Access the pdf here
Access the pdf of The Association’s position on the SCN here
Access the pdf of the June editorial on the SCN here



‘Do we have to go on reading about the Standing Committee on Nutrition?’ asked an Association member recently. Or even ‘Do we really need to know about the SCN?’ Others have said more or less the same things. Fair enough, for our editorial comments on the SCN started in June, and our website home news pages have been and are covering the current SCN crisis in substantial detail, last month and this month. Our answer is yes, please do go on reading, and yes, we think you do need to know. Only some of us in the profession have a special interest in the SCN as an organisation. But all of us are surely keenly interested in the vision and mission of the United Nations family, of which the SCN is a special part. This is illustrated by the picture above, and the other pictures of happy children on the cover of World Nutrition this month, and within the Association’s position paper on the nature and purpose of the SCN that follows this editorial. With all its shortcomings, mostly not of its own making, the United Nations system continues to give hope for the future of humanity and of the living and physical world.

Within the UN system, the same is and should be true of the SCN. This hope is we think well illustrated by pictures of happy children, and above all, children from impoverished places. These are within Latin America and former USSR, also within countries where average income is high, in many countries in Asia, and throughout Africa, most of all south of the Sahara. Reggie Annan, who comes from Ghana, reminds us every month of the good things that are happening in sub-Saharan Africa.

Harmonisation

The SCN was founded in 1977, and so has been in existence for over half the history of the United Nations itself. Its core purpose has always been to harmonise UN agencies’ policies and activities concerning nutrition, and concerning food inasmuch as these relate to nutrition. This is a hard task. One reason is that there are 20 or so UN agencies and entities whose work includes nutrition, all with their own mandates and responsibilities, which may clash. One example. The World Health Organization (WHO), like national governments’ ministries of health, broadly speaking works within a medical model of health. By contrast the Food and Agriculture Organization of the United Nations (FAO), like national governments’ ministries of agriculture, fisheries and food, is centrally concerned with food systems, including production, manufacture, distribution, sale and consumption. These two agencies see nutrition through different lenses.

A further consideration is that individual UN agencies may have a number of internal departments concerned with nutrition, but from different viewpoint. Again one example. The UN Children’s Fund (UNICEF) has been the lead UN agency championing breastfeeding. But it is now increasingly taking a lead in the distribution of vitamin supplements and of ready to use therapeutic foods (RUTFs) to impoverished children. These two approaches should not clash. But increased focus on external nutrition and food aid for young children may distract national governments, international aid agencies, local health professionals, and communities and families themselves, from the need for exclusive and continued breastfeeding.

Certainly the UN system needs a nutrition harmonising body. Only the UN agencies can get their own acts together, with appropriate expert and informed advice. This is why it’s so often said ‘if the SCN did not exist, it would be necessary to invent it’. Certainly its members need to be senior executives, with the authority to hammer our policies some of which may not suit their own agencies, for the general good.

Policy-making

The SCN has also always been concerned with discussion, agreement and implementation of new or revised nutrition policies, as well as with making existing policies harmonious. An example is the use of supplements of vitamin A not just to prevent or treat deficiency states, but in particular as a way to reduce general mortality in young children. As readers will know, this policy has been vigorously attacked (1) and then defended (2) in World Nutrition this year.

The current policy on vitamin A supplementation was developed, in the late 1980s and early 1990s, in part within the SCN, in partnership in particular with UNICEF and WHO, and leading academics (3,4). In more recent years discussion of nutrition policy within the SCN has become diffuse. There are a number of reasons for this. One has been an ‘open door’ style of admitting what eventually turned out to be large number of people from outside the UN system, with variable qualifications and abilities, into the SCN annual open sessions. The point here is that the SCN has always been engaged in the formation policies.

The crisis

Any reader of the Association’s website last and this month will know that the SCN has been in crisis for almost a decade now. The general decline of the SCN’s authority emphatically does not indicate failure of its recent senior and other staff; they have proved their dedication in frustrating circumstances, and continue to do so. (We declare an interest: some of these are Association members). It certainly does reflect the weakening of the UN system by external forces notably since 2000. In an obvious and basic sense, the SCN can only be as good as the UN itself.

The resolution

Many Association members have been engaged with the SCN for periods of its history, as senior UN executives, UN advisors, SCN staff, members of member state bilateral or civil society organisation groups, and in other capacities. Collectively these members of the Association have a deep knowledge of the SCN and its place in the UN system. The Association therefore responded to the request of a number of its members, and also colleagues and contacts inside and outside the UN system, to agree our position on the SCN. This we have done. Our position paper, agreed by our Council, mandated by our membership in such matters, follows this editorial.

We gave serious consideration to the option that the SCN be abolished, and its work given to or subsumed within another body that might be more competent. This would be a mistake. The core function of harmonisation of UN policies has to be carried out by the UN agencies themselves. Many more UN agencies should be engaged in this work, which should be exclusively a UN responsibility. The UN senior executives that meet together to harmonise policies, are obviously free to invite advisors with observer status, to support their work. This way of working is similar to the original nature of the SCN from its foundation and into the 1990s.

We decided that the harmonisation function and the policy development and revision function are separate, and should be separated. Here we do think that senior UN executives need to work together with people of equivalent status and experience from other actor groups, including representatives of member states, civil society organisations, foundations, and industry, and also individual independent experts. An outline of how this can best work is contained in our position paper.

The place of industry

The role of industry, also known as ‘the private sector’, is critical. So far the UN, in attempting to formulate ‘public-private partnerships’, has proved to be ignorant and incompetent, to the point of stupidity. The UN is not alone in this, as this month’s website home page news story on the pathetic new UK nutrition policy shows.

Discussion, agreement, action, monitoring, revision and improvement of and on public policy of any type, is possible only with the engagement of industry as able, willing, and active partners. To give an analogy relevant to public health and also to nutrition, the reshaping of cities to make them safe for walkers and cyclists, and to include secluded areas for citizens and children, of course must engage engineers, architects and developers as partners. They know how to do the business.

But engagement with industry will not work in the public interest if most of the people round the table from industry are committed to private interests that damage public goods, including public health. So far in our field, the ‘private sector’ has in practice generally meant public relations people from those sectors of the food, drink and associated industries whose products, consumed in typical quantities, damage personal and public health. This is silly. The responsibility of the UN system includes being intelligent and informed. This includes engagement of industry, outside and also inside the food, drink and associated industries, prepared to be constructive. This implies thought, research, understanding of how industry works, and personal invitations to specific senior executives, with pressure not to accept deputies.

The first engagement with industry needs to be with those sectors with no commercial interest in public health, or whose business may improve as a result of improved public health. The second engagement needs to be with sectors within the food, drink and associated industries whose commercial interests do not harm public health. Conflicted industries, including food and drink manufacturers whose profits depend on products which, consumed in typical or feasible quantities, are damaging to personal or public health, cannot be members of any process designed to protect and improve health. Rational discussion centres on whether they should be excluded, or admitted as observers by personal invitations to senior executives with powers to make and change policy only. The Association has made the second choice.

A brief explanation of our policy paper follows.

Our conclusions and recommendations

It is not possible rationally to defend the SCN in its recent or present form, or in a form that would amount only to adjustment. First, since its foundation the SCN has been mainly concerned with malnutrition in the ‘classic’ sense of undernutrition, involving deficiencies of nutrients, food insecurity, and at worst hunger and even starvation. But now, other UN and other bodies and initiatives have been set up to address these issues. These include the intra-governmental Committee on Food Security (CFS), the UN Secretary-General’s High Level Task Force (HLTF), the intra-UN agency REACH initiative, and the multi-actor Global Action on Nutrition (GAP) initiative, segueing into the Scaling Up Nutrition (SUN) initiative.
These have been given impetus by the recent related finance, fuel and food crises, which have increased global inequity, poverty and misery. If the SCN remained a separate body focused on undernutrition, there would not be much left for it to do.

The gap left by these bodies and initiatives is nutrition as a whole. This wider scope will justify the permanent existence of the SCN, especially when the UN agencies and other bodies are rightly focused on specific issues such as food insecurity crises.

The scope of the SCN should address nutrition, and food as this relates to nutrition, as a whole. It should not be confined to undernutrition and its prevention, control and relief. A substantial amount of its work should therefore be strategic.

The SCN has two separate functions

Second, the SCN has two functions. One is to harmonise the nutrition policies and programmes of many UN agencies. The other function is deliberative – in effect, to discuss issues that may take shape as UN nutrition policies. These two functions have been mixed together, notably in the SCN’s week-long annual meetings. This has caused confusion.

Some UN executives have felt that it is not appropriate for people outside the UN to be members of meetings that discuss harmonisation of UN policies. We agree.

The SCN has two separate functions, harmonisation and deliberative. The harmonisation governing body is UN business, and all its members, without exception, should be senior UN officials. The deliberative forum and its membership should be multi-actor.

SCN members as representatives

Third, normal UN rules specify that people from outside the UN who are eligible to participate in UN meetings, do so not as individuals, but as representatives, of relevant organisations or entities.

By contrast, for the last ten years or so, members of the SCN civil society group, and also some of the bilateral (government) group, have participated in SCN business and meetings as individuals, with no real representative credentials. Anybody identifying themselves as from civil society, and sometimes also from a member state, has been able to turn up at SCN meetings and say what they like.

This has been resented by some UN executives, who feel that members, and observers, of the SCN process should, as usual, be representatives, and identified as such. Exceptions can be made in the case of individual scholars. We agree.

The SCN should remain a UN body, controlled in all its work by the UN, and dedicated to the UN principles that uphold peace, justice, freedom and human rights. All members of the SCN should be representatives.

The line between non-conflicted and conflicted industry

The future of the SCN has been debated for five years and more. One sticking point has been its relationship with ‘the private sector’. One change proposed by critics of the SCN should not take place. This is that representatives of conflicted industry be admitted as full members of the SCN.

Members of the harmonising governing body of the SCN should all be senior executives of relevant UN agencies. Industry outside and also inside the food, drink and allies sectors may participate in the deliberative forum. Non-conflicted and conflicted industry need to be distinguished, with a small number of representatives of conflicted industry invited as observers. It is essential that the UN agencies make initial invitations, ensure that most people from industry have no public health conflicts, ensure that food industry members and observers altogether represent food systems as a whole, limit numbers, limit transnationals, control balance, monitor developments, and accept only main board executives and not public affairs people. Similar discipline for the other constituencies is appropriate

Industry outside and also inside the food, drink and allied sectors should engage with the SCN’s deliberative forum. Non-conflicted industry representatives should be eligible to be members of the forum. Some representatives from industries with conflicted interests may be invited as observers. Some of this editorial was posted as part of the home page news stories in our November issue.

The editors

References

1. West KP Jr, Klemm RDW, Sommer A. Vitamin A saves lives. Sound
   science, sound policy. [Commentary]. World Nutrition 2010; 1, 5: 211-229. Obtainable at: www.wphna.org.
2. Latham M. The great vitamin A fiasco. [Commentary] World Nutrition May 2010, 1, 1: 12-45. Obtainable at www.wphna.org.
3. West KP Jr, Sommer A. Delivery of oral doses of vitamin A deficiency and nutritional blindness: A state of the art review. SCN Nutrition policy discussion paper no 2. Geneva: ACC/SCN, 1987. (online at http://www.unscn.org/layout/ modules/resources/files/ Policy paper_No 2.pdf).
4. Beaton G, Martorell R. L’Abbe K, Edmonston B, McCabe G, Rossi A, Harvey B. Effectiveness of Vitamin A Supplementation in the Control of Young Child Morbidity and Mortality in Developing Countries. Nutrition policy discussion paper no 13. Geneva: ACC/SCN, 1993. (online at http://www.unscn.org/layout/modules/resources/files/Policy paper No_13.pdf)

Acknowledgements and request

Readers are invited please to respond. Please use the response facility below. Readers may make use of the material in this editorial, provided acknowledgement is given to the Association, and WN is cited.

Please cite as: Nourishing our future. [Editorial] World Nutrition, December 2010, 1, 7: 286-292. Obtainable at www.wphna.org

The opinions expressed in all contributions to the website of the World Public Health Nutrition Association (the Association) including its journal World Nutrition, are those of their authors. They should not be taken to be the view or policy of the Association, or of any of its affiliated or associated bodies, unless this is explicitly stated.