26 May 2016

Dear Chair, Panel Members and members of the project writing team,

Congratulations on the draft HLPE report on Nutrition and Food Systems. The draft is comprehensive and well written. Below I propose a few points for consideration

I wondered what will set this report apart from the recent GloPan report and a number of others cited in the report and indicated as forthcoming in the covering letter of the input request? There is little controversy presented in the report. The real substance of HLPE reports is to present the points of controversy and disagreement and bring science into the debate on what policy makers should believe and then to guide them in their actions.

One trait of HLPE reports that is missing in this report is the framework related to international human rights and in particular the rights of children with regard to nutrition such as the International Convention on the rights of the Child of 1989 and the African Charter on the rights and Welfare of the Child (1999). This could be one very distinctive component of this HLPE report, reminding countries if their obligations and providing opportunities to strengthen their policies and actions in this regard.

While the report is a great piece of work bringing together these elements, it does not really set out the points of contention. They feature in the report but not as controversies. These include issues such as:

a.  The report provides a balance of underweight, malnutrition and overweight and obesity and reports that 44% of countries reported in the GNR have problems with both underweight and overweight. What the report does not provide insight into is that this problem often occurs in the SAME household. How is this possible and what needs to be done about it?

b.  The fats vs sugar debate

c.  The use of high fructose sugar derivatives and the impact on diabetes rates – see the ‘Skinny on Obesity” by Dr Lustig of the University of California.

One issue the HLPE report could put firmly on the debate table for CFS is whether or not it is time for pubic policies to regulate consumption and shift consumption behaviour for improved nutrition? How is it possible that we know so much about the debates but governments are not ready to accept that we need large scale pubic policy action? Dr Lustig from the University of California’s ‘Skinny on Obesity” episode 7 (http://www.uctv.tv/shows/The-Skinny-on-Obesity-Ep-7-Drugs-Cigarettes-Alcohol-and-Sugar-23723) sets out why dealing with obesity should be a public health issue. His arguments for action are very persuasive and well worth considering as a policy message. He states that there are four reasons for public health action:

·  Identifies an exposures where mass behavioural change and environmental change is needed and instituted it for the benefit of society

·  Toxic and abused at the same time regulation is needed.

·  This exposure is unavoidable – the excessive availability and adulteration of foods with sugars and the availability at low cost of sugary foods and drinks. The food environment is such that these sugars are difficult to avoid unless you prepare all foods form raw ingredients.

·  Has a negative effect on society (the stats on health care costs, lost productivity etc.)

Sugar fits this bill on all four counts. The New Nordic Cuisine story is a powerful case of how change can be championed.

No mention is made of how higher education and training programmes can be recurriculated to solving the nutrition and food systems issues. Most training is very silo’ed. We need to get professionals entering the field schooled in these current debates and ready to deal with them. For example, most reports written by nutritionists refer to overweight and obesity as overconsumption – a phrase that depicts the professional training of these professionals and the blindness too seeing that overweight and obese people are very likely to suffer from inadequate intakes of essential nutrients. There is a significant body of research emerging about how nutrient deficiencies are related to regulation of hormones and satiety. Far too little research has been done to understand these medical and biochemical elements. This could be a recommendation for further research.

Along the same line, few educational programmes at universities train students in this area. Countless meetings and papers bemoan the capacity gaps with regard to nutrition at all levels - from community centres, health care systems and research. Maybe it is time to do something about boosting the supply of nutritionists who understand food security and the food system and are able to play an active role in shaping this in future. A neat example of such a programme in Agricultural economics is the Collaborative Masters in Agricultural Economics and Allied Economics run by the AERC that recognised a dearth of this capacity in Africa and set out to do something about it. Over 10 years close to a 1000 graduates have been added to the continental capacity. See http://aercafrica.org/index.php/collaborative-masters-in-agricultural-and-applied-economics-overview.

Many national food guides and recommendations for consumption are not within the reach of the average and especially not poor households. This could be a challenge articulated in the report. For example, research we recently completed researched what people grow, eat and what they can grow to improve their diets year-round. More research is needed such as this but the findings need to be translated into accessible tools for communities to use. See http://www.researchmatters.up.ac.za/researcher-projects/view/29.

There is very little recognition of the role of gut health in nutrition and the potential for understanding and exploiting this better for health and nutrition.

The section on gender (p57) is not really about gender – it focusses on women. This is a missed opportunity given a whole range of new initiatives to promote men’s involvement in maternal and child care for better nutrition. See the article at http://theconversation.com/when-men-tackle-mother-and-child-health-lessons-from-malawi-69501 for some ideas to balance this section and turn the section into a debate.

The report could do much more in terms of tying the various HLPE reports into this topic. How can social protection, water, climate change (somewhat addressed), prices, waste (also somewhat addressed) be linked into this discussion.

Best wishes with finalising this important report!

Yours sincerely,

Sheryl

Prof Sheryl Hendriks

Director: IFNuW

Institute for Food, Nutrition and Well-being
University of Pretoria / Postal and courier address:
Private Bag X20 Hatfield, 0028
South Africa
Physical address:
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Website: www.up.ac.za/ifnuw