Nutrition and national development: Establishing the connection

The three major strands of the nutrition planning literature — the socio-economic consequences of malnutrition, its determinants and characteristics, and the solutions offered to the problem — are examined by the authors and found wanting. There are serious limitations both in analysis of the problems and proposals for action in most work on nutrition policies because macro-level social, institutional, economic and political factors are neglected.     

Towards a food and nutrition policy in Tanzania

Fragments of a nutrition policy are seen throughout the different phases of Tanzania's modern history. Efforts of the pre-Independence period culminated in formation of a committee on nutrition which advocated improving food storage, food legislation and standardization, and nutrition education. After independence, an initial period of concentration on cash crops was followed by increased cooperation with the Ministry of Agriculture, and some nutritional surveys were undertaken. After the Arusha Declaration in 1967 a basic needs strategy giving greater stress to food production and adequate nutrition received emphasis, and a Food and Nutrition Centre was established with 4 departments: food science and technology; manpower development; medical nutrition; and planning and coordination. Emphasis on production is reflected in a target of reducing malnutrition by 30 to 50% in every region by 1981, and an interdisciplinary approach is being used to achieve this goal. The basic similarity in proposed activities during the various phases of Tanzania's history indicates that political will is necessary for carrying out the policies.     

Multisectoral nutrition planning: a post-mortem

Multisectoral nutrition planning emerged in the early 1970's as a bold new approach to combating malnutrition in low-income countries. Conceptually elegant and operationally ambitious, it blossomed on paper but collapsed in practice notwithstanding vigorous promotion by international assistance agencies. This essay reviews the meteoric rise and fall of the multisectoral approach and then proceeds to examine its theoretical underpinnings. The essay concludes by identifying 12 lessons learned that, if heeded, can help the current generation of intersectoral initiatives against malnutrition to realize their potential. In retrospect, it was a mistake to assign responsibility for nutrition to economic planners and scientists who possessed little political influence or operational authority. Nutrition requires high-level political sponsorship if it is to command resources, be integrated with established ministerial responsibilities and have staying power. Nutrition planning bcame attractive to basically conservative governments anxious to accommodate international benefactors without having to accept more fundamental reforms; the analysis of malnutrition causality focused primarily on attributes of the malnourished and their families, not on the social, economic, and political order around them.     

National nutrition planning: lessons of experience

National nutrition planning has failed to fulfill its initial promise because of inadequate consideration of political and administrative obstacles to applying the methodology. The political and operational contexts within which multisectoral nutrition planning has occurred are reviewed in order to draw insights and lessons from the experience of the last 10 years. Considered are the political process, macro and micro planning, the multisectoral approach, integration with agricultural and health planning, nutrition interventions, community participation, cost benefit analyses, and information systems evaluation, management and organization. Emphasis on the multisectoral causation of malnutrition has contributed substantially to nutrition programming and remains indispensable for improving nutrition, but requires more thoughtful response to practical implementation problems. Integrating nutrition concerns more effectively into health and agriculture systems offers a more promising approach than efforts to attack malnutrition by encouraging multisectoral nutrition coordinating agencies and national plans.     

Nutrition planning is alive and well, thank you

This article is a rejoinder to an article by John Osgood Field which discussed the failure of multisectoral nutrition planning. The author argues that, although nutrition planners may have been overly optimistic in their hopes that political systems could be made responsive to the problems, significant advances have been achieved. He outlines many of the successes of nutrition planning and the importance of multisectoral work. Malnutrition is a problem that escapes all the standard programmes, and cannot be tackled through the health and agriculture sectors alone.     

Rejoinder: nutrition planning is alive and well,thank you

This article is a rejoinder to an article by John Osgood Field which discussed the failure of multisectoral nutrition planning. The author argues that, although nutrition planners may have been overly optimistic in their hopes that political political systems could be made responsive to the problems, significant advances have been achieved. Many of the successes of nutrition planning and theimportance of multisectoral work are outlined. Malnutrition is a problem that escapes all the standard programs, and cannot be tackled through the health and agriculture sectors alone. There has been much critical thinking by many concerned people various countries. To suggest that nutrition planners moved blindly is to ignore much of the literature. A number of cautions--some of them very early--make it clear that practitioners were not oblivious to the bureaucratic constraints and political realities Professor Field now identifies. It would be cruelly wrong to suggest that no progress has been made. Nutrition planning may have borne fruit of a different sort than some of its early advocates envisioned, but there is no question that it bore fruit. The issue is whether nutrition planning has influenced the way people think about nutrition and the way they analyze problems. And about this there can be no doubt.     

Resource flows through the multilateral system for food and agriculture : Trends of the decade

The tenth session of the World Food Council in Addis Ababa, Ethiopia, held on 11–15 June 1984, undertook an assessment of international activities in the decade since 1974 for meeting the World Food Conference objectives of improving the global food system and overcoming the blight of world hunger. One document prepared for the session looks specifically at the activities of the multilateral institutions since the 1974 conference, in terms of both resource and programme commitments. This article provides a summary of that WFC document.     

Integrating fisheries,food and nutrition – Insights from people and policies in Timor-Leste

The important role of fish in food and nutrition security is becoming more widely acknowledged by the fishery sector and within food policy. Integration of fish and food policy, at national, regional or global levels, is required to ensure the contribution of fisheries and aquaculture to human health is supported through governance arrangements. We explore this aspect of food policy integration in Timor-Leste, where malnutrition is a critical health problem. Consumption of fish is low by international standards and only a small proportion of the population engages in fishing. We used a mixed method approach involving desktop policy analysis, interviews and social network analysis to explore interactions among sectoral instruments and organisations. Our results show generally good integration of food security into fisheries policies, but a lack of integration of fish into food policies. Policy network analysis revealed evidence of collaboration and cooperation between sectors, however, consideration of fish and food concerns was not well embedded across all organisations. We discuss challenges and options for future integration of fisheries into sustainable food systems in Timor-Leste and more broadly, including the need for greater political will and resources, combined with clearer targets and actions within instruments.     

Nutritional functional classification study of Panama

Despite significant progress, wide-spread malnutrition persists in Panama. This article describes a study which found that over half the malnutrition in the country is clustered in functional groups economically connected to the agricultural sector and which indicates that food availability is a serious problem for 25% of the population. Food intake deficits were equally prevalent among the urban and rural populations. Dietary composition was not seen as the principal problem; rather malnutrition problems are linked to low wages and poor access to public services. A nutrition policy for Panama must be centred first on employment and income generation, and then on extending and maintaining public health and nutrition services, particularly for the extremely poor in the central provinces. Food policy per se would not seem a priority area for public intervention.     

The economics and nutritional impacts of food assistance policies and programs

Recent evidence on malnutrition and poverty raise important questions on the role of food assistance policies and programs. In this review article, we examine evidence on the economic and nutritional impacts of international food assistance programs (FAPs) and policies. The returns on investments in FAPs are, on average, high but depend considerably on the targeting and cost structures as well as on food quality and role of complementary activities. We disaggregate findings into four classes of recipients. Returns to FAPs are highest for children under two. But, FAPs oriented towards early childhood interventions are less well funded than are interventions aimed at school-age children or at the broader, largely adult population even though available evidence indicates that these latter classes of interventions offer considerably lower average returns in economic, health, and nutrition terms. Nonetheless, FAP effectiveness in achieving any of several objectives varies with a range of key factors, including targeting, additionality, seasonality, timeliness, incentive effects, social acceptability and political economy considerations.     

Survey on attitudes to nutrition planning

The results of a worldwide survey of nutrition planning professionals' attitudes towards nutrition policy are presented. The objective of the survey was to determine what those involved in nutrition planning perceive to be the causes of hunger and malnutrition, and their views on the effectiveness of the programs implemented to overcome these problems. In mid-1979, a questionnaire was compiled comprising 48 questions related to attitudes towards nutrition policy, voluntary questions about social class, political classification and professional behavior and a question on perceived major impediments to solving malnutrition in the world. The questionnaire was sent to 728 professionals 87 countries; 250 replies from 55 countries; 250 replies from 55 countries were received. 44% of respondents resided in the US, 16% in Latin America and the Caribbean, 14% in the Far East, 12% in Africa and the Middle East and 13% in Europe, Canada and Australasia. Self-classification of political beliefs is the most clear cut correlate in predicting attitudes towards food and nutrition policy. There appear to be 2 clear schools of scientific/political behavior in the sample: one holds a more moderate, but generally liberal, set of views regarding the failure of modern technology in resolving world hunger and nutrition problems; a 2nd more liberal group believes political causes to be at the root of hunger. There is no single profession that can be typified as a breeding ground for nutrition planners. While the European trained and/or native group tends to be more to the left in their attitudes than their counterparts in the US, both groups are decidedly liberal and believe that social structural changes are needed to solve the problems of hunger and malnutrition in the world.     

Implementing the World Food Summit Plan of Action: organisational issues in multi-sectoral planning

Despite current ideological and philosophical objections to planning, it survives in new forms, generating Policy Framework Papers, Poverty Assessments or multi-sectoral Action Plans to implement the resolutions of international conferences. The World Food Summit Plan of Action will generate a new wave of such plans. History shows that the road to multi-sectoral planning is littered with organisational elephant-traps. The traps can be avoided, however, by learning the lessons of past experiments with multi-disciplinary or multi-sectoral planning. The literatures on integrated rural development, multi-sectoral nutrition planning, farming systems research, national food security planning, poverty planning and industrial organisation are all of help. They suggest that the key is to establish a task culture, characterised by co-operative goal definition, a high degree of participation, supportive leadership, and strong integration of planning and implementation. A ten point action plan is derived from these principles for follow-up to the World Food Summit.     

Cautious optimism at the World Food Council

How does the World Food Council assess the changes that have taken place on the food scene since its establishment nine years ago? What is the outlook for structural reform in the agricultural and food sectors? What are their thoughts on the new hunger lobby, and on the growing movement which questions the value of much official aid? How does the Council see the prospects for the next decade? Robin Sharp went to Rome to find out.     

Sustainability of food and nutrition security policy during presidential transitions

Developing countries with democratic governments periodically experience presidential transitions that affect political and institutional performance. Unforeseen uncertainties during transitions are not faced strategically and interrupt collaboration among country teams expected to jointly implement policies, including policies intended to contribute to food and nutrition security. In some low- and middle-income countries, these obstacles result in persistent hunger, malnutrition, and death mainly affecting the most vulnerable populations and contributing to unequal human development.We aimed to understand what mechanisms determined sustainability of Food and Nutrition Security Policy (FNSP) during presidential transitions, from socio-political and nutritional perspectives, in a Central American country that experiences a change of president every four years. Purposeful criterion and snowball sampling were used to recruit 52 policy actors from all relevant sectors and levels, elected or appointed, that had contributed to implementing the FNSP adopted since 2006. Data from semi-structured interviews were analyzed using open, axial, and selective coding. Results were verified using content analysis for obtaining emerging themes in news, speeches, and documents.Twenty-four forces simultaneously shaped a dynamic process determining sustainability during transitions. The forces for sustaining FNSP were Backed Up, Beneficial, Championed, Importance, Institutionally Sound, Owned, Sensitive, Shared, Steady Resources, Strategic, Transition Effect, and Trusted. The forces for not sustaining FNSP were Antagonistic Underlying Structure, Campaigning, Dysfunctional Transition, Fractioned, Haphazard, Insensitive, Irrelevant, Misrepresentation, Neglected, Rivalry, Unsound Institutions, and Unsteady Resources. These forces determining FNSP sustainability during transitions were molded by the emerging reasons for sustaining and for not sustaining policy actions as reported by the study participants. The forces favored or impeded the sustainability of an action or part of it. The forces operated at all levels and sectors, but forces affected actions differently in these. The forces did not compete, but combinations of them brought about outcomes that policy actors in charge and their collaborators could intentionally influence. The potential of forces to shape sustainability of FSNP depended on interacting actors responding to emerging events within specific contexts. Roles performed by civil society, governmental officials, and international cooperation were critical for policy sustainability during transitions.These results are consistent with Lewin’s Force Field Theory on the complex dynamics embedded in intersecting forces within contexts and identify the specific forces that were operating. Although the 24 forces were identified in one context, the set of forces likely captures the range of forces that may operate in other similar political contexts. The knowledge that such forces may be operating could be helpful in ensuring sustainability of policies in the future. Actors and other stakeholders can identify the predominant specific forces operating for a policy and activate or promote the forces that enhance sustainability and deactivate or suppress the forces that inhibit sustainability. Foreseeing or creating opportunities to activate (or deactivate) and promote (or suppress) forces during the early stages of a presidential transition could help sustain policies and related practices that benefit food and nutrition security.     

Revisiting the UNICEF malnutrition framework to foster agriculture and health sector collaboration to reduce malnutrition: A comparison of stakeholder priorities for action in Afghanistan

High rates of undernutrition persist in Afghanistan, but community-level information is scarce on its underlying causes. Developing policy in such situations is affected by varying stakeholder perspectives on the issues. This study uses the UNICEF malnutrition framework and a rapid assessment methodology to compare how stakeholders at community, provincial and national levels describe the food and nutrition situation. Consistent differences in problem definition by administrative level and between agriculture and health sectors were apparent. Stakeholders at all administrative levels widely agreed on the need to improve incomes and employment to ensure food security because of the many constraints to agricultural production. Provincial and national level stakeholders further agreed on the need for nutrition education at all levels of society. The research illustrates how local adaptation and application of the UNICEF malnutrition framework can reveal divergent perspectives, as a first step toward finding common ground and an appropriate policy response.     

The fight against hunger: Its history on the international agenda

The problem of worldwide hunger was first recognized as an issue for international concern within the League of Nations before the second world war. However, it was not until after the war, and the demise of the League of Nations, that it was put firmly on the international agenda. This article traces the history of the fight against hunger from those days to the World Food Conference in 1974.     

Galvanizing political commitment in the UN Decade of Action for Nutrition: Assessing commitment in member-countries of the Scaling Up Nutrition (SUN) Movement

In pursuit of the global ambition of ending all forms of malnutrition, it is important to understand, measure and strengthen political commitment for nutrition. Building commitment involves advocating, establishing institutions, adopting policies, mobilizing resources and coordinating responses – within and outside of government, across sectors, from national to local levels – for as long as necessary to ensure results, sustained over time. As the Scaling Up Nutrition (SUN) Movement enters its tenth year of existence, this study asks if political commitment for nutrition is evident in the 60 SUN member countries and how this commitment translates into results.Guided by a theoretical framework, we use indicators from the SUN Movement's Monitoring, Evaluation, Accountability and Learning (MEAL) system to measure five forms of political commitment for nutrition - expressed, institutional, operational, embedded and system-wide - in countries stratified by income and duration of SUN membership. We further determine the association between assessed levels of commitment and progress towards achieving established global nutrition targets. In doing so, we identity important commitment gaps.Results show that countries that joined the SUN Movement early (2010–12) had higher expressed and institutional commitment scores compared with late joiners (2013–17), with no difference between low and middle-income countries. For operational commitment, early joiners had higher scores for the finance and legislation subcomponents but not for nutrition-specific intervention coverage. Low-income countries, however, had significantly lower scores for the nutrition-specific intervention coverage sub-component of operational commitment and lower embedded commitment scores compared with middle-income countries. A positive association was found between institutional and operational commitment, irrespective of country economic status. Early joiners in the SUN Movement were more likely to rank in the top half of SUN countries for all four forms of commitment. When divided into terciles based on their overall rank for system-wide political commitment, countries in the highest tercile were more likely to be making progress in the reduction of U5 child stunting.The results point to the importance of working to strengthen all forms of commitment, especially converting expressed and institutional commitments into operational commitment. While institutional commitment matters, it can be ‘tokenistic’ only if there is limited capacity to operationalise that commitment. Countries with system-wide political commitment appear to achieve better nutrition impact. It is difficult to determine whether early joiners were already more committed to nutrition and therefore more likely to join the SUN Movement or whether membership in the SUN Movement compelled such commitment. Most likely it is a combination of both, but it is hard to disentangle the direction of causality without measuring changes in commitments over time, and complementing this type of analysis with qualitative research on the perspectives of different stakeholders. Nonetheless, the ongoing measurement and reporting of political commitment can inform dialogue with country and global-level stakeholders on how to galvanize further commitment during the UN Decade of Action on Nutrition especially in view of the 2020 Nutrition for Growth (N4G) Summit in Tokyo, Japan.     

Improving the food environment in kindergartens and schools: An overview of policies and policy opportunities in Europe

Childhood obesity and unhealthy nutrition are high on the European policy agenda because of their association with chronic diseases and due to the related social and economic burden. In 2014, the EU Action Plan on Childhood Obesity 2014–2020 was launched with an overarching goal to halt the rise of overweight and obesity in children by the year 2020. To facilitate the implementation of the Action Plan, the Directorate-General for Health and Food Safety of the European Commission provided support to bring together 25 Member States plus Norway for a Joint Action on Nutrition and Physical Activity (JANPA). The current paper is based on the results of JANPA and presents the explored policy options to improve children's nutrition by targeting the food environment in and around kindergartens and schools. We conclude that for effective actions countries need to combine various mutually reinforcing policies in parallel, including the provision of healthy foods, lowering the availability of unhealthy foods, restricting marketing, and promoting education. Success will depend on the coherence of messages and on the engagement of a wide range of stakeholders and sectors. Evaluation should be carefully designed, using indicators of progress towards the goal of improving diet and reducing obesity in children.     

Macroeconomic adjustment,food availability and nutrition status in Nigeria. A look at the 1990s

Faced with balance of payment problems, declining commodity prices, and a corresponding reduction in foreign exchange earnings, Nigeria implemented a structural adjustment program in 1986. This step was taken in response to encouragement from the International Monetary Fund and the World Bank, and was aimed to accomplish the following: find the true value of the official currency; overcome public sector inefficiency through improved public expenditure and parastatal rationalization; reschedule medium- and long-term debt to relieve debt burden; and encourage net foreign capital inflow while limiting foreign loans. Implementing and adhering to these macroeconomic adjustment policies has brought unprecedented inflation, lower real earnings, and increased malnutrition among lower income sectors of the population. The poor have suffered diminishing access to nutritious foods. Conscribed access to food and compromised nutritional status will most likely persist into the 1990s unless corrective policies are adopted. Appropriate policy would aim to increase the poor's access to food and limit population growth.     

National food strategies and food policy reform

National food strategies, sponsored by the World Food Council, are intended to produce policy blueprints for improving food production in poor countries. International experience with agricultural development discloses wide agreement on national and local policy specifics which should have priority. However, the absence of research into the political attitudes and processes which foster consensus on goals and the reconciliation of competing desirable policies, eg short term v long term, equity v efficiency, may impede the desired policy reform.