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“It is worth remembering that nutrition didn’t feature at all in the first set of goals. It was the forgotten MDG,” says Marc Van Ameringen.
As the world this week marks 500 days until the end of the millennium development goals (MDGs), I got an interview with the executive director of the Global Alliance for Improved Nutrition (Gain).
As far as Van Ameringen is concerned, the development community first snubbed nutrition some 30 years ago.
“In the 80s other global health issues had come to the fore: HIV/Aids, TB, malaria, and noncommunicable diseases. As global health took off, nutrition fell more and more out of favour. People were looking for quick fixes: a bed net, ARVs, a vaccine. Nutrition doesn’t give you that.”
One of the criticisms for the MDGs has been their granularity: complex needs broken down into simple deliverables often ignoring the complex solutions needed. Universal primary education has been a good example of this. While attendance has increased dramatically, the quality of teaching or learning environments has not seen similar attention and investment, resulting in children who’ve been moved through school and still lack basic literacy.
As 2015 rolls in, there is still no quick fix for obesity and malnutrition – how will nutrition fare in the new development agenda? It’s a question researcher Lawrence Haddad asked in 2012:
“At a recent nutrition meeting I realised that I don’t yet have a clear idea of where nutrition should fit into the next set of development goals. I also realised that the wider nutrition community has not had this discussion either. As many critical decisions will be made in the next six months, we need to get our act together.”
The three options Haddad laid out then depended on what he called “political space” as well as on the ability for the nutrition community to reach a consensus on the “targets and timelines” and these are viewpoints Van Ameringen shares.
“We have a fractured sector that doesn’t agree on very much,” he says. “Anyone looking to have an impact looks at the nutrition community and thinks: ‘Why would I get into that?’
“The number of obese people on the planet has risen. In 2008 more than 1.4bn people were overweight, of these 500m were obese. The cost to health systems is steep but there is no coalition of players willing to come together to seek solution. Private companies are doing everything possible to prevent regulation, governments and the UN for their part are not prepared to step up. There is an urgency for action but the response from the nutrition community is more evolution than revolution.”
On targets and timelines Van Ameringen adds: “Yes, it’s true, we have a lot of blunt instruments. In some communities, you will find an overweight woman, a stunted child and the whole family is micronutrient deficient. How do we deal with that? We need a much more stratified map of where people are and what their nutritional status is.”
He talks about supporting a “livelihoods model” but when I suggest that that is the kind of language that says to some his organisation is in cahoots with the corporations, he says: “The fixation with multinationals in the nutrition space ignores the fact that in Africa, only 10% of all food is packaged food and that’s already skewed between international and local players.
“Yes multinationals set trends but it’s local entrepreneurs who change things and they don’t have to be for profit, they could be social entrepreneurs. This is all about adopting a value chain approach; thinking about where you can insert nutrition all along that supply chain and that’s a bit of a revolution. Maybe its in the fertiliser or in the feed but it could also be in the retail outlets. Businesses in Kenya, Tanzania and Mozambique are leading the way and building their own markets. They are not waiting for their governments to do it for them.”
It is clear that Van Ameringen is not the only one frustrated with business as usual in nutrition – you only need read the comments beneath Haddad’s blogpost. But in the next 500 days, what sort of change could still have an impact?
“There is new momentum,” says Van Ameringen. “People are coming together with common purpose and in early June one of the key bodies planning the post-2015 agenda, the Open Working Group called for a goal to “end hunger, ensure food and nutrition security for all.”
So the missing goal has now been found and is likely to draw the kinds of resources that have long been needed. But as he and his organisation continue to make the case for multi-stakeholder partnerships as the way to deliver results over the next 15 years, it must feel like winning the battle and not the war.
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Correction: The article was amended on 22 August to reflect that 1.4bn people are overweight, not 3.4bn as previously published.
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