Hidden Hunger: Strategies to Improve Nutrition Quality. Группа авторов

Outcomes of an implementation process are different degrees of implementation, from “paper implementation,” to process implementation, to performance implementation. The outcome of an intervention process on the other hand is an established evidence base. Interventions and implementation research have different target groups. Interventions focus on groups of people such as children, women, the infected, or the undernourished. Implementation on the other hand focuses on client groups such as practitioners, managers, organizations, or communities (in systems). For accelerated success with economic and policy innovations for nutrition, a stronger focus on policy and program implementation is called for, since it is critical for impact.

      Directions for Policy Innovations

In most countries, political leaders have verbally and symbolically committed to addressing food and nutrition, but adequate financial resources were not allocated [8]. Low cohesion of the policy community has been identified as a major underlying cause of the low-priority status of food and nutrition. Furthermore, there is still is a lack of structured exchange between science and policy at national and international levels. The world food and agricultural system and the governance of its international dimensions show signs of serious malfunctioning [9, 10]. The incoherent and inadequate response to the acute food price crisis in 2008 was just one indication. What can be done about these constraints?

      Nothing less than a re-design of the current global food and nutrition governance system is needed, that means policy innovation at large scale is needed. It would include 2 sets of policy innovations, nutrition getting an organizational home at global level, and science and policy on food and nutrition coming together in a well-defined institutional framework. There should be no illusion that any such policy innovations can be translated into reality in the short run. Political economy forces will prevent that.

      Regarding the first, nutrition as a global problem with at least its 3 dimensions of undernutrition, micronutrient deficiencies, and obesity, currently has no well-defined organizational home. Many low-income nation states are not capable to address the nutrition problems effectively by themselves. The recently emerging Scaling Up Nutrition Movement involving more than 50 countries with the UN playing a facilitating role is a promising international effort to overcome this deficiency. Food assistance in failed states and war-affected regions remains a tremendous challenge. A more comprehensive emergency aid mechanism is called for, in which the food and nutrition element covered by WFP remains essential, and where non-governmental actors find improved ways to effectively engage in coordinated ways. The complex nature of the problem calls for an equally complex organizational arrangement at an international level, and not just one entity to handle it all.

Regarding the second, the way policy and science interact related to food, nutrition and agriculture has to be re-shaped as well. Currently, actors on the supply side of scientific information, such as universities and other public or private research organizations, show some interaction and exchange among each other. However, the different actors on the supply side interact with the demand side (e.g., governments, NGOs, or international organizations) mainly on a one-to-one basis. A structured exchange of a more inclusive nature is missing between providers and users of research in the field of food, nutrition, and agriculture. The current and future challenges of food and nutrition security justify a permanent institutional arrangement for this purpose. Re-designing the current system toward an International Panel on Food, Nutrition and Agriculture would provide decision-makers with research-based evidence and enhance the exchange between science and policy (Fig. 3). The set-up of the panel would be partly following the design of the Intergovernmental Panel on Climate Change and applying the principle of separating the provision of science-based assessments from political decision-making, where the latter should be based on facts but takes value judgements on trade-offs into account. Existing organizations and mechanisms would form building blocks of the strengthened and re-designed governance system.²

      Conclusion

Nutritional improvement requires nutrition sciences, but also inputs from social sciences, including economics and political science. While emphasizing multi-disciplinary approaches, this article focused on economic and political innovations. It is increasingly understood that broad-based economic growth combined with social interventions reduces undernutrition, but the relationships between economic development and malnutrition and obesity are more complex [11]. To improve nutrition and reduce hunger especially in low- and middle-income emerging economies, several conclusions for economic and political innovations can be drawn:

Fig. 3. Toward the “International Panel on Food, Nutrition and Agriculture” (IP-FNA). Source: von Braun and Kalkuhl [10].

      1 Political economy analyses of nutrition policy choices need to be combined with economic and implementation research to identify feasible and best policies.

      2 Efficient and effective nutrition policy needs a systematic focus on goals and instruments, with all potential instruments taken into consideration, excluding none for instance because of ideological bias.

      3 Nutrition policy requires more attention, leadership, and funds, as well as a global organizational home, rather than spread across global/UN organizations.

      4 The evidence base for nutrition policies must be strengthened by establishing a systematic science and policy interface, similar to what has evolved for the field of climate change with Intergovernmental Panel on Climate Change.

      References

1Malabo Montpellier Panel: NOURISHED: How Africa Can Build a Future Free from Hunger and Malnutrition. Dakar, Senegal, 2017.

2Access to Nutrition Foundation (2016), Access to Nutrition Index Report 2016, Access to Nutrition Foundation, Utrecht. https://www.accesstonutrition.org/sites/in16.atnindex.org/files/resources/atni-global-index-2016.pdf.

3Reich MR, Balarajan Y: Political economy analysis for nutrition policy. Lancet Glob Health 2016;2:e681–e682.

4Gillespie S, et al: The politics of reducing malnutrition: building commitment and accelerating progress. Lancet 2013;382:552–569.

5Tinbergen J: On the Theory of Economic Policy. Amsterdam, North-Holland, 1952.

6von Braun J: Agricultural Change and Health and Nutrition in Emerging Economies. Agriculture and Rural Development in a Globalizing World, edited by Prabhu Pingali and Gershon Feder, Chapter 14. Earthscan Food and Agriculture Series. London, Routledge, 2017, pp 273–291.

7Fixsen DL, Naoom SF, Blase KA, Friedman RM, Wallace F: Implementation Research: A Synthesis of the Literature. Tanpa, FL, University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research