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How to work multisectorally at country level : nutrition

WHO – Lausanne University Seminar on Non Communicable Diseases Geneve, 9 May 2012. How to work multisectorally at country level : nutrition. F.Branca Director, Department of Nutrition for Health and Development WHO. The multifaceted challenge of malnutrition.  .

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How to work multisectorally at country level : nutrition

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  1. WHO – Lausanne University Seminar on Non Communicable Diseases Geneve, 9 May 2012 How to work multisectorally at country level : nutrition F.Branca Director, Department of Nutrition for Health and Development WHO

  2. The multifaceted challenge of malnutrition 

  3. 171 million children under 5 are stunted (in 2010) Prevalence of Stunting

  4. 500 million obese individuals aged 20+ years (2008) Source: Global status report on noncommunicable diseases 2010. World Health Organization 2011

  5. 200 150 100 50 0 AFRICA ASIA LATIN AMERICA Stunting prevalence and number affected in developing countries 50 48.6 190 40.3 39.3 40 38.2 37.7 138 Number of stunted (millions) 30 27.6 Stunting (%) 23.7 100 18.1 20 60 13.5 45 51 10 13 10 7 0 1990 2000 2010 1990 2000 2010 Source: Department of Nutrition, World Health Organization

  6. 20 10 8 15 6 10 4 5 2 0 0 AFRICA ASIA LATIN AMERICA Overweight prevalence and number affected in developing countries 8.5 18 6.8 6.9 6.8 14 13 13 5.7 Number of overweight (millions) 4.9 Overweight (%) 4 3.7 7 3.2 4 4 4 4 1990 2000 2010 1990 2000 2010 Source: Department of Nutrition, World Health Organization

  7. Children's overweight increasing more rapidly in LMI countries Source : WHO

  8. The double burden of malnutrition Source: WHO Global Database on Child Growth and Malnutrition

  9. Category of public health significance (anaemia prevalence) Normal (<5.0%) Mild (5.0-19.9%) Moderate (20.0-39.9%) Severe (≥40.0%) No Data 293 million children under 5 are anemic Source: WHO Global database on Anaemia, 2006

  10. United Nations Subcommittee on Nutrition Fourth Report on the World Nutrition Situation, 2000

  11. Changes in food systems Source : FAO, 2004

  12. Interventions and strategies 

  13. Infant and Young Child Feeding • Protection, promotion and support of appropriate IYCF • Exclusive breast feeding for 6 months • Complementary feeding (need strengthening and support for use of local foods, food fortification, micronutrient supplementation) • Feeding of IYC in difficult circumstances (HIV, malnutrition, emergencies, LBW) • Health services • Baby Friendly Hospital Initiative • Pre-service education and in-service training • Maternity protection • Code of marketing of breastmilk substitutes • Monitoring and evaluation

  14. Global Strategy on Diet, Physical Activity and Health (2004) Reducing trans fatty acids and salt Restricting availability of energy dense foods and high calorie non-alcoholic beverages Increasing availability of healthier foods including fruits and vegetables Practice of responsible marketing to reduce impact of unhealthy foods to children Making healthy options available and affordable Providing simple, clear and consistent food labels that are consumer friendly Reshaping industry to introduce new products with better nutritional value Making physical activity accessible in all settings

  15. Global nutrition targets • 40% reduction of childhood stunting by 2025 • 50% reduction of anemia in women of reproductive age by 2025 • 30% reduction of Low Birth Weight by 2025 • 0% increase in childhood overweight by 2025 • Increase exclusive breastfeeding rates in the first 6 months up to 50% by 2025 • Reducing and maintaining childhood wasting to less than 5% by 2025

  16. Outline of comprehensive implementation plan ACTION 1 : To create a supportive environment for the implementation of comprehensive food and nutrition policies ACTION 2 : To adopt efficient strategies and include all required effective health interventions with an impact on nutrition in plans for scaling up ACTION 3: To stimulate the implementation of non health interventions with an impact on nutrition ACTION 4 : To provide adequate human and financial resources for the implementation of health interventions with an impact on nutrition ACTION 5 : To monitor and evaluate the implementation of policies and programmes

  17. Agriculture and food production Micronutrient fortification of staple foods Micronutrient fortification of complementary foods Salt iodization Water fluoridation Interventions to improve food security at household level Interventions to improve the nutritional quality of foods (reduction of salt, fat and sugar content,elimination of trans-fatty acids) Trade Taxation and application of price policies Enacting legislation on marketing of foods and non-alcoholic beverages to children Provision of food in public institutions Nutritional labelling of food Social protection Conditional and unconditional cash transfers Food aid Education Women's primary and secondary education Improvement of diet and physical activity in schools Labour Support to lactating working women(through adopting and enforcing the ILO Maternity Protection Convention, 2000 (No. 183) and Recommendation (No. 191) Information Conducting social marketing campaigns Labelling of food products Non-health interventions with an impact on nutrition

  18. ACTION AREAS • Supporting a healthy start • Ensuring safe, healthy and • sustainable food supply • Providing comprehensive • information and education • to consumers • Implementing integrated actions • Strengthening nutrition and • food safety in the health sector • Monitoring and evaluation • HEALTH CHALLENGES • Diet related noncommunicable diseases • Obesity in children • and adolescents • Micronutrient deficiencies • Foodborne diseases The European Food And Nutrition Action Plan

  19. Country strategies and plans 

  20. Global Review of food and nutrition policies • Questionnaire circulated to 193 WHO Member States • 117 respondents (Ministry of Health) • Additional sources for data validation and integration

  21. 90 79 80 75 70 67 66 65 62 62 60 57 57 55 52 52 51 50 50 50 50 47 46 46 % 43 40 35 32 31 28 30 24 22 18 20 10 5 3 1 0 EMR AFR EUR SEAR WPR AMR Components of food and nutrition policies Underweight Overweight IYCN Vitamins and Minerals All four areas

  22. 100 92 90 80 73 70 66 63 60 55 50 45 % 40 30 25 17 20 15 14 9 8 7 10 4 2 0 0 0 0 AFR EUR WPR AMR EMR SEAR Nutrition governance President or Prime Ministers Office Ministry of Health Ministry of Agriculture

  23. Choice of interventions Comprehensiveness Coverage and quality Policy coherence Population awareness Targeting Level of investments Coordination for delivering interventions What is limiting progress?

  24. What is there for each actor ?(1) Government • Agricultural sector : primary production, food processing, distribution and retail is mindful of health objectives • Consumer protection : adequate information is provided to consumers. • Education : schools orient food preferences and consumption towards healthy goals • Urban planning : enhance access to healthy and safe food • Labour : adequate parental leave, breastfeeding breaks and flexibility to support working women during lactation • Social policy : social benefits to improve the food security of vulnerable population groups

  25. What is there for each actor ?(2) non government • Advocacy NGOs and consumers’ organizations : monitor the implementation of commitments from the public sector and the private sector • Food operators : improve the availability of healthy foods including fruits and vegetables, products with lower levels of saturated fats, added sugars and salt • Media : support awareness raising campaigns about nutrition and food safety • Advertisers and marketers : comply with recommendations about the marketing of food and non-alcoholic beverages to children.

  26. Slovenia : health in all policies(FNAP 2005-10) • CAP Fruit School Scheme (2009/10) : 75 % participating primary schools, involving agriculture, education and health sector. • Education sector : School nutrition programs. In 2008 - all children 1-18 eat up to four cooked meals per day in the public education institutions. Up to one third of meals are distributed for free and the rest of them are subsidized by the state budget. • Finance : differentiation in taxation of different types of foods • Culture : reducing marketing pressure to children • Social affairs : nutrition for undeprivileged population groups. • Activities with private sector (with public health leadership) : reformulation of food products,

  27. Western Pacific – legislative action • Taxation on beverages (American Samoa, Fiji) • Taxation on foods (Fiji. PNG, Samoa, Solomon Islands) • Taxation on foods and drinks for the establishment of a prevention fund (French Polinesia) • Import laws (Cook Islands, Micronesia, Fiji) • Restrictions on the use of ingredients with little nutritonal value (Fiji) • Controls on advertising (Fiji) Source : Clarke & Mc Kenzie, WHO, 2007

  28. http://www.who.int/nutrition/en/index.html

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