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• Recommendation 58: National governments are encouraged to establish nutrition targets and intermediate milestones, consistent with the timeframe for implementation (2016–2025), as well as global nutrition and noncommunicable disease targets established by the ¹¹ Including by implementing effective risk assessment and management practices on safe wastewater use and sanitation.
¹² FAO/WHO International Network of Food Safety Authorities (http://www.who.int/ foodsafety/areas_work/infosan/en/).
130 Ending Malnutrition World Health Assembly. They are invited to include – in their national monitoring frameworks – agreed international indicators for nutrition outcomes (to track progress in achieving national targets), nutrition programme implementation (including coverage of interventions) and the nutrition policy environment (including institutional arrangements, capacities and investments in nutrition)¹³. Monitoring should be conducted, to the fullest possible extent, through existing mechanisms.
• Recommendation 59: Reports on implementation of the commitments of the Rome Declaration on Nutrition will be compiled jointly by FAO and WHO, in close collaboration with other United Nations agencies, funds and programmes and other relevant regional and international organizations, as appropriate, based on country selfassessments as well as information available through other monitoring and accountability mechanisms (e.g. Scaling Up Nutrition selfassessment reports, reports to the FAO Conference and the World Health Assembly, and the Global Nutrition Report).
• Recommendation 60: The governing bodies of FAO and WHO, and other relevant international organizations are requested to consider the inclusion of reports on the overall follow-up to ICN2 on the agendas of the regular FAO and WHO governing body meetings, including FAO regional conferences and WHO regional committee meetings, possibly on a biennial basis. The Directors-General of FAO and WHO are also requested to transmit such reports to the United Nations General Assembly as appropriate.
¹³ Monitoring frameworks may be developed based on the Global Monitoring Framework for Maternal, Infant and Young Child Nutrition, the Monitoring Framework for the Global Action Plan on Noncommunicable Diseases, as well as indicatorsfor monitoring food security (FAO prevalence of undernutrition, food insecurity experience scale, and other widely used indicators).
Appendix C ICN2: Information Note on the Framework for Action
Summary: Key Messages from the Framework for Action
• For effective implementation of policies to improve nutrition an enabling policy environment is essential. This means explicit political commitment, greater investment, cross-government policies and plans, along with multistakeholder governance mechanisms.
• Sustainable food systems are key to promoting healthy diets, and innovative food system solutions are needed.
• Information and education concerning healthy dietary practices are vital, but consumers must also be empowered through enabling food environments that provide safe, diverse and healthy diets.
• While a food systems approach is important, coherent action is also needed in other sectors. These include international trade and investment, nutrition education and information, social protection, health system delivery of direct nutrition interventions and other health services to promote nutrition, water, sanitation and hygiene, and food safety.
• For the purpose of accountability, the Framework for Action adopts existing global targets for improving maternal, infant and young child nutrition and for noncommunicable disease (NCD) risk factor reduction.
132 Ending Malnutrition
1. INTRODUCTION The political declaration of the Second International Conference on Nutrition to be held in Rome, Italy, on 19–21 November 2014 addresses the multiple challenges of malnutrition in all its forms to inclusive and sustainable development and health. The 10 commitments of the Rome Declaration on Nutrition (see box) set out a common vision and provide a mandate, as well as the obligations, for governments to address nutrition in the coming decades.
Summary of the 10 Commitments to Action in the Rome Declaration on Nutrition
1. Eradicate hunger and prevent all forms of malnutrition worldwide
2. Increase investments for effective interventions and actions to improve people’s diets and nutrition
3. Enhance sustainable food systems by developing coherent public policies from production to consumption and across relevant sectors
4. Raise the profile of nutrition within relevant national strategies, policies, action plans and programmes and align national resources accordingly
5. Improve nutrition by strengthening human and institutional capacities through relevant research and development, innovation and appropriate technology transfer
6. Strengthen and facilitate contributions and action by all stakeholders and promote collaboration within and across countries
7. Develop policies, programmes and initiatives for ensuring healthy diets throughout the life course
8. Empower people and create an enabling environment for making informed choices about food products for healthy dietary practices and appropriate infant and young child feeding practices through improved health and nutrition information and education
9. Implement the commitments of the Rome Declaration on Nutrition through the Framework for Action
10. Give due consideration to integrating the vision and commitments of the Rome Declaration on Nutrition into the post-2015 development agenda process including a possible related global goal The Framework for Action (FFA) provides a set of voluntary policy options and strategies – in the form of 60 recommended actions – for use primarily by governments as well as other stakeholders, as appropriate, to guide the implementation of the political declaration.
ICN2: Information Note on the Framework for Action 133 This Information Note, prepared by the joint FAO and WHO Secretariat, is intended to accompany the FFA, and provides additional information that may be helpful to Member States and other stakeholders. For ease of reference, the document follows the structure of the FFA.
1.1 Background There has been significant progress in reducing hunger and undernutrition since the 1992 International Conference on Nutrition (ICN), but progress has been uneven and unacceptably slow. The prevalence of those suffering from chronic dietary energy insufficiency has declined, but remains unacceptably high, with over 800 million people suffering from chronic undernourishment, mainly in South Asia and Sub-Saharan Africa.
Chronic malnutrition (stunting) still affects 161 million children under 5 years of age, while acute malnutrition (wasting) affects 51 million children under 5 years of age. In addition, over two billion people suffer from one or more micronutrient deficiencies.
Furthermore, alongside the problems of chronic undernourishment (hunger), undernutrition and micronutrient deficiencies (also referred to as ‘hidden hunger’), most countries in the world are also facing increasing problems associated with obesity and diet-related noncommunicable diseases (NCDs). Over half a billion adults are obese and 42 million children under 5 years of age are overweight while diet-related NCDs are becoming serious global public health problems even in low- and middle-income countries, creating the “multiple burden” of malnutrition (hunger/undernutrition;
micronutrient deficiencies; obesity and diet-related NCDs).
Meanwhile, the food system has continued to evolve with a greater proportion of food now processed and traded internationally. The availability of highly-processed commercial food products high in fat, sugars and salt/sodium has increased, often replacing healthy local diets and foods with the needed micronutrients, and resulting in excessive consumption of energy, fats, sugars and salt. The fundamental challenge today is to sustainably improve nutrition through implementation of coherent policies and better coordinated actions across all relevant sectors, strengthening, preserving and recovering healthy and sustainable food systems.
1.2 Purpose and Targets The nature of this Framework for Action is voluntary. The purpose of the FFA is to guide implementation of the commitments of the Rome Declaration on Nutrition adopted by the Second International Conference on Nutrition held in Rome, Italy, on 19–21 November 2014. Building on existing commitments, goals and targets, the FFA provides a set of policy options and strategies which governments (including the European Union 134 Ending Malnutrition and other regional organizations on matters of their competency), acting in cooperation with other stakeholders, may incorporate, as appropriate, into their national nutrition, health, agriculture,¹ education, development and investment plans, and consider in negotiating international agreements to achieve better nutrition for all.
As governments have primary responsibility for taking action at country level, in dialogue with a wide range of stakeholders, including affected communities, the recommendations are principally addressed to government leaders. They will consider the appropriateness of the recommended policies and actions in relation to national and local needs and conditions, as well as national and regional priorities, including in legal frameworks. For the purpose of accountability, this FFA also adopts existing global targets for improving maternal, infant and young child nutrition² and for NCD risk factor reduction³ to be achieved by 2025.
2. CREATING AN ENABLING ENVIRONMENT FOR EFFECTIVE
ACTIONFollowing the 1992 ICN, many countries developed and implemented national nutrition strategies and action plans, reflecting their own priorities and strategies for alleviating hunger and malnutrition in all its forms. However, implementation and progress have been patchy and often unsatisfactory due to inadequate commitment and leadership, lack of financial investments, weak human and institutional capacities and lack of appropriate accountability mechanisms.
Actions to address malnutrition in all its forms are among the most cost-effective for development, providing very high economic returns. The potential human, societal and economic gains from turning the commitments of the Rome Declaration on Nutrition into action are substantial, while the costs of inaction are high. Available resources should be used to implement and scale up the most appropriate, cost-effective, evidence-based, nutrition interventions. This often requires complementary investments in other related sectors including food and agriculture, health, education, water, sanitation and hygiene, as well as trade.
Fulfilling the human right to food and fighting malnutrition in all its forms requires a sustained enabling policy environment and improved ¹ The term “agriculture” includes crops, livestock, forestry and fisheries.
² (1) 40% reduction of the global number of children under five who are stunted; (2) 50% reduction of anaemia in women of reproductive age; (3) 30% reduction of low birth weight;
(4) no increase in childhood overweight; (5) increase exclusive breastfeeding rates in the first six months to at least 50%; (6) reduce and maintain childhood wasting to less than 5%.
³ (1) Reduce salt intake by 30%; and (2) halt the increase in obesity prevalence in adolescents and adults.
ICN2: Information Note on the Framework for Action 135 governance mechanisms for food, health and related systems. Key requirements for the establishment of such enabling environment and improved
governance mechanisms are:
• political commitment and leadership to prioritize structural, sustainable and equitable nutrition-enhancing approaches and strong national nutrition governance;
• adoption of effective and coherent policies, strategies and programmes, and effective multisectoral cooperation mechanisms, to address the structural determinants and causes of malnutrition, and its effects;
• increased and better aligned public and private investments in support of established nutrition goals;
• enhanced and sustained human and institutional capacities for effective action, including policy and programme design, management, monitoring and evaluation of nutrition outcomes and investments;
• allocation of national and international resources to ensure healthy diets for all, with special focus on the most nutritionally vulnerable life stages and specific dietary needs;
• engagement of trusted and trusting partners ready to align interests, and to create and sustain inclusive interaction;
• regular and systematic public assessments of progress to enhance accountability and effectiveness, and to improve resource use;
• international support for the implementation of national nutrition policies and programmes, as appropriate, and nutrition-sensitive approaches agreed at international level.
136 Ending Malnutrition
ICN2: Framework for Action
Taking the key required elements listed above into account, the FFA sets out a series of seven recommended actions to create an enabling environment and
governance mechanisms for effective action (Recommendations 1–7):
• Recommendation 1: Enhance political commitment and social participation for improving nutrition at the country level through political dialogue and advocacy.
• Recommendation 2: Develop – or revise, as appropriate – and cost National Nutrition Plans, align policies that impact nutrition across different ministries and agencies, and strengthen legal frameworks and strategic capacities for nutrition.
• Recommendation 3: Strengthen and establish, as appropriate, national crossgovernment, inter-sector, multi-stakeholder mechanisms for food security and nutrition to oversee implementation of policies, strategies, programmes and other investments in nutrition. Such platforms may be needed at various levels, with robust safeguards against abuse and conflicts of interest.