Executive Summary
9Since 2008 many governments, civil society organizations,research groups and intergovernmental agencies havesought ways to scale up effective actions for better
nutrition. The collective experience to date suggests thatsuch efforts are successful if all the different groups that
seek to enable improvements in people’s nutrition work
together in support of sound national policies, theimplementation of effective interventions, and sector
programs that are sensitive to the determinants ofmalnutrition. The Road to Good Nutrition brings together
the thinking of many world experts on this subject, each ofwhom addresses from their specialist perspective thequestion of how to improve the nutritional status of theworld’s population as a whole.
Chapter One, by Martin Bloem (Chief Nutrition and HIV/AIDS Policy/Global Coordinator UNAIDS – United Nations
World Food Program; Adjunct Associate Professor, – Johns
Hopkins Bloomberg School of Public Health, Baltimore,USA) explains how stunting is the result of inadequate
nutrition in early life and how it has severe consequencesthat last a lifetime. Stunting prevents individuals fromachieving their potential, physically, intellectually andeconomically. Its consequences are severe and irreparable,both for the individual and for society as a whole. While
the world has seen significant advances in the field ofnutrition since the development of the Millennium
Development Goals (MDGs), which were to be reached by
2015, stunting remains a problem of global dimensions:according to the latest report of UNICEF/WHO/World Bank(2012), 165 million children under 5 are stunted, and many
school-age children, adolescents and adults today suffer theconsequences of the stunting that they experienced during
their early years of life. Chapter One outlines the problemof stunting and traces it to inadequate nutrition, especiallyin the first 1,000 days of life. It argues that the right toadequate nutrition (as opposed to simply food) should berecognized as a Human Right.
Chapter Two, by Marie Ruel (Director, Poverty, Health andNutrition Division, International Food Policy ResearchInstitute [IFPRI], Washington DC, USA) explains that foodsecurity and nutrition security are related but distinct
concepts. Infants, young children, pregnant andbreastfeeding women are especially vulnerable toundernutrition. For this reason, nutrition interventions
must focus on the critical ‘first 1,000 days’ window ofopportunity. Marie Ruel explains how achieving food andnutrition security is a multi-faceted challenge which requiresa multi-sectoral approach – a theme which reappears invarious forms throughout this book.

Food security is necessary, but not sufficient, to ensure
nutrition and to prevent childhood malnutrition. Children
also need their caregivers to provide them with appropriate
feeding, caregiving, hygiene, and health-seeking practices inorder to grow, develop and stay healthy. Food systems canplay a critical role in protecting both food security andnutrition if careful attention is paid to targeting the poor,
reducing inequalities, including gender inequalities, andincorporating nutrition goals and action where relevant.
The book’s third chapter is authored by Hans Konrad
Biesalski, Head of Department, Biological Chemistry andNutrition, University of Hohenheim , Managing Director ofthe Food Security Center in Stuttgart, Germany. Drawingon Hans Konrad Biesalski’s recently published work Hidden
Hunger (Springer Verlag 2012) this chapter describes thephenomenon of hidden hunger. This term refers to a chroniclack of vitamins and minerals, which is not immediately
apparent and which can exist for a long time before clinicalsigns of malnutrition become obvious. It affects over 3 billion
people worldwide, contributing to many millions of deaths
especially in children and young females, and also increasing
the risk of non-communicable diseases such as diabetes,
cardiovascular disease, cancer and osteoporosis. Linked to a
general decline in meeting nutritional standards, hidden
hunger is also a problem in the developed world. Solutionsare nevertheless available: many countries have implemented
mandatory or voluntary fortification of folic acid, vitamin Dor iodine. The experience of many countries indicates that thefortification of staple or processed foods may be an efficient
way to provide an adequate intake of micronutrients.
Eileen Kennedy (Professor of Nutrition and Former Dean of
the Friedman School of Nutrition Science and Policy at Tufts
University, Boston, USA) authors Chapter Four, which deals
with the recent phenomenon of obesity. The current increase inobesity in the global population is unprecedented:
Worldwide, approximately 1.4 billion adults are overweight,
and 500 million are obese. This phenomenon is closely linked
to inadequate nutrition, and is driving a massive increase in
the incidence of nutrition and lifestyle-related noncommunicable diseases (NCDs). This rise in NCDs is placing
an increasing burden on social and healthcare systems. The
challenge is daunting. Eileen Kennedy argues that theinternational community must aggressively implement
multi-pronged strategies to combat overweight and obesity,
while at the same time tackling undernutrition.
John Hoddinott, Deputy Director, Poverty Health andNutrition Division, IFPRI, Washington DC, USA, presents
Chapter Five, whose subject is the economic cost ofmalnutrition. In addition to its substantial human costs,

undernutrition has lifelong economic consequences. John
Hoddinott argues, however, that there exist feasible
solutions to many dimensions of undernutrition, and thatfighting undernutrition has considerable economic benefits– most notably in terms of improving schooling, cognitive
skills and economic productivity. Spending that reduces
both chronic undernutrition and micronutrient deficiencies
is an excellent investment in economic terms, and is one of
the smartest ways to spend global aid dollars.
John Hoddinott’s economic analysis of the problem ofmalnutrition is followed by a presentation of best practicein nutrition by Victoria Quinn, who is Senior Vice Presidentof Programs, Helen Keller International, New York, USA,
and Adjunct Associate Professor, Friedman School of
Nutrition Science and Policy, Boston, USA. Explaining that
undernutrition is a complex and multifaceted phenomenon,
and that it does not have a single cause, or a single solution,
Victoria Quinn uses the Conceptual Framework of YoungChild Nutrition to explain the causes of undernutrition andoutline possible modes of intervention. At the nationallevel, increased government investment in proven nutritionspecific and nutrition-sensitive interventions is essential for
improving nutrition, while at the family level, women havea critical role to play.
Victoria Quinn’s analysis of best practice in nutrition iscomplemented by a contribution from Werner Schultink,
Associate Director, Nutrition Section, Programme Division,
UNICEF, New York, on How to Improve Nutrition
Through Effective Programming. Werner Schultink
concludes that efforts to scale up nutrition programs areworking, benefiting women and children and theircommunities in many countries, and points out that suchprograms all have common elements: political commitment,
national policies and programs based on sound evidence
and analysis, the presence of trained and skilled community
workers collaborating with communities, effective
communication and advocacy, and multisectoral, integrated
service delivery.
Chapter Eight is penned by Joachim von Braun, Director of
the Center for Development Research (ZEF) and Professor
for Economic and Technological Change at the Universityof Bonn, Germany. Food prices today are not only set bysupply and demand but also influenced by financial
markets. Joachim von Braun explains how sudden pricerises, or ‘spikes’, cause big problems for nutrition of thepoor. He argues that healthy diets need to be affordable,
which requires increased productivity in the food system toprevent high prices. Unfortunately poor countries are hit
worst by spikes in food prices, as they cannot afford

adjustment measures. The solution therefore needs to beworked on globally, and the issue taken more seriously.
Joachim von Braun’s price-specific analysis is followed by abroader interrogation of the governance of nutrition byStuart Gillespie, Senior Research Fellow, Poverty, Healthand Nutrition Division, IFPRI, and CEO of the Transform
Nutrition Research Program Consortium. Taking the themeof Making Nutrition Good Politics, Stuart Gillespie outlines
the potential of governance for improving the nutritional
status of the world’s poorest and most disadvantaged
populations. Believing that progress in reducing
undernutrition cannot be sustained where governancesystems are weak or absent, he reasons that strong
leadership – in the form of ambassadors championing thepolitical cause, as well as more mid-level, lateral leadershipto facilitate intersectoral action – is fundamental to success.
While Stuart Gillespie focuses on governance as one of thefactors essential for delivering improved nutrition, TomArnold (Member of Lead Group of the Scaling Up
Nutrition [SUN] movement and former CEO of ConcernWorldwide) explains the key role that advocacy has to play.
Noting that it requires a solid evidential base in order tosucceed, Tom Arnold outlines the importance of presenting
arguments in simple and powerful language and ofmaintaining commitment and momentum over time inorder to bring about change. An important political andpolicy mechanism for achieving progress is the SUN Movement,
which brings together governments, civil society and theprivate sector to work in a coordinated way to reduce earlychildhood undernutrition. Real progress can be made overthe next decade if we deliver on what we know is possible,
concludes Tom Arnold.
The following chapter of this book, number Eleven, isunique in being co-written by three authors: Alan Dangour(Senior Lecturer, London School of Hygiene and TropicalMedicine [LSHTM]; Marguerite B Lucea (Faculty ResearchAssociate, Johns Hopkins University School of Nursing(JHUSON), Baltimore, MD; and Alain Labrique (Director,JHU Global mHealth Initiative and Assistant Professor,
Department of International Health & Dept ofEpidemiology (jt) Bloomberg School of Public Health).
Together they present the power of innovation in the battle
against malnutrition. In a chapter packed with topical casestudies of innovation in practice, they argue that
innovations across the entire span of human nutrition have forcenturies targeted aspects of the farm-to-table continuum, andshow how recent transformative innovations targeting
distribution systems, leveraging public-private partnerships,
and utilizing technological advances have the potential to10

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catalyze research and improve nutrition in both the developed
and developing world.
Asma Lateef, Director, Bread for the World Institute,
Washington DC, USA, follows with a chapter on the rolethat civil society has to play in improving nutrition.
Describing hunger and malnutrition as an ‘unfinished agenda’,
Asma Lateef argues that food security and nutrition should beexplicitly addressed in the goals for the post-2015
development framework, and that stunting should be apriority indicator. Civil society organizations are uniquely
positioned to advocate for greater attention to hunger andmalnutrition, and can play an important role in elevating
nutrition as a priority for the next set of goals. She concludes
that communicating the fundamental role that good nutrition
has to play during pregnancy and early childhood must be partof advocacy efforts in the near future.
The final chapter of the book is written by Saskia de Pee(Adjunct assistant Professor Friedman School of Nutrition
Science and Policy, Tufts University, Boston, and visiting
assistant Professor, Wageningen University, theNetherlands). Saskia de Pee’s contribution describes how
the world of nutrition has evolved in recent decades.
Throughout the 20th century, knowledge and approaches
for addressing malnutrition developed within specificscientific and professional disciplines, but there was limited
cross-disciplinary coordination, even with other players in

A well-nourished mother and infant: Elizabeth Farma 16, breastfeeds
her two-month-old son Emmanuel at the Bonthe District Hospital,Sierra Leone
Source: UNICEF/NYHQ 2010-0952/Olivier Asselin

the food and health systems. Understanding the forms andconsequences of undernutrition, being able to cost theeconomic impact of undernutrition, and having examples ofwhat is required and what works to prevent undernutrition,
including good governance, has generated the strong
momentum behind nutrition that exists today. The
involvement of so many is essential, and while everyone
should focus on what they are good at, Saskia de Peeargues, there is a great deal of cross-disciplinary work to bedone in a target-oriented manner. It is important to develop
context-specific solutions based on the global body ofknowledge and expertise, and to monitor, evaluate andshare these experiences using the information andcommunication technology available today.
Finally Patrick Webb, Dean for Academic Affairs, Friedman
School of Nutrition Science and Policy, Tufts University,
Boston, USA, provides an eloquent afterword to thisvolume. “This book,” he writes, “captures the fact that
there has not been a time in recent decades when so many
people agreed on what needs to be done or why. The
momentum has to be maintained. The next decade of the21st century should be focused squarely on a global effort
to get it done well, while documenting how. Unlesscoherent, cost-effective actions with measurable impacts
quickly emerge from the current cresting wave of goodwill
toward nutrition, the wait for another may be far too long.
Now is the time.”

Malnourished mother breastfeeding her newborn in Kenya: the signs ofmalnourishment are evident in both mother and childSource: Mike Bloem Photography

Case study

The One Thousand Days Mission

Maternal undernutrition – a mother’sstory (Bangladesh)

The 1,000 days between a woman’s pregnancy and herchild’s 2nd birthday offer a unique window ofopportunity to shape healthier and more prosperous
futures. The right nutrition during this 1,000-day
window can have a profound impact on a child’s ability
to grow, learn, and rise out of poverty. It can also shapea society’s long-term health, stability and prosperity.

Farida is a Bangladeshi housewife of 23. She lives in theSreepur Upazila, a rural subdistrict close to the capital,
Dhaka. Married at the age of 17, within a year she fellpregnant. During her pregnancy, Farida had no access toskilled prenatal care or education. To stay healthy andaid her pregnancy she wore a tabij (a charm amulet) anddrank paani puri (a mint drink). Unfortunately, after
going into premature labor she lost her baby within half
an hour of delivery. Two years later, Farida became
pregnant once more, but received limited medicalattention. Tragically her second child arrived stillborn.
Several months later, Farida met a Community Nutrition
Worker from Plan Bangladesh’s affiliate Prankteek,
called Nurunnahar. She advised Farida to attend Plan’s
notional information sessions. At these sessions shelearnt the importance of prenatal care, a nutritious dietand receiving proper rest during pregnancy. The lessons
learned in the nutrition sessions were complemented byregular household visits from Nurunnahar, during which
Farida could consult with her on questions or concerns.
When Farida became pregnant for a third time, she went tomedical centers near her home for regular prenatal visits.
On this occasion, she gave birth to a healthy baby boy. She
breastfed him after delivery, and continued exclusive
breastfeeding until her son was six months old. Now 17
months old, Farida’s son is happy, healthy and keeps hervery busy! Farida is thankful for her son, and wants others
to be able to have the same opportunities for care that she
did. “I have lost my first two children through ignorance,”
she said. “I don’t want any other mother to have the sameexperience. I am grateful to Nurunnahar.”
Source: Thousand Days Partnership, USA
http://thousanddays.org/success-story/material-undernutrition-a-mothersstory June 2011 (abridged)

Today, undernutrition is still a leading cause of death ofyoung children throughout the world. For infants andchildren under the age of two, the consequences ofundernutrition are particularly severe, often irreversible,
and reach far into the future.
During pregnancy, undernutrition can have a devastating
impact on the healthy growth and development of achild. Babies who are malnourished in the womb have ahigher risk of dying in infancy and are more likely toface lifelong cognitive and physical deficits and chronic
health problems.
For children under the age of two, undernutrition can belife threatening. It can weaken a child’s immune system
and make him or her more susceptible to dying from
common illnesses such as pneumonia, diarrhea and malaria.
Source: Thousand Days Partnership, USA
http://thousanddays.org/about/

One Thousand Days Organization
Solutions to prevent and treat undernutrition alreadyexist. Every day, 1,000 Days partners are putting provensolutions into action in communities around the world.
By working in alignment with the Scaling Up Nutrition(SUN) Framework, 1,000 Days partners join a movement
to work across sectors and specialties to achieve better
nutrition results. By prioritizing proven nutrition solutions,progress is being made and lives are being changed for thebetter. Strong nutrition programs, sound policies andbetter investments can make a difference in the lives ofmothers and children today in a way that dramatically
improves the health and well-being of future generationsof individuals, families and communities.
Source: Thousand Days Partnership, USA
http://thousanddays.org/resources/success-stories/

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