Project GCP/BGD/037/MUL National Food Policy Capacity Strengthening Programme (NFPCSP)

1. Project GCP/BGD/037/MUL National Food Policy Capacity Strengthening Programme (NFPCSP) Training Workshop on FOOD SECURITY CONCEPTS, BASIC FACTS & MEASUREMENT ISSUES 25 June – 07 July, 2011 Topic: Analytical Approaches for Food security Sub-topic 2c : Analytics 3: Food UtilizationLecture : Food Utilization/Nutrition By Mohammad Abdul Mannan, PhD Nutrition Advisor, NFPCSP-FAO

2. Background Conceptual framework Nutrition and health status Food consumption and nutrition situation Seasonality and disaster Linkage with different sectors Concluding Way forward Outline of the presentation

3. Food security – An evolving concept • In the 50s and 60s: Food security = self sufficiency in major staples • After World Food Conference of 1974:Food Security = Access to sufficient food • World Food Summit of 1996:“Food security exists when all people, at all times, have physical and economic access tosufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life”. • Food Security is part of Nutrition Security • The concept of Nutrition security — ensuring access to food that is nutritious as well as sufficient — is increasingly being used to stress the importance of the quality of food for people of all ages

4. What is Nutrition? Nutritionis the science and practice of consuming and utilizing foods. It is the study of nutrients in food, how the body uses nutrients, andthe relationship between diet, health and disease.

5. Why nutrition is important? • Foundation to development contributing to MDG’s • Economic benefit • LBW perpetuates the intergenerational cycle of undernutrition and disease • Economic growth alone unlikely to yield Nutrition results

6. Conceptual framework for analyzing the causes of malnutrition Malnutrition, death & disability Outcomes Disease Inadequate dietary intake Immediate causes Inadequate maternal & child CARE practices Insufficient access to FOOD Underlying causes at household / family level Poor water, sanitation & inadequate HEALTH services Quantity and quality of actual resources – human, economic & organisational - and the way they are controlled Basic causes at societal level Potential resources: environment, technology, people UNICEF

7. The food and agriculture sector and nutritionNarrowing the “nutrition gap”the gap between what foods are available and what foods are needed for a healthy diet • Diets are often low in quantity, quality and variety (hunger and micro-nutrient deficiencies) • Increased production of staple foods is not sufficient • Need to ensure local availability and access of the right mix of foods in all seasons • Consumers must be informed • Collaboration must be established with : (a) social protection programmes to support the poorest and (b) with health & multi sectors/programmes

8. Source: FAO, 2010

9. Undernourishment: FAO estimates • Proportion of undernourished population remains the largest in South Asia • Between 1990-92 and 2005-07,prevalence of undernourished decreased in Bangladesh by 11%, the largest decline in South Asia Source:SOFI ,2010

10. CONTEXT : Bangladesh continues to have the highest Cer DES - 80%

11. Undernourishment trends

12. FOOD CONSUMPTION SITUATION • Significant + correlations between DES Cer% and child MN rates Source: Authors' own calculation from FAO RAP 2007

13. RELATIONSHIPS WITHIN THE FS FRAMEWORK

14. Nutritional and healthstatus This ‘vicious cycle’ is known as the “malnutrition-infection cycle”: INADEQUATE DIETARY INTAKE Weight loss, growth faltering and reduced immunity, which lower the body’s ability to resist infection. leads to this causes this results in Loss of appetite, malabsorption of nutrients, altered metabolism and increased nutrient needs. Longer, more severe and more frequent disease episodes. leads to

15. Nutritional and healthstatus Nutrition and health are closely linked: NUTRITIONAL STATUS disease contributes to malnutrition HEALTH STATUS while malnutrition makes an individual more susceptible to disease. This can eventually lead to severe malnutrition and death.

16. FOOD CONSUMPTION SITUATION • Increase in consumption of vegetables by 20% (157g); potato by 50% (63g) Source: Adapted from BBS-HES/HIES, 1991-2005

17. FOOD CONSUMPTION SITUATION • DEI Cer % decreased from 80 % to 73 % in the last 10 years • FAO recommendation contribution of cereals to DEI optimally 60% • Prospects by 2020 Source: Authors’ own calculations

18. Source: WHO SEARO, 2007

19. Vehicleemission Crops Agricultural practices Cooking Livestock Landfills Storage Seafood Industrial emissionsand effluents Source of hazards in the food chain Processing Retail Distribution

21. Population Pyramid - Bangladesh

22. Health services Health services delivery includes- Maternal, Neonatal and Child Health Communicable disease control TB and Leprosy control HIV/AIDS prevention and control Non communicable disease control including Emergency preparedness programme and climate change, Hospital based emergency obstretic care, Health education and promotion, Hospital services at upazila, district, and tertiary level, and Alternative medical care.

23. NUTRITION SITUATION • % Decline in BMI (< 18.5) in women over the last decade 53 % to 26% • Emerging concern of double burden- prevalence of overweight (BMI > 23)

25. Stunting and Underweight • Indicators for under five children remain alarming despite improvements • Nutrition outcomes highly susceptible to variability of food prices

26. NUTRITION SITUATION • 3 fold increase in % of UW among 6-12 month infants • Faulty weaning and feeding behaviour along with infectious diseaseare critical factors

27. Vitamin A supplementation

28. NUTRITION SITUATION • Night blindness almost non existent, prevalence below 0.1% in 2006; • Attributed to blend of actions VAC distribution with EPI and food based • strategies • VAD is still high, 30% among women and children Source: HKI, 2006

31. NUTRITION SITUATION • Success due to USI initiated in 1994-95; marked annual decline of 3.48%; • Physiological iodine deficiency still exists around 36% Source :Yusuf et al, 2008

34. Food safety in horticulture : Bangladesh Results- Survey (fruit ripening) JACKFRUIT RIPENING, BHALUKA, MYMENSINGH Source: Hassan et al,2010, BAU

35. Consumers’ perception on quality and safety Consumers’ willingness to pay more for purchasing safe fruits and vegetables

36. Framework on access to education, credit, and health care

37. From farm to table, table to farm: a new agricultural paradigm (Rouse and Davis, 2004)

38. AGRICULTURE-NUTRITION LINKAGES • Horticulture technology models from DAE show a wide range and quantity of fruits • Can be produced over a 10 year period at HH level • Fruits rich in vitamins and minerals; contribute to food security and dietary diversity An example of a small mixed orchard intercropped with vegetables Source: DAE, MoA: GoB/FAO/UNDP Integrated Horticulture and Nutrition Development (BGD/97/041) 2000 -2006

39. AGRICULTURE-NUTRITION LINKAGES • Vitamin A supply from fruits/HH/d and per capita noted to be adequate • Provides substantial part of the RDA for micronutrients at HH and individual levels • Papaya and drumstick leaves : furnish 97% of the RDA for Vitamin A Source: Report on Food based Nutrition Strategies for Bangladesh, Integrated Horticulture and Nutrition Development Project, FAO/GoB/UNDP, 2000 -2006

40. DESIRABLE DIETARY PATTERN • Current national average cereal intake 469 g/person/d (rice 449g) contributing to 70% DEI as against the optimal FAO/WHO norm of 55% -60% • Need to reduce cereal intake and increase non-cereal foods • Need to increase calorie intake Source: FPMU, MoFDM, MoA, MoH&FW, NFPCSP Expert Consultation, August 2007

41. DESIRABLE DIETARY PATTERN Desirable food basket total energy intake set at 2350 kcal and % energy from cereals proposed at 55%; absolute terms 375 g(350 g rice + 25g wheat & other cereals) some 77 g less than present intake (rice low by 90g and wheat up by 13g) Source: FPMU, MoFDM, MoA, MoH&FW, NFPCSP Expert Consultation, August 2007

42. Thresholds for assessing nutritional status in emergency situation • Starting point for interpretation, rather than the sole basis… • Thresholds vary

43. Adaptation of Health sector: Community action for malnutrition amidst climate change Climate change through nutrition intervention and mainstreaming nutrition consideration in food, agriculture and health sectors: • Increase vector borne diseases like malaria and dengue fever due to global warming and climate change • Increase depletion of nutrients, minerals and reserves due to diarrhoea – because of increased flooding and drainage congestion • Increase heat strokes –further aggravated by shortages of drinking water • Increase malnutrition, morbidity, mortality suffering and loss of productivity • Reduce the capacity of individuals to adapt to climate change Actions needed • Review evidence of relationship among nutrition, health and climate change • Establish community based nutrition program • Deliver integrated package of health and nutrition • Home gardening, poultry rearing, fisheries development • Food storage and processing technologies • Population planning at community level

44. Feeding programmes: decision making frameworks

45. Malnutrition and Mortality – can we review rates in order to diagnose food crises, health crises and famines that kill?

46. The Country Investment Plan • Responding to L’Aquila Initiative and in line with the 5 Rome Principles, the CIP was Approved on 14 June 2010 following the Bangladesh Food Security Forum. • Translates the policy frameworks in a comprehensive set of 12 priority investment programmes and aims at • convergence and alignment of domestic and external funding • mobilizing additional resources: • Bangladesh qualified as first Asian country receiving a grant under the Global for US $ 52.5 million • The revised CIP, based on extensive consultation, incorporatesover 400 projects of which 146 ongoing (for US$ 3.036 billion) and 262 in pipeline (for US$ 4.945 billion of which US$ 3.299 billion are priority).

47. Concluding Remarks • Bangladesh is an exemplary case of a consistent long term effort to put in place a comprehensive policy framework for food security and nutrition • HPNSDP is ready for implementation • This framework provides a platform for • Dialogue among government, civil society and development partners • Alignment, coordination and harmonization of interventions • Within the FS framework, CIP is the tool for prioritizing, enhancing effectiveness and scaling up food security investments • Food security is critical to nutrition security – ensuring access to safe and nutritious food – emphasis on quality of food • A conducive institutional setting and continued commitment of all partners are needed to sustain the implementation and monitoring process in the medium/long term

48. Way Forward • Global/regional/national commitment to mobilize the necessary resources to address the problem decisively. • Improve capacity building and awareness raising on food and nutrition security at household level • Integrate /strengthen nutritional considerations into agriculture, food and health policies and interventions to improve food security and nutrition • Establishing information and surveillance systems that are critical for developing evidence-based food security and nutrition policies. • Sustain involvement of multiple actors – strengthen/establish community based and national mechanisms for nutrition

49. THANK YOU FOR YOUR KIND ATTENTION !