Here I will look ahead just one year. Fast-forwarding to October 2011, what may this letter be saying then? Starting from where the Association is now, where can we get to in twelve months? What will our new term’s first annual report be able to say?

Our website, and World Nutrition

Whatever it says, we certainly will have an attractive place for our report, as I have for this letter. This is our website, and within it World Nutrition. In this last year, these have been our most obvious achievement. This month we have been averaging what will amount to over 6,000 sessions on our website, from over 80 countries. This total has more than doubled since the launch of WN in May. (‘Hits’ run at 8 to 10 times higher, but the significant number is that of sessions).

But never mind the width, feel the quality. Within our resources, this website has begun to give a service to members, and also to all its visitors, that does our profession proud. On our website, one much-accessed feature is our members’ profiles, giving our profession a human face. Our very different columnists are also popular features. Website editor Geoffrey Cannon complains that nobody from Asia, preferably with a track record, has yet come forward with a commitment to write a column every month for the next year.

Some colleagues have said to me that our website is too much like those of popular newspapers. Is this really a criticism? Let’s not retreat behind an academic curtain and vainly try to stay in a comfort zone. Public health nutritionists are, or need to be, in the public policy arena, and this means that we need to mingle and engage with policy-makers and decision-takers who have no interest in our techniques and methodologies, and who may give us 30 seconds to explain why they should pay any attention to what we have to say, before they commit very serious financial and human resources.

This alone, it seems to me, is a compelling argument to make our website arresting, while always remaining accurate and faithful to our science, and thus get used to getting to the point and speaking and writing clearly and plainly. Jokes also are welcome. In this next year I want it to be accessed, enjoyed and used by more and more influential policy-makers, and by leading journalists, who will be guided by us in what they discuss, decide, broadcast and write.

This month our World Nutrition commentary, ‘Vitamin A saves lives. Sound science, sound policy’, is by Keith West, Rolf Klemm and Alfred Sommer, of the Bloomberg School of Public Health at Johns Hopkins University. It strongly defends the current orthodox practice of administration of vitamin A capsules to all children between 6 months and 5 years in all countries defined as being at high risk of under-nutrition. It responds to ‘The great vitamin A fiasco’, the commentary by Michael Latham of Cornell University in the first issue of WN this May, which as its title indicates, attacks current policy and practice. Those of you who attended the Porto congress may have engaged in the debate between Michael Latham and Keith West, organised as a result of our WN commentaries. Michael Latham’s commentary itself has been discussed at the most senior level within relevant UN agencies, aid and development organisations, and national governments.

World Nutrition fills what until now has been a big almost empty space in our profession. Nutrition journals, including our sister journal Public Health Nutrition, are full of facts. What’s been missing, are ideas. As a profession we still on the whole seem to assume that all we need to come up with conclusions, recommendations and solutions, is to accumulate data. Yes, we do need facts and information, organised into evidence. But what we also need are principles and concepts. These are needed to shape and frame our work, and to gauge the quality of different types of evidence. The principles of WN itself are summed up in its Manifesto. Please read it, and send any comments to me please.

Let’s stop seeming to be afraid of value judgements. These are what the profession of public health is all about. It is not a neutral discipline. One outstanding feature of Porto 2010 was the debates masterminded by Noel Solomons. These amplified the controversy sessions at the 2006 Barcelona congress, and followed a suggestion to the Porto organisers from the Association. Some prominent Association members, including Walter Willett, Barry Popkin, Carlos Monteiro, and Geoffrey Cannon, as well as Michael Latham, spoke for, or against, important and genuinely controversial topics. We intend that more such debates be held not only by experts gathered behind closed doors, but also in the open – in World Nutrition.

Rio 2012

After Porto 2010, Rio 2012. This time next year we will have plenty to report on the next world public health nutrition congress. This is being held between 27-29 April 2012, as a partnership between the Association and the local hosts Abrasco, the leading Brazilian national professional organisation concerned with public health. This good news, following our announcement earlier this year that the bid from Brazil had been accepted, began on this home page last month and continues this month.

Above, I’ve mentioned the need for ideas and principles to shape and guide our work. These also apply to public meetings. In July this year I spent a week in Rio with our Abrasco colleagues. Our new Council has now approved some principles for Rio 2012, which are also agreed by the president and council of Abrasco. These include:

• Interaction. Congresses above all should be occasions for discussions and
  conclusions. There is a place for the set-piece plenary presentation. But we will return to the classic concept of round-tables, symposia, and workshops, as fully interactive. Round-tables and symposia will include as much time for discussion as for presentations. Workshops will extend over the three days of the congress.
   
• Dynamism. Rio 2012 will have a beginning and end as well as a middle. Its
  broad theme is ‘knowledge – policy – action’. On key themes, the task of interactive sessions will be to come to agreed positions, which the whole congress will be invited to revise and then agree. These series of agreements will then be taken forward, on this site, within WN, and also in recommendations to policy-makers.
   
• Participation. Invited participants, whether from other continents, Latin
  America, or Brazil itself, will be expected to engage with the whole three days of the congress. This will include committing to workshop and other interaction, to listening and learning as well as speaking. Models for participation include literary festivals such as that organised in Paraty, Brazil, by FLIP (see www.flip.org.br).
   
• Authenticity. The congress will, as an event, be consistent with the recommendations explicitly and implicitly contained in its programme. One thing this means, is that the food provided at the venue will be delicious and also nourishing, and wherever possible sourced locally or from Brazil. After my first visit to Rio in July I can assure gourmet readers that they are in for some big treats.
   
• Integrity. Another thing this means is that the congress will be funded with public money as well as by registration fees, and supported by public institutions. Private support from companies whose business is ethical and unconnected with food and nutrition will also be accepted. This was part of Abrasco’s specification in making their bid. The accounts of the congress will be published.

More on this, and the general principles of nutrition congresses, are published this month in WN in its second ‘Conferences: What for?’ editorial. If you want to help shape Rio 2012, you are welcome: please email me now.

Developing our capacity

When the Association was founded, after the 2006 Barcelona congress, one commitment we made was to develop the capacity of our profession, globally, and in particular in less-resourced countries and among young professionals. This is a special personal interest of mine, and I should say straight away that we have not yet made much concrete progress. So now on behalf of the Council and membership, I am making a renewed commitment.

Capacity development was the theme of a pre-congress workshop at Porto. Led by Council members Roger Shrimpton and Roger Hughes, it brought people together from a number of lower-income countries. One thing is for sure. Throughout the less-resourced world, the development of capacity is not well matched to what is needed. In some countries there is a large community level workforce charged with delivering services, but with little guidance and direction. In other countries there is a large pool of people trained at postgraduate level, but with no jobs, or infrastructure within which to work. The governments of many countries encourage junior university teachers to go to European or North American universities to gain a PhD. But often when they return, it becomes evident that the training they have had does not match the needs of their country.

Thus, a key role for the Association is to see this bigger picture and work out how to join its pieces all together. Fieldworkers need to be appropriately trained. Nutrition staff working at community level need appropriate supported. Universities need to provide the right training, and university staff need support to deliver this higher level training. So you can see why our small task force itself needs its capacity developed, with support from committed Association members. If you are willing and able please email me now.

By this time next year I also intend that our certification scheme is in place. This is also part of development of capacity. I wish I could guarantee this, and we have now formed a new task force to carry the plans forward, convened by Roger Hughes. But again, we ourselves need more capacity – meaning, more members willing and able to put in some hours.

We know what is needed. Our certification scheme will be a benchmark for standards of competence. Employers in any country will see that certified professionals have reached an internationally agreed standard of excellence. This will transform the career prospects of many professionals, most of all from less-resourced countries. Certified public health nutritionists should also be the key resource within each country to ensure services are delivered and monitored. Another key role will be to support the wider workforce, such as nurses and teachers delivering nutrition services on a daily basis.

Affirmative action for Africa and Asia

Outside the UK, much of my own work for many years now has been with colleagues in Africa (South Africa, mostly) and Asia (India, mostly). This, as well as other experiences, has shown me that it’s not much good being an academic in our field, if we approach our work mainly from an academic point of view. Too many of us – including me, sometimes – are fascinated by problems and are not determined to identify realistic solutions. Too many of us take an abstract approach, without paying much attention to realities. Scan the final conclusions in papers published in learned nutrition journals. Notice how often they say, in effect ‘something really needs to be done’ or ‘more research is needed’. Sorry, esteemed colleagues, this isn’t good enough.

Now I come to another area where, as a profession and as an Association, we must make progress. In my work in resource-strapped countries I am struck, again and again, by how hard it is for researchers to do their work and to get it funded. These include brilliant and imaginative scientists who could readily get nice jobs in the US or Europe, but who are committed to remain in their own countries and communities.

For example, a group of us are trying to get support to carry out a study on breast cancer in South Africa. (Like obesity, diabetes and heart disease, in Africa cancers of types almost unknown up to the first half of the 20th century, are now common. It’s a struggle. One of our local partners, in a rather matter of fact way, told us: ‘This whole year has been characterised by multiple service disruptions. Smaller ones like loss of theatre time due to multiple causes (power outages, failure of steam-supply, non-delivery of linen), longstanding problems with the IT network that meant that we had to carry our server through the hospital, breakdown of the hospital mammography service, preparations and shut-downs for the World Cup – and now finally we have the countrywide public service strike’.

Again, I recall some years back working in Mumbai (Bombay, as was) during its worst floods in decades. Our Indian colleagues were either stuck in their first floor office, or having to wade chest high in water to get home. Yet within a day everybody was back to work, as normal. Very little help came from outside. The people of Mumbai helped each other and just got on with it, because they knew that was what they had to do. The high water marks are still visible.

World public health problems are transnational. They can be addressed successfully only if the research done in less-resourced countries is adequately funded. This is surely obvious. But so often, reviewers and editors are biased against research originated in Africa or Asia. On one occasion a reviewer of an application with which I was associated said that the methods proposed could not be delivered – meaning, bluntly, that we are lying in order to get the money. Maybe we were unlucky, but I doubt it. Bias against less-resourced researchers is not something people want to talk about.

Of course work should be supported on merit. But the odds are stacked against researchers from impoverished countries. We need affirmative action to build the capacity that exists in Europe or North America to do excellent work in Africa and South Asia. This must involve advocacy – from us individually, from us as members of research teams, and from our Association. This too is a job for the coming year.

Barrie Margetts
Email: b.m.margetts@soton.ac.uk