A collective call to strengthen monitoring and evaluation efforts to support healthy and sustainable food systems: 'The Accountability Pact'.

There is widespread agreement among experts that a fundamental reorientation of global, regional, national and local food systems is needed to achieve the UN Sustainable Development Goals Agenda and address the linked challenges of undernutrition, obesity and climate change described as the Global Syndemic. Recognising the urgency of this imperative, a wide range of global stakeholders - governments, civil society, academia, agri-food industry, business leaders and donors - convened at the September 2021 UN Food Systems Summit to coordinate numerous statements, commitments and declarations for action to transform food systems. As the dust settles, how will they be pieced together, how will governments and food corporations be held to account and by whom? New data, analytical methods and global coalitions have created an opportunity and a need for those working in food systems monitoring to scale up and connect their efforts in order to inform and strengthen accountability actions for food systems. To this end, we present - and encourage stakeholders to join or support - an Accountability Pact to catalyse an evidence-informed transformation of current food systems to promote human and ecological health and wellbeing, social equity and economic prosperity.

Which aid spending categories have the greatest untapped potential to support the reduction of undernutrition? Some ideas on moving forward.

The financial resource needs for the reduction of undernutrition are significant, while the returns from reducing undernutrition are large. Yet the share of public resources allocated to the reduction of undernutrition remains disproportionately small. For overseas development assistance, the investment in nutrition-specific and nutrition-sensitive categories amounts to less than 3% of the total. What is the potential for other categories of public resource investments to reduce undernutrition, and in which sectors are these investments to be found? This paper proposes a framework for addressing this question and ventures some suggestions as to which of the categories of overseas development assistance beyond the well-known "nutrition-specific" and "nutrition-sensitive" categories are most likely to yield improvements in nutrition status if they could be redesigned with this in mind. We conclude that policy makers should look widely within the underlying and basic determinant intervention space for investments that, when changed at the margins, could result in significant improvements in nutrition.

Postgraduate education in nutrition in south Asia: a huge mismatch between investments and needs.

BACKGROUND: Despite decades of nutrition advocacy and programming, the nutrition situation in South Asian countries is alarming. We assume that modern training in nutrition at the post graduate level is an important contributor to building the capacity of individuals to think and act effectively when combating undernutrition. In this context, this paper presents a regional situation analysis of master's level academic initiatives in nutrition with a special focus on the type of programme we think is most likely to be helpful in addressing undernutrition at the population level: Public Health Nutrition (PHN). METHODS: This situational analysis of Masters in nutrition across South Asian countries viz. India, Pakistan, Bangladesh, Sri Lanka, Afghanistan, Maldives, Nepal, Bhutan was conducted using an intensive and systematic Internet search. Further, detailed information was extracted from the individual institute websites and library visits. RESULTS: Of the 131 master's degree programmes we identified one that was in PHN while another 15 had modules in PHN. Most of these universities and institutions were found in India with a few in Bangladesh and Sri Lanka. In the rest of the countries, neither nutrition nor PHN emerged as an academic discipline at the master's level. In terms of eligibility Indian and Sri Lankan programmes were most inclusive, with the remaining countries restricting eligibility to those with health qualifications. On modules, no country had any on nutrition policy or on nutrition's interactions with agriculture, social protection, water and sanitation or women's empowerment. CONCLUSION: If a strong focus on public health nutrition is key to reducing undernutrition, then the poor availability of such courses in the region is cause for concern. Nutrition master's courses in general focus too little on the kinds of strategies highlighted in the recent Lancet series on nutrition. Governments seeking to accelerate declines in undernutrition should incentivize the delivery of postgraduate programmes in nutrition and Public Health Nutrition (PHN) that reflect the modern consensus on priority actions. In the absence of PHN type programmes, the competence to scale up nutrition capacity is likely to be impaired and the human potential of millions of infants will continue to be squandered.

The economic rationale for investing in stunting reduction.

This paper outlines the economic rationale for investments that reduce stunting. We present a framework that illustrates the functional consequences of stunting in the 1000 days after conception throughout the life cycle: from childhood through to old age. We summarize the key empirical literature around each of the links in the life cycle, highlighting gaps in knowledge where they exist. We construct credible estimates of benefit-cost ratios for a plausible set of nutritional interventions to reduce stunting. There are considerable challenges in doing so that we document. We assume an uplift in income of 11% due to the prevention of one fifth of stunting and a 5% discount rate of future benefit streams. Our estimates of the country-specific benefit-cost ratios for investments that reduce stunting in 17 high-burden countries range from 3.6 (DRC) to 48 (Indonesia) with a median value of 18 (Bangladesh). Mindful that these results hinge on a number of assumptions, they compare favourably with other investments for which public funds compete.

Can nutrition be promoted through agriculture-led food price policies? A systematic review.

OBJECTIVE: To systematically review the available evidence on whether national or international agricultural policies that directly affect the price of food influence the prevalence rates of undernutrition or nutrition-related chronic disease in children and adults. DESIGN: Systematic review. SETTING: Global. SEARCH STRATEGY: We systematically searched five databases for published literature (MEDLINE, EconLit, Agricola, AgEcon Search, Scopus) and systematically browsed other databases and relevant organisational websites for unpublished literature. Reference lists of included publications were hand-searched for additional relevant studies. We included studies that evaluated or simulated the effects of national or international food-price-related agricultural policies on nutrition outcomes reporting data collected after 1990 and published in English. PRIMARY AND SECONDARY OUTCOMES: Prevalence rates of undernutrition (measured with anthropometry or clinical deficiencies) and overnutrition (obesity and nutrition-related chronic diseases including cancer, heart disease and diabetes). RESULTS: We identified a total of four relevant reports; two ex post evaluations and two ex ante simulations. A study from India reported on the undernutrition rates in children, and the other three studies from Egypt, the Netherlands and the USA reported on the nutrition-related chronic disease outcomes in adults. Two of the studies assessed the impact of policies that subsidised the price of agricultural outputs and two focused on public food distribution policies. The limited evidence base provided some support for the notion that agricultural policies that change the prices of foods at a national level can have an effect on population-level nutrition and health outcomes. CONCLUSIONS: A systematic review of the available literature suggests that there is a paucity of robust direct evidence on the impact of agricultural price policies on nutrition and health.

From Nutrition Plus to Nutrition Driven: how to realize the elusive potential of agriculture for nutrition?

BACKGROUND: Agriculture has the potential to have a bigger impact on nutrition status than it currently does. The pathways between agriculture and nutrition are well known. Yet the evidence on how to increase the impact of agriculture on nutrition is weak. OBJECTIVE: To outline some of the possible reasons for the weak evidentiary link between agriculture and income and to highlight some approaches to incentivizing agriculture to give nutrition a greater priority. METHODS: A review of literature reviews and other studies. RESULTS: Agriculture does not have a strong poverty and nutrition impact culture, the statistical links between aggregate agriculture and nutrition data are weak, literature reviews to date have not been sufficiently clear on the quality of evidence admitted, and the evidence for the impact of biofortification on nutrition status is positive, but small. Some tools are proposed and described that may be helpful in raising the profile of nutrition outcomes, building nutrition outcomes into impact assessments of agriculture, measuring the commitment to undernutrition reduction, and helping to prioritize nutrition-relevant actions within agriculture. Leadership in agriculture and nutrition is also an understudied issue. CONCLUSIONS: Agriculture has a vast potential to increase its impact on nutrition outcomes. We don't know if this potential is being fully realized as yet. I suspect it is not. Tools that help promote the visibility of nutrition within agriculture and the accountability of agriculture toward nutrition can possibly contribute to moving "from Nutrition Plus to Nutrition Driven" agriculture.

Food security: the challenge of feeding 9 billion people.

Continuing population and consumption growth will mean that the global demand for food will increase for at least another 40 years. Growing competition for land, water, and energy, in addition to the overexploitation of fisheries, will affect our ability to produce food, as will the urgent requirement to reduce the impact of the food system on the environment. The effects of climate change are a further threat. But the world can produce more food and can ensure that it is used more efficiently and equitably. A multifaceted and linked global strategy is needed to ensure sustainable and equitable food security, different components of which are explored here.

Feeding the world in the coming decades requires improvements in investment, technology and institutions.

The world is food secure at the global level, yet nearly 800 million are food insecure. "Business as usual" is not going to bring us close to meeting the Millennium Development Goal of halving the proportion of the population consuming less than the minimum energy requirement. So what has to change? The three papers in this session offer clues in three broad areas: (a) increased investment-by developing and developed countries-in public goods such as agricultural research, education, and clean water, (b) technologies to boost agricultural productivity for the poor and institutions that guide the diffusion and application of technology that need to be developed and (c) national-level institutions and governance structures to be strengthened and held accountable for protecting and respecting human rights, for providing the right types of national-level public goods to those that most need them and for preserving peace and stability.