Corinna Hawkes: ICN2—a starting point for preventing malnutrition in all its forms?

Corinna HawkesIt was pouring with rain when I arrived on a delayed flight to Rome for the Second International Conference on Nutrition (ICN2), which was organised by the Food and Agriculture Organization (FAO) and the World Health Organization (WHO). But I was glad to have arrived at last. ICN2 had been a long time coming. Postponed for two years—it was originally scheduled for 2012, 20 years after the first ICN in 1992—preparations had been fraught and fractious.

By the time I left the conference, several days on—this time in glorious sunshine—170 governments had adopted two outcome documents, 150 civil society groups had agreed about their key tasks for nutrition, and scores of experts had dispensed their wisdom in six roundtable panels and nine side events. Meanwhile, in a kind of mad frenzy, everyone had tried to nudge their way into the pass only plenary room to get a glimpse of the Pope—who, for the first time in his tenure, addressed the FAO.

Long hours notwithstanding, I had some fun at ICN2. I got to see old colleagues, attended embassy receptions, met politicians in show-off mode—and even caught a glimpse of the Pope myself. But that’s hardly the point. Did ICN2 make a difference? Will ICN2 have an impact on one of the world’s most serious public health problems?

Only time will tell. But here’s an initial assessment.

In my view, ICN2 proved important in two ways. First, it brought together people who don’t often get together: in the political spectrum, delegations came from ministries of health, agriculture, and international development; from the United Nations system came reps from FAO, WHO, the UN World Food Programme, Unicef, the World Bank, and more; in civil society, fisher folk came together with large, anti-hunger non-governmental organisations; and donors came out in full force. That might sound like no big deal, but it’s a step: a tiny, tentative step towards a better global governance system for nutrition, food, and agriculture—a system that needs all these players coming together, embracing one another, and all figuring out who should be doing what and how.

Moreover, it’s a big deal that malnutrition in its varied forms was represented. This is something that my own organisation, World Cancer Research Fund International, along with our colleagues from the NCD Alliance, had strongly advocated. As evinced in the Global Nutrition Report and the WHO Global Nutrition Targets Policy Brief Series (both of which were released at the conference), multiple burdens of wasting, low birth weight, stunting, anaemia, overweight/obesity, and diet related non-communicable diseases are the “new norm.” So the first commitment in the Rome Declaration on Nutrition to “eradicate hunger and prevent all forms of malnutrition worldwide” is to be welcomed. At last a global emphasis for a global problem—a seeming unity for an ever growing movement fighting malnutrition in all its forms.

Second, it wasn’t only the problems that found common ground: but their solution—or, rather, their solutions. Assorted statements read out by delegates confirmed that the solutions come in many forms. We heard about local, national, and international solutions; solutions in agriculture and food systems; in the healthcare system; in education. Most of all we heard about how the solutions fall into multiple sectors. As the Brazilian health minister put it, “addressing malnutrition is only possible through a set of complementary and inter-sectoral policies, [including] promotion of the whole food system, from production and distribution to consumption.”

The focus on food systems, and the commitment in the Rome Declaration to enhancing “sustainable food systems,” is to be applauded. It’s a relatively new, innovative, and often untested space, yet a space in which I am confident many different types of solutions will emerge in the future.

ICN2 was a moment of consolidation and an opening. In this way, it was an important and memorable moment: a reflection on everything that’s been achieved and an invitation to begin the future.

But what future? Member states agreed broad commitments (Rome Declaration) and a long shopping list of actions (Framework for Action). The commitments are progressive and worthy; the shopping list is a very handy combination of tried and tested and innovative solutions. They are to be supported. But accountability to implement these commitments remains unclear despite, as put by the civil society statement, strong accountability being “imperative for ensuring that the commitments made at ICN2 truly contribute to ending malnutrition in all its forms.” And, despite the UN director general Ban Ki-moon’s plea for countries to name the actions they would take to implement the Rome Declaration and the Framework for Action—and the FAO director general José Graziano da Silva’s call for less “blah blah”—rarely did the government delegates state what they were going to do differently, post ICN2, as a result of these documents. The documents were adopted in a matter of minutes at the commencement of the conference. And then they somehow disappeared.

I, for one, don’t want them to disappear. For, despite real progress since the first ICN, the world is off track to meet the WHO Global Nutrition Targets and the WHO non-communicable disease targets. According to the numerous talks in the roundtables, side events, as well as the statement made by a broad coalition of civil society organisations, we need to do lots of things differently: scaling up, leadership, accountability, food system change. The list goes on.

One key issue that came up time and time again—with a dedicated roundtable—was the need for policy coherence. In my own presentation on policy coherence, I talked about how the multiple objectives in the food system mean some incoherence is inevitable. But I also talked about how identifying shared objectives across sectors can actually lead to more powerful solutions for all involved. Idealistic maybe. I certainly felt it was idealistic given that no clear international framework was presented at ICN2 for how to create more coherence and coordination—not in policy, or in governance. Yet we know that the UN, governments, donors, the private sector, civil society organisations all need to be part of a clear and better system of coherent governance to effect real change.

So, my conclusion on ICN2? It’s only going to make a real difference if it is seen as the initiation of a process rather than its conclusion—the start, not the end. And if this helps prevent malnutrition—in all its forms—then we can safely say it will indeed have made a difference.

Corinna Hawkes is a specialist in food policy who has worked at WHO, and is currently head of policy and public affairs at World Cancer Research Fund International. Her work involves advocating for a comprehensive policy approach, which encourages healthier eating worldwide to reduce the risk of cancer and non-communicable diseases.

Competing interests: None declared.