Tom Harrison

Following a number of management roles in NGOs and the tea sector, Tom became an independent consultant focussing on private sector development and cross-sector partnership. He has completed assignments for, among others, DFID, GIZ, the World Bank and UNDP. For a decade Tom had a lead role in management of the Business Innovation Facility (BIF) for which he was Technical Director for which he supporting BIF’s work in Myanmar he was involved in supporting large companies to develop innovative business models that benefit people on low incomes. This year Tom has led new partnership development for the Work and Opportunities For Women (WOW) Programme and has undertaken a review of a market-systems programme in Zambia and an evaluation of a partnership between Oxfam and Unilever.

Understanding nutrition terms: definitions, doses and diets

Retail, Manufacturing or Consumer Goods
Bangladesh
India
South Asia
28. Dec 2012

Recently I had the very good fortune to travel with a public health expert. She has the gift of being able to explain complex issues clearly to a non-expert. I took the opportunity to ask about some of the technical aspects of nutrition, an area that is becoming increasingly important within the BIF portfolio, and inclusive business more generally (see my previous blog on food fortification and IB). It seems I was using some of the technical language loosely – and wrongly – which I’m sure many of us non-experts also do.


Here is what she explained to me:

What is the significance of this? For me there are three main things.


Firstly, as a non-specialist in nutrition there are a number of traps we can fall into when using the language. In particular we all think we know what malnutrition is. In my conversations with my colleague I wrongly used the term malnutrition interchangeably with under-nutrition, and in my mind this also covered micro nutrient deficiency. As more and more non-specialists in nutrition get involved in this field, we need to use these basic terms accurately.

Secondly, we need to understand what the specialists are telling us. If we don’t understand the fundamental issues that these terms are describing, we will not be able to make best use of the advice that experts such as my colleague are able to offer. As more companies enter this space from an inclusive business perspective, there will be many people involved who are not experts in public health aspects of nutrition, and they will need to interact effectively with the experts.

Thirdly, the technical terms point to an underlying issues which seems to me to be fundamental to some of the tensions that are evident in the debate around the role of the private sector in nutrition. From what I understand, malnutrition is mostly about food products, where as micro nutrients are more often a pharmaceutical product. When these two get mixed up it can cause confusion.

The most effective way to address many micro-nutrient deficiencies is a regular supplementary ‘dose’ of the micro-nutrient administered by health professionals. The ‘dose’ itself will by a product manufactured by a drug company, but usually this is ‘free at the point of delivery’, having been procured by a government agency or an NGO.

Avoiding malnutrition requires a balanced ‘diet’ – the point being that this is about food. Aside from emergency feeding or subsistence agriculturalists, food is delivered by a market system with private sector producers and manufacturers. Even when long term food imbalances exist, it is increasingly recognized that giving people food handouts leads to dependency and is very harmful to market systems. Therefore no one expects food to be ‘free at the point of delivery’ and the role of companies in selling nutritious food Is not questioned – its only when they are selling food that does not contribute to a balanced diet that they are criticized.

However we are entering a situation where products are being developed that can supplement other sources of micro-nutrients and also have some protein and calorie content. Are these a dose or a diet?

From the perspective of the health sector they should they be free and it is wrong for companies to market them direct to consumers. But if these are foods, they help people to achieve good nutrition and a balanced diet, and market systems are the best system for them to reach many millions of people in a sustainable way.

I think that understanding the difference between malnutrition and micro nutrient deficiency is a minimum for any of us to enter this debate. It may not resolve it, but at least we will all understand the arguments that our opponents are making.