Here-to-fore the discussion has elaborated on the complex linkages between various socio-cultural issues and socio-economic factors influencing the potential for achieving nutritional security beyond 2000. Asian countries have made great strides over the past 5 decades in dealing with problems of poverty, malnutrition and other aspects of nutrition insecurity. Food production has increased, child malnutrition has declined along with infant and child mortality. Despite these impressive gains, Asians continue to suffer from poverty, hunger and malnutrition in staggering proportions (ACC/SCN, 1997).
Strategies and measures that can be adopted, adapted and implemented by Asian countries, hold the key to the 21st century in terms of linking nutrition and development outcomes. Past international initiatives were seriously concerned with the hunger and malnutrition and several plausible sets of interventions and actions evolved. While many of these initiatives also showed concern for the poor, not all were able to translate the concern for improving nutritional well-being into action (FAO 1996). As a result, identification of successful ways and means for achieving progress is especially important.
Planners and policy makers need an effective policy and programme framework for making decisions and formulating workable and effective interventions. These not only need to easily adapt to different country situations, but they also need to be sensitive and responsive to the Asian socio-cultural contexts and complexities, especially since the socio-economic situation is rapidly changing, urbanizing and encountering threats of excess and deficits in both food and nutrition insecurity. Additional features of effective measures involve nutritional surveillance and provision of nutritional security in emergency situations and during the current economic crisis underway in Asian countries.
Malnutrition being complex in its determinants, requires the use of broad based economic policies as a means of its elimination on the one hand, and the use of more targeted interventions on the other. What is typically needed is a combination of different types of macro-economic policies and measures that effectively alleviate poverty and malnutrition while also serving countries as support for sustainable nutritional security. Selected examples of effective policy and programme activities undertaken by South Asian and South-East Asian countries featured in Appendices C and D depict some of the steps taken towards overcoming nutrition insecurity or its threat, in the Asian region.
National Plans of Action for Nutrition (NPANs) were designed in response to the the International Conference on Nutrition and these mark a major achievement of Asian countries. These plans often reflect the concerns and effective networking among national organizations, non-governmental organizations (NGOs), academia, private sector/industry and communities, and they call for collective action and initiatives regarding nutrition.
Over the past five decades, there also have been a number of scientific and action-oriented conferences, which influenced both the philosophy and technical focus of these nutrition action plans. As a result, there is a shift in focus towards nutritional well-being of future generations, food needs of growing populations, and sustainable strategies and mechanisms for overcoming nutrition problems. Building effective frameworks for implementing plans with this focus evolves from discussion of successful measures for implementing these strategies and achieving goals beyond 2000.
The diversity among Asian countries with programme interventions to enhance food and nutritional security is featured in appendices C and D. Review of these interventions gives rise to identification of several major components for building a national framework for designing interventions to achieve nutritional security beyond 2000. An effective framework thus would contain these basic components:
The following discussion identifies some of the features for these components by giving emphasis to their support for effective strategies and measures. Illustrations of successful interventions are identified and supplemented by elaboration in the appendices of specific policies and programmes undertaken by South Asian and South-East Asia countries to achieve nutritional security beyond 2000.
Responsive macro-economic and trade regimes. Over the past decade or so, some important changes are underway with significant impact on macro-economic policies supporting food production and trade, including developing food standards (Orriss 1998). Although industry and national regulators strive for production and processing systems which ensure that all food be “safe and wholesome”, complete freedom from risks is an unattainable goal. Food safety and wholesomeness are related to a level of risk that society regards as reasonable, and in context and comparison with other risks in life. As risk analysis will play a vital role in the future work of the WTO, it has been introduced as the discipline of standarisation in the SPS Agreement, whereby member states are expected to justify levels of protection higher than those in Codex standards by using risk assessment techniques. Food safety risk analysis is the fundamental methodology underlying the development of food safety standards, giving rise to an estimate of the probability and severity of the adverse health effects in exposed populations, consequential to hazards in food (FAO 1997).
Risk assessment involves policy guidelines that are documented so as to ensure consistency and transparency. Examples include establishing the population(s) at risk, establishing criteria for ranking of hazards, and guidelines for application of safety factors, such as Hazard Analysis and Critical Control Point (HACCP) System. Risk profiling entails describing a food safety problem and its context, in order to identify those elements of the hazard or risk relevant to various risk management decisions. This risk profile identifies those aspects of hazards given emphasis in decisions about priorities and assessment policy, and other aspects of the risk that are relevant to the choice of safety standards and management options. Risk management entails the process of weighing policy alternatives in the light of the results of assessment and, if required, selecting and implementing appropriate control options, including regulatory measures.
Risk management encompasses risk evaluation, risk management option assessment, implementation and review. Risk evaluation identifies food safety problems, establishes these profiles, ranks hazards as priorities for assessment and management, establishes assessment policy for conduct of assessments, commissions assessments, and considers the assessment results. Risk management option assessment entails three activities; namely, identification of available management options, selection of the preferred management option taking account of appropriate safety standards, and the final management decision. The protection of human health is the primary consideration in arriving at decisions, with other factors (such as economic costs, benefits, technical feasibility, risk perceptions) being considered as appropriate. Risk communication is an essential component of risk analysis, involving the exchange of information and opinions concerning the risk and risk-related factors among risk assessors, risk managers, consumers and other interested parties (FAO 1998d).
In order to harmonise sanitary and phytosanitary measures on a wide a basis as possible, WTO members are encouraged to base their measures on international standards, guidelines and recommendations where they exist (WTO Home Page, June 1999). However, members may maintain or introduce measures which result from higher standards if there is scientific justification or as a consequence of consistent risk decisions based on an appropriate risk assessment. The SPS Agreement spells out procedures and criteria for the assessment of risk and the determination of appropriate levels of sanitary or phytosanitary protection. It is also expected that WTO members would accept the sanitary and phytosanitary measures of others as equivalent if the exporting country demonstrates to the importing country that its measures achieve the importing country's appropriate level of health protection. The SPS agreement includes provisions on control, inspection and approval procedures.
Diversification of food production and marketing. In the developing countries of the world and especially in Asia, any discussion of achieving the combined objectives of food and nutritional security flows from the view of agriculture as the engine of food production. Recognition of the impinging role of agriculture on food and nutrition thus becomes essential to sustainable development. Increasing food production to meet the needs of a rapidly rising population is the major challenge facing Asian countries in the area of food security. Increasing the diversification of food production as essential to nutritional security. Achieving the objectives of these twin pillars requires a combination of strategies to guard against possible evils arising from the indiscriminate use of potential resources, and measures responding to these two essential factors:
Biological diversity in nature's gene pool not only facilitates development of hardy species, it also supports varieties capable of surviving new environmental challenges. A wide range of crops, animals, fish and forest products not only make food production and, thus, food and nutrition security more secure from season to season, but such farming systems also are less damaging to the environment. This approach to dietary diversification supports production and utilization of a diversified and nutritious food base, beyond what is currently available in Asia, shown in Figure 10, below. This approach needs support from social marketing strategies promoting food diversification in agricultural development in the context of nutrition communication and education.
Source: FAOSTAT, Rome, 1999
Home Gardens not only maintain their importance as major sources of a diversified and nutritious food base, they also provide self-sustaining occupations and essential income for small scale farmers, women and communities throughout Asia. Women and especially children also contribute foraged and traditional foods. Forestland, meadows, wetlands, fallow land and even weeds in cultivated fields usually supply the variety (and micronutrients) in diets. It is desirable to preserve these lands either in the natural or wild states or encourage communities to wisely husband them.
Marketing of food crops, indigenous foods, traditional foods, also contributes to improving food security through provision of increased income and promotion of employment generation, whereby gains in real income from marketing typically translate into gains in food consumption and diversity in nutrition. As a result, those affected can acquire more food, reduce their work loads and thus improve child care, enhance household sanitation and housing environments, improve water availability in terms of both quantity and quality, and at the same time, strengthen effective demands for both preventive and curative health care. Further, raising income typically exerts a positive and significant effect on nutrition (von Braun, 1995).
Biotechnology has a long history of use in food production and processing, as it combines traditional practices and the latest techniques based on molecular biology. Use of modern biotechnological techniques open up great possibilities of rapidly improving the quantity and quality of food available. Its benefits include providing resistance to crop pests to improve production and reduce chemical pesticide usage, thereby making major improvements in food quality and their nutritional value. Biotechnology is also being used as food additives and for a wide range of applications to food fermentation.
Recognition of its potential benefits is accompanied by worldwide concern and renewed efforts to guard against the uncertainties and potential risks associated with their use (FAO/WHO 1996). These efforts are directed towards identifying criteria for risk assessment, using scientific methods and analysis of food safety appropriate to biotechnology research. International instruments guide these efforts. Assessing its contribution requires ensuring that biotechnology also plays a major role in improving the quality of life on a long-term basis. Further development, testing and micro-implementation of appropriate technologies for diverse agro-ecologies remains a challenge for future decades and beyond.
Income and employment generation. Malnutrition and nutrition insecurity are overcome by innovative mechanisms for generating and diversifying employment and income. Major interventions feature employment in exchange for cash or food, and credit to the poor to support consumption stabilization and self employment. Other income generation schemes, such as home gardening and livestock production, have become important features of national strategies. These mechanisms address three central problems facing Asian countries today: food and nutrition insecurity, growing unemployment and poor infrastructure (von Braun, 1995). Some employment schemes lend viable support for land and water systems and other infrastructure improvements.
Equity in nutrition is an inseparable part of equity within rural communities and between rural and urban areas of the country. Extreme socio-economic inequities, leading to widespread destitution appears to be the cause of malnutrition in Asia, especially in South Asian countries. An equitable system facilitates access by the lowest income people in communities to an acceptable level of basic services. Achieving equity in nutrition thus decreases differences in access to and utilization of food and nutrition services. Socially disadvantaged groups and ethnic minorities are commonly affected, but the complex socio-cultural factors giving rise to these inequities are often ignored.
An explicit focus on women is essential to successful strategies and mechanisms. Recognition of the need to involve women in their design evolves not simply from a limited concern about equity of women with men as both beneficiaries and contributors to development. Rather, women need to be active participants because they have experience with successful achievements in ensuring community and household food and nutrition security evolving throughout centuries in the socio-cultural contexts of Asian countries. These successful strategies and measures for food production, processing, preservation for storage or exchange are major features of the socio-cultural traditions passed on from grandmothers to mothers to daughters throughout Asian countries. As a result, Asian women offer cumulative knowledge, but their potential remains untapped. The involvement of poor and rural women may be most essential flowing from their vast experience with efforts to identify cost-effective and energy efficient measures that are workable within the constraints of low income and limited access to productive resources.
Women farmers need to be recognised as major food producers and this requires their fair access to land ownership, water and other natural and productive resources (e.g. technology) and support services (e.g. agricultural extension, credit and training in agriculture, food and nutrition. Women also need to participate in design and review of ‘food friendly’ macro-economic and trade policies. The active participation of women is essential to identify ways of overcoming the bias limiting nutrition adequacy to girls from infancy throughout childhood. The nutrition-inequity interaction is strongly influenced by the degree and form of subordination of women. Maternal malnutrition and childhood wasting, especially for the girl child and adolescent, are critical indicators of equitable assess to nutritional security and prospects for the future. Thus, the resultant inequities need priority attention in policy frameworks for Asian countries, especially in South Asia.
Overcoming basic and functional literacy, especially among girls and women, is an essential component of successful programmes. Overcoming urban/rural disparities in access and quality of education is essential. The production and use of education materials and curricula reflecting rural perspectives, and including emphasis on rural concerns and strategies for achieving food and nutritional security are essential elements.
Food subsidies and rationing, food stamps, and food distribution systems. Food related income transfers are often used to improve nutrition, but they involve price subsidies that are high in terms of fiscal and economic costs. These programmes incorporate a combination of targeting methods, including the targeting of commodities and beneficiaries. Geographical targeting of beneficiaries support the establishment of systems in food deficit areas with poor populations. Food stamp programmes serve as vehicles to provide incomes to poor households. In order to be effective in the context of assuring nutrition security, food stamp programmes should be directed towards those who are very poor. Food distribution systems are established as public distribution systems PDS) in countries subject to food shortages to meet the food and nutrition security needs of the very poor. (Dreze and Sen 1988). PDS are most effective when buffer stocks are available, but when they are not, imports may be necessary substitutes.
Nutritional surveillance. There is thus the need to develop national information systems, to analyse the underlying causes of undernutrition and overnutrition, to develop indicators of progress towards achieving targets and, to this end, to identify indicators that will be regularly monitored (FAO, 1998). Nutrition surveillance systems produce the basic information for monitoring the environment and, at the same time, it produces warning signals that trigger actions to overcome nutrition insecurity. Nutrition surveillance is defined as an on-going system for generating information about the current and future magnitude, distribution and causes of undernutrition and micronutrition deficiencies in populations for policy formulation, programme planning, management and evaluation (WHO 1976).
In the absence of an effective surveillance system furnishing information and explanation, lack of information or misinformation becomes the most important influence on understanding and, therefore, on limiting decision making about actions. Effective nutritional surveillance systems, thus, are envisaged to embody four primary objectives (Gillepsie 1995), namely, problem identification and sensitisation or advocacy, macro-and micro-level planning, timely warning, and programme monitoring and evaluation. Continuous monitoring and assessment of the nutritional scenario discussed in Section III, when supplemented by development of timely warning systems focused on national and household food and nutritional insecurities, prepare governments to more effectively respond to any adverse situations, such as the emergency situations.
Nutrition surveillance systems with these features, therefore, need to be institutionalized within the existing infrastructure of the Government. The Food Insecurity and Vulnerability Information Mapping Systems (FIVIMS) is being developed as a model for this purpose. The systems not only identify undernourised people and those who are at risk, they also provide information about the causes of their food insecurity and vulnerability, factors as diverse as poverty, inadequate marketing infrastructure, drought or civil strife that leave them exposed to the threat of hunger. FIVIMS use existing information-gathering systems (e.g. indicators discussed in Section III) and promote the sharing of information between partners, at national and international levels, to cut costs and save time. Focusing on nutrition goals and responses requires information supporting assessment and analysis of nutrition problems, as well as information for monitoring and evaluation of outcomes of programmes and projects discussed as strategies and measures. The early warning and rapid response features of these food and nutrition surveillance systems are essential during emergency situations.
Nutrition education and dietetic counselling. The most effective tool for nutritional education and dietetic counselling are food based dietary guidelines (FBDGs) that reflect dietary traditions and culinary practices of the complex and diverse array of socio-cultures in Asian countries. Their initial design responds to scientifically accurate and technically sound information and, thereafter, is regularly reviewed and modified as appropriate in response to recent research, especially findings pertaining to nutrient requirement, consumption patterns and the nutrition situation of the target population. Asian FBDGs also promote preservation of the traditional diet and of traditional ways of producing and processing food. To minimise the negative consequences of the nutritional transition beyond 2000, they promote the merits of cereal-based dietary practices in Asia, such as the nutritional importance of fiber intake, and the beneficial effects of the fatty acid profile in the ‘invisible fat’ contained in cereals (Achaya 1986, Gopalan 1988). High intakes of vegetables also are promoted. FBDGs restore traditional methods of processing by promoting them as yielding nutritional benefits, e.g. malting of grains, sprouting of legumes, and hand pounding of grains.
Besides, there is need for innovation and versatility in health and nutrition services to furnish information and support for overcoming undernutrition and emerging problems, arising due to overnutrition. There is need for targeted efforts, with special emphasis on general education and nutrition education, and counseling. The FAO package on nutrition education, entitled “Get the best from your food” furnishes one illustration of the type of educational tool that needs to be utilised in Asian contexts. Nutrition education through the mass media, in health centers, school system and health programmes need to incorporate sensitive and responsive measures taking account of the process of population ageing and its socio-economic consequences for nutritional insecurity among older people, especially among older women and widows.
Food Quality and Safety. Three major areas of concern deserve special attention to enhance Asian prospects beyond 2000. The first involves responses to concerns about the safety of foods produced and processes outside the household, such as street foods. The second responds to the qualitative inadequacies of micronutrients in the food supply, and the third involves the strengthening of food control systems and promoting good manufacturing practices along with appropriate nutrition education highlighting consumer protection. Educating households and communities about appropriate food handling is essential to reduce food contamination and related illnesses. Food is subject to harmful contamination from the soil it is grown in, from the plant or animal it is derived from, from handling during processing and preparation, and from the dish it is served on.
Formal and non-formal education and media are important contributions to increasing awareness about consumer protection needs of families and communities. These elements of nutrition education are viewed as important components of primary and secondary school curricula; and for curricula in the education and agricultural sectors, food and nutrition sciences, and health sciences; and as mechanisms for nutritional intervention in medical facilities. Besides, special efforts to promote non-formal education are necessary to increase nutritional awareness and compliance with FAO/WHO Codex standards among policy-makers, and especially among employees within food export and inspection agencies and among food industry operators.
Setting standards, identifying codes for practice and designing regulations in compliance with international standards adopted by the Codex Alimentarius Commission ensure food quality and safety. Effective strategies involving people's participation to improve the quality and safety of street foods are being implemented in Calcutta and Bangkok. A strong relationship among the authorities and the hawkers' representatives led to the preparation of policy guidelines for the regulation of street foods in Calcutta (Chakravarty and Canet 1996). Thailand developed a ten-step code of practice for street food vendors that is used and monitored by local authorities to motivate implementation (Dawson et al 1996).
FAO provides technical assistance to member countries in food quality control, including safety and such assistance are made available more for the developing countries in order to establish or strengthen the food control systems. The effective strategies towards achieving nutritional security, therefore, would call for strengthening such technical assistance from FAO. Specifically, there is a need for technical assistance in establishing the infrastructure for an enhanced food control programme, assessing laboratory service requirements, providing guidance to develop legislation and procedural manuals, setting up reputable inspection and certification systems, and providing training and staff development. FAO member countries increasingly recognise that both the SPS Agreement and the TBT Agreement have implications for the work of the Codex Alimentarius Commission. Increasing consumer interest in food safety, the SPS and TBT Agreements of WTO, harmonisation initiatives, and the need for more transparency, is leading to increased scientific, legal and political demands being made on the standards, guidelines and recommendations elaborated by Codex.
Food fortification is an essential feature of nutrition strategies to alleviate micronutrient deficiencies (FAO 1995). As illustration, salt is one of the most suitable vehicles for iodine fortification to prevent iodine deficiency problems. It has been successfully and, in general, safely used for over seventy years in programmes around the world. Cereals are the most widely used vehicles for iron fortification, although many others, such as milk products, sugar, curry powder, soya sauce and cookies, have been successfully used. Foods successfully fortified with vitamin A include margarine, fats and oils, milk, sugar, cereals, and instant noodles. A limited number of food vehicles are suitable for vitamin D fortification, e.g. margarine, vegetable oils and dairy products. Vitamin E, as tocopherol acetate, is added to fats and oils including margarine and fat spreads and breakfast cereals. There are technologies available for vitamin C fortification of fruit juices, fruit juice drinks, other related beverages, dairy products and some breakfast cereals. There are no problems related to the technology of the addition of B vitamins to cereals and grains.
Food regulations need to cover the fortification of foods with micronutrients, and these should be in compliance with international standards adopted by the Codex Alimentarius Commission. As illustration, food labels need to be clear and easy to understand with attention to harmonizing labeling requirements. Better information on nutrient analysis and food composition is needed on food labels. Measures to assist individuals with food intolerances need to be implemented, and labels need to show greater sensitivity to socio-cultural diversity. Claims in food labeling or advertising need to be carefully monitors, and regulations adopted and enforced that prohibit false or misleading claims. National Codex Committees need to be established and/or strengthened to assist the process of ensuring a safe food supply (See Appendix E for national level Codex contact points).
HIV/AIDS. More than 90 per cent of all adults living with HIV/AIDS live in developing countries. Not only is the incidence increasing in Asian countries, but the numbers are growing in alarming proportions in South-East and South Asia, with more than half of all new infections occurring among children and young people under age 25 years. HIV/AIDs also seems likely to intensify rural poverty. Malnutrition as inherent to the AIDS syndrome, not only contributes to poor health status, but by extension, to low labour productivity, low incomes and livelihood insecurity. People with AIDS are particularly vulnerable because without a good diet, they cannot maintain good health and live a longer life to provide for their children. Coping mechanisms often disintegrate soon after adult death, and food intake frequently declines sharply among surviving members.
HIV/AIDS morbidity and mortality intensify nutritional insecurity in several ways. They trigger food insecurity of households. They render some households chronically food insecure and, thus, their members become chronically undernourished. The most vulnerable members are infants, young children, pregnant and lactating women, and older persons, especially widows. There also is an increase in the frequency and extent of food insecurity in these households. For design of effective interventions, policy makers, planners and nutritionists need a comprehensive understanding of the interrelationships of HIV/AIDS to insecurities of food, nutrition and socio-economic deprivation, with socio-cultural sensitivity to family dynamics and coping mechanisms.
Partnerships of wide range are essential if governments are to effectively design and implement strategies and measures to achieve nutritional security beyond 2000. As illustration for micronutrient malnutrition, successful approaches to introduce food fortification requires strong support from a range of private and public sector partners. Co-operation of the food industry is usually sought at a very early stage of programme development, but planners, practitioners and policy makers at various levels of government make the initial and vital contributions to fortification efforts. These partnerships contribute to long term food diversification strategies by providing improved preservation technologies, techniques, improved semi-processed foods, and by promoting consumption of locally available micro nutrient rich foods in the diet or as a food fortificant. Several successfulul partnerships are operating in Asian countries. Thus, simple nutritional and technological solutions exist and considerable progress has been made through partnerships. Mandatory compliance is ensured through legislation and regulations, and supplemented by political and financial incentives furnished in many forms and from various sources as contributions to strengthening these partnerships.
Nutritional insecurity is a likely outcome in situations of natural calamities, civil war and strife in the country and other related conditions requiring relief and rehabilitation when individuals and households become vulnerable and are at high risk of deteriorating nutritional status. The most vulnerable households include those headed by poor women; urban slum dwellers; poor rural households, and especially those without land; and refugee or displaced persons' households. The most vulnerable people in these households are infants, preschool children, adolescents, pregnant and lactating women, older persons, the disabled and orphans.
Emergency situations require a policy framework supporting quick decisions and rapid interventions for rehabilitation flowing from effective monitoring, evaluation and mobilization strategies. Effective responses require decisions be made in collaboration with the victims, who are often skilled and productive forces but currently either under-employed or unemployed. Their potential can become an essential resource and their assistance can be mobilized and organized as a major component of community responses to emergency situations. To this end, victims need to actively participate in decision making about appropriate responses to emergency situations.
As support for policy and intervention strategies, indicators need to be identified for monitoring both progress and effectiveness of relief and rehabilitation provisions. Effective interventions are sensitive to the socio-cultural situation, especially the local governing culture, traditions and work procedures. Effective indicators highlight changes in the overall impact of the emergency situation and changes introduced by intervention strategies on the target area and its population. It is also necessary to assess other factors which influence these strategies and thereby the effectiveness of indicators, such as climate, market prices, prevalence of conflict of violence in the community, and a range of socio-cultural factors which differentiate people, such as ethnicity and religion.
Effective intervention strategies during natural calamities, civil war and strife in the country and other related conditions combine relief and rehabilitation when individuals and households become vulnerable and are at high risk of deteriorating nutritional status. These strategies involve the promotion of home production of food, improved utilization of food, and food processing using appropriate technology. They entail increasing the purchasing power of household members and enhancing community capacities for response to emergency situations. While food aid is often an essential initial response to furnish relief, sustainable strategies for nutritional well being combine relief with rehabilitation strategies involving the promotion of home food production.
Capacities of communities need to be enhanced following emergency situations. Community organizations most frequently identified as targets include women's groups, farmer co-operatives, saving and credit groups, water users' associations, children's groups, and organizations of youth and senior citizens. Older persons are particularly effective in Asian communities, as senior members of most households exercise major influence in community decisions. Existing skills need to be identified and, thereafter, supplemented by training and investments.
There is a major role for international agencies in alleviating emergency situations, e.g. furnishing suitable technical expertise on short notice, updating skills of existing permanent and temporary staff, and provision of good supervision and training in the field. As capacities at both national, regional and community levels also need to be strengthened, effective co-ordination ensures that nutrition security becomes an integrated components of all activity responses to emergency situations.
The current economic crisis that has engulfed much of South East Asia appears to have impinged on various spheres of development as well as nutritional status. While information on its specific impact on nutritional status of the community is yet to be made available from countries in the region, the situation indeed calls for integrated and sustained community action to address the nutrition problems that are evolving as formidable challenges in the near future. Comments on the impact of the socio-economic crisis in Asian countries with reference to the food and nutrition situation and status constitute this section (FIVIMS Expert Consultation. 1998). Notably, the developing countries most affected by the crisis have not yet established adequate social safety net programmes, similar to those found in industrialized countries (FAO 1999).
Typical examples of Indonesia, the Republic of Korea and Thailand are in the midst of major crises. The World Bank estimates shown in Figure 11 below highlight the negative impact of a reversal in poverty alleviation in all three countries, although in varying degrees (World Bank 1999). Poverty lines are set at around one US$/day for Indonesia, two US$/day in Thailand, and four US$/day in the Republic of Korea. Between 1997 and 1998, poverty doubled in Indonesia and it nearly tripled in urban areas in the Republic of Korea. Indonesia and Thailand are elaborated subsequently (Soekirman 1999; Tontisirin and Bhattacharjee 1998).
Figure 11. Poverty Incidence, World Bank Estimates (per cent)
Source World Bank News Release, 2 June 1999.
In Indonesia, the impact of the economic crisis is being rapidly transformed into a nutritional crisis with serious implications for the future. Major food shortages and accelerating food prices during the first three months of 1998 triggered rioting and social unrest.
The most obvious impact is a 24.4 per cent drop in standards of living (World Bank 1999). This drop is immediately translated into reduced purchasing power and limited ability of households to access their basic needs of food and health care. Qualitative dietary studies (HKI 1998) show decreased consumption of relatively expensive foods such as milk, eggs and fortified noodles in Jawa, Kalimantan and South Sulawesi. The proportion of mothers and children who drank milk before the crisis (in June 1996) was twice that during the crisis (in June 1998).
Coinciding with these findings, the prevalence of severe malnutrition (marasmickwashiorkor) increased from 5 per cent to 10–18 per cent in 1996–1997 and as much as 12 to 30 per cent in 1998. There is evidence of a shifting pattern for weight gains among children under age 5 years, whereby, on 45 per cent of children gained weight during the crisis in 1998 in contrast to 75 per cent in 1997, before the crisis. Besides, vitamin A deficiencies are re-emerging among women, e.g. the prevalence of night blindness is higher than observed 12 months ago. Childhood anaemia also has increased.
Poverty alleviation is a major component of long term national policy to achieve food and nutrition objectives in Thailand. The Poverty Alleviation Plan (PAP) initially focused on improving the quality of life of 7.5 million poor people in the northern, northeastern and extreme southern regions. To achieve its objectives and to promote equity, PAP adheres to five principles: 1) priority is given to specified areas where poverty is concentrated; 2) living standards supporting a subsistence level of living for all people; 3) emphasis to people eventually becoming self-reliant; 4) low cost and affordable technology, and handled by the people themselves; and 5) people's participation and promotion of self-reliance in decision making and problem solving.
The declining trends for the prevalence of poverty, shown in Table 20 below, are due to PAP implementation through this multi-sectoral approach. Further evidence is featured in Figure 11 above, where World Bank estimates show relatively small increases in poverty due to the economic crisis, from 11.4 per cent in 1996 to 12.9 per cent in 1998.
Table 20. Poverty Incidence in Thailand, 1988–1996
(per cent)
| Region | 1988 | 1990 | 1992 | 1994 | 1996 |
| Central | 32.9 | 20.7 | 15.4 | 7.2 | 6.2 |
| East | 15.5 | 19.4 | 11.9 | 7.5 | 3.8 |
| West | 32.0 | 26.4 | 13.1 | 12.5 | 9.3 |
| North | 32.0 | 23.2 | 22.6 | 13.2 | 11.2 |
| Northeast | 48.4 | 43.1 | 39.9 | 28.6 | 19.4 |
| South | 32.5 | 27.6 | 19.7 | 17.3 | 11.5 |
| Bangkok | 6.1 | 3.5 | 1.9 | 0.9 | 0.6 |
| Total average | 32.6 | 27.2 | 23.2 | 16.3 | 11.4 |
| Total (millions) | 17.9 | 15.3 | 13.5 | 9.7 | 6.8 |
Source: The Poor Thai 1998
The economic crisis in Thailand is giving rise to poverty and declines in earnings, as suggested by a 13.6 per cent decline in the standard of living (World Bank 1999). Rural areas are most affected. Available evidence, newspaper reports and economic records suggest four additional effects; namely, adoption of prudent life styles with reductions in consumption, varying degrees of psychological stress among severely affected individuals, declines in nutritional adequacy in terms of total daily dietary energy, and declines in both food supplies and micronutrients. Available evidence about the current nutrition situation suggests that the progressive improvements in nutrition experienced over the past two decades as part of poverty alleviation are being sustained.
The economic crisis has here-to-fore not become manifest as food insecurity, due partly to the ‘food safety net,’ established in the country through the long term efforts of the Royal Family and co-operative efforts between the government and non-governmental organizations (NGOs). The Royal Family promotes ‘self-sufficiency of food’ through improvement programmes of agriculture and food production operating throughout the country, with special efforts directed to people in the vulnerable regions bordering Thailand. His Majesty the King of Thailand gives priority to food production as a priority for consumption, followed by economic improvement.
These holistic prevention and control strategies for addressing nutritional problems have been developed and are being implemented at various levels through the agriculture, health and nutrition services and systems within the country, utilising a participatory community involvement approach. Integrated farming systems are practised to optimise the use of available land. A typical land distribution for use of existing resources among most rural households is outlined in Table 21 below, which His Majesty the King of Thailand encourages this optimal use of land by rural households. This combination of measures supports a simple, self sufficient system of food production for home consumption that is well established in most rural households.
Table 21. Typical Land Use by Rural Households in Thailand
| Land purpose | Proportion for use (per cent) |
| Housing | 10 |
| Reservoir of water Fish ponds | 30 |
| Home gardens Fruit trees, raising poultry | 30 |
| Cultivation of staples (rice) | 30 |
Source: Tontisirin and Bhattacherjee 1998
Government support schemes have been set up in response to the economic crisis. For instance, a social investment fund links communities with NGOs supporting community based activities. This support fund is used to provide investment for assistance with such activities as, small-scale farming, food enterprises, fruit processing, and self-help activities. Various food production, processing and marketing schemes for the unemployed are also components of this government support, and these activities are supported by training programmes. The government also established credit co-operatives at the community level to support rural and urban groups. This assistance also enables groups to meet the nutritional and income needs of the most economically disadvantaged.
