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International Public Nutrition and Emergencies: The Potential for Improving Practice

Workshop summary

by Anuradha Harinarayan, Feinstein International Famine Center, Tufts University

Aworkshop was organised by the Feinstein International Famine Center in June this year. This workshop provided a forum for both technical and non-technical representatives of NGOs, UN, governments and academic institutions to consider the potential of using a Public Nutrition approach to tackle nutritional problems in complex emergencies.

Workshop proceedings

The first day of the workshop focussed on the conceptual issues related to the role and significance of malnutrition in emergencies and speakers addressed issues relating to malnutrition and vulnerability and the responsibilities within the international humanitarian system for addressing nutritional problems. The discussions in the plenary session raised a number of issues to do with the value of a Public Nutrition approach in tackling some of the concerns. Participants agreed that the common misconception about the scope of nutrition among the wider humanitarian system tends to give it a narrow focus on malnutrition and feeding people. This inability to take account of the wider determinants of malnutrition is a constraint to improving program design and impact. There was a difficult and at times contentious discussion where participants who were drawn from a range of backgrounds had to come to a common understanding of Public Nutrition and its applicability to emergency situations. Once there was greater clarity on the conceptual issues, the focus of the workshop shifted towards operational matters.

Presentations on the second day included operational tools and frameworks that are currently used by agencies and have a direct impact on nutrition. Representatives from UNHCR, UNICEF and WFP presented the memoranda of understanding between key UN agencies.

Six case-study presentations also illustrated the various components of a Public Nutrition approach, including in-depth assessment, analysis, program design and constraints of using the approach (Concern Worldwide, Helpage International, Care International, Action contre la Faim, UNHCR and NutritionWorks).

Workshop outcomes

Most key decisions about nutrition in emergencies are made by non-nutritionists. Hence participants agreed on the necessity of raising levels of awareness and understanding amongst senior policy-makers and all actors in the humanitarian sphere, about the impact of their actions on nutrition. Recommended strategies for achieving this included:

  1. Developing better multi-sectoral working relationships and strengthening relationships with donors and key decision-makers in the humanitarian system. Such a relationship should be based on the knowledge that individual components of a Public Nutrition approach are not viewed as competing priorities.
  2. Institutional learning, training and capacity building, particularly in relation to institutions based in developing countries and building upon initiatives such as the Sphere project. Appropriate training and education curricula and related materials were felt to be needed for both specialist and non-specialist staff working in food and nutrition related programmes at all operational levels. Information was seen to be central to the process of institutional learning, education of the media, and informing key decision-makers within the donor community. The papers presented at the workshop, plus an overview of the proceedings, are published as a special issue of the Disasters Journal, which may be ordered using the form included in this Newsletter, or ordered directly from Blackwell Publishers Journals (108 Coulee Road, Oxford OX4 1JF, UK or 350 Main Street, Malden, MA 02148, USA).

What is Public Nutrition?

Public Nutrition is a broad-based problem-solving approach to addressing nutritional problems of populations or communities. In contrast to clinical nutrition, the emphasis is shifted from the individual to the population level, and from a narrow set of technical interventions to a wide range of strategies, policies and programs to combat malnutrition.

Public Nutrition recognises that food insecurity is only one of the determinants of malnutrition in emergencies, and interventions need to address both the health and social environment to have an impact on malnutrition. Public Nutrition is distinct from Public Health in a few key ways - Public Health tends to approach nutritional problemsolving using a medical, disease prevention model, which rarely takes account of public policy in food-related fields outside of health, like economics, trade or agriculture. This distinction is highly relevant to Public Nutrition in emergencies, where Public Health strategies fall short of taking account of the wider social, economic and political determinants of access to food, relevant public policies and community and individual strategies for dealing with food insecurity. Additionally, a Public Nutrition approach makes explicit the impact of the political, economic and health environment on a family's ability to care for its members and itself.

This approach requires that a context specific analysis of the types and causes of malnutrition form the basis of decision-making at all stages of the project cycle including, planning and designing programmes, implementation, monitoring and evaluation.

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Anuradha Harinarayan (1999). International Public Nutrition and Emergencies: The Potential for Improving Practice. Field Exchange 8, November 1999. p12. www.ennonline.net/fex/8/international

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