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Public procurement: a double duty action to address obesity and undernutrition

Author: Corinna Hawkes
Co-Chair of the Global Nutrition Report’s International Expert Group.

Corinna will be giving a presentation at ICO2016 on 'Healthy food procurement and why is it a promising policy for obesity prevention?'

In the lead up to this, she is doing a series of blogs looking at the five areas of her presentation. Click here to read the first blog.

The 2015 Global Nutrition Report published in September, showed very clearly that malnutrition manifests itself in many different forms. Kids may be too short for their age (termed “stunting”), adults may be underweight, women anaemic. Obesity is a sign of malnutrition, too. So is having a nutrition-related noncommunicable disease.

As co-chair of the group leading the Global Nutrition Report, I am happy to see the report pay more attention to obesity this year – we tracked progress in adult obesity, diabetes and childhood overweight, monitored policy responses, and in general integrated the obesity into a report that originated from an undernutrition-focused initiative. Read what we have to say at www.globalnutritionreport.org.  

The division between the undernutrition and obesity communities has an understandable history. The two sets of problems are very different – one is about inadequacy and the other about excess. Yet they are also very much the same: both are caused by poor quality diets, unhealthy environments and inadequate breastfeeding. Both sets of problems begin in the first 1000 days of life; both have intergenerational effects.

In my view we can bring the communities together by developing a shared understanding of the policies and programmes that can tackle both undernutrition and obesity. It makes sense that some solutions will be shared: an action that helps prevent an aspect of undernutrition could do a “double duty” for obesity, and vice versa. While there are always going to be important differences, it’s simply inefficient to treat the different types of “bad” nutrition as separate problems.

Yet as we show in the 2015 Global Nutrition Report , the multiple faces of malnutrition are typically dealt with by different policies and programmes.  We need to find what we call “double duty” actions that can have benefits across the board. It’s in the interests of the obesity community to engage here: if policies and programmes to address undernutrition don’t take the real shift towards obesity into account, they will be missing a prevention opportunity – and even worse, increasing the risk of kids eating unhealthily.

One action I feel has strong potential to do “double duty” is public procurement, especially into schools.  At the moment we are seeing school food programmes emerge in countries all over the world. Yet the emphasis of those emerging in low- and middle-income countries tends to be different to those in higher-income settings. In Latin America, school feeding has historically been seen as critical to what is termed “social protection” – in this case making sure that people have enough food. In African countries a lot of emphasis has been placed on the role of school feeding in encouraging school attendance: evidence is clear that providing school meals in developing countries can have this effect. At the international level, the World Food Programme – the largest humanitarian provider of school meals worldwide – has a specific emphasis on hunger and micronutrient deficiencies. Everywhere, there is an emerging emphasis on “home grown school feeding” – sourcing food from family and local farmers as a means of supporting agricultural development.

In contrast, in North America and Europe, as well as some higher-income countries in Latin America, the emphasis has been on setting food and nutrition standards from an obesity perspective. In short, getting poor quality, calorific, foods out of schools. While school food programmes in North America and Europe can and should learn from the experiences in the developing world, double duty means crossing over in the other direction too: kids everywhere, whatever their nutritional risk need nutritious diets. It is high diet quality that should be the unifier between all of these programmes and the way we address all forms of malnutrition. 

Yet it is evident there is a huge gap in guidance for nutritional quality and menu composition for the school food programmes in low- and middle-income countries. Here there are guidelines for minimum calories available – making sure kids have enough –  but far less so for overall good nutrition.  An analysis of school feeding programmes in eight Latin American countries reveals some of the challenges: the nutritional quality of the meals is largely unknown; processed foods are widely served; many lack adequate fresh foods and diversity.

The same is found in school meal programmes in Africa. Take the case of Ghana, where the school meal programme serves at least 1.6 million primary school children a year. The programme has had many benefits – but there are no nutritional guidelines for the programme, nor standards for the food available in schools. While obesity rates themselves are very low, analysis indicates that confectionary and sugary drinks are available in around half of the schools studied – so the risk is there. So is the opportunity. Dr Aulo Gelli, who is studying the programme from his base at the International Food Policy Research Institute, thinks programmes can do more to simultaneously address short-term problems like anemia and other micronutrient deficiencies whilst also tackling medium-terms risks related to changing quality of diets and related behaviours. He is evaluating an intervention which will include nutrition education as part of school feeding, with the aim of teaching kids about healthy eating habits.  

Public procurement can do a “double duty.” If designed right, it can help prevent undernutrition and the unhealthy diets associated with obesity. But for that to happen we in the obesity community need to step out of our comfort zone and talk to folks who deal with the different side of the nutritional coin.  What do we have to lose?

The Global Nutrition Report will be convening a meeting to talk about the links between undernutrition and obesity and “double duty actions” at the ICO 2016. If you are interested, please contact me directly on corinnahawkes1@sky.com