Frontiers Paper

Commentary: The policy sciences framework has great utility for those working on food and nutrition policy but few researchers or practitioners in those areas are familiar with it.  This paper serves as an introduction to the PSF presenting some of its core dimensions and principles in terms of themes and approaches more easily recognized in food/nutrition discourse, outlining the broad landscape for research and practice in the food/nutrition space (Figure 1) and providing several examples of its application.  Future papers in this section of the Policy Sciences Library will illustrate how portions of the PSF are already being used in food/nutrition and indicate how its more intentional and systematic application in the future could enhance research and practice.

History of Nutrition

 Commentary: This paper provides a brief overview of the evolution of nutrition sciences and policy and indicates how its origins as a reductionist science has posed challenges for addressing it through policy. 

Elements of the Policy Sciences Framework in the Lancet Nutrtion Series

Commentary:

The Lancet Nutrition Series (LNS) published in 2008 was a pivotal achievement in the history of efforts to analyze and address undernutrition in low and middle income countries. Together with subsequent nutrition series in The Lancet in 2013 and 2021 it greatly enhanced global and national attention to the importance of undernutrition, catalyzed important institutional reforms, generated new levels and sources of financing and influenced choices regarding policy instruments and interventions. In light of its extraordinary influence in shaping subsequent policy to address undernutrition it provides

an intriguing opportunity to examine it through the lens of the Policy Sciences Framework (PSF). Specifically, although the PSF was not used by the organizers and authors as an explicit guiding framework, this examination demonstrates that many elements of the PSF are reflected in the LNS.

Overview: 

The Lancet Nutrition Series (LNS) was organized by leading international nutrition researchers and practitioners as an exercise in Intelligence and Promotion, designed to influence policy decisions of national and international organizations working in nutrition and related sectors. It exerted a strong influence on subsequent policy and this is likely due to several features of the Social Process and Context, notably: it drew upon the respect and skill of a large number of leading international researchers and organizations; was published in a highly influential journal; was able to draw upon a large body of accumulated evidence/intelligence concerning undernutrition; and came at a time when nutrition champions/participants existed in respected and well-resourced (wealth) international organizations such as the Bill and Melinda Gates Foundation, the World Bank, several UN agencies and bilateral donors, who could use the findings in their respective Promotion, Invocation and Applications efforts at global and national levels.

Papers 1 and 2 represent elements of the Problem Orientation. They brought together extensive bodies of data on the magnitude and geographic distribution of undernutrition and estimated or summarized the impact of undernutrition on several scope values such as child mortality and morbidity, disability over the life course, cognitive development, schooling, economic productivity and chronic disease risk. This paper found that undernutrition is the largest risk factor for the global burden of disease. In demonstrating the impact of undernutrition on a wide range of outcomes the paper sought to appeal to the scope values and base values of a wide range of participants beyond the health sector, at national and international levels.

Paper 3 estimated the efficacy of a large number of biomedical and behavioral interventions to address various forms of undernutrition. As such it represents a focus on the Alternatives portion of the Problem Orientation. It classified these interventions into five categories:

1. interventions with sufficient evidence for implementation in all 36 countries that, together, represent 90% of nutritionally stunted children (n=14 interventions);

2. interventions with evidence suitable for implementation in specific situational contexts (n=11 interventions);

3. interventions with insufficient or variable evidence (n=10 interventions);

4. interventions with evidence demonstrating no effect (n=9 interventions); and

5. interventions not analyzed but which may have broad and long-term benefits, such as education, untargeted economic strategies or those for poverty alleviation, agricultural modifications, farming subsidies, structural adjustments, social and political changes, and land reform.

   
   

Paper 4 focuses on challenges, dynamics and strategies at the national level that influence nutrition agendas and the choice, quality and level of implementation of various nutrition actions. As such, it gives explicit attention to the role of Contextuality in the Prescription, Invocation, Application and Termination processes, as part of the Decision Function. In contrast to Papers 1-3 which drew exclusively upon RCTs and epidemiologic data, this paper tapped into the Perspectives of national stakeholders to understand the contextual realities at country level and suggest experience-based Strategies (as part of the Social Process) for ways in which national and international actors can improve the Prescription, Application and Termination of nutrition actions. Notably, this paper highlighted some positive country level experiences where agricultural, food and economic programs and policies were associated with improved nutrition, thereby “giving permission” for countries to consider actions beyond paper 3, beyond the health sector and beyond RCT-level evidence.

Paper 5 exposes long-standing and deeply embedded dysfunctions in the Social Processes and Decision Functions of the international nutrition system. That system consists of international and donor organisations, academia, civil society, and the private sector which have impaired progress in addressing undernutrition. It identifies the need for reforms so that the system can perform key stewardship functions, reduce fragmentation of effort, mobilize resources, provide services in emergencies, strengthen human and institutional capacity in low- and middle-income countries, make research

agendas responsive to country needs and establish a new global governance structure that can provide greater accountability and participation for civil society and the private sector. The nature and extent of the dysfunctions in the international system were described with unusually frank and critical language. Considering the publication of this paper in a highly visible and respected journal (The Lancet) it presented a serious threat of deprivation in respect and rectitude for a wide range of influential organizations in the international nutrition system and, as such, sought to provide the motivation to undertake the needed reforms.

ReflectionThis high-level examination reveals that the LNS contained many elements of the PSF, despite that the PSF was not explicitly used as a guiding framework. This is surprising on the surface, given that nutrition emerged as a laboratory science and continues to have a strong biomedical orientation. This is reflected in papers 1-3 which were able to draw upon hundreds of empirical papers accumulated over several decades in order to conduct the modeling and meta-analyses. Those empirical studies on the causes and consequences of child undernutrition and associated interventions are the most common types of studies in the overall literature on child undernutrition. In contrast, the authors of papers 4 and 5 had to creatively undertake and assemble information from an eclectic range of sources, including ad hoc surveys, focus groups and interviews with country level implementers and nutrition leaders, key informant interviews with global level participants, online reports in donor organizations and systematic literature searches. They also drew heavily on the accumulated experience of the paper authors who collectively had spent decades as practitioners or researchers in the international nutrition system. These authors had different disciplinary backgrounds and, thus, different perspectives on the challenges

at national and international levels. They also were well-established in their respective organizations and were commited to going beyond the methods, assumptions and implicit values represented in papers 1-3. As a result, the overall LNS ended up paying explicit attention to Contextuality, validating the need for multisectoral actions beyond the health sector and Promoting reforms in the Social and Decision Processes at national and international levels, to complement the lists of biomedical interventions promoted in paper 3. The focus and conclusions in papers 4 and 5 were in tension with those in paper 3 and required some negotiation to bring to fruition, thereby illustrating the influence of the Social Process on the Intelligence function even in the production of the LNS itself.