Food and nutrition

This topic is being watched by the PHM for a long time: several testimonies and analyses are available in the three editions of the Global Health Watch, for example. The struggle for the realization of the right to nutrition (under the broader perspective of the right to health) and for  food security is part of the history of PHM worldwide, at the global, regional and local levels. See list of suggested references below.

The 63rd WHA, held in May 2010, requested the Director-General "to develop a comprehensive implementation plan on infant and young child nutrition as a critical component of a global multisectoral nutrition framework for preliminary discussion at
the Sixty-fourth World Health Assembly and for final delivery at the Sixty-fifth World Health Assembly, through the Executive Board and after broad consultation with Member States" (Resolution WHA 63.23).

An outline of this implementation plan was released during the 128th EB meeting (EB 128/18) and has been since then under analysis of Member States and Civil Society.

During the 64th WHA, PHM WHO Watchers, together with other allied Civil Society organisations, followed the discussions on this issue and critically analysed the outline of the implementation plan. A position statement was produced, with inputs from civil society organizations with expertise in nutrition, such as IBFAN, and experts on the subject (PHM position statement). This statement circulated widely through the web and amongst Member States and civil society present at the WHA. The statement was read by one of the PHM Watchers during the official session in the 64th WHA (Day report).  

The main issues that have been higlighted by the PHM in this statement remain of great concern and should be kept as guidance for the watching process:

• It is imperative that nutrition strategies address not only the immediate nutritional needs of children (i.e. their right to nutrition), but also the complex socioeconomic and political determinants of malnutrition. So, it is crucial that issues of trade be addressed, because trade agreements (called the free trade, which favour countries of the North with heavy subsidies and create dependency of poorer countries) are at the origin of food insecurity. 
• Country governments and international bodies such as the WHO must actively advocate for policies and measures to enforce a regulation of trade and marketing of unhealthy foodstuffs in order to protect the health of populations, and of children in particular, from aggressive corporate influence. This issue needs to be seriously addressed. And it is of great concern that industry participation is envisaged in the development and implementation of the plan, but there isn't any mention of guidance on the management of conflicts of interest.
• Food and nutrition is not an isolated topic. It should be seen in the context of the wider health systems and as part of comprehensive primary health care. Therefore, the implementation plan must be aligned with the wider health systems, which should be based on primary health care with strong community participation. This is crucial to make nutritional interventions sustainable in local contexts. The use of Ready-To-Use-Food (RTUF), which are industry products to treat severe acute malnutrition, is an example: instead of relying on local ingredients that could enable the local production of this kind of product where it is needed, industry promotes their patented brands and create dependency of poor countries on them. This logic is completely inadequate and leads to the opposite direction in terms of food security and right to nutrition. By the way, RUTF are being heavily promoted by UNICEF. Although RUTFs (eg Plumpynut) are highly effective, they medicalise the problem and can undermine longer-term sustainable responses to the problem of child undernutrition
• There is concern that the issue of breastfeeding is not receiving much attention. The focus seems to be fading within the broader approach to nutrition in general. The battle for breastfeeding is far form being won, violations of the International Code of Marketing of Breast-milk Substitutes have been repeatedly reported by civil society organisations.  It is therefore imperative to keep on with the pressure for the Code to be taken seriously and make institutions and stakeholders, including WHO and UNICEF themselves, accountable.   

In October 2011, during the World Conference on Social Determinants of Health (WCSDH), held in Rio de Janeiro, Brazil, the issue of Food and Nutrition was brought up by PHM activists, present in good number at the Conference. It was stressed that food security is higly dependant on trade issues, so trade agreements need to be addressed in order to tackle this problem. It is to be regretted that there's no mention to trade in the Rio Declaration. This was highlighted during the closing session of the Conference, where Professor David Sanders spoke for PHM. See a part of this talk on http://www.youtube.com/watch?v=7W4a0gR5UoY.

During these several WHO events, many Member States have pronounced the same concerns as PHM. The statements of Southeast Asia countries (such as Sri Lanka, India and Thailand) and South America (such as Bolivia, Paraguay, El Salvador and Brazil) were alligned with PHM's position. This is to be valued in the watching process to strengthen advocacy strategies.

Suggested references:
- Global Health Watch 1 - chapter D3 ("Food"). Available at: www.ghwatch.org/node/22
- Global Health Watch 2 - chapters C3 ("Reflections on globalisation, trade, food and health") and D3.I ("Protecting breastfeeding"). Available at: www.ghwatch.org/ghw2/report-summary
- Global Health Watch 3 - chapter D2 ("UNICEF and the medicalisation of malnutrition in children")
- "Hungry for profit" - article by Sophie Arie. BMJ 2010;341:c5221.
- "Revitalising primary health care requires an equitable economic system - now more than ever" - article by David Sanders, Fran Baum, Alexis Benos and David Legge. J Epidemiol Community Health (2010). doi:10.1136/jech.2009.095125.
- "Ready-to-use therapeutic food RUTF stuff. Can the children be saved with fortified peanut paste?" - commentary by Michael Latham, Urban Jonsson, Elizabeth Sterken and George Kent. World Nutrition February 2011, 2, 2, 62-85.
- United Nations Standing Committee on Nutrition including Food and Nutrition Portal
- See WHO Nutrition Page
- See Scaling up Nutrition
- See Joint Statement by FAO, IFAD, WFP (July 2009) on Implementing the internationally agreed goals and commitments in  regards to global public health.
- see WHO's Essential nutrition actions paper
- World Bank (2010): Scaling up Nutrition: What will it cost? (Note the preference for micronutrients!)
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