المنتدى العالمي المعني بالأمن الغذائي والتغذية

Dear Members,

On behalf of FAO/WHO Joint Secretariat we would like to thank all participants for their active involvement and their insightful comments on the political outcome document of the Second International Conference on Nutrition (ICN2).

The online discussion gathered a wide range of  views, allowing this process to be highly participatory and benefit from important inputs from food security and nutrition stakeholders representing Member States, UN organizations, individual academics, civil society and the private sector.

A Joint Working Group of regional representatives of FAO and WHO Members is now considering all inputs received and based on these and other comments will develop the final version of the political outcome document for adoption at the ICN2 in November.

For more information please see the following documents:

- Background and statistics (EN FR ES)

- Summary of the discussion (EN FR ES)

- Contributions received, available in the proceedings and on this weboage

To know more about the Second International Conference on Nutrition (ICN2) please visit the website.

Thank you again for your participation.

The FSN Forum Team

This contribution represents a consolidated position resulting from consultations with NGOs, research and different french ministries in charge of nutrition.

Commitment V: establishing governments’ leadership and financing for eliminating multiple threats of malnutrition and align where appropriate with regional and global governance structure to work towards an eradication of malnutrition globally.

Commitment VI: encouraging contributions from all actors in society including populations most affected by malnutrition, and civil society;

ACF welcomes the link with the post-2015 agenda, however we would like to have a more specific statement of intent for the ten-year plan of action to be integrated into the global development efforts for post-2015. They must also be part of efforts to achieve the targets set already by the World Health Assembly in reducing malnutrition.

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1 Action Against Hunger | ACF International is a leading civil society organisation engaged in over 40 high burden countries, able to bring experience and expertise in key areas relevant to the Second International Conference on Nutrition (ICN2). ACF has worked on the integration of nutrition, livelihood, food security water, sanitation, hygiene and health for over three decades, at all levels from grassroots to national policies and related global arenas, as practitioners, partners and respected analyst of the local, national and global response to nutrition.

Comments on the Rome document for ICN-2 from Sight and Life:

·         Overall, would like to see more clarity around the outcomes for the meeting.

·         Would also like to see more specificity/direct linkages to clarify the relevance of the outcomes for developing country policymakers.

·         Clause 2, RE: “micronutrient deficiencies have not improved,” though there is still work to be done, we’ve made tremendous progress. Take vitamin A as an example. In 1999, only 16 percent of children were receiving the necessary two annual doses of vitamin A; by 2007, that figure had more than quadrupled to 72 percent. Today, in some countries, 100 percent coverage has been achieved.

·         Clause 3. Causes of malnutrition described are too narrow and just food-focused not considering care and health.

·         Clause 6. Refer to other initiatives/commitments, such as Scaling up Nutrition, Nutrition for Growth, World Health Assembly, Zero Hunger.

·         Clause 7. Refer to WHA targets for 2025.

·         Clause 9. A food system has many entry points and does not have a base (agriculture). In the food system, each actor and sector has a function and the whole is greater than the sum of its parts because of the synergy created among well-functioning parts. When one part is unable to contribute to 100% capacity, the system as a whole compensates for this lag.

·         Sustainable and equitable food system by definition are resilient; endurance and remaining productive is inherent in the definition of sustainability, thus term resilient is redundant.

·         Clause 10. Consumption of a diverse and balanced diet, such as vegetable oil and animal source foods, leads to a healthy intake of saturated fats. Food processing technologies that convert naturally occurring fats into forms (i.e., trans fat) that are detrimental for health should be avoided.

·         Not all people can access a balanced diet because of lack of knowledge and resources. The nutrient profile (density) of food can be a lens used to examine the healthiness of our food system. Food fortification shall be considered as a cost-effective and safe approach to increase nutrient density of foods.

·         Clause 11. Advanced packaging technologies should be considered to reduce food spoilage and wastage.

·         Clause 12. Policies should encourage private-public-partnerships to co-create public goods such as improved nutrition and health.

·         Private sector role in facilitating a nutritious food system is evident

·         Clause 13. Rural livelihoods need improvements, including access to quality health services, education, safe water, sanitation, improved housing (i.e., non-dirt floors, non-leaky roofs), and social protection programs. 

·         Clause 15. Nutrition interventions must be evidence based. Nutrition assessments are required to understand what the nutritional gaps are (lack of energy, protein, micronutrients) or essential fatty acids) and cost-effective interventions (e.g., fortification, supplementation) should be designed to fill these nutrient gaps. Supplementation with micronutrients and provision of food supplements shall be provided for the most vulnerable, women and their children.

·         Clause 17. Advancing the nutrition agenda in political circles will require a multisector approach via task forces, technical advisory groups. Effective strategies for multisector alignment, financial management, and shared objectives need to be tested and implemented.

·         Advancing the nutrition agenda also requires a reframing our nutrition story. We need science that will help us explain how the health and education systems affect nutrition outcomes. A nutrition lens in addition to the development lens is needed too.

·         Political commitment is not completely lacking at country level. Would be beneficial to highlight that greater commitment is needed while at the same time acknowledge and highlight country success stories, noting that political commitment can translate into positive difference on nutrition outcomes.

·         Clause 20. We urgently need a systematic approach to scaling up of interventions and this can be achieved through implementation science. Many of the evidence-based interventions work under tightly controlled conditions, but we lack knowledge in taking them to scale.

o   There is also a need to recognize and effectively support human capacity to take programs to scale, including leadership training for policy makers and program managers. Organizational behavior theories, rewards and compensations and certifications systems, continuing education and mentorship programs need part of our discussions for improving capacity in nutrition. 

o   We require new assessment tools suitable for the field for rapid and reliable assessment of the (micro)nutrient status of populations.

1.      Do you have any general comments on the draft political declaration and its vision (paragraphs 1-3 of the zero draft)?  

We believe this is a great effort that is being made and we are very pleased to be able to make contributions.

In general, we observed that there is many valuable aspects in the document, but overall it is ambiguous in many ways, many definitions are not well established. Examples: malnutrition-it is not clear and it does not exactly define that overweight and obesity is part of malnutrition, it refers only to “overconsumption”; safe food- leads to think it is regarding to only processed foods and that traditional fresh grown foods from the different localities do not meet in this concept).

It is not based on the best interest of the child nor children´s rights; children are even mentioned as “consumers” but not as right holders. Overall human rights are not mentioned, only economic, social and cultural rights; which is very important but it is also important to mention and to base all the proposals and policies regarding human rights.

Breastfeeding is only mentioned once in the whole paper when it is one of the most effective measures for malnutrition; we believe it needs to be reinforced.

Accountability of private sector is not mentioned at all, nor the importance of conflict of interest when regarding industry involvement and partnerships, industry is only partially mentioned as part of the problem when it has been a big part of the problem for NCD´s and for undernutrition as well.

Marketing to children is not mentioned and it needs to be very clear that is a very strong issue regarding nutrition in children.

Some words can be complemented: sugars- for free sugars or added sugars; safe food- for safe nutritious food; regulations- for strong regulations; healthy food- for healthy, natural and fresh food.

In the commitments part VI, it does not establish if it is including private sector and what would the role be.

2.      Do you have any comments on the background and analysis provided in the political declaration (paragraphs 4-20 of the zero draft)?   

Paragraph 4 establishes elimination of malnutrition is imperative for ethical, political and economic reasons but not for the best interest of the child, nor for the child´s rights, nor for human rights.

Paragraph 5 does not recognize the importance of the protection of women and children particularly when breastfeeding. Instead of using word “including” it can be “specially” women and children. Breastfeeding is only mentioned in paragraph 7, when it is one of the most important effective measures for malnutrition.

Paragraph 8 only mentions Economic, Social and Cultural Rights; Human rights need to be mentioned too.

Paragraph 13 mentions safe food, it can be substituted for “safe nutritious food”.

Paragraph 14 where it says “Reliable and relevant nutrition information, sensitive to cultural norms and preferences, needs to be effectively disseminated to improve behaviour and practices”, the idea is confusing. The food that needs nutrition information is usually processed food, then the sentence is followed by sensitive to cultural norms and preferences… it leads to think that processed food´s nutrition information needs to be sensitive to cultural norms and preferences, when what it needs is to warn about the risks of intake and inform consumers of the real contents of it, allowing the population to make real informed decisions.  On the same paragraph, when it talks about regulation, it can say “strong regulation” instead. On the last part, where it talks about local food cultures, it is better if it establishes “local foods and cultures”.

Paragraph 15 must establish that the “partnerships” must be without conflict of interest and it must clarify that these “partnerships” must be for the public interest.

Paragraph 19 must specify the role of private sector, the importance of the public interest and the conflict of interest.

Paragraph 20 must include monitoring on programmes and policies. Also it must include industry´s form of accountability.

3.      Do you have any comments on the commitments proposed in the political declaration? In this connection, do you have any suggestions to contribute to a more technical elaboration to guide action and implementation on these commitments (paragraphs 21-23 of the zero draft)?

Please provide your comments in the appropriate fields relating to these commitments:         

21.Commitment I: aligning our food systems (systems for food production, storage and distribution) to people’s health needs;    

                Food production that allows countries their own sustainability and sovereignity, coming from small and medium producers.

Commitment II: making our food systems equitable, enabling all to access nutritious foods.     

Nutritious fresh, natural foods.

 Commitment VI: encouraging contributions from all actors in society;              

                Is not clear is all actors include private sector. If it does, what would the role be of private sector and the regulations they need to follow on, as well as the forms of accountability.

Thank you for the opportunity to comment on the Zero Draft.  Please find our feedback attached.

Please find attached Welthungerhilfe´s comments on the ICN2 zero draft political outcome document.

Please, find attached the proposed amendments of the Ministry of Health and of the Ministry of the Rural Development and Food of Greece on the ICN2 zero draft political outcome document for 19 November 2014

Norwegian comments: ICN2 zero draft outcome document

General comments

• Norway welcomes international work on the inter linkages between global food security and nutrition and their effects on human health. ICN2 should build on ongoing work and forge these important inter linkages.
• Norway supports the need for strong political leadership and multi-sector action in nutrition, and supports joint efforts by the health and agriculture/food systems communities.
• ICN2 should make a significant contribution to a Post 2015-agenda in this field.
• The multiple threats of malnutrition are a major threat to sustainable development and increased welfare for the people of the world.
•  Norway strongly supports the right to food and believes the outcome document/Framework of action needs to contain strong rights based language.

Overall Comments to the Zero Draft

• The document should have a human right-based approach and frame the document on the international human rights obligations. The commitment to fight hunger, ensure adequate food and nutrition and fair distribution of food, needs to be at the heart of the document.  
• To the extent possible, use internationally agreed language in order to avoid unnecessary discussion and confusion about scope and content. The document needs to be cleaned in terms of precise and correct terminology, not least in terms of the medical aspects of nutrition and its terminology and aetiology.
• The zero draft should include a more stringent reference to achievements made in WHO and FAO within the scope of food security and nutrition, on which we want to build on, and how the nutrition agenda could be advanced through a more holistic approach.
• The gender perspective must be included and be mainstreamed into the document. Women make essential contributions to food security and nutrition, and need to be ensured equal access to resources and access to nutritious food and health.
• We would like to see a shorter, better structured and more precise document. The document should be forward looking, setting the agenda and the mechanisms for action.  The health perspective need to be adequately covered. The framework of action needs to be clear on what we seek to do and achieve.
• The new plan of action should set goals with targets and indicators that can be measured – and establish a framework for financing and accountability for action. In addition, the framework of action should try to identify cross-sectorial cooperation, action and commitments. It would be helpful if an analysis be made of the different challenges faced by men, women, girls and boys in food security and nutrition to be used in the plan of action.
• Governments with the public and private sector all have responsibility to produce food system solutions that support nutrition.  
• A clarification of the the term “food systems” is called for. ICN2 can add value by defining and including the need to reform the food systems to progressively realize the right to food for all.
• We favour to use the words nutrition, health, food security and food systems in the title of the document.  It reflects the multidimentional and multisectoral approach that needs to be taken to properly address nutrition.

Specific Comments to the paragraphs:

Para 1

This para must make clear that malnutrition is a major cause of death and disability and has major impact on the economy.

Para 2

 To bullet point on women and anemia: Please insert; 1/3rd of all women of “reproductive age” suffer from anaemia

To bullet point on obesity; More precise language is called for.

To bullet point on Socio economic differences; These are large and exist within countries, but also between countries (vital to establish an international responsibility for action).

Para 3

This para introduces the concept “food systems”.  This paragraph is key to the document and should serve as the anchor and focus of the outcome document. 

Para 4

This para needs to recognize that the right to adequate food and nutrition is a human right.

Para 5

This para needs more precise language on special need and target groups, such as the pregnant and lactating woman, infant and young children, and to the importance of exclusive breastfeeding and the benefits of continued breastfeeding .(i.e. first 1000 days to the age of 2 years as a window of opportunity, people suffering specific diseases, school age children, etc).

Para 6

This para is vague in reference to “renew the commitments”. This para should refer to updated commitments and policies in WHO and FAO, such as targets on nutrition made by the WHA in 2012. The para should also refer to the responsibility/obligation of the FAO Committee for food security (CFS) in nutrition. This paragraph gives an opportunity to raise the need to include nutrition into the Post 2015-agenda.

Para 7

Make a reference to the WHA 65 Global Action Plan o NCDs, adopted by all member states and by so has authority. We propose to split para 7 into two parts, where the first part deals with maternal, infant and young child nutrition and health, and the second part deals specifically with NCDs and refers to the global NCD targets. If we call for renewed commitments, we also need to be clear on reporting on those commitments. 

Para 9 – 20 are critical and need to be more precise and ordered.  These recommendations should be focused on the development of food systems (including taking into account the smallholder farmer/producer into the food systems, social protection and promotion of breastfeeding).

Para 9

A definition of “food systems” could be set out prior to para 9. ”Food systems” is a key concept for the rest of the document, and highlighting and explaining the concept will help advance the global understanding of the key role food systems have for enhancing nutrition. In order to avoid the vague concept of “good nutrition”, a rephrasing of the first sentence is suggested; “Recognize that progressively achieving the right to adequate food for all requires more sustainable, equitable and resilient food systems“. Further, we believe aquaculture has a huge potential to ensure safe and healthy food to the benefit of nutrition and peoples health. Please include “aquaculture” in the last sentence of the para.

Para 10

Nutrition and health should be important considerations in decisions on primary food production and processing. The responsibility of actors/participants in food production and processing should be highlighted. Food processing that negatively effects health and nutrition should be avoided. We suggest to rephrase the last part of the paragraph (after the semi-colon) to: “food systems should enable improved nutrition by providing year-round access to safe and nutritious foods, promoting healthy diets and avoiding food processing that negatively affects nutrition and health.” Further, the inclusion of support to enhanced research into nutrient rich crops, is called for.

Para 11

Text on the reduction on food loss and food wastage and the protection of food safety must be developed. In addition, we suggest to replace the word “seeds” in para 11 with “genetic resources” as this is a more precise term that includes animals and fish. Further, replace “and storage loss” with “throughout the food chain”).

Para 12

In this paragraph distinction should be made between traditional versus modern value chains. Reference should be made to “Health in all policies” which is a well-known approach in public health policies.

Para 13

This para is unclear and mix different issues. The content of this paragraph could be included elsewhere in the document.  We miss a clear emphasis on benefits of exclusive breastfeeding and continued breastfeeding, and on the importance of breastfeeding promotion, protection and support. The paragraph should also include language on the need for competent personnel in nutrition and breastfeeding in the healthcare system. Support to small holder farmers to increase the quantity, quality and value of production as well as store, market and enhance total productivity as part of food systems, should be reflected (either here or in para 9). Language on women’s role in food production and the economy should be included.

Para 14

Food and nutrition in a cultural context should be addressed. Proper nutrition labelling is important in order to help consumers make informed decisions about healthy choices, healthy diets and healthy lifestyles. Public information must be made available to make informed decisions. Regulation of advertising, legislation on the right to food, regulations of food systems and taxations are legal means to regulate towards more healthy and nutritious food. We would like to see language on this included in the document. This is necessary in order to promote positive changes in eating behavior toward healthy foods.

We are pleased to see that reference has been made to the responsibility of governments to protect consumers, especially children, from misleading commercial messages promoting unhealthy foods. The term “energy-dense, nutrient-poor foods” is, however, better and more frequently used than “energy-dense, but nutrition-poor”. At the end of this sentence, instead of “…which can induce addictions….”, use “…which can induce unhealthy dietary habits”.

Para 15

Interventions and partnerships for improving maternal and child health and nutrition deserves a full paragraph by itself. Language on incentives for production of positive processed foods – weaning foods, bio-fortification etc could be included.

Language on social protection and safety nets to protect the nutritionally poor (access and equity) should be included in this paragraph.

Para 16 or 17

Necessary to include language on the need to develop international support and cooperation on food safety assessment and management.

Para 20

To establish better data and an accountability system to enhance and monitor action is critical.  Just recognizing this is not enough – accountability mechanisms need to be defined, and regular reporting need to take place on achievements made. Goals, targets and specific indicators need to be established, that can be measured and a followed up in reviews and action cycles. This will set the stage for the Post-2015-agenda on nutrition.

Para 21

This para should include a section on developing, introducing and expanding the use of special targeted foods for special needs groups such as supplements for pregnant/lactating women; weaning foods etc.