Nutrition Policy Crossroads: Insights from Action Against Stunting Day Roundtable

UKRI GCRF Action Against Stunting Hub commemorates 8 September as Action Against Stunting Day. It is a day when we come together to take cognisance of our contribution to the fight against stunting across the country hubs and extend thoughts and efforts to children suffering from and prone to stunting worldwide.  

The first edition (September 2021) identified the critical priorities in addressing the challenges of stunting:

1. Raise awareness about stunting and the effects it has on people and communities.
2. Deliver the latest evidence-based approaches to malnutrition.
3. Launch a set of commitments among change agents worldwide, specifically in the worst affected countries.

The second edition (September 2022) was the first hybrid event hosted at the London School of Hygiene and Tropical Medicine (LSHTM), which explored the question of ‘How to advance a just transition to sustainable food systems and food security through appropriate policies, investments and support.’ It focused on advancing a just transition to sustainable food systems and food security through appropriate policies, investments and support.   

The third edition (September 2023) focused on raising awareness about the issue of child stunting to cultivate dialogue and inspire action in the nutrition advocacy sector through policy-level discussion and activities with relevant stakeholders to revolutionise how the world thinks and acts in response to stunting. 

Action Against Stunting Day 2023 Roundtable Meeting 

The meeting comprised three sessions covering global transition, country-level policy contexts, and future pathways.  

Session 1: Child stunting & global transitions 

The discussions diverged into two key areas: actions to transform global food systems to fight child stunting and relevant policy measures to avoid backsliding on international and national child stunting targets. 

While answering the questions, Saul Morris, Director of Program Services, GAIN, highlighted the need to reform the global food systems debate on child malnutrition. He outlined that actions must address the required change and that specific foods and policies should be prioritised. The profile of child malnutrition must be raised as a policy agenda item along with engaging the private sector. Besides supporting national pathway development, the need remains to reconcile differing priorities among ministries.  

Callum Northcote, Head of Hunger and Nutrition, pointed out that the crowded global policy space and governments’ short election cycles hinder prioritisation and long-term policymaking for child malnutrition. He suggested three concrete actions:

• Educating policymakers and the public in a clear and relatable manner,
• Demonstrating the scale of the problem using tools such as ‘cost of diet’ and
• Presenting solutions while turning them into shared responsibility by engaging various stakeholders such as consumers, producers, and businesses.

We must frame stunting as everyone’s problem by putting it in the context of broader issues such as mental health and social protection.  

Alok Ranjan, Director of Programmes and Investments, mentioned how different components of malnutrition may require different approaches and solutions. Tailoring solutions to different life cycle stages, such as preconception, maternal nutrition, and the first two years of a child’s life, is essential. Localised and sustainable solutions and policies should be the focus rather than depending on solely global solutions. Collective efforts are required to break down silos and integrate sectors and partnerships between funders, implementers, governments, and the private sector.

Abigail Perry, Director of Nutrition, World Food Program, remarked stunting as a smoke detector or fire alarm for various underlying problems with development, demanding a rethink from multiple dimensions besides nutrition. The political economy of nutrition and food systems is vital. Nutrition needs to be framed as essential rather than an aspiration, as poor nutrition can undermine economies, increase healthcare costs and lead to an unhealthy workforce. Collaboration, data-driven evidence, and reframing the narrative are essential to help people realise their entitlement to a healthy, nutritious diet. At the same time, understanding how economic interests influence power dynamics between various stakeholders and decision-making is vital. 

Marie McGrath, Technical Director, Emergency Nutrition Network, asked for stunting to be viewed as a marker of risk, not an outcome. She also pointed out how the existing research, including systematic reviews, meta-analyses, and clinical trials, might not be sufficient in helping understand the state of things. What is lacking is a deeper understanding of the “how” and practical implementation of strategies to scale up interventions rather than searching for a single magic solution. Along with collaboration over the whole-child approach, local knowledge and community input should shape policies and interventions. The role of context is significant, and practical implementation and community involvement are essential to better management and improved outcomes. 

Stephen Allen, Theme lead Gut Health & Parasitology, UKRI GCRF AAS Hub, added that public education and advocacy are essential to create a demand for better child nutrition. Norm-setting and collaboration with the private sector can help drive demand. The focus should be on defining health outcomes and affordability. 

Speakers also agreed that lessons from vaccine campaigns can be applied to nutrition. The importance of affordability and addressing costs is highlighted. Rethinking and redefining systems in a context-specific manner is crucial, where social brokerage and relationships can play a significant role in policy implementation. Giving control of nutrition information back to the people is essential. The social justice perspective should be integrated into the nutrition debate. 

Session 2: Unpacking the relationship between policy and research  

The country leaders provided insights into the challenges and strategies to help address stunting and malnutrition in different regions and contexts alongside the ongoing development.  

In her keynote, Dr Bharati Kulkarni, Country lead India, UKRI GCRF AAS Hub, pointed out that stunting elimination and improving early childhood development are crucial for India to become a knowledge-based economy by 2047. A multi-sectoral approach, such as India’s National Nutrition Mission (Poshan Abhiyan), is required to address the determinants of stunting. There remains a need for implementation research to:

• Ensure the effective delivery and integration of programs at the child level.
• Improve supply-side and demand-side interventions
• Focus on behaviour change and capacity building

Besides undernutrition, increasing overweight and obesity due to processed food consumption remains prevalent. Thus, research on changing consumer preferences, interventions to promote healthier food choices, and improvements in the food system are needed. 

Dr Deepak Saxena, Director Indian Institute of Public Health Gandhinagar, India, informed the listeners about Gujarat’s context. Gujarat has established a Center of Excellence on Nutrition, mid-level training centres for Integrated Child Development Services (ICDS), and a State Resource Center for monitoring ICDS. However, there remains a gap between implementation and desired outcomes. Advocacy efforts should prioritise policy formulation, including district-level action plans, identifying high-risk pockets and more and involve stronger dialogues between researchers and policymakers. 

There remains the need to design differential childcare models for malnutrition based on evidence-based findings and pilot strategies with scalability. He also pointed out the importance of deep data analytics and advanced predictive models for informed interventions, which require collaboration from the State Government for data access. The unreliability of existing government data emphasises the need to develop a capacity for deep data analytics within nutritional tracking systems. 

Dr Babacar Faye, Country lead Senegal, UKRI GCRF AAS Hub, discussed the fight against stunting in Senegal and West Africa while mentioning the persistence of disparities. A lack of knowledge about the root causes, low population participation in policy development, political instability, crises, and climate change affect efforts to address malnutrition. Climate change affects agricultural production and nutrition-related problems, particularly in arid zones. Collaborative discussions among ministries and institutions are crucial for addressing malnutrition effectively.  

Dr Irma Ardiana, Director of Infant and Child Family Development, Family Planning Board of Indonesia and Dr Umi Fahmida, Country lead Indonesia, UKRI GCRF AAS Hub, presented the Indonesian scenario.

Dr Irma discussed how Indonesia is working towards global megatrends impacting development goals. Stunting remains a challenge, but prevalence has declined from 30.8% in 2018 to 21.6% in 2022. Initiatives and strategies to accelerate stunting prevention include family planning, nutrition, healthcare, water, and sanitation improvements. Specific intervention indicators track stunting reduction progress. Challenges include data fragmentation, budget allocation, program management, geographical factors, and cultural considerations. There is a high demand for research to inform policymaking, especially in areas like family-based interventions, community-based models, food security in disasters, and the impact of social security on children’s anthropometry. Data interoperability is challenging in Indonesia, hindering comprehensive information gathering and analysis. 

Dr Umi discussed the importance of local wisdom and the absence of a one-size-fits-all approach to addressing stunting. She stated that efforts need to be redirected to incorporate local values and knowledge into strategies along with consideration of social security aspects in interventions.  

Session 3: Pathways to Action 

The session brought insights into the importance of advocacy, addressing climate change’s impact on nutrition, and the need for integrated policies and public engagement to tackle global nutrition challenges. 

Kate MacMohan, Policy and Parliamentary Advocacy Officer, All-Party Parliamentary Group (APPG) Nutrition for Development, emphasised the need for greater engagement from the public and politicians to address global nutrition challenges. She highlighted the efforts of the APPG Nutrition for Development in raising the profile of nutrition in international development. She further discussed the challenges in regaining parliamentary energy for global nutrition, including competing priorities and budget constraints. Advocacy is vital for educating parliamentarians about malnutrition and increasing public awareness. It needs to align with the public’s level of understanding, where education and awareness-building can mobilise public support and solidarity for long-term nutrition interventions. 

Jack Ryan, Food Systems Specialist, COP28, led the discussions from Dubai, highlighting the COP28 agenda linked to child health and development. He discussed the impact of current food systems on climate change and their role in exacerbating stunting. He highlighted how climate change threatens stunting through reduced agricultural yields and water scarcity. While emphasising the importance of addressing the food systems and climate nexus to achieve global goals, he presented the COP28 UAE Presidency’s focus on food systems and agriculture as a priority. The four pillars of action in the COP 28 food systems and agriculture agenda are national-level action, non-state actor involvement, innovation, and finance. He also briefed the audiences about initiatives like the Landscape Action Agenda on regenerative landscapes and the Food Systems Financing Accelerator. 

Marie McGrath took on the disconnect between policies concerning the interplay between wasting and stunting and their integration into practice in several countries. These issues are intimately connected, especially at the ground level, where children face concurrent risks. While discussing the Global Action Plan on Child Wasting, she advocated for better policy integration at the country level and real-time evaluation of policy changes. The research should involve an in-depth examination of how policy changes were attempted and whether they were successful, helping understand who benefited from them and whether the changes had the desired impact. Countries must lead in shaping policies and strategies based on their specific needs and context. What is it? What is the evidence and the knowledge they have? What is it they need? How can we learn? It would also be valuable to conduct research and investigation into the pathways of policy change.

Terri Sarchs, Nutrition Policy Team Lead, Foreign, Commonwealth & Development Office, emphasised the significance of advocacy in driving change, citing the success of campaigns like the school meals campaign. She discussed the need to shift focus from production to consumption and diets. She also advocated for government intervention in the food system, such as banning unhealthy foods and taxing sugar and alcohol. There also remains the need to explore the connection between climate and nutrition and the role of research in accessing climate finance for nutrition investments. 

Conclusion

The Roundtable Meeting on Action Against Stunting Day 2023 consisted of informative sessions covering global transitions, country-level policy contexts, and future pathways. Key takeaways included the need for holistic approaches to transform food systems, educating policymakers and the public, engaging various stakeholders, and tailoring solutions to different stages of mother and child health.

The meeting also highlighted the significance of community involvement, local knowledge, and context-specific policies. Speakers stressed the importance of public education and advocacy, collaboration with the private sector, and addressing affordability. The social justice perspective was integrated into the nutrition debate, emphasising the need for norm-setting and defining clear outcomes.

The attendees also discussed climate change’s impact on child nutrition, the need to drive change, shift from a production to a consumption focus, and explore climate-nutrition connections. They also took note of the interconnectedness of wasting and stunting, advocating for better policy integration and real-time evaluation. 

In essence, the Action Against Stunting Day 2023 Roundtable Meeting exemplified the commitment of the UKRI GCRF Action Against Stunting Hub to combat stunting and malnutrition. The Hub continues to lead the way in advancing the fight against stunting, fostering dialogue, and inspiring actionable change worldwide.