tag:blogger.com,1999:blog-63351461973421511882024-03-16T01:09:42.243+00:00Development Horizons by Lawrence HaddadSome unguarded reflections, thoughts, and ideas on international development from Lawrence Haddad of the Global Alliance for Improved Nutrition (GAIN). These opinions are not necessarily representative of or endorsed by GAIN.Lawrence Haddadhttp://www.blogger.com/profile/17265061444076801962noreply@blogger.comBlogger667125tag:blogger.com,1999:blog-6335146197342151188.post-28710403011774384862019-09-30T15:06:00.003+01:002019-09-30T15:06:55.984+01:00Food systems: the outrage deficit<div class="MsoNormal">
<span lang="EN-GB">I just completed a trio of meetings in Asia
(TICAD), Africa (AGRF) and North America (UN General Assembly) all of which had
a strong set of dialogues around food systems, asking how they need to be
rebuilt to promote human health, rural livelihoods and planetary health.<o:p></o:p></span></div>
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<span lang="EN-GB">I am really optimistic about the potential
of food systems to address these issues.
<o:p></o:p></span></div>
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<span lang="EN-GB">First, there is a strong and unusual
alignment of interests. Gearing a food
system towards greater consumer access of nutritious and safe food is obviously
good for human health; it is good for reducing greenhouse gas emissions
(although less clear on things like water, energy and fertiliser use); and it
could be good for livelihoods as high nutrition value crops tend to be higher
market value crops. Whenever interests
are aligned, the potential for aligned action is great. <o:p></o:p></span></div>
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<span lang="EN-GB">Second, there are many actions we can take
within the food system that we know will work to improve these 3 sets of
outcomes (health, environment, livelihoods): many recent reports have outlined
these, including the very recent FOLU <a href="https://www.foodandlandusecoalition.org/global-report/">Growing Better</a>
report and they include things like realigning food production subsidies and
public procurement of food towards nutritious and sustainable foods, reducing
food loss and waste, sugar taxes and subsidies for the consumption of fruits
and vegetables, stronger regulations on the marketing of food, and incentives
to companies small, medium and big to produce more nutritious and sustainable
food. <o:p></o:p></span></div>
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<span lang="EN-GB">Third, because small and medium enterprises
(SMEs) are so important for the consumption, production and marketing of food
in lower income countries (in fact they dominate the real food systems ordinary
people rely on), there is a chance to make nutritious safe food more accessible
through these SMEs - without having to rely on trying to change food multinationals. There may even be the potential to leapfrog
western food systems in some countries. <o:p></o:p></span></div>
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<span lang="EN-GB">But there are three things that give me
pause for thought and temper my optimism.
<o:p></o:p></span></div>
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<span lang="EN-GB">First, there does not seem to be a
widespread sense of urgency to change food systems. Yes, food systems were talked about in these
three meetings, but they were only a small percentage of the topics discussed
and you tend to see the same people at each event. Are we generating the sense of urgency that
permeates into related issues and sectors? Not yet. Having a regular drumbeat of data on what the
world is eating that resonates across countries would help to build the
pressure to act. <o:p></o:p></span></div>
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<span lang="EN-GB">Second, for those who already recognise
this and want to change food systems, it is difficult for them to know how to
prioritise their energy. For example,
where to start? Is it in the production,
storage, distribution, processing, marketing or retailing parts of the food
system? Or is it in the demand generation side with consumers, or targeting the
rules, subsidies and regulations of the enabling environment? What are the metrics we should follow and
what is the target for transformation? The <a href="https://eatforum.org/eat-lancet-commission/eat-lancet-commission-summary-report/">EAT
Lancet report</a> provides some guides on the consumption of different foods,
but the targets are controversial on the science and on the idea of
universality. We need UN consumption targets
and we need food system data and tools for prioritisation to help guide
decision makers at the national level. <o:p></o:p></span></div>
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<span lang="EN-GB">Third, and perhaps most importantly, there
is an outrage deficit. By generating so
much ill health, food systems are bankrupting health systems which are having to
mop up the growing expense and suffering caused by poor diets. By generating so many greenhouse gases, food
systems are a major contributor to climate change and environmental
degradation. Through food waste cause by an underinvestment in infrastructure,
food systems are undermining rural livelihoods. For outrage, read the <a href="https://www.npr.org/2019/09/23/763452863/transcript-greta-thunbergs-speech-at-the-u-n-climate-action-summit">transcript</a>
of Greta Thunberg’s extraordinary speech at the UN General Assembly last week. Where are the Greta Thunbergs – of any
age—talking about the food system and saying “how dare you pretend this can be
solved with business as usual and some technical solutions?”?<o:p></o:p></span></div>
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<span lang="EN-GB">There is the challenge for us all. The
alignment of interests has not yet gelled into an alignment of urgency, outrage,
and action. We need to target our energy against the dysfunctions of food
system as a whole, not just be transfixed by the more extreme examples of poor
practices. Many of the technical challenges of rebuilding food systems can be
solved, and with our many partners, we at GAIN are working on these challenges.
But the political mobilisation needed to spark a sense of outrage at the slow
pace of change has not yet emerged.</span></div>
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<span lang="EN-GB">So I call on partners in the civil society
space who are so experienced in campaigning to set aside egos and logos, and
join forces to create a global, deliberate, organised and ambitious campaign to
revolutionise food systems.<span style="mso-spacerun: yes;"> </span>Everywhere. For
everyone.<o:p></o:p></span></div>
<br />Lawrence Haddadhttp://www.blogger.com/profile/17265061444076801962noreply@blogger.com0tag:blogger.com,1999:blog-6335146197342151188.post-54744065948927114452018-11-05T16:04:00.002+00:002018-11-05T16:06:27.818+00:00Youth are the Future: They are also the Present<div style="background-color: white; border: 0px; box-sizing: border-box; color: #504f4f; font-family: Arial, sans-serif; font-size: 16px; margin-bottom: 13.6625px; margin-top: 13.6625px; outline: 0px; padding: 0px; vertical-align: baseline;">
During the recent World Food Prize week in Des Moines, I was invited to give talks to 3 groups of young people: the <a href="https://www.fas.usda.gov/programs/borlaug-fellowship-program" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Borlaug Fellows</a>, the <a href="https://www.vanguardngr.com/2017/10/adesina-set-new-african-youth-institute/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">African Youth Institute</a>, and the <a href="https://www.worldfoodprize.org/en/youth_programs/global_youth_institute/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Global Youth Institute</a>. I was delighted to do so. The first group was the oldest—early career researchers and policymakers, the second being young African entrepreneurs, scientists, and scholars and the third group being high school students from around the world.</div>
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The addresses were tailored a bit to each group, but they had many common elements and here they are.</div>
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<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">You are the future. But you are also the present. Too often we stop at “you are the future” and of course that is true, but whether a high school student or an early career professional, these young people are the present. They have agency. They have tools like social media to mobilise and organise and speak out, they have computer literacy to design apps that can promote accountability and transparency, they have an ability to multitask and they have numbers—the we are approaching a youth bulge in many parts of the world. Many of these young people are already entrepreneurs, leaders and consumers. Many of them will soon become voters and employees. They have power, individually and collectively. Let’s support it and help focus it.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Learn your craft, but live broadly. If you hone your skill, whatever that is, people will beat a path to your door. This requires hard work, focus and dedication. Think of the dozens of performances the Beatles gave in the Cavern Club in Hamburg. But you have to live widely too. That means read outside your area of specialism (blogs, websites, newspapers, nonfiction books), talk to people who are in different locations, sectors, political spaces. Get a rounded picture of a situation because it will help you deploy your specialism. Understand how to tune into the frequency of those who do not think like you because this is the only way you will ever persuade them to think differently. Also be open to your own views being challenged. The global financial crisis of 2007-8 made me think hard about some of the assumptions economists make about development (I even wrote a <a href="https://www.researchgate.net/publication/227468960_Five_Assumptions_of_Dominant_Thinking_in_International_Development" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">paper</a> about it).</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Understand how change happens and don’t be afraid to be a part of the process. If you are reading this, the chances are that you have chosen your profession because you want to leave the world a better place than you found it. That means understanding how chance happens. Sound evidence is not sufficient to spur change, it may not always be necessary, but it sure is helpful. Master it better than the person you are trying to influence. Watch for opportunities to effect change. Usually these opportunities manifest themselves if there is a change in leadership or some big crisis (i.e. every crisis is an opportunity). But to contribute to that change you need to be brave and insert yourself. Make that presentation to the group of parliamentarians, find investors for your idea that will change the world, write that op-ed, brief your local political leaders, organise that rally.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Develop a wide range of skills that are not always taught in school or university. Communication—oral and written—is so important. This is about listening as well as speaking. Keep it simple. Short sentences, no jargon. Like you are writing home to your folks. Once you are in the bubble it is difficult to remember that most of the people you need to persuade to do something are not residents of said bubble. Be an entrepreneur—find people to back your ideas. Talk to them with evidence, passion but patience and they will come around. Broker relationships. It may not be easier to get things done when you are in alliances and movements and partnerships but it is more enduring.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Treat people well. This sounds obvious, and often we have to work with people we do not like or respect. But as well as being the right thing to do, if you are kind, treat people like you want to be treated yourself, don’t give in to the temptations of hierarchy, and put the issue before yourself, you will find people want to work with you, listen to you, take brave decisions with you and act alongside you.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Identify people who inspire you. Try to learn from them, emulate them and also don’t be afraid to challenge them. I was lucky enough to have some of these fantastic people around me and they helped me grow up fast. They know who they are.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Finally, don’t forget who you work for. Ultimately it is not your teacher, parent, line manager, programme leader or even yourself. If you are reading this, you have already decided to work for and with those who are less fortunate than you in large part because of the randomness of where on the planet they were born. They are the ultimate boss. It is easy to forget this. Don’t.</li>
</ol>
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<span style="color: #504f4f; font-family: arial, sans-serif;"><a href="https://www.gainhealth.org/knowledge-centre/youth-are-the-future-they-are-also-the-present/" target="_blank">This blog was originally published on the GAIN website</a></span></div>
Lawrence Haddadhttp://www.blogger.com/profile/17265061444076801962noreply@blogger.com0tag:blogger.com,1999:blog-6335146197342151188.post-17754569251366824202018-11-05T16:03:00.003+00:002018-11-05T16:05:43.975+00:00Why I am driven to fight malnutrition<h2 style="background-color: white; border: 0px; box-sizing: border-box; clear: both; color: #504f4f; font-family: AvantGardeGothicITCW02Dm; font-size: 0.875em; margin: 0px 0px 20.5px; outline: 0px; padding: 0px; vertical-align: baseline;">
<span style="border: 0px; box-sizing: border-box; font-family: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">At GAIN we are passionate about changing the world to abolish the malnutrition that destroys lives, families and undermines communities and nations. In giving his acceptance speech for the 2018 World Food Prize, GAIN Executive Director Lawrence Haddad turned to the personal experiences that shaped commitment – we offer this as an example of the personal and human character of malnutrition – its causes and the potential resources to eliminate it.</span></h2>
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<a href="https://www.worldfoodprize.org/en/about_the_prize/ambassador_kenneth_m_quinn/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-size: 16px; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Ambassador Quinn</a><span style="font-family: "arial" , sans-serif; font-size: 16px;">, the</span><span style="font-family: "arial" , sans-serif; font-size: 16px;"> </span><a href="https://www.worldfoodprize.org/en/dr_norman_e_borlaug/about_norman_borlaug/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-size: 16px; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Borlaug</a><span style="font-family: "arial" , sans-serif; font-size: 16px;"> </span><span style="font-family: "arial" , sans-serif; font-size: 16px;">and</span><span style="font-family: "arial" , sans-serif; font-size: 16px;"> </span><a href="https://www.worldfoodprize.org/en/about_the_prize/mr_john_ruan_sr/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-size: 16px; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Ruan</a><span style="font-family: "arial" , sans-serif; font-size: 16px;"> </span><span style="font-family: "arial" , sans-serif; font-size: 16px;">families, and distinguished guests, I would like to thank the</span><span style="font-family: "arial" , sans-serif; font-size: 16px;"> </span><a href="https://www.worldfoodprize.org/en/about_the_prize/council_of_advisors/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-size: 16px; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Council of Advisors</a><span style="font-family: "arial" , sans-serif; font-size: 16px;"> </span><span style="font-family: "arial" , sans-serif; font-size: 16px;">for selecting David Nabarro and me as this year’s World Food Prize Laureates. It means so much, to so many of us, that this community has recognised the transformative power of nutrition.</span></h4>
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So, this speech. My first attempt at writing it reminded me of the UK civil servant who retired to write poetry, but ended up writing poems that sounded like ministerial briefings. My first speech sounded like a policy brief. But tonight is very special, and so I ditched that and decided to get out of my comfort zone and share with you some things that I rarely acknowledge to others, and perhaps not even to myself.</div>
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I was brought up by a warrior mother. She fought like a tiger for me and my sister. When we no longer had a father, she became both parents. When we had no money for new clothes she got us good used clothes. When it looked like I could not get into a good state school, she made sure I did. That is the power of mothers. Thank you mom.</div>
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I was born in Africa and raised in England. I am very proud of my African roots, but I was lucky to be brought up in a country like England with its powerful welfare system. Our small family qualified for a council flat in a London tower block, I got free school meals, free prescription glasses, and a free university education. That is the power of the state.</div>
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So to my uncle. He was the first in our family to go to university. He worked at a small flavouring company. As a teenager I would get regaled with stories of the things the food industry was doing in the 1970s: freeze dried coffee, instant mash potatoes, and ravioli in a can. If you can make ravioli in a can taste OK then anything is possible! That is the power of business.</div>
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My mother worked as a volunteer in Save the Children in London. She had no child care and so she brought me along. While helping out I talked to staff. I was inspired by their sense of purpose and their conviction that they could make a difference. That is the power of civil society.</div>
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So, by age 18, I had powerful examples of the roles mothers, governments, civil society and businesses play in shaping destiny. But 1 in 3 people on this planet are denied a say in shaping their destiny–because they are malnourished. That is outrageous, unacceptable and cannot be tolerated.</div>
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So all of these different actors have to come together to end malnutrition. That is because the things that converge to generate malnutrition are powerful—not enough food, water, sanitation, health care—and they must be vanquished by even more powerful alliances drawn from all corners of society.</div>
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But that is not enough. Those coalitions, alliances and movements need a spark: a spark to catalyse the outrage.</div>
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It was when I went to work in the Philippines and India as a young man that the fire was lit for me. The shock of seeing the skin of babies impossibly stretched across bone. The shock of hearing about farmer suicides because of the despair of failed harvests. The shock of seeing girls deprived of food that is routinely given to their brothers. The shock of seeing a mother trying desperately to care for a child with constant diarrhoea.</div>
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This was visceral: only experienced, as Dr Borlaug would say, by going to the farmer. This was when I realised that malnutrition was about injustice. And it radicalised me.</div>
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Since then I have been a monomaniac on a mission. Generating evidence on how to end malnutrition. Learning about how change really happens. Working with countless others to become a part of the change process. Many of you in the house tonight are sisters and brothers in arms — and I honour you for your generosity of spirit, time and commitment.</div>
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Working together, I believe with all my being, that we can consign malnutrition to the history books – and sooner than we think.</div>
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I have only been able to this work because of my incredible family. So my deepest thanks and love go to my wife, Frederique, and to my children, Sovanne and Raphael. They have made many sacrifices for my work. They have put up with many absences and –when present—a certain level of grumpiness, distraction, and absentmindedness. Despite all of this they have provided me with unending amounts of inspiration, support, encouragement and love. That is the power of family and that is the power of love.</div>
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Thank you.<br />
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<a href="https://www.gainhealth.org/knowledge-centre/why-i-am-driven-to-fight-malnutrition/" target="_blank">This blog was originally published on the GAIN website</a></div>
Lawrence Haddadhttp://www.blogger.com/profile/17265061444076801962noreply@blogger.com0tag:blogger.com,1999:blog-6335146197342151188.post-66904168949520538472018-10-08T08:27:00.002+01:002018-10-08T08:27:36.374+01:00SUN membership is relevant for ALL countries, no matter their income level. Here’s why.<div style="background-color: white; border: 0px; box-sizing: border-box; color: #504f4f; font-family: Arial, sans-serif; font-size: 16px; margin-bottom: 12.3375px; margin-top: 12.3375px; outline: 0px; padding: 0px; vertical-align: baseline;">
<em style="border: 0px; box-sizing: border-box; font-family: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><strong style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">By <a href="https://www.gainhealth.org/organization/leadership/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Lawrence Haddad</a>, GAIN’s Executive Director</strong></em></div>
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Since 2010, the <a href="https://scalingupnutrition.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Scaling Up Nutrition (SUN)</a> Movement has inspired a new way of working collaboratively to end malnutrition–in all its forms. And yet, 1000 days into the <a href="http://www.who.int/sdg/en/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">SDG era</a>, no high-income country has become a member of the SUN Movement. Why does this matter?</div>
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First, all countries experience high levels of malnutrition in at least one of its many manifestations. For example, according to the <a href="http://globalnutritionreport.org/wp-content/uploads/2017/11/Report_2017-2.pdf" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">2017 Global Nutrition Report</a>, the UK has obesity rates of 27%, Germany has raised blood cholesterol rates of 70%, 28% of French men have high blood pressure and, according to the <a href="https://www.wcrf.org/dietandcancer/resources-and-toolkit" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">2018 World Cancer Research Fund Report</a>, Japan has colorectal cancer rates of 39 per 100,000 — one of the highest in the world. And in nearly all high-income countries poor nutrition is related to 5 of the top 10 risk factors in national disease burdens. By joining SUN the high-income countries can learn from other members, share experiences of what is effective in reducing these expressions of malnutrition, and work together with other members to develop new solutions to address them.</div>
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Second, many high-income country governments do not achieve the same level of coherence across government departments in fighting malnutrition that their aid programs expect from low and middle income countries. Which European country has a whole of government approach to obesity, one that brings together urban planners, agriculture, health, education, transport and trade? I can’t think of one. Joining SUN will help high-income countries achieve greater coherence in their battle against malnutrition.</div>
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Third, nutrition affects global public goods. For example, what the high-income countries grow and eat affects the poorest in the most climate-affected countries such as Bangladesh, Pakistan and many of the nations of Africa. The high-income countries have a responsibility to fix the enormous externality that their food production and consumption choices generate for those least able to adapt to climate change. Becoming a member of SUN will empower civil society within high-income countries to champion more climate smart agriculture and consumption and guide policymakers to more win-win solutions for people and the planet.</div>
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Finally, the enrollment of high-income countries embodies the highest principles of the SDGs. The SDGs are for all countries and all people. As this century progresses we will increasingly be left with the more complex problems, and they will be the ones that affect all countries and will require a degree of cooperation not seen today if they are to be tamed. We are talking about climate mitigation, conflict prevention, insurance against financial crises, the prevention of infectious disease pandemics — and the lowering of nutrition related non- communicable diseases.</div>
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The SDGs reject the assumption that the low and middle-income countries have a monopoly on nutrition problems and the high-income countries have a monopoly on nutrition solutions. It is time that high-income country governments realise this and join SUN. Citizens of the world–whether from high, middle or low-income countries–deserve no less.</div>
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<em style="border: 0px; box-sizing: border-box; font-family: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Lawrence is a member of the <a href="https://scalingupnutrition.org/sun-supporters/sun-movement-executive-committee/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">SUN Executive Committee</a> but this view is personal and does not necessarily represent the view of the Committee.</em></div>
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<a href="https://www.gainhealth.org/knowledge-centre/sun-membership-is-relevant-for-all-countries-no-matter-their-income-level-heres-why/" target="_blank">This blog was originally published on the GAIN Website</a></div>
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Lawrence Haddadhttp://www.blogger.com/profile/17265061444076801962noreply@blogger.com0tag:blogger.com,1999:blog-6335146197342151188.post-70120400624814709762018-09-17T07:55:00.004+01:002018-09-17T07:55:42.872+01:00Food Safety and Healthy Diets: Docking, Colliding or Passing in the Night?<div style="background-color: white; border: 0px; box-sizing: border-box; color: #504f4f; font-family: Arial, sans-serif; font-size: 16px; margin-bottom: 11.9625px; margin-top: 11.9625px; outline: 0px; padding: 0px; vertical-align: baseline;">
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 <a href="https://www.youtube.com/playlist?list=PLPHLdH2gKE0coGr2rkVUUkoSauSqZlbR5" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">presentations</a> at the <a href="http://www.pas.va/content/accademia/en.html" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Pontifical Academy of Sciences</a> – <a href="https://www.gainhealth.org/knowledge-centre/event/technical-workshop-on-food-safety-and-healthy-diets/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">GAIN technical workshop</a>in the Vatican made clear, food safety threats are on the rise as food systems modernise but the capacity to control those risks lags behind.</div>
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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.</div>
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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.</div>
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Second, food “unsafety” can generate large numbers of <a href="http://www.who.int/healthinfo/global_burden_disease/metrics_daly/en/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Disability-Adjusted Life Year (DALYs)</a> lost. The <a href="http://www.who.int/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">World Health Organization (WHO)</a> 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).”</div>
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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.</div>
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So what are the pros and cons of trying to link thinking and action in food safety with healthy diets?</div>
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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.</div>
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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.</div>
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But I would urge both communities to find ways of moving closer together. Consider the following:</div>
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<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Individual foods can be safe, but in certain diet combinations they are deadly, generating massive DALY burdens (see the <a href="http://www.healthdata.org/results/country-profiles" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">country profiles at IHME</a>). Will unsafe diets usurp unsafe foods as a policy priority? I think this a risk for the food safety community.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">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 <a href="https://www.cgiar.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">CGIAR</a>–our world class international agricultural research system–there is only one in food safety, and that was started just 2 years ago.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">No one in the healthy diets community is implementing a set of actions at <u style="box-sizing: border-box;">all</u>points 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.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Finally, food standards and safety agencies are sometimes powerful: they are not called “authorities” for nothing. Some, like the <a href="https://www.fssai.gov.in/home" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Indian Food Standards and Safety Authority</a>, 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.</li>
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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.</div>
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<a href="https://www.gainhealth.org/knowledge-centre/food-safety-and-healthy-diets-docking-colliding-or-passing-in-the-night/" target="_blank">This blog is also available on the GAIN website</a></div>
Lawrence Haddadhttp://www.blogger.com/profile/17265061444076801962noreply@blogger.com0tag:blogger.com,1999:blog-6335146197342151188.post-39581615705696422132018-07-13T09:00:00.000+01:002018-07-13T09:00:02.869+01:00Making the Most of the Current Window of Opportunity for Nutrition in Pakistan<div style="background-color: white; border: 0px; box-sizing: border-box; color: #504f4f; font-family: Arial, sans-serif; font-size: 16px; margin-bottom: 14.6875px; margin-top: 14.6875px; outline: 0px; padding: 0px; vertical-align: baseline;">
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.</div>
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In 2013 the <a href="http://www.ids.ac.uk/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Institute of Development Studies (IDS)</a> and the <a href="http://www.akdn.org/our-agencies/aga-khan-foundation" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Aga Khan Foundation</a> released a collection of papers by Pakistani authors entitled “<a href="https://www.ids.ac.uk/publication/seeing-the-unseen-breaking-the-logjam-of-undernutrition-in-pakistan" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Seeing the Unseen: Breaking the Logjam of Undernutrition in Pakistan”</a> it was edited by me,<a href="https://www.gainhealth.org/people/zulfiqar-bhutta/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;"> Zulfi Bhutta</a> and <a href="http://lansasouthasia.org/content/haris-gazdar" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Haris Gazdar</a>. In the <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/1759-5436.12025" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Introduction</a> 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 <a href="https://www.humanitarianresponse.info/sites/www.humanitarianresponse.info/files/documents/files/NNS%202011.pdf" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">2011 National Nutrition Survey (NNS 2011)</a>, which show an increase in stunting, have created some momentum for nutrition”.</div>
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How have things moved on?</div>
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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.</div>
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Second, guided by the Ministries of Planning, Development and Reform and the National Health Services, and supported by the <a href="http://scalingupnutrition.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Scaling Up Nutrition Movement (SUN)</a>, the outgoing Federal Government has already committed 10 billion rupees (about $100m) to nutrition in this financial year, which represents a major boost.</div>
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Third, civil society is trying to replicate what was so successful in <a href="https://www.sciencedirect.com/science/article/pii/S0306919213001577" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Peru</a>—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.</div>
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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.</div>
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Fifth, businesses really seem to be stepping up to the plate. The <a href="http://sunbusinessnetwork.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Sun Business Network (SBN)</a> 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.</div>
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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.</div>
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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.</div>
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Finally, the urban agenda is surfacing—with the<a href="https://www.worldbank.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;"> World Bank</a> a strong proponent of leveraging urbanization for nutrition.</div>
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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.</div>
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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 <a href="https://www.thenews.com.pk/print/339332-the-menace-of-malnutrition" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">editorial</a> 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.”</div>
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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.</div>
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<a href="https://www.gainhealth.org/knowledge-centre/program/pakistan/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Find out more about GAIN’s work in Pakistan</a></div>
Lawrence Haddadhttp://www.blogger.com/profile/17265061444076801962noreply@blogger.com0tag:blogger.com,1999:blog-6335146197342151188.post-90522856138192944252018-07-02T13:41:00.004+01:002018-07-02T13:41:41.963+01:00Adolescents as Nutrition Catalysts: a Fire has been Lit!<div style="background-color: white; border: 0px; box-sizing: border-box; color: #504f4f; font-family: Arial, sans-serif; font-size: 16px; margin-bottom: 14.6875px; margin-top: 14.6875px; outline: 0px; padding: 0px; vertical-align: baseline;">
A couple of weeks ago <a href="https://www.gainhealth.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">GAIN</a> and the <a href="http://www.who.int/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">World Health Organization (WHO)</a> organised a consultation <a href="https://www.gainhealth.org/knowledge-centre/event/adolescents-agents-of-change-for-a-well-nourished-world-2/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">“Adolescents: Agents of Change for a Well Nourished World”</a>. 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 <a href="https://www.spring-nutrition.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">SPRING</a> (a <a href="https://www.usaid.gov/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">USAID</a> initiative), the second by <a href="https://www.ennonline.net/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">ENN</a>/<a href="https://www.lshtm.ac.uk/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">London School of Hygiene and Tropical Medicine</a>, the third by GAIN/WHO and the fourth will be in September 2018, hosted by <a href="https://www.ifad.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">IFAD</a> and <a href="https://www.savethechildren.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Save the Children</a>.</div>
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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.</div>
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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.</div>
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We were able to bring in expertise from organisations such as the <a href="http://www.shornokishoree.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Shornokishoree Network Foundation (SKNF)</a>, Quantum, <a href="http://restlessdevelopment.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Restless Development</a>, <a href="https://www.one.org/international/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">ONE</a>, <a href="https://www.purpose.com/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Purpose PBC</a>, <a href="https://www.ashoka.edu.in/pages/CSBC-73" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Ashoka’s Centre for Social and Behaviour Change</a>, and <a href="https://ncdfree.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">NCDFREE</a> – 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 <a href="https://www.globalfinancingfacility.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Global Finance Facility</a>, the <a href="https://www.odi.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Overseas Development Institute</a>, and the <a href="https://www.younglives.org.uk/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Young Lives Programme</a>. In addition we had key food and nutrition stakeholders: <a href="http://www.fao.org/home/en/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">FAO</a>, <a href="http://www1.wfp.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">WFP</a>, <a href="https://www.ifad.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">IFAD</a>, <a href="https://www.savethechildren.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Save the Children</a>, <a href="https://www.spring-nutrition.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">SPRING</a>, <a href="https://www.ennonline.net/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">ENN</a>, <a href="https://www.concern.net/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Concern Worldwide</a>, <a href="https://www.nutritionintl.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Nutrition International</a> and the <a href="https://www.aku.edu/Pages/home.aspx" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Aga Khan University</a>.</div>
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But the x-factor in the consultation was the participation of 10 adolescents from Bangladesh, Indonesia, Pakistan and Zambia. More about them later.</div>
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I can’t possibly do justice to the richness of the meeting, but here goes.</div>
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<strong style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Why focus on adolescents?</strong></div>
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<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">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.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">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.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">The data we do have suggests that a very large proportion of adolescents experience at least one form of malnutrition.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">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.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">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.</li>
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<strong style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">What kinds of actions or programmes should be developed?</strong></div>
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The specifics are less clear here. But there are some key principles:</div>
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First, as <a href="http://www.who.int/reproductivehealth/about_us/staff/Chandra-Biography/en/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Dr. Chandra-Mouli</a> 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).</div>
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Second, try to build nutrition into existing policies and programmes that seek to improve the wellbeing of adolescents.</div>
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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.</div>
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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).</div>
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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?)</div>
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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.</div>
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<strong style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">How to design and implement programming?</strong></div>
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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.</div>
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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.</div>
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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.</div>
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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.</div>
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<strong style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">So what does all this mean?</strong></div>
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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.</div>
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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.</div>
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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.</div>
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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”.</div>
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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.</div>
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We are still working on finalising the wider set of specific commitments from the different organisations, but GAIN’s are as follows:</div>
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<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">GAIN will not organize any meeting on adolescent nutrition without meaningful involvement from adolescents</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">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</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">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</li>
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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!</div>
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<a href="https://www.gainhealth.org/knowledge-centre/adolescents-as-nutrition-catalysts-a-fire-has-been-lit/" target="_blank">This blog is also available on the GAIN website</a></div>
Lawrence Haddadhttp://www.blogger.com/profile/17265061444076801962noreply@blogger.com0tag:blogger.com,1999:blog-6335146197342151188.post-62654829070920773752018-06-25T17:08:00.001+01:002018-06-25T17:08:42.306+01:00The Man Who Nourished the World<div style="background-color: white; border: 0px; box-sizing: border-box; color: #504f4f; font-family: Arial, sans-serif; font-size: 16px; margin-bottom: 14.0938px; margin-top: 14.0938px; outline: 0px; padding: 0px; vertical-align: baseline;">
<em style="border: 0px; box-sizing: border-box; font-family: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><strong style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">By <a href="https://www.gainhealth.org/organization/leadership/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Lawrence Haddad</a>, GAIN’s Executive Director</strong></em></div>
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My delight at being told that I was one of <a href="https://www.worldfoodprize.org/index.cfm?nodeID=94236&audienceID=1" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">2018’s World Food Prize Laureates</a> 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, <a href="https://www.worldfoodprize.org/en/dr_norman_e_borlaug/about_norman_borlaug/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Dr. Norman Borlaug</a>. After talking to <a href="https://www.worldfoodprize.org/en/about_the_prize/ambassador_kenneth_m_quinn/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Ambassador Quinn</a>, the President of the <a href="https://www.worldfoodprize.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">World Food Prize Foundation</a>, 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 <a href="https://sustainabledevelopment.un.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Sustainable Development Goals</a>.</div>
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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.</div>
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First, somewhat freakishly, I have been interested in both nutrition and agricultural economics from the age of 18. My undergraduate degree at the <a href="http://www.reading.ac.uk/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">University of Reading</a>, UK, was a joint one: in food science and food economics. I followed these dual interests throughout subsequent studies at the <a href="https://www.umass.edu/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">University of Massachusetts</a> and at <a href="https://www.stanford.edu/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Stanford University</a>. 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.</div>
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Second, the first 3 years of my post PhD work was in starting up a new MSc in Quantitative Development Economics at the <a href="https://warwick.ac.uk/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">University of Warwick</a>, 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.</div>
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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<a href="http://www.cgiar.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;"> Consultative Group on International Agricultural Research (CGIAR)</a> at the <a href="http://www.ifpri.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">International Food Policy Research Institute (IFPRI)</a> 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 <a href="https://www.gainhealth.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">GAIN</a> 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.</div>
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Finally, being forced to become a blogger at the <a href="http://www.ids.ac.uk/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Institute of Development Studies</a> (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 (<a href="https://twitter.com/l_haddad" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">my Twitter account</a>descriptor is “an evidence based champion of efforts to end malnutrition”).</div>
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Since the call with Ambassador Quinn, I have been refreshing my knowledge of Norman Borlaug. As Leon Hesser’s excellent Borlaug biography – <a href="http://www.deltafarmpress.com/bourlag-man-who-fed-world" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;"><strong style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">The Man Who Fed the World</strong></a>—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 <a href="https://www.rockefellerfoundation.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Rockefeller Foundation</a>— 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.</div>
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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.</div>
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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.</div>
Lawrence Haddadhttp://www.blogger.com/profile/17265061444076801962noreply@blogger.com0tag:blogger.com,1999:blog-6335146197342151188.post-55656501373255328492018-06-15T09:09:00.001+01:002018-06-15T09:09:24.114+01:00Packaged Foods—What Role Can They Play in Improving the Consumption of Nutritious Food?<div style="background-color: white; border: 0px; box-sizing: border-box; color: #504f4f; font-family: Arial, sans-serif; font-size: 16px; margin-bottom: 14.1094px; margin-top: 14.1094px; outline: 0px; padding: 0px; vertical-align: baseline;">
<em style="border: 0px; box-sizing: border-box; font-family: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><strong style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">By <a href="https://www.gainhealth.org/organization/leadership/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Lawrence Haddad</a>, GAIN’s Executive Director</strong></em></div>
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This was the question asked at a <a href="https://www.wbcsd.org/Projects/FReSH" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">FReSH</a>-organised <a href="https://www.gainhealth.org/knowledge-centre/event/eat-stockholm-food-forum-2018/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">side event</a> at the recent <a href="https://eatforum.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">EAT Forum</a> meeting in Stockholm.</div>
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As the <a href="http://glopan.org/sites/default/files/ForesightReport.pdf" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">2016 Global Panel Report on Food Systems and Diets</a> 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).</div>
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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.</div>
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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.</div>
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The products included (1) a new <a href="https://www.kelloggs.com/en_US/home.html" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Kellogg’s</a> “Force of Nature” granola type cereal with lower sugar, all recyclable packaging materials and a good taste, (2) a good tasting fruit smoothie (<a href="http://froosh.com/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">froosh</a>) containing only fruit (the fruit fibres giving it a smoothie feel) with all recyclable materials, (3) reformulated <a href="https://www.nesquik.com/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Nesquik</a> cereal (two versions, one to meet <a href="http://www.who.int/mediacentre/news/notes/2013/salt_potassium_20130131/en/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">WHO guidelines on sugar and salt</a> and one to meet the more stringent <a href="https://www.nytimes.com/2018/02/07/health/obesity-chile-sugar-regulations.html" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Chilean standards necessary to avoid the black warning labels on the front of pack</a>) and (4) <a href="https://www.dsm.com/markets/foodandbeverages/en_US/products/modumax.html" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">ModuMax</a>, a “taste modulator” from <a href="https://www.dsm.com/corporate/home.html" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">DSM</a> that helps to moderate negative organoleptic characteristics in foods that have been reformulated to have lower sugar and salt.</div>
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My takeaways:</div>
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<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">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 <a href="https://www.nesquik.com/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Nesquik/Nestle</a>. 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.)</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">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 <a href="http://froosh.com/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">froosh</a> 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.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Are the companies that are providing business-to-business (B2B) products (like <a href="https://www.dsm.com/markets/foodandbeverages/en_US/products/modumax.html" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">DSM with ModuMax</a>) 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.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">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).</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">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?</li>
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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.</div>
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That is why <a href="https://www.gainhealth.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">GAIN</a> is exploring the development of a relationship with <a href="http://www.firmenich.com/en_INT/index.html" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Firmenich</a> to begin to focus on flavour issues in nutritious foods.</div>
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And the scores? Wildly different among the 4 assessing groups! Delicious.</div>
Lawrence Haddadhttp://www.blogger.com/profile/17265061444076801962noreply@blogger.com0tag:blogger.com,1999:blog-6335146197342151188.post-59308841270587089372018-06-11T07:37:00.002+01:002018-06-11T07:49:26.481+01:00Are We Misusing Stunting as a Measure of Child Nutrition?<div style="background-color: white; border: 0px; box-sizing: border-box; color: #504f4f; font-family: Arial, sans-serif; font-size: 16px; margin-bottom: 12.75px; margin-top: 12.75px; outline: 0px; padding: 0px; vertical-align: baseline;">
<em style="border: 0px; box-sizing: border-box; font-family: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><strong style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">By <a href="https://www.gainhealth.org/people/dr-lynette-m-neufeld/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Lynnette M. Neufeld</a>, GAIN’s Director, Knowledge Leadership & <a href="https://www.gainhealth.org/organization/leadership/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Lawrence Haddad</a>, GAIN’s Executive Director </strong></em></div>
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The consistent evidence that childhood stunting is associated with poor child development and school performance (<a href="https://www.sciencedirect.com/science/article/pii/S027795361730583X?via%3Dihub" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Perkins et al. 2017</a>) and health and human capital development more generally (<a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(07)61692-4/fulltext" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Victora et al 2008</a>) 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.</div>
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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 <a href="https://academic.oup.com/jn/article/148/3/311/4930811" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Journal of Nutrition by Pirumal and colleagues</a> provides an excellent overview of the potential risks and pitfalls of using stunting in an unthinking way.</div>
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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.</div>
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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.</div>
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This leads to several potential misuses and misinterpretations of stunting. Specifically:</div>
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<li>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.</li>
<li>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.</li>
<li>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.</li>
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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.<br />
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At <a href="https://www.gainhealth.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">GAIN</a> 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.</div>
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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.</div>
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Lawrence Haddadhttp://www.blogger.com/profile/17265061444076801962noreply@blogger.com0tag:blogger.com,1999:blog-6335146197342151188.post-48802149004905004152018-05-28T10:20:00.002+01:002018-05-28T10:21:39.898+01:00Food Loss and Food Waste in Sub-Saharan Africa: A Critical and Welcome Review from Megan Sheahan and Chris Barrett<div style="background-color: white; border: 0px; box-sizing: border-box; color: #504f4f; font-family: Arial, sans-serif; font-size: 16px; margin-bottom: 13.8594px; margin-top: 13.8594px; outline: 0px; padding: 0px; vertical-align: baseline;">
Given all the talk and action around food loss in Sub-Saharan Africa (SSA), it is a shame this <a href="https://www.sciencedirect.com/science/article/pii/S0306919217302440" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">review</a> in the <a href="https://www.journals.elsevier.com/food-policy" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Food Policy journal</a> was not written 10 or even 5 years ago. Why?</div>
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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.</div>
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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.</div>
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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 <a href="https://sustainabledevelopment.un.org/sdg12" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">SDG 12</a> 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.</div>
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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.</div>
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<a href="https://www.gainhealth.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">GAIN</a>, working with its partners, is seeking to reduce the <a href="https://www.gainhealth.org/programs/agriculture-nutrition/postharvest-loss-alliance-for-nutrition/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">loss of nutritious food</a> 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).</div>
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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.<br />
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<a href="https://www.gainhealth.org/knowledge-centre/food-loss-and-food-waste-in-sub-saharan-africa-a-critical-and-welcome-review-from-megan-sheahan-and-chris-barrett/" target="_blank">This blog is also available on the GAIN website</a></div>
Lawrence Haddadhttp://www.blogger.com/profile/17265061444076801962noreply@blogger.com0tag:blogger.com,1999:blog-6335146197342151188.post-53353990840105402372018-05-23T00:00:00.000+01:002018-05-23T00:00:32.152+01:00The 2018 Access to Nutrition Index and the need for a “Charter for Responsible Food and Beverage Companies”<div style="background-color: white; border: 0px; box-sizing: border-box; color: #504f4f; font-family: Arial, sans-serif; font-size: 16px; margin-bottom: 14px; margin-top: 14px; outline: 0px; padding: 0px; vertical-align: baseline;">
I am a big fan of the <a href="mailto:https://www.accesstonutrition.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Access to Nutrition Index</a> (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.</div>
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This week sees the launch of the third global index and it provides a highly credible set of scores. During my stint at the <a href="http://www.globalnutritionreport.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Global Nutrition Report</a> the <a href="https://www.accesstonutrition.org/who-we-are" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Access to Nutrition Foundation (ATNF)</a> 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.</div>
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As with most ATNI reports, there is good news and bad.</div>
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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.</div>
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<a href="https://www.nestle.com/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Nestlé</a> 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. <a href="https://www.frieslandcampina.com/en/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">FrieslandCampina</a> and <a href="https://www.kelloggcompany.com/en_US/home.html" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Kellogg</a>show 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.</div>
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There is, however, plenty of room for improvement.</div>
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Consider the following:</div>
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<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Some company scores actually declined. For example, <a href="https://www.generalmills.com/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">General Mills</a>’ score worsened due to poorer data release and some companies such as the Brazilian giant, <a href="https://www.brf-global.com/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">BRF</a>, did not provide any data.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">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.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">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.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Only 6 companies cover responsible marketing to children in ALL media.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Only 3 companies offer global support to working parents in terms of facilities for expressing and storing breast milk <em style="border: 0px; box-sizing: border-box; font-family: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">as well as</em> paid parental leave.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Only 2 companies commit to labelling ALL nutrients globally.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Only 3 companies commit to lobbying in support of measures to prevent and address obesity.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Only 3 companies have global policies to make nutritious food more available and accessible to all, including low income and high priority populations.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Only one company has extended its policy on responsible marketing to children to adolescents in the 13-18 age group.</li>
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So the report clearly provides a basis for a “Charter for Responsible Large Food and Beverage Companies”, including the following:</div>
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<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><u style="box-sizing: border-box;">Commit to reformulate all products.</u> 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.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><u style="box-sizing: border-box;">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</u>. No exceptions.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><u style="box-sizing: border-box;">Commit to market responsibility to all children 0-18 years of age, via all media</u>. No exceptions.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"><u style="box-sizing: border-box;">Commit to not lobby against the introduction of diet related public health measures for which there is a scientific consensus</u>. There may be debate over timing and implementation, but not over the public health benefits.</li>
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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.</div>
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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.</div>
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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.</div>
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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?</div>
Lawrence Haddadhttp://www.blogger.com/profile/17265061444076801962noreply@blogger.com0tag:blogger.com,1999:blog-6335146197342151188.post-7298217314209705252018-05-01T16:07:00.000+01:002018-05-01T16:07:11.312+01:00Ethiopia’s New Leadership: Will It Deliver for Nutrition?<div style="background-color: white; border: 0px; box-sizing: border-box; color: #504f4f; font-family: Arial, sans-serif; font-size: 16px; margin-bottom: 11.5156px; margin-top: 11.5156px; outline: 0px; padding: 0px; vertical-align: baseline;">
This is an exciting time to be in Ethiopia. A new Prime Minister, <a href="http://www.dw.com/en/ethiopia-who-is-new-prime-minister-abiy-ahmed-ali/a-43180360" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Dr. Abiy Ahmed Ali</a>, was appointed in early April and the <a href="https://www.reuters.com/article/us-ethiopia-government/ethiopias-new-premier-reshuffles-cabinet-as-part-of-reform-bid-idUSKBN1HQ0TV" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">newly reshuffled cabinet</a> was announced last week—a new generation radiating hope, with a focus on unity, youth, and economic growth.</div>
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But will this new dawn also generate added impetus in Ethiopia’s fight against malnutrition in all its forms? There is certainly success to build on: under 5 stunting rates may be 38% but they have come down from 58% 16 years ago. That is faster than one percentage point a year and is considered to be good performance.</div>
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But there are storm clouds a plenty. The country continues to be hit by drought playing havoc with food availability and food prices. On top of this, diabetes, hypertension and overweight rates, while still low compared to many other countries in Africa, are increasing fast, driven by rapid urbanisation and changing lifestyles among other things.</div>
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Food consumption is at the centre of all forms of malnutrition and <a href="http://www.ifpri.org/publication/rising-costs-nutritious-foods-ethiopia" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">recent research</a>by Kalle Hirvonen and colleagues at IFPRI has shown just how much the real price of nutritious foods has risen over the past 16 years while the real price of cereals has stayed constant and those of sugar, fats and salt have actually decreased. Just imagine what the declines in stunting would have been if the price of nutritious foods had stayed constant or even declined.</div>
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The need for available, affordable and desirable nutritious food is at the heart of <a href="https://www.gainhealth.org/about/gain/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">GAIN’s mission</a>. We basically do two things: (1) make foods that vulnerable populations already eat more nutritious, and (2) make nutritious foods (typically unavailable or unaffordable) more likely to be consumed by the most vulnerable.</div>
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As I saw on my trip to Addis last week, <a href="http://www.gainhealth.org/wp-content/uploads/2018/01/GAIN-Ethiopia-Factsheet-2017.pdf" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">GAIN in Ethiopia</a> is working with partners to (1) help the Government implement its new voluntary fortification standards, (2) develop low cost home grown complementary foods that can be sustainably accessed by low income households and (3) reduce food loss in nutritious food value chains. We are planning additional work in a number of new areas that draw on our experience of linking governments, business and civil society to improve the consumption of nutritious foods.</div>
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Our view at GAIN is that while business is often a part of the problem it is also a big part of the solution. So we are happy to work with responsible businesses to find new solutions. And Ethiopia is brimming with entrepreneurial talent, much of it in the form of social enterprise start-ups, often run by individuals barely out of their teens. They relish the challenge of trying to reduce the price of nutritious foods. We met several of them at <a href="http://www.bluemoonethiopia.com/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Blue Moon</a> which provides support to these start-ups.</div>
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Small and medium enterprise business platforms can help to develop investible propositions for governments and business to improve the consumption of nutritious foods by surfacing and connecting businesses with these ambitions, providing them with some market analysis, and helping them understand the legislative and policy environment they work in.</div>
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But we don’t have to rely solely on markets for scale because Ethiopia has of one of the largest social protection programmes in Africa, the <a href="http://projects.worldbank.org/P146883?lang=en" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">PSNP</a> (Productive Safety Net Programme). The potential for this programme, reaching 8-10 million households every year, to serve as a platform for diet diversity via vouchers and choice of eligible foods must surely be high.</div>
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So will the new government deliver for nutrition? Yes, if the rest of society plays its part. We know that improved nutrition is everyone’s business AND everyone’s responsibility.</div>
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We will certainly be working with GAIN and partners in Ethiopia to try to convince the new PM and his team that malnutrition sits uncomfortably in a nation that sees itself as a middle income country <a href="http://www.worldbank.org/en/country/ethiopia/overview" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">by 2025</a>, a leading light in Africa, and a source of manufacturing and innovation. The motto, <a href="https://www.huffingtonpost.com/jennifer-schwab/made-inethiopia-yes-ethio_b_8235988.html" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">“Made in Ethiopia”</a> will only become a reality when we have made malnutrition in Ethiopia a bad dream.</div>
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<a href="http://www.gainhealth.org/wp-content/uploads/2018/01/GAIN-Ethiopia-Factsheet-2017.pdf" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Download the GAIN Ethiopia Factsheet</a></div>
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<a href="https://www.gainhealth.org/knowledge-centre/ethiopias-new-leadership-will-it-deliver-for-nutrition/" target="_blank">This blog is also available on the GAIN website</a></div>
Lawrence Haddadhttp://www.blogger.com/profile/17265061444076801962noreply@blogger.com0tag:blogger.com,1999:blog-6335146197342151188.post-15039399544580627362018-03-28T13:37:00.002+01:002018-03-28T13:40:11.202+01:00The consumption of animal sourced foods by infants in low-income settings: Does it need to increase? And, if so, what is holding it back?<div style="background-color: white; border: 0px; box-sizing: border-box; color: #504f4f; font-family: Arial, sans-serif; font-size: 16px; margin-bottom: 13.4688px; margin-top: 13.4688px; outline: 0px; padding: 0px; vertical-align: baseline;">
I have just finished reading a very useful new <a href="http://www.ifpri.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">IFPRI</a> <a href="https://www.ifpri.org/publication/animal-sourced-foods-and-child-stunting" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Discussion Paper</a> by <a href="http://www.ifpri.org/profile/derek-headey" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Derek Headey</a>, <a href="http://www.kallehirvonen.com/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Kalle Hirvonen</a> and <a href="https://www.human.cornell.edu/people/jfh246" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">John Hoddinott</a>. The paper pulls together data on the food intake of 112,553 children 6-23 months old contained within Demographic and Health Surveys (DHS) across 46 low and middle income countries since 2006 (when more standardised and disaggregated food recall data began to be collected).</div>
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The paper asks three questions: (1) how does infant food intake vary across country? (2) what is the association between food intake components and infant linear growth? and (3) how sensitive is a food’s intake to the price of the food in question? There is a specific focus on animal sourced foods (ASF), given the density of high quality proteins and micronutrients in these foods.</div>
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The paper has its limitations, for example the data are 24 hour recall data and so are subject to recall error and the statistical analysis (i.e. beyond describing the data) cannot go to the subnational level (because the prices are national). Nevertheless, this is by far the best attempt to pull together and analyse this type of data that we have and, for organisations such as <a href="http://www.gainhealth.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">GAIN</a>, which deliver programmes with partners, it is invaluable, and, in some respects, startling.</div>
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So what does the paper tell us?</div>
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<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Half of all 6-23 month old children in Sub Saharan Africa did not consume even one ASF in the previous 24 hours, whereas 84% of kids in Latin America and the Caribbean consume at least one ASF.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Over 10% of all children in Asia and Africa consumed no food in the previous 24 hours (although it is not clear if that means no breastmilk was also consumed).</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Fish, eggs and legumes/nuts are the least consumed foods in all regions at 19.9%, 21.9% and 25.9% of infants, respectively.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">The consumption of any ASF and any fruit is positively associated with decreased likelihood of stunting, especially for infants over 18 months of age, but, curiously, vegetable and pulse consumption were not, even when looking only at the subset of infants who do not meet the minimum diet diversity score.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">For the group of infants as a whole, dairy, meat and fish consumption had the strongest and most significant associations with reductions in stunting prevalence (although egg consumption less so) and more so in the upper age groups, with fish significant in all age groups.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">By region, for 18-23 month olds, vegetable consumption (either Vitamin A rich or leafy green) had very little association with stunting rates in any region. Dairy was strongly associated with stunting reduction in Latin American and Caribbean, south, east and central Asia and east and southern Africa, but not elsewhere. Fish consumption was only significantly associated with stunting reduction in west and central Africa and Latin American and Caribbean (and in Latin America and the Caribbean the authors could not separate out fish and meat consumption). Vitamin A rich fruit consumption was only associated with stunting reduction in Latin American and Caribbean and egg consumption only in west and central Africa. Consumption of “other fruit” was only significantly associated with stunting reduction in south, central and eastern Asia. Surprisingly meat consumption was not significantly associated in any region at 5%–with the exception of Latin American and Caribbean (again, note the authors could not separate meat and fish consumption for this region).</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">How important are prices in deterring consumption? Normalising food prices in each country (and we also have high income country data available from this ICMP source) relative to that country’s cheapest staple cereal, we find that it costs between 6.0 and 11.5 times as much to buy a calorie from leafy green vegetables as it does to buy a calorie from the country’s cheapest cereal (even in high income countries the ratio is 9).</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Prices of other foods relative to the cheapest staple are highest in the two African regions, which probably reflects, in part, high costs of moving foods around in this geography. The highest prices relative to the cheapest cereal are for fresh cows milk, vegetables and, interestingly, fortified baby cereal (which is 16-24 times as expensive as the cheapest cereal in Africa and Asian regions).</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Egg and dairy consumption is most sensitive to changes in their own price (as prices go up, consumption goes down) but the consumption of meat and fish is less sensitive to own prices.</li>
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So what does this all mean? First, the region, country (and presumably subnational area) really matters: consumption of different diet components is highly context specific. Second, the relationship between diet components and stunting is also quite context specific. Third, the relationship between the price of a food and its consumption is consistent (negative) although the magnitude varies by food.</div>
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The paper points out that if the public nutrition goal is to increase the consumption of animal source foods for infants (or any age group), then we need to reduce the price of these foods for all and this means expanding the availability of that food (while maintaining profit so that farmers actually grow it). This strategy would of course raise issues of concern around sustainability – how can we make ASF cheaper for infants in low-income countries without leaving those very same children with fewer natural assets to manage when they grow up?</div>
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Current strategies to convince parents to increase the consumption of ASF for infants are hampered by the high price of ASFs because families will sell the foods for income to buy other foods and other things – but the food that is purchased is not as rich in high quality protein and micronutrients as the food that is sold. In this high price context it is less easy to convince farming parents to forego income to feed high priced nutrient rich food to their infants.</div>
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This paper resonates with GAIN’s mission—to make nutritious foods more available, affordable and desirable. Affordability of nutritious food is a real constraint to nutrition status and this paper presents data from 46 countries to show this. But the results in the paper also point to potential sustainability trade-offs. We need more science to chart any trade-offs (or synergies).</div>
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In short, we need to get the price of nutritious foods down in a sustainable way—if we don’t these foods will not be eaten by the people that need them the most.<br />
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<a href="https://www.gainhealth.org/knowledge-centre/consumption-animal-sourced-foods-infants-low-income-settings/" target="_blank">This blog is also available on the GAIN website</a></div>
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Lawrence Haddadhttp://www.blogger.com/profile/17265061444076801962noreply@blogger.com0tag:blogger.com,1999:blog-6335146197342151188.post-12673762489775146652018-02-23T11:04:00.000+00:002018-02-23T11:04:19.293+00:00How Important are Businesses to Addressing Malnutrition in the “Many Kenyas”?<div style="background-color: white; border: 0px; box-sizing: border-box; color: #504f4f; font-family: Arial, sans-serif; font-size: 16px; margin-bottom: 14.2031px; margin-top: 14.2031px; outline: 0px; padding: 0px; vertical-align: baseline;">
I just returned from a visit to our Kenya partners. Kenya was one of the <a href="http://www.globalnutritionreport.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Global Nutrition Report’s (GNR)</a> star performers in 2017 in terms of stunting reduction – with levels nationally of 26%. But the rates vary wildly by the 47 counties: Kitui and West Pokot are both above 45% and Kilifi and Mandera are in the high 30’s (see the <a href="https://dhsprogram.com/pubs/pdf/fr308/fr308.pdf" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">2014 Kenya Demographic and Health Survey</a>, p. 162).</div>
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At the same time, Kenya is experiencing an upsurge in overweight, obesity and other risk factors for diet-related <a href="http://www.who.int/mediacentre/factsheets/fs355/en/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">non-communicable diseases (NCDs)</a>. The country is in full “double burden” mode with undernutrition and other manifestations of malnutrition such as obesity and diabetes running in parallel, often in the same communities or families.</div>
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In this context, a focus on improving diets makes sense because it is core to preventing <u style="box-sizing: border-box;">all forms of malnutrition</u>. Improving the consumption of nutritious safe food is the ultimate “double duty” action—one that addresses undernutrition as well as the diet related NCDs.</div>
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What is driving the phenomenon of the double burden? The usual suspects–urbanisation, income growth, increasing availability and glorification of cheap junk food– are probably to blame. We have to guess, because the last nationally representative individual food intake survey was conducted in 1994 (although this <a href="http://documents.wfp.org/stellent/groups/public/documents/ena/wfp285586.pdf?_ga=1.83081238.1639770126.1463141962" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">2016 WFP survey of diet diversity</a> via food frequency is very useful).</div>
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Are there causes for optimism that Kenya can counter this double burden? Yes, several.</div>
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First, the central government is just about to elevate nutrition to the Presidential level through the new <a href="https://scalingupnutrition.org/wp-content/uploads/2013/10/Kenya-National-Nutrition-Action-Plan-2012-2017-final.pdf" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">National Food and Nutrition Security Policy Implementation Framework</a>, which has been signed by all 47 County Governors. This is excellent because we know that attention and leadership from the very top of government pushes nutrition up the political and development agenda, with results in terms of funding, staffing and awareness across society.</div>
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Second, one of President Kenyatta’s <a href="https://www.standardmedia.co.ke/article/2001270097/the-big-four-are-rightly-pegged-on-kenya-vision-2030" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">4 big priorities</a> for his new term is Food Security and Nutrition. On closer inspection of the speech I find reference to diversifying production, improving water for agriculture and improving vegetable, fruits and fish production, and generating jobs. Coupled with commitments on universal health care and to improving the enabling environment for businesses to provide jobs for young people, this sounds promising. And it is really needed: a recent <a href="https://reliefweb.int/sites/reliefweb.int/files/resources/cost_of_the_diet_turkana_policy_brief_0.pdf" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Save the Children Cost of Diet study</a> in Turkana county found that the cost of a nutritious diet was 10 times the monthly cash transfer funded by the Government with help from <a href="https://www.gov.uk/government/organisations/department-for-international-development" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">DFID</a> (and the highest cost was for adolescents due to their higher nutrient requirements). Now we look for government policies, legislation, tariffs, taxes and spending that support these promising goals.</div>
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Third, the Kenyan nutrition community, admittedly from my limited interactions, seems committed and coherent. I met senior government representatives including the Principal Secretary, <a href="http://www.health.go.ke/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Ministry of Health</a>, Mr. Julius Korir, Dr. Peter Cherutich, the Director of Preventive and Promotive Health Services and Ms. <a href="https://www.youtube.com/watch?v=gBTcM-0_TW8" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Gladys Mugambi</a> Head of Nutrition and Dietetics and <a href="http://scalingupnutrition.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Scaling Up Nutrition (SUN)</a>Focal Point, as well as representatives of the UN community, researchers from <a href="http://ciat.cgiar.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">CIAT</a>, development partners, and business leaders. It was encouraging that everyone in the nutrition sector is so alert to the ravages of climate change and the uncertainty it generates in food production and consumption.</div>
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From a GAIN perspective our dynamic new Country Director <a href="https://www.gainhealth.org/people/leah-kaguara/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Leah Kaguara</a> is leading a short, sharp country strategy development process. GAIN works to <a href="http://www.gainhealth.org/wp-content/uploads/2017/10/GAIN-Strategy-2017-2022.pdf" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">improve the consumption of nutritious safe food</a> required for healthier diets. So naturally a key strategic question we will have to answer is “should we work with partners in the most deprived areas where there are few businesses to bring together with government, and few markets to shape?” This is an important question and one that, at least for me, does not have an easy answer. Why?</div>
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First, do the counties with the highest prevalence of stunting actually have the largest number of stunted children? The counties where the largest number of stunted children are located may not be the most remote or deprived counties (see <a href="http://kcl.academia.edu/AndySumner" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Andy Sumner’s work</a> on the location of poverty): it is possible that these areas may have fairly well developed markets with availability of healthy foods better than others.</div>
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Second, just because markets are thin in some areas, does that mean they cannot be developed? For example, if a stronger cold chain is developed (such as through our <a href="https://www.gainhealth.org/postharvest-loss-alliance-nutrition/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">PLAN programme</a>) in order to reduce food price volatility by improving food storage, can that bring small and medium sized companies into the value chain?</div>
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Third, are we assuming that small enterprises are not present in poor and remote areas? Our experience with the <a href="https://www.gainhealth.org/knowledge-centre/project/marketplace-for-nutritious-foods/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Marketplace for Nutritious Foods</a> suggests otherwise. (And let’s not forget that farmers are businesses.)</div>
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Fourth, county governments employ many people, and the workplace programmes we run with businesses could be adapted to public sector employment. Does the <a href="http://www.health.go.ke/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Ministry of Health</a>, for example, make it easy for its employees to eat nutritious and safe food?</div>
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Finally, even in areas where humanitarian work is the main activity, small businesses can be crowded in, witness the <a href="http://www1.wfp.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">World Food Programme</a>’s programme for Syrian refugees which uses <a href="https://www.coindesk.com/united-nations-sends-aid-to-10000-syrian-refugees-using-ethereum-blockchain/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">blockchain</a> technology and vouchers to be redeemed with participating small vendors.</div>
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You can tell what my prior views are, but my colleagues and I will keep an open mind. Nevertheless, what is clear, even from my short trip, is that there are “many Kenyas” in terms of nutrition outcomes, governance, identity, capacity and programme coverage. Understanding context is always a vital principle, and in Kenya it is no exception.</div>
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There are green shoots everywhere, but we need to be under no illusions that tackling this double burden of malnutrition in Kenya will require a massive collective effort – by government, citizens, health professionals, businesses, and donors – to turn around. While Kenya is on track to meet <a href="http://www.who.int/nutrition/global-target-2025/en/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">global World Health Assembly targets</a> – for under 5 stunting, wasting, overweight, and exclusive breastfeeding – for other critical indicators such as women’s anemia, adult obesity and adult diabetes it is off course (see the 2017 Kenya <a href="https://www.globalnutritionreport.org/files/2017/12/gnr17-Kenya.pdf" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">country profile</a> from the Global Nutrition report).</div>
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Improving the quality of diet is a no-regrets “double duty” action to reduce malnutrition in all these forms. So we need to get behind the President’s commitment to improve food security and nutrition—and to hold the government, and other stakeholders, accountable for progress towards meeting that commitment.</div>
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<a href="https://www.gainhealth.org/knowledge-centre/important-businesses-addressing-malnutrition-many-kenyas/" target="_blank">This blog is also available on the GAIN website</a></div>
Lawrence Haddadhttp://www.blogger.com/profile/17265061444076801962noreply@blogger.com0tag:blogger.com,1999:blog-6335146197342151188.post-40795084658697276942018-02-09T08:17:00.001+00:002018-02-09T10:40:50.868+00:00Why Nutrition Needs to Find Blue Oceans<div style="background-color: white; border: 0px; box-sizing: border-box; color: #504f4f; font-family: Arial, sans-serif; font-size: 16px; margin-bottom: 14.5625px; margin-top: 14.5625px; outline: 0px; padding: 0px; vertical-align: baseline;">
Funding for nutrition has increased significantly over the past 10 years, which is a very good thing. So has the number of initiatives, organisations and programmes addressing nutrition. But is this an unqualified good thing?</div>
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<span style="font-family: Arial, sans-serif;">On the plus side, this could lead to a greater diversity of partners, approaches, ambition, reach and influence, and could result in stronger alliances and a bigger impact on nutrition status</span>. But, if we have a monoculture—everyone chasing the same funds to do the same things without coordination– that is a likely to be bad for coherence, bad for nutrition outcomes and bad for eradicating malnutrition.</div>
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Business strategists call the latter outcome a Red Ocean scenario (everyone is fighting in the same space for the same resources, the red signifying blood) and the former a Blue Ocean scenario (stakeholders are trying to expand the nutrition space by venturing into waters where few nutrition actors are to be found). Here is the original Harvard Business Review <a href="https://hbr.org/2004/10/blue-ocean-strategy" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">article</a> from 2004.</div>
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Clearly we need nutrition to move more quickly into blue oceans. Every <a href="http://www.globalnutritionreport.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Global Nutrition Report</a> since 2014 has stressed this with calls to reach out to new sectors, new stakeholders, new disciplines, new alliances and new geographies. So we can clearly talk the talk. Our increasing realisation of the centrality of what we eat in preventing all forms of malnutrition should keep us less fractured and more coherent. But how do we get into those blue oceans? It is hard. We all want to belong to a gang. It is so much more comfortable to interact with people who use the same language, have similar frames of reference, and who commune regularly in the context of a series of major meetings.</div>
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I would argue that we have to do more to get out of our comfort zones, to meet people who don’t think much about malnutrition but who offer a new opportunity to advance nutrition all the while getting their own development goals met more sustainably. (We have one big advantage here, every family, community and each human being eats every day! So unlike advocating around many other critical topics, we have a common starting point.)</div>
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This past year I have written several blogs illustrating the benefits of ocean-going nutritionists! The mobile phone providers who can spread nutrition messaging, cold chain firms who can provide low cost refrigeration solutions, trade regime lawyers who can help strategize about how to reduce tariffs on key inputs to healthy food systems (e.g. insulation material), consumer rights groups who can work on class action litigation, human rights organisations that can document nutrition rights’ violations, infrastructure experts who can advise on what works and does not work in the PPP space, education specialists who can help design school based nutrition programmes that appeal to students. The list goes on……</div>
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Nutrition institutions need to give their nutrition champions the license, skills and support to roam in the blue oceans. And all of us need to share our nautical charts on where those oceans are and what is in them. The blue ocean is big. We need to operate in it.</div>
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<a href="https://www.gainhealth.org/knowledge-centre/nutrition-needs-find-blue-oceans/" target="_blank">This blog is also available on the GAIN website</a></div>
Lawrence Haddadhttp://www.blogger.com/profile/17265061444076801962noreply@blogger.com1tag:blogger.com,1999:blog-6335146197342151188.post-31529565659754934992018-01-29T08:23:00.000+00:002018-01-29T08:23:28.349+00:00How to Persuade People to Eat More Nutritious Food?<div style="background-color: white; border: 0px; box-sizing: border-box; color: #504f4f; font-family: Arial, sans-serif; font-size: 16px; margin-bottom: 14.4219px; margin-top: 14.4219px; outline: 0px; padding: 0px; vertical-align: baseline;">
I just finished reading ‘<a href="https://www.publishersweekly.com/978-0-393-24331-4" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Why you eat what you eat</a>” by <a href="http://www.rachelherz.com/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Professor Rachel Herz</a>. Fascinating, and together with Professor Michael Spence’s “<a href="https://www.penguin.co.uk/books/295794/gastrophysics/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Gastrophysics</a>” it caused me to reflect on the radical changes we need to effectively promote healthy and nutritious diets, and reverse the out-of-control trends in malnutrition affecting every country.</div>
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<a href="https://www.gainhealth.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">GAIN</a>’s purpose is to advance nutrition by improving the consumption of nutritious and safe food. To do this at scale in a sustainable way we consider three aspects of food systems – demand for, supply of and the overall enabling environment to increase the consumption of such foods.</div>
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Of these perhaps the most difficult and often-ignored challenge is building the demand for more nutritious foods. Companies do build the demand for their food products —nutritious or otherwise—but they look to government to build the demand for more nutritious eating habits, and thus these types of foods. For companies to “go it alone” on this front is too expensive and can put them at a competitive disadvantage.</div>
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But here’s the problem. Governments are not good at developing the demand for nutritious foods. There are exceptions, but most public health campaigns emphasise “good for you” “high in fibre” type messaging. This approach utilises only one button out of a veritable airplane console of buttons that are available to change eating behaviours. To activate all of these buttons, governments need to work with marketing departments and advertising companies for whom identifying and pushing these buttons is their day-to-day job. In this way governments can stay true to their nutritional guidelines but employ engaging and memorable strategies.</div>
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So, what are these myriad buttons that can influence what people eat that Professor Herz analyses. First, I noticed that the word “price” comes up only once in the book and then to remind us that the higher the price of the bottle of wine, the better it tastes when compared to the same wine labelled at a lower price! It is true that most people on low incomes are very price sensitive, but before they worry about price and affordability, they need to want to buy the food in the first place. Second, surprisingly, only 90 of the 270 pages of the book are devoted to taste and smell. The other 180 pages are devoted to everything else that makes us eat what we eat.</div>
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The global food industry spends $14bn a year on food adverts that push these non-taste and non-smell buttons. That is about the same as the entire UKAid budget. Why do they spend this amount (and by implication why do governments need to pair up with them in the effort to stimulate more healthy food)? They do it because the evidence shows that the how food is profiled and contextualised is profoundly influential on what we buy and eat. Some examples of this cornucopia of profiling:</div>
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<strong style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Language</strong></div>
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<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">When the same popcorn is described in two different ways, very different amounts are consumed. When the taste alone is described, less is eaten than when other senses are described such as the smell (of going to the movies), the texture (buttery), and the sound (crunch)</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">When <a href="http://www.oreo.com/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Oreo cookies</a> are described as “organic”, more are consumed</li>
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<strong style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> </strong><strong style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Images</strong></div>
<ul style="background-color: white; border: 0px; box-sizing: border-box; color: #504f4f; font-family: Arial, sans-serif; font-size: 16px; list-style-image: initial; list-style-position: initial; margin: 0px 0px 1.5em 3em; outline: 0px; padding: 0px; vertical-align: baseline;">
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Trail mixes that have an image of running shoes on the front of the pack are considered healthier, even if they are not</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Carrots wrapped in <a href="https://www.mcdonalds.com/us/en-us.html" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">McDonalds</a> paper are rated tastier than the same carrots wrapped in identical paper without the logo!</li>
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<strong style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Colour & Shape</strong></div>
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<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Round chocolate shapes are rated as sweeter, even when not</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Blue angular plates mean food served on them is more likely to be rated salty</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">The occasional redder potato chip in those tube stacks act as traffic lights and are more likely to stop consumption of the next layer of less red chips</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">The more food that is piled on a plate, the less good we are at estimating its calorific value (we tend to underestimate the amount)</li>
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<strong style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Music</strong></div>
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<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">High pitched music makes foods taste sweeter, low pitched makes them taste more bitter</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Accordion music in supermarkets results in more French wine being bought</li>
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<strong style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> </strong><strong style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Emotions</strong></div>
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<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Comfort food really works—it comforts you when you are stressed and because of that, you eat more and more of it (the Herz book reminds us that “stressed” is “desserts” spelled backwards)</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Restaurant adverts work better when they tell you that this is a place where many engagements and anniversaries are hosted (love and emotion) versus talking about the quality of the food served at the restaurant</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Labels that talk about “health” make us less guilty about eating more. Labels that say the food is “decadent” encourage diminished consumption</li>
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Are there examples of this kind of science and art being brought to campaigns for healthy food? Most of the examples in Prof Herz’s book are from the US and other high-income countries. And a new example is <a href="https://vegpower.org.uk/#welcome" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">VegPower</a> (UK), which identifies vegetable consumption with superhero power.</div>
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In the middle and low-income countries there are some examples I know of:</div>
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<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Ecuador’s <a href="https://www.researchgate.net/profile/Chessa_Lutter/publication/317387899_Eggs_in_Early_Complementary_Feeding_and_Child_Growth_A_Randomized_Controlled_Trial/links/59df4ab7aca27258f7d7799b/Eggs-in-Early-Complementary-Feeding-and-Child-Growth-A-Randomized-Controlled-Trial.pdf" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Lulun</a> egg consumption campaign</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Indonesia’s <a href="http://ehg.lshtm.ac.uk/2015/08/12/behaviour-change-campaign-to-reach-50-million-mothers-in-indonesia/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Healthy Gossip</a> campaign (involving GAIN)</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Ghana’s <a href="http://obaasimaghana.com/home.php" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Obaasima</a></li>
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But we need more, and they all need to be evaluated from a nutrition and business perspective.</div>
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But let’s get real–who will pay for this? I’d like to see some combination of government and foundation funding for this. Governments should be in the driver’s seat. Public funding could be earmarked from sin taxes. And why should they pay for it? Because, the market for healthy food is going to grow, but just not quickly enough. Governments should try to accelerate the nutritious food market development. Doing so will boost the health of their populations and lower health costs (remember poor diet is the biggest cause of global ill health, with massive social costs), incentivise companies to invest in their country (with the jobs and tax revenues that brings), and establish the country as a modern nutrition agenda setter for others.</div>
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<a href="https://www.gainhealth.org/knowledge-centre/persuade-people-eat-nutritious-food/" target="_blank">This blog is also available on the GAIN website</a></div>
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Lawrence Haddadhttp://www.blogger.com/profile/17265061444076801962noreply@blogger.com0tag:blogger.com,1999:blog-6335146197342151188.post-76319071820569535392017-12-22T22:45:00.002+00:002017-12-22T23:09:47.821+00:00Favourite songs from 2017 (a blog not about nutrition)<div class="MsoNormal">
Readers, apart from my family, friends, nutrition and Manchester
United, music is one of my great passions.<o:p></o:p></div>
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Here are my favourites from 2017, in no particular
order (song, band).<span style="mso-spacerun: yes;"> </span>Enjoy. <o:p></o:p></div>
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<b style="mso-bidi-font-weight: normal;">Over Everything –
Courtney Barnett and Kurt Vile<o:p></o:p></b></div>
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Put two laid back storytellers together and what do you get?
A masterpiece of a song. Sounds like it took them 5 minutes to write it, but
sure it was more like 5 days.<span style="mso-spacerun: yes;"> </span>Pity the
rest of the album is not quite as good. <o:p></o:p></div>
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<b style="mso-bidi-font-weight: normal;">On Hold – The xx<o:p></o:p></b></div>
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I always find this band a bit twee and morose, but they have
really nailed it on this great pop song.<span style="mso-spacerun: yes;">
</span>Message to the xx: cheer up. <o:p></o:p></div>
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<b style="mso-bidi-font-weight: normal;">Drew Barrymore – SZA<o:p></o:p></b></div>
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New artist, pronounced “scissor”.<span style="mso-spacerun: yes;"> </span>Great debut and the rest of the album is just
as good.<span style="mso-spacerun: yes;"> </span>My wife introduced this artist
to me: reminds me of Amy Winehouse, Lolo and Mary J Blige. <o:p></o:p></div>
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<b style="mso-bidi-font-weight: normal;">Put Your Money on
Me—Arcade Fire<o:p></o:p></b></div>
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OK, it sounds a lot like Abba, but who cares?<span style="mso-spacerun: yes;"> </span>Easy to be a snob about this band, but I
think they are supremely talented and brave to give their pop sensibilities
free rein. <span style="mso-spacerun: yes;"> </span>The album is underrated. <o:p></o:p></div>
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<b style="mso-bidi-font-weight: normal;">The Underside of
Power—Algiers<o:p></o:p></b></div>
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There’s something about this song that reminds me of The
Clash.<span style="mso-spacerun: yes;"> </span>It’s a highly structured song
that sounds unstructured.<span style="mso-spacerun: yes;"> </span>The Clash did
that a lot, but it also reminds me of The Clash because it is political. <o:p></o:p></div>
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<b style="mso-bidi-font-weight: normal;">Moonshine Freeze –
This is the Kit<o:p></o:p></b></div>
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Saw this band in a record shop in Brighton. Had heard them
before, but never live.<span style="mso-spacerun: yes;"> </span>Blew me
away.<span style="mso-spacerun: yes;"> </span>Great debut album.<span style="mso-spacerun: yes;"> </span>Folky but playful, with great melodies.<span style="mso-spacerun: yes;"> </span>Think they will go far. <o:p></o:p></div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;">Tonite—LCD Soundsystem<o:p></o:p></b></div>
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<br /></div>
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Have loved James Murphy’s music for the last 10 years and I was
sad when LCD Soundsystem retired in 2011.<span style="mso-spacerun: yes;">
</span>So glad they are back.<span style="mso-spacerun: yes;"> </span>Album is
great (Bowie-esque) but this song is a standout for me—just lots of fun.<span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;">Up All Night –War on
Drugs<o:p></o:p></b></div>
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<br /></div>
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It must have been daunting to follow up 2014’s sublime album
“Lost in the Dream” but 2017’s “A Deeper Understanding” nearly does it.<span style="mso-spacerun: yes;"> </span>My favourite is the opening track which just
makes me happy. <o:p></o:p></div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;">Pa’lante – Hurray for
the Riff Raff<o:p></o:p></b></div>
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<br /></div>
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Meaning “Go Ahead” or “Go For It” in Spanish, this song is
really 3 songs in one—the first a personal challenge to “be someone”, the
second part a Beatle-esque interlude and the third part a reprise of the first,
but with a more political angle.<span style="mso-spacerun: yes;"> </span>A
striking and moving song. <o:p></o:p></div>
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<br /></div>
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<b style="mso-bidi-font-weight: normal;">Love without Violins—The
Gift and Brian Eno<o:p></o:p></b></div>
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<div class="MsoNormal">
Had the privilege of seeing The Gift (a Portuguese band) in
Brighton this year.<span style="mso-spacerun: yes;"> </span>A large group of
talented musicians that can play a wide variety of styles, I thought this
collaboration with the unique Brian Eno was surprising and spectacular. <o:p></o:p></div>
Lawrence Haddadhttp://www.blogger.com/profile/17265061444076801962noreply@blogger.com0tag:blogger.com,1999:blog-6335146197342151188.post-45377356210941321332017-12-20T09:43:00.005+00:002017-12-20T09:43:54.020+00:00Stuck in the Middle: Nutrition Programming for Adolescents<div style="background-color: white; border: 0px; box-sizing: border-box; color: #504f4f; font-family: Arial, sans-serif; font-size: 16px; margin-bottom: 14.2969px; margin-top: 14.2969px; outline: 0px; padding: 0px; vertical-align: baseline;">
Adolescents (or “Generation Z” as businesses call them) are a group that are both talked about and ignored by the nutrition community.</div>
<div style="background-color: white; border: 0px; box-sizing: border-box; color: #504f4f; font-family: Arial, sans-serif; font-size: 16px; margin-bottom: 14.2969px; margin-top: 14.2969px; outline: 0px; padding: 0px; vertical-align: baseline;">
Everyone is talking about them right now. There are two workshops that I know of on the topic in the past couple of months: one in Washington organised by <a href="http://www.paho.org/hq/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Pan American Health Organization</a>/<a href="http://www.who.int/en/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">World Health Organization (WHO)</a>, <a href="https://www.usaid.gov/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">USAID</a>/<a href="https://www.spring-nutrition.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">SPRING</a> and partners, and one in London organised by <a href="http://www.ennonline.net/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">ENN</a>, <a href="https://www.savethechildren.org.uk/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Save the Children UK</a> and the <a href="https://www.lshtm.ac.uk/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">London School of Hygiene and Tropical Medicine (LSHTM)</a>. There are probably more. And yet adolescents are also ignored: there is little data on them, and few nutrition interventions designed by or even for them.</div>
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I attended the London workshop earlier this week. It was very well organised around population groups, outcomes and interventions.</div>
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Some things I noted/learned/realised:</div>
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<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Adolescents can make good nutrition status time travel. Adolescents are a bridge across generations, biologically of course due to the growth spurts they experience and in terms of their future role as parents, but also in terms of norm setting and social and emotional development.</li>
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<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">The cost of the adolescent girl diet is one of the most expensive in a household as found by the <a href="http://www1.wfp.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">World Food Programme (WFP)</a>’s research. This is because girl adolescents have a high nutrient requirement and these are found in relatively expensive foods.</li>
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<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Age matters – for nutrition and neuroscience. <a href="https://www.gainhealth.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">GAIN</a> is finding different anthropometric trends among adolescents 10-14 and 15-19 years in Bangladesh. There is an accelerated decrease in stunting and underweight among younger adolescents, but also an increased acceleration of overweight and obesity as compared to the older adolescents. Behavioural research from the UK finds that adolescents 12-15 years of age are more likely to pay attention to health messages whereas 15-19 year olds are more distracted by competing issues. Also the younger age group is more likely to be influenced by parental views, whereas the older group are influenced by their peers. In fact, the risk loving behaviour of adolescents is similar to those of people in their 20s, but only if peers are not involved. Once they are involved the 15 year olds get heavily influenced by peer pressure. We cannot treat adolescents as a single target group.</li>
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<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">There are likely important rural/urban differences. For example we heard about how all adolescents in Malawi tell us their food choices are influenced by resources (cost, time, knowledge), context (availability, family dynamics, information sources) and ideals (modernity, tradition). Yet for the urban groups modernity was much more valued than for rural groups.</li>
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<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Function matters. There is a need to put more focus on function when it comes to indicators: height and body mass index are important to predict risk of birth obstruction (on one end of the malnutrition spectrum) and non-communicable disease (on the other end). But in the nutrition world we rarely measure function (physical, cognitive and psychosocial). Can’t we do so more directly if that is what we are interested in?</li>
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<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">The nutrition community is coming late to the adolescent party. For example, adolescent health has been championed by WHO through its longstanding efforts on <a href="http://www.who.int/maternal_child_adolescent/documents/global-standards-adolescent-care/en/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">adolescent responsive health systems</a> and the more recent call to action: <a href="http://www.who.int/maternal_child_adolescent/topics/adolescence/framework-accelerated-action/en/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Global Accelerated Action for the Health of Adolescents (AA-HA!): guidance to support country implementation</a>. The human immunodeficiency virus<em style="border: 0px; box-sizing: border-box; font-family: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;"> (</em>HIV) and sexual reproductive health colleagues have for years been experimenting and learning how to work with adolescents. In nutrition, we are just starting to understand the challenges of programming for adolescent nutrition. We don’t even routinely break out reporting from survey data such as Demographic Health Survey (DHS) & Multiple Indicator Cluster Surveys (MICS) for adolescent girls from the women of reproductive age group (15-49).</li>
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<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">The unintended consequences of getting programming wrong for adolescents are not trivial. For example early puberty may be one outcome, which may lead to early age at first pregnancy and poor outcomes for mother and child. In addition, programs that target girls only may risk backlash from boys who feel excluded.</li>
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<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Most programmes aimed at improving adolescent nutrition will have to work through other sectors. This is because there are many different (but short lived opportunities) to find the “hour in the day” that adolescents can control and engage with programs. This means that nutrition champions have to really think hard about what they have to offer these other sectors. For instance, can improved adolescent nutrition really improve school outcomes in a cost effective way? If yes, why wouldn’t education leaders embrace it? We need to do the research and then influence the education leaders.</li>
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For me the key is for nutrition to learn from others. How do those who design policies and programmes for adolescents in education, HIV prevention, sports and recreation, the prevention of violence and decent work reach these age groups?</div>
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In fact, is there even a role for stand-alone nutrition interventions for adolescents beyond micronutrient supplements? Will all the effective interventions be found in the nutrition sensitive space? Should the nutrition field put more effort into shaping the food systems (access) in which adolescents live or preparing adolescents to make the best food choices possible (demand)? I don’t know.</div>
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What I do know is that we have to learn from others, adapt the learning, try the most plausible, evaluate them rigorously and then share the findings in an engaging way. What we can’t do is nothing. One of the most memorable quotes from the presentations in London was from a Cambodian girl drawing a picture of herself crossing a line, saying “This is me—in the middle”.</div>
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When adolescents are going through such rapid transitions we can’t leave them stranded in the middle without adequate support. We need to design and implement new approaches to address adolescent nutrition. Adolescents are looking for allies, for people to listen to them, and for investors and others to take a chance on programmes that will help them through the sometimes wonderful, sometimes frightening turbulence of this time in their lives.</div>
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As the <a href="http://www.who.int/mediacentre/events/2017/wha70/en/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">2017 World Health Assembly</a> said, lack of evidence is no longer an adequate excuse for inaction.</div>
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<em style="border: 0px; box-sizing: border-box; font-family: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">I would like to thank Alison Tumilowicz who leads GAIN’s adolescent research for her valuable inputs to this blog.</em></div>
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<a href="https://www.gainhealth.org/knowledge-centre/stuck-middle-nutrition-programming-adolescents/" target="_blank">This blog is also available on the GAIN website</a></div>
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<a href="https://www.gainhealth.org/about/our-priorities/#adolescent-girls" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Find out more about GAIN’s work on adolescent nutrition here</a></div>
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<a href="https://www.gainhealth.org/knowledge-centre/no-excuses-inaction-adolescent-nutrition/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Read more on adolescent nutrition here</a></div>
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<a href="http://www.gainhealth.org/wp-content/uploads/2017/08/Embodying-the-Future-How-to-Improve-the-nutrition-of-adolescent-girls-in-Pakistan.pdf" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Download GAIN’s report ‘Embodying the Future: How to Improve the nutrition status of adolescent girls in Pakistan’ here</a></div>
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Lawrence Haddadhttp://www.blogger.com/profile/17265061444076801962noreply@blogger.com0tag:blogger.com,1999:blog-6335146197342151188.post-81355787605733638072017-11-21T10:25:00.000+00:002017-11-21T10:38:38.620+00:00The State of Nutrition in Nigeria: From Security Threat to Economic Imperative<div style="background-color: white; border: 0px; box-sizing: border-box; color: #504f4f; font-family: Arial, sans-serif; font-size: 16px; margin-bottom: 14.9375px; margin-top: 14.9375px; outline: 0px; padding: 0px; vertical-align: baseline;">
Last week I spent some time in Lagos and Abuja with the GAIN Nigeria Office. We met with government officials, entrepreneurs, civil society, reporters and development partners. It was a stimulating visit set against the devastating backdrop of a mounting malnutrition crisis, especially in the North East of the country where a famine has been declared. In fact one of the officials I spoke to told me it had gone beyond a crisis to being a clear and present danger to national security.</div>
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Nigeria certainly has too much malnutrition. Stunting rates are 33 percent and declining too slowly, wasting rates were 7 percent in 2015 and are now surely significantly higher given the situation in the North East. In addition, anaemia rates and overweight rates for adult woman are, respectively, 49 percent and 55 percent. Unfortunately, the double burden is booming in Nigeria.</div>
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<img alt="" class="size-full wp-image-13089 aligncenter" height="431" sizes="(max-width: 549px) 100vw, 549px" src="https://www.gainhealth.org/wp-content/uploads/2017/11/nigeria.jpg" srcset="https://www.gainhealth.org/wp-content/uploads/2017/11/nigeria.jpg 549w, https://www.gainhealth.org/wp-content/uploads/2017/11/nigeria-300x236.jpg 300w" style="box-sizing: border-box; clear: both; display: block; height: auto !important; margin: 0px auto; max-width: 100%;" width="549" /></div>
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It should not be like this. Nigeria has an abundance of natural resources, a vibrant entrepreneurial spirit, and was an early member of the <a href="http://scalingupnutrition.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Scaling Up Nutrition (SUN)</a> Movement <a href="https://scalingupnutrition.org/wp-content/uploads/2012/10/SUN-MP-REPORT_EN.pdf" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">(2011)</a>. It is true that the economy has been stagnant for the past few years and levels of poverty remain around 50 percent, but you get the feeling that the country has the potential to actually live up to the “economic powerhouse of Africa” tag it once had. The challenge is to enable the dynamism of the South of the country and elsewhere to drive nutrition improvement, livelihood generation, resilience and growth, especially in the more remote and conflict affected North East.</div>
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So where are the weak links in the nutrition improvement chain? As the excellent <a href="http://scalingupnutrition.org/sun-countries/nigeria/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">SUN Country Dashboard for Nigeria</a> notes (above), the country does well on enabling environment and on legislation, relative to the other 60 SUN members. But it does less well on scaling of interventions and quality of food supply and on the <a href="https://sustainabledevelopment.un.org/?menu=1300" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">SDG</a> drivers of nutrition (such as <a href="https://en.wikipedia.org/wiki/WASH" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">WASH</a>, women’s empowerment and age of marriage).</div>
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When we delve further into the aggregate scores and look at all 75 indicators, we can see that some areas of relatively good performance don’t actually look so good. For instance, the relatively good score on finance is due to development partners providing 99 percent of the total nutrition-specific funding. As for government spending, the SUN dashboard says that the <a href="http://www.nigeria.gov.ng/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Government of Nigeria</a> spends only 0.8 percent of its 2014 budget on nutrition specific interventions. The<a href="http://www.gainhealth.org/wp-content/uploads/2017/11/GNR-Report_2017.pdf" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;"> Global Nutrition Report of 2017</a>presents even more bleak statistics: it says the Government spends only 0.2 percent of its budget on nutrition sensitive AND nutrition specific interventions. Clearly the government needs to step up and invest its own resources in nutrition. Another example of hidden weak performance is the <em style="border: 0px; box-sizing: border-box; font-family: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">relatively</em> good score for infant and young child feeding, but in <em style="border: 0px; box-sizing: border-box; font-family: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">absolute</em> terms only 10 percent of infants meet the <em style="border: 0px; box-sizing: border-box; font-family: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">minimum</em> diet adequacy score; this is shockingly low but only slightly below the SUN member median of 11 percent.</div>
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But for me, the most striking gap highlighted by the SUN dashboard is the Government’s apparent lack of appreciation that nutrition is a <em style="border: 0px; box-sizing: border-box; font-family: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">driver of</em> <em style="border: 0px; box-sizing: border-box; font-family: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">development</em>. For example, Nigeria’s national development plans barely mention malnutrition (in any of its forms); the orientation of agriculture to nutrition is low, as measured by the SUN dashboard (although there is the promise of some change here); and, of course, there is the low spending on nutrition programs from the Governments own budgets, which is always the firmest test of commitment.</div>
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During my trip, I was struck (as in other GAIN country office trips) by how dynamic the small and medium enterprise CEOs are. Take the two partners in the <a href="https://www.gainhealth.org/postharvest-loss-alliance-nutrition/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Postharvest Loss Alliance for Nutrition (PLAN)</a>. This programme, conceived of and managed by GAIN and partners supports small and medium businesses that are trying to improve packaging and crating for transport and display, as well as their cold chains in fresh (and nutritious) produce so they can reduce their postharvest waste and grow their businesses. The two CEOs from<a href="http://www.bestfoodsgroupng.com/index.php" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;"> Best Foods Nigeria Ltd</a>. and <a href="http://www.alyx-limited.com/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Alyx Ltd.</a> were restless, energetic, driven, focused and in constant problem solving mode. Ironically, they could see the bigger picture better than many policy analysts – because they are a part of that picture.<br />
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEihL8ORdGaTzgPAVMBzO6qjyxpxQJEl8GBvAt6TF_NSDQyKTgE3tyNzbavhMT8fob0FBaKMOpW1kROFWvhOBRsFXpn_Ba3uxOxIV-1T7t1CwYibPgNBvEvo_jYn3NW_d6NlRN9aT0x0NfEg/s1600/LH+Blog.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="376" data-original-width="1120" height="133" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEihL8ORdGaTzgPAVMBzO6qjyxpxQJEl8GBvAt6TF_NSDQyKTgE3tyNzbavhMT8fob0FBaKMOpW1kROFWvhOBRsFXpn_Ba3uxOxIV-1T7t1CwYibPgNBvEvo_jYn3NW_d6NlRN9aT0x0NfEg/s400/LH+Blog.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Alyx Ltd. Mobile cold chain. Abuja, Nigeria</td></tr>
</tbody></table>
For example, the CEOs noted several ways in which the government could help them better provide low cost fruits and vegetables to low income populations. Specifically, they pointed out that: (a) import tariffs on insulation materials for the portable cold chain collection points (that can be taken out into the fields) are around 30 percent, (b) as are the tariffs for solar panels and batteries that will allow the portable and fixed cold chain points to be off the grid and (c) reused materials (the companies repurpose existing metals and other materials) do not count as collateral when applying for formal finance loans.</div>
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So the policies and rules that could make a food system more nutrition sensitive are not always obvious to those working outside the system, that’s why GAIN strives for the duality of being both a participant within, and an analyst of, food systems: it gives us a wealth of insights as to how to work with partners to help fix the systems. The <a href="http://sunbusinessnetwork.org/countries/nigeria-3/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">SUN Business Network</a> which GAIN convenes in Nigeria (and which the <a href="http://www1.wfp.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">World Food Programme</a> convenes in other countries in the region) is also a fantastic platform for the nutrition community to forge new alliances and partnerships with businesses who are acting responsibly to improve nutrition.</div>
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In conclusion, there were several things that made me hopeful that more rapid progress on reducing malnutrition in Nigeria can be made: the profile the media is giving nutrition at the moment—this is an opportunity to get the message out that nutrition is an investment in resilience and development; the <a href="http://dangote.com/touchinglives.aspx" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Dangote Foundation</a>’s new US$100 million commitment to nutrition which should leverage even more external funding for development; the <a href="http://fmard.gov.ng/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Federal Ministry of Agriculture and Rural Development</a>’s ambition to scale up the availability of biofortified crops; the dynamism and thoughtfulness of the Chair and Vice Chair of the Healthcare Services Committee in the House of Representatives (just like the US system) and their commitment to malnutrition reduction; the development partners we met who were more passionate, informed and action oriented on nutrition than in many other places I have visited; and the enthusiasm of small and medium enterprises to develop their businesses in ways that make nutritious foods more available and affordable.</div>
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And the best way to sustain optimism and deliver on it is by strengthening nutrition accountability mechanisms to hold our feet to the fire. For example, I would like to see an annual Nigerian Nutrition Report, similar to the <a href="http://www.globalnutritionreport.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Global Nutrition Report (GNR) </a>or the <a href="http://www.ifpri.org/publication/india-health-report-nutrition-synopsis" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">India Health Report</a>, where outcomes, legislation, policy and investment could be tracked for all 36 states, highlighting successes, bottlenecks and solutions.</div>
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GAIN Nigeria will certainly play its part in supporting the government’s efforts to meet the <a href="https://sustainabledevelopment.un.org/?menu=1300" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Sustainable Development Goals</a>. During my stay in Abuja, we hosted an event to mark our 15<span style="border: 0px; bottom: 1ex; box-sizing: border-box; font-family: inherit; font-size: 12px; font-style: inherit; font-weight: inherit; height: 0px; line-height: 0; margin: 0px; outline: 0px; padding: 0px; position: relative; vertical-align: baseline;">th</span> anniversary (one of 15 events around the world). Fifty or so partners from a range of organisations were present. Together, we explored the malnutrition challenges in the country and the opportunities to make good nutrition a reality for all Nigerians. As <a href="https://www.gainhealth.org/people/michael-ojo/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Michael Ojo</a>, our strong new Country Director put it: let’s remember who the real “boss” is here: those whose lives, livelihoods and lifecourses are at risk because of malnutrition. Remembering this will make us less likely to be complacent. He also said that working together we are more than the sum of our parts and that together we can accelerate reductions in malnutrition in Nigeria. Exactly.</div>
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<a href="https://www.gainhealth.org/knowledge-centre/state-nutrition-nigeria-security-threat-economic-imperative/" target="_blank">This blog is also available on the GAIN website</a></div>
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Lawrence Haddadhttp://www.blogger.com/profile/17265061444076801962noreply@blogger.com0tag:blogger.com,1999:blog-6335146197342151188.post-17472093843942986002017-11-13T09:39:00.000+00:002017-11-13T10:46:02.944+00:00Scaling Up Nutrition (SUN) – the 2017 Global Gathering: Inspiration, Connection, Progress and Love<div style="background-color: white; border: 0px; box-sizing: border-box; color: #504f4f; font-family: Arial, sans-serif; font-size: 16px; margin-bottom: 14.5469px; margin-top: 14.5469px; outline: 0px; padding: 0px; vertical-align: baseline;">
I just returned from the <a href="http://scalingupnutrition.org/about-sun/sun-movement-global-gathering/sun-movement-global-gathering-2017/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">2017 SUN Global Gathering (GG)</a> in Abidjan, Cote d’Ivoire. This three day meeting brought together teams from all of the <a href="http://scalingupnutrition.org/sun-countries/about-sun-countries/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">60 SUN member states</a>, the four Networks (civil society, UN, donors, business—including a few GAIN colleagues), the <a href="http://scalingupnutrition.org/sun-supporters/sun-movement-secretariat/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">SUN Movement Secretariat</a>, the <a href="http://scalingupnutrition.org/sun-supporters/sun-movement-executive-committee/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">SUN Movement Executive Committee</a> (which I am a member of) and the <a href="http://scalingupnutrition.org/sun-supporters/sun-movement-lead-group/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Lead Group</a> (the highest level officials and champions, chaired by <a href="https://www.unicef.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">UNICEF</a>’s Executive Director, <a href="https://www.unicef.org/media/media_53427.html" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Tony Lake</a>).</div>
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This was the first GG since 2015 and the first held in a SUN member country. Its objectives include to energise and inspire, to reconnect and network, and to learn and reflect. The GG did brilliantly on the first two, but we could, in my opinion, improve on the “learn and reflect”.</div>
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On the energise and inspire front, the GG was remarkable. For instance, we had the <a href="https://en.wikipedia.org/wiki/Vice-President_of_Ivory_Coast" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Vice President of Cote D’Ivoire</a>, the former President of Tanzania, many ministers from Africa and many other senior government officials from Africa, Asia and Latin America. Tony Lake was also present for the full three days, testimony to his dedication. These senior politicians and officials (such as <a href="https://www.afdb.org/en/about-us/organisational-structure/the-president/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Akin Adesina</a>, the President of the <a href="https://www.afdb.org/en/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">African Development Bank</a>) talked with great passion, authenticity and fluency. They knew the core facts: malnutrition affects one in three people, is responsible for nearly half of all under five deaths, leads to losses in GDP of at least 11 percent and investing in preventing it yields benefit cost ratios of 16:1. They weren’t speaking from scripts they were speaking from the heart and from a place of pragmatism (malnutrition is holding our economies back). This was mightily impressive and it is too bad that the top officials from donor agencies were not present to witness it.</div>
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But inspiration was not just restricted to these folks: for example, we had a junior Parliamentarian, 15 year old, Spectacular Gumbira from Zimbabwe (a well named, amazing and powerful speaker, completely unfazed by an audience of 900 people), Myriam Sidibe a powerhouse behaviour change advocate from <a href="https://www.unilever.com/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Unilever</a> and <a href="http://www.ohchr.org/EN/Issues/WaterAndSanitation/SRWater/Pages/CatarinaDeAlbuquerque.aspx" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Catarina de Albuquerque</a>, Executive Chair of <a href="http://sanitationandwaterforall.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Sanitation and Water For All</a>making connections into the WASH sector. In addition, a range of inspirational nutrition leaders were honoured by <a href="https://sightandlife.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Sight and Life</a> and by <a href="http://scalingupnutrition.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">SUN</a>, including <a href="https://www.impatientoptimists.org/Authors/P/Ellen-Piwoz" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Ellen Piwoz</a> from the <a href="https://www.gatesfoundation.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Gates Foundation</a> who won two prizes, both richly deserved.</div>
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On the reconnect and network front, the GG did a great job. There were the marketplaces that were set up by all 60-country members, the long breaks in-between sessions, the network meetings and the well-chosen venue with plenty of meeting spaces. Having the meeting in a SUN member country also gave the proceedings a feeling of balance. People like me from European and North American organisations were not able to dominate the proceedings—this was a country first meeting, where egos and logos were checked at the door. The feeling was one of solidarity not hierarchy; one of ideas, not protocol. There was, as <a href="https://en.wikipedia.org/wiki/David_Nabarro" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">David Nabarro</a> (Special Adviser to the UN Secretary General on Agenda 2030 and former SUN coordinator) put it, a lot of love. And I would add solidarity, too.</div>
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On the learning and reflection front there was a good session on nutrition in fragile contexts and how SUN could be more relevant, there was some progress on getting civil society and business networks talking to resolve issues around due diligence and accountability of businesses, and there was a short plenary on the new <a href="http://scalingupnutrition.org/progress-impact/monitoring-evaluation-accountability-learning-meal/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Monitoring, Evaluation, Accountability and Learning (MEAL)</a> resources for guiding us along the SUN theory of change. Despite this, and this is solely my own view, we could have done better on the learning and reflecting front. This really matters greatly, as we know more about the damage malnutrition does, than what works to combat it.</div>
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For example, there are some big questions looming which we did not really take on:</div>
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<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">SUN is scaling well and thinking more about impact, but what about its sustainability beyond 2020, which marks the end of the current funding cycle? Can we really call ourselves a movement if we are so reliant on donor funding? Shouldn’t some of the direct funding for SUN infrastructure come from members (to be fair, I know much of the indirect funding does already come from members)?</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">The double burden of malnutrition is rapidly increasing—the latest <a href="http://www.gainhealth.org/wp-content/uploads/2017/11/GNR-Report_2017.pdf" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Global Nutrition Report (2017)</a> counts 60 percent of countries facing significant burdens of undernutrition (under five growth faltering or adult micronutrient deficiency) as well as overweight/obesity. That percent is likely to grow before it diminishes, so what is the SUN movement’s response? What will we do differently? Can we shy away from the difficult but inevitable discussions which surround curbing some of the unhealthy dietary trends driving this?</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Urbanisation is growing rapidly in Africa as elsewhere—this presents both an opportunity and a challenge to nutrition—what does the SUN movement need to do adapt? For example, SUN already has Indian States as members, should it also invite cities to be members?</li>
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All in all the GG was a great success. The SUN Coordinator, <a href="https://www.gainhealth.org/people/gerda-verburg/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Gerda Verburg</a>, deserves a great deal of credit for her energy and her “telling it like it is” style. Her team did a superb job of making all the thousands of moving parts mesh together well.</div>
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I leave you with one positive and I believe insightful reflection someone shared with me at the end. It was that at the first GG, country members looked a bit bewildered—what is this SUN Movement and what does it mean for me? Country representatives knew what they needed, but were less sure of how to articulate it and to negotiate for it. In Abidjan, they said, it felt as if the country members were in control of the movement: there was a clarity from them about what was needed from others, a confidence on the articulation of those needs and an abundance of know-how on what to do to secure the needed support.</div>
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And this country driven approach is essential to <strong style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">S</strong>caling <strong style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">U</strong>p <strong style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">N</strong>utrition. SUN’s ultimate success will be measured in terms of whether it contributed – at the country level – to mobilising additional domestic and external resources to nutrition advancement, whether it contributed to existing resources being spent more effectively and whether it contributed to nutrition being increasingly seen as a core driver of the <a href="https://sustainabledevelopment.un.org/sdgs" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">SDGs</a>. We must never forget that SUN is a global movement. That means movement the world over as well as movement in more “global” circles. The movement marches on!<br />
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Lawrence Haddadhttp://www.blogger.com/profile/17265061444076801962noreply@blogger.com0tag:blogger.com,1999:blog-6335146197342151188.post-29339782501414863682017-11-07T09:07:00.003+00:002017-11-09T12:24:36.878+00:00The 2017 Global Nutrition Report: Nourishing the SDGs<div style="background-color: white; border: 0px; box-sizing: border-box; color: #504f4f; font-family: Arial, sans-serif; font-size: 16px; margin-bottom: 14.7031px; margin-top: 14.7031px; outline: 0px; padding: 0px; vertical-align: baseline;">
How nice to be asked to write a blog about the <a href="http://www.gainhealth.org/wp-content/uploads/2017/11/GNR-Report_2017.pdf" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">2017 GNR “Nourishing the SDGs”</a> (of course I would have anyway!).</div>
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I love the title and the narrative behind this year’s report, which can be summarised as:</div>
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1. “Let’s make good nutrition the global social norm”;</div>
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2. Disparate communities working on different nutrition outcomes need to come together to have a stronger voice. Implementers, investors and policymakers can do this by looking for double/triple duty actions that address more than one type of malnutrition;</div>
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3. Nutrition needs to be made compatible with other sectors – not just what they can do for nutrition, but what nutrition can do for them. Also we need coherence across sectors – even if we can’t convince sector x to do more for nutrition, let’s at least make sure it does not undermine nutrition; and</div>
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4. People should be put at the centre of our efforts—no person should be left behind and every voice should count.</div>
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I particularly like the sentence near the beginning of the report and repeated towards the end: “The bottom line is that nutrition needs some staying power. While global goal setting and dedicated decades for nutrition are important to spur action, let’s work to mainstream nutrition, so much so that it is considered commonplace to have optimal nutrition.”</div>
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Staying power, think about that. “Staying” implies that the good profile nutrition has right now is at risk – it might not stay. “Power” implies that nutrition is the vital “cog” in the <a href="https://sustainabledevelopment.un.org/?menu=1300" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">SDG</a> machinery. If it is not working, then things will grind to a halt. We have to find ways to make it stay around; we need to emphasise and enhance its cog-like functions in the SDG juggernaut.</div>
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But let’s get to the numbers between the beginning and the end of the report. There are plenty. Here are some facts that made me sit up and take notice:</div>
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On the <strong style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">magnitude, location, targets and pace of change</strong> of malnutrition outcomes:</div>
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<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">All 140 countries with data on under five growth, women’s anemia and adult overweight suffer from one of these burdens. All of them. In previous reports at least we had one or two exceptions.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">85 out of 140 countries have serious levels of overweight and one form of undernutrition. That is 61 percent, up from 44 percent in previous reports. The double burden of malnutrition really is the “new normal”. The challenge now is to make good nutrition the new norm.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Women’s anemia rates have increased overall, but more countries seem to be making progress—these are new <a href="http://www.who.int/en/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">World Health Organization (WHO)</a> estimates that contain good and bad news.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Adolescents: “The nutritional status, behaviours and outcomes of adolescents form a very small part of global monitoring frameworks for nutrition. The only targets that address adolescent nutrition directly are the Maternal, Infant, Young Child Nutrition (MIYCN) target for anemia of 15-49 year olds, but these are not broken out by adolescents.” While the obesity target includes an indicator for adolescent obesity, the anaemia target does not look at anaemia in adolescents separately. Beyond these, indicators are largely missing.”</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Why does the absence of data on adolescent nutrition matter? “Where estimates are available, from the WHO, these suggest that iron deficiency anaemia is the leading cause of disease burden and disability among adolescents in 2015”. Read that again: anemia is the leading cause of disease burden in adolescents, yet we have very poor data on it.</li>
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<strong style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Funding</strong></div>
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<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Nutrition specific spending from aid donors as a percentage of total <a href="https://data.oecd.org/oda/net-oda.htm" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Official Development Assistance (ODA)</a> actually declined from 0.57 percent to 0.5 percent in the past year. What more can we do to support our donor champions to get this number up to at least the 2-3 percent needed to meet the <a href="http://www.who.int/nutrition/global-target-2025/en/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">World Health Assembly (WHA) targets</a>?</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Country budget allocations to nutrition as a percentage of overall national budgets: once again the country estimates of nutrition spend (specific +sensitive) show wild variations. We need some analysis on why some countries are so low (e.g. Nigeria on 0.2 percent and why some are so high e.g. Nepal at 13.1 percent).</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Of the nutrition sensitive ODA spending, only 11 percent is found in the education sector – are we doing enough here? Is this where we should be focusing much more on double duty actions?</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">ODA spending on obesity and diet related <a href="http://www.who.int/mediacentre/factsheets/fs355/en/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Noncommunicable Diseases (NCDs)</a> constitutes only $25m – about 0.01% of global ODA. Feeble – we know it is difficult, but donors must do better, for example through double duty counting.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">There are essential calls to improve the way nutrition actions are reported in the ODA <a href="https://stats.oecd.org/Index.aspx?DataSetCode=CRS1" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Creditor Reporting System (CRS)</a>: to better align the nutrition specific codes with actual interventions and to also introduce a nutrition policy code in CRS for nutrition sensitive and policy actions. Donors can change this. But I suspect the nutrition champions within them need some evidence on the consequences of our current miscounting of nutrition spending.</li>
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<strong style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">N4G commitments</strong></div>
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<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">The (self) reporting on the <a href="https://nutritionforgrowth.org/nutrition-growth/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">2013 Nutrition for Growth (N4G)</a> commitments continues in this GNR. This year the no response rate from the 200 or so commitments made in 2013 was 49 percent– worse that the 45 percent in 2016.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Businesses were the worst offenders: with a 66-70 percent no response rate. My colleague<a href="https://www.gainhealth.org/people/jonathan-tench/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Jonathan Tench</a> has some great and sophisticated ideas for improving response rates in a panel in the report. My suggestion is less sophisticated. Name the companies. This will get their attention and the attention of their investors.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">On donor financial commitments I like Fig 5.3, which compares commitments made over the 2013-2020 period versus disbursements made over the 2013-15 period. Most donors seem to be on track.</li>
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<u style="box-sizing: border-box;">Away from the numbers</u></div>
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But numbers are not everything. Imagery is important and the report also does well here.</div>
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For instance, the language around universality of the SDGs is motivating: we need greater disaggregation of data to ensure no one is left behind and less disaggregation in country groupings—north/south dichotomies are increasingly meaningless in a multiple burden world.</div>
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I like the idea of data value chains to help us identify the weak links in the generation, understanding and use of data, but how to get governments and donors more excited to invest in this? We really need a study showing the value added of good data. How do we make the benefits visible to stack up against the very visible costs?</div>
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The five areas for action that are illustrated beautifully on the cover are a nice way to reach across the 17 SDGs (roughly, food systems, infrastructure, health systems, equity & women’s empowerment, and peace).</div>
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There is the nice quote about “Improved nutrition cannot be a singular set of targets in a silo – rather it is an indispensable cog, without which the SDG machine cannot function smoothly.“</div>
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The examples of “double duty” actions introduced in the <a href="http://www.gainhealth.org/wp-content/uploads/2017/09/GNR-2016_From-Promise-to-Impact.pdf" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">2016 GNR</a> are nicely expanded. Examples include paying more attention to NCDs within undernutrition interventions delivered by the health system, and focusing on access to improved water, not only for infection prevention, but also to act as a counterweight to high soda consumption.</div>
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The “gatefold sleeve” graphic (I’m really showing my age here) on pages 10-11 is great – stick it on your wall – as a visual story of the report. Indeed the graphics in the report keep getting clearer and simpler every year.</div>
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In general the “call to action” language was downplayed in this GNR but the four sets of actions remain powerful:</div>
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<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Build for nutrition while harnessing nutrition’s power across the SDGs.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Stand shoulder to should on obesity and diet related NCDs when addressing undernutrition.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Be bold in your commitments to nutrition improvement—we will not get the window of another <a href="http://www.who.int/nutrition/decade-of-action/en/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Decade for Action</a>—this is likely to be it, folks.</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Invest in understanding and strengthening resource data value chains.</li>
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So a massive congratulations to the GNR secretariat, the Stakeholder Group, the Independent Expert Group, the funders, the authors, the other partners, the reviewers and, especially, the GNR co-chairs: <a href="https://www.city.ac.uk/people/academics/corinna-hawkes" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Corinna Hawkes</a>, <a href="http://www.bioethicsinstitute.org/people/jessica-fanzo" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Jessica Fanzo</a> and Emorn Udomksemalee. I am proud that GAIN is a member of the report’s stakeholder group.</div>
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By nourishing the GNR, they are all nourishing the SDGs.</div>
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<a href="https://www.gainhealth.org/knowledge-centre/2017-global-nutrition-report-nourishing-sdgs/" target="_blank">This blog is also available on the GAIN website</a></div>
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<a href="http://www.globalnutritionreport.org/the-report/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Download the 2017 Global Nutrition Report: Nourishing the SDGs here</a></div>
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Lawrence Haddadhttp://www.blogger.com/profile/17265061444076801962noreply@blogger.com0tag:blogger.com,1999:blog-6335146197342151188.post-4503601834444760512017-10-23T10:13:00.001+01:002017-10-23T10:13:32.790+01:00Buoyant in Buenos Aires: the IUNS Conference<div style="background-color: white; border: 0px; box-sizing: border-box; color: #504f4f; font-family: Arial, sans-serif; font-size: 16px; margin-bottom: 13.5px; margin-top: 13.5px; outline: 0px; padding: 0px; vertical-align: baseline;">
Last week, several of the <a href="http://www.gainhealth.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">GAIN</a> team were participating in the<a href="http://icn2017.com/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;"> 2017 International Union of Nutrition Sciences (IUNS)</a> meeting in Buenos Aires. There were thousands of participants from all over the world and hundreds (perhaps thousands) of presentations. Quite a lot of bench science, but also a lot of field and program research, and even some policy research.</div>
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All in all the GAIN team made <a href="http://www.gainhealth.org/knowledge-centre/gain-symposia-sessions-iuns-21-icn/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">14 presentations and showcased 12 posters</a>. I was really proud of all of them, but a special mention is reserved for <a href="http://www.gainhealth.org/people/dr-lynette-m-neufeld/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Lynnette Neufeld</a>, GAIN’s Director of Knowledge Leadership. Wonderfully, Lynnette was voted by the Council and country representatives <a href="http://www.gainhealth.org/knowledge-centre/gain-lynnette-neufeld-voted-president-elect-iuns/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">as the new President Elect of the IUNS</a>. This means she has four years to prepare for her tenure, which begins at the 2021 IUNS in Japan. This is an incredible honour, one that is bestowed on her by her peers and the full membership. I know she will do a great job and we will support her all the way.</div>
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So what did I make of the Conference?</div>
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Obviously I could not go to that many sessions (I gave a talk on nearly every day; there were lots of small group meetings I needed to attend, and many of the formal sessions I wanted to go to ran simultaneously) so, as usual, my views are impressionistic and partial. (And yes I would have made these observations and recommendations even if Lynnette were not the President Elect!)</div>
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1. The sessions could have been better aligned so that they aggregated up to answer big questions. There was, of course, some of this (and it must be like n-dimensional chess to get the alignment right), but I felt the presentations somehow did not build on each other enough. Half the world is malnourished, we need science to help find practical solutions, fast.</div>
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2. There weren’t enough young people presenting. There were lots of people in their 40s and 50s making great presentations, but I would have liked to have seen more mentoring of younger people. The presentations by our own Djeinam Toure and Corey Luthringer were two of the most interesting I heard. Look at dynamic sectors such as business and IT: they are brimming with young people and benefit accordingly.</div>
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3. There was not as much disciplinary diversity as I would have liked to see. I suppose this is the international union of “nutrition sciences” but the “how” is just as important as the what and why, and we need to reach out to other disciplines who are working on nutrition issues to understand these “how” issues better (e.g. the political scientists, the financial analysts, the institutional economists, the behavioural psychologists, the business administrators, the lawyers and the climate scientists). For example, there was not one presentation over the six days including the word “governance” or the phrase “public-private partnership”. Real world solutions desperately need to better link new evidence to stakeholders outside academe.</div>
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4. Everyone had to state whether they had a conflict of interest before their presentation, but in none of the sessions I attended did anyone have a conflict to declare. That struck me as odd. <a href="http://www.gainhealth.org/wp-content/uploads/2017/10/Why-isn%E2%80%99t-there-more-research-on-public-private-engagements-in-nutrition_Lawrence-Haddad-Presentation_October-2017.pdf" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">In the last of my five talks</a>, I declared an interest. The talk was arguing for more independent evaluations of public-private partnerships in nutrition. This is clearly in GAIN’s interests because we want more independent evaluations to draw on. This will allow us to do better work and attract more resources, so we can have bigger impact. OK, it is not exactly Big Tobacco, but this class of conflict is worth declaring, it seems to me. This is not just about duties, it makes interventions more interesting and real.</div>
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But without a doubt the most fun event was the GAIN 15<span style="border: 0px; bottom: 1ex; box-sizing: border-box; font-family: inherit; font-size: 12px; font-style: inherit; font-weight: inherit; height: 0px; line-height: 0; margin: 0px; outline: 0px; padding: 0px; position: relative; vertical-align: baseline;">th</span> birthday party organised by <a href="http://www.gainhealth.org/people/bonnie-mcclafferty/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Bonnie McClafferty</a>, our Director of Food Value Chains. Bonnie had organised a really interesting session earlier in the day on “Shaping Food Systems”, but the birthday party had better music and dancing.</div>
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We had the party because we wanted to thank the folks we asked to give us input into our <a href="http://www.gainhealth.org/wp-content/uploads/2017/10/GAIN-Strategy-2017-2022.pdf" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">new strategy</a>, as well as our staff, partners and investors: past, present and future. We had over a 100 people there and the positivity was fantastic. It was wonderful to be able to celebrate our contributions, standing shoulder to shoulder with our partners, over these past 15 years, and to mark the great year we have just had.</div>
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But the birthday party is merely the appetiser for the main course. To mark our 15<span style="border: 0px; bottom: 1ex; box-sizing: border-box; font-family: inherit; font-size: 12px; font-style: inherit; font-weight: inherit; height: 0px; line-height: 0; margin: 0px; outline: 0px; padding: 0px; position: relative; vertical-align: baseline;">th</span> birthday a bit more seriously, in the next two months each of our 15 country offices will host a policy roundtable discussion on the future of food systems: in Abuja, Addis Ababa, Copenhagen, Dar es Salaam, Delhi, Dhaka, Geneva, Islamabad, Jakarta, Kabul, London, Maputo, Nairobi, Ottawa, Utrecht and Washington DC.</div>
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Watch out for them!</div>
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<a href="http://www.gainhealth.org/wp-content/uploads/2017/10/Why-isn%E2%80%99t-there-more-research-on-public-private-engagements-in-nutrition_Lawrence-Haddad-Presentation_October-2017.pdf" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Download Lawrence Haddad’s presentation ‘Why isn’t there more research on public-private engagements in nutrition’ here</a></div>
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<a href="http://www.gainhealth.org/knowledge-centre/buoyant-buenos-aires-iuns-conference/" target="_blank">This blog is also available on the GAIN website</a></div>
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<a href="http://www.gainhealth.org/knowledge-centre/gain-symposia-sessions-iuns-21-icn/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Find out more about GAIN’s presentations and posters at IUNS here</a></div>
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<a href="http://www.gainhealth.org/wp-content/uploads/2017/10/GAIN-Strategy-2017-2022.pdf" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Download GAIN’s new strategy here</a></div>
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Lawrence Haddadhttp://www.blogger.com/profile/17265061444076801962noreply@blogger.com0tag:blogger.com,1999:blog-6335146197342151188.post-77834786215451433732017-10-19T09:37:00.003+01:002017-10-23T10:13:26.287+01:00Micronutrient Powders: Getting a Grip on Effective Implementation<div style="background-color: white; border: 0px; box-sizing: border-box; color: #504f4f; font-family: Arial, sans-serif; font-size: 16px; margin-bottom: 13.5px; margin-top: 13.5px; outline: 0px; padding: 0px; vertical-align: baseline;">
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I had heard of <a href="http://www.gainhealth.org/knowledge-centre/understanding-adherence-micronutrient-powders/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">micronutrient powders (MNPs)</a> before I joined <a href="http://www.gainhealth.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">GAIN</a>, and, I suspect like many non-experts, I assumed it was a pretty simple intervention.</div>
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How wrong I was.</div>
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For those of you who are less familiar with the nutrition world, MNPs are sachets of powdered vitamins and minerals that can be added to complementary foods and given to children on a daily basis. They were introduced by <a href="http://www.gainhealth.org/people/stanley-zlotkin/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Dr. Stanley Zlotkin</a> (who is also a member of GAIN’s Board) in the late 1990s. Easy to use, MNPs do not change children’s dietary habits but can be added to semi-solid foods that are already part of a child’s diet. More importantly, MNPs boost children’s micronutrient intake and reduce their risk of iron deficiency and anaemia.</div>
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A just published Supplement of <a href="http://onlinelibrary.wiley.com/doi/10.1111/mcn.2017.13.issue-S1/issuetoc" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Maternal and Child Nutrition</a> contains a series of papers emerging from a Consultation that summarise the lessons learned from operationalizing MNPs. A subsequent paper which took advantage of the Consultation’s extensive systematic literature search published in <a href="http://cdn.nutrition.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Current Developments in Nutrition</a> summarises what is known about factors affecting adherence to MNP recommendations.</div>
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The Consultation drew on the reflections of 49 MNP implementers and experts and a review of published and grey literature.</div>
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Here are the key points from the overview article by <a href="http://onlinelibrary.wiley.com/doi/10.1111/mcn.12493/full" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Dhillon et al.</a> and adherence paper by <a href="http://cdn.nutrition.org/content/1/6/e001123" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Tumilowicz et al</a>.</div>
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1. Iron deficiency anemia (IDA) is the leading cause of years lived with disability among children (I did not know that!)</div>
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2. Peak prevalence of IDA occurs at 18 months after which iron requirements decline and iron intake increases through complementary foods (I did not know that either)</div>
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3. MNPs have generally replaced iron drops/syrups because they show similar efficacy in reducing IDA (by 51 percent) and anemia (by 31 percent) in children under two years of age, but with higher acceptability and fewer side effects</div>
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4. Global scale up has been helped by the fact that MNPs are easy to use and do not require dietary change and, on average, cost USD 0.02 per sachet to produce.</div>
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5. Scale up of MNPs has been rapid: from 36 interventions in 22 countries in 2011 to 59 interventions in 50 countries in 2014.</div>
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6. Of the 50 countries, nine were implementing national programmes and 20 subnational programmes (I guess the remaining 21 were doing pilots).</div>
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7. Despite rapid adoption the extent to which the quality and scalability of MNPs can be maintained is yet to be established. Hence this Consultation.</div>
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8. The Consultation looks at 3 dimensions of MNP implementation (1) planning and supply, (2) delivery, social and behaviour change communication, and (3) continuous program improvement</div>
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9. Planning and Supply</div>
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<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">High quality research and data analysis to justify MNP intervention is not always conducted fully</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Leadership is an important driver of intervention uptake, but so too is the need to find more effective approaches to address childhood anemia</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Sustainable funding remains a challenge despite evidence of high cost effectiveness – it is good to discuss long term funding early on in implementation. Adding to existing national programmes improves sustainability (e.g. social protection in Mexico and Dominican Republic)</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Securing reliable and regular supply of MNPs is a challenge for many countries. This means that countries often rely on global suppliers, but this uses valuable foreign exchange, and can lead to long procurement lead in times and problems around local languages and packaging</li>
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10. Delivery, Social and Behaviour Change Communication and Training</div>
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<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Here the models vary by design feature: (price: free, subsidized or full cost) x (point of distribution: facility health workers, community members, pharmacists) x (sector: health, social protection, agriculture</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Free distribution through the non-health sector – for example, social protection and early childhood development programs – has shown higher coverage rates than free distribution via health systems</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Subsidized distribution has achieved a wide variety of coverage rate</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Whatever the delivery strategy, more and more MNP programmes have been linked to broader infant and young child nutrition objectives</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Programs are increasingly measuring appropriate use and intake adherence in addition to just coverage</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Social and behaviour change (SBCC) need to be applied throughout program cycle</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Regular refresher training of MNP distributors is essential to ensure high quality counselling and messaging</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Two thirds of all MNP interventions are funded entirely by development partners and this is not really sustainable</li>
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11. Continuous Program Improvement</div>
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<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Lack of documented MNP experiences, especially those implemented at scale. There are 15 peer reviewed papers and most come from pilots and were externally funded with few examples of them being used to improve implementation</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Most programmes do not apply a mapping of programme theory to track progress or make course corrections efficiently</li>
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12. Factors Affecting Adherence</div>
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<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">From the perspective of caregivers, positive changes in their children (for example, improved health, increased appetite, increased energy) and acceptance of food mixed with MNP are the main reasons for continuing to use it</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">Caregivers are less likely to stop feeding MNP if they are informed of potential negative side effects (such as changes in stool)</li>
<li style="border: 0px; box-sizing: border-box; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline;">In addition to SBCC strategies, administration regimen (fixed or flexible dosage schedule), which may be related to caregivers’ capacity to remember to give MNPs, is frequently cited as a program design feature affecting adherence.</li>
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As the papers note, “..implementing MNP programmes effectively remains a complex challenge” and “preparing food with MNP correctly and succeeding in getting a child to eat it depends on a complementary feeding process that requires a complex set of caregiver behaviors and caregiver-child interactions”.</div>
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As someone who has spent time outside as well as inside the nutrition world, I’m wondering how complex MNP programs are to implement effectively compared to the program it replaced, namely iron drops/syrups. I’m also wondering how MNPs stack up against other nutrition interventions (e.g. promotion of exclusive breastfeeding, Vitamin A supplementation, biofortification) and against other development interventions (e.g. social protection, WASH, public works programs). My experience suggests they all require careful planning, linking of supply and demand elements, and learning feedback loops. They all require sustainable funding. The impacts of none are resilient to poor design and implementation.</div>
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The state of MNP implementation reminds me of the state of conditional cash transfers in the 90’s. Everyone was jumping on the bandwagon, and many of the transfer programs did not have an impact on nutrition status because of poor design, poor implementation, poor evaluation, or some combination of the three. But as the good evaluations rolled in, meta-analyses were able to identify the rules of thumb that made positive impact more likely and sustainable at scale, and this was the trigger for governments, such as Ethiopia, to invest their own resources in them.</div>
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In sum, there are two things I have learned from the past year at GAIN that speak to these issues: (1) it is harder to design and implement effective programmes than it is to design and implement effective evaluations of them and (2) if you don’t evaluate programmes it is even harder to design and implement them effectively!</div>
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The papers in this supplement are a valuable reflection on the MNP experience to date, and I am happy that GAIN was a contributing partner in the endeavour.</div>
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<a href="http://www.gainhealth.org/knowledge-centre/understanding-adherence-micronutrient-powders/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Find out more about micronutrient powders (MNPs) here</a><br />
<br />
<a href="http://www.gainhealth.org/knowledge-centre/learning-community-health-activist-nutrition-challenges-mozambique/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: Arial, sans-serif; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Read our blog about GAIN’s MNPs program in Mozambique</a></div>
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<a href="http://www.gainhealth.org/knowledge-centre/micronutrient-powders-getting-grip-effective-implementation/" target="_blank">This blog is also available on the GAIN website</a></div>
Lawrence Haddadhttp://www.blogger.com/profile/17265061444076801962noreply@blogger.com0tag:blogger.com,1999:blog-6335146197342151188.post-13199407297773867902017-10-11T09:37:00.000+01:002017-10-11T10:51:15.283+01:00The New Expert Panel Report on Nutrition and Food Systems: What is Different?<div style="background-color: white; border: 0px; box-sizing: border-box; color: #504f4f; font-family: Arial, sans-serif; font-size: 16px; margin-bottom: 14.8281px; margin-top: 14.8281px; outline: 0px; padding: 0px; vertical-align: baseline;">
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The <a href="http://www.fao.org/cfs/en/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">UN Committee on Food Security’s</a> (CFS) <a href="http://www.fao.org/cfs/cfs-hlpe/en/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">High Level Panel of Experts </a>(HLPE) report on <a href="http://www.gainhealth.org/wp-content/uploads/2017/09/HLPE-12-Nutrition-and-food-systems.pdf" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">“Nutrition and Food Systems”</a> was released at the 44<span style="border: 0px; bottom: 1ex; box-sizing: border-box; font-family: inherit; font-size: 12px; font-style: inherit; font-weight: inherit; height: 0px; line-height: 0; margin: 0px; outline: 0px; padding: 0px; position: relative; vertical-align: baseline;">th</span> CFS this week. The team was led brilliantly by <a href="http://www.bioethicsinstitute.org/people/jessica-fanzo" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Prof. Jess Fanzo</a>. I was one of the team members.</div>
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There have been a number of reports on food systems in the past year – including the <a href="https://www.glopan.org/foresight" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Global Panel Report</a> and the <a href="http://www.ipes-food.org/images/Reports/IPES_report01_1505_web_br_pages.pdf" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">IPES report</a> – and next year we have the <a href="http://eatforum.org/" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">EAT</a>–<a href="http://www.thelancet.com/commissions" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Lancet Commission</a> report on sustainable and healthy food systems. This report is specially important as the CFS is the apex body in the international UN system looking at nutrition and food policy.</div>
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So what is different about the HLPE report? Here is my take:</div>
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First, its main audience is CFS members: governments, UN agencies and other development partners, civil society groups and companies. This means it has to be couched in the more measured, careful language of diplomacy rather than advocacy.</div>
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Second, the report was produced through a very inclusive process. The report team was balanced by geography, disciplinary background and organisation type. This meant forging compromises that all team members could live with, with the expectation that this will increase the chances of a wider buy in from stakeholders.</div>
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Third, it is, subversively, a bit radical. Statements such as “The risks of making well intentioned but inappropriate policy choices are much smaller than the risks of using a lack of evidence as an argument for inaction” are fairly heretical for many nutrition investors guided by Lancet 2008 and 2013. For the more market based interventions within the food system the hard evidence is usually not present and one has to trust educated best guesses and calculated risks as a guide to action. This is an implicit challenge to a trend towards ever more specific searches for evidence to prove interventions are justified.</div>
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Fourth, the report gives equal focus to three features of food systems: food supply, food environments and consumer orientation. Some of the other reports mentioned have not been as balanced and especially do not spend enough time on the creation of the demand for healthy food.</div>
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Fifth, the report is very action orientated. For example, there are 26 pages of text on priorities for action in food supply chains, food environments, and in orienting consumer behaviour. The “investment priority wheels” for the three types of food systems are also useful guides to sequencing action.</div>
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Sixth, the report bravely takes on the barriers and enablers for action: bravely because these are all quite context specific and deal with power asymmetries. This kind of political economy analysis needs to be developed further in future HLPE (and other) reports.</div>
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Seventh, climate issues are woven throughout the report, not confined to one section or chapter. Other environmental footprint issues could be strengthened in future reports, but to be fair the evidence on the wider environmental footprint of different foods in different countries is sorely lacking.</div>
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Finally, the private sector is taken seriously. It is not merely characterised as a malevolent actor. One of the HLPE team members was even from the private sector –a first, I believe for the HLPE, but brave and necessary. Given, as the report notes, the public sector is the duty bearer for ensuring food systems enhance food security and nutrition for all, and the private sector is main investor in food systems, it makes sense for the two sides to understand each other better.</div>
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I did, however, have quibbles with some of the private sector language (come on, did you expect me to have no quibbles with anything?). For example, the report states “The private sector is primarily seen as part of the problem, but it can and should also be part of the solution.” Some stakeholders do in fact see the private sector this way, as primarily part of the problem, but many do not. And the private sector is already part of the solution – it is just that it is also part of the problem (as, incidentally are governments – some of whom have good, some less good policies). Also, the report does little to dispel the notion that the private sector is a multinational monolith. For example, Small and Medium Income Enterprises (SME) are only mentioned once.</div>
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<a href="http://www.bioethicsinstitute.org/people/jessica-fanzo" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Jessica Fanzo</a>, the Report Team Leader, and <a href="https://nutrition.tufts.edu/profile/faculty/eileen-kennedy" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Eileen Kennedy</a>, the HLPE member who was our spiritual guide and inspiration, deserve a great deal of credit as do the HLPE secretariat. They got us through the hard times when it all seemed too overwhelming and when we could not sometimes reach consensus.</div>
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All in all, it is a report I’m proud to be associated with. The content, presentation and generation process were all thoughtful, deliberative and inclusive.</div>
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So, read it, critique it, share it, but most of all, use it and act on it!</div>
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<a href="http://www.gainhealth.org/wp-content/uploads/2017/09/HLPE-12-Nutrition-and-food-systems.pdf" style="border: 0px; box-sizing: border-box; color: #bb173c; font-family: inherit; font-style: inherit; font-weight: inherit; margin: 0px; outline: 0px; padding: 0px; text-decoration-line: none; vertical-align: baseline;">Download the HLPE “Nutrition and Food Systems” Report here</a></div>
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<a href="http://www.gainhealth.org/knowledge-centre/new-hlpe-report-nutrition-food-systems-different/" target="_blank">This blog is also available on the GAIN website</a></div>
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Lawrence Haddadhttp://www.blogger.com/profile/17265061444076801962noreply@blogger.com0