With other members of Civil Society, we met the Special Rapporteur in Rome last week at the Committee on Food Security. She also came to our side meeting on Conflicts of Interest. Here is her promised report on Nutrition.
REPORT OF THE UN SPECIAL RAPPORTEUR ON THE RIGHT TO FOOD TO THE 2016 UN GENERAL ASSEMBLY: NUTRITION – MALNUTRITION
Link to Full 24-Page Report: http://www.wunrn.org/pdf/ga2.pdf
Type size larger for easier reading.
Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Underlying factors of malnutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
III. Global nutrition governance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
Human rights approach and State responsibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Conclusion and recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Introduction
Malnutrition, in all its forms, has become a universal challenge. Today, nearly
800 million people remain chronically undernourished, more than 2 billion suffer
from micronutrient deficiencies, and another 600 million are obese. These three
forms of malnutrition coexist within most countries, communities and even
individuals. Ensuring the right to adequate food extends far beyond merely ensuring
the minimum requirements needed for survival and includes access to food that is
nutritionally adequate. Increasingly, the right to adequate nutrition is being
recognized as an essential element of the right to food and the right to health.
The underlying causes of malnutrition are complex and multidimensional, and
access to nutritious food is often a key indicator of socioeconomic inequality.
Women and children are particularly sensitive to malnutrition, while poverty, gender
inequality and lack of access to adequate sanitation, health and education services
are aggravating factors. Today’s food systems, which are dominated by industrial
production and processing, as well as trade liberalization and aggressive marketing
strategies, are fostering unhealthy eating habits and creating a dependence on highly
processed, nutrient-poor foods. Unequal access to and control over resources, as well
as unsustainable production and consumption patterns, which lead to environmental
degradation and climate change, also contribute to the malfunctioning of food
systems.
Recognizing the growing threat of malnutrition in all its forms and its negative
impacts on economic development, universal health and efforts to reduce inequality,
the international community has taken major initiatives to ensure global policy
action. The World Health Organization (WHO) global targets to improve maternal,
infant and young child nutrition by 2025, the Global Action Plan for the Prevention
and Control of Non-Communicable Diseases 2013-2020 and the political
commitments made at the Second International Conference on Nutrition, in 2014, to
ensure the right of everyone to safe, sufficient and nutritious food are encouraging
responses. It is now also recognized that nutrition plays a crucial role in fulfilling
the 2030 Agenda for Sustainable Development.
Yet the world is not on track to reach these global targets.2 It is time to
translate commitment into action. The United Nations Decade of Action on
Nutrition, proclaimed in April 2016, presents a unique opportunity to ensure a
coherent, inclusive and transparent response to malnutrition, embedded within
human rights. Applying a human rights-based approach to nutrition policy
acknowledges rights holders and the duty of Governments to refrain from actions
that negatively affect the right to nutrition and to implement strategies that tackle
malnutrition’s root causes. Recognizing that private sector involvement in
responding to malnutrition cannot be ignored, it is necessary to establish suitable
safeguards to prevent negative corporate influences on nutrition governance. States
should be supported in their efforts to regulate and hold the food industry
accountable, to encourage behavioural changes in the population and to improve
access to nutritious food through social protection. Finally, it is crucial to recognize
that malnutrition will continue to persist, unless a coordinated effort is made to shift
from unsustainable industrial food systems to ones that are “nutrition sensitive”.
The Special Rapporteur wishes to acknowledge the important contributions
made to this topic by the former Special Rapporteur on the right to food and the
former Special Rapporteur on the right of everyone to the enjoyment of the highest
attainable standard of physical and mental health in their respective reports on the
right to an adequate diet (A/HRC/19/59) and on unhealthy foods, non-communicable
diseases and the right to health (A/HRC/26/31).
United Nations A /71/282
General Assembly
Distr.: General
3 August 2016
Original: English
16- 13441 (E) 240816
*1613441*
Seventy-first session
Item 69 (b) of the provisional agenda*
Promotion and protection of human rights: human rights
questions, including alternative approaches for improving the
effective enjoyment of human rights and fundamental freedoms
Right to food
Note by the Secretary-General
The Secretary- General has the honour to transmit to the General Assembly the
interim report of the Special Rapporteur on the right to food, Hilal Elver, submitted
pursuant to General Assembly resolution 70/154.
* A/71/150.
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Interim report of the Special Rapporteur on the right
to food
Summary
The present report, submitted pursuant to General Assembly resolution 70/154,
is dedicated to reiterating the importance of a rights- based approach to “adequate
food”, that is, nutritious food for all. It discusses the underlying factors affecting
nutrition, including industrial food systems, unhealthy eating environments and the
growing threat of non- communicable diseases, as well as the harmful effects of trade
liberalization and unregulated marketing of food products. The Special Rapporteur
outlines nutrition governance at the global level and considers its shortcomings, and
recommends taking a human rights- based approach to combating malnutrition at both
the global and national levels.
Contents
Page
I. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
II. Underlying factors of malnutrition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
III. Global nutrition governance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
IV. Human rights approach and State responsibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
V. Conclusion and recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
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I. Introduction
1. Malnutrition, in all its forms, has become a universal challenge. Today, nearly
800 million people remain chronically undernourished, more than 2 billion suffer
from micronutrient deficiencies, and another 600 million are obese. These three
forms of malnutrition coexist within most countries, communities and even
individuals. Ensuring the right to adequate food extends far beyond merely ensuring
the minimum requirements needed for survival and includes access to food that is
nutritionally adequate. Increasingly, the right to adequate nutrition is being
recognized as an essential element of the right to food and the right to health.
2. The underlying causes of malnutrition are complex and multidimensional, and
access to nutritious food is often a key indicator of socioeconomic inequality.
Women and children are particularly sensitive to malnutrition, while poverty, gender
inequality and lack of access to adequate sanitation, health and education services
are aggravating factors. Today’s food systems, which are dominated by industrial
production and processing, as well as trade liberalization and aggressive marketing
strategies, are fostering unhealthy eating habits and creating a dependence on highly
processed, nutrient- poor foods. Unequal access to and control over resources, as well
as unsustainable production and consumption patterns, which lead to environmental
degradation and climate change, also contribute to the malfunctioning of food
systems.1
3. Recognizing the growing threat of malnutrition in all its forms and its negative
impacts on economic development, universal health and efforts to reduce inequality,
the international community has taken major initiatives to ensure global policy
action. The World Health Organization (WHO) global targets to improve maternal,
infant and young child nutrition by 2025, the Global Action Plan for the Prevention
and Control of Non- Communicable Diseases 2013- 2020 and the political
commitments made at the Second International Conference on Nutrition, in 2014, to
ensure the right of everyone to safe, sufficient and nutritious food are encouraging
responses. It is now also recognized that nutrition plays a crucial role in fulfilling
the 2030 Agenda for Sustainable Development.
4. Yet the world is not on track to reach these global targets.2 It is time to
translate commitment into action. The United Nations Decade of Action on
Nutrition, proclaimed in April 2016, presents a unique opportunity to ensure a
coherent, inclusive and transparent response to malnutrition, embedded within
human rights. Applying a human rights- based approach to nutrition policy
acknowledges rights holders and the duty of Governments to refrain from actions
that negatively affect the right to nutrition and to implement strategies that tackle
malnutrition’s root causes. Recognizing that private sector involvement in
responding to malnutrition cannot be ignored, it is necessary to establish suitable
safeguards to prevent negative corporate influences on nutrition governance. States
should be supported in their efforts to regulate and hold the food industry
accountable, to encourage behavioural changes in the population and to improve
access to nutritious food through social protection. Finally, it is crucial to recognize
__________________
1 The Special Rapporteur intends to dedicate a future report to the effects of climate change on
nutrition.
2 International Food Policy Research Institute, Global Nutrition Report 2016: From Promise to
Impact — Ending Malnutrition by 2030 (Washington, D.C., 2016), p. xviii.
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that malnutrition will continue to persist, unless a coordinated effort is made to shift
from unsustainable industrial food systems to ones that are “nutrition sensitive”.
5. The Special Rapporteur wishes to acknowledge the important contributions
made to this topic by the former Special Rapporteur on the right to food and the
former Special Rapporteur on the right of everyone to the enjoyment of the highest
attainable standard of physical and mental health in their respective reports on the
right to an adequate diet (A/HRC/19/59 ) and on unhealthy foods, non- communicable
diseases and the right to health (A/HRC/26/31 ).
A. Malnutrition in all its forms
6. Malnutrition includes undernutrition, micronutrient deficiency and conditions
associated with excess intake and nutritional imbalance. Undernutrition is a
consequence of consuming too few essential nutrients, caused by either insufficient
food intake or repeated infectious diseases. The most basic kind of undernutrition is
protein energy malnutrition, which in its acute form leads to wasting. Identifying
wasting in children is crucial because the condition is reversible, if appropriately
addressed. In its chronic form, it is caused by sustained poor dietary intake or
repeated infections during the first 1,000 days of a child ’s life and can lead to
stunting. Stunting is irreversible and leads to shortness in stature, immediate and
long- term morbidity and mortality and problems with cognitive functioning.3
7. Micronutrient deficiency describes a condition in which there is a lack or
shortage of vitamins and minerals. Also referred to as “hidden hunger”, it increases
vulnerability to infection, birth defects and impaired development and can lead to
premature death. For example, iron deficiency leads to anaemia, vitamin A
deficiency weakens the immune system, and iodine deficiency int erferes with brain
development.4
8. “Unbalanced nutrition” occurs when the body is exposed to too much dietary
energy and leads to overweight and obesity. It may result from eating too much or
too many of the wrong things, as well as insufficient exercise, and can lead to an
increased risk of heart disease, hypertension, diabetes and diet- related cancers.5
9. Traditionally, undernutrition and “hidden hunger” were considered specific to
the developing world, while obesity was commonly perceived to mostly affect
developed countries. It is now recognized that different forms of malnutrition
coexist within most countries. Obesity rates are increasing in developing nations
that are exposed to globalization while undergoing economic transition and urban
migration. This is part of the global “nutrition transition”, which is seeing a rise in
consumption of energy- dense yet nutrient- poor foods, coupled with more sedentary
lifestyles. As a consequence, many countries are now confronted with not only
undernutrition but also rising rates of obesity.6
__________________
3 World Food Programme (WFP), “Hunger glossary”, available from www.wfp.org/hunger/
glossary; WFP, “Types of malnutrition”, available from www.wfp.org/hunger/malnutrition/types.
4 WFP, “Types of malnutrition”.
5 WHO, “Obesity and overweight”, fact sheet, June 2016.
6 Bryan L. McDonald, “Food as a key resource for security and stability: implications of changes
in the global food system 1950-2000”, Penn State Journal of Law and International Affairs,
vol. 3, No. 2 (2015), pp. 42-55.
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B. Nutrition-sensitive groups
1. Women
10. Women are more vulnerable to malnutrition than men because of different
physiological requirements. Although women require 35 per cent less dietary energy
per day than men, they need at least the same amount of nutrients. Consequently, a
woman’s ideal diet contains significantly more nutrients than those of a male
counterpart.
11. Women who are lactating and pregnant require an even more nutrient – rich diet.
To ensure the health of the fetus, a diet consisting of at least 20 per cent protein and
higher levels of iron, folate and calcium is essential. Malnourished mothers are
more likely to give birth to underweight babies, who in turn are 20 per cent more
likely to die before the age of 5.7 Diets that consist of less than 6 per cent protein in
utero have been linked with many deficits, including decreased brain weight,
obesity and impaired brain communication.8
2. Children
12. The first 1,000 days of a child’s life determines a person’s physical and
intellectual development. Children receiving appropriate nutrition during this
window are reportedly 10 times more likely to overcome life – threatening childhood
diseases and likely to complete 4.6 additional schooling levels and to raise health ier
children themselves.9 The stages of a child’s development are cumulative, and
inadequate nutrition at an early stage can have lasting negative impacts, setting the
child on a higher trajectory of risk of malnutrition throughout life. The Committee
on the Rights of the Child, in its general comment No. 15, noted that understanding
the life course was essential in order to appreciate how health problems in
childhood affected public health in general.
13. WHO has concluded that malnutrition is the underlyi ng contributing factor in
about 45 per cent of all child deaths.10 While the world has made progress in
addressing undernutrition, for example by reducing stunting by more than a third
since 1990, this progress is not fast enough. In 2014, there were 159 mi llion stunted
and 50 million wasted children in the world,11 and by 2030, stunting is expected to
affect 129 million children.12
14. At the same time, there were 41 million overweight children under the age of 5.11
If this trend continues, 70 million infants and young children will be overweight or
__________________
7 WFP, “Women and hunger: 10 facts”. Available from www.wfp.org/our-work/preventing-hunger/
focus-women/women-hunger-facts.
8 Food and Agriculture Organization of the United Nations (FAO), The State of Food Insecurity in
the World 2000: Food Insecurity, When People Live with Hunger and Fear Starvation (Rome,
2000), p. 11.
9 John Hoddinott and others, “Adult consequences of growth failure in early childhood”, The
American Journal of Clinical Nutrition, vol. 98, No. 5 (November 2013). See also 1,000 Days,
“Why 1,000 days”, available from http://thousanddays.org/the-issue/why-1000-days.
10 WHO, “Children: reducing mortality”, fact sheet, January 2016. Available from www.who.int/
mediacentre/factsheets/fs178/en.
11 United Nations Children’s Fund (UNICEF), WHO and World Bank Group, “Levels and trends in
child malnutrition: key findings of the 2015 edition”, September 2015.
12 Save the Children, Unequal Portions: Ending Malnutrition for Every Last Child (London, 2016),
p. v.
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obese by 2025.13 Economic and cultural factors contribute to childhood obesity.
Energy- dense foods are often more affordable and aggressively marketed towards
children, while some cultures may associate higher weights in children with being
healthy.
15. There are significant differences in malnutrition rates between countries. In
2014 almost all wasted children lived in Asia and Africa, while stunting affected
predominantly Asia, as well as Africa. In 2013, it was estimated that close to
31 million overweight children lived in developing countries.14
3. Importance of breastfeeding
16. Breastfeeding is a powerful influence on child survival and development and
prevention of child malnutrition. It provides optimal nutrition for young infants,
reducing the incidence and severity of infectious diseases and contributing to
obesity prevention. Breastfed babies are protected from illnesses through the
mother’s antibodies, while those who are not are exposed to increased chances of
malnutrition, non- communicable diseases and suboptimal cognitive development. In
addition, infant formula and other breast milk substitutes can cause poor growth or
illness if water quality and hygiene standards are not met.
17. WHO recommends breastfeeding within one hour of birth and exclusive
breastfeeding for the first six months of life. Nutritionally adequate and safe
complementary foods should be introduced at 6 months of age, together with
continued breastfeeding up to 2 years of age or beyond. Yet only about 36 per cent
of infants between 0 and 6 months old are exclusively breastfed. 15 In high- income
countries, fewer than one in five infants are breastfed for 12 months, and only two
out of three children between 6 months and 2 years of age receive breast milk in
low- and middle- income countries. These rates have not improved in two decades. 16
In addition, few children receive nutritionally adequate and safe complementary
foods. A total of 823,000 children’s lives could be saved yearly if all children
between 0 and 23 months were optimally breastfed.17 One of the major obstacles to
breastfeeding is the misleading marketing by baby food companies of breast milk
substitutes and the lack of corporate accountability for the adverse consequences of
such abuses.
II. Underlying factors of malnutrition
A. Economic and social determinants
18. In the Rome Declaration on Nutrition, adopted in 2014, States recognized that
the root causes of malnutrition were complex and multidimensional. They includ e
__________________
13 WHO, “Facts and figures on childhood obesity”, October 2014, available from www.who.int/
end-childhood-obesity/facts/en; WHO, “Obesity and overweight” (see footnote 5).
14 WHO, “WHO Global Strategy on Diet, Physical Activity and Health: childhood overweight and
obesity”. Available from www.who.int/dietphysicalactivity/childhood/en.
15 WHO, “Infant and young child feeding”, fact sheet No. 342, January 2016.
16 WHO, “Maternal, newborn, child and adolescent health: increasing breastfeeding could save
800,000 children and US$ 300 billion every year”, January 2016. Available from www.who.int/
maternal_child_adolescent/news_events/news/2016/exclusive -breastfeeding/en.
17 “Breastfeeding: achieving the new normal”, The Lancet, vol. 387, No. 10017 (January 2016).
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social, economic, political and cultural determinants. Poverty, social exclusion,
gender inequality, low socioeconomic status and lack of control over productive
resources, for example land- grabbing and seed patenting, are all major contributors
to malnutrition. Similarly, malnutrition is aggravated by poor sanitation and the
absence of safe drinking water and adequate housing, as well as a lack of education,
health and social protection services.
19. Poverty and inequality are drivers of obesity and micronutrient deficiency, in
addition to undernutrition. Low- income populations are particularly vulnerable to
obesity. Processed foods tend to be highly accessible and relatively cheap and can
be stored for long periods without spoiling. In the United States of America for
instance, low- income neighbourhoods often lack food retailers that sell fruits,
vegetables, whole grains and alternative low- fat options.18 Unable to afford healthier
food options, individuals may become overreliant on poor- quality foods, essentially
being forced to choose between economic viability and nutrition and exposed to
“double malnutrition”.19
20. Women are responsible for much of the food cultivation and preparation of
family meals, but they disproportionately lack access to adequate food and are more
vulnerable to malnutrition. In its general recommendation No. 34, the Committee on
the Elimination of Discrimination against Women noted that rural women were
among those most exposed to malnutrition and hunger. Patriarchal norms contribu te
to gender inequality, with women facing systemic discrimination in accessing land
and natural resources, decision- making, education and health- care services and
experiencing increased vulnerability to violations of their sexual and reproductive
rights. Such factors impede their ability to provide adequately nutritious foods for
themselves and their families, leading to intergenerational cycles of malnutrition.20
B. Impact of food systems
21. In the Rome Declaration on Nutrition, it was acknowledged that current food
systems were being increasingly challenged to provide adequate, safe, diversified
and nutrient- rich food for all that contributed to healthy diets due to, inter alia,
constraints posed by resource scarcity and environmental degradation, a s well as by
unsustainable production and consumption patterns, food losses and waste, and
unbalanced distribution.
22. Food systems include production, processing, transport and consumption of
food and are shaped by political, environmental, cultural, and socioeconomic factors.
The industrial food system currently dominates the world. It focuses on increasing
__________________
18 Lucy M. Candib, “Obesity and diabetes in vulnerable populations: reflection on proximal and
distal causes”, Annals of Family Medicine, vol. 5, No. 6 (November 2007); Food Research and
Action Center, “Why low-income and food-insecure people are vulnerable to obesity”, available
from http://frac.org/initiatives/hunger-and-obesity/why-are-low-income-and-food-insecurepeople-
vulnerable-to-obesity.
19 Michael Via, “The malnutrition of obesity: micronutrient deficiencies that promote diabetes ”,
ISRN Endocrinology, vol. 2012 (2012).
20 Mafalda Galdames Castro and Maria Daniela Nuñez Burbano de Lara, “Gender and food
sovereignty: women as active subjects in the provision of food and nutrition ”, in Right to Food
and Nutrition Watch 2015: Peoples’ Nutrition Is Not a Business (2015); WFP, “Women and
hunger” (see footnote 7); Save the Children, State of the World’s Mothers 2012: Nutrition in the
First 1,000 Days (2012), p. 11.
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food production and maximizing efficiency at the lowest possible economic cost and
relies on industrialized agriculture, including monocropping and factory farming,
industrial food processing and mass distribution and marketing. Reflecting their
affordability, availability and aggressive marketing strategies, industrialized food
products constitute a very significant portion of the world’s food sales.21
23. The impact of industrial food systems on nutrition and public health is
alarming. Monocropping depends heavily on chemical inputs such as synthetic
fertilizers and pesticides, while animals grown on factory farms are given growth
hormones and antibiotics. The food processing industry uses preservatives, artificial
colourants, additives and other chemicals in order to enhance the appearance,
flavour and shelf life of food products. Ultraprocessed foods may also contain high
levels of sodium, sugar, trans- fats and saturated fats, so that they are energy dense
yet lacking in nutritional value.22
C. Unhealthy eating habits and non-communicable diseases
24. Diets based on highly processed “denatured” foods contribute to
non- communicable diseases, which are shortening the human lifespan. According to
WHO, such diseases are collectively responsible for almost 70 per cent of all deaths
worldwide, and this is expected to rise to 75 per cent by 2020. 23 The consumption of
unhealthy foods has been determined to be an important factor that increases the
risk of non- communicable diseases, reinforcing the damage done by tobacco use,
alcohol consumption and physical inactivity.24
25. Increases in unhealthy eating habits are outpacing increases in healthy ones
throughout most of the world. While improvements in diet quality have been
greatest in high- income nations, people living in many of the wealthiest countries
still have among the poorest- quality diets in the world, because they have some of
the highest consumption rates of unhealthy food. An alarming pattern is also
emerging in formerly low- income countries as they become richer.25
26. Increased meat, sodium, sugar and fat consumption are causing diets to
become less healthy. High sodium consumption raises blood pressure, raising the
risks of heart disease and strokes, while excessive sugar consumption is associated
with weight gain. While meat and other livestock products provide high – value
protein and are sources of micronutrients, their overconsumption leads to ex cessive
intakes of fat and sodium. As early as 2002, WHO recommended moderating
processed meat consumption to reduce the risk of colorectal cancer and classified
processed meat as carcinogenic to humans (Group 1). The Global Burden of Disease
__________________
21 A/HRC/26/31, paras. 5-6.
22 Marion Nestle, Food Politics: How the Food Industry Influences Nutrition and Health, revised
ed. (Los Angeles, California, University of California Press, 2013); Rob Moodie and others,
“Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultraprocessed
food and drink industries”, The Lancet, vol. 381, No. 9867 (February 2013).
23 Interview with Fumiaki Imamura, lead researcher of the study entitled “Dietary quality among
men and women in 187 countries in 1990 and 2010: a systematic assessment ” (2015).
24 WHO, “Non-communicable diseases”, fact sheet, January 2015.
25 Fumiaki Imamura and others, “Dietary quality among men and women in 187 countries in 1990
and 2010: a systematic assessment”, The Lancet Global Health, vol. 3, No. 3 (March 2015).
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project estimates that approximately 34,000 cancer deaths per year worldwide are
attributable to diets high in processed meat.26
27. Worldwide data suggest that average sodium and sugar consumption is well
above minimal physiological needs. Processed food consumers unknowingly
consume three to five times more sodium than required, which is particularly
troubling when such foods target children. For example, a global study conducted in
2015 reviewed 387 popular children’s meals and found sodium levels to be
dangerously high.27 Similarly, over the past 50 years, global sugar consumption has
more than tripled, particularly in the form of sweetened beverages.28
28. There are also concerns that pesticides and additives in food may contain
endocrine- disrupting chemicals. While this requires further research, it is suspected
that such chemicals are associated with abnormal growth patterns and
neurodevelopmental delays in children and may also increase susceptibilit y to
non- communicable diseases.29
D. Trade liberalization and foreign direct investment
29. Trade liberalization and foreign direct investment (FDI) by transnational
corporations in the processed food industry have played a large role in increasing the
availability of ultraprocessed foods on the global market.30 The removal of policies to
protect domestic markets has strongly affected the increase in production of certain
unhealthy foods, as well as their availability and cost. Countries that embrace market
deregulation experience a faster increase in unhealthy food consumption.31
30. Trade liberalization has also allowed transnational corporations to gain
influence on the global food supply chain and, in turn, on food systems. They have
obtained control over agricultural production, processing, retailing, advertising and
food imports and exports. By investing in technology used in the processed food
industry, for example agrochemicals and hybrid seeds, extraction technology used in
food processing, and additives to increase the shelf life of food products, large – scale
food production achieves substantially lower costs while increasing profit margins.
31. FDI is playing a significant role in the “nutrition transition”. The food
processing industry is now the largest recipient of FDI, particularly in support of
energy- dense, nutrient- poor foods. FDI allows companies to become transnational
by purchasing or investing in “foreign affiliates” located in other countries, which
then produce food for the domestic markets. This allows the foreign – based company
to bypass import tariffs and lowers transportation and production costs. By flooding
__________________
26 WHO, “Q&A on the carcinogenicity of the consumption of red meat and processed meat”,
October 2015. Available from www.who.int/features/qa/cancer-red-meat/en/.
27 World Action on Salt and Health, “New international study reveals dangerously high levels of
salt in children’s meals and calls for global action now”, 18 August 2015. Available from
www.worldactiononsalt.com/less/surveys/2015/Children’s%20Meals%20Survey/160652.html.
28 Dylan Neel, “The sugar dilemma”, Harvard College Global Health Review (October 2012).
29 WHO, “Children’s environmental health: endocrine disrupting chemicals” (2016). Available from
www.who.int/ceh/risks/cehemerging2/en.
30 Eddy Lee, “Trade liberalization and employment”, DESA Working Paper No. 5 (New York,
October 2005).
31 A/HRC/26/31, para. 7.
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markets with cheap refined grains, corn sweeteners and vegetable oil, FDI has
become a driving force behind rising obesity rates in developing countries.32
E. Aggressive marketing
32. The level and effect of investment by the food industry in the marketing of
unhealthy food products is startling. Persistent advertising campaigns, discount
offers, exclusive contracts with food outlets and pricing and packaging strategies are
all used to drive demand.
33. “Junk food” companies tend to use tactics similar to those used by tobacco
companies in the 1980s, when science began linking smoking to serious health
problems. Some companies even fund scientific research, manipulating results in
support of their products, or add minimal amounts of healthy ingredients to enable
them to present their products as “healthy”.
34. Marketing strategies are particularly harmful when they target untapped
markets in developing nations, a spillover from the “saturation” of markets in
developed countries. The effect of introducing fast food on the diet quality of poorer
populations is especially dangerous when there is a lack of knowledge or education
and where individuals are vulnerable to manipulative marketing practi ces.33 If left
uncontrolled, undernutrition in lower- income countries will be rapidly eclipsed by
obesity and non- communicable diseases, as is already the case in China, India and
many middle- income countries.23
F. Product-based approaches to malnutrition
35. Nutrition policies should be multidimensional and avoid promoting isolated
interventions to fight malnutrition, including “medicalized” and product- based
approaches focusing on ready- to- use therapeutic foods. Such measures have been
criticized as unsustainable “technical” solutions to social problems. Fortified foods
are often too expensive for or unavailable to those most affected by micronutrient
deficiencies. Such initiatives can also undermine dietary diversity, have a negative
impact on healthy eating practices and adversely affect small- scale local producers
by moving away from culturally appropriate, affordable and sustainable food
sources. Excessive reliance on product- based solutions, for example nutrient pills
and other methods of food fortification, also has adverse health implications,
especially if they are highly processed. Even biofortification, which seeks to deliver
__________________
32 Ibid., paras. 6-8; Corinna Hawkes, Delia Grace and Anne Marie Thow, “Trade liberalization,
food, nutrition and health”, in Trade and Health: Towards Building a National Strategy, Richard
Smith and others, eds. (Geneva, WHO, 2015); Anna K. Sims, “Obesity prevention: assessing the
role of State and non-State actors under international law”, Chicago Journal of International
Law, vol. 16, No. 1 (summer 2015); Anne Marie Thow and Benn McGrady, “Protecting policy
space for public health nutrition in an era of international investment agreements”, Bulletin of the
World Health Organization, vol. 92, No. 2 (February 2014); Corinna Hawkes, “The role of
foreign direct investment in the nutrition transition”, Public Health Nutrition, vol. 8, No. 4 (June
2005); FAO, “Globalization of food systems in developing countries: impact on food security
and nutrition”, FAO Food and Nutrition Paper No. 83 (Rome, 2004).
33 Judith Hodge, The Future of Global Relations: Food Fortification — A “Techno-Fix” or a
Sustainable Solution to Fight Hidden Hunger? (Bonn, Deutsche Welthungerhilfe and Terre des
Hommes Deutschland, 2014); A/HRC/26/31, para. 10.
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naturally fortified foods, may turn out to be another “technical fix” for the problem
of hidden hunger.33
36. Such initiatives are particularly concerning because the private sector can
advocate food supplements so effectively.34 For example, commercialization of such
products as ready- to- use- therapeutic foods, branded with the logos of transnational
companies, may also increase consumers’ brand loyalty to a company’s unhealthy
soft drinks and snack foods.33 Furthermore, many businesses involved in fortified
products are the same multinationals violating the International Code of Marketing
of Breast- milk Substitutes.
37. Nevertheless, fortification initiatives do make an important contribution to
efforts to achieve food and nutrition security, provided they form part of a
comprehensive strategy that addresses the social, economic and cultural
determinants of food systems. Such solutions must always be critically evaluated
and narrowly implemented to ensure that they are used only to provide temporary
relief and do not replace long- term solutions, such as diversification of agriculture,
or interfere with local production systems.35
III. Global nutrition governance
38. To respond to universal malnutrition challenges, a coordinated multisectoral
policy response is needed at every level. This requires dialogue between all relevant
sectors and actors, including nutritionists, development actors, civil society, donors,
the private sector and government officials. Furthermore, it is important to establish
accountability mechanisms to assess planning, budgeting and the results of
nutrition- related interventions.36
39. It is also critical to address malnutrition in all its forms as one issue to avoid
policy fragmentation. In a recent study among 139 low- and middle- income
countries for example, only 39.6 per cent had nutrition policies that addressed all
forms of malnutrition, despite facing the effects of a “nutrition transition”.37
40. At the height of the food price crises in 2008, it was suggested that global
governance of nutrition was dysfunctional.38 Since then, significant initiatives have
been undertaken at the global level. Examples include the Scaling Up Nutrition
movement and two major campaigns of the Secretary- General: “Every woman, every
child” and the Zero Hunger Challenge.
__________________
34 Flavio Luiz Schieck Valente, “The corporate capture of food and nutrition governance: a threat to
human rights and peoples’ sovereignty”, in Right to Food and Nutrition Watch 2015: Peoples’
Nutrition Is Not a Business (2015), pp. 17-18.
35 Andrew Jones and Gebisa Ejeta, “A new global agenda for nutrition and health: the importance
of agriculture and food systems”, Bulletin of the World Health Organization, vol. 94, No. 3
(March 2016).
36 Second International Conference on Nutrition, Chairs’ summary of round table 3 (Governance
and accountability for nutrition).
37 Bruno F. Sunguya and others, “Strong nutrition governance is a key to addressing nutrition
transition in low- and middle-income countries: review of countries’ nutrition policies”,
Nutrition Journal, vol. 13, June 2014.
38 The Lancet Global Health, “The international nutrition system: fragmented, dysfunctional and
desperately in need of reform”, press release, 16 January 2008.
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A. Mapping the global nutrition governance
41. In 2011 the WHO Global Action Plan for the Prevention and Control of
Non- Communicable Diseases initiated action to tackle malnutrition
comprehensively, including unbalanced nutrition and obesity. In 2012, the World
Health Assembly endorsed six global nutrition targets to improve maternal, infant and
young child nutrition by 2025. Commitment to reach those targets was reaffirmed at
the Second International Conference on Nutrition, held in Rome in 2014.
42. The Conference is considered a landmark event that brought together the
global community to discuss nutrition, acknowledging malnutrition in all its forms.
Its outcome document, the Rome Declaration on Nutrition, pledges 10 commitments
to action, recognizing the importance of a life- cycle approach to preventing
malnutrition, as well as empowering people to make informed food choices. States
committed to increasing investment in nutrition and moving towards sustainable
food systems. The Framework for Action adopted at the Conference recognizes that
effective and coherent nutrition policies require adequate financing and investment,
political commitment, systematic public monitoring and accountability processes. It
also calls for collaboration across all systems, including food, health, trade,
investment, education, social protection, water and sanitation and hygiene.
43. Leaders at the Conference also recognized the importance of integrating their
political commitments with the post- 2015 development agenda and of anchoring
nutrition targets in the Sustainable Development Goals.39 The Goals have a universal
character and cannot be achieved without special attention to nutrition. While Goal
2 explicitly refers to “nutrition” and Goal 3 to non- communicable diseases, nutrition
is arguably interwoven within all 17 Goals, as well as 50 indicators.40
44. As suggested, the root causes of malnutrition go beyond a lack of sufficient
and adequate food, and to combat them requires actions similar to those embedded
in a variety of interrelated development goals, including those pertaining to health,
access to resources, environmental degradation, climate change and women ’s
empowerment. The Sustainable Development Goals cannot be achieved without
special attention to nutrition, and vice versa.
45. On 1 April 2016, following the recommendations of the Conference, the
General Assembly proclaimed 2016- 2025 the United Nations Decade of Action on
Nutrition. The Decade presents a unique opportunity to centralize globally agreed
targets, align actors around implementation and address the shortcomings identified
in the current nutrition governance system.
B. Shortcomings of the global governance system
46. While ambitious targets have been set to ensure global governance of
nutrition, much more is needed to live up to the challenge of sustainability while
providing each person with enough food to live a healthy and productive life, as
__________________
39 Second International Conference on Nutrition, Chairs’ summary of round table 1 (Nutrition in the
post-2015 development agenda).
40 Standing Committee on Nutrition, “Nutrition and the post-2015 Sustainable Development
Goals”, policy brief, Geneva, November 2014.
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targeted by the Sustainable Development Goals. Several shortcomings within the
existing system should be addressed.
47. Despite the potential success of the Goals, nutrition is mentioned in only 1 of
the 169 targets, and overweight and obesity are not mentioned. More importantly,
whether the Sustainable Development Goal targets have the innovation necessary to
ensure a successful shift towards sustainable food systems and provide the
framework for global governance of agriculture, food, nutrition and health seems
doubtful.41 In addition, some targets lack the focus necessary to enable effective
implementation, or they contribute to several Goals, thereby creating possible
conflicts. Action to meet one target could have unintended consequences on others
if they are pursued separately. Moreover, the monitoring mechanism for the Goals
based on voluntary national reporting and review mechanisms, through the highlevel
political forum on sustainable development of the General Assembly, may not
be effective enough to reach agreed targets. Finally, a major shortcoming is the fact
that the human right to adequate food is not specifically articulated in the Goals.
48. Ensuring adequate financing is also a struggle. For example, to reach the
World Health Assembly goal on stunting by 2025, a doubling of government
funding and a quadrupling of donor spending is necessary.42 Technical knowledge,
political will and efficient accountability systems are needed to reach existing
nutrition goals.
49. There are concerns that the accountability system of the Rome Declaration on
Nutrition is unclear and that its policies are fragmented. Owing to i ts multisectoral
nature, as well as the long- term impact of malnutrition on human development and
invisibility of some of its consequences, accountability is complex. As articulated in
Sustainable Development Goal 17, ensuring effective accountability requ ires a clear
understanding of data collection as well as systematic tracking systems at both the
country and global levels. The Global Nutrition Report 2016 attempts to fill the gap
by providing a data tracking system, drawing data from United Nations agen cies.
Although this might lead to criticism owing to its connection with the nutrition
industry, it is arguably the most independent mechanism to date.
C. Private sector involvement and conflict of interest
50. Today’s nutrition governance also lacks effective mechanisms to regulate
private sector involvement in nutrition programmes. The corporate influence on
national and international food and nutrition policy spaces has become increasingly
visible as programmes seek multi- stakeholder arrangements. Both the Sustainable
Development Goals and the Second International Conference on Nutrition mention
the importance of “multi- stakeholder partnerships” with private sector participation.
51. While recognizing that companies play a big role in fighting malnutrition,
there is a danger in giving corporations unprecedented access to policymaking
__________________
41 Corinna Hawkes and Barry M. Popkin, “Can the Sustainable Development Goals reduce the
burden of nutrition-related non-communicable diseases without truly addressing major food
system reforms?”, BMC Medicine, vol. 13, June 2015.
42 Lawrence Haddad, “The global governance of nutrition: why it matters”, 25 February 2016.
Available from www.developmenthorizons.com/2016/02/the-global-governance-of-nutritionwhy.
html.
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processes, which may produce conflicts of interest at several levels unless governed
properly. It has been questioned whether nutrition policies can deliver both shortterm
financial returns for companies and long- term social and health benefits that
help to effectively tackle global malnutrition challenges. 33 Adequate safeguards are
thus needed to ensure that the private sector does not use its position as a
“stakeholder” to influence public policymaking spaces on nutrition to promote
commercial objectives.43
1. Public-private partnerships
52. The private sector has significantly exerted its influence over nutrition
governance through public- private partnerships, which may blur the line between
public interest and financial gain. Involvement by the private sector may be driven by
direct financial returns, such as tax breaks, market penetration and positive public
relations, as well as increased corporate influence in nutritional policymaking.
53. Limited guidelines exist on how to manage such partnerships. They may be
useful where public sector solutions are not available or effective, and the private
sector may have an important role to play in driving innovation to reduce
malnutrition. To avoid conflicts of interest, it is important to assess whether the
private sector’s activities are compatible with the goal of reducing malnutrition.
Actions motivated by profit seeking alone should be discouraged. A memorandum
of understanding or legal contract that lays out specifies objectives to avoid and
resolve conflict of interest and ensure effective and transparent monitoring can he lp
to manage such partnerships.44
54. In 2010, the Scaling Up Nutrition movement, a new type of multi- stakeholder
and multisectoral partnership, was launched by the Secretary- General together with
donors, businesses, researchers, Governments and civil society to provide support to
57 Member States to improve food policies during the first 1,000 days of child
feeding. While the movement’s goals are welcomed and have seen success in
reducing child malnutrition in several countries, especially in increased funding,
capacity- building, advocacy and establishing a civil society network and
coordinating with the United Nations, the initiative has also been subject to
criticism. As a self- described “movement”, it has no accountability to the United
Nations or other intergovernmental body or process. While business partnerships are
promoted, there is no careful management of corporate involvement to ensure that it
is confined to implementation, without influencing public health and nutrition
policymaking. Conflicts of interest have also been identified where businesses
involved in the initiative were simultaneously marketing foods leading to obesity
and non- communicable diseases. While efforts were recently made, for example by
excluding infant formula manufacturers that violate the International Code of
Marketing of Breast- milk Substitutes, it remains unclear as to how the initiative
prevents companies from gaining improper access to markets and policymaking, or
how violations are detected and evaluated.44
__________________
43 Vivica I. Kraak and others, “Balancing the benefits and risks of public-private partnerships to
address the global double burden of malnutrition”, Public Health Nutrition, vol. 15, No. 3
(March 2012).
44 John Hoddinott, Stuart Gillespie and Sivan Yosef, “Public-private partnerships and the reduction
of undernutrition in developing countries”, IFPRI Discussion Paper No. 01487 (Washington,
D.C., International Food Policy Research Institute, 2015).
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2. Philanthropic organizations
55. Increasingly, philanthropic foundations are investing in global nutrition
initiatives. While donations are difficult to track, such private institutions are
generally larger than many Governments and have the ability to influence nutrition
policies without the concomitant obligations to ensure respect for human rights.45
Recognizing the financial constraints faced by many countries, it is imperative to
establish a monitoring and accountability system to ensure that private foundations
operate within the human rights system, rather than fulfilling t his responsibility on a
voluntary basis.
56. The Global Alliance for Improved Nutrition is one of the leading private
networks focusing on malnutrition reduction, mainly through fortification,
supported largely by the Bill and Melinda Gates Foundation. Several allegations of
conflict of interest have been made against the Alliance. In particular, organizations
working to address infant malnutrition questioned whether its work was motivated
primarily by efforts to open new markets for its members. An effecti ve, independent
evaluation mechanism is needed for balancing private sector involvement in
nutrition policies.
IV. Human rights approach and State responsibility
A. Normative foundation of human rights
57. International law instruments provide a normative and legal foundation for the
human right to adequate food and nutrition. Article 25 of the Universal Declaration
of Human Rights and article 11 of the International Covenant on Economic, Social
and Cultural Rights recognize the right to adequate food and the fundamental right
of everyone to be free from hunger. Dealing with global nutrition challenges
through a rights- based perspective is not only desirable but also obligatory, given
that nutrition is an inherent element of the right to food. In its general comment No.
12, the Committee on Economic, Social and Cultural Rights interpreted the right to
food as obliging every State to “ensure for everyone under its jurisdiction access to
the minimum essential food which is sufficient, nutritionally adequate and safe, to
ensure their freedom from hunger”.
58. The clear inclusion of a nutrition dimension to the right to food confirms the
latter’s interconnection with the right to health. In fact, nutrition is considered as the
vital link between the right to health and the right to food and ensures that the human
rights framework promotes both rights.46 In its general comment No. 14, the
Committee on Economic, Cultural and Social Rights affirmed that the right t o health
placed a core obligation on States to “ensure access to the minimum essential food
which is nutritionally adequate and safe, to ensure freedom from hunger to
everyone”. This implies that if nutritious food is not readily available, accessible or
__________________
45 David McCoy, Sudeep Chand and Devi Sridhar, “Global health funding: how much, where it
comes from and where it goes”, Health Policy and Planning, vol. 24, No. 6 (November 2009).
46 Emilie K. Aguirre, “The importance of the right to food for achieving global health”, Global
Health Governance, vol. IX, No. 1 (spring/fall 2015).
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affordable, the enjoyment of the highest attainable standard of physical a nd mental
health cannot be met.47
59. The Voluntary Guidelines to Support the Progressive Realization of the Right
to Adequate Food in the Context of National Food Security also recogn ize that State
obligations to ensure the right to food include responsibilities towards ensuring
standards of nutrition and health. In the Guidelines, it is noted that “States should
take measures to maintain, adapt or strengthen dietary diversity and healthy eating
habits and food preparation, as well as feeding patterns, including breastfeeding,
while ensuring that changes in availability and access to food supply do not
negatively affect dietary composition and intake”.48
60. A relatively new proposal, the draft Framework Convention on Global Health,
suggests that the right to adequate food should be interpreted to mean the right to a
standard of nutritional quality and not just the right to a caloric minimum. 46
61. Several international conferences under United Nations auspices have
consolidated international law by recognizing nutrition and health within the context
of the human right to food. As early as 1992, the World Declaration on Nutrition of
the First International Conference on Nutrition referred to the Universal Declaration
of Human Rights and the right to food, with States committing to ensure “sustained
nutritional well- being for all people”. The Rome Declaration on World Food
Security, adopted in 1996, reiterated “the right of everyone to have access to safe
and nutritious food, consistent with the right to adequate food and the fundamental
right of everyone to be free from hunger”. This was reaffirmed at the Second
International Conference on Nutrition, in 2014.
62. While nutrition support in the past was often considered charitable action, it is
increasingly regarded as a result of a failure to protect an essential human right,
attributed largely to a lack of sufficient nutrition governance and accountability.
Applying a human rights- based approach to nutrition facilitates the implementation
of procedural rights, such as participation, accountability, non – discrimination and
transparency. The Second International Conference on Nutrition confirmed that
embedding nutrition in a human rights agenda made issues of governance and
accountability central to effective implementation.
63. Access to nutritious food is often a key indicator of socioeconomic
inequalities. Discussing nutrition within a rights- based framework is critical to
ensuring that marginalized and vulnerable populations disproportionately affected
by malnutrition are guaranteed a certain level of nutrition and health, rather than a
minimum number of calories needed for survival. Such recognition is crucial for the
reduction of nutritional and health inequalities around the world.46
64. Children and pregnant and lactating women enjoy even further protections.
The Convention on the Rights of the Child confirms that, to ensure the full
implementation of a child’s right to enjoy the highest attainable standard of health,
States must take appropriate measures to combat disease and malnutrition through,
inter alia, the provision of “adequate nutritious foods” (art. 24 (2) (c)) and that in
case of need they must provide material assistance and support programmes,
including with regard to nutrition (art. 27 (3)). The Convention also calls for the
protection and promotion of exclusive breastfeeding for infants up to 6 months of
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47 Sims, “Obesity prevention” (see footnote 32).
48 Guideline 10.1.
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age, and for breastfeeding to continue alongside appropriate complementar y foods
preferably until 2 years of age.49
65. The protection and promotion of breastfeeding is also enshrined in the
International Code of Marketing of Breast- milk Substitutes, adopted by the World
Health Assembly in 1981. The Global Strategy for Infant and Young Child Feeding,
adopted in 2002, sets out the obligations of States to develop, implement, monitor
and evaluate comprehensive national policies addressing infant and young child
feeding, accompanied by a detailed action plan.
66. Article 12 of the Convention on the Elimination of All Forms of
Discrimination against Women obliges States to ensure appropriate services during
pregnancy and lactation. Unfortunately, it fails to protect a woman’s individual right
to adequate food and nutrition beyond the parameters of pregnancy and
breastfeeding. Considering their increased sensitivity to malnutrition, it is vitally
important to ensure this right.
B. Corporate responsibility
67. Placing nutrition governance within the human rights framework also
underlines the responsibility of corporations in the food and nutrition industry to
respect human rights and to contribute to equitable access to nutritious foods. Such
responsibility is implied in the Universal Declaration of Human Rights, which
underlines that “everyone has duties to the community” (art. 29) and that groups and
persons must refrain from activities causing encroachment on the rights enshrined in
the Declaration (art. 30).
68. The Guiding Principles on Business and Human Rights, endorsed by the
Human Rights Council in 2011, formally recognize the responsibility of enterprises
to avoid infringing on the human rights of others and to address adverse human
rights impacts with which they are involved.50 Logically, this responsibility includes
the adverse impacts of the food industry with respect to the right to adequate food.
69. In the technical guidance on the application of a human rights – based approach
to the implementation of policies and programmes to reduce and eliminate
preventable mortality and morbidity of children under 5 years of age
(A/HRC/27/31 ) Member States are urged to regulate private actors over which they
exercise control, including producers and marketers of breast milk substitutes and
other relevant companies (para. 70 (g)). The Committee on the Rights of the Child,
in its general comment No. 15, also calls upon private companies to comply with
the International Code of Marketing of Breast- milk Substitutes and relevant World
Health Assembly resolutions. In its most recent resolution on ending inappropriate
promotion of foods for infants and young children, adopted in May 2016, the World
Health Assembly called upon manufacturers and distributors of foods for infants and
young children to end all forms of inappropriate promotion.
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49 See general comment No. 15 of the Committee on the Rights of the Child. Through their mention
in that general comment, both the Global Strategy for Infant and Young Child Feeding and the
International Code of Marketing of Breast-milk Substi