David Nabarro: Malnutrition problem requires multipartner solutions

David Nabarro, special representative of the U.N. secretary-general for food security and nutrition. Photo by: Simon Ruf / UNMEER / CC BY-ND

Malnutrition is the “new normal,” according to the 2016 Global Nutrition Report released earlier this week: 44 percent of countries are experiencing “very serious levels” of both undernutrition and obesity; nearly half of all deaths in children under five — around 3 million lives a year — can be attributed to undernutrition.

For David Nabarro, special representative of the U.N. secretary-general for food security and nutrition, it’s vital that the global community recognizes the damage caused by malnutrition in early life for the longer term development and well-being of individuals, societies, and even nations — and works together to help communities and individuals come into that mid-range.

Nabarro has a wealth of experience in the field of nutrition, particularly the dual burden of under- and overnutrition, starting nearly 40 years ago as a child health doctor with Nepal Children’s Society.

The landscape of the nutrition movement has changed since then, particularly with more collaboration and engagement from the private sector. Malnutrition is a multifaceted problem, and requires multiple actors to solve it, Nabarro told Devex in an interview.

“Business is part of the solution; it’s not always to be portrayed as a problem,” he said. 

Rather, he said, it’s a case of finding the right way in which different stakeholders can work together and set standards.

“It’s better to engage and be open than to create absolute exclusion for any sector or any group in responding to a particular challenge,” he said. “And that particularly applies to the involvement of private actors in issues around health and nutrition.”

Here are a few excerpts from the conversation, edited for length and clarity.

In relation to improving nutrition and meeting the nutrition indicators in Sustainable Development Goal 2, what role do you see the private sector playing?

Nutrition, particularly in young children, is an outcome of many different processes that happen in upbringing.

In general, we distinguish whether malnutrition is caused by lack of access to appropriate nutrients, which therefore relates primarily to feeding; whether it’s caused by an illness that in turn might reduce the intake of nutrients or the way nutrients are used; whether it’s due to perhaps the mother not having enough time to feed her child, and therefore, it has to do with the context in which people live.

So, where does business fit in? Well, I’d say it may be relevant in all those areas. We tend to look at business, perhaps, as a provider of foods that are suitable for children. That’s, in fact, incredibly important in many households — what we call complementary feeds. But it can be a problem, especially if the foods provided through business actually deter women from breastfeeding, or deter families from using local foods for child feeding.

Indeed, there are many examples … Business can also be helpful in improving access to water and improving hygiene and sanitation … [providing] soap and also helping people to get connected to water supplies, particularly access to wells and other sources of clean water.

Do you feel that the private sector is being engaged as early on as possible?

I’ve been very impressed by the way in which business can offer solutions early on in the analysis of determinants of poor nutrition and in the response. And, actually, that applies both to undernutrition and overnutrition.

At the same time, it’s important that national governments, supported by bodies such as the World Health Organization, actually set the parameters for business involvement. We’re seeing that in much of development now — that businesses want to know the context within which they’re operating; they want to know what the boundaries are because that then helps them then make their choices about how they’re going to get engaged.

So the answer is: Involve early, involve constantly and provide the right kind of environment or context, including regulations if necessary, in which businesses can be involved.

All the stakeholders involved in nutrition issues, whether they’re civil society, business or even government, need to be doing this in a responsible way, which puts households, and particularly mothers at the center.

That again has been the underlying thinking around the business network of the Scaling Up Nutrition movement and other groups such as [the Global Alliance for Improved Nutrition]. All these things require extreme openness between the different actors, and whenever we’re looking for ways to involve multiple stakeholders in a development issue, it’s extremely important that time is invested in established contrasting relationships between the stakeholders and that trust is kept under review, and at the same time, if something goes wrong, then the challenges are analyzed and, if necessary, relationships are re-examined.

Looking across the food security value chain  from farm to fork  how do the different sectors, governments or society, private sector and funding work together to ensure that solutions are prioritized across the entire chain?

It’s important to recognize that a value chain is not just about cash value for the different actors along the chain, the producers, the processes and retailers or distributors. It’s also about nutritional value and it’s also about the potential environmental cost associated with a particular production pathway.

There is a lot of questioning about whether hyper-processed foods convey benefits because they’re convenient and incredibly valuable to people who are short of time, but at the same time, they may lead to inappropriate consumption resulting in obesity or even high blood pressure. So, at all times, the way in which different actors are working in the value chain must depend on the ways in which they can contribute, not just by making money, but also by contributing to nutritional outcomes.

Those who are working on the value chain [should] appreciate how much they can produce nutritionally advantageous foods if they work together, but also, at the same time, how issues such as marketing systems need to be done with great care, and linked often to proper education of consumers so that adverse consequences do not happen.

Innovation is seen as critical to combat under or malnutrition. But how can we better use existing technologies as well, such as micronutrient powders, in more sustainable ways to improve nutritional health in the first 1,000 days and beyond?

If you examine the challenges associated with children getting sufficient nutrients early in life, it usually boils down to whether or not parents, particularly mothers, can obtain food that’s sufficiently high nutrient in concentration.

What we would all encourage … is an analysis of the constraints, an analysis of how those constraints can best be resolved and then careful use of existing food production systems to help overcome them.

It’s often possible at the local level to produce high energy, high nutrient density food using vitamin additives and all kinds of high energy compounds, particularly fats, milk-based compounds … And that means building on the existing products, building on what’s already known. There’s not often a need for a huge amount of manufacturing though for children who are acutely malnourished, particularly in crisis situations, there are special foods that again can be produced locally.

This is local innovation that’s already available.

There are also particular issues like packaging. It’s quite difficult to keep food fresh and to avoid contamination in very hot situations and so improvements in packaging can be incredibly helpful.

Can you innovate, get the cost down, while at the same time improving access particularly for poor people? Yes, but there’s a vast amount still to be done on that … For very small children, particularly when they’re sick, even in extreme, isolated and poor settings, pre-packaged foods can be incredibly helpful for busy mothers.

And we sometimes undervalue mothers’ time: They are often seen as a free good, but it’s not. I’m extremely interested in the economic analyses of the value of introducing packaging that improves access and keeps food clean. So it’s innovation that’s already available but the analyses of whether or not it should be more widely distributed I think is still a little bit incomplete.

Looking toward the future, how can development implementers, actors and stakeholders have an impact?

The SUN movement is one example of an effort to create that context within which that can happen, always seeking to stress that it’s the national government — through its own process of rules and regulations — that has to be setting the terms under which these interactions happen ... It then seeks to encourage those on that platform to work in a principled way, to have access to information, to be able to undertake their own examinations and then to share their findings with each other and, of course, there is an advocacy element.

The multifaceted nature of poor nutrition is not something that can be dealt with using a single intervention. It requires working in multiple sectors and a full dialogue with communities where malnutrition is a problem.

All concerned must continuously focus on results. First principle is: Do no harm. The second principle is: Make out for certain that when you’re looking for results, you assess how your working practice is influencing all in society but particularly those who are most disadvantaged. It’s not adequate to just look at the average — you have got to look at those who are most in need and make sure nobody is left behind.

What role do you think the private sector should play in fighting malnutrition? Have your say by adding a comment below.

Power of 5 is a global campaign in partnership with Amway, focused on raising awareness of the issue of childhood malnutrition, and the critical role nutrition plays in early childhood development. Learn more about the work of our partner and its micronutrient powder Nutrilite Little Bits here and join the conversation online using #powerof5.

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    Helen Morgan

    Helen Morgan is an Associate Editor at Devex. She has a background in human rights, radio and journalism, and has written for a variety of international publications while living and working in Buenos Aires, New York and Shanghai. She is now based in Barcelona and supports editorial content on campaigns and media partnerships at Devex. She is currently studying a master's degree in contemporary migration.