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THE Prevention of Stunting Food Fortification WITH SIGHT AND LIFE | VOL. | VOL. | Sight and Life THE PREVENTION OF STUNTING FOOD FORTIFICATION WITH VITAMIN B₁₂ MICRONUTRIENT STATUS IN VIETNAM DRUMMOND: A HERO OF NUTRITION SCIENCE AND ADVOCACY Contents D 05 Editorial 82 Partners in the Nutrition Space: GAIN – The Global Alliance for Improved Nutrition 08 Special Feature Copenhagen Consensus 2012: Solving the World’s Challenges 86 GAIN at a Glance 10 The Relevance of Micronutrients Positions and Statements to the Prevention of Stunting 88 2012 Copenhagen Consensus: 20 Biscuits Fortified with Multiple Micronutrients Micronutrient Interventions Judged Number One for Schoolchildren in Vietnam in Fight Against World Hunger 28 Food Fortification with Vitamin B12: 90 In-Home Fortification with Micronutrient Powders Potential Benefits and Open Questions An Update on Evidence and Safety 40 Ritual Fluids in Relation to Early Child Nutrition Congress Reports in Quetzaltenango, Guatemala 96 CARIG Conference 2012, San Diego 48 Xanthophylls as Provitamin A Carotenoids Field Reports 56 Micronutrient Status in Vietnam Comparisons and Contrasts with Thailand 102 Report from Cambodia and Cambodia Success for Laing Sokne 68 Opinion 1: Reflections on “Micronutrient Status 104 Report from South Africa in Vietnam: Comparisons and Contrasts with Thailand Putting Smiles on Faces in Ivory Park, and Cambodia” While Building Bridges to Better Nutrition 69 Opinion 2: How to Reduce Stunting: Going Beyond 106 News the Well-Recognized Micronutrients 114 Publications The Bigger Picture 122 Imprint 72 A Day in the Life of Dr Noel W. Solomons 123 Disclaimer 76 Sir Jack Cecil Drummond DSc, FRIC, FRS: A Hero of Nutrition Science and Advocacy ⇢ 4 1. A structure, typically cylindrical, in which fodder or forage is kept. 2. A pit or under- ground space for storing grain, green feeds, etc. 3. Military – an underground installation constructed of concrete and steel, designed What is to house a ballistic missile and the equip- a silo? ment for firing it. Source: Dictionary.com, 2012 Welcome The Silo Effect – And What We Can Do About It stop “working in silos”; and yet it seems that this is much harder At the recent Child Survival: Call to Action event in Washington, to do than to talk about. A Google search indicates that we are D.C, a new child survival goal of 20 or fewer child deaths per not alone in this battle: I am amazed by the number of courses 1,000 live births by 2035 was set. Through multiple partner- and books that are available to “train” you on how to break down ships, focus on high-burden populations, implementing high im- or manage silos. A closer look reveals that, in business, the rea- pact solutions, empowerment of women and mutual accounta- sons given for contemporary management considering silos as bility, this ambitious target can be achieved. Attending the event damaging are related to their negative impact on employee mo- myself, I was struck by the fact that health interventions – and tivation and team effectiveness. One author writes: “This type of thus the treatment rather than the prevention of disease – were mentality will reduce the efficiency of the overall operation, reduce the focus of attention. The importance of nutrition as a founda- morale, and may contribute to the demise of a productive culture.” tion for health and development was barely mentioned, even by And that sums it up for me. Our continued working in silos (while the few participants working both in the health and the nutri- the deadline for the Millennium Development Goals [MDG] tar- tion sectors. How can this narrow approach address the pressing gets and the new emphasis on reducing stunting and non-com- problem of child mortality and morbidity? Why do we continue municable diseases [NCDs] is keeping us from achieving what to work in silos in this way? needs to be done) is making many feel despondent. Tragically, it When I think of silos, I see in my mind’s eye the highest could spell the end of all the hard work that has gone into getting elevations in the corn plains of Iowa, which I witnessed when nutrition high on the global development agenda and trying to driving from Des Moines to Ames in the summer of 2001 to par- keep it there. ticipate in a memorial conference in honor of James Allen Olson, Remaining in our silos could, in fact, lead to nutrition’s big- a pioneer in vitamin A and carotenoid research. Jim Olson will gest missed opportunity. always be remembered for integrating different disciplines and Yet silos don’t just appear spontaneously. In his book Break valuing both young and senior scientists (see the 11th James Out of the Silo Mentality, Jeffrey Cufaude writes, “They're created Allen Olson Memorial Lecture elsewhere in this magazine). Re- by a mix of mindset, culture, and process factors that many asso- markably, silos rarely exist alone: they more commonly occur at ciations share. The good news: If you can correct those factors, you least in pairs, or else several in a row – and, interestingly, they can eliminate silos and keep them from coming back.” are almost all connected in some way. Silos are hugely impor- tant, as they are reservoirs for storing significant produce, often The challenge of behavior change grains or other crops – vital sources of life for many. Yet when Behavior change is the hardest of all challenges, and it requires we use the term ‘silo’ in today’s world, it generally has a negative the smartest interventions. So often we lament that behav- connotation. It refers to the way that the many sectors which ior change is what makes our work so difficult. How do we get should combine to address the challenges of malnutrition (in mothers to move back to breastfeeding? How do we get people its broadest sense) tend to function in isolation, with an inward to abandon their sedentary lifestyles and become more active? focus and vertical information and communication. The positive has become a negative. Nutrition’s biggest missed opportunity In the last few years, there has been much talk in the public health nutrition space about the need to address the “silo ef- fect”, to “break down silos”, to end the “silo mentality” and to ⇢ 6 EDITORIAL How do we mobilize communities to demand nutritious foods? challenge that we need to tackle. As with all tough issues, avoid- Now we have to apply such questioning to ourselves! We all need ing the matter won’t help. We should instead actively seek out to consider the patterns of behavior and, even deeper, the struc- people with different backgrounds, different ways of thinking, tures, subconscious beliefs and mental models that may be help- different experiences and different disciplines, and find ways to ing to perpetuate the continued existence of our silos. engage with them with a view to addressing the challenge. In a TED Talk posted in August, entitled Dare to Disagree The sin of self-interest (www.ted.com/talks/margaret_heffernan_dare_to_disagree. The challenge of behavior change is compounded by the fact that html), Margaret Heffernan, author of the book Willful Blindness: while almost all the stakeholders agree that the win-win we can Why we ignore the obvious at our peril, eloquently illustrates that achieve by working together for the greater good could bring good disagreement is central to progress and that the best part- benefits to everyone, the harsh reality is that we all, more often ners aren’t what she refers to as “echo chambers”. Heffernan than not, act out of self-interest. “I own this area – It’s not my says: “Most of the biggest catastrophes rarely come from secret/ job – Knowledge is power – I have to deliver for my annual report/ hidden information but from information that is out there but that shareholders …” We all know these phrases only too well. we are willfully blind to because we can’t or don’t want to handle the conflict that it provokes. BUT when we dare to see and we create “Self-interest is but the survival of conflict, we enable ourselves and the people around us to do our best thinking.” the animal in us. Humanity only Real change comes when we are more afraid of the silence begins for man with self-surrender.” than we are of facing the conflict. It’s time we stopped talking about the breaking down of silos Henri Frédéric Amiel and the need for dialog and started having the courage to col- laborate, as different but equally necessary stakeholders, amid the conflict we face. We should use our best and most innova- The reforming of competition tive thinking to ensure that the universal right guaranteed to all Another component in the mix is the competitiveness which has – that to adequate food, which includes adequate nutrition – is become all-pervasive – and all the more so as many are looking accessible to all. at the same pot for funding, and that pot seems to be shrinking. To reform our way of working, we must perhaps reform the na- ture of competition itself. With best regards, This is a topic in its own right, but the Harvard Business School, in an on-line article on redefining health care (www. hbs.edu/rhc/value.html), defines healthy competition as value- based competition which is ‘positive-sum’ (as opposed to zero- sum or negative-sum). This is because when value improves, all system participants can benefit. We should perhaps apply this principle to our own thinking. “We should actively seek out people with different ways of thinking” Collaborating in conflict There is a pervasive tendency to view conflict as a negative ex- perience that is to be avoided at all costs.
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