PUBLIC HEALTH PAGES

Teresa González de Cossío, Juan Rivera Dommarco, Gladys López Acevedo, Gloria M, Rubio Soto, (eds). Nutrición y pobreza. Política pública basada en evidencia. México: Banco Mundial/Secretaría de Desarrollo Social, 2008.The Minister was awakened at 5:30 in the morning by the sound of his cell phone ringing. It was the Prime Minister.

–Minister, it's good that you are already awake. I would like to ask you to do something very important –The prime minister said hurriedly–. As you may remember, in the coming month I will be attending the Summit of Countries Fighting for the Flora and Fauna of Plentiful Rivers; it is a very important meeting at which I will have the opportunity to speak of our country's accomplishments in this area to leaders from all over the world. It occurred to me that for this occasion we could launch a new program to increase the number of carp, European lobster and harlequin frogs, like the ones on my ranch, in the largest rivers in the south of the country. I already spoke to the Minister of Foreign Affairs and asked him to begin the procedures to import, if necessary, some of these species from abroad. I also spoke recently to the Minister of Finance, asking him to look into ways to finance this important project. I would like you to prepare a draft summary of this program, which will be coordinated within your department; please have it ready by next Monday morning. Best regards.

The Prime Minister spoke at the summit about the importance of biodiversity, water and life, and he announced the introduction of the Special Program for Protected Fresh-Water Species, the first of its kind in the world. With this program they hoped not only to increase the density of fauna in the country's rivers, but also to strengthen the economy and tourism in the region in the future. The budget for the first year of the project was 100 million dollars; it generated 20 positions in the ministry and began operation in the eastern part of the country, as suggested by members of Parliament from this region.

It is naïve to think that public policy, in any part of the world, would not be affected by the vagaries of the political situation of the time. Public policy decisions are made in the midst of serious time restrictions, multiple pressures, and often looking for results in the short-term. That is the nature of these types of decisions.

Furthermore, those of us who design programs, strategies and public actions are human beings with strengths and weaknesses. Unfortunately, there is no Divine Law describing the path to follow in order to improve academic achievement, reduce poverty, increase the salary of the rural worker, reduce global warming, improve the quality of education, avoid epidemics, etc. Instead, what we have been doing since the beginning of time are experiments in trial and error. Sometimes public policy actions are successful, and other times they fail to yield results. All of this obviously depends on how these public actions are carried out.

For this reason, it is essential to have science, technology, and information involved in the process of designing public policy. Programs and strategies will have better results when their actions have been evaluated and their problems and successes documented. Therefore the publication of the book Nutrition and Poverty: Evidence-based Public Policy comes as good news for those who make decisions in public policy programs and strategies; it strives to "contribute to the improvement of public policies in nutrition, especially those geared toward populations living in poverty. [It] provides current information on the nutritional status of the Mexican population and analyzes the evidence regarding the appropriateness, focus and effectiveness of the main programs that combat poverty with nutrition-based objectives (which have been implemented in the country)...".

The first chapter of the book, written by some of the most experienced nutrition researchers in the country –Juan Rivera, Teresa Shamah, Salvador Villalpando, Lucía Cuevas, Verónica Mundo and Carmen Morales Ruan– describes the current nutritional situation of Mexico's population. Chapter 2 is written from the public perspective, pointing out the advances and challenges in the country's social development policy, specifically in the area of nutrition. Chapter 3 gives a review of actions, programs and strategies that have been carried out in the country's recent history to strengthen diet and nutrition. The reader can witness the changes in focus that have been made in order to solve this problem over the years. The final chapters, using the most advanced evaluation methods, demonstrate the results that have been achieved in some of the most important programs. Above all they describe the elements which have been effective and what remains to be done.

The book answers questions like the following: What are some of the nutritional characteristics of the Mexican population? What are the age and gender characteristics of the malnourished? Are there differences between the nutritional conditions of different geographical areas? What percentage of the Mexican population is overweight and obese? What recent strategies have been implemented to combat malnutrition? Have they all worked? For nutritional reasons, which is better: to provide food baskets or cash to the poor? What role does nutrition education play in the success of those programs? What mistakes have been made, and what more needs to be done? The book covers a lot of useful topics, bringing together information that has been scattered in numerous recent documents.

Responses to these questions can make it easier for those who have to design and redesign nutrition-based programs in the country. The book reminds us that the problem of chronic malnutrition persists in rural communities, especially among indigenous populations. It also points out that the lack of micronutrients in children and the increase in obesity in all groups of the population are some of the most important topics on the agenda of nutrition policy in this country today. Tackling these problems involves revising the nutritional content of the programs that are currently providing food to children. The book also documents the necessity to create different policy actions for different types of nutritional problems.

The book shows that in the area of nutrition it is not necessary to start from zero when designing public policies. The evidence that we need in order to create more efficient and effective interventions already exists. The book does not claim that science is a substitute for policy in public policy decisions. Rather, it seeks to encourage public discussions that take into consideration the evidence already presented. Achieving this would be a major advancement in the performance of public policies. We hope that other areas of public policy have the vision to invest in science, information and evidence to design actions, programs and strategies, thus minimizing unfounded efforts and those based only on good intentions.

The Special Program for Protected Fresh-Water Species had major problems during its second year of operation. Despite the fact that its budget increased by 30% compared to the previous year and despite a major effort from the operators, there was a drastic reduction in the number of animals of the imported species due to the fact that they were not accustomed to the local climate, especially the high temperatures in the eastern part of the country. The native species were also affected due to the transmission of diseases brought in by the imported species. When the program was terminated in its third year, there had been a reduction in the density of the fauna in the rivers in which it was implemented. The Prime Minister and the Minister continued working tirelessly for the benefit of their citizens.

Gonzalo Hernández Licona
ghernandezl@coneval.gob.mx