Hunger-Undernutrition Blog

Renormalizing “normal”

By Cara George, with Humanitas Global Development

Genetics influence everything about how we are created –from our eye color, to whether we can roll our tongues, even our ability to smell. But what about height? Sure, genetics play a role in that as well. But a recent entry The Global Crisis You Never Heard Of: Stunting on the 1,000 Days Blog points to stunting, or stunted growth, as a dangerous phenomenon, linked to horrifying statistics on impaired brain development and mortality resulting from diarrhea, due to chronic nutritional deficiencies.

Development work consists so heavily of creating a “new normal”. One idea we’re developing here at Humanitas Global Development is how to promote behavior change in a current nutrition project underway in Central America, where the target population does not even understand that they are stunted because everyone else around them is short too. Having served as a Peace Corps Volunteer in  Guatemala, I experienced this firsthand. At 5'6" tall, I always felt at average height in the US, and once in Guatemala, it took some getting used to the feeling of towering above everyone in my town - even the men. 

How do you “convince” a population of chronically malnourished individuals that genes are not solely responsible for their height, and encourage a new way of perceiving “normal”? And how does one work to establish fresh ideas around what is healthy and normal, especially when it means working in a cultural context that does not see the problem or issue in the same way?

Since our readers work in such a variety of areas and geographical/cultural contexts, we want to know your successes and challenges in working towards a “new normal”!

Nutrition Reaches New Heights in Davos

Photo:  AFP

A guest blog by Jane Badham, JB Consultancy, South Africa

When you wake up in Davos, it is to a winter wonderland in an idyllic Swiss Alpine resort and it is easy to forget why you are there.

The World Economic Forum (WEF) states on its homepage that it  is “an independent international organization committed to improving the state of the world by engaging business, political, academic and other leaders of society to shape global, regional and industry agendas.” This got me wondering as to what ENGAGEMENT truly is.

The Free On-line Dictionary gives some ten possible meanings including ‘To draw into; involve’ and making it more personal, those that are engaged should ‘involve oneself or become occupied; participate’. It is thus essentially about conversation, discussion, debate and sharing of thoughts and so many of us who attended the WEF and expected to walk away with a list of concrete actions that are going to be taken, might be disappointed. But I have begun to learn that if you are not on the chess board, you can’t play the game! And so the great news from Davos 2012 for nutrition is that a number of events were held were nutrition (often partnered with food security) was placed under the spotlight.

The tipping points

Four key tipping point issues for me were highlighted:-

1. The need for a diverse range of stakeholders to invest in nutrition especially during the first 1000 days of life;
2. The importance of scaling-up proven and cost effective nutrition interventions at a country level with countries leading the process;
3. The fact that we have to have out of the box thinking and look at new ways (‘Disruptive innovation’ as it was described by one participant) to solve what might seem like an intractable problem;
4. The recognition that we all have to work in partnership and harness the strengths of others that we have not typically drawn into nutrition.

Thus it seemed that the WEF 2012 theme ‘The Great Transformation: Shaping New Models’ is as relevant to nutrition as it may be to any of the numerous other topics that were included in the packed agenda and that had people rushing from place to place to engage!

Transforming the way nutrition does business

It was fitting that the day of food and nutrition security at Davos began with a breakfast honouring what is undoubtedly the best initiative that nutrition has seen in a long time – the Scaling Up Nutrition (SUN) movement (www.scalingupnutrition.org).

The inaugural Sight and Life (www.sightandlife.org) Nutrition Leadership Award was presented by Klaus Kraemer to David Nabarro, who as Marc van Ammeringen of GAIN (www.gainhealth.org) said “stepped up in 2009 and took the leadership role when nutrition didn’t really want to be led and since then through the SUN structure and process has brought everyone together and has finally given nutrition traction.” 

David was quick to make it clear as he accepted the award on behalf of SUN, that the award was not to him as an individual “but to the thousands who have come together to make the SUN shine.” It was exactly the making of a global movement with collaboration never seen before coming together to support the SUN team and the now 26 countries that have signed on and committed to scaling up nutrition, that was the reason for SUN being chosen for this award. Now we need others to step forward to claim the award in the years to come by making the SUN truly shine and reach the millions most in need.

Thinking BIG

David thinks big - “nutrition should become a new development goal on its own as we look beyond 2015” but perhaps many of us in nutrition haven’t dared aspire to these heights or just perhaps we silently recognized we cannot do it alone and yet remained in the security of our silo. A recurring theme wherever food and nutrition security were discussed was the need for partnerships; the need for everyone to take ownership; the need to stop apportioning blame as to who should have done or should do what. It is all of our problem and in the words of Josette Scheeran of the World Food Programme (www.wfp.org) who moderated the session on 'Ensuring Food Security' (http://www.livestream.com/worldeconomicforum) “The topic of food affects every person on earth. It can’t wait until tomorrow – many things are optional, but this is not… If people don’t have food they have 3 options: They can revolt, they can migrate or they can die. We need a better plan. ”

The time is NOW

So as much as Davos is about engagement, I left with a plea to each one of us working in the arena of public health and nutrition - to lead from where we stand. To truly engage by turning words into actions, to take a leap and partner with those we might never have considered. For nutrition to have the United Nations Secretary General, Ban Ki-Moon include it is his Five-Year Action Agenda (http://www.everywomaneverychild.org/component/content/article/10-media/235-remarks-remarks-to-the-general-assembly-on-five-year-action-agenda-qthe-future-we-wantq) and for food and nutrition security to have been spoken about in no less than four events at Davos, truly means we are reaching new heights, BUT it must not just be on the snowy hills of the Swiss Alps, it must become a reality in countries, communities, homes and individual lives across the world.

Weekday Vegetarianism

By Cara George, with Humanitas Global Development

With the upcoming primaries and election, one of the hot topics is bound to be climate change. While it’s important to pressure politicians to take large measures, we often overlook the small things that we ourselves can do for a big impact on saving the environment, besides carrying around a trendy water bottle or colorful canvas grocery bags.  Although we and our readers tend to work more on the macro, wide area of impact project side, there is still very much the desire to take part in smaller-scale actions such as reducing meat consumption.

I recently re-visited a TED talk that I’d watched a while back about becoming a “Weekday vegetarian” (Watch VIDEO here: Graham Hill: Why I'm a weekday vegetarian) and through some Google searches, have seen a lot of material surrounding the subject. Whether for better health, environmental reasons, animal rights, money savings, or a ton of other reasons, many people take the plunge to become full-fledged vegetarians, or vegans. Yet, there are some of us that just can’t seem to let go of a good piece of fried chicken, the occasional (or not-so-occasional) juicy cheeseburger, and your great aunt’s famous roast at family gatherings.

As a society we love labels – just look at all the options on your facebook to declare your relationship status. But labels can be very excluding and inflexible. There’s no label for “I try to eat vegetarian but if you offer me a bite of your shrimp tempura, I can’t say no.” The idea behind “weekday vegetarianism” is just what it sounds like – not giving up on your favorite meat options, yet making a commitment to lower your meat intake.

Proper nutrition must accompany decreased meat intake to account for a healthy balance in diet. The Vegetarian Resource Group offers suggestions to fortify your intake of iron, calcium, and other essential vitamins and minerals commonly consumed through meat. It is also important to be aware of how certain food combinations increase or block nutrient absorption (such as calcium blocking absorption of iron).

What is your take on reducing meat consumption?  We at the Hunger and Undernutrition Blog want to hear your stories or advice!

Working Together is Critical for Success

Guest blog post by Robert Baldwin with the Flour Fortification Initiative

In October I was in Albania on a joint mission between the Flour Fortification Initiative and UNICEF to advance flour fortification in that Balkan nation. Throughout the week, our team met in small groups with more than 35 decision and policy makers and policy shapers in the public, private and civic sectors. We were impressed with their willingness to work together to make it happen. The Ministry of Health, acknowledged by all as the entity to lead the effort, was confident that it could embrace and engage all other sectors in working together to achieve the goal.

Albanian leaders proved once before that they could work together to fortify a staple food when in 2008 they successfully undertook a salt iodization program. At week’s end our team was confident that these folks were on the right path toward fortifying flour. While there are a number of ways to decrease micronutrient deficiencies, the Albanians recognized that flour fortification is a cost efficient, technologically simple way to improve the nutrition status of a great number of people in a short timeframe.

Their commitment to work together to accomplish that goal shows that they understand micronutrient malnutrition is a multi-sector problem that demands a multi-sector response.

Oftentimes, when speaking to a group about micronutrient malnutrition, I ask the question “Do you think that micronutrient deficiencies are primarily a health sector problem?” Invariably, more than half respond with a “Yes” answer.

My response is that it is not exclusively a public health problem, but more of a societal problem. This issue of hidden hunger impacts almost all aspects of a society’s lifecycle:

• It impacts the education sector—the intellectual development of children is impaired, creativity is diminished, inventiveness is stifled.
• It affects the labor sector—nutritionally impoverished adults can’t perform at full capacity, lose time from the job, and thus are not a productive as they can be.
• It impacts the economic sector—lost productivity leads to lower wages which restrict purchasing power— these and other factors contribute to lowering a country’s GDP.
• It does affect the health sector by contributing to blindness, lowering immunity to disease, contributing to childhood morbidity and maternal mortality, increasing the incidence of debilitating birth defects, while contributing to the overall increased cost of health care.

If you buy the argument that this is a problem across society, then it is unreasonable to expect the health sector alone to deal with and solve the problem. The public health sector often provides the leadership necessary to alleviate the problem. Yet to effectively combat micronutrient malnutrition, it must muster the collaboration of other agencies within the public sector, as well as involving, from the start, the energies, experience and skills of the private and civic sectors.

This formula soon becomes apparent to those engaged in the effort to achieve national-scale flour fortification in a country. Collaboration among representatives from multiple sectors is not easy to accomplish at first and requires great effort on the part of all involved. Working together, however, they have greater strength than any one partner working alone.

 

Bread for the World Calls for Updates to US Food & Farm Policies

A guest blog by Todd Post, Bread for the World Institute

Bread for the World Institute unveiled today its 2012 edition of the Hunger Report, Rebalancing Act: Updating U.S. Food and Farm Policies. The 2012 Report picks up where the 2011 report left off, arguing for a stronger focus on U.S. food security programming on the 1,000 days window from pregnancy to age two.

The 2011 Hunger Report, Our Common Interest: Ending Hunger and Malnutrition, introduced Feed the Future, the U.S. global hunger and food security initiative, which is one of the Obama Administration's signature foreign aid programs. The 2012 report proposes ways for Feed the Future to be better coordinated with the U.S. emergency food aid program, P.L.480.

Feed the Future and P.L. 480 represent a very distinct division of labor in U.S. food security programming. The 2012 Hunger Report aims to bring both more into alignment. Feed the Future presents the U.S. government with an opportunity to test ways of coordinating agricultural development assistance and food aid, making U.S. foreign aid both more efficient and effective.

For example, Feed the Future supports improvements in agricultural infrastructure. Why not direct some of the resources for improving infrastructure to help countries build their capacity to do more local and regional purchase of food aid? Critics often say that developing countries don't have the infrastructure to mill and fortify food aid up to U.S. standards. Well, here's an opportunity to address that problem. This would achieve development objectives as well as strengthen parts of the agriculture and food production value chain.

In 2011 two impressive reports by U.S. government agencies examined the nutritional quality of food aid shipped from the United States. Nutritional quality matters most when targeting certain groups, such as young children, pregnant and lactating women, and those with compromised immune systems. A USAID/Tufts University report and a GAO report considered the feasibility of improving nutritional quality of food aid. The bottom line is it will cost more to provide more nutritious food aid.

The prospect of Congress committing new resources to improve the nutritional quality of food aid appears unlikely. In lieu of that, the 2012 Hunger Report argues for phasing out practices of monetizing food aid and using those savings to improve nutritional quality of food aid.

Monetizing food aid is a practice NGOs use to run agricultural development projects mostly. It goes back decades and became popular as agricultural development assistance fell out of favor with donors.

Monetization has always been controversial. It is widely understood to distort markets, hurting the same smallholder farmers that agricultural projects aim to help. Moreover, monetizing food aid is an extremely inefficient way to provide development assistance. Over a recent three-year period, GAO found that close to one-third of resources set aside for monetizing food aid, more than USD$200 million, was lost to development projects due to inefficiency.

Monetization may have been justified in some sense before Feed the Future, but now that the U.S. has stepped up investments in agricultural programming again, there may no longer be a compelling reason to continue this practice. NGOs may push back, but given when we know about the importance of early childhood nutrition, Bread for the World Institute thinks it makes good sense to eliminate monetization and divert those resources to improving the quality of food aid.

World Food Week on Link TV: The Hungry Planet

Guest blog post by Lauren Hauser with Link Media, Inc. 

Food: It's basic, and it's universal. But around the world it means so many different things. In 2011, the worst drought in 60 years to hit East Africa is causing severe famine threatening over 13.3 million people. At the same time, in many parts of the developed world obesity and diabetes run rampant, and worldwide 1.3 billion tons of food are lost or wasted annually. 

Across the world, food can be simple, extravagant, precious or abundant. It shapes our beliefs, and makes us question our convictions. In some places, it's a matter of sport, and in others, it means life or death. Starting on World Food Day- October 16, 2011, throughout the rest of the week, Link TV is airing a week of programming uncovering various global perspectives on food. Join us in learning, discovering, and sharing your voice. 

Click here to find airtimes, or to watch many of our programs online. You can also browse for action ideas once you have been inspired. 

Link Media, Inc. is a national non-profit media network that brings audiences global and national news, uncompromising documentaries and diverse cultural programming, connecting American's to the world. Link TV offers in-depth programs on issues that matter, without censorship or commercials. We link people to the heart of the news, organizations in the forefront of social change and provide ways to take action.

 

 

Fortifying Flour Where People Eat Rice

Guest Post by Scott J. Montgomery, Director of the Flour Fortification Initiative

One of the projects underway at the Flour Fortification Initiative is developing a strategy for fortifying wheat flour in Asia. When I describe this, people’s initial response is always some variation of: “Don’t they just eat rice there?”

Yes, the main cereal grain consumed in Asia is rice. But in many regions, wheat consumption is also high enough that fortifying wheat flour has the potential to deliver essential vitamins and minerals to millions of people.

Consider Malaysia, a country of 28 million people. The daily food supply quantity of rice is 314 grams per person, according to the Food and Agriculture Organization of the United Nations (FAO). That is high, as expected, but the amount of wheat in the daily food supply is also high at 181 grams per person per day.

The following table shows the rice and wheat daily food supply quantity for eight other Asian countries where the wheat in the daily food supply is more than 75 grams per person, based on FAO data.

Daily Food Supply (grams per capita per day)
Country	Rice	Wheat
Brunei Darussalam	1006	100
China	315	185
India	291	164
Japan	233	122
Maldives	178	180
Nepal	321	104
Republic of Korea	312	139
Sri Lanka	400	121
Source: Food and Agriculture Organization of the United Nations, 2007

These countries would be wise to use a multi-faceted approach to improve the nutritional status of their people. And the amount of wheat in their food supply is high enough that flour fortification should be considered in their approach. Flour can be fortified with iron, zinc, vitamin A, vitamin D, folic acid, and other B vitamins such as niacin and riboflavin. Together these vitamins and minerals increase productivity, reduce neural tube birth defects, improve maternal health, and strengthen immune systems.

Some may counter that rice fortification would be more appropriate in these countries. Currently the technology for rice fortification is evolving and is not widely practiced. Flour fortification has been practiced for decades, and modern mills already have the technology to implement the process. In countries where wheat flour is frequently consumed as a secondary cereal, flour fortification could make a health impact now while the technology to fortify rice is being developed and adopted.

Another reason we encourage flour fortification in Asian countries is that wheat consumption is increasing throughout the region. Instant noodles, made with wheat flour, are so popular that a cup noodle museum recently opened in Japan.

A study of wheat flour consumption in Indonesia shows that people are eating more flour products such as instant noodles, sweet bread and biscuits. Average national consumption of flour increased from a 15-year low of 45 grams per capita per day to 51.5 grams per capita per day in 2008. The study concluded: “This trend in increased consumption of wheat flour is accompanied by a decline in rice consumption as Indonesian’s diversify their diet as a result of economic development.”

If flour fortification becomes standard milling practice now throughout Asia, then the addition of vitamins and mineral to flour will be routine business as people diversify their traditional rice-based diets with more flour-based foods.

In Nepal, flour fortification had been voluntary, but in August this year the government made it mandatory for industrial mills to add iron, folic acid, and vitamin A to wheat flour. Now three countries in Asia – Nepal, Indonesia, and the Philippines – require fortification of wheat flour. The strategy we are developing with our partners in the public, private, and civic sectors will help provide the advocacy and technical resources needed for other countries in Asia to follow these examples.

Nutrition Takes Center Stage in the Battle Against Non-Communicable Diseases

 
Secretary-General Ban Ki-moon addresses high-level meeting on the prevention and control of non-communicable diseases.

Guest blog post by Fokko Wientjes, with DSM

Will history judge last week’s United Nations Summit on Non Communicable Diseases as a watershed moment in the battle against malnutrition?

Quite possibly, yes. The fact that the summit took place is an achievement that should not be underestimated. As this blog reported last week, this year represented only the second time in its history that the UN has discussed a health issue at its General Assembly, yet the resulting discourse between the political, non-governmental and business worlds has led to an unprecedented consensus forming around the role nutrition can play in reducing the burden of NCDs and spurring development.

This consensus is built on the understanding that a child’s diet in the first thousand days (between pregnancy and age two) is crucial. Crucial because, with the right kind of nutrition, it is possible to reduce the risk of an NCD, such as diabetes, heart disease, obesity and certain cancers, later in life. Crucial because essential nutrients early in a child's life allow the brain to develop, giving children a chance to grow to their economic and social potential.

These benefits are so acute that the Copenhagen Consensus, the think tank, has calculated that making sure a population has the right kinds of micronutrients could increase a country’s GDP by 2%.  This analysis reinforces that micronutrients are among the most cost-effective interventions a government could make in terms of generating an economic return on investment.

We have known this for some time, which is why we at DSM have been involved in a number of initiatives aimed at making sure some of the world’s most hard-pressed populations have access to adequate nutrition. We underlined this commitment in New York last week, when we launched Future Fortified, a program aimed at delivering food fortification to nutrition black spots in the Nile Delta and elsewhere, along with our partners GAIN and Herbalife.

Future Fortified is just one of a number of ambitious and worthy projects aiming to alleviate nutrition deficiency and improve food security in the developing and developed world. The UN’s Scaling Up Nutrition (SUN) program and the 1,000 days campaign, launched last year at the tenth anniversary of the Millennium Development Goals, received wide-scale backing from UN Secretary General Ban Ki-moon, U.S. Secretary of State Hillary Rodham Clinton and others last week. We continue to work with our partners in the private and public sectors on other initiatives, including Project Laser Beam, a US$50 million, five-year partnership to tackle child malnutrition.

A second, and perhaps equally critical, consensus also developed in New York last year. This was the acceptance that the private sector can and should play a role in providing the solution. Business must engage in this challenge, together with stakeholders in the public sector. We believe that only through such a cross-fertilization of know-how, innovation, experience and resources, a lasting solution can ever be achieved.

This Rubicon has now been crossed and there now pervades a real belief that, beyond providing short term remedies, the goal of long term, sustainable nutrition security for all is a genuine possibility. These are inspirational times and all of us involved in this quest are united in a commitment that we will not let this opportunity pass.

United Nations High-Level Meeting on Scaling Up Nutrition

This week marks the one-year anniversary of the official unveiling of Scaling Up Nutrition (SUN) and a focused effort to address nutrition during the first 1,000 Days between pregnancy and age 2.

The United Nations is holding a High-Level Meeting to share progress to date and discuss action steps moving forward. Since the launch of this initiative in 2010, leaders from across sectors have worked hard to support country adoption and adaptation of SUN and nutrition efforts to address needs during the first 1,000 Days.

The High-Level SUN Task Force is chaired by the UN Secretary-General Ban Ki-moon, with FAO Director-General Jacques Diouf serving as Vice-Chairman. Assistant Secretary-General David Nabarro was appointed Coordinator of the Task Force in January 2009.

We will be sharing outcomes from this meeting and corresponding events, along with highlights of best practices from countries that are SUN early adopters.

Please share your own feedback and perspectives so that the broader community, that is not in NY this week, also can benefit.

To read the Secretary General's opening remarks from yesterday, please click here.

Chicago Council Releases New Report on Agriculture and Non-communicable Diseases

This morning at the UN Headquarters in New York City, the Chicago Council on Global Affairs released a new report on the link between agriculture and non-communicable diseases entitled Bringing Agriculture to the Table: How Agriculture and Food Policy can Play a Role in Preventing Chronic Disease.  The report offers recommendations on how key actors in the fields of health and agriculture, such as national governments, agrifood businesses and consumers, can combine their efforts to address the devastating impacts of NCDs.

The unveiling of the report was followed by a panel discussion on the importance of integrating agriculture and public health with project chair Dr. Rachel Nugent of the Chicago Council and representatives from Pepsico, IFPRI and the Rockefeller Foundation.  Topics discussed include value chains, the economic impacts of NCDs and the importance of marketing for behavior change.

The Chicago Council released the report in advance of this morning's opening session of the UN High-Level Meeting on NCDs.  An electronic version of Bringing Agriculture to the Table is available on the Chicago Council's website.  To access a copy of the report, click here.