Political economy analysis for nutrition policy

The past decade has seen increasing global policy attention to nutrition. Concrete steps have been taken to construct a global governance architecture for nutrition and also to mobilise resources for action.1Gillespie S Haddad L Mannar V Menon P Nisbett N The politics of reducing malnutrition: building commitment and accelerating progress.Lancet. 2013; 382: 552-569Google Scholar Efficacious, low-cost interventions exist,2Bhutta ZA Das JK Rizvi A et al.Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost?.Lancet. 2013; 382: 452-477Google Scholar and there is greater consensus around technical issues, including the role of nutrition-specific and nutrition-sensitive interventions in addressing malnutrition in different settings.3Black RE Alderman H Bhutta ZA et al.Maternal and child nutrition: building momentum for impact.Lancet. 2013; 382: 372-375Google Scholar The economic argument to invest in nutrition is well developed, supported by cost-benefit analyses and studies that quantify the cost to scale up interventions.4Horton S Shekar M McDonald C Mahal A Krystene Brooks J Scaling up nutrition: what will it cost? World Bank, Washington, DC2010Google Scholar Additionally, the normative argument to protect and promote the right to food and health supports a moral obligation to act.5Jonsson U Nutrition and the convention on the rights of the child.Food Policy. 1996; 21: 41-55Google Scholar However, as stakeholders gather at the Second International Conference on Nutrition (ICN2) and commit to the Rome Declaration on Nutrition this month, significant challenges remain in implementing the global nutrition agenda and in translating policy momentum into tangible results. Historically, implementation of nutrition policy has confronted persistent obstacles.6Pinstrup-Andersen P The political economy of food and nutrition policies. International Food Policy Research Institute, Washington, DC1993Google Scholar This is not surprising since progress requires success at each step in the policy reform cycle: building political commitment for nutrition, designing and revising relevant policies, getting new policies accepted and adopted, and implementing the policies in ways that advance nutrition goals. Many obstacles arise from political economy sources, suggesting that better understanding of these factors could help mitigate impediments and advance nutrition goals.7Reich MR Balarajan Y Political economy analysis for food and nutrition security. World Bank, Washington, DC2012Google Scholar There is growing agreement, both in the academic literature and from development agencies, that development cannot be understood, analysed, or managed without explicit recognition of the roles of politics, economics, and institutions in shaping what happens.7Reich MR Balarajan Y Political economy analysis for food and nutrition security. World Bank, Washington, DC2012Google Scholar In practice, application of a political economy perspective broadens the operational lens to look beyond technical solutions, sensitising practitioners to the roles of power, incentives, institutions, and ideas that shape policy processes in reality. Expansion of conceptual horizons is particularly relevant for nutrition: our review of the literature on the political economy of food and nutrition security showed how these factors create a powerful web of obstacles to achieving nutrition security.7Reich MR Balarajan Y Political economy analysis for food and nutrition security. World Bank, Washington, DC2012Google Scholar Although the nutrition community is constantly engaged in political economy in practice, the capacity for systematic analysis is limited.8Leroy JL Menon P From efficacy to public health impact: a call for research on program delivery and utilization in nutrition.J Nutr. 2008; 138: 628-629Google Scholar Thus, more systematic application of political economy analysis for food and nutrition security, along with serious capacity development in this field, could help implement nutrition reforms. Applied political economy analysis covers a spectrum of approaches and tools that can assist policy makers with making decisions and identifying political strategies for reform.7Reich MR Balarajan Y Political economy analysis for food and nutrition security. World Bank, Washington, DC2012Google Scholar These can be applied at different levels, from national to subnational levels; to sectors or thematic areas; to specific projects or policy reforms; and they vary in terms of scope and focus.9Mcloughlin C Topic guide on political economy analysis.http://www.gsdrc.org/docs/open/PEA.pdfGoogle Scholar, 10Poole A Political economy assessments at sector and project levels.http://www.gsdrc.org/docs/open/PE1.pdfGoogle Scholar, 11Department for International DevelopmentPolitical economy analysis: how to note. DFID, London2009Google Scholar This spectrum extends from in-depth political economy analyses (which are detailed, theory-based “academic” analyses done by experts to provide rich contextual understanding of political economy drivers relating to specific contexts and events), to rapid-assessment studies (which are quick, problem-focused diagnostic assessments that can be carried out with minimal training in the method).12Fox AM Balarajan Y Cheng C Reich MR Measuring political commitment and opportunities to advance food and nutrition security: piloting a rapid assessment tool.Health Policy Plan. 2014; (published online June 5.)http://dx.doi.org/10.1093/heapol/czu035Google Scholar Depending on needs, purposes, and resources (especially time, money, and expertise), different kinds of political economy analysis can be used to inform policy making for nutrition security. Although these vary in the degree of academic validity and practical application, they share similar principles to help guide political economy analysis: (1) clear articulation of the specific research question; (2) selection of the stage of the policy cycle for analysis (agenda-setting, policy design, policy adoption, and implementation); (3) systematic step-wise approach to answer the research question, with application of political economy analysis tools to support the policy process; and (4) design or assessment of political strategies. This systematic approach to political economy analysis should improve the utility and quality of the analysis in the diverse settings where this work can be carried out, and be complemented by a process of periodic reassessment of political strategies and actions, with monitoring of outcomes against expectations. The field of global nutrition has an urgent need to bring political economy analysis into the consciousness of policy advocates, policy analysts, and policy makers. Mainstreaming of applied political economy analysis can increase the development effectiveness for nutrition and increase the likelihood of politically feasible reforms that fit the local context. Lack of political will is often cited as an obstacle to progress for nutrition—despite the fact that this term is both vague and passive. Unpacking this lack of political will (by stage of policy cycle, issue, and political economy driver) would help to identify the obstacles that need to be addressed through the development of political skill. More systematic use of political economy analysis across the policy cycle could improve efforts to create nutrition security, especially in varied contexts where undernutrition stubbornly persists. We declare no competing interests.