The Hunger Summit held in London on 12 August has had mixed reviews. Not from me. I would have given it six stars if I had been invited - but as I wasn't, have slashed the score to five stars. I expect David Cameron knew I was going to be on holiday!

Political positioning

There are two reasons to be positive. The first is that the Summit was about political positioning rather than substantive content. There may be battles to be fought – as we shall see – but this is not the moment for detailed parsing of theleaders’ statement. In my experience of these kinds of events, the meeting itself consists largely of people being given an opportunity to say their thing, with no time for discussion or debate. There are sometimes some announcements. There will probably be a photo opportunity. There will certainly be a press release. In this case, we had all three. See the press release for details. In fact, there is also a transcript of the event on the No 10 website, and the Summit looks like having been a choreographed session of prepared statements.

It would be easy to be cynical about the formula. But don't be fooled. Read my account of the last Downing Street Summit on food, in 2008. The real work takes place beforehand, and, more importantly, afterwards. You can be sure that there will civil servants thinking about follow-up, not least because David Cameron has said that hunger will be a (the?) priority of the UK leadership of the G8Group of Eight next year. Personally, I am one of those who thinks that the G8Group of Eight should be abolished now that we have the G20, but if it is going to continue, tackling hunger seems like a valuable project for it to take on. So, all power to David Cameron's elbow, and to what must certainly be the supporting hand of Andrew Mitchell, the UK Secretary of State for International Development. First a commitment to immunisation, then family planning, now hunger, and with theMDG Panel report to follow - plus a pragmatic report on global governance for the G20 in 2011: the Prime Minister is certainly covering the ground in international development.

By the way, it is not just UK politicians who deserve credit for this initiative. I haven't looked at the history, nor done the anthropology of the policy process - I hope someone will - but this has Brazilian fingerprints all over it, in addition to those of the UK. The Vice-President of Brazil co-hosted the Summit, and the lineage of the event can be traced back to President Lula's social protection programme, Bolsa Familia, and to his anti-hunger programme, Fome Zero. It is also relevant that the new Director General of FAO, Jose Graziano da Silva, is Brazilian. Did you notice the approving reference to the FAO Committee on Food Security in the joint statement? One in the eye for the G20's claimed leadership on food security, I think.

Malnutrition in the mainstream

The second reason to be positive is that the Summit marks another step in the gradual movement of malnutrition out of the shallows and into the mainstream. It may be surprising to learn that malnutrition has not always been there, bobbing happily downstream with such popular issues as primary education and infectious disease. Surely the large aid agencies have always taken malnutrition seriously (think WHO, FAOFood and Agriculture Organisation of the United Nations and UNICEF)? And surely the image of the hungry child is the very well-spring of our commitment to international development?

In practice, nutrition has often struggled to receive the recognition it deserves, as a composite indicator of well-being, and as an entry point to policy on health, food access and household caring capacity. The field had some extraordinary advocates – Alan Berg, for example, at the World Bank, Urban Jonsson at UNICEF, and people like Nevin Scrimshaw, Philip Payne and George Beaton in the academic community. But, believe me, I was a member of the UN’s Advisory Group on Nutrition from 1990 to 1996, and it felt like an uphill struggle. A book I helped to organise, edited by Stuart Gillespie and others, entitled ‘Combating malnutrition: Time to Act’, and eventually published by the World Bank in 2003, tried to identify and explain turning points in nutrition policy. Jim Levinson, another great advocate, captured the mood when he wrote in the book (Pg 101) that the ‘homelessness’ of nutrition contributed to ‘a lack of recognition as a legitimate field of development and reduce(d) financial support’.

Just as one example, DFIDDepartment for International Development had a succession of excellent health advisers, including David Nabarro, who now coordinates responses to the food crisis for the UN, but never a nutrition adviser. It was represented at the UN’s Sub-Committee on Nutrition, now the Standing Committee on Nutrition, not by a civil servant, but by a Professor from the London School of Hygiene and Tropical Medicine, Philip Payne. I remember trying to sell nutrition to the British Government on many occasions, including once unsuccessfully to Gordon Brown, at an event which I think must have been linked to the 2001Westminster Conference on Child Poverty, which he organised jointly with Clare Short. I later wrote a private note for DFIDDepartment for International Development Ministers on the idea of a guarantee against malnutrition. It was only when they reported that they had tried but could not get traction inside the house that I published the note, in May 2005, as an ODI Opinion.

Slowly, things have begun to change. In the policy field, nutrition was subsumed in the child mortality goal of the originalInternational Development Targets, promulgated by the Development Assistance Committee of the OECD. In theMillennium Declaration of the UN General Assembly in 2000, which established the MDGs, reduction of hunger was mentioned as an objective, but the stated goal was to reduce absolute poverty by half by 2015. It was not until the goals were supplemented by indicators a year later, that reducing the proportion of underweight children became ratified as one of the indicators of progress towards the poverty goal.

More recently, there have been some important initiatives: GAIN, the Global Alliance for Improved Nutrition, was created in 2002; WFPWorld Food Programme launched its Ending Child Hunger and Undernutrition Initiative in 2006; SUN, a multi-stakeholder partnership on Scaling Up Nutrition, was launched in 2009; the G8Group of Eight last year announced a New Alliance for Food Security and Nutrition; and at Rio this year, Ban Ki Moon launched a Zero Hunger Challenge. Meanwhile, many NGOs have earned great credit for their persistence on the topic of hunger and malnutrition, including of course UNICEFUnited Nations Children's Fund and Save the Children, both involved in organising the petition on hunger for the Hunger Summit, signed by 500,000 people. TheGates Foundation has also been a player. The founder of the Children’s Investment Fund, Chris Cooper-Hohn, was given a speaking role at the Hunger Summit.

In the real world, the proportion of children underweight fell from 31% to 26% between 1990 and 2008, with progress in all regions except Western Asia, according to the UN. The UN concluded that progress was being made, but not fast enough to reach the MDG of halving undernutrition by 2015. Some countries have seen much faster progress, however: Bangladesh, Thailand, Cameroon and Ethiopia, among others.

There is another piece of policy process anthropology to be carried out on the change in mood, but I would surmise that a report commissioned from IDSInstitute for Development Studies, Sussex by SCFSave the Children Fund in 2007 on opportunities for greater DFIDDepartment for International Development and ECEuropean Community leadership on chronic malnutrition played an important part – at least as far as DFIDDepartment for International Development was concerned. Lawrence Haddad and his colleagues made an eloquent case for tackling malnutrition, and concluded, echoing Jim Levinson, that

‘Our assessment is that DFIDDepartment for International Development and the ECEuropean Community assign chronic malnutrition a medium level of priority although much of this assessment depends on just how nutrition-friendly the indirect nutrition interventions are. Chronic malnutrition is widely recognised by both DFIDDepartment for International Development and ECEuropean Community as crucial to reducing child mortality, morbidity and in promoting learning in school and economic productivity in the labour market.  However, nutrition is seen by the ECEuropean Community and DFIDDepartment for International Development as a supporting investment rather than a foundational one. We identify ten reasons for this.

Chronic malnutrition does not fit neatly into the developing country sectoral silos that donor agencies are increasingly linking up with;

1. Chronic malnutrition is seen as everybody’s business and nobody’s responsibility – there are few institutional champions;
2. Chronic malnutrition has not been seen as linked to the governance agenda, although there are clearly opportunities for it to be;
3. Within DFIDDepartment for International Development and the ECEuropean Community there are few institutional incentives to pay attention to nutrition;
4. International agencies are not seen as capable or willing to support or put pressure on DFIDDepartment for International Development or the ECEuropean Community to do more;
5. Parliamentary bodies have no particular incentive to pressure DFIDDepartment for International Development or the ECEuropean Community on nutrition;
6. Tracking spending flows on nutrition is difficult;
7. Attributing impact on nutrition status of indirect nutrition interventions is difficult;
8. There are some clear direct interventions but these are seen as involving too much or too little behaviour change to be sustainable;
9. The move to direct budget support and SWAPs means these direct nutrition programmes will be underfunded in the absence of champions.

We are optimistic that DFIDDepartment for International Development and the ECEuropean Community could do more on nutrition within the constraints under which they currently operate.’

IDS went on to make specific recommendations to DFID, the ECEuropean Community and SCF, including better use of monitoring data and the appointment of a nutrition champion in DFID.

More recently, in 2011, ODIOverseas Development Institute (London) contributed a useful review of issues in food security and nutrition to the Foresight Study on the Future of Food and Farming. They placed special emphasis on minimum income and social protection.

Whatever the drivers, the change in the profiling of hunger and nutrition is undeniable – and the holding of a Hunger Summit ratifies the move from the shallows to the mainstream.

Will the follow-up deliver?

Will the follow-up process be able to deliver? The golden rule is that three things have to be in place for successful policy change: leadership; civil society support; and a convincing story-line, or policy narrative. The first is in place, judging by participation at the Summit (including the EUEuropean Union Commissioner, the Irish Prime Minister, the Bangaldesh and Kenyan Prime Ministers, a senior minister from India, and Paul Polman from Unilever, in addition to those already mentioned). It is also worth noting again that the G8Group of Eight proposal builds strongly on the New Alliance for Food Security and Nutrition launched by Barak Obama at this year’s G8Group of Eight (and see my comments here) – although that focused more on agricultural production than on nutrition. The second looks to be on track, with the NGOs planning a joint campaign on food and hunger, targeted at the G8Group of Eight meeting in 2013. The third is where work needs to be done.

The official statement by David Cameron and Michel Temer puts the main focus on access to technology and access to markets, backed up by ‘political will and leadership’. I said I would not try to deconstruct the statement, but the paragraph on leadership is tantalisingly ambiguous, noting Brazil’s commitment to ‘guaranteeing the rights to food, education and health’ without quite saying that recognising the right to food is a universal prescription. Instead, there is a sentence on transparency of data and effective monitoring. I would be very curious to know more about this careful piece of drafting – and about the status of a rights-based approach to malnutrition. The paragraph reads as follows:

‘But none of this can substitute for political will and leadership. This is something that has been used in Brazil to bring rates of stunting down by half in ten years. Brazil did this through leadership, prioritising technology and market access to the very poorest, guaranteeing the rights to food, education and health, and investing in agricultural research and innovation. Transparency of data sources and nutrition results have allowed governments in countries like Brazil to track progress on nutrition indicators and allowed others to analyse the data and confirm the successes being made.’

As far as commentary on the Summit is concerned, there has been a range of views, helpfully brought together on the website of BOND, presumably by the always-engaged UK Food Group. Owen Barder, George Monbiot and Lawrence Haddad are among those who have commented, in addition to the NGOs. There is strong support for a commitment to reducing malnutrition. Some, however, are concerned that agribusiness will displace small farmers and distort markets. Others make the point that malnutrition is shaped internationally as well as by national policy, noting the negative impact on the poor of the Common Agricultural Policy, of US and EUEuropean Union biofuel policies, and of speculation in commodity markets. The impact of the global food crisis on the caring capacity of households is noted, especially the pressure on women’s time. An argument is made against meat consumption, on the grounds that it drives up staple prices. A plea is made for food justice.

These are familiar debates, which will need to be aired in coming months, alongside others: cash crops versus food crops; the role of food aid; cash transfers versus food relief; approaches to targeting; and so on. Personally, I have beenworking on these issues for ever, and have views on all of them. For now, can we start with six core principles that should inform action?

Principles to inform action

First, both transitory and chronic malnutrition matter for well-being and development: short term shocks as well as long term food poverty. That means paying attention to wasting as well as stunting, famine relief and safety nets as well as long-term poverty reduction and behaviour change.

Second, measures to increase food production and food access are both important, but it is not axiomatic that one leads to the other. Higher production contributes more food to the economy, obviously, and lowers prices for food, as well as adding to jobs and foreign exchange. Better access means hungry people are able to acquire more food. Sometimes, poor people with access to land may be able to grow more food for their own consumption, and perhaps provide jobs for others in the process. Sometimes, however, some poor people may be able to acquire food by other ways than growing it: by growing a cash crop like coffee, by finding a job outside agriculture, or by receiving a transfer from the state. It is a mistake to confuse food production with what Amartya Sen called food entitlement.

Third, tackling malnutrition is about more than producing and consuming food. As UNICEFUnited Nations Children's Fund discovered, the key ingredients include access to clean water, improved sanitation and health services, as well as the capacity to care for children within the household, including women’s education and the promotion of breast-feeding. That is why nutrition is a multi-sectoral challenge – and also why rates of undernutrition are a good proxy for overall development progress.

Fourth, in a globalised economy, it makes no sense to consider nutrition policy as being only about local agricultural policy, local food markets, and local health services. As experience of food crises since 2008 has shown, global shocks affect local food prices and availabilities. That is why agricultural trade, biofuels policy, food aid and the management of commodity markets all need to be at least on the radar screen of nutrition policy.

Fifth, sustainability and resilience need to be central to nutrition policy, especially in the face of climate change. The G8, in particular, can help to bring together the poverty focus of the MDGs, the environmental focus of the Rio sustainable development goals, and the shock management focus of the G20. David Cameron is well-placed to do this, given his role with the MDG Panel.

Sixth, action on malnutrition will not happen unless it is prioritised, monitored and funded. Champions may be fine, provided they have authority; focal points may be more useful. However, centralised and over-ambitious policy coordination units have been shown not to work well.

To conclude, it is true that reducing under-nutrition has been a development success. However, it is also true that big problems remain – 170 million children in the developing world are stunted, many millions are wasted. Hence the five stars for David Cameron’s Hunger Summit, as a call to action which deserves support.