The Nutrition Challenge in the Twenty-First Century: What Role for the United Nations?

The United Nations Administrative Committee on Coordination, Sub-Committee on Nutrition (ACC/SCN), at its recent annual meeting in Nepal decided to set up a small but high level International Commission on Nutrition. The proposal was stimulated by three new pieces of evidence on the world nutrition situation: - recent evidence of slowdown in rates of nutrition progress, such that a halving of serious and moderate malnutrition in South Asia now seems likely at present rates to take 200 years; - the absolute deterioration of nutrition in Sub-Saharan Africa; - at the same time, progress to combat micronutrient deficiencies has accelerated dramatically over the last five years, especially for iodine and vitamin A deficiencies. The SCN proposed that the high level Commission should review this situation and make recommendations on goals and objectives for accelerating nutritional progress during the next decade or two, especially in the area of protein energy malnutrition. It was hoped that the Commission could undertake this work during 1997, in order to have a report ready for review at the next SCN meeting, which will be held in Oslo in April 1998. The Commission should include three or four distinguished international experts, including a senior economist. It was hoped that the commission could be chaired by someone of high political standing, to give visibility and leadership to the work of the Commission and to its report. The SCN expressed the hope that Mrs. Go Harlem Brundtland might be willing to take on this roe. Those who have so far agreed to accept a role on this Commission are Professor Philip James, CBE, Director, Rowett Research Institute, Aberdeen, Scotland; Dr Mahbub ul Haq, President, Human Development Centre, Islamabad, Pakistan; and Dr Ricardo Uauy, Director, Institute of Nutrition and Food Technology, Santiago, Chile.

Rates of preschool underweight are declining in many countries in all regions of the world. In some regions severe malnutrition is essentially eliminated. Progress towards reducing mild and moderate underweight is very uneven, however, and there is now evidence of a slowdown compared with the late 80s. In Sub-Saharan Africa trends are static, while numbers of malnourished continue to increase due to population growth. At the same time we have seen, in recent years, successful advances against micronutrient malnutrition. Again progress is uneven and there are concerns about long-term sustainability. Political commitment combined with effective programme strategies are the main ingredients for accelerated and consistent progress. Agencies of the United Nations can play a critical role in drawing attention to the problem of malnutrition (its costs and consequences) and fostering policy shifts that support effective programmes.

Present efforts to eliminate micronutrient deficiencies have focused on iodine, vitamin A and iron. Newer aspects of the impact of these deficiencies on reproductive health require attention. For example, the impact of vitamin A and iron deficiency on maternal mortality as a consequence of altered immune function and other host defense mechanisms may be particularly relevant.

Other micronutrients with potential public health significance, such as zinc and folate, need to be assessed and implications for future programme development identified. Zinc has been shown to influence duration of gestation and fetal growth. Poor zinc intake may contribute to stunting in areas where complementary foods are low in flesh foods. Fortification of complementary foods and dietary diversification strategies have been proposed to improve zinc nutrition during pregnancy, infancy and in the elderly.

Folate is now recognized as a key nutrient for normal organogenesis. Supplementation of women before conception will reduce the incidence of neural tube defects. In addition, folate deficiency appears to lower homocysteine levels, an independent risk factor for coronary heart disease. The beneficial effects of folate are obtained at levels well above usual intake.

The timeliness for a review of nutrition objectives of the UN system is evident. From a wider UN perspective, there is a strong case for a strategic review of the role of the UN in mobilising international action in response to the nutrition challenges of the twenty-first century. This would have several benefits. It would serve to highlight the evolving nutrition problems in both North and South, map and champion the current role of the UN in meeting those challenges, identify the strengths and weaknesses of the UN in dealing with nutrition, and set out a vision of the future role of the UN in addressing global nutrition challenges.

The SCN is itself at a cross-roads, with a new Chair, a new Technical Secretary, and substantially a new AGN. Furthermore, a large work programme has been completed, producing the Reports of the World Nutrition Situation, the reviews of large country programmes, and evidence on resource flows to nutrition. Another of the SCN's work activities, the Refugee Nutrition Information System, has a strong base of support from bilateral agencies and involves a large number of NGOs. In addition, the SCN itself has been subject to review and now has a new mandate explicitly supporting the work of individual agencies. The World Food Summit has helped to focus new energy and resources on nutrition issues.

GOAL

The major goal of this work would be to provide a catalyst for renewed commitment to nutrition among the United Nations family of agencies. A new commitment among the UN agencies would be a step towards mobilising greater nutritional awareness and action in countries and regions.

OBJECTIVES

The objectives of this work would be:

a) to take stock of the achievements and the failures regarding world nutrition to date and to describe how the UN system has contributed to these achievements and failures;

b) to review the challenges facing member states in the 21st century and opportunities to overcome them;

c) to define the collaboration, services, and activities the member states should expect and would need from the UN system to meet these challenges; identify priority support needs;

d) to identify ways to coordinate between and among UN agencies and between UN agencies and member states, for the purpose of responding optimally to the challenges

e) discuss ways to enhance commitment and interest in nutrition by governments, UN agencies, donor agencies and development banks;

f) to describe the role of the SCN in this process.

PRODUCT

The main report should not be too long, not more than 60 pages, covering:

Introduction

- purpose of the report
- terms of reference, any departures
- methods and procedures followed

Part I

1. Where nutrition stands at the end of the 20th century

- overview of nutrition problems worldwide
- causes, costs and consequences of malnutrition
- nutrition as an outcome of the development process
- emerging issues

2. Success stories of the last two decades

- models for successful interventions.
- main lessons
- impact of income growth on nutrition
- the role of behaviour (of the poor, of policy makers)
- specific health and nutrition interventions
- key issues concerning costs and benefits, targeting and design
- new research questions

Part II

3. A vision for the future

- realizing human rights for food and nutrition universally
- goals for 2020: ending malnutrition throughout the lifecycle
- undernutrition, stunting, tow birthweight
- micronutrients (iodine, vitamin A, iron, zinc, folate, EFAs)
- obesity
- ensuring household food security for all:

· in famine
· in normal situations

- goals for 2020 and beyond

· prevention of premature death and disability throughout the life cycle
· maternal and perinatal mortality (reproductive health)
· diet-related non-communicable chronic disease
· nutritional needs of the elderly
· healthier and longer life for all

4. An agenda for action

- country action
- regional and international

5. Where does the UN stand in relation to future nutrition challenges and what is the role of the SCN?

Conclusion

- summary of main findings and conclusions for action; next steps.