Building centres of excellence, and a new approach to food guides.

In January we argued that 2009 should be the year of solutions, and that more resources and thought should be invested in solution-focused activities. In this issue we publish a letter responding to that call, with a proposal for centres of excellence in nutrition research in low-income countries (termed ‘emerging markets’ in the letter). The proposal is reached based on, among other things, the lack of authors from developing countries writing and publishing on topics of local importance. The letter raises important issues, and leaves some important questions unanswered. Who could disagree with a call for such centres? Indeed, we know of at least one such centre recently established in South Africa (H Vorster, personal communication). A key concern has been finding good researchers to work in such centres and keeping them there – there is a serious need for workforce development. Various leadership programmes have been established around the world to support the development of skills in young scientists, with a view to supporting them to become leaders in the future. But excellence in research alone will not reduce malnutrition in all its forms (this term has been recommended to engender a broader understanding of global nutrition problems) around the world. If we were sitting in an African university we might find the proposal a little patronizing. In any case, who will set the agenda for this research, who will decide what models and approaches are likely to be most productive, who will determine the scope and content of research studies, and who will turn research findings into solutions? When looking at the research priorities for many international and national research bodies we will find the term ‘innovation’, where the meaning is to further develop all the -omics research in order to find new molecular solutions. Probably most of the effective solutions to the worldwide nutrition problems are not to be categorized as molecular or even innovative. A key message from The Lancet series on undernutrition was not so much that we need more evidence regarding what to do, but that we need a better system and structure that supports practice that applies evidence that leads to solutions. We need to go beyond knowing, to knowing how and showing how. We need to encourage young scientists to stay in their own countries, and we need to address the social, political and economic reasons why impoverished countries stay poor. This is not a matter of better reductionist science to find the underlying mechanisms of action. This requires people to stand up and challenge our current paradigms. Those of us in the North may not like what people in the South have to say. Are we ready to be told?