Posted April 1998
IT IS CLEAR that an agency such as the Food and Agriculture Organization of the United Nations (FAO), centered on agriculture, food security, living conditions of rural populations, nutrition, and many other related issues has always been concerned with health. It should also be obvious that in a world in which over 800 million people suffer from hunger and many hundred million more from malnutrition, there cannot be health for all.
However, the FAO concern for health has evolved significantly from a very productivist and commodity-oriented perspective as defined by the 1974 World Food Conference under the concept of "food security", to the definition endorsed by the 1996 World Food Summit, "food security exists when all people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life". The definition has thus evolved over time from a supply perspective to a demand one with less emphasis placed on agricultural production and more on the human needs dimensions of food security, thus bringing FAO's concern and activities closer to the focus of the theme of your Commission.
In fact, in both the Rome Declaration and the Plan of Action of the World Food Summit, one can find a number of references to health. Health is stressed not only as previously mentioned as an important dimension of food security, but also in the context of sustainability, as part of human resource development or as a criterion for resource allocation. Access to primary health care, including reproductive health services, health relations to nutrition or to poverty eradication are also highlighted in the Summit Plan of Action.
We would like to stress that rural populations have generally less access to health services, often due to an insufficiently developed infrastructure in rural areas and to other factors such as poverty of the populations. FAO is also concerned that health services should adapt to the changing needs of rural populations due to environmental changes or depletion of natural resources and to the modifications in the age structure of rural populations, e.g. rapid ageing.
We would now like to highlight some specific issues: nutrition, HIV/AIDS, human trypanosomiasis and onchocerciasis.
The importance of nutrition to health is emphasized throughout Chapter VIII on Health, Morbidity and Mortality in the ICPD Plan of Action. This is further strengthened through the World Food Summit Rome Declaration: the Heads of State and Government pledged their commitment to "reducing the number of undernourished people to half their present level no later than 2015".
FAO has a unique position in the United Nations dealing with all aspects of food and nutrition. Priority programmes directly related to health include efforts to ensure food quality and safety throughout the stages of production, storage, transportation, processing and marketing, and the development of agricultural and food-based programmes to improve nutrition and rural and national economies.
Nutrition and population issues are clearly inter-linked and several of FAO's activities since 1995 are directly relevant to the work of the Commission. This is particularly true for the topic chosen for 1998 as most nutrition activities, projects or programmes should contribute to improved health and, therefore, decreased mortality. Nutrition-related activities are also an effective means to ensure the appropriate involvement of women in the development process.
The health aspects of FAO's nutrition activities can be seen in its work in household food security and community nutrition. Clearly, sustained access to nutritionally adequate and safe foods is essential to good health. Prevention of micronutrient deficiencies, along with preventing protein-energy malnutrition, is also important. For example, appropriate amounts of vitamin A have been shown to increase resistance to disease and therefore reduce morbidity and mortality. FAO has actively promoted food-based approaches, allowing households to make the best use of existing resources, particularly through diversification of food production and consumption and safe processing and handling.
The participatory appraisal of the causes of malnutrition raises awareness (both of beneficiaries and of local institutions) of existing population constraints and of their implications at household level. The key role women play in ensuring health and nutrition in the household is also more easily defined by such participatory approaches. This can lead to the identification of a combination of activities likely to address or mitigate such problems. In-service training of local staff in household food security and nutrition issues, as developed by FAO, could therefore provide a useful contribution to population and development programmes and projects.
This is also true of FAO's work in the field of nutrition education, in which sustainable and nutritionally appropriate food habits are promoted, and where specific attention is given to the requirements of women, infants and young children.
Malnutrition is the final outcome of a variety of problems, e.g. household food insecurity, lack of information or poor health. Therefore appropriate anthropometric indicators can be useful as either targeting tools for population programmes and policies or for monitoring and evaluation purposes. Ensuring adequate flows of information on nutrition and food insecurity, as recommended by the World Food Summit, should provide a significant contribution to population and development programmes, projects and activities.
Improved nutrition also requires that food supplies are of good quality and safe. Low quality or unsafe food can be a significant cause of malnutrition, morbidity and mortality. In this area FAO carries out work on food standards, quality and safety which includes policy formulation and developmental projects on food control, food law and technical regulations; food quality and safety control programmes for the food industry; establishment of national export food certification programmes; food contamination monitoring programmes; regional training programmes and workshops on specific technical aspects of food control; publications and technical manuals on food control subjects; and expert consultations to address specific problems concerning food quality and/or safety.
All of this work takes into account the work of the science-based recommendations of FAO/WHO Expert Committees and the Codex Alimentarius Commission. The resulting standards, recommendations and guidelines for food quality and safety are essential to all country programmes, and active FAO technical assistance and cooperation are provided to developing countries to ensure effective use of this FAO work to improve domestic and exported food products, and promote better overall development.
In the area of HIV/AIDS, FAO had noted in case studies changes in agricultural production and in household food security. With support from UNDP, FAO was able to conduct studies first in East Africa, then in West Africa. We shall not stress here the impacts of HIV/AIDS on agricultural production such as declines in areas cultivated, disruptions in timeliness of agricultural activities, loss of skills in the crucial links of the production chain. However, we would like to mention that these studies have shown negative impacts also on the food security and nutrition of households. For example, livestock and food reserves are sold to cover medical costs. This results in periods of hunger before the new crops are available, a general decline in the quantity of food available at household level, and a loss of diversity in food intakes, more starchy foodstuffs and less animal protein in the dietary intakes. Such declines in food security and nutrition not only can hamper the development of children, but also reduce the resistance of individuals to other diseases. FAO wishes to stress that its studies have only covered rural areas in Africa and that the results cannot be generalized to other regions. The stage has now been reached where FAO is beginning to examine the existing responses of the public and private agricultural sector to HIV/AIDS and the possibilities to improve these responses as part of the overall struggle against the epidemic.
Regarding human trypanosomiasis it is perhaps relevant to recall that the incidence of human trypanosomiasis or Sleeping sickness has risen dramatically in the 1990s due largely to the civil strife that has beset many central African countries. The symptoms of civil strife - abandonment of farms, mass migration to sparsely populated areas, deterioration of medical systems - have created conditions conducive to increased tsetse and human contact, increased incidence of the disease, and reduced surveillance of Sleeping sickness.
It is important to distinguish between the problems associated with the control of Sleeping sickness and the control of trypanosomiasis in domestic livestock. There is evidence that trypanosomiasis epidemics tend to re-occur in a number of disease foci that are confined to particular locations, mainly in Angola, Congo Dem. Rep., Sudan and Uganda. Animal trypanosomiasis is widespread and found all across tsetse infested Africa, in an area of 10 million square kilometers.
To address the tsetse fly problem in Africa, FAO / IAEA / OAU and WHO have created the Programme Against African Trypanosomiasis (PAAT) which became formally endorsed by the governing bodies of both FAO and WHO during 1997; it is believed that since early 1995 PAAT enabled focus and direction in the collective efforts to clarify and counter this problem.
Finally, in the area of onchocerciasis, FAO's action is to be viewed primarily within the context of the Onchocerciasis Control Programme (OCP), covering 11 countries in West Africa (Benin, Burkina Faso, Cote d'Ivoire, Ghana, Guinea, Guinea-Bissau, Mali, Niger, Senegal, Sierra Leone and Togo). The OCP was formally established in 1974 with the support of the donor community under the Committee of Sponsoring Agencies (CSA) including UNDP, WHO, the World Bank and FAO. FAO's guidance and views concerning the monitoring of the impact of the larvicides on the river environment have been particularly useful.
Today, OCP is one of the most successful health programmes in Africa: it has virtually eliminated onchocerciasis as a public health problem and a serious constraint to socio -economic development in the eleven-country area in which it operates. It has also established itself as a model of intercountry cooperation and of long-term commitment by donors to achieve an important development objective.
With the disease brought under control in West Africa, opening up approximately 25 million hectares of arable land, the most fertile in the entire area, the participating countries and the sponsoring agencies are now emphasizing their concern that this potential be tapped in a sustainable manner. FAO has been designated lead technical agency to coordinate support for sustainable settlement and socio-economic development of the oncho-freed zones. For example, it carried out with the cooperation of CICRED and national study teams surveys on spontaneous resettlements which provide invaluable information to formulate appropriate and new policies for successful resettlement schemes.
In 1995, FAO joined in with the other three OCP sponsoring agencies to create the African Programme for Onchocerciasis Control (APOC), a new Programme building on the OCP success and lessons to help control the disease in eighteen countries, elsewhere in Africa.