Publication [ID: 127]

Nourishing Millions – Stories of change in nutrition

This new publication from A4NH/IFPRI is a collection of stories of change. It begins by recognising that nutrition is currently receiving unprecedented attention, but recognises that people need guidance on how to design, implement and evaluate nutrition policies and programs if the new attention is going to be translated into successful outcomes, rather than a passing fad.

The publication sets the stage by looking at the evolution of nutrition over 50 years, and particularly the ‘either’ ‘or’ debates on priorities over the decades. From a focus in the 1960s on protein energy malnutrition through to the 1990s when the seminal UNICEF nutrition framework paved the way for a multisectoral, multilateral, multi-level approach to the challenge of malnutrition. The last decade was marked by the seminal Lancet series, also illustrating that while nutrition specific interventions were needed they were far from sufficient to meet the challenge with much of the challenge requiring multisectoral action. The current decade has been marked by more multi actor activities, around action and advocacy – the Scaling Up Nutrition movement, the Nutrition 4 Growth activities birthed with the 2011 London Olympics.

Success stories – what works and where

The rest of the publication is then focused on the success stories, what works, where did it work. It is founded on the levels of the UNICEF framework – nutritional deficits at the individual level requiring nutrition specific interventions, the underlying causes of malnutrition requiring multi sectoral interventions, and the underpinning enabling environment, political will and nutrition sensitive policies. The first section focuses on the nutrition specific stories – where has change happened and it highlights three stories of change. The first is Infant and Young Child Feeding now focused on the first 1000 days, the second is Community Management of acute malnutrition, which has also reduced the rates of severe acute malnutrition, and finally the various forms of fortification – universal salt iodization, Vitamin A capsule distribution and Multiple Micronutrient Powders (Sprinkles.)

Making other sectors more nutrition sensitive

The second set of stories tackles the underlying causes - making other sectors more nutrition sensitive - the multisectoral approach to malnutrition. Chapter 6 looks at agriculture, the sector with the clearest linkage to nutrition given it is responsible for delivering the world’s food supply either as food for consumption or as the raw materials for processed foods. Alongside this many of the world’s farmers are among the poorest, and increasing their incomes enables them to purchase more nutritionally adequate diets. Stories highlighted include the lauded homestead food production approaches, promoted by Helen Keller International, and biofortification. The first focuses on combining home gardens with animal husbandry to deliver more diverse and nutritious diets, when combined with better agricultural, health, nutrition and hygiene practices. Biofortification recognizes the ability to increase the micronutrient content of staple crops through plant breeding. While diet diversity is the ultimate solution, biofortification is important to increase consumption of key micronutrients for the world’s poorest who have staple grain dominated diets.

Impoving nutrition sensitivity of social protection programms

Other stories in this section focus on improving the nutrition sensitivity of social protection programs, with examples from Mexico and Bangladesh, and examples from the water, sanitation and hygiene (WASH) again in Bangladesh but also in Mali. The final chapter in this section focuses on the challenge of overweight and obesity, where time is too short to know if any country can reverse its obesity epidemic. But the section examines some countries, which have managed to stop the upward trend in childhood obesity, by using targeted food taxes and subsidies, nutrition labelling, regulations affecting the nutritional quality of food in schools, and mass media campaigns.

Required change on policy level

The final set of stories unravel how change plays out at the policy level, and the different levels at which policy and practice come together to achieve change. One story focuses on Brazil, where multi sectoral action has achieved success – through a blend of targeted income redistribution, and universal access to healthcare, education, and sanitation services. The story examines key policies and programs linked to maternal schooling, family purchasing power, maternal and child healthcare, and water supply and sanitation services. The key to change anywhere is leadership, and chapter 18 looks at both movements for change such as SUN, as well as personal stories of 10 nutrition champions around the world. The report recognises that ultimately successes in nutrition depend on committed people to envision, implement and evaluate them. The goal of Nourishing Millions, and the stories it tells, is to inspire policymakers, practitioners, researchers, educators, students, and ordinary citizens to replicate and scale up action against malnutrition, generating further successes for future generations.

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