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Suggested Citation:"6 The Global Response to the Crises." Institute of Medicine. 2010. Mitigating the Nutritional Impacts of the Global Food Price Crisis: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12698.
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6
The Global Response to the Crises

A wide constellation of people and organizations work on nutrition and food security issues. These include, for example, multilateral United Nations (UN) agencies, bilateral government agencies, nongovernmental organizations, universities, research institutions, foundations, and the private sector. As described by moderator Hans Herren of the Millennium Institute, the following presentations helped workshop participants understand the landscape of the global nutrition field, the people and organizations who work in it, and their respective roles, functions, and capacities to respond to the outcomes of the recent food price and economic crises.

INTRODUCTION TO THE GLOBAL NUTRITION LANDSCAPE

Ruth Levine, Ph.D.,

Vice President for Programs and Operations; Senior Fellow

Center for Global Development


The Center for Global Development recently published a document titled Global Nutrition Institutions: Is There an Appetite for Change? The project followed work done for the Lancet series on maternal and child undernutrition, in which some key weaknesses were identified in the way international institutions are organized and work together, and the level of funding and capacity they have (Morris et al., 2008). The paper took a closer look at these issues with the hope of provoking thinking and conversation about how the institutional arrangements could be improved to serve the current needs of the international nutrition community (Levine and Kuczynski, 2009).

Suggested Citation:"6 The Global Response to the Crises." Institute of Medicine. 2010. Mitigating the Nutritional Impacts of the Global Food Price Crisis: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12698.
×

Global Nutrition Landscape Comprised of Many Actors, Spread Thinly

A large set of different roles needs to be filled in any sector or across any sectors, and the nutrition and food security areas are no exception (Table 6-1). Owing to historical and other factors, there is persistent confusion and sometimes conflict around which institutions play which roles and how they do that together.

One role could be characterized as that of setting norms. In this area, the World Health Organization undertakes work, and the UN Standing Committee on Nutrition also acts as a forum for UN agencies to discuss topics on this subject.

Research activity is principally being undertaken by academic institutions and in specialized research institutions. Generally, research is quite widely disseminated but often without a defined role to play in policy and programmatic decisions.

TABLE 6-1 Illustrative Organizations Active in International Nutrition

Category

Organization

Key Role(s) Related to Nutrition

Multilateral Agencies

 

 

 

UNICEF

Program implementation focused on maternal and child health, norms, and standard setting. Focus is on nutrition security, micronutrients, breast-feeding, and emergency response.

 

United Nations Standing Committee on Nutrition

Network of food and nutrition professionals. Promotes cooperation among UN agencies and partner organizations, including NGOs, in support of community, national, regional, and international efforts to end malnutrition.

 

The World Bank

Project and sector financing to countries with loans on near commercial and soft terms. Supports government implementation of projects and policy reforms with technical assistance from The World Bank staff and consultants.

 

World Food Programme (WFP)

Implementation of emergency response and food aid. Provides logistics and support through development programs. Operates school feeding programs.

Suggested Citation:"6 The Global Response to the Crises." Institute of Medicine. 2010. Mitigating the Nutritional Impacts of the Global Food Price Crisis: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12698.
×

Category

Organization

Key Role(s) Related to Nutrition

 

World Health Organization (WHO)

Sets standards, and establishes policies and programs. Biomedical and public health focus on reduction of micronutrient malnutrition, growth assessment, and surveillance.

Bilateral Agencies

 

 

 

Canadian International Development Agency (CIDA)

Donor with focus on micronutrient and other technical interventions, such as vitamin A programming and iodine.

 

U.S. Agency for International Development (USAID)

Largest bilateral donor; focus on targeted maternal and child health projects, micronutrient interventions.

Nongovernmental Organizations

 

 

 

Academy for International Development

Short-term technical assistance, product research and marketing. CARE Technical support. Focus on the delivery of food commodities and resources during emergencies.

 

Global Alliance for Improved Nutrition

Supports public-private partnerships to address micronutrient deficiencies.

 

Helen Keller International

Intervention delivery; research, and advocacy functions. Focus on nutrition, child survival, and eye health.

 

Manoff Group

Intervention delivery, communications and behavior-centered programming.

 

Micronutrient Initiative

Intervention delivery and research. Focus on micronutrient and vitamin deficiencies, vitamin A supplements, fortification.

 

PATH

Development of new diagnostics for micronutrient deficiencies; innovation in biofortified foods.

Universities and Research Institutions

 

 

 

Consultative Group on International Agricultural Research (CGIAR)

Research; alliance of members, partners and 15 international agricultural centers. Focus on food security.

Suggested Citation:"6 The Global Response to the Crises." Institute of Medicine. 2010. Mitigating the Nutritional Impacts of the Global Food Price Crisis: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12698.
×

Category

Organization

Key Role(s) Related to Nutrition

 

Cornell University

Training and research, including basic science, community nutrition, policy development.

 

Instituto de Investigación Nutricional (Lima, Peru)

Research and program implementation, teaching and training services in health and nutrition. Focus on community health in Peru.

 

International Center for Tropical Agriculture (CIAT)

Development of biofortified foods.

 

International Food Policy Research Institute (IFPRI)

Scientific research and related activities; supported by CGIAR; focus on food security and poverty reduction. Implementing HarvestPlus.

 

Johns Hopkins University Bloomberg School of Public Health

Research and training in public health nutrition.

 

London School of Hygiene and Tropical Medicine

Research and training in public health nutrition.

 

Mahidol University, Thailand

Research and policy analysis, training, and consultation.

Private Sector

 

 

 

Danone

Grameen Danone partnerships to promote local entrepreneurship in nutrition.

 

Unilever

Partnership with the WFP to improve the nutrition and health of poor school-aged children.

Philanthropies

 

 

 

Bill & Melinda Gates Foundation

Focus is on reducing micronutrient deficiencies and undernutrition in vulnerable groups, particularly women and children less than 2 years through Global Health Program; Global Development Program includes grant making to increase quantity and quality of staple foods.

 

Children’s Investment Fund

Emerging emphasis on nutrition and food security as part of long-term development programs.

SOURCE: Levine and Kuczynski, 2009.

Suggested Citation:"6 The Global Response to the Crises." Institute of Medicine. 2010. Mitigating the Nutritional Impacts of the Global Food Price Crisis: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12698.
×

A small number of funders are active in international nutrition. The U.S. Agency for International Development (USAID) and the Canadian International Development Agency have been longstanding financial supporters among the development agencies. There are now some new entrants into funding nutrition and food security efforts, including Irish Aid, the United Kingdom (UK) Department for International Development, the European Union (EU), and the Bill & Melinda Gates Foundation.

On the implementing side, there are large international nongovernmental organizations (NGOs) such as Save the Children and CARE. Important implementers are also governments in developing countries where, within ministries of health, social protection, and to some extent ministries of agriculture, there are nutrition-related activities underway, funded either through domestic sources or with external support.

Several entities are involved in policy development, advocacy, and building capacity. The major UN agencies—including the United Nations Children Fund (UNICEF), the World Health Organization (WHO), and the World Food Programme (WFP)—all play roles across many of those different domains: implementation, research, generating and allocating funding, setting norms, and building capacity.

Major Challenges

Three inherent characteristics of the field of nutrition make it a special challenge institutionally, as well as in terms of communication to policy makers. First, there is not always a clear, direct link between nutritional status and tangible, measurable outcomes such as lives lost. As a result, the international nutrition community ends up being dependent on disability-adjusted life years (DALYs), which are not very compelling or intuitively understood. Further, it is not entirely clear under what health problem (or even social problem) nutrition broadly fits, because poor nutrition contributes to many types of poor health outcomes; in this way, nutrition is everyone’s problem, but no one’s responsibility. In addition, there are quite profound measurement errors that interfere with the ability of institutions and policy makers to determine what to do about nutrition. Both under- and overnutrition are relative constructs without necessarily a very direct line to a biomedical result. To motivate action and attract champions and clear lines of action, this lack of a direct link to a tangible outcome is a major challenge for global nutrition actors.

Second, nutrition is part of the poverty and social justice agenda. It is more about the distribution of resources in a society than anything else. As a result, it is not entirely clear who the nutrition “constituency” is. Relative to the size of the problem and compared to some other problems for which biomedical solutions (vaccines, drugs) dominate, there are few technological solutions. Nutrition has to do with the social determinants of health as well as a set of individual behaviors,

Suggested Citation:"6 The Global Response to the Crises." Institute of Medicine. 2010. Mitigating the Nutritional Impacts of the Global Food Price Crisis: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12698.
×

which complicates categorizing nutrition as a specific, tractable health issue in need of a solution.

The third inherent characteristic of nutrition that makes it institutionally complicated is how profoundly it spans sectors—primarily health and agriculture. These two sectors, unfortunately, do not have a long track record of successfully working together or having a mutual understanding.

The current arrangement of institutions, and the interactions among them, does not seem able to handle either the broad nutrition challenges that have persisted for decades or the more immediate challenge of food security amidst the economic crisis. Funders encounter a fractious environment of institutions and groups attempting to establish norms and priorities and advocating their own technical solutions or implementation approaches. Groups with particular interests defend their territory, which is not surprising in an environment of restrained resources, but this undermines other messages about priorities. Partially as a result, decision makers at the national and subnational levels often receive contradictory or confusing guidance from international partners and face a somewhat chaotic set of program ideas and implementations to support.

Does the Nutrition Community Have What It Takes to Respond to the Current Challenges?

Six elements are commonly found among successful large-scale public health achievements (Levine, 2007). One is adequate, reliable, and long-term funding. This is clearly missing from the nutrition sector relative to the size of the problem. Funding for nutrition programs is low. Relatively few international agencies have made significant commitments at the national level. With some exceptions, domestic resources for nutrition programs are low.

The second element that is essential for success is the existence of genuine champions and leadership at the international and national levels. Such champions for nutrition are also missing at the moment. Nutrition is not very prominent on the global health agenda. Those in the nutrition community have a track record of talking within the nutrition community; they gravitate toward technical subjects and have difficulty broadly communicating consistent messages, not only about the importance of under- and overnutrition, but also about a set of actions that with sufficient resources could make a major positive difference.

The third element necessary for success is technological innovation within effective delivery systems. That does not mean a magic bullet. What has been observed in other global health successes is that there is a real momentum established when a new approach or new idea is “packaged” and talked about in a coherent way. There is a lot of promise within the nutrition community, and there are some excellent examples from the past, but much debate remains about the most promising approaches, especially regarding the appropriate role

Suggested Citation:"6 The Global Response to the Crises." Institute of Medicine. 2010. Mitigating the Nutritional Impacts of the Global Food Price Crisis: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12698.
×

of the private sector as a delivery channel and as a partner in addressing nutrition challenges.

The fourth element is technical consensus among the recognized expert community, including both at the national level and internationally, about the magnitude of the problem and the way forward. Much progress has occurred in nutrition in the past few years, with the Lancet series in particular providing clear evidence and a synthesis of evidence about the window of opportunity from birth to 2 years. The series identified a set of interventions that has now been reasonably well evaluated (Bhutta et al., 2008). At the same time, there is still some debate around that technical consensus; there are remaining questions about ready-to-use therapeutic feeding, for example. There is little agreement about what the connections should (or can) be between the health, nutrition, and agricultural communities and their interventions.

The fifth element of success is good management on the ground, often termed capacity. Currently, major capacity gaps are observed in nutrition. This lack of capacity can be attributed to the persistent shortages in funding as well as the sectoral spread of responsibilities. In international agencies, there are not many positions that focus full-time on nutrition; at a country level, similar situations lead to weak on-the-ground capacity.

The final element that is required for success is effective use of information for awareness creation, monitoring, learning, and evaluation. The nutrition community has suffered from insufficient translation of the evidence that does exist to decision makers at the policy level.

The Way Forward

Recently, within the international nutrition community, much discussion has focused on the lack of institutional capacity and other weaknesses. There is a real recognition that there are institutional problems to solve. There are questions about which members of the UN family will emerge to take the lead in bringing players together to define coherent messages to nonnutrition policy communities, advocating for more resources, and becoming a channel for those resources to be used.

It is unlikely that members of the nutrition community themselves are going to spontaneously solve these problems. Instead, what may be required is a high-level mandate for institutional change. Ideally, that mandate should come from leaders in the developing world through the vehicle of the G20 or other forum. Short of that, the mandate should come from some of the major funding agencies working together to lay out a set of expectations about how institutions should and could learn to allocate roles and work together.

At the same time, there need to be adequate resources or additional resources devoted to bolstering institutional capacity within the key UN agencies and others,

Suggested Citation:"6 The Global Response to the Crises." Institute of Medicine. 2010. Mitigating the Nutritional Impacts of the Global Food Price Crisis: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12698.
×

so that there can be a response to that mandate. The institutional leadership—the key coordinating institution—needs to come from within the UN family.

Serious engagement of the private sector is an element that needs to be fostered. Significant new resources need to be brought to bear (at a minimum internationally, but ideally from affected countries themselves) to help with the processes of establishing a technical consensus, building the evidence, scaling up key programs, and monitoring their results.

THE ROLE AND CAPACITY OF FOUNDATIONS IN RESPONDING TO THE CRISES

Haddis Tadesse, M.P.A., Policy and External Relations Officer

The Bill & Melinda Gates Foundation


The Bill & Melinda Gates Foundation believes that people are trapped in poverty and ill health not because of how smart or dedicated they are, but simply because of where they were born and, consequently, whether they have access to tools, technologies, vaccines, health care, or the general environment necessary to lead a healthy and productive life. The Bill & Melinda Gates Foundation cannot be involved in every important development issue; instead, a few key questions drive its decisions about which issues to focus on: What issues affect the most people? What issues have been neglected? Where can the Foundation make the greatest impact?

The Global Development Program

The Bill & Melinda Gates Foundation gives about 50 percent of its resources to global health, about 25 percent to U.S. programs that focus mostly on education, and about 25 percent to global development, of which agricultural development is the largest program. The Global Development Program was designed with a set of key principles:

  • Philanthropy plays an important but limited role. The Bill & Melinda Gates Foundation can take risks, move quickly, and catalyze change, but large-scale, sustainable change is driven by markets and governments. The Bill & Melinda Gates Foundation sees its role as complementing and strengthening governments, not competing with or replacing them.

  • The focus must be on benefitting individuals. There are many ways to approach and quantify development. Individual people are the lens through which the Bill & Melinda Gates Foundation views and measures success.

  • The greatest impact can be achieved by focusing on a few key, long-term issues.

Suggested Citation:"6 The Global Response to the Crises." Institute of Medicine. 2010. Mitigating the Nutritional Impacts of the Global Food Price Crisis: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12698.
×

More than 1 billion people live on less than $1 a day, and about 1 billion people are chronically hungry. This kind of grinding poverty often reduces life to a daily struggle for survival. Food, water, shelter, health care, and education can seem like luxuries. A majority of the people who live on less than $1 a day rely on agriculture but struggle to grow enough food to eat. Because the Bill & Melinda Gates Foundation is concerned with reducing hunger and poverty, agriculture was an obvious place to start.

The story of agricultural progress parallels the story of human progress. Over the past 200 years, nearly every part of the developed world has seen an agricultural transformation that has dramatically reduced poverty and hunger. When agriculture flourishes, so does society; where it doesn’t, hunger and poverty take root. Yet agriculture in developing countries has been neglected by country governments and donors over the past several decades. That neglect has produced a lower level of food production than is necessary.

Farmers in Africa and in South Asia face starkly different circumstances than those in more prosperous regions. While of course African farms should not necessarily look like farms in the United States, they lend themselves to comparison. A typical farmer in the United States will have a large tract of land; a tractor equipped with a global positioning system (GPS), air drill, and other technologies that analyze soil; variable fertilizer applications; access to the best scientists in the world; and a global supply chain. The experience of a typical farmer in Africa is vastly different. She has a very small amount of land; no reasonable access to input or output; no roads; no extension services; no access to credit; no marketing information; and, should production fall, there is no safety net to protect her. For Africans, farming is a risky and unforgiving enterprise.

Agricultural Goal of the Gates Foundation

The goal of the Bill & Melinda Gates Foundation is simple, yet ambitious. It is to help 150 million farming families move out of poverty while significantly improving child and household nutrition. The approach begins and ends with the small farmer. Everything the Bill & Melinda Gates Foundation does is focused on him or, more likely, her. Women are at the center of these efforts, and the impact of each grant on gender is considered.

The Bill & Melinda Gates Foundation focuses on sub-Saharan Africa and South Asia simply because about 80 percent of the people who make less than $1 a day live in those regions. The results the Bill & Melinda Gates Foundation seeks include increased household incomes, child weights, and the quality and quantity of diets.

The story of one small farmer’s success—of growing, harvesting, and selling—is bound in the larger story of agriculture. Success requires not only quality seeds and healthy soils, but also good information, access to markets, and supportive policies. This is why the Bill & Melinda Gates Foundation is pursuing

Suggested Citation:"6 The Global Response to the Crises." Institute of Medicine. 2010. Mitigating the Nutritional Impacts of the Global Food Price Crisis: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12698.
×

improvements along the entire agricultural value chain. Obstacles to success in this space span sectors, and so do solutions. The Bill & Melinda Gates Foundation partners with organizations in the public and private sector in developing and developed countries.

Since its inception, the Bill & Melinda Gates Foundation has given 136 grants with a total commitment of $1.2 billion. The average size of grants is about $9.2 million. By far, the largest grantee is the Alliance for Green Revolution in Africa, which is a Nairobi-based organization led by Africans. The current chair of the alliance is former UN Secretary-General Kofi Annan; its mission is to usher a uniquely African Green Revolution on the continent. In Africa, the Bill & Melinda Gates Foundation’s grants represent less than 5 percent of the total global commitment of $9 billion for agriculture and agricultural spending in Africa.

Lessons Learned

The Bill & Melinda Gates Foundation has learned that the major determinant of success is the design of programs. The Bill & Melinda Gates Foundation chooses programs that are focused on the customer—in this case, smallholder farmers, and particularly women.

Another lesson learned is that the Bill & Melinda Gates Foundation cannot merely invest in science, technology, and production. Instead, market access programs, in which farmers have the ability to market their crops, earn income, and reinvest in their own agriculture, are key to empowerment and sustainability.

Additionally, the quality of partnerships defines the success of the Bill & Melinda Gates Foundation. The organization itself does not implement any projects on the ground; in this way, partners are paramount. Public-private partnerships offer a powerful opportunity to respond to the challenges of a global problem. By combining resources, merging expertise, and sharing risks, partnerships can deliver results. For partnerships to succeed in these joint ventures, each partner needs their roles defined clearly, based on the strength that each partner brings. Results of such partnerships must be tracked over time.

For example, the cocoa partnership aims to raise incomes through improved knowledge and productivity by working with a dozen multinational corporations to double the income of 200,000 cocoa-farming families in five African countries. When a single family achieves this goal, it is a great success. When such success is experienced by entire communities, it is development. Although it is not the Bill & Melinda Gates Foundation’s core competency, the foundation has initiated some short-term, emergency grants around food security during the food crisis in multiple countries.

Suggested Citation:"6 The Global Response to the Crises." Institute of Medicine. 2010. Mitigating the Nutritional Impacts of the Global Food Price Crisis: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12698.
×

Solutions and Investment Ideas

The following solutions and investment ideas were offered by the Bill & Melinda Gates Foundation:

  • Research—If agriculture is to change for the better, the international agriculture community needs to identify and fund research with the greatest promise.

  • In-country investment—Using new funding modalities, rapid and effective expansion of donor financing for agriculture is needed.

  • Support local transformative efforts—On-the-ground initiatives that are tailored to local farmers need to be supported.

  • Build human capacity network—A large cadre of well-trained, motivated agricultural scientists and extension workers must be created.

  • Reinvest in agricultural value chain—Private companies that look beyond corporate social responsibility and find neutral business value should be identified.

  • Invest in livestock—Investing in livestock is critical and contributes to nutrition, risk mitigation, and crop protection.

  • Protect food security in biofuel production—Biofuel needs to be produced in a manner that protects food security.

  • Expand feeding programs—Appropriate strategies for local procurement of food must be established. (The WFP is the leading agency in this effort.)

  • Infrastructure—Agricultural growth and poverty reduction depend on investment in agriculture.

  • Pilot large-scale programs in country—Large-scale pilot farm programs intended to stand as models should be supported.

Even with all these opportunities available, there are still great challenges and risks ahead. To succeed over the long term, agriculture needs to be both environmentally and economically sustainable for the small farmer. Climate change is a major issue that farmers are facing, and it particularly affects the poor in developing countries. The world population is projected to be 9 billion by 2050; nearly 50 percent more people will need to be fed on less arable land than currently exists today.

The Bill & Melinda Gates Foundation is optimistic about the future. Developing countries are making enormous progress. The incredible benefits from science and technology that have been witnessed over the past several years will continue. Renewed attention is being given to hunger and agriculture. Success is possible, and great partners around the world will make it happen.

Suggested Citation:"6 The Global Response to the Crises." Institute of Medicine. 2010. Mitigating the Nutritional Impacts of the Global Food Price Crisis: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12698.
×

THE ROLE OF FOOD COMPANIES IN RESPONDING TO THE CRISES

Derek Yach, M.B., Ch.B., M.P.H.,

Senior Vice President of Global Health Policy

PepsiCo


The international development community is off target in its effort to achieve the Millennium Development Goals (MDGs). The role of the private sector in achieving these goals is rarely discussed, but changing economic realities are leading to novel ways of doing business. There are a number of companies seeking closer integration of financial performance and social purpose (Table 6-2).

PepsiCo’s CEO Indra Nooyi calls it “performance with purpose” and is proposing that the compensation of executives be linked to their financial performance and to the attainment of broader health and environmental goals (PepsiCo, 2007). The notion of “creative capitalism” is one that Bill Gates has been advancing in his effort to find the interface between financial and social gain (Gates, 2008). Mohammed Yunus has epitomized the bringing together of public-private partnerships through the Danone and Grameen Bank partnership to address the nutrition needs of poor communities (Yunus, 2008). There is now a recognized need to develop new business models that generate profits while improving population health and the environment.

A Role for Food Companies in Addressing Undernutrition

This section outlines eight actions that indicate specific roles for private food companies in addressing world hunger. These actions ideally are taken in collaboration with public and other civil society players.

Investment in Agriculture, Especially Smallholders

It often comes as a surprise that food companies actually grow a lot of their food directly or that they buy actual commodities. In fact, Lay’s chips come from potatoes; a can of Pepsi depends upon cola nuts grown in Senegal and vanilla pods from the trees of Madagascar; and Quaker’s oats are grown around the world in real fields. Nestlé directly employs more than 600,000 farmers around the world. The footprint of agriculture made by food companies around the world is enormous.

This creates opportunities for food companies to support smallholder farming in a number of countries, as well as to employ those who do not currently have jobs. The long-term viability of the global food supply requires government action and corporate philanthropy aimed at helping farmers access higher-quality seed, microcredit, fertilizer, and efficient irrigation systems.

Suggested Citation:"6 The Global Response to the Crises." Institute of Medicine. 2010. Mitigating the Nutritional Impacts of the Global Food Price Crisis: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12698.
×

TABLE 6-2 Examples of Food and Beverage Companies’ Actions to Reduce Global Hunger

Company

Action

Likely Impact

General Mills

Support of local high-value corn in China

Stimulating local economy; supporting local agriculture

PepsiCo

Support of local potato farmers in Peru, China, and South Africa; citrus farmers in Indian Punjab; corn farmers in Mexico; oats farmers worldwide; and investment in pilot projects to address hunger in Nigeria, South Africa, Mexico, and India

Stimulating local economy and local agriculture; developing new products and business models to address hunger

Unilever

Commitment to World Food Programme to combat child hunger in Kenya, Indonesia, Ghana, and Colombia; creation of Annapurna iodized salt in Ghana

Reduction of child hunger; improvement of child nutrition, health, and education; increased school attendance; reduction of micronutrient deficiencies; improvement of health outcomes

PepsiCo Foundation

Investment in Save the Children for obtainment of food, deworming drugs, breast-feeding advice, and tools for proper hygiene in India and Bangladesh; invest in strengthening the World Food Programme’s distribution capabilities

Reduction of child hunger; disseminating information; educating population; providing pharmaceuticals for achieving better health outcomes (overall disease reduction); disseminating information for purposes of providing better food aid to populations

Coca-Cola

Commitment to Nets for Life for distribution of malaria nets in sub-Saharan Africa

Reduction of malaria and malaria-related diseases

Nestlé

Development of Popularly Priced Product portfolio to offer food and beverage products high in nutrient quality for consumers in poverty

Reduction of hunger; improvement of health outcomes

Heinz

Early supporter of Sprinkles’ satchel of micronutrients and Britannia’s iron-fortified biscuits in India

Reduction of micronutrient deficiencies; improvement of health outcomes

Danone

Creation of innovative social business partnership with Grameen Bank in Bangladesh for distribution of nutrients to undernourished populations

Reduction of micronutrient deficiencies; improvement of health outcomes; support of local agriculture

Suggested Citation:"6 The Global Response to the Crises." Institute of Medicine. 2010. Mitigating the Nutritional Impacts of the Global Food Price Crisis: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12698.
×
Expanded Use of Corporations’ Core Capabilities in Distribution and Quality Control

The private sector’s efficient distribution systems—particularly those of companies like Coke, Pepsi, Nestlé, Unilever, and Procter & Gamble that distribute small consumer goods—could be leveraged to address hunger and malnutrition. Global food companies can leverage distribution expertise to help NGOs and the WFP develop successful strategies for reaching the hungry. For example, an evolving partnership between the PepsiCo Foundation and the WFP places PepsiCo retirees with distribution expertise in positions within the WFP in order to increase distribution capability in other countries. Expanding such systems could build upon food companies’ expertise in food quality, forecasting, and marketing (Yach, 2008).

Sustained and Greater Support for Fortification of Staples and Commonly Consumed Nutritious Foods and Beverages

Micronutrient deficiencies affect 2 billion people worldwide and contribute to birth defects, stunted development, and disease. Many food companies have taken their role in food fortification very seriously, especially when their products are widely consumed in the developing world. The Global Alliance for Improved Nutrition, through its corporate partnership programs, assists food companies in using their current product lines to meet nutrition criteria. While there is no intent for classic Pepsi to become a superfortified product, many products within the increasingly healthier side of PepsiCo’s portfolio could and should be fortified, especially in countries with major micronutrient needs. To further such processes, food companies need partners in many countries because fortification programs are not simple to implement, assess, or monitor.

Innovation and Expansion of the Portfolio of Foods Currently Available for Complementary Feeding in Settings of Acute and Chronic Undernutrition and Support for Breast-Feeding

Food companies could be far more forceful about their support for breastfeeding. Unfortunately, the centrality of breast-feeding tends to slip off the agenda when other products are being promoted.

Ready-to-eat therapeutic foods are another area where food companies can and should play a role. PepsiCo is working with Valid International to support the development of ready-to-use therapeutic foods in Nigeria. There is a huge demand for food and food products that is currently not being met in crisis areas; this is a “window of opportunity” for food companies to play a role in preventing the worst effects of food crises like the current one (Sheeran, 2008).

Suggested Citation:"6 The Global Response to the Crises." Institute of Medicine. 2010. Mitigating the Nutritional Impacts of the Global Food Price Crisis: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12698.
×
Cocreation of New and Innovative Social Business Models to Help Combat the Global Burden of Undernutrition

A satisfactory business model for many companies may actually be one that simply breaks even. Muhammed Yunus’s idea for “social business” is a nonloss, nondividend company in which profits are reinvested to expand reach and improve the product. In partnership with Danone and Grameen Bank, Yunus succeeded in delivering nutrients to undernourished individuals in Bangladesh. Other companies may demand a marginal or very small profit margin or a profit margin that will extend over decades.

If food companies find ways to develop these social business models, a large amount of resources would be liberated within companies (although this would require that Wall Street tolerate companies doing this). Given the new environment since the economic crisis, such models are more likely to get a higher degree of support than they would have in the past.

Investment in the Development of Nutrition Science Capacity, Especially in Developing Nations

Food companies’ investment in the development of nutrition science capacity is not for philanthropic reasons, but rather for self-interest. Top nutrition and medical journals focus overwhelmingly on obesity while ignoring India, China, and Africa, which make up 40 percent of the total world population. In such developing countries, neither food companies nor public health agencies can find the nutrition scientists needed for their work. In this way, it is in food companies’ best interests to invest in building the science base in nutrition in developing countries. In particular, PepsiCo supports the International Union of Nutritional Sciences, the International Nutrition Foundation, and the Tufts School of Nutrition initiative to identify ways of building a global plan to enhance capacity for nutrition science in low- and middle-income countries.

Innovative Product Reformulation Aimed at Developing Low-Cost Nutritious Foods for All Markets

Food companies are uniquely more capable than the public sector at making foods tasty and fun. At the same time, tasty and fun does not have to mean not healthy and nonnutritious. In fact, the key to increasing the quality of nutritious food is to focus on taste, recognizing that of course the tastiest and healthiest foods will always remain fresh fruit and vegetables, but fresh fruits and vegetables simply cannot solve all the massive undernutrition problems the world is facing.

Suggested Citation:"6 The Global Response to the Crises." Institute of Medicine. 2010. Mitigating the Nutritional Impacts of the Global Food Price Crisis: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12698.
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Committed Advocacy by Multinational Food and Beverage Corporations for Nutrition-Friendly Trade Policies

Food companies can and should support significant changes to trade policies that encourage subsidies that make it easier to grow and eat nutritious foods. A change in policies around subsidies could have a big impact on agricultural production in developing countries as well as incentivizing food companies’ expansion into areas that address undernutrition and other health issues such as cardiovascular disease.

THE ADVOCACY ROLE OF CIVIL SOCIETY ORGANIZATIONS IN RESPONDING TO THE ECONOMIC AND FOOD PRICE CRISES

Asma Lateef, B.A., M.A., Director

Bread for the World Institute

Overview

Bread for the World Institute is the research and education affiliate of Bread for the World, a collective Christian voice urging decision makers to end hunger at home and abroad. Bread for the World is a grassroots advocacy organization with a network of 60,000 members, churches, and denominations in the United States. Bread for the World Institute provides the research and policy analysis that informs Bread for the World’s legislative advocacy. Bread for the World mobilizes its network to generate personalized letters, e-mails, and phone calls to members of Congress on particular legislation around hunger and poverty.

Civil society organizations (CSOs) like Bread for the World Institute need to capitalize on the current opportunity (the best in decades) to get nutrition on the global agenda. The food price crisis and the economic crisis have shone the spotlight on the vulnerability that exists in the developing world. The current crises can serve as a clarion call for advocacy organizations to help initiate a response to not only the crisis but also the underlying chronic conditions that exist. CSOs can play a distinct advocacy role in shaping the global response to the global economic crisis, particularly the focus on food security, agriculture, and nutrition. Opportunities abound for CSOs to engage governments and international institutions on what is happening on the ground, policy recommendations, and implementation.

Civil Society’s Advocacy Role

There is a role that advocacy organizations can play to engage in the policy debate within the CSO community. CSOs can educate and rally by drawing attention to and defining the issues, building consensus among policy advocates, and

Suggested Citation:"6 The Global Response to the Crises." Institute of Medicine. 2010. Mitigating the Nutritional Impacts of the Global Food Price Crisis: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12698.
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working together to shape and advance policy solutions and recommendations. Additionally, CSOs have a role in the policy debate with the administration and Congress. CSOs can persuade through elevating the importance and urging leadership on an issue; they can engage in the debates that are raging within or between Congress and the administration; and they can play a brokering role by carrying information and messages between different players, identifying common objectives, and adding pressure when needed.

CSOs have a further role to play in engaging and mobilizing grassroots constituents. For example, the media frenzy around the current food crisis was very helpful in the United States as it galvanized a series of very high-profile initiatives. The Lancet series came just as there was growing awareness of the food price crisis, but the ensuing food riots, particularly from a national security angle, grabbed the attention of policy makers.

The Center for Strategic and International Studies sponsored a Task Force on the Global Food Crisis chaired by Senators Lugar and Casey. A CSO coalition came together to develop the Roadmap to End Global Hunger. The Chicago Council on Global Affairs did a report on global agricultural development. This series of high-profile events created momentum. CSOs can play a role by showing the connections between these issues and how specific policy actions can help. CSOs can build relationships with congressional offices and staff to show there is a long-term commitment to the issues.

The initial policy advocacy toward the global food crisis was focused on the short-term response—boosting immediate agricultural production, safety nets, and cash and food assistance programs. As the Food and Agriculture Organization of the UN (FAO) and others updated alarming food insecurity and hunger data, advocacy efforts expanded their focus to include addressing malnutrition. There is a growing recognition that an important part of a more comprehensive food security strategy must focus attention on addressing and preventing malnutrition, particularly during the first 2 years of life.

Recent and Future Advocacy Opportunities

Advocacy organizations in the United States focus on the U.S. administration and government’s response. High-level global meetings are an opportunity for CSOs to engage government on their preparations and plans for these international meetings.

At the global level there have been a number of events:

  • June 2008 Summit on Food Security in Rome,

  • July 2008 UN High-Level Task Force and the Comprehensive Framework for Action,

  • March 2009 World Bank Roundtable,

  • April 2009 G20 Summit in London,

Suggested Citation:"6 The Global Response to the Crises." Institute of Medicine. 2010. Mitigating the Nutritional Impacts of the Global Food Price Crisis: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12698.
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  • July 2009 G8 Summit in L’Aquila, Italy,

  • September 2009 G20 Summit in Pittsburgh, Pennsylvania, and

  • Annual UN General Assembly meeting.

At the national level in the United States, Congress recently passed an emergency supplemental bill that included funding for agriculture development and for such short-term emergency responses as getting seed and credit out to farmers. It also included funding for food aid and a pilot project for local and regional purchase of food aid. The United States has also recently restated its commitment to achieve the MDGs, which is another tremendous step forward. Senators Lugar and Casey introduced a bill called the Global Food Security Act that was focused on agriculture, influenced by the conversations around the Center for Strategic and International Studies report. The House version of that bill, which has just been introduced by Representative McCollum, includes maternal and child undernutrition as part of a comprehensive approach.

At the national level are these initiatives:

  • Emergency supplements,

  • Meetings with the Obama transition team,

  • Lugar-Casey/McCollum bill,

  • McGovern/Emerson Roadmap legislation,

  • Appropriations,

  • Obama administration’s Food Security Initiative,

  • Foreign aid reform, and

  • Quadrennial diplomacy and development review.

All of these initiatives are occurring in the context of a larger “rethink” within the administration and Congress about the way the United States provides foreign aid with a focus on country ownership, outcome-oriented development programs, capacity building, and policy coherence. Representative Howard Berman, the chairman of the House Foreign Affairs Committee, has introduced a bill that calls for the administration to develop a national strategy for global development. At this critical moment in time, there is an urgency for CSOs to engage the public and the government on nutrition issues.

THE ROLE AND CAPACITY OF CIVIL SOCIETY IN RESPONDING TO THE CRISES

Tom Arnold, M.S., Chief Executive Officer

Concern Worldwide


There is a sense of opportunity amidst the current global food crisis—a hopefulness that the hunger agenda will become a political focus. This opportunity is

Suggested Citation:"6 The Global Response to the Crises." Institute of Medicine. 2010. Mitigating the Nutritional Impacts of the Global Food Price Crisis: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12698.
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a direct response to the food price crisis that brought the issue of food security to a level of “political influenza,” more so than at any time since the early 1970s.

Money is not the key to solving the problem; the key is policy change. What is the political economy of change in regard to these issues? Where are the levers of power and influence that will wake people from a current state of relative comfort with 1 billion hungry people in the world? How can this food and nutrition agenda achieve significant change? Change cannot be brought about by governments acting on their own. It must be brought about by new forms of partnerships between civil society, the private sector, and foundations.

Innovation on the Ground

The larger international NGOs can have significant impact through innovation on the ground in the countries where they work. For example, Concern Worldwide and Valid International were the pioneers in developing the “community-based management of severe acute malnutrition” approach. In 2000, Concern Worldwide initiated this approach in three countries. Through the processes of group program design, proper data collection, and sharing that information within the nutrition and wider community, policy change at the international level was achieved. Other work in the area of safety nets and conservation farming are equally promising. Such successful initiatives need to be encouraged and expanded.

New Models of Partnership

Concern Worldwide has significant and important partnerships with the International Food Policy Research Institute (IFPRI) and the Cary Group—the largest Irish international food company. These partnerships look at action research on the ground, nutrition status, livelihoods, and HIV/AIDS data. Such partnerships are becoming common between NGOs and business.

Other opportunities exist for partnerships between businesses and higher education institutions. Such partnerships should be seen as learning communities, where the results that are generated from well-designed programs can feed into a learning loop for the benefit of all.

Advocacy

Civil society must play a crucial role in advocacy at the national and international levels if the hunger agenda is to change. The UN High-Level Task Force has created a virtual network that connects work at the UN level with all of the major NGOs working in the field. At the European level, the European Food Security Group brings together all of the major European NGOs and engages directly with the European Commission and the European Parliament. In the United States, the Roadmap to End Global Hunger is a similar, very positive initiative, and should

Suggested Citation:"6 The Global Response to the Crises." Institute of Medicine. 2010. Mitigating the Nutritional Impacts of the Global Food Price Crisis: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12698.
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be further built upon. The Global Hunger Index is a document produced by IFPRI that ranks every country in regard to hunger on an annual basis; this document is becoming an important advocacy tool (Grebmer et al., 2009).

Leadership in Ending Hunger

Perhaps most important of all is the concept of leadership—at national and international levels—and how it can be the stimulus for change. If the hunger problem is to be solved, the critical locus of leadership must be at the national level for food-insecure countries. Unless there is policy change at the national levels, all of the good intentions at the international level will not lead to change. That crucial connection between the global and the national agendas must not be forgotten.

The comprehensive framework for action, which arose from the Rome summit in 2000, provides a sensible framework for policy change going forward—a set of short- and longer-term actions that need to take place. These actions must be supported by resources from donors, such as the $20 billion commitment from the G8. There is a nonfinancial dimension to the $20 billion commitment as well. Such an international political commitment has additional power to change policy at the national level.

The United States has a critical role to play, and there seems to be a shift in current U.S. policy from food aid to farming. Undergoing such a transition, however, will trigger challenges in dealing with the “iron triangle”—the farmers, the shippers, and the aid agencies—who will not want such change.

The European Union (EU) is important as well; the fact that the EU is beginning to think about the importance of nutrition is significant and important. In particular, Ireland has an important role to play. The Irish Hunger Task Force produced a report last year that is widely recognized as being a quality product focusing on three areas: (1) promoting the productivity of small-scale African agriculture, (2) putting a very clear focus on nutrition, and (3) Ireland playing a leadership role in advocating for change at the global level.

MITIGATING THE NUTRITIONAL IMPACT OF THE GLOBAL FOOD SECURITY CRISIS: THE ROLE AND CAPACITY OF UN AGENCIES IN RESPONSE TO THE CRISIS

David Nabarro, M.D., Coordinator

UN System High-Level Task Force on the Global Food Security Crisis

Context

From the perspectives of the world’s 2 billion poorest people, food and nutrition systems were in crisis long before food prices shot up in 2007. Economic contraction made the situation worse. Because of high levels of malnutrition

Suggested Citation:"6 The Global Response to the Crises." Institute of Medicine. 2010. Mitigating the Nutritional Impacts of the Global Food Price Crisis: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12698.
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and growing hunger, increasing numbers of people in resource-poor settings are unable to realize their right to food—a right to access the food they need, when they need it. Food production, processing, and distribution systems are not serving the interests of small-scale producers, as evidenced by the fact that there are great differences between the prices paid to producers and the prices paid by consumers. Volatility in food prices and variations in supplies are impeding global progress toward the MDGs. These are all very complex issues that are symptoms of seriously dysfunctional systems.

High-Level Task Force on the Global Food Crisis

The structure of the High-Level Task Force (HLTF) is such that it is a time-limited UN system entity established at the end of April 2008 by the UN Chief Executive Board. The HLTF includes the WFP, FAO, International Fund for Agricultural Development, The World Bank, International Monetary Fund, UNICEF, UN Development Progamme, World Trade Organization, UN Conference on Trade and Development, the International Labour Organization, and 14 other UN entities. The UN Secretary-General, Ban Ki-moon, chairs the HLTF, and Jacques Diouf, the FAO director general, is vice chair. The HLTF has one coordinator and a small secretariat.

The mandate of the HLTF is that it is not to be a new organization; it was developed to avoid creating new bureaucratic and intergovernmental layers. It is simply a mechanism to try to make the UN system work in a more integrated and coordinated way on policy and program issues. The goals of the HLTF are to enable access to food in the short-term through improved nutrition, social protection, and food systems (taking account of life-cycle vulnerabilities); and in the longer-term to improve availability of food with an emphasis on small-scale agriculture and making markets and systems for trading foods function in the interests of poor people. The unifying principles of the HLTF are a commitment to MDG 1; bridging short- and long-term responses to try to end the divide between humanitarian development and trade approaches to food issues; and an attempt to have an integrated response.

The HLTF is a construct of the agencies under the chairmanship of the UN Secretary-General, who has a strong role as the chair; it is not a member state construct. The main outcome of the HLTF aims to have UN agencies work well together at the country level. It has been recognized that there are turf battles and inconsistencies between different agencies on the ground that lead to a lack of credibility in the eyes of national governments and donors. The Committee on Food Security is a completely different entity. Its aim is the governance of food security in member states through relationships with civil society and producer organizations in the private sector. The HLTF is a subset of, and subject to, the Committee on Food Security. The HLTF is on the implementation and agency side, not the governance of member states side.

Suggested Citation:"6 The Global Response to the Crises." Institute of Medicine. 2010. Mitigating the Nutritional Impacts of the Global Food Price Crisis: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12698.
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The HLTF developed the Comprehensive Framework for Action as a means for organizing collective actions in pursuit of immediate and longer-term outcomes to be taken forward by different stakeholders working in partnership (not limited to the HLTF membership) under the leadership of national authorities.

The Comprehensive Framework for Action has two objectives. The first is to improve access to food and nutrition support and to take immediate steps to increase food availability. The desired outcome of this objective is to meet the immediate needs of vulnerable populations. This will be accomplished by:

  • Offering emergency food assistance and nutrition interventions, and enhancing safety nets and making them more accessible;

  • Boosting smallholder farmer food production;

  • Adjusting trade and tax policies; and

  • Managing macroeconomic implications.

The second objective of the Comprehensive Framework for Action is to strengthen food and nutrition security in the longer run by addressing the underlying factors driving the food crisis. The desired outcome of this objective is to increase longer-term resilience and global food and nutrition security. This will be accomplished by:

  • Expanding social protection systems;

  • Sustaining the growth of smallholder farmer food production;

  • Improving international food markets; and

  • Developing an international consensus on biofuel production.

The HLTF focuses on four lines of work. The first is to support realization of the Comprehensive Framework for Action outcomes in countries. The HLTF will respond both to country needs and requests from national authorities. At the national level in the majority of countries, there has not been a comprehensive approach to food insecurity undertaken. Instead, there has been compartmentalization of the response. Second, the HLTF has been advocating for the resources needed for urgent action as well as long-term investment based on the right to food, the need for adequate nutrition, and reduction in vulnerability. Third, the HLTF is trying to inspire a broader engagement in food issues so that the hundreds of stakeholders involved in food security issues in any one country can come together in a concerted movement for food security. Fourth, the HLTF would like to ensure accountability through assessing achievements, reviewing progress, demonstrating results, adjusting activities that are suboptimal, and presenting reports.

Suggested Citation:"6 The Global Response to the Crises." Institute of Medicine. 2010. Mitigating the Nutritional Impacts of the Global Food Price Crisis: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12698.
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High-Level Meetings on Food Security

The High-Level Meeting on Food Security for All in Madrid in January 2009 was a very important initiative. It challenged a number of different actors to find ways to stimulate more resources and achieve more open consultations and partnerships for food security. One billion Euros were pledged at this meeting, but more importantly, there was a clear consensus that the way forward was the twin approach of the Comprehensive Framework for Action (immediate and long-term), with addition of FAO Right to Food Guidelines as a basis for analysis, action, and accountability. The need for a mechanism to properly coordinate financing as well as a need for extensive and open consultations for establishing partnerships was also expressed.

At the G8 Initiative on Food Security in L’Aquila in July 2009, there was a focus on comprehensive (both short- and long-term) food production, access, and use. Additionally, there was a clear recognition of the role of agriculture, not only for food production, but also as a means for community resilience and as a base for economic growth and development.

In L’Aquila, there was real attention paid to vulnerabilities, particularly of young children and women, and to the commitment to support national efforts and regional initiatives to improve food security as well as to ensure a coordinated international response. There was emphasis on engaging producer organizations and civil society on the importance of the private sector and on producers having greater access to the value chain.

A commitment of $20 billion in food and agricultural assistance to those suffering the effects of the food crisis was also made at the G8 initiative. President Obama managed to increase the sum from $15 billion to $20 billion because of the intensity with which all the leaders (not only the G8—26 countries were represented) supported the need for a new initiative on food security. The $20 billion commitment is simply a statement of intention, and no one knows precisely how much of this is “new” money. But it is important to give adequate attention to those at risk of malnutrition and affected by chronic hunger within this new thinking.

Challenges and Solutions

Outstanding and challenging policy issues remain. They include ensuring the generation of knowledge and its application to:

  • Enable populations to realize their right to food,

  • Improve humanitarian access to food,

  • Incorporate nutrition-related analysis and action in response,

  • Examine and pursue options for predicting future crises and mitigating them (e.g., through price stabilization),

Suggested Citation:"6 The Global Response to the Crises." Institute of Medicine. 2010. Mitigating the Nutritional Impacts of the Global Food Price Crisis: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12698.
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  • Pursue food-trading systems that benefit poor people,

  • Promote best practices for conservation agriculture,

  • Respond to the needs of marginal populations (especially pastoralists), and

  • Promote the development of biofuels that do not compete with food crops.

As the world moves into a prolonged period of economic downturn, national authorities and international organizations have concerns that the needed private and public investments in agriculture, social protection, and a fair trade system will not be immediately forthcoming. The structural problems in food and agriculture may persist, as will the risk of extreme volatility in prices.

What can be improved upon is an increased recognition of the likely magnitude and duration of the food security crisis in different countries. The international food security community must be able to adapt its response to changing circumstances and emerging threats to food security such as volatility in food, energy, and financial markets; climate change; and water scarcity. The international community will need to mobilize and use the necessary resources while sustaining political commitment.

There is a need to improve funding of food assistance, smallholder production, and social protection. Options to do so include coordinating funds provided through existing funding channels (e.g., the World Bank, International Fund for Agricultural Development, WFP, FAO, regional banks, bilateral donors, and foundations) so that they respond to country needs in an integrated way, or establishing novel funding mechanisms that pool donor resources and react in a predictable way to country needs.

Within that context, as international organizations align themselves, they are functioning within a much broader, more substantive, and novel form of partnership, built around a joint understanding of the issues, an understanding that there are opportunities to act, and an eagerness to achieve that goes beyond static rigid structures and move toward empowering and open partnerships, almost social movements. In this new paradigm, institutions must take joint responsibility for ensuring that results carry through. This is a new way of working—separately, but together; strategically and opportunistically.

Suggested Citation:"6 The Global Response to the Crises." Institute of Medicine. 2010. Mitigating the Nutritional Impacts of the Global Food Price Crisis: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12698.
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THE ROLE AND CAPACITY OF UNICEF IN RESPONDING TO THE CRISES

Werner Schultink, M.D., Chief of Child Development and Nutrition

UNICEF

Background

The United Nations Children’s Fund (UNICEF) has a presence on the ground in more than 100 countries. In most of these countries, UNICEF also has staff especially focused on nutrition and public health. However, looking back at the end of 2006 or 2007, much of UNICEF’s nutrition work was focused on the prevention of mortality and, in this way, had less of an impact on MDG 1. In 2007, just before the Lancet publication was released, UNICEF underwent a review. The information in the Lancet was used, and a significant number of experts reviewed UNICEF’s nutrition programming.

As a consequence of that review, nutrition programming was modified to place more emphasis on nutrition interventions during pregnancy and in adolescence. UNICEF attempted to significantly enhance its work in infant feeding, including breast-feeding and complementary feeding.

In the UN system, UNICEF plays the lead role for interventions that mitigate the impact of emergencies, acute as well as prolonged. Taking the lead in these efforts has considerably strengthened the collaboration that UNICEF has with its sister agencies, especially the WFP, WHO, and FAO. For example, the REACH initiative involved four UN agencies and a significant number of NGOs who agreed upon a core set of interventions and approaches that are being piloted in Laos and Mauritania.

UNICEF Reaction to Food Price Increases

In July 2008 when food prices escalated, UNICEF was experiencing extremely limited progress in the reduction of malnutrition. Between 1995 and 2005, UNICEF estimated that the reduction in stunting was at best a reduction from 33 percent to 30 percent, and the wasting rate hovered around 10 to 11 percent during the entire time period.

When the food crisis occurred, UNICEF participated in the initiation of the High-Level Task Force of the Secretary-General, which proposed two main pillars of intervention—one to provide immediate relief and the other to look at the required long-term action to improve the sustainability and the availability of food.

UNICEF focused on immediate relief and the provision of nutrition security for vulnerable groups. The phrase nutrition security was chosen deliberately, because UNICEF feels that household food security is very different from nutri-

Suggested Citation:"6 The Global Response to the Crises." Institute of Medicine. 2010. Mitigating the Nutritional Impacts of the Global Food Price Crisis: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12698.
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tion security, especially when considering the consequences of undernutrition for young children. If action is not taken at a very early age, the consequences of undernutrition can lead to lifelong negative impacts, and, ultimately, an entire lost generation.

UNICEF applied $50 to $60 million of its own resources to stimulate a package of immediate relief with a focus on nutrition security for vulnerable groups. Throughout this process, UNICEF had regular contact with the WFP and WHO on the types of interventions supported, the role of other agencies, and which countries would receive UNICEF’s focus. This is an indication of the strong collaboration between UN agencies during the crisis.

Forty-two countries were selected, based on high under-five mortality rates, high malnutrition rates, and high HIV rates. UNICEF realized that the high food prices may have an impact on households affected by HIV, who likely already manage on a very meager income and are net buyers of food.

Impact of UNICEF Response to Food Price Crisis

UNICEF’s funds were distributed quite rapidly. Almost all of the selected countries received funds (over and above their already available budgets) by the end of July, and 70–80 percent of these funds were actually used. About 80 percent of the funds were used for the expansion of nutrition and health programs; 28 countries worked on evidence building and the enhancing of data availability. For example, 9 countries in West Africa conducted smart surveys, seven are in the pipeline, and a number of other studies and data collection efforts were made, including the strengthening of surveillance in Zimbabwe.

Another noted impact was a rapid increase in the treatment of children suffering from severe and acute malnutrition. In 2007, UNICEF distributed about 4 million kilograms of ready-to-use therapeutic foods, and in 2008 that number jumped to 10 million kilograms. With this increase, an estimated 750,000 to 1 million children suffering from severe and acute malnutrition were treated.

The use of multiple micronutrients was also expanded. For example, in Afghanistan, Cambodia, Indonesia, and Laos, large groups of people were reached (with a focus on children 6 to 24 months of age) with micronutrient supplements to improve the quality of their complementary food. A significant number of countries, such as Angola, the Congo, Ethiopia, Mali, Malawi, and Kenya, further improved their infant feeding programs.

Also accompanying this outreach was an increase in the capacity of national institutes and NGOs to carry out this work. To expand outreach, basic community workers and health workers in the field must be enabled to implement programs and educate mothers. Much capacity strengthening occurred in 25 countries, including Benin, Cambodia, Liberia, Mozambique, and Zambia. For example, prior to the crisis in Mozambique, the provision of immunizations, impregnated bed nets, vitamin A supplements, and deworming medication was effectively

Suggested Citation:"6 The Global Response to the Crises." Institute of Medicine. 2010. Mitigating the Nutritional Impacts of the Global Food Price Crisis: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12698.
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accomplished only once a year. In 2008, as a consequence of the food crisis and with UNICEF support, Mozambique modified its programs to be implemented twice a year, leading to an enormous increase in coverage with essential interventions. Finally, UNICEF also supported a number of social safety net programs. For example, cash support was provided in Madagascar, Ethiopia, and Malawi.

Without knowing to what extent these interventions will translate into lasting changes in wasting or stunting rates or in other indicators, it is safe to assume that at least a number of indicators will have shifted. UNICEF has reached more children with treatment of severe and acute malnutrition and, in this way, prevented child deaths. A substantial number of children were reached with vitamin A supplements, and the first steps were taken to improve infant feeding in a number of countries. The focus on “nutrition security” is of crucial importance when considering the lives of children and the consequences they will face in later life.

THE ROLE AND CAPACITY OF THE WFP IN RESPONDING TO THE CRISES

Martin Bloem, M.D., Ph.D., Chief for Nutrition and HIV/AIDS Policy

World Food Programme

Evolution of the WFP’s Focus on Nutrition

Over the past 2 to 3 years, the WFP has undergone significant changes. Owing to the new leadership of Josette Sheeran in combination with external circumstances, the agency developed a new strategic plan. The transition has been quite dramatic as the WFP has moved from a food agency to a food assistance agency.

Twenty years ago, the WFP provided direct food assistance and food transfers, mainly from Europe, the United States, and Canada to lower-income regions. In contrast, today almost 70 percent of the WFP’s budget is in cash, so the WFP is able to buy food locally. Local procurement is different from shipping food internationally; it is cost-effective, but has required new strategies in food assistance.

Another major deviation from the past at the WFP is a move away from the focus on acute hunger; today, the WFP focuses on acute and chronic hunger. Suddenly, programs must focus on stunting and other chronic problems. This transition occurred through much consultation with the WFP’s donors because it has many consequences in how such problems are tackled.

In the context of the new strategic plan, the focus on nutrition is taken very seriously. Josette Sheeran declared nutrition as extremely important for the WFP because it is necessary for an agency that delivers food assistance to 80 to 100 million people every year to have a positive impact on nutrition. The WFP no

Suggested Citation:"6 The Global Response to the Crises." Institute of Medicine. 2010. Mitigating the Nutritional Impacts of the Global Food Price Crisis: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12698.
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longer focuses merely on delivering food, but also on “what is in the food basket.” The connection between access to food and nutrition has not always been assumed, so this too is a new way of thinking. The WFP designed a “nutrition improvement strategy” that is based on the Lancet series and designates an important role for the private sector.

The WFP’s Role in Responding to the Food Crises

In an effort to align the WFP’s strategy for responding to the current food price and economic crises with other UN agencies, an issue brief was written. This document described how to improve nutritional status under the current circumstances, focusing intently on the importance of micronutrients.

Early in 2009, the Gandolfo meeting was held in Rome to discuss the potential implications of the economic crisis, climate change, and high food prices on nutrition. A consensus from this meeting was published in the Journal of Nutrition. Another outcome of the Gandolfo meeting was an issue brief with the following recommendations. First, more funding is needed in the field of nutrition to implement all of the new, proven strategies. A second recommendation is to focus on target groups, in particular minus 9- to 24-month-old children and women. Historically, the WFP did not focus on particular groups, so this is a fundamental change that aligns the WFP with the broader nutrition community. The third recommendation is that inadequate diets need to be supplemented with micronutrient powders or lipid-based products. The fourth recommendation is to enable access to nutritious foods. In the past, UN agencies only focused on the known market-based production channels. Now, it is broadly understood that it is also important to focus on the market base, and to do this in two different ways—through buying locally and partnering with the private sector.

One WFP program, the P4P program, works with small farmers so they can buy locally. Local products, however, may not be capable of improving nutritional status, so a value chain is needed. The community’s food processing needs improvement through the help of local industries (supported by larger companies).

The WFP has many partnerships with the private sector. One noteworthy partnership is with DSM Nutritional Products, a Dutch vitamins and minerals company. The WFP’s partnership with DSM began in 2007 with an interest in novel food products, funding, and enormous technical support that led to great progress in a short period of time. The WFP has benefitted greatly from this partnership and has pushed DSM to work with local customers in WFP recipient countries. For example, the WFP uses micronutrient powders that are not available in local markets, so must be imported. If DSM were to sell to local markets, the WFP could purchase micronutrient powders in the local market. An added benefit of a local supply of such products is that they don’t require extensive social marketing because local populations become aware of the products on their

Suggested Citation:"6 The Global Response to the Crises." Institute of Medicine. 2010. Mitigating the Nutritional Impacts of the Global Food Price Crisis: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12698.
×

own. Today the private sector plays a much larger role in the WFP’s programs than merely funding. Last year, the WFP’s budget was around $5.6 billion, and the private-sector contribution was about $100 million in total.

Partnerships at the local level are extremely important. The WFP’s new strategic plan involves partnerships with local governments, local NGOs, international NGOs, local private-sector organizations, and international private-sector organizations. While partnerships come with their own challenges, this new model is a promising solution that is only possible when both parties have common local data, analysis, and goals.

THE ROLE AND CAPACITY OF FAO IN RESPONDING TO THE CRISES

Hafez Ghanem, Ph.D., Assistant Director-General, Economic and Social Development Department

Food and Agriculture Organization

Reforming Global Governance for Food Security and Nutrition

The last major food crisis to face the world was in the mid-1970s. At that time, there was a call for strengthened global governance of food security, which led to the 1974 World Food Conference, and the establishment of the World Food Council and the Committee on World Food Security (CFS). The CFS was established to serve as a forum in the United Nations system to examine major problems and issues affecting the world food situation and to review and follow-up on policies concerning world food security. The Committee was useful when it began and played a large role in supporting major initiatives in support of world food security in the mid-1970s, including a call for funding for the Green Revolution and investments in South Asia, which led to a reduction in hunger.

But the world has changed. In 2009, after some progress in hunger reduction until the mid-1990s, there is again a large increase in the number of hungry people in the world, coupled with decreased investment in agriculture. The current trading system in agriculture is neither fair nor efficient. Biofuels provide opportunities for some farmers, but also present great risks for food security. Climate change is also playing a significant role in agriculture and food security, where agriculture can both be a great contributor to carbon emissions as well as be greatly affected by climate change. More recently, the impact of high and volatile food prices and the financial and economic crises have exacerbated the already high levels of chronic hunger and malnutrition in the world.

The importance of these factors and their implications for world food security all highlight the need for a renewed mechanism of governance to address fundamental weaknesses in the mechanisms governing global food security. There is general agreement that the CFS’s performance has been inadequate, which leaves a

Suggested Citation:"6 The Global Response to the Crises." Institute of Medicine. 2010. Mitigating the Nutritional Impacts of the Global Food Price Crisis: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12698.
×

vacuum in the global system of governance. The CFS should be renewed to focus more on key issues affecting global food security and include broader participation of key partners in the design and implementation of a food security policy agenda at global, regional, and national levels.

In order to improve upon the global governance structures, the members of FAO have begun the process of reforming the Committee to make it more focused and useful in addressing world food security issues. The process is ongoing. The overall goals are to redefine the role of the Committee on World Food Security so that it can be more action-oriented and to expand Committee membership beyond FAO’s member states, to include broader participation from other key stakeholders, such as representatives from the NGO/CSO private sector and other UN agencies.

FAO Reform

FAO itself is also undergoing a major reform. An extensive external evaluation of FAO—the first one of its kind for a major UN agency—concluded that if FAO did not exist, it would have to be reinvented. However, FAO as it currently exists needs major changes.

The FAO reform involves introducing new or revised structures and mechanisms, including for management of the organization, new personnel systems, a new organizational culture, and new and improved governance of FAO itself. This reform is an important part of FAO’s response to the current economic and financial crisis because unless the institution is modernized and able to seize opportunities, it will not properly address those most in need.

For decades, FAO has been arguing and advocating for the importance of investing in food security and nutrition; for decades it has been ignored. Suddenly, politicians are paying more attention and are now demanding that FAO and the broader international food, nutrition, and agriculture communities respond and rise to meet these new challenges. FAO must seize this opportunity to become a more effective and efficient organization in order to help address the needs of the billion undernourished people in the world.

Initiative to Support Farmers During the Food Price Crisis

A specific FAO initiative in response to the food crisis is to help farmers in developing countries increase their productivity in the short run through supply of seeds and fertilizers. This initiative started with seed money from FAO and the Spanish government, but now obtains major support from the European Commission and covers 88 countries.

As one would expect (especially economists), when food prices go up, supply responds and production increases. This was evident in response to the higher food prices of 2008, where the supply of cereals for the world increased by more than 10 percent. Interestingly, that increase in supply came almost exclusively

Suggested Citation:"6 The Global Response to the Crises." Institute of Medicine. 2010. Mitigating the Nutritional Impacts of the Global Food Price Crisis: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12698.
×

from developed countries. Developing countries’ output increased by only 1.5 percent—all from India, China, and Brazil. Poor farmers in developing countries were unable to buy fertilizers or seed, and had insufficient access to markets. For them, the high prices were not an opportunity they could seize.

FAO’s initiative supports farmers in the developing world in order to allow them to seize the opportunity offered by high commodity prices. It is a short-term initiative, because it does not deal with the fundamental structural problems in the agricultural system, but it is important to allow these poor farmers to respond.

THE ROLE AND CAPACITY OF WHO IN RESPONDING TO THE CRISES

Francesco Branca, M.D., Ph.D., Director, Department of Nutrition for Health and Development

World Health Organization

WHO Response to the Food Crisis

WHO responded to the global food crisis by pursuing the following tasks:

  • Monitor the health and nutritional status of member states’ populations.

  • Support countries in scaling up nutrition action, such as managing severe malnutrition, promoting breast-feeding and complementary feeding practices, improving access to specific micronutrient supplements, delivering primary health care services, and promoting food hygiene.

  • Support countries in strengthening and implementing integrated national nutrition policies.

  • Develop and scale up social protection actions related to health and nutrition, such as working with member states to promote free or low-cost health services.

  • Support member states in assessing and addressing the health and nutritional effects of food insecurity, including building capacity and training national counterparts and WHO teams, as well as designing plans and programs that can mobilize resources through the Comprehensive Framework for Action, UN Central Emergency Response Fund, and other international mechanisms.

Strategic Focus

WHO has more than 100 offices, but not many are dedicated to nutrition exclusively. About 20 percent of staff has some focus on food and nutrition. In reaction to the crisis, then, WHO was forced to reflect on its role and strategy

Suggested Citation:"6 The Global Response to the Crises." Institute of Medicine. 2010. Mitigating the Nutritional Impacts of the Global Food Price Crisis: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12698.
×

in order to optimize its resources for nutrition. WHO produced a strategic paper suggesting that the organization focus on the following areas:

  • Development and operationalization of integrated food and nutrition policies.

  • Intelligence of needs and response.

  • Development of evidence-based program guidance.

  • Country-level advocacy and technical assistance.

WHO is seen as a “convener” within the UN family, so these initiatives were additionally proposed to WHO’s sister agencies.

In the area of food and nutrition policies, WHO has been analyzing member countries’ readiness to accelerate action in nutrition. The objective of such analysis is to assess existing gaps and constraints and to identify opportunities to integrate and expand nutrition-related actions in countries. An action plan is developed with recommendations to guide harmonized action for improved nutrition. Additionally, a baseline of current nutrition status and nutrition action in the 36 countries with the highest burden is established.

As a normative agency, WHO must provide technical guidance to member states. Offering guidance in collecting nutrition information and establishing national nutrition surveillance systems is an important normative role WHO plays. A new global database, the Nutrition Landscape Information System, will be launched very soon. This system provides an interface of country profiles with all of the country data collected through WHO’s nutrition databases, as well as some of the data from sister agencies on policy implementation and other food security indicators.

Partnerships

WHO believes in the importance of working in partnerships and is engaged in a number of partnerships, including the UN Standing Committee on Nutrition and the REACH initiative. WHO also works at the regional level to create partnerships.

A new initiative, the Pan American Alliance for Nutrition and Development, was created to propose and implement comprehensive, intersectoral coordinated programs that are sustained over time, operate within the framework of human rights, and take a gender-sensitive and intercultural approach that contributes to reducing malnutrition and accelerating the attainment of the MDGs. This new alliance will look at effective interventions and advocate in high-burden countries for greater action in nutrition (WHO, 2009).

Suggested Citation:"6 The Global Response to the Crises." Institute of Medicine. 2010. Mitigating the Nutritional Impacts of the Global Food Price Crisis: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12698.
×

DISCUSSION

This discussion section encompasses the question-and-answer sessions that followed the presentations summarized in this chapter. Workshop participants’ questions and comments have been consolidated under general headings.

Leadership

It was suggested by some workshop participants that UN agencies should take the lead in nutrition issues. At the same time, the view was expressed that nutrition departments in UN agencies rank low in the organizations; as a result, individuals with nutrition expertise are not in senior leadership roles.

Some leadership mechanisms were explored, such as the H8 mechanism, which is used in health. While perhaps not particularly effective, it does guarantee that the heads of agencies and important organizations talk about a topic on a regular basis. Without such a mechanism, when the heads of UN agencies come together, the chance that they talk for a significant period of time on nutrition is quite minimal.

The Standing Committee on Nutrition (SCN) was discussed. At the moment, the SCN is not officially related to any higher-level UN reporting mechanism—not to the heads of agencies, not to the UN Economic and Social Council, not to any other chamber, which makes it a voluntary mechanism that could be more effective if structured differently.

Nutrition Interventions Can Deliver

It is helpful for programs to convince funders that programs can change nutritional status. For example, vitamin A and salt iodization programs have been successful in delivering change in nutritional status at a relatively low price. Recently, many countries in sub-Saharan Africa have demonstrated substantial increases in breast-feeding rates. If these success stories are documented by countries, a sense of trust that nutrition programs can “deliver” is built with donors. In this way, it is the nutrition community’s responsibility to convince people that nutrition is important. It influences mortality, influences a country’s development, and influences the development of children over a long period of time. There is no longer disagreement on these facts because data exist, but now convincing evidence needs to show that nutrition interventions can “deliver” at a reasonable price.

Collaboration

One workshop participant felt that real incentives to work collaboratively are still absent in the international nutrition community. From an institutional

Suggested Citation:"6 The Global Response to the Crises." Institute of Medicine. 2010. Mitigating the Nutritional Impacts of the Global Food Price Crisis: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12698.
×

perspective, resources for staff and activities are made available by funders if requested by an individual agency. In terms of funding, there seem to be more incentives for acting individually and autonomously than in a coherent way that is fully aligned with what national governments might see as a priority. Another participant disagreed, stating that one of the reasons resources in food and nutrition have been lacking is because of the fragmentation. Evidence is beginning to show that alignment is proving attractive to funders.

Coordination Mechanism for Funding

Funding for food and nutrition varies from level to level and subject to subject. One area where the food and nutrition community needs to move toward harmony is on the coordination of what happens with money that goes through multilateral channels. One participant suggested that if governments want to access resources, they currently have to “knock on lots of different doors,” present multiple applications, and deal with many different people. A solution (that was credited to Jeff Sachs) is that of a vertical fund that would lump all the donor money into one place, much like the Global Fund to Fight AIDS, Tuberculosis and Malaria.

It was also suggested that a coordinating mechanism is needed to make sure that when money comes from different multilateral and bilateral agencies, particularly at the country level, there is a very clear and transparent process for which national authorities can get information about what money they might be able to access and how they can access it. Additionally, this mechanism would help the multilateral agencies themselves in responding collectively to a national request.

Lessons Learned from Tobacco Control

Obviously the tobacco and food sector are dramatically different. The successes seen through the Framework Convention on Tobacco Control are often referred to, however, in discussions of food and nutrition policy. The tobacco control community recognized the need for UN coherence, and the priorities of the different UN agencies were clarified. For example, when WHO took charge of a UN-wide agreement on the roles of The World Bank, FAO, UNICEF, International Monetary Fund, and WHO, progress began. This had broad implications at the country level, because people saw the importance of defining various agencies’ approaches, such as FAO dealing with tobacco supply, while WHO dealt with demand reduction.

A second lesson learned from tobacco control is the importance of getting a stronger voice from local NGOs throughout the process of negotiation. Tobacco control witnessed incredible organization of NGOs who held everyone to account and gave support. In the nutrition world, there are few major indigenous voices

Suggested Citation:"6 The Global Response to the Crises." Institute of Medicine. 2010. Mitigating the Nutritional Impacts of the Global Food Price Crisis: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12698.
×

from developing countries that are active in the major debates. Part of the problem the nutrition community faces has to do with not hearing the outrage from local voices.

Finally, it should be noted that tobacco control was a legally driven process. There was a regular convening of governments, NGOs, and the private sector (including the pharmaceutical industry) at every major meeting. The fact that trade, health, agriculture, and all of the complex interests were represented meant that common constituencies moved ahead at the same time.

In terms of food and nutrition, part of the problem is in delineating the responsibility of WHO and FAO. Going back to the 1946 constitution, the role of WHO on food and nutrition relative to FAO is very “fuzzy.” Additionally, the WFP didn’t exist at that time, but it now plays a very strong and critical role, so it also needs to be built into the process.

“Food and Nutrition Security” Tactic

It was suggested that the international nutrition community begin referring to “food and nutrition security” all in one expression. Food security is on the map, but nutrition security and food security are not the same concept, and nutrition policies are somehow seen as separate from food security; if policies and programs for food and nutrition security are discussed jointly, it might make a big impact.

Another participant noted the importance of differentiating between food safety and nutrition in the context of food security. There is some controversy among FAO membership around the focus on nutrition versus food safety.

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In 2007 and 2008, the world witnessed a dramatic increase in food prices. The global financial crisis that began in 2008 compounded the burden of high food prices, exacerbating the problems of hunger and malnutrition in developing countries. The tandem food price and economic crises struck amidst the massive, chronic problem of hunger and undernutrition in developing countries. National governments and international actors have taken a variety of steps to mitigate the negative effects of increased food prices on particular groups. The recent abrupt increase in food prices, in tandem with the current global economic crisis, threatens progress already made in these areas, and could inhibit future efforts.

The Institute of Medicine held a workshop, summarized in this volume, to describe the dynamic technological, agricultural, and economic issues contributing to the food price increases of 2007 and 2008 and their impacts on health and nutrition in resource-poor regions. The compounding effects of the current global economic downturn on nutrition motivated additional discussions on these dual crises, their impacts on the nutritional status of vulnerable populations, and opportunities to mitigate their negative nutritional effects.

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