|Ending Malnutrition by 2020: An Agenda for Change in the Millennium - Final report to the ACC/SCN by the commission on the nutrition challenges of the 21st century (ACC/SCN, 2000, 104 p.)|
|6. Vision and Goals for the Future|
The practical value and impact of existing goals has already been demonstrated because sufficient time has elapsed to both mobilise and achieve results. Experience shows that the main need is for strong national action, often mobilised by the catalytic efforts and support of one or more of the UN agencies and its field staff. Many of the current goals relate to the year 2000 (a table listing existing goals is in Annex 2). As this year approaches, work is now needed to adapt and carry forward the goals into the 21st century. The World Food Summit established a goal to halve the number of food-insecure people in 1996 by no later than 2015. WHO's Health for all in the 21st century sets its proposals for the next century in the context of "strengthened support for key values: human rights, equity, ethics and gender sensitivity". Nutrition is then identified as the leading goal for improved health outcomes by the year 2020, as follows:
"By 2005, health equity indices will be used within and between countries as a basis for promoting and monitoring equity in health. Initially, equity will be measured on the basis of a measure of child growth: the proportion of children under five years who are stunted should be less than 20 per cent in all countries and in all specific sub-groups within countries by the year 2020." (WHO, 1998b)
We strongly endorse the goal set out at the World Food Summit and the focus on health, equity and child stunting in the WHO document. However, there are new issues which WHO, and others in the UN system concerned with action to reduce undernutrition, now need to address:
regional and/or national goals are now needed given the wide range in stunting rates. A single goal as a global objective needs to be supplemented by regional and national goals which challenge prevailing national trends. Consistency also needs to be developed to ensure that goals for reduction of 'undernutrition' are seen essentially as those for preventing the stunting of children. As noted in Chapter 2, stunting is the dominant contributor to childhood underweight.
experience shows that goals for 15 or 20 years ahead need to be supplemented by shorter-term goals for the next 5 or 10 years if they are to have political relevance and impact
the UN would benefit from ensuring that the goals for reducing poverty and poor nutrition are consistent, even if the two are not necessarily linked.
Our proposal is therefore that the UN agencies, with the help of the ACC/SCN, work together to identify global, regional and country-level intermediate goals for the reduction of childhood underweight by the year 2010, as well as 2015 (see Figure 6.1). As a basis for discussion, we would suggest that by the year 2005 each country should halve the proportion of its children under five classified as underweight or stunted in 1995, and halve it again by the year 2015. This is a relevant but feasible challenge for most countries because it would:
incorporate implicitly the reduction in the total number of pre-school underweight or stunted children in all countries by 2020, as well as the concern about equity within provinces. A major requirement would be to reduce stunting rapidly in the worst-affected regions.
form a bridge with the World Food Summit goal of halving by 2015 the number of people estimated as chronically food insecure.
apply to all countries as broad guidelines, but could be modified and adapted to each country's specific situation and prospects.
draw on the positive experience of UNICEF and UNFPA in using goals expressed in terms of reducing the national proportions of people affected by specific forms of deprivation.
There is also a need to explore other nutrition goals in four areas:
Rapid reduction in micronutrient deficiencies is vital. This, together with an assurance of improved levels of maternal nutrition, should be linked to the stunting goals.
A new goal specifically related to the need to transform maternal nutrition and health in many countries is essential.
The International Conference on Nutrition introduced a goal for ending deaths from famine. There is a need to elaborate indicators concerned with selective vulnerabilities - e.g. because of seasonal deprivation, in times of drought or other natural disaster and at times of war and economic crisis.
Goals to stem the rapid rise in overweight and obesity in adults as well as children are needed with a clear need to integrate these goals into a broader strategy against the major adult diseases of diabetes. Cardiovascular disease and cancers.