How can we deal with malnutrition in food assistance programs?

1. How can we deal with malnutrition in food assistance programs? USDA & USAID International Food Aid Conference April 14-16, 2008 Martin Bloem Chief, Nutrition Service World Food Programme

2. Rice and food through the eyes of food policy and nutrition Income Food Rice Employment Food availability Rice Political stability International trade Plant/animal foods Intrahousehold distribution Grain/ cereals Diversified diet Food Micronutrients Food Food fortification Malnutrition Food Policy Nutrition

3. Rice and food through the eyes of food policy and nutrition Staple Food Income Rice Employment Food availability Rice Political stability International trade Plant/animal foods Intrahousehold distribution Grain/ cereals Balanced diet Food Micronutrients Food Food fortification Malnutrition Food Policy Nutrition

10. Private Sector Bilateral Institutions Multilateral Institutions Development Banks  IMF Manifestation undernutrition Immediate Causes Inadequate Dietary Intake Disease Insufficient Health Services & Unhealthy Environment Inadequate Care for Mothers and Children Inadequate Access to Food Underlying Causes Inadequate Education Resources & Control Human, Economic & Organizational Basic Causes Political and Ideological Superstructure Economic Structure Potential Resources

11. The conceptual framework for underlying causes of malnutrition Malnutrition Food Care Health

12. The conceptual framework for malnutrition in practice? Malnutrition Health Food Care

13. “I’m one of the few nutritionists who believes in the revolutionary idea that lack of food is a cause of malnutrition” -Michael Golden, at the SCN meeting, 2007

14. Green Revolution • What is the role of the production of staple food (energy) on malnutrition

15. Malnutrition rates and Rice pricesTorlesse, Kiess and BloemJ. Nutr. 133:1320-1325, May 2003

16. Rice consumption and rice pricesTorlesse, Kiess and BloemJ. Nutr. 133:1320-1325, May 2003

17. Choices and economic status Not poor Rice Rice and vegs Rice, vegs, and eggs Rice, vegs, eggs, meat Less poor Rice Rice and vegs Rice and eggs Rice and meat Rice Rice and vegs Rice and eggs Moderate poor Rice Rice and vegs Very poor Very, very poor Rice

18. Non-rice food expenditure and malnutritionTorlesse, Kiess and BloemJ. Nutr. 133:1320-1325, May 2003

20. Food Diversity and malnutritionKlotz et al. (in prep)

21. Intake of animal products and malnutrition Klotz et al. (in prep)

22. Daily cost of a diet and income (SCF UK) • The research, carried out in four locations in Bangladesh, Ethiopia, Myanmar and Tanzania, showed that between 15 (in Ethiopia) and 79 (in Bangladesh) per cent of households simply couldn't afford to feed their children a healthy diet. • The comparative cost of the diet compared with the equivalent average weekly earnings in the UK, • Bangladesh €2429 a week • Ethiopia € 967 a week • Myanmar € 834 a week • Tanzania € 847 a week

23. Lessons learned • Poverty is one of the key determinants of malnutrition • Poor people have limited access to micronutrient rich foods (non-grain component of total food expenditure).

24. Nutrition and Emergencies • Saving Lives: • Micronutrients (vitamin A, zinc, iron, etc) • Prevention and Treatment of Malnutrition • Complementary Foods • Ready to use supplementary food products • Ready to use therapeutic food products

25. Micronutrient powders (sprinkles) • 1996: Dr. Stanley Zlotkin begins conceptual development of Sprinkles in response to a global initiative to control childhood anemia;

26. Tsunami December 2004

28. Joint Statement WHO/UNICEF/WFP: Preventing and controlling micronutrient deficiencies in populations affected by an emergency

29. Obstacles • Formulation • Malaria-endemic areas • Family, Child • Iron component • Production • Packaging • Family, child • Shelf life • Print • Educational material • Formative research • acceptability

30. Development of ready to use therapeutic foods

31. Management of severe acute malnutrition in children

32. WHO/UNICEF/SCN Consultation

33. Joint Statement WHO/UNICEF/WFP: Community-based management of severe malnutrition

34. How do we make WFP’s programs more effective?

35. FEEDING BETTER FOOD… Nutrition Strategy Corn Soy Blend FORTIFICATION 2007 2010 - 2012 20% WFP FOOD FORTIFIED 100%+ MICRONUTRIENT NEEDS MET General Food Basket Cereals, Pulses, Legumes, Vegetable Oil, Salt, CSB + micronutrients COMPLEMENTARY FOODS SPRINKLES DSM is playing a critical strategic role in enabling WFP to launch the strategy at the global level.

36. Role of the private sector

38. Effective programs • There is need for the • Use of the “right food and food products” which have proven to be effective in saving lives, and preventing and reducing malnutrition • Understanding of the different cultural and ecological settings of regions, countries and communities where we work • A long-term vision behind emergency responses to make these programs part of sustainable solutions both at local and global level.

39. Paul Farmer • "We've proven that people in poor settings with very complex diseases can be treated and cured," • "We've had some victories," • "But if I were truly influential, everyone in the world would have the right to healthcare, food, clean water, other basics. That's the goal."

40. March 2003 Source: Farmer, 2003

41. September 2003, six months later Source: Farmer, 2003