NGOs is now directed towards major private sector participation. Nevertheless, the camel’s head (not just the nose) is already in the tent. It would be to the SCN’s advantage to invite private sector leaders to form a fourth grouping within the SCN structure. Since academics are, in current parlance, embed-ded in each of the four groups, a fifth grouping for them is not neeembed-ded.
This brief history highlights how the SCN has evolved into a uniquely valuable organization that has much more expertise and influence today than at any time in its history. The global experience and competence represented at this current meeting indicates what an extraordinary institution the SCN has become. Now the challenge is for the SCN and its member institutions to make the critically im-portant contributions necessary if the international system is to achieve the Millennium Development Goals (MDGs).
The SCN and the Millennium Development Goals The mandate of the SCN is
...to serve as the UN focal point for promoting harmonized nutrition policies and strategies throughout the UN system, and to strengthen collaboration with other partners for accelerated and more effective action against malnutrition.
Its aim is
...to raise awareness and concern for nutrition problems of global, regional and national levels; to refine the direction, increase the scale and strengthen the coherence and impact of actions against malnutrition worldwide and to promote cooperation of UN agencies and partner organizations.
I will provide an overview of the role nutrition plays in achieving the MDGs and suggest how the SCN can play a vital role in this process. The mechanisms available to the SCN are multiple:
▪ discussions and resolutions at annual meeting
▪ discussions, reports and recommendations of working groups
▪ follow up activities by the Secretariat
▪ commissioned papers and reviews
▪ SCN News and other publications
▪ coordination meetings on special topics
▪ actions of the Steering Committee.
Working groups, along with ad hoc task forces, should be the principal means of maintaining SCN’s influence and momentum between meetings. Their effectiveness is now limited by short sessions at annual meetings that are usually clogged with reports. These groups must also have a single strong chair with available time to dedicated to the subject.
To be more effective, the SCN must make much greater use of its additional implementation mecha-nisms.
▪ Assigning responsibility for specific activities to working groups between annual meetings and creating new working groups or task forces for such purposes. Some working groups should have their own secretariat for continuing actions between, and in preparation for, SCN meet-ings.
▪ Through advocacy, influencing private sector organizations, including both global and local food companies, to adopt nutritionally sound practices (eg, fortification and enrichment with appropriate micronutrients, affordable and nutritionally sound complementary foods for infants and young children).
▪ Adopting strategies and mechanisms for much broader and strategic communication of SCN analyses and recommendations, including strategically placed reviews and advocacy pieces, tele-vision programmes, resources for science and policy writers, and prominent lectures.
▪ Persuading internationally recognized leaders (Nobel and World Food Prize laureates, former UN agency directors, etc) to serve as advocates for specific nutrition programmes during inter-national and regional UN meetings and inter-national visits.
Two additional points: the Secretariat should see its role as promoting and facilitating the strategies that the members implement towards the MDGs; and as a contribution to developing future leaders in nutrition, young nutrition scientists, particularly from the country or region in which the SCN meets,
should continue to be invited to participate.
Nutrition and the Millennium Development Goals
Below are specific actions the SCN should undertake in respect to the MDGs:
Goal 1 – Eradicate extreme poverty and hunger
It is the mission of the SCN and its agency partners to do everything possible to reduce hunger. The SCN should commission and distribute authoritative and compelling reviews of the relationship be-tween poverty and hunger. It should also support proven measures to reduce poverty such as micro-credit and policies to support peasant agriculture (eg, agricultural extension, subsidized inputs, and guaranteed minimum prices).
Goal 2 – Achieve universal primary education
The effectiveness of universal primary education is in part dependent on avoiding the cognitive dam-age associated with iodine deficiency in pregnancy, iron deficiency in infancy and protein-calorie mal-nutrition in preschool children. The SCN should demonstrate to government planners that education is less cost-effective if iodine deficiency in pregnancy and infancy and protein-calorie malnutrition in pre-school years are not corrected. It should also disseminate evidence on the strong link between nutrition, education and achieving the other MDGs.
Goal 3 – Promote gender equality and empower women
Gender equality and empowerment of women has long been an initiative of the SCN and its agency partners. The SCN has already widely distributed “The Asian Paradox,” an article attributing the higher rate of stunting in Asia to the chronic under-nutrition of Indian women and the strong gender bias that robs them of control of their lives. The SCN should continue to publicize, in ways that influ-ence policy-makers, the connection between the empowerment of women and the achievement of the other MDGs. It should also identify and promote specific measures that will improve the status of women in a society.
Goal 4 – Reduce child mortality and Goal 5 – Improve Maternal Health
Goals 4 and 5 can be achieved only with the kind of initiatives and actions that the SCN has been pro-moting. The SCN and its members are already playing a major role in the elimination of micronutrient deficiencies, such as iodine, vitamin A, folic acid, iron and zinc, as public health problems, but there are serious gaps in its efforts. Continuing to promote early exclusive breastfeeding and supporting bet-ter prenatal care will also help.
Goal 6 – Combat HIV/AIDS, malaria, and other diseases
Infectious diseases and malnutrition are synergistic which should be viewed as a part of the SCN’s mandate for action. The SCN should aim to influence national and international policies and pro-grammes to promote research and disseminate information about the role nutrition plays in the sever-ity and outcome of infectious diseases and on the effect of infections in precipitating nutritional defi-ciencies and stunting.
Goal 7 – Ensure environmental sustainability
Nutrition is dependent on food, but food security requires sound cropping practices, water manage-ment, and sustainable animal and fisheries production. The SCN should take into account the need for environmental sustainability in research, policy, planning and implementation. It should also work with agencies and organizations promoting environmentally sustainable food production.
Goal 8 – Develop a global partnership for development
Because of the link between malnutrition and poverty the SCN should promote global partnerships for development. The SCN’s members are already involved in such partnerships, this should be recog-nized and strongly encouraged.
The effectiveness of the SCN on various food and nutrition issues has varied over time but has always been positive. Progress has been made in:
▪ controlling vitamin A and iodine deficiencies
▪ the promotion of breastfeeding and baby friendly hospitals
▪ the inclusion of folic acid in iron and multinutrient supplementation and fortification pro-grammes
▪ the fortification of rations for refugees
▪ the promotion of a human rights approach to nutrition.
However, the SCN has not been effective in two areas of importance. One is timely and appropriate complementary feeding. Last December, SCN News featured articles on, “Meeting the Challenge to Improve Complementary Feeding.” The SCN needs to respond with actions to address the serious problems identified in this report. For the first time this year, complementary feeding is a major com-ponent of the working group’s agenda.
The response of the SCN is addressing iron deficiency, which is closely related to complementary feed-ing, has also been disappointing. This is an important neglected area of nutrition for which there are specific, urgent and effective responses that could make an important contribution towards achieving the MDGs.
At last year’s meeting in Chennai, India, Betsy Lozoff and I presented evidence and called for actions to prevent the extremely widespread and serious cognitive damage of children in developing countries caused by iron deficiency in infancy. With few exceptions, the SCN and its members have done little on this issue or the other consequences of early iron deficiency across the life cycle. In fact, the work-ing group on iron has been incorporated into a swork-ingle workwork-ing group dealwork-ing with all micronutrients.
The UN Special Session on Children called for a population-wide 30% reduction in anaemia, including iron deficiency, by 2010. Concerted effort toward achieving this target could become an example of how the new SCN can tackle a major, relatively neglected problem, vigorously and effectively. Reduc-ing iron deficiency would have a major impact on nearly all of the MDGs.
Table 1 leaves no doubt that iron deficiency is a massive global health problem. As this tabulation shows, the global prevalence rates are staggeringly high with over two billion iron deficient persons.
In addition:
▪ prevalence rates in women and children in most developing countries are 40% to 60%
▪ generally, anaemia prevalence rates for pregnant women in developing countries exceed 50% to 60%
▪ at up to 100% the prevalence of functional iron deficiency is double that of anaemia.
Even full term, exclusively breastfed infants need either supplementary iron or iron fortified comple-mentary foods from six months of age. For low birth weight babies, additional iron is needed from two months of age. Under one year of age, the required iron cannot be supplied from unfortified food in any society. Iron deficiency is unique in the extent of its adverse impact on health and its economic and social costs at any age or stage in the life cycle including:
▪ high risk of lasting cognitive damage in infancy
▪ poorer pregnancy outcomes and lower iron stores in infants
▪ impaired learning in school, reduced growth, and increased rate of infections in children and adolescents
▪ high risk of moderate to severe anaemia in pregnancy
Region Prevalence %
Africa 293,000,000 46
Americas 142,000,000 19
Eastern Mediterranean 184,000,000 45
Europe 86,000,000 10
South East Asia 778,000,000 57 Western Pacific 598,000,000 38
Total 2,032,000,000 37