles at IHME). Will unsafe diets usurp unsafe foods as a policy priority? I think this a risk for the food safety community.
  • Food safety is already at risk of becoming an orphan issue. For example, next year’s WHO/FAO International Conference on Food Safety is the “First”. The first!  In addition one of the major multilateral donors at the workshop said that food safety was not a priority for them. And I was surprised to see that there is no “food safety index” to compare different country efforts to keep their food safe and exert some pressure on them to do better. Finally I was taken aback by how little research is dedicated to food safety in the food and agriculture sphere. For example while there are over 50 flagship projects in the CGIAR–our world class international agricultural research system–there is only one in food safety, and that was started just 2 years ago.
  • No one in the healthy diets community is implementing a set of actions at allpoints in a given food system to improve diet. System thinking is not yet the default way of working of governments, donors, businesses or civil society.  Food safety experts could teach us a thing or two about working across food systems.
  • Finally, food standards and safety agencies are sometimes powerful: they are not called “authorities” for nothing. Some, like the Indian Food Standards and Safety Authority, are moving into the nutritious food/healthy diet vacuum and making things happen. They are exercising their agency. The healthy diets community needs to harness this dynamism, but they won’t be able to unless they engage.
So let’s work for healthy diets and food safety to achieve some good docking complementarities, to prevent unnecessary collisions and ensure that the two issues and communities do not blithely pass each other in the darkness. People deserve better.

13 July 2018

Making the Most of the Current Window of Opportunity for Nutrition in Pakistan

I just returned from a trip to Islamabad to meet the GAIN team and some of our partners. I’m no expert on Pakistan, but compared to 2013, the commitment to accelerate reductions in malnutrition seems to have increased significantly.
In 2013 the Institute of Development Studies (IDS) and the Aga Khan Foundation released a collection of papers by Pakistani authors entitled “Seeing the Unseen: Breaking the Logjam of Undernutrition in Pakistan” it was edited by me, Zulfi Bhutta and Haris Gazdar.  In the Introduction to that collection the editors noted “The coming together of three events: the massive flooding of 2010 and 2011, which exposed chronic as well as acute undernutrition; with the recent decentralisation of health services to the provinces; and the results from the 2011 National Nutrition Survey (NNS 2011), which show an increase in stunting, have created some momentum for nutrition”.
How have things moved on?
First, nutrition is reported to be much more prominent in the next 5 year draft National Development Plan which is waiting to be ratified by the new Government elected in late July.
Second, guided by the Ministries of Planning, Development and Reform and the National Health Services, and supported by the Scaling Up Nutrition Movement (SUN), the outgoing Federal Government has already committed 10 billion rupees (about $100m) to nutrition in this financial year, which represents a major boost.
Third, civil society is trying to replicate what was so successful in Peru—getting all the political parties to make SMART commitments to nutrition in their manifestos and then holding whichever one gets into power to those promises.
Fourth, the Provincial Food Authorities have become powerful forces for change in the Provinces. Starting out in the food safety space these Authorities are extending their interests into the nutrient dimensions of food.
Fifth, businesses really seem to be stepping up to the plate. The Sun Business Network (SBN) has revived with a new injection of resources and capacity and has 33 member businesses with plans to get to 100 in the next couple of years.
Sixth, the government officials I talked to in the Ministries of Planning, Development & and Reforms and in the National Health Services were all talking about food systems and how these systems frame the nutritious foods choices people have and how they make the choices.
Seventh, the adolescent and youth agenda is high on the development agenda with senior policy makers and development partners understanding that the current youth bulge can bring both a new set of opportunities (e.g. empowerment, entrepreneurship and a redefinition of what a healthy diet looks like) but also problems (unemployment and unrest) if the approach is not right.
Finally, the urban agenda is surfacing—with the World Bank a strong proponent of leveraging urbanization for nutrition.
Of course all of these opportunities present risks. There is “many a slip between cup and lip” when it comes to what is in development plans and what actually gets done (in all countries!). Committing to spend $100m on nutrition is good, but what will it be spent on and what is the capacity to spend it (wisely)? Party political manifestos are often not worth the paper they are written on. A food systems framing can lead to action in new areas, but also to paralysis, as policymakers are overwhelmed with data and things they could do within the system. Provincial Food Authorities can be powerful agents of change, but less so if they do not align standards to make the work of business as seamless as possible over different geographies. And we know businesses can be as much a part of the affordable nutritious food problem as it is a part of the solution. Finally, a focus on urbanisation that is detached from rural transformation will run the risk of deepening divides.
But from a non-expert perspective, I detected a steely glint in the eye of all the public and private officials I met (most of them not nutritionists, by the way) and a determination that they are not going to let this moment slip to press home the advantage for nutrition. As a recent editorial by a former Finance Minister in a leading national newspaper put it “Pakistan is one of the emerging economies of the world with a notable economic growth potential that is threatened by the burden of pervasive malnutrition. Unless immediate action is taken, the crisis of malnutrition will continue to negatively affect Pakistan’s economic performance. It also has the potential to condemn future generations to a catastrophic future of deprivation and poverty.”
I couldn’t agree more and GAIN will do whatever we can to work with all stakeholders to make sure these opportunities are seized to accelerate reductions in malnutrition — in all its forms.

02 July 2018

Adolescents as Nutrition Catalysts: a Fire has been Lit!

A couple of weeks ago GAIN and the World Health Organization (WHO) organised a consultation “Adolescents: Agents of Change for a Well Nourished World”. This was the third in four “stepping stones” towards forging a consensus on promising approaches for programming to improve adolescent nutrition outcomes. The first was hosted by SPRING (a USAID initiative), the second by ENN/London School of Hygiene and Tropical Medicine, the third by GAIN/WHO and the fourth will be in September 2018, hosted by IFAD and Save the Children.
We at GAIN wanted to learn from others as we build on our adolescent nutrition landscape reports and begin working with our partners in Bangladesh, Indonesia, Mozambique and Pakistan to design interventions that are likely to improve the nutrition status of adolescents.
There were 2 key features of the consultation that GAIN and WHO were determined to make happen: (1) we wanted to learn from those outside the nutrition ecosystem who had extensive experience of working with adolescents and (2) we wanted direct and meaningful engagement with adolescents themselves. It would have been much easier not to do this, but much less interesting and legitimate we thought.
We were able to bring in expertise from organisations such as the Shornokishoree Network Foundation (SKNF), Quantum, Restless DevelopmentONEPurpose PBCAshoka’s Centre for Social and Behaviour Change, and NCDFREE – all of whom work with young people on a regular basis. Also participating were development organisations who are beginning to do more work on adolescent issues such as the Global Finance Facility, the Overseas Development Institute, and the Young Lives Programme. In addition we had key food and nutrition stakeholders: FAOWFPIFADSave the ChildrenSPRINGENNConcern WorldwideNutrition International and the Aga Khan University.
But the x-factor in the consultation was the participation of 10 adolescents from Bangladesh, Indonesia, Pakistan and Zambia. More about them later.
I can’t possibly do justice to the richness of the meeting, but here goes.
Why focus on adolescents?
  • There are a lot of adolescents. Asia and Africa are experiencing a youth bulge as their countries go through a demographic transition. In the next 5-10 years we will be at “peak youth” as they hit the labour force and the voting rolls.
  • Despite being so prominent in the population numbers, adolescents are virtually invisible in nutrition data and in nutrition programming. We really only have data on 15-19 year old girls. Virtually nothing on girls 10-14 or boys 10-19.
  • The data we do have suggests that a very large proportion of adolescents experience at least one form of malnutrition.
  • Malnutrition in adolescence affects the development of key brain functions—there is plenty of development going on after the first 1000 days into the 4000 -7000 day period.
  • Because the transition from childhood to adolescence carries the promise of more power to make their own decisions, adolescents are catalysts for social change. Whether campaigning for stricter gun control in the USA, the prevention of child marriage or bans on single use plastics, adolescents have enormous potential agency. Adolescents can redefine norms around, say, healthy eating—if we support them in the right way.
What kinds of actions or programmes should be developed?
The specifics are less clear here. But there are some key principles:
First, as Dr. Chandra-Mouli from WHO said, we should stop doing “interventions” we know do not work in this space (e.g. high profile public meetings, and one off trainings).
Second, try to build nutrition into existing policies and programmes that seek to improve the wellbeing of adolescents.
Third, in building nutrition in, do not dilute the existing programs’ ability to talk about really difficult and awkward topics, e.g. on puberty and sexuality.
Fourth, the demand side is vital: find ways to engage with adolescents on their terms—what influences their choices (e.g. taste, convenience, privacy, looks, aspiration, sports, celebrity, superheroes)—but don’t talk explicitly about nutrition (its boring).
Fifth, what can we do to make sure healthy food is available in or near schools (our Zambian adolescents shared some heart-breaking reality about food at school) or in markets (e.g. in Java, where is the healthy fast food that tastes good and is the “cool” thing to buy and eat?)
Finally, strengthen accountability around what powerful stakeholders are or are not doing with or for adolescents, e.g. State of Youth reports, petitions, campaigns, declarations and policy scorecards.
How to design and implement programming?
First and foremost—work with adolescents in a meaningful way. As one participant said, “let them be your guide”. They best understand their reality, the opportunities and limits and how to seize and navigate them.  They can help us figure out where they are and how to get there—they will not necessarily be where the programmers want the programming to be.
Second, build the capacity of the adolescents and the rest of us to engage with each other. As one participant said the “peacocks” (adolescents) and the “turtles” (the rest of us) need to work together for change and neither group probably has much experience of doing so. They both need to learn.
Third, like any agents of change, adolescents can achieve more working together (the “power with” multiplying the “power within”). We need to support their organisation, their ability to educate and their ability to agitate.
Finally, we need to let them lead. This is potentially the most challenging aspect because we are so used to being in control. But if adults only view adolescents as instrumental to the former’s goals, they are being exploitative.
So what does all this mean?
Interestingly it seems to me that the adolescent agenda is not plagued by the usual institutional territoriality in development.  Not yet anyway.  For example, there is no obvious UN agency charged with promoting the rights and wellbeing of this age group. This creates space for duplication, but also for collaboration. Fortunately, we are more in the collaboration space at the moment.
This lack of formalised institutional leadership also gets us into a different but familiar territory, namely that “adolescents are everyone’s business and no one’s responsibility”. And because there is a bit of a vacuum of leadership around adolescent nutrition, many agencies are stepping in, in a coordinated way, and that is encouraging. Now the challenge is for the stepping stones to actually create a path towards significant commitments of resources to adolescent nutrition programs and policy.
We need the UN to come together around the adolescent nutrition agenda and call a meeting in 2019 where member state governments can shape a series of “asks” and turn them into commitments for governments, and all other investors–such as NGOs, research organisations, businesses, development donors–to make.
The one group we don’t have to ask to make commitments is adolescents—they are living their commitment. And if the rest of us do not step up to make commitments to support them, then they may just do it without us.  “Never about us without us” may become “if you don’t step up then step away”.
Fortunately, at the consultation, a large number of organisations made commitments that they will report back on publicly in June 2019 – to the adolescents attending the meeting and to everyone else.  The commitments do not involve major funding, but they do involve change.  And even though some of the commitments probably relate to actions that were going to be undertaken in any case, the most important thing is that the commitments were made public, allowing all of us to monitor them and to assess progress against them.
We are still working on finalising the wider set of specific commitments from the different organisations, but GAIN’s are as follows:
  • GAIN will not organize any meeting on adolescent nutrition without meaningful involvement from adolescents
  • GAIN will attempt to connect the Indonesian adolescent representatives with the Ministry of Health in Indonesia and set up a dialogue between the adolescents and the Ministry’s representatives
  • GAIN will set up or use existing national adolescent networks for meaningful engagement and capacity building in the design phase of adolescent nutrition programs in countries where GAIN is/will be working
Such public pledging is unusual, and I think it happened because the adolescent participants made us not only think about the issues, but to really experience feeling and emotions around the issues. And when thinking and feeling come together, action is inevitable and change is unstoppable.  A fire is lit and it cannot be extinguished!

25 June 2018

The Man Who Nourished the World

By Lawrence Haddad, GAIN’s Executive Director
My delight at being told that I was one of 2018’s World Food Prize Laureates was matched only by, well, sheer surprise. After all I have not led a team of scientists to develop a breakthrough technology like the founder of the Prize, Dr. Norman Borlaug. After talking to Ambassador Quinn, the President of the World Food Prize Foundation, it became clear that the contribution being recognised was the ability to be effective in multiple roles in order to help elevate nutrition to the “top table” of development. In other words, to help convince powerful decision makers that good nutrition is fundamental to delivering the Sustainable Development Goals.
My capacity to connect the roles of researcher, policy influencer, organisational leader and communicator of the issues to broader audiences was helped by a number of things, and  shaped by the thousands of colleagues with whom I have worked.
First, somewhat freakishly, I have been interested in both nutrition and agricultural economics from the age of 18. My undergraduate degree at the University of Reading, UK, was a joint one: in food science and food economics. I followed these dual interests throughout subsequent studies at the University of Massachusetts and at Stanford University. Being an economist, and striving to see the bigger development picture – and where nutrition might fit in – has been invaluable for me as a champion for nutrition.
Second, the first 3 years of my post PhD work was in starting up a new MSc in Quantitative Development Economics at the University of Warwick, UK. I loved the “start up” feel of setting up the course and it was there that I learned to teach properly and communicate more clearly and effectively. However, being a clear communicator is necessary but far from sufficient condition for being persuasive. Influencing is key.
So the third thing that helped elevate nutrition on the agenda was the experience of trying to convince a wide range of people that nutrition matters – learning what they are interested in and finding ways to connect nutrition to that. Interestingly, being a member of the Consultative Group on International Agricultural Research (CGIAR) at the International Food Policy Research Institute (IFPRI) in the 1990s helped develop that skill.  Back in those days there was not much interest in nutrition—just in crop and animal productivity enhancement. We had to think hard about ways to engage the agronomists and economists on nutrition. Working at GAIN involves helping to effect change with decision making constituencies working in a newer area – the way governments and businesses think about what and how they can do together to advance nutrition.
Finally, being forced to become a blogger at the Institute of Development Studies (in my role as Director) required me to write more succinctly, on a wider range of topics, and to leave the comfort zone of research to venture opinions based, as far as possible, on evidence (my Twitter accountdescriptor is “an evidence based champion of efforts to end malnutrition”).
Since the call with Ambassador Quinn, I have been refreshing my knowledge of Norman Borlaug. As Leon Hesser’s excellent Borlaug biography – The Man Who Fed the World—makes clear, Borlaug was unstoppable in his pursuit of improved varieties to stave off hunger in Mexico, Asia and Africa. His sheer hard work, relentless drive and single-minded focus –in the fields, labs, classrooms, boardrooms and Ministerial chambers – helped to bend the world to his view. His vision was forged on getting the ground level details right, always framed within a big picture political economy view. Connecting these two levels is a very unusual ability. His focus on capacity building, on organisational arrangements and on communications to help sustain his efforts is inspiring. It was a revelation to see how instrumental he was—working with the Rockefeller Foundation— in the creation of the CGIAR. Without him, IFPRI—where I learned how to be a policy researcher and was inspired by some of the great policy influencers—probably would not have existed and the course of my own career would probably have been very different.
The world that Norman Borlaug wanted to help feed in the 1950s-70s is both similar and different from today. It is similar in that, unfortunately, hunger is still with us. But while the absolute numbers of hungry people have not declined enough, they now account for a much smaller share of the world’s population and this is testimony to the work of Dr. Borlaug and many others. But it is different too. Dr. Borlaug surely could not have anticipated the explosion in obesity, diabetes, hypertension and other diet related noncommunicable diseases we have witnessed in the past 40 years. If he were alive I am sure he would now be arguing for improving the productivity of non-staple foods such as fruits, vegetables, pulses, eggs, dairy, fish and poultry. The prices of these foods, which are high in micronutrients such as minerals and vitamins, are increasing and productivity improvements would help drive their prices down. In the absence of such a focus, low and middle-income households are being priced out of nutritious food and lured into cheap, empty and unhealthy junk food calories. Good diet is fundamental to the prevention to malnutrition in all its forms.
So the central issue of our time is this: not how to feed the world, but how to nourish it. Were he here today I am sure Dr. Borlaug would have been at the forefront of this fight, perhaps recast by some as “The Man Who Nourished the World”. In his absence, we have to come together across government, research, business, foundations and civil society to pick up the mantle and focus on actions to nourish the world so we can end malnutrition by 2030.

15 June 2018

Packaged Foods—What Role Can They Play in Improving the Consumption of Nutritious Food?

By Lawrence Haddad, GAIN’s Executive Director
This was the question asked at a FReSH-organised side event at the recent EAT Forum meeting in Stockholm.
As the 2016 Global Panel Report on Food Systems and Diets noted, average households in nearly all countries in the world acquire the majority of their food from the market (as opposed to growing it or receiving it in kind). Most of these purchases are of packaged foods. In addition, we know that the sales of processed foods (which has a strong overlap to packaged foods) are flat in high-income countries (but with a switch within the static sales towards products lower in sugar, salt and fat) while increasing in middle-income countries (and I would guess, low-income countries, although we have no data on that).
So there is a big business opportunity in packaged foods in low and middle-income countries, but is there also a nutrition opportunity? Given the trends in developing country markets (more food purchases from the market and a growing purchases of packaged foods), the answer is surely yes.
The format of the side-meeting included the introduction of 4 new packaged food products with nutritious food aspirations from 4 companies. The participants were then asked whether, based on what they had heard, they thought the foods were nutritious, environmentally and socially sustainable, with a viable business model. To do this participants tested the products, asked questions about 4 dimensions of performance–health, social, environmental and business–and gave the product a highly subjective summary score from 1-8 on each dimension.
The products included (1) a new Kellogg’s “Force of Nature” granola type cereal with lower sugar, all recyclable packaging materials and a good taste, (2) a good tasting fruit smoothie (froosh) containing only fruit (the fruit fibres giving it a smoothie feel) with all recyclable materials, (3) reformulated Nesquik cereal (two versions, one to meet WHO guidelines on sugar and salt and one to meet the more stringent Chilean standards necessary to avoid the black warning labels on the front of pack) and (4) ModuMax, a “taste modulator” from DSM that helps to moderate negative organoleptic characteristics in foods that have been reformulated to have lower sugar and salt.
My takeaways:
  • Some companies have made substantial changes to their products’ profiles (e.g. towards lower sugar, higher fibre) over the past 5-10 years—and we saw some interesting data from Nesquik/Nestle. Small but frequent and persistent changes can add up to big changes. They are not transformational in a big bang sense, but they are a reaction to a transformation in consumer preferences or government regulation.  Interestingly it is very difficult to track these changes over time as the databases are not public and it is difficult to find public info on food product labels from 5 or 10 years ago. (Although it is easy enough to track if the formulations are different in different geographies.)
  • How much effort should big food companies put into reformulating existing core products versus introducing new “healthier” products? The latter are less likely to upset consumers “stop tampering with our favourite foods!” but are at risk of small sales/termination, or of simply replacing an equally healthy natural option with a more expensive processed and packaged product (e.g. if froosh replaced an apple in a lunchbox). The answer to this portfolio balance issue is obviously context and outcome specific, but it is clear that some companies are struggling with this question.
  • Are the companies that are providing business-to-business (B2B) products (like DSM with ModuMax) the ones that are going to help the whole system change given their massive indirect consumer reach via their business customers? How much effort should system changers invest in the B2B companies vis a vis the companies that sell direct to consumers? Again, context specific.
  • Packaged food companies need to be aware of the narrative: processed foods=unhealthy foods. Processed foods can provide nutrition, convenience, safety and affordability if those are the key design criteria guiding the processing. Don’t blame the technology; rather blame the bigger incentives that drive companies towards unhealthy processed foods (weak incentives—carrots and sticks– from some governments combined with weak consumer demand for nutritious foods in many contexts, together with unscrupulous behaviour from some businesses).
  • The completion of the 4-dimension assessment (health, business, environmental, social) was not easy in the absence of data (preferably independently verified data). In addition, just exactly what the social dimension means was not clear—is this where affordability comes in or is this about the working conditions in the supply chains, both, or is it about something else?
Finally, it is important to note that all the company representatives in the room (about a quarter of the participants) emphasised the need for nutritious foods to lead with flavour. If a more nutritious food is not tastier and more delicious than the less nutritious variants or brands, then it is highly unlikely to be a market success. Those of us in the public sector need to embrace this idea—typically we just focus on acceptability and palatability of nutritious foods.
That is why GAIN is exploring the development of a relationship with Firmenich to begin to focus on flavour issues in nutritious foods.
And the scores?  Wildly different among the 4 assessing groups! Delicious.

11 June 2018

Are We Misusing Stunting as a Measure of Child Nutrition?

By Lynnette M. Neufeld, GAIN’s Director, Knowledge Leadership & Lawrence Haddad, GAIN’s Executive Director 
The consistent evidence that childhood stunting is associated with poor child development and school performance (Perkins et al. 2017) and health and human capital development more generally (Victora et al 2008) has elevated nutrition in the development agenda. The result has been an unprecedented focus on addressing stunting and some renewed development resources focused on doing so.
But the focus on stunting may be a double-edged sword for the nutrition and development communities if we are not careful with the use and interpretation of this measure. The recent commentary in the Journal of Nutrition by Pirumal and colleagues provides an excellent overview of the potential risks and pitfalls of using stunting in an unthinking way.
The paper highlights the origin of the indicator (height for age below a designated cut-off, usually 2 standard deviations below the reference mean, i.e., Z-score of < -2, referred to as HAZ) as a population level marker of sub-optimal human capital development, poverty and deprivation. For this reason, the prevalence of stunting can be a powerful and appropriate tool for advocacy for greater action to reduce undernutrition.
The paper also reminds us that at an individual level there is nothing inherently wrong with being short unless one is short because of growth faltering (i.e., failing to reach genetic potential due to deprivations in food consumption, care and the health environment).  It also surfaces the key limitation of stunting as a summary indicator of lost human capital, namely that it ignores any growth faltering that occurs elsewhere along the height for age distribution, not just below a -2 HAZ.
This leads to several potential misuses and misinterpretations of stunting. Specifically:
  1. Stunting prevalence understates the magnitude of the problem of growth faltering at the population level. Many of those even with HAZ > -2 may have experienced growth faltering and we are missing these children in all of our counts of the magnitude of the problem.
  2. An HAZ of < - 2 is not a threshold marker of malnutrition or disease for any single individual child. The associations between growth faltering and adverse outcomes exist regardless of the magnitude of that growth faltering and there is no documented strengthening of the relationship between growth faltering and adverse outcomes at the threshold of - 2 HAZ.
  3. While several direct causes of growth faltering have been identified, poverty, deprivation and inequality lie at its core and it is unrealistic for program designers and investors to expect individual, household and community level interventions that focus on only one or even several of the more direct causes to have much of an impact on stunting, particularly over short project cycles.
So what to use to assess changes in child nutrition over time? In addition to stunting we should be looking at mean and standard deviation of HAZ and at the slope of change in HAZ by age (we want it to be close to zero). In other words, in countries with evidence of growth faltering, we want to see rightward shifts of the entire HAZ distribution because this will reflect positive improvement in growth of all children.
At GAIN we and our partners strive to improve the consumption of nutritious safe food for all, especially the most vulnerable and we want our programmatic efforts to contribute to improving child growth. We recognise however, that the indicators we can change in the shorter term as a direct result of our programs are more likely to relate to the nutritional quality of diets.
Program investors need to recognise that the prevention of growth faltering requires many factors to move simultaneously in the right direction over a significant time period.  Several countries have made substantial progress in doing so, typically based on a solid foundation of progress in development indicators such as GDP, inequality and women’s status. But designing and scaling nutrition programs that effectively address key drivers of stunting, such as GAIN’s focus on diet quality, is also vital.  The right program indicators are those that are achievable within a program context but have a clear path to progress towards ultimate outcomes, like improved growth. Getting this balance right should lay the ground for sounder and more transformative nutrition investments.

28 May 2018

Food Loss and Food Waste in Sub-Saharan Africa: A Critical and Welcome Review from Megan Sheahan and Chris Barrett

Given all the talk and action around food loss in Sub-Saharan Africa (SSA), it is a shame this review in the Food Policy journal was not written 10 or even 5 years ago. Why?
First, it helps remind us why we might be interested in reducing food loss and waste: to improve food security, to improve food safety, to reduce wasted resources and to increase profits along the food supply chain. Often these objectives will not align and we need to be clear about which one we are most interested in affecting.
Second, it helps identify gaps in knowledge: we don’t know much above the drivers of food loss and waste in SSA; there is little reliable data on the magnitude of food losses beyond the farm gate – particularly for the nutritious and highly perishable foods — there is little apparent interest or understanding of the nutrient quality of food losses, and there are very few evaluations of interventions that assess the impacts on human well being or assess the spill over effects up and down the food value chain.
Third, it introduces some economic realism into the debate: given that reducing food loss is expensive, the optimal level of loss and waste is surely not zero (a widespread assumption, although not in SDG 12 which calls for halving per capita global food waste at the retail and consumer levels and reducing food losses along production and supply chains). The paper also notes that optimal levels of food loss and waste will differ by the different objectives listed above.
Fourth, it highlights gaps in action: most current interventions are on farm, directed at hermetic storage, and there are very few efforts focused on broad based investment areas that may deliver reductions in food loss and food waste but will also deliver broader based benefits, e.g. in infrastructure, rural finance and warehouse receipt systems.
GAIN, working with its partners, is seeking to reduce the loss of nutritious food along the selected food value chains in Nigeria, Indonesia, and Ethiopia — and this paper resonates: we look to reduce food loss with a view to improve the availability of nutritious food, but also to improve profits for supply chain actors including farmers; we work beyond the farm gate (where there is little evidence to guide); we look at nutrient loss as well as food quantity loss and we seek to estimate impacts at the human level (e.g. on what people eat) and up and down the supply chain (although this is challenging).
So if you are working in Sub-Saharan Africa on reducing food loss along food supply chains you would do well to read this critical but thoughtful paper and consider how we, as a community, can gather better evidence before another 5 or 10 years pass.


This blog is also available on the GAIN website

23 May 2018

The 2018 Access to Nutrition Index and the need for a “Charter for Responsible Food and Beverage Companies”

I am a big fan of the Access to Nutrition Index (ATNI).  It is one of the few independent science-based mechanisms to fame and shame the 22 biggest food and beverage companies on their efforts to improve nutrition through the marketing and formulation of their products.
This week sees the launch of the third global index and it provides a highly credible set of scores. During my stint at the Global Nutrition Report the Access to Nutrition Foundation (ATNF) team were kind enough to undertake sector level analyses for us and I got to see some of the excellent quality assurance mechanisms put in place for the data collection, analysis and reporting.
As with most ATNI reports, there is good news and bad.
First the good: most companies are upping their game in terms of their scores. It is hard to know how much of this behaviour change is due to the Index itself versus responses to prevailing trends, but I suspect the Index has had a significant effect on many companies who want their investors to see that they take these issues seriously.
NestlĂ© is the highest scoring company with 6.8 out of 10, up from 5.9 in 2016, but, as a set, the average score per company is still low: 3.3, up from 2.5 in 2016.  FrieslandCampina and Kelloggshow the largest gains since 2016, largely as a result of greater disclosure and more publicly available material on their efforts to improve nutrition.  These companies (and there are more listed in the report) should be congratulated for these improvements.
There is, however, plenty of room for improvement.
Consider the following:
  • Some company scores actually declined. For example, General Mills’ score worsened due to poorer data release and some companies such as the Brazilian giant, BRF, did not provide any data.
  • Of the 22 companies scored, 16 define one or more targets to reformulate their products, but only for some of their products, for some nutritional components and with considerable fuzziness over baselines and timelines.
  • Of the 22 companies, only 2 have targets relating to positive components of a healthy diet recognized in the ATNI methodology, such as fruits and vegetables.
  • Only 6 companies cover responsible marketing to children in ALL media.
  • Only 3 companies offer global support to working parents in terms of facilities for expressing and storing breast milk as well as paid parental leave.
  • Only 2 companies commit to labelling ALL nutrients globally.
  • Only 3 companies commit to lobbying in support of measures to prevent and address obesity.
  • Only 3 companies have global policies to make nutritious food more available and accessible to all, including low income and high priority populations.
  • Only one company has extended its policy on responsible marketing to children to adolescents in the 13-18 age group.
So the report clearly provides a basis for a “Charter for Responsible Large Food and Beverage Companies”, including the following:
  1. Commit to reformulate all products. Reduce the salt, sugar and fat where it needs to be reduced and increase nutrients and fibre-rich ingredients such as fruits and vegetables where it needs to be improved.  It can be a 5-year programme, but commit to it, and provide baselines, targets and dates so stakeholders can follow progress.
  2. Commit to having a programme in their companies that makes it easy for breastfeeding parents to express, store and feed infants with breastmilk; and provide parental leave. No exceptions.
  3. Commit to market responsibility to all children 0-18 years of age, via all media. No exceptions.
  4. Commit to not lobby against the introduction of diet related public health measures for which there is a scientific consensus. There may be debate over timing and implementation, but not over the public health benefits.
As I have said in many places, food companies must be celebrated when they get it right and show progress and called out when they do not.  This report does this in a clear, balanced and therefore powerful way.  And the more specific and transparent the commitments, the more powerful the plaudits and the criticisms become, because we can be more sure of the quality of the assessments.
Those who do not report any data to ATNF simply look like they do not care about their customers’ wellbeing. They do this at their peril.  The world is changing and the clamour for healthier food is only going to get louder—the best ethical and commercial position, surely, is to get out ahead of it.
When we look up the word “responsible” in internet search engines we get prompts for responsible travel, responsible investing, responsible government and responsible finance, but not for responsible food companies.
Food manufacturers, it is time to reach for the prize of being the most “responsible” company.  ATNF will reward you for it.  But much more importantly, your investors, your employees, your employees’ families — and your customers will reward you for it.  Who among you will be the first?