Consultation on the LANCET series on
Maternal and Child Nutrition 2013
Key Issues
Dr Arun Gupta
Regional coordinator, International Baby Food Action Network (IBFAN) Asia
19th July 2013
Open Statement
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This series should not be allowed to become an opportunity for commercial
exploitation of malnutrition.
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The conflict of interest of the leader of the series and some
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Prioritization of interventions has been achieved through several assumptions
and imputations
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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
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Safety concerns with some interventions Mic. Nuts link with bloody diarrhea
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Engaging with the private sector and unregulated marketing of commercial
foods
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Burden of overnutrition is not dealt with
Two points
Conflict 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
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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 Launch
 Coalition 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
industry
 RMNCH 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.
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Further….
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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
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A Policy and institutional mechanism for conflict of interests (
Elimination and management, primary Prevention like “precautionary
principle”
Commitments:
◦
Several World Health Assembly resolutions
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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?
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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 Countries on a
composite WBTi score 2005,08,12)
129
76
74
69
68
72
80
71.5
80.5
88.5
88.5
94
87
86.5
100
90.5
99
107.5
120
116
119
124
140
60
30
31.5
40
20
0
Afghanist an
Bangladesh
Bhut an
India
Maldives
Nepal
Pakistan
Sri Lanka
When Corporations Break the
RULES at will !
What next ?
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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.