SPEECH DELIVERED AT OPENING OF INDONESIAN NATIONAL SEMINAR ON IDD ELIMINATION, 1993

by David P. Haxton

SPONSORED BY PAMM AND GOVERNMENT OF INDONESIA IN PRESENCE OF MINISTER OF PEOPLE'S WELFARE AND MINISTER OF HEALTH.

March 15, 1993

It is a pleasure and privilege to be part of this discussion group today as we try to sort out ways in which an imaginative alliance between private industry... in this case, that part principally engaged in the food industry . . and public health systems . . in this case those that must deal with national policy on nutrition and oversight of public welfare. I believe that this idea of an alliance of this nature . . be it formal or otherwise .. is an idea whose time has come.

However, having said that, we deal also today with the question of an idea whose time has come, but about which we have been slow, in deed to act. I cite the problems of iodine deficiency disorders. It seems incredible that the world has known about the basic cause of the problem for 8 decades and has known what to do about it for about that long but as we approach the end of the century, we still have 1 billion people at risk and manifestations of the problem on all continents. It is even more incredulous when we take into account that for most of that time we have know how to prevent IDD; what it costs to do so; and the essential fact that the process actually works.

So what has taken us so long to put an idea whose time came, into action for those that silently await the lifting of the burden of the stealthy scourge of IDD? Let me cite a few obstacles in the path:

a. Inadequate awareness of the problem. This was due to lack of communications between those that held the knowledge and those that could apply it for public health.

b. Inadequate comprehension of the magnitude and the consequences of the problem. Again, lack of communication between those that knew and those that could act.

c. In adequate political commitment to address the problem. This was evident in governments as well as development agencies. Again due in part to poor communications.

d. Lack of assurance of an adequate supply of raw material to assure permanence.

e. Primitive methods of salt production, packaging, and quality assurance.

f. Inadequate communication between policy makers and profitable productive capacity.

I believe that in good part, these same obstacles have been in the path of progress in reducing a good number of insults that affect women and children, including immunizations, diarrhoea management, family planning, vitamin A deficiency, and iron deficiency.

So, where are we today?

We certainly are not starting at base zero. Much has happened and much progress has been recorded. As science worked diligently to expand our knowledge base and to reveal the consequences of a range of disorders resulting from the absence in diets of a minuscule amount of iodine daily, a good number of nations introduced effective interventions principally based on the production, marketing and consumption of iodated salt. During the 1960's, a good number of governments began programmes, and while some of those progressed, most suffered from lack of political commitment to the permanence of the programme; or from managerial problems; or from lack of collaboration between the public and the private sectors, and the lack of communications with the buying public in order to sustain demand for iodated salt in the market at acceptable prices.

International development agencies expressed concern and offered help. But most assistance was time bound and certainly not on a scale commensurate with the magnitude of the problem. Nor were the UN agencies and the bilateral aid agencies imaginative in seeking allies in the private sector to undertake tasks more suited to industry than to government.

Since the late mid 1980's, however, there has been a growing recognition of what we talk about today and progress is evident everywhere. As impressive as the formal gains are, however, the Global Summit on Children in 1990 once and for all gave global political endorsement to the effort to virtually eliminate IDD, Vitamin A deficiency, and iron deficiency in this decade.

Put another way, the scientists of the world, the planners of the world, the economists of the world to the world political leaders the these goals COULD be achieved.. Moreover, it was seen to be good politics to do so. The political leaders accepted this advice and said that the goals SHOULD be achieved. So it comes to us : Our task seems to be that of determining how to implement plans which will see that the work GETS done.

We are not here to address all of the issues in micronutrient malnutrition, of course. But there are one or two which are essential to success and to our meeting today. The major one is to address the question of how private industry might become more interested in an alliance with government in the elimination of micronutrient malnutrition.

The corollary to that is to suggest what minimal elements of national policy are suggested in order to facilitate that alliance, accelerate its inception, and guide its implementation.

To ally private sector development in the food industry . . especially in the fortification of foods and in the production of supplements . . with the public needs for the foods and the supplements will help to assure that we become able to insert our needs in to appropriate financial channels, both public and private; in to communications channels, both public and private; into universities and other centers of learning and training; and into other sectors of private industry and of government. This unique combination of interests can help to demonstrate how a public health problem can be addressed in the private sector.

We shall need to talk of some specifics.. and we shall do that. Permit me, at this juncture, however, to remind us of some of the assets which can be combined to make our tasks somewhat easier than might have been in earlier years. For example, we now know that the major threats to the lives and normal growth of children around the world can be defeated in large measure, by informing parents and supporting them in basic and inexpensive actions like: getting infants immunized; using moral therapies for diarrhoeal disease; maintaining exclusive breast feeding in early months; applying new knowledge of when to apply other foods; recognizing acute respiratory infections; spacing births; and consuming foods with nutritional benefits. The knowledge is available. The problem is that those who need to know it are not receiving it in convenient and persistent ways. The social marketing of ideas has not kept abreast of the commercial marketing of products.

The surge in the communications capacity of virtually all nations over the last ten years has made it possible, for the first time, to put that knowledge and these techniques at the disposal of the great majority of the world's peoples. Sixty percent of the adults in developing countries can now read and write. Eighty percent of all children now enrol in school. But, we need also to remember that radio reaches into a majority of all homes and television into a majority of all communities.

In addition, we need to recall that "development has happened". We now have more than 2 million doctors; 6 million nurses, tens of millions of health workers now at work. In addition of have tens of thousands of non governmental organizations... not including private industries .. which when added together make for a massive network of support for solid communications and effective social marketing for improved nutritional efforts.

We have still another set of circumstances which we should consider in our acceptance of the task to virtually eliminate micronutrient malnutrition from the globe in our time. I refer to the dramatic change in global geo-politics. This not only will readjust the focus of government to government development cooperation, but will open opportunities more widely and more rapidly to apply the ingenuity of private enterprise to new countries, new challenges, and new markets.

This will not be without its problems. As the major protagonists of the "cold war" both enter periods of readjustment to the new environment, and reduce investment in military hardware and unproductive investment, there will be strains in all elements of society. But, we need to be assured that in the readjustment period which is inevitable, we do not allow the progress of the past few years on the improvement in the condition of children and women to be the first to suffer as national policies are readjusted. With a mutual focal on the elimination of micronutrient malnutrition, both industry and government have an opportunity to show that social development of this kind is not only " doable" but is a good investment in the country, and good politics as well.

Both industrialized and developing countries stand at a clearly marked cross road to health and nutrition. IF the choice is the road to primary health care through reliance on medical technology, then the path will be steep and difficult, and will require expenditure of more resources for less forward movement than most countries can afford, and will allow fewer and fewer people to benefit If, on the other hand, the road of primary reliance on empowering people with knowledge to take on responsibilities of their own, and more control over their own health and nutrition, with easier access to knowledge, then the way will broaden and allow a large portion of the human family to move forward towards "health for all"

But such empowerment has many hindrances, of course, like : grinding poverty; lack of education; muddied propaganda; limited access to basic services like clean drinking water, safe sanitation and adequate housing. So the mere empowerment of people cannot be a substitute for government action to accelerate that process by investment in the basic community services and by initiating imaginative ways in which to mobilize the entire national community into acceptable health and nutrition goals.

The Montreal Meeting on Ending Hidden Hunger outlined our challenge in a neat way by suggesting that there are three major methods in which improved consumption of iodine, vitamin A and iron can be achieved : through dietary change; through fortification of foods; and through supplementation. All of these call upon the talents and resources in the private sector. . not exclusively, of course, but significantly.

The power of persuasion of the commercial marketing forces can be applied, it seems to me, in helping to change dietary habits. While this implies the need to have a product available once the idea has been considered, that is after all the essence of marketing, I suppose. When these are natural foods, like fruits and vegetables, private sector activity is already involved in growing, harvesting, packaging, processing and marketing them in most places.

In the cases of food fortification with iodine, as in the case of salt; or of vitamin A, as in the cases of sugar, or tea or soft drinks; or of iron, as in the case of flour; the role of private industry is already evident. What is required is e expansion and acceleration of efforts.

Supplements of these micronutrients is also a field for interest of the private sector.. as has been demonstrated in a number of industrial countries.

So what is it we can work on today? This meeting is a direct, legitimate derivative of the Global Summit on Children which called upon the world to virtually eliminate micronutrient malnutrition. That as followed by the Montreal Meeting on Ending Hidden Hunger. ILSI, PAMM, CDC and others had a meeting in Atlanta on how science, industry, and government might collaborate on some aspects of micronutrient malnutrition. ICCIDD and others have fostered meetings between industry and government on how to collaborate in salt iodation and more on scheduled this year.

Our task is simply put: Since most of us agree that there is a way that industry can increase its investment in and apply its talents in elimination of micronutrient malnutrition, then perhaps we can focus on what policies on the part of a government would be most conduce to encouraging this to happen and to accelerating the process.

Since WWII, and in good part because of the "cold war", development policy makers and agencies put great emphasis on the role of governments in a range of economic, social and development activities. We are seeing shifts in that approach all around the globe. For the most part the shifts seem to be : (a) attempts to "privatize" holdings and infrastructure of the productive elements in society like manufacturing, mining, transport, and real estate. A shift from centrally planned activities to market driven priorities; (b) attempts to shift responsibility and management of basic services in education, health, agriculture, from government support completely to a shared support of public and private resources; and (c) a growing awareness that public health and improved basic services are good investments for a healthy productive population and such is good for business.

In this global set of changes, it is not too ambitious to think of a mutually beneficial endeavor in each country to eliminate the insults of micronutrient malnutrition. What is required is to overcome the existing mutual suspicion and mistrust between government and private industry. While not an easy task, there are ways and means of beginning.. or of accelerating. One way is to make suggestions on policy and procedure.. and that is in part why we are here.

PAMM among others has been asked by governments to suggest ideas for policy formulation on national planning for micronutrient malnutrition elimination. Our experience needs to be supplemented with the experience of business and industry in this connection and, thus, we have this modest forum in which to begin to discuss these issues . . or at least to list them.

We cannot, of course, design a policy for a sovereign government nor should we be so pretentious. But we can respond to the queries informally put to us to suggest a framework. What outline would we give that framework? While we look to you for leadership, suggestion, and guidance, permit us to suggest some categories of activities which might merit discussion and analysis by you and your colleagues:

a. Governments have the responsibility to protect the populace. The nature of the law and regulation which provide guidelines to food production, food processing, and marketing of nutritionally beneficial food products is important. What should be consider as essentials in that ?

b. Governments have the responsibility to finance themselves, mostly through taxes and fees. But this power also provides the authority for tax relief and incentive. What kind and how much is required in this field? How will such provision assist in competition or restrain it?

c. Private industry cannot be expected to produce fortified foods for each and every citizen (as desirable as that would be from all angles!). But if the private market reaches, say, the vast majority of consumers, the burden on the public health ministry and other services is reduced to mutual benefit. This would allow for more focus of limited resources.

d. Government will need to comprehend that profit making is not a negative quality and should be encouraged in this field. Private industry will understand that all profit need not derive from the first sale!

e. The vast range of marketing talents; the market research methodologies and processes; the vast networks of private sector activity provide an efficient and effective combination of the new communications networks available and the knowledge of nutrition which is required. How can governments and private industry work on health and nutrition issues to mutual benefit and "profit"?

f. Quality assurance of the process as well as the product are important. Both industry and government have vested interests in making only the best available. What are the minimal standards which need to be set and in what framework? How can public and private sector R and D be mutually supportive?

How can industry assist in some conditions to assure that the personnel required in food technology, in food processing, in quality assurance are available in the country and favorably inclined to mutual support and collaboration on these issues?

g. How can agencies like PAMM, ICCIDD, INAG, IVACG, UNICEF, and others assist. . or at least indicate where .. private industry can enter new countries with new ventures? How can the wide range of government contacts of these development agencies be of assistance to private sector development in mutually beneficial ways?

h. What mechanisms can we suggest that would take these discussions to the next phase of consideration? Would these include mutual support for national promotion seminars, or conferences? (Like in Guatemala, Philippines and China) Would these include mutual support for continent wide meetings of science, industry, commerce, government and development agencies to seek ways to apply talents to the problem? (Like in Europe? or in Central Asia? or in South East Asia?)