Tackling global nutrition challenges – a WHO perspective

1. Tackling global nutrition challenges – a WHO perspective F.Branca Director Department of Nutrition for Health and Development WHO

2. Stunting prevalence and number affected in developing countries

3. Achievement of MDG 1

4. 178 million children under 5 are stunted Prevalence of Stunting

5. 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 293 million children under 5 are anemic Source: WHO Global database on Anaemia, 2006

6. Exclusive breastfeeding rates in children <6 months are stalling Global Trend

7. Major causes of death in children under 5 with disease-specific contribution of undernutrition, 2004

8. Over 500 million adultsare obese

9. Why little progress? • Inadequate investments • Inadequate coordination among players • Inadequate coverage • Inadequate responses • Life course not addressed • Social determinants not considered

10. Implementation of the Code of Marketing Breast milk substitutes • 63 Member States reported as having Code legislation or regulations in place (65%); • 22 Member States reported as having adopted only voluntary measures (23%); • 9 Member States did not complete the questionnaire sent (12%).

11. Different policy and operational support needed FACTOR 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) Readiness Factor MCU groups (from stunting and anemia level and trend) Strong Nutrition Governance Medium/weak Nutrition Governance Strong Nutrition Governance Medium/weka Nutrition Governance MCU 1 Best for reduction of both child stunting and maternal anemia Vietnam Angola (-) Indonesia Kenya Pakistan South Africa Bangladesh India Cambodia Mozambique MCU 2 Best for reduction of child stunting, and worst for reduction of maternal anemia Egypt Peru Philippines DR Congo* (-) Ethiopia MCU 3 Worst 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 4 Worst for reduction of both child stunting and maternal anemia Burundi Cote D’Ivoire (-) Madagascar Nepal Uganda Malawi U R Tanzânia * emergency countries NOTE: countries with good coverage (>70%) of at least 4 antenatal care visits are in bold type; those with medium coverage (30-70%) are shown as underlined text; and those with low coverage (<30%) of at least 4 antenatal care visits are shown as italicised text.

12. Sharp improvements in exclusive breastfeeding rates are possible Source: UNICEF database; current EBF >25 and increase >10 percentage points; OR EBF >80%

13. A new political environment "Given the importance of nutrition to maternal, newborn and child health and other broader development programming, Ministers stressed that nutrition needs to be better integrated in development efforts. Ministers recognized that investments in nutrition could have a catalytic impact on making progress towards the Millennium Development Goals (MDGs)." G8 Development Ministers' Meeting 28 April 2010, Halifax

14. Donors' nutrition strategies • Canadian initiative on maternal and child health • US Global Health Initiative • nutrition strategies (France, UK, European Commission, Ireland).

15. Scaling up nutrition – a framework for action • focus on country level action; • scale up evidence-based cost-effective interventions to prevent and treat undernutrition, with highest priority to the minus 9 to 24 months; • take a multi-sectoral approach that includes integrating nutrition in related sectors; • provide substantially scaled up domestic and external assistance for country owned nutrition programmes and capacity; • support major efforts at the national and global levels for strengthening the evidence base through better data, monitoring and evaluation, and research.

16. Evidenced Based Direct Interventions toPrevent and Treat Undernutrition • Promoting good nutritional practices ($2.9 billion): • breastfeeding • complementary feeding for infants after the age of six months • improved hygiene practices including handwashing • Increasing intake of vitamins and minerals ($1.5 billion) • Provision of micronutrients for young children and their mothers: • periodic Vitamin A supplements • therapeutic zinc supplements for diarrhoea management • multiple micronutrient powders • de-worming drugs for children (to reduce losses of nutrients) • iron-folic acid supplements for pregnant women to prevent and treat anaemia • iodized oil capsules where iodized salt is unavailable • Provision of micronutrients through food fortification for all: • salt iodization • iron fortification of staple foods • Therapeutic feeding for malnourished children with special foods ($6.2 billion): • Prevention or treatment for moderate undernutrition • Treatment of severe undernutrition (“severe acute malnutrition”) with ready-to-use therapeutic foods (RUTF).

17. Call for action WHO is calling the attention of MSs to the need of scaling up interventions to address infant and young child nutrition and to increase the investment in nutrition through comprehensive approaches, as part of a global action plan on nutrition.

18. Draft resolution A Draft resolution (EB126.R5) on Infant and Young Child Nutrition was proposed by Peru and endorsed by the EB with minor modifications.

19. Member States commitments (1) to increase political commitment to reducing malnutrition in all its forms; (2) to strengthen and expedite the implementation of the Global Strategy for Infant and Young Child Feeding with emphasis on giving effect to the International Code of Marketing of Breast-milk Substitutes, adopted in resolution WHA34.22; (3) to develop or review current policy frameworks addressing the double burden of malnutrition and allocate adequate human and financial resources to ensure its implementation; (4) to scale up interventions to improve infant and young child nutrition, including the protection and promotion of breastfeeding and timely, safe and appropriate complementary feeding; the implementation of supplementary and therapeutic feeding interventions for severe malnutrition; and the control of vitamin and mineral deficiencies; (5) to include these strategies in comprehensive maternal and child health services and supporting to the aim of universal coverage and principles of primary health care, including strengthening health systems as outlined in WHA62.12; (6) to strengthen nutrition surveillance systems and improve use and reporting of agreed Millennium Development Goals indicators to monitor progress; (7) to implement the WHO Child Growth Standards by their full integration into child health programmes;

20. Requests to WHO (1) to strengthen the evidence base on effective and safe nutrition actions to counteract the public health effects of the double burden of malnutrition and describe good practices for successful implementation; (2) to mainstream nutrition in all WHO’s health policies and strategies and confirm the presence of essential nutrition actions in the context of the reform of primary health care; (3) to continue and strengthen collaboration with other United Nations agencies and international organizations involved in the process of ensuring improved nutrition including clear identification of leadership, division of labour and outcomes; (4) to support Member States, on request, in expanding nutritional interventions related to the double burden of malnutrition, monitoring and evaluating impact, strengthening or establishing effective nutrition surveillance systems, and implementing the WHO Child Growth Standards; (5) to develop a comprehensive implementation plan on infant and young child nutrition as a critical component of a global multisectoral nutrition framework for preliminary discussion at the Sixty-fourth World Health Assembly and for final delivery at the Sixty-fifth World Health Assembly, through the Executive Board and after broad consultation with Member States.

21. http://www.who.int/nutrition/en/index.html