5. Food security and nutrition

Technical background documents 1-5
Volume 1
FAO, 1996

Contents

Acknowledgements

Executive summary

1. INTRODUCTION

Complementary perspectives on nutrition

2. CURRENT AND FUTURE DIMENSIONS OF THE NUTRITION PROBLEM

How many people are hungry and/or malnourished?

Where and who are the food-insecure and malnourished?

Future challenges posed by population pressure and economic change

3. BASING POLICY ACTION ON AN UNDERSTANDING OF THE CAUSES OF MALNUTRITION

Causes and linkages

Linkages among agriculture, food security and nutrition

4. POLICIES AND ACTIONS NEEDED TO IMPROVE NUTRITION

Past international initiatives

Policies and programmes and their impact

Cost considerations

Priorities and approaches for nutrition policy actions

BIBLIOGRAPHY

ANNEX: NUTRITIONAL CONSIDERATIONS IN PAST GLOBAL INITIATIVES

Acknowledgements

The preparation of the World Food Summit technical background documents has mobilized, in addition to FAO’s own staff contribution, a considerable amount of expertise in the international scientific community, drawn from partner international institutions and governmental or non-governmental circles. The process has been monitored at FAO by an internal Reading Committee, composed of staff selected ad personam and established to ensure that the whole collection meets appropriate quality and consistency criteria.

The present document has been prepared by Dr Joachim von Braun of the University of Kiel, Germany, in collaboration with John Lupien, Jean-Pierre Cotier, Maarten Immink and Brian Thompson of FAO; Joanne Csete, Micheline Beaudry and David Alnwick of the United Nations Children’s Fund (UNICEF); David Steeds, Hans Binswanger, Harold Alderman and Judith McGuire of the World Bank; and Mercedes de Onís and Chizurun Nishida of the World Health Organization (WHO). After initial review within FAO by all technical departments, invited colleagues and the Reading Committee, a first version was published and circulated for comments to governments, international governmental organizations (IGOs) and non-governmental organizations (NGOs), as well as to peer reviewers. Much appreciated comments and advice have been received from Dr Gopalan of the Nutrition Foundation of India; Suzanne S. Harris of the Human Nutrition Institute, International Life Sciences Institute (ILSI); Dr R. Uauy Dagach of the Institute of Nutrition and Food Technology, University of Chile; Gérard Viatte of the Organisation for Economic Co-operation and Development (OECD); Prof. Chen Chunming of the Chinese Academy of Preventive Medicine, Beijing, China; Per Pinstrup-Andersen and Lawrence Haddad of the International Food Policy Research Institute (IFPRI); Gérard Ghersi of Université Laval, Canada; Patrick Webb of the World Food Programme (WFP); Marc Cohen of Bread for the World, United States; Clive Robinson of Christian Aid, United Kingdom; and Vicky Quinn of the United Nations Children’s Fund (UNICEF), Ghana.

While grateful for the contributions received from all reviewers, the FAO Secretariat bears responsibility for the content of the document.

Executive summary

Improving nutrition is an issue of supreme importance to many millions of people throughout the world who are suffering from persistent hunger and malnutrition and to others who are at risk of doing so in the future. There is general consensus today that a complex set of factors determines hunger and malnutrition. Important causes are related not only to food and agriculture, but also to people’s knowledge and behaviour. Policies have a strong influence on all causes. The aim of this paper is to examine the relationships among food security, agriculture and nutrition and to outline nutrition-improvement policies that offer the promise of bringing about rapid and sustained improvement.

Malnutrition may be viewed from three different perspectives: as the lack of a basic human right, as a symptom of broader poverty and underdevelopment problems or as a cause of these poverty and underdevelopment problems. There are powerful arguments for all three perspectives and, in terms of considering specific actions, the three are certainly complementary.

In order to design effective policies, it is necessary to gain a clear understanding of the linkages among food security, agriculture and nutrition as well as all determinants of nutritional well-being.

• Food and the security of its supply are preconditions for nutritional well-being. Poverty is a major determinant of food insecurity and poor health; the poor lack adequate means to obtain food in the quantities and qualities needed for a healthy life. In addition, food insecurity and hunger in a number of countries are caused primarily by armed conflicts or are actually used as instruments to conduct such conflicts.
• The significance of agriculture in improving nutrition is due, first, to its principal role, i.e. the production of food of the desired quality and quantity, and, second, to its direct and indirect role in providing employment and income to the poor throughout the economy, particularly in low-income countries.
• Health, sanitation and the care given to vulnerable members of society have a strong influence on nutrition. Malnutrition leads to substantial losses in productivity and the misallocation of scarce resources as a result of decreased work performance and diminished cognitive ability and school performance.

Exactly how many households and individuals are affected by malnutrition is unknown because of difficulties of definition and measurement and inadequate data. Any overview of best estimates of major nutritional problems must emphasize the following:

• An estimated 841 million people are hungry (food-energy deficient), i.e. 20 percent of the developing countries’ total population. This figure does not include the hungry in industrialized countries and in economies in transition.
• Some 190 million children are underweight, 230 million children are stunted and 50 million children are wasted. The last figure may understate the actual magnitude of the problem because it captures only current acute problems which may worsen in certain seasons or circumstances. Nutritional problems resulting in low body weight are also prevalent among adults and adolescents in developing countries.
• Vitamin A deficiency is a public-health problem in at least 60 countries; some 40 million children are suffering from this deficiency. About 29 percent of the world’s population is at risk of iodine deficiency. Worldwide, about 2 billion people are affected by iron deficiency, a condition to which women and preschool children are particularly prone.
• The problem of undernutrition is paralleled by extensive and growing public-health problems with obesity, not only in the richest and the poorest countries, but also in low- and middle-income countries, and especially in urban areas.

It is necessary to fulfil a number of preconditions before it is possible to conduct sustained actions to improve nutrition, and the specific actions needed to tackle a given country’s nutritional problems vary according to its situation. These often unfulfilled preconditions include:

• appropriate macroeconomic policies and development strategies (with related trade, storage and food-aid policies, where applicable), which are a precondition for a functioning economy capable of employment-intensive growth;
• policies and programmes for increasing agricultural production and raising productivity in low-income countries, which are a precondition for future security of adequate nutrition – a precondition in which effective national and international agricultural research systems play a key role of sustainable nutritional improvement.

The range of specific actions to be taken varies from one country to another and may include:

• programmes for reducing poverty (including employment and infrastructure-improvement programmes);
• sustainable food- and nutrition-related transfer programmes (such as food subsidies and food stamps), which address the immediate causes of malnutrition of the poor as much as possible;
• direct nutrition and health interventions (e.g. targeted feeding, micronutrient programmes, nutrition education, integrated nutrition programmes, sanitation and health actions and relief programmes), which address both the short- and long-term symptoms and causes of nutritional problems, including those of higher-income groups, by focusing on changing behaviour.

Building on past international commitments and ongoing initiatives for nutritional improvement, the paper concludes with a set of priority areas of attention and actions addressing:

• the malnutrition/mortality cycle, with clearly defined targets for measurably reducing malnutrition;
• human-resource development for nutrition, including attention to actions facilitating reduced population growth;
• the promotion of employment-intensive growth, especially through agricultural growth promotion and employment programmes for the poor;
• famine prevention, including mechanisms for preventing famines related to armed conflicts;
• the facilitation of community and household self-help through education and empowerment, especially for women.

Any consideration of the costs of nutritional improvement must also take into account the benefits that would be forfeited through non-action. Focusing on (fiscal) spending and ignoring the resultant benefits is misleading. The guiding principle in considering the cost aspects of improving nutrition must be to achieve the defined nutritional goals rapidly and sustainably through the use of a portfolio of the most cost-effective policy instruments.

Only if the urgency and significance of the food security and nutritional situation are readily apparent will appropriate action be taken and the international support for such action be sustained. The availability of organizational capacity is a prerequisite for monitoring changes in the nutritional situation and for evaluating the effects of nutrition policies and programmes.

It is imperative that the governmental organizations, particularly ministries, as well as non-governmental interests involved in nutrition improvement activities be well coordinated at the national level. Such coordination can be stimulated by international organizations, but it often lacks a well-established framework. It is necessary to develop national strategies involving all food and agricultural interests in order to ensure that actions aimed at food-security and nutritional improvement are sustained and consistent. Progress in implementing the strategy will be enhanced when all nutrition improvement efforts are coordinated by a problem-oriented, lean management structure that recognizes that improving and maintaining adequate nutrition for all at all times strongly depends upon the relevant actors in the non-governmental arena, especially food producers.

Past international initiatives regarding food security and nutrition have stimulated actions for improvement. Drawing on new insights, new global circumstances and new forms of cooperation, the World Food Summit offers an opportunity to build on past initiatives. The creation of a transparent and reliable international reporting system for measuring national progress in achieving nutritional well-being (e.g. reduction in the proportion and number of underweight children and other relevant indicators, presented in map and other forms) will be instrumental in creating the proper political understanding for implementing the needed actions. National food-for-all campaign committees will be one of the most appropriate instruments to monitor the food and nutrition situation at national and subnational levels and to promote actions that will alleviate problems of hunger and malnutrition. The follow-ups to previous international commitments, i.e. the World Summit for Children and the International Conference on Nutrition (ICN), have gone in the right direction, and this approach should be reinforced.