Consultation on the LANCET series on Maternal and Child Nutrition 2013

Key IssuesDr Arun Gupta

Regional coordinator, International Baby Food Action Network (IBFAN) Asia

19th July 2013

Open Statement This series should not be allowed to become an opportunity for

commercial exploitation of malnutrition. The conflict of interest of the leader of the series and some Prioritization of interventions has been achieved through several

assumptions and imputations Ignored relevant, contemporary, and high quality evidence

◦ The modeling basis for management of Moderate Acute Malnutrition (MAM) is unclear.

◦ Further, the text in the section on Acute Malnutrition will create intense pressure for introducing specific products marketed by multinational corporations (RUTF and RUSF) without supporting high quality evidence

Safety concerns with some interventions Mic. Nuts link with bloody diarrhea

Engaging with the private sector and unregulated marketing of commercial foods

Burden of overnutrition is not dealt with

Two pointsConflict of interests in policy

development, how to prevent and manage with aim to eliminate

Accelerating action on infant and young child feeding : the unfished agenda.

Conflict of interests Many types, Direct/indirect, declared

/undeclared…but these are real and exist Two authors of Lancet Series members of

the ‘Nestle Creating Shared Value Advisory Committee’.

Lancet projects Scaling up Nutrition(SUN) as a viable global leadership ,

SUN has GAIN, and food industry on leadership team ( Unilever, Britannia)

GAIN is an adviser to Lancet series.

Conflict of interests contd.Organisers of the Lancet LaunchCoalition for Nutrition Security, ‘Save the

children’ hosts it. Pepsi and others are funding IFPRI : 2011 Conference on nutrition and

agriculture was funded by Pepsi It is complex…PHFI and GAIN were partners sometime back Indirect interests of “foundations” in food and

drink industryRMNCH coalition has private sector Child Survival call to Action has private sector…Question is How to keep Public Interest

supreme?

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How does it work for Pvt. Sector?

Advocate ‘Multi-stakeholder platforms’ and PPPs , innovations to gain control.

These are known CSR tools of business/private sector.

“Despite the common reliance on industry self-regulation and public-private partnerships, there is no evidence of their effectiveness or safety” Lancet Feb 2013.

Further…. Nutrition sensitive interventions miss advocacy and

are downplayed. 8 out of 10 interventions in Lancet on Nutrition are

“products” Call for deregulations/self regulations, IMS Act was about be repealed in 2005. Concerns: Independence is lost, in the absence of

any policy and mechanisms No Minsitry seems to have a policy on conflict of

interests When we have huge resources committed to feeding

programmes (e.g. NFSO), should we not have safeguards from commercial exploitation and lure of ‘assured markets’.

What are solutions A Policy and institutional mechanism for conflict of interests

( Elimination and management, primary Prevention like “precautionary principle”

Commitments:

◦ Several World Health Assembly resolutions

◦ Roll Back Malaria

◦ Art 5.3 of Framework Convention For Tobacco Control

◦ 12th Plan ‘Health’ and Women Agency and Child Rights’ ‘Chapter

“23.26 Monitoring the compliance of the IMS Act by companies will also be taken up for effective implementation of IMS Act, while ensuring that commercial influences and conflict of interest do not undermine optimal infant and young child feeding practices.

“23.271. Conflict of Interest: Policy guidelines and mechanisms will be developed to ensure that infant feeding practices are kept free from commercial influences and that nutrition programme implementation is free from conflict of interest, as mandated by the IMS Act”.

20.76.“To avoid medical conflicts of interest, legislation requiring drug companies to disclose payments made to doctors for research, consulting, lectures, travel and entertainment would also be considered.”

20.194 “On the lines of the National Institute of Clinical Excellence (NICE), ….proposed institute outside the Department of Health, but within the Ministry, is to provide it an element of objectivity and independence from practitioners, and to avoid conflict of interest.”

Above all

Hon’ble Supreme Court observation on Feb’ 8, 2011 on WRIT PETITION (CIVIL) NO. 681 OF 2004 to have independent scientific experts on panels of FSSAI.

What are the solutions?National Nutrition Authority/Council with a

technical arm….◦ It should drive convergence and advocacy, and

should be briefing MPs, Ministers, Political Parties not GAIN or others now.

Brazil example CONSEA A national council having power and “housed

in and reports to office of the president of the republic”. It formulates and proposes public policy to Guarantee human right to healthy and adequate food. Representation right up to municipal level

CAISAN : Made up of senior officials of many government ministries responsible for implementation and monitoring the policy.

Progress and status of South Asian Progress and status of South Asian

Countries on a composite WBTi scoreCountries on a composite WBTi score 2005,08,12)2005,08,12)

30

90.5

31.5

68

88.5

71.576

116

86.5 87

7269

119

80.5

88.5

124

99

107.5

94

74

129

0

20

40

60

80

100

120

140

Afghanistan Bangladesh Bhutan India Maldives Nepal Pakistan Sri Lanka

When Corporations Break the RULES at will !

What next ? Roundtable 8th April 2013 led to specific

recommendations WCD: Revive National Breastfeeding Committee MOH: National Technical committee on the pattern of

NTAGI in NRHM/NHM to deal with IYCF and nutrition Government order to appoint district level authority,

Civil Surgeons under IMS Act. National Food Security Ordinance 2013 provides cash

compensation and commits to promote exclusive breastfeeding for the first six months : That needs a ‘skilled counsellor’ nearly for every 10-20 babies born otherwise its spirit will be defeated.