RAP Working Paper Series 1/1
 | Nutritional Security: Asian Perspective Beyond 2000 |
prepared by
Biplab K. Nandi
The designations employed in the presentation of material in this publication do not imply the expression of any opinion whatsoever on the part of the Food and Agriculture Organization of the United Nations concerning the legal status of any country, territory or any area or of it's authorities, or concerning the delimitation of it's frontiers or boundaries. Opinions expressed in this paper are those of the author alone and do not imply any opinion whatsoever on part of the FAO.
The author, Dr. Biplab K. Nandi, is the Senior Food and Nutrition Officer, FAO RAP, Bangkok. The current publication is a part of a Working Paper Series produced by the FAO Regional Office. Also in this Working Papers Series on Food and Agriculture -- Asian Perspective Beyond 2000:
- Asian Livestock : Year 2000 and beyond
- Women in Development of Agriculture and Rural
Economies: Asian Scenario beyond 2000
- Fishery Perspective into the Next Millennium
This is an unedited version. Your comments and suggestions are welcome.
For copies, contact:
Meetings and Publications Officer
FAO Regional Office for Asia and the Pacific
Maliwan Mansion, 39 Phra Atit Road
Bangkok 10200, THAILAND
Telephone: (662) 281 7844
Facsimile: (662) 280 0445
(RAP Publication 1999/24)
Foreword
As we all know, one of the most dramatic achievements in the region has been the remarkable progress in reducing the extent of famine, hunger and starvation. Progress in averting famine was achieved by undertaking a wide range of concerted actions to enhance the development of agriculture leading to the production of greater quantities of safe and nutritious food.
The recent Asian financial crisis has further emphasized the critical role of agriculture on the road to economic recovery. There is an increased pressure on domestic food production and supply to meet the needs of a growing population. Our current and achievable challenge, therefore, is to build upon and accelerate the progress registered in the region to ensure safe, secure and nutritious food for the future.
This publication was prepared to enhance Asian prospects for achieving nutritional security towards 2025 by serving as a catalyst for further and sustained actions. It is part of a series of publications being prepared by FAO Regional Office staff for dissemination to planners, policy makers, concerned professionals and concerned citizens with a view to enhance the focus and effectiveness of information and communication related to the overall mandate and programme priorities of FAO in the Asia-Pacific region.
It reminds us that the bottom line indicator for success in agricultural and rural development should, therefore, not merely be increased food production and income, but the quality and diversity of food and its contribution to achieving nutritional security in nations, communities as well as for each person in every household. It introduces the strong need for examining the nutritional aspects of diets of populations both in macro and micro level perspectives. Addressing food diversity issues necessitates the use of food based strategies integrated closely with community based approaches that play a crucial role in achieving nutritional security, especially at micro level situations. Adoption of such an approach would facilitate the possibility of universal access to safe and nutritious food as a basic right to households and populations at large.
It is in this spirit that this Working Paper on ‘Nutritional Security: Asian Perspective beyond 2000’ is being produced. We realize that this is not the last word on the subject, and invite your valuable comments and observations on the Working Paper. These will encourage and guide the author to finalize the publication in due course of time. I trust the publication will prove to be a useful guide towards nutritional security of the region in the future.
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| Dr. Prem Nath Assistant Director General and Regional Representative for Asia and the Pacific |
Preface
Malnutrition exists as part of the complex, widespread problem of poverty and deprivation that affects millions of people in Asia. In spite of increase in food supplies the world over, the underlying situation of most nutrition problems has not changed very much over the past 5 decades. Poverty, ignorance and disease coupled with inadequate food supplies, unhealthy environments, social stress and discrimination persist and combine to cause malnutrition. FAO initiatives such as the International Conference on Nutrition (ICN) and the World Food Summit (WFS), have not only propelled national efforts towards ensuring the most basic human rights, that is the right to enough food to support a healthy life, but they have accelerated efforts to reduce malnutrition and micronutrient deficiencies.
Indeed food and the security of food supplies, and the ultimate impact of food on nutritional well-being are imperative for nutrition improvement of households, communities and nations. Consequently, ensuring food security is a necessary condition for improving nutritional status and, in turn, for achieving nutritional security. In essence, nutritional security denotes the consumption and psychological use of adequate quantities of safe and nutritious food by every member and encompasses the process of equitable distribution among members of households and communities. However, merely achieving food access does not necessarily result in nutrition security. There is, instead, need to ensure a varied food intake, comprising all the essential macro and micro nutrients (vitamins and minerals), through a diversified diet.
This publication uses FAO data to show that there is enough food available in the world, if distributed according to individual requirements, to meet the energy needs for an active, healthy life. It views the nutritional scenario of Asian countries in global perspective while also highlighting the wide diversity with the region. It shows that available food is not equitably distributed to all within nations, communities or households. It documents that undernutrition still exists in countries with adequate food supplies, and it also shows that an inadequate food supply clearly indicates there will be an even higher prevalence of nutritional problems.
Nutrition insecurity needs to be addressed in the context of monitoring and surveillance of nutrition situations, which call for ensuring food security, improving dietary adequacy, and overcoming vulnerability through a whole range of factors that influence nutritional status. The Asian nutritional scenario features a wide range of available data that could furnish a basic framework at the country level to develop information systems with respect to food security problems. Taking account of research undertaken within each country and national data collection, it is possible to analyse some of the underlying causes of malnutrition, to develop indicators to help achieve undernutrition-reduction targets and to determine what indicators will be regularly monitored. Continuous monitoring and assessment of the nutritional scenario at various levels with development of timely warning systems would keep the country prepared to face any adverse developments or food insecurity situations. These nutrition indicators not only need to be periodically updated, but they need to be supplemented by sub-national data and micro-studies and programme assessment to facilitate regular monitoring of policy and program implementation and options.
The Asian nutritional scenario is viewed in global perspective and in regional perspective as a comparison among countries. The analysis draws on the most recent research available on the impacts of nutritional insecurity. It draws on FAO data to highlight progress and constraints along with emerging trends. An attempt has been made to compile available data on the recent food and nutrition indicators from some countries in the region. However, there still exists scope to update this information periodically. This process of compilation and analysis can serve as a model for creation of national and sub-national perspectives, which, in turn, would enhance the scientific basis for identification of nutritional security needs along with intervention points for implementation of policies and programmes. As contribution to this process, the discussion of strategies and mechanisms furnishes an overview of the range of options being implemented within the region, and these are supplemented in the appendices.
As illustration of the process, the proportion of underweight children provides the most commonest indicator of malnutrition. FAO data for Asian countries highlights trends in underweight prevalence as particularly indicative of nutrition progress and more generally of human development. Underweight, even in mild form increases risk of death and inhibits cognitive development in children, leads to reduced fitness and productivity among adults. The research discussed in the analysis shows its perpetuation from one generation to the next, through malnourished women having low birth weight babies. From the point of view of enhancing Asian prospects, the analysis concludes that it is essential to target actions, especially reductions in prevalence of LBW infants. Therefore, limiting this intergenerational transfer requires preventive action at the community level with particular emphasis on improving nutrition for the girl child, young girls, adolescents and young women before they become pregnant, and before they give birth to LBW infants.
The analysis of emerging trends highlights the impact of two major processes simultaneously underway in many Asian countries - urbanization and globalization. Rapid urbanization is shown to profoundly affect dietary and food demand patterns, and the quality of food in Asian countries. Within countries, changes in diet and life style associated with urbanization, higher incomes and longevity are giving rise to the emergence of diet related non-communicable diseases as major problems. These include obesity, cardiovascular diseases, diabetes, certain types of cancer and dental caries. Associations between these diseases and certain dietary factors (notably excess intake of energy and fat, especially saturated fat and cholesterol) and lifestyle factors (mainly smoking, emotional stress and lack of physical exercise). As support for national action, there is a need to examine the potential for a similar evolution within each country, taking account of prevalence data for various socio-economic groups and of population ageing, especially as regards an Asian perspective on osteoporosis.
This publication seeks ways to ensure safe food that will not cause harm to the consumer. It draws on the experience of FAO with inter-governmental co-operation in setting international standards that evolve from the Codex Alimentarius Commission (CAC), established by FAO/WHO. Supplementing Codex standards, member states of the FAO have adopted a series of international instruments dealing directly or indirectly with biosafety and biotechnology. The growing significance and influence of CAC is discussed in response to the World Trade Organization (WTO) and its Application of Sanitary and Phytosanitary Measures, known as the SPS Agreement, and Technical Barriers to Trade, known as the TBT Agreement. The features of risk analysis and assessment discussed here are necessary responses to globalization and liberalization with national production and international trade of safe food.
This Asian perspective highlights nutritional security as essentially a poverty problem. The priority beyond 2000 is, thus, to invest more in poor people with the objective of enhancing their productivity, health and nutritional well being by increasing their access to remunerative employment and productive assets. The focus on strategies and measures introduces the various ways governments enhance access to safe and nutritious food by targeting measures ensuring that food reaches the poorest and most malnourished people. Disparities among refugee populations need to be addressed appropriately, with the continuance of short-term food assistance for those most adversely affected. FAO also identifies target countries, as Low Income Food-Deficit Countries (LIFDCs) suffer not only from inadequate food supplies, but also from low income for imports to make up for this food deficit.
Integrated rural development strategies investing in human resource development contributing to food and nutrition security should be promoted. Intersectoral mechanisms can help to identify priority problems, review and prepare nutrition security plans and establish intersectoral mechanisms for action. Poverty reduction coupled with support for health and education and with extensive and sustained community based programs aimed at improving nutrition, are vital in bringing about rapid improvement. Adding people's participation to this approach yields a multi-disciplinary approach to rural development recording immense success in rural communities. As a result of this combination, there is a shift in policy orientation towards the involvement of all household members, especially of women. The empowerment of women must be given priority, and women must be integrated into all activities as decision makers, and as resources for sustainable development
Well designed community projects in consonance with agricultural development and nutritional improvement are needed. Dietary behaviour and subsequently nutritional status can be improved when people's participation and nutrition communication strategies are designed appropriately using an integrated approach. To support a diversified and nutritious food base, agricultural and food policies should be developed which give due weight to dietary quality, derivation of foods, and the overall trends in supply. Many countries would do well by increasing their fruit and vegetable production and processing as this has marked implications with respect to addressing micronutrient malnutrition. This Asian perspective on nutritional security, not only identifies the importance of variety and diversity in food both produced and consumed, it also reminds us that nutritional security can be achieved with traditional foods and diets, and even further enhanced by home gardens and traditional methods of food processing, preparation and preservation.
This publication has attempted to identify the vital inter-links implicated in nutritional security. The impinging role of agriculture on food and nutrition and its potential effects on nutritional security indeed need to be addressed from a broad perspective. An integrated approach in the context of Asian communities, and multi-sectoral components is seen as enhancing Asian prospects towards nutritional security, as we enter the new century and beyond.
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| Biplab K. Nandi Senior Food and Nutrition Officer |
Food and Agriculture Organization of the United Nations
Regional Office for Asia and the Pacific
Bangkok
July 1999
Hyperlinks to non-FAO Internet sites do not imply any official endorsement of or responsibility for the opinions, ideas, data or products presented at these locations, or guarantee the validity of the information provided. The sole purpose of links to non-FAO sites is to indicate further information available on related topics.
I. Food Security and Nutritional Security
A. Sufficient quantities of safe and nutritious food
Food security defined
Nutritional security defined
Linkages of these twin pillars
Consequences of insecurities
B. Regional Overview in Global Perspective
Dietary Energy Supply (DES)
Chronic energy Deficiency (CED)
Protein energy malnutrition (PEM)
Micronutrient deficiencies
Non-commuicable diseases and obesity
C. National commitments to the twin pillars
International Conference on Nutrition
World Food Summit
Commitments of Asian governments
D. International standards for safe and nutritious food
Codex Alimentarius Commission
World Trade Organization
Application of Sanitary and Phytosanitary Measures (SPS) Agreement
Technical Barriers to Trade (TBT) Agreement
Joint FAO/WHO Expert Committee on Food Additives (JECFA)
International instruments on biosafety and biotechnoogy
Convention on Biological Diversity
International Undertaking on Plant Genetic Resources
A. Enhancing availability and accessibility
Inadequate linkages
Without access
Insufficient access
Socio-economic factors
B. Enhancing quantity and quality
Sufficient quantity
Urban agriculture
Food fortification
Food safety
Codex Alimentarius
Food control systems
C. Socio-economic and socio-cultural dimensions
People's participation
Poor and rural women
Low Income Food Deficit countries
Traditional diets
Traditional processing methods
Integrated rural development
A. Nutrition and Related Indicators
Underweight and wasting
Stunting
Children
Adolescents
Women
Low birth weight
Maternal mortality
Infant mortality
Prematurity and gestation
LBW survivors
Poor survivors
Disease effects in adulthood
LBW and Body Mass Index
Iodine (IDD)
Vitamin A (VAD)
Iron (IDA)
Life expectancy, infant and child mortality
Population increase
Dietary Energy Supply
Food insecurity
Underweight
Vitamin A deficiency (VAD)
Rural poverty
Consumption outside the household
Food shifts
Undesirable features
Food safety and food contamination
Environmental pollutants and industrial toxicants
Degenerative diseases
Cancer
Diabetes
Hypertension, coronary heart disease (CHD)
Obesity in adults, adolescents and children
Anorexia nervosa
Micronutrient deficiencies
Osteoporosis, Asian perspective
V. Strategies and Measures towards Nutritional Security
A. Effective Strategies and Measures
B. Building Effective Frameworks
Responsive macro-economic and trade regimes
Diversification of food production
Income and employment generation
Equity
Women
Functional literacy
Food subsidies and rationing, and food stamps
Nutritional surveillance
Nutrition education and dietetic counseling
Food based dietary guidelines (FBDGs)
Food Quality and Safety
HIV/AIDS
Partnerships
C. Nutritional Security in Emergency Situations
D. Nutritional Impact of Economic Crisis
Overview
Crisis in Indonesia
Crisis response in Thailand
VI. Enhancing prospects beyond 2000
Poverty
LIFDCs
Demographic transition
Food friendly macro-economic and trade regimes
Women
Nutrition situation and nutrition security linkages
Low birth weigh (LBW)
Preventive strategies
Breast feeding
Nutrition education
Indicators and micronutrients
Consumer protection
Commitment and People's participation
Appendix A. Nutrition and Related Indicators in South Asia
A1. Bangladesh
A2. India
A3. Maldives
A4. Nepal
A5. Pakistan
A6. Sri Lanka
Appendix B. Nutrition and Related Indicators in South-East Asia
B1. Cambodia
B2. China
B3. Indonesia
B4. Myanmar
B5. The Philippines
B6. Thailand
B7. Vietnam
Appendix C. Strategies and Measures in South Asia
C1. Bangladesh
C2. India
C3. Sri Lanka
Appendix D. Strategies and Measures in South-East Asia
D1. Indonesia
D2. The Philippines
D3. Thailand
D4. Vietnam
Appendix E. Codex Alimentarius Commission Contact Points
List of Figures
Figure 1. DES for Asia and Pacific Countries, 1996
Figure 2. Number of Undernourished People, 1990–1992 and 1994–1996
Figure 3. Carbohydrates, Fats and Proteins as Percentage Shares of DES for Asia and Pacific Region, 1994–1996.
Figure 4. Major Food Groups as Shares of DES for Asia and Pacific Region, 1994–1996
Figure 5. Underweight Prevalence among Children under Age 5 Years
Figure 6. Wasting Prevalence among Children under Age 5 Years
Figure 7. Stunting Prevalence among Children under Age 5 Years
Figure 8. Number of Food Insecure People, 1990–1992 and 2010
Figure 9. Obesity Prevalence among Children under Age 5 Years
Figure 10. Food Groups as a Percentage of Total DES, 1994–1996
Figure 11. Poverty Incidence, 1997–1998 World Bank Estimates
List of Tables
Table 1. DES by Region and Economic Group
Table 2. Member States of the Food and Agricultural Organization of the United Nations (FAO, RAP), and of the Codex Aliminatrius Commission (CAC) and the World Trade Organization (WTO), 1996
Table 3. Wasted, Stunted and Underweight Children, 1990
Table 4. Prevalence of Stunting among Adolescents, Selected Countries, Latest Available Year
Table 5. Mean Weights and Heights of Mothers (Post Partum), Selected Asian Countries, Latest Available Year
Table 6. Low Birth Weight (LBW) in Selected Asian Countries, Latest Available Year
Table 7. Infant, Child and Maternal Mortality, and Life Expectancy, WHO Estimates, 1978 and 1998
Table 8. Nutritional Status in Selected Asian Countries, Latest Available Year
Table 9. Nutrition Related Indicators in South Asian Countries, Latest Available Year
Table 10. Population at Risk of and Affected by Micronutrient Deficiencies (in millions), Latest Available Year
Table 11. Prevalence of Anaemia (per cent) in Selected Groups of South Asian Countries, Latest Available Year
Table 12. Life Expectancy, Infant and Child Mortality, Mortality under Age 50, and GNP/Capita, 1995–2025
Table 13. Population (in millions) in Selected Asian Countries, 1997–2025
Table 14. Dietary Energy Supply (DES), 1969–1971 forward, with Projections to 2025
Table 15. Prevalence and Number of Underweight Children, under Age 5 Years, 1975–2005
Table 16. Trends in Prevalence of Clinical Signs of VAD, 1975 to 2025
Table 17. Achievements and Prospects for Alleviating Rural Poverty, Selected Asian Countries, 1970–2025
Table 18. Dietary Energy Supply (DES) from Major Food Groups, Selected South East Asian Countries, 1980–1982 and 1990–1992
Table 19. Estimates and Projections for the Total Population, Aged 60 Years and above, Selected Asian Countries, 1980–2050
Table 20. Poverty Incidence in Thailand, 1988–1996
Table 21. Typical Land Use by Rural Households in Thailand
Table 22. Selected Nutrition Indicators for Bangladesh
Table 23. Child Nutrition, Health and Consumption Indicators for Slum Children, Aged 6 to 59 Months, Bangladesh, 1988
Table 24. Total Population, Urbanisation Rate, Energy Requirements and DES, India, 1965, 1995 and 2025
Table 25. Prevalence of Severe PEM in Selected States of India, 1975–1979 and 1988–1990
Table 26. Chronic Energy Deficiency (CED), Iron Deficiency Anaemia (IDA) and Iodine Deficiency Disorders (IDD), India
Table 27. Selected Nutrition Indicators for Nepal, Latest Available Year
Table 28. Total Population, Urbanisation, Energy Requirements, and DES, Nepal, 1965, 1995 and 2025
Table 29. Total Population, Urbanisation and DES, Pakistan, 1965, 1995 and 2025
Table 30. Dietary Energy Supply (DES), Sri Lanka, 1970–1991
Table 31. Average Food Consumption and Contribution of Food to Total Energy by Major Food Groups, Indonesia
Table 32. Selected Nutrition Indicators, Indonesia
Table 33. Prevalence of Stunting by Age, Sex and Area, Indonesia, 1994
Table 34. Prevalence of Iron Deficiency Anaemia by Target Group, Indonesia, 1995
Table 35. Selected Nutrition Indicators for Myanmar, Latest Available Year
Table 36. Selected Nutrition Indicators for Thailand, Latest Available Year