The year 2015 presents a unique opportunity for the global development community to build on and strengthen the momentum initiated by the Millennium Development Goals (MDGs).
Building on progress made
Scheduling the launch of the post-2015 development agenda for September 2015 provides us with the time necessary to undertake consultations and discuss what exact goals are needed to maximize progress. While the MDGs started from ground zero, creating a baseline for global hunger and poverty targets, the sustainable development goals (SDGs) will hit the ground running, propelled by over a decade of lessons learned. Given this experience, the coming years offer unprecedented potential for human development.
With respect to nutrition, the current discourse and action are informed by a number of strategies and approaches which evolved over the course of the MDGs. Nutrition has captured global attention and has remained a featured agenda item for most development partners. A number of international initiatives, multi-stakeholder processes and commitments add fuel to the fire, including the Scaling Up Nutrition Movement (2009), the Global Nutrition for Growth Compact (2013), the United Nations Secretary-General’s Zero Hunger Challenge (2012), and the Second International Conference on Nutrition (ICN2).
Food Systems for Nutrition
Held jointly by the Food and Agriculture Organization of the United Nations (FAO) and the World Health Organization (WHO) in November 2014 in Rome, ICN2 convened almost 170 Member States to address the multiple challenges of malnutrition. The conference produced two outcome documents, the Rome Declaration on Nutrition, which outlines current challenges and commits to addressing them in the coming decade, and a complementary Framework for Action, which lists 60 actions that countries may select from to guide national nutrition strategies.
A key message from ICN2 was that food systems around the world are changing rapidly and becoming more complex. Recent trends in industrialization, globalization and commercialization have profound implications for what foods are being produced, the degree to which they are being processed, and how people are consuming them.
This message has been broadcast ever more loudly by the international nutrition community in recent years. It is in large part a reflection of mounting concern over the impact and sustainability of current consumption and production patterns. Although commercialization and specialization in agricultural production, processing and retailing have enhanced efficiency throughout the global food system, increasing year-round availability and affordability of a diverse range of foods (FAO, 2013, p. v), “double” or even “triple” burdens of malnutrition are also increasingly ubiquitous. Today, most countries suffer from some combination of stunting, anemia, and/or obesity and overweight.
The negative environmental effects associated with these patterns of food system change include land degradation, unsustainable water use and heavy reliance on pesticides and fertilizers, to name a few. They present a major concern not only in regard to their obvious agroecological impact, but also with respect to increased risk of food insecurity and poverty, with subsequent insidious implications for nutrition and health.
As such, the quality of global, national and local food systems is increasingly considered reflective of the integral role played by agriculture in food security and nutrition outcomes. Sustainable Development Goal (SDG) 2—end hunger, achieve food security and improved nutrition and pro- mote sustainable agriculture—is a clear acknowledgement of the links between these important components. It is also uncharted territory that offers unprecedented opportunities to tackle a range of challenges facing current food systems. These include increasing support to small-scale food producers, improving environmental sustainability, increasing resilience in production practices, and reducing food waste and losses.
Ensuring that Nutrition Does Not Get Lost
Of the 17 SDGs and 169 targets proposed by the United Nations Open Working Group, only SDG 2 includes a provision on nutrition. That said, the fact that it embeds sustenance in the context of food security and sustainable agriculture is an achievement, as it acknowledges the crucial role played by food-based approaches to nutrition. Furthermore, consolidating nutrition, food security and agriculture into the same goal increases accountability with respect to health and environmental impacts of agricultural production practices and food system development.
The risk of the SDG 2 phrasing is that the concept of “improved nutrition” is conflated with the conventional hunger reduction construct, with the focus defaulting to food quantity and national calorie availability, as opposed to the quality of available foods and household or individual access to them. This is a common problem in food security discourse. Although the original 1996 World Food Summit definition of food security included “ensuring year-round access to adequate, safe, diverse and nutrient-rich foods for all”, over the years the concept has been reduced in many contexts to gross calorie availability. As a result, we now often talk about “food security and nutrition” to safeguard the latter from being forgotten.
How can we ensure that the nutrition component of SDG 2 is upheld and not overshadowed? Two suggestions, both based on the premise that consideration of food quality (as opposed to quantity) is key. First, agricultural productivity must pay attention to nutrient-dense foods. Second, countries must recognize that there are multiple entry points for improving nutrition through agriculture and food systems. There are many ways to improve the quality of foods available in a given food environment. Indeed, given the current rapid pace of commercialization and specialization in agricultural production, a wide range of opportunities are available.
Identifying Entry Points
The ICN2 Framework for Action includes a section on “Sustainable food systems for promoting healthy diets”, with more recommendations than almost any other section. These range from the promotion of crop diversification, to establishing national food or nutrient-based standards, strengthening local food production and processing, and exploring regulatory or voluntary instruments for promoting healthy diets. The broad scope of the recommendations is indicative of all the different ways to increase the nutrition sensitivity of food and agriculture systems. That said, the trick is to identify which of these multiple entry points will provide the most leverage, given sociocultural preferences, the political climate, and the surrounding policy landscape.
While the former fall squarely under the purview of individual countries, international consensus is emerging on which policy areas offer the greatest potential for nutrition impact. These include: agricultural production policies, strategies designed to impact consumer purchasing power (e.g. cash transfers, consumer subsidies), policies pertaining to food transformation and consumer demand, and market and trade system policies such as import tariffs or bans (Global Panel on Agriculture and Food Systems for Nutrition, 2014).
Across the board, the emphasis is on using policy levers to increase availability and affordability of diverse, nutritious foods, thus making food systems more nutrition-sensitive. Environmentally-viable production practices which improve agricultural sustainability—with subsequent long-term positive implications for food security and nutrition—are an important part of the picture.
SDG 2 opens a wide door in terms of policy and programme entry points for improving nutrition through agriculture. However, in terms of nutrition monitoring and evaluation, the parameters are narrower. To date, there is broad consensus on which indicators best measure progress in critical nutrition outcomes. Recommended by the United Nations System Standing Committee on Nutrition (UNSCN) as a suite, these include stunting, wasting, overweight, exclusive breastfeeding, low birth weight and anemia prevalence in women of reproductive age. These indicators are used to assess progress towards the World Health Assembly global nutrition targets and to estimate the percentage of national budget allocated to nutrition (UNSCN, 2014).
They are all being promoted for inclusion under SDG 2. Also included within the recommended suite of nutrition indicators agreed upon by UNSCN is the Minimum Dietary Diversity—Women (MDD-W), specified as “the percentage of women, 15-49 years of age, who consume at least 5 out of 10 defined food groups” (FANTA/FAO, 2014). This indicator is currently the only validated option for assessing adult diet quality at the individual level. It is a proxy for micronutrient adequacy of the diets of women of reproductive age. Women consuming at least five out of ten food groups have a greater likelihood of meeting their micronutrient needs than women consuming foods from fewer food groups. The MDD-W is a key indicator that links all the components of SDG 2 by highlighting nutritional quality of food intake, while emphasizing the role of agriculture in promoting good health (UNSCN, 2014).
It is important to note that overall, the development and validation of food-based indicators has lagged conspicuously behind other types of nutrition-related metrics. For the most part, these indicators have not fundamentally changed since the 1970s; they still measure availability and access to calories (Herforth, 2015), reflecting the reductionist food security view mentioned above. Increasing demand for and availability of globally comparable, routinely collected indicators of diet adequacy is imperative for holding agriculture and food systems to a higher, more health-centred standard. SDG 2 offers a tremendous opportunity in this regard.
Food and Agriculture Organization of the United Nations (2013).The State of Food and Agriculture 2013: Food Systems for Better Nutrition. Rome. Available from http://www.fao.org/docrep/018/i3300e/i3300e00.htm.
Food and Agriculture Organization of the United Nations, and Food and Nutrition Technical Assistance (2014). Introducing the Minimum Dietary Diversity—Women (MDD-W): Global Dietary Diversity Indicator for Women, July 15–16, 2014. Washington, D.C. Available from http://www.fantaproject.org/sites/default/files/resources/Introduce-MDD-W-indicator-brief-Sep2014.pdf.
Food and Agriculture Organization of the United Nations, and World Health Organization (2014). Rome Declaration on Nutrition. Second International Conference on Nutrition, Rome, Italy, 19-21 November 2014. Available from http://www.fao.org/3/a-ml542e.pdf
Food and Agriculture Organization of the United Nations, and World Health Organization (2014). Framework for Action. Second Interna- tional Conference on Nutrition, Rome, Italy, 19-21 November 2014. Available from http://www.fao.org/3/a-mm215e.pdf.
Global Panel on Agriculture and Food systems for Nutrition (2014). How Can Agriculture and Food System Policies Improve Nutrition? Technical Brief, November 2014. London, UK. Available from http://www.glopan.org/technical-brief.
Herforth, Anna (2015). (In press) Access to Adequate Nutritious Food: New Indicators to Track Progress and Inform Action. In The Fight against Hunger and Malnutrition: The Role of Food, Agriculture, and Targeted Policies, David E. Sahn, ed. Oxford University Press.
United Nations Standing Committee on Nutrition (2014). Priority Nutrition Indicators for the Post-2015 Sustainable Development Goals. Policy Brief. Geneva, Switzerland. Available from http://www.unscn.org/files/Publications/Policy_brief_Priority_Nutrition_Indicators_for_the_Post-2015_SDGs.pdf.