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19th International Congress on Nutrition(Bangkok, 5 October 2009)
Global efforts towards achieving the MDGsand nutrition well-being
Dr Ala Alwan
Assistant Director-General
World Health Organization
19th International Congress on Nutrition(Bangkok, 5 October 2009)
Which challenges are we facing?
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• Underweight
• Wasting
• Stunting
• Overweight/obesity
• Micronutrient deficiencies
• Nutrition-related non-communicable
diseases
• Interfaces with foodborne diseases
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19th International Congress on Nutrition(Bangkok, 5 October 2009)
UndernutritionPersistent burden of disease
• Child undernutrition accounts for 30% of the deaths of
children under 5 years of age
• Child undernutrition and maternal undernutrition account for 11% of the global burden of disease
• Stunting, severe wasting and intrauterine growth retardation
are the most important health risks in children under 5
• Deficiencies of vitamin A, zinc, iron and iodine are
responsible for an increase in mortality and morbidity
• Iron deficiency anaemia is responsible for at least 20% of
maternal deaths at delivery
19th International Congress on Nutrition(Bangkok, 5 October 2009)
178 million children are stunted(under 5 years of age)
Prevalence of Stunting
Source : WHO Global Database for Child Growth and Malnutrition, 2009
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19th International Congress on Nutrition(Bangkok, 5 October 2009)
293 million children are anaemic(under 5 years of age)
Source: WHO/CDC. Worldwide prevalence of anaemia 1993-
2005. WHO Global Database on Anaemia. Geneva, World
Health Organization, 2008.
!!
!
!
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
19th International Congress on Nutrition(Bangkok, 5 October 2009)
Exclusive breastfeeding rates are stalling(children less than 6 months of age)
Source : WHO database on IYCN, 2008
12
20
25
1416
24
38
14
43
32
38
18
35
42
21
46
29
36
0
10
20
30
40
50
60
70
80
90
100
Africa Americas EasternMediterranean
Europe South-EastAsia
Western Pacific
Global
1986-1990
1991-1995
1996-2002
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19th International Congress on Nutrition(Bangkok, 5 October 2009)
Nutrition-related noncommunicable diseasesIncreasing burden of disease
• Excess Body Mass Index was responsible
for more than 30 million Disability-Adjusted Life Years (DALYs) in 2000
– Ischaemic heart disease
– Type II diabetes
• Prevalence of obesity has been increasing
over the last 10 years
• Poor people are disproportionally affected
Over 500 million adults are obese
Source : WHO Global BMI database, 2009
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19th International Congress on Nutrition(Bangkok, 5 October 2009)
Group III - Injuries
Group II – Other deaths from non-communicable diseases
Group II – Premature deaths from non-communicable diseases (before 70), which are preventable
Group I – Communicable diseases, maternal, perinatal conditions and nutritional deficiencies
14 million premature deaths from non-communicable diseases occur in developing countries
0
5,000,000
10,000,000
15,000,000
20,000,000
25,000,000
30,000,000
High-income
countries
Upper middle-
income
Lower middle-
income
Low-income
countries
1.8M 1.9M
6.0M
6.1M
19th International Congress on Nutrition(Bangkok, 5 October 2009)
Deaths from non-communicable diseases Global projected increase
0
2
4
6
8
10
12
2000 2005 2010 2015 2020 2025 2030
De
ath
s (
mil
lio
ns
)
Cancers
Stroke
Road trafficaccidents
HIV/AIDS
TB
Malaria
Acute respiratoryinfections
Ischaemic
heart disease
Perinatal
ww
w.w
ho.in
t/health
info
/glo
bal_
burd
en_dise
ase
/2004_re
port_
update
/en/in
dex.h
tml
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19th International Congress on Nutrition(Bangkok, 5 October 2009)
+17%-3%38835.758.2Total
+20%+11059.712.4Western Pacific
+21%-16%898.014.7South-East Asia
+4%+7%888.59.8Europe
+25%-10%252.24.3Eastern
Mediterranean
+17%-8%534.86.2Americas
+27%+6%282.510.8Africa
Trend: Death from NCD
Trend: Death from infectious
disease
NCD deaths
(millions)
NCD deaths
(millions)
Total deaths
(millions)
Geographical regions (WHO
classification)
2006-2015 (cumulative)2005
(WHO, 2005)
Deaths from non-communicable diseases Low- and middle income countries are most affected
19th International Congress on Nutrition(Bangkok, 5 October 2009)
Preventable foodborne diseasesThousands of people die every day from these diseases
• More than 4 billion cases per year of foodborne
diarrhoeal disease
• In developing countries 1.9 million children <5 die each
year because of diarrhoeal diseases
• Up to 70% of these cases may be caused by foodborne
pathogens
• This does not include other foodborne diseases, such as diseases caused by chemicals in food (e.g. aflatoxin or
acrylamide)
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19th International Congress on Nutrition(Bangkok, 5 October 2009)
Signs of improvement?
• In the last 20 years:
– Improvement in low birth weight
– Associated with improved body-mass-index in women
– Associated with lowered child underweight
prevalence
• Significant number of countries are showing successful
transition from steady or slightly improving malnutrition
rates to accelerated reduction
• Asia: virtuous cycle of improved women’s nutrition and
health, leading to better developed infants and better
grown mothers, driving inter-generational improvement
• Globally, progress is insufficient
19th International Congress on Nutrition(Bangkok, 5 October 2009)
The food crisis has eroded progress
The 2008 food crisis has led to increased wasting rates,
increased admissions for malnutrition and changes in dietary intakes (in vulnerable groups and in countries
with limited resilience:
– reduction of higher nutrient density foods
– reduction of meals
– reduction of portion
– use of famine foods
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19th International Congress on Nutrition(Bangkok, 5 October 2009)
"The global economic crisis derails progress against poverty"
• GDP growth in developing countries is expected to slow
to 2.1%
• recessions are projected in Europe and Central Asia (-2.0%), and Latin America and the Caribbean (-0.6%)
• Cash inflow to developing countries will decrease as
result of reductions in foreign direct investment, foreign
aid and migrant workers remittance
• The number of extremely poor is estimated to have increased by 130-155 million globally in 2005-2008
• 53 million more expected in 2009
Source : SCN
19th International Congress on Nutrition(Bangkok, 5 October 2009)
Climate change Impact on food and nutrition security
• Higher temperatures, greater rainfall variability and extreme weather events will affect global agriculture
• Climate change will reduce water availability, increasing animal and plant pests and diseases
• Global warming will affect the world’s poorest regions the most
• The impact will depend on the levels and types of investments to improve agriculture’s adaptive and resilience capacity and to adjust production methods
• Action is needed to reduce risks to malnutrition and food safety
Source : FAO
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19th International Congress on Nutrition(Bangkok, 5 October 2009)
What action is needed?
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19th International Congress on Nutrition(Bangkok, 5 October 2009)
What is limiting progress?
• Choice of interventions
• Focus on the greatest benefits
• Quality of interventions
• Comprehensiveness
• Coverage
• Policy coherence
• Population awareness
• Commitment by policy makers
• Investments
• Capacity
• Coordination among players
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19th International Congress on Nutrition(Bangkok, 5 October 2009)
Source: World Bank (adapted)
Principal development partners Global nutrition arena
International
Financial
Institutions
Public
Private
Partnerships
Private Foundations
UN Agencies
Bilaterals
Government
Agencies
Academia &
Research
Institutions
NGOs
Partners in
nutrition
UNICEF
WFP
SCNFAO WHO
IFAD
AfDBWB
AsDB
IADB
GAIN
MI
Global Fund
Gates Foundation
Rockefeller Foundation
HKI
AKF
WABALa Leche League
BRAC
SCF
CARE
Line Ministries responsible for nutrition
Ministries of Planning
Ministries of Finance
IrishAid Netherlands
DFID
NORAD
GTZ
SIDA
CIDA
JICA
USAID
DANIDA
EuropeAid
Universities
19th International Congress on Nutrition(Bangkok, 5 October 2009)
$0.01
$0.06
$0.10
$0.42
$0.92
$0.93
$3.90
$0.06
$0.21
$0.22
$0.23
$0.24
$0.33
$0.45
$0.53
$0.80
$1.14
$1.16
$1.33
$1.65
$7.40
Water Education/Training
Water Resources Protection
River Development
Waste Management/Disposal
Basic Drinking Water Supply & Sanitation
Water resources policy/admin. mgmt
Water Supply/Sanitation - Large Systems
Health Education
Medical Education/Training*
Medical Research
Basic Health Infrastructure
Medical Services
Basic Nutrition
Tuberculosis Control
Family Planning
Malaria Control
Basic Health Care
Reproductive Health
Infectious Disease Control
Health Policy & Admin. Management*
HIV/AIDS & STDs*
Health ODA Commitments (2007)(in US$ billions)
Total Health ODA: $22.1 billion
Source:
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19th International Congress on Nutrition(Bangkok, 5 October 2009)
Scaling up direct actions
The implementation at scale of effective interventions may
reduce infant mortality by 25%
and reduce growth retardation in
36 countries with high prevalence
by one third,
thus eliminating
60 million Disability-Adjusted Life-Years
19th International Congress on Nutrition(Bangkok, 5 October 2009)
• Promotion of breastfeeding and adequate complementary feeding
• Micronutrient supplementation in children and women
• Micronutrient fortification of food
• Supplementary feeding
• Therapeutic feeding
• Growth assessment and promotion
• Antenatal care
• Hygiene
• ORS
• Immunization
• Deworming
• Maternal tobacco consumption
• Malaria control
Effective direct actions
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19th International Congress on Nutrition(Bangkok, 5 October 2009)
Supporting policies
– Health: personnel, budget
– Social: poverty alleviation, cash transfers
– Education: schools
– Environment: water and sanitation
– Agriculture and food production : food security, food safety
– Trade
19th International Congress on Nutrition(Bangkok, 5 October 2009)
1. Raising the priority accorded to non-
communicable diseases in
development work at global and
national levels
2. Establishing and strengthening
national policies and programmes
3. Reducing and preventing risk factors
4. Prioritizing research on prevention and
health care
5. Strengthening partnerships
6. Monitoring NCD trends and assessing
progress made at country level
Global Strategy for the prevention of Non Communicable Diseases – Action Plan 2008-2013
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19th International Congress on Nutrition(Bangkok, 5 October 2009)
UN Economic and Social CouncilHigh-level Segment 2009
“Noncommunicable diseases must be addressed if we want to put an end to poverty in 2015. Under this year's leadership by the Prime-Minister of Qatar, ECOSOC has given a high profile to the need to include non-communicable into global discussions on development. We need to continue this momentum.”
H.R.H. Princess Muna Al-HusseinHashemite Kingdom of Jordan
“Why are we not responsive to requests from low- and middle-income countries to help build national capacities to address noncommunicable diseases? Because these problems are beyond those targeted by the MDGs.”
Ambassador Sylvie LucasPresident of ECOSOC
19th International Congress on Nutrition(Bangkok, 5 October 2009)
Food and nutrition policies:a 1992 perspective
• Improving household food security
• Protecting consumers through improved food quality and
safety
• Preventing and managing infectious diseases
• Promoting breastfeeding
• Caring for the socioeconomically deprived and
nutritionally vulnerable
• Preventing and controlling specific micronutrient
deficiencies
• Promoting appropriate diets and healthy lifestyles
• Assessing, analysing and monitoring nutrition situations
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19th International Congress on Nutrition(Bangkok, 5 October 2009)
• Ensuring that agricultural and trade policies take into account public health
• Providing correct information to the consumers and restricting marketing of food with poor nutrition profiles
• Strengthening social safety nets and promotehealthy diets among groups of low socio-economic status
• Improving environmental sustainability of food production
Food and nutrition policies:a 21st century perspective
19th International Congress on Nutrition(Bangkok, 5 October 2009)
Prioritising high-burden countries
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19th International Congress on Nutrition(Bangkok, 5 October 2009)
Different policy and operational support neededFACTOR 1:
Better Health System Capacity,
variable Nutrition Governance
FACTOR 2:
Poorest Health System
Capacity, Consistent Good
Nutrition Governance
FACTOR 3:
Poor Health System Capacity,
Variable Nutrition Governance
(High PH Expenditure)
Strong
Nutrition Governance
Medium/weak
Nutrition Governance
Strong
Nutrition Governance
Medium/weka
Nutrition Governance
MCU 1Best for reduction of both
child stunting and maternal
anemia
Vietnam Angola (-)Indonesia
Kenya
Pakistan
South Africa
BangladeshIndia
CambodiaMozambique
MCU 2Best for reduction of child
stunting, and worst for
reduction of maternal
anemia
Egypt
PeruPhilippines
DR Congo* (-) Ethiopia
MCU 3Worst for reduction of child
stunting, and best for
reduction of maternal
anemia
Ghana
Yemen (-)
Cameroon
Myanmar
Nigeria
Sudan*
Burkina Faso Guatemala
Mali
Niger
Zambia
MCU 4Worst for reduction of both
child stunting and maternal
anemia
BurundiCote D’Ivoire (-)
Madagascar
Nepal
Uganda
Malawi U R Tanzânia
MCU groups
(from stunting
and anemia
level and trend)
Readiness
Factor
19th International Congress on Nutrition(Bangkok, 5 October 2009)
Which roles have players in the nutrition arena?
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19th International Congress on Nutrition(Bangkok, 5 October 2009)
The United Nations System
• Scaling up direct
interventions
• Joint action planning at
global and country level
• Joint advocacy with
governments and donors
• Identifying and describing
global processes
• New UN synergies for
better nutrition governance
and accountability
19th International Congress on Nutrition(Bangkok, 5 October 2009)
Governments
• Intersectoral food and nutrition policies
• National plans and policies to prevent and control non-communicable diseases
• Strengthening health systems
• Policy coherence: health in all policies
• Intersectoral coordination
• Invest in health and poverty reduction
• Monitoring and evaluation
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19th International Congress on Nutrition(Bangkok, 5 October 2009)
Civil society
• Assist in implementation
• Awareness raising
• Social mobilization
• Advocacy
• Soliciting and monitoring commitment
19th International Congress on Nutrition(Bangkok, 5 October 2009)
Academia
• Fill research gaps:
– Relationships between nutrition and health
– Epidemiology
– Effective interventions
– Translational research
• Build capacities :
– Technical training in nutrition
– Policy and programme design
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19th International Congress on Nutrition(Bangkok, 5 October 2009)
Private sector
• Role of the private sector in improving the quality, safety and access to food supply
• Food producers and distributors, catering and restaurants are an important actor in public health driven and lead food and nutrition policies
• Improve availablity of foods with healthier nutrition profile, less aggressive marketing practices, protection of breastfeeding, promotion of adequate and safe complementary foods
19th International Congress on Nutrition(Bangkok, 5 October 2009)
What is the response of WHO?
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WHO has a major responsibility for promoting healthy
nutrition for all the world's people, through
collaborative support to Member States, particularly
in their national nutrition programmes, in partnership with other intergovernmental and nongovernmental
organizations, and their related sectoral approaches.
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19th International Congress on Nutrition(Bangkok, 5 October 2009)
The WHO Nutrition Network
Geneva (23 NHD)(4 CHP)(4 CAH)
Manila (2)
Cairo
Tashkent (1)
Dushanbe (1)
New Delhi (2)
Copenhagen (4)
Brazzaville (1)
Washington DC
Suva (1)
Hanoi (1)
Boroko (1)
Beijing (3)
Vientiane (1)
Phnom Penh (1)
Ulaanbaatar (1)
Accra (1)
Maputo (1)
Niamey (1)
Asmara (1)
Addis Abbaba (1)
Moscow (1)
Istanbul (1)
Astana (1)
Rabat (1)
Amman (1)
Beirut (1)
Teheran (1)
Damascus (1)
Islamabad
Palestine (1)
Sana'a (1)
Abu Dhabi (1)
Khartoum
Riyadh
Kuwait (1)
Doha (1)
Muscat (1)
Djibouti (1)
Manama (1)
La Paz (1)
Panama (1)
Managua (1)San Jose (1)
Brasilia (1)Santiago (1)
San Salvador (1)Santo Domingo (1)Guatemala (1)
Tegucigalpa (1)
Dili (1)
Jakarta (1)
Male (1)
Dhaka (1)
Yangon (1)
Colombo (1)
Thimphu
Kathmandu (1)
Pyongyang
Nonthaburi (1)
6 Regional Offices150 Country Offices
140 staff
19th International Congress on Nutrition(Bangkok, 5 October 2009)
The WHO-wide nutrition agenda
Communicable diseases
Child and adolescent health
Emergencies
Non-communicable diseases
Social determinants
Environment
Nutrition and
food safety
Health systems
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19th International Congress on Nutrition(Bangkok, 5 October 2009)
1. Development and operationalization of integrated food
and nutrition policies
2. Intelligence of needs and response
3. Development of evidence based programme guidance
4. Country-level advocacy and technical assistance
Scaling up on WHO strategic priorities
19th International Congress on Nutrition(Bangkok, 5 October 2009)
Landscape Analysis Assessing Countries' Readiness to Accelerate Action in Nutrition
1. Assess existing gaps/constraints and identify
opportunities to integrate and scale up nutrition-related
actions in countries
2. Develop an "action plan" and recommendations to
guide consolidated/harmonized action
3. Establish a baseline related to current status of nutrition
and nutrition action in the high-burden countries
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19th International Congress on Nutrition(Bangkok, 5 October 2009)
1
2
34
5
WHO Nutrition Databases
Who Database on Child Growth and Malnutrition
Who Global Data Bank on Infant and Young Child Feeding
Vitamin and Mineral Nutrition Information System
WHO Global Database on Body Mass Index
National Nutrition Policies and Programmers
1
UN Databases
UNDP
UNICEF
UN Statistics Division
UNICEF
Food and Agriculture Organization (FAO)
2
3
4
WHO Database
WHO Core Health Indicators5
Other International Data sources
World Bank
Democratic and Health Surveys (DHS)
IFPRI
Country Level Databases
Nutrition Landscape Information System
19th International Congress on Nutrition(Bangkok, 5 October 2009)
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!!
!
Implementation Status
Implementing
Adoptation being discussed
Not being discussed
Status unknown
Implementation WHO Child Growth Standards
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19th International Congress on Nutrition(Bangkok, 5 October 2009)
• Evidence-based nutrition policy making
• Best practices for implementation
• Effective nutrition interventions
Nutrition Programme Guidance
Maternal and Child Nutrition
Maternal and Child Nutrition
Nutrition and
the Environment
Nutrition and
the Environment
Nutrition and Growth Surveillance
Nutrition and Growth Surveillance
MicronutrientsMicronutrients
Nutrition in Emergencies and
Humanitarian Crisis
Nutrition in Emergencies and
Humanitarian Crisis
Nutrition Care for Groups
with Special Needs
Nutrition Care for Groups
with Special Needs
Nutrition in HIV, TB and other
Communicable Diseases
Nutrition in HIV, TB and other
Communicable Diseases
Nutrition and Chronic Disease
Prevention
Nutrition and Chronic Disease
Prevention
UndernutritionUndernutrition
WHO E-Library for
Nutrition Programmes Guidance: Recommendations,
Evidence and Best Practices
WHO E-Library for
Nutrition Programmes Guidance: Recommendations,
Evidence and Best Practices
19th International Congress on Nutrition(Bangkok, 5 October 2009)
Scientific advice on nutrition
• Codex Alimentarius
• Dietary reference Values
• Dietary goals
• Food Based Dietary Guidelines
• Nutrition profiling
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19th International Congress on Nutrition(Bangkok, 5 October 2009)
Conclusions
"I see two main areas where leadership is needed, and can make a significant difference for health.
First, we need leadership to deliver interventions for nutritional deficiencies to those in greatest need. The interventions already exist. They are cost-effective, and many bring spectacular results. Here, the need is for leadership and innovation in devising delivery systems.
Second, leadership is needed to ensure that policies governing agriculture, food production, and trade are firmly anchored in human nutritional needs and are shaped by health concerns. This is a need for political leadership."
Dr Margaret Chan
Director General
World Health Organization
19th International Congress on Nutrition(Bangkok, 5 October 2009)
Thank you.
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