Symposium on Nutrition Stocktaking and Challenges for the 21st Century

Address by Kul C. Gautam
Deputy Executive Director
To the United Nations Sub-Committee on Nutrition
Symposium on Nutrition Stocktaking and Challenges for the 21st Century
Washington, DC, 11 April 2000

Mr Chairman and distinguished participants,

At this meeting, which has so many of the world’s “who’s who” on nutrition, I am afraid that if I speak about nutrition, I will make a fool of myself and reveal my ignorance or superficial knowledge on nutrition. There is an expression in my language that says: “don’t light a candle where there is bright sunshine”. Guided by that advice, I won’t speak on nutrition to this assembly of some of the world’s best and brightest on the subject. Instead, I will speak about a safer subject – mobilization – and will raise some questions for us all to ponder and act upon.

Let me assure you that I’m not trying to avoid UNICEF’s responsibility as a member of the SCN to speak on nutrition. We have here a large delegation from UNICEF, and I do have a written statement prepared by my competent colleagues which we will circulate to you afterwards.

I have read the 4th Report on the World Nutrition Situation, the Final Report of the Commission on the Nutrition Challenges of the 21st Century, the Draft Strategic Plan for the ACC/SCN, and the fascinating report of last year’s SCN meeting.What I gather from these reports – and so many others on the subject of nutrition – is the following: That nutrition – and malnutrition in particular – is a subject that has been over-studied and under-acted-upon. We now understand quite adequately the problem of malnutrition – its grave and lasting consequences and, on the other hand, the virtuous impact of effective, positive nutrition interventions. Yet the world is not mobilizing enough to end malnutrition as a public health problem.

Instead, even as we speak, a famine of horrific proportions is unfolding in the Horn of Africa. Fifteen years ago, a similar famine aroused the world’s conscience, and a massive response through Live-Aid, Band-Aid, and “We are the Children” campaigns. Today, there seems to be a compassion fatigue. Although we know better than ever before what needs to be done, what approaches work, and the world’s capacity to respond is so much better now than ever before, it is hard to arouse the world’s compassion for what appear like chronic crises in the Third World, and even harder to arouse genuine solidarity for long-term development.

We would probably get a lot more media coverage on famine and malnutrition if we could fly in Elian Gonzalez to Ethiopia, than all the excellent reports of the ACC/SCN.

What is to be done? And where have we failed?

In 1990, the World Summit for Children endorsed eight nutrition goals. They were all ambitious, but none were unattainable. It is worth reflecting on why we have greater success in achieving some goals than others.

Tremendous progress has been made on salt iodization and IDD elimination. Respectable progress has been made on vitamin A deficiency reduction. Good progress has been made on breastfeeding promotion, especially through the Baby-Friendly Hospital Initiative.

Some would argue that, unlike protein-energy malnutrition, or basic education, these goals had easy technical fixes, silver bullets, and did not require serious behavioural change, etc. I respectfully disagree.

In all the goals where we have had significant success, the key has been our ability to communicate and articulate the goals in simple, easily understandable ways to decision-makers and leaders; to demonstrate convincingly how the goals are achievable in their political or official lifetime; how the goals can be pursued without emptying the state coffers; what political, tactical, moral benefits it would bring to them, and what international support and recognition can be brought to bear. In some cases, attracting the support of the private sector has been useful. In all cases, invoking publicity by the media has been vital.

In goals where we have faltered, we have failed to articulate them and position them in such a convincing manner.

Many of us recall the inspiring manner in which the late Jim Grant of UNICEF used to convince leaders, great or small, to pursue goals that at first seemed impossible, but he made them seem impossible not to pursue as our incoming chairman referred to when giving the example of the meeting of Central American presidents for USI.

Sometimes, in nutrition, we are more concerned about being scientifically correct than programmatically effective. We wish to do the right thing, but don’t do it right.

Now, ten years after the World Summit for Children, we are at UNICEF embarking on developing a new agenda for children in the next decade. In this new agenda, Early Childhood Care, Survival, Growth and Development, with nutrition as a vital element, will be a core component.

I’d like to invite the nutrition community to suggest – as you had done ten years ago and as SCN has done over the past quarter century, as Richard Jolly reminded us – a new set of goals, targets and strategies around which we could try to mobilize political leaders, corporate leaders, civil society organizations and the media.

Let me pose a couple of questions on whose feasibility we would appreciate your advice.

Yesterday, at a meeting on early childhood care and development, World Bank Vice-President Eduardo Doryan spoke about how child growth might be made a proxy for poverty reduction indicator. For over two decades, we have known the value, the sensitivity of child growth as the best measure of child nutrition. Yet growth monitoring has not quite gone to scale except in a few countries.

Can we now take up this subject and try to nail child growth as the gold standard of measuring the success of development efforts? Both the 4th World Report and the Nutrition Commission report emphasize that where child growth has been monitored at community level in combination with guidance and support for parents, child malnutrition rates have declined more rapidly. Can we make child growth monitoring and promotion a new political imperative?

When the World Bank and IMF missions visit countries, they always ask questions about a variety of economic indicators – on GDP growth rates, inflation rates, balance of payments. What if the Bank missions made a practice of also asking about the status of GMP – growth monitoring and promotion, or child growth rates?

Our chairman is the architect of the wonderful Human Development Report. But I am not sure that we have ever really made a case that child development is the foundation of human development, that the most important growth indicator is that of growth of the foetus in the womb and of the baby under two years of age. If development is about empowering people, then empowering mothers, families and communities to monitor the most important growth indicator would seem to merit high development priority.

As nothing succeeds like success, can we now envisage double fortification of salt – adding iron to combat anaemia? How wonderful it would be if we could transform our most spectacular failure of the past decade – not making a real dent in the world’s most prevalent micronutrient malnutrition, anaemia – as the new decade’s most spectacular success. Fortification might not be the only answer. Perhaps there are other approaches as well. But surely, this ought to be feasible if we put our minds to it.

I read somewhere an analysis that at current rates, it will take a century to reduce malnutrition to a level at which it would stop being a public health problem. Our challenge ought to be to eliminate malnutrition as a public health problem within a single generation, not in 100 years. My reading of these documents indicates to me that we now have the know-how to make this feasible. What is lacking, as your chair, Richard Jolly emphasizes, is vision, and a bold leadership.

We, here at the SCN, we are or can be those leaders. If not us, who? If not now, when?

May I suggest to the development agencies and donors present here that we endeavour to double our investment and triple our impact over the next five years on nutrition programmes? That as a minimum, we identify 10 to 15 countries, mostly in South Asia and sub-Saharan Africa, with major problems on malnutrition, where the conditions are ripe for our joint action in new partnership.

Let me say without stealing the thunder from Eduardo’s presentation next, that the World Bank as the single largest funder of nutrition could certainly double or triple its investment in nutrition. Can we United Nations agencies and bilateral donors help with good project preparation work at the country level, and creation of demand from governments for nutrition loans so that the Bank can triple its investment?

We at UNICEF are committed to putting a sharp young-child focus on our nutrition efforts – in fact in all our development efforts – to emphasize the dynamic concept of growth and to redouble our outreach and partnership with you all. We believe that UNICEF, with our increasingly human rights and child rights-oriented approach to programming, can play an important advocacy role to position nutrition as a central development concern.

If we can join hands to do that, we might have some hope of getting the protesters outside the barricades to join us inside for a common cause.

Mr. Chairman, I apologize – I may have veered off the subject quite a bit. I hope my written statement, which will be distributed shortly, will offer a more orderly response to the important work ahead of the Sub-Committee.

Thank you.