Expanding the Scope of Health Care: A roundtable discussion on nutrition’s impact on health, featuring World Food Program Senior Nutrition Advisor Martin Bloem
Hidden hunger and malnutrition are surpassing food security and starvation as some of the greatest health challenges plaguing our global food system today. With about two billion people suffering from malnutrition in both developed and developing countries and another two billion suffering from hidden hunger, there is a clear need for new approaches to counterbalance this growing crisis and the economic burden that accompanies it.
Overall, there is a need for cross-sector solutions that can connect the dots between the food we consume, where the ingredients are grown, and how it finally makes its way to our plates.
As part of Ashoka Changemakers’ Nutrients for All campaign, Marzena Zukowska, Media Manager and Strategist at Changemakers, sat down with Martin Bloem, Senior Nutrition Advisor with the World Food Programme, and other experts on health and nutrition. The discussion featured some unique perspectives on what we can do to refocus our food system on delivering nutrients.
Martin Bloem, Senior Nutrition Advisor at the World Food Programme
David Aylward, Senior Adviser, Global Health and Technology at Ashoka
Chloe de Roos Feinberg, Knowledge Manager for Health, Innovation, and Business Models at Ashoka Changemakers
Cindy Kaplan, Founder of the Spoon Foundation
How has public awareness of the link between nutrition and health changed over time?
David Aylward: One of the things our Ashoka Fellows and other experts in the field have taught us is that if you just focus on health care in the traditional narrow sense of fixing people that are sick, you are not going to solve the overall problem. Focusing more holistically on people, where they live, and what they eat is what is necessary.
Martin Bloem: I think it’s the most exciting time to be a nutritionist. It’s only now that policymakers are starting to recognize that nutrition is important. The focus on the first 1000 days, starting with conception until two years, is critical. If you don’t have the right growth in the first two years, then you are deprived of equal opportunities for the rest of your life. And not just the individual is deprived – entire communities have high percentages of people who are “stunted,” who have not developed in the most optimal way.
How should countries work to address nutrition issues?
Martin Bloem: Preventing stunting is so important for economic development that if you put some money into [promoting nutrition in] the first 1000 days of life, it will benefit the country in the short and long-term. When it’s about obesity – a much more complex behavioral problem – the issue is different. If you are stunted you have an increase in mortality. Obesity leads to slight increases in mortality but also enormous cost to the health system. In middle-income countries, they have both obesity and stunting. That’s why we need to tackle both in a similar way. For instance, use community-based activities, and involve the public and private sectors. Take lessons from the multi-causal problem of HIV that has seen immense improvement through the use of multifaceted solutions. People from all different sectors need to come together.
Chloe de Roos Feinberg: We need to look to the social entrepreneurs to find local solutions. Positive deviance is a way to find the bright spots that can be expanded. Within the Ashoka Fellows we see the role of appropriate information, and innovations that combine the supplement or food and the training that goes along with that. We are shifting from telling people what to do, to making the environment in which they’re living more appropriate. If you put healthy food in front of a lot of people, they still don’t necessarily know what to do with it. The goal should be to connect the steps along the value chain to ensure that all the elements are put in place.
How can consumers ensure that they’re getting a full range of the proper, bioavailable nutrients?
Cindy Kaplan: Bioavailability is impacted by how the food was prepared. Some examples of optimizing food preparation are sprouting, soaking and fermenting of traditional porridges. Other foods, like tea and tannins, can inhibit nutrient intake. It’s important to distance the timing of tea from mealtime. Vitamin C can increase iron absorption. The emotional and physical environment in which a person eats can also impact absorption – children in orphanages face a high stress environment, and many tend to have short stature. It’s not all due to nutrition, because stress itself has an impact on nutrient absorption. Some bodies also demand more nutritional input, like kids with lower birth weight, and children with disabilities. So it is multifactorial even with the same food going in.
Martin Bloem: Here is a good example: in the past, we never understood why India, with an abundance of vegetables in the common diet, had such high rates of vitamin A deficiency. It turns out that vegetables are not a good source of bioavailable vitamin A. We need the public and private sectors to work together, because you need good [governmental] rules to understand what is feasible.
How can the food industry support efforts to improve nutrition?
Marzena Zukowska: We don’t have to make a choice between taste and fortification. Incentivizing consumer behavior is how the food industry might be an interesting focal point between producers/suppliers and consumer demand.
Martin Bloem: I think it’s a very difficult area. Some say you cannot work with the food industry – they equate it to the smoking industry. Nevertheless, we want to work with the private sector to develop a market that is bigger and more affordable. Changing the availability of food is crucial. We need to react as consumers – meaning, don’t settle for something you don’t want.
Cindy Kaplan: The message has to be customized by country and environment. [Nutrition] education should focus on the impacts with respect to brain development, school performance, and the ability to hold a job long-term.
David Aylward: With new metrics to measure optimal nutrition, I can see how to take advantage of it from a business standpoint. We’re starting to see the market respond, though some will refuse to change. We should focus on the ones who do want to change. There are certainly companies interested in doing the right thing.