12 December 2012

Africa: The MDGs - Where Does Nutrition Fit?

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At a recent nutrition meeting I realised that I don't yet have a clear idea of where nutrition should fit into the next set of development goals.

I also realised that the wider nutrition community has not had this discussion either. As many critical decisions will be made in the next 6 months, we need to get our act together.

So what are the options? A preliminary set might look something like this:

1. Business as usual.

That is, the underweight indicator in the poverty and hunger MDG. This seems unsatisfactory given the ambiguity attached to underweight--improvements in it do not necessarily track healthy growth (e.g. overweight but short kids).

2. Nutrition as a separate MDG.

There is probably not enough political space for this, given that the MDG set is already health-heavy. But if there were space would this be a good thing? It would probably draw more resources to nutrition (that is what the health MDGs did, by most accounts) and heaven knows nutrition needs that. It would also be a goal that could be embraced by rich and poor countries alike, thus unifying the under and over nutrition sides of the coin and generating a truly global goal, leading the way on other goals that will have to be global. A battery of indicators would be used: stunting, wasting and a healthy range for underweight (young children) and body mass index (adolescents and adults). The World Health Assembly might be supportive of this given the stunting target they recently announced.

3. More nutrition indicators throughout the MDGs, but no MDG on nutrition.

This seems more politically feasible, but maybe less desirable for the reasons given above. If it were an option, what would go where? Stunting is a marker of chronic undernutrition, but it is also a marker for poverty and deprivation in general. It could be used as an indicator for MDG1, with the hope that its existence will bring nutrition interventions into the poverty frame as they are a proven way of moving a stunting MDG1 indicator in sustainable ways that which generate high benefit cost ratios.

Did this happen with the underweight indicator? I don't think so, but I could be wrong. But even if I am right, things might be different now with the energy of the SUN movement. Wasting could be used as an indicator of child ill-health--we know that kids with severe acute wasting are many times more likely to die as kids without. Ironically this could help the treatment of SAM be better rooted in the health sector (it does not have much traction there).

Diet diversity could be an indicator of food security (quantity, indirectly and quality, directly) and of agricultural productivity (via income effects and via improved physical access to food where markets don't work well). If we could measure resource use and ecosystem services, we could begin to think about sustainable diets.

There could be combinations of 1 and 3 and 2 and 3. There are probably other options out there.

And then there is the case of targets and timelines: should the aspiration be to end undernutrition? To halt the increase in overnutrition? To halve both rates?

What do you think?

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