全球粮食安全与营养论坛 (FSN论坛)

The attached documents convey the collective comments of the platform of public interest civil society organizations and social movements that have actively engaged in the preparatory process for the Second International Conference on Nutrition (ICN2) and continue to advance its follow-up, including the Decade of Action on Nutrition, in the context of the civil society vision statement on nutrition. Besides the overarching and specific comments on the first draft programme (currently only in English), civil society’s vision for the Decade is articulated in the Civil Society “Manifesto” on the Decade of Action on Nutrition (available in English and Spanish - French will soon follow).These documents are still at advanced but not yet final stage as consultations are still ongoing at various levels of the multiple constituencies of the group.

On behalf of the NNEdPro Global Centre for Nutrition and Health in Cambridge, we are delighted to submit our response to this cardinal and timely initiative. We particularly hold the fort in regard to Nutrition Education of healthcare and public health professionals as a self-sustaining strategy to promulgating adequate preventative as well as therapeutic aspects of Nutrition across at-risk populations, globally. We would be happy to have further dialogue and form partnerships with both the secretariat as well as other relevant stakeholders.

Professor S Ray, NNEdPro Chair and Executive Director & Dr G Jones, Head of Core Support for the NNEdPro Group

The Need for Nutrition Education/Innovation Programme (NNEdPro) and its Global Centre for Nutrition and Health in Cambridge, welcomes the opportunity to comment on the first draft of the ‘FAO/WHO Work Programme of the UN Decade of Action on Nutrition, 2016-2025’.

Q1. Does the work programme present a compelling vision for enabling strategic interaction and mutual support across existing initiatives, platforms, forums and programmes, given the stipulation of Res 70/259 that the Decade should be organized with existing institutions and available resources? 

As a global organisation concerned with malnutrition at all levels we fully support a collective vision that is inclusive of all, irrespective of life stage, geographic location or economic standing. The vision should underpin the work programme and its inclusion of activities addressing the complex and multi-factorial issues of over and under nutrition, food security, availability, sustainability, safety and access to knowledge and training.

The draft work programme identifies the use of existing institutions and resources but must also ensure that it is open to utilising the skills and assets of emerging stakeholders as well as institutions with established FAO/WHO relationships. 

To achieve the commitments made at ICN2, in the 2025 Global Nutrition and diet-related NCD targets and in the 2030 Agenda for Sustainable Development it is essential activities are inclusive, accountable and transparent with data collection and evaluation undertaken in agreement with open data principles.

Q2.What are your general comments to help strengthen the presented elements of the first draft work programme of the UN Decade of Action on Nutrition? 

The Nutrition Decade aim to ‘be for all’ is commendable, as malnutrition is a global issue impacting on health and the environment, as well as the economy at both national and global level. However research has shown there are currently significant gaps in the required nutrition knowledge and skills to deliver change, particularly in countries with the greatest need. This is an area that needs to be developed, as without a trained and competent workforce nutrition interventions will be limited in their impact and effectiveness. Whilst it is the focus of Action Area 3, the need for nutrition education, knowledge and training actually underpins all the Action Areas. We believe that the work programme would be strengthened by providing further clarity that nutrition education, training and skill development is the foundation for all action, so as to underpin the importance to member states investing in this fundamental requirement. In addition we believe the draft work programme would be strengthened by the explicit mention of the role of implementation science. The funding, application and capacity for implementation science could, for example, be highlighted in Table 1. Furthermore, it is important for such Nutrition Education to be targeted towards a critical mass of healthcare and public health professionals and not just simply the population at large. The benefit of targeting such a group would be that statutory regulated professionals have a responsibility to consistently discharge safe, effective and evidence-informed advice, taking into account individualised requirements and circumstances. Internalising adequate Nutrition knowledge and skills within the healthcare and public health workforce is therefore a self-sustaining strategy.

Q3.Do you feel you can contribute to the success of the Nutrition Decade or align yourself with the proposed range of action areas? 

NNEdPro is a global organisation with expertise in researching, developing and delivering nutrition education and skill development. Our multi-country network is ideally placed to support the Nutrition Decade in supporting the development of measurable markers for the nutrition knowledge and skill level of those delivering change and activities at a global, national and local level. Through our partnership with GODAN (Global Open Data for Agriculture and Nutrition) we can also support the implementation requirements for open data collection and reporting.

Q4.How could this draft work programme be improved to promote collective action to achieve the transformational change called for by the 2030 Agenda for Sustainable Development and the ICN2 outcomes? What is missing? 

To promote collective action the draft work programme would be improved by the inclusion of more specificity in respect to timelines, activities, responsibilities and measurable outcomes. This could be achieved by providing more detail in Table 2 following dialogue with member states and stakeholders.

Clearer measures of capacity, activities and outcomes would be beneficial for transparently assessing impact and success. NNEdPro would request in particular the inclusion of measures for nutrition education provision (particularly to the healthcare and public health workforce) and for the measurement of the level of nutrition knowledge and skill of those delivering interventions and initiatives ‘on the ground’. This would enable Member States to clearly determine and measure investment in this area and enable global comparisons and accountability.

Q5. Do you have specific comments on the section on accountability and shared learning? 

NNEdPro supports transparent reporting and the principles of open data. The use of a publicly-accessible repository would enable nutrition researchers to explore this rich dataset for further research and investigations to further this area of knowledge. We would also seek to utilise our Annual International Summit in Medical Nutrition Education and Research for knowledge exchange from the UN Decade of Actions in Nutrition, with a dynamic international cross-section of healthcare professionals in particular. 

Thank you for the opportunity to provide comments on the first draft of the Work Programme of the UN Decade of Action on Nutrition, 2016-2015.

The Global Obesity Centre (GLOBE) is a research group based in the Centre for Population Health Research at Deakin University and a WHO Collaborating Centre. Our vision is to catalyse improvements in population health, with a focus on obesity, through innovative research that empowers people and enables healthier environments.

Comments are arranged according to the headings and numbered paragraphs of the draft Work Programme.

Background

The background should explicitly acknowledge the contribution of climate change to malnutrition. Also it should indicate that this workplan is building on the acknowledged double burden of under-nutrition and overnutrition such that synergistic programmes and policies are sought.

Paragraphs 3 and 4

• Including the global nutrition and diet-related NCD targets from ICN2 and the SDGs (currently in the footnote on page 2) would (1) focus the work programme and (2) better represent the full scope of malnutrition the programme seeks to address

Aims and added value

Paragraph 9

• There is an overemphasis on policy in the aims and consequent underemphasis on programmes and financial commitments. National and international policies are a critical part of the change that is required to combat malnutrition but will need to be implemented together with complementary financial commitment and innovative programmes.

Paragraph 11

• Advocacy, networks and accountability appear to be the main value adds of the work programme.
• In addition to “Put in place an accessible and transparent mechanism for tracking progress” we recommend a point on shared communication of successful initiatives in order to spread progress more rapidly.
• Significant value would be added by including support for sourcing finance.
• The Nutrition Decade could also add value by incentivizing creativity and calling for innovation.
• With global nutrition and diet-related NCD targets already in place, It will be important to prioritise tracking and achieving in addition to the already stated setting impact and outcomes.

 Guiding principles

It was difficult to determine what the guiding principles are from paragraphs 12 to 15. To make the principles clearer we suggest

• Focusing paragraph 12 on taking action that builds on existing efforts
• Focusing paragraph 13 on equity (addressing malnutrition for all people everywhere)
• Adding a new paragraph on synergistic partnerships (participation with all actors who are committed to reducing all forms of malnutrition)
• Joining paragraphs 14 and 15 to form a principle of creating enabling environments (helping partners and people remove barriers to action)

Action Areas

Paragraph 17

• This paragraph could strengthen the localized approach mentioned in sentence two more by identifying ways of financing, evaluating and sharing such programs.

Paragraph 18

• Acknowledge rather than map existing nutrition-related initiatives and movements. Mapping would be a huge under-taking that will hinder action. Also, develop mechanisms to strategically build on successful existing initiatives.

Action area 1

Paragraph 19

• We endorse the food systems approach but note that work on marketing, retailing and consumption is under-emphasised in the work programme. Suggestions follow for strengthening these areas.

Paragraph 20

• It is hard to see the value of international guidelines and standards on healthy diets given those that WHO already have in place. These should be updated and promoted as a supportive piece of work but not an action area of the work programme

Paragraph 21

• Nuts and seeds have been left out of this and other paragraphs listing the food groups that the work programme will focus on. They should be included as important part of a healthy diet

Paragraph 22

• Some of the background information on Food safety could be included in the background section rather than here
• Join with paragraph 23

Make action area 2 action area 5

• While this is an important action area, most preventive action happens outside the health system. Also treatment represents a response so action areas 3-5 should be promoted in the list because they focus on prevention

Action area 3

• This action area is missing a paragraph on reducing marketing, particularly to children, which should be considered a social protection activity
• A greater emphasize needs to be placed on teaching children horticulture and food purchasing skills

Action Area 5

• Food retail environments need to be included here

Action Area 6

• The commercial determinants of malnutrition need to be recognised and actions are needed to help countries manage conflicts of interest and achieve transparency in policy-making, political donations, programme financing and related areas.

Means of implementation

Paragraph 42

• It is not clear why countries commit to (1) (2) or (3). Achieving in country nutrition targets implies mobilizing financial resources for domestic action. ‘And’ requires a greater commitment and would achieve a greater collective impact.

Paragraph 46

• This is the first mention of the Nutrition Decade Secretariat. They should be introduced in the background.

Nutrition champions

Paragraph 47

• Governments may prefer to be invited rather than declared as Nutrition Decade champions

Funding modalities

What incentives can the Nutrition Decade provide to encourage funders to support innovative programmes to combat malnutrition?

Paragraph 56

• The World Bank estimates do not include costs of scaling up effective programmes for obesity prevention or reducing marketing. Theses should be estimated so countries can address malnutrition in all its forms.

Paragraphs 64-66

• We see the value of a visual identity for the Nutrition Decade but recommend this is kept low key. The specific and specialized campaigns mentioned in para 66 may be counter to not establishing new structures as mentioned in para 67

Accountability and Shared Learning

• Will there be a country to champion Nutrition Decade at the UN General assembly?
• What accountability will be in place for financial commitments?

Paragraph 75

• How will the UN system identify good practices to support evaluations?

Table 1

• Addressing the impact of climate change on fruit, vegetable and animal sources of foods should be a topic or more explicit in existing topics

Table 2

• A forum on financing is needed in the first biennium

Thank you for the opportunity to contribute comments.



While I am far from having a comprehensive understanding of what actions are already in place, or will be initiated, I understand that a comprehensive response like this is needed, and could make unprecedented progress, under any conditions and circumstances. 



What I would offer, from my point of view, is that there doesn’t seem to be anything upfront in this document accounting for the unprecedented cultural transformation (which will take decades) necessary to mitigate global warming/climate change.  The following--“Address the increasing number of emergencies (including natural disasters, conflicts and chronic emergencies) affecting the nutritional status of vast populations” (top of p. 4)—is a “close relative” to what I’m suggesting, but… there still seems to be an assumption of some kind of “status quo”.  It seems to me that “in unprecedented flux” rather than “status quo” would better characterize the next three decades.



Also, we live in very complex cultural landscapes, and there are many different kinds of moral compasses attempting to navigate such landscapes.  As a consequence, people who are not sufficiently informed about critical issues are everywhere, and they are investing their time, energy, and money—voting—all the time.  Even a most comprehensive approach like the one outlined in this draft will not help people who perceive that their rights and freedoms to act as they see fit—even if irresponsibly—are established and sovereign rights.



Further, besides the unprecedented challenge of mitigating global warming/climate change, I believe that what we have now is a convergence of critical challenges (here is a two page description of the ten most critical challenges identified by this writer) [all documents referred to in this comment accessible on homepage of The Community Peacebuilding and Cultural Sustainability (CPCS) Initiative at www.cpcsi.org .]



I understand there may not be many who agree with my own personal assessment.  Even so, a valid argument can still be made that a “Recalibrating Our Moral Compasses Survey”--



--a very careful and conscientious approach to identifying critical challenges and solution-oriented activity--and to comparing that input with working definitions for “right livelihood” and “moral compasses” (to increase consensus on such definitions)--



--which sought responses from carefully selected people from around the world (possibly 300) who are who are well known in fields of activity associated with creating a peaceful and sustainable world--



--could be a catalyst for collaborative problem solving a the local community level (such as Community Visioning Initiatives, Neighborhood Learning Centers, and Neighbor to Neighbor Community Education Projects in local newspaper)(and such a survey could be undertaken by a coalition of universities and colleges).

Summary Point:  if more people discovered for themselves how unprecedented the challenges ahead are (from international “Recalibrating… Surveys”, and subsequent local collaborative problem solving), and how much we need to be learning and working together to manage the profound cultural transformation needed to respond to such challenges, better decisions would be made locally, by many more people, and across a much wider spectrum of challenges and positive tipping points.



More in depth discussion along these lines can be found in:

1)  "Unprecedented Challenges Ahead--February 2017"  (2 pages; Feb. 2017)

2)  “Convergence of Critical Challenges Alert to Peacebuilders, Chaplains--from cpcsi.org” (10 pages; Feb., 2017)(accessible on homepage of www.cpcsi.org)

 

Dear Ms. Campeau and the UN Team,

Thank you for the opportunity to give inputs/comments on this draft document.

We would like to highlights the points below:

* Diversification and promotion of plant-based sources of foods, particularly fruits and vegetables.

* Currently about 2 billion people suffer from incorrect nutrition or micronutrient deficiency, in order to address this scourge and achieve the SDGs an approach like One Health, in this case One Nutrition is needed, where different stakeholders with different skills are giving contributions, e.g. Agricultural Economists, Soil experts, etc.

* Vertical integration of food production should be discouraged and small producers encouraged to diversify their production.

* The link between nature, culture and diets needs to be further explored and harnessed.

* Nutrition education and training (institutional capacity building) needs to focus on governments and policy makers

Je note que le programme prend en compte des aspects importants en matière de sécurité alimentaire et nutritionnelle en Afrique, notamment, la gestion des fruits et légumes, la question des pertes et gaspillages. Toutefois, il y a besoin aussi d'insister sur les spéculations comme les racines et tubercules (manioc, igname, taro) qui donnent de hauts rendements en Afrique et qui peuvent être source de plusieurs appuis nurtritionnels. Il en est de même de certaines spéculations à forte valeur ajoutée économique, sociale et nutritionnelle en Afrique de l'Ouest comme le riz et la banane plantain. Enfin, je souhaiterais qu'un accent particulier soit mis sur la protection sociale, notamment la question de lutte contre la pauvreté, vue sous son angle dynamique. Il s'agit de retenir quelques mesures appropriées et différenciées contre la pauvreté chronique et la pauvreté transitoire des exploitants agricoles. Au fait, la pauvreté chronique est un frein essentiel à la promotion de la nutrition et de la sécurité alimentaire en Afrique.  

Dear Colleagues,

So many thanks for this opportunity to provide feedback on this very important document. Please find our comments below.  We look forward to collaborating with you to end malnutrition, in all of its forms.

Sincerely yours,

Ekin Birol, HarvestPlus

Dear UN colleagues,

We appreciate and wholeheartedly support your leadership and global vision to combat malnutrition in all of its forms.  We would like to congratulate you on a very well-written and -thought out first draft of the work programme and thank you for the opportunity to provide feedback thereon.

Here are a few comments and suggestions for your consideration:

1. We really appreciate the thought you have put into the mechanisms for ensuring accountability for the commitments to be made.  The “carrot” approach of nutrition champions is especially positive and encouraging.  We suggest the selection of the champions to be as transparent as possible and to be based on the rate of progress a country makes towards reaching the targets to be set.  Otherwise the selection of champions may be questioned. We were wondering, in addition to the “carrot” approach would you also consider a “stick” approach (e.g., the World Bank’s recent naming and shaming of the countries that fail to prevent stunting in children).
2. Related to the setting of the targets and measurement of the progress, we would recommend UNSCN to regularly validate the countries’ self-assessments (trust but verify) and we also recommend the methodology and the data behind the target setting, progress evaluation and validation checks to be vetted by international experts in nutrition and evaluation, and to be open to public discussion and access.
3. Despite the thought you have put into the mechanisms for ensuring accountability for the commitments to be made, the commitments are still voluntary and there are no visible sanctions.  We recommend the UNSCN to consider Paris Agreement type global efforts to tackle global the global malnutrition problem and to set global and national/regional level targets and establish mechanisms and timelines for achieving these targets.  UNSCN could perhaps consult with the UNFCC on their learnings from such efforts and the effectiveness of implementing mechanisms such as the sustainable development mechanisms. International financial institutions could also be persuaded to couple national grants and loans to the level/efficacy of activities/policies/programmes a country is implementing to reach nutrition targets.
4. Action areas identified are comprehensive and also caters for future changes (e.g., population growth, urbanization, climate change, changing food preferences).  Acknowledgement of trade as an area of action is most welcome, given that several regions of the world (e.g., sub-Saharan Africa) will not be able to feed their populations – even if productivity gains are realized as a result of adoption new technologies – in the future. 
5. Two important issues/topics that we think are missing from the action areas are: (a) both in situ and ex situ conservation of agricultural biodiversity – which is crucial for the development of productive and nutritious varieties/breeds of crops and livestock that are adapted to ever-changing and agroclimatic conditions, and (b) biofortification, i.e., development and delivery of micronutrient-enriched staple food crops, which has been proven to improve vitamin A and iron deficiency status.  Both conservation of agricultural biodiversity and promotion of biofortified crops merit inclusion under action area 1 (sustainable, resilient food systems for healthy diets). UNSCN might consider consulting/collaborating with the Convention on Biological Diversity on (a), and with HarvestPlus on (b).  Both of these topics should also be included among the potential topics for the development of commitments and the establishment of action networks, listed in table 1.
6. Table 2 (Page 15) lists the meetings/conferences where UN Decade of Action on Nutrition will be promoted in 2017 and 2018. You could also include in this list the third Global Conference on Biofortification, which will be held in India in Q2 of 2018.

Many thanks for your consideration. We would be happy to elaborate on/discuss any of the comments raised above.

Sincerely yours,

Ekin Birol

The Association for Nutrition welcomes this opportunity to comment on the first draft of the ‘WHO/FAO Work Programme of the UN Decade of Action on Nutrition, 2016-2025’.

Q1. Does the work programme present a compelling vision for enabling strategic interaction and mutual support across existing initiatives, platforms, forums and programmes, given the stipulation of Res 70/259 that the Decade should be organized with existing institutions and available resources?

The collective vision of ‘a world where all people at all times and at all stages of life have access to affordable, diversified, safe and healthy diets’ is compelling and fully supported by the Association for Nutrition.  This draft work programme presents the rightly aspirational aim of the Nutrition Decade providing a clearly-defined time-bound operational framework that utilises and works with existing structures and available resources. We support the acknowledgement of the need for open, inclusive, accountable and transparent activities;  communication at all levels is essential for the successful implementation of actions to achieve the commitments made at ICN2, in the 2025 Global Nutrition and diet-related NCD targets and in the 2030 Agenda for Sustainable Development.  

Q2.What are your general comments to help strengthen the presented elements of the first draft work programme of the UN Decade of Action on Nutrition?

We fully support the guiding principle that the Nutrition Decade will be fully inclusive, as malnutrition is a global issue with 45% of the cases of under-five mortality attributable to under-nutrition. The number of countries simultaneously experiencing the complex burden of different forms of malnutrition is an increasingly common issue and highlights the need for multifaceted action by professionals who are suitably trained in nutrition science.

The Global Nutrition Report 2014 included a conceptual framework highlighting the fundamental role enabling (an) environment for nutrition improvement has in obtaining the ultimate goal of achieving benefits from improved nutrition status. A key facet for achieving this is the provision of professionals with the knowledge and skills to support and address the nutrition issues in their locality. The World Food Programme has also noted >80% of the world’s most food-insecure live in countries prone to natural disasters with high-levels of environmental degradation, and the need to build resilience of vulnerable people to disaster risk and climate change. These findings reiterate the fact nutrition professionals are vital in improving the knowledge, capacity and skill required for addressing complex situations and essential in empowering current and future generations to undertake practices that improve their nutritional status.

However scientific papers published by Association for Nutrition Registrants have demonstrated substantial gaps in knowledge and skill exists in countries of great need. In particular, registrants involved in the MDGs and SUN movement have highlighted the particular inadequacy in professional capacity in nutrition in Africa. For example, Ellahi et al (2015) found limited nutrition training was available in Africa compared to identified level of need. In this review of nutrition training provision, serious questions were raised in regards to programme structure, curricula content, standardisation, knowledge and practical/ interpersonal skills. These, combined with the fact that nutrition support in many countries is provided by health or support workers, rather than nutrition professionals, creates a potential bottleneck to ensuring evidence-based delivery of interventions and action.

Jackson and Ashworth3 (International Malnutrition Task Force) have also highlighted the need for capacity building and the emphasis required on the prerequisite of nutrition training and education and the potential establishment of Communities of Practice to address the, ‘current piecemeal, scattered capabilities that are not fit for purpose’.

All six Action Areas are underpinned by the need for evidence based nutrition policy and practice, both at strategic and frontline levels. This can only be guaranteed if nation states have a qualified, trained and trusted workforce. Therefore we feel that this needs to be strengthened throughout the draft work programme.   

Q3. Do you feel you can contribute to the success of the Nutrition Decade or align yourself with the proposed range of action areas? 

The Association for Nutrition has longstanding experience in researching, developing and validating nutrition competency requirements not only for nutrition professionals but also for those working or volunteering in health & social care, catering and fitness & leisure capacities, who alongside nutrition professionals carry a responsibility to use, translate or provide nutrition advice to the public. This work, undertaken with the support of UK’s Department of Health & Public Health England, has extended our reach into the quality assurance of nutrition training provisions for these wider workforces.

The Association for Nutrition can contribute to the success of the Nutrition Decade through input and support relating to the development of international standards to enable nations to ensure action is supported by qualified, trained and trusted workforces. Our registrants also have the expertise to deliver training, support and research for the Nutrition Decade from a policy to frontline delivery, on both a national and international level.

Q4.How could this draft work programme be improved to promote collective action to achieve the transformational change called for by the 2030 Agenda for Sustainable Development and the ICN2 outcomes? What is missing?

The draft work programme would be strengthened by the provision for a set of standards by which all nation states can measure and ensure those delivering actions are suitably qualified and competent in nutrition to deliver evidenced-based support and activities, providing the ability to undertake comparisons of delivery across nation states. Setting and monitoring against these standards also has the potential to create education development and subsequent empowerment of individuals gaining skills and knowledge to support improved health as noted in Action 3 para 30.

Q5. Do you have specific comments on the section on accountability and shared learning?

The Association for Nutrition supports the transparent reporting of progress and the use of an open access database, which would enable nutrition researchers to explore this rich dataset for further research and investigations to further this area of knowledge.

On behalf of the Scaling Up Nutrition Civil Society Network, please find attached our response to the first draft work programme of the UN Decade of Action on Nutrition. We would like to thank you for the opportunity in input and look forward to working collaboratively together.

Please find below comments to the draft Work Programme of the UN Decade of Action on Nutrition.

General comments on the draft work programme of the UN Decade of Action

- It is an excellent draft which translates into action ICN2 and Agenda 2030 commitments on nutrition. In particular, Italy wishes to underline the added value of focusing on stimulating concrete nationally-determined policies and programmes with the objective of creating sustainable food systems and enabling environments that promote healthy dietary practices. A localized approach is of utmost importance in order to ensure member state ownership of initiatives and policies in the context.

- What stands out in the draft is the operationalization of a “food system” approach, which is crucial in order to promote healthy, sustainable diets that improve nutrition. All actions and initiatives should thus be conceputalised not as isolated interventions but as placed in the context of a “food system”, thus taking into account political, environmental, cultural and socio-economic factors such as poverty, inequality and climate change. More reflection on the root causes on malnutrition in all its forms (poverty, unemployment) would be appreciated.

- Having this in mind, within the first action area on sustainable, resilient food systems for healthy diets, more detail would be appreciated on the issue of local diets, in particular on its outcomes in terms of mitigating the impact of climate change on health. 

- Moreover, a reference to the issue of migration and migrant populations could be included in the document, as migration flows have had a significant effect on the nutritional conditions of populations. As an example, it would be important that countries develop “national epidemiological observatories on nutrition" in order to be able to exchange data and implement the adequate health policies for nutrition (such as correcting for any possible lack of micro or macro nutrients). 

- Finally, we appreciate the establishment of Nutrition Decade champions and of action networks on specific topics of relevance for the Decade, as mechanisms for encouraging commitment.