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Multisectoral Nutrition Interventions: Impact and Transitions in Undernutrition, Stunting and Wasting in Children – An Open Experiment in Two Remote Blocks of Karnataka by Veena S Rao, Shalini Rajneesh, Chaya Degaonkar, Hanimi Reddy, S Bharadwaj

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Multisectoral Nutrition Interventions: Impact and Transitions in Undernutrition, Stunting and Wasting in Children Living in Two Remote Blocks of Karnataka, India

 The Karnataka Multisectoral Nutrition Pilot Project, led by the Karnataka Comprehensive Nutrition Mission was implemented in Devadurga Block, Raichur District and Chincholi Block, Gulbarga District, two most backward Blocks in Karnataka, India, between 2015-2018. Interventions were inter-sectoral and intergenerational and addressed root causes of malnutrition. This paper analyses real time data that emerged from the project regarding underweight, stunting and wasting among 8606 children in the cross-sectional group and 699 children in the cohort group aged 6 months to 3 years. Data indicates that percentage of ‘normal children’, that is, not underweight, wasted or stunted, increased by 9 percentage points from baseline to endline; underweight reduced by half and wasting by almost two-thirds. Stunting increased by one percentage point, with previously wasted and underweight children transitioning into stunting, while around one-third baseline stunted children became non-stunted. This constant transition between the three anthropometric indicators suggests that they impact each other constantly and coexist simultaneously in different combinations as children grow. Hence, policy and programmes for addressing/preventing them, should view them in an integrated, holistic manner

By Veena S Rao[1], Shalini Rajneesh[2], Chaya Degaonkar[3], Hanimi Reddy[4], S Bharadwaj[5]

Multisectoral Nutrition Interventions: Impact and Transitions in Undernutrition, Stunting and Wasting in Children

An Open Experiment in Two Remote Blocks of Karnataka, India

Supported by Karnataka Evaluation Authority, Department of Planning, Programme Monitoring and Statistics, Government of Karnataka

 

Introduction

The Karnataka Multisectoral Nutrition Pilot Project (KMNPP) was implemented under the leadership of the Karnataka Comprehensive Nutrition Mission (KCNM) which was announced by the State Government in 2010.

The Mission Strategy, which was intersectoral in nature, was finalized in January 2011, after high level consultation with experts from Government, nongovernmental and international organizations.[6]

The strategy was piloted successfully in Gubbi and Shikaripura Blocks between 2011 and 2014. In July 2014, the Government of Karnataka received a grant of USD 4.55 million from the World Bank/JSDF Trust Fund, for replicating the strategy in two of the most backward Blocks in Karnataka – Devadurga Block, Raichur District and Chincholi Block, Gulbarga District. Chincholli Block has a total population of 2,54,287 and has 136 villages. The total population of Devadurga Block is 2,80,606 with 173 villages. The human development indicators of these two Blocks are among the worst in Karnataka. Devadurga is ranked 176 out of 176 taluks and Chincholli is ranked 173 out of 176 taluks. [7]

Box 1: Nutrition Indicators of India, Karnataka, Raichur and Gulbarga Districts

Nutrition Indicators India Karnataka Raichur Gulbarga
Infant Mortality Rate (IMR) 41* 26.9*

25.4**

NA NA
Maternal Mortality Rate (MMR) 113*** 92*** NA NA
Stunting % (Children below 5 years of age) 35.8 * 36.2*

35.4**

37.2*

39.8**

52.2 *

34.5**

Wasting % (Children below 5 years of age) 21.0 * 26.1*

19.5**

23.2*

34.9**

34.0*

25.0**

Underweight  % (Children below 5 years of age) 38.4 *  35.2 *

32.9**

41.2*

40.7**

56.7*

36.2**

Infants 6-23 months receiving adequate Diet % 9.6*

 

8.2*
12.8**
3.3*

13.0**

2.6*

15.4**

Anaemia  among women aged 15-49 years % 53.1 *

 

44.8*

47.8**

58.7*

60.4**

43.1 *

56.0**

Anaemia among children age 6-59 months % 58.6*

 

60.9*

65.5**

70.6*

73.6**

72.4*

75.1**

Anaemia among women aged 15-19 years % 44.8*

47.8**

62.2*

64.8**

61.4*

46.6**

Anaemia among Pregnant women aged 15-49 years % 50.4 45.4*

45.7**

73.1*

69.1**

53.9*

58.0**

Body Mass Index (BMI) is below normal (BMI <18.5 kg/m2) among  Women aged 15- 49 years %  

22.9*

 

20.7*

17.2**

20.8*

23.3**

22.5*

20.8**

Female literacy Rate (15-49 years)% 68.4*

 

71.7*

76.7**

 

54.3**

 

68.2**

Source: * NFHS 4 (2015-16) ** NFHS 5 (2019-20) *** SRS Bulletin (2016-18)

On account of the intrinsic inter-sectoral nature of the projects, they would be operated through the Karnataka State Rural Livelihoods Promotion Society (KSRLPS), Department of Rural Development, under the technical guidance of the Karnataka Comprehensive Nutrition Mission.

Implementation of the Pilot Project started in July 2015, after receiving necessary approval and selection of the implementation partner NGO, Karnataka Health Promotion Trust

Unique Features of the Strategy

The pilot project interventions aimed at addressing the root causes of malnutrition in India, viz.,

  • Directly addressing the inter-generational cycle of malnutrition by simultaneous targeting and addressing the nutritional needs of infants, children, adolescent girls and pregnant and nursing mothers.
  • Bridging the information deficit through a sustained, multi-layered general public awareness campaign, most importantly through interpersonal communication, to reach the general public, focusing at the household level, regarding proper nutritional practices within existing family budgets and proper child, adolescent and maternal care, and creating demand for on-going government programmes.
  • Bridging the calorie-protein micronutrient deficit among the inter-generational target groups by providing appropriate fortified multigrain energy food supplementation for consumption.
  • Accelerating, integrating and tightly monitoring multi-sectoral ongoing programmes that have impact on malnutrition, such as Immunization and Vitamin A Supplementation, Anaemia Control, Water and Sanitation, etc., and achieving convergence between the ongoing programmes so that they operate simultaneously, and filling programmatic gaps.
  • Increasing programme coverage by demand creation through involvement of the community, NGOs, SHGs and VPs.
  • Making available low-cost energy foods for the general population.
  • Real time monitoring of the beneficiaries’ nutrition indicators, particularly regarding underweight, stunting and wasting of children, body mass index of adolescent girls, pregnancy weight gain, and incidence of low birth weight babies

It is important to note that the Karnataka Multisectoral Nutrition Pilot Project (KMNPP) was not a supplementary food programme alone. It was a comprehensive programme that began with an intensive behaviour change communication campaign. It then proceeded to bridge the nutritional dietary gap for the targeted groups, namely, infants below 3 years, adolescent girls, and pregnant women. Low cost fortified energy food produced from locally available agricultural produce, specifically formulated for the three inter-generational target groups was produced by women from local Self Help Groups (SHGs) working in Production Units set up during the first year of the project. This component was supported by Global Alliance for Improved Nutrition (GAIN)

Selection of beneficiaries

Beneficiaries were shortlisted through a Gram Sabha (Village Assembly) where the poorest families of the village were selected. The selection criteria used was on the basis of certain auto-inclusion, deprivation and nutrition indicators regarding annual income per family, source of livelihood, land owned per family, food intake and nutritional status. Children below the age of 36 months, adolescent girls between 11-18 years of age, and pregnant and lactating women who fell within the most deprived 40% of the population were selected.

Beneficiaries registered at the start of the project-

Block Children

0-5 months

Children

6-35 months

Adolescent girls 11 to 18 years Pregnant women Lactating mothers Total
Chincholi 417 6038 8107 783 1660 17005
Devadurga 152 6522 8396 841 2090 18001
Total 569 12560 16503 1624 3750 35006
Project Interventions at Preparatory Stage (July 2015-September 2016)

A Village Nutrition Volunteer (VNV) was appointed in each village by the partner NGO and trained. The Training Module was provided by the KCNM. The VNVs were trained to ensure accuracy for measuring the weight and height of infants, children, adolescent girls and pregnant women. The responsibilities of the VNV consisted of all the critical essential interventions required for improving nutritional status of families/communities, but were presently not part of any on-going programme. These were mainly, household counselling and counselling for mothers and adolescent girls for behavior change regarding proper affordable diets, personal hygiene, proper storage of water in the household, the importance of sanitation, basic principles of the inter-generational cycle of malnutrition, proper child care practices, the importance of adolescent girls’ nutritional and health care, of pregnancy care and proper weight gain and the negative impact of malnutrition on the lives of people. The VNV also explained through counselling the importance of nutrition impacting programmes, such as, immunization, IFA, sanitation and creating demand for them. The VNV was provided simple household level IEC on the subjects to strengthen the household counselling sessions. For details, please see link below.[8]

The VNV thus supplemented the responsibilities by the Anganwadi Worker[9] and ASHA worker[10], and the three of them worked well as a team, calling themselves the three sisters.

The VNV’s first task was to create Nutrition Cards for all beneficiaries in which nutrition indicators, such as age, height, weight and other indicators specific to each target group, eg., for children- whether the child was exclusively breast fed for the first six months, when was complementary feeding started, diarrhea episodes, immunization status, Vitamin A doses, details of sanitation and safety of drinking water and its storage in the household, were recorded.

There was a monthly recording of height and weight for children. For adolescent girls, weight was recorded every month, and height was recorded every quarter. Monthly monitoring meetings were held by the NGO partner at village and block levels and bi-monthly reviews were held by KCNM at mission level. For infants, details about immunization, exclusive breast feeding, initiation of complementary feeding, diarrheal episodes were continuously recorded and monitored. For pregnant/lactating women there was monthly weight monitoring, and counselling regarding additional diet and proper pregnancy weight gain, and consumption of Iron and Folic Acid tablets. For adolescent girls, quarterly height and weight measurements, school attendance, and consumption of Iron and Folic Acid tablets were recorded and monitored. The VNV visited every beneficiary household at least once a month, and more often if required in case of illness or emergency.

A strong multi layered IEC campaign was created by KCNM which aimed at bringing about behaviour change regarding proper nutritional and health practices, dietary diversification, within the family and community, and within their household budgets, particularly regarding care of children, adolescents, and pregnant and lactating women.

SHGs were strengthened, and empowered through information and awareness on nutrition and health so that they could be active participants in bringing about behaviour change.

VNVs motivated and assisted the families to apply to Panchayats for construction of toilets in their homes. After Mission intervention in October 2016, 6989 toilets have been constructed and are being used – (3347 in Chincholi and 3642 in Devadurga Blocks) as at the end of June 2018.[11]

Real Time Monitoring: The Project was vigorously monitored at the Mission and community levels. Data from Nutrition Cards was compiled, reviewed and monitored at field level by the NGO field workers, and at the Mission level on a real time basis.

The core activity in the project was the regular house to house counseling regarding essential health and nutritional messages, both before and after supplementary nutrition started. The VNV visited every beneficiary household at least once a month, and was available on call if there was any special or urgent request from any beneficiary family in the village. To prevent information overload and to ensure that the messages start getting absorbed by the families in a sustained manner, they were disseminated in phases, through household counseling, through flipcharts and charts, through radio and Cable TV and through wall paintings.

Details and phases of the multi layered IEC campaign are available at the link below.[12]

Box 2 below provides timelines and key milestones of the implementation of the Pilot Projects.

Box 2- Key milestones implementation timelines

Key Milestones Devadurga Chincholi
Selection of NGO Implementation partner 2015 2015
Baseline survey December 2015 December 2015
Selection, training and placement of Village Nutrition Volunteers

Selection of beneficiaries

Development of IEC material

2015 2015
Setting up of production units  2016 2016
Monthly/Quarterly  monitoring of anthropometric and other measures of all beneficiaries in all villages September 2016, till September 2018 September 2016, till September 2018
Motivation for construction and use of toilets October 2016 onwards October 2016 onwards
Regular house to house counselling regarding essential health and nutritional messages
·        Phase 1 – Communication messages April-2016 April-2016
·        Phase 2 – Communication messages February-2017 February-2017
·        Phase 3 – Communication messages August-2017 August-2017
Consumption of fortified energy food by beneficiaries December-2016 October-2016
(Details regarding the implementation of the pilot projects are available at http://karnutmission.org.in)

In terms of real time monitoring, the period between December 2015 to September 2016 is considered as ‘preparatory phase’ as systems were being setup, field staff was being appointed and trained, beneficiaries in all project villages were being selected, and Nutrition Cards with indicators were being filled up.  The next two years (October 2016 – September 2018) may be treated as ‘implementation phase’. Implementation phase may further be divided into two major parts – from December 2015 to September/November 2016 as only ‘Information Education and Communication (IEC)’ phase and November 2016/January 2017 until September 2018 as ‘IEC + supplementary nutrition’ phase.

The present paper presents the data and analyses the outcomes of the Karnataka Multi-Sectoral Nutrition Pilot Project interventions on three undernutrition indicators of stunting, wasting and underweight among a cross-section of children aged 6-35 months, and in a cohort of children, and the changes and transitions of these indicators among them, between the time period September 2016 (baseline) and September 2018 (end-line), as the interventions progressed in the project area.

Project Design

This study has used a natural experimental design, consisting of cross-sectional baseline and end-line survey of the entire number of 6–35-month-old children who came within the project at any time and left at any time between September 2016[13] to September 2018. The data emerging during the transition process for this cross sectional group of children has been analysed at seven points in time.  (Table 2) We also identified a cohort of 699 children who were beneficiaries of the project continuously from September 2016 until September 2018, from a mean age of 9.6 months to 33.6 months. The anthropometric data of this group of children has been analysed at six points in time.

DATA COLLECTION

Baseline data for this study was finalized after completion of the preparatory stage of the project between December 2015 to September 2016. As the project was a natural experiment, where all children in the age group of 6-36 months could enter and exit at anytime, the number of children registering from inception till conclusion varied. The total number of children who had enrolled at any time during the project period was 28,599. Of these, 5511 children formed the cohort group and the remaining 23,088 children constituted the cross-section group. After eliminating cases of erroneous and missing data, the number of children in cohort group with correct and complete data reduced to 699 and number of children in cross- section group reduced to 8606. Seasonal migration of families for employment during the agricultural lean season, is another reason for missing data for children.

Total number of children registered  Total Cohort Group September 2016 to 2018 Total Cross-sectional group September 2016 – 2018
Children with complete data used for analyses 9305 699 8606
Children with incomplete/incorrect data – not used for analyses 19294 4812 14482
Total 28599 5511 23088

Background information about every child, date of birth, caste, gender, type of delivery (home/institutional), birth weight, details about initiation of breast feeding, introduction of complementary feeding were collected and recorded in the child’s Nutrition Card. The date of the VNV’s visit, and follow-up data including age (in completed months), weight (in kilograms), height (in centimetres) was recorded, on a monthly basis along with data regarding, immunization, diarrhoea episodes, and other illnesses. Infantometers were used to measure the length of infants, and digital scales for measuring the weight of infants, children, adolescents and adults. Height of children who could stand and adolescent girls was taken with a measuring tape against a wall. All the follow-up data was cleaned for outliers and missing information and all records with missing data for age and weight and height were excluded from the analysis. For the cleaned data, the anthropometric measures were calculated using WHO 2007 ‘Anthro Software Stata’ version for less than 36-month-old children.

The primary outcomes for the program in this paper are the three undernutrition measures of stunting, wasting and underweight among children aged 6-36 months. Severity of these three outcome variables are classified as moderate (below -2 standard deviations) or severe (below -3 standard deviations) or normal (children without moderate or severe condition), by using WHO child growth standards median (WHO, 2009).

All analysis was done using SPSS statistical software package version 22 and Stata version 14. Socio-economic and demographic characteristics about the two project blocks were mainly obtained from the tables of primary census abstract of the two blocks according to 2011 census. Changes in child nutrition outcomes at different periods of follow-up were measured as percent changes in the measure as compared to the baseline values, and the significance was estimated using Fisher’s exact Chi-square test. Significance of change in outcome measures was presented at p value <0.05, <0.005 and <0.0005 levels.

Results: Cross Sectional Group 

Table 1 presents percent change in severity of stunting, wasting and underweight from base line in September 2016 until September 2018 among the cross-sectional group at different points in time as indicated, and the significance of change in indicators as compared to the base line by the end of two years of intervention (September 2018). Stunting dropped from 70.0% at baseline to 63.2% at end-line and severe stunting dropped from 46.7% to 41.0%; wasting dropped from 14.4% at baseline to 6.1% at end-line and severe wasting dropped from 5.4% to 2.2%; underweight dropped from 44.6% at baseline to 22.5% at endline and severe underweight dropped from 19.0% to 6.3%.  Hence, as the interventions progressed, there was a significant drop of 56% in moderate wasting levels and of 59% in severe wasting levels.  Interventions had maximum and significant impact on underweight as proportion of severely underweight children dropped by 67% (from 19% to 6.3%) and moderately underweight children dropped by a significant 37% (from 26% to 16%).  Due to interventions, there was significant drop in both severe wasting (59%) and moderate wasting (56%). Although significant, drop in severe stunting was 12% and moderate stunting was 5%.

Thus, Table 1 conclusively establishes that there was significant improvement in stunting, wasting and underweight even with only IEC interventions and behaviour change until December 2016. However, with IEC and nutrition supplementation which started in October 2016 in Chincholli Block and in December 2016 in Devadurga Block, the improvements in anthropometric measures became highly significant. 

Table 1: Percent changes in severity of three anthropometric measures as interventions progress and significance of change in these measures as compared to baseline (pre-intervention) period, among 6-35 month old children in Cross Section Group

Results: Cohort Group

Table 2 below describes the percent change in severity of stunting, wasting and underweight among cohort of 699 children who were periodically followed from an average age of 9.6 to 33.6 months, right through the complete duration of the project intervention phases. With increase in age of child and duration of intervention, there was a corresponding substantial and significant decline in proportion of moderate as well as severely wasted and underweight children. However, during this period there was slight and insignificant increase (12%) in proportion of moderately stunted children, and negligible and insignificant drop (3%) in proportion of severely stunted children.  There was also a highly significant drop (89%) in proportion of severely wasted children from 7.6% to 0.9%, and significant drop (43%) in moderately wasted children from 8.0% to 4.6%. Almost similar changes were noticed in severe and moderate underweight levels, during this period.

From Table 2, it may be concluded that as the child’s age increased from average 9.6 months to 33.6 months and as the duration of interventions progressed there was significant and corresponding decline only in wasting and underweight indicators. There was no significant change, in fact a marginal increase in the percentage of moderately stunted children, and a marginal decrease in the percentage of severely stunted children.

Another important conclusion that can explain the marginal increase of moderately stunted children is that, as some children came out of the wasted and underweight category, they transitioned into stunting, particularly moderate stunting, because though their weight for age and weight for height indicators had improved within 2 years of the project period, this time was not enough for improvement in the height for age indicator, which would enable them to move out of the stunting category. Clearly, to reverse the transition of newly stunted children who were previously underweight or wasted, the focused inter-generational and inter-sectoral interventions as in this Pilot Project need to be in operation for a much longer period. This is more clearly and numerically explained in Figures 1 to 3 below.  

Table 2: Key anthropometric measures, percent change, significance of change in the measures as compared to baseline, as children’s age grew from 9.6 to 33.6 months in the Cohort group

#: The anthropometric categories are not exclusive. Children falling within them could also have combinations of other anthropometric deficits.Chi-square (Fishers exact test): * p <0.05, ** p<0.005, *** p<0.0005 n.s.: The change is not significantly different
Gender Variations

Variations in proportion of stunting, wasting and underweight in cohort of children, in both the intervention blocks, according to the gender of the children are provided in Table 3.

Both at baseline and at end of implementation phase, girls appear to have better indicators than boys for all the three anthropometric measures. The Table shows that in both the blocks and among both the genders, as the duration of intervention phase reached 24 months, there was a decrease of more than 60% in the proportion of wasted children and around 50% decrease in the proportion of underweight children. However, there was an increase in the percentage of stunted children (63.9% to 64.8%) in both blocks, but only among male children.  Proportion of wasted children at 9.6 months who became stunted by 33.6 months was 22% more among boys as compared to girls (69% among boys and 47% among girls) and proportion of children who were underweight at 9.6 months who became stunted by 33.6 months was 14% more among boys as compared to girls (44% in boys and 30% in girls). The reasons for the lower impact of interventions on the nutritional indicators of male children requires further research. 

Table 3: Prevalence of three anthropometric measures by gender in both blocks in September 2016 (average age of child 9.6 months) and in September 2018 (average age of child 33.6 months)

  % Stunting % Wasting % Underweight
9.6 months 33.6 months 9.6 months 33.6 months 9.6 months 33.6 months
Blocks
Devadurga (N=377) 65.0 66.6 16.7 5.6 44.8 19.1
Chincholi (N=322) 62.7 62.7 14.3 5.3 43.8 23.9
Gender
   Boys (N=347) 65.4 69.7 18.4 5.8 49.3 23.3
   Girls (N=352) 62.5 59.9 12.8 5.1 39.5 19.3
Total (N=699) 63.9 64.8 15.6 5.4 44.3 21.3
Changes and Transitions within Undernutrition, Stunting and Wasting

Figures 1, 2 and 3 provide valuable data and insights regarding the weight and height changes that occurred as the interventions progressed in duration among the cohort group, and how the three anthropometric measures transitioned as the children grew from an average age of 9.6 to 33.6 months and the duration of interventions completed 24 months in September 2018.  In the base line, out of 699 children 477 are stunted, 109 are wasted and 310 are underweight. Out of 477 stunted children, overlap of wasting into stunting is 13% and overlap of underweight into stunting is 51.5% . Among 310 underweight children, there is an overlap of 28.7% children who are wasted.

Figure 1 shows the mean height (cm) and weight (kg) of 447 stunted children and their anthropometric transition over the course of the project. The Figure indicates the critical correlation between age, height, and weight which enables a stunted child to transition from stunting to underweight and then transition to be being neither underweight, neither wasted nor stunted. The Figure also indicates the correlations between age, height, and weight where the children continued with severe or moderate stunting, or developed severe or moderate underweight, or severe or moderate wasting.

Figure 1 also presents graphic representation of the changes that occurred in weight (in kilograms) and height (in centimetres) of 447 stunted (severe or moderate) children of 9.6 months age that enabled them to transition to acquire different anthropometric combinations by the time they became 33.6 months of age after having continuously received 24 months of KMNP interventions.

Out of the 447 children who were stunted at the beginning of interventions, 108 (24%) children became normal (not stunted, not wasted and not underweight) by 33.6 months. The mean weight of these children increased by 63% (from 7.8 KG at 9.6 months to 12.7 KG by 33.6 months) and their height increased by 26% (from 66.7 to 84.2 CM) and height and weight intersected at around 18.6 months and both continued to grow at the rate required for their age.

However, half (n=225) of the stunted children continued with severe stunting at 33.6 months because their mean weight increased by 59% (from 7.4 to 11.8 KG) but their mean height increased only by 19% (from 65.5 to 78.0 CM). Their height and weight intersected at around 27.6 months and thereafter the pace of increase in height for age was slower than the pace of increase in weight for age.

95 (21%) children continued with moderate stunting by 33.6 months, as in these children weight increased by 56% (from 7.8 to 12.2 KG) and height increased by 26% (from 66.7 to 83.9 CM), and the pace of increase in both weight and height for age was slow. 

Figure 1: Role of weight (in KG) and height (in CM) as children who were stunted at baseline (September 2016 aged average 9.6 months) transitioned to different nutritional indicators by end-line (September 2018 aged average 33.6 months)

Conclusions that can be drawn from Figure 1:

Out of the 447 severely /moderately stunted children with average age of 9.6 months in September 2016:

  • 225 (50%) continued to be severely stunted at average age of 33.6 months in September 2018, as the pace of these children’s weight gain was much faster than the pace of their height gain which remained inadequate;
  • 95 (21%) children remained moderately stunted as the pace of increase in both weight and height gain for age was slower than required.
  • 5 (1%) shorter children with poor weight gain developed severe underweight;
  • 13 (3%) taller children with higher height gain and lower weight gain became severely wasted;
  • 1 shorter child was no longer stunted and became underweight
  • 108 (24%) children whose average height was shorter than those of other groups acquired normal status, ie., not stunted, not wasted, and not underweight, as their height and weight gain were optimal.

Thus, amongst these stunted children, the tallest children (with mean height gain of 23.7 cm in two years) and low corresponding weight gain (with mean weight gain of 3.2 KG in two years) transitioned to wasting and the shorter children with optimal weight and height gain became normal. The children who were stunted at beginning of intervention (September 2016 or aged 9.6 months) and became normal by end of intervention (September 2018 or aged 33.6 months), gained an average of 200 grams weight per month,  and their height increased by an average of 0.7 centimetres per month.  However, half of the stunted children in September 2016 continued with severe stunting in September 2018 as these children gained an average of 183 grams weight and 0.5 centimetres height per month, while the children with 183 grams weight gain and o.7 centimetres height gain per month continued with moderate stunting. 

Figure 2 shows the mean height (cm) and weight (kg) of 109 wasted children and their anthropometric transition over the course of 24 months of the project. The figure indicates the critical correlation between age, height, and weight which enables a wasted child to transition from wasting to becoming neither underweight, neither wasted nor stunted.

Figure 2: Role of weight (in KG) and height (in CM) as children who were wasted at baseline (September 2016 or child aged average 9.6 months) towards their transition to different indicators by end-line (September 2018 or child aged average 33.6 months)

The figure also indicates a correlation between age, height, and weight where the children continued with moderate wasting, severe wasting, developed severe stunting, became severely underweight.

Of the 109 children who were wasted in September 2016 (average age 9.6 months), 30 (28%) children became normal by September 2018 (average age 33.6 months). These children had relatively better height but less than normal weight in September 2016 and from then onwards, mean weight increased by 85%, from 7.2 KG to 13.3 KG by September 2018 and their mean height increased only by 17% (from 75.5 to 88.7 CM). Their mean height and weight intersected at 27.6 months, and thereafter the pace of increase in both variables for age remained optimal.

For 32 (29%) of 109 wasted children at September 2016 (child aged 9.6 months), signs of wasting were eliminated by September 2018 (child aged 33.6 months), and they transitioned into the moderately stunted category. During the two years of intervention phase their mean weight increased by 86% (from 6.4 to 11.9 KG) and their mean height increased by 12% (from 69.2 to 77.6 CM) Their mean height and weight intersected at around 27.6 months and then pace of increase in both variables continued, but pace of increase in height for age was sub-optimal.

Of these 109 children who were wasted in September 2016, 21 (19%) children developed underweight by September 2018, as pace of growth in weight for age did not match the pace of growth in height and these two variables did not intersect till child’s age grew to 33.6 months.

14 (13%) children developed stunting by 33.6 months as pace of increase in height for age was slower, and mean weight and mean height started intersecting at around 33.6 months.

11 (10%) children continued with severe wasting at 33.6 months due to slower pace of increase in mean weight as compared with pace of increase in mean height and both variables never intersected.

Only one child continued with moderate wasting by 33.6 months of age as the pace of increase in weight was much less than pace of increase in height during 9.6-33.6 months, and both variables had no chance to intersect in this period.

Conclusions that can be drawn from Figure 2:

Out of the 109 severely /moderately wasted children with average age 9.6 months in September 2016:

  • 14 (13%) children constantly gained weight and transitioned from wasting to severe stunting by the end of the project in September 2018. During baseline three of these children were wasted and severely stunted, four were wasted and moderately stunted and 7 were only wasted but not stunted.
  • 32 (29%) children had rapid weight gain and moderate height gain and transitioned to moderate stunting;
  • 12 (11%) relatively taller children with lowest weight gain remained severely/moderately wasted by the end of the project in September 2018;
  • 21 (19%) children with very poor weight and height gain for age developed severe underweight;
  • 30 (28%) children with optimal weight and height gain for age reached normal status with no stunting, no wasting and no underweight.

Thus, taller wasted children in this category, with lower weight gain remained wasted; taller children with optimal weight gain became normal; and those children who gained constant weight but did not gain enough height for age, transitioned into the stunted category.

Thus, from Figure 2 it may be concluded that those children who were wasted at the beginning of intervention and gained on an average 254 grams weight and 0.55 centimetres height per month, became normal by end of intervention in September 2018. However, 42% of the wasted children in September 2016 transitioned to moderate/severe stunting by September 2018 due to poor average weight and height gains of 229 grams weight and 0.35 centimetres height per month. Children with average weight gain of 204 grams per month and height gain of o.48 centimetres per month developed severe stunting.       

Figure 3 shows the mean height (cm) and weight (kg) of 310 underweight children and their anthropometric transition over the course of 24 months of the project. The figure indicates the critical correlation between age, height, and weight which enables an underweight child to transition from severe underweight to moderate underweight, and then transitions into being neither underweight, neither wasted nor stunted.

The figure also indicates a correlation between age, height, and weight where the children continued with severe underweight, moderate underweight, and developed severe wasting, or transitioned from underweight to severe or moderate stunting.

Figure 3: Role of weight (in KG) and height (in CM) as children who were underweight at baseline (September 2016 with average age 9.6 months) towards their transition to different nutrition indicators by end-line (September 2018 with average age 33.6 months)

Figure 3 provides graphic representation of how weight and height by age influence the transition of 310 underweight (severely or moderately) children from September 2016 (average age 9.6 months) to reach different combinations of three anthropometric measures by September 2018  (average age 33.6 months) after 24 months of interventions.

Of them, around 25% children (n=73) became normal with no stunting, wasting or underweight, as these children’s weight increased by 88% (6.7-12.6 KG) and height increased by 25% (66.3-82.8 CM) during intervention period. For slightly more than one-fourth (n=83) children the problem of underweight disappeared but mild stunting appeared by 33.6 months, as in these children weight increased by 88% (6.6-12.4 KG) and height increased only by 18% (65.7-77.8 CM), and both these variables intersected at around 27.6 months, after which the pace of increase in height for age was sub optimal.

However, around one-fourth (n=75) children continued with moderate underweight at 33.6 months and 9% (n=29) children continued with severe underweight, as during two years of intervention their weight increased moderately by 46% (from 6.3 to 9.2 KG) although their height increased by 22% (from 65.1 to 79.1 CM), the pace of increase in weight in these two groups was slower than that of pace of increase in height and both variables did not intersect during 24 months of intervention.

Also, 44 (14%) children developed signs of severe stunting as pace of increase in height was slower than pace of increase in weight, although both variables intersected at 27.6 months age. Six (2%) children developed signs of severe wasting by 33.6 months as pace of increase in weight dropped consistently during the last three months of the project. 

Conclusions that can be drawn from Figure 3:

Out of the 310 severely /moderately underweight children with average of 9.6 months in September 2016:

  • 44 (14%) children constantly gained weight but pace of height gain was too slow resulting in transition from underweight to severe stunting by 33.6 months;
  • 83 (27%) children with rapid weight gain but slow height gain transitioned to the moderately stunted category;
  • 75 (24%) children with moderate weight gain continued with moderate underweight;
  • 73 (24%) children who put on both weight and height rapidly became healthy (no stunting and no wasting and no underweight).
  • 6 (1%) children with rapid weight and height gain till 30.6 months but later due to drop in weight gain transitioned to severe wasting
  • 29 (9%) children with poor/stagnated weight gain continued with severe underweight.

Thus, from Figure 3 it may be concluded that 73 (24%) of children who were underweight at beginning of intervention (September 2016) became normal by end of intervention (September 2018). These children gained on an average 246 grams weight and 0.69 centimetres height per month.  However, 41% of the underweight children in September 2016 transitioned to moderate/severe stunting by September 2018 due to poor height gain.  Those who transitioned to moderate stunting gained an average of 242 grams weight and 0.5 centimetres height per month. Those children who gained an average weight of 246 grams and o.71 centimetres average height per month developed severe stunting.  Due to poor weight gain (121-154 grams), 34% underweight children continued with moderate/severe underweight.

Thus, from Figures 1-3 we may conclude that KCNM interventions were successful in transitioning 24-28% stunted/wasted/underweight children at baseline to become not stunted, not wasted and not underweight, at end-line due to weight gain of (200-254 grams per month) and height (0.54-0.70 centimetres) gain between baseline and end-line.

Our findings (Figures 2-3) also show that 29% of 109 wasted children at baseline (child aged 9.6 months) were no longer wasted by end-line as they had transitioned to moderate stunting and another 13% wasted children at baseline transitioned into severe stunting by end-line (child aged 33.6 months). On the same lines, 27% of 310 underweight children at baseline were no longer underweight by end-line but transitioned into moderate stunting and another 14% transitioned into severe stunting by end-line.

Figure 4 presents transition among the three anthropometric measures, as interventions progressed from September 2016 till September 2018, among a cross-section of 6–35-month-old children ranging from 1817 to 3374, followed-up at different points of time, who may not be the same children, but entered into the project at different points in time. The data indicates that the interventions were successful in improving nutrition levels of children, as the proportion of normal (no stunting and no wasting and no underweight) children increased from 21% at base line to 30% by September 2018 or completion of two years of intervention period, regardless of the period that the children had been under the project. A similar decline was noticed in proportion of children who were ‘’moderately/severely wasted and moderately/severely stunted and moderately/severely underweight’’ by the end of the two-year intervention period. Interventions were also successful in reducing proportion of children with different combinations of anthropometric measures. For example, children who were ’not wasted but with severe/moderate stunting and underweight’ dropped from 27-15%. Further, the percentage of children who were not wasted and not underweight and were stunted increased from 34% to 46%.

From Figure 4 it may be concluded that even among the cross-section of children with different periods of intervention, there is a 44% increase in proportion of normal children. On the lines of cohort group, even in the cross-sectional group there is an increase in proportion of only stunted children from 34% to 46% between baseline (September 2016) to end-line (September 2018), confirming the trend as seen in Figures 1,2 and 3 that many children who overcame wasting and underweight during the project period, transitioned into the stunted category. 

Figure 4: Key anthropometric measures, percent change, significance of change in the measures as compared to baseline, in the Cross Section group, as interventions progressed from September 2016 to September 2018

Summary of key findings
  • The percentage of ‘normal’ children, that is those who did not suffer from undernutrition, stunting and wasting increased from 21.7% at baseline to 30.5% at end line in the cohort group, and from 20.5% at baseline to 29.5% at end line in the cross-sectional group; underweight decreased from 44.3% at baseline to 21.3% at end line in the cohort group and from 44.6% at baseline to 22.6% at end line in the cross sectional group; wasting decreased from 15.6% at baseline to 5.4% at end line in the cohort group and from 14.4% at baseline to 6.1% at end line in the cross sectional group.
  • By the end of intervention phase (September 2018) as compared to baseline (September 2016), there was significant drop in both moderate and severe stunting, wasting and underweight levels, in the cross-sectional group. Stunting dropped from 70.0% at baseline to 63.2% at end-line and severe stunting dropped from 46.7% to 41.0%; wasting dropped from 14.4% at baseline to 6.1% at end-line and severe wasting dropped from 5.4% to 2.2%; underweight dropped from 44.6% at baseline to 22.5% at endline and severe underweight dropped from 19.0% to 6.3%
  • As compared to baseline (when average child was aged 9.6 months – September 2016) by the end-line (when average child was aged 33.6 months – September 2018) there was a significant decline in severity of only underweight and wasting indicators among the cohort group of children (severe stunting: 45.2 to 43.8, moderate stunting: 18.7 to 21.0; severe wasting: 7.6 to 0.9, moderate wasting: 8.0 to 4.6; and severe underweight: 20.3 to 5.6, moderate underweight: 24.0 to 15.7). In the cohort group, influence of interventions on improvement of anthropometric measures was highest for wasting followed by underweight, with only marginal and insignificant increase in moderate stunting. This can be explained because 29% children who were wasted and 27% children who were underweight at baseline (aged 9.6 months) transitioned into the stunting group by the time, they grew to 33.6 month (Figures 2 and 3).
  • Although, influence of interventions on reduction in wasting and underweight levels were almost uniform in both the blocks and on both genders, the nutritional indicators of girls were slightly better as compared to boys, both at baseline and end-line.
  • Data in Figures 1-3 indicates the following transitions from baseline (September 2016) when the children’s mean age was 9.6 months till end of the project, (September 2018) when their mean age was 33.6 months:

25% of stunted, 28% wasted and 24% of underweight children at baseline transitioned to normal (no stunting, no wasting and no underweight) at the end of the project, due to optimal gain in both weight (200-254 grams per month) and height (0.54-0.7 centimetres per month) for age.

27% of underweight and 29% of wasted children of the total cohort group at 9.6 months were no longer underweight or wasted and transitioned into moderate stunting at the end of the project.

18.2% of underweight (Figure 3) and 6.6% wasted children at baseline were no longer underweight or wasted by the end of the project and transitioned to moderate and severe stunting.

Hence, while 15.4% of the total cohort group progressed from stunting to non stunting, a new group of 19% cohort children transitioned from wasting and underweight to stunting and 2.7% children transitioned from stunting to wasting and underweight.  

  • From the stunted category, taller children with higher height gain and lower weight gain became severely wasted; shorter children with poor weight gain developed severe underweight.
  • From the wasted category, taller wasted children with lower weight gain remained wasted, taller children with optimal weight gain became normal, and those children who gained constant weight and poor height gain transitioned into the stunted category.
  • From the underweight category, children whose weight gain for age was optimal but height gain for age was not optimal, transitioned from underweight to severe stunting by 33.6 months; children with rapid weight gain but slow height gain transitioned to the moderately stunted category; children with rapid weight and height gain till 30.6 months but later due to drop in weight gain transitioned to severe wasting; children with poor/stagnated weight gain continued with severe underweight.
  • It can be concluded that KCNM interventions were successful in reducing the incidence of underweight and wasting among children between baseline to endline. Interventions were also successful in increasing proportion of normal children (not wasted, not stunted, not underweight) in both the cross-sectional and cohort groups between baseline and end-line.
A Unique Project that Provides Insights about Anthropometric Transitions

Perhaps this is a first of its kind project that provides evidence of the role of changes in weight (in KG) and height (in CM) of children who are underweight / wasted / stunted at 6 months as they transition to normalcy (no stunting and no wasting and no underweight) or to other indicators by the time they reached the age of 30 months, and also how three anthropometric measures transition within themselves, either improving, remaining static, or deteriorating, with increase in age and increase in duration of intervention.

Most interesting is the effect of the interventions in revealing the dynamics of stunting. KMNPP interventions were successful in significantly reducing severe stunting by 12% and moderate stunting by 5% in the cross-sectional children aged 6-35 months (Table 2). However, in the cohort group there has been a non-significant reduction in severe stunting from 45.2% to 43.8%, and an increase in moderate stunting from 18.7% to 21%. (Table 3). A study of Figures 1, 2, and 3 clearly indicates the pattern of the stunting transition. The total number of stunted children at baseline in September 2016 was 447, (63.9% of 699 cohort group children). Out of them, 108 children (15.4% of 699 children) were no longer stunted in September 2018. However, 127 out of 310 underweight children at baseline (18% of 699 children) transitioned from the underweight category to the stunted category in September 2018 as their height for age was increasing at a slower pace than weight for age. Additionally, 46 out of 109 wasted children at baseline (6.5% of 699 children) transitioned to stunted category in September 2018 as their weight for age increased but was not matched with increase of height for age. In total, therefore, while there was a 15.4% elimination of stunting within the cohort group, there was an addition of 19% stunted children who had transitioned from the wasted and/or underweight category. If we take into account 2.7% stunted children who transitioned to the wasting and/or underweight category, this could be a plausible explanation as to why the incidence of stunting in the cohort group increased overall by around 1 percentage point as can be seen in Table 2 and Figure 1. Hence, as the interventions were of a duration of only two years, which may not be a threshold duration for higher impact on reducing stunting, the analysis related to transition of beneficiary children between the three outcome indices of stunting, wasting and underweight, may require interventions of a much longer duration and more research for a robust interpretation. 

Conclusion

The positive outcomes of this project provide clear evidence that through a multisectoral and intergenerational approach, the problem of under-nutrition in children can be addressed rapidly and successfully at community/family level through the KMNPP strategy of:

  1. Addressing the information deficit among families and communities and bringing about behaviour change through effective and sustained grassroots IEC campaign which provides knowledge and awareness about proper nutrition practices, proper child, adolescent and maternal nutritional care, and creating demand for on-going, nutrition, health and sanitation programmes.
  2. Bridging the calorie-protein micronutrient deficit among target groups by making available affordable fortified, multi grain energy food supplementation for the targeted population.
  3. Creating actual convergence of nutrition and nutrition related services at the village and community level by involving community groups like NGOs/SHGs/panchayats, and creating demand through awareness generation.
  4. Real time monitoring

As this intervention has been successfully implemented in one of the most backward areas of India by supplementing and converging with existing government programs, and because the ‘’socio-ecological approach’’ of the intervention design involves family, community and governmental agencies as stakeholders to the program; and because the project actually implements several principles that have been advocated by experts over the last few decades, such as, the inter-sectoral, intergenerational interventions; emphasis on IEC and behaviour change; emphasis not only on exclusive breast feeding until six months, but also on complementary feeding, the lack and inadequacy of which is the root cause of child undernutrition in India, there is strong justification for its replication in chronic malnutrition areas. The interventions are simple but comprehensive, they address programmatic gaps, they provide for a dedicated village level volunteer, and a certain sequence of essential interventions with real time monitoring that can be replicated in any pocket of chronic undernutrition.

This study also concludes that the three anthropometric deficits of wasting, stunting and underweight, all born out of common causes of deprivation impact each other, transition within themselves, and can coexist simultaneously in different combinations. Hence, policy and programmes for addressing or preventing them, by both governments and development agencies, should not view these indicators separately in isolation, but in a much more integrated and holistic manner through the common lens of child undernutrition.

References

Directorate of Census Operations, Karnataka (2011), District Census Handbook, Gulbarga, Census of India

Directorate of Census Operations, Karnataka (2011), District Census Handbook, Raichur, Census of India

Human Development Division Planning, Programme Monitoring and Statistics Department, Human Development Performance of Districts, Taluks and Urban Local bodies in Karnataka 2014- A Snapshot, Government of Karnataka- http://14.139.60.153/handle/123456789/12283

ICMR- Indian Council of Medical Research, NIN- National Institute of Nutrition (2019): Impact Evaluation of Karnataka Multi-Sectoral Nutrition Pilot Project

International Institute for Population Sciences (2017): National Health Family Survey (NFHS 4), Karnataka state report 2015-16. Mumbai

International Institute for Population Sciences (2017): National Health Family Survey (NFHS 5), Karnataka state report 2019-20. Mumbai

Ministry of Health and Family Welfare, Government of India, UNICEF and Population Council, 2019: Comprehensive National Nutrition Survey (CNNS) National Report, New Delhi

Office of Registrar General (2020): Special Bulletin on Maternal Mortality in India 2016-18, Sample of Registration System, New Delhi

Suresh Kunhi Mohammed,  Abeyah Alomair, India: Piloting a more intense approach to malnutrition in Karnataka (2020), World Bank  https://blogs.worldbank.org/endpovertyinsouthasia/india-piloting-more-intense-approach-malnutrition-karnataka

Website of Karnataka Comprehensive Nutrition Mission www.karnutmission.org.in

____________________________________________________________

Acknowledgements 
  1. Government of Karnataka – Mr S V Ranganath and Mr T M Vijay Bhaskar, former Chief Secretaries, Government of Karnataka; Ms Vandita Sharma, Additional Chief Secretary & Development Commissioner; Dr Ramana Reddy, Former Additional Chief Secretary Health and Family Welfare; Mr Subhash Chandra and Dr Nagambika Devi, former Additional Chief Secretaries, Department of Rural Development and Panchayati Raj; Dr Shalini Rajneesh, Additional Chief Secretary, Planning, Programme Monitoring and Statistics Department; Mr Selva Kumar, former Mission Director, National Rural Health Mission and Mr D V Swamy, former Mission Director, National Rural Livelihoods Mission, Karnataka.
  2. World Bank and JSDF – Ms Julie Mc’laughlin, Dr Patrick Mullen, Ms Abeyah A Al- Omair, Dr Suresh Kunhi Mohammed, Ms Mohini Kak
  3. Global Alliance for Improved Nutrition – Dr R Sankar, Mr Tarun Vij, Dr Sadhana Bhagwat, Dr Arijit Chakarvarthy
  4. Karnataka Health Promotion Trust (KHPT), implementation partner- Mr Mohan H L, Mr Ramachandra Rao, Ms Agnita RN, Mr Shivayogi Matapathi, Mr Manjunath Doddawad
  5. Ms Harshita Chinnaswamy, Research Assistant
Endnotes 

[1] Ms Veena S Rao was Advisor to Karnataka Comprehensive Nutrition Mission and conceptualized and led the pilot projects. Presently, she is Director, AuroCentre for Public Nutrition, Public Health and Public Policy

[2] Dr. Shalini Rajneesh is presently Additional Chief Secretary, Department of Planning, Programme Monitoring and Statistics, Government of Karnataka

[3] Dr. Chaya is the lead in Karnataka Evaluation Authority, Department of Planning, Programme Monitoring and Statistics, Government of Karnataka

[4] Mr. Hanimi Reddy is a statistician with International Centre for Research on Women(ICRQ)

[5] Mr S Bharadwaj is a statistician with Sigma Research and Consulting Pvt Ltd.

[6]http://karnutmission.org.in/AboutUs/strategy/KARNATAKA%20COMPREHENSIVE%20NUTRITION%20MISSION.pdf

[7]Human Development Performance of Districts, Taluks and Urban Local bodies in Karnataka 2014- A Snapshot http://14.139.60.153/handle/123456789/12283

[8] http://karnutmission.org.in/documents/KMSNPP_Report_26DEC18.pdf

[9] Village level worker of the national Integrated Child Development Program

[10]  Accredited Social Health Activist – Village level  health worker under the National Health Mission

[11] Data from project and Taluk Panchayats (Block elected bodies)

[12] http://karnutmission.org.in/documents/KMSNPP_Report_26DEC18.pdf

[13] All the preparatory activities were completed in September 2016, namely, selection of beneficiaries in both the Blocks, selection and training of VNVs in both the Blocks, distribution of Nutrition Cards to all beneficiaries, and the commencement of data entry and real time monitoring

 

 

 

Forthcoming, India: Certificate Course on Public Nutrition, Public Health and Public Policy

PEAH is pleased to feature here a Certificate Course on Public Nutrition, Public Health and Public Policy, which was structured by our acknowledged partner Ms Veena Rao and reviewed by Indian and international experts. The Course will be taught through the Centre for Extended Education, Mount Carmel College, Bangalore and the Auro Centre for Public Nutrition, Public Health and Public Policy, India, for which Ms Rao is Director. The Course will begin in August this year and will be taught in an interactive online mode. An introductory Webinar about the Course, maybe the first of its kind in India, will be held on May 21 at 4 pm, India time

 Comprehensive Certificate Course on Public Nutrition, Public Health and Public Policy

Dear Sir/ Madam,
Mount Carmel College, Autonomous, Centre of Extended Education(CEE), in collaboration with Sri Aurobindo Society Auro Centre for Public Nutrition, Public Health and Public Policy is pleased to announce a forthcoming, comprehensive Certificate Course on Public Nutrition, Public Health and Public Policy.
Our pursuit is to proliferate education and transform students into professionals who further, responsibly achieve, and exercise their potential to empower society.
Course Commencement- August 2022
Admissions Starts : June 2022
Admission Link is provided in the brochure

Duration of the Course - 6 months

Minimum Qualification: Graduation in any field (Pursuing or Completed)

Open to Students and Professionals

The course is designed to enable a student to:

– Study India’s nutritional indicators and their causes.
– Understand the state of Public Nutrition in India, the varied dimensions of Food and Nutrition Insecurity as it exists in India, and how it impacts public health and human resource development and economic development.
– Critically examine the Policy responses, initiatives or lack of them, and their effectiveness in addressing the problem of Food and Nutrition Security and Community Nutrition in India
– Study the design and content of ongoing national programmes addressing undernutrition and micronutrient deficiency, and their impact.

Interested candidates are invited to participate/ enroll in this Program.

A conclave is conducted on the 21st May, Saturday, 2022.
Date : 21st May 2022

Time: 4PM – 5PM

Register to get the Meeting Link

https://forms.gle/spKcBvcga3VJGLWY9

Reflections on Transforming Higher Education for the 21st Century: PART 3

This paper was prompted by several factors: (1) an earlier invited  chapter,included in a book entitled  Civil Society and Social Responsibility in Higher Education, created in partnership with the International Higher Education Teaching and Learning Association; (2)  increasing global  awareness and  adoption of the One Health (and Wellbeing) concept/approach across political arenas and disciplines;   and (3) the urgency for academia - as it has historically done - to take a leadership role in responding  to the unprecedented and complex challenges the world now faces with climate change and upholding democracy at the top of global agendas. Recent elections in several European countries represent a welcome shift from authoritarianism and  populism - the erosion of liberal values  - to centrist politics, a trend that may be cause for optimism around the world.

Education, formal / non-formal, research and community engagement are key, as UNESCO advocates, in bringing “shared values to life” and cultivating “an active care for the world and for those with whom we share it.”  Transforming the way we “think and act” necessitates a more holistic understanding of  planet sustainability as well as re-thinking what and how we learn and, in particular, re-directing current conceptualisations  of  curricula, research and policy development  toward a new academic  “knowledge ecology (symbiotic relationship) between all living things  and the environment) through  the development of an “interconnected ecological knowledge system.”

Time is not on our side. The UN International Panel for Climate Change (IPCC) in its latest report has warned that unless we limit global warming to 1.5C. and cut carbon emissions by 43%  by 2030  the world is on course for catastrophic warming of 3.2 C by the end of this century. Biodiversity loss, emerging infectious diseases, such as Covid-19, and geopolitical tensions are also at the forefront of global crises in this decade, which must surely lead us to question our fundamental relationship to the planet  and to each other.

Because of subject-matter scope, the paper is being published by PEAH in three parts over few weeks span:

Part 1: The One Health & Wellbeing Concept

Part 2: Development of a Global ‘All Life’ narrative

Part 3: The international One Health for One Planet Education Initiative (1 HOPE) and the ‘ecological  university’

George Lueddeke

By George LueddekePhD

Consultant in Higher, Medical, and One Health Education

Global Lead – International One Health for One Planet Education initiative (1 HOPE)

Reflections on Transforming Higher Education for the 21st Century

BRINGING ‘SHARED VALUES TO LIFE’

Part 3: The international One Health for One Planet Education Initiative (1 HOPE) and the ‘Ecological  University’

 

 Part 1: The One Health and Wellbeing Concept

Part 2: Development of a Global ‘All Life’ Narrative

 

The folly of a limitless world

In the Living Planet 2014 report, Dr Marco Lambertini, director general of  Worldwide Wildlife Federation (WWF) International, gently reminded that given the state of the world including a huge drop  (c. 50%) in population sizes of vertebrate species, “We need a few things to change.” These included finding “unity around a common cause,” public, private and civil society “to pull together in a coordinated effort,” and “leadership for change“ especially  for “Heads of state to start thinking globally” and along with “businesses and consumers …to stop behaving as if we live in a limitless world.”  He called for the world to “stop and think” about the kind of future we are heading for.”

In the intervening seven years, the decline of species has continued and globally, as the Living Planet 2020 report confirmed, now stands at 68 percent (Figure 6) with the highest drop in South America and the Caribbean at 94 percent. The world is indeed “in trouble,” underscored  by  the International Panel on Climate Change (IPPC) 2021 report .

A short  article, entitled ‘Silent Earth: The decline in insect life is a threat to the survival of humans and all living species’ focused on insects, which account for more than half of all species on the planet (c.8.5 million) and are “in precipitous decline” about “ 34 per cent a decade.” The consequences are startling: “the world would soon run out of food. Not enough crops could be grown to the feed the world. The world would become barren. The extinction of bird species would accelerate.” Humankind continues to be responsible (irresponsible?), as stated in the piece, and while farmers are now spraying crops and apparently are using pesticides sparingly, “The toxic load grew sixfold between 1990 and 2015.”

Figure 6:  Decline of species across the globe

(Source: COP26 presentation: Tackling the Root Causes of Climate Change, 2021)

 

Global and national organisations are commended for their resolve to strengthen equity, access and quality through meetings, conferences and reports leading to specific statements of intent and recommendations since the launch of the UN-2030 SDGs.   These include the UN – 2030 SDGs (2015), the Incheon Declaration for Education 2030 (2015-based on SDG 4), UNESCO’s education mission (2017), the Commonwealth Education Policy Framework (2017), the World Bank Group ‘World Development report 2018,’ and the OECD Education 2030 initiative (2018).

During these years, funding of education became a top priority, including a high-level event in 2017 during the seventy-second session of the UN general Assembly in New York: “Financing the future: Education 2030” highlighting, as one example, that globally “130 million girls are out of school today…pushing back against poverty, war and child marriage to go to school” and the urgency to “invest in girls.” UN Secretary General Guterres emphasised that “investing in education is the most cost-effective way to drive economic development, improve skills and opportunities for young women and men, and unlock progress on all 17 Sustainable Development Goals.” These comments were echoed by the former UK Prime Minister and UN Special Envoy for Global Education and UN Education Commission Chair, Gordon Brown, stressing that “Delivering an education for all-and not just some children is the civil rights struggle of our time” especially in light of the refugee crisis then and now exacerbated by the war in Ukraine and conflicts elsewhere.

Perhaps the incoming Director-General of UNESCO and former French Minister of Culture and Communication, Audrey Azoulay, said it best in 2017 in her investiture speech highlighting:

“The challenges posed by to the world today by environmental degradation, terrorism, attempts to discredit scientific findings, attacks on cultural diversity, the oppression of women and the massive displacement of populations,” necessitating “the need for concerted strategies in the framework of multinationalism to face the challenges today and tomorrow.”

The Minister’s theme was well captured in the OECD The future of education and skills 2030 project in 2018 which put forth that education was “more than getting a good job and high income” but “the need to care about the well-being of their friends and families, their communities and the planet.”

Education and research for the 21st century

As discussed in this article, to address climate change, biodiversity loss and avoid a repeat of the pandemic, the shift from human-centrism (anthropocentrism) – ’it’s all about us’- to eco-centrism – ‘it’s about all species, including us, and relationship to the planet – is profound.  Taking on board the One Health and Wellbeing concept, Earth Charter values and principles and the UN Sustainable Development Goals could make the difference between planet sustainability and a dystopic world.

Whether we are able to achieve a “more just, sustainable and peaceful world” will depend on the decisions we make now as opportunities for social transformation are becoming increasingly time- limited. There is no question that new thinking is required and that both education and research are key in moving societies in new directions to ensure planet sustainability.  To these ends, here are a few re-orientations to consider by governments, corporations and civil society in general to sustain life on the planet shifting from:

  • Human-centrism to eco-centrism;
  • subject fragmentation to disciplinary integration;
  • knowledge transfer to knowledge discovery;
  • intervention to prevention and a future consciousness;
  • individualism to ‘learning from and with others’:
  • those who ‘have‘ to those who ‘have not’;
  • thinking globally to acting locally;
  • profit margins to self-fulfilment and ‘doing something good’;
  • self-interests, ambition, power to understanding, compassion and truth.
The international One Health for One Planet Education initiative (1 HOPE)

Transformations in the preceding paragraph reflect the importance, as UNESCO contends, for an “education” that is “transformative” and that cultivates “an active care for the world and for those with whom we share it.”  In Part 2 of this article a similar argument was made for today’s research priorities.

1 HOPE originated with ‘Ten Propositions for Global Sustainability’ (Annex), outlined in  Survival: One Health, One Planet, One Future , and in particular Proposition #7 which called for  consideration of the One Health and Wellbeing (OHW) concept becoming “the cornerstone of education systems and societal institutions” underpinning  the UN-2030 SDGs. In 2018/19 several working groups (education and governance) were established by the One Health Education Task Force, hosted by two leading One Health organisations, the One Health Commission (OHC), and the One Health Initiative (OHI), to take forward the One Health concept and the SDGs in sub-Saharan Africa (SSA) and the Americas. While spearheaded by dedicated and highly experienced colleagues in these regions (Higher Education at the  University of Global Health Equity [Rwanda] and  Primary/Secondary Education  at the University of Yaoundé [Cameroon]) , implementation proved to be challenging partly because of the need to (1) create   greater awareness of I HOPE across highly populated regions and build concept understanding and ‘ownership’; (2)  engaging  cross-disciplinary working group members; (3)  reconciling competing time pressures / university priorities; (4)  funding/infrastructure to support planned pilot activities; and (5)  the emergence of Covid-19. Considered collectively, these   difficulties necessitated a comprehensive review of 1 HOPE building on OHC/OHI progress and leading to the formation of sub-regionally-focused  planning teams (Africa , Americas, Asia, Europe, Oceania) while continuing to raise awareness of 1 HOPE (IPR) and the SDGs as  integrative concepts and approaches globally in association with various organisations. In the past year, these have  included, among others,  the University of Pretoria/Future Africa, the Indian Regional Association for Landscape Ecology the International Student One Health AllianceGIZ-HWC,  the International Veterinarian Students’ Association, Afrique One–ASPIREOne Health Lessons, the CORE Group, the All India Institute of Hygiene and Public Health,  and COP-26.

Further to regional consultations during 2021/2022, consortium planning groups have to date generally agreed on five ways forward:

  • focusing on priority concerns or needs at regional or sub-regions levels;
  • adopting the main 1 HOPE aspiration and regional involvement (Figures 7 & 8), informed by the OHHLEP definition of One Health (Part 1);
  • establishing regional consortia led by ‘university – affiliate’ planning teams with representatives drawn from a cross-section of disciplines and societal sectors (civil, gov’t, business);
  • strengthening collaborations with existing regional organisations engaged in addressing immediate and longer-term risks or problems related to present and future global sustainability; and
  • considering the formation of a global 1 HOPE ‘advisor forum’ to guide regional strategic planning.

Figures 7 & 8: The international One Health for One Planet Education initiative (1 HOPE)

(Source: Rebuilding Trust and Compassion in a Covid-19 World, 2021)

University leadership: Towards the ecological university

In his book The Ecological University: A Feasible Utopia,   Emeritus Professor Ronald Barnett at the UCL Institute of Education reminds us that our ‘responsibility’ is steeped in values and matching these for  the 21st century and to mass higher education remains a major gap.

He concludes that our university “knowledge ecosystem” is impaired – too bounded, too imbued with the interests of the powerful –and with limited levels of critical reason.” Mirroring the interconnection and indivisibility of the SDGs, the author  proposes a new university “knowledge ecology (symbiotic relationship between all living things  and the environment) and the development of an “interconnected ecological knowledge system”  that recognises six different regions of knowledge or zones: knowledge, learning, culture, persons, society more broadly, and the natural world. Of these,  the author  maintains  that economics  has become the most dominant in universities. However, as this article highlights, climate change has now become the most serious global risk, demanding identifying root causes and mitigating their impact on the planet and all species.  From educational, research and community perspectives, we are now tasked to take a much more holistic view of the world, assumptions, beliefs, practices and the urgency, as Professor Kuiken argues, to pay “equal attention to the health (and wellbeing) of ecosystems, animals, and humans” while ensuring that environmental boundary conditions are not transgressed. In short, Professor Barnett calls for “a new kind of knowledge management” that “engages with the world,” and where “university leaders” become “active epistemologists” – “ethically oriented and imbued with a concern for the whole Earth.”

This shift in global priorities has significant  implications for education and research encouraging  policy-makers  to re-think the purpose and priorities of societal institutions, including universities and schools (Annex). The SDGs have shown the way by making us aware of the interdependency of human activity and collective impact on the planet along with  the need to re-structure education systems to integrate these realities through the developments of  interconnected ecological knowledge systems with a concern for the whole Earth.  A hallmark of this transformation would be to  foster integrative thinking and helping learners / researchers to find their way through disconnected bodies of information and perspectives including finding ways to  curb society’s huge appetite for exploitation, brutal competition and conflict.

In this regard, Professor Jeffrey Sachs, president of the UN Sustainable Development Solutions Network, referencing the SDSN Leadership Council Statement on the War in the Ukraine, recently noted the “heightened responsibility educators and  university leaders” have in better preparing  students to face and help address these unimaginable and devastating situations. His key message resonated with the main themes of this article underscoring  that universities “must teach not only scientific and technical know-how to achieve sustainable development, as important as those topics are today, but also the pathways to peace, problem solving, and conflict resolution.

With the latter in mind,  Figure 9  illustrates how  concepts and constructs discussed in this article  might be brought together as a conceptual framework in the development of the ‘ecological university’ based on the underpinning the values of the One Health and Wellbeing concept and basic  principles of the Earth Charter to inform the UN-2030 SDGs in  order to achieve  the UN Transformative Vision. 

Figure 9:  A conceptual framework for building the ecological university

Considerations for transformative change and global sustainability

As things stand, we are facing unprecedented global risks – climate change, biodiversity loss, emerging diseases, geopolitical tensions, to name several threats, while also seeing an increasingly fractious, divided and dangerous world.

Dr. Marco Lambertini, Director General of the WorldWide Fund for Nature International (WWFI) challenged us several years ago to respond to three main questions:

  • “What kind of future are we heading toward?”
  • “What kind of future do we want?”
  • “Can we justify eroding our natural capital and allocating nature’s resources so inequitably?”

William Joy, an American computer scientist, posed similar queries in Why the future doesn’t need us  providing  the main rationale for doing so, that is:  if we could agree “as a species, what we wanted, where we are headed, and why, we could make our future much less dangerous and then might understand what we and should relinquish.” 

Concluding comments

After billions of years of evolution, in just a few decades we have come to an inevitable turning-point. While we have made significant scientific / technological progress, we have failed to safeguard life on the planet including ours (we are but one of about 8.5 million species!). Although we have cognitive and affective capacities for achieving a harmonious world, our lives continue to be overridden by the self-interests, ambitions, and power of a few (1%?) -think  AI and technology! 

In the longer run, it appears that “a more just, sustainable and peaceful world” can only be achieved if we all realise the consequences of our short-term thinking (e.g., profits over survival, control or enslavement over freedoms) and learn to rise above the human-fabricated divisions and inequities that divide us (social, political, religious, economic, etc.). If we fail, so will future generations and humanity. Democratic societies depend on a shared belief in ‘something greater than themselves’ and holding ‘power to account’.

The United Nations, including the Youth Forum ,and Higher Education  have  pivotal roles to play in  safeguarding  our democratic freedoms.  The UN, “the world’s largest universal multilateral international organisation” has offices in 193 countries and 37,000 employees, and there are over 90,000 institutions and 200 million students across higher education. With their immense outreach capacity, knowledge base and combined leadership synergy, they are in a prime position to raise awareness that ‘the one thing we have in common is our planet’, that major societal transformations are required – compassion, empathy trust for global sustainability, and that making the world work better is our greatest challenge. The younger generation has the most to gain by raising their collective voice about global sustainability but also the most to lose by not doing so. As Nelson Mandela, former president of South Africa said several decades ago: “Sometimes it falls upon a generation to be great. You can be that generation. Let your greatness blossom.” Now is the opportunity for doing so and meeting the challenges set by the 126 Noble Laureates in their Our Planet, Our Future’ Statement and delivered to world leaders ahead of the G-7 Summit in 2021.

“Ultimately,” Emeritus Professor of Neurology Dr. David Wiebers at the Mayo Clinic in Rochester, Minnesota, USA reminds us: “the survival not only of other species on this planet, but also of our own, will depend upon humanity’s ability to recognise the oneness of all that exists, and the importance and deeper significance of compassion for all life.”

The choice is ours!

 Annex

Figure 10: Ten Propositions for Global Sustainability

 WHAT IF?

News Flash 479: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

News Flash 479

Weekly Snapshot of Public Health Challenges

 

Dr. Gregory D. Bossart Memorial One Health Scholarship 2022 Application Deadline July 1, 2022, 11:59 pm EDT

WHO Special session of the Regional Committee for Europe Virtual session, 10–11 May 2022: WHA75: Health emergency in Ukraine and neighbouring countries, stemming from the Russian Federation’s aggression 

MSF comments on the clinical trial resolution at the 75th World Health Assembly

Webinar Registration: People’s realities, determinants of health, democratic governance: Connecting dots outside the doors of the World Health Assembly – G2H2 policy debates, May 2022

Webinar Registration: Pillars of Health launch event in the European Public Health Week May 20, 2022 02:00 PM in Amsterdam

Social justice now for an equitable tomorrow: Reflections from the Consortium of Universities for Global Health Conference 2022

Reflections on Transforming Higher Education for the 21st Century: PART 2 Development of a Global ‘All Life’ Narrative by George Lueddeke

Call for Papers: PLOS Medicine Special Issue on the COVID-19 Pandemic and Global Mental Health

China’s Zero-COVID Strategy is ‘Unsustainable’, says Tedros After Six-Week Shanghai Lockdown

Three COVID-19 vaccine doses prove more protective than two in new study

COVID-19 vaccine delivery and demand ‘slowing down’

Africa’s vaccination effort is not losing steam. It is becoming more strategic

COVID-19, Long-Term Care, and Migration in Asia

End Malaria Faster: Taking Lifesaving Tools Beyond “Access” to “Reach” All People in Need

A DEADLY DIVIDE: TB COMMITMENTS VS TB REALITIES FINAL REPORT

Adenovirus, COVID-19 examined as possible cause for mysterious hepatitis

Catastrophic health expenditure in sub-Saharan Africa: systematic review and meta-analysis

WHO highlights glaring gaps in regulation of alcohol marketing across borders

Human Rights Reader 628: WOMEN ARE NEITHER A BIOLOGICAL NOR A DEMOGRAPHIC MINORITY, BUT THEY ARE TREATED AS A MINORITY

Most Maternal Deaths Are Preventable: How To Improve Outcomes in South Africa

Fighting child sexual abuse: Commission proposes new rules to protect children

If global health equity is to stand a chance, the UK must cancel its plans to offshore asylum seekers to Rwanda

Are death and suffering in Ukraine different than in Yemen, Afghanistan or Ethiopia? Double standards in humanitarian assistance

Systemic exclusion of Dalits within local governance: Between dream and reality of affirmative action policies for fair representation

Parameswaran Iyer: transforming sanitation behaviour at scale

Extended mandate: First meeting of Executive Steering Group on Shortages and Safety of Medicinal Products (MSSG)

Report: Hunger reached record high in 2021, may worsen in 2022

Cost of living crisis deepens malnutrition

Tyre wear: an underestimated source of air pollution that needs to be tackled 

Exclusive: U.N. climate czar Carney in new bid to get private equity onboard

Progress on reducing harmful gas flares is stalling, World Bank says

EU agencies push back glyphosate assessment to mid-2023

Vanuatu’s push for legal protection from climate change wins crucial support

Global Climate and Health Alliance: Upcoming climate and health events

 

 

 

 

 

 

 

 

 

 

Reflections on Transforming Higher Education for the 21st Century: PART 2

This paper was prompted by several factors: (1) an earlier invited  chapter,included in a book entitled  Civil Society and Social Responsibility in Higher Education, created in partnership with the International Higher Education Teaching and Learning Association; (2)  increasing global  awareness and  adoption of the One Health (and Wellbeing) concept/approach across political arenas and disciplines;   and (3) the urgency for academia - as it has historically done - to take a leadership role in responding  to the unprecedented and complex challenges the world now faces with climate change and upholding democracy at the top of global agendas. Recent elections in several European countries represent a welcome shift from authoritarianism and  populism - the erosion of liberal values  - to centrist politics, a trend that may be cause for optimism around the world.

Education, formal / non-formal, research and community engagement are key, as UNESCO advocates, in bringing “shared values to life” and cultivating “an active care for the world and for those with whom we share it.”  Transforming the way we “think and act” necessitates a more holistic understanding of  planet sustainability as well as re-thinking what and how we learn and, in particular, re-directing current conceptualisations  of  curricula, research and policy development  toward a new academic  “knowledge ecology (symbiotic relationship) between all living things  and the environment) through  the development of an “interconnected ecological knowledge system.”

Time is not on our side. The UN International Panel for Climate Change (IPCC) in its latest report has warned that unless we limit global warming to 1.5C. and cut carbon emissions by 43%  by 2030  the world is on course for catastrophic warming of 3.2 C by the end of this century. Biodiversity loss, emerging infectious diseases, such as Covid-19, and geopolitical tensions are also at the forefront of global crises in this decade, which must surely lead us to question our fundamental relationship to the planet  and to each other.

Because of subject-matter scope, the paper is being published by PEAH in three parts over few weeks span:

Part 1: The One Health & Wellbeing Concept

Part 2: Development of a Global ‘All Life’ narrative

Part 3: The international One Health for One Planet Education Initiative (1 HOPE) and the ‘ecological  university’

George Lueddeke

By George Lueddeke, PhD

Consultant in Higher, Medical, and One Health Education

Global Lead – International One Health for One Planet Education initiative (1 HOPE)

Reflections on Transforming Higher Education for the 21st Century

BRINGING ‘SHARED VALUES TO LIFE’

PART 2: Development of a Global ‘All Life’ Narrative

 (Part 1: The One Health and Wellbeing Concept)

 

On human thought, Beliefs, and behaviour

Throughout the millennia education has played a critical role in shaping human interactions, including to the present when after 4.5 billion years of evolution and revolutions – cognitive, agricultural, scientific, information– humanity is now at a precipice.

In A vision for human well-being: transition to social sustainability,  the authors argued that “[M]aintaining a healthy environment and transitioning toward sustainability”  is difficult  as “communities and societies are inherently conservative, and do not change unless something pushes them… despite the fact that many see disaster looming.”

Two of their key premises are that sustainability requires “human societies that function well” and that “social, economic and political breakdown only perpetuates environmental abuses.” The main obstacles to sustainable development, they asserted, can be traced to global unwillingness or capacity “to provide the resources necessary of the communities most in need” by ensuring “a more equitable global distribution of resources and empowerment” and “a global focus on growth in well-being instead of consumption.”

Taking a largely humancentric stance, the authors advanced that in order to achieve these aims we need a “systematic effort to monitor progress towards well-being (physical, social, emotional) and understand its drivers, “while recognising that communities currently in poverty will need additional consumption in order to do well.”

However, simply acknowledging that deprivation, hunger, suffering and inequities exist is not enough. We have the data, but, as David Wiebers, Emeritus Professor of Neurology at Mayo Clinic posits, too often we lack the “principal motivation to reach beyond ourselves and beyond what we may have thought possible, ” including extending “compassion and care”  to “beings other than humans, who also have a consciousness and a set of yearnings that demand uncompromising respect.” For Professor Wiebers “Scientific achievement is indeed a wonderful thing-in direct proportion to how much it either reflects or reinforces compassion for all life.”

As Figure 3 illustrates, both human and ecosystem measures (non-human animals, plants, environment) are critical as these interventions determine the health and wellbeing of humankind in a reciprocal relationship.  

Figure 3: Links between human well-being and the environment

(Source: Science Direct:   A vision for human well-being: Transition to social sustainability  [2012])

Building blocks for global sustainability

Today’s unprecedented perils demand major transformations to move societies in the direction of social and environmental sustainability. According to the authors, previously cited,  of ‘Why ecocentrism is the key pathway to sustainability,’ anthropocentrism, which, as mentioned,  “values other lifeforms and ecosystems insofar as they are valuable for human well-being, preferences and interests,” remains the main “ideology in most societies around the world – permeating academia and domestic and international governance.”

In contrast, the authors contend “that a fully sustainable future is highly unlikely without an ecocentric value shift that recognises the intrinsic value of nature and a corresponding Earth jurisprudence.”  Underpinned by ecocentric values and principles, learning that “cultivates an active care for the world and with those we whom we share it” remains our best option for ensuring the sustainability of the planet and all life. To these ends, several key constructs and developments are particularly timely and pivotal in shaping global education and research environments: the One Health (and Wellbeing) concept applied to all species and the planet, the Earth Charter and the UN-2030 Sustainable Development Goals: 

The One Health and Wellbeing Concept

The concept/approach, discussed previously, underpins the belief that “the health of people, other animals and the ecosystems of which we are a part are inextricably woven together,”  and emphasising “ respect and care to all life, and indeed to terrestrial and aquatic ecosystems themselves.”

The Earth Charter

Launched in 2000, the Earth Charter, (EC) was “[C]rafted by visionaries over twenty years ago” and, as summarised in Figure 4, “is a document with sixteen principles, organized under four pillars that seek to turn conscience into action” and “inspire in all people a new sense of global interdependence and shared responsibility for the well-being of the whole human family, the greater community of life, and future generations. It is a vision of hope and call to action.

The EC Education Center, located on the campus of the UN Mandated University for Peace in San José, Costa Rica, “offers a variety ofonline and on-site education programmes that highlight the importance of incorporating sustainability values and principles into decision-making and education. Its “work is implemented under the UNESCO Chair on Education for Sustainable Development with the Earth Charter, which generates educational programmes and research activities at the intersection of sustainability, ethics and education.” 

Figure 4: The Earth Charter

 Pillars and Principles -‘Turning Conscience into Action’

(Source: Earth  Charter Organisation: Celebrating 20 years of the Earth Charter with a new face! [2020])

The UN Global Goals 

Millennium Development Goals (2000-2015)

Coincidentally, the year 2000 also saw agreement by world leaders at a UN summit of the Millennium Development Goals (MDGs) setting targets for poverty reduction, primary education, equality, child mortality, maternal health, HIV/AIDS, malaria and other diseases, environmental sustainability and global partnerships.

While the final report acknowledged that progress was “made across the board, from combatting poverty, to improving education and health, and reducing hunger, “ much more needed to be done. UN Secretary-General Ban Ki Moon in the report Foreword highlighted that “we know what to do” and called for “unswerving political will, and collective, long-term effort“: tackling  root causes and do more to integrate the economic, social and environmental dimensions of sustainable development.”  

The Sustainable Development Goals (2016-2030)

Superseding the MDGs, on 25 September 2015, 193 Member States of the United Nations General Assembly ratified the UN 2030 Sustainable Development Goals (SDGs), as shown in Figure 5. 

Figure 5: The Sustainable Development Goals (SDGs) [2016])

(Source: United Nations,  [2016])

The UN Transformative Vision underpinning the seventeen SDGs focuses on both human and environmental needs prioritising the interconnections between the two. In the past few years, the root causes of global threats have become much clearer as are attempts to address these (e.g., surveillance data, green economy, prevention [vaccines]). However, global adoption of the SDGs and in particular its main aim to “create a more just, sustainable and peaceful world” remains a fundamental global challenge as current events and on-going risks are demonstrating. Truth, trust, compassion, and collaboration are key to planet sustainability but continue to be eroded by authoritarian agendas that place self-interests (e.g., geographical expansionism) despite the fact that climate change and conflicts threaten the future of all species including homo sapiens.

In this regard Professor Jared Diamond’s seminal book, Collapse:  How Societies Choose to Fail or Survive, based on, among others, “ancient Maya, Anasazi and Easter Island” societies,” is even more critical today than in 2005 when it was first published.  Main reasons for societal demise, the author concluded, were lack of “long-term planning and willingness to reconsider core values.” While the present world situation seems irreconcilable, perhaps placing our faith and trust in the new generation – Generation Z (born from 1997 onward) – is the way forward. As Mary Meehan, a cultural scientist said in a Forbes article several years ago: “They represent boundary-blurring countries and the reality of our shifting global culture. Already they display a great interest in and tolerance of ‘others.’ ”

A recent US cultural intelligence report entitled  Gen Z Complexities: You’ve Only Heard Half the Story highlights that in terms of politics, Gen Z   “are perceived to neatly fit under a liberal umbrella, focused on issues like social justice, climate activism, gun safety and voting rights.”   In addition, climate change and inaction are major concerns” prompting many to commit “their lives to finding a solution.”   Gaining “economic, social, and political power, the changes they’ll look to make will be structural, but not superficial” – which could not only encourage” humans to reconnect with their planet,”  as Professor Johan Rockström at the Stockholm Resilience Center advocates, but also take on board  the urgency to re-orient thinking from ‘it’s all about us’ (human-centrism) to ‘it’s about all species and planet sustainability (ecocentrism)”. 

Impact of Covid-19 on SDG progress

 The SDG Report 2020, prepared by the United Nations Department of Economic and Social Affairs (UNDESA) in collaboration with more than 50 international agencies, noted that progress on meeting SDG targets was already slow with many of the goals not reaching their targets by 2019. While the latter report was disappointing, the SDG Report 2021 was devastating, as most of the developments  over the past few years, were “halted or reversed,” also underscored  in a The Lancet Public Health editorial . The pandemic had “exposed and intensified inequalities within and among countries” as well as crises relating to climate, biodiversity loss and pollution, including increasing poverty, hunger, health, education, sanitation, greenhouse gas emissions, infectious diseases, to name a few areas – all threatening “peace and safety from violence” requiring “a major realignment of most countries’ national priorities toward long-term, cooperative, and drastically accelerated action.”

The university sector:  Valuing the SDGs – Impact Rankings 2021

In July 2019, the President of the 8th Economic and Social Council (ECOSOC) Youth Forum, where voluntary national reports against the SDGs were considered, voiced similar concerns calling “upon young people to continue to raise their voice, advocate for the SDGs, and hold their Governments accountable for the commitments made in the 2030 agenda.”

In this respect The Times Higher Education SDG Impact 2021 global university performance tables may be telling. The impact rankings are “the only global performance tables that assess universities against the UN SDGs” providing “comprehensive and balanced comparison across four broad areas: research, stewardship, outreach and teaching.” The 2021 impact rankings include submissions from 1,118 universities and 94 countries/regions. The UK’s University of Manchester leads other universities for the first time along with three Australian universities – the University of Sydney, RMIT University and La Trobe University in the top four. Interestingly, ‘Russia is the most-represented nation in the table with 75 institutions, followed by Japan with 73.’

Perhaps unsurprisingly, in terms of research priorities all top universities still focus on human health and well-being (human-centrism – SDG # 1,4,5,10,16; SDG #8, Decent Work and Economic Growth, and SDG #9, Industry Innovation and Infrastructure) and not with ensuring the sustainability of all life – plants, nonhuman animals and the environment (eco-centrism-) on which all life on this planet depends (SDG# 13,14,15 and climate emergency). SDG #16, Peace, Justice, and Strong Institutions is mentioned by only 5. Few universities, it seems, have considered how many of the solutions we seek are found in the natural world. 

Toward a new narrative for global sustainability (research and education!)

In his groundbreaking paper, ‘Implications of Transformative Changes for Research on Emerging Zoonoses,’ Professor Thijs Kuiken, argues for “a new narrative that promotes a sustainable way of living” and, as summarised  in the Table, “would be an integral part of nature and balance our needs with those of other living species”.  While his article focuses on zoonosis – infectious diseases of animal origin, his proposal has wider implications for education, research and public policy and transformative change toward sustainability implemented by “leaders of universities, institutes, societies, and funding bodies” across societal sectors and disciplines”.

Table:  Possible Effects of a New Narrative on Choice of Problems, Methods and Solutions of Research on Emerging Zoonoses

(Source: EcoHealth: ‘Implications of Transformative Changes for Research on Emerging Zoonoses, 2021)
Research section Current narrative New narrative
Research problem formulation Focus on human health Equal attention to health of ecosystems, animals, and humans
Emphasis of financial cost to society Equal attention to ecological, social, and financial costs to society
Restricted scope e.g., interaction between pathogen and human cost only Broad scope: interrelated ness of all organic and inorganic elements in the system included
Choice of scientific methods Emphasis on financial cost Equal emphasis on environmental impact
Development of solutions for addressing zoonotic disease issues Emphasis on current event Attention to all events of this nature
Short term Also, long-term
Solution for proximate causes well accepted Solution for proximate causes accepted only if action undertaken to deal with ultimate causes
Acceptability determined by possibility to continue financial profit of human activity involved Acceptability determined by improvement to health and well-being of humans and animals, and to health integrity of ecosystems
Reconciling global funding inequities and addressing new existential challenges

Adoption of a new ecocentric narrative could also raise awareness, highlighted in an informative article last year by Dr Bruce Kaplan, co-founder of the One Health Initiative and  Richard Seifman, UN Association of the National (USA) Capital Area. A follow-up commentary  underscored the pressing need to strengthen  funding of world organisations, including  WHO which receives approximately US $6 billion annually; the FAO, c. $2.6 billion and the OIE (the World Organisation for Animal Health (OIE), only c. $32 million!

As investments in humanity’s future, these figures pale in comparison to the global  human and  financial costs of Covid-19 to date:  6.25 million  deaths as well as  517 million cases; and economic costs: US $ 12.5 trillion and beyond , set against a world annual economy (Gross Domestic Product [GDP] – all goods and services) estimated around $ 95 trillion in 2021 and Global military spending  which for the first time stands at US $ 2 trillion – with  mainly the USA, China, India, UK, and Russia spending 65 % of the total.

These amounts are staggering and should make government and corporate policymakers re-think the rationales of these escalating expenditures, human values that underpin them and where they may eventually lead if not reconsidered on moral or injustice grounds alone and how to mitigate these in future.

Worldwide, about US $4.7 trillion are allocated to education annually but “only 0.5% is spent in low income countries, while 65% is spent in high income countries, even though the two groups have a roughly equal number of school-age children.”  Public spending on higher education is about US $1 trillion per year with a major “shift of higher education’s centre of gravity from the Global North to the Global South,” according to a “definitive world report” launched the by Toronto-based Higher Education Strategy Associates (HESA).

The number of higher education institutions in the Global South “nearly doubled from a little over 40,000 to nearly 70,000, to reach a global institutional total of 90,000” (versus c. 20,000 in the Global North.)  However, “the number of dollars per student is going up in the North, but going down in the South,” while funding in the Global North is allocated to “quality, equity and research,” whereas “[I]n the Global South, the money mostly goes to increased capacity and access.”

Concluding comment

In the  introduction to the SDG Report 2021,  Liu Zhenmin, UN Under-Secretary-General for Economic and Social Affairs, calls for “a unified vision of coherent, coordinated and comprehensive responses from the multilateral system.”  In light of the unprecedented risks we face (climate change, democracy,  political tensions), global  responses aligned with the SDGs necessitate, as the UN USG asserts,  “action and participation from all sectors of society, such as “ Governments at all levels, the private sector, academia, civil society and individuals – youth and women, in particular.”

————————————-

 Parts 1 and 2 of the present article have argued for the wider adoption of the ecocentric One Health and Wellbeing concept to underpin the Earth Charter values and principles and together informing the UN Transformative Vision and action, including cultivating, as UNESCO advocates,  “an active care for the world and for those with whom we share it.” 

Part 3 to follow considers societal options -education and policy directions -  for doing so.

News Flash 478: Weekly Snapshot of Public Health Challenges

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

News Flash 478

Weekly Snapshot of Public Health Challenges

 

Webinar registration: People’s realities, determinants of health, democratic governance: Connecting dots outside the doors of the World Health Assembly – G2H2 policy debates, May 2022

University for Peace: Interactive E-Learning Module on Operationalizing the Right to Development in Implementing the Sustainable Development Goals. Round One: 22 June to 19 July 2022. Round Two: 19 October to 15 November 2022. Application Deadline: 5 June 2022

EPHA Meeting registration: MEP Interest Group Annual Meeting: Investigating the environmental dimensions of AMR. 17 May 2022 | 15:00 – 17:30 CEST | Online

Global Health Watch 6: UK Book Launch 30/05/22 19:00 – 20:30 Online

WHO Coronavirus (COVID-19) Dashboard

Omicron-led Surge Tests China’s Zero Covid Policy

After Months of Deadlock, WTO’s TRIPS Council Will Finally Discuss Intellectual Property Waiver Compromise

MSF urges governments to reject the draft COVID-19 text tabled at WTO, that would set a negative precedent

MSF: Vaccine Case Study Series

Understanding the Cost-Effectiveness of COVID-19 Vaccination in Nigeria

COVID-19 vaccine wastage in the midst of vaccine inequity: causes, types and practical steps

Audio Interview: Do We Need New Covid-19 Vaccines?

WHO recommends shorter treatment for drug-resistant TB

U.S. diplomats pressure European regulators to curb clinical trial transparency

Warren Urges Biden Administration to Lower Prescription Drug Prices Using Existing Executive Authority

Reflections on Transforming Higher Education for the 21st Century: PART 1 The One Health & Wellbeing Concept by George Lueddeke

Funding and Education Are Key to Effective Implementation of ‘One Health’ Agenda

One Health Commission: 2021 Annual Report

Stopping Human Diseases Often Starts With Animals

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Reflections on Transforming Higher Education for the 21st Century: PART 1

This paper was prompted by several factors: (1) an earlier invited  chapter,included in a book entitled  Civil Society and Social Responsibility in Higher Education, created in partnership with the International Higher Education Teaching and Learning Association; (2)  increasing global  awareness and  adoption of the One Health (and Wellbeing) concept/approach across political arenas and disciplines;   and (3) the urgency for academia - as it has historically done - to take a leadership role in responding  to the unprecedented and complex challenges the world now faces with climate change and upholding democracy at the top of global agendas. Recent elections in several European countries represent a welcome shift from authoritarianism and  populism - the erosion of liberal values  - to centrist politics, a trend that may be cause for optimism around the world.

Education, formal / non-formal, research and community engagement are key, as UNESCO advocates, in bringing “shared values to life” and cultivating “an active care for the world and for those with whom we share it.”  Transforming the way we “think and act” necessitates a more holistic understanding of  planet sustainability as well as re-thinking what and how we learn and, in particular, re-directing current conceptualisations  of  curricula, research and policy development  toward a new academic  “knowledge ecology (symbiotic relationship) between all living things  and the environment) through  the development of an “interconnected ecological knowledge system.”

Time is not on our side. The UN International Panel for Climate Change (IPCC) in its latest report has warned that unless we limit global warming to 1.5C. and cut carbon emissions by 43%  by 2030  the world is on course for catastrophic warming of 3.2 C by the end of this century. Biodiversity loss, emerging infectious diseases, such as Covid-19, and geopolitical tensions are also at the forefront of global crises in this decade, which must surely lead us to question our fundamental relationship to the planet  and to each other.

Because of subject-matter scope, the paper is being published by PEAH in three parts over few weeks span:

Part 1: The One Health & Wellbeing Concept

Part 2: Development of a Global ‘All Life’ narrative

Part 3: The international One Health for One Planet Education Initiative (1 HOPE) and the ‘ecological  university’

George Lueddeke

By George Lueddeke, PhD

Consultant in Higher, Medical, and One Health Education

Global Lead – International One Health for One Planet Education initiative (1 HOPE)

Reflections on Transforming Higher Education for the 21st Century

Bringing ‘Shared Values to Life’

PART 1: The One Health and Wellbeing Concept

 
Article purpose

This paper  examines  how higher education can be encouraged to “think beyond ‘narrow academic pursuits” and  become more  “productive, disruptive forces for positive change and progress capable of understanding and solving complicated real-world problems.”

To these ends, the article considers four main themes:

  • existential risks facing our planet and civilisation;
  • a new worldview and narrative for global sustainability;
  • an international education initiative to help sustain life on the planet;
  • building interdisciplinary knowledge systems with “a concern for the whole Earth”.

Taken together, they lead to considerations for university transformation and global sustainability.

Planetary risks in the early decades of the third millennium

Planet  Earth is now in its sixth mass extinction phase with global wildlife  decline  – ‘the living forms that constitute the fabric of the ecosystems’– about 68 percent  loss since 1970.  The last species’ extinction on this scale was 65 million years ago when an asteroid wiped out the dinosaurs.

As mentioned in  Planet Earth: Averting a Point of No Return, we have become that “asteroid.” The urgency to reconsider civilisation priorities, integrate new values and adopt a more sustainable way of life could not be greater. To a large extent, beginning with the industrial era in the mid-eighteenth century, human progress has been accomplished at a high cost as Professor Samuel Myers in his lecture for the Academy of Medical Sciences at Harvard University reminded us a few years ago:

“… the scale of human impacts on our planet’s natural systems is hard to overstate: to feed ourselves, we annually appropriate about 40% of the ice-free, desert free terrestrial surface for pastures and croplands; we use about half of the planet’s accessible water, largely to irrigate our crops, and we exploit 90% of global fisheries at, or beyond, their maximum sustainable limits. In the process, we have cut down 7–11 million km² of the world’s forests and dammed more than 60% of its rivers. The quality of air, water, and land is diminishing in many parts of the world because of increasing global pollution. These and other processes are driving species to extinction at roughly 1000 times baseline rates while reducing population sizes of mammals, fishes, birds, reptiles, and amphibians by half in the past 45 years.”

Towards a new worldview

Our worldview remains the main obstacle or culprit in our struggle for planet survival. As shown in Figure 1, the world can be viewed through two main lenses: anthropocentric (human-centrism) or ecocentric (all life). In their comprehensive qualitative and quantitative grounded theory study How Ecocentrism and Anthropocentrism Influence Human-Environment Relationships in a Kenyan Biodiversity Hotspot, the authors note that

“While an anthropocentric mindset predicts a moral obligation only towards other human beings, ecocentrism includes all living beings. Whether a person prescribes to anthropocentrism or ecocentrism influences the perception of nature and its protection and, therefore, has an effect on the nature-related attitude.”

The authors of  Why ecocentrism is the key pathway to sustainability “see ecocentrism as the umbrella that includes biocentrism and zoocentrism  because all three of these worldviews value the non-human with ecocentrism having the widest vision.” In support, they cite Stan Rowe’s scientific rationale that “backs the value shift”: “All organisms are evolved from Earth, sustained by Earth. Thus Earth, not organism, is the metaphor for Life.”

Figure 1:  Human-Centrism and Eco-Centrism

(Source: PEAH- COP26: Tackling the Root Causes of Climate Change, 2021)

 

 

Integrative health concepts underpinning sustainability

According to a Johns Hopkins University  study distinguishing among three main interdisciplinary health concepts involving global experts, the researcher  identified three main camps, including:

(1) those that deal with “improving human health from the population perspective, transcending national borders, some including both preventive and individual-level clinical aspects” (e.g., public health, global health).

(2) those that are “largely concerned with the sustainability of our civilisation and resource consumption on the planet and human health” (e.g., planetary health, ecological health); and

(3) those that “encompass human, animal, plant, and environmental health and well-being” (e.g., One Health, One World-One Health).

The One Health concept

As shown in Figure 2, and underscored by the authors of ‘A Blueprint to Evaluate One Health,’  the One Health concept is integral to the ecocentric ethic (a moral purpose?), that is, shifting  from reactive sectoralised interventions (‘it’s all about us’) to multi-sector preventive actions at social, ecological, economic and biological levels of society” (‘it’s about all species’).

Figure 2: The One Health Triad

(Source: World Bank - ONE HEALTH Operational Framework for strengthening human, animal and environmental public health systems at their interface, 2018)

 

 

This holistic  perspective is reflected in the definition of One Health by the One Health High Level Expert Panel (OHHLEP) established on 21 May, 2021, co-chaired by Professor Wanda Markotter and Professor Thomas Mettenleiter. Responding to “global health threats” and promoting “sustainable development” with a view to developing “a common language and understanding around One Health”, members agreed that:

One Health is an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals, and ecosystems.

It recognizes the health of humans, domestic and wild animals, plants, and the wider environment (including ecosystems) are closely linked and inter-dependent.

The approach mobilizes multiple sectors, disciplines and communities at varying levels of society to work together to foster well-being and tackle threats to health and ecosystems, while addressing the collective need for clean water, energy and air, safe and nutritious food, taking action on climate change, and contributing to sustainable development.

 

 

Considered historically, the origins of One Health  can be traced  to ancient Greece and   “father of medicine,” also considered the first epidemiologist, Hippocrates (c. 400 BCE), who  urged  physicians to consider the environment in which patients  lived. While sanitation in ancient Rome is “legendary,” it likely made things worse largely because of  parasitic infections, and it took  another 1800 years or so before  basic understanding of the causes of diseases was possible.

In separate articles published in 2014, Professor John McKenzie et al. in Australia and Professor Paul Gibbs in the United States reached similar conclusions regarding One Health milestones. Both recognised  major contributions in the 19th and 20th centuries of  individuals such as  Dr. Rudolph Virchow, “the father of comparative medicine,” Sir William Osler, Sir John McFadyean,  Dr. James Steele and Dr. Calvin Schwabe; to name but a few leading lights.

The increase and severity of viral pandemics sweeping across the world in the 1990s and early decades of the 21st century spawned the proliferation of One Health organisations and networks. These included – in  2004: the Wildlife Conservation Society;  in 2008: the American Veterinary Association, the One Health Initiative, the Centres for Disease Control and Prevention; in 2009: Afrique One – ASPIRE , the One Health Commission; in 2010:  the Tripartite FAO, OIE, WHO, UNICEF, UNISIC, the World Bank, the  EcoHealth Alliance, the European Union.  One Health reports and conferences (e.g., Australia, Canada, China, South Africa, USA) alerted the world about the on-going microbial threats, emerging diseases, influenza, and pandemics.

While these developments were welcomed by the One Health community and policymakers, it became clear that there was a need for strengthening collaboration among multi-disciplinary partnerships and developing the expertise to operationalise the One Health approach. Both McKenzie and Gibbs called for leadership development, multi-level education and training courses, cost benefit analyses, and increasing interdisciplinary engagement beyond veterinary and human medicine.

Professor Gibbs’ query was particularly timely and relevant in 2014: Is One Health simply “a short-lived response” to “emerging diseases” or “a paradigm shift” leading “to a wide and deep-rooted commitment to interdisciplinary action for the protection and needs of society in the 21st century.”?

The first report, entitled the World at Risk in 2019,  of the  Global Preparedness Monitoring Board (GPMB), chaired by Dr. Gro Harlem Brundtland, former Prime Minister of Norway and Director-General of the World Health Organization, reflected an on-going concern for the slow global response to pandemics and impending global crises highlighting  “a cycle of panic and neglect.”

Early 2020 Covid-19 confirmed the world’s unpreparedness for a major global pandemic with unprecedented deaths, cases and socio-economic consequences leading to a frantic search for vaccines and unparalleled lifestyle changes – shining a light on global inequities and the need to place responsibility for the root causes of climate change, biodiversity loss and emerging infectious diseases on humankind.

Accountability for global threats was  confirmed for the first time with statements referencing One Health by member countries of  the Joint G20 Finance and Health Minister Meeting Communiqué  in  2021 and  the G7 Leaders’ Statement 2022 – perhaps  recognising  that no single nation has the capacity to address  global existential risks we face and heeding  esteemed naturalist and broadcaster Sir David Attenborough’s wake-up call:

The fact is that no species has ever had such wholesale control over everything on earth, living or dead, as we now have. That lays upon us, whether we like it or not, an awesome responsibility. In our hands now lies not only our own future, but that of all other living creatures with whom we share the earth.”