The long road to nutrition security

Early in June 2014, the Micronutrient Forum Global Conference, took place in Addis Ababa, Ethiopia. Here, Marie Ruel, Director of the Poverty, Health and Nutrition division at the International Food Policy Research Institute (IFPRI), speaks on the discussion held there on agriculture and food-based interventions and the role of the ‘nutrition community’.

Marie, referring to your presentation on local value chains for nutrient-rich food at the Micronutrient Forum’s Global Conference 2014, is there sufficient data on that in the development context to say that value chains really contribute to nutrition security?

No, actually, that is one area where we have very little information. We think that value chains are a type of platform that should be leveraged, especially for micro-nutrient foods like dairy and animal source foods, and fruits and vegetables. But not much work has yet been done yet on how to turn these value chains into a way to improve nutrition. For example, the process of making dairy products ought to be readily available for the poor and readily accessible to allow for transformation along the value chains. Products can be fortified and transformed into yoghurt, which is easier to keep. So there are many ways to use value chains for nutritious food in an attempt to improve nutrition, but there is very little evidence of successful practice so far.

Maybe you could share with us the chief highlights of the discussion on agriculture and food-based interventions at the conference.

We had a great session on so-called food-based approaches. It focused largely on biofortification and whether biofortified foods are actually a good way to improve micro-nutrient status. The conclusion was regarding the aspects of bioavailability or the body’s ability to absorb micronutrients in biofortified foods, they are very bioavailable. Conventional breeding can lead to crops that have a lot more micronutrients than the traditional ones, and these micronutrients are well absorbed and well utilised by the body. It really is a win-win solution. The conclusion of the efficacy trials looking at how well these crops can contribute to improving micronutrient foods was very positive for all the nutrient-crop combinations. This includes crops that are rich in iron, zinc or vitamin A. This is all very exciting. We finally have a body of evidence on the usefulness of biofortification. Now, the next phase is to work on the delivery, on the scaling up. Now that we know it works, we need to figure out the ‘how’. This is a big issue that we are discussing at the Micronutrient Forum. In many cases, we know what to do, but we are really struggling with the ‘how’ question.

Another point about food-based approaches in general is that we need to remember that diet is really what should provide us with all the nutrients we need, including the micronutrients, as well as the calories. We should just have a balanced diet, and not be constrained or limited. If everybody in the world had a good diet, a diversified and healthy diet, we would not need any other interactions to improve micronutrients. But we know this is not the reality. However, it still means that the basis of all the strategies that countries should have, the first intervention, should be to try to improve the food system, make it more micronutrient-rich and more accessible for the poor, and focus on equity in this respect. Food-based approaches are not there to treat micronutrient deficiency, they are there to prevent it. We should manage to get the right food to the people that need it, and shift the balance of people that have a deficiency to people in a normal state. They can then be treated with supplements, and things like that. So the main conclusion is that a food-based approach should not be an afterthought. It should be at the core of every national strategy to improve micronutrients.

From my perspective, a lot of people who are coming out of that lower end of poverty are victims of the marketing machine. They are caught by all the bad brands, and often all their newly gained income is lost. So maybe your approaches should consider how to actually tackle this challenge with those brands that are selling all the “bad food”?

Yes, definitely. And this is a very, very difficult nut to crack. We know that there is very little learning from developed countries or countries in transition about what works to prevent them from going from under-nutrition directly into over-nutrition and obesity and risk of chronic diseases. We know that there is no healthy medium, they just go straight from not having enough to eat to eating the wrong types of food with way too many calories and getting into the overweight and obesity cycle. Unfortunately, we do not have good examples of how to ensure that this transition goes more smoothly into health. But the one thing that is constant across under-nutrition and over-nutrition is the lack of information. Education is at the absolute centre of everything we should do. People should have good knowledge and information about what they ought to eat and what not, what foods contain, what their requirements are, and how they should feed their young children.

Bad habits start early in life. We know that with pre-schoolers and children when they go to school, the mothers have to be educated very early on so that they do not let them fall into the trap of responding to all the marketing of junk food. But this is a very, very big agenda for research and implementation. I have to say that generally, donors have not always been so interested in this area, so that it is understudied, especially in transition countries and poorer countries.

What could donors be doing in this respect?

The whole food system is where you have to start with, and it is very complex. I think donors have separated the issues related to under-nutrition from those related to overweight and obesity, as many of us, even researchers. Ten years ago, I myself tried to develop a programme at IFPRI that was linking under-nutrition and over-nutrition as part of a continuum, as opposed to: ‘Oh, we need to focus on this with the amount of under-nutrition, and on this with the overweight.’ Basically, consumer awareness and education, as well as all of the behaviour change strategies, are part of this continuum. If people are more informed, they will know that fruits and vegetables are good for you, whether you’re undernourished or eating too many calories. They will learn how to not eat too much fat – just because of the fact that they are undernourished they do not need that large a proportion of calories from fat. This is very much at the heart of what we should do and what we should work more on.

But again, behaviour change, communication and education are not very sexy for donors. And this is not a magic bullet. So we’ve had donors that were not really interested in funding large endeavours to improve people’s knowledge or to disseminate information. But we are lagging behind on that, we are not very effective. When you see how effective the food industry is in marketing its products, why aren’t we as good at marketing good diets? That is certainly one area where donors could contribute. We have a long way to go to understand and develop the methodologies to track what the impacts of food systems on nutrition are; things like different legislation, like a fat tax or a tax on junk food. And then there is the whole issue of breast feeding and women working in jobs having maternity leave. Lots of policies and legislation have been tried here and there, but we do not know their impact because it is complicated to track down. I think this is an area where we need to do better and work more on developing the methods to understand the different impacts of different changes in the food system and how they affect nutrition.

Do you think that there might not be enough expertise in the donor world on behaviour change communications, and that maybe institutions like yours should be working on getting that expertise in there and informing people on what the added value of behaviour change is?

That is a very good point. I had never thought of it that way. But even in places like our research institute, we are not really experts in behaviour change communication at all. We engage in research, but we have not done any research on what the best approaches are in specific situations. This is a different field. We need to borrow from other fields, the fields of education, including adult education and, as you said, from the private sector on how you change people’s behaviour. It is really not just among the donors but among the whole nutrition community that I think we need to learn from other sciences on how to do this better, and on how to evaluate it. That is a long way to go.

The Global Donor Platform for Rural Development kindly gave us permission to publish the abridged version of the interview conducted by Pascal Corbé.