Table 3

Comparison of governance areas for undernutrition and obesity at global and national levels

Governance areaUndernutritionObesity
AccountabilityGlobal: multilaterals, bilaterals, NGOs and others that have a legal or adopted nutrition mandate are not punished or rewarded for their individual or collective performance. Persistent coordination problems result. Also, accountability for food production or crop diversion hard to establish.Global: accountability is very weak for transnational corporate activities and foreign government policies related to food, such as in subsidy, tax and trade. Largely, accountability mechanisms are absent.
National: engagement of many sectors creates coordination problems and clouds accountabilities. Government tends to be least accountable to the marginalised people most vulnerable to undernutrition, indicating the need for improved state performance overall.National: accountabilities for unhealthy foods and deceptive marketing are difficult to establish precisely, and citizens’ demand for accountability is often influenced in favour of private interests and against health professionals.
ParticipationGlobal: in theory, national representation in the UN system assures the channel of participation by citizens, but this is highly problematic in many cases, including weak or failed states, or for marginalised or excluded groups, such as migrants, refugees or the vulnerable. Areas of low participation are at greatest risk of undernutrition.Global: national representation in global affairs is predominantly in non-health areas and is often linked to corporate interests. This calls for supranational regulatory mechanisms to allow more participation, or the channels for other states and citizens to influence national government positions.
National: participation by citizens is weak in many cases. People who need nutrition interventions may not be aware, and even if they are, cannot always express their demand effectively. Typically, this need is not visible or meaningful to the state, not reflected in programmes of services, and weak participation means it does not connect to democratic or judicial accountability mechanisms.National: participation is often strong—because citizens exercise electoral and economic power in support of corporate interests, and food products and consumption patterns that are unhealthful. The participation problem is not the ability to influence, but the contest for perception about foods, food companies and regulation.
ResponsivenessGlobal: multilaterals, bilaterals, NGOs and others operating in nutrition do not respond to the demands and needs of those they ostensibly serve. This is underpinned by low participation and missing or absent accountability mechanisms.Global: extremely limited accountability mechanisms mean that there is no easily identified authority to respond specifically to obesity-related issues.
National: those most likely to suffer undernutrition are typically not able to organise or participate, making it difficult for even well-intentioned states to identify and respond.National: government responses may be more immediate to well-organised corporate demands; responsiveness to citizens often concentrated around infrequent elections. Citizens may favour unhealthy policies, as well.