Global Forum on Food Security and Nutrition (FSN Forum)

Consultation

Nutrition and Food Systems - HLPE consultation on the V0 draft of the Report

At its 42nd session in October 2015, the UN Committee on World Food Security (CFS) requested the High Level Panel of Experts on Food Security and Nutrition (HLPE) to prepare a report on Nutrition and Food Systems. This report is expected to be presented at CFS 44 in October 2017.

As part of the process of elaboration of its reports, the HLPE is organizing a consultation to seek inputs, suggestions, and comments on the present V0 draft. This open e-consultation will be used by the HLPE to further elaborate the report, which will then be submitted to external expert review, before finalization and approval by the HLPE Steering Committee.

HLPE V0 drafts are deliberately presented early enough in the process - as a work-in-progress, with their range of imperfections – to allow sufficient time to give proper consideration to the feedback received so that it can play a really useful role in the elaboration of the report. It is a key part of the scientific dialogue between the HLPE Project Team and Steering Committee, and the rest of the knowledge community. It should be noted that the present V0 draft report does not yet identify areas for recommendations as it is too early to determine the major propositions stemming from the report.

It should be noted that there are several reports that have just been released or will be released over the coming year including the Foresight Report on the Future of Diets (September 2016) and the EAT-Lancet Commission on Sustainable Diets and Food Systems (June 2017). The Project Team members will ensure that these reports will be kept in due consideration.

In order to strengthen this draft, the HLPE would welcome submission of material, evidence-based suggestions, references, and examples, in particular addressing the following important questions:

  1. The purpose of this report is to analyse the ways in which food systems influence dietary patterns and hence nutritional outcomes. The objective is to focus on consumers and consider sustainability issues. The report aims to be solution oriented and to highlight efficient policies and programs. Are those major objective(s) clearly reflected in the V0 draft?
  2. Do you think that the overall structure of the draft is comprehensive enough, and adequately considered and articulated? Does the draft strike the right balance of coverage across the various chapters? Are there important aspects that are missing? Does the report correctly focus on the links between nutrition and food systems without straying beyond that?
  3. Does the conceptual framework need to be edited? Simplified? Should “the food environment” as defined in the draft be central to the framework?  
  4. Are production systems and their role in shaping diets and nutritional outcomes adequately addressed?
  5. Does this draft cover adequately the main controversies in the field of Nutrition and food systems? Are there any remaining gaps?
  6. The project team is working on a categorization of food systems. Are you aware of specific approaches of use in that perspective, and particularly of quantitative indicators that could be used?
  7. Does this draft adequately show the multiplicity and complexity of diets and nutrition issues across different food systems and specific contexts with a good regional balance?
  8. What areas of the document are in need of strengthening or shortening?
  9. Chapter 4, Section 4.1 contains case studies/examples of effective policies and actions in different contexts/countries across the food system for diets and nutrition. Could you offer other practical, well-documented and significant examples to enrich and provide better balance to the variety of cases and the lessons learned, including the trade-offs or win-win outcomes in terms of addressing the different dimensions of diets for FSN?
  10. Section 4.2.2 on “Institutional Changes and Governance Across the Food System Movements for Nutrition” requires more work, and more inclusion of evidence and of the various players. Any inputs on this section are most welcome.
  11. Is the report too technical or too simplistic? Are all the concepts clearly defined?
  12. Are there any major omissions or gaps in the report? Are topics under-or over-represented in relation to their importance?

We thank in advance all the contributors for being kind enough to read and comment and suggest inputs on this early version of the report.

We look forward to a rich and fruitful consultation.
 
The HLPE Project Team and Steering Committee

This activity is now closed. Please contact [email protected] for any further information.

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Moises David Rojas Peña

Dominican Republic

Nutrición y Sistema Alimentarios

La desnutrición es el resultado del consumo insuficiente de alimentos  y de la aparición repetida de enfermedades infecciosas. La desnutrición puede ser crónica, aguda y desnutrición según peso para la edad.
La desnutrición implica tener un peso corporal menor a lo normal para la edad, tener una estatura inferior a la que corresponde a la edad (retraso en el crecimiento), estar peligrosamente delgado o presentar carencia de vitaminas y/o minerales (malnutrición por carencia de micronutrientes o mejor conocida como hambre oculta).
Los factores que influyen en la desnutricion, aunque normalmente se menciona a la pobreza como la causa principal de la desnutrición, existen otras causas tan importantes como ésta, tales como  la no lactancia materna exclusiva, la presencia de enfermedades como diarrea, infecciones respiratorias agudas, y otras; la falta de educación y de información sobre la buena o adecuada alimentación, el no consumo de suplementos vitaminados o alimentos fortificados, y el costo de los alimentos.
Esta se compone de bajo peso, retraso del crecimiento, emaciación y deficiencias en esencial vitaminas y minerales. Además, la deficiencias de micronutrientes la falta de el hierro o deficiencia de yodo son todavía prevalente, lo que indica que muchos países están luchando con múltiples cargas de desnutrición. 
Una publicación de UNICEF de 2006, expresa que todos los años nacen en el mundo más de 20 millones de niños y niñas con un peso inferior a los 5.5 libras, lo que equivale al 17% de todos los nacimientos del mundo en  desarrollo, es decir una tasa que duplica el nivel de los países industrializados que es de  7%.
Desnutrición en la República Dominicana 
Entre 1940 y 1989 la desnutrición habría sido responsable de la muerte de 265 mil menores de cinco años que tendrían entre 15 y 64 años en el 2004 y, por tanto, formarían parte de  la población en edad de trabajar.
De acuerdo al Informe del Estado Mundial de la Infancia 2007, entre los años de 1998-2005 en el país un 11% de los recién nacidos nacían con bajo peso, y en los años de 1995-2005 el 2% padecían de desnutrición moderada y grave y un 9% de desnutricion crónica (talla/edad) moderada y grave.
En el país la deficiencia de talla para la edad se daba en el 7% de los niños y niñas menores de 5 años; de forma severa en el 2%. Las regiones de Enriquillo con un 10%, el Valle 9% y Cibao Nordeste 9% eran las que presentaban mayor desnutrición crónica.  También San Juan de la Maguana y Elías Piña eran los lugares donde estaban los más altos porcentajes de desnutridos, ya que aproximadamente un 6% de niños y niñas presentaban desnutrición aguda.
La desnutrición crónica en menores de 5 años con el nuevo patrón de la OMS, en 9.8%.   Se observa como el nivel educativo de la madre influye de forma significativa en la desnutrición.  De esta manera, la desnutrición crónica en hijos de madres sin educación es de 15.4% y en los hijos de madres con niveles educativos secundario o superior es de 9.4% y 4.7% respectivamente.
El factor decisivo en la presencia de desnutrición aguda en los menores de 6 meses, se debe a la baja práctica de la lactancia materna exclusiva en menores de 6 meses, la cual es de sólo 7.8%.  Esta situación es responsable de la alta prevalencia de la desnutrición aguda entre los menores de 6 meses que es de 5.6%, en contraste con la presentada entre los niños de 18 a 23 meses de 0.6%. 
Otros factores que causan el hambre y la desnutrición están los desastres naturales, los conflictos, la pobreza, la falta de infraestructura agrícola y la sobre-explotación del medio ambiente. Recientemente, el número de personas con hambre se incrementó debido a las crisis financieras y económicas. 
El costo que representa el hambre y la desnutrición crónica para las naciones en desarrollo, representa más 450 mil millones de dólares al año. 
Las soluciones que se plantean para enfrentar el problemas son las siguientes.  Realizar una alianzas con las instituciones responsables del área de la salud y la alimentación. Regular la venta de alimentos en el entorno escolar y los horarios de publicidad de ciertos tipos de comida. Que en las escuelas de tanda extendida se incluyan espacios para que los niños realicen actividad física regular. 
Que la decisiones de los alimentos que lo componen no se escojan en base a los hábitos de alimentación de los niños, como ocurre en la actualidad, sino que se diseñe una dieta balanceada que pueda educarles sobre la buena alimentación.
 

Claudio Schuftan

PHM
Viet Nam

Overall general comments: (all in a personal capacity)

[V0 is way too long and academic to digest. It must be drastically cut for it to have any impact on the CFS. If V0 cannot say what is needed and why in 30 pages, CFS will simply be overwhelmed (I am not talking about an executive summary, but a convincing piece of around 33 pages). One possibility, to start with, is to put the case studies in annex and summarize the outcomes of those in the main report.].

·         V0 variously speaks of food, nutrition and/or unhealthy environments. Using this terminology, avoids using already UN-sanctioned language as relates to the influence of a) the physical environment, and b) of the social determinants of nutrition (a la Social Determinants of Health that are very explicit of what these determinants are).

·         The concept of ‘value chain’ replaces the over 50 year old concept of ‘food chain’ (from production to digestion). Yes, it adds increases and losses of nutrients along the chain. But does it/shouldn’t it also add the tracking of for-profit hikes or distortions of food prices negatively affecting poor consumers as foods go from producers to consumers? (the latter not presented in Figure 27, p68 and only tangentially touched upon in Fig 29, p69)

·         VO mentions the concept of food sovereignty only twice: Once anteceded by “it is argued…” and another time quoting CSM. It does not take a stand on whether the concept ought to be recommended for adoption by the CFS

·         VO mentions the concept of ultra-processed foods 3 times: Once quoting the Brazilian Dietary Guidelines, once citing Popkin, and once just describing these products are consumed. V0 does not take a clear position on them.

·         V0 does not mention the grave issue of land grabbing at all. This cannot be omitted in this day and age.

·         There are very few examples worldwide of where the burdens of malnutrition have been made a political priority (Brazil for example--although in jeopardy now). The best we have to show for is a collection of vertical interventions with little or no participation of the affected, i.e., the claim holders. Malnutrition has simply not been addressed as a human rights violation. Publications like the Lancet Nutrition Series have nothing but contributed to this, claiming to be the best our profession(als) has(ve) to offer.

·         In multiple places and indifferent contexts (7 times), V0 refers to “the poor”… This is such a depersonalizing pejorative thing to do… What we are really talking about is “those individuals and groups rendered poor by an unfair economic system”. Along the same vein, V0 mentions poverty alleviation or reduction 2 times when what it really ought to be talking about is “disparity reduction” in a 99/1 world.

·         V0 mentions nutrition-sensitive approaches or programming five times without ever defining the concept.

·         If we take the example of the needed mobilization aimed at democratizing all instances of nutrition governance, we have to be clear that this objective is not separate from, but very much part of, a mobilization effort of a wider perspective. To treat nutrition governance as somehow independent of national and global economic and political governance is outright absurd. Simply said, proclaiming that the challenges of nutrition governance can be dealt independently plays the important political role aimed at obscuring the vested interests and power relations at play. (relates to p72 and p104)

·         Section 4.2 on p92 and beyond focuses on food system supply interventions. This is only one arm of the problem! The bigger constraints, many of us argue, are on the demand side, i.e., on the social determinants of nutrition as I argue in the first bullet above and also below as I critique the conceptual framework. (For instance: is innovation in technology really a very high priority? (Line 11 p92).

·         In many places, V0 calls for multidisciplinary or multisectoral approaches to solve the problems of right to food violations. There is nothing terribly wrong with this concept, but it just gratuitously assumes that looking at the problem of these violations from a ‘wider’ multi-professional perspective is going to automatically lead us to the better, more rational and egalitarian solutions. The call is for sharing paradigms among the different scientific disciplines or sectors where practitioners come from. But by just putting together brains ‘sowed’ differently, without considering where they are coming from ideologically, is not going to, all of a sudden, make a significant difference in the outcome and the options chosen. They may well stay in the domain of immediate or underlying causes, only now everybody involved contributing a small monodisciplinary window to the package of (still pat?) solutions proposed. Multidisciplinary approaches simply, most often, take the social and political context (i.e., the individual and institutional power relations) as given; they therefore end up being conservative in their recommendations.

Specific comments:

INTRODUCTION

·         Line 16 p9: not only decision-makers in the public and private sector (duty bearers) need to be empowered; they already have excess power in the prevailing system. It is claim holders that need to empower themselves to demand changes in the food system.

·         Line 18 p9: The SDGs are not per-se accountability tools…

·         Line 25 p10: It is not for the current leaders (duty bearers) alone to act for nutrition. Claim holders have to be given a say.

CONCEPTUAL FRAMEWORK

·         Line 15 p11: The definition given is for Food Systems and not for Nutrition Systems which the VO claims to also address. The definition wrongly puts socioeconomic growth and equity (should be equity and equality!) only as outcomes and not as determinants. [see comment on social determinants (and not only outcomes) above].

·         The Conceptual Framework diagram p14:

o   Under Political and Economic Drivers, only livelihoods and income, markets and trade are mentioned. The more structural political and drivers are not mentioned: not acceptable in this day and age.

o   A special box is allocated to consumer behaviors, but not a word is mentioned here about the role of Big Food in negatively influencing those behaviors: Should be in the diagram. (This is mentioned on p17, but not in the diagram). (The role of Big Food in shaping consumer behavior is also missing on page 108).

o   The economic and social impacts are placed on the very right of the diagram as outcomes; should economic and social considerations not also find a place on the very left of the diagram as determinants of the food system?

THEREAFTER:

·         Lines 1-6 p16: Mention is missing of the documented negative effects of fee trade agreements.

·         Line 7 p16: GDP/cap is actually meant, but we know it is an average so of no help for work from a right to food perspective.

·         Lines 21-29 p16: The determinants of demographic drivers are missing here.

·         Lines 36-49 p16: No mention is made of the encroachment of cash crops displacing food crops.

·         Lines 14+15 p18: No mention is made of why some vulnerable groups rendered poor spend most of their income on food.

·         Line 29 p18: Reformulation of ultra-processed foods is not the solution as clearly shown by Monteiro et al. Yes, industry can reformulate, but will boast about it as an advertising gimmick….and we will still be hooked on ultra-processed (junk) food for ever longer. (also in p83)

·         Lines 24-35: Mention of the Brazilian Guidelines ought to be made here too.

·         Lines 2-4 p24: Again here, economic and social equity parameters are seen as outcomes and not also as determinants.

·         Lines 25-32 p33: The focus called for must also include regulating Big Food/Big Soda and the advertising of ultra-processed foods and soft drinks.

·         Lines 16-21 p38 (Conclusions): See the 6th bullet of my general comments.

·         Lines 32-40 p50: To preserve the fairness of V0, the critical literature towards the SUN Initiative (not a movement…) must be quoted, particularly in what pertains to the conflicts of interest of and lack of substantial investments by participating private sector actors to address the multiple burdens presented in V0. (Will this come after line 42 in p104?).

·         Lines 18-19 p54: For many years, open trade on food dumped highly subsidized US grains in countries rendered poor with devastating consequences for small farmers.

·         Lines 20-21 p.54: Increased trade is actually seldom associated with rising incomes; look at NAFTA.

·         Lines 42-43 p54: Yes, nutrition and trade policies are included in the SDGs, but better coherence will not resolve the negative effects of the latter; much more is needed in terms of protecting nutrition in existing and upcoming FTAs. (V0 says this in the next page).

·          At this point I started skipping….Just too much information to digest…

 

·         Lines 19-25 p.62: This is the crux of the problem we are faced with in 2016 and beyond!

·         Line 13 p72: Says: “Having good governance helps to support the provision of social services.” …. Not always the case: look at the USA.

·         Lines 3-14 p86: This intro on nutrition education totally ignores educating and organizing consumers about the role Big Food and Big Soda play in eating and drinking habits that lead (not only) to NCDs. This, so consumers turned claim holders can demand their governments regulate and or tax ultra-processed foods.

·         Lines 2-7 p87: CODEX is mentioned in a positive role here. But CODEX gives an inordinate place in the table to Big Food/Big Soda with public interest civil society organizations being shut out of meaningful negotiations that protect consumers.

·         Lines 21-24 p87: What the example of Chile does not say is that the levels of unwanted nutrients in the labeling’s ‘red light’ (‘stop sign’) category are set too high due to industry pressures; permitted levels will go down to internationally recommended levels only over a period of four years: a typical delaying tactic by industry.

·         Line 16 p91: Why is V0 asking more R&D in nutrient-rich foods? The Brazilian Guidelines are clear about the alternative (and correct) options.

·         Line 37 p93:  V0 says: “There are also ethical issues with genetic modification… Should it rather say: “There are serious issues….?

·         Lines 29-38 p96:  V0 says: “Increasingly, technology is playing a bigger role in influencing behavior through nudges or prompts in purchasing decisions.” Meaning what?   and  “A technology focus on prevention through nutrition and wellness category could be a well over USD trillion dollar market opportunity”. Really?? …and why should V0 worry about market opportunities?  Furthermore, “The increase in available technology has empowered consumers to take charge of their own health”. Really??  …this must come from some type of a fabricated evidence source…

·         Lines 13-17 p87:  V0 says: “The ability to connect the right social nudges through information and convenience will help combat the issues of obesity.” Very unclear what this is supposed to mean, but it somehow rings wrong to me.

·         Line 41 p100: V0 calls for subsidies for nutrient-rich foods. Why only? Why not mentioning subsidies for unprocessed foods as the Brazilian Guidelines call for?

·         Lines 4-23 p104: By targeting the very poor, safety nets somehow attempt to ‘reduce poverty’ but, in reality, going for safety net approaches means accepting the exacerbation of inequality. As said above the real issue is not poverty alleviation, but rather disparity reduction.

·         Line 29 p104: Why do these require “top-level design”? Is V0 not for participatory approaches?

·         Lines 19-28 p105: V0 does not mention the many published important PPP critiques relating to inherent conflicts of interest in private sector participants. (Also missing on Line 42 p109). (I see V0 plans to still add a short section on conflicts of interest on page 107).

·         Line 33 p109: V0 speaks of a nutrition-sensitive value chain approach and centers the same on nutrients, not on foods….Is this the way to go?

I AM AWARE THESE COMMENTS ARE LONG AND DO NOT HIGHLIGHT THE MANY GOOD POINTS THE V0 DRAFT HAS. THE INTENTION JUST IS TO MAKE IT BETTER.