Increasing children’s interest in eating local and traditional foods can increase their overall nutrition and health
Opinion piece by Lyndon Haviland, DrPH, MPH, a distinguished scholar at the CUNY School of Public Health and Health Policy.
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Margie Ferris Morris and Peter Morris interviewed Dr. David Nabarro on a recent trip to Switzerland. David currently is the Founder and CEO of 4SD, a social enterprise based in Geneva. He has been a long-time advocate of nutrition and food security issues and was the recipient of the 2018 World Food Prize, along with Lawrence Haddad.
World Hunger Education Service (WHES): As the world is changing so fast, could you give us a short history of your involvement with food security/hunger issues – and how you became involved and served as the UN point on Food Security and later was awarded the World Food Prize in 2018.
David: My career began with public health, especially children’s health and why they were not doing well in early life. This included the child’s life in the home and their well-being. From that view, it was easy to get involved in agriculture and food security. Public health has remained my compass throughout my career.
In 2008, there was a food price crisis. At that time, the UN Secretary General was looking for someone who could coordinate the collective response. He wanted someone familiar with public health. I had experience of coordinating between UN agencies and was made a deputy UN coordinator, and then coordinator, for food security. I helped the UN agencies to organize themselves on food and stayed in this role until 2014. I watched as the UN developed a much more integrated approach on food and food security – one which encouraged different groups to come together and work in synergy.
During my time as the food security coordinator for the UN, one of the areas on which I found myself focusing was nutrition. There were three quite distinct views on the best ways to enable people to be better nourished:
- Working from a focus on health and health care;
- Working from a focus on what people eat – diets and the foods on which they are based;
- Working from a focus on household well-being and resilience in the face of poverty – the economics of nutrition
Increasingly I have developed the view that nutrition belongs in every professional group.
I joined a group of nutrition leaders from communities, local authorities and national governments; from professional and civil society organizations, from across the UN system and the World Bank, and from bilateral donor agencies and philanthropic organizations. We worked together on the concept for a movement to Scale Up Nutrition (SUN) focusing within the first 1,000 days of a child’s life. We were informed by a special series of articles on nutrition produced by The Lancet, a medical journal. This encouraged convergence of thinking and alignment of action around nutrition and it inspired many to intensify efforts. The movement was not a program led by a UN agency (like WHO or FAO) or other international body. The movement was designed to be led from within countries by national nutrition platforms where multiple actors – from different sectors and different disciplines – would come together for women’s and children’s nutrition. One feature of these in-country efforts for nutrition is that the different actors from multiple sectors would share the same purpose, agree on priority outcomes and align their actions.
There were several features that seemed to be important for the success of in-country efforts. First – creating a “big tent” of nutrition actors who agreed on a series of principles and shared a common purpose: this reduced the potential for different entities to be concerned about who was inside the tent and who was on the outside. Second – ensuring that a diverse set of stakeholders participated in the national platform – not just from governments, but also from the private sector, civil society, and science.
When the SUN Movement was launched in New York at the end of September 2010, we thought that maybe 20 countries would get involved in the early stages. In practice, growth was rapid and strong with more than 60 countries joining, with three Indian States, many donor governments, and numerous businesses, civil society organizations and scientific institutions wanting to be involved.
I worked as SUN Movement Coordinator from 2010 through to 2014. I noticed that countries which engaged in this SUN Movement from the beginning are the countries where there have been significant improvements in nutritional status.
This association was noticed by members of the committee responsible for deciding who would receive the World Food Prize. They were impressed by ways in which the SUN movement widened public interest in ways to improve nutrition while keeping the focus on specific outcomes that really matter. They considered that the SUN Movement is a significant achievement. I’ve done something that is useful, and so I was awarded the prize, together with Lawrence Haddad, whose science has been really special.
For many people this was exciting, for it is not often that the World Food Prize goes to people who have been involved in the kind of organizational work that created the conditions for the SUN movement. Normally the Prize goes to people who have made a scientific discovery in the lab or in the community. Many of us rejoiced that an effort to encourage multi-disciplinary action for nutrition had found its way into the World Food Prize. It has been wonderful to be recognized in this way.
WHES: At some fundamental level, what has been the overall achievement of SUN? Not in terms of government programs or money spent, but actual progress that can be attributed to this movement?
David: From my perspective the main achievement of the movement has been that it encourages different actors within SUN countries to come together and work in synergy. As they do so, they increase the likelihood of levels of malnutrition will reduce more rapidly than would otherwise be the case. In my view, people’s nutrition improves as a result of changes in the interactions between different systems within societies and in how they exert influences on people’s nutritional well-being. I have never held the view that reducing levels of malnutrition among women and children can be directly attributed to volumes of finance expended: system shifts can rarely be directly attributed to patterns of expenditure. It is hard to prove causality though there seems to be a strong association between progress with nutrition and diverse actors coming together around a shared narrative.
WHES: You’ve done so many different things in your career. Where have you done that you personally felt made the most difference?
David: The way of working that gives me greatest professional satisfaction and pleases me the most involves enabling all with an interest to engage and partner on an issue which concerns them all. I spend most of my time helping to create the conditions for this way of working together. I like to create conditions that enable all concerned to engage, work together and take decisions through together focusing on the issue and not worrying about professional, organizational or institutional identity. Indeed, for me this way of working involves leaving logos and egos outside the room.
I enjoyed being involved in the framing of several new partnerships:
- Roll Back Malaria (RBM) – I was responsible for this effort in WHO over two years (1999 – 2001): it was wonderful to watch as different groups come together and prepared collective action on malaria, under the stewardship of Gro Harlem Brundtland, WHO Director General. It involved collective action by many different governments, community organizations, scientific institutions and professional groups. It has been an absolute joy to see levels of malaria mortality drop so profoundly, particularly among children in Africa.
- UN System Influenza Coordination – I was involved in the effort by the UN to reduce the intensity and consequences of H5N1 (Avian Influenza) outbreaks between 2005 and 2010. My responsibility was to help groups of animal, human, and environmental health practitioners work effectively together. The concept of One Health Working evolved and became a meaningful identity for those who were working on the challenge of reducing the consequences of avian influenza.
- UN system High Level Task Force on Food Security (2008 -14), Movement to Scale Up Nutrition (2010 – 14), Responses to the West African Ebola outbreak (2014 – 15); Advancing the UN’s work on the Sustainable Development Agenda and Climate Action (2016 – 17). I served as coordinator for these initiatives as Special Adviser to the Secretary-General of the UN.
On each assignment I found that extraordinary energy comes from connecting people so that they will work together rather than their being fragmented into different initiatives. These connections unleash valuable new energy through bringing multiple actors together and encouraging them to establish force fields rather than being tightly wired together. This is a way of working that tends to achieve results while making people feel good. That is one of the reasons why I have also had the good fortune to stay connected to many of the people that I have worked with in my earlier career – we enjoy this style of working and find it to be both constructive and effective. I keep asking myself: why isn’t this way of working the norm? Why is it so common that when groups tackle problems they focus more on what makes them different rather than on working together, aligning and synthesizing their efforts. I want to be sure that there is as much encouragement as possible for those who want to combine efforts for the common good: I just do not know why it isn’t the norm.
One of my priorities now is to take this approach to collective leadership and this way of working and make it into something that people can learn to do intentionally, rather than just stumbling upon it by accident. I am teaching collective leadership for systems change through our social enterprise 4SD.
WHES: With U.S. funding to the UN under increasing scrutiny and attack, what do you see as the unique and beneficial role multilateral actors play in ending hunger and good development?
David: The term “multilateral” is used to describe the process of national governments working together on massive challenges which affect all our futures – like climate change, the future of food, access to drinking water and disease outbreaks. Typically, these challenges do not stay within national boundaries. They are bigger than any one government can tackle alone: they need the collective energy of leaders working together. It makes absolute sense that there are institutions designed to bring governments together so they can work on the challenges multilaterally.
Over the years the US has consistently supported multilateral efforts by bringing governments together with shared purpose. One example of this approach is the Global Health Security Agenda (GHSA) which was fostered by the United States and other governments some years ago to tackle infectious diseases crossing borders. GHSA is brilliant because it made it easy for like-minded governments to come together – however, it could be faulted, as it was only a selection of countries, so if there were other countries, which for whatever reason – political or other – could opt out so there was a limit to what that agenda could do.
So, what is the alternative? We could work through more formal structures. The formal structure we have is the United Nations system, which is based on one member, one vote. We have other formal structures that are there for specific purposes, e.g. the World Bank, which has a different governance. From my perspective, however, the United Nations offers the most legitimate institutional base for multilateral action.
Multilateral mechanisms of the UN are not always appreciated by every nation: the UN is sometimes portrayed as flawed and not fit for purpose. Some wealthier nations feel that others are ganging up on them (e.g. anxieties about the disparity of wealth between nations with wealthier countries being asked to redistribute their wealth among poorer ones). This has led to some of the rich countries perceiving that the multilateral mechanism through the United Nations is one that they feel very unsure about. There are some parts of the multilateral UN system that the rich countries are anxious about because they feel that they are systematically biased against the economic and political policies of the rich world.
What I would like to see is greater value given to universal multilateralism with more attention being paid to the misgivings of the wealthier nations, particularly given that through the budgeting system of the UN they are giving quite a large fraction of the budget. The United States generally pays 22 percent of the UN regular budget and has historically paid even more for peacekeeping. It’s no good just saying that the multilateral system – one country, one vote – means there will sometimes be criticism of U.S. policies on some issues that the U.S. and other rich nations must just put up with. We must recognize it is legitimate for those who pay significant sums of money to have their concerns heard, just as it is legitimate in a one country, one vote system for those who disagree with policies of some of the rich nations to express that disagreement. And, for me, finding ways to navigate those political anxieties is key to multilateral working. If we cannot navigate them, we will not achieve the full potential of our multilateral working, and if we can’t do that, then we can’t tackle the big issues of our time.
WHES: What do you see as the greatest threats in the near or long-term future for continued progress on hunger?
David: Over the last three years, we’ve seen rises in the estimated number of hungry people in the world. The pattern is clear; the numbers are coming up because of a combination of the effects of changing climate and violence that involves civilians. In parts of the world that are already fragile, such as the Sahel and several river delta areas, the impact of climate change leads to irregularity of rainfall and salination of productive land. These decrease productivity of land and increase poverty: they provoke fights over resources, and sometimes outright warfare, as we have seen in recent years in the western Sudan. There is a definite link between the risk of conflict and climate change. And obviously if there are not good mediation systems in local communities, then conflict can become violent, and this is particularly likely if governments are going to weigh in on one side or the other, so I do see these as very, very tightly interconnected.
The conflict over available resources is exacerbated by climate change and more likely to turn into violence because of the inability of governments to establish systems for the peaceful mediation of conflict.
I fear there is not really the level of global political intent to do everything possible to stop these conflicts. I think this lack of intent is the most disappointing part, because of the impact on hunger and child survival. To recap, the three major issues are:
- The problem of war,
- The problem of climate change, and
- The general inability of world leaders, through the instruments they have at their disposal – such as the UN security council – to work together on resolving conflict.
Often when member states act within the conflict – even joining the conflict – and that may well exacerbate things rather than improve them.
WHES: What specific program that you have seen has had a strong impact on hunger in a community? Would that be different than an approach that has made a difference at a county level?
David: In my experience hunger reduction at community level occurs most rapidly If you get different actors together to diagnose what is happening and work on the issues together. This way of working needs leadership and willpower. For example, in India, Maharashtra state has a Nutrition Mission. Some districts have fantastic results, other districts, less good results. As I understand it the good results are due to the capacity for local organizations to bring people together. At the central or country level, it is much harder to incentivize collective working and get leaders to consolidate around these ideas. However, there are several policy levers that can help.
I have found that a good collective buy-in is enabling girls to continue education later in life so they are able to have agency and to take steps in local communities. I am impressed by the power of productive social safety nets, such as in Ethiopia. This has been strongly advanced by the Government and has proved to be super-helpful. When government leaders take a personal interest, then their agencies get involved.
WHES: What are some ways people reading this interview can start to have an impact on world hunger either in their own community or on a more global level?
David: It has to start with having that fire within you. It needs to come from your own inner anger and frustration. Here is my narrative. We produce a lot of food within our world. There IS enough FOOD to go around. Hunger is with us due to failure of political processes…political failure. Hunger is a moral blot on humanity. Hunger is an immediate challenge to society in that the hungry may only get one meal a day. This impacts their future development and handicaps them. We must deal with problem of hunger where it is…there are always underlying circumstances…just about any one of us, whatever our status, can contribute, making sure people get good food when they need it.
WHES: Do you see a future for local food fortification (to address vitamin mineral gaps) on a large population scale?
David: YES!! I would encourage effective local food fortification – it is important to properly manage it well at local level. It should not be used as an excuse to avoid the purchase and use of locally produced foods in creating healthy and nutritious diets.
WHES: Do you have any views about how we (e.g. everyone) can/should ever get to funding for the massive scaleup of Community Managed Acute Malnutrition (CMAM) approaches to address hidden hunger?
David: We have to make sure that this is inside the purview of good development initiatives. It is an immensely empowering for communities. Every child should have access to therapeutic nutrition if needed.