The Political Economy of Multi-sectoral Programming of Adolescent Nutrition: Global Discourse and Emerging Lessons from Pakistan

Measures to pragmatically address adolescent nutrition are increasingly important with the rise in obesity among young persons, along with persistent challenges of undernutrition. Public health measures face the danger of being siloed ineffective solutions unless ideated with sectors outside of health that hold the power, influence, and contextual understanding to resource and deliver such interventions. Despite global calls for more joined-up working across relevant sectors, less is known about how to effectively co-opt other sectors for programming of adolescent nutrition in a collaborative governance model. Adolescent health requires multi-faceted solutions that cross-cut social-cultural issues for lifestyle interventions, combined with regulatory interventions for countering commercial determinants, as well as development interventions linked to historical poverty-oriented paradigms. Progress has often floundered because the political economy of adolescent health has not been placed at the centre stage of programming adolescent health nutrition. The political economy approach provides a useful lens to understand how more impactful, societal responses to adolescent nutrition can be brought about through balancing the politics of power, resources, and narratives across sectors integral to adolescent health. This chapter draws on current political economy insights from global examples of adolescent health, supported by a deeper dive into the country governance ecosystem of adolescent nutrition programming from the low- and middle-income country context of Pakistan to articulate key lessons for wider multi-sectoral responses for adolescent nutrition. Exploration of the political economy of adolescent nutrition has too often focused on policy discourses but not on institutional dynamics and governance arrangements that must be better understood to co-opt other sectors in the leadership and delivery of adolescent health interventions. This chapter particularly draws attention to the importance of navigating the governance architecture within countries that have been less well understood and given marginal importance. Key learnings from this chapter include an inclusive framing with a social-behavioural ideology to build diversity within core coalitions, an organisational home outside the health sector for programming across sectors, leadership-building efforts, and technical assistance for convening, which can have domino effects on building collaborative governance for adolescent nutrition. The chapter emphasises that the process of how multi-sector programming for adolescent nutrition is brought about within countries is perhaps even more important than the prescriptive content of globally advocated interventions.