PLAN OF ACTION FOR NUTRITION


I. INTRODUCTION

1. General

1. Despite considerable progress in recent decades, the world still falls far short of the goal of adequate food and nutrition for all. Over 780 million people, mainly in Africa, South Asia and Latin America, do not have enough food to meet their basic daily needs for energy and protein. More than two billion people subsist on diets that lack the essential vitamins and minerals required for normal growth and development and for the prevention of premature death and disabilities such as blindness and mental retardation. At the same time hundreds of millions suffer from diseases caused or exacerbated by excessive or unbalanced dietary intakes or by the consumption of unsafe food and water.

2. Eradicating hunger and malnutrition is within the reach of humankind. Political will and well-conceived policies and concerted actions at national and international levels can have a dramatic impact on these nutrition problems. Many countries, including some of the poorest, have adopted and taken measures to strengthen food, nutrition, agriculture, education and health and family welfare programmes, which have dramatically reduced hunger and malnutrition. The current challenge is to build upon and accelerate the progress already made.

3. This global Plan of Action for Nutrition is designed to provide guidelines for governments, acting in partnership with non-governmental organizations (NGOs), the private sector, local communities, families and households and the international community, including international organizations, multilateral financing institutions and bilateral agencies, to achieve the objectives of the World Declaration on Nutrition adopted by the International Conference on Nutrition (ICN). It contains recommendations on policies, programmes and activities that resulted from an intensive ICN consultative process involving country-level preparations of national plans and regional consultations that included country representatives. It also represents the drawing together of a wide range of expert opinion from around the world on the many facets of problems that must be vigorously attacked to achieve proper nutritional status for all on a sustainable basis. Thus, this Plan of Action builds upon preceding work and represents a major step in preparing and implementing national nutrition improvement plans in coming years.

4. Coherent and effective action at local, national and international levels to achieve nutritional well-being is imperative. However, resources, needs and problems vary between and within countries and regions of the world. Therefore, the situation in each country and region needs to be assessed in order to set priorities for formulating specific national and regional plans of action, giving tangible expression to policy-level commitments to improve the nutritional well-being of the population. This should entail considering nutritional impacts of overall development plans and of all relevant sectoral development policies and plans. These plans should identify short- and long-term priority areas for action; specify goals, which should be quantified where feasible, to be achieved within specified time frames; define the roles of relevant government ministries, local communities and private institutions; and, as appropriate, include estimates of resources that are required. The plans should take into account the goals set forth in the World Declaration on Nutrition and be formulated by governments with the active participation of academic and local communities, NGOs and the private sector.

2. Overall objectives

5. To achieve satisfactory nutritional status, it is essential to ensure continued access to sufficient supplies of a variety of safe foods at affordable prices and of safe drinking-water so that all people, especially the poor and vulnerable groups, can have nutritionally adequate and safe diets. This is an issue of supreme importance to the many millions of people worldwide who currently suffer from persistent hunger, malnutrition and micronutrient deficiency diseases and to those others who are at risk of suffering in the future.

6. Good nutritional status is dependent upon each person having appropriate intakes of macronutrients and micronutrients, combined with adequate health and care and access to safe drinking-water. Nutritional status also depends on the availability of sufficient knowledge about appropriate diets, taking into account local food habits to prevent problems of undernutrition and of diet-related non-communicable diseases. Healthy and properly nourished people are both the result of successful development and contributors to it. Nutritional well-being should be adopted as a key objective in human development and must be at the centre of development strategies, plans and priorities.

7. Development policies and programmes in developed and developing countries should be sustainable and environmentally sound and lead to improved nutrition and health for both present and future generations. Equally important is the implementation of agricultural, food, health, family welfare, population, education and development policies that will achieve and maintain a balanced relationship between population needs and available resources as well as between rural and urban areas.

8. Food emergencies that deteriorate into famines are, in many cases, an indication of a lack of emergency preparedness. While the development of national early warning systems and the existence of emergency food reserves can help to avoid famines, other factors, such as open political environments at local and central levels and a free press, are crucial.

II. MAJOR POLICY GUIDELINES

9. Each country should make firm social, economic and political commitments to achieving the objective of promoting the nutritional well-being of all its people as an integral part of its development policies, plans and programmes in the short and long run. At the same time, agriculture, health, education and social welfare, as well as all other relevant sectors and ministries, should consider and, where appropriate, incorporate nutrition objectives into their plans, programmes and projects. They should also strengthen their capacity to foster public awareness and social responsiveness as well as to implement and monitor the progress of these programmes and projects. Equally necessary is ensuring coordination through adequate mechanisms to harmonize, promote and monitor programmes of different ministries, NGOs and the private sector to improve nutritional status.

10. Agricultural and overall economic policies should seek to preserve and enhance the productive capacity of agriculture where appropriate, to foster the sustainable growth of agricultural productivity and to create conditions that enable the agricultural sector to fulfil its multifunctional role as a source of food, employment, income and natural products delivered through sound natural resource management. Problems of local food shortages should be addressed through a judicious combination of production, trade and appropriate levels of national, regional and local stocks, with due regard given to the principles of an open international economic system.

11. Assuring access to adequate and safe food supplies, health care, education and related services can and must be achieved by using sustainable measures that are environmentally sound. This requires careful planning and utilization of natural resources to meet the nutritional and other needs of the growing world population on a lasting basis without jeopardizing the capacity to meet the needs of future generations. Providing incentives and motivating farmers to adopt sustainable and efficient practices are essential.

12. Development strategies to reduce poverty and ensure better nutrition for all should be oriented towards achieving economic growth with equity, ensuring social justice and protecting and promoting the well-being of all, particularly of vulnerable groups. Policies that discriminate against people on the basis of gender, age, ethnic, tribal, religion, political affiliation or other grounds militate against social justice. All people in all societies must have equitable access to economic resources and opportunities, adequate and safe food, healthy living conditions and health services, clean water, sanitation and education and related services since these are basic requirements for nutritional well-being.

13. Infants, young children, pregnant and nursing women, disabled people and the elderly within poor households are the most nutritionally vulnerable groups. Priority must be given to protecting and promoting their nutritional well-being. Towards this end, their access to adequate care within the household and to health, education and other basic social services, such as family planning, maternal and child health (MCH) clinics and social security schemes, should be ensured. Special attention must be given to the nutritional, health and educational needs of female children and adolescents, which have often been overlooked in the past. Other groups that may be at risk include some indigenous populations, refugees and displaced persons, and these groups may require particular care and services to ensure their nutritional well-being.

14. The dramatic deterioration of the nutrition situation in Africa is of serious concern and demonstrates the vulnerability of much of the African population. It calls for tangible and sustained support from the international community. In this context, support should be given to the proposals for combating drought and desertification in Africa and in other countries facing similar situations adopted by the United Nations Conference on Environment and Development in 1992. This support must also be given to proposals to promote and protect agriculture and farmers' organizations. The initiative of the OAU, in cooperation with FAO, WHO, UNICEF and other relevant international organizations, to develop a Regional Nutrition Strategy emphasizing the need for the implementation of national plans of action is strongly commended and should be concretely supported.

15. People-focused policies for nutritional improvement must acknowledge the fact that people's own knowledge, practices and creativity are important driving forces for social change. Local community involvement, including that of families and households, is a prerequisite for improving food production and sustaining access to food and for instituting adequate nutrition improvement programmes and projects. The importance of the informal sector in the processing and distribution of food should be recognized. Special efforts must be made to ensure the genuine participation of all people, particularly the poor and the marginalized, in the decisions and actions that are of concern to them in order to improve self-reliance and assure positive results. All relevant sectors of government should act in concert with communities and, as appropriate, with NGOs. Community involvement should lie not only in their indicating their perceived priorities but also in planning, managing and evaluating community-based interventions. Communities must be empowered to achieve sustained nutrition development. People's needs should be the focus for all partners in development in the identification of problems and in the planning, implementation and evaluation of intervention.

16. Women are inherently entitled to adequate nutrition in their own right as individuals. They need to constantly balance their reproductive, nurturing, educational and economic roles, which are so important to the health and nutritional well-being of the household and of the entire community. Indeed, they are the main providers of meals, care and nutrition information in the household and they have a fundamental role in assuring improved nutritional status for all. Women play a key role in the socio-economic development of rural areas and in many societies they are also the main producers of food. Special attention should be given to the nutrition of women during pregnancy and lactation. All forms of discrimination including detrimental traditional practices against women must be eliminated in accordance with the 1979 Convention on Elimination of All Forms of Discrimination Against Women. In order to promote and ensure meaningful equality between men and women, women's roles in the community must be understood. This will facilitate the sharing of their workload and responsibilities with other household members. Equity in the allocation of food between girls and boys must be promoted. Women and girls should be afforded equitable access to economic opportunities and to educational and training opportunities. Legal measures and social practices should guarantee women's equal participation in the development process by ensuring their access to and right to utilize productive resources, markets, credit, property and other family resources. Women and men should have equal access to programmes on family life education, which among other things would enable couples to plan the spacing of their children. In addition to improving education of women, and taking into account the role of men in controlling resources and in determining the nutritional status of household members, the nutrition education of men and boys should be enhanced. FAO and WHO have been requested to participate actively in the Fourth World Conference on Women to be held in Beijing, the People's Republic of China, in 1995 and to provide documentation for that conference, in close collaboration with the World Bank, UNDP, UNICEF and other relevant UN bodies, on the importance of women's and young girls' nutritional well-being and health for their own development and for the social and economic development of their countries.

17. Nutritional well-being is a prerequisite for the achievement of the full social, mental and physical potential of a population so that all people can lead fully productive lives and contribute to the development of the community and the nation with dignity. This implies that improving access to food supplies and to health, education and social services contributes to the development of people. It is also necessary to develop and strengthen capacities for planning, managing and evaluating activities, as well as for providing services, through the training of adequate numbers of personnel in relevant disciplines, particularly in food and nutritional sciences. It is also necessary to strengthen the teaching of nutrition in universities, medical and agricultural faculties, schools of health sciences and other concerned educational institutions.

18. Population policies need to have pride of place in the strategy for ensuring adequate nutrition for all, at all times. Countries should devise appropriate population policies, programmes and family planning services to allow prospective parents to freely and knowingly determine the number of their children and the spacing of their births, taking into account the interests of present and future generations. Relevant international organizations are encouraged to participate actively in the World Conference on Population and Development to be held in Cairo, Egypt, in September 1994.

19. Health is an essential element of human development requiring the action of many social and economic sectors in addition to that of the health sector. The gross inequality in the health status of people now existing between developed and developing countries as well as within countries is unacceptable and requires urgent political, social and economic attention. Inadequate health care can have serious adverse effects on nutritional status. Governments have a responsibility to protect and promote the health of their people and should formulate national policies, programmes and services in accordance with the strategy for Health for All. (Global strategy for Health for All by the year 2000, Health for All Series No. 3, WHO, Geneva, 1981).

20. Increased economic and technical cooperation among countries can be of particular importance in promoting nutritional well-being. Regional discussions that were part of the preparations for the ICN highlighted the value of increased cooperation among developing countries and within and between regions in tackling common problems, in learning from each other's experiences and, where possible, in channelling regional resources to regional problems in the spirit of economic and technical cooperation among developing countries. Such cooperation exists in many regions and must be strengthened with appropriate support from international organizations. Increased economic and technical cooperation among developed and developing countries is also essential to decrease the existing disparities in the use of food resources.

21. To achieve the objective of nutritional well-being, it is essential that adequate financial, technical and in-kind resources for implementing necessary programmes and projects are provided. Each country should therefore make all efforts to allocate the resources needed for this purpose. As some of the programmes might need resources that are currently beyond the capacity of many developing countries, the international community, particularly bilateral agencies, multilateral financing institutions and international organizations, should support country efforts in this direction. Important ways in which the international community can assist include an increase in official development assistance in order to reach the accepted UN target of 0.7 percent of the GNP of developed countries as reiterated at the 1992 UN Conference on Environment and Development. Economic assistance measures should be designed in such a way that they promote the long-term financial and economic stability of a recipient country.

III. INTERSECTORAL ISSUES

22. Improved nutrition requires the coordinated efforts of relevant government ministries, agencies and offices with mandates for agriculture, fisheries and livestock, food, health, water and public works, supplies, planning, finance, industry, education, information, social welfare and trade. It also requires the cooperation of universities and research institutions; food producers, processors and marketers; the health care community; educators at all levels; the media and NGOs involved in all of these sectors. Therefore, national intersectoral coordination mechanisms are needed to ensure the concerted implementation, monitoring and evaluation of policies, plans and programmes. Community involvement is imperative in all aspects of planning and execution of nutrition improvement activities.

23. Many intersectoral issues must be addressed in policies and programmes to improve nutrition, with close cooperation and coordination by all. Among these issues are:

(a) creating, building and strengthening government institutions and community and private infrastructure to address nutritional problems, with special attention given to management and training skills;

(b) carrying out a wide range of nutrition training in the agriculture, health, economic and education sectors;

(c) using mass media to increase awareness and promote better nutrition;

(d) strengthening relevant research on identified problems and developing effective interventions through, inter alia, the building of institutional capacity and the provision of adequate financial support to research;

(e) strengthening educational systems and social communication mechanisms to improve and implement nutritional knowledge, especially at the individual, family and community levels;

(f) creating better monitoring and surveillance systems and mechanisms related to food, nutrition, health and education to assure positive policy and programme responses to surveillance and monitoring.

24. These common and essential issues are discussed as appropriate in the thematic areas in the following section of this Plan of Action.