Interview with Dr Katharina Lichtner, Managing Director of the Family Larsson-Rosenquist Foundation, on Breastfeeding and Malnutrition

Our Advocacy & Comms Lead interviewed Dr Katharina Lichtner, Managing Director of the Family Larsson-Rosenquist Foundation: one of the members of our Stronger Foundations community.

We wanted to learn more about the Foundation’s work on breastfeeding, as well as Katharina’s unique perspectives on the barriers facing the malnutrition community today.

— — —

Hi Katharina! First up: can you tell us a bit about what led you to work with the Family Larsson-Rosenquist Foundation?

If I’m honest, I didn’t really choose this role — the role chose me! I was headhunted for the job whilst I was working in the tech start-up space. I had realized my role at the time wasn’t in an environment that I wanted to work in and I think the diversity of my background made my step into the Foundation a great fit.

I started my career working in science, I did a PhD in Immunology, and then I worked in consulting and finance for many years in roles spanning investment, communications and technology. The red thread throughout my business career was to build and grow things: participating in starting businesses, integrating acquired business units, building the next thing, building another organization.

All this meant that I was coming to my current role with a strong business background and private-sector orientation: something that the Foundation wanted to bring into the mix. I’m now trying to employ these skills in the development sector, which I think brings a different angle to my work.

A rich and interesting background. So, we’d like to know: what does a typical day look like in your role?

What characterizes my work the most is that there isn’t a typical day. It often ends up being quite different to what I am expecting when I look at my calendar in the morning.

The Foundation covers a broad spectrum of work and, likewise, my role spans a great deal. My work can involve anything from conceptualizing new approaches to overseeing the more operational elements of the Foundation to having scientific discussions and thinking about how we’re funding research projects. It also frequently involves working in a very hands-on way with our partners in Low- and Middle-Income Countries, which involves travelling at least a week out of every month, and liaising and strategizing with the Foundation Board.

I guess the core theme that’s weaving through the work I do is that I’m often picking out topics where I believe there is a need for deeper development: where I think the field is under conceptualizing, where we don’t really understand the inner mechanics of the problem and where we need to try new approaches.

As part of this, I’m often looking for ideas we can “steal” from the private sector, such as how we can more efficiently work towards best practices. In the breastfeeding space, for example, we have over 1000 published interventions, of which we are not sure how many will work at scale or how transferable they are from one setting to the next. I would question if we need that number of interventions, and think instead we should try to build a toolbox of maybe 20 to 30 that do work well, learn how to execute them and measure their impact very efficiently so that we can get a lot done with a lot less capital.

Let’s focus on what you find most frustrating about the space you’re working in. If you could wave a wand and make one major barrier to what you’re trying to achieve at the Foundation disappear, what would it be?

If I had a magic wand, I would take away the undue influence of formula companies on the environments in which mothers are breastfeeding.

An important report has just come out from the WHO, including research from a Lancet series, that looks at how the formula industry’s marketing practices are really subversively undermining women’s confidence and ability to breastfeed. This is plunging many children into malnutrition because it undermines not only the amount of food they consume but also the quality of it.

The thing that’s shocking about this issue is that it’s ubiquitous: it’s in any country, whether rich or poor. These companies are very hard to fight, simply because of their sophistication and the financial means they can put behind their work. It’s subterfuge really: influencing the space in a way that people can’t see, a sort of mass manipulation.

It’s also essentially a redistribution of funds from society into the coffers of the formula industry. At the end of the day, low breastfeeding rates lead to negative health impacts later in life for many, the burdens of which are being shouldered by society while the formula companies are reaping enormous revenue. And that is by no way balanced by the taxes they are paying back to states.

I’m not saying that addressing the influence of formula companies would fix everything. But it would mean we could concentrate on the other more systemic issues that need to be addressed to promote breastfeeding — many of which I believe are solvable.

Now, let’s think about solutions. If you had to prioritize a specific intervention that you believe would have the greatest impact on rates of malnutrition, which would you choose?

From my end, I wouldn’t want to even answer that question because it’s fundamentally projecting ideas that I think we should get away from. I don’t think there’s any single intervention on anything — whether it’s for breastfeeding, malnutrition, climate, education, health — that can make a substantial difference for a significant number of people. And I think the earlier and the more we start to move away from that view, the better.

One of the criticisms I would have of the development sector and of many institutions within it is that we are still dreaming of this golden bullet. But we need to move towards systemic views and process-oriented approaches where we define and develop complex solutions for complex problems.

At our Foundation, our approach is to work more flexibly with the solutions that already exist and think about how they can be combined with other systems and interventions in new ways. This helps us develop plans that are more complex and able to deal with issues in a much more fundamental and sustainable way.

As long as we keep a view on individual interventions, we’re not going to solve the problems. We need to focus on where those issues are embedded and understanding the larger systems and complexities at play.

A very valid point. As we wrap up, here’s one for the food-lovers in our community: what was the most memorable dish you’ve ever had?

I’ve been very lucky to have eaten well in so many places around the planet, for so many years now, that I find it hard to say. However, one meal does stand out among the rest.

We did some work in China for a while and I was invited to what must have been the best fish dinner I’ve ever had. We had a table full of highly curated pieces of fish, lots of different kinds. There were beautiful little fillet pieces and fish balls, all raw, and we had a simmering pot of really nice Chinese vegetable broth. You would put the bits of fish on top of the soup and let them simmer through. We were just eating fish and the bits and pieces from the soup all evening and everything was phenomenally delicious and well decorated. It was basically a fish Fondue Chinoise done in a very sophisticated way — which I loved.

Nourishing Equality

By Martha Flynn, Advocacy and Communications Lead, Stronger Foundations for Nutrition

Last year, I made a bold step from almost a decade’s work in the gender equality space and took up the helm as the Advocacy & Communications Lead at Stronger Foundations for Nutrition: an ambitious coalition of private philanthropies working to end malnutrition.

Though I was by no means an expert, I did know that malnutrition was profoundly gendered: girls and women are 50% more likely to be undernourished than boys and men, in part because they often eat last and eat least when food is scarce. But the scale of the gender inequalities in malnutrition would soon shock me.

In late 2022 we discovered that rates of malnutrition among women were even more profound than had been imagined. Research by Lancet Global Health found that a staggering 2 in 3 women of reproductive age were lacking the essential vitamins and minerals they need to thrive – far higher than previously expected. And this week, ahead of International Women’s Day, UNICEF released new data showing that a staggering 1 billion adolescent girls and women worldwide suffer from undernutrition.

These rates might not have come as such a shock to my new colleagues in the nutrition community. They already knew that global hunger was increasing after years of decline and that the rising cost-of-living was eating away at many people’s ability to buy healthy and nutritious food. They also knew that food crises like the ones we find ourselves in today often hit women the hardest.

This International Women’s Day must be the start of a shift in perspective: we must recognize that the fight to end malnutrition and the fight to achieve gender equality are intimately intertwined.”

Good nutrition provides the building blocks for every person’s chance in life: determining everything from our ability to ward off disease to our emotional and mental well-being. And globally, we’re building on unstable foundations. For example, almost a third of women worldwide suffer from anemia: a condition associated with low iron levels that zaps your energy, clouds concentration and weakens your immune system.

True equality cannot exist if so many women are lacking the basic nutrients they need to learn, to thrive, to discover what they’re truly capable of.

And this not only has dramatic implications for women individually. Women’s malnutrition is a vicious cycle that compounds inequalities from each generation to the next: many malnourished women go on to become malnourished mothers who give birth to malnourished children who may, eventually, become malnourished mothers themselves.

Challenging the underlying causes of inequalities in malnutrition will also force us to wake up to the discrimination and biases that are driving them: the reasons why resources are so often unequally shared, why so many women face barriers to the care they need and why they disproportionately feel pressure to prioritize their children’s needs over theirs. All questions that are key to the broader struggle to realize women’s rights.

So as we wake up today to calls to action to strengthen girls’ education, close the gender pay gap and boost women’s political representation, let us remember that nourishing equality must start with addressing malnutrition from the earliest points in girls’ and women’s lives. Because a better — and more equally — nourished world is a stronger one.

Nourishing People and Planet: A Call to Action for a Stronger World

At COP27, Stronger Foundations is calling for leaders to place nutrition at the heart of global efforts to combat and adapt to climate change.

COP27, from 6th to 18th November 2022 in Sharm El-Sheikh, Egypt, brings together governments and non-state actors to tackle the threat of climate change. Historically, issues relating to food systems and nutrition have been largely absent from official negotiations and side-events, despite their significant relevance to addressing the climate crisis.

COP27 represents somewhat of a turning point, with food systems featuring more prominently than ever and with nutrition initiatives starting to take shape.

Still, nutrition is not yet fully at the table, and there has never been a more important time to prioritize human health.

“When we put people at the center of sustainable growth, we can nourish humanity and build a stronger world.”

COP27 happens against the backdrop of sky-rocketing rates of hunger and malnutrition, precipitated by intensifying global conflict, protracted humanitarian crises and the fall out of the pandemic. We must draw greater attention to the foundational role of nutrition within climate change and food system transformation. If we do not, there is a risk that nutrition will remain largely on the sidelines, and that the climate crisis and new “nutrition-blind” climate policies will further exacerbate rates of malnutrition.

 

Fortunately, we know what we need to do. When we put people at the center of sustainable growth, we can nourish humanity and build a stronger world. Philanthropy — through catalytic investment and long term commitment — can play a central role in enabling collective action:

– We must support communities and countries in developing and championing their own solutions, enabled by world class science and data
– We must compel and enable greater corporate accountability, in support of sustainable and people-centric growth
– We must invest into diverse nutritious food innovation and value chain development, so that it is easy to choose the healthy and sustainable option
– We must support the transition to more sustainable models of production, particularly for smallholders whose very lives depend on a successful harvest
– And we must engage all of us as responsible and health-seeking consumers, investors and advocates in the fight for our collective lives as we build a stronger world

 

A Call to Action: Nourishing People and Planet

To ensure a climate crisis does not become a humanitarian crisis, we must strengthen safety nets for the treatment and prevention of climate-related malnutrition

– Strengthen systems for malnutrition crisis planning and response, including further development of early warning systems for outbreaks of child wasting and improved real time national food balance sheets
– Scale up research on the impacts of climate related shocks, especially heat stress, on health and nutrition status and access to services
– Increase the speed and predictability of humanitarian aid for wasting treatment, unlock greater levels of longer term development funding, and increase the fiscal space of high-burden countries to allocate domestic budgets for wasting prevention and treatment
– Mobilize a holistic response that moves beyond food aid to respond to severe malnutrition, including strengthening the supply of / emergency stocks of RUTF and commodities like Small Quantity Lipid Nutrient Supplements (SQ-LNS)

 

To ensure countries are at the center of their own sustainable growth, we must support local and national leaders to develop data-driven food transition pathways

Define and collect national and sub-national data on diet quality as a measure of nutritious and sustainable food consumption
– Formalize contextually-driven reference diets which balance nutritional adequacy, accessibility and sustainability, and corresponding targets
– Build the capacity of local research institutions and advocates to champion locally-led solutions for nutritious and sustainable production and consumption
– Linked to the development of Nationally Determined Contributions (NDCs), National Adaptation Plans (NAPs) and National Nutrition Strategies (NNS), realign national policies, including through subsidy reform and implementation of new tax models, to incentivize nutritious food production and distribution informed by the true cost of food

 

To ensure that the agricultural growth we continue to need to feed families and move millions out of poverty is also good for human health, we must unlock innovation across diverse production systems

Increase research and access to more productive and resilient inputs for a diverse basket of healthy foods, including fruits, vegetables and pulses
– Develop exemplars of nutritious, regenerative agricultural production
– Support the development of better storage, cold chain, market capacity and infrastructure for nutritious food production, with particular focus on models of smallholder inclusion and women’s participation

 

To ensure that we can adequately supply healthy, sustainable and contextually-appropriate diets, we must strengthen key nutritious value chains, emphasizing food sovereignty wherever possible

– Nutritious food production
– Low carbon, quality animal proteins (e.g. small-scale production of fish and poultry), including investments in affordable, sustainable feed value chains
– Plant-based proteins
– Fruits and vegetables
– Biofortified whole grains, legumes and staples
– Nutritious value addition
– Food fortification
– Nutrition-sensitive processing (e.g. reduced refining of whole grains)

 

To ensure consumers are able to make the best choices for themselves, their families, and the planet, we must understand and support their needs for good food

– Improve and strengthen regulation around product labeling
– Analyze what drives consumer choice and support the development of strategies to increase demand for nutrient-rich foods, including through compelling campaigns
– Understand and address harmful gender norms which disempower women’s food choice and access, reducing the associated costs on household health and nutrition

 

To ensure that the financial burden of this transition is not a barrier to transformation, we must catalyze scale financing aligned to the size of the need and cost of inaction

– Achieve the Global Goal on Adaptation, through at least doubling climate financing for adaptation, with the greatest share of funding flowing to the most vulnerable countries
– Support countries, states and local actors by reducing barriers to accessing finance, through development, technical assistance and streamlined requirements
– Unlock capital markets by de-risking investment, including through technical and financial support through impact investing, validation of instruments like nutrition-sensitive green bonds, and payment for ecosystem service models including voluntary carbon markets
– Repurpose public purchasing to drive dollars already spent on food to food that is nourishing and sustainably produced

© WFP/Michael Duff

25,000 Einsteins: The forgotten story of a mineral that fueled global prosperity

This week, the World Health Assembly will meet in Geneva to discuss progress against key health indicators including iodine deficiency (ID). Sounds technical, niche, boring? As world leaders meet this same week in Davos, Switzerland’s experience shows us that good nutrition can change the course of human history.

In the early 1900’s, parts of Switzerland suffered from high incidences of ID. Severe ID in pregnancy is one of the leading causes of poor cognitive development and physical disabilities among children, including goiter: the visible swelling of the thyroid gland. To give you a sense of the scale of ID during this time, around 60% of children in the areas of Bern and Zurich had goiter.

The average IQ of someone with ID is roughly 13 points lower than without ID. But after iodized salt and tablets were introduced in 1915, IQs increased, and goiter in children was all but erased. Today, more than 94% of households use iodized salt. The collective increase in average IQ of those children in Bern and Zurich is the equivalent of adding more than 25,000 Albert Einsteins to the Swiss population.

Think about that. Switzerland consistently ranks at the very top of World Economic Forum lists in terms of competitiveness and innovation. Where would this world leader be without good nutrition?

Government health officials in Ghana test the iodization levels of salt.

Sadly, the WHO has highlighted that, despite remarkable progress over the last few decades, people in 21 countries around the world continue to have insufficient iodine intake. And it is estimated that nearly 50 million people suffer from some degree of ID-related brain damage.

Imagine, for just a moment, that you were born without enough access to this important nutrient. Imagine how that would impact your future. Now imagine 50 million more potential doctors, scientists, and pioneers who weren’t given the chance at their best start in life just because they didn’t have access to something as simple as iodized salt.

Malnutrition is devastating for everyone suffering from it, but bigger than that, it is undermining the potential of all of us to prosper. How can we expect the world to tackle the great challenges it faces today, and weather the untold storms of tomorrow, when we leave so many of our very best behind?

 

© Jason Tuinstra

New coalition of private donors will work as a community of impact to end malnutrition

New philanthropic collective, Stronger Foundations for Nutrition, announces over $1 billion from members and partners in nutrition for growth year of action.

Today, bold new commitments to fight malnutrition from a diverse and growing community of funders were announced alongside the formation of a new catalytic entity called Stronger Foundations for Nutrition. These funding commitments and the coalition driving them were announced at an official Nutrition for Growth side event, Financing the Nutrition Agenda: New Commitments, New Partnerships. The coalition, first formed on the margins of the 2017 Global Nutrition Summit and now in rapid scale up mode, brings together diverse philanthropic and corporate donors, working across health and food systems on four continents, to make catalytic new investments to improve nutrition outcomes around the world.

“Beyond the dollars themselves, the diversity of this community shows there is real innovation happening in how funds are raised and disbursed, and that it is time to start dreaming bigger to truly end malnutrition.”

Matt Freeman, Executive Director of Stronger Foundations for Nutrition

Malnutrition is the number one killer of children globally and 40 percent of the world cannot afford adequate diets, yet malnutrition is largely considered an afterthought in global health and development — receiving less than 1% of official development assistance. Stronger Foundations for Nutrition aims to elevate malnutrition as one of the world’s greatest and most critical challenges.

With founding membership from the Bill & Melinda Gates Foundation, Children’s Investment Fund Foundation, Tata Trusts, Rockefeller Foundation, Dangote Foundation, Eleanor Crook Foundation, King Philanthropies, Family-Larsson Rosenquist Foundation, Chaudhary Foundation, Kirk Humanitarian, and Rotary International, Stronger Foundations for Nutrition works across health, food and social protection systems in pursuit of all nutrition outcomes and more virtuous and sustainable food systems.

Commitments made at the event included:

King Philanthropies, a new foundation based in Silicon Valley, announced that they will invest $100 million to improve nutrition and food security. “King Philanthropies is increasingly focused at the intersection of extreme poverty and climate change; consequently, fighting malnutrition is a priority,” said Kim Starkey, CEO of King Philanthropies. “Those in extreme poverty will be disproportionately affected by climate change, which is already threatening food security and worsening malnutrition.”

The Rockefeller Foundation announced that they will support the creation of new, more robust metrics for tracking diet quality which can help align stakeholders around a common vision of success. Additionally, soon to be announced investments aimed at leveraging the power of institutional food procurement systems will shift the consumption of 20 million people globally toward more sustainably produced, healthy diets.
Givewell, an organization channeling large scale private giving to highly impactful and cost-effective global health and development programs, has committed to disburse $28 million to community-based management of acute malnutrition, and seeks future opportunities to scale up evidence-backed nutrition interventions that are highly cost-effective at saving and improving lives.

The Bill & Melinda Gates Foundation committed an initial $10 million (on top of their previously announced $922 million commitment) to join the UNICEF-managed Nutrition Commodity Fund to expand the fund’s product offering to include maternal nutrition products such as Multiple Micronutrient Supplements (MMS) to improve women’s health, improve birth outcomes and prevent acute malnutrition, match-funded by contributions from national governments.

Rotary International committed $2.5 million from The Rotary Foundation as part of a holistic nutrition program in Ethiopia, alongside the END Fund, Eleanor Crook Foundation and the Power of Nutrition. Rotary International will seek future opportunities to leverage the network of more than 1.4 million Rotarians around the world to improve nutrition outcomes by joining the Steering Committee of Stronger Foundations for Nutrition.

Eleanor Crook Foundation, in partnership with KRAFTON (PUBG: BATTLEGROUNDS) and other gaming companies, announced it aims to reach more than 1 million children with Ready-to-use-Therapeutic Foods in 2022, funded by donations mobilized through the LifePack video gaming campaign.

Rabobank committed to measure dietary diversity as a key indicator in all smallholder agroforestry carbon projects certified and sold on the Acorn carbon marketplace.

Additional philanthropic commitments from Stronger Foundations for Nutrition members made in the 2021 Nutrition for Growth Year of Action include:

$922 million from the Bill & Melinda Gates Foundation over the next five years to advance the foundation’s systems approach — prioritizing efforts across food, health and social protection systems to reach the most vulnerable. The pledge is the foundation’s largest nutrition commitment to date.

$50 million from the Children’s Investment Fund Foundation, investing alongside the UK Foreign Commonwealth and Development Office and UNICEF to form a Nutrition Commodity Fund to focus on the treatment, early detection and prevention of child wasting. This investment creates a new ecosystem for wasting financing, allowing countries to unlock matched funding with domestic allocations to procure and distribute highly impactful nutrition interventions to prevent and treat wasting.

This brings the total philanthropic commitments pledged in 2021 to over $1 billion. Since the Nutrition for Growth Summit in 2013, these private philanthropies have pledged more than $3.4 billion to nutrition, joining governments, civil society organizations and the private sector to raise new resources toward ending malnutrition. The community of philanthropic funders for nutrition has grown from just two at the 2013 Nutrition for Growth Summit to more than a dozen funders today.

© Adrien Taylor

New commitments to end malnutrition unfold at this Nutrition for Growth side event

 

With this event, we’ve exceeded $1 billion in philanthropic commitments in this Nutrition for Growth Year of Action!

On December 6, 2021 exciting new commitments to nutrition from a diverse and growing community were announced.

Global malnutrition is one of the greatest challenges of our time. It is the leading cause of child death, and contributes to a staggering loss of educational and economic potential for people and for nations.

More targeted nutrition financing, from more diverse actors, needs to be delivered now to meet the scale of the challenge we face, and these new commitments show it’s time to start dreaming bigger to truly end malnutrition.

“Today, a child dies of malnutrition every 11 seconds.. If we can send billionaires into space, we can stop kids dying from malnutrition…It’s time to make our voices louder and it’s also time to get focused.”

Will Moore, CEO of the Eleanor Crook Foundation

Commitments were delivered across three critically important themes:

– Integrated health service delivery
– Inclusive, sustainable, and nutritious food systems for all
– Innovative models of investment to transform nutrition at scale

The event was moderated by Nemat Hajeebhoy, Chief of Nutrition for Nigeria at UNICEF. In addition to diverse participation from the global nutrition community, we heard exciting commitments from leaders in private foundations including:

Chris Elias, President, Global Development, Bill & Melinda Gates Foundation
Roy Steiner, Senior Vice President, Food Initiative, Rockefeller Foundation
Kim Starkey, Chief Executive Officer, King Philanthropies
Will Moore, Chief Executive Officer, Eleanor Crook Foundation
Tom Thorfinnson, Chief Strategy Officer, Rotary International
Neil Buddy Shah, Managing Director, GiveWell
Kara Weiss, Chief Executive Officer, CRI Foundation
and many more…

© Annie Spratt