<div dir="ltr"><div class="gmail_default" style="font-size:large"><br></div><br><div class="gmail_quote"><div dir="ltr" class="gmail_attr">---------- Forwarded message ---------<br>From: <b class="gmail_sendername" dir="auto">David</b> <span dir="auto"><<a href="mailto:dlegge@phmovement.org">dlegge@phmovement.org</a>></span><br>Date: Sat, Jan 20, 2024 at 11:37 AM<br></div><br><div class="msg-7179203351095097640"><u></u>
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<span class="m_-7179203351095097640mcnPreviewText" style="display:none;font-size:0px;line-height:0px;max-height:0px;max-width:0px;opacity:0;overflow:hidden">Stunting is static and anaemia in young women increasing</span>
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<h1 style="text-align:center;display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:26px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal">Global failure to achieve nutrition targets: stunting is static and anaemia in young women increasing </h1>
<p style="font-family:Tahoma,Verdana,Segoe,sans-serif;font-size:12px;line-height:100%;text-align:left;margin:10px 0;padding:0;color:#202020">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 <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=14db5e6879&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">EB154/22</a> (the biennial report on the Plan) which provides an update progress towards the realization of the <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=887439d854&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">comprehensive implementation plan</a> on maternal, infant and young child nutrition and on implementation of the <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=362a7d282f&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">International Code</a> of Marketing of Breast-milk Substitutes.<br>
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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.<br>
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Document <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=d1cacd1754&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">EB154/22</a> 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. <br>
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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.</p>
<h2 style="display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:22px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal;text-align:left">The structural drivers of malnutrition</h2>
The Secretariat report (<a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=178f16b79a&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">EB154/22</a>) 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. <br>
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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<a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=91bbfd7b1a&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank"> Lancet</a> on the political economy of infant and young child nutrition.<br>
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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. <br>
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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). <br>
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IBFAN/BMA has <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=c3c479aa2a&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">recently reported</a> 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.
<h2 style="display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:22px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal;text-align:left">Food security, dietary diversity, food sovereignty </h2>
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. <br>
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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.
<h2 style="display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:22px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal;text-align:left">Putting healthy nutrition at the core of primary health care</h2>
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.<br>
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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. <br>
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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.<br>
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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.
<h2 style="display:block;margin:0;padding:0;color:#202020;font-family:Helvetica;font-size:22px;font-style:normal;font-weight:bold;line-height:125%;letter-spacing:normal;text-align:left">Breastfeeding</h2>
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.<br>
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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 <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=4e289542ca&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">WHA75(21)</a> which requested guidance for Member States on regulatory measures to restrict digital marketing of breast-milk substitutes, which has led to a <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=f5ce14ba30&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">new guidance</a> of 11 recommendations for Member State action.<br>
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In a <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=db3073625b&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">preliminary comment on this EB agenda item IBFAN</a> has highlighted digital marketing, infant feeding in emergencies, messaging and global trade. PHM joins with IBFAN in:
<ol>
<li>calling on WHO to adopt a strong resolution demanding that member states implement fully the new guidance;</li>
<li>emphasising the importance of protecting and supporting women who want to breastfeed in humanitarian and emergency situations; </li>
<li>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</li>
<li>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.</li>
</ol>
<b></b><b>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. </b><br>
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<b>PHM joins with IBFAN in calling for a strong resolution demanding that member states fully implement the <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=c22545c942&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">guidance</a>. 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.</b>
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<p style="font-family:Tahoma,Verdana,Segoe,sans-serif;font-size:12px;line-height:100%;text-align:left;margin:10px 0;padding:0;color:#202020">The full <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=018213aa9b&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">PHM commentary on this item</a> provides more detail and references. See also Tracker links to <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=e8d911d60b&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">previous discussions of maternal, infant and young child nutrition</a>. </p>
<p style="font-family:Tahoma,Verdana,Segoe,sans-serif;font-size:12px;line-height:100%;text-align:left;margin:10px 0;padding:0;color:#202020"><span style="font-size:12px">The WHO Tracker and PHM item commentaries are produced as part of <b>WHO Watch</b> which is a project of the <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=4b747c0213&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">People's Health Movement</a> in association with <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=b97ba77994&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">Medicus Mundi International</a>, <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=2e3fcc0152&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">Third World Network</a> and a number of other civil society networks. WHO Watch contributes to democratising global health governance, through new alliances, new information flows and by broadening the policy discourse.</span></p>
<p style="font-family:Tahoma,Verdana,Segoe,sans-serif;font-size:12px;line-height:100%;text-align:left;margin:10px 0;padding:0;color:#202020">See the WHO Tracker page for this EB154 session (<a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=cb89ed2837&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">here</a>). See PHM’s <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=52e801ba77&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">integrated commentary</a> on the full agenda of EB154 (or read the <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=ec94ecc45f&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">flipbook version</a>). To ensure that you receive Update Alerts <a href="https://phmovement.us20.list-manage.com/track/click?u=559d715f58f654accf3de987e&id=167d912859&e=ade41a541f" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">subscribe</a> to the Updater. <br>
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<p style="font-family:Tahoma,Verdana,Segoe,sans-serif;font-size:12px;line-height:100%;text-align:left;margin:10px 0;padding:0;color:#202020"><span style="font-size:12px">To provide feedback on this newsletter please write to <a href="mailto:editor@phmovement.org" style="color:#007c89;font-weight:normal;text-decoration:underline" target="_blank">editor@phmovement.org</a>.</span></p>
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