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«Jomo Kwame Sundaram Vikas Rawal Michael T. Clark Tulika Books Published by Food and Agriculture Organization of the United Nations (FAO) Viale delle ...»

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Ending

Malnutrition

from commitment to action

Jomo Kwame Sundaram

Vikas Rawal

Michael T. Clark

Tulika Books

Published by

Food and Agriculture Organization of the United Nations (FAO)

Viale delle Terme di Caracalla, 00153 Rome, Italy

in association with

Tulika Books

35 A/1 Shahpur Jat, New Delhi 110 049, India

©FAO, 2015

Cover design: Alpana Khare

Cover photo: ©M A Sriram/The Hindu

ISBN (FAO edition): 978-92-5-108872-2

ISBN (Tulika Books edition): 978-93-82381-64-8

The designations employed and the presentation of material in this information product do not imply the expression of any opinion whatsoever on the part of the Food and Agriculture Organization of the United Nations (FAO) concerning the legal or development status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The mention of specific companies or products of manufacturers, whether or not these have been patented, does not imply that these have been endorsed or recommended by FAO in preference to others of a similar nature that are not mentioned. The views expressed in this information product are those of the author(s) and do not necessarily reflect the views or policies of FAO.

FAO encourages the use, reproduction and dissemination of material in this information product. Except where otherwise indicated, material may be copied, downloaded and printed for private study, research and teaching purposes, or for use in non-commercial products or services, provided that appropriate acknowledgement of FAO as the source and copyright holder is given and that FAO’s endorsement of users’ views, products or services is not implied in any way.

All requests for translation and adaptation rights, and for resale and other commercial use rights should be addressed to www.fao.org/contact-us/licence-request or to copyright@fao.org.

FAO information products are available on the FAO website (www.fao.org/publications) and can be purchased through publications-sales@fao.org Contents List of Tables v List of Figures vii List of Boxes ix Preface xi Acknowledgements xv 1 Uneven Progress in Reducing Hunger and Malnutrition 1 Hunger and malnutrition in the world today............2 Reducing caloric undernourishment.................3 Slow and uneven progress in reducing malnutrition...

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1.1 Prevalence of undernourishment and number of undernourished persons, by region, 1990–92 and 2014–16.... 4

1.2 Estimated prevalence and number of children under 5 years of age affected by low weight-for-age, by region, 1990 and 2012. 8

1.3 Estimated prevalence and number of children under 5 years of age affected by stunting (moderate or severe), by region, 1990 and 2012............................ 9

2.1 Supply of different types of foods, by regions of the world, 2011 (kilogram per capita per year)................ 19

2.2 India: Average consumption of milk, kg per capita per annum. 25

2.3 Biodiversity in home gardens in selected countries of the world. 27

2.4 United States: Average energy density and price per unit of dietary energy for different food groups, 2001–02......... 30

2.5 France: Price per unit of dietary energy from different food items, 2000.............................. 31

2.6 United Kingdom: Average price per unit of dietary energy from different food groups, 2012.................. 31

2.7 Indonesia: Share of selected commodity groups in total food expenditure, by monthly per capita expenditure class, rural and urban, 2013 (percent)...................... 32

2.8 Malaysia: Share of selected commodity groups in total household food expenditure, by monthly household expenditure class, 2009–10 (percent)................ 33

2.9 South Africa: Share of selected commodity groups in total food expenditure, by deciles of monthly per capita expenditure, 2010–11 (percent)................... 33

2.10 India: Share of selected commodity groups in total food expenditure, by fractile classes of monthly per capita expenditure, rural and urban, 2011–12 (percent)......... 34 v vi Tables

3.1 Income multipliers of social protection programmes, by country 42

3.2 Production multipliers of social protection programmes, by country................................ 43

3.3 Latin America and the Caribbean: Coverage of and public expenditure on conditional cash transfer programmes, by country, 2009–10 (percent)..................... 52

5.1 Number of persons and proportion of population not having access to piped water on premises, by region, 2012 (million and percent)............................. 75

5.2 Number of persons and proportion of population not having access to improved sanitation, by region, 2012 (million and percent)................................ 75

5.3 India: Proportion of households by different types of sanitation facility, 2011 (percent).................. 79 Figures





1.1 Prevalence of Undernourishment, by country, 2014–16..... 5

1.2 Success in meeting the World Food Summit Target and the Millennium Development Goals Target 1c, by country, 2014–16 6

1.3 Prevalence of anaemia among pre-school children and women of reproductive age, by country, 1993–2005 (percent).. 10

1.4 Prevalence of iodine deficiency in population, by country, 1993–2006 (percent)......................... 11

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3.1 Brazil: Public expenditure on and number of beneficiary family farmers, Programa de Aquisição de Alimentos (PAA), Brazil, 2003–12............................ 46

3.2 Brazil: Public expenditure on and number of children provided meals through Programa Nacional de Alimentação Escolar (PNAE), 1995–2012..................... 47

3.3 Proportion of children of primary and secondary school going age provided meals at school, by country, 2012 (percent). 50

4.1 Proportion of households consuming adequately iodized salt, by country, 2000–13...................... 65

–  –  –

In November 2014, representatives from over 170 governments, together with leaders of intergovernmental organizations and civil society – including non-governmental organizations, researchers, the private sector, and consumer representatives – converged in Rome for the Second International Conference on Nutrition (ICN2). ICN2 was not a technical meeting;

it was organized to mobilize and unite the international community for the protracted struggle against malnutrition. Organized by the Food and Agriculture Organization of the United Nations (FAO) and the World Health Organization (WHO), ICN2 and its preparatory process provided both a forum and event in which the world community, led by governments, affirmed its shared commitment to eradicating malnutrition by adopting the Rome Declaration, and reaching agreement on a comprehensive, harmonized Framework for Action.

A central contribution of ICN2 was to put sustainable access to healthy diets at the centre of food production, distribution, and consumption.

The perspective was comprehensive. Through the Rome Declaration on Nutrition and the Framework for Action, countries committed to eradicate all forms of malnutrition worldwide: hunger or ‘undernourishment’ (inadequacy of dietary energy and protein intake); undernutrition (including micronutrient deficiencies, particularly during the ‘first thousand days’ from conception to age 2); and obesity and diet-related non-communicable diseases.

The Rome Declaration commits governments, inter alia, to ensure sustainable food systems for universal access to balanced and diversified diets. The Framework for Action sets out how to create an enabling environment for a wide variety of effective nutrition actions, including public policy interventions, to give effect to these commitments. The tools recommended are manifold: nutrition education and information; social protection to improve the nutritional status of schoolchildren, the poor,

xixii Preface

and vulnerable; scaled-up health system interventions to enhance nutrition;

improved drinking water, sanitation, and hygiene; and enhanced food safety.

The 2013 edition of the annual FAO flagship report, The State of Food and Agriculture, took as its theme, food systems for better nutrition, and provided important background for ICN2. The report showed how various aspects of the food system – from inputs and production to transportation, processing, storage, retailing, food preparation, and consumption – influence the availability of diverse, nutritious foods, and affect people’s access to and utilization of foods. Healthier, more sustainable food systems, the report showed, are key to securing healthy diets over the course of the life-cycle for all children, women, and men.

This book summarizes the role of food systems in improving nutrition, and highlights the measures necessary for its implementation on a global scale. It makes the case for more coordinated and concerted policy approaches, as well as greater international cooperation, to address malnutrition in all its forms. It argues for increasing food availability through increased investments in agriculture, including by specifically promoting investments to enhance the availability of nutrient-rich foods. Such investments are preconditions for a major breakthrough on nutrition, but, in many circumstances, the availability of more nutritious food by itself may not improve nutritional outcomes. By reviewing selected experiences of using social protection programmes to address hunger and malnutrition, this book argues for the expansion of coverage and the design of social protection programmes to ensure better popular access to adequate nutritious food – by ensuring both affordability and availability when needed. While recognizing the vital importance of appropriate fortification and supplementation in dealing with specific micronutrient deficiencies, the book cautions against placing nutrition supplements at the centre of the strategy. It argues instead for public regulation of and popular education about nutritional supplementation to prevent abuses and to ensure that profit does not take precedence over need.

In accord with the ICN2 consensus, the book also identifies complementary actions required to improve nutrition. According to the latest statistics available, about 750 million persons in the world do not have access to safe water supply, while 2.5 billion people do not have access to improved sanitation. Closing these gaps requires political commitment at the highest level, involvement of all the relevant parts and levels of government, sustained fiscal support, and much greater popular awareness of health, nutrition, and hygiene.

The new post-2015 Sustainable Development Goals (SDGs), to be adopted by UN member-states in September 2015, present an extraordinary opportunity to invigorate the commitments and practical vision that emerged from ICN2. The ICN2 outcomes were formally welcomed in a resolution adopted by the UN General Assembly on 6 July 2015, with a Preface xiii decision made to consider other outstanding issues, including a follow-up programme of action, soon after the September 2015 UN Summit.

This publication is intended to provide a useful resource to policymakers, and their partners and supporters in civil society, expert communities, and the private sector, as they seek to transform ICN2 commitments and recommendations into concrete actions.

Vikas Rawal coordinated the preparation of the manuscript of this book.

He is the lead author of chapters 1-5, and Michael Clark of chapter 6, on Governance.

–  –  –

This book has emerged from the lengthy expert consultations and intergovernmental negotiations that led to the Second International Conference on Nutrition (ICN2) and the adoption of its two outcomes – the Rome Declaration and the Framework for Action – by consensus in November

2014. Jointly organized by the World Health Organization (WHO) and the Food and Agriculture Organization of the United Nations (FAO), ICN2 was a culminating event that drew on and contributed to growing global interest in nutrition. The ICN2 outcomes and their preparatory processes brought together a large number policymakers and experts from governments, academic and technical research institutes, international organizations, civil society, the private sector, foundations, and philanthropies. In so doing, it established a comprehensive new international foundation for collaboration.

The ICN2 preparatory process began several years before, with various consultations and materials on national circumstances and experiences commissioned and presented to expert groups to develop an evidence base for the conference. The FAO’s flagship report, The State of Food and Agriculture, for 2013 focused on Food Systems for Better Nutrition, and helped to fill an important gap in nutrition policy by calling attention to the fundamental role of food systems in meeting – or not meeting – nutritional needs. It provided important guidance on steps to be taken to promote adoption of effective, evidence-based policies and regulation as well as informed consumers.

In this context, it is a pleasant but nonetheless challenging duty to record the many contributions that have been made to the preparation of this work. We must start by recognizing, en masse, the many colleagues who contributed to the ICN2 process, including the Preparatory Technical meeting in November 2013 and the complex intergovernmental negotiations, involving national representatives from both FAO and WHO, that produced the outcomes. The conference itself gathered more than 2,200

xvxvi Acknowledgements



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