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[Claudio Schuftan]

From: Vandana Prasad <chaukhat at yahoo.com>


*International Conference on Critical Public Health Consequences of the
Double Burden of Malnutrition and the Changing Food Environment in South
and South East Asia*

India International Centre, New Delhi
28th – 30th March, 2018

*CONFERENCE DECLARATION*

More than 350 people, with 72 invited resource persons, including
researchers, activists, practitioners and policy makers from 13 countries
and 21 states in India met over three days in the International Conference
on Critical Public Health Consequences of the Double Burden of Malnutrition
and the Changing Food Environment in South and South East Asia.

Five plenary sessions and 13 workshops provided a platform for the sharing
of global campaigns, studies, and experiences, including specific country
experiences from Brazil, Afghanistan, Thailand, Bangladesh, Nepal, Mexico,
South Africa, Malaysia, and India.

The workshops discussed issues related to agricultural crises, women’s
labour, livelihood and nutrition, law, policies, programmes at national and
global levels, conflicts of interest, culture and indigenous knowledge,
scientific evidence on undernutrition, obesity, non-communicable diseases
(NCDs), nutrition and the market, management of acute malnutrition along
with the role community mobilisation, and networking among campaigns at
local, national and international levels. The role and responsibility of
the state and public policy in addressing these structural factors was
emphasized.

The high level of undernutrition in many countries of South and South East
Asia along with rapid transition to obesity resulting in the ‘double burden
of malnutrition’ in the region was discussed. The substantial morbidity and
mortality from communicable diseases such as tuberculosis (TB), malaria,
pneumonia, and diarrhoea usually associated with under-nutrition; and NCDs
like diabetes, hypertension, cardiac disease, and strokes, associated with
obesity were raised as major public health concerns. In India, the disease
profile of NCDs is somewhat different, with one-third of diabetics actually
having low body mass index (BMI) and with haemorrhagic stroke (possibly
caused by hypertension) now being the highest cause of death among the
poorest quintile of the population. These pathways are not well understood.

The importance of understanding the politics and political economy of
hunger, undernutrition as well as obesity was highlighted throughout the
Conference. Socioeconomic inequalities based on income, region, caste and
gender resulting in an uneven burden of malnutrition and disease, with the
most marginalised being most affected, emerged as a common theme throughout
the Conference.

The Conference recognised that both undernutrition and obesity have common
underlying roots in our globalized world. These primarily relate to the
impact on food systems (from farm to fork); on current agricultural
practices, and practices related to food production, manufacture,
distribution, trade, and commercial practices.

It was also made evident that the global trade regime under the aegis of
the World Trade Organization (WTO) and increasingly impacted by Free Trade
Agreements (FTAs) has had a profound impact on agricultural practices and
food trade in different parts of the world, as well as on food and
nutrition security, food habits, and food sovereignty. RECOMMENDATIONS
General Concerns and Call for Action
The Conference calls upon claim holders to organize and mobilize to demand
from governments across the world to broaden the purview of nutrition
policy to bring in a multi-sectoral approach that simultaneously addresses
immediate, as well as basic, causes of malnutrition. Interventions for
addressing the double burden of malnutrition must be rooted in an approach
that ensures equitable food systems. The Conference expresses concern that,
across the region, local foods are being taken over by processed and
ultra-processed foods reducing food diversity and also the nutrient quality
of the food. This process is being witnessed across the spectrum in public
programmes aimed at tackling malnutrition (e.g. Ready-to-use therapeutic
food for severe acute malnourishment, packaged foods as supplementary
nutrition) on one end and the spread of ultra-processed foods sold in the
markets by global food companies and large corporations on the other. To
counter these trends, governments must introduce health-oriented fiscal
policies and strong advertising and marketing regulations.

Experiences around the world show that public policies that are oriented
towards the poor contribute to more equitable income and resource
distribution, and that decline in absolute poverty and universal access to
social services are central to achieve improvements in undernutrition.
Social determinants of nutrition including access to sustainable
livelihoods as well as basic public services are critical in improving
nutrition outcomes. Demands for greater equality and universalisation of
public services must, therefore, become part of all efforts. Protecting and
promoting decentralised community control over food systems is a must for
the creation of food and nutritional security. Apart from provisioning more
nutritious foods, it would also foster deeper understanding of the
importance of diverse diets and nutrition.

Systems for monitoring by the community and mechanisms for increased
accountability and transparency need to be actively pursued by civil
society organisations and social movements. Greater decentralisation is
required for democratisation of food systems and deepened understanding of
the importance of diverse diets and nutrition. The move towards
privatisation of health and nutrition services needs to be resisted and
there must be an emphasis on both public funding and public provisioning.

Dietary Diversity and Nutrition Public programmes for procurement and
distribution of food must be designed in a manner where they encourage
local production and consumption of locally available diverse foods such as
millets, vegetables, fruits, eggs, and meat.

Policies towards making foods such as millets, fruits, vegetables, pulses,
nuts and seeds more available and affordable for all must be put in place.
Efforts must be made to ensure that such foods (cooked and raw) must be
easily available and accessible at all places including the home, school,
street, and workplaces. Micronutrient deficiencies must be primarily
addressed through ensuring adequate access good quality food and dietary
diversity. We believe that the dilution of the link between food and
nutrition by the medicalisation and commodification of food needs to be
continuously resisted.

We raise caution on the introduction of genetic modification technology in
food in the name of improving food and nutrition security and emphasise
that any interventions that have been known to impact health negatively,
need to be resisted. In the context of infectious diseases, comprehensive
management of the disease must include treatment, supplementary food and
financial support along with sufficient investments made on interventions
for prevention.

*Conflict of Interest (CoI) and Commercialisation*

The Conference recognises that the increasing trend towards corporate and
private philanthropic funding, public-private partnerships and
multi-stakeholder initiatives raises complex issues and concerns in
relation to nutrition governance and CoI. The PPPs promoted by
international agencies such as the UN and WHO to tackle the global burden
of NCDs have led to distortion of the definition of CoI and that has
damaging consequences.

The Conference demands guidelines and legal measures to prohibit
participation of food corporates and their front organisations in public
policy making and programme implementation to avoid conflict of interest.
National measures that give effect to the International Code of Marketing
of Breastmilk Substitutes and subsequent World Health Assembly resolutions
must be effectively implemented, monitored and enforced to protect
breastfeeding from commercial influence of baby food manufacturers by
effective implementation. Vigilance and stern oversight/action on this are
asked from progressive movement partners.

The long-term effects of ultra-processed foods on obesity and NCDs is a
rising concern. At the same time, evidence on association of mortality with
and relative efficacy of Ready-to-use Therapeutic Foods (RUTF); which share
many characteristics of ultra processed foods, as compared with different
food interventions for the treatment of severe acute malnourishment (SAM)
is weak. In this context, the Conference recommends that interventions for
addressing SAM be based on the use of home/community based diverse foods
along with improved care arrangements. Vigilance and stern oversight/action
on this are asked from progressive movement partners.

Effective legal measures need to be put in place to regulate promotion of
ultra-processed Foods to children, to levy extra taxes on high fats, high
sugar and salt food items and mandatory front of pack nutrition labelling
that allows consumers to check labels, thus, avoiding the increasing use of
these unhealthy foods causing overweight and obesity.


*Community’s rights over resources*
Laws and policies related to land must be amended to protect the land
resources of small and marginal farmers and the agricultural livelihood
options of landless labourers and prevent the transfer of agricultural and
forest land to corporations. It must be ensured that farmers are not locked
into unfair agreements with corporations that violate farmers’ right to
independently decide on crops to be grown.

Public investments in agriculture must be enhanced towards micro-irrigation
and judicious usage of water, promoting resilience to climate change,
reviving traditional seeds and crops, decentralised storage and
procurement, with remunerative prices for small and marginal farmers for
all food crops.

Investments in public food programs, including community-based management
of acute malnutrition, must be strengthened through decentralized,
production, processing and distribution procurement of local diverse foods
which supports rural livelihoods.

Community rights over forest resources must be protected and minimum
support price for forest produce must be ensured. Civil society must
continue its efforts to mobilize communities to take up this role.
The commodification of water and its illegal appropriation by private
enterprise, and, in particular, Big Soda is an area of priority for social
mobilization to actively oppose this trend.

Women’s labour and rights The knowledge, as well as unpaid and underpaid
labour of women farmers in South Asia, with respect to production,
gathering, raising, and processing of food and care, is critical to food
environments which have nutrition rich, ecologically sensitive, diverse
foods at the household, community, and national level.

Women’s social, economic and biological roles have to be recognized as
being central to food and nutrition security and nutrition policies have to
be looked at through the lens of empowering women and communities to retain
and strengthen control over their resources and food environments.
Women’s nutrition has to be a priority across the life cycle and not just
only be womb centric (only considered a priority during her reproductive
years). Addressing gender discrimination (intersecting with class, caste,
ethnicity, marital status, disability) in food, education, mobility, access
to resources and bodily integrity is critical to sustainable nutritional
security.

Comprehensive maternity entitlements and quality child care services are
public goods and nutrition security must be ensured with public investments
in universal, unconditional entitlements to all women and children.


*Evidence use and nutrition policy*

There is need for increased political momentum, through use of rigorous
processes on collecting, synthesizing and reporting evidence to ensure that
policy recommendations on
nutrition and health are informed by the best available research evidence.
The use of systematic reviews and evidence and gap maps (EGMs) in nutrition
related aspects specific to India could help identify research gaps, inform
design of new studies, and provide guidance where evidence is not
available, for relevant policy-making in the country.

However, there is also a danger in privileging certain methodological
approaches such as RCTs in research, as is the trend in nutrition and
public health fields. In this process practitioner-led and operational
research tends to be side-lined. An evidence-based approach, in any
circumstance, must not undermine human rights-based approaches to food and
nutrition on grounds of inadequacy of ‘evidence’. Systems must be evolved
where rigorous research based on diverse methods as well as experiential
knowledge are given due credit.

Movements Given the commonality of the problems faced across South and
South East Asia, and the potential for learning from each other, there is
an urgent need to re-initiate the South Asia Right to Food and Nutrition
Movement. The Conference suggests the setting up a small working group for
this purpose The Conference gives a call to all participants to join the
World Public Health and Nutrition Association (WPHNA) and collaborate
globally especially on conflict-of-interest issues. The conference gives a
call for closer co-ordination between social movements working on food,
health, nutrition and land, forests, water, women’s rights, trade unions,
informal workers to extend the reach of the discourse on the right to food
and nutrition. The Conference reiterates the need for a human rights
approach to food and nutrition, an approach which recognizes fundamental
rights of people and puts people not profits at the center of all policies
and interventions.

*Specific recommendations for India*

Available from chaukhat at yahoo.com
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