milk Substitutes—in the context of other enabling changes—in dramatically improving breastfeeding practices in Brazil.


SUN institutional transformation indicators


Scaling Up Nutrition (www.scalingupnutrition.org) is a global movement led by 54 member countries. These member coun- tries, which seek to prioritize efforts to address malnutrition, are supported by a wide range of development partners from civil society to the UN, donors, research institutes, and businesses.


One of the premises of SUN is that efforts to reduce mal- nutrition need to become more coordinated across sectors and stakeholders and more aligned with results frameworks. Accord- ingly SUN members are pioneering a new way of assessing insti- tutional transformation for nutrition improvement. Thirty-seven countries8


have conducted self-assessments of their annual


progress in relation to four processes defined in the 2012–2015 SUN Movement Strategy:


• bringing people into a shared space for action, • ensuring a coherent policy and legal framework, • aligning actions around a common results framework, and • tracking finances and mobilizing resources.


In these self-assessments, participants from a range of stakeholders were asked to agree collectively on joint scores for various “progress markers” that make up the four processes


(Figure 7.4). Countries report significant advances in bringing people together (process 1) and developing coherent policy and legislation frameworks (process 2). However, they have made relatively little progress in aligning actions around common results (process 3) and in tracking investments for nutrition (process 4).


The scores show that the tremendous ongoing efforts to


coordinate multiple stakeholders, develop policies and legisla- tion, and mobilize resources for nutrition have yet to be fully translated into properly managed and monitored actions and into investments that are scaled up, aligned, and adequately accounted for.


This innovative work mirrors the work of Food-EPI in over- weight and obesity and highlights the gaps between policy and action, but also the forward momentum of the countries involved.


Diet-related risk factors for noncommunicable diseases and the policy environment


Noncommunicable diseases like hypertension and diabetes are rapidly growing nutrition problems worldwide, and in most regions policy in these nutrition areas remains weak. Table 7.1 shows the number of people in each UN region who live in countries with both high prevalence of risk factors for hyper- tension and diabetes and weak policy scores. These data show


FIGURE 7.3 PERCENTAGE OF COUNTRIES WITH A TOP SCORE FOR EACH ENABLING ENVIRONMENT INDICATOR 54


51


International Code of Marketing of Breast-milk Substitutesa


41 41 32 29 19 Wheat fortificatione (2014) (N = 181) Policy on hypertensionf Policy on diabetesg (2010) (N = 178) (2010) (N = 179) (2014) (N = 164)


Undernutrition mentioned in national development plans and economic growth strategiesb


(2014) (N = 107)


Extent of constitutional right to foodc (2003) (N = 136)


Maternity protectiond (2011) (N = 169)


Source: See Technical Note 1 at www.globalnutritionreport.org.


Notes: Years in parentheses are years for which data are available. N = number of countries with data. a


b Countries ranked 1–20 out of 107 countries ranked according to number of times “undernutrition” is mentioned in national development plans. c


d Countries that have ratified International Labour Organization Convention 183. e


Countries that have enacted laws encompassing all or many of the provisions of the code. Countries with constitutions that explicitly provide for the right to food. Countries that have mandated fortifying wheat with at least iron or folic acid.


f Countries that have available and fully implemented policies on managing hypertension. g Countries that have available and fully implemented policies on managing diabetes.


ACTIONS & ACCOUNTABILITY TO ACCELERATE THE WORLD’S PROGRESS ON NUTRITION 53


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