Remembering and acting on 'Malnutrition': A Latin American Network to Foster Deep Learning on Nutrition Interventions Past and Present

This proposal will bring together a diverse group of anthropologists, historians, public health and nutrition specialists, and epidemiologists to create a research network to tackle the challenge of malnutrition in Latin America. The central objective of this network is to change the approach of future nutrition programmes by taking into account 'lost' learning on what has, or has not worked in the past; as well as taking into account what has, or has not worked, according to the perspectives of those communities most commonly targeted for nutrition interventions. The network will be a partnership between UK research institutions and researchers, public health experts and activists in Peru, Colombia and Nicaragua and will focus on these Latin American countries. All three countries have been identified in the most recent global nutrition data as places of 'double burden', which means that there are high rates of obesity and diabetes, alongside high rates of micronutrient deficiencies such as anaemia and undernutrition. Most troubling is that these complex and overlapping forms of malnutrition in Peru, Colombia and Nicaragua exist despite a long history of nutrition interventions in the region. It is clear that a new way of 'doing nutrition' is needed.

The members of the proposed network are particularly concerned with the multiple layers of past and present nutrition interventions experienced by communities a result of changing public health and nutrition priorities at national and global level. We want to better understand the complex factors that shape the success (or failure) of nutrition interventions through a deeper understanding of what these past and present attempts to mitigate malnutrition have looked like from the standpoint of the 'target community', and what these attempts look like when viewed through the lens of history. We know, for example that how 'target communities' receive and react to behaviour change messages related to food preparation, breastfeeding, food production, and improved sanitation can vary widely. We also know that the question of 'poor nutrition' and how to remedy it at the local level is often part of complex politics of race, gender, ethnicity and socio-economic status. What we do not know is how those communities most targeted for 'nutrition' change have lived these distinct cycles of intervention into their eating, parenting, cooking and agricultural practices over long periods of time; and how disconnected (or not) their experience has been from nutrition policy change at the national level. By participating in a network focusing directly on such community experience, researchers from these countries, policy makers and practitioners will increase their capacity to understand how past, present and future interventions in these areas might work as complementary layers rather than a potentially uncoordinated mess of approaches and messaging.

Our network will be grounded in a practice of 'mutual learning', which means to say that we seek a relationship of equals across the network where distinct forms of knowledge and diverse perspectives on what matters in nutrition research will be welcomed. We intend to share what we learn and expand outwards from more traditional sources of nutrition 'expertise' to include historical, political and cultural interpretations of nutrition interventions at grassroots levels, as well as through analysis of national nutrition policy-making processes. For our methods we will use exploratory ethnographic research (participant observation in sites selected through consultation with the public health schools and local contacts); oral history methods (in-depth one-to-one interviews and group oral history interviews, or 'witness seminars'); and archives-based historical research.

This multidisciplinary research partnership aims to reframe future programme approaches by examining both past and present nutrition interventions from policy to on-the-ground implementation and give due prominence to how such multiple layers are experienced from the point of view of different individuals within these communities. In each country, this partnership will actively engage with a large network of actors to form an interdisciplinary alliance.

Existing networks and associations will gain from new knowledge, capacity building & strengthening of alliances. In Peru these will include civil society organisations such as the Roundtable for the fight against poverty and ForoSalud and the Initiative Against Child Malnutrition. In Nicaragua this will involve the 40 farmer organisations affiliated with GPAE, as well as non-governmental organisations promoting nutrition and health, including SoyNica, World Vision, and FAO and the World Food Programme. In Colombia, we will invite FIAN Colombia, active in the right to food / nutrition, and the National Network of Family Agriculture.

Public health practitioners, health authorities and related multi-sector authorities will benefit from debating approaches to new overlapping nutrition challenges, gaining more insight in what does and doesn't work at the local level. They will include community health workers, clinical practitioners, and public health authorities. For example, we will invite to meet: departmental delegations such as the Regional Health Direction in Ayacucho and provincial health authorities in Colombia and Nicaragua, as well as local representatives of social programs (JUNTOS, FONCODES) in Peru, those of the Ministry of Agriculture and Rural Development in Colombia, and agriculture and MiFamilia government offices in Nicaragua.

Policy actors at national and international levels will gain from the generation of evidence at community level to reinforce policy initiatives that approach nutrition as a multi-causal issue, and to strengthen multi-sector alliances. In network meetings in Colombia we will look at the cross-ministry policy in the National Plan for Food and Nutrition Security 2012- 2019. In Peru this will include the policy alliances between the Ministry of Health and the Ministry of Development and Social Inclusion, regarding the National Strategy "Inclusion for Growth" as well as the Multi-sector plan for the fight against anaemia (2018), and the National Strategy for Food and Nutrition Security 2013-2021. In Nicaragua recent policy action for 2019 to 2022 in the National System for Production, Consumption and Commerce on family production, food and nutrition security will be addressed. FAO, UNICEF, PAHO and other nutrition actors in all countries will also be invited to these meetings.

Academic institutions including researchers and students at UNSCH, UPCH, UoA and CIES UNAN and IDS and Sheffield in the UK will benefit from the partnership dedicated to capacity-building in multi-disciplinary and community engagement methods. At national level historians and ethnographers working in nutrition and public health will gain from an extended audience. This will strengthen academic networks such as the Network for Historical and Social Studies of Nutrition and Food in Latin America, and the Peruvian Association of History of Science, Technology and Health (invited to early network building activities). We will invite other expert institutions to join, including INCAP, Nicaragua, the Institute of Nutrition Research, Peru, and the nutrition group within the National Institute of Health, Colombia.

Communities and populations targeted in nutrition outreach programmes will gain from the opportunity to make visible the limitations to current technocratic approaches, contributing to improvement in addressing causes of malnutrition. Community authorities, cooperative directors and women's federations will be invited to join the network in pilot sites