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1 19th International Congress on Nutrition (Bangkok, 5 October 2009) Global efforts towards achieving the MDGs and nutrition well-being Dr Ala Alwan Assistant Director-General World Health Organization 19th International Congress on Nutrition (Bangkok, 5 October 2009) Which challenges are we facing? • Underweight • Wasting • Stunting • Overweight/obesity • Micronutrient deficiencies • Nutrition-related non-communicable diseases • Interfaces with foodborne diseases

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19th International Congress on Nutrition(Bangkok, 5 October 2009)

Global efforts towards achieving the MDGsand nutrition well-being

Dr Ala Alwan

Assistant Director-General

World Health Organization

19th International Congress on Nutrition(Bangkok, 5 October 2009)

Which challenges are we facing?

����

• Underweight

• Wasting

• Stunting

• Overweight/obesity

• Micronutrient deficiencies

• Nutrition-related non-communicable

diseases

• Interfaces with foodborne diseases

2

19th International Congress on Nutrition(Bangkok, 5 October 2009)

UndernutritionPersistent burden of disease

• Child undernutrition accounts for 30% of the deaths of

children under 5 years of age

• Child undernutrition and maternal undernutrition account for 11% of the global burden of disease

• Stunting, severe wasting and intrauterine growth retardation

are the most important health risks in children under 5

• Deficiencies of vitamin A, zinc, iron and iodine are

responsible for an increase in mortality and morbidity

• Iron deficiency anaemia is responsible for at least 20% of

maternal deaths at delivery

19th International Congress on Nutrition(Bangkok, 5 October 2009)

178 million children are stunted(under 5 years of age)

Prevalence of Stunting

Source : WHO Global Database for Child Growth and Malnutrition, 2009

3

19th International Congress on Nutrition(Bangkok, 5 October 2009)

293 million children are anaemic(under 5 years of age)

Source: WHO/CDC. Worldwide prevalence of anaemia 1993-

2005. WHO Global Database on Anaemia. Geneva, World

Health Organization, 2008.

!!

!

!

Category of public health significance(anaemia prevalence)

Normal (<5.0%)

Mild (5.0-19.9%)

Moderate (20.0-39.9%)

Severe (≥40.0%)

No Data

19th International Congress on Nutrition(Bangkok, 5 October 2009)

Exclusive breastfeeding rates are stalling(children less than 6 months of age)

Source : WHO database on IYCN, 2008

12

20

25

1416

24

38

14

43

32

38

18

35

42

21

46

29

36

0

10

20

30

40

50

60

70

80

90

100

Africa Americas EasternMediterranean

Europe South-EastAsia

Western Pacific

Global

1986-1990

1991-1995

1996-2002

4

19th International Congress on Nutrition(Bangkok, 5 October 2009)

Nutrition-related noncommunicable diseasesIncreasing burden of disease

• Excess Body Mass Index was responsible

for more than 30 million Disability-Adjusted Life Years (DALYs) in 2000

– Ischaemic heart disease

– Type II diabetes

• Prevalence of obesity has been increasing

over the last 10 years

• Poor people are disproportionally affected

Over 500 million adults are obese

Source : WHO Global BMI database, 2009

5

19th International Congress on Nutrition(Bangkok, 5 October 2009)

Group III - Injuries

Group II – Other deaths from non-communicable diseases

Group II – Premature deaths from non-communicable diseases (before 70), which are preventable

Group I – Communicable diseases, maternal, perinatal conditions and nutritional deficiencies

14 million premature deaths from non-communicable diseases occur in developing countries

0

5,000,000

10,000,000

15,000,000

20,000,000

25,000,000

30,000,000

High-income

countries

Upper middle-

income

Lower middle-

income

Low-income

countries

1.8M 1.9M

6.0M

6.1M

19th International Congress on Nutrition(Bangkok, 5 October 2009)

Deaths from non-communicable diseases Global projected increase

0

2

4

6

8

10

12

2000 2005 2010 2015 2020 2025 2030

De

ath

s (

mil

lio

ns

)

Cancers

Stroke

Road trafficaccidents

HIV/AIDS

TB

Malaria

Acute respiratoryinfections

Ischaemic

heart disease

Perinatal

ww

w.w

ho.in

t/health

info

/glo

bal_

burd

en_dise

ase

/2004_re

port_

update

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tml

6

19th International Congress on Nutrition(Bangkok, 5 October 2009)

+17%-3%38835.758.2Total

+20%+11059.712.4Western Pacific

+21%-16%898.014.7South-East Asia

+4%+7%888.59.8Europe

+25%-10%252.24.3Eastern

Mediterranean

+17%-8%534.86.2Americas

+27%+6%282.510.8Africa

Trend: Death from NCD

Trend: Death from infectious

disease

NCD deaths

(millions)

NCD deaths

(millions)

Total deaths

(millions)

Geographical regions (WHO

classification)

2006-2015 (cumulative)2005

(WHO, 2005)

Deaths from non-communicable diseases Low- and middle income countries are most affected

19th International Congress on Nutrition(Bangkok, 5 October 2009)

Preventable foodborne diseasesThousands of people die every day from these diseases

• More than 4 billion cases per year of foodborne

diarrhoeal disease

• In developing countries 1.9 million children <5 die each

year because of diarrhoeal diseases

• Up to 70% of these cases may be caused by foodborne

pathogens

• This does not include other foodborne diseases, such as diseases caused by chemicals in food (e.g. aflatoxin or

acrylamide)

7

19th International Congress on Nutrition(Bangkok, 5 October 2009)

Signs of improvement?

• In the last 20 years:

– Improvement in low birth weight

– Associated with improved body-mass-index in women

– Associated with lowered child underweight

prevalence

• Significant number of countries are showing successful

transition from steady or slightly improving malnutrition

rates to accelerated reduction

• Asia: virtuous cycle of improved women’s nutrition and

health, leading to better developed infants and better

grown mothers, driving inter-generational improvement

• Globally, progress is insufficient

19th International Congress on Nutrition(Bangkok, 5 October 2009)

The food crisis has eroded progress

The 2008 food crisis has led to increased wasting rates,

increased admissions for malnutrition and changes in dietary intakes (in vulnerable groups and in countries

with limited resilience:

– reduction of higher nutrient density foods

– reduction of meals

– reduction of portion

– use of famine foods

8

19th International Congress on Nutrition(Bangkok, 5 October 2009)

"The global economic crisis derails progress against poverty"

• GDP growth in developing countries is expected to slow

to 2.1%

• recessions are projected in Europe and Central Asia (-2.0%), and Latin America and the Caribbean (-0.6%)

• Cash inflow to developing countries will decrease as

result of reductions in foreign direct investment, foreign

aid and migrant workers remittance

• The number of extremely poor is estimated to have increased by 130-155 million globally in 2005-2008

• 53 million more expected in 2009

Source : SCN

19th International Congress on Nutrition(Bangkok, 5 October 2009)

Climate change Impact on food and nutrition security

• Higher temperatures, greater rainfall variability and extreme weather events will affect global agriculture

• Climate change will reduce water availability, increasing animal and plant pests and diseases

• Global warming will affect the world’s poorest regions the most

• The impact will depend on the levels and types of investments to improve agriculture’s adaptive and resilience capacity and to adjust production methods

• Action is needed to reduce risks to malnutrition and food safety

Source : FAO

9

19th International Congress on Nutrition(Bangkok, 5 October 2009)

What action is needed?

����

19th International Congress on Nutrition(Bangkok, 5 October 2009)

What is limiting progress?

• Choice of interventions

• Focus on the greatest benefits

• Quality of interventions

• Comprehensiveness

• Coverage

• Policy coherence

• Population awareness

• Commitment by policy makers

• Investments

• Capacity

• Coordination among players

10

19th International Congress on Nutrition(Bangkok, 5 October 2009)

Source: World Bank (adapted)

Principal development partners Global nutrition arena

International

Financial

Institutions

Public

Private

Partnerships

Private Foundations

UN Agencies

Bilaterals

Government

Agencies

Academia &

Research

Institutions

NGOs

Partners in

nutrition

UNICEF

WFP

SCNFAO WHO

IFAD

AfDBWB

AsDB

IADB

GAIN

MI

Global Fund

Gates Foundation

Rockefeller Foundation

HKI

AKF

WABALa Leche League

BRAC

SCF

CARE

Line Ministries responsible for nutrition

Ministries of Planning

Ministries of Finance

IrishAid Netherlands

DFID

NORAD

GTZ

SIDA

CIDA

JICA

USAID

DANIDA

EuropeAid

Universities

19th International Congress on Nutrition(Bangkok, 5 October 2009)

$0.01

$0.06

$0.10

$0.42

$0.92

$0.93

$3.90

$0.06

$0.21

$0.22

$0.23

$0.24

$0.33

$0.45

$0.53

$0.80

$1.14

$1.16

$1.33

$1.65

$7.40

Water Education/Training

Water Resources Protection

River Development

Waste Management/Disposal

Basic Drinking Water Supply & Sanitation

Water resources policy/admin. mgmt

Water Supply/Sanitation - Large Systems

Health Education

Medical Education/Training*

Medical Research

Basic Health Infrastructure

Medical Services

Basic Nutrition

Tuberculosis Control

Family Planning

Malaria Control

Basic Health Care

Reproductive Health

Infectious Disease Control

Health Policy & Admin. Management*

HIV/AIDS & STDs*

Health ODA Commitments (2007)(in US$ billions)

Total Health ODA: $22.1 billion

Source:

11

19th International Congress on Nutrition(Bangkok, 5 October 2009)

Scaling up direct actions

The implementation at scale of effective interventions may

reduce infant mortality by 25%

and reduce growth retardation in

36 countries with high prevalence

by one third,

thus eliminating

60 million Disability-Adjusted Life-Years

19th International Congress on Nutrition(Bangkok, 5 October 2009)

• Promotion of breastfeeding and adequate complementary feeding

• Micronutrient supplementation in children and women

• Micronutrient fortification of food

• Supplementary feeding

• Therapeutic feeding

• Growth assessment and promotion

• Antenatal care

• Hygiene

• ORS

• Immunization

• Deworming

• Maternal tobacco consumption

• Malaria control

Effective direct actions

12

19th International Congress on Nutrition(Bangkok, 5 October 2009)

Supporting policies

– Health: personnel, budget

– Social: poverty alleviation, cash transfers

– Education: schools

– Environment: water and sanitation

– Agriculture and food production : food security, food safety

– Trade

19th International Congress on Nutrition(Bangkok, 5 October 2009)

1. Raising the priority accorded to non-

communicable diseases in

development work at global and

national levels

2. Establishing and strengthening

national policies and programmes

3. Reducing and preventing risk factors

4. Prioritizing research on prevention and

health care

5. Strengthening partnerships

6. Monitoring NCD trends and assessing

progress made at country level

Global Strategy for the prevention of Non Communicable Diseases – Action Plan 2008-2013

13

19th International Congress on Nutrition(Bangkok, 5 October 2009)

UN Economic and Social CouncilHigh-level Segment 2009

“Noncommunicable diseases must be addressed if we want to put an end to poverty in 2015. Under this year's leadership by the Prime-Minister of Qatar, ECOSOC has given a high profile to the need to include non-communicable into global discussions on development. We need to continue this momentum.”

H.R.H. Princess Muna Al-HusseinHashemite Kingdom of Jordan

“Why are we not responsive to requests from low- and middle-income countries to help build national capacities to address noncommunicable diseases? Because these problems are beyond those targeted by the MDGs.”

Ambassador Sylvie LucasPresident of ECOSOC

19th International Congress on Nutrition(Bangkok, 5 October 2009)

Food and nutrition policies:a 1992 perspective

• Improving household food security

• Protecting consumers through improved food quality and

safety

• Preventing and managing infectious diseases

• Promoting breastfeeding

• Caring for the socioeconomically deprived and

nutritionally vulnerable

• Preventing and controlling specific micronutrient

deficiencies

• Promoting appropriate diets and healthy lifestyles

• Assessing, analysing and monitoring nutrition situations

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19th International Congress on Nutrition(Bangkok, 5 October 2009)

• Ensuring that agricultural and trade policies take into account public health

• Providing correct information to the consumers and restricting marketing of food with poor nutrition profiles

• Strengthening social safety nets and promotehealthy diets among groups of low socio-economic status

• Improving environmental sustainability of food production

Food and nutrition policies:a 21st century perspective

19th International Congress on Nutrition(Bangkok, 5 October 2009)

Prioritising high-burden countries

15

19th International Congress on Nutrition(Bangkok, 5 October 2009)

Different policy and operational support neededFACTOR 1:

Better Health System Capacity,

variable Nutrition Governance

FACTOR 2:

Poorest Health System

Capacity, Consistent Good

Nutrition Governance

FACTOR 3:

Poor Health System Capacity,

Variable Nutrition Governance

(High PH Expenditure)

Strong

Nutrition Governance

Medium/weak

Nutrition Governance

Strong

Nutrition Governance

Medium/weka

Nutrition Governance

MCU 1Best for reduction of both

child stunting and maternal

anemia

Vietnam Angola (-)Indonesia

Kenya

Pakistan

South Africa

BangladeshIndia

CambodiaMozambique

MCU 2Best for reduction of child

stunting, and worst for

reduction of maternal

anemia

Egypt

PeruPhilippines

DR Congo* (-) Ethiopia

MCU 3Worst for reduction of child

stunting, and best for

reduction of maternal

anemia

Ghana

Yemen (-)

Cameroon

Myanmar

Nigeria

Sudan*

Burkina Faso Guatemala

Mali

Niger

Zambia

MCU 4Worst for reduction of both

child stunting and maternal

anemia

BurundiCote D’Ivoire (-)

Madagascar

Nepal

Uganda

Malawi U R Tanzânia

MCU groups

(from stunting

and anemia

level and trend)

Readiness

Factor

19th International Congress on Nutrition(Bangkok, 5 October 2009)

Which roles have players in the nutrition arena?

����

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19th International Congress on Nutrition(Bangkok, 5 October 2009)

The United Nations System

• Scaling up direct

interventions

• Joint action planning at

global and country level

• Joint advocacy with

governments and donors

• Identifying and describing

global processes

• New UN synergies for

better nutrition governance

and accountability

19th International Congress on Nutrition(Bangkok, 5 October 2009)

Governments

• Intersectoral food and nutrition policies

• National plans and policies to prevent and control non-communicable diseases

• Strengthening health systems

• Policy coherence: health in all policies

• Intersectoral coordination

• Invest in health and poverty reduction

• Monitoring and evaluation

17

19th International Congress on Nutrition(Bangkok, 5 October 2009)

Civil society

• Assist in implementation

• Awareness raising

• Social mobilization

• Advocacy

• Soliciting and monitoring commitment

19th International Congress on Nutrition(Bangkok, 5 October 2009)

Academia

• Fill research gaps:

– Relationships between nutrition and health

– Epidemiology

– Effective interventions

– Translational research

• Build capacities :

– Technical training in nutrition

– Policy and programme design

18

19th International Congress on Nutrition(Bangkok, 5 October 2009)

Private sector

• Role of the private sector in improving the quality, safety and access to food supply

• Food producers and distributors, catering and restaurants are an important actor in public health driven and lead food and nutrition policies

• Improve availablity of foods with healthier nutrition profile, less aggressive marketing practices, protection of breastfeeding, promotion of adequate and safe complementary foods

19th International Congress on Nutrition(Bangkok, 5 October 2009)

What is the response of WHO?

����

WHO has a major responsibility for promoting healthy

nutrition for all the world's people, through

collaborative support to Member States, particularly

in their national nutrition programmes, in partnership with other intergovernmental and nongovernmental

organizations, and their related sectoral approaches.

19

19th International Congress on Nutrition(Bangkok, 5 October 2009)

The WHO Nutrition Network

Geneva (23 NHD)(4 CHP)(4 CAH)

Manila (2)

Cairo

Tashkent (1)

Dushanbe (1)

New Delhi (2)

Copenhagen (4)

Brazzaville (1)

Washington DC

Suva (1)

Hanoi (1)

Boroko (1)

Beijing (3)

Vientiane (1)

Phnom Penh (1)

Ulaanbaatar (1)

Accra (1)

Maputo (1)

Niamey (1)

Asmara (1)

Addis Abbaba (1)

Moscow (1)

Istanbul (1)

Astana (1)

Rabat (1)

Amman (1)

Beirut (1)

Teheran (1)

Damascus (1)

Islamabad

Palestine (1)

Sana'a (1)

Abu Dhabi (1)

Khartoum

Riyadh

Kuwait (1)

Doha (1)

Muscat (1)

Djibouti (1)

Manama (1)

La Paz (1)

Panama (1)

Managua (1)San Jose (1)

Brasilia (1)Santiago (1)

San Salvador (1)Santo Domingo (1)Guatemala (1)

Tegucigalpa (1)

Dili (1)

Jakarta (1)

Male (1)

Dhaka (1)

Yangon (1)

Colombo (1)

Thimphu

Kathmandu (1)

Pyongyang

Nonthaburi (1)

6 Regional Offices150 Country Offices

140 staff

19th International Congress on Nutrition(Bangkok, 5 October 2009)

The WHO-wide nutrition agenda

Communicable diseases

Child and adolescent health

Emergencies

Non-communicable diseases

Social determinants

Environment

Nutrition and

food safety

Health systems

20

19th International Congress on Nutrition(Bangkok, 5 October 2009)

1. Development and operationalization of integrated food

and nutrition policies

2. Intelligence of needs and response

3. Development of evidence based programme guidance

4. Country-level advocacy and technical assistance

Scaling up on WHO strategic priorities

19th International Congress on Nutrition(Bangkok, 5 October 2009)

Landscape Analysis Assessing Countries' Readiness to Accelerate Action in Nutrition

1. Assess existing gaps/constraints and identify

opportunities to integrate and scale up nutrition-related

actions in countries

2. Develop an "action plan" and recommendations to

guide consolidated/harmonized action

3. Establish a baseline related to current status of nutrition

and nutrition action in the high-burden countries

21

19th International Congress on Nutrition(Bangkok, 5 October 2009)

1

2

34

5

WHO Nutrition Databases

Who Database on Child Growth and Malnutrition

Who Global Data Bank on Infant and Young Child Feeding

Vitamin and Mineral Nutrition Information System

WHO Global Database on Body Mass Index

National Nutrition Policies and Programmers

1

UN Databases

UNDP

UNICEF

UN Statistics Division

UNICEF

Food and Agriculture Organization (FAO)

2

3

4

WHO Database

WHO Core Health Indicators5

Other International Data sources

World Bank

Democratic and Health Surveys (DHS)

IFPRI

Country Level Databases

Nutrition Landscape Information System

19th International Congress on Nutrition(Bangkok, 5 October 2009)

!!

!!

!

Implementation Status

Implementing

Adoptation being discussed

Not being discussed

Status unknown

Implementation WHO Child Growth Standards

22

19th International Congress on Nutrition(Bangkok, 5 October 2009)

• Evidence-based nutrition policy making

• Best practices for implementation

• Effective nutrition interventions

Nutrition Programme Guidance

Maternal and Child Nutrition

Maternal and Child Nutrition

Nutrition and

the Environment

Nutrition and

the Environment

Nutrition and Growth Surveillance

Nutrition and Growth Surveillance

MicronutrientsMicronutrients

Nutrition in Emergencies and

Humanitarian Crisis

Nutrition in Emergencies and

Humanitarian Crisis

Nutrition Care for Groups

with Special Needs

Nutrition Care for Groups

with Special Needs

Nutrition in HIV, TB and other

Communicable Diseases

Nutrition in HIV, TB and other

Communicable Diseases

Nutrition and Chronic Disease

Prevention

Nutrition and Chronic Disease

Prevention

UndernutritionUndernutrition

WHO E-Library for

Nutrition Programmes Guidance: Recommendations,

Evidence and Best Practices

WHO E-Library for

Nutrition Programmes Guidance: Recommendations,

Evidence and Best Practices

19th International Congress on Nutrition(Bangkok, 5 October 2009)

Scientific advice on nutrition

• Codex Alimentarius

• Dietary reference Values

• Dietary goals

• Food Based Dietary Guidelines

• Nutrition profiling

23

19th International Congress on Nutrition(Bangkok, 5 October 2009)

Conclusions

"I see two main areas where leadership is needed, and can make a significant difference for health.

First, we need leadership to deliver interventions for nutritional deficiencies to those in greatest need. The interventions already exist. They are cost-effective, and many bring spectacular results. Here, the need is for leadership and innovation in devising delivery systems.

Second, leadership is needed to ensure that policies governing agriculture, food production, and trade are firmly anchored in human nutritional needs and are shaped by health concerns. This is a need for political leadership."

Dr Margaret Chan

Director General

World Health Organization

19th International Congress on Nutrition(Bangkok, 5 October 2009)

Thank you.

������.