Overview Of The Nutrition Debates At The 67th World Health Assembly

Reflecting its growing place on the international policy agenda, nutrition was a major focus of last week’s World Health Assembly.

The 67^th annual World Health Assembly took place from 19-24 May.

Part of the focus was on the upcoming second International Conference on Nutrition (ICN2), a joint event of the WHO and the UN Food and Agriculture Organisation (FAO), which will be held in Rome on 19-20 November of this year. In addition, nutrition is considered a focus of the 11^th session of the open working group on sustainable and development goals, in preparation of the post-2015 Development Agenda at the UN.

Malnutrition remains a huge concern worldwide. Some 840 million people are undernourished, according to a FAO report and 162 million children suffer from stunting, according to the joint UNICEF-WHO-World Bank Child Malnutrition Database. Moreover, about 2 billion people suffer from “hidden hunger,” a deficiency of micronutrients. But at the same time, there are increasing concerns about the rise of obesity, and growing attention to diet-related non-communicable diseases (NCDs). Nutrition issues are only indirectly related to intellectual property rights so far, but observers see possible connections arising in the future.

The World Health Assembly mainly addressed the question of nutrition in the WHO report on maternal, infant and young child nutrition, under item 13.2 (document A67/15) [pdf]. As the 1000 days from pregnancy of the mother to the second year of the child are decisive for the future of the child, those populations are particularly targeted.

The secretariat report contains an annex on the creation of a monitoring framework to follow child nutrition, another with recommendations on inappropriate marketing of “complementary” food, and an addendum on a report on the preparation of the ICN2 (A67/15/Add.1).

The secretariat asked member states for further guidance on “(a) next steps to develop risk assessment and management tools for conflicts of interest in nutrition; (b) the global monitoring framework on maternal, infant and young child nutrition; (c) next steps to address the inappropriate marketing of complementary foods; and (d) a Member State-driven process to develop an outcome document for the Second International Conference on Nutrition.”

The discussion of the report was opened by FAO Director General José Graziano da Silva. “ICN2 presents us with a great opportunity to shine the spotlight on nutrition. Let’s not lose this opportunity,” da Silva told the assembly. He also highlighted the importance of a multi-stakeholder participation to the process. WHO Director General Margaret Chan also participated in the discussion.

The report, adopted with an amendment, put in place a monitoring framework on nutrition and established a working group which will work on indicators and will “consider ‘tracer’ indicators for policy and programme implementation in health and other sectors relevant to the achievement of global nutrition targets; and to design the extended set of indicators,” according to Annex 1 of the report.

Inappropriate Marketing of Complementary Food

Member states in 1981 adopted an International Code on Marketing of Breast-milk Substitutes which defines complementary food as “any food whether manufactured or locally prepared, suitable as a complement to breast milk or to infant formula, when either become insufficient to satisfy the nutritional requirements of the infant. Such food is also commonly called ‘weaning food’ or breast-milk supplement.”

In Resolution WHA65.6 of the 65^th WHA, they asked the director general to provide clarification and guidance on the inappropriate promotion of foods for infants and young children. The WHO then established a scientific and technical advisory group (STAG) to work on this guidance. Five recommendations are proposed in Annex II of the report and are further detailed in a STAG paper.

The organisation Helen Keller International (HKI) presented, during a side event hosted by Senegal and Nepal, the results of a Gates Foundation-funded project called “Assessment and Research on Child Feeding” (ARCH) assessing promotion practices on complementary food in four countries.

In a document submitted to the WHA, HKI stated that although recommendations proposed by the STAG are a positive step, “documented inconsistencies in information, policy and approach indicate that more detailed and specific guidance is needed to address the full spectrum of marketing and promotion of commercially prepared complementary foods.”

During the WHA discussions on the report on malnutrition, some countries also asked for stronger recommendations.

Catching Conflicts of Interest in Nutrition

The question of conflict of interest was raised several times during the discussion before the WHA. Some delegations asserted it must be prevented, although others underlined the importance of the private sector and the food industry.

The nongovernmental International Baby Food Action Network (IFBAN) noted with concern that Scaling Up Nutrition (SUN) was engaged in the WHO’s nutrition policy. SUN is a network gathering 51 governments, civil society, the United Nations, donors, businesses and researchers with the goal to improve nutrition, according to their website. IFBAN argued that it “allows businesses on its decision making body in conflict with WHA Resolution 65.6” and “encourages the setting up of partnerships and networks with businesses at national level, opening the door to inappropriate influence of nutrition policies” (full statement here).

The delegate of Namibia said it could be impossible to check potential conflicts of interest at the national level and asked the support of the WHO. Member states asked the secretariat to “convene informal consultations with Member States on tools to manage undue industry influence,” according to a WHA press release.

Preparation for the ICN2

The preparation of the ICN2 was also discussed. ICN2 will review progress made since the first ICN of 1992 and “will propose a flexible policy framework to address today’s major nutrition challenges and identify priorities for enhanced international cooperation on nutrition,” according to the FAO website.

Several member states and NGOs called for a multi-stakeholder participation, including UN organisations, NGOs, private sector and other stakeholders.

“We believe that multi-stakeholder participation contributes to the debate, strengthens our decisions, and helps generate the political consensus needed to push the nutrition agenda forward, including for the implementation of the Framework for Action we wish to see adopted in November,” da Silva said.

The delegate of Italy announced financial support for the organisation of the ICN2, which was welcomed by da Silva, who asked other members to follow suit.

Nutrition and Food Security in the Post-2015 Agenda

A side event organised by the World Bank and the UN System Standing Committee on Nutrition convened a multi-stakeholder panel addressing the question of the positioning of nutrition in the post-2015 Development Agenda.

Deborah Malta, director of the NCD Surveillance and Health Promotion sector in the Ministry of Health of Brazil, stressed the importance of including health in the post-2015 agenda and the wish of Brazil to include non-communicable diseases (NCDs), food security and alcohol consumption in the agenda.

Asma Lateef, director of the Bread for the World Institute, underlined that good goals and targets are important. She said that hunger and nutrition are part of the unfinished agenda of the Millennium Development Goals (MDGs) and are weakly addressed. Lateef welcomed the fact that the open working group proposed a goal entirely dedicated to food security and nutrition, but raised concern about the low number of nutrition targets going forward.

The open working group on sustainable development goals (OWG) was created by the UN General Assembly to proposed sustainable development goals to be integrated in the post-2015 Development Agenda.

Joshua Lozman, deputy director in the Global Policy & Advocacy section of the Bill & Melinda Gates Foundation, presented a discussion paper proposing to include sustainable agriculture, food security, and nutrition issues in the post-2015/Sustainable Development Goals (SDG) Framework.

Anna Lartey, director of the nutrition division of FAO, affirmed that the post-2015 agenda should look at and focus on the entire food system, as it is not working well enough to address food security and nutrition challenges. She also mentioned that FAO’s proposed targets and indicators for food security, nutrition and sustainable agriculture for the post-2015 DA.

Another panel composed of Francesco Branca, director of the Nutrition for Health and Development section of WHO, and Ariel Pablos-Méndez, assistant administrator for global health at USAID, discussed the launch of the first of series of six stunting policy briefs for the achievement of the WHA global nutrition targets.

Closing the side event, David Nabarro, the UN Secretary General’s special representative for food security and nutrition, said that the post-2015 Development Agenda differs from the Millennium Development Goals as the last goals were directed toward developing countries, the post-2015 Development Agenda will apply to the entire world.

Several NGOs and some countries also stressed during the discussion on maternal, infant and young child nutrition the need to see nutrition at the heart of the post-2015 Development Agenda.