Srujith Lingala, Manager Technology and Entrepreneurship at Sight and Life
Most Recent, Food Systems
According to our estimates, 600 million jobs will be needed by 2030 to absorb the growing global workforce, which makes SME development a high priority for many governments around the world[i].
(The World Bank)
If we want to help improve the nutrition levels and health of a population, we should therefore look to bolster its SMEs.
Room for improvement
Sight and Life has long been interested in finding ways to boost the productivity and income of SMEs in LMICs and has researched different business models which can be most effective. Recently, we investigated constraints in egg production in four countries – Kenya, Ethiopia, Malawi, and India – and identified five business models that are viable and sustainable (read more on why we love eggs here). Of those five, the Egg Hub model has proven to be the most successful. An ‘Egg Hub’ is a centralized unit providing high quality affordable inputs, extension services, training, and market access to small and medium farm enterprises (out-growers) involved in layer farming. This approach showed rapid increase in egg yields, achieved self‐sufficiency, reduced the price of eggs, and provided a high income for the farmers, a majority of whom are women. We found that this model was successful in improving hen productivity from an average of 40 eggs per bird to 270-300 eggs – an outstanding result.
This study demonstrates how impactful the right kind of efforts can be on SMEs, the livelihoods they support, and food systems. To enable more of this sort of targeted investment all along the value chain, Sight and Life is initiating Food Systems Innovation Hubs in rapidly emerging markets such as Nigeria, Bangladesh, and Rwanda. These hubs will work to alleviate malnutrition through corporate partnerships, impact investors, and government collaboration in the context of a robust entrepreneurial culture in these geographies.
An important milestone in the evolution of the Micronutrient Forum, and in the growth of the global nutrition community as a whole, took place in November 2020. Four years after its previous very successful conference, which took place in Cancun, Mexico, the Micronutrient Forum (MNF) held its fifth global conference, MNF CONNECTED.
For five days, people from all over the world came together online to explore the conference theme of ‘Building New Evidence and Alliances for Improving Nutrition.’ This was a bold experiment – a strong act of recovery from the disappointment of having to cancel the 5th MNF global conference in its originally planned form in Bangkok during March of this year as a result of the COVID-19 pandemic.
A huge effort went into planning the original conference; an ever greater effort went into planning and delivering this innovative virtual alternative. In its own words, “The Micronutrient Forum serves as a global catalyst and convener for sharing expertise, insights and experience relevant to micronutrients in all aspects of health promotion and disease prevention, with special emphasis on the integration with relevant sectors.” This mission was very effectively fulfilled during MNF CONNECTED.
Structure and content
The online conference was structured in five tracks:
Track 1: Micronutrient Biology and Status Assessment
Track 2: Efficacy and Safety of Micronutrient Interventions
Track 3: Program Effectiveness
Track 4: Designing an Enabling Environment for Micronutrients
Track 5: Food Systems
Conferences always provide a wealth of information and a host of opportunities to exchange research findings and opinions. MNF CONNECTED 2020 was no exception. Making a virtue of necessity, the conference organizers created a dedicated website that was strongly branded and easy to navigate, giving visitors the sense of entering a special space full of information and action.
Launched in advance of the conference, this website functioned as a place of meeting, information and sharing for all participants, providing the opportunity to conveniently review and select elements from the extensive conference program. The content included sessions that were livestreamed each day along with a large amount of pre-recorded contributions that could be viewed on demand.
A significant advantage of this format was that conference delegates had the opportunity to watch sessions that might otherwise have been running simultaneously, and to follow contributions from all of the tracks – an important consideration in the context of an event whose aim is to be a “global catalyst and convener for sharing expertise, insights and experience.” This facilitating role is also being expanded beyond what would have been possible in the context on a traditional conference, for the entire conference content will remain online and be accessible to delegates for the coming year.
The enforced choice of online delivery had the additional benefit of reducing attendance costs considerably and eliminating travel costs completely, making this event accessible as never before. Delegate numbers exceeded 3,500, with an unprecedentedly high level of participation on the part of colleagues from low- and middle-income countries. Certain of these, however, reported that the broadband coverage in their location was insufficient to cope with the requirements of streaming – an issue that will certainly be addressed if a similar conference is held again.
First established in 2006 as the successor to the International Vitamin A Consultative Group (IVACG) and the International Nutritional Anemia Consultative Group (INACG), the Micronutrient Forum convened international conferences in Istanbul in 2007, Beijing in 2009, Addis Ababa, Ethiopia in 2014, and Cancun, Mexico in 2016. It was chaired by Alfred Sommer (professor and former dean of Johns Hopkins Bloomberg School of Public Health, and the former Chair of IVACG) from its inception until 2010, when it lapsed due to USAID’s decision to discontinue support. A group of interested organizations, including Sight and Life, brought it back to life after brief hiatus and in 2014 convened the Addis conference. From 2010 to 2017 Lynnette Neufeld (Director, Knowledge Leadership at GAIN) was Chair of the Steering Committee of the Micronutrient Forum.
Since staging its 2016 conference, the Micronutrient Forum has become a legal entity and non-profit organization under the leadership of Executive Director Saskia Osendarp and MNF Board Chair Howdy Bouis, entering a new level of organizational maturity.
Expectations of the 5th global conference were therefore high – and additionally so because of the impact of the COVID-19 pandemic on many of the world’s poorest and most vulnerable populations. As Princess Bajrakitiyabha Narendira Debyavati, the Princess Rajasarinisiribajra of Thailand, observed when formally opening the conference on 9 November, the global nutrition community can still connect and collaborate in the face of COVID-19, working harmoniously to combat micronutrient deficiencies around the world.
This sense of urgency was likewise conveyed by Lawrence Haddad, Executive Director of GAIN, who gave the keynote speech during the opening of the conference. Looking forward to next year’s United Nations Food Systems Summit, with its stated aim to “launch bold new actions to deliver progress on all 17 SDGs”, as well as to the Nutrition for Growth (N4G) Summit to be held in December 2021, Lawrence stated that “our global food system is on the wrong track, and we have to find the levers to get it onto the right track,” emphasizing that “2021 is the best opportunity for positive change we will have in the next ten years.” (Watch the full session: How to meet global micronutrient needs within sustainable food systems)
This, then, was the setting for the work of the five conference tracks – not just to present the findings of self-contained research studies and implementation programs but to seek the connections between these lines of endeavor. Time and again, the interrelated themes of connection and collaboration were revisited by conference speakers and also delegates, who had the opportunity to correspond with presenters via a live chat facility and also to connect with them online before or after their live sessions.
Micronutrient biology, the subject of conference Track 1, is something that can be influenced by designing and delivering appropriate interventions on the basis of scientific evidence. The enabling environment, the subject of Track 4, can likewise be shaped by targeted policy interventions. Delivering effective programs (Track 3) based on efficacious and safe micronutrient interventions (Track 2) can help address micronutrient deficiencies.
The challenge of inadequate food systems
However, the 2020 edition of the State of Food Security and Nutrition in the World, jointly prepared by FAO, IFAD, UNICEF, WFP and WHO and published by FAO in July, estimates that almost 690 million people went hungry in 2019 – up by 10 million from 2018, and by nearly 60 million in five years. One reason for this is the world’s inadequate food systems, which fail to deliver many of the elements essential for a healthy, balanced diet, and which also do not meet the nutritional requirements of the world’s most vulnerable populations. The very concept of ‘food systems’ is a relatively new one, however – there was no conference track dedicated to it when the Micronutrient Forum last convened, in 2016 – and although inadequate food systems might be easy to diagnose and describe, they are much less easy to fix.
This conundrum was eloquently and memorably expressed by David Nabarro, the founding coordinator of the UN Scaling Up Nutrition (SUN) Movement, who is currently advising the Director General of WHO on its response to the COVID-19 pandemic. In his concluding observations on 13 November, he observed that, “A malnourished child does not have an alarm light on its head to flash ‘nutrition emergency’. The emergency is invisible – and it leads to lifelong disadvantages that are mental, emotional, and physical, as well as economic. This magnificent MNF CONNECTED has realized that malnutrition is a sign that things are not right. Acting to change this is complex, however.” Quoting Saskia Osendarp, and thanking her for her leadership in delivering this conference, David continued, “We need to step out of our own shadow and work together as never before.” (Watch the full session: Look up, don’t look down: how to redesign the future for nutrition post-COVID19)
“The power of us”
This was the key take-away from a remarkable event that was a milestone in every sense of the word. Saskia Osendarp re-emphasized David Nabarro’s point in her concluding remarks: “We all want to meet up again physically, but this conference has shown how connected we can all be. There are no magic bullets, and we must work much more closely across sectors to address micronutrient deficiencies – using the power of us.”
Klaus Kraemer, Chair of the Micronutrient Forum Conference Committee, and Managing Director of Sight and Life Foundation, observed in this context that, “As a global nutrition community, we need to speak in a clear and coordinated voice.” For, as he continued, “If we want to change policy, we need to speak the language of policy.” This will be a major challenge for the nutrition community – to speak clearly in a concerted voice that external decision-makers can understand.
Too important to be left to nutritionists?
Eileen Kennedy, professor and former dean of the Friedman School of Nutrition Science and Policy at Tufts University, perhaps had this in mind when she quoted a nutritionist of days gone by as saying that nutrition was too important to be left to the nutritionists. (Watch the panel discussion: How to keep micronutrients as a priority with shifting global, national and donor priorities?) The remark had been made not in this century but in the previous one, by Howard A. Schneider, Director of the Institute of Nutrition at the University of North Carolina, at the Nutrition-related Oversight Review, Hearings Before the Subcommittee on Domestic and International Scientific Planning, Analysis, and Cooperation of the Committee on Science and Technology, U.S. House of Representatives, Ninety-fifth Congress, First Session, in 1977.
“The nourishment of human beings is a complex affair that taps a multitude of the components and agencies of both our public and private lives,” said Schneider. “Like Clemenceau’s aphorism that war is too important to be left to the generals, I sometimes am persuaded that human nutrition is too important to be left to nutritionists.”
From “The power of us” to “Speech to power”
The achievements of MNF CONNECTED were great. For them to be translated into action, intensified cross-sectoral collaboration is necessary. But so is speech to power. As Francesco Branca, Director of the Department of Nutrition for Health and Development at WHO put it: “We can’t have a world with three billion left out.” (Watch the full session: How to meet global micronutrient needs within sustainable food systems)
MNF CONNECTED will be the subject of a Sight and Life Special Report that is scheduled for publication on 1 February 2021. Watch this website for further information.
Puja Peyden Tshering,Consumer Insights Specialist at Sight and Life
Most Recent, Perspectives
The global food system is recalibrating in the wake of many factors, one of which is the increasing demand for traditional proteins, driven in large part by low-or-middle-income emerging markets in the Global South (see Alternative Proteins: What’s the deal?). What this has led to is the rise of a new category ‘Alternative Proteins’ encompassing everything from re-engineered plant-based legumes to lab-grown meats. The mushrooming of new brands in this category have been centered in the Global North, with some markets even reaching close to saturation point (read this to find out what all the hype is about). The market share is expected to change as the case for alternative proteins in the Global South gains traction.
At Sight and Life, we thought it would be interesting to study how some alternative protein brands have chosen to open conversations with their consumers in such a fresh, new category. It becomes easier to understand the way brands speak if one were to look at them through the archetype lens, providing the brand a more human feel. Similar to how fictional characters are written according to paradigms in order to help understand their actions, a brand archetype is a way of presenting a brand and define its symbology, values, behaviors, messages – as a persona, thus making it more recognizable and relatable to target audiences. We looked at the main sources of brand communications available to decode the semiotics – the official brand website, the major social media accounts, official digital/ television advertisements, if any, and digital banners.
– The novelty of the alternative proteins’ category allows for bold claims, bold brand names, bold imagery
– The current marketing is for a consumer higher up in Maslow’s Hierarchy of Needs – looking for a greater sense of purpose to participate in, a future-forward perspective
– Improving the world is an often-cited end goal and functions as the gratification – the product sensory experience is not usually the show runner
– Most brands in this space tend to speak to the public the same way they would to an investor – however, Impossible Foods and Beyond Meat have evolved and struck up new conversations with the consumer
Innocent vs. Hero Archetype
First, we looked at Impossible Foods and Beyond Meat, both based out of the United States. Both these brands stand out as more evolved in their marketing to consumers in that they attempt to engage the consumer in a less technical and more emotional conversation. This strategy could be because both brands are available in retail and need to do more than highlighting the scientific angle to their products.
Take Impossible Foods, for instance. The brand talks about respecting the magical moments we celebrate (all in the company of good food), without harming the planet. Impossible Foods has set out on a mission to create ‘Paradise’, a world where everything and everyone lives in harmony. When it talks about its mission (#MissionEarth and #MissionImpossible), much of the brand imagery alludes to elements of an ideal world – happy adults, happy youth, happy children, happy creatures, happy trees, and a blue sky. If you pay attention to the brand’s vocabulary, you can see it is current, outspoken, and determined, and seems to speak to a younger audience – the millennials and Gen Z – fitting into the Innocent archetype. The Innocent is someone that dreams of the ideal, is an eternal optimist, and celebrates wholesomeness.
Impossible Foods is not just for vegetarians; it is for meat lovers and the environmentally conscious and the flexitarians who may be a bit of all three. It also spotlights its science story, the champion being ‘heme’ – this is what makes the meat ‘bleed’ and gives it the right texture and flavor. Impossible Foods celebrates great taste, as much as the lack of environmental repercussions – which is significant since it shows that it understands the consumer is ultimately tempted by indulgence and not delayed gratification, no matter how noble the cause. It works hard to lend a sense of purpose to the Impossible Foods consumer in a vibrant, cool way – pops of color, flat icons, catchy hashtags et al. On social media, you can see Impossible Foods stand up for causes that are outside of environmental concerns. The leadership team even writes on Medium.com, a popular online publishing platform. In short, the brand continues to leverage every opportunity and every channel to reach its target consumer.
Now, let’s look at Beyond Meat. This brand brings to mind the Hero archetype, looking to inspire others to do better, achieve more, truly test the limits, go beyond and not settle for the standard. The Hero is an archetype that strives for mastery, showing courage that improves the world and this is exemplified in Beyond Meat’s communication. For starters, the brand logo is a buffalo that’s wearing a cape. The Hero is all about action, and Beyond Meat is no exception.
Most of the brand’s imagery is dark and grave – a great deal of black is used to convey the brand’s bold personality, and the green bits pop up in places for greater emphasis. Much of the copy in the brand’s videos and banners is serious or inspirational. Beyond Meat breaks down four main reasons to make meat from plants: improve human health, positively impact climate change, address global resource constraints, and improve animal welfare. It features well-known sports and television personalities who act as Beyond Ambassadors.
Here we see two brands communicating a sense of purpose to the consumer – Join #MissionImpossible or #GoBeyond. Impossible Foods does shine a spotlight on its all-star element, heme, assuring the consumer of an equally – if not more – fulfilling gastronomic experience. Still, the real hero is the consumer, who chooses to further this larger cause. Beyond Meat also places the responsibility on its consumer to challenge the status quo and find a better solution.
Talking Logic vs Talking Emotions
Let us now move to the last two brands we considered, which have not yet started speaking to consumers, but are looking to craft their identity. In Hong Kong, HK Avant Meats is a brand that has innovated the production of high quality, sustainable, and tasty fish products. The brand uses cell technology to harvest premium delicacies from our seas and oceans, without harming the water bodies. How well does the brand convey this to an outsider, a potential consumer? Based on the website, the brand’s vocabulary is currently more scientific and functional than emotional, with terms such as ‘cell technology’, ‘GMO-free’, ‘innovate’, ‘sustainable’ etc. There are two products under the Avant Meats banner – Avie and Zellulin. The imagery for both is opposite to the clinical environment the brand sets up on its homepage: Avie feels like a lifestyle brand for younger millennials while Zellulin cues a luxury category such as cosmetics or perfumes.
Lastly, there is Clear Meat, a start-up from India. The brand is resting on scientific credentials at the moment and does not yet elaborate on product experience. If we were to delve into the semiotics here, we see the process is celebrated more than the end product. This message is also apparent as the brand speaks of gratification and the emphasis on the process continues to overshadow the product.
From even a glance as cursory as this, we can see that given the novelty of the conversation, brands run the risk of speaking to consumers the same way they would talk to a potential investor. The consumer that these brands are targeting (potentially targeting – in the case of the last two) is ahead of the curve, someone who is aligned to the brand’s journey and mission and advocates the cause and not the product alone. Such a consumer could appreciate the larger objective and may even be willing to compromise on indulgence. This leads us to question how alternative protein brands should be speaking to consumers in the Global South? Could we alter the manifestations of such archetypes such that they resonate with low-and-middle-income consumers? In the seesawing between purpose and indulgence, how much weight should each carry? Can the sense of purpose be made more personal and placed within the Global South consumer’s direct needs? And lastly, will the product be the hero, or should the consumer be the hero?
Investments in Plant-Based Food Companies (2010–2019)
The alternative protein industry can be segmented by protein source and level of processing: fortified or otherwise modified plant-base (including fungi and algae), insect-based, and lab-grown meat or by application: direct consumption, animal feed, and supplements. With a current market capitalization of $2.2 billion and concentrated in the Global North, most alternative protein startups and associated funding focused initially on segments with existing demand and potential growth opportunities like plant-based products. However, there is a rising favorable environment for alternative protein in the Global South due to increasing disposable incomes, consumer affinity towards sustainable consumption, less competition, and growing venture capital funding for startups. Furthermore, as European and American markets are becoming saturated with alternative protein products and more competitive, we anticipate these companies expanding their business model to the Global South. This plant-based movement has also spurred new developments such as the European Alliance for Plant-based Foods (EAPF), bringing together like-minded organizations in the plant-based value chain around a unique mission: To put plant-based foods at the heart of the transition towards more sustainable and healthy food systems.
At Sight and Life, we are working to advance innovations that need cross-sectoral expertise in nutrition, marketing, and business models in the Global South. We seek to pre-empt the movement of alternative protein into the Global South and identify priority focus areas as the industry shifts geographical focus. Two alternative protein segments relevant to these markets over the next five years are plant-based processed products and insect-based animal feed.
The plant-based category is the largest source of alternative proteins today. In 2019, plant-based companies in the U.S. raised nearly US$ 750 million, or 90% of the total funding for alternative proteins. These companies are sustainable and significantly less resource-intensive than animal husbandry and their products, due to the dominant use of ingredients of soy and pea. Paired with environmental benefits, the ability to closely mimic a range of meat variants at a competitive price, plant-based meats are well-positioned to cater to the Global South. Moreover, multi-national food companies and protein producers, which have a presence in low-and middle-income countries, are investing in plant-based products.
Why insect-based animal feed?
The demand for animal source foods in the Global South is witnessing a sharp rise, with demand projected to increase by 73% by 2050. The market has seen a spike in input costs as traditional feed ingredients such as soy and fishmeal commodity prices rise. More and more farms are therefore demanding cheaper feed sources such as insects, as meat consumption increases. Though large-scale production of insect feed occurs in the Global North, there is an opportunity to scale existing small and medium enterprises in the Global South by adopting and innovating new technologies.
To meet the unique nutrition needs, the share of wallet and palate of the consumers, three areas that need attention are accessibility, awareness, and local taste preferences. Along these lines, Sight and Life will share insights in a three-part blog series on approaches that would make alternative proteins relevant for consumers in the Global South.
Making alternative proteins aspirational
Marketing a new product becomes critical in a new category, especially when consumers do not have any previous food product perceptions. In the next blog post, we investigate how alternative protein brands have established themselves and communicate with their consumers. Puja Peyden Tshering, Sight and Life’s consumer insights specialist, analyses four brands through an archetype lens, understanding the brand through a more human feel. Read the thought-provoking questions she raises as companies start speaking to consumers in the Global South in this blog post.
Inclusive business models for alternative proteins
Alternative proteins currently cater to the premium segments, millennials, and Gen Z in the Global North, who enjoy a high spending power. But for alternative proteins to successfully cater to low-and-middle-income countries, affordability is a crucial lever. Sight and Life’s business model specialists, Kalpana Beesabathuni and Srujith Lingala, together with interns Hannah Wang and Emily Voorhies, identified market opportunities and viable business solutions that are sustainable and capable of producing protein alternatives to wrap up the series.
All graphics created by Sight and Life’s Architect and Design Specialist Anne Milan.
On August 28, 2020, Times of India published “Take-Home Rations: A route to nutrition security” by Dr. Rajan Sankar of TINI Tata Trusts (read the more about Dr Rajan Sankar here) and Kalpana Beesabathuni,Sight and Life’s Global Lead for Technology and Entrepreneurship. The full article can be read here.
The disruption of food systems by Covid-19 and its impact on the availability of nutritious food in large parts of the country has brought to light the importance of the Take-Home Rations (THR) programme and its potential to deliver fortified food to the last mile in the country. The THR programme is unique in its reach and scale; it is also well resourced with a budget of Rs. 13,500 crore and hundreds of millions of beneficiaries. The current crisis presents a window of opportunity for THR to fully realise its promise and transform India’s nutrition security scenario.
India is home to one-third of the world’s stunted children (4.7 crore) and half of the world’s wasted children (2.6 crore). Nearly 41% of children less than five years old are anaemic. To combat malnutrition, the Government of India launched the Integrated Child Development Services (ICDS) programme in 1975; it offers a variety of nutrition and health services for the first 1,000 days of life. This time span is vital for preventing long-term consequences associated with malnutrition, particularly during pregnancy and also when infants transition out of breastfeeding.
I had convinced my son that “fizzy” drinks were disgusting. I told him they were bad for him, that they are full of teeth rotting sugar and that they did not taste nice. He believed me and never wanted to try one. However, eventually, children reach an age where their friends become authorities on seemingly everything, and they start to listen more to their mates than their mum.
On the school run yesterday, my 8-year old son: “Oliver says, mixing red and blue makes green.”
Me: “No, I am sure that makes purple.”
My son: “No, Oliver knows Mummy.”*
Me: “Why are you digging a massive hole in our lawn?”
My son: “Freddy said we could find diamonds in our gardens.”
Me: “Err no, darling, we don’t have diamond mining in the UK.”
My son: “Yes, we do. Freddy told me so (as he carries on digging).”
When Oliver and Freddy told my son that he should try a “fizzy” drink as they were “fun”, he no longer listened to me and my warnings. He used his pocket money to buy a can of Cola-Cola. The result – he loved it! Why do you love it? I asked him.
“It makes me smile Mummy,” he replied simply.
For me, this uncomplicated response summed up everything – unless healthy and nutritious drinks such as milk and water make my eight-year-old “smile”, he will keep wanting Coca-Cola. And although I can use a metaphorical “stick” and ban him from drinking such drinks now, without the “carrot”, I will not win the battle in the long run. As soon as he is old enough to walk to school and go out by himself, he will just choose to buy unhealthy drinks with his pocket money.
Apart from my son’s questionable trust in his friend’s advice (and their questionable art and geological knowledge), what can we learn from his Coke experience? And how can we use such insights to create demand for nutritious food and drinks?
For me, the key is this
LISTEN. Listen to your target audience – the people whose behavior you want to change. Whatever people do, even if it seems foolish to you, they will have their reasons. These reasons might not be rational (as my son’s experience demonstrates), but then we are driven by emotion, and our decisions and actions are rarely logical.
Many of you might have focused on educational interventions in the past, believing that people simply need to know what is good for them and what is not. However, do not be fooled; education does not always work.
If we always made rational decisions, none of us would overeat, smoke, salute three times to magpie birds (which I do due to a silly old English superstition), or drive like lunatics. But rest assured, when you ask and listen, your target audience will have their reasons.
When I worked at the Department of Health England, they ran the 5-a-day campaign, trying to encourage people to eat more fruit and vegetables. However, during the campaign run, consumption went down. Why? They made the incorrect assumption that knowledge and changes in attitudes are sufficient, and ignored beliefs or benefits gained from eating unhealthy foods (do carrots and broccoli make my 8-year-old smile? You can guess the answer).
The whole social marketing discipline is based on the idea of exchange, and if you want people to change their behavior, you have to offer them something in return. Often this is non-monetary – a feeling of belonging, sophistication, or security. Or, an alternative product that gives them the same or greater benefits as the product they are currently using. These benefits must be immediate, as we value these more than longer-term ones.
You only can work out what the exchange should be by listening to your target audience and understanding the benefits they derive from the negative behavior, such as consuming high-sugar soft drinks. Coke gave my son immediate happiness; how can we create that same feeling with a healthy drink?
For deeper insight on formative research, take a look at our Action in Brief on “Eat More, Eat Better”, a behavior change strategy to support improved food access and food choices for women in the northern Indian state of Rajasthan.
This summer Sight and Life are running a three-day course as part of the Swiss Lugano Summer School. The session “Generating demand for better public health goods and services: A systems and consumer-centered approach” and will explore how social marketing, behavioral insights, and innovations in behavioral science can be used to create demand for healthy products and behaviors. The course will also explore how public-private partnerships can make healthy products more attractive to consumers and develop sustainable business models. Further details and where you can enroll click here.
I hope to “see” some of you there.
*In case you are wondering, mixing yellow and blue make green.
Nutrition in the Workplace is a Winning Solution During and Post-COVID-19
Diet and nutrition of the workforce during and post-COVID-19
The COVID‑19 crisis has had a dramatic impact on the world’s workforce; partial or total workplace closures have restricted business operations and have affected an estimated 80% of the global workforce. The worst-hit workers are those working in small and medium-sized enterprises, and low-wage workers in informal employment, with limited access to safety nets. For others, adjustments in the work process and arrangements to work from home have enabled them to retain their jobs during COVID‑19.
A survey among employees highlighted the main challenges workers face to eat healthily:
1) easiest food choices aren’t always the healthiest
2) “I don’t always have time to buy and prepare healthy food”
3) “it’s too expensive”
4) “the people I’m around don’t eat healthily.”
A pre-COVID-19 survey in the UK revealed that infections, musculoskeletal problems, mental health conditions, and diabetes were among the main health reasons for sick absence. However, nutrition as a direct modifiable factor for many of these health conditions is often overlooked by employers. Higher absence rates among workers can be expected post-COVID-19 due to “suspected infections” but also as a result of increased mental problems; approximately half of the young people reported anxiety or depression since the start of the pandemic. Therefore, during and post-COVID-19 pandemic, healthy eating, and nutrition programs in the workplace are important in fostering employee immunity, physical and mental health. Centrally distributed workplace nutrition provides the opportunity to reach many workers and contribute to employees’ essential nutrient requirements.
Evidence for nutrition programs at work
Workplace nutrition programs can include “education” or “coaching” programs to encourage workers to consume more nutritious foods. Access to nutrition consultation and personalized nutrition advice has a significant potential health improvement rate. Nutrition programs can also include (subsidized) nutritious food offers at work, such as healthy lunch choices or fruits, fortified lunches, or micronutrient supplements. The evidence for the health benefits of nutrition in the workplace is growing. Micronutrients provided to workers through fortified foods or supplements significantly improved workers’ nutrition status in various workplace settings. Anemia, common colds, urinary tract infections, and work absence were reduced in Bangladeshi women garment factory workers receiving multi-micronutrient-fortified rice along with iron and folic acid supplement and nutrition counseling for 10 months. Infection-related work absence was reduced by almost two-thirds in healthcare workers consuming multi-micronutrient supplements for one year. Other reported benefits of providing micronutrients in the workplace are manifold; reduced heart rate, improved body mass index scores, bone density, perceptual and cognitive functioning, improved mood, and reduced depression.
What are the benefits for the worker and employer?
Employers bear many of the costs related to absenteeism and presenteeism. On average, employees cost businesses the equivalent of three months per year in lost productivity. Unhealthy eating (too much salt, sugar, saturated fat), as well as inadequate essential nutrient intake, raises the risk of low productivity. By optimizing workplace nutrition, workers receive the nutrition needed to stay alert and focused while employers benefit from reduced absenteeism and less presenteeism or unproductive use of time. Better nutrition also equates to improved resilience to infections and stress – other potential pathways to better work performance.
Employers’ social responsibility for the nutrition of own employees
Employers have an essential role to play during the COVID-19 crisis to provide good nutrition, especially for the most vulnerable in society. It is important that work environments facilitate good nutrition to support the physical and mental health of their workers. Investing in workplace nutrition is a high return on investment for the employer and can increase workers’ health, work attendance, morale, efficiency, and productivity. A recent report by GAIN-SUN-Eat Well demonstrated that “workforce nutrition” is a win-win for employers looking to improve both employee health and business outcomes. Moreover, it can contribute to the nutrition targets of the United Nations Sustainable Development Goals (SDGs), specifically SDG 2 (zero hunger), SDG 3 (good health and wellbeing), and SDG 8 (decent work and economic growth).
There is a growing awareness among the public and private sectors that workplace nutrition can benefit both employees and businesses. IMPAct4Nutrition (read more in our Action in Brief on IMPact4Nutrition) is an example of a public-private engagement that aims to bring together the diverse private sector interested in contributing to the Indian Government’s social movement named POSHAN Abhiyaan or National Nutrition Mission. Diverse partners are engaged including UNICEF, Sight and Life, CSRBox, Tata Trusts, and the Confederation of Indian Industries. The priority by IMPAct4Nutrition is promoting nutrition in the workplace by targeting key nutrition behaviors in the workplace in three areas; assets and core business for nutrition, cash/corporate social responsibility for nutrition, and employee engagement for nutrition. During COVID-19, IMPAct4Nutrition has developed digital training modules to support companies in promoting good nutrition across their business ecosystem with practical, easy to follow tips on how employees can maintain an appropriate nutritional status. Through these modules, the platform is reaching 10 million employees, their families, and communities in 51 companies across India.
In June 2020, IMPact4Nutrition was honored with a UNICEF global INSPIRE Award in the category ‘Best Multistakeholder Engagement’. Nearly 100 campaigns from 50 countries were nominated and voted on by UNICEF staff worldwide.
The reward is high
A successful workplace nutrition program can be part of a broader organization’s framework tailored toward health and wellness. A successful program requires buy-in from leadership as well as a dedicated coordinator and resources for implementation. Quantitative data such as surveys, nutrition, and health data will help to evaluate if the program was a success. Besides the employer, trade unions, foodservice operators, and incentives by insurance companies can further contribute to a positive nutrition environment at work.
Nutrition programs in the workplace offer a direct opportunity to workers and employers; they have the potential to improve workers’ physical and mental health, and loyalty and thereby improve work attendance, productivity, and employer reputation. The potential return on investment of investing in workplace nutrition is high. Therefore, proper nutrition in the workplace is a win-win proposition for employers and employees. Investing in workers’ nutrition should be a goal if organizations are to thrive.
There are many hungry bellies to feed around the world and we are merely scratching the surface to nourish the vulnerable populations of the world. Due to the current COVID-19 pandemic triggering lockdowns around the world, issues in nutrition such as food systems and malnutrition have been heightened and are now more of a global urgency than ever before. Here at Sight and Life, we are working on initiatives in Rwanda, South Africa and India to help improve the lives of those in need during this crisis.
“The only silver lining during this grave crisis has been how quickly and effectively we’ve been able to work together as a team and with our partner organizations to identify food insecurity hotspots and mobilize resources for emergency hunger relief. The guiding principle behind our efforts has been to look beyond just filling bellies but make sure adequate and critical nutritional needs are met,” expresses Sight and Life team members.
In India, we have partnered with grassroots NGOs across India, such as Aahawaan Foundation, based in Bangalore, and Kutumb, working in Uttar Pradesh, to donate grocery kits and nutritious food to the affected communities.
Kutumb is an organization attending to abandoned and slum children by giving them a sense of family. They are also dedicated to strengthening all units of marginalized and underprivileged families, realizing that children can be nurtured best in a family setting. Together with Kutumb, we provided nutritious food to over 1500 children with moderate acute malnutrition in 75 villages located in Uttar Pradesh.
In Bangalore, we teamed up with the Aahawaan Foundation who is committed to providing basic requirements and facilitate the development of the overall potential of people and their communities. Together, we delivered 15-day grocery kits with staples and fortified kernels as top-up was delivered to migrant workers and their families ensuring that the nutritional needs are met, beyond just filling stomachs.
“I was unsure of how I would provide for my own children and was hence, worried about feeding my neighbor’s children as well. This ration will help me cope with this crisis for some more time,” explains Sita Ben, one of the many women workers our partner reached with an essential food kit. She spoke about her difficulties during this pandemic as she is responsible for her children and neighbor’s children as they are unable to return due to the lockdown in India. Now she can sleep a little bit knowing she has the ability to feed her and her neighbor’s children.
Meanwhile, in Delhi, monthly ration kits made it to 200 daily-wage households. The kits contain additional essential supplies such as oil for cooking, grains, lentils, and an egg for a family of four in order to help ease the pain of many in unfortunate situations.
“A great number of my fellow countrymen are forced to walk a thousand miles, often hungry, just to reach the safety and comfort of their families. We are grateful for the opportunity to raise funds on their behalf and support them with nutritious meals,” explains the Sight and Life team.
We are committed to doing more however, we need support. Please donate to via our Milaap or GoFundMe crowdfunding page to further our efforts. We are also interested in partnering with organizations that have similar initiatives and are located in Rwanda, South Africa, or India.
Five-step plan to prevent an impending nutrition famine during COVID-19 in India
Srujith Lingala, Manager Technology and Entrepreneurship and Dr. Basanta Kar, Recipient of the Sight and Life Global Nutrition Leadership Award
Most Recent, Perspectives
India’s isolation measures in response to COVID-19 are having a far-reaching impact and is among one of the largest initiatives globally to impose strict limitations on its 1.3 billion citizens. People with pre-existing vulnerabilities, marginalized communities, pregnant and lactating women (PLW), daily wage earners, migrant workers, and the elderly have been the hardest hit as the protective measures disrupt the economy.
To ease the effects of the pandemic, the national and state governments have announced extensive stimulus packages and policy measures. The national government on 12th May announced a $265 billion relief package aimed at injecting liquidity into the economy. The first tranche of $ 22.6 billion included several social protection measures such as payment of ex gratia amount to marginalized populations, increased wages for workers under the National Rural Employment Guarantee Act, doubling rations for three months, collateral-free loans to women’s Self Help Groups (SHGs), the inclusion of support to COVID-19 under Corporate Social Responsibility (CSR), and financial assistance to villagers through farmer cooperatives. These aid benefits are aimed to help more than 810 million Indians and are a step in the right direction.
In addition, integrating nutrition in the current policies will be fundamental to improving nutritional status and building immunity of the population, especially high need groups like PLW and children under 5 years of age. The WHO guidance on diet during the COVID-19 pandemic states that “good nutrition is crucial for health, particularly in times when the immune system might need to fight back”. India is already battling a high prevalence of malnutrition (Table 1). As India, in unison with the rest of the world, battles an evolving pandemic of unprecedented proportions, policymakers must be vigilant, agile, and innovative to halt our population from sliding into hunger and acute malnutrition due to the COVID-19 outbreak.
Source: Comprehensive National Nutrition Survey 2016-2018, Ministry of Health and Family Welfare Govt. of India.
We propose a five-point plan to put nutrition-sensitive policy measures in place to combat the adverse effects of COVID-19:
1. Increase budget and coverage for essentials
Many state and national governments have gone beyond the entitlement provisions under the National Food Security Act – 2013 to announce a stimulus package, the key elements of which are grain and pulses, and cash transfers to lower-income households. While this is a necessary and commendable step, a much stronger nutrition-sensitive hunger mitigation and food programming scheme is crucial. A basic, nutritious diet, recommended by the EAT-Lancet Commission, would cost at least INR 33.69 per day. Accounting for a family of 4, cash transfer of INR 500 per month would only satisfy a family’s requirement for approximately four days a month! Most states’ announcement of transferring an additional INR 1,000 only satisfies their requirement for an additional eight days. India has surplus food grains to weather the current crisis. Universal access and 3x more rations, irrespective of possession of ration cards, will be effective in addressing hunger including the 70 million poor households who lack an identification document.
2. Address malnutrition through dietary diversity, supplementation, and fortification:
Current food supplies through the Targeted Public Distribution Systems (TPDS) are predominantly comprised of grain and pulses. In the current situation where farm supply chains are expected to take at least four months to be restored, essentials such as vegetables, milk, and eggs, could be sourced directly from the farmers and made available in the open markets, supplied through public distribution systems and provided as weekly take home supplies to children and PLW. A few state governments such as the Telangana government have directed Anganwadi workers to provide eggs to mothers and children. Scaling such initiatives to a national level will help improve nutrition outcomes during the pandemic.
The honorable Prime Minister of India, in his address to the nation, ‘Mann ki baat’ on 25th August 2019, announced fortification of rice that is distributed to India’s poor through the public distribution systems, Integrated Child Development Services (ICDS) and mid-day meals. This would be the right time to implement the policy and improve access to fortified products including salt, edible oil, flour, rice, and milk. The aforesaid initiative is critical in the current scenario when nutrient consumption is bound to be erratic due to cash and food shortages.
3. Create awareness about nutrition practices:
Increasing evidence suggests that malnutrition increases susceptibility to infections including COVID-19. We, therefore, need to create awareness about better nutrition practices. The National Nutrition Mission (POSHAN Abhiyaan)’s Jan Andolan movement is a platform to engage in civil society and engage people to be committed to better nutrition. The Jan Andolan initiative can be utilized to implement a social behavior change campaign addressing food safety and feeding practices at the household level. Second, front-line workers can be empowered to halt the rise of malnutrition. They can be trained and equipped with behavior change communication equipment on nutrition care during pandemics. Empowering them with the right information and communication technology (ICT) equipment will enable them to spread information through digital platforms while following social distancing norms.
4. Incentivize farmers and small enterprises to produce nutrition-rich crops and food:
The following initiatives can improve the livelihoods of small-scale farmers and enterprises while improving access to nutrition. Incentivize smallholder farmers to produce nutrition-rich crops and staple foods and thus improving access to safe and nutritious diets across the value chain. Micro small and medium enterprises (MSMEs) can be motivated to produce and process nutritious and culturally appropriate foods using millets and legumes such as lentils, chickpea, groundnut, ragi which contain many nutrients and can store for long periods. They can also be prepared by women self-help groups authorized to prepare take-home rations and then the ICDS channel can distribute these foods to PLW and young children.
5. Harness technology for better nutrition:
India has a successful history of using technology to improve socio-economic and public health outcomes. For example, the Arogya Setu app, recently developed by the National Informatics Centre, uses technology to track coronavirus infections, thus providing a valuable tool in the fight against the pandemic. The government can similarly engage entrepreneurs to develop technologies to forecast the trend and pattern of disease burden in future months, rectify supply chain management of key food and nutrition supplies, revitalize already introduced software in public distribution systems to monitor food supplies.
Nutrition is a great equalizer. It can create the right environment to stimulate growth, economic development, and progress of an entire generation, thus propelling India on a path towards excellence. India has demonstrated early successes in managing the pandemic through strict isolation measures, innovative use of technology, and public health services. As we fight a pandemic of epic proportions, accounting for the nutritional needs of the world’s most vulnerable will not only give us the strength and immunity to fight COVID-19 but also save lives and give more babies the healthy start they deserve, irrespective of their socio-economic status.
Reaching Last-Mile Communities in South Africa with Fortified Food
In South Africa during the current COVID-19 pandemic, massive food security issues have arisen in addition to the daily challenges of access to water and harsh living conditions. While under a nationwide lockdown, food distribution is critical to impoverished South African communities.
To help change the situation of many families living in South Africa, Sight and Life has provided Level Up, a fortified instant cereal full of nutritional benefits, through our longstanding partner Sizanani Mzanzi, supplier of the instant cereal. In partnership with organizations like Bambanani and Savanna Lodge, we have helped immensely in securing a meal a day for the most vulnerable members of the rural communities. These communities consist of young children and old age individuals who struggle with various health issues like HIV and AIDS, tuberculosis, diabetes, hypertension, and malnutrition. “The support and generous funding from Sight and Life allows this process to occur and provide nutritious meals to families for four to eight weeks,” states Ed Rakhorst, project manager for Bambanani.
Impact of nutrition
Typically, fortified cereals are offered in school to underprivileged and malnourished children ensuring they are consuming a healthy meal that contains all the essential vitamins and minerals required in their daily diet. Due to the lockdown putting a hold on children attending school this daily meal has not reached those who need it most.
Level Up cereal is endorsed by the South African Heart and Stroke Foundation and provides 13 vitamins and 4 minerals while also being high in fiber, energy and protein creating a nutritious meal.
In late April 2020, Sight and Life teamed up with long time partner Bambanani, a humanitarian organization based in Phalaborwa, Limpopo, South Africa, to deliver fortified food to last-mile communities, especially those children affected by school closings.
Bambanani focuses on the care, schooling, and nutrition needs of children from 0-6 years of age, including some orphaned and disabled children. Sight and Life donated Level Up cereal for children and their families to be distributed through the Bambanani network of schools.
“Most of these children are unable to receive adequate daily nutritional requirements due to the following socio-economic factors such as unemployment and overpopulated communal living,” explains Rakhorst.
At the Reneilwe School in Namakgale, there are many touching scenarios as to why these children and their families are in need. From unemployed or living on social grants to children with health concerns each story is important. For example, Blessing receives Level UP because he does not eat well, and his health is not good. Adding to this already difficult situation, his parents are unemployed and have no income or social grants for their family of six. Or there is Happy who lives in a household consisting of four uncles (one consumes alcohol), two aunts, and a total of five children all living together below the poverty line and receiving Level Up. These are just two of the many circumstances in which Bambanani can touch and change the lives of those in need.
Through Bambanani, the Level Up product is also fed to children that are diagnosed with HIV to get back on their feet, full of energy, and live their lives like normal children. These children will use the Level Up product seven days a week to maintain a healthy diet full of the needed vitamins and minerals.
Located in Mpumalanga, South Africa, Savanna Lodge is a private game farm and dedicated to helping the local villages where many of their staff live. They have been delivering Level Up cereal, donated by Sight and Life, at least once a day to vulnerable orphans and children and elderly community members providing an extra boost of vitamins and minerals needed during this time.
“We have been able to distribute a box of cereal to every child at the center (Tiyimiseleni Project) and will continue to do so for as long as the lockdown continues. Thereafter, the cereal will be used at the center itself. It has been distributed to Hlayisekani Nursing Home, and stock is being kept for Mketsi Primary School,” explains Jennifer Harman, project manager for Savanna Lodge.
Tiyimiseleni Project is a community care center run as a social responsibility project by Savanna Lodge. It supports about 250 vulnerable children and HIV/AIDS orphans, giving them a safe place to go to where they get a nutritious meal, have an adult to talk to, can do their homework, and just be children for a while.
Mketse Primary School has approximately 650 students and is situated in an area where it is estimated that around 25% of the children come from child-headed households. The vision of the passionate Headmaster and dedicated staff is to provide knowledge and skills that will enable students to carry out a productive role in society and so give back to their community. Sight and Life has a longstanding relationship with the school and contribute towards this vision through its support of the school lunch program. In so doing, we are supporting keeping these children’s young bodies healthy, active, and ready to learn.
In the communities around Savanna Lodge, the situations are less than ideal. One such example is Maria’s family consisting of seven family members and both parents have passed away. She is 20 years old and unemployed and the siblings (ages 3 to 16) are in schools and they attend Tiyimiseleni home-based are for regular meals and medical assistance. Savanna built a house for Maria and her siblings to live in as they do not have identification documents making them unable to apply for state social grants. Currently, the schools and the home-based care centers are closed due to the COVID-19 pandemic and all of the children rely on the school feeding scheme from Tiyimiseleni for their daily meal. The donation of Level Up cereal made by Sight and Life provides them with at least one regular meal a day for many weeks.
The Nyambi family of three struggles as the mother is unemployed and undergoing HIV treatment and raising two children (8 and 14 years old). Due to the two children not having identification documents they are unable to claim state social grants to help support the family. Therefore, they have no income, or extended family members to assist them. The children are reliant on school feeding programs and meals from Tiyimiseleni home-based care thus making the Sight and Life contribution extremely important.
“This is just the beginning, there is more to be done during challenging times like this pandemic and in the long-term to take on malnutrition. We are proud to support and work with partners and organizations such as Bambanani and Savanna Lodge, who care for people and their futures,” remarks Klaus Kraemer, Managing Director for Sight and Life.
The Convergence of COVID-19, Climate Change and Malnutrition
Klaus Kraemer, Managing Director for Sight and Life
Most Recent, Perspectives
When I set out to write this piece about COVID-19, climate change and malnutrition, I asked myself whether there might be anything new that I could add to the debate, given the myriad blogs, commentaries and webinars already proliferating on the subject. In my quest for lasting solutions to the global scourge of malnutrition, it is important for me not to lose sight of the big picture, to learn from the past, and not to jump on the bandwagon when global priorities change.
In my hometown in Germany, from where I am writing these lines, the lockdown following the outbreak of the COVID-19 pandemic has been relaxed slightly this week; in addition to grocery stores and pharmacies, small shops are now permitted to open again. We have not been hit really hard here in terms of food supply over the past weeks. Following the initial wave of panic buying, the supermarket shelves are now restocked, and innovations are occurring in the supply chain. Besides home delivery, a drive-in system for purchasing fruit and vegetables has been set up. You order and pay at a booth, and the guys take the pre-packed box with fresh produce from the ramp and load it into the trunk of your car. This development allows certain businesses to keep trading during this difficult time, certain jobs to be protected, and the supply of fresh produce to the population to be continued.
The potential for a new global food and nutrition crisis
COVID-19 is having its most devastating impact, however, on low-wage and migrant laborers (and their families) in low- and middle-income countries (LMICs) as a result of the lockdowns and border closures imposed to contain the spread of the virus. When these workers lose their jobs, they don’t get paid, and neither they nor their families can eat. The expected economic downturn triggered by COVID-19 will exacerbate this dire situation all around the world. It will come as no surprise that there are people already today who claim that they are more scared to die of hunger than of COVID-19. In 2019, according to the 2020 Global Report on Food Crises, 135 million people were affected by acute food insecurity, with an additional 183 million people subsisting on its fringes. These individuals are likely to slide into hunger and even starvation due to the COVID-19 outbreak this year. Moreover, according to the World Food Programme (WFP), some 300 million primary school children have been robbed of their regular, and often sole, daily nutritious meal at school due to school closures.
Although the UN Food and Agriculture Organization (FAO) expects a record wheat harvest in 2020 and reported low food commodity prices for March of this year, countries in Southeast Asia have increased trade barriers and imposed export bans on food items such as eggs (Thailand) and rice (Vietnam and Cambodia, on a temporary basis). Moreover, the lockdown has already led to rioting in the streets in some countries. There is an uncomfortable sense of reliving the 2007–2008 food price crisis when “…weather shocks, greater demand for grain-fed livestock among a growing global middle class, biofuel development from grain crops, food stock hoarding, and globalized trade in food commodities … increased prices and dwindling grain stockpiles have caused civil strife and political instability.”
‘Nutrition in the Perfect Storm’
This quote is taken from an article entitled ‘Nutrition in the Perfect Storm’ that we published in Sight and Life Magazine in 2008, raising concerns about widespread micronutrient deficiencies during the food price crisis and the detrimental consequences of this development for nutritional status, health and wellbeing. During crises such as drought, flooding and locust plagues, poor families suffer reduced dietary diversity and forgo the consumption of relatively expensive micronutrient-rich foods such as eggs, meat, fruit and vegetables in order to fill their bellies with empty calories from starchy staples and energy-dense processed foods. The recommendations provided in our 2008 paper are still relevant for the current crisis: “… support micronutrient supplementation, fortification and food-based strategies to address micronutrient malnutrition among vulnerable population groups…” to mitigate the development of “a potential ‘lost generation’ of unhealthy children, and irreversible economic loss.”
The food price crisis of 2007–2008 was a contributory factor in the Arab Spring in the early 2010s – a protest movement across North Africa and the Middle East that in many cases triggered violent crackdowns whose long-term consequences are still being felt around the world today. With its power to destroy lives and livelihoods, COVID-19 has the potential not just to damage the health and wellbeing of populations but to trigger civil unrest, violence, new wars and increased tides of migration unless it is tackled effectively not only in the wealthy West but particularly in LMICs. Its effects are insidious and its ramifications far-reaching.
In this context, it is also worrying that the COVID-19 pandemic has led to the deferral of measles immunization campaigns even in countries that are experiencing a measles outbreak. This will likely be compounded by the UN recommendation to suspend planned mass vitamin A supplementation for children under 5. It is questionable how well alternative distribution routes will work as suggested. The re-emergence of vitamin A deficiency-related blindness and mortality in children will be the grim consequences. Granaries may be full for the moment at least, but the expected supply chain disruptions caused by the COVID-19 pandemic will probably cause more severe malnutrition than was witnessed in the aftermath of the 2007–2008 crisis. Sight and Life has responded to the COVID-19 pandemic by coordinating demand for food, with a supply of fortified food and supplements to a number of grassroots NGOs in India, Rwanda and South Africa and with a GoFundMe crowdfunding page to raise additional resources.
Interest in climate-smart innovations is rising rapidly among the young entrepreneurs. At Sight and Life, we nurture and encourage such enthusiastic and passionate young professionals through the Elevator Pitch Contest by Sight and Life (EPC). Our most recent EPC attracted entries from 45 countries and three times more applications than previous contests.
The time to act was yesterday
The time to act to mitigate the consequences that the combination of COVID-19 and climate change will have on nutrition was yesterday. Many countries around the world have policies in place for micronutrient supplementation and food fortification, but in many cases these are not well implemented or effectively enforced. A considerable increase of effort is required, despite the pressing challenges of COVID-19. This will be more than a stop-gap solution: it will also be an investment for the long-term future of individuals, societies, and economies as a whole – even, I have no doubt, of the global economy itself. For all we know, adequate micronutrient intakes as part of nutritious and safe diets can only increase population resilience in the face of crises – present and future.
COVID-19, climate change and malnutrition have converged to create an unprecedented challenge for the global nutrition community. The dangers for millions of people around the world are imminent and very real. More than ever before, the knowledge, insight and commitment of nutrition professionals are in demand. In crisis, however bleak, there is always a sliver of opportunity. We may be obliged to distance ourselves physically at this challenging time, but we stand united as never before in our passion to end malnutrition in all its forms.
Our nutrition community has successfully engaged with other disciplines and sectors in the past decade, turning exciting new scientific insights into policies and programs that have the potential to deliver better nutrition for everyone on the planet. Now, as we face a universal enemy in the form of COVID-19, is the time for us to truly act as one to combat its effects.
Breda Gavin-Smith, Global Public Health Nutrition Manager for Sight and Life
Most Recent, Nourish Notes
As the coronavirus (COVID-19) is spreading rapidly across the globe, it is important to take note of the approaches that can help prevent and fight infections, particularly viral infections. Evidence already suggests that viral infections are one of the world’s greatest public health challenges (WHO, 2020). The World Health Organization (WHO) estimates seasonal influenza results in 3-5 million cases annually. Today we understand hygiene and social distancing play a key role in protecting yourself and others from contracting a virus while also slowing the spread of infections. Here are a few simple ways to reduce your risk to infections:
– Wash your hands regularly for 20 seconds with soap and water or alcohol-based hand rub.
– Cover your nose and mouth when you sneeze or cough with a disposable tissue or flexed elbow.
– Avoid close contact with people who are sick.
– Stay at home and self-isolate from others if you feel unwell.
Good nutrition is fundamental to improving immunity. The immune system is the body’s defense against disease and infection and it has long been established that several factors influence the function of the immune system including stress, sleep and nutrition (Song et al, 2019; Patel et al 2012 and Gombart et al 2020). The WHO guidance on diet, especially during the current pandemic states that “good nutrition is crucial for health, particularly in times when the immune system might need to fight back” (WHO, 2020). Providing a diet high in nutritious foods rich in vitamins and minerals supports optimal function of the immune system by providing antioxidants to slow damage of cells caused by free radicals (Lobo 2010) or assisting in T-cell production (Cohen 2017).
Although, presently, we do not have data concerning nutritional factors in relation to the risk and severity of viral diseases such as COVID-19 the role of nutrition in immunity has been well established. For example, a study on the role of vitamin A in the treatment of measles in children found a reduced risk of mortality and pneumonia when vitamin A was administered over two days (D’Souza and D’Souza, 2002). The European Journal of Clinical Nutrition concluded that “Without adequate nutrition, the immune system is clearly deprived of the components needed to generate an effective immune response” (Marcos et al, 2003). Good nutrition is thus important in supporting an optimum immune system which can reduce the risk of viral infections (Beck and Levander, 2000).
It is now recognized that the complex, integrated immune system requires several micronutrients that have essential, often synergistic roles at every phase of the immune response (Gombart et al, 2020). In fact, even marginal deficiencies in certain nutrients have been shown to impair the immune system (Gombart et al, 2020). Micronutrients are believed to work collectively to support an optimum immune system. Based on a variety of systematic and clinical data, vitamins A, B6, B12, C, D, E, folate, zinc, iron, copper, and selenium (read our Vitamin and Mineral: a brief guide) are particularly important to boosting immune response.
The chart below identifies the role of these vitamins in immunity and shares recommended amounts and sources in the diet. In a forthcoming post, we will highlight the important minerals supporting the immune system and the work Sight and Life has achieved over the past 30 years to ensure access to vital nutrients, especially for children and women of childbearing age.
*Current advice on supplementation concludes that consuming a balanced diet provides all the necessary nutrition required but where there are challenges in meeting dietary recommendations, supplements are a useful addition in helping meet our nutritional needs (EUFIC, 2020).
*Please note these are approximate values and can vary based on recommended reference values employed.
Gysin DV, Dao D, Gysin CM, Lytvyn L, Loeb M (2016). Effect of vitamin D3 supplementation on respiratory tract infections in healthy individuals: a systematic review and meta-analysis of randomized controlled trials. PloS one.11(9).[Online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5025082/ (Accessed on 1st April 2020)
Lobo V, Patil A, Phatak A, Chandra N. Free radicals, antioxidants and functional foods: Impact on human health. Pharmacogn Rev. 2010;4(8):118–126. doi:10.4103/0973-7847.70902
Marcos, A., Nova, E. & Montero, A (2003). Changes in the immune system are conditioned by nutrition. Eur J Clinical Nutrition57, S66–S69 [Online] Available at: https://www.nature.com/articles/1601819 (Accessed on 7th April 2020)
On December 17, 2019, Devex published “Opinion: Engaging nutrition to improve pregnancy outcomes” by Klaus Kraemer, managing director of Sight and Life and adjunct associate professor at the Johns Hopkins Bloomberg School of Public Health. The full article can be read here on Devex.
Good nutrition sets off a ripple effect. It can dismantle inequity, poverty, and poor health and drive progress at every stage in life. It supports physical and cognitive development, helps prevent a number of medical conditions — from spina bifida to diabetes — and saves lives.
During and after pregnancy, nutrition demands are greater — as are the consequences of not meeting them. For mothers, ensuring a healthy pregnancy limits the risk of life-threatening complications. And for their children, good nutrition during pregnancy can be the difference between being born healthy and being born physically or mentally disadvantaged.
It is critical that we sustain our momentum on nutrition, a task that requires greater investment in cultivating a cadre of leaders to take us there, argues Klaus Kraemer, director at Sight and Life.
While diet diversity remains the preferred means for women to meet nutrient requirements during pregnancy, many nutrient needs cannot be met through diet alone, especially in resource-constrained settings. As such, it is imperative that we reach women and girls with effective interventions for improving maternal nutrition that are ready for global scale-up now. Multiple micronutrient supplementation, or MMS, during pregnancy could be one way to help meet maternal nutrition needs.
Srujith Lingala, Kalpana Beesabathuni, Klaus Kraemer and Rebecca Olson
Most Recent, Perspectives
On a quiet morning in rural Mchinji, a small district in Malawi, Grace wakes up and walks over to the house she constructed just a year ago. She inspects her 1,200 chickens carefully – they are all hale and healthy! It will soon be time for their breakfast – a specially formulated meal with the right mix of carbohydrates, protein, vitamins and minerals so they can lay healthy and fresh eggs. All of this is thanks to the egg hub – a Maeve, Lenziemill and Sight and Life project that aims to increase the income of farmers like Grace by providing high quality and affordable inputs, credit, training, and access to markets; as well as increase availability and affordability of eggs in Malawi.
Challenges to improving egg consumption in Malawi
As a source of high-quality protein, vitamins and minerals and fatty acids, eggs have the potential to dramatically improve nutrition outcomes for vulnerable populations. Yet, in many parts of the world eggs remain inaccessible to those who need it the most. At the same time, the poultry industry is growing exponentially in many low- and middle-income countries (LMICs), making it an important source of income for poor households.
In Malawi, 37% of children under five are chronically malnourished (stunted), and about 86% of the population lives in rural areas, where most people practice smallholder subsistence farming. The rural poor are particularly affected by malnutrition despite increases in caloric consumption across all socioeconomic quintiles. Although eggs have proven nutrition benefits, eggs continue to be scarce and costly in Malawi – the average per capita annual consumption is only 27 eggs, compared to 180 globally.
This is due to multiple demand and supply side challenges, notably disease and mortality among chickens, cost and quality of production inputs, and access to credit and markets leading to high egg cost (8-11x the price of cereals, compared to 1.6x in the US and 3.4x in Europe) and low availability. Cultural beliefs and taboos also undermine egg consumption. For example, in some Malawian communities, eating eggs is associated with stomach pains, or even with babies becoming bald.
Increasing egg production using the Egg Hub model
In Malawi, there is a huge unmet domestic demand for chicken meat and eggs; and the Government of Malawi is committing to improving food security and nutrition through progressive national livestock strategies.
Against this background, interventions and innovations across the poultry value chain that consider the role of poultry for society and the prevailing farming systems are increasingly being implemented. The Maeve/Lenziemill/ Sight and Life egg hub projectwas launched in 12 villages in central Malawi to set up and develop bird poultry farms with 3-year break even period.This project has brought together various partners to support poultry farmers, who are organized into groups of five. In addition to receiving specialized feed, the groups also receive all important vaccinations for the birds, which are ready to lay when they arrive at the farms, training, and continuous supervision.
Since the project was initiated in September 2018, 60 farmers have been registered, received training, established farms and started egg production; and a total of 12,000 birds were placed in these farms to start egg production. The program aims to produce 3.5 million eggs annually. Sight and Life has also built a digital platform for the farmers to track progress, program outcomes and biosecurity protocols.
Not only has the project led to increased egg production and consumption among participants like Grace and their families, but it has also increased their incomes as the eggs are also being sold in local markets.
“There has been a surge of excitement and interest in the villages to the point where we have had current farmers also asking for more chickens to meet their local demand. It is very exciting to see the overall demand and drive the farmers.” – Maya Stewart, fund recipient & Director of the Maeve project
The way forward
In addition to addressing supply side concerns, Sight and Life will also create demand through a targeted social marketing campaign, making eggs aspirational and desirable for caregivers of young children, pregnant and lactating women. Sight and Life is on a quest to end malnutrition, and we believe in the power of eggs to improve health and nutrition for all.
The Elevator Pitch Contest (EPC), founded by Sight and Life, is a competitive platform for students and young professionals to present their innovative ideas in front of a distinguished team of experts, investors, and the nutrition science community. It is an interactive approach whereby an entrepreneur must boil down their concept into a precise and persuasive pitch in order to spark interest from potential financiers – a critical part of the entrepreneurial process as competition for research and investment funds increases.
To date, there have been three EPCs held, the first in Cancun during the Micronutrient Forum in 2016, the second in Boston during the American Society for Nutrition (ASN) in 2018 and recently in Mumbai during the 19th World Congress of the International Union of Food Science and Technology (IUFoST) in 2018. Three finalists sat down to chat with us about their progress and success since the competition.
The three finalists are:
Andrea Spray, London School of Hygiene and Tropical Medicine
At the EPC in Boston, Andrea presented a dietary intake innovation called INATU that measures the impact of women’s time on nutrition.
“[EPC] is a great opportunity to hone new practical skills, and to engage with top experts in your field. It really was a great honor to participate. It was a lot of work, but I think that you get as much out of it as you put in. This type of opportunity is rare for young entrepreneurs/students/innovators.” – Andrea Spray (EPC Boston)
Anne-Julie Tessier, Keenoa
During the EPC in Boston, Anne-Julie walked away with the first-place prize for her innovative artificial intelligence (AI) based food diary.
“I would recommend EPC without a doubt! Because it is a unique and enriching experience to kick-start your company.” – Anne-Julie Tessier (EPC Boston)
Alex Warrington, Future Food Now
Pitched her solution for using aflatoxin at-risk groundnut cake as a by-product from oil crushing to be used as a feed source for insect farming at IUFoST and won. Find out more about her innovation here.
“The EPC has helped me to better define my project and given me more confidence when presenting. I also met some great people whom I continue to speak with today.” – Alex Warrington (EPC Mumbai)
How has the EPC contest helped you?
Andrea Spray (EPC Boston): Having just completed field work on the INATU pilot, the EPC helped me to quickly synthesize and prioritize key messages about our innovation, try to articulate them in a way that our target audience would find compelling, and really push the horizon of my own thinking about what comes next.
Anne-Julie Tessier (EPC Boston): My team and I had pitched Keenoa to investors, but never had participated in such an event in the context of a scientific meeting before. The EPC helped me tailor my pitch to scientists and permitted us to reach a wider audience by presenting at ASN. It was an occasion of increasing awareness of our innovation among scientists and nutrition experts and it permitted us to grow our network globally.
Alex Warrington (EPC Mumbai): The EPC gave me the impetus to make my idea happen.
What did participating in the contest mean to you personally and your innovation?
Andrea Spray (EPC Boston): For me personally, it was the first time I was presenting my PhD dissertation research to a truly public audience, and to some of my “hero” experts in the field of nutrition. It was also the first time I had done an elevator pitch, and so I put in a lot of effort into optimizing my presentation for that purpose. Finally, I had never thought of the path of entrepreneurship before; the EPC provided insight into that world that I definitely would not have otherwise been exposed to. For the innovation, it was the first time to solicit feedback and impressions from a broad audience, and it provided helpful visibility to our work.
Anne-Julie Tessier (EPC Boston): While some of my PhD colleagues were presenting their work in poster or oral sessions at the ASN conference, I was proud to attend the meeting as one of the Sight and Life elevator pitch finalist to present Keenoa. Participating and winning the EPC marked an important milestone for our company as it was the first time showcasing our innovation to international scientists.
Alex Warrington (EPC Mumbai): Before participating, I just had a concept which I was not sure I could see to fruition, but through participating I began to realize how important my project had become to me. I wanted to succeed and make my idea a reality.
Did you find the entire EPC experience useful? Why?
Andrea Spray (EPC Boston): The platform to present my research in such a dynamic format was the primary benefit of having participated in the EPC. The preparation alone prompted numerous conversations about the work that I otherwise would not have had at such an early point in the research process. I found the in-depth engagement with various Sight and Life colleagues enriching, as was the opportunity to learn about related work of my peers.
Anne-Julie Tessier (EPC Boston): The overall EPC experience was useful on many levels. One of the highlights of the EPC experience was our inspirational meeting with Simone Frey, Managing Director at Atlantic Food Labs GmbH and EPC judge. I could highly relate to her career path; it was refreshing and motivating to learn from a woman in entrepreneurship who also has a doctorate degree. It was also an honor to meet with other students from various universities who all work towards improving nutritional assessment; sharing our ideas and learning from their experience was enriching. The overall discussions with mentors, students and the incredible Sight and Life team, without whom this experience would have not been possible, were insightful with regards to entrepreneurship, graduate studies, intellectual property and much more.
Alex Warrington (EPC Mumbai): We had some great coaching on presentation content and delivery from Nirjhor Rahman of YGAP Bangladesh. I really appreciated meeting fellow finalists who were all so inspiring, and it was exciting to talk about possible solutions to problems such as aflatoxin contamination with like-minded entrepreneurs. The social media coverage and videos also provide me with quality future marketing materials for my project.
What lesson(s) did you learn from your experience?
Andrea Spray (EPC Boston): So many things! First and foremost, I learned a lot about presenting research with an entrepreneurial mindset. The experience also reinforced for me how very different the circumstances are in low-income and high-income country settings for nutrition assessment. Several of my EPC “competitors” are working with state-of-the-art technology, whereas working in rural low-income settings we’re interested in low-tech solutions that can be transformative for the field. Our challenge is less the technology and more the overall system.
Anne-Julie Tessier (EPC Boston): I grasped the importance of networking with entrepreneurs and students; it is key in creating future collaborations and getting surrounded by insightful mentors.
Alex Warrington (EPC Mumbai): How to successfully pitch in only five minutes! I also had not been involved in filming before so I hope I have learnt some skills for being in front of the camera!
What is the current status of your idea/project?
Andrea Spray (EPC Boston): I am currently writing up results of the validation of using our innovative approach (i.e. wearable cameras and image-assisted 24-hour recall) to assess diet diversity and time allocation. That combined with results of our feasibility and acceptability research will be crucial in identifying next steps.
Anne-Julie Tessier (EPC Boston): Nutrition is key in chronic diseases prevention. Our mission at Keenoa is to empower dietitians by giving them state-of-the-art technologies to maximize their impact on the health of the population. We have reached a product market fit in Quebec, Canada. Now our goal is to expand commercialization in Canada and United States. We have initiated validation of Keenoa as a tool to assess dietary intake in research, results should be published soon!
Alex Warrington (EPC Mumbai): I am currently in discussions with universities and business to determine the best feed source and location for the pilot insect farm in Africa. I am slowly teaching myself WordPress and have created a website where you can follow the project’s progress: futurefooodnow.co.uk
How has the funding from EPC help further your innovation?
Andrea Spray (EPC Boston): EPC funding covered my travel expenses to attend and participate in the ASN conference in Boston, thus enabling exposure to an audience of experts we would not otherwise have reached. With that exposure, I received truly valuable bits of feedback that I suspect will be incorporated into future work.
Anne-Julie Tessier (EPC Boston): The monetary award from the EPC helped us creating what we call food builders to be integrated in the Keenoa mobile app. These are to further facilitate data entry by the end user and increase accuracy of dietary assessment; it was the natural prolongation of food recognition from pictures of meals.
Alex Warrington (EPC Mumbai): The funds are going to be used for the initial costs of research into the food safety of insects fed on the chosen aflatoxin contaminated feed source.
What are your future plans?
Andrea Spray (EPC Boston): With the conclusion of the validation research, I am wrapping up my PhD dissertation. I hope to defend that by the end of the calendar year. In the meantime, I am also ramping back up my nutrition consulting/research work, including a follow-on Drivers of Food Choice grant. It has been an incredibly challenging few months trying to get this research done, so in the near future I am looking forward to some much-needed R&R.
Anne-Julie Tessier (EPC Boston): With Keenoa, we aim to fundamentally change dietary assessment in dietetics practice and research field. My vision for Keenoa is to see all dietitians and nutrition researchers use it to accurately and precisely quantify the impact of nutritional interventions on the health of individuals and communities. Our future plans are to accelerate commercialization worldwide. To do so we will grow our team. On the tech side, as we collect data, we train our algorithms to get better at predicting food items from pictures.
Alex Warrington (EPC Mumbai): Once the food safety research has begun, I intend to apply for more funding to ensure that the business model is viable – exploring market opportunities for insects as food and feed.
On August 6th, at the 2019 Asian Congress of Nutrition in Bali, Sight and Life organized a symposium on the topic of eggs, which represents one of its flagship programs. The session entitled “Achieving Improved Nutrition in a Sustainable Way – The Case of Increased Egg Consumption” gathered experts in the field of nutrition, sustainable business models, environmental sustainability, science and research and was skillfully moderated by Dr Regina Moench-Pfanner (ibn360).
The session made an important case on how crucial it is to go beyond nutrition and to increasingly account for externalities in our way of thinking and in the way we implement programs and projects. This shift in thinking has become necessary in light of pressing global issues such as climate change. Eggs provide a useful example to start unpacking some of these challenges.
The science can no longer be EGG-nored
The days where eggs were blamed for driving up cholesterol levels are thankfully over. Evidence is mounting regarding the benefits of eggs for child nutrition and potential benefits for women during pregnancy and birth outcomes. This power food is at last getting the attention it deserves.
Think of it – there is no food such as the egg. Dr Jeya Henry of the Clinical Nutrition Research Center in Singapore reminded the audience of the astonishing properties of this functional food: “from gelling, to emulsifying, to thickening and foaming properties, eggs’ form of proteins is simply incredible” he adds that “an average egg is roughly 50-60 g in weight. No other food on the planet has almost all the micronutrients and the most significant amino acid patterns packed in such a small quantity”.
Ms Gulshan Ara from icddr,b shared the recent and fascinating results from a trial conducted in Bangladesh where the effect of an egg-based nutritious snack was tested on child growth. Results showed that on average, intervention children became 2.55 cm taller compared to control children. Egg based nutritious snacks contribute to improving both linear growth and cognitive development in children <2 years of age.
Yet, although eggs’ nutritional value is undebatable, it would be presumptuous to assume they are the magic bullet…
Indeed, there is an array of known and unknown externalities that come along the way and must be understood; acknowledged; and addressed.
“Eggs have the potential to be considered in 2020s as a sustainable and irreplaceable animal source food for improved nutrition.” Dr Klaus Kraemer
Environmental consequences of egg production
One of the key obstacles relates to the environmental consequences of the production of eggs, but also animal welfare issues. Using Life Cycle Assessment (LCA) methods, a recent study by Abín et al, conducted in Spain revealed that natural land transformation, terrestrial ecotoxicity and freshwater ecotoxicity were the top three most notably affected categories and that the highest source of environmental impact was production of hen feed (specifically soybean and palm oil cultivation), but also the breeding of young chicks to replace the exhausted laying hens. Such findings encourage the development of innovative triple duty solutions addressing the environmental externalities, without failing to address the over and under nutrition components.
“It’s time for nutritionists to design and adapt their solutions in the context of the entire supply chain and the environmental consequences of it.” Dr Martin Bloem
Luckily, there are solutions. During the session, one of these solutions was shared by Srujith Lingala from Sight and Life. Through its Eggciting project, Sight and Life is working on making eggs available and affordable to low income households by supporting the introduction of innovative poultry business models in Ethiopia, India, Indonesia, and Malawi.
The Egg Hub
The ‘Egg hub’, one of Sight and Life’s recent innovations, is a centralized unit offering farmers high-quality, affordable inputs, extension services, training and market access. Through aggregation, egg hubs solve the supply-side challenges typically faced by small- and medium-
scale poultry farms. They can help countries with low-yield production systems make the transition to the efficient, high-yield systems that are associated with much lower market prices.
In Malawi, where the egg hub model was tested, initial findings point towards the fact that the egg hub has enabled 60 farmers to receive inputs and produce 4.5 million fresh eggs every year, but also to resell them within their communities. Each farmer makes a net income of USD 922 per year, 2.3 x the minimum wage in Malawi. Innovative farming models such as the egg hub are an effective and sustainable means of improving nutrition and increasing incomes of small and medium scale farmers.
In the present landscape where commitment for nutrition is at its peak and where the climate change debate is ever increasing, economically viable and sustainable solutions are welcomed as the interest to invest in these is significant.
Filling the egg gap
Public solutions exist as well. Dr Saskia de Pee (Fill the Nutrient Gap, WFP) shared the example of Indonesia where a social safety net program called Bantuan Pangan Non-Tunai (BPNT), that enables poor households to buy 15 kg of rice per month at a very low price, is transitioning to a commodity specific e-voucher. Following a cost of the diet analysis, FNG analyzed which locally available foods should be included in BPNT’s pre-determined local food basket to meet the household members’ recommended nutrient intake in the most cost-effective way. The results showed that the cost of a nutritious diet was approximately 1.2 million IDR/month per household, and the voucher value of 110 000 IDR/month per household (10% of the cost of nutritious diet). Eggs, rice, and green leafy vegetables were identified as the foods able to meet the most nutritional requirements for the lowest cost. Since then, they have been selected for the ‘Nutritious Package’ that was modeled for the BPNT program.
Watch out for unknown EGG-sternalities
What about other readily solutions that are coming to the market, such as JUST Egg and Impossible Burgers? Dr Martin Bloem, Director of the John Hopkins Center for a Livable Future, warns that “there are many unknown unintended consequences related to the production of these types of alternative forms of meat, particularly in terms of their nutrient composition, their use of antibiotics and water, as well as other chemical properties”. From a nutritional and environmental perspective, these alternative forms of meat need to be critically assessed.
Prioritize and compromise
Whilst animal welfare may be a priority in higher income countries, Environmental Enteric Dysfunction (EED) for instance, is more prevalent in lower resources settings and therefore present a higher priority to address. “At this stage, cages are critical to help reduce contact with feces and other hazards” explains Dr Klaus Kraemer from Sight and Life. “Chicken feces can affect the gut microbiota of children, and the difficulty of avoiding contact of children with feces can lead to chronic inflammation causing the gut to leak whereby the body burns the nutrients instead of using them for growth”. Klaus argues for the need to price externalities and to innovate even further for improved caging to successfully separate chickens from the children. It is our duty as nutritionists not only to help decision makers prioritize actions but to ensure the access of this power food to those who need it the most.
Are eggs EGG-citing?
Last but not least, consumer insights are primordial. Cultural factors play a role in many nutrition practices, including taboos or beliefs around egg consumption. Some of these insights were uncovered by Dr Maria Adrijanti from World Vision Indonesia, who throughout her presentation, made the case of increased egg consumption in Indonesia. The Eggciting project, a collaboration between Sight and Life, World Vision and DSM aims to increase availability, accessibility and consumption of eggs in Indonesia at the household level by addressing bottlenecks in the supply chain and boosting consumer demand. In terms of consumer demand, the project uses a social marketing approach to better understand some key issues including but not limited to: understanding household food purchasing power and decision-making; understanding how eggs are used in the daily diet; examining the awareness, knowledge, attitudes and beliefs around egg consumption; identifying key community influencers, their role and motivations in offering dietary advice, and specifically their view on eggs.
One initial insight regarding the traditional Indonesian diet and Sulawesi diet and egg consumption revealed that there are two kinds of chicken eggs that are popular in Indonesia – the native egg and the ‘broiler’ egg. The former is perceived as more delicious, and fresher compared to the broiler eggs and is usually used as medicine.
Thinking in systems
Daring to think beyond our current actions, daring to imagine the far-reaching and unintended dramatic consequences of our actions can be daunting and uncomfortable. A systems way of thinking isn’t easy for those of us who’ve been programmed to think in siloes, but our attitude of denial is catching up with us. The nutrition community can no longer play deaf towards the ever-increasing global environmental cries and concerns of the planet, which must go hand in hand with what we are trying to achieve. The fight against malnutrition is a complex one, which requires innovative solutions which can address that complexity. Learning from our mistakes isn’t just the cumbersome thing to do, it’s the ethical thing to do. This session was an egg-cellent example of the kinds of conversations we should increasingly be having – conversations that aim to understand the perspectives of the different sectors involved, and whose objective is to not only design new solutions but to adapt and re-adapt existing ones to the current context.
The egg isn’t unbeatable, it’s adaptable
“The illiterate of the 21st century will not be those who cannot read and write, but those who cannot learn, unlearn, and relearn” – Alvin Toffler
The 2019 summer conference season opened in an intense way for me. With barely one intervening week, I had the privilege of attending two fascinating conferences that differed in most aspects but converged on the complementary pathways towards the common and ultimate goal of a better-nourished and healthier world.
Reflections from Baltimore
The first conference was Nutrition 2019, the annual meeting of the American Society for Nutrition, hosted in Baltimore, home to Johns Hopkins University, one of the leading nutrition research institutions in the world. Five intense days with hundreds of lectures, presentations, panels and posters organized in themes ranging from cellular and physiological metabolism to global and public health nutrition. As expected, great learning and networking, accompanied by the recurring wish one could multiply oneself so as not to miss one or more exciting parallel sessions. Nearly 3,500 participants from scores of countries, albeit with diminished participation from Africa and Asia compared to last year’s edition. I had the opportunity to present a poster on complementary food safety and quality in Rwanda (poster shown below), the detailed content of which was recently published in Maternal & Child Nutrition.
A few topics stood out. Perhaps the most emergent was the microbiome, a theme that has now migrated from the margins to the center of clinical and translational nutrition. The most thought-provoking microbiome presentation in my view was by Dan Knights from the University of Minnesota. In a panel titled “You Are What Your Microbes Eat” exploring the interplay between diets and the gut microbiome, he borrowed from physics the metaphor of dark matter to describe the countless compounds present in foods that are not captured on any nutrition label yet strongly influence microbiome composition and metabolism. Intriguingly, responses of specific gut microbes to the same foods are often different from person to person, pointing to the need for a personalized approach to the microbiome and nutrition and mirroring the emergence of nutrigenomics and personalized nutrition, another salient topic in the conference.
Sustainability was another theme on the move towards the mainstream of nutrition, certainly influenced by the EAT-Lancet Food in the Anthropocene report[i]. The challenges of nudging consumers and food systems towards healthy diets and sustainability, and the multiple tradeoffs involved, were highlighted in several sessions, including a dense panel discussion moderated by Klaus Kraemer, Managing Director of Sight and Life, and Eileen Kennedy, Dean of the Friedman School of Nutrition Science and Policy at Tufts University.
A special event, rich in historical perspective and fond memories, was the Kellogg Prize for Lifetime Achievements in International Nutrition Lectureship. Marie Ruel, Director of IFPRI’s Poverty, Health, and Nutrition Division, was this year’s prize recipient, recognized for her outstanding work of more than 25 years on policies and programs to alleviate poverty, food insecurity and malnutrition in developing countries. What made the ceremony particularly touching was the presence of many other leaders in the field who were mentors, colleagues, or mentees of Marie’s, a testimony to the expanse and depth of her contributions.
My overall perception of the field, partly from having attended both the 2018 and 2019 editions of ASN, is that it is currently in a stage of incremental and relatively modest advances; areas such as the microbiome and personalized nutrition show tantalizing promise, yet they involve complex science in its early stages, which likely implies a translational pathway a few years long, not to mention translational challenges to low-resource contexts.
Impressions from Hyderabad
The second conference was the Agriculture, Nutrition & Health (ANH) Academy Week 2019. Held in Hyderabad, the bustling and sprawling high tech hub of Southern India, this was a much smaller and more intimate event of about 400 participants from a broad array of food system-related disciplines. It was the Academy Week’s fourth edition, the previous ones having been held in Addis Ababa, Kathmandu and Accra. The first two days were dedicated to learning labs, followed by a three-day research conference. Overall, a superb interdisciplinary and cross-sectoral gathering that stretched participants’ world views and thinking across boundaries.
And it was the progress in the interdisciplinary dialogue on food systems that impressed me the most. We have been talking about ag-nutrition integration for a few years now, but the road has been bumpy and uphill, with dissonances ranging from language to priorities and expectations. It felt so much smoother and fluid at this Academy Week. To me, this gathering was one among a number of signals that we are now reaching an upland in which we can switch gears towards more integrative thinking and holistic approaches to the food system. These refined approaches incorporate not just nutrition and health but also sustainability – now inextricably linked with agriculture –, equity and socioeconomic development, while acknowledging the need for inclusive governance to co-create win-wins and negotiate inevitable tradeoffs with fairness. The good research presented at the conference included innovative tools (such as Agrifood) to facilitate the complex and consequential decision-making involved.
I thus stepped into the second half of 2019 with renewed optimism from these two conferences and the complementary and increasingly convergent learning agendas they represent. Health system-based approaches and the first thousand-day focus remain vital, but are insufficient to address the multiple burdens of malnutrition. Food system-based approaches can benefit the whole population from cradle to grave, spanning the food insecurity-malnutrition spectrum and addressing other dimensions also relevant to nutrition outcomes. With these two wings in tandem, we will be able rise faster towards a better-nourished, healthier, fairer, and more sustainable world.
For additional pictures from ASN visit here and for ANH visit here.
[i] Willet et al., “Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems”. Lancet 2019; 393: 447–92.
Harnessing Public and Private Sector Engagement for Improved Nutrition
Breda Gavin-Smith, Global Public Health Nutrition Manager & Kesso Gabrielle van Zutphen, Knowledge and Research Manager
Most Recent, Perspectives
“Why are things not better when we know so much more than before?” is the uncomfortable question the 2018 Global Nutrition Report leaves us with. In this blog post, we argue that part of this slow progress in improved nutrition is due to the elephant in the room which can no longer be ignored – the private sector.
The private sector has long been engaged in initiatives aimed at preventing and treating malnutrition, producing products to treat severely malnourished children and manufacturing nutrient-rich and fortified foods. At the same time, some private sector actors have engaged and are still engaging in harmful practices.[i] Consequently, public-private engagement remains difficult due to a lack of trust, differing goals, objectives, working cultures and timeline expectations.
Engaging the private sector – positive developments
There is a growing recognition that complex and multi-dimensional issues such as the double burden of malnutrition require cross-sectoral and holistic approaches. Governments must remain in the driver’s seat as the legislative and standard setting body, whilst convening and pooling together the resources, knowledge and expertise of different stakeholders. Multiple actors have varying roles in providing solutions to the burden of malnutrition and the private sector is one key player. A number of initiatives involving the private sector have made valuable contributions to improving nutrition outcomes through product reformulation, improved labeling standards, restrictions on marketing and distribution to vulnerable groups. In low and middle income countries (LMIC), these efforts have concentrated on food safety or fortification of staple foods (flour, rice, oil) and condiments with micronutrients.
Several initiatives such as Sizanani Manzi (social business originally founded by Sight and Life & DSM South Africa) and OBAASIMA (PPP), have used consumer insights and a demand driven approach to develop nutritious products for vulnerable populations. Sizanani Manzi conducted consumer research in the economically disadvantaged townships of Ivory Park and Soweto in South Africa: through food diaries, shopping tours and in-depth interviews it aimed to understand purchasing and consumption habits for instant porridge and juice concentrate, which revealed to be the most frequently consumed convenience foods and thus the easiest vehicles through which the required nutrients could be delivered to low-income consumers on a regular basis. The OBAASIMA (PPP) in Ghana applied a demand-driven approach, with the use of a ‘quality seal’ logo to distinguish products meeting nutrient profile (sugar, salt, saturated fat) and fortification standards for women of reproductive age.
Mobilization of the private-sector is increasingly viewed as essential to creating change in food systems and global, national and local food environments. Moreover, international agencies have repeatedly called for increased engagement with the private sector to address the double burden of malnutrition in LMICs. Sustainable Development Goal 17 in particular, encourages “global partnership for sustainable development, complemented by the use of multi-stakeholder partnerships” as a means of implementing the 2030 Agenda. It also invites states and other stakeholders to “encourage and promote effective public, public-private and civil society partnerships” that “mobilize and share knowledge, expertise, technology and financial resources, to support the achievement of the Sustainable Development Goals in all countries, in particular developing countries.”
Still…what is missing?
At present, little has happened in measuring the impact of public private engagement and their impact on nutrition outcomes. Independent impact evaluations are scarce and as reviewed by Hoddinott et al., “considerable caution is thus warranted when assessing PPPs in nutrition.[ii]” Simply put – we are uncertain as to whether or not, and to what extent nutrition PPPs actually work. Assembling the missing data, developing appropriate indicators, screening for quality and publishing it in peer-reviewed journals will better align business efforts to investments in positive nutrition actions (e.g., marketing, packaging, labeling), and boost efforts to hold businesses and governments accountable and inform on what makes for a successful PPP in nutrition.[iii] Independent evaluation mechanisms such as the Access to Nutrition Index (ATNI) are commendable initiatives that can serve as useful private sector accountability tools. Not only do we need more of these tools to help create transparent environments and initiate dialogue between both parties, but these tools also need to be more relevant to small and medium sized companies in LMICs, who play a vital role in meeting consumers’ needs and who make up the bulk of the food system. The time has come to move from talk and advocacy to action. Being able to show the impact of PPPs on nutrition is a first step in that direction.
Additionally, there is an urgent need for evidence-based dialogue between governments, civil society and the private sector. Governance and organizational structures need to be looked at more closely – how do existing and should future PPPs manage conflict of interest? How do they manage power imbalances? Differing language and jargon? Values? Monitoring and evaluation? Is there a recipe for success? If captured in a systematic way, these learnings can support the development of a framework to enable jurisdictions to undertake an evidence-informed approach to assess partnership development opportunities with the food industry.[iv]
How do we go about filling the gap?
At Sight and Life, one of our core strategic areas is to build and support PPPs in nutrition. Through consumer insights, market research and private sector expertise, we design, test and innovate viable (business) models that will increase supply and demand for nutritious foods for the reduction of malnutrition in all its forms.
In light of this challenge and our engagement in multisectoral partnerships for nutrition, Sight and Life was invited to organize a working group) on “Harnessing public-private partnerships to improve nutrition outcomes” at the 2018 International Symposium on Understanding the Double Burden of Malnutritionin Vienna (Austria). The session served as a knowledge sharing and learning session amongst different stakeholders on better understanding the levers and the blockers for public-private engagement for nutrition. The group attempted to answer the following questions:
– How do we learn and share our knowledge on what makes public private engagement work?
– What currently exists in this regard? What is missing? How can we fill the gap?
– How do we measure the impact of public private engagement and public-private partnerships more specifically?
– What is stopping public private engagement?
– What tools can we use to evaluate the work – to understand why they worked or not?
– How can we put people at the center?
Saskia Osendarp (Micronutrient Forum) shared about the Tswaka study, a multi-sectoral partnership between Sight and Life, the North West University of South Africa, the Global Alliance for Improved Nutrition (GAIN), DSM and Unilever, which examined the effects of two lipid-based complementary food supplements on older infants’ growth, iron status and psychomotor development among children living in an underprivileged community in South Africa. Saskia revealed that the journey the partners embarked on in 2010 was not always an easy one, with many challenges, and eventually a successful completion after more than eight years! You can read the peer-reviewed publication of the study here; the infographic here; and don’t miss the soon to be published article “The Tswaka study: a journey into an innovative public-private research partnership” in the next edition of the Sight and Life magazine due in June of 2019.
Stineke Oenema (UNSCN) shared about the 2018 High Level Panel of Experts’ (HLPE) report on “Multi-stakeholder partnerships to finance and improve food security and nutrition in the framework of the 2030 Agenda” which provides an excellent starting point to frame the challenge at hand. The report suggests relevant criteria to enable governments and non-state actors to perform their own assessments of partnerships and identify pathways for improvements by means of a questionnaire. The proposed common methodology has the potential to strengthen transparency and accountability by improving the learning process through knowledge generation and sharing. Two key recommendations of the report and relevant to this blog’s topic are to (1) increase the impact of multi-stakeholder partnerships through effective monitoring, evaluation and experience sharing and (2) integrate different forms of knowledge and explore further areas of research on multi-stakeholder partnerships to finance and improve nutrition in all its forms.
In the context of these examples and in light of the PPP debate, we see three elements which we believe will help us move forward in building and supporting effective PPPs for nutrition and will ultimately accelerate our progress towards the reduction of malnutrition in all its forms.
1.Understand and share information on existing partnerships
To support further effective partnering for nutrition we must understand what makes PPPs successful, challenging, and what makes them fail. Before doing that, we first need to gather information on them. At present, it is difficult to find detailed and publicly available information on existing PPPs. A great part of the available data is self-reported with no guarantee of independent verification. An online register of PPPs[v] would enhance transparency and could serve as an excellent starting point. It is important to note that simple registration will have limited value add without clear guidance on the adequate level of information to be reported. In particular, partnerships should disclose appropriate information on goals and commitments, members and their contributions, governance and financial arrangements.
2.Translate the collected information into knowledge and learnings
Once the information has been collected, it needs to be curated and screened for quality, with the aim of establishing a research agenda that will enable us to measure the impact of these partnerships on nutrition outcomes. A curated online hub that would look to (1) increase the impact of public-private engagement through effective monitoring, evaluation and experience sharing and (2) integrate the different forms of knowledge and explore further areas of research on public-private engagement in order to finance and improve them.
3. A framework on innovative methodologies and metrics to assess the impact of PPPs
Further research could use the readily available criteria on what makes PPPs work, to develop innovative methodologies and metrics to assess the short- and long-term impacts of PPPs on food security and nutrition. For instance, the High Level Panel of Experts for Food Security and Nutrition (HLPE) Multi-stakeholder partnerships to finance and improve food security and nutrition in the framework of the 2030 Agenda report provides a potential framework to start developing metrics in the areas of transparency, accountability, trust, the partnering process and on when and how to engage.
Sight and Life is interested in hearing from anyone keen to invest or partner with us on PPPs for nutrition. To contact us regarding this endeavor, please send an email to email@example.com
Breda Gavin-Smith, Global Public Health Nutrition Manager & Kesso Gabrielle van Zutphen, Knowledge and Research Manager
Most Recent, Demand Creation
With most food consumed across the world being obtained from the marketplace, from large, multinational companies to small street vendors, businesses have a significant influence on the food people eat. However, we know that businesses are interested in promoting their own products, thus there is a need for wide ranging market development for more affordable, accessible, and nutritious food.
There is increasing recognition on the role of demand creation for improving consumption of nutritious foods. Food purchase drivers, and subsequent purchase decisions, need to be addressed to adopt healthy eating behavior and improve diets. Yet, for that – fundamental questions have yet to be addressed:
What motivates consumers to buy and consume more nutritious foods?
How can we make nutritious diets and foods more desirable to consumers?
On March 2019, during the 4th Hidden Hunger Congress in Stuttgart, Germany, Breda Gavin-Smith, Sight and Life’s Global Public Health Nutrition Manager, co-chaired a session with Alessandro Demaio, CEO of EAT on “The role of demand creation in addressing the double burden of malnutrition”. The session brought together four visionaries in order to further understand the significant role of demand creation in improving the consumption of healthy nutritious foods.
The role of demand creation across the food system in addressing the double burden of malnutrition – setting the scene
Rowena Merritt, Head of Research at the National Social Marketing Centre, examined the principles underpinning demand creation and provided an overview on how it can address the double burden of malnutrition. Knowledge is not enough to change the behavior of beneficiaries and target consumers because rational decisions are overrated when it comes to food. When creating demand for nutritious foods, it is therefore imperative to link desired behavior change with something the consumer cares about. What is it that they value? What moves them? What motivates them? There is much the public sector can learn from the private sector when it comes to communicating promises and benefits (as opposed to facts, figures or product features as is often does) and there are successful examples showcasing this. The key and challenge is to offer consumers/beneficiaries immediate benefits that outweigh the barriers of changing their behavior. When this is done, we can start seeing a change in behavior.
“It would be easy to give the public information and hope they change behavior, but we know that doesn’t work very satisfactorily. [If it did] none of us would be obese, none of us would smoke and none of us would drive like lunatics.”
– Ian Potter, Director New Zealand Health Sponsorship Council
Identifying opportunities to increase supply and demand for nutritious foods – the Fill the Nutrient Gap
Natalie West, Nutrition Consultant at Fill the Nutrient Gap (FNG), looked at how the FNG assessment identifies opportunities to increase the demand for nutritious foods. The FNG situation analysis for decision making identifies context-specific barriers and entry points for food, health and social protection systems to improve nutrition through increasing availability, access, affordability and choice of healthy, safe, nutritious foods. It does so through the review and analysis of secondary sources of information on access to and availability of nutritious foods, and Cost of the Diet analyses and modeling that assess affordability of a nutritious diet, and possible improvements thereof. Stakeholders from multiple sectors (food system, health, agriculture, food processing, marketing, retail, and social and behavior change communication) are engaged throughout the process. Based on the FNG results, they formulate recommendations around improving nutrient intake, and supply and demand stimulation for nutritious foods. Demand creation is not only about consumer demand, but also about awareness and push by policy makers, to ‘enable’ or ‘allow’ consumers to have demand (i.e. making nutritious choices available and affordable).
An example of a double duty in action – incorporating demand creation as a key component in improving micronutrient intake in Ghana – the case of OBAASIMA
Daniel Amanquah, Food Fortification Specialist for Sight and Life, reviewed OBAASIMA which is a demand driven approach to address micronutrient deficiencies in Ghana. Consumer demand for nutrient-dense foods has a greater chance of success if foods fit the underlying consumer values that inform and guide consumption decisions and purchasing choices. Factors that drive demand for nutritious foods are convenience, affordability, and the aspirational value of nutritious foods. OBAASIMA recognizes the importance of consumer values and conducts insight research to help understand the target population. The OBAASIMA demand creation strategy draws on deep consumer insights and deploys above and below-the-line marketing to ensure continued consumer awareness and affinity for the OBAASIMA seal. The seal trademark is awarded to products that adhere to the minimum fortification content, as well as nutrition criteria on maximum allowable levels of sugar, salt, fat, and trans-fat. This helps inspire healthy food choices by making products easily identifiable and recognizable.
Chef’s Manifesto – leveraging chefs to create demand for healthier foods
Paul Newnham, Director at the SDG2 Advocacy Hub, spoke on the importance of engaging diverse actors in creating demand for healthier foods. New voices must be brought into nutrition conversations that are struggling to reach their target audience. As food influencers and the bridge between farm and fork, chefs have an important role to play in helping us to rethink food– what we eat and how its produced – with conversations that prioritize taste and language that inspires action. Present in our schools, neighborhood gardens, community projects and businesses, chefs can speak to farmers, consumers, politicians and communities alike with a message of sustainable, nutritious food for all to deliver the Sustainable Development Goals by 2030. Adding greater food diversity to our plates is a first step in making Agenda 2030 a reality, as biodiversity not only adds nutritional value to our diets but also strengthens food systems and builds climate resilience. The Chefs’ Manifestois an initiative that works to bring new voices into the food system debate, raise awareness about key challenges and solutions, and bridges the gap between high-level UN debates and the general public.
Food Forever and the Chefs’ Manifesto are joining forces to launch the 2020FOR2020 campaign whose aim is to inspire 2,020+ chefs from across the world to champion biodiversity by 2020. Chef actions will be showcased online and at global food events throughout the year to demonstrate how chefs can inspire better ways of cooking, eating and advocating for biodiversity conservation.
Find out more about demand generation and this Sight and Life session by checking out the presentations of each speaker:
The Society for Implementation Science in Nutrition (SISN) began on a wintery, New York evening in February, 2014. Eva Monterrosa, formerly Sight and Life’s Senior Scientific Manager, and Klaus Kraemer, Director of Sight and Life, together with Jessica Johnston and Rolf Klemm, met at Jean-Pierre Habicht and Gretel H. Pelto’s home to discuss a presentation by Eva on the role of context in fostering, developing and implementing nutrition interventions. Based on their previous experiences, they were concerned there was not a venue where the important ideas in the presentation could be published. The conversations began with the idea of creating a working group focused on implementation science, but quickly moved to consider a more formal, long-term institution, such as a scientific society.
The group appointed itself as a six member Secretariat. The first goal of the Secretariat was to identify a group of founding members for a meeting in Addis, Ethiopia during the Micronutrient Forum in June 2014. “The enthusiasm and broad support from the nutrition community for SISN and its role in convening and shaping the discussion for implementation research in nutrition was an exciting moment and positive affirmation we were headed in the right direction,” described Eva Monterrosa, who led the Secretariat. SISN was gaining momentum. Commitments came quickly from thirty-one experts with diverse experiences and the first meeting with the founding members in Ethiopia was a success.
The founding members all had years of experience in nutrition implementation and research and encompassed a range of organizational experiences, national perspectives, academic and cultural backgrounds, and program experiences. The list, in alphabetical order, consisted of: Mandana Arabi, Jean Baker, Gilles Bergeron, Martin Bloem, Howarth Bouis, Namukolo Covic, Luz Maria De-Regil, Stephan German, Stuart Gillespie, Jean-Pierre Habicht, CJ Jones, Klaus Kraemer, Karin Lapping, Rolf Klemm, Anna Lartey, Robert Mwadime, Banda Ndiaya, Lynnette Neufeld, Eva Monterrosa, Juan Pablo Pena Rosa, Gretel Pelto, David Peters, Juan Rivera, Marie Ruel, Werner Schultink, Meera Skear, Rebecca Stoltzfus, Emorn Udomkesmalee, Cesar Victora, Patrick Webb, and Stan Zotklin.
Understanding the Ambition
Implementation science was not in Sight and Life’s wheelhouse until Klaus Kraemer, Managing Director of Sight and Life, reviewed and was mystified by the data in the 2013 DEVTA trial, which was published in The Lancet. Previously, randomized controlled trials conclusively demonstrated that high-dose vitamin A supplementation of children under five years of age reduces mortality by 24%. However, the DEVTA trial in India showed a non-significant 4% reduction in child mortality. Jean-Pierre Habicht observed that “This randomized controlled trial, as is typical of such trials, was carefully designed to interpret positive effects as due to the supplementation. However, it was not designed to interpret a lack of effect”. In particular, it did not have plausible evidence of wide spread effective implementation.
The massive study had bare bone supervision of the intervention with only 18 monitors overseeing the work of over 8,300 Anganwadi workers and the participation of a million children. It also remained unclear how well mothers were counseled, how many and how often children received the intervention, how much of the supplement was wasted or shared, and what other socio-biological factors could have affected program utilization. Gretel Pelto pointed out that “understanding the behavior of implementing staff is as important as understanding household behavior” neither of which were studied by the DEVTA trial. The disconnect between the DEVTA trial and disconnect between all of the previous work, which had established the importance of Vitamin A supplementation for child survival and child health was the tipping point and motivation for Sight and Life’s commitment to implementation science. As Klaus Kraemer explains, “This drastic fluctuation in understanding the results of field trials clearly demonstrates the importance of implementation science and was a significant driver behind Sight and Life’s push to further implementation science.”
With a mission to convene, advocate, disseminate and promote dialogue among scientists, policy leaders, government officials, funders and practitioners to advance the science and practice of nutrition implementation world-wide, SISN headed into its first operational year (2015) with a full agenda. Following a two-day meeting in Castel Gan