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close this bookEnding 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.)
close this folder6. Vision and Goals for the Future
View the document(introduction...)
View the document6.1 A Vision
View the document6.2 Achieving rapid progress for the 21st century
View the document6.3 The need to review goals and options
View the document6.4 Integrating goals for diet-related diseases
View the document6.5 An integrated approach

6.4 Integrating goals for diet-related diseases

Until now, the UN has followed the convention of considering nutritional deficiencies and "excesses", i.e. the diet-related adult chronic diseases, as separate. This is no longer sensible. The Commission recognises that both dietary deficiency and adult chronic disease now affect developing countries as well as the developed world and Central and Eastern Europe. The two sets of disorders are fundamentally linked through poor maternal nutrition. Thus, policy developments with community involvement must simultaneously take on this broader range of issues and develop coherent approaches for tackling the problems.

It is vital that all countries wake up to the increasing problem of non-communicable diseases and develop goals to deal with this problem. The Commission proposes the following (adapted from WHO, 1998c and World Cancer Research Fund, 1997):

establish a population strategy to reduce morbidity and mortality from coronary heart disease in people under 70 years by 50% by 2020, taking account of the Norwegian and Finnish experiences. Dietary guidelines will be needed to take account of local food patterns.

reduce the incidence of NIDDM progressively by halving the rate in the adult population by 2020. This will require a major programme to prevent overweight and obesity in all age groups.

establish a public health goal that population average BMI throughout adult life should be within the range 21-23 kg/m2 thus ensuring that a very high proportion of the population have a BMI within the designated normal range of 18.5-24.9 kg/m2. This target should probably be lower for Asia with average BMIs of 20-21 kg/m2 and individual BMIs not exceeding 23 kg/m2.

reduce the incidence of common types of cancer by 30% through amplifying vegetable and fruit consumption (World Cancer Research Fund, 1997).

reduce incidence of hypertension progressively by halving the rate in the adult population by 2020 through comprehensive strategies aimed at reducing salt and alcohol consumption and limiting excess adult weight gain.

a physical activity goal should be one where adults maintain a physical activity level of over 1.75 times the basal metabolic rate (i.e. activity costing 75% more than basal requirements), with opportunities for vigorous physical activity.

WHO and FAO recently developed a strategy for translating the traditional nutritional population goals into a more practical formulation. Dietary goals should be developed nationally and could be based on recent analyses of the optimum nutritional content (Box 6.1).

It is appropriate to set regional and/or national goals for ending undernutrition and micronutrient deficiencies in refugee camps and in the community, for halving the prevalence of low birthweight by transforming maternal nutrition and health care, by developing breast feeding goals and focusing on improving the education and the economic capacity, as well as the health, of women.