A model for integrated action: IAEA, UNICEF & WHO collaborate to tackle the double burden of malnutrition
Craftivist Collective / Save the Children
Cornelia Loechl is the Section Head of the Nutritional and Health-related Environmental Studies Section of the International Atomic Energy Agency (Vienna).
Efforts are building to address malnutrition worldwide as part of the Decade of Action on Nutrition, yet responses to date have largely occurred in silos, with limited coordination or communication between actors working across the spectrum of the double burden of malnutrition.
In order to address this and spur greater, integrated approaches to end both undernutrition and obesity, October 2017 saw a pioneering 3-day joint workshop co-hosted by the International Atomic Energy Agency (IAEA), UNICEF, and WHO. This meeting further characterized and examined the double burden of malnutrition with a focus on double-duty actions. More than 40 participants attended from all regions, representing scientific, multilateral, governmental, academic, and civil society sectors. The outcomes included: an exchange of the latest evidence regarding all forms of malnutrition and their interlinkages, identification of research and policy gaps to be addressed, and sharing of best practice as well as successful case studies.
A core focus of the meeting was improving collaboration between nutrition policy stakeholders, to place the double burden of malnutrition on research, policy, and practice agendas. It was a shared view of the meeting that the multisectoral nutrition community should endeavour to work together to improve understanding of the common factors that lie behind the double burden of malnutrition. In addition, it should facilitate a dialogue to bring nutrition to the forefront of health and social policy and strategy development. Improving understanding of the shared drivers of the double burden of malnutrition is crucial; this encompasses biological mechanisms, socioeconomic status, and food environments. In addition, attention needs to be paid to less understood aspects such as exposure to environmental hazards and socioecological factors. Civil society has a critical role in fostering of political will and capacity to reframe current policies and interventions, including through the vital role it plays in ensuring policy accountability for tackling malnutrition.
A second theme of the meeting was the need to reframe nutrition interventions to address the double burden. Double-duty actions need not be an additional burden for governments, and existing resources and structures can be augmented and capacities built to address the double burden in an efficient and cost effective manner. A core component of this will be an expansion of metrics used in the evaluation of malnutrition interventions to ensure that we adequately assess their impact across the entire malnutrition spectrum. As such, interventions should not only be measured by singular endpoints, such as their ability to influence a total reduction in obesity. In addition, they should also be assessed on their influence on intermediate outcomes, such as changes in diet and/or improvements in nutrition practices. Evaluations of nutrition interventions should also strive to reflect outcomes across the entire malnutrition spectrum so as not to miss important and even unintended health impacts. For instance, randomized controlled designs, although strong, are not always appropriate, but rigorous evaluation strategies embracing the complexity of double-duty actions will help us to understand if, why, and how nutrition plans are effective. Such an approach would also improve the understanding of the pathways of impact of such interventions. In addition, stable isotope techniques should be considered to provide accurate evidence to enable design and evaluation of interventions, especially those related to infants and young child feeding in the first 1000 days, assessing metabolic changes related to the double burden of malnutrition, and evaluation of diet quality.
The third major theme involved the need for comprehensive and coherent policy, encompassing nutrition, food systems, environments, and urbanization. For the challenge of policy coherence to be overcome, nutrition-specific policies must support action on all forms of malnutrition, and be complemented by nutrition-sensitive policies across the sectors that govern the food supply and broader determinants of nutrition. This could involve reorienting policies to create incentives for the production and consumption of healthy diets, access to sanitation, and sustainable urbanization. It will require strategic engagement with sectors such as agriculture, trade, and education, as well as consideration of the existing policy environment and political context in these sectors. Forming win-win alliances with the informal sector and retailers as gatekeepers of what people eat and do will be beneficial.
Building on the foundations of this inaugural meeting, the IAEA will organize an interdisciplinary and multilevel conference in Vienna in late 2018, in cooperation with WHO and UNICEF. This will bring together over 300 leaders, scientists, experts in the field, and representatives from government bodies and international organizations, working alongside civil society actors, to address knowledge and research gaps and discuss innovative and contextually-relevant double-duty actions.
Through this expanding collaboration, IAEA will continue to further strengthen measurement tools to inform evidence for biological mechanisms through the use of accurate nuclear and isotopic techniques. UNICEF will continue its efforts influencing food systems to deliver healthy, affordable, and sustainable diets for all children, leaving no-one behind. The WHO will continue its role in co-convening the Decade of Action on Nutrition, while also incorporating the outcomes of this tri-agency collaboration into its ongoing work with The Lancet and other partners, developing a journal series on the double burden of malnutrition, due in 2018.
If the global double burden of malnutrition is to be comprehensively addressed, it is imperative that this model of multi-sectoral, collaborative working becomes the norm for international action.
This is a joint post with Simon Barquera (National Institute of Public Health, Cuernevaca, Mexico); Anne-Marie Thow (University of Sydney, Sydney, Australia); Jennifer Orgle (CARE, Atlanta, GA, USA); Víctor Aguayo (UNICEF, New York, NY, USA); and Francesco Branca (WHO, Geneva, Switzerland). The authors alone are responsible for any views expressed in this publication and they do not necessarily represent the decisions or policies of any third party.
The sixth paragraph and the affiliations of the coauthors were corrected on Dec 4, 2017