Programa de formación sobre políticas globales de nutrición para el desarrollo sostenible

Negotiation and decision making in global nutrition policy: Governance of the World Health Organization

Brian Payne, Juan Pablo Pena-Rosas, Diana Estévez, Mónica Flores-Urrutia

Evidence and Programme Guidance Unit, Department of Nutrition for Health and Development, World Health Organization, Geneva, Switzerland

enshrines the highest attainable standard of health as a fundamental human right. One of the functions of WHO as set in its Constitution is to promote, in cooperation with other specialized agencies where necessary, the improvement of nutrition, housing, sanitation, recreation and economic empowerment and other aspects of environmental health. Adequate nutrition is the foundation of wellbeing, health and development. Conversely, malnutrition at any stage of the lifecycle has acute and long-term consequences for diminished intellectual ability, economic productivity, reproductive performance and susceptibility to disease (1,2). The World Health Assembly (WHA) is the supreme decision-making body for the WHO. The World Health Assembly is the forum through which the WHO is governed by its 194 Member States and meets annually in Geneva, Switzerland. Members States, Associate Members, as well as representatives of the Executive Board, participating intergovernmental and non-governmental organizations admitted into relationship with the Organization are invited to be represented at the session. WHO consults the United Nations and specialized agencies and Member States on international agreements or international regulations proposed for adoption and brings their comments to the attention of the World Health Assembly along with the comments received from governments. The renewed commitment to address malnutrition, both internationally and regionally, is reflected in recent declarations adopted at the United Nations High-level Meeting of the General Assembly on the Prevention and Control of Noncommunicable Diseases in 2011 and two movements, Scaling-Up Nutrition (SUN) and Thousand Days (adopted by stakeholders and donors since 2010). In the area of nutrition, extensive negotiations and decision-making led to the adoption of a resolution on infant and young child nutrition in 2011 (WHA63.23) and the endorsement of the Comprehensive implementation plan for maternal, infant and young child nutrition in 2012 (WHA65.6). The 2011 resolution resolution urged Member States to strengthen their political commitment to reduce the prevalence of malnutrition in all its forms, to accelerate implementation of the global strategy on infant and young child feeding, and to scale up existing programmes. In January 2012, the 128th Executive Board further developed this framework to reflect the importance of maternal nutrition and the double burden of malnutrition (undernutrition and overweight) in children. Since the approval of the Comprehensive plan, food and nutrition policies have received increased political attention both nationally and internationally. Members States and their partners have committed to the achievement of the six global targets by 2025: 40% reduction in the number of children under- 5 who are stunted; 50% reduction of anaemia in women of reproductive age; 30% reduction in low birth weight; no increase in childhood overweight; increase the rate of exclusive breastfeeding in the first 6 months at least 50% and to reduce and maintain childhood wasting to less than 5%. Subsequently, Member States requested WHO to prepare a set of nutrition-based indicators for the monitoring the implementation of progress towards the achievement of these six global targets. In 2014, the Second International Conference in Nutrition was convened by WHO and the Food and Agriculture Organization of the United Nations (FAO) in Rome, Italy. Ministers and Representatives of the Members States of FAO and WHO endorsed the Rome Declaration on Nutrition and a Framework for Action to guide its implementation. This declaration reaffirmed the commitments made at the first International Conference on Nutrition in 1992 and the 1996 and 2002 World Food Summits. These commitments are aligned with relevant international targets and action plans, including the six global nutrition targets and the WHO global action plan for the prevention and control of noncommunicable diseases 2013-2020. Signatories committed to the eradication of hunger, the prevention micronutrient malnutrition and to reverse the trend in obesity. The levels of commitment need further negotiations among national and subnational stakeholders in order to implement the actions and to adopt and adapt the goals. Six core indicators were agreed in 2015 to monitor progress in the implementation. During the 68th WHA Member States renewed their commitment to address critical aspects of maternal and child nutrition. Moreover, it is expected that in September 2015 the United Nations Assembly approve the establishment of the Decade of Action on Nutrition 2015-2025. This process will require a greater commitment to align these efforts to the sustainable development goals. Developing nutrition policies within the global context of significant disparity in resources and differing nutrition priorities require contributions from many stakeholders. The debate and decision-making process of the WHO aims to assist countries to improve the health of their citizens by providing evidence-informed guidelines and examples of best practices. Further actions must be taken to meet the WHA 2025 targets. Of the 99 countries for which we can make assessments for four of the six global targets, 68 are on course to meet one or more of them (4). This disparity in health outcomes of countries attest to the need for accelerated efforts from multiple sectors. References 1. Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, et al. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet. 2008; 371(9608):243-60. 2. Engle PL, Black MM, Behrman JR, Cabral de Mello M, Gertler PJ, Kapiriri L, et al. Strategies to avoid the loss of developmental potential in more than 200 million children in the developing world. Lancet. 2007; 369(9557):229-42. 3. Van de Poel E, Reza Hosseinpoor A, Speybroeck N, Van Ourti T, Vega J. Socioeconomic inequality in malnutrition in developing countries. Bull World Health Organ. 2008; 86:282-91. 4. WHO. Comprehensive implementation plan on maternal, infant and young child nutrition; 2014 Geneva: World Health Organization (úblications/CIP_document/en/, accessed 26 June 2015).