A decade of nutrition policy and political economy research with A4NH

The Agriculture for Nutrition and Health (A4NH) programme comes to a close at the end of 2021. Over ten years and two waves of programming, A4NH has catalysed, funded and supported highly impactful research on the links between agriculture, nutrition and health. This important contribution to agri-food and nutrition science has been combined with social science and policy research contributed by many partners and convened by researchers at the International Food Policy Research Institute and the UK’s Institute of Development Studies.

The A4NH programme was innovative in working closely with other programmes of research in agriculture, nutrition and health. Initial research by the Transform Nutrition consortium on the factors shaping an enabling environment for nutrition, and the wider politics of childhood undernutrition, grew into projects researching national level commitment for nutrition and building community voice and accountability in the way nutrition and health services are delivered and run.

Centring political economy and public policy concepts and theory adapted from political science, health systems and development research has been an important part of this programme. This has included identifying how prior knowledge and ideas, or problem ‘framing’ can shape a policy context, and how coalitions of different actors operate in different institutional contexts, including across government and the various sectors involved in nutrition, and between different levels of policy and implementation. Power differentials between diverse actors, whether government departments, donors and national governments, state and commercial actors, citizens and policy makers, men and women, elites and non-elites shape outcomes profoundly. This body of work has prompted calls for further power analysis in the ANH and food systems field.

Research on nutrition capacity and leadership also had an important impact on our approach to building capacity in the international nutrition workforce. It led to a dedicated summer school for policy makers and practitioners that ran for many years at IDS and which was then rolled out regionally with partners in India and West Africa, the latter through the successor programme Transform Nutrition West Africa. Training was also extended to the network on Scaling Up Nutrition (SUN) Movement and Comprehensive Africa Agriculture Development Programme (CAADP) Focal Points for African and Asian Countries in 2018 and 2019.

Throughout, our work has been enriched by dialogue and collaboration with others working in the non-communicable disease, healthy diet and health equity fields, and by broader work on power, health governance and human rights. Research into nutrition equity grew directly from these connections and was focused on mapping A4NH work and gaps on equity. The conceptual work this catalysed contributed to the framing of the 2020 Global Nutrition Report ; and has just been published as the Nutrition Equity Framework. These concepts, fundamental to work in other fields, have now begun to find a place more centrally in A4NH research.

Policy focused research

Beyond academic impact, perhaps the most important legacy of this research has been through engagement with the policy processes themselves. Research as part of Alive and Thrive in Ethiopia, Bangladesh and Vietnam, and in India, POSHAN, involved policy process research that sought to engage directly and deliver evidence that would inform policy and action. Throughout the A4NH programme, attention has been paid to the stories policy makers and affected communities tell including finding new ways to amplify through research focussed on different country’s ‘stories of change’ in nutrition. This research included efforts to link to country policy and programme processes from the start in a way that would position the evidence generated to encourage uptake.

In India, the POSHAN model combined this work with a myriad of formal and tacit strategies to engage policy makers on their own grounds and responding to their evidence and data needs.This was part of long term and reflexive engagement between researchers and policy makers that was far beyond the usual research-publish-disseminate cycle.

A decade of change

As we reach the milestone of a decade of A4NH research, we also reflect on what has changed, what we have learnt and what could have been done differently. First, within the context of the COVID-19 pandemic, 2021 has highlighted the global social and economic inquities that exist and in part reveal the depth of power imbalances globally. An analysis reflects on what the nutrition policy community might learn from a humbler examination of international nutrition’s own history. This identifies the ties we have as professionals to the less savoury aspects of the global system: racism and colonial exploitation.

Our research has highlighted the little-known history of how the once burgeoning field of ‘social nutrition’ was silenced over decades of cold-war politics in favour of some of the technocratic approaches which still dominate in the nutrition world today. But these are not only historical processes. We recognise and reflect on how some of the critiques current in global health on authorship, partnership, funding and working relations are still shaped by colonial connections; and how the broader forms of privilege available to Northern based researchers apply equally to some of the work we have been involved in. This also applies to work within A4NH, across the Consultative Group on International Agricultural Research (CGIAR), which has funded our work, as much as to high-level processes such as the Food Systems Summit, with which we have engaged. It is also a factor that shapes any discussion on ‘what we would do differently’ if we were to start the decade again. Perhaps another ‘story of change’ on this perspective would generate valuable lessons for the CGIAR system as it transitions to a new set of initiatives that value partnerships between South and North.

Second is the reckoning international nutrition must now make with its blindspots related to dietary and other causes of disease rooted in industrialised food systems. While the global nutrition discourse has been celebrated as shifting, rightly, to food systems and a consideration of malnutrition in all its forms, international meetings are still dominated by implicit and sometimes explicit assumptions about knowledge solutions flowing from North to South. This is happening just as malnutrition and hunger problems worsen in many Northern countries including the US and the UK.

2021 is also the year in which The American Heart Association Diet and Lifestyle Recommendations, a science based set of dietary recommendations, were updated to include the advice to eat more unprocessed and minimally processed foods. This followed the growing evidence on the risks to human health of diets composed increasingly of Ultra Processed Foods. But, despite this, at the year’s international summits including the UN Food Systems Summit and the Nutrition for Growth event hosted by the Japanese Government, attention to these issues was minimal or minimised.

Much work, including from some of us within A4NH, went into such international processes and a key question for now is whether the country focused sustainable transformation pathways, some of which did focus on better regulation, can be better protected from the conflict of interest issues. This was publicised by several leading Non-Communicable Disease charities (also, here). Rigorous political economy studies of the various actors and interests that lead to the omissions in the global dialogue are already on the research agenda. It demonstrates yet another facet a fascinating yet tumultuous year for nutrition policy studies and global health more generally.

As A4NH comes to a close, those of us involved in this work are thankful for the collaborations and ideas it has inspired on a subject so fundamental to the future of our societies. We look forward to the next decade of research and action on these important issues.