|SCN News, Number 16 - Nutrition of the School-aged Child (ACC/SCN, 1998, 80 p.)|
The Symposium on Challenges for the 21st Century: 'A Gender Perspective on Nutrition through the Life Cycle' took place on 30-31 March 1998 during the
SCN'S 25th Session in Oslo, Norway. Following the opening address by Richard Jolly, SCN Chairman, the Minister of International Development and Human Rights in Norway, Hilde Johnson, welcomed participants to Norway. We were delighted that Dr Gro Harlem Brundtland presented the keynote address on 'Food, Nutrition and Health in a Global Perspective'.
The Symposium was chaired by Kaare Norum, Director and Professor at the Institute for Nutrition Research, Oslo, Norway. Presented here are the abstracts of the presentations, including the abstract of the 1998 Abraham Horwitz Lecture, 'Breastfeeding: From Biology to Policy' by Isatou Semega-Janneh.
The report of the proceedings of the Symposium are expected to be published in October and will be available from the SCN Secretariat, c/o World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland. Tel: 41 22 791 0456 Fax: 41 22 798 8891 Email: email@example.com Details of all SCN publications are regularly updated on our website: http://www. unsystem. org/accscn/
THE GLOBAL NUTRITION CHALLENGE IN THE MILLENNIUM: PRESENTATION OF THE MAIN REPORT
by Philip James
(Commission Chair and Panel of Commission
Rowett Research Institute, Scotland
Following the ACC/SCN meeting in Kathmandu in 1997, a Commission was established to consider the need for new initiatives, particularly in relation to the persistent burden of childhood protein-energy malnutrition. The contributions of UN and other international agencies to this endeavour were seen as the crucial components of any new plan. A reassessment of global trends in health has revealed that a range of issues needs to be tackled in a new coordinated way if the plea for the human right to health is to be converted into action. A preliminary perspective will be presented.
NUTRITION CHALLENGES AND GENDER IN ASIA
by Suttilak Smitasiri
Institute of Nutrition, Mahidol University, Thailand
Though science has increased knowledge leading to the improvement of nutrition in the past fifty years, recent reports indicate that malnutrition is still a contributory factor to half of the deaths of our children today. In Asia, during this same period, there have been many successful nutrition interventions which have demonstrably changed nutrition situations. Prevalence and numbers of malnutrition in the populations in general, are going down but progress among countries and different areas within countries are often uneven. South Asia, for example, still has the world's highest prevalence of childhood malnutrition and some countries in South East Asia still have widespread problems. Moreover, the recent Asian economic crisis will undoubtedly challenge all nutrition workers as to how to improve or maintain nutrition situations in the region.
Thailand is an Asian country which has made good progress nutritionally in the past twenty years. In this paper, the author attributes Thailand's success to good strategic thinking of leaders in the field of nutrition and development, a determined commitment of several sectors, good participatory action plans, systematic monitoring and most importantly, an effective social mobilisation process at all levels. Essential elements in the Thai holistic nutritional development process which led to rapid progress are discussed. The issue of gender in the development process is critical to the success of empowering women, men, families and communities in taking positive actions towards nutritional change. A gender issue in the Thai context is discussed and synthe-sised. Lastly, some remedial suggestions are made which might be helpful to other countries, particularly those in South Asia.
ACHIEVING THE 2020 VISION, WITH SPECIAL REFERENCE TO GENDER ISSUES
by Per Pinstrup-Andersen
International Food Policy Research Institute
Achieving good nutrition for all is within reach. However, while business as usual is likely to reduce the number of malnourished people, a different approach is required to achieve universal food security and good nutrition. The 2020 Vision for Food, Agriculture, and the Environment is a world where every person has access to sufficient food to sustain a healthy and productive life, where malnutrition is absent, and where food originates from efficient, effective, and low-cost food systems that are compatible with sustainable use of natural resources.
The action needed to achieve the 2020 Vision falls into six priority areas discussed in the paper. Such action will require new or strengthened partnerships between individuals, households, farmers, local communities, the private sector, NGOs, national governments, and the international community. It will require a change in behaviour, priorities and policies. And it will require strengthened cooperation between industrial and developing countries, as well as among developing countries. Failure to take action will lead to persisting hunger and poverty, continuing degradation of natural resources, increasing conflicts over scarce resources, and widening gaps between the rich and poor.
GENDER AND NUTRITION IN THE GLOBAL BURDEN OF DISEASE, 1990 - 2020
by Alan Lopez
World Health Organization, Geneva, Switzerland
Reliable information on the causes of disease and injury in populations, and how these patterns of ill-health are changing, is a critical input into the formulation and evaluation of health policies and programmes, and for the determination of priorities for health research and action. Such assessments must take into account not only causes of death, but also the impact of non-fatal outcomes and the comparative importance of major health hazards or risk factors.
The Global Burden of Disease Study, which commenced in 1992, is perhaps the first comprehensive assessment of global health conditions, providing quantitative estimates of premature death and disability from over 100 diseases and injuries, and 10 major risk factors, for 8 geographical regions of the world, by age and sex. Contributions from death, disability and risk factors have been assessed using a time-based metric of future potential years of life lost or lived with a disability, namely Disability-Adjusted Life Years, or DALYs.
In 1990, about 1.3 billion DALYs were lost as a result of new cases of disease and injury in that year, almost 90% of which occurred in developing regions. Of the global total, about 52% of DALYs lost in 1990 arose from male mortality and morbidity, compared with 48% among females. The pattern of DALYs lost varied quite markedly between the sexes. For example, at ages 15-44 years, the leading causes of DALYs lost for women (worldwide) were depression, tuberculosis, anaemia, suicide, bipolar disorder and obstructed labour whereas for men the leading causes were road traffic accidents, depression, alcohol use, homicide, tuberculosis and war.
Of the 10 major risk factors evaluated, malnutrition was by far the leading contributor to DALYs worldwide, causing an estimated 16% of the global burden of disease in 1990 (18% in developing regions), with the contributions to disease burden being particularly evident in Sub-Saharan Africa (33%) and India (22%).
Projections of the burden of disease were made based on scenarios according to the degree of optimism or pessimism about changes in the variables used to project health status. The baseline assumptions suggest that by 2020, ischaemic heart disease will be the leading cause of DALYs worldwide (rising from 5th place in 1990), followed by depression (4th), road traffic accidents (9th), stroke (6th), chronic obstructive pulmonary disease (12th) and lower respiratory infections (1st). On current trends, tobacco is expected to be the leading underlying cause of death and disability worldwide in 2020, causing more deaths (8-9 million) than AIDS, tuberculosis and complications of childbirth combined.
ABRAHAM HORWITZ LECTURE BREASTFEEDING: FROM BIOLOGY TO POLICY
by Isatou Semega-Janneh
Department of State for Health, Social Welfare & Women's Affairs, The Gambia
The biological benefits of breastmilk and breastfeeding for mothers and infants in both developing and industrialised countries are well documented. Recent research findings have demonstrated physiological, immunological, psychological and economic factors in favour of exclusive breast-feeding for up to 6 months. Global trends, however, show that exclusive breastfeeding is practiced by a minority of mothers only. This may be attributed to a combination of cultural, social, economic and political factors.
This paper discusses the importance of providing local communities with adequate information about the advantages of breastmilk and exclusive breastfeeding and the equally important need for public support through government commitment and encouragement. The example given is that of the Baby Friendly Community Initiative (BFCI), implemented by the Ministry of Health in 12 communities in The Gambia. It shows how communities equipped with enough information can be motivated into action to promote breastfeeding. It also shows the critical role of government encouragement and support and how positive results from field trials can be subsequently translated into national policy.
In the BFCI, community members, both men and women, were trained and certified as Village Support Groups on Infant Feeding. Innovative ways of disseminating information were used by them to educate mothers and fathers on maternal and infant nutrition, environmental sanitation and personal hygiene. Evaluation of the intervention has demonstrated that while exclusive breastfeeding was initially practiced by none, all mothers now do so and the term as translated into the local Mandinka language -Susudiri Timaringo - is a password in all the communities. The Ministry of Health has now launched exclusive breastfeeding as a policy objective and will gradually enable the project to go from pilot to national scale.
International commitment to breastfeeding is well recognised in the form of declarations, strategies and global initiatives. The paper, however, calls for more aggressive ways for SCN member agencies, through their specialised areas of work, to further stimulate national and local governments to view breastmilk as a critical natural food resource that must be optimally utilised in the best interest of the child, family and society.
Policy options would include public and community support to pregnant and lactating mothers and also adequate nutrition, care and advice. Legal protection in the form of regulated maternity leave for women in the formal sector should be strengthened while solutions must be sought for the majority of women working in the informal sectors.
Finally, the potential impact of HIV/AIDS on the safety of breastmilk and breastfeeding must be reviewed including solutions that do not jeopardise breastfeeding of infants everywhere.