Global Forum on Food Security and Nutrition (FSN Forum)

Closing note by Jody Harris and Leslie Amoroso, facilitators

Dear all,

Thank you very much to all who participated in this fascinating, rich and lively exchange.  We are grateful to those who contributed in writing, as well as to those who read and reflected on the contributions of others. The discussion covered important topics related to “nutrition-enhancing agriculture and food systems”, and significant knowledge, ideas, views and experiences were shared from many parts of the world, and from several different fields, sectors and professions. Comments on the core background and expert papers as well as on the key three questions (policy, programmes and partnerships) were received and will be synthesized into a final document. The outcome of this exchange will be used to enrich the discussions at the ICN2 Preparatory Technical Meeting from  13 to 15 November 2013 and thereby feed into and inform the  ICN2 itself which will be held at FAO headquarters from 19 to 21 November 2014.

Emerging themes and key ideas from the most recent posts (from 19 to 29 July) are summarized below; those from previous posts were summarized by the facilitators on July 18th, and can be seen on the online discussion pages.

The need to balance short-term measures to tackle malnutrition with those aimed at achieving long-term impact was raised by participants, along with the key role nutrition-enhancing agriculture has in addressing food and nutrition security of populations affected by protracted crises, and in strengthening the resilience to shocks. Several contributors highlighted Non-Communicable Diseases (NCDs) and the continuum of under-to over-nutrition in their posts, urging us not to focus too narrowly on one part of the equation.  The need to use evidence-based science for effective nutrition policy was recognized, and yet the lack of relevant evidence, is cited as a challenge, as is strengthening inter-sectoral coordination at different levels. In terms of getting programmes and policies enacted, the issues of incentives for effective implementation and of capacity development (human and institutional) were mentioned from various angles. The importance of preserving the environment, as a basis for environmentally sustainable agricultural production, was stressed, as was the need to think about post-harvest and food safety issues along the value chain. Finally, the theme of diversification both of diets and of agriculture was maintained, as was the importance of nutrition education and gender issues. Common ground may be identified between those proposing smallholder agriculture as a sustainable solution, and those proposing more private sector involvement in markets. A rich and varied set of issues, and some important experiences and contributions on each!

We again thank you for your time and for sharing your views and experiences with us, and look forward to continuing the dialogue at ICN2 and beyond...

Jody and Leslie

Thank you very much to the facilitators for a very interesting discussion and for all these rich contributions. It seems that one elements has not been addressed so much in this discussion is how nutrition-sensitive agriculture can play a key role in addressing food and nutrition security of populations affected by protracted crises and in strengthening resilience to shocks. (thus making a link between this FSN Forum discussion and the previous one on food security in protracted crises – you may also be interested by the following paper on Nutrition in Protracted Crises: http://www.fao.org/fileadmin/templates/cfs_high_level_forum/documents/Nutrition_ProtractedCrises_DufourEgal.pdf ).

This is an important issue because the highest rates of malnutrition are reported in highly crisis-affected areas, such as in Sahel and in the Horn of Africa, and severe food and nutrition crises are happening with greater frequency. A “nutrition-sensitive” development agenda (and thus nutrition-sensitive agriculture) must, therefore, take into consideration exposure to food-related shocks and threats and to the issue of resilience.  

Both resilience and nutrition have recently benefitted from growing attention and strong political momentum, and there is a growing body of work on resilience programming at a conceptual and operational level. Agriculture is essential to both, and there is increasing interest in the role of agriculture in resilience programming on one hand, and on linkages between nutrition and resilience on the other. But there has been little literature, to date, on the nexus between nutrition, agriculture and resilience. FAO is therefore preparing an issues paper on linkages between nutrition and resilience, and the role of agriculture in that relationship.

This paper describes how nutrition and resilience are obviously strongly inter-linked: fighting malnutrition is crucial to resilience-strengthening because well-nourished individuals are healthier, can work harder, and have greater physical reserves. Households that are nutrition secure are better able to withstand external shocks. Moreover, adopting a resilience perspective allows an emphasis on the structural vulnerabilities that underlie malnutrition, the root causes of nutrition and food insecurity, and offers thus an opportunity to strengthen preventive activities. This further implies treating and preventing malnutrition through a combination of short and long-term nutrition actions, including nutrition-sensitive agricultural interventions.

Using the FAO resilience framework, which is adapted from the Hyogo Framework for Action (see page 20 of the FAO Resilience Livelihoods programme framework - http://www.fao.org/docrep/015/i2540e/i2540e00.pdf), the paper identifies entry points for maximizing nutritional outcomes of food and agriculture interventions designed to improve resilience, and vice versa, improve the “resilience outcomes” of food and agriculture-based interventions.

The following are just some of the entry points and recommendations that are identified, for each of the four pillars of the FAO resilience framework:

Pillar 1: Enabling the environment:

• Support linkages and synergies between food and nutrition security policies & strategies and resilience/DRM planning. Food and agriculture interventions contribute to both sets of strategies and can help clarify concrete synergies at the implementation level.
• Enhance linkages between resilience-related coordination structures and food and nutrition security coordination mechanisms (which include nutrition-sensitive agriculture), especially linking development-oriented coordination initiatives such as SUN and REACH to more emergency-related coordination bodies such as Nutrition and Food Security clusters, at national, regional and global levels.
• Develop capacities for resilience planning with a nutrition lens (ensuring resilience planning addresses the underlying causes of malnutrition and includes nutrition-sensitive agriculture as relevant), and nutrition planning with a resilience lens (i.e. looking both at treatment and prevention, and includes nutrition-sensitive agriculture as relevant).

• Strengthen and further develop flexible funding mechanisms adapted to a resilience approach, combining support to short and long-term interventions and linking humanitarian and development activities and multi-sectoral strategies. 

Pillar 2: Watch to safeguard (early warning)

• Advocate for the use of diet-related coping strategies are early indicators of pending crisis.
• Consider nutritional status (especially stunting) as an indicator of the erosion of people’s resilience and of greater vulnerability, to inform food and nutrition security planning.

Pillar 3 : Apply disaster risk reduction / prevention and pillar 4: Prepare and respond

• Use nutrition causal analysis as a planning tool for integrated food and nutrition security programming as part of a preventive approach and emergency response, and for selecting key interventions by livelihoods groups.
• Use nutrition indicators including stunting data to inform targeting strategies for resilience-building and food and agriculture interventions as this helps focus on populations / individuals at risk.
• Make nutrition an explicit objective of resilience programmes and vice versa to guide people to reflect on the linkages and impact that their activities have on nutrition.
• Promote diversification of food intake and livelihoods as key preventive approach for both nutrition and resilience programmes.
• Include nutrition education in all programmes as means of empowering households to use resources optimally for Food and Nutrition Security and thus increase resilience
• Link agriculture to social protection programmes in other sectors designed to protect nutrition

Work on this paper is still ongoing, but it will be available shortly and is intended contribute to discussions for the technical preparation of the ICN2. We will share it with FSN members when ready!

Best regards,

Domitille Kauffmann and Charlotte Dufour, FAO Nutrition Division.

Nutrition-enhancing agriculture and food systems

I acknowledge the contribution of diverse persons from the group to the topic. I’m contributing to the various sections mentioned that will enhance food based approaches to better nutrition as:

Policy issues: A national comprehensive Food and Nutrition Policy comprising all relevant sectors addressing all levels and with emphasis on food based systems is needed at the country level. The development, coordination and lead institution should be linked to the Presidency to give the policy a national look and to encourage multi-sectoral approach, also as a national priority. If possible the Ministry of Food and Agriculture (Forestry and Fisheries – depending on the country) are encouraged to have their own policy direction that consist of :

• Production and Consumption: of improved crop varieties with high nutritive value (like Quality Protein Maize, iron rich beans, high vitamin A Orange Flesh Sweet Potato, etc). These bio-fortified food crops could be promoted especially in poor areas of high deficiencies. Households could be encouraged to go in other agricultural productions to meet dietary needs of the family (like animal production like snails, small ruminants, fishery, poultry, piggery, grass-cutter, some types of insects etc; fruits and vegetables). Even some forestry products (like mushrooms) could be domesticated to enhance consumption. The Ministry of Food and Agriculture could work closely with Food Research Institutions including the Universities to breed high yield and disease resistant nutritive stocks/ varieties, and for increased shelf life and storage. To ensure all year round availability, households could be encouraged to process and preserve some food (both crops and animals). The approach may be in a form of campaign to bring all on board.

• Promotion of Right to Food: government should respect, protect and fulfil (promote and provide) the Right to Food by ensuring that all people can enjoy this right. Consequently, all other rights must be enjoyed by every single one such as right to water, employment, health, access to natural resources for production, education and others. Good governance at the lower level with citizen participation in programs is also essential.

• Nutrition education: Extension and health workers could work together especially at the community level to educate rural and farm families particularly adolescent girls, women of reproductive age and household care givers on importance of nutrition. This extension education could be coupled with mass and social education on consumption of food groups and dietary diversity, with good source of water, hygiene and sanitation.

• Social protection: for the poor and vulnerable in society such as School Feeding Program for school children in primary schools; food ratios and/ or stipends for People living with HIV/AIDs, children under five years and the aged.

• Utilization:   Local foods could be encouraged and promoted. 

• The knowledge gaps: are the nutritive value of local vrs exotic foods, food safety and quality, food handling, agrochemical uses, food preparation and storage etc

Program issues: The policy (as stated above) could be implemented through education and   simple messages on the different food groups targeting specific areas with nutrition challenges. Adopting aggressive marketing and advertising through social media, radio, TV and mobile vans in the communities to enhance food based nutrition will go a long way to bring all on board. In Ghana, there is this program on food groups as: Glo (fruits and vegetables – vitamins and minerals), Grow (Protein foods) and Go (energy giving foods). The message is simple and loved by even children. It must however be translated into various languages and promoted in all spheres of the country.

Partnerships: The Head of State’s leadership in food based approach is indispensable in holding the policy and program together and therefore it is highly recommended that the coordination and harmonization of the program be housed in the Presidency. National Planning office could support in the development of programs. At the conception phase of the program, all relevant Ministries, Departments and Agencies involved in Nutrition related programs should be consulted and involved in the initial planning stage.

Anna Antwi

GD Resource Centre

(also Food Security Advisor to Foreign Affairs, Trade and Development Canada – formerly CIDA)

Warm thanks to Jody and to Leslie for facilitating this excellent conversation, and to the many contributors sharing critical ag-nut efforts from around the world.

As a USAID-funded global nutrition project, SPRING (Strengthening Partnerships, Research, and Innovation in Nutrition Globally) recently undertook a program-wide review of agriculture-nutrition programming under the US Government’s Feed the Future global food security strategy. This ‘Landscape Analysis’  reviewed 160+ project documents, and included stakeholder interviews and selected case studies across the 19 Feed the Future countries active in Africa (12), SE Asia (4), and Latin America and the Caribbean (3). We hope to publish the full report soon, but in the interim please see our website for the Landscape Analysis presentation.

We reviewed with pleasure Mr. Wasti’s points (7/26) around ‘orienting’ agricultural experts to the importance of nutrition. His comments on proper approaches to nutrition education in integrated programming are likewise well taken. These were among the same points that appeared to us during the Landscape Analysis process in a variety of ways, and merit further attention.   

Keeping with Mr. Wasti’s idea of ‘orientation’, we can at the same time begin to respond to the facilitators call for experience around ‘programme issues’, which certainly include the need to bring agricultural experts and nutrition experts together under a shared vision. While there is literature in the management sciences regarding program integration, there is little research that is targeted towards the development context. Thus one of SPRING’s focal points going forward, is the development and dissemination of agriculture-nutrition operations research, looking specifically at how projects themselves are meeting the agriculture-nutrition integration challenge at both field and institutional levels.

The need for further evidence, instruction, and best-practice guidance in agriculture-nutrition integration became clear during our five Agriculture and Nutrition Global Learning Exchange Events (AgN-GLEEs), which brought to light the disconnect between an understanding of what needs to  be done, versus how to effectively do it. Based on the learning needs identified during these events, we would like to highlight two particular points we’ve included in our Landscape Analysis global report (in process) that relate to the programme portion of the FSN discussion:

- Target SBCC Activities Along All The Steps Leading From Agriculture To Nutrition. General ‘nutrition education’ around what to eat and where to find vitamins is not sufficient when trying to effectively link agriculture with nutrition. SBCC strategies and messaging should center on translating the gains from specific agricultural production and related income generation into achievable health and nutrition outcomes. This requires investment in context assessments, including formative research, to identify and address barriers associated with food production, purchase, preparation, intra-household distribution and consumption patterns of all family members. There remain a large array of assumptions that growing nutritious food will necessarily lead to nutrition outcomes - when in fact all the intermediate steps leading from food production to food use (consumption, sale, storage, etc) must be explicitly considered.

- Empower Women by Building a Supportive Family and Social Environment. The nutrition community has long focused on women and children; with the push for ag-nut integration, agriculture is becoming increasingly accountable to consider women’s labor, time use, and control of productive assets. Women’s involvement in agriculture can be improved by focusing on the more profitable links of the value chain process (not just production), and their control of on- and off- farm income earned and decision-making power must be supported by social norms, formal laws, and/or behavior change initiatives. Male family members, mothers-in-law and the opinion setters and influencers in the communities and society need to be targeted with messages explaining that sharing resources and joint decision-making with women benefits the whole family and community.

We hope to continue pushing this conversation forward, and are indebted to the FSN for facilitating such a critical discussion going into the ICN2. Please visit our site for additional agriculture-nutrition material, presentations from of our AgN-GLEEs, and upcoming webinars that highlight field-based success in ag-nut programming.

Warm Regards,

- The SPRING Agriculture/Nutrition Team

Dear FSN members,

I thank the Forum stewards for devoting space and time to this important matter, and for accommodating a variety of views on it.

The topic briefing said: "Notwithstanding the importance of the role of agriculture in producing food and generating income, employment and livelihoods, it is the food system as a whole i.e. the post-production sector beyond agriculture including processing, storage, trade, marketing and consumption that nowadays contributes significantly more to the eradication of malnutrition."

This is undoubtedly true, and what we see in country after country are populations urban and rural within which households make decisions (as consumers) for food in rapidly changing socio-cultural environments that are unfortunately disconnected from the myriad worlds of small food producers. There is, particularly in cities with populations of over half a million, considerable ignorance about food production. Such disconnectedness and ignorance is in far too many cases the hidden currency of the food systems referred to in the paragraph above. While the expectation may be - using the rubrics of governance and corporate responsibility - for food retailers to make the food chain transparent and trustworthy, doing so gets in the way of profitability and so is left undone. What becomes of nutrition (malnutrition as much as misapplied nutrition) in such scenarios, which are the norm in an urbanised planet?

Next, the topic briefing has said: "Nutrition-enhancing agriculture and food systems are those that effectively and explicitly incorporate nutrition objectives, concerns and considerations, improve diets and raise levels of food and nutrition security. Actions may include making more nutritious food more accessible to everyone or to specific targeted groups, supporting smallholders and boosting women’s incomes, ensuring clean water and sanitation, education and employment, health care, support for resilience and empowering women in a deliberate attempt to explicitly improve diets and raise levels of nutrition.

As this is a wide shelf, upon which nutrition is placed as one subject, and that is why I suggest the effective and explicit incorporation of nutrition objectives be diminished proportionately, for to insist on its primacy while attempting to preserve the importance of the 'actions' also mentioned will be confusing. The link between purchasing power of households (whether they are growers or not) and their access to food for example will govern the outcomes of many of these actions, and who is to say which is the more important of these other than the households themselves? What is also missing from this shelf is the the importance of government spending on the social sector, and equally on agricultural research and on food-related subsidies. On these matters there is usually much tension that exists, between the attempts to reduce or neutralise government (that is, public) influence in policy-making and spending, and between a private sector that wants to step in more actively.

The topic briefing continued: "Agriculture and food-based strategies focus on food as the primary tool for improving the quality of the diet and for addressing and preventing malnutrition and nutritional deficiencies. The approach stresses the multiple benefits derived from enjoying a variety of foods, recognising the nutritional value of food for good nutrition, and the importance and social significance of the agricultural and food sector for supporting rural livelihoods."

While the attention given to the diversity in diet and to rural livelihood is encouraging, it needs to be unequivocally said that the majority of traditional farming communities and indigenous peoples have, over generations, developed agricultural systems that are productive and environmentally sustainable, and which deliver 'nutritional value' automatically. These cultivating communities have domesticated thousands of crop species which, until the middle of the 20th century, were grown without agrochemicals. It is no surprise that the reason we espy, more conspicuously in organic retail outlets in Europe for example, a revival in 'ancient' or 'heirloom' cereals and fruit, is the reaction by concerned consumers to the atrophying of traditional agricultural knowledge and practices and the desire to ensure it is not lost altogether. It is small diversified farming systems that offer the most promising models to promoting agricultural and horticultural biodiversity, that conserve natural resources while doing so, that sustain yields sans agro-chemicals, and that are resilient in the face of environmental and economic change without compromising on nutrition and food security.

The topic briefing also added: "The multiple social, economic and health benefits associated with successful food-based approaches that lead to year-round availability, access to and consumption of nutritionally adequate amounts and varieties of foods are clear."

The new and seemingly permanent availability of food and the new idea of access to nutrition (which is not always associated with a typical food basket) that can be delivered, therapeutically through bio-technological methods and by employing genetic modification, needs to be halted. The idea of perennial availability is in conflict with the need to divorce modern industrial agriculture and food retail from its dependence on oil and gas. This is a limit that has long been recognised in the fossil fuels era, and in 1973 D Pimentel provided a breakdown of energy inputs for the production of a hectare of maize (about a third of the energy employed in corn production was fuel). In today's market-determined crop production and food retailing systems, the ratios of dependency have risen much further (see D A Pfeiffer, 'Eating Fossil Fuels: Oil, Food and the Coming Crises in Agriculture', 2006, which had for agriculture in the USA the following: 31% for the manufacture of inorganic fertiliser; 19% for the operation of field machinery; 16% for transportation; and 13% for irrigation).

The topic briefing has further stated: "The causal pathway from the food system to nutritional outcomes may be direct - as influenced by the availability and accessibility of diverse, nutritious foods and thus the ability of consumers to choose healthy diets, as well as indirect – mediated through incomes, prices, knowledge and other factors. Interventions that consider and affect food systems as a whole can potentially achieve more widespread nutritional outcomes than single uncoordinated actions."

There is little that the multi-dimensionally poor can choose from, in reality, and a representative reading of national and sub-national food balance sheets at the household level will prove this sad truth. The current method of providing food involves industrialised systems that are centralised and oriented towards profit (a position central to the recent 2013 June Conference on Agroecology for Sustainable Food Systems in Europe, sub-titled 'A Transformative Agenda', and organised by the European Network of Scientists for Social and Environmental Responsibility (ENSSER) and several like-minded partners). Such a method is also averse to regulation, let alone social needs. In such a linear approach, the assumption are made (because the current macro-economics of 'growth' permit it) of an unlimited supply of energy and raw materials (neither of which there is), and of an environment which can ceaselessly absorb pollution and waste (it cannot). This is the background against which new actors claim to be addressing priorities to strengthen nutrition and banish malnutrition.

Better nutrition emerges when communities repossess their cultural and ideological spaces to develop productive systems that minimise external inputs, pollution and waste by becoming circular in nature, by returning to principles that reflect the natural world - which is based on cycles, and in which the ‘waste’ from one species is food for another, or is converted into a useful form by natural processes.

Thank you and regards, Rahul Goswami

Making national agriculture policy frameworks more sensitive to nutrition

In 2011, Action Contre la Faim (ACF) has published a technical manual on how to maximize the nutritional impacts of programmes and interventions in the field of agriculture, food security and livelihoods (available bit.ly/12XOncg).

In fact, various tools exist that are very useful to make agriculture more sensitive to nutrition at programme and project level. As underlined previously in this discussion, many existing guidelines and recommendations have been the basis of the “Synthesis of Guiding Principles on Agriculture Programming for Nutrition”, recently published by FAO.

The programme level matters, but agriculture policies are a prerequisite for programmes to deliver. In order to transform investments in agriculture that have a potential for nutrition into actually nutrition-sensitive investments at a large scale, the national agriculture policy frameworks need to integrate nutrition as a priority. If agricultural policies are able to provide the right kind of priority and incentives for nutrition, they will foster and support the multiplication of many individual and collective nutrition-sensitive initiatives.

This is why ACF is analysing the nutrition sensitivity of agricultural policy framework in different countries. We are also willing to assess to what extent the promising international agenda on nutrition-sensitive agriculture currently translates into policies and practices at country level.

There is a double challenge to be taken up at country level: integrating agriculture as a key sector in national mutli-sectoral undernutrition reduction strategies while also mainstreaming nutritional concerns, objectives and actions into sectoral agriculture policies, to increase their sensitivity to nutrition.

We have found that there is actually a lag between what is increasingly being promoted at the international level and the responses of actors in the field. Even in countries that have ambitious multisectoral strategies against undernutrition, the agriculture sector has not necessarily dedicated a high priority to nutrition.

Most of the constraints to a higher prioritization of nutrition by the agriculture sector are highly interrelated, including:

- weak knowledge and evidence base

- absence of adequate information and monitoring systems for nutrition in the agriculture sector

- difficulties in making cross-sectoral coordination mechanisms around nutrition work

These constraints need to be addressed jointly, to transform the vicious circle of low consideration and underinvestment into a virtuous circle.

To make agriculture more sensitive to nutrition at country level, the right set of incentives should be developed and embedded at different levels, from the highest policy framework to the day-to-day activities of extension workers in the field. These incentives should aim at overcoming most of the constraints to a higher prioritization of nutrition by agriculture, by compensating for the lack of common language between agriculture and nutrition, the low level of knowledge on nutrition from the agriculture side and the weak accountability of the agriculture sector vis-à-vis nutrition. This last point is particularly important: the agriculture sector has for long been evaluated on the basis of its contribution to income generation and economic growth, not on the basis of its contribution to better nutrition.

Providing the right incentives to the agriculture sector is therefore a great challenge ahead. This should include:

Making explicit what is agriculture contribution to better nutrition: at the field level, the pathways between agriculture and nutrition are not so well-known. What role can play the agriculture sector for nutrition should be made more explicit. The agriculture sector and the nutrition community should work together to identify what contribution the agriculture sector could bring to the fight against undernutrition in the country, depending on the context-specific determinants of undernutrition and characteristics of the agriculture and food systems. (Though agriculture is only one part of the wider food system, it is a major component, especially in the rural areas of low and middle income countries, where lives the majority of the population affected by under-nutrition.)

Incorporating nutrition and food consumption indicators into information and monitoring systems: agriculture information systems rarely include nutritional and food consumption related indicators (such as the Household Diet Diversity Score for instance) into their methodologies and surveys. However, information is a key to adequate decision making. Therefore, it is required to establish better information and monitoring systems linking agriculture and nutrition data. Such systems will support building and improving cross-sectoral analysis and dialogue around nutrition. This should include plans to monitor and mitigate the potentially negative consequences on nutrition that may arise from large scale intensive agricultural investments.

Strengthening policy coordination around nutrition: existing multisectoral coordination mechanisms around nutrition, when they exist, are often primarily related to the health sector, especially at the national level. There is thus an institutional challenge to increasing the participation of the agriculture sector to such coordination body, to facilitate cross-sectoral dialogue around nutrition. Better coordination between agriculture and other sectors around nutrition are needed and must be supported to build effective governance for nutrition at country level.

Ensuring nutrition training opportunities are available: the knowledge and understanding of nutrition is very heterogeneous at the level of agriculture ministries. Furthermore there is a lack of both basic and on-the-job training on nutrition available for agriculturalists and extension service staffs. There is a need for training on both general nutrition knowledge and specifically on the links between agriculture and nutrition. The training efforts should focus in particular on extension agents, whose role makes it possible to spread messages on nutrition to farmers and communities, but should also include civil servants from Ministries of Agriculture at central level.

Dedicating more funding for the implementation of nutrition-sensitive agriculture programmes: the low level of funding available for nutrition-sensitive programmes unfortunately reflects the level of priority dedicated to nutrition within the agriculture sector. More funding is therefore needed for agriculture programmes and interventions that will in particular take on board the following issues (only marginally integrated into 'traditional' rural development programmes):

- set up targeting tools to ensure the most vulnerable communities will benefit from agricultural investments

- dedicate a specific attention to the role of women in agriculture (in particular through increased access to land, inputs and income) while making sure nutrition gains are maximized for both mothers and children (through introduction of timesaving technologies, childcare nurseries when appropriate, and nutritional education and awareness-raising)

At the international level as well, more efforts should be put in building stronger consensus on agriculture and nutrition. The recently established “Global Panel on Agriculture and Food Systems for Nutrition” could be a vehicle for this, if it associates enough countries and civil society organisations to its work. Nutrition should also be made a high priority in international agriculture forums, particularly the CFS (Committee on World Food Security), as the most inclusive international policy forum focusing on agriculture, food security and hunger reduction. A future HLPE report on the challenges of making food systems and agricultural policies work better for nutrition would represent a good opportunity for this.

Integrated home gardening, and farming systems for nutrition –  Example from the South of Bangladesh

In Bangladesh, integrated home gardens fall within the national concept of “Ekti Badi, Ekti Khamar” meaning one household, one farm.”  In rural areas, 75% of households reportedly have a home garden.  A range of 25 fruit crops, 29 vegetables, and 12 spices can be cultivated, even in small home gardens of less than 50 square-metres. Income from the home gardens is usually controlled by women and is more likely to be used for better diets, education, health care and others directly benefitting women and children. Estimates from the national Food Security and Nutritional Surveillance Project 2011-12, show that 56% of households have only home gardens, 62% have backyard poultry but 42% of households with homestead gardens also have backyard poultry.  The same source also estimates that homestead gardening with backyard poultry g decreased from 41% in February-May of 2010-11 to 35% in February-May of 2011-12. The current situation shows that integrated home gardening needs enhanced resilience to land degradation, water scarcity, bio-security (especially avian flu), and climate change, particularly in high risk areas, such as in the Southern region in Bangladesh. 

Around a tenth of gardens in selected villages of the Southern districts were destroyed completely by soil salinity, and seeds could not germinate. Amidst this situation, about half of the households implemented coping practices using organic compost and a little over a third planted crops in pits leached with water. Mulching with rice straw, coconut coir and other locally available organic materials were used to increase water retention of the soil and develop compost.  Greater resilience was found in salinity among vegetable crops which include Indian spinach (pui shak), sweet gourd, okra and kang kong (kolmi shak) which are good sources of micronutrients. Kang kong was noted to be the most saline resistant crop but this is relatively new to Southern Bangladesh. It is essential that strategies and input resources have specific nutrition considerations integrated into agriculture extension while promoting integrated home gardening, particularly in flood affected areas. Households with larger plots of land are also seen to be moving from rice cultivation to shrimp cultivation which is more remunerative and this has affected the day labour opportunities for poor households.  Households with better knowledge and means to adopt salinity coping practices were mostly the better off ones. 

Kind regards,

Lalita

The NCD Alliance (NCDA) was founded by four international NGO federations representing the four major non-communicable diseases (NCDs) – cancer, cardiovascular disease, chronic respiratory diseases, and diabetes – uniting a network of 1,000 member associations and a further 1,000 civil society organisations in more than 170 countries. NCDA echoes and fully supports the comments made by the International Diabetes Federation.

NCDs are the leading cause of morbidity and mortality, accounting for two out of three deaths and half of all disability worldwide. 80% of NCD deaths are occurring in low- and middle-income countries (LMICs), exacting a heavy and growing toll on both physical and mental health and economic security. NCDs are related to both under- and overnutrition. Maternal undernutrition increases the risk of an infant developing obesity and NCDs later in life.[i] And overweight and obesity, including childhood obesity, are major drivers of the global NCD epidemic. At the UN High Level Meeting on NCDs in September 2011, UN Member States affirmed that NCDs are leading threats to social and economic development in the 21st century, and nutrition and agriculture as key issues in their prevention and control.[ii]

Nutrition is a cornerstone in the fight against NCDs, and population nutrition is a function of the food system. The global food system supplies the world with food necessary to sustain life, but it is also responsible for an influx of highly processed foods full of saturated fats, sugars and salt, contributing to the global rise in NCD prevalence.

We welcome the opportunity to contribute to the preparations for the Second International Conferences on Nutrition (ICN2) and this discussion on Nutrition-sensitive agriculture. In particular, NCDA acknowledges, welcomes and supports the Expert Paper contributed by Hawkes et.al.  “Leveraging agriculture and food systems for healthier diets and noncommunicable disease prevention: The need for policy coherence”.

Key Messages

• Today we face a triple burden of malnutrition: undernutrition, micronutrient deficiency and overnutrition/overconsumption, often times in the same country, community or household.
• NCDs are related to both under- and overnutrition. Maternal undernutrition increases the risk of an infant developing obesity and NCDs later in life. And overweight and obesity, including childhood obesity, are major drivers of the global NCD epidemic.
• Globally, just under one billion people are undernourished, while two billion people are overweight or obese. 65% of the world‘s population live in a country where overweight and obesity kills more people than underweight. In 2011, an estimated 43 million children under 5 years old were overweight, with the majority living in low and middle income countries. 
• Globalisation in the food system has enabled the great availability, affordability and acceptability of unhealthy eating patterns. This makes a significant and negative contribution to NCDs and their metabolic and behavioural risk factors, including overweight/obesity, and elevated levels of blood pressure and cholesterol.
• Nutrition-enhancing agriculture and food systems are one part of the solution to malnutrition in all its forms, including poor quality diets associated with NCDs.
• NCDA strongly supports the call by Hawkes et. al. that food and agriculture systems operate through “policy coherence”, and that policies for NCD prevention “directly interface with agriculture and foods systems…”
• Policies with particularly high potential impact on NCD risk factors are those that influence substitutions between different types of fat and meat, and make fruits and vegetables more available, affordable and acceptable.
• Policies are also needed to discourage high-calorie, nutrient-poor foods, such as fiscal policies, taxation, and policies to significantly reduce the marketing of these foods to infants, young-children, adolescents and their caregivers.
• NCDs are multisectoral issues, which require multisectoral solutions, including nutrition and agriculture. Civil society mobilisation will be crucial to creating and sustaining nutrition-enhancing agricultural systems.
• More attention and efforts are needed from civil society and others to create policy coherence between agriculture policy and policies aimed at the nutritional risk factors for overweight/obesity and NCDs.

The International Diabetes Federation (IDF) is the unique global voice of the diabetes community. IDF’s strength lies in the capacity of our 220 national Member Associations – who connect global advocacy to local reality and deliver vital diabetes prevention, treatment and care in over 170 countries worldwide. As a founding federation of the NCD Alliance, IDF fully supports and reinforces all comments made in the NCD Alliance response. In these comments, IDF provides the diabetes perspective on nutrition-enhancing food systems.

The world is facing a diabetes crisis. The numbers are bleak and are becoming worse: more than 371 million people are living with diabetes today, a number that is expected to rise to 552 million in less than 20 years .  While previously considered a disease of the rich, evidence shows diabetes disproportionately impacts the poor and vulnerable. Today nearly two-thirds of people with diabetes live in low- and middle-income countries.

Diabetes and nutrition are closely linked; overweight and obesity are among the leading risk factors for diabetes, and undernutrition in early life has been shown to increase risk for diabetes later in life. Nutrition is a cornerstone in the fight against diabetes and obesity, and population nutrition is a function of the food system. The global food system supplies the world with food necessary to sustain life, but it is also responsible for an influx of highly processed foods full of saturated fats, sugars and salt, contributing to the global rise in diabetes and other noncommunicable diseases (NCDs).

We welcome the opportunity to contribute to the preparations for the Second International Conference on Nutrition (ICN2) and this discussion on Nutrition-sensitive agriculture. In particular, IDF acknowledges, welcomes and supports the Expert Paper contributed by Hawkes et.al.: “Leveraging agriculture and food systems for healthier diets and noncommunicable disease prevention: The need for policy coherence”.

Key Messages

• Globalisation of the food system has enabled availability, affordability and acceptability of unhealthy eating patterns. This makes a significant negative contribution to diabetes and its metabolic and behavioural risk factors, including overweight and obesity.
• Today we face a triple burden of malnutrition: undernutrition, micronutrient deficiency and overnutrition/overconsumption, often in the same country, community or household.
• Both under- and over-nutrition are contributing to the spiralling rise of diabetes and other NCDs. Maternal undernutrition increases the risk of the child developing obesity and type 2 diabetes later in life. Overweight and obesity, including childhood obesity, promote insulin resistance and are major drivers of the global type 2 diabetes epidemic
• Nutrition-enhancing agriculture and food systems provide part of the solution to malnutrition in all its forms, including poor quality diets associated with diabetes. Improvements should include actions at the local level, notably to promote the production and market movement of plant-based foods.
• IDF strongly supports the call by Hawkes et. al. that food and agriculture systems operate through “policy coherence”, and that policies for NCD prevention “directly interface with agriculture and foods systems…”
• Nutrition policies for the prevention and control of diabetes must aim to increase fruit and vegetable consumption and decrease consumption of highly-processed foods which are high in salt, sugar, and saturated/trans fats. To achieve this, food and agricultural systems need to supply foods and beverages consistent with these goals. In many countries this will require a dramatic change in the types of products grown, produced, marketed and sold – which can only be achieved through collaborative, forward-thinking policy initiatives at all levels from local to international.
• Diabetes and NCDs are multisectoral issues, which require multisectoral solutions, including policies on nutrition and agriculture. Active involvement of civil society will be a fundamental element of creating and sustaining nutrition-enhancing agricultural systems.
• More attention and efforts are needed from civil society and others to encourage policy coherence between agriculture policy and policies aimed at the nutritional risk factors for overweight/obesity and diabetes.

For more information, please refer to the attached document

US Council for International Business response for the FAO’s Global Forum on Food Security and Nutrition Discussion on Nutrition-Enhancing Agriculture and Food Systems

We would like to thank the FAO for the opportunity to submit comments to this online discussion. For your background information, USCIB is the American affiliate of the International Chamber of Commerce (ICC), the Business and Industry Advisory Committee (BIAC) to the OECD, and the International Organisation of Employers (IOE).  As such, we work closely with intergovernmental bodies, including the OECD, WTO, ILO, UN bodies and vis-à-vis foreign business communities and their governments.  In addition, we would like to highlight that USCIB is a membership based organization which operates under bylaws that provide the framework under which we consult with our own stakeholders. Our processes are transparent.  We provide views and inputs which are built through a consultative process and reflect a consensus among our large membership.  We therefore hope that the FAO reads this submission within this context.

The questions below are extremely broad and encompass themes which are complex.  Although an online consultation will solicit some input, we would like to suggest that the FAO create a more targeted approach to engaging with stakeholders, including the private sector. We recommend a formal consultation with stakeholders, including the private sector, to have a more robust and complete discussion on these important issues related to nutrition.

Prior to responding to the questions below in more detail, USCIB would like to underscore the following:

• An effective nutrition policy must be developed using evidence-based science;

• The private sector can play an important role in achieving a more nutrition-enhancing food system by innovating and investing in the food and agricultural sector;

• Food systems should place emphasis on food safety, quality and assurance, with regard to the product itself;

• Preservation of natural resources to continue to grow food is necessary for nutrition;

• Empowering women and girls is important; and

• Effective and efficient nutrition policies require coordination across government ministries working with the private sector and civil society.

Policy issues: What policies can make agriculture and food systems more nutrition-enhancing? What are the knowledge gaps in policies associated with nutrition-enhancing agriculture and food systems?

With regards to these aforementioned questions, we would like to highlight the International Life Sciences Institute (ILSI) related work on building an effective nutrition policy. ILSI is a nonprofit, worldwide organization whose mission is to provide science that improves public health and well-being to states. To build an effective nutrition policy there should be a high probability for the effectiveness of nutrition-related interventions with low probability for unintended consequences. To achieve this balance, it is important to have an adequate level of scientific evidence.

The data essential for developing and implementing effective nutrition strategies include: knowledge of what a population is eating, knowledge of nutritional and health status of the population and key subpopulations, behavioral changes important to successful implementation and program evaluation of outcomes.

While having the correct data is crucial, it is equally important to have the right institutional arrangements in place to best support coordination and implementation of effective nutrition strategies. Effective and efficient nutrition policies require coordination across government ministries working with the private sector and civil society.

The private sector can play an important role in achieving a more nutrition-enhancing food system by innovating and investing in the food and agricultural sector. In addition though, meeting the growing challenges of the future, such as constrained resources, greater demand, and of course health-related challenges, will require policies that promote innovation and efficiency across the supply chain, from production to distribution and consumption.

With regards to distribution and consumption, it is particularly important to reduce waste and post-harvest losses, and lower costs of storage, transportation, and processing which can reduce costs and help to make foods more available. These actions would help to improve food access and food products.

USCIB believes that the private sector know-how in the areas of innovation, science and technology, as well as good production and management practices, can be increasingly harnessed through effective partnerships with research institutions, farmers, policy-makers, and civil society. The private sector plays a critical role in further strengthening markets, economic growth and livelihoods. While private sector involvement is key, there is also a need for government collaboration particularly in helping to ensure greater policy coherence such as reducing barriers to trade.

Programme issues: What do nutrition-enhancing agriculture and food systems look like? What have been the success stories and lessons learned from programmes at country level? How can we monitor the impact of such programmes on food consumption and nutrition?

To answer the questions above, we would like to highlight the following areas that need to be further addressed to provide an adequate response:

Food, Diversity, Safety and Quality Assurance

It is important to understand what the population is eating.  Essential nutrients for humans are provided across the diverse pattern of foods which means that diversity is essential for good nutrition. Therefore, promotion of good nutrition is not a simple matter of emphasizing approaches that “one size fits all.”

Additionally, due to ecological, economic, cultural or special physiological needs, human diets may require specific interventions that complement the nutrient gaps that may occur. Therefore, it is desirable to have nutrition interventions such as biofortification, food fortification, products formulated to satisfy nutritional requirements of specific groups of the population and food supplements.

Equally important is to ensure a population has access to food products that are safe. Food systems should place an emphasis on food safety, quality and assurance, with regard to the product itself. Likewise, food companies should provide the necessary information to ensure foods are delivered and prepared in a safe manner.

Nutrition Education

Nutrition education is another important area to address.  It is important to provide the necessary facts which are focused on evidence-based science so consumers can make the appropriate decisions for their families. For this reason, we believe that international (evidence-based) standards such as CODEX, provide consumers with the right information/environment to make choices. Subjective standards are not helpful to the consumer.

Sustainable Agricultural Production

Preservation of natural resources to continue to grow food is necessary for nutrition. USCIB urges the FAO to promote food systems that protect natural resources especially since there are continuing challenges that the agriculture industry must face such as population increases, climate change, and water availability.  As such, USCIB would like to highlight the importance of careful end-to-end management throughout the whole supply chain – from soil quality, water preservation, productivity/yields, to building climate change resilience, fortification, R&D, and post-harvest losses.

In this area, private sector plays an important role in research and development, technologies, innovation, and supply chain management. This includes working with smallholder farmers who are key players in helping to ensure a more sustainable, productive, and equitable agricultural development.   Nestlé’s Rural Development Framework is an example of how the private sector invests in the development of farmers and their livelihood.  In fact, nutrition is identified as one of the priorities. http://www.nestle.com/asset- library/documents/investors/2013%20events/2013%2006%2017%20-%20rural%20development%20conf%20call.pdf

In addition, we would like to also include an example of how one company places strong emphasis on environmental conservation and performance.  Coca Cola’s Sustainable Agriculture Guiding Principles set expectations for ingredient suppliers to address sustainability challenges specific to agriculture, including areas such as workplace and human rights, environment, and farm management systems. http://assets.coca-colacompany.com/3e/b9/a13dd0a04750b2226f5904e94c8f/coca-cola-sustainable- agricultural-guiding-principles-april-2013-pdf.pdf

Empowering Women and Girls

Another crucial issue includes ensuring the empowerment of women and girls both economically and socially. These members of society have an important role in the decisions made at the household level with regards to food and nutrition. Therefore, we believe that it is important to promote policies that

help women become farmers, traders and business owners. Equally important is that these members of society are educated and properly informed to make healthy choices for their households. The private sector can play a crucial role in empowering women and girls. Nestlé’s Action Plan on Women in the Cocoa Supply Chain reflects the company’s commitment to addressing this important issue.

http://www.nestlecocoaplan.com/wp-content/uploads/2013/05/action-plan-women-in-cocoa-supply- chain1.pdf

Partnerships: How can we work across sectors and build strong linkages between food and agriculture, social protection, employment, health, education and other key sectors? How can we create sustainable partnerships? How can we build effective governance for nutrition?

With regards to partnerships, the areas that the FAO questions refer to are very broad. We recommend that the FAO be more precise in outlining what type of partnerships and linkages it is interested in. Prioritizing the areas in which FAO is interested in creating partnerships with various stakeholders would be a more effective manner to obtain input.

In light of the question, however, USCIB would like to highlight the work that the food and beverage industry has engaged with the WHO’s 2004 Global Strategy on Diet, Physical Activity and Health (Global Strategy) and most recently the WHO Global Action Plan on NCDs (2013-2020) and the monitoring framework. Cooperation between governments and the food and beverage industry is necessary to the adoption of a multi-sector approach to addressing nutrition challenges. For example, many food and beverage companies have already partnered with the WHO, its regional offices, Member States and the wider public health community to deliver positive outcomes with regards to diet, physical activity and health. Some of the steps include:

• Reformulating existing products and developing innovations that offer healthier options for populations;

• Providing populations with clearer information about the nutritional composition of foods and beverages;

• Adopting voluntary measures on the marketing and advertising of food and beverages particularly to children and

• Promoting greater physical activity, sports and healthier lifestyles.

For more information about how the food and beverage industry has worked with the WHO, please refer to https://www.ifballiance.org/ and to a 3rd party report by Accenture https://www.ifballiance.org/sites/default/files/AccentureMonitoringReport2012FINALDecember2012.pdf

On the question of governance, we would recommend that the FAO clarify what is meant by that term. For example, we would like a clarification on who or whom would be governed? And on what legal basis would those entities be governed?