On Thursday 25 March, 2021, one year and two days following the official declaration of a national lockdown in the United Kingdom (where all three authors of this piece live), a group of nutrition experts past and present gathered to discuss how to do the ‘deep learning’ necessary to better face the impacts of COVID-19 on food systems and malnutrition in all its forms. At this stage of the ongoing ‘crisis,’ it is clear to all who work in this sector that society’s most vulnerable, and especially children, will be the most negatively impacted by the pandemic when it comes to food insecurity and malnutrition amongst a range of other ill-health effects.
In light of these significant challenges, and in spite of ‘zoom fatigue,’ the seminar was a space for much-needed intergenerational critical reflections on what needs to be salvaged from a collective past in order to move forward with greater imagination. There was a kind of symmetry in what we called for in the paper (forthcoming) – a broader set of perspectives and a greater degree of inclusion when it comes to who ‘sits at the table’ in global nutrition research and decision making – and the increased potential for cross-cutting conversations as a consequence of these new ways of working.
The jumping off point for the seminar was a rapid bibliographic and archival review of the core institutions of global health and global nutrition, and tensions over time between technical quick-fix approaches to food, nutrition and health crises on the one hand, and the influence of systems thinking, social nutrition and social medicine approaches on the other.
Chronologically, the historical review began in the early 1930s with the initiation of the League of Nations Health Organization’s work on international nutrition, and ended with the turn away from the Primary Health Care approach articulated in the Declaration of Alma Ata and back toward narrower forms of international health and nutrition cooperation at the turn of the 1980s. We illustrate in the paper the ways in which nutrition and global health development were intimately intertwined with imperialism, colonialism and the racist assumptions that underpinned them, and we suggest that not all of this problematic past has been shed. The paper, and the seminar organized to discuss it, is an attempt on our part to encourage a more honest reckoning with this past and to learn from it, and better yet, apply that learning in our day-to-day practice.
The discussants, which included Tom Scott-Smith of Oxford University and Jessica Fanzo of the Johns Hopkins Bloomberg School of Public Health, among others, reflected on the tensions between technical and social approaches at the point when international health and nutrition collaborative efforts first took shape. The suppression of rights-based approaches in favor of less-politicized medicalized and scientifically driven approaches was identified as a particularly resonant theme. Similarly, the question of whether or not nutrition is ‘inside’ or ‘outside’ of global health (with its institutional affiliation and resource allocation implications) was viewed as contentious and unresolved. Barbara Harriss-White suggested that wherever it sits within the UN system or among a host of iNGOs now working in this space, nutrition often swims in a ‘wide Sargasso Sea of neglect.’
When it comes to the question of ‘seats at the table,' one clear historical finding was the extent to which turf battles and aggressive scientific disputes pulled the field in competing directions. There is a newfound willingness to reflect critically on the connections between the origins of nutrition, global health and development as ‘disciplines’ and the imperial and colonial processes that influenced them. Scott-Smith cautioned those working in contemporary global nutrition not to read the past through the lens of the present, given that the terms of past debates are so different now. Some discussants’ development as nutritionists occurred in parallel with the tensions and negotiations within the UN system that occurred in the wake of independence movements and the fall of empires, which influenced their perceptions of the history presented. All agreed that historical knowledge can help us question our assumptions about a linear path of progress in global health and nutrition.
The stickiest – and unanswerable – question that the seminar addressed was whether or not COVID-19 is an inflection point similar to the mid-1970s, when there were forces pulling in both directions, e.g. toward the technical quick fix and the social medicine/social nutrition and systems approaches which embrace complexity and long term change. Is COVID-19 a ‘crisis’ unlike all previous crises, or are we actually witnessing repeating patterns of how crisis is handled within global nutrition, health and development?
Given the current reckoning with the very problematic structures and systems of racism on which these fields have been built, we returned again to question whether now is a time to ‘build back better’ or to question more critically and with greater force the very foundations? By way of concluding the discussion, but with the aim of beginning new conversations, we ended with a call for greater humility for all current practitioners of global health, nutrition and development; a more inclusive approach to whose knowledge and expertise ‘counts’ at these highest levels of decision making and resource allocation; and more of the kinds of critical reflexivity and uncomfortable conversations about this shared past that will enable deeper learning and – if we are feeling optimistic – transformative change.
Erica Nelson is a Research Officer at the Institute for Development Studies (IDS). Stuart Gillespie is a Nonresident Senior Research Fellow at the International Food Policy Research Institute (IFPRI), who conducts work as part of A4NH's Research Flagship on Supporting Policies, Programs, and Enabling Action for Research. Nick Nisbett is a Senior Research Fellow at IDS. The analysis and opinions expressed in this piece are solely those of the authors.
Acknowledgements: The event discussed here was hosted by IDS in partnership with IFPRI and funded by the CGIAR Research Program on Agriculture for Nutrition and Health (A4NH).
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