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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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Childhood overweight and obesity Overweight and obese children are at higher risk of developing serious health problems, including type 2 diabetes, high blood pressure, asthma, other respiratory problems, sleep disorders and liver diseases. They may also suffer from psychological effects, such as low self-esteem, depression and social isolation. Childhood overweight and obesity also increase the risk of adult obesity, NCDs, premature death and disability in adulthood. Actions to prevent and address childhood overweight and obesity should start with breastfeeding promotion (considering its role in reducing the risk of childhood obesity), healthy school feeding programmes (with the provision of fresh fruits and vegetables at schools as well as the restriction of sugarsweetened beverage consumption) and other policies and programmes that address the social determinants of health. Food marketing powerfully influences people’s food choices. Excessive marketing pressure, particularly on children, has promoted unhealthy dietary practices. Measures to limit such influences are therefore needed. Stronger actions at the global level are required for reducing and preventing childhood overweight and obesity – in line with the global target of no increase in childhood overweight by 2025 – alongside actions to address undernutrition problems.

148 Ending Malnutrition

ICN2: Framework for Action

The FFA sets out the following four recommendations to address childhood

overweight and obesity (Recommendations 38–41):

• Recommendation 38: Provide dietary counselling to women during pregnancy for healthy weight gain and adequate nutrition.

• Recommendation 39: Improve child nutritional status and growth, particularly by addressing maternal exposure to the availability and marketing of complementary foods, and by improving supplementary feeding programmes for infants and young children.

• Recommendation 40: Regulate the marketing of food and non-alcoholic beverages to children in accordance with WHO recommendations.

• Recommendation 41: Create a conducive environment that promotes physical activity to address sedentary lifestyle from the early stages of life.

Anaemia in women of reproductive age Lack of vitamins and minerals presents a global public health problem.

Iodine, vitamin A and iron deficiencies are the most important globally, and present a major threat to health and development. Iron deficiency anaemia, the most common and widespread nutritional disorder in the world, especially impairs the health and wellbeing of women. Anaemia increases the risk of maternal and neonatal adversities. Failure to improve anaemia consigns millions of women to impaired health and quality of life, generations of children to impaired development and learning, and communities and nations to reduced economic productivity. In order to achieve the global target of a 50% reduction in anaemia in women of reproductive age by 2025, direct nutrition interventions need to be implemented together with strategies to promote healthy and diversified diets are needed. Implementation of recommendations on provision of healthy diets in schools and preschools, provision of nutrition education, treatment and prevention of infectious disease and improved hygiene and sanitation is also important.

ICN2: Information Note on the Framework for Action 149

ICN2: Framework for Action

The FFA sets out the following two recommended actions to address anaemia

in women of reproductive age (Recommendations 42–43):

• Recommendation 42: Improve intake of micronutrients through consumption of nutrient-dense foods, especially foods rich in iron, where necessary, through fortification and supplementation strategies, and promote healthy and diversified diets.

• Recommendation 43: Provide daily iron and folic acid and other micronutrient supplementation to pregnant women as part of antenatal care; and intermittent iron and folic acid supplementation to menstruating women where the prevalence of anaemia is 20% or higher, and deworming, where appropriate.

3.5.2 Interventions in health services to improve nutrition Besides delivering interventions that directly improve nutrition, health systems also need to deliver other interventions that impact on nutrition, including promoting health, preventing and treating infections, and improving women’s reproductive health.

Frequent bouts of infectious diseases, such as acute enteric infections, are an important cause of child undernutrition, helping to explain why child undernutrition still exists in populations which are generally food secure. Infectious diseases – such as malaria, HIV/AIDS, tuberculosis and some neglected tropical diseases – contribute to the high prevalence of iron deficiency anaemia and undernutrition in some areas. Worm infestations can impair nutritional status by causing internal bleeding, diarrhoea and poor absorption of nutrients. Infections can also cause a loss of appetite which, in turn, can lead to reduced nutrient intake. Breastfeeding is one way to provide protection for infants against infections in circumstances of poor sanitation.

Access to integral health care services that ensure adequate support for safe pregnancy and delivery for all women is critical to be able to improve maternal and child health, and to break the intergenerational cycle of malnutrition in all its forms. Adolescent pregnancy is associated with higher risk of maternal mortality and morbidity, stillbirths, neonatal deaths, preterm births and low birth weight. Women who have very closely spaced pregnancies are more likely to have maternal anaemia and preterm or low-birth-weight babies. Efforts to prevent adolescent pregnancy and to encourage pregnancy spacing are therefore needed.

150 Ending Malnutrition

ICN2: Framework for Action

The FFA includes the following six recommendations on health services to

improve nutrition (Recommendations 44–49):

• Recommendation 44: Implement policies and programmes to ensure universal access to and use of insecticide-treated nets, and to provide preventive malaria treatment for pregnant women in areas with moderate to high malaria transmission.

• Recommendation 45: Provide periodic deworming for all school-age children in endemic areas.

• Recommendation 46: Implement policies and programmes to improve health service capacity to prevent and treat infectious diseases.¹⁷

• Recommendation 47: Provide zinc supplementation to reduce the duration and severity of diarrhoea, and to prevent subsequent episodes in children.

• Recommendation 48: Provide iron and, among others, vitamin A supplementation for pre-school children to reduce the risk of anaemia.

• Recommendation 49: Implement policies and strategies to ensure that women have comprehensive information and access to integral health care services that ensure adequate support for safe pregnancy and delivery.

3.6 Water, Sanitation, and Hygiene Water is a finite resource essential throughout the food system – from production to consumption. Agriculture and food production accounts for more than two thirds of freshwater withdrawals.¹⁸ To achieve sustainable, healthy diets, more rational water use will be required, along with changes to consumption patterns. To meet this challenge, food production systems need to adapt with a combination of relevant measures. Greater water use conservation, along with other relevant measures to reduce food – including water – waste and loss, are required to achieve sustainability.

Access to safe drinking water and adequate sanitation is recognized as a human right¹⁹ essential for health, prevention of diarrhoeal disease, and thus ¹⁷ Including prevention of mother-to-child transmission of HIV, immunization against measles, and antibiotic treatment for girls with urinary infections.

¹⁸ Water in a changing world. United Nations World Water Development Report 3. World Water Assessment Programme. UNESCO/Earthscan, 2009.

¹⁹ The main international treaties explicitly recognizing the right to water include the 1979 Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW, Art.14{[}2{]}) and the 1989 Convention on the Rights of the Child (CRC, Art. 24). The main political declarations were passed by the UN General Assembly and the UN Human Rights Council, both in 2010.

ICN2: Information Note on the Framework for Action 151 to improve nutrition. Diarrhoea is the second leading cause of death among children under five, and lack of safe drinking water – along with inadequate sanitation and hygiene – are major risk factors. Children who are affected by undernutrition are more likely to die from diarrhoea. In turn, diarrhoea undermines nutrition by reducing appetite and food absorption.

Over one billion people still practice open defecation. In line with the global call to action on sanitation, efforts should focus on improving hygiene, changing social norms, better management of human waste and waste-water, and completely eliminating the practice of open defecation by 2025.

ICN2: Framework for Action

The FFA sets out the following three recommended actions on water, sanitation

and hygiene (Recommendations 50–52):

• Recommendation 50: Implement policies and programmes using participatory approaches to improve water management in agriculture and food production.²⁰

• Recommendation 51: Invest in and commit to achieve universal access to safe drinking water, with the participation of civil society and the support of international partners, as appropriate.

• Recommendation 52: Implement policies and strategies using participatory approaches to ensure universal access to adequate sanitation²¹and to promote safe hygiene practices, including hand washing with soap.

3.7 Food Safety and Antimicrobial Resistance (AMR) Food safety needs to be integrated into the global food security and nutrition agenda to make significant progress in improving nutrition. Food safety problems threaten the nutritional status of populations, particularly vulnerable groups like the elderly, pregnant women and children. Food contaminated by chemical or biological hazards, including environmental pollutants, is the origin of many diseases, ranging from diarrhoea to cancer, undermining people’s lives, health and nutrition well- being, directly and indirectly.²² ²⁰ Including by reducing water wastage in irrigation, strategies for multiple use of water (including wastewater), and better use of appropriate technology.

²¹ Including by implementing effective risk assessment and management practices on safe wastewater use and sanitation.

²² WHO Initiative to Estimate the Global Burden of Foodborne Disease. http://www.who.

int/foodsafety/foodborne_disease/FERG2_report.pdf 152 Ending Malnutrition Morbidity due to diarrhoea, dysentery and other enteric diseases – arising from unsafe food, contaminated water and poor sanitation – has not declined much over recent decades. In some developing countries, children are chronically exposed, through their diets, to aflatoxins, which are not only carcinogenic, but also probably contribute to stunting.

ICN2: Framework for Action

The FFA sets out the following five recommended actions on food safety and

antimicrobial resistance (AMR) (Recommendations 53–57):

• Recommendation 53: Develop, establish, enforce and strengthen, as appropriate, food control systems, including reviewing and modernizing national food safety legislation and regulations to ensure that food producers and suppliers throughout the food chain operate responsibly.

• Recommendation 54: Actively take part in the work of the Codex Alimentarius Commission on nutrition and food safety, and implement, as appropriate, internationally adopted standards at the national level.

• Recommendation 55: Participate in and contribute to international networks to exchange food safety information, including for managing emergencies.²³

• Recommendation 56: Raise awareness among relevant stakeholders on the problems posed by antimicrobial resistance, and implement appropriate multisectoral measures to address antimicrobial resistance, including prudent use of antimicrobials in veterinary and human medicine.

• Recommendation 57: Develop and implement national guidelines on prudent use of antimicrobials in food-producing animals²⁴according to internationally recognized standards adopted by competent international organizations to reduce non-therapeutic use of antimicrobials and to phase out the use of antimicrobials as growth promoters in the absence of risk analysis as described in Codex Code of Practice CAC/RCP61-2005.

One emerging food safety issue of global concern is antimicrobial resistance (AMR). While antimicrobial drugs are essential for both human and animal health and welfare, and critical to food producers’ livelihoods, their misuse has led to growing AMR threats to humans and agro–ecological ²³ FAO/WHO International Network of Food Safety Authorities (http://www.who.int/foodsafety/areas_work/infosan/en/).

²⁴ The term refers to animals used for the purpose of food production. 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 on the monitoring of food security including indicators of FAO prevalence of undernourishment, food insecurity experience scale, and other widely used indicators.

ICN2: Information Note on the Framework for Action 153 environments. Addressing AMR therefore requires a multisectoral “One Health Approach”, but significant challenges still remain in translating internationally recognized standards and guidelines into appropriate national policies and actions.²⁵ 4 FOLLOW-UP AFTER ICN2 Endorsement by the United Nations General Assembly (UNGA) The United Nations system – and particularly FAO and WHO – has an important role to play in supporting national and regional efforts, enhancing international cooperation and monitoring follow-up to the ICN2.

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