Next year’s Global Nutrition Summit in Japan marks the start of a demanding Sustainable Development Goals (SDG) race to end malnutrition by 2030. But if we are to have any chance of crossing the finishing line in time, we have to run a different race to the one we have been running for the past 5 years. The current race is too narrowly focused on ending undernutrition. It is predominantly state dependent. And it is oblivious to the limits of nature’s resources.
So, the race to 2030 must be different. It needs to be focused on ending malnutrition in all its forms, and it needs to respect nature’s limits. And we need some more runners and riders, with government, civil society and business all together at the start line and working together.
Tokyo is our chance.
Putting this into practice means three things: bigger commitments from the usual suspects, the recruitment of unusual suspects to the nutrition cause, and a focus on transformational actions from all.
First, let’s look at the usual sets of nutrition stakeholders, each of whom made commitments of varying ambition in 2013. Let’s start with the donors. As the Global Nutrition Report (GNR) notes, most of them are on track to meet their commitments from the Nutrition for Growth (N4G) Summit and some of the biggest donors (DFID, USAID, and BMGF) had already met their 2020 commitments by 2016! Donors need to make even more ambitious nutrition commitments in 2020 and see nutrition as core priority within economic growth, food systems, environment, education, and social protection policy and programmes, as well as the domain of health systems. They have shown they can deliver on their promises. But how do they make the case for more resources for nutrition? Well the benefit cost ratio of 16 for scaling up undernutrition programmes will not be easily beaten by other investments. And with 6 of the top 10 risk factors for the global burden of disease being diet related, investing in making nutritious foods more available and affordable is a true no regrets, multiple-benefit investment.
As for Governments, few financial commitments were made in 2013. Subsequent Scaling Up Nutrition (SUN) work, reported in the GNR, shows that government spending on nutrition, both specific and sensitive, is highly variable—ranging from 0.2% to 15% of government budgets. We don’t need all countries to be at 15% of budgets spent on nutrition but we do need a minimum threshold and it should be a lot higher than 0.2% if nutrition in all its forms is to be improved. Governments need to commit to a number, by a date, and then meet it.
Businesses also made commitments in 2013. These commitments were primarily around ensuring their workforces had better access to better nutrition programmes. This is important, but represents a bolt-on of nutrition to their business models rather than an embedding of nutrition at the core of their businesses. This was probably the best that could be done at the time, but now we know a lot more about how to align business and nutrition goals by focusing on reducing less healthy parts of diets and making nutritious foods (e.g. fruits, vegetables, pluses, animal source proteins such as eggs and milk) cheaper, more available and more desirable.
Investing in making nutritious foods more available and affordable is a true no regrets, multiple-benefit investment.
Civil society made many commitments in 2013, but by and large they were not particularly ambitious or SMART commitments. They need to do better in 2020 and go beyond setting goals for others.
So far we have been talking about bigger and SMARTer orthodox commitments from existing nutrition stakeholders. But to run the new race and achieve faster impacts on reducing all forms of malnutrition we need to do two big things. First we need to get a wider circle of potential nutrition stakeholders to Japan. And second we need truly transformative commitments, in addition to the more orthodox ones.
Why do we need new stakeholders? Because nutrition outcomes are determined within a set of complex systems which include actors seemingly on the fringes of nutrition but who have potentially the biggest leverage. Think of the financiers who could kick start nutritious food sectors in local food systems, advertising agencies that could develop imaginative campaigns for nutritious foods, the mobile phone operators who could provide platforms for public sector messaging around nutrition, and the low cost cold chain operators who can help meet the growing demand for fruits, vegetables and other fresh foods. In the public sector we look to ministries of environment and climate, infrastructure and education who should be able to find common cause with those who want more nutritious food to be available and affordable. In civil society the consumer rights associations, social movements driven by adolescents and climate and gender equity campaigners and activists. A wide circle of actors have a stake in improving nutrition--they just don’t know it yet.
Why do we need transformative commitments? Transformation is about changing our behaviours, structures and our very nature so that nutrition can be improved. And we need such transformations to run the new race to 2030.
Governments have to make it easier for businesses to do good things for sustainable nutrition improvement and harder for them to do unhelpful things. Governments are too passive, unimaginative and poorly coordinated when it comes to directing businesses towards public goods and away from public bads.
Businesses have to focus more on the medium term business case for nutrition. Which side of history do they want to be on? Those that saw which way things were moving and acted decisively and early to adapt to those health and environment trends for the benefit of their consumers? Or do they want to be those who are seen as having their head in the sand, squeezing out every last drop of profit from a socially counterproductive business models, and risking everything on their ability to change at the last second? Enlightened CEOs will be in the first group and we believe their customers and shareholders will thank them for it.
Transformation is about changing our behaviours, structures and our very nature so that nutrition can be improved
Donors have to change too. They have to take more risks. The world of “all forms of nutrition”, especially constrained by a set of environmental limits, is an unsettling one for them, as it is for all of us. In this new world, there is no stress-tested Lancet set menu of actions that can act as a defence against media claims that aid is being wasted. To end malnutrition in all its forms, donors will have to take measured risks. A lack of evidence is no excuse for inaction when people are dying and getting sick in such numbers from malnutrition, a phenomenon now affecting every country including rich and poor. Reforming food systems can help tackle all these issues, but we see little evidence of ambition and innovation among most OECD donors and international agencies. To counterbalance the risks, verify: evaluate, learn, share, and course correct. We all have to do this, but donors, with their influence and dedicated resources, are pivotal.
Civil society has to get the balance right between principle and pragmatism. Both are vital but frequently they clash. When they do, the easy thing to do is to default to the most rigid of principles, but this is not always the right thing to do for nutrition. Decisions are about weighing risks and that is not easy to do, partly because it means working with those we disagree with, not just like-minded allies. But the benefits of that hard work will accrue to those who are suffering from malnutrition—that should be incentive enough.
Can we end malnutrition by 2030 as the SDGs challenge us to do? Probably not. The task is big, and time is short. But can we make a much, much bigger impact than we are making now. Can we accelerate reductions in undernutrition and begin to make inroads on overweight, obesity and diet related non-communicable diseases? Absolutely. We believe this with all our being. Many others do too. We must come together in the lead up to Japan 2020.
In Tokyo we must inspire the world and give hope to the hundreds of millions of people dying from malnutrition and the billions more living and suffering with it.
Can we accelerate reductions in undernutrition and begin to make inroads on overweight, obesity and diet related non-communicable diseases? Absolutely.
We can do this by demonstrating the boldness of the commitments made, their powerful transformative power, and the sheer sweep of actors they come from. But above all we will sow hope through our determination to meet these commitments -- and then by actually meeting them. We can win the race to 2030, but only if we run the right race. Let’s start now.