المنتدى العالمي المعني بالأمن الغذائي والتغذية

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    • Para 6:  urges to "renew commitments" made in 1992. One of those commitments was the elimination of vitamin A deficiency. The only response that has been made by the donor community since then (and by most governments with exception of a few such as Thailand and Vietnam, which have implemented large-scale and successful food-based approaches) has been the distribution of megadose vitamin A capsules. These actually have only a small and temporary impact on vitamin A deficiency (usually reducing it for only 4-5 months/year) and thus, despite their being distributed on a very large scale in over 100 countries for many years now, vitamin A deficiency is still prevalent.

      One of the problems is that the implementation of this approach has led to at best a lack of enthusiasm for the implementation of food-based approaches which are more likely to work and to be sustainable. (See for example http://www.wphna.org/htdocs/downloads/WPHNA_web_commentary_may2010.pdf)  In contradiction to donor-centric arguments that these approaches are more expensive than capsules, they can often actually generate income for the beneficiaries.

      Thus I would argue that ICN2 no longer make promises about the elimination of vitamin A deficiency but instead should set a deadline by which countries replace capsule approaches with food-based approaches. The steps that might be involved in doing that safely and conservatively are listed at the end of this article: http://www.independentsciencenews.org/health/vitamin-a-wars-the-downsides-of-donor-driven-aid/

      Ted Greiner, PhD

      Professor of Nutrition

      Department of Food and Nutrition

      Hanyang University

      222 Wangsimni Ro

      Seoul 133-791

      South Korea

    • The ICN would make an important contribution to global policymaking toward the elimination of all forms of malnutrition if the developing countries would openly question what is going on lately in the donor world. We have seen how disastrous passive acceptance of assistance completely on the donors’ terms has been in the case of vitamin A deficiency. Not only were capsules the only thing on offer, their universalization to over 100 countries has actively inhibited the expansion of what developing country governments always expressed as their preference and what was emphasized in the first ICN: food based approaches.  (Latham, Michael, et al. "World Nutrition." Journal of the World Public Health Nutrition Association 1.1 (2010).; http://www.independentsciencenews.org/health/vitamin-a-wars-the-downsides-of-donor-driven-aid/ http://www.fao.org/fileadmin/user_upload/agn/pdf/Greiner_VITAMIN_A_Final.pdf) This kind of cloaked imperialism now threatens to expand to the entire field of nutrition.

      IFPRI has recently published Stuart Gillespie's quite good chapter on politics and nutrition in their recent 2013 Global Food Policy Report and published it as a separate article on their website: http://www.ifpri.org/blog/transforming-political-will-action-nutrition. Gillespie's points are all well taken.

      But to resort to Field's old "underbelly" metaphor (Field, John Osgood. "The soft underbelly of applied knowledge: conceptual and operational problems in nutrition planning." Food policy 2.3 (1977): 228-239.), the question is what all this new political will is being mobilized to do exactly? To what extent will it undertake to deal with the time consuming and low-PR task of addressing weaknesses in capacity? When addressed, will education and training efforts aim to create Alan Berg's "nutrition engineers" (Berg, Alan. "Sliding toward nutrition malpractice: time to reconsider and redeploy." Annual review of nutrition 13.1 (1993): 1-16.) or people with only theoretical scientific knowledge? 

      So far the signs are not promising. SUN, like the Millennium Development Goals, has been successful in mobilization even the USA basically by being “non-political”. (Which really means not questioning the currently ascendant neoliberal model of development.) This has involved inviting Big Agriculture and Big Food to the policymaking forums/tables where they have not been welcome in the past, either at international or national levels. It is hard to imagine what benefits are expected to accrue from such "partnerships" if indeed the intention is to avoid conflicts of interest or merely giving large transnational corporations, many of whom are highly complicit in harming nutrition via infant formula or junk foods, a way to score extremely low-cost public relations points. 

      The recent 2013 addition to the Lancet nutrition series by Black et al identified 10 high priority interventions (Bhutta, Zulfiqar A., et al. "Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost?." The Lancet382.9890 (2013): 452-477.). Given the way complementary feeding is being interpreted in recent years (local foods are inadequate to solve the problem), the only one of those 10 that would not involve the import of fortificants and/or other products from the rich countries is breastfeeding. Even breastfeeding in recent decades focuses not on empowering communities, families or mothers themselves, but on improving the work of modern health care professionals (eg the Baby Friendly Hospital Initiative). 

      Thus the community-based nutrition approaches which Stuart and others (Tontisirin, Kraisid, and Stuart Gillespie. "Linking community-based programs and service delivery for improving maternal and child nutrition." Asian Development Review 17.1/2 (1999): 33-65.) focused so brilliantly on when the United Nations System Standing Committee on Nutrition was still active (now dead in the water as punishment for NOT being willing to indulge in collaboration with industry) will likely not see much emphasis as these currently committed billions roll. One wonders in indeed, how many of them will even cross developing country borders. 

      Ted Greiner, PhD

      Professor of Nutrition

      Department of Food and Nutrition

      Hanyang University

      222 Wangsimni Ro

      Seoul 133-791

      South Korea

      1. Do you have any general comments on the draft political declaration and its vision (paragraphs 1-3 of the zero draft)?  
      • “micronutrient deficiencies have not improved” Is this correct, even with respect to IDD?
      1. Do you have any comments on the background and analysis provided in the political declaration (paragraphs 4-20 of the zero draft)?   
      • “Together with inadequate physical activity, dietary risk factors account for almost 10% of the global burden of disease and disability.” Hard to believe it’s that small.
      • Congratulations on the wording of point 14. More explicit wording on actions needed to fight the promotion of unhealthy foods would be useful.
      1. 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)?

      I think the commitments below are too general, not actionable, too related to agriculture. There needs to be explicit mention of the need to switch from product-based nutrition programming (provision of vitamin A capsules and RUSF) to programming aimed at improving diets based on local foods.

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

      23. Commit to integrate the objectives and directions of the Ten Year Framework for Action into the post-2015 global development efforts.   

      I don’t see the Ten Year Framework for Action explained anywhere—indeed the draft action document does not seem to be online.

       

       

      See the attachments: