Meeting the Nutrition Challenge: A Call to Arms

Statement made by the Sub-Committee on Nutrition at its 24th Session, 25 March 1997 at the UNICEF Regional Office for South Asia, Kathmandu, Nepal

The latest evidence suggests a slow-down in the rate of nutritional advance in many regions of the world and a downturn in some countries, especially Sub-Saharan Africa. This is a most worrying trend, totally contrary to the commitments of the International Conference on Nutrition and the World Food Summit. Not only is it contrary to commitments, it is unnecessary. Even over the last five years dramatic advances have been demonstrated in some areas of nutrition, most specifically in reducing by 1.5 billion the number of people at risk from iodine deficiency disorders. Clearly the world can make progress in nutrition through forthright action by the international community combined with commitment by countries.

In 1992, on the occasion of the International Conference on Nutrition (ICN), and with the participation of UN organizations and other concerned agencies, the governments of 159 states adopted the World Declaration and Plan of Action for Nutrition, thereby declaring their determination to eliminate hunger and reduce all forms of malnutrition. They reiterated also their commitment to the nutrition goals of other UN conferences, including in particular the 1990 World Summit for Children (WSC). At the World Food Summit in 1996, governments and UN Agencies declared that it was intolerable that more than 800 million people do not have sufficient food to meet their needs, and reaffirmed the right of all to adequate nutrition and food security.

By adopting the World Declaration and Plan of Action for Nutrition at the ICN, governments agreed to develop national plans of action, with technical expertise from UN agencies. Moreover, all concerned agencies of the UN system were urged to define ways and means of giving appropriate priority to their nutrition-related programmes so as to ensure vigorous and coordinated implementation of activities recommended in the ICN Declaration and Plan of Action. The ACC/SCN accepted a special responsibility for facilitating coordination of the follow up to the ICN.

The SCN brings to your attention the Joint FAO/WHO Progress Report on the Implementation of the ICN World Declaration and Plan of Action for Nutrition and UNICEF's WSC Follow-up: Mid-Decade Review, prepared in 1996 as part of the reporting process to monitor progress in achieving the goals of the ICN and the WSC. We note with satisfaction that 106 countries have prepared national plans of action for nutrition. Most countries where the national plan has been endorsed by the government are now actively pursuing its implementation. However, several countries, particularly the poorest, still lack the human and financial resources necessary for implementation, and this is a matter of concern to the SCN. A major achievement of the ICN and the WSC has been the raising of awareness of nutrition problems and their links to physical and mental development, and thus to productivity and economic progress.

Despite real efforts, the latest evidence shows a slow-down in nutritional progress and in some regions a downturn. Nearly five years after the ICN and nearly seven years after the WSC, and despite very real progress by countries in developing and strengthening their food and nutrition policies and programmes, global impact on nearly all forms of malnutrition falls far short of that required to meet the goals for the year 2000. The SCN expresses deep concern that still nearly 200 million children under five years of age, well over a third of all children in developing countries, continue to be malnourished. Furthermore, recent analyses indicate that 56% of young child deaths in developing countries are associated with malnutrition.

In some regions such as Sub-Saharan Africa and South Asia, stagnation of nutritional improvement combined with a rapid rise in population has resulted in an actual increase in the total number of malnourished children. If current trends continue, no region except Latin America and the Caribbean will reach the ICN and WSC goals for the reduction of child malnutrition by the year 2000. The SCN also draws attention to the lack of progress in tackling iron deficiency anaemia which affects the health and development of tens of millions of children and women in spite of the availability of practical low-cost interventions.

Over the past five years, the international community through WFP and UNHCR has been able to meet each year the minimum food requirements of 25 million victims of manmade or natural disasters. There have been undoubted improvements in the emergency response to crisis, as well as in ration planning, distribution and monitoring. Starvation and major outbreaks of micronutrient deficiency diseases have been averted in recent crises. However, although the minimum quantity of food has been made available, there remains considerable room for improvement in the quality of the ration, particularly the micronutrient content.

The socio-political situation in many countries of Africa has led to massive population displacement, making an estimated population of over 2 million people inaccessible to humanitarian assistance. Mortality rates among refugees and displaced persons in some makeshift camps in Zaire have been ten times the normal rate due to security and political events leading to severe disruption of aid deliveries. While the SCN is encouraged by the improvement in the levels of malnutrition among refugee populations as indicated by estimates of trends, it is deeply concerned that most internally displaced and inaccessible populations remain at high nutritional risk.

Estimated food needs world-wide for grain, to maintain consumption and meet emergency needs, will nearly double over the next decade. At the same time, global food aid deliveries have been continuously reduced since 1993. This has resulted in the priority allocation of food aid to emergency situations, at the expense of development projects. The SCN wishes to bring to the attention of governments and UN agencies the impact that this shift will have on enabling poor rural people to improve their household food security and meet their nutritional requirements.

While further action to combat undernutrition is needed, attention must also be directed towards problems of diet-related diseases such as chronic degenerative diseases and obesity. These conditions are assuming an alarming significance not only in industrialized nations but also in developing countries where they coexist with undernutrition, reflecting shifts in life-style and dietary habits. The changing demographic profile of the world population, with a progressive increase in the proportion of elderly people, demands that attention and actions be specifically directed to address the food and other needs of this vulnerable group. In the face of increasing rural to urban migration and AIDS-related deaths of young adults, as well as decreasing family size, we can no longer assume that the elderly are cared for adequately within extended families.

...malnutrition is not simply the result of inadequate food availability or inadequate access to health services and a clean environment. The quality of care and feeding offered to children, which is critically dependent on women's education, social status and workload, is now seen as a significant contributing factor.

On the positive side, the SCN wishes to highlight the dramatic progress that has been made in combatting iodine deficiency disorders. In 1990 about 30% of the world's population was at risk of iodine deficiency and an estimated 43 million people were affected by some degree of mental impairment as a result of inadequate iodine intake before or during infancy and early childhood. As a result of efforts catalysed by both the WSC and the ICN, it is estimated that 1.5 billion people have started consuming iodized salt for the first time, resulting in the protection of 12 million infants every year from mental retardation. The SCN is pleased to report that if progress is maintained, the goal of virtual elimination of iodine deficiency disorders will be attained by the year 2000. Key factors responsible for this success include the determination and commitment of governments, the significant role played by the SCN in promoting a consensus among the UN agencies on the nature of the problem and appropriate solutions, the willingness of the donor community to support well-developed and targeted national programmes, and the recognition of the need for partnerships with the private sector.

There is need to adopt a holistic approach to the prevention of malnutrition. There is now general recognition that malnutrition is not simply the result of inadequate food availability or inadequate access to health services and a dean environment. The quality of care and feeding offered to children, which is critically dependent on women's education, social status and workload, is now seen as a significant contributing factor. Special efforts should include the improvement of the situation of women, with particular attention to their health and nutrition throughout the life cycle, and the promotion, protection and support of breastfeeding and appropriate complementary feeding and better care of young children. All strategies to combat malnutrition should be firmly based on the principles of community participation and should include appropriate monitoring systems. Further action is also needed to improve the response to food emergencies, and to design appropriate safety nets for the most vulnerable in such emergencies, and to find political solutions to allow humanitarian access to those in need.

The SCN through its coordinating efforts has identified the tools needed for successful action. At our annual meetings, through presentations and discussion at SCN Symposia, and by examining case studies of successful nutrition interventions, we have refined these tools and stand ready to meet the challenge of reducing malnutrition. We view with concern, however, the lack of priority accorded to nutrition in some member organizations of the SCN. Member governments must also construct policies that facilitate and support nutrition action. Strengthening national institutions is a key element in meeting the human resource requirements for the implementation of nutrition programmes.

The SCN strongly urges governments, UN organizations and the donor community to redouble their efforts towards tackling the problem of malnutrition. The continuing scandal of widespread malnutrition is a clear violation of human rights, and in particular the rights of the child. Economic growth is an essential but not sufficient prerequisite for progress in efforts to reduce the prevalence of malnutrition. The adoption of deliberate strategies to tackle the poverty-malnutrition nexus, with full community participation, is urgently needed. The SCN calls upon the governments and the international community to respond to this urgent plea for action.