Panel 8.3 Investing in Civil Society to Promote Accountability to Policy and Governance Commitments on Obesity and Nutrition-Related Noncommunicable Diseases Corinna Hawkes World Cancer Research Fund International In 2011, the 193 member governments of the United Nations made a series of commitments at a high-level meeting to prevent and control noncommunicable diseases (NCDs). 1 These include advancing policies for unhealthy diets (for example, implementation of the World Health Organization’s [WHO’s] recommendations on food marketing to children 2), improving governance of obesity through multisectoral engagement, and promoting the capacitybuilding of nongovernmental organizations (NGOs). A road map to implement and monitor these commitments was then set in WHO’s Global Action Plan for the Prevention and Control of NCDs 2013–2020 3 and Global Monitoring Framework with targets (for example, a halt in the rise of diabetes and obesity) and indicators (for example, the adoption of national policies that limit food marketing to children and limit saturated and trans fats in foods). 4 As public interest “watchdogs,” civil society entities have a unique role to play in monitoring the implementation of these commitments. Yet—as recognized by these documents— capacity building is needed to enable them to do so. Significant investment can pave the way. For example, as part of the broader strategy of the Danish International Development Assistance (Danida) to support civil society in development, it has funded a series of NCD alliances in East Africa (Kenya, Rwanda, Tanzania, Uganda, and Zanzibar) since 2010. 5 Modeled after the global NCD Alliance, the organizations bring together groups concerned with heart disease, cancer, diabetes, and lung diseases to raise the political priority of NCDs; build public awareness; and provide support for education, treatment. and patient concerns. 6 Another example is the Obesity Prevention Program at Bloomberg Philanthropies. 7 The Program has provided a $10 million three-year grant to Mexican civil society organizations (CSOs) and research institutes to build obesity prevention into their work. Recipients include 1 United Nations General Assembly. Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases. UN: New York, 2011. Available online at: http://www.un.org/ga/search/view_doc.asp?symbol=A/66/L.1. 2 World Health Organization. Set of Recommendations on the Marketing of Foods and Non-alcoholic Beverages to Children. Geneva: WHO, 2010. 3 World Health Organization. Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020. Geneva: WHO, 2013. Available online at: http://www.who.int/nmh/events/ncd_action_plan/en/. 4 World Health Organization. Draft Comprehensive Global Monitoring Framework and Targets for the Prevention and Control of Noncommunicable Diseases. Geneva: WHO, 2013. Available online at: http://apps.who.int/gb/ebwha/pdf_files/WHA66/A66_8-en.pdf?ua=1. 5 NCD Alliance. Building a Movement: National NCD Alliances. Online resource: http://www.ncdalliance.org/nationalalliances. 6 Ministry of Foreign Affairs in Denmark (Danida). Strategy for Danish Support to Civil Society in Denmark. December 2008. Available online at: http://www.netpublikationer.dk/um/9218/pdf/samfundsstrategien_uk.pdf. 7 Bloomberg Philanthropies. Obesity Prevention. Online resource at: http://www.bloomberg.org/program/public-health/obesity-prevention/. www.globalnutritionreport.org 1 the campaigning organization, El Poder del Consumidor, 8 pioneer of Alianza Por La Salud Alimentaria, comprising 22 CSOs concerned about high levels of obesity in Mexico. 9 Facilitated by funding and international monitoring tools, these CSOs work to hold governments to account. The Healthy Caribbean Coalition—an alliance of more than 40 health-based NGOs to combat NCDs and associated risk factors 10—published an assessment of progress in 2014, guided by the Benchmarking Tool developed by the global NCD Alliance. 11 The tool consists of questions based around the six objectives of WHO’s NCD Action Plan. The assessment identified nutrition as the area of least progress; no countries reported the existence of national nutrition strategies or policies on food marketing to children, despite commitments made to implement WHO’s set of recommendations on marketing to children. 12 The Government Healthy Food Environment Policy Index (Food-EPI) is an international monitoring tool developed by INFORMAS (International Network for Food and Obesity/NCDs Research, Monitoring, and Action Support), an initiative of the World Obesity Federation and the University of Auckland. Food-EPI monitors across seven policy domains (such as food marketing, labeling) and seven governance domains (such as leadership, multisectoral responses). 13 Users can compile the results into an index of good practice to compare countries and track progress. Following testing in New Zealand, Food-EPI will be used in Thailand, Fiji, Mexico, Chile, and South Africa in 2014/2015. Monitoring teams comprise CSOs and academia, with funding from diverse international and national sources. Investment in global-scale monitoring is necessary to bring together national-level data. WHO has several instruments used to assess progress against international policy and governance commitments on obesity and NCDs, including the NCD Country Capacity Survey, 14 the Global Status Report on NCDs, 15 and the Global Database on the Implementation of Nutrition Action (GINA). 16 CSOs have developed more detailed tools. For example, the World Cancer Research Fund (WCRF) International NOURISHING Framework includes a regularly updated repository of healthy eating policies from around the world. 17 The International Baby Food Action Network and United Nations Children’s Fund (UNICEF) monitor the actions of 198 8 El Poder del Consumidor. Quienes Somos. Online resource at: http://elpoderdelconsumidor.org/quienessomos/. 9 Alianza por la Salud Alimentaria. Quienes Somos. Online resource at: http://alianzasalud.org.mx/quienessomos/. 10 The Healthy Caribbean Coalition. Online resource at: http://www.healthycaribbean.org/about_us.html. 11 NCD Alliance. National/Regional NCD Civil Society Benchmarking Tool. In: An Online Advocacy toolkit. Available online at: http://ncdalliance.org/sites/default/files/rfiles/NCD%20Toolkit%20FINAL.pdf. 12 Healthy Caribbean Coalition. A Civil Society Regional Status Report: Responses to NCDs in the Caribbean Community. Barbados: Healthy Caribbean Coalition, 2014. Available online at: http://www.healthycaribbean.org/projects/documents/HCC-NCDA-RSR-FINAL-MARCH-2014.pdf. 13 Swinburn B, Vandevijvere S, Kraak V, Sacks G, Snowdon W, Hawkes C, et al. Monitoring and benchmarking government policies and actions to improve the healthiness of food environments: a proposed government Healthy Food Environment Policy Index. Obesity Reviews 2013;14( S1):24–37. 14 World Health Organization. Assessing National Capacity for the Prevention and Control of NCDs. Available at: http://www.who.int/chp/ncd_capacity/en/. 15 World Health Organization. Global Status Report on Noncommunicable Diseases 2010. Geneva: WHO, 2011. Available online at: http://www.who.int/nmh/publications/ncd_report2010/en/. 16 World Health Organization. Global database on the implementation of nutrition action. Online resource at: https://extranet.who.int/nutrition/gina/en/home. 17 WCRF International. WCRF International Food Policy Framework for Healthy Diets: NOURISHING. Online resource at: http://www.wcrf.org/int/policy/our-policy-work/our-policy-framework-promote-healthy-dietsreduce-obesity www.globalnutritionreport.org 2 governments to implement the WHO International Code on Marketing of Breast Milk Substitutes. 18 To improve accountability, funders should invest in increasing staffing capacity in national CSOs and finance the time-consuming process of collecting and collating information on NCD policy implementation and indicators of good nutrition governance. CSOs need to engage with the research community in this process and develop focused projects and proposals for monitoring policy and governance to hold their governments to account. 18 International Baby Food Action Network. State of the Code charts. Available online at: http://ibfan.org/codewatch-reports. www.globalnutritionreport.org 3