CAUSALITY ANALYSIS

1. CAUSALITY ANALYSIS

2. Underlying Determinants of Child Malnutrition Presentation at the World Breastfeeding Conference New Delhi, 6-9 December 2012 Urban Jonsson, The Owls

3. SOME PHILOSOPHY OF SCIENCE • “Nothing is more practical than a good theory” (Einstein) • “You find what you look for”(Kuhn) • “The challenge is to ask the right questions – The answers can be found by amateurs (Einstein) • “I shall make it as simple as possible, but not simpler” (Einstein)

4. My Contribution • If there is no agreement on the causes of a problem, it is unlikely to be any agreement on the selection of priority actions to address the problem • This is why there must be an agreed upon Conceptual Framework of Causality

5. CONCEPTUAL FRAMEWORK • Evidence based and scientific • Hierarchy of causes (immediate, underlying and basic/structural causes) • Must capture all potentially important causes • Must be simple to communicate

6. UNICEF NUTRITION STRATEGY (1990) • The UNICEF Nutrition Strategy 1990 consists of two components: • The Triple A Approach • The Conceptual Framework of Causality

8. CONCEPTUAL FRAMEWORKS • A large number of Conceptual Framework for the causality of malnutrition have been suggested over since the 1950s • UNICEF’s Conceptual Framework is today the best known and has been adapted and adopted by most organizations

9. CAUSALTY ANALYSIS • Identify and specify the major manifestation of the problem • Identify the key immediate causes • Identify the key underlying causes of the immediate causes • Identify the key basic/structural causes of the underlying causes

10. SOCIAL DETERMINANTS

11. Social, Economic, Political and Culture Process Malnutrition Insufficient Dietary Intake Disease Inadequate Household Food Security Inadequate Maternal & Child Care Inadequate Health Service & Unhealthy Environment Inadequate Responsibility, Authority and Resources Social Processes And Generation of Capacity (Social Trends) Potential of Society Social Organization and Relations

12. SOCIAL TRENDS • Employment/Unemployment • Inclusion/Exclusion • Social cohesion/Alienation • Accountability/Corruption • Democracy/Non-democracy • Peace/Conflict

13. Social, Economic, Political and Culture Process Malnutrition Insufficient Dietary Intake Disease Inadequate Household Food Security Inadequate Maternal & Child Care Inadequate Health Service & Unhealthy Environment Inadequate Responsibility, Authority and Resources Social Processes And Generation of Capacity (Social Trends) Potential of Society Social Organization and Relations

14. POTENTIAL OF SOCIETY • Ecology, incl. climate and soil • Other natural resources • People with knowledge and skills • Technology

15. Social, Economic, Political and Culture Process Malnutrition Insufficient Dietary Intake Disease Inadequate Household Food Security Inadequate Maternal & Child Care Inadequate Health Service & Unhealthy Environment Inadequate Responsibility, Authority and Resources Social Processes And Generation of Capacity (Social Trends) Potential of Society Social Organization and Relations

16. SOCIAL ORGANIZATION AND RELATIONS • Ownership of the means of production • Socio-economic groups and caste • Gender relationships • Other power relationships • Political factors, incl. laws and rules • Ideological factors, incl. culture, religion, habits and traditions

17. Social, Economic, Political and Culture Process Nutritional status Dietary Intake Health condition Level of Household Food Security Level of Maternal & Child Care Level of Health Service & Healthy Environment Capacity of Responsibility, Authority and Resources Social Processes And Generation of Capacity (Social Trends) Potential of Society Social Organization and Relations

18. Social, Economic, Political and Culture Process Overnutrition Inadequate Dietary Intake Health status Inadequate Quality of Household Food Security Inadequate Child Care Inadequate Health Services Inadequate Responsibility, Authority and Resources Social Processes And Generation of Capacity (Social Trends) Potential of Society Social Organization and Relations

19. SOME WORDS ON OVERNUTRITION • The word ‘overnutrition’ is misleading, as ‘overhealthy’ also would be • The UNICEF Conceptual framework explains the causes of ‘overnutrition’ as well as it explains causes of ‘undernutrition’

20. SOME WORDS ON OVERNUTRITION • However, ‘food’ in particular and ‘care’ are most is often the key underlying causes of ‘overnutrition’ • The strong promotion of ultra processed food is a key basic cause of ‘overnutrition’

21. SOME CONCLUSIONS ABOUT CFs • Facilitates a ‘focused’ analysis • Facilitates a multi-sectoral dialogue • Improves program preparation, implementation, monitoring and evaluation • Strengthens the advocacy to address basic causes

22. COMMON MISUNDERSTANDINGS OF MALNUTRITION CAUSALITY • Mono-focal (they emphasise a limited set of potential causes) • Universal (they underestimate context-specificity) • Insular (they underestimate the linkages among causes of malnutrition)

23. COMMON WRONG WIEWS ON MALNUTRITION CAUSALITY • Supply-oriented (they emphasise problems in the supply of food, nutrients or health services) • Excessively macro or micro in perspective (they either focus at the individual behavioral or biological level or at the level of aggregates like markets or food supplies) • ●

24. COMMON WRONG WIEWS ON MALNUTRITION CAUSALITY • Discipline-bound (they emphasise the perspectives from one or a limited range of disciplines) • Expert-oriented (they over-estimate the ability of experts and outsiders to analyse and comprehend the complex realities that create malnutrition

25. COMMON WRONG WIEWS ON MALNUTRITION CAUSALITY But most of all, most people do not understand the concept of “necessary, but not sufficient conditions”.

26. REVIEW OF SOME AGENCIES AND INITIATIVES

27. AGENCIES AND INITIATIVES REVIEWED • UNICEF • FAO • DANIDA (Denmark) • DFID (UK) • SAVE THE CHILDREN • EU • REACH • SUN

28. Questions about CF and HRBA • Is the need for a Causality Analysis recognised? • Are different levels of Causality recognised? • Are immediate, underlying and basic causes recognised? • Is each of Food, Health and Care recognised?

29. Questions about CF and HRBA • Is each of Food, Health and Care understood as ‘necessary but not sufficient condition? • Does ‘care’ include women and mothers? • Is nutrition recognised as a human rights? • Is a HRBA recommended

30. UNICEF

31. JONSSON (UNU 1980)

32. UNICEF (1990)

33. UNICEF (1998)

34. UNICEF (2006)

35. Social, Economic, Political and Culture Process Malnutrition Insufficient Dietary Intake Disease Inadequate Household Food Security Inadequate Maternal & Child Care Inadequate Health Service & Unhealthy Environment Inadequate Responsibility, Authority and Resources Social Processes And Generation of Capacity (Social trernds) Potential of Society Social Organisation and Relations

36. FAO

37. FAO

38. DANIDA (Denmark)

39. DANIDA (Denmark)

40. DFID (UK)

41. DFID (UK)

42. SAVE THE CHILDREN

43. SAVE THE CHILDREN (2008)

44. SAVE THE CHILDREN (2012)

45. EUROPEAN UNION (EU)

46. EUROPEAN UNION (EU)

47. REACH

48. REACH Malnutrition, death & disability Outcomes Inadequate dietary intake Disease Immediate causes Inadequate maternal & child CARE practices Insufficient access to FOOD Underlying causes at household / family level Poor water, sanitation & inadequate HEALTH services Quantity and quality of actual resources – human, economic & organisational - and the way they are controlled Basic causes at societal level Potential resources: environment, technology, people UNICEF

49. SUN FRAMEWORK FOR ACTION (2010)

50. SUN MOVEMENT ROAD MAP (2012)