Members of the World Health Organization (WHO) are evaluating progress on the Decade of Action on Nutrition 2016-2025 (The Decade) at the 152nd meeting of the United Nations (UN) agency’s Executive Board. Their discussion comes in the midst of rising levels of hunger and food insecurity in many parts of the world, making it particularly relevant. Knowing that food and nutrition affect, and are affected by many different factors – not only health but also agriculture and farming as well as trade and finance, attracting significant corporate interests – members of the WHO find themselves in front of difficult questions. Are they doing enough to address the systemic drivers of malnutrition and non-communicable diseases (NCDs)? How can they introduce a lens of critical political economy when it comes to the links between health, food, the environment and ecology?
Missed targets
The United Nations’ (UN) Millennium Development Goals (MDGs) set as the first of eight ambitious goals “to eradicate extreme poverty and hunger” by 2015. Specifically, the goal was to halve the proportion of people who suffer from hunger between 1990 and 2015. The prevalence of underweight children under 5 in the set period did decline worldwide from 24.5% in 1990 to 14.1% in 2015, but the target of halving the proportion of children underweight was not met. Progress on tackling undernutrition was also unevenly distributed between and within different regions of the world. Taking stock in 2015, there were still 94.5 million children under 5 years underweight, 163.4 million experiencing stunted growth, and 47.3 million of too low weight for their height.
At the same time, it became increasingly clear that eliminating malnutrition worldwide would be a more complex challenge than anticipated. Obesity and associated diet-related chronic diseases such as diabetes, hypertension, and cardiovascular diseases were on the rise, highlighting the increasing double burden of malnutrition, in which over- and undernutrition exist at the same time. By 2016, more than 1.9 billion adults and 379 million children were overweight and obese. In 2014, representatives of governments, civil society, and the private sector acknowledged this new dimension to malnutrition was acknowledged at the 2nd International Conference on Nutrition (ICN2), organized by the WHO and the Food and Agriculture Organization (FAO). The conference resulted in the Rome Declaration, which recognised the complexity of the root causes of malnutrition, acknowledging the role of poverty, access to food, and links between sanitation and hygiene, safe drinking water, and access to education and malnutrition. The accompanying Framework for Action included 60 concrete recommendations ranging from issues as wide ranging as supporting local food production to trade issues and Universal Health Coverage. It also included the request to follow up on progress in forthcoming FAO and WHO meetings.
Two years later, the UN launched the Decade of Action on Nutrition (2016-2025) along with the new Sustainable Development Goal (SDG) 2 “End hunger, achieve food security and improved nutrition and promote sustainable agriculture”, which was set a year earlier in 2015. The Decade is led by the WHO and the FAO, and has as a vision:
“to build a world where all countries, organizations and others working on nutrition coordinate action and strengthen collaboration so that all people at all times and at all stages of life have access to affordable, diversified, safe and healthy diets.”
Although not accompanied by any new funding, The Decade was meant to inspire national-level actions toward SDG 2, setting the agenda across UN agencies.
Vertical interventions take over
Unfortunately, the discussion on diet in the health arena is currently completely divorced from issues of food production, biodiversity and trade. Malnutrition is a topic that has been progressively medicalized, focusing on vertical interventions and quick technological fixes for nutrient deficiencies. This has shifted the discourse away from a comprehensive approach which takes into consideration the systemic drivers of malnutrition, such as the globalization of food systems, corporate agri-business, and its connection to the larger political economy.
The conceptualization of diet as an individual choice and a private good fails to recognize the important social, economic and environmental dimensions of diet and food. This skewed view of malnutrition is reinforced by the tendency to see human biology as a closed system in which nutrients act, thus setting aside the social, cultural, economic and political context in which it exists.A better view of nutrition should be found in the concept of food sovereignty as defined in the Declaration of the Forum for Food Sovereignty, Nyéléni, Mali (2007). The declaration was supported by 500 peasants, farmers, fishers, pastoralists, indigenous peoples, and other representatives from more than 80 countries, and states:
“Food sovereignty is the right of peoples to healthy and culturally appropriate food produced through ecologically sound and sustainable methods, and their right to define their own food and agriculture systems. It puts the aspirations and needs of those who produce, distribute and consume food at the heart of food systems and policies rather than the demands of markets and corporations.”
WHO members need to take bold action on malnutrition
Soil degradation, natural disasters, droughts, conflicts, cost of seeds, volatile food prices, and increasing debts will throw up new challenges for food production in the coming decades, particularly for small farmers and producers. Climate breakdown demands fundamental reform of the political economy of our food and energy systems if we wish to make any progress towards ending hunger and malnutrition by the end of The Decade. It is therefore a welcome change that the UN report on the Implementation of The Decade (2022) mentions:
“The nutrition narrative shifted towards a more holistic approach linking it with food systems, ecosystems, climate, and the health of humans and animals, recognizing the potential for policy options across food systems to deliver double/triple duty actions that address malnutrition in all its forms. There is also increased recognition of the role of agroecology and biodiversity for enhancing food systems resilience in crisis-prone areas.”
Unfortunately, according to the WHO progress report, the organization’s members in their actions have in recent years focused more on information policies, awareness-raising campaigns, and incentivizing behavioural change, rather than structural interventions. But it is only structural interventions that apply to the intersection of health with the food sector such as marketing restrictions, fiscal policies, and managing conflict of interest of big corporations, which can address the commercial determinants of health. Close collaboration with other ministries is necessary to strengthen food systems and address issues of trade.
The report presented at the Executive Board’s meeting is silent on the issues of small-scale producers, local food systems, forced migration, and land alienation contributing to malnutrition. Although not traditionally considered part of the mandate of health ministries, in a holistic upstream view of health, structural multi sectoral interventions are unmissable. Seeing the human body more holistically as an open system, intimately connected to political economy as well as ecology, is vital to re-envision how issues of trade, food production as well as ownership of land, oceans, and rivers are part of sustainable action on nutrition. It is therefore crucial that the WHO provides stronger normative guidance to its members, to drive bold interventions rooted in food sovereignty to end malnutrition in this decade.
The WHO Watch team members are Aletha Wallace (Belgium); Dian Maria Blandina (Indonesia/Germany); Marta Caminiti (Italy); Sarai Keestra (Netherlands); Chiamo Seraphine (Cameroon). The team is being assisted by Lauren Paremoer (South Africa), Jyotsna Singh (India) and Gargeya Telakapalli (India).
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