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
Priorities and approaches for nutrition policy actions
ANNEX: NUTRITIONAL CONSIDERATIONS IN PAST GLOBAL INITIATIVES
The preparation of the World Food Summit technical background documents has mobilized, in addition to FAOs 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 Childrens 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 Childrens Fund (UNICEF), Ghana.
While grateful for the contributions received from all reviewers, the FAO Secretariat bears responsibility for the content of the document.
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 peoples 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.
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:
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 countrys nutritional problems vary according to its situation. These often unfulfilled preconditions include:
The range of specific actions to be taken varies from one country to another and may include:
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:
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.