«Jomo Kwame Sundaram Vikas Rawal Michael T. Clark Tulika Books Published by Food and Agriculture Organization of the United Nations (FAO) Viale delle ...»
¹¹ The term ‘nutrition education’ refers to education and information dissemination efforts including promotion, advocacy, information, communication, counselling, empowerment, consumer education, behavioral change communication and ‘social marketing at individual, community, national and international levels to promote voluntary adoption of food choices and other food- and nutrition-related behaviours conducive to health and well-being.
142 Ending Malnutrition
ICN2: Framework for Action
The FFA sets out the following three recommended actions for nutrition
education and information (Recommendations 19–21):
• Recommendation 19: Implement nutrition education and information interventions based on national dietary guidelines and coherent policies related to food and diets, through improved school curricula, nutrition education in the health, agriculture and social protection services, community interventions and point-of-sale information, including labelling.
• Recommendation 20: Build nutrition skills and capacity to undertake nutrition education activities, particularly for front line workers, social workers, agricultural extension personnel, teachers and health professionals.
• Recommendation 21: Conduct appropriate social marketing campaigns and lifestyle change communication programmes to promote physical activity, dietary diversification, consumption of micronutrient-rich foods such as fruits and vegetables, including traditional local foods and taking into consideration cultural aspects, better child and maternal nutrition, appropriate care practices and adequate breastfeeding and complementary feeding, targeted and adapted for different audiences and stakeholders in the food system.
3.4 Social Protection In 2012, the UN General Assembly recommended comprehensive universal social protection beginning with basic or minimum ‘social protection floors’.
Given the limited and uneven progress in reducing poverty, hunger, food insecurity and malnutrition, and the currently dim prospects for economic and employment growth in much of the world, comprehensive social protection is needed to eliminate poverty and malnutrition in all its forms.
Social protection measures, such as food distribution, cash transfers, decent job creation and school feeding, can increase incomes and strengthen resilience. When combined with relevant health services, well-designed social protection programmes result in improved height, reduced anaemia, increased dietary diversity, and raised consumption of nutrient-dense foods, especially in low-income households with infants and children.
These measures can substantially enhance small producer resilience by preventing destitution in times of crisis besides raising production and productivity, both on- and off-farm, taking into account local contexts and market capabilities.
ICN2: Information Note on the Framework for Action 143
ICN2: Framework for Action
The FFA sets out the following three recommended actions for social protection (Recommendations 22–24):
• Recommendation 22: Incorporate nutrition objectives into social protection programmes and into humanitarian assistance safety net programmes.
• Recommendation 23: Use cash and food transfers, including school feeding programmes and other forms of social protection for vulnerable populations to improve diets through better access to food which conforms with the beliefs, culture, traditions, dietary habits and preferences of individuals in accordance with national and international laws and obligations, and which is nutritionally adequate for healthy diets.
• Recommendation 24: Increase income for the most vulnerable populations by creating decent jobs for all, including through the promotion of selfemployment.
3.5 Strong and Resilient Health Systems Health systems are increasingly challenged to tackle the evolving needs presented by the multiple forms of malnutrition and their health consequences.
Strong health systems are needed to prevent and treat malnutrition in all its forms through the delivery of evidence-informed nutrition interventions, as well as to prevent and treat recurrent infections which can aggravate undernutrition. In addition, health systems also have to deal with the longterm health consequences associated with overweight and obesity, and the prevention and control of diet-related NCDs.
Effective delivery of direct nutrition interventions as well as prevention and treatment of diseases which can aggravate nutrition problems require strong and resilient national health systems. Health systems need to be linked to and coherent with food systems, and both need to strive for equity and the full realization of the right to enjoy the highest attainable standard of physical and mental health and the right to food.
Access to health services and financial risk protection for all – including the most marginalized and most vulnerable – is needed. This means universal health coverage (UHC), which implies that all people have access, without discrimination, to nationally determined sets of the needed promotive, preventive, curative, palliative and rehabilitative essential health services and essential, safe, affordable, effective and quality medicines, while ensuring that the use of these services does not expose the users to financial hardship with a special emphasis on the poor, vulnerable and marginalized 144 Ending Malnutrition segments of the population.¹² Achieving UHC will lead to stronger, more efficient and more equitable health systems.
The FFA sets out the following four recommended actions for strong and
resilient health systems (Recommendations 25–28):
• Recommendation 25: Strengthen health systems and promote universal health coverage¹³, particularly through primary health care, to enable national health systems to address malnutrition in all its forms.
• Recommendation 26: Improve the integration of nutrition actions into health systems through appropriate strategies for strengthening human resources, leadership and governance, health system financing and service delivery, as well as the provision of essential medicines, information and monitoring.
• Recommendation 27: Promote universal access to all direct nutrition actions and relevant health actions impacting nutrition through health programmes.
• Recommendation 28: Implement the WHO Global Strategy on Infant and Young Child Feeding, the WHO Comprehensive Implementation Plan on Maternal, Infant and Young Child Nutrition 2012–2025, and the WHO Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020 through commensurate financing and adequate policies.
3.5.1 Delivery of direct nutrition interventions In developing policies and programmes to address nutrition challenges, it is imperative to give special attention to the nutrition of mothers, infants and young children. Although different age-groups need appropriate attention, as identified in the life course approach (e.g. pre-school children, adolescent girls), ensuring appropriate nutrition during the first 1,000 days is especially critical, and has a lasting impact on the survival, health and development of the individual.
Due to contemporary demographic transitions and resulting changes in the age structures of populations – with increased proportions of the elderly ¹² World Health Assembly Resolution A67.14. Available at: apps.who.int/gb/ebwha/pdf_files/WHA67/A67_R14-en.pdf ¹³ In accordance with preambular paragraph 9 of resolution WHA67.14, universal health coverage implies that all people have access, without discrimination, to nationally determined sets of needed promotive, preventive, curative, palliative and rehabilitative essential health services and essential, safe, affordable, effective and quality medicines, while ensuring that the use of these services does not expose users, especially the poor, vulnerable and marginalized segments of the population, to financial hardship.
ICN2: Information Note on the Framework for Action 145 – actions are also required to provide adequate health and nutrition support to address the specific needs of the elderly. Direct nutrition interventions need to be integrated and implemented together with nutrition-sensitive interventions.
Promote, protect and support breastfeeding Breastfeeding is one of the most effective ways to improve child survival and to promote healthy child growth and development. It needs to be promoted, protected and supported in all circumstances. Exclusive breastfeeding¹⁴ in the first six months of life ensures adequate, affordable, acceptable, appropriate and readily available food security and nutrition on a continuing basis. Breastfeeding contributes to enjoyment of the highest attainable
ICN2: Framework for Action
The FFA sets out the following five recommended actions to promote, protect
and support breastfeeding (Recommendations 29–33):
• Recommendation 29: Adapt and implement the International Code of Marketing of Breast-milk Substitutes and subsequent relevant World Health Assembly resolutions.
• Recommendation 30: Implement policies and practices, including labour reforms, as appropriate, to promote protection of working mothers.¹⁵
• Recommendation 31: Implement policies, programmes and actions to ensure that health services promote, protect and support breastfeeding, including the Baby-Friendly Hospital Initiative.
• Recommendation 32: Encourage and promote – through advocacy, education and capacity building – an enabling environment where men, particularly fathers, participate actively and share responsibilities with mothers in caring for their infants and young children, while empowering women and enhancing their health and nutritional status throughout the life course.
• Recommendation 33: Ensure that policies and practices in emergency situations and humanitarian crises promote, protect and support breastfeeding.
¹⁴ WHO recommends early initiation of breastfeeding (in the first hour), and exclusive breastfeeding for the first six months of life to achieve optimal growth, development and health, followed by nutritionally adequate and safe complementary feeding while breastfeeding continues for up to two years of age or beyond.
¹⁵ As specified in the International Labour Organization’s Maternity Protection Convention No. 183 and the corresponding Recommendation 191.
146 Ending Malnutrition standard of health as recognized in the Convention on the Rights of the Child. The International Code of marketing Breast-milk substitutes needs to be adopted through the legislative tools that each country has, to protect breastfeeding. The FFA adopts the global target to increase the rate of exclusive breastfeeding in the first six months up to at least 50% by 2025.
Wasting Severely wasted children are estimated to be, on average, 11 times more likely to die than their healthy counterparts.¹⁶ The global target to reduce and maintain childhood wasting to less than 5% by 2025 is adopted by the FFA. Both moderate and severe wasting can be addressed by the communitybased management of malnutrition approach, comprising of treatment and community awareness raising to facilitate early detection and treatment.
Globally, only around 14% of wasted children are currently being reached by treatment services.
ICN2: Framework for Action
The FFA sets out the following two recommendations to address wasting (Recommendations 34–35):
• Recommendation 34: Adopt policies and actions, and mobilize funding, to improve coverage of treatment for wasting, using the community-based management of acute malnutrition approach and improve the integrated management of childhood illnesses.
• Recommendation 35: Integrate disaster and emergency preparedness into relevant policies and programmes.
Stunting Childhood stunting remains one of the world’s most fundamental challenges for improved human development. The global target of 40% reduction in the number of stunted children under five years of age is adopted by the FFA. Stunting results from a complex web of individual, household, environmental, socioeconomic, political and cultural influences. Direct nutrition interventions need to be integrated and implemented together with nutrition-sensitive interventions and actions on social protection, health system strengthening, breastfeeding, prevention and treatment of diarrhoea and other infectious diseases, water, sanitation and hygiene, reproductive health and food safety.
¹⁶ WHO. Global Nutrition Targets 2025: Reduce and maintain childhood wasting to less than 5%. WHO Policy Brief, Geneva, 2014.
ICN2: Information Note on the Framework for Action 147 Actions to prevent wasting have direct impacts on stunting, e.g. by enabling the early detection and treatment of stunting. Therefore, actions to address wasting and stunting should be coordinated and integrated for better results.
The FFA sets out the following two recommendations to address stunting (Recommendations 36–37):
• Recommendation 36: Establish policies and strengthen interventions to improve maternal nutrition and health, beginning with adolescent girls and continuing through pregnancy and lactation.
• Recommendation 37: Establish health policies, programmes and strategies to promote optimal infant and young child feeding, particularly exclusive breastfeeding up to six months, followed by adequate complementary feeding (from six to 24 months).