Policies which provide linkages among various development sectors and promote the involvement of stakeholders in all development activities will most likely impact on the nutritional status of people
Awareness of the nutrition problem and its direct relationship to poverty, economic progress and quality of life increased considerably during the 1990s. Consequently, there is a better understanding of the multisectoral and multifactoral causes of nutrition problems in developing countries. Indeed, at no time in human history has the common resolution to solve the problem been so pervasive.
The goals set to be reached by the year 2000 were:
(a) a reduction in severe as well as moderate malnutrition, among children under five years of age, by half of the 1990 levels;
(b) a reduction in the rate of low birth weight (2.5 kg or less) to less than 10%;
(c) a reduction in iron deficiency anaemia in women by one-third of the 1990 levels;
(d) virtual elimination of iodine deficiency disorders;
(e) virtual elimination of vitamin A deficiency and its consequences, including blindness;
(f) empowerment of all women to breastfeed their children exclusively for four to six months and to continue breastfeeding, with complementary food, well into the second year;
(g) promotion of growth and regular monitoring to be institutionalized in all countries by the end of the 1990s; and
(h) dissemination of knowledge and supporting services to increase food production to ensure household food security.
WHO/UNICEF, 1990. Report of the World Summit for Children
In 1990, the World Summit for Children, held in New York, brought together heads and representatives of governments, who not only agreed to take positive actions to redress the situation, but drew up eight goals for nutrition, to be reached by the year 2000 (see Box 6). The United Nations itself enumerated four nutrition goals for its Fourth Development Decade, which in broad terms seek to end hunger and malnutrition (see Box 7).
Member States must implement agreements already reached in order for the following four goals to be achieved during the decade:
(a) eliminate starvation and death caused by famine;
(b) reduce malnutrition and mortality among children substantially;
(c) reduce chronic hunger tangibly; and
(d) eliminate major nutritional diseases.
ACC/SCN, 1995. Report of the World Summit for Social Development
Other recent global initiatives in which nutrition figured prominently include:
Den Bosch Conference on Agriculture and the Environment, held in 1991 and organized by FAO and the Government of the Netherlands;
United Nations Conference on Environment and Development, held in Rio de Janeiro in 1992;
International Conference on Population and Development, held in Cairo in 1994;
World Summit for Social Development, held in Copenhagen in 1995;
Fourth International Conference on Women, held in Beijing in 1995;
The World Food Summit, held in Rome in 1996;
The United Nations Millennium Summit, held in New York in September, 2000;
The World Food Summit Five Years Later, held in Rome in 2002; and
The World Summit on Sustainable Development, held in Johannesburg in 2002.
The United Nations Conference on Environment and Development (UNCED) resulted in the adoption of Agenda 21 and the Rio Declaration (UN, 1992). Adherence to these conventions is essential to ensure a stable and predictable environment for agricultural production, in order to meet the global food security challenge and growing demands from food consumers. Commitments made at the UNCED were re-affirmed at the World Food Summit on Sustainable Development. Of direct relevance to nutrition, this summit also reaffirmed the Millenium Development Goal, to halve by the year 2015, the proportion of the world's people whose income is less than $1 a day; and halve between 1992 and 2015, the proportion of people who suffer from hunger.
In 1992, the ICN pledged itself to the World Declaration and Plan of Action for Nutrition. The ICN linked nutrition to development and articulated how the nutrition problem could effectively be tackled within the context of development. The World Declaration and Plan of Action for Nutrition sought to eliminate hunger and all forms of malnutrition, particularly among undernourished population groups. The ICN theme for incorporating nutrition into development policies and programmes articulated goals that clearly detail what actions can be taken to incorporate nutrition into development policies and programmes (see Box 8).
United Nations member states have committed themselves to drastically reduce hunger and poverty by 2015
Recognizing that sustainable development of food and nutrition security needs to be addressed simultaneously with economic growth, governments, in collaboration with all parties concerned and supported where necessary by appropriate legislative measures should:
(a) Analyse the effects of macro-level policies and sectoral or integrated development plans on nutritional well-being, especially of the most vulnerable population groups.
(b) Increase awareness among policy-makers and planners of the extent and severity of nutritional problems and their causes, of the economic benefits, the activity status of interventions and of activity status of different socio-economic groups.
(c) In countries where it is appropriate to do so, incorporate clear nutrition goals and components in national development policies and sectoral plans, programmes and projects, particularly in the areas of food and agriculture, livestock, fisheries, forestry, rural and urban development, commerce, infrastructure, credit, water and sanitation, health, education, environmental and social-welfare, and adopt benchmarks of success with clear time frames and budget allocations, as appropriate.
(d) In countries where the operation of the market as a mechanism for the coordination of production and the consumption of food is relied upon, develop education and communication programmes so that nutrition objectives can be achieved through appropriate consumer choice based on enhanced consumer awareness and knowledge, and encourage the development of social welfare policies that will enable the more vulnerable population groups to exercise informed dietary choice.
(e) Develop or strengthen the technical capacities of, and institutional mechanism with, each relevant ministry and at intermediate levels of government to identify nutritional problems and their causes, and to improve the planning, management and evaluation of programmes and development projects that affect nutrition. Links with appropriate research and training institutions should be strengthened as well.
(f) Establish a flexible national mechanism with strong technical support to promote effective intersectoral co-operation, to keep the nutrition situation in the country under continuous review and to facilitate the development of national nutrition policies and programmes.
(g) Encourage and support the full involvement of communities and the participation of the people therein in the identification of their own nutritional problems as well as in the implementation, monitoring and evaluation of development programmes.
(h) Encourage the private sector, including small-scale producers and processors, industries and NGOs, to promote nutritional well-being by considering the impact of its activities on the nutritional status of the people.
(i) Assess the impact of new development programmes and projects on nutrition to clearly identify the potential benefits for or risk to nutritional well-being among vulnerable population groups.
(j) Develop and use relevant indicators of nutritional well-being to monitor progress in social and economic development and establish appropriate mechanisms to regularly provide information on the population's nutritional status and factors affecting it, especially that of vulnerable groups, to policy-makers and planners and all interested sectors, both private and public.
(k) Incorporate appropriate and relevant elements of nutrition in school curricula, starting from primary school.
(l) Improve nutrition by directing additional investment into agricultural research where necessary to:
FAO/WHO, 1992b. ICN. World Declaration on Nutrition. Plan of Action for Nutrition. Rome
The world has come to accept that poverty not only constitutes a denial of fundamental human rights but also that poverty alleviation is an economic imperative for global prosperity. Without a significant reduction in the level of poverty, the well-being of a large proportion of the worlds population is, and will continue to be, significantly compromised.
According to the 2002 Human Development Report, globally, the number of people living in extreme poverty is declining at a slow but steady rate. In 1990, 29 percent of the world's population lived in extreme poverty and the rate had decreased to 23 percent in 1999 (UNDP, 2002). The report also reveals that global primary school enrolments increased from 80 percent in 1990 to 84 percent in 1998. Furthermore, there has been some improvement in water and sanitation issues: since 1990, 800 million more people have access to improved water supply and 750 million more to better sanitation. However, disparities continue to exist: 5 percent of the world's richest people have an income which is 114 times higher than that of the poorest 5 percent. Africa's situation is grim; in recent years, human development has degenerated in this region. Around the world, each day more than 30,000 children die of preventable diseases, and about 14,000 people are infected with HIV/AIDS. Each year, millions of people die because of hunger and of these, six million are children below the age of five (FAO, 2002).
Since malnutrition and poverty are intertwined, policies and programmes to reduce poverty are urgently required to alleviate malnutrition. These policies and programmes need to:
empower individuals, households and communities to gain greater control over their life and resources;
strengthen gender equality and empower women;
facilitate the economic growth of the poor by creating an enabling environment to support productivity and increased income;
ensure active participation of the poor in the political, social and economic development process; and
facilitate the building of social safety nets to prevent people from falling into destitution.
Policies and programmes which create an enabling environment to support productivity and increased incomes are urgently needed to promote equity and sustainable development
In the design and management of targeted poverty alleviation programmes, it would be beneficial to consider the following issues:
The political economy of poverty: the need to invest scarce resources on projects that benefit the poor.
Strategic issues: the need for narrowly targeted programmes, and linkages between macroeconomic policies and poverty alleviation programmes.
Conceptual issues: how targeting and poverty are defined, and the distinction between the poor and vulnerable.
Institutional issues: how governments can adapt their administrative and organizational systems to effectively reach the poor; how NGOs can most effectively be used; whether programmes should be implemented through existing line ministries or new institutions; the role of decentralization; and the strategies for capacity building.
Operational issues: project selection, approaches to targeting, incorporating NGOs and improving project and programme sustainability.
Data requirements: the definition of the kinds of information required and the feasibility of obtaining this information in a timely and cost-effective manner.
Sectoral issues: the need to consider conducive conditions for agricultural and rural development, housing and urban development, education, health and nutrition and how these conditions affect the design and management of poverty alleviation programmes in each of these sectors.
Gender issues: the need to consider that, while both men and women suffer from the effects of poverty, there are a number of reasons why the burden rests particularly on women and why poverty alleviation strategies would be most helpful if they specifically address gender issues.
An analysis framework of nutrition and development can be found in Figure 3. This conceptual framework shows the multisectoral and multifactoral causes of malnutrition, identifying key issues in society - the economy, health, education and the environment - which link nutrition to development.
One of the main aims of development is to break the insidious inner cycle of malnutrition and disease, which leads to low productivity. This cycle reduces the capacity for an adult to generate income, thus resulting in the synergistic cycle of malnutrition-disease-poverty. The cycle is thus closed and poverty continues to flow from one generation to the next (Grant, 1995).
Policies are formulated to enhance the ability of a country to achieve set development goals. Generally, for a policy to directly impact on nutrition, it must promote access to adequate food; good health and sanitation; and sound physical and psychological care. Furthermore, it is helpful when such policies are aimed at protecting the environment and conserving natural resources to support agriculture and the overall economy.
Policies which provide linkages between various development sectors and promote the involvement of stakeholders, in all development activities, will most likely impact on the nutritional status of people. It is critical that the capacities of people benefiting from programmes and projects arising from such policies be developed and strengthened. Sectoral policies that have an impact on nutrition are discussed in the following section.
POLICIES ON AGRICULTURE
A large number of people who are prone to food insecurity and are nutritionally vulnerable live in rural areas, where their occupation is mainly subsistence agriculture. The majority are low-income groups, such as small-scale farmers and pastoralists. Most of these people are unable to produce enough food to meet their daily requirements. At the same time, they cannot afford to buy enough food to supplement their needs. These people often lack required farming inputs such as extension services, access to technology, land, storage facilities and credit to increase their agricultural productivity.
In response, policies in agriculture need to encourage access to means of production such as land, credit, improved seeds, water, extension services, inputs and appropriate technology. Policies that provide support to food production by small-scale farmers will enhance household food security and increase the income of these farmers.
Promotion of cash crops and non-traditional foods can affect production and availability of food crops to the detriment of household consumption and nutritional status. Other conditions within this sector that affect nutrition indirectly are marketing, pricing, non-release of buffer stocks and absence of land reforms. A decrease in food consumption due to higher food prices resulting from a rise in producer prices can have a negative impact on food availability (particularly for the poor) and nutritional status. Therefore, appropriate intervention strategies that are targeted at the vulnerable need to be designed and put in place. Sound environmental policies are encouraged for those who live in environmentally fragile areas to support their farming activities. Governments are encouraged to adopt policies that promote the production and availability of nutritionally adequate foods to all population groups. In most countries where malnutrition is a public health problem, policy changes relating to export crops and staples, which could improve availability of domestic food supplies, need to be assessed.
POLICIES ON HEALTH
Access to basic health services is often inadequate in many developing countries. This is usually the result of an insufficient number of health centres, long distances to reach health facilities and/or lack of infrastructure facilities such as roads and communications.
Often, illnesses such as measles, diarrhoea, gastroenteritis and malaria are responsible for the high mortality rate of infants and young children in developing countries. These illnesses also have a direct impact on nutritional status. In addition, poor nutritional status further exacerbates this condition through a weakened immune system. If no intervention measures are taken, these diseases continue to ravage the poor rural populace. Programmes and projects to reduce the prevalence of these illnesses will improve infant and child survival rates.
The Primary Health Care Programme integrates both curative and preventive services, and has made a positive impact on nutritional status
Health policies that promote access to health care facilities and services for the poor, such as the Primary Health Care Programme, which integrates both curative and preventive care services for women and children, have shown a positive impact on the nutritional status of individuals (World Bank, 1994).
Policies that promote the use of mobile clinics or health services in remote areas increase access to health services. For example, providing immunization for all children up to five years of age wherever they are located will reduce morbidity and mortality of infants and pre-school age children (World Bank, 1994). The overall effect is improved nutritional status and wellbeing for infants and children.
Policies that support the provision of teaching hospitals to the exclusion of neighbourhood clinics can reduce public access to health care facilities, thus affecting nutritional status negatively. Policies that encourage access to basic health services and family planning strengthen the primary health care system. Improving access can also be achieved through provision of better equipment, materials (drugs, vaccines, etc.), personnel, training of traditional health personnel such as birth attendants, and better incentives for health personnel who choose to work in rural areas.
Lack of sound population policies that promote affordable family sizes can negatively affect nutrition. In addition, high medical fees and government cutbacks in the social sector due to economic reform can also affect access to facilities such as family planning services, thereby undermining nutritional well-being. It would be beneficial to have policies that aim at promoting small families through well-spaced births and encouraging couples not to have more children than they can adequately care for. Family planning information and services could be actively promoted not as a birth control measure but as a component to the broader reproductive health care system. It is also useful for policies to strive to develop new partnerships with NGOs, civil society and the private sector in the health care delivery system.
POLICIES ON ACCESS TO SAFE WATER AND SANITATION
Adequate food supply, good health and safe water and sanitation are pre-conditions for good nutritional status. As they are interrelated, good nutritional status can only be achieved if all three conditions are ensured.
Current water and sanitation policies in many developing countries are inadequate. As a result, diseases such as guinea worm, diarrhoea, cholera and other waterborne illnesses are of high prevalence and nutritional status is compromised. In addition, improved access to safe water and adequate sanitation for all reduces the heavy workload of women who otherwise have to trek long distances in search of water, a situation that impedes on their child care and family nurturing responsibilities.
Policies that provide equitable access to safe water and put in place a system for maintaining good sanitation are strongly encouraged.
Safe water and good sanitation are pre-conditions for good nutritional status
POLICIES ON EDUCATION
Basic education is the most powerful single intervention for increasing economic development and improving the health and nutritional status of infants and young children. World Bank estimates (1991) show that, on average, each year of the first three years of basic education in a population adds 9 percent to the GDP; and each additional year from three to six years adds 4 percent to the GDP. Furthermore, the estimates revealed that an increase of one year of primary education for women lowers the infant mortality rate by 2 percent. Empirical studies have shown that, disregarding household food supply, income and other related factors, increased maternal education has a positive impact on nutritional status (FAO/WHO, 1992).
Basic education is the single most powerful intervention for increasing economic development
Discrimination in school enrolment of girls has an undesirable impact on nutrition: women's educational levels significantly affect fertility in that educated women are more likely to work in the paid labour force, and women who work outside the home tend to have fewer children than those who are not in formal employment (UN, 1989). Higher productivity of women, as measured by their income, is associated with delayed marriage and thus delayed child bearing and lower total fertility. Moreover, an educated woman is likely to be concerned with giving her family an adequate diet. Womens participation in the paid labour force is often associated with greater income control and increased influence on the familys nutritional wellbeing (UN, 1989). In order to enhance sustainable national development with equity and good quality of life, it is advised that policies that promote education, particularly qualitative universal primary education and adult education, are developed and implemented.
POLICIES ON INFRASTRUCTURE
Policies that do not support adequate provision of basic infrastructures to the general populace usually have a negative impact on nutrition. For example, roads that are not accessible throughout the year, or that by-pass food-producing areas or communities, can result in the instability of food supplies and food shortages. Similarly, inadequate transportation systems can affect food availability through higher prices.
Therefore, it is very important to analyze the effects of various infrastructural policies on nutrition in order to ensure that maximum benefit to nutrition and national development are able to be derived from such policies.
POLICIES THAT FOCUS ON WOMEN AND GENDER EQUALITY
Policies that focus on women promote gender equality while encouraging equal access to education, health, job opportunities, land and credit. These policies also need to provide strategies to end domestic violence. In addition, all forms of discrimination against women, especially in the economic sphere of life, need to be eliminated.
It is noteworthy that all countries have signed the protocols on the 1989 Convention on the Elimination of All Forms of Discrimination Against Women (FAO, 1998c).
People's participation on all issues that affect them socially, politically and economically is key. This promotes accountability and transparency in government and engenders good governance and equity. Popular participation in governance helps to prevent strife and conflicts, promote stability and legitimacy, and ultimately ensures household food security and nutritional wellbeing.
Policies that promote gender equality need to promote equal access to education by both genders
The subject of population and development could best be addressed by considering issues such as population and birth spacing based on the sensitivities and cultures of the people.
However, urbanization takes place at a rapid pace in developing countries, and more than 60 million inhabitants are added every year to cities and towns. Consequences of rural-urban migration are of concern in many countries. Transformation of production, processing, marketing, transportation and distribution induced by rapid urbanization represent major challenges for the entire food sector. Population growth is the major reason for increased food production and it puts additional pressure on natural resources.
Countries with rapid population growth face especially difficult challenges in ensuring food security. The early stabilization of the world's population is a condition for sustainable food security. Development of human resources is essential to promote rapid economic growth and overall national development. Without investment in human capital or human capital formation, the concept of sustainable human development would be illusory.
People's participation in social, economic and political issues that pertain to their lives is key to sustainable development and politically stable societies
Therefore, an enabling environment could be established through policies that promote the participation of all citizens in all matters that concern them, while facilitating broad-based participation on a decentralized basis in the development process. Such policies help to create an enabling environment for small-scale agriculture, micro-enterprises and the informal sector. This is an essential prerequisite for the stimulation of people's initiatives and creativity, and for enhancing output and productivity. In addition, policies and programmes that address economic growth with equity, especially among the poor, can promote a more humane, just and egalitarian society, which facilitates good governance and stable societies.