IV. Strategies and actions

25 The basic goal of protecting and promoting nutritional well-being for all will be achieved only through a combination of policies involving various sectors at various levels of responsibility. Based on the worldwide consultations held in preparation for the ICN, actions to be considered by governments in their efforts to improve nutrition are presented below. These are grouped under nine action-oriented themes, allowing each sector and actor to determine how it can best address nutritional problems, taking into account the specific needs and conditions in each country.

1. Incorporating nutritional objectives, considerations and components into development policies and programmes

26. Significant improvements in nutrition can result from the incorporation of nutritional considerations into the broader policies of economic growth and development, structural adjustment, food and agricultural production, processing, storage and marketing of food, health care, education and social development. Such policies have an impact on nutrition through food availability and prices, incomes, environmental conditions and health status, care and feeding practices and other socio-economic factors. Development policies and programmes can also have varying impacts on the nutritional well-being of different population groups.

27. Efforts to improve nutritional well-being should be based on the recognition of improved human welfare in harmony with the environment and nature as the primary goal of social and economic development. While a population's nutritional status is determined by an array of social, economic, environmental and biological factors that affect its ability to acquire, consume and effectively utilize food adequate for its needs, a healthy well-nourished population is also essential for successful social and economic development Improving nutrition should therefore be seen both as a goal of development in its own right and as a means of achieving it. Recognizing that the sustainable development of food and nutrition security needs to be addressed simultaneously with economic growth, governments, in collaboration with all parties concerned and supported where necessary by appropriate legislative measures, should:

(a) Analyze the effects of macro-level policies and sectoral or integrated development plans on nutritional well-being, especially of the most vulnerable population groups. This would entail the elaboration of a common understanding of the relative importance of various determinants of nutritional status for different population groups and of how various policies may affect nutrition through their impacts on food security, health status, care and feeding practices.

(b) Increase awareness among policy-makers and planners of the extent and severity of nutritional problems and of their causes, of the economic benefit of interventions and of how activities under their control can affect the nutritional status of different socio-economic groups,

(c) In countries where it is appropriate to do so, incorporate clear nutrition goals and components in national development policies and sectoral plans, programmes and projects, particularly in the areas of food and agriculture, livestock, fisheries, forestry, rural and urban development, commerce, infrastructure, credit, water and sanitation, health, education, environmental and social welfare, and adopt benchmarks of success with clear time frames and budget allocations, as appropriate.

(d) In countries where the operation of the market as a mechanism for the coordination of production and the consumption of food is relied upon, develop education and communication programmes so that nutrition objectives may be achieved through appropriate consumer choice, based on enhanced consumer awareness and knowledge, and encourage the development of social welfare policies that will enable the more vulnerable population groups to exercise informed dietary choice.

(e) Develop or strengthen the technical capacities of, and institutional mechanisms within, each relevant ministry and at intermediate levels of government to identify nutritional problems and their causes and to improve the planning, management and evaluation of programmes and development projects that affect nutrition. Links with appropriate research and training institutions should be strengthened as well.

(f) Establish a flexible national mechanism with strong technical support to promote effective intersectoral cooperation, to keep the nutrition situation in the country under continuous review and to facilitate the development of national nutrition policies and programmes.

(g) Encourage and support the full involvement of communities and the participation of the people in the identification of their own nutritional problems as well as in the implementation, monitoring and evaluation of development programmes.

(h) Encourage the private sector, including small-scale producers and processors, industry and NGOs to promote nutritional well-being by considering the impact of its activities on nutritional status.

(i) Assess the impact of new development programmes and projects on nutrition to clearly identify the potential benefits for or risks to nutritional well-being, particularly among vulnerable population groups.

(j) Develop and use relevant indicators of nutritional well-being to monitor progress in social and economic development and establish appropriate mechanisms to regularly provide information on the population's nutritional status and factors affecting it, especially that of vulnerable groups, to policy-makers and planners and all interested sectors, both private and public.

(k) Incorporate appropriate and relevant elements of nutrition in school curricula starting from primary school.

(1) With a view to improving nutrition, direct additional investment into agricultural research where necessary to:

· address the problem of seasonality through diversification in food production, including fruits and vegetables, livestock, fishery and aquaculture;

· promote environmentally sound and economically viable farming systems to increase crop production and maintain soil quality, to encourage resource management and resource recycling;

· encourage the development of safe biotechnology in animal and plant breeding and facilitate the exchange of new advances in biotechnology related to nutrition;

· develop techniques that decrease post-harvest crop losses and improve food processing, storage and marketing;

· develop and disseminate technologies that respond to women's needs and ease the workload of women;

· improve extension services to cooperate more effectively with farmer and consumer communities in identifying research needs;

· improve training methods at the international, national and local levels to ensure dissemination of new technologies;

· address the needs of small and poor farmers including those dependent on poor quality or fragile land;

· develop technology and systems applicable to small-scale agriculture;

· encourage intensive food production at the farm and household levels, taking account of prevailing local conditions;

· develop more effective techniques for the traditional production of food at the household and community levels.

28. International, bilateral and regional agencies should assist and strengthen national capabilities to incorporate nutritional considerations into national development in countries where it is appropriate to do so.

2. Improving household food security

29. Food security is defined in its most basic form as access by all people at all times to the food needed for a healthy life. Achieving food security has three dimensions. First, it is necessary to ensure a safe and nutritionally adequate food supply both at the national level and at the household level, Second, it is necessary to have a reasonable degree of stability in the supply of food both from one year to the other and during the year. Third, and most critical, is the need to ensure that each household has physical, social and economic access to enough food to meet its needs. This means that each household must have the knowledge and the ability to produce or procure the food that it needs on a sustainable basis. In this context, properly balanced diets that supply all necessary nutrients and energy without leading to over-consumption or waste should be encouraged, It is also important to encourage the proper distribution of food within the household, among all its members.

30. The right to an adequate standard of living, including food, is recognized in the Universal Declaration of Human Rights. Food security should be a fundamental objective of development policy as well as a measure of its success. Household food insecurity affects a wide cross-section of the population in both rural and urban areas. The food-insecure socio-economic groups may include: farmers, many of them women, with limited access to natural resources and inputs; landless laborers; rural artisans; temporary workers; homeless people; the elderly; refugees and displaced persons; immigrants; indigenous people; small-scale fishermen and forest dwellers; pastoralists; female-headed households; unemployed or underemployed people; isolated rural communities; and the urban poor, Increasing the productivity and incomes of these diverse groups requires adopting multiple policy instruments and striking a balance between short-term and long-term benefits. The choice of policies must be attuned to the characteristics of a country's food security problem, the nature of the food-insecure population, resource availability and infrastructural and institutional capabilities at all levels of government and communities. Breast-feeding is the most secure means of assuring the food security of infants and should be promoted and protected through appropriate policies and programmes.

31. Bearing the above in mind, in countries where the food-chain is not secure and household food insecurity is a problem, governments, NGOs and non-profit organizations, the private sector and international organizations should, as appropriate, work in a collaborative manner to:

(a) Adopt development strategies to create conditions for economic growth with particular focus on the alleviation of poverty, food security and sustainable agricultural systems.

(b) Strike an optimal balance between macroeconomic policy objectives and food security needs, minimize the possible adverse impact of structural adjustment programmes on the food security of the poor and, where some negative effects are unavoidable, introduce appropriate measures to alleviate these hardships. In the countries concerned, governments and international organizations should promote programmes that will increase food production and, where appropriate, agricultural trade, so that poor countries and poor segments of a population have improved access to food. International lending practices should be re-examined and long-term action must be planned to maintain food supplies at those levels required to meet the needs of growing populations.

(c) Adopt and implement land-use policies where appropriate to enhance food security through the setting aside of adequate areas of agricultural lands and aquatic and other natural resources for the production of food and other sources of nutrition.

(d) Adopt policies and programmes to strengthen local leadership, including balanced gender training; enhance community involvement; promote people's participation; develop rural areas to stem rural-urban migration; and empower women, both as producers and consumers. Women and women's organizations are often very efficient, effective and fundamental in improving household food security.

(e) Adopt special programmes that will enhance productivity with a view to reducing costs and increasing and stabilizing production and incomes of the poor, Such programmes could include improving the access of small-scale producers to inputs, credit and other essential services, as well as to markets through improved infrastructure. The role of agricultural cooperatives and effective extension services in increasing production and producer incomes should be stressed.

(f) Improve access to work opportunities or production factors for urban and rural workers, female heads of households, those employed in the informal sector and unemployed and underemployed people by stimulating the creation of jobs, increasing their skills, providing credit on easy terms and increasing the availability of improved technologies, other inputs and means of production.

(g) Improve access to land and other natural resources by introducing and implementing agrarian reforms and, in particular, through the effective implementation of tenancy reforms and the promotion of efficient utilization of agricultural resources and resettlement in new lands, wherever feasible. Such actions must be taken in full compliance with applicable international laws and agreements.

(h) Increase employment opportunities, particularly in rural areas, by encouraging the private sector to augment such opportunities in agriculture, industry, handicraft and business.

(i) Stabilize food supplies through adequate stockholding in the form of strategic food security reserves as a first line of defence in emergencies; improve post-harvest handling, packaging, storage, preservation, transport and distribution of food to reduce losses at all stages; enhance animal health and production possibilities including fish farming and attention to fisheries resources; ensure a stable supply of fuel for cooking meals; carry out research and introduce measures to improve production, utilization and preservation of indigenous and traditional foods; improve rural food processing technologies; increase marketing facilities at the village, cottage and industrial levels to smooth the food supply flow throughout the year; introduce a variety of cropping strategies, such as crop rotation, mixed cropping, biological inputs and planting of perennial fruit-bearing trees, and develop other agroforestry approaches; ensure an adequate supply of clean and safe water; promote household and community gardens; and ensure the sustainability of food supplies by employing production and marketing systems based on safe and renewable resources that protect the environment and biodiversity.

(j) Improve emergency-preparedness planning through: effective early warning and other information systems; food security reserves; preparation of contingency plans of action to meet emergencies; and enhancing the entitlement of affected people through, for example, public-works programmes; as well as introduce measures to prevent natural disasters, such as irrigation schemes, flood control schemes, etc. In this respect, the international community can play an important role by providing timely and well-targeted food aid and other technical and financial assistance, particularly in the form of food-for-work programmes and for rehabilitation. Coordinated action of relevant organizations of the UN system is of particular importance in this context. Food aid should not interfere with, or be considered as a substitute for, local food production. The special needs of refugees and displaced persons, who include people affected by wars, civil unrest or natural disasters, should be given priority attention in food aid programmes. The provision of food supplies should strive to meet minimal nutritional requirements. NGOs can also provide significant help through effective and appropriate disaster management training at all levels, early warning, food and nutrition surveillance schemes, nutrition education, resource mobilization and action-oriented programme implementation.

(k) Strengthen planning of food-related assistance programmes so that they reach the population in need without disrupting the local economy or local food habits including food production and marketing. Such programmes could include food distribution systems, particularly for the poor and unemployable, and income transfer schemes, such as targeted food subsidies, food stamps and feeding programmes for vulnerable groups with a view to promoting nutritionally adequate diets. In particular, introduce self-targeting food distribution and income transfer schemes for those foods consumed primarily by the poor by locating public food distribution centres in areas where the poor live, taking into account that these populations should be able to select nutritionally adequate diets from the range of foods available.

(I) Strengthen the coping mechanism of the household to meet emergencies by improving its capacity to protect itself from the impact of an emergency through, for example household and community food storage; group savings and credit schemes, diversification of income and employment sources, and improved marketing infrastructures. Action could also include helping the household when the emergency occurs, for example, by supplying seeds for growing short-term crops, by providing food aid, livestock feed and water and, when the emergency is over, by introducing rehabilitation measures to help the household recover from adverse effects of the emergency.

(m) Adopt or strengthen a public sector policy supporting labor-intensive public works programmes and programmes to reduce geographical isolation, especially in sub-Saharan Africa where priority actions are needed to quickly alleviate acute nutritional problems. Labor-intensive infrastructure programmes are one of several valuable instruments that may be used to improve employment, income and access to food. They transfer and stabilize benefits, thus decreasing the risk of consumption shortfalls among the poor, and can strengthen needed infrastructure, such as roads, to facilitate better trade and movement of foods from rural to urban centres, promote resource conservation or irrigation and land development or combat such problems as desertification.

(n) Encourage necessary research by governmental, international and private institutions to promote household food security through better food production, handling and storage and prevention of food losses, crop and genetic diversity, and improved food processing, preservation and marketing Research should be done on household handling of food and interfamily food distribution to assure adequate food availability and to protect the nutritional value of food and prevent food losses and wastage Such research can enhance rural employment and promote the role of women, in particular, in all aspects of food production, processing and marketing. Research should also be carried out on appropriate cost-effective indicators to measure household food security problems and to measure progress of appropriate programmes in solving those problems.

(o) Promote better general and nutritional education to eliminate illiteracy and improve knowledge in the selection of a safe and adequate diet and of food production, processing, storage and handling techniques at all levels, especially the household level. Programmes should be directed at household leaders, with particular focus on women, and should also include home economics education for both boys and girls. The awareness of men and women of the benefits of limiting household size and the advantages of family planning practices should be increased. The role of mass media in delivering positive nutrition improvement messages and eliminating harmful food taboos should be emphasized. It is important to develop and carry out public information campaigns to improve the quality of nutrition through better use of available food supplies by the households and to promote recognition of the fact that each member of a household should be able to share fairly in available food resources irrespective of sex, age or any other individual characteristic.

(p) International financial and specialized agencies should give high priority to assisting countries with their programmes for strengthening household food security. The nature of such support may be increased investment in production enhancement projects such as irrigation, soil fertility improvement and soil and water conservation, intensification of agriculture or assisting countries undertaking structural adjustment. Assistance should also include technology transfer adapted to the local conditions in developing countries to improve food production and processing while protecting intellectual property rights as appropriate; the training of personnel at all levels, and the establishment of a suitable economic environment to improve the competitiveness of developing countries.

3. Protecting consumers through improved food quality and safety

32. A safe food and water supply of adequate quality is essential for proper nutrition. The food supply must have an appropriate nutrient content and it must be available in sufficient variety and quantity. It must not endanger consumer health through chemical, biological and other contaminants and it must be presented honestly. Food safety and quality control ensures that the desirable characteristics of food are retained throughout the production, handling, processing, packaging, distribution and preparation stages. This promotes healthy diets, reduces food losses and encourages domestic and international food trade. Food quality encompasses the basic composition of foods and aspects concerning food safety. Consumers have the right to a good quality and safe food supply, and government and food industry actions are needed to ensure this. Effective food quality and safety control programmes are essential and may comprise a variety of measures, such as laws, regulations and standards, together with systems for effective inspection and compliance monitoring including laboratory analysis. Where appropriate, governments, in close collaboration with other interested parties, should:

(a) Adopt and strengthen comprehensive measures to cover the control of food quality and safety with a view to protecting the health of consumers and producers and ensuring sound production, good manufacturing and fair trade practices. Where measures exist they should be regularly reviewed and updated, as appropriate, for better producer and consumer protection.

(b) Establish measures to protect the consumer from unsafe, low quality, adulterated, misbranded or contaminated foods. Measures should include provisions for minimum acceptable levels of food quality and safety, for differences in the ways in which food is produced, processed, packaged, labeled and stored, as well as for the conditions under which it is presented and purveyed. Food regulations should also cover the fortification of foods with micronutrients and should fully take into account the recommended international standards of the Codex Alimentarius Commission. Food labels should be clear and easy to understand and attention should be given to harmonizing labeling requirements; better information on nutrient analysis and food composition is needed for this task. Measures to assist individuals with food intolerance’s should be considered. Claims in food labelling or advertising should be carefully controlled and false or misleading claims should be prohibited. FAO and WHO should encourage greater involvement of developing countries in Codex activities and review avenues to facilitate such participation and they should find appropriate means of making contact with concerned food control institutions and provide them with information and technical knowledge in this field.

(c) Give high priority to establishing food safety and quality control infrastructures, including food inspection, sampling and laboratory facilities to enforce the law and regulations, to ensure that food products comply with applicable requirements for domestic consumption or export.

(d) Give consumer and producer organizations rights of consultation with advisory and decision-making bodies and facilitate open and transparent access to information and participation in the establishment of food safety, quality control and labeling standards. Also, establish or strengthen mechanisms to resolve consumer problems with the food supply Cooperation should be fostered among the food sector, government and consumers.

(e) Establish effective working relationships with the food industry, including producers, processors and purveyors of food, in order to ensure that food industry quality control systems are adequate to secure compliance with requirements of the law and regulations. Primary responsibility for production, manufacturing and distribution of the food supply rests with the farming, agricultural processing and retailing sectors. Thus the food industry should provide safe, wholesome, nutritious and palatable foods so that the health of consumers is protected.

(f) Support international and multilateral efforts to extend and enhance food standards and food-labeling programmes. Developing countries should be provided with international technical assistance to improve their food safety and quality programmes for domestic markets and international trade.

(g) Develop the human resources required for designing, implementing and monitoring food and water quality control systems. Education and training in the safe handling of agrochemicals are essential for farmers and for food handlers, both commercial and domestic.

(h) Implement, through national legislation, regulation and other appropriate measures, existing international agreements on the marketing and distribution of agrochemicals, such as the International Code of Conduct on the Distribution and Use of Pesticides.

(i) Promote the development of sustainable and ecologically sound agricultural practices and integrated pest management and strengthen research and extension programmes that help facilitate their adoption. Techniques that help reduce the use of agricultural chemicals should be encouraged.

(j) Support consumer education to contribute to an educated and knowledgeable public, safe practices in the home, community participation and active consumer associations. FAO and WHO should provide member countries with material on food quality and safety for use in consumer education programmes.

(k) Promote research on food quality and safety, including weaning products and street foods, taking into account the socio-economic conditions of production, handling and storage technologies.

(i) Develop surveillance and monitoring programmes for food-borne diseases and contaminants.

(m) Ensure that foods for emergency feeding programmes for refugees and displaced persons are of good quality and safe for consumption. Mechanisms should be established to monitor specific problems such as pest infestation, contaminants and product age and to promote the exchange of relevant information.

4. Preventing and managing infectious diseases

33. The interaction of infection and malnutrition has an overwhelming impact on health status, particularly in lower socio-economic groups. It is a major cause of death, sickness and disability in infants and young children and an important contributor to women's ill health and reproductive problems. Preventing, controlling and correctly managing infections improves nutritional well-being and markedly enhances the productivity of the adult population. Governments, in cooperation with all concerned parties, should:

(a) Adopt or strengthen, as appropriate, measures to ensure that safe food and safe water supplies are readily available in sufficient quantities to provide adequate environmental sanitation for all and to improve waste disposal systems.

(b) Prevent food-borne and water-borne diseases and other infections in infants and young children by encouraging and enabling women to breast-feed exclusively during the first four to six months of their children's lives.

(c) Promote sound weaning practices by encouraging the use of nutritionally adequate, safe and appropriate locally available foods.

(d) Provide or strengthen, as appropriate, specialist education for health workers and general education and specific nutrition and health information for communities, parents and individuals, enabling them to provide safe and adequate diets and effectively prevent and manage infections. This would include providing training and information on food, sanitation and primary health care, particularly the management of diarrhoea, and on dietary needs throughout the life cycle, including periods of illness, for relevant health, agriculture and other extension workers at all levels ce prevent, control, eliminate and/or eradicate infectious, parasitic and other communicable diseases, including those spread by animal vectors, by improving the environment and ensuring adequate primary health care services, including immunization programmes, diarrhoeal disease control, control of acute respiratory infections and extending AIDS prevention and control programmes to all populations.

(f) Encourage intersectoral collaboration between agriculture, health and other relevant sectors to prevent and control infectious diseases, especially zoonoses. Close collaboration with NGOs and the private sector should be ensured.

(g) Ensure and support nutrition management, where shown to be effective, in the prevention and reduction in severity of infectious diseases.

(h) Promote research on nutrition-related aspects of transmission and management of infectious diseases, taking into account all socio-economic aspects, and ensure the application of relevant findings.

5. Promoting breast-feeding

34. Breast-feeding provides infants and young children with the ideal nutrition. Together with its many beneficial effects, such as those on child spacing and the prevention of disease, it is the most inexpensive form of infant feeding. All women should be enabled to breast-feed their babies exclusively for the first four to six months, and, while giving appropriate supplementary food, to continue breast-feeding for up to two years or more. In order to do so, the international community needs to create awareness and provide maximum support to women to breast-feed, and governments and concerned parties of the private sector should:

(a) Support and encourage mothers to breast-feed and adequately care for their children, whether formally or informally employed or doing unpaid work. ILO conventions and regulations covering this subject may be used as a starting-point for the. States that agree with these conventions and regulations.

(b) Make all efforts to have maternity facilities take part in the "Baby Friendly Hospital Initiative" of WHO and UNICEF, incorporating the good practices described in the joint WHO/UNICEF statement on protection, promotion and support of breast-feeding through improved maternity services. These sound practices should also be used as a guideline as adapted to home deliveries.

(c) Encourage and support collaboration between health care systems and mother-support networks, including the family and the community, if necessary by promoting the establishment of mother-support groups.

(d) Take actions to give effect to the principles and aim of the International Code of Marketing of Breast-Milk Substitutes, as adopted by the 1981 World Health Assembly and reconfirmed by subsequent World Health Assembly resolutions.

(e) Ensure that health and other care providers receive high quality training in breast-feeding issues, using updated training material, and that they are informed about relevant national marketing regulations or policies.

(f) Ensure as far as possible that information disseminated on the feeding of infants and young children is consistent and in line with current scientific knowledge and take steps to counteract misinformation on infant feeding.

(g) Consider with utmost care issues regarding breast-feeding and human immunodeficiency virus (HIV) infection on the basis of the most up-to-date, authoritative scientific advice and referring to the latest WHO/UNICEF guidelines, and request that WHO, in close cooperation with UNICEF, breast-feeding and other experts, convene technical meetings on a regular basis to review the latest scientific publications on these issues and update the guidelines.

6. Caring for the socio-economically deprived and nutritionally vulnerable

35. Care refers to the provision in the household and community of time, attention, support and skills to meet the physical, mental and social needs of socio-economically deprived and nutritionally vulnerable groups. Among these groups the growing child is the most vulnerable, but others include women, the elderly and the mentally, physically and sensory disabled. Among the socio-economically deprived are refugees, displaced persons, some indigenous peoples, those in isolated communities, the landless, the unemployed, recent immigrants, orphans and children in difficult circumstances. Individuals most at risk of malnutrition are those who are both physiologically vulnerable and socio-economically deprived, Countries should recognize that the skills and abilities of the care giver, who is usually the mother, are crucial to the quality of care, particularly the selection and preparation of food for the family, including the mother herself, the children and other dependents.

36. In general, the provision of care is primarily a responsibility of the family. However, society also has an obligation to assist those who cannot care for themselves. The role of government should be to provide a supportive environment for family- and community-based care and to provide direct services when additional care is needed. Care within the family includes support during and after pregnancy, breast-feeding, providing security, reducing child stress, providing shelter and clothing, feeding and bathing, preventing and treating illness and showing affection and respect. Care facilities outside the family include curative and preventive health clinics, prenatal and maternal care centres, traditional healers or members of extended family networks, community and government social and economic support systems and programmes for income generation. Caring should recognize the dignity and rights of vulnerable people. Actions to improve the care of the socio-economically deprived and nutritionally vulnerable will be most successful if they are sensitive to the particular needs and traditions of a local community and respond to these. Governments are encouraged to work in a collaborative manner with local community groups, the private sector and NGOs, Governments, in cooperation with other concerned parties, should:

(a) Ensure that all infants and young children, particularly children in difficult circumstances, have access to adequate, well-balanced and safe diets, health care and education to enable them to attain and maintain their full physical and mental growth potential and proper nutritional status. Particular attention should be given to care for the female child.

(b) Promote sound weaning practices, including timely introduction of supplementary foods, adequate quantity and quality of weaning foods and improved feeding practices, such as more frequent and supervised feedings.

(c) Enhance the legal and social status of women from birth onwards, assuring them of respect and equal access to caring, education, training, land, credit, equity in wages and remuneration and other services, including family planning services, and empower them economically so that they have better control over the family resources.

(d) Promote support of care givers to preserve their physical and mental health and enhance their skills and knowledge to improve nutrition. Decrease women's workload by supporting research and extension services on time- and energy-saving devices, where applicable.

(e) Adapt nutrition, health and education support services to adolescent girls and boys to prepare them to fulfil their future roles as well-nourished, productive adults and parents.

(f) Prepare and motivate adult males to fully participate in and take responsibility for the nutritional well-being and support of their families, as well as to be sensitive to women's needs in protecting and promoting family well-being.

(g) Foster recognition of the contribution that the elderly make to the household and community activities. Promote caring of the elderly through traditional forms of family support and through the introduction of special measures where needed.

(h) Provide care for disabled individuals to enable them to reach their potential and become self-supporting, ensuring their opportunities in education, employment and housing.

(i) Enhance the nutritional status of the indigenous people through the development and implementation of culturally acceptable strategies that involve the community.

(j) Encourage and foster community awareness, organization and leadership to promote and ensure its own nutritional development including adequate care of its vulnerable households and individuals, such as female-headed households.

(k) Enhance food and nutrition programmes directed at urban poor and especially street children.

37. Among refugees and displaced populations, high rates of malnutrition and micronutrient deficiencies associated with high rates of mortality continue to occur. The magnitude of the problem has grown over the last decade. Increased political commitment to and accountability for the protection and promotion of the nutritional well-being of refugees, displaced populations, those under occupation, prisoners of war and other affected groups are urgently required in accordance with international humanitarian law. Governments, in collaboration with the international community, should:

(a) Provide sustainable assistance to refugees and displaced persons and work to monitor and ensure their nutritional well-being, giving high priority to the control of diseases and to the prevention of malnutrition and outbreaks of micronutrient deficiency diseases. Wherever feasible such assistance should encourage their ability to support themselves rather than increase their dependence on external assistance. The food provided should be nutritionally adequate and safe.

(b) Identify, within civilian populations situated in zones of conflict, refugee and displaced populations and groups needing special care including the disabled, the elderly, children, mothers and other nutritionally vulnerable groups in order to plan to provide for their special needs.

(c) Promote the basic human rights of refugees and displaced persons.

(d) Ensure a rapid, coordinated and appropriate response by improving communications with the international community, including concerned entities of the United Nations as well as NGOs.

(e) Work to ensure the safe and timely passage of the totality of food and medical supplies to those in need in conflict zones, and the creating and using of "humanitarian corridors of tranquillity" where available.

(f) Ensure assistance to refugees returning to their home countries until they are reintegrated into society.

(g) Make efforts to develop policies that ensure stability so as to avoid the massive migration of refugees and displaced persons, which causes additional pressure on any community.

7. Preventing and controlling specific micronutrient deficiencies

38. Micronutrient deficiencies are a matter of major public health concern. They are widespread, although the prevalence of a particular deficiency can vary considerably within and between countries Deficiencies of vitamin A (including beta-carotene), iodine and iron are especially important because of their serious health consequences, wide geographic distribution and the existing global commitment to their control.

39. Vitamin A deficiency and its consequences, including blindness, poor growth, increased severity of infections and death, are fully preventable, making its control one of the most effective child health and survival strategies that governments can undertake The protection, promotion and support of breast-feeding is an effective way of preventing vitamin A deficiency in infants and young children.

40. Over one-fifth of the world's population lives in iodine-deficient areas, Iodine deficiency is the most common preventable cause of mental retardation. Additional consequences of iodine deficiency are reproductive failure, goitre, increased mortality and economic stagnation. Children, adolescent girls and women are particularly vulnerable. The means for its correction are readily available and provide an exciting opportunity for its elimination by the year 2000.

41. Iron deficiency and/or anemia is the most common micronutrient deficiency, especially affecting young children and women of reproductive age. Uncorrected anemia can lead to learning disabilities, an increased risk of infection and diminished work capacity and to death of women during pregnancy and at childbirth. Thus, iron deficiency has an impact on all segments of society.

42. Deficiencies of other micronutrients such as folate and other B-complex vitamins, vitamin C, selenium, zinc and calcium also significantly affect health and may merit increased attention by governments in countries where deficiencies exist.

43. Recognizing the international, regional and national resources, coordination and support required, governments, in collaboration with international agencies, NGOs, the private sector/industry, other expert groups and the community, should adopt an appropriate combination of the following strategies:

(a) Assess the extent and epidemiology of micronutrient deficiencies and develop a national policy for prevention based on their distribution and cause, the severity of deficiency and available resources.

(b) Accelerate efforts to achieve the elimination of vitamin A and iodine deficiencies and a reduction in iron deficiency in accordance with the year 2000 goals of the World Summit for Children and the Montreal Conference on Micronutrient Malnutrition.

(c) Formulate and implement programmes to correct micronutrient deficiencies and prevent their occurrence, promoting the dissemination of nutrition information and giving priority to breast-feeding and other sustainable food-based approaches that encourage dietary diversification through the production and consumption of micronutrient-rich foods, including appropriate traditional foods. Processing and preservation techniques allowing the conservation of micronutrients should be promoted at the community and other levels, particularly when micronutrient-rich foods are available only on a seasonal basis.

(d) Implement the most appropriate combination of the following measures: improved food availability, food preservation, food and nutrition education and training, dietary diversification, food fortification, supplementation and pertinent public-health measures such as primary health care, promotion of breast-feeding and safe drinking-water. International and regional cooperation in the sharing of resources to enable economies of scale should be encouraged.

(e) Ensure that sustainable food-based strategies are given first priority particularly for populations deficient in vitamin A and iron, favoring locally available foods and taking into account local food habits, Supplementation of intakes with vitamin A, iodine and iron may be required on a short-term basis to reinforce dietary approaches in severely deficient populations, utilizing primary health care services when possible. Supplementation should be directed at the appropriate vulnerable groups, especially women of reproductive age (iodine and iron), infants and young children, the elderly, refugees and displaced persons. Supplementation should be progressively phased out as soon as micronutrient-rich food-based strategies enable adequate consumption of micronutrients.

(f) Ensure and legislate for the fortification of foods or water with necessary micronutrients, where feasible, when existing food supplies fail to provide adequate levels in the diet. Fortification should be regularly evaluated for various reasons. Where iodine deficiency is a significant public health problem, the iodization of all salt for both human and livestock consumption is required, recognizing that this is the most effective long-range measure for correcting iodine deficiency.

(g) Ensure that nutrition education and training programmes are implemented at the community, school and national levels to provide information on proper food preparation, nutritional value and bio-availability and other factors that affect micronutrient status, especially of the young, and to promote the consumption of foods that are rich in micronutrients.

(h) Strengthen micronutrient surveillance capabilities and activities by devising indicators to monitor the above strategies for achieving national goals related to coverage, compliance and effectiveness in targeted populations.

(i) Support research on the role of micronutrients in health and disease, on the development of inventories and food composition tables of existing and potentially significant food sources of micronutrients, including inter alia green and yellow vegetables and fruits, palm oil, fish and other locally available food sources of micronutrients, on weaning foods, on factors affecting the bio-availability of nutrients in food, on indigenous methods of food processing and preparation affecting micronutrient availability, on nutrition education; and on the improvement of existing techniques for the assessment and correction of micronutrient deficiencies.

(j) Develop sustainable institutional capacities and human resources, including training of professionals, non-professionals and community leaders, in order to achieve the goals of micronutrient deficiency control and prevention.

(k) Consider, as appropriate, coordinating micronutrient deficiency control activities under the direction of a national committee, with the appropriate political support, authority, legislation and infrastructure that reflects national commitment.

(1) Encourage FAO, WHO and all other concerned international agencies and NGOs to provide assistance in combating all aspects of micronutrient deficiency problems, through monitoring and surveillance, research and production and consumption of micronutrient-rich foods.

(m) Recognize that refugees and displaced persons, as well as being susceptible to iodine, vitamin A and iron deficiencies, are also susceptible to other deficiencies, particularly vitamin B₁ deficiency (beriberi), niacin deficiency (pellagra) and vitamin C deficiency (scurvy) Donor countries and involved organizations must therefore ensure that the nutrient content of food used for emergency food aid meets nutritional requirements, if necessary through fortification or ultimately through supplementation. To the extent possible, such foods should be culturally appropriate.

8. Promoting appropriate diets and healthy lifestyles

44. Non-communicable diseases related to unhealthy lifestyles and inappropriate diets are becoming increasingly prevalent in many countries. With greater affluence and urbanization, diets tend to become richer on average in energy and fat, especially saturated fat, have less fibre and complex carbohydrates and more alcohol, refined carbohydrates and salt. In urban settings exercise and energy expenditure frequently decrease, while levels of smoking and stress tend to increase. These and other risk factors, as well as increased life expectancy, are associated with the increased prevalence of obesity, hypertension, cardiovascular diseases, diabetes mellitus, osteoporosis and some cancers, with immense social and health care costs. Dental caries is also an important diet-related condition in some regions.

45 While generally positive, urbanization, particularly in developing countries, can lead to severe economic and social stresses among poor populations. Often, too rapid urban growth results in heavy demands on urban facilities, resulting in large numbers of poor people living in crowded slums with limited access to clean water, sanitation facilities, health care and. food Excessive urbanization, particularly rural-urban migration, may also contribute to the fragmentation of society and the breakdown of traditional values and care and feeding practices. Dietary and lifestyle changes following migration to more affluent areas can affect health status in positive and negative ways, often exposing immigrants, particularly minorities, to an increased risk of diet-related non-communicable diseases. Both primary and secondary prevention of these diseases are important Governments, together with other groups, should:

(a) Assess the dietary intake and nutritional status of the population (see section 9 below).

(b) Assess the strength of evidence of links between diet and disease in the context of their own situation, taking into account international and other national assessments and current scientific findings. Consider which dietary targets are appropriate in the context of the prevalence of deficiency and diet-related chronic diseases.

(c) Develop comprehensive policies for improved food supplies and nutrition, adapted to local conditions in each country, and support and encourage home gardens, traditional food production and consumption patterns that support nutritional well-being.

(d) On the basis of energy and nutrient recommendations, provide advice to the public by disseminating, through the use of mass media and other appropriate means, qualitative and/or quantitative dietary guidelines relevant for different age groups and lifestyles and appropriate for the country's population.

(e) Implement and support the design of appropriate community-based nutrition education programmes in conjunction with appropriate communication strategies, such as nutrition labelling, that enable individuals and families to choose a healthy diet, and give high priority to ensuring that these programmes reach target groups.

(f) Encourage the adaptation of nutrition and consumer information and intervention programmes to differences in socio-economic conditions, language barriers and cultural beliefs and attitudes regarding foods, health and disease.

(g) Promote from an early age a knowledge of food and nutrition, food safety, food preparation, healthy diets and lifestyles through the curricula of schoolchildren, teachers, health professionals, and the training of personnel involved in agricultural extension.

(h) Encourage institutionalized food services and the catering sector to provide and promote healthy diets.

(i) Take appropriate actions to discourage smoking, drug and alcohol abuse.

(j) Sponsor and promote exercise programmes to all, targeting children and high-risk groups, and provide recreation and sporting facilities with the participation of community, public and private organizations.

(k) Promote employment and better living conditions in rural areas to prevent excessive migration to cities.

(l) Support special nutrition and consumer education, nutrition interventions and follow-up activities for those groups of immigrants that may need special attention.

9. Assessing, analysing and monitoring nutrition situations

46. Information on the nature, extent, magnitude and severity of different types of nutritional problems, as well as their causes, resources and how they are changing over time, is essential for the development, implementation, monitoring and evaluation of effective policies and programmes to improve nutrition. Information is also needed to provide early warning of impending nutritional emergencies and for ongoing programme management. The basic aim should be to provide relevant and accurate information that can be utilized efficiently. Therefore, information must be timely, relevant to the decision-makers and communicated effectively at the appropriate levels. These levels range from the individual and household level, through the community and national levels, to the international level. Open access to information regarding the nutritional situation must be ensured for all interested parties. Utilization of information may be facilitated by the establishment or strengthening of specific bodies or mechanisms. Data collection and analysis have costs that must be balanced against the overall resources available for the programme. Governments, in close cooperation with all parties concerned, should:

(a) Identify the priority nutritional problems in the country, analyse their causes, plan and implement appropriate remedial actions and monitor and evaluate efforts to improve the situation. This would include selecting appropriate indicators and methods for assessing and monitoring problems of food security and undernutrition, micronutrient deficiencies and overnutrition.

(b) Establish or strengthen data collection, analysis and reporting systems within appropriate institutional frameworks in a sustainable fashion in order to meet the relevant priority information needs of planners, policy-makers, programme managers and communities as they address nutritional problems.

(c) Provide basic and ongoing training of personnel in relevant ministries and institutions for data collection, analysis, presentation and utilization.

(d) Make maximum use of existing data sources and information systems to avoid duplication of efforts and to encourage a coordinated multisectoral approach for taking action. Relevant sources of data could be in particular the ministries responsible for agriculture, health, education, commerce and trade, finance and planning, scientific research and social welfare, as well as universities, the private sector and NGOs. Data could include information on mortality, morbidity, anthropometry, food availability, food intake, food prices, breast-feeding, food quality and safety, along with information on knowledge, attitudes and practices, family size and income, rainfall and landholding.

(e) Encourage the development and use of innovative approaches such as risk mapping, sentinel sites and rapid appraisal techniques for information gathering and utilization. Establish a system for the exchange of information between developing countries (South-South) and also between developed and developing countries for training and research.

(f) Promote community-based information systems to support local problem identification analysis and action.

(g) Develop and strengthen growth monitoring and promotion and nutrition surveillance within primary health care systems.

(h) Promote the strengthening of research and training of personnel in nutrition, especially for food sciences, nutrition, biology, food toxicology, epidemiology, human and social sciences and related interventions.

(i) Cooperate with other governments, research institutions, NGOs and international organizations to promote and support regional and international collaboration in gathering food and nutrition information and in surveillance and early warning activities. This should also include the building of capacities within countries and promoting the establishment of focal points for training and research at national and regional levels.

(j) Support and encourage, where appropriate, the development and use of local food composition information.