Author: Lawrence Haddad, Executive Director, GAIN
This was the title of my Martin J Forman Lecture at IFPRI earlier this week (slides here and video here). Martin Forman was the Director of Nutrition at USAID in the 60s, 70s and 80s and was highly influential in getting the agency (and everyone else) thinking about nutrition beyond health systems. I was asked by IFPRI to choose something big and controversial as a topic for the Lecture and I couldn’t think of anything bigger and more controversial than business and nutrition.
The topic is big because while overseas development aid is vital for development, government commitment and business resources will become ever more important in the SDG era. This is especially true for diets, because more and more people buy food from markets. Out of about 40 countries that the World Bank LSMS team has worked on, only one, Mozambique, has more than 50% of households getting food from own consumption—in all the others, food from market purchases was the predominant source. And what do markets mean? Businesses.
Businesses are already shaping food supply and demand—how can this be shaped for better nutrition? Not enough of us are posing this question, let alone answering it. Why is that? Because the topic is also controversial. We are paralysed by a fear of engagement. Concerns over reputational risk, the fear of doing damage, and sheer distrust are holding us back. These are fed by a lack of evidence on when, how and why to engage, a lack of transparency in engagement and a weak accountability infrastructure.
In order to occupy the substantial middle ground between thinking “business is the answer” and “business has no business in nutrition” we need a much more enabling environment. Accountability can be strengthened by the collection and public sharing of data on which businesses are behaving responsibility with respect to compliance with codes such as the marketing of breastmilk substitutes; by tracking product formulation; and by tracking transparency of operations. The failure to declare conflicts of interest needs to be made harder. There should be public registers of the terms of public private partnerships as there are in the “land grab” governance arena.
These accountability tools should be applied to Governments and civil society organisations too. No organisation is free of conflicts of interest. For instance, NGOs that specialise in a particular type of nutrition intervention run the risk of influencing donors and governments to implement the interventions they have capacity in. Evaluations of public-private partnerships and the extent of their contributions to advancing nutrition should be supported by research funders. There is no research programme anywhere in the world on this topic—there should be. The capacity of all stakeholders to engage needs to improve: governments to set and enforce priorities and standards and to identify opportunities to engage; civil society organisations to monitor and enforce these standards and also to engage with businesses; and businesses themselves to engage with the public sector and to understand the nutrition fault lines much better than they do now.
But fundamental to all this is the need to engage. Social Behaviour Change Communication (SBCC) says it all: to change, we have to communicate. Behaviour will not change without it. Frankly people have been anxious about the consequences of engaging: of being labelled corporate sell-outs, Trojan horses, and in bed with the “baby killers”. If engagement with business is done in an indiscriminate and irresponsible way, these kinds of sentiments might be warranted although I personally think name calling is very unhelpful.
But what are the costs of failing to engage? Well, businesses have done good things for nutrition. The fortification of foods for the general population is a good example—it has benefit cost ratios of 6-9 (Copenhagen Consensus paper from 2012 by Hoddinott, Torero and Rosegrant) and most of the costs are taken on by businesses (although some of this may be passed on to consumers).
And businesses are capable of doing much more. First, consider funding. Matching funding mechanisms are just beginning to take hold: think of the Power of Nutrition (CIFF and DFID), the Amsterdam Initiative on Malnutrition (Government of Netherlands), Global Development Alliances (USAID) and the Business Platform for Nutritious Research (Government of Canada). If these mechanisms take off they could lead to significant increases of funding for nutrition. Second, consider the skills of firms to influence consumer choices around foods. They tend to target the right brain side of things: emotions, intuition and imagination. Current behaviour change efforts in nutrition tend to be more left brain: a focus on logic, facts and tasks. Can firms help to bring some of the right brain thinking into the creation of the demand for healthier foods? Maybe. My final example is the kind of mechanism exemplified by GAIN’s Marketplace for Nutritious Foods. The Marketplace directs small amounts of public funds in one off investments to small and medium sized businesses in countries with high levels of undernutrition. The one-off interventions are designed to help small and medium sized firms overcome barriers to market entry to bring their healthy food innovations to market. The program has had success in increasing the number of healthy servings brought to market by the companies. Whether this actually reduces the price of healthy diets and improves diets is a question we are assessing now. But if they do, small initial investments have a potential to scale nutritious foods at pennies per serving.
The title of my talk “Virtuous Emulsification of Business and Nutrition” signaled that there needs to be an emulsification of business and nutrition: they can’t be treated as oil and water indefinitely. But there is one critical proviso: emulsifications can be healthy or unhealthy. We need a virtuous emulsification, one that helps us navigate this complex and fraught terrain, one where a stronger enabling environment de-risks the space for everyone.
During the long Q and A after the Lecture, I found myself saying “I don’t know” to many of the excellent questions. If I had been presenting a research paper that would have been worrying. But perhaps even more worrying was that I sensed that no one in the audience of 150 knew the answers to these questions either. We need to find them — and fast. Martin Forman himself was calling for these answers in 1971—45 years ago. We can’t wait even 4 or 5 years for the answers to the hard questions about business and nutrition, we need to start now—there is too much at stake for the standoff between business and nutrition to continue.
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Published 21 December 2016