Seizing Opportunity from the Jaws of Crisis: A Playbook for Nutrition

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International Food Policy Research Institute (IFPRI)

Ellen G. Piwoz MARTIN J. FORMAN MEMORIAL LECTURE Virtual Event - Seizing Opportunity from the Jaws of Crisis: A Playbook for Nutrition DEC 10, 2020 - 10:00 AM TO 11:30 AM EST

Government & Nonprofit

Seizing Opportunity from
the Jaws of Crisis
A Playbook for Nutrition
Ellen G. Piwoz, ScD
30th Annual Martin J. Forman Lecture
December 10, 2020

I was invited to offer “personal and often unconventional
views about major issues related to international nutrition”…
and..
“reflect on my overall body of
work, the challenges I faced,
and what I see as the next
frontier for nutrition.”

Four Common Truths
1. The multisectoral nature of nutrition has long been
recognized
2. Nutrition is contextual and requires adapted solutions
3. Progress requires investing in people and institutions
4. It is critical to know how to get things done in your
organization – no matter where you work

Reflecting on Personal Experience (2008 to present)

The Lancet Maternal and Child Undernutrition Series
was a launchpad for creating change

The pandemic has brought to light just how integral
nutrition and food systems are to health, livelihoods,
and the environment….
The enormous burden of disease associated with poor
nutrition and unhealthy diets, coupled with the unaffordability
and declining consumption of healthy foods underscores that
nutrition and food systems belong together and that
policies are urgently needed to address nutrition and food
issues holistically and coherently

My Nutrition Playbook
Nutrition
Playbook
Financing
comes
first
Put
evidence
into
action
Research
that is
strategic
Advocacy
that
unites
Empower
future
leaders

We are at a critical juncture…
 There are political opportunities on the horizon
A new US administration
SUN entering a new phase
UN Food Systems Summit
Tokyo Nutrition for Growth Summit
 Join together, embrace the challenge, seize the opportunity, come
up with a playbook for the new realities we face.

Thank you!
Special thanks to key informants
Mary Ann Anderson, Phil Baker, Shawn
Baker, Jess Fanzo, Marcia Griffiths, Nemat
Hajeebhoy, Maura Mack. Purnima Menon,
Will Moore, Anne Peniston, Abi Perry,
Rahul Rawat, Meera Shekar, Hope Sukin,
Mellen Tanamly, Cesar Victora, Neil
Watkins, Patrick Webb
Hannah Guedenet (slides)

This document summarizes the evolution of understanding and approaches to addressing malnutrition over the past 50 years. It began with a focus on treating severe protein deficiency and hunger in the 1950s-1960s. In the 1970s, the importance of multisectoral interventions was recognized. However, these had little impact, leading to a more isolated focus on micronutrients and breastfeeding in the 1980s. Understanding continued evolving in the 1990s-2000s to incorporate the political economy of nutrition and promote biofortified crops. High-level political commitment to addressing undernutrition increased significantly from 2010 onward among international organizations and governments. The book explores lessons learned from different contexts and times on improving nutrition.

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BY WEAVING STORIES together with analysis and description in this book, we have sought to convey the variety of experiences in tackling malnutrition in different contexts throughout the past five decades. This narrative approach is intended to help the reader translate an experience into his or her own context, showing many examples of what can be done and how success can be achieved. Our aim is not only to inform action, but to inspire.

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ODISHA, A STATE of 42 million people in eastern India, is one of the poorest in the country. It has faced many development challenges over the years, including insurgent movements, large pockets of extreme deprivation among scheduled tribe communities, social disparities, and natural disasters, as well as a relatively late fiscal turnaround (in 2004–2005) in comparison with other states. Yet Odisha has made significant progress in reducing child undernutrition—less than India as a whole, but more than many other richer states. How has it achieved this progress?

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SEVERE ACUTE MALNUTRITION (SAM)—extremely low weight for one’s height—is a life-threatening condition affecting mostly children under five years of age. It is caused by a combination of infection, such as diarrheal disease, and poor diets that are inadequate for nutritional needs. SAM is one of the top three nutrition-related causes of death in children under five according to the 2008 Maternal and Child Nutrition Lancet Series. A child with SAM is 11 times more likely to die than a well-nourished child. Despite the size of the problem, until the early 2000s SAM appeared to be a so-called neglected disease: little support went to large-scale treatment programs targeted toward children with SAM. Few countries-even among those with a high prevalence of malnutrition-had a clear national policy for detecting and treating SAM children.10 The development and adoption of a new approach-the community-based management of acute malnutrition (CMAM)-was to change the public health nutrition landscape by bringing treatment out of hospitals and into the community

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FEW SECTORS HAVE clearer links to nutrition than agriculture. Most simply, of course, agriculture is a source of food. Because many poor households around the world grow food that they both consume and sell for income, agricultural interventions can have a massive effect on the lives of people in developing countries. Through the decades, and most famously in Asia’s Green Revolution, development projects have sought to boost agricultural production of staple foods as a way of improving people’s nutrition. Yet, while consuming a sufficient quantity of calories is important, especially among undernourished populations, quality matters too. Thus, the traditional focus on producing enough food to meet people’s calorie needs has evolved into a deeper understanding that to improve nutrition, we also need people to consume balanced, high-quality, and diverse diets that contain enough essential nutrients to meet their daily requirements.

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OVERWEIGHT AND OBESITY prevalence has increased substantially over the past decades, affecting 2.1 billion people worldwide and causing 3.4 million deaths globally.1 Currently, 42 million children are overweight or obese—the result of a staggering 47.1 percent rise in prevalence between 1980 and 2013.2 No longer exclusive to affluent societies, obesity has reached alarmingly high levels in many low- and middle-income countries (LMICs).3 In fact, the number of individuals who are overweight or obese (1.9 billion) has now surpassed the 794 million people who do not get enough calories.4 Nearly half of all overweight children under 5 years of age now live in Asia, and a further 25 percent are found in Africa.

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This document summarizes key information on improving nutrition over the past 50 years, including paradigms in international nutrition from the 1950s to present. It discusses lessons learned from community nutrition programming case studies in countries like Bangladesh, as well as the importance of infant and young child feeding best practices. The document also examines approaches to tackling micronutrient deficiencies through interventions like salt iodization in China and micronutrient powders in Mongolia. Finally, it outlines the community-based management of acute malnutrition model and case studies of its implementation in countries such as Malawi.

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THE CALLS FOR strong leadership in the fight against global and national malnutrition have multiplied during the past decade. The role of nutrition champions in advocating for nutrition, formulating policies, and coordinating and implementing action in nutrition have increasingly been recognized in such countries as Peru, Brazil, Thailand, and the Indian states of Tamil Nadu and Maharashtra. Global initiatives such as the Scaling Up Nutrition (SUN) Movement, the African Nutrition Leadership Programme, and the European Nutrition Leadership Platform have invested in building up capacity for leadership among national governments, civil society, and the private sector. The World Public Health Nutrition Association’s guide on competencies needed to build up the workforce in global public health nutrition identified leadership as key. More widely, leadership within the field of public health has been highlighted as key to moving child or maternal health higher up on the global agenda and tackling critical issues such as HIV and AIDS at the national and community levels.

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RAPID ADVANCES IN economic development and healthcare in Brazil have contributed to significant improvements in child health and nutrition in recent decades. Brazil met Millennium Development Goal 1—halving the proportion of people whose income is less than $1 a day and halving the proportion of people who suffer from hunger, and Goal 4—reducing by two-thirds the under-five mortality rate. Beyond significant advances in reducing poverty and improving food and nutrition security throughout the country, Brazil has also been successful in reducing socioeconomic inequality in malnutrition. What lies behind this success? This case study examines the policies, approaches, and process that contributed to the reduction in child stunting and other key indicators of malnutrition.

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THAILAND REDUCED CHILD undernutrition by more than half within one decade—an achievement recognized by the nutrition community as one of the best examples of a successful national nutrition program. Underweight rates among children under five decreased from more than 50 percent to less than 20 percent from 1982 to 1991, and severe and moderate underweight rates were nearly eliminated. The underweight rate was further reduced to 10 percent by 1996 and to 9 percent by 2012. Maternal care interventions were also successful. Thailand improved the reach of antenatal care—coverage increased from 35 percent in 1981 to near 95 percent in 2006. And iron-deficiency anemia prevalence among pregnant women was reduced from nearly 60 percent in the 1960s to 10 percent in 2005.

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REMARKABLE IMPROVEMENTS IN welfare and human development indicators in Bangladesh—including a notable reduction in the poverty headcount—have accompanied recent economic growth.1 Some aspects of nutrition have been part of this success story. For example, the percentage of underweight children declined by 1.1 percent per year and stunting rates declined by 1.3 percent per year between 1997 and 2007.2 And this trend has continued, with rates of child stunting falling to 36 percent in 2014 (Figure 12.1). Other countries may have experienced shorter, quicker reductions, but the Bangladesh story reflects “one of the fastest prolonged reductions in child underweight and stunting prevalence in recorded history.

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Topic 1: Popular fad diets vs. Nutrition Introduction: As someone who feels constantly unhealthy, I closely follow popular diets in search of a healthier me. I have embarked several diets that left me feeling average at best. For four years I was a vegetarian, vegan for three months, paleo for two months and keto for two months. Each of these diets restricted me from the nutrients I needed, as well as added a layer of problems and complications. They also left me tired, and unable to process things later on when I ended each diet. When I decided to eat meat again after four years, I vividly recall many times where my life was consumed by hovering over a toilet after only a few bites of meat. It greatly impacted my social life, and my doctor warned me that these diets were dangerous to a young adult. After several blood tests, we found that these diets ended up giving more problems than benefits. They found that I was low in important nutrients such as magnesium, potassium, vitamins B12, D, became I became dangerously anemic (low in iron). Topic Proposal: My topic is focused on the short/long term effects fad diets and how the youth interprets diets displayed in popular media. Fad diets are diets popularized by the media that typically focus on the elimination of eating certain food groups to achieve weight-loss. However, this leads to a huge impact of nutrition given that restriction of entire food groups can erase one’s intake and even ability to process vital nutrients. The most common diets suggest limiting consumption of carbohydrates, fats or/and over-indulging in foods such as grapefruit. These diets, while promoting something considered positive, weight-loss, also can lead one into serious health problems. Focus: I am to focus on the common misconceptions on dieting and weight-loss. I want to uncover the great risks that come with the most popular dieting methods due to the restriction of vital nutrients as well as a solutions that nutritionists actually support. In hopes of finding a solution, I also want to take a look into positive diets promoted in the media, or if there is even a diet that is generally helpful and doable for the general public. Importance: While many people seem to focus on the obesity epidemic in the U.S., I want to focus on more plausible dieting solutions that promote long term health and healthy weight loss. The nutrients people deprive themselves of can lead to an even more unhealthy society caused by the lack of education on healthy dieting habits. Many people look to social media to find healthy goals and role models end up greatly damaging their body and could later on effect their children and society at a whole. Students and young adults are most at risk for joining unhealthy diets given that they are on social media the most. If DU and other schools promote healthy relationships with food it would benefit their ability to perform as well as their life and longevity. Sources: I will research fad di ...

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Dietetics is the science of how nutrition affects health. Dietitians study nutrients and their impact on the human body, and work to develop balanced diets to prevent disease. The profession of dietetics developed in the early 20th century to address malnutrition and nutritional deficiencies. Today, dietitians work in clinical settings, research, education, industry, and more to advise on healthy eating and evaluate diets based on scientific studies linking nutrition and lifestyle to health outcomes.

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Seizing Opportunity from the Jaws of Crisis: A Playbook for Nutrition

1. Seizing Opportunity from the Jaws of Crisis A Playbook for Nutrition Ellen G. Piwoz, ScD 30th Annual Martin J. Forman Lecture December 10, 2020

2. I was invited to offer “personal and often unconventional views about major issues related to international nutrition”… and.. “reflect on my overall body of work, the challenges I faced, and what I see as the next frontier for nutrition.”

3. Methods

4. Four Common Truths 1. The multisectoral nature of nutrition has long been recognized 2. Nutrition is contextual and requires adapted solutions 3. Progress requires investing in people and institutions 4. It is critical to know how to get things done in your organization – no matter where you work

5. Reflecting on Personal Experience (2008 to present)

6. The Lancet Maternal and Child Undernutrition Series was a launchpad for creating change

7. The pandemic has brought to light just how integral nutrition and food systems are to health, livelihoods, and the environment…. The enormous burden of disease associated with poor nutrition and unhealthy diets, coupled with the unaffordability and declining consumption of healthy foods underscores that nutrition and food systems belong together and that policies are urgently needed to address nutrition and food issues holistically and coherently

8. My Nutrition Playbook Nutrition Playbook Financing comes first Put evidence into action Research that is strategic Advocacy that unites Empower future leaders

9. We are at a critical juncture…  There are political opportunities on the horizon A new US administration SUN entering a new phase UN Food Systems Summit Tokyo Nutrition for Growth Summit  Join together, embrace the challenge, seize the opportunity, come up with a playbook for the new realities we face.

10. Thank you! Special thanks to key informants Mary Ann Anderson, Phil Baker, Shawn Baker, Jess Fanzo, Marcia Griffiths, Nemat Hajeebhoy, Maura Mack. Purnima Menon, Will Moore, Anne Peniston, Abi Perry, Rahul Rawat, Meera Shekar, Hope Sukin, Mellen Tanamly, Cesar Victora, Neil Watkins, Patrick Webb Hannah Guedenet (slides)

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