As the immediacy of ICN2 fades questions remain over whether or not ICN2 made a difference.
Do the documents sufficiently challenge the attributes of modern food systems which
are widely recognised as failing to deliver what is needed? Do they identify actions
capable of shifting the current food policy paradigm towards something in which public
health and eco-systems viability are at the heart of food production and consumption?
Do the documents mandate action or provide clear targets? As outlined in Table 2, the answer is mixed. Laudable aspirations may be there, but the contents of the
documents do not appear strong enough or systemic enough to challenge the status quo. A year after the events, it is hard to see how ICN2 can be considered a ‘game changer’
and to have transformed global food and nutrition politics or, more specifically,
to have operationalized better links of food and nutrition interventions with the
range of other pressing issues suggested by the evidence on food systems. These include
food’s environmental challenge 6], 7],–not least climate change whose policy structures were to be decided by the end of
2015 8]. Food is and remains a major cause of environmental damage, but it is also the terrain
on which much wider politics is fought out: urbanisation, employment, distribution
of wealth, social inequalities, the nature of progress and modernity. All these attributes
of modern food systems could and should be central to any debate about the future
but despite copious evidence on the harshness of food markets, the legacy of social
divisions within and between societies, the threat of impending climate change and
ecosystem loss, full and frank debate was largely side-lined or de-emphasised over
the ICN2 processes. So must ICN2 be judged for its timidity rather than silence? Is
its failure to re-energise food debate after a moment of international interest in
and immediately after the Great Recession of 2007–10 a missed opportunity rather than
a failure of evidence, a lack of leadership or the inevitable dilution of vast multilateral
processes?
Table 2. Was ICN2 a ‘game changer’?
To damn ICN2 with faint praise may seem harsh; it is easy to criticise global gatherings
as compromised, but let us consider the stark evidence of the need for firm policy
reorientation via meetings such as ICN2. If not here, where can this happen in a globalised
world? One big change since the first ICN in 1992 is the rapid rise in obesity and
the fragmentation of the picture of diet-related ill-health. 0.8 billion people worldwide
are undernourished 9], and experience symptoms of wasting and stunting, while more than 1.5 billion adults
are overweight or obese 10]. In many countries a triple-burden of malnutrition exists with the co-existence of
under-, mal- and over-nutrition. This complexity occurs across and within countries,
communities, families and even individual life-courses. While the ICN2 documents acknowledge
some of the complexity posed by the co-incidence of under-, mal- and over-nutrition,
they stop short of offering viable solutions. The thinking underpinning the documents
appeared locked into ‘policy business largely as usual’. Yet, if change is to occur,
this paradigm needs to be challenged and replaced. While pragmatists might judge that
global gatherings are hardly likely to be game-changers, the critics are nonetheless
correct that the world must dispel any fantasy that business-as-usual will deliver
results; timidity is part of the problem.
ICN2 certainly witnessed a range of opinion, from realists to radicals, from pragmatists
to incrementalists, from advocates of ‘nutrients first’ to ‘food systems change’.
But this range of positions was compartmentalised along familiar UN lines: inside
the main hall versus outside, rich country versus poorer ones, pro-growth versus sustainability
first adherents, and more. These divergences need to be addressed rather than be used
as justifications for blocking the dialogue about viability and strategy that urgently
needs to happen, if the world is to sort out the slow car-crash that is the food system’s
impact on health and environment. At ICN2 this simply did not happen, which was and
remains a missed opportunity.
Whatever this missed opportunity was due to, it was not lack of evidence. In this
respect ICN2 fits a pattern noted by other analysts and leads to questions as to whether
existing UN bodies are appropriate for the enormous challenges ahead. On trade policy,
it should be noted, bilateralism is replacing globalism; there has been no revision
of world trade rules since 1994 but bilateral deals proliferate, including on food.
One review of the failure of international food and health governance, in this case
of the failure to eliminate maternal and child undernutrition in high-burden countries,
concluded that recurring themes in the failure of transnational institutions were:
fragmentation, lack of an evidence base for prioritised action, institutional inertia,
and failure to join up with promising developments in parallel sectors 11]. It called for a radical overhaul of institutions. Lack of evidence is not something
that can be said to apply to food and health; lack of evidence of successful interventions
perhaps but not lack of evidence suggesting the need to try. Critics might argue that
in this respect, ICN2 was ‘situation normal’ and showed how mired the UN has become
in the competing narratives and interests of post-modern world ideologies and economies;
and that the high ideals voiced in the 1940s 12] or 1970s 13] for food system reform 13] have been subsumed in the realpolitik of a world dominated by corporate power where
markets rule and economics triumphs over public health 14], 15].
The capacity to chart a clear way forward at ICN2 was not helped by the fact that
it was a meeting of not just one but two UN institutions with different mandates,
budgets, political traction and priorities, the FAO and WHO. While the WHO focuses
on health across systems, throughout the life course and in preparedness and prevention
of non-communicable diseases (NCD) and communicable diseases, the FAO is focused on
eradicating hunger and malnutrition, eliminating poverty and driving economic progress.
While these agendas can align in many ways, the economic solutions to poverty and
malnutrition have been largely penetrated by a prevailing market ethos which critics
see as favouring deference to multi-national corporations, foreign direct investment
and a processed food paradigm of which health researchers are increasingly critical
. The failures of ICN2 therefore go beyond the normal failures of the UN system to
a systemic failure of the ‘wicked problems’ linked to the disconnect between those
focused on eradicating hunger and poverty and those focused on promoting health 16].
That said, ICN2 gave some grounds for optimism. The societal awareness of the enormity
of the food and health challenge is spreading. Worries about the thoughtless spread
of meat-based diets grows 17]. Even poor countries now acknowledge rising obesity. Concern about the tsunami of
‘non-food’ foods washing over the world and distorting diets also grows 18], fuelled by experience of the wiles of marketing 19]. At the policy level, even a few years ago, the mismatch of economics and health
was dismissed and the default position was that health follows wealth. The 2007–08
commodity and banking crisis momentarily dented the confidence of market advocates,
but they quickly reasserted their version of normality. Its allure, however, is less
assured inside the World Bank and the IMF. The latter, for instance, now recognises
that stark inequalities dampen growth. Rightly, policy advisors are quietly moving
away from the fiction that vast inequalities can be justified by trickle-down economics
20], 21].
The agenda laid out by ICN2 must be judged in this more fluid context; it is only
one global convention amidst many. But that, surely, is why there was no need for
Ministers of Health to be cautious. On the contrary, now is the time to argue fiercely
that health should be at the heart of sustainable development, to be central rather
than a ‘bolt-on extra’. Surely the state of food and nutrition today can be transformed
only if reshaped also to meet the sustainability agenda (low carbon, low water, supporting
biodiversity, waste-reducing, land use efficient, etc.), by being firm about (rather
than kowtowing to) food corporate power and by insisting that health is at the heart
of economic policy. This combination poses enormous challenges and is not for the
faint-hearted, but it is what the evidence suggests is needed for the mid-21st century.
And what else are meetings such as ICN2 if not for making such commitments? ICN2 was
a golden opportunity to inject these perspectives into national and international
public discourse. Here is where the imagination for change could be sparked.