How can we deal with malnutrition in food assistance

programs?

USDA & USAID International Food Aid Conference

April 14-16, 2008Martin Bloem

Chief, Nutrition Service

World Food Programme

Rice and food through the eyes of food policy and nutrition

Food

Rice

Food Policy Nutrition

Employment

Income

Foodavailability

Politicalstability

Internationaltrade

Grain/cereals

Rice

Food

Food

Food fortification

Micronutrients

Malnutrition

Diversifieddiet

Plant/animalfoods

Intrahouseholddistribution

Rice and food through the eyes of food policy and nutrition

Food

Rice

Food Policy Nutrition

Employment

Income

Foodavailability

Politicalstability

Internationaltrade

Grain/cereals

Rice

Food

StapleFood

Food fortification

Micronutrients

Malnutrition

Balanceddiet

Plant/animalfoods

Intrahouseholddistribution

InsufficientHealth Services &

Unhealthy Environment

undernutrition

DiseaseInadequate Dietary Intake

Inadequate Carefor Mothers

and Children

Inadequate Education

Resources & ControlHuman, Economic &

Organizational

PotentialResources

Political and Ideological Superstructure

Economic Structure

UnderlyingCauses

ImmediateCauses

BasicCauses

Manifestation

MultilateralInstitutions

Development Banks

IMF

BilateralInstitutions

PrivateSector

Inadequate Access to

Food

The conceptual framework for underlying causes of malnutrition

Malnutrition

Food Care Health

The conceptual framework for malnutrition in practice?

Malnutrition

Food

Care

Health

“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

Green Revolution

• What is the role of the production of staple food (energy) on malnutrition

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

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

Choices and economic status

Very, very poor

Less poor

Not poor

Moderate poor

Very poor

Rice

Rice Rice and vegs

Rice

Rice

Rice and vegs Rice and eggs

Rice and vegs Rice and eggs Rice and meat

Rice Rice and vegs Rice, vegs, and eggs Rice, vegs, eggs, meat

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

Food Diversity and malnutritionKlotz et al. (in prep)

2928272625242322212019181716151413121110987654321

Non Rice Items consumed in last 7 days (sum)

155

150

145

140

135

95

% C

I Ch

ild's

MU

AC

(m

m)

Cases weighted by Design weights for Division

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

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

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).

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

Micronutrient powders (sprinkles)

• 1996: Dr. Stanley Zlotkin begins conceptual development of Sprinkles in response to a global initiative to control childhood anemia;

Tsunami December 2004

Joint Statement WHO/UNICEF/WFP: Preventing and controlling micronutrient deficiencies in populations affected

by an emergency

Obstacles

• Formulation– Malaria-endemic areas– Family, Child– Iron component

• Production– Packaging

• Family, child• Shelf life• Print

• Educational material– Formative research– acceptability

Development of ready to use therapeutic foods

Management of severe acute malnutrition in children

WHO/UNICEF/SCN Consultation

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

How do we make WFP’s programs more effective?

2007 2010 - 2012

20% WFP FOOD

FORTIFIED

20% WFP FOOD

FORTIFIED

100%+ MICRONUTRIENT

NEEDS MET

100%+ MICRONUTRIENT

NEEDS MET

FORTIFICATION

COMPLEMENTARY FOODS

SPRINKLES

Corn Soy

Blend

General Food Basket

Cereals, Pulses, Legumes, Vegetable

Oil, Salt, CSB

Nutrition Strategy

FEEDING BETTER FOOD…

DSM is playing a critical strategic role in enabling WFP to launch the strategy at the global level.

+ micronutrients

Role of the private sector

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.

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."

March 2003

Source: Farmer, 2003

September 2003, six months later

Source: Farmer, 2003