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Afterword:
Now is the Time

Patrick Webb
Dean for Academic Affairs,
Friedman School of Nutrition Science and Policy,
Tufts University, Boston, USA

Does the world really need this book? Do the shelves ofanalysts and policy-makers need the weight of yet anothercompendium of ideas, statistics and rhetoric?
The answer, perhaps surprisingly, is yes. Such a book isneeded now, more than ever, because it reflects the rapid
convergence of opinion around priority problems and likely
pathways towards solutions.
The 2008 Lancet Series on Maternal and Child
Undernutrition highlighted what was then called the“fragmented and dysfunctional” state of the international
nutrition system.1 That “the system is broken” became anoft-repeated mantra of the late 2000s, a signal that perhaps
the biggest challenges to be faced came from within.
Progress towards common purpose in nutrition had long
been plagued by poorly articulated technical definitions,
nutrient-centric debates, and competing institutional mandates.
As a result, donor funding dedicated to nutrition was scarce,
national governments chose to focus on other priorities
offering more obvious gain, and science paid more attention todemonstrating the efficacy of narrowly defined interventions
than to explaining how to make policies and programs work.

The calls have been heard
A mere half decade later, things are starting to lookdifferent. Calls for more resources, for greater politicalprioritization, and for more effective implementation ofnutrition actions are being heeded. There is still a long way
to go, no doubt, but the calls are being heard in the grandhalls of governance, as in the corridors of academia andunder the shade trees of civil society. Commitment tochange is growing rapidly among developing-country
politicians, donor funding has risen, scientists are sheathing
their swords, and even private industry is sometimes invited
to the table of global debate.
The 2013 Lancet series2 update on maternal and childnutrition only used the term “dysfunctional” once, and thento describe how things were, not how they have become.
Instead, the new series focused on the importance ofaccelerating evidence-based actions at scale, the essential
complementarity offered by nutrition-sensitive
programming that address underlying determinants, and on
the need to sustain all initiatives (politically as well as
financially) by shaping effective policy processes.
These changes in the tone of global discourse, linked towidespread adoption of a common lens through which to
scrutinize what we do and how, represent a pivotal momentin humanity’s recurring war on want. There is a sense
running throughout this book that the attainment of soundnutrition for all people everywhere is no longer a fantasticaldream, but a genuine possibility.

It is imperative that we act
If accepted as truly possible, it is imperative that we act inways that make it so. The foregoing chapters articulate that
great progress has recently been made in reducing prevalence
rates of stunting; but 165 million children are still affected.3
Wasting has fallen globally, but only slowly and not much in
Africa. Most micronutrient deficiencies remain poorly
measured and hard to uncouple from the poor diets and poor
health that continue to blight more than a billion people.
Obesity and chronic non-communicable diseases are spreading
rapidly – now manifest as much in developing, as inindustrialized, countries. Thus, the world cannot afford totreat one problem at a time. Improving nutrition in all of its
forms is a massive unfinished social, economic, political andhumanitarian agenda. Progress is still not fast enough or
far-reaching enough to prevent the deaths and blighted lives ofmany hundreds of millions of people, including those still to beborn in the coming decade. It has to be accelerated, made fully
inclusive, and sustained.
None of which is easy. The task at hand is complex, so thesolutions are anything but simple. Evidence-supported actions
are needed on a wide scale to address the very specificrequirements of adolescent girls, pregnant women, mothers
and their infants, and children as they grow and develop into
productive adults. Some actions must be pursued with
universal coverage, but others must be targeted at the mosturgent cases first. Some must prevent, protect and promote,but other actions that save and treat and make whole again are
equally relevant to the common goal. Appropriate policies areneeded to enhance the nutritional resiliency of individuals aswell as of entire populations. Disasters that all too often erode
past gains must be anticipated so that effective responses canbe prosecuted with necessary vigor. And carefully designed
activities supportive of agricultural and income growth, socialprotection, quality education and health represent essential
contributions to the solution set. A critical component of all of theabove is the generation of high-quality empirical evidence of whatworks best in what context.
This book captures the fact that there has not been a time inrecent decades when so many people agreed on what needs
to be done or why. The momentum has to be maintained.
The next decade of the 21st century should be focusedsquarely on a global effort to get it done well, while
documenting how. Unless coherent, cost-effective actions
with measurable impacts quickly emerge from the current
cresting wave of goodwill toward nutrition, the wait foranother may be far too long. Now is the time.
References
1. Morris S, B Cogill, R Uauy, for the Maternal and Child Undernutrition
Study Group. Effective international action against undernutrition: why has itproven sodifficult and what can be done to accelerate progress? Lancet
2008:371;608–21.
2. The Lancet. Maternal and Child Nutrition. Special Series of four papers andrelated Commentaries. June 6, 2013. http://www.thelancet.com/series
maternal-and-child-nutrition.
3. UNICEF. Improving Child Nutrition: The achievable imperative for global
progress. New York:UNICEF, 2013.

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