PHM-Exch> Fwd: [PHM NEWS] Global failure to achieve nutrition targets

Sat Jan 20 05:51:35 PST 2024

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From: David <dlegge at phmovement.org>
Date: Sat, Jan 20, 2024 at 11:37 AM

Stunting is static and anaemia in young women increasing

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Global failure to achieve nutrition targets: stunting is static and anaemia
in young women increasing

The Comprehensive Implementation Plan on Maternal, Infant and Young Child
Nutrition adopted in 2012 expires in 2025. WHO’s Executive Board meeting in
Geneva from 22 January will be considering where to go next with maternal,
infant and young child nutrition. The Board’s deliberations will be
informed by document EB154/22
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=14db5e6879&e=ade41a541f>
(the biennial report on the Plan) which provides an update progress towards
the realization of the comprehensive implementation plan
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=887439d854&e=ade41a541f>
on maternal, infant and young child nutrition and on implementation of
the International
Code
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=362a7d282f&e=ade41a541f>
of Marketing of Breast-milk Substitutes.

The WHO Comprehensive Implementation Plan for Maternal, Infant and Young
Child nutrition promised to end all forms of malnutrition by 2030,
including achieving, by 2025, agreed targets on stunting and wasting in
children under 5 years of age, and address the nutritional needs of
adolescent girls, pregnant and lactating women and older persons. The Plan
also addresses anaemia in reproductive age women, low birth weight and
overweight in children, and exclusive breastfeeding in the first six months
of life.

Document EB154/22
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=d1cacd1754&e=ade41a541f>
projects that global progress on maternal and infant nutrition will fall
way short of reaching stunting, anaemia, low birth weight, childhood
overweight, and wasting targets set for 2025, and will marginally achieve
the exclusive breastfeeding target. Stunting, low birth weight and wasting
have only reduced by less than 2% since the 2012 baseline, and anaemia in
reproductive age women and childhood overweight has actually increased
since the 2025 targets were set.

In 2018, UNICEF and WHO proposed new targets for 2030, projecting the 2025
targets of the Comprehensive Implementation plan to the 2030 deadline for
the SDGs. These included more ambitious targets for exclusive breastfeeding
(≥70% in the first 6 months of life) and wasting (<3%). However, at the
current rate the world is not on track to meet these targets; the state of
maternal, infant and young child nutrition is getting worse, rather than
better.
The structural drivers of malnutrition The Secretariat report (EB154/22
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=178f16b79a&e=ade41a541f>)
does not provide any analysis of the drivers of the malnutrition crisis nor
does it describe the obstacles to effective implementation of agreed
actions. The section on the five actions simply lists various activities
which have taken place in the last two years with no reflection on why the
five actions have not impacted on the six targets.

For the Secretariat to ask the Board to consider what should replace the
Comprehensive Implementation Plan from 2025 onwards without offering any
analysis of the drivers of malnutrition or the obstacles to effective
action, suggests deep cognitive dissonance. In contrast, see Lancet
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=91bbfd7b1a&e=ade41a541f>
on the political economy of infant and young child nutrition.

Despite the attention of different UN agencies to issues of nutrition,
there appears to have been little attention towards the political economy
of food systems, and the role of big agriculture and big food in shaping
food supply globally. Nutrition policy must engage with the origins of
food, its interconnectedness with land ownership and use, its mediation
through neoliberal globalisation and trade, and how our disconnect from the
origins of food is also contributing to ecological crises including climate
heating.

Global leadership for effective regulation of sugary drinks and the
marketing of unhealthy products to school-age children is needed to curb
increases in childhood obesity across different WHO regions. This is
important as the combination of undernutrition in early life and
overnutrition due to an obesogenic environment in later life predisposes
towards non-communicable diseases such as diabetes type 2, cardiovascular
disease and other aspects of metabolic syndrome. The report fails to report
action on the regulation of foods high in fat salt and sugar (HFSS) or
ultra processed foods (UPF).

IBFAN/BMA has recently reported
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=c3c479aa2a&e=ade41a541f>
on the adoption by the Codex Alimentarius of a new standard on follow up
formula for older infants and young children which ‘greenlights’ products
which are sweetened, unnecessary, ultra-processed and flavoured.   Food
security, dietary diversity, food sovereignty  The Secretariat report
provides no analysis of food insecurity and the need for substantive food
system reform that addresses structural inequities inherent in global food
systems.

The report regrets that official development assistance for nutrition
specific interventions is insufficient and PHM shares this regret. However,
nutrition specific interventions do not address the distortions embedded in
global food systems. Reaching the 2025/2030 targets will require rethinking
the claims that big corporate agri-business can provide solutions for
global food security through its control of global supply chains and
reliance on technofixes. Food sovereignty should be the basis of a new
approach.  Putting healthy nutrition at the core of primary health care The
EB document mentions that nutrition services should be included in
universal health coverage. Universal health coverage proposes public
funding of a minimal benefit package comprising services that are purchased
from both public and private service providers, with private health
insurers competing in the market for beyond-the-package services.

In contrast primary health care puts prevention and a healthy environment
for children to grow and develop at its core. Community health workers can
play an important role in child malnutrition and their contributions have
been documented in countries such as India, Thailand and Bangladesh.

PHM rejects a model in which nutrition is seen as a "service" which can be
commodified into a stripped-down market-based health system. Instead,
adequate nutrition, especially in early life, must be seen as a fundamental
human right and as the basis on which health is built. This includes
attention for dietary diversity and food sovereignty as a part of a
community participation approach to ending malnutrition.

There are very real nutrition needs which can be addressed through targeted
and context specific nutrition services, for example, micronutrient
deficiencies in adolescent girls and young women, and during gestation and
lactation. However, such services must be shaped by context and embedded in
comprehensive primary health care and integrated with community wide
programs directed to dietary diversity and food sovereignty.  Breastfeeding
The most serious weakness of this report is the lack of emphasis on
breastfeeding, which is the intervention that has the best cost-benefit for
several outcomes, including infant mortality. The document talks about
exclusive breastfeeding, but all breastfeeding is important. The document
states that there was a significant increase in exclusive breastfeeding,
but it also states that out of 106 countries with sufficient data, most
(between 90 and 100 countries) have not and are not likely to achieve the
2025 target. This is very concerning.

Since the International Code of Marketing of Breast-milk Substitutes came
into action in 1981, only 32 countries have adopted legal measures to
implement measures aligned with the Code. In 2022 the WHA adopted decision
WHA75(21)
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=4e289542ca&e=ade41a541f>
which requested guidance for Member States on regulatory measures to
restrict digital marketing of breast-milk substitutes, which has led to a new
guidance
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=f5ce14ba30&e=ade41a541f>
of 11 recommendations for Member State action.

In a preliminary comment on this EB agenda item IBFAN
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=db3073625b&e=ade41a541f>
has highlighted digital marketing, infant feeding in emergencies, messaging
and global trade. PHM joins with IBFAN in:

   1. calling on WHO to adopt a strong resolution demanding that member
   states implement fully the new guidance;
   2. emphasising the importance of protecting and supporting women who
   want to breastfeed in humanitarian and emergency situations;
   3. calling for safeguards to prevent humanitarian programs from
   promoting ultra-processed fortified products as magic bullets with no
   mention of breastfeeding or the importance of bio-diverse foods; and
   4. calling on UN and humanitarian agencies to challenge the
   corporate-led food system that has done so much harm to the ecosystem and
   bio-diverse sustainable foods.

*PHM urges member states to request that the Secretariat undertake a
comprehensive review of the economic and political circumstances which
sustain the nutrition crisis (including the structures and dynamics of
global food systems) and the commercial and political barriers to the
effective implementation of the five actions of the comprehensive
implementation plan.  *

*PHM joins with IBFAN in calling for a strong resolution demanding that
member states fully implement the guidance
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=c22545c942&e=ade41a541f>.
This resolution should include strong accountability provisions based on
peer review principles. It should also include provisions which will
contribute to strong professional and community constituencies which will
encourage governments to implement the guidance.*

The full PHM commentary on this item
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=018213aa9b&e=ade41a541f>
provides
more detail and references.  See also Tracker links to previous discussions
of maternal, infant and young child nutrition
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=e8d911d60b&e=ade41a541f>
.

The WHO Tracker and PHM item commentaries are produced as part of *WHO
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<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=4b747c0213&e=ade41a541f>
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<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=b97ba77994&e=ade41a541f>,
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See the WHO Tracker page for this EB154 session (here
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=cb89ed2837&e=ade41a541f>).
See PHM’s integrated commentary
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=52e801ba77&e=ade41a541f>
on the full agenda of EB154 (or read the flipbook version
<https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=ec94ecc45f&e=ade41a541f>).
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