Nutrition policies:from 1992 ICN to 2014 ICN2 Chizuru Nishida Coordinator, Nutrition Policy and Scientific Advice Department of Nutrition for Health and development WHO/HQ

1. Nutrition policies:
from 1992 ICN to 2014 ICN2
Chizuru Nishida
Coordinator, Nutrition Policy and Scientific Advice
Department of Nutrition for Health and development
WHO/HQ
PREPARATORY TECHNICAL MEETING
FAO Headquarters, Rome, Italy
13-15 November 2013

2. The ICN Preparations (1990 – 1992)
Country and Regional level:
 Designation of an official country focal
point
 Country paper --- nutrition problems,
past experience in confronting them,
plans for future action
Regional / Sub-regional
technical consultations
Draft World Declaration and Plan of action for Nutrition
Global level:
 Framework paper on Meeting the
Nutrition Challenge
 8 theme papers
 Case studies
- Topic approach
- Whole country approach
 Main background paper on
"Assessment and analysis of trends and
current problems in nutrition"

3. The International Conference on Nutrition (ICN)
Rome, 5 – 11 December 1992
A Preparatory Committee (PrepCom) held in Geneva, 18 – 24 August 1992:
 Reviewed and revised the draft of the World Declaration and Plan of
Action for Nutrition
The Conference in Rome, 5 – 11 December 1992:
 Adopted the World Declaration and Plan of action for Nutrition

4. What was pledged:
(ICN, Rome, December 1992)
To make all efforts to eliminate before the end of this decade (by 2000):
• famine and famine-related deaths
• starvation and nutritional deficiency diseases in communities affected by
natural and man-made disasters
• iodine and vitamin A deficiencies
To reduce substantially within this decade (by 2000):
• starvation and widespread chronic hunger
• undernutrition, especially among children, women and the aged
• other important micronutrient deficiencies, including iron
• diet-related communicable and noncommunicable diseases
• social and other impediments to optimal breast-feeding
• inadequate sanitation and poor hygiene, including unsafe drinking-water

5. "........ Rome was not built in a day, and our alliance to achieve nutritional
well-being will unfortunately take time to reach its objectives. However,
with this Declaration and Plan of Action, we are the architects of a new
nutrition order…... We must fulfill our responsibility , no our obligation, to
lift the burden of malnutrition, in all its forms, from the frail shoulders of
our newborn, our young children, our mothers, the coming generation, and
indeed all humanity.
... A clarion call for solidarity and concerted action has rung out ….. We
must all respond….. We have a mandate for action. Let time not escape,
for now is the time to act……."
Dr Hiroshi Nakajima, Director-General, WHO
Extract from the ICN Closing Remarks
Rome, 11 December 1992

6. Status of NPAN No. of Countries
Final/draft/preparing NPAN 139
- Final NPAN prepared 72
- Draft NPAN 26
- NPAN in preparation
(plan formulation has been hampered by various causes,
including lack of local capacity, inadequate institutional
arrangements, lack of resources or political turmoil)
41
World Declaration on Nutrition
(adopted by 1992 ICN)
"..... we (the Ministers and the Plenipotentiaries) ... affirm our determination to revise or
prepare, before the end of 1994, our national plans of action, including attainable goals and
measurable targets, based on the principles and relevant strategies in the Plan of Action for
Nutrition. We pledge to implement it."

7. ICN Plan of Action for Nutrition
Strategies and actions:
• incorporating nutritional objectives, considerations and
components into development policies and programmes;
• improving household food security;
• protecting consumers through improved food quality and safety;
• preventing and managing infectious diseases;
• promoting breast-feeding;
• caring for the socio-economically deprived and nutritionally
vulnerable;
• preventing and controlling specific micronutrient deficiencies;
• promoting appropriate diets and healthy lifestyles;
• assessing, analysing and monitoring nutrition situations.

8. Regional review meetings to evaluate the progress and experiences of countries
in developing and implementing national nutrition plans and policies
1. 1996 - 1997
2. 1999 - 2001
Key elements and obstacles in successfully developing and translating
national nutrition plans and policies into action
1. Official governmental adoption & political
support
• not just having nutrition budget line
• but specifically allocated
"governmental funds" for nutrition
• influential ministry leading the process
• having high profile advocate
2. Intersectoral coordinating mechanism
• location in the government
• specifically allocated budget for their
operation
• members from all concerned
stakeholders
3. Ability to translate plans into action
• Prioritization of activities & designation
of responsible sectors/ministries
4. Disconnect between national policy priority
and regional / provincial level policy
priority
5. Lack of human capacity in nutrition
6. Frequent turnover of staff -- Lack of
institutional memory and continuity
7. Incorporation of monitoring & evaluation
mechanism
8. Unavailability of reliable national food,
nutrition and health data
9. Continuously changing international
context of macropolicy on food and
nutrition

9. Global Nutrition Policy Review
• Questionnaire based survey conducted in 2009 – 2010
• 7 modules:
1. Overview of the nutrition policy and architecture
2. Infant and young child nutrition
3. International Code of Marketing of BMS
4. School-based programmes
5. Vitamins and minerals
6. Obesity and diet-related noncommunicable diseases
7. Food security and agriculture policies
• 123 countries responded
• Report published 2013
– Served as background paper for CIP-MIYCN
• Data available on the WHO Global Database on the Implementation of
Nutrition Action (GINA) www.who.int/nutrition/gina

10. Policy environment and main gaps
Policies
• Most countries have nutrition policies,
but they do not:
− Address challenges of the double burden of
malnutrition
− Address nutrition challenges throughout
lifecourse
− Include evidence-informed actions
comprehensively
− Address underlying and basic causes of
malnutrition
• Food security strategies seldom include
nutrition goals or actions
Coordination
• Intersectoral coordination mechanisms exist in
most countries, but they do not:
− Address existing challenges
comprehensively
− Anchor in high-level policy making
frameworks e.g. PMO
Implementation
• Most countries implement some key
interventions at national scale, but they do not:
− Implement a comprehensive set of
essential nutrition actions at scale
− Address maternal nutrition through
reaching out to girls and reproductive age
women before pregnancy
− Address adequately risk factors for obesity
and diet-related NCDs
Monitoring and evaluation
• Most countries conduct national surveys,
but they do not:
− Include relevant indicators
− Disaggregate data sufficiently to address
inequities
− Conduct surveys routinely in a timely
manner
− Use collected data for inform policy
formulation
Source : WHO, 2013. Global Nutrition Policy Review

11. Coordination mechanisms for nutrition
Sectors
• Most often involved:
Health, education, food
and agriculture
• Least often involved:
Finance
Location
• Most often in the
Ministry of Health
Source : WHO, 2013. Global Nutrition Policy Review

12. Are nutrition problems coherently addressed?
Policy content in countries with and without a double burden of malnutrition
Countries with stunting ≥20%
and women’s obesity ≥5%
Source : WHO, 2013. Global Nutrition Policy Review
Countries with stunting <20%
and/or women’s obesity <5%

13. Are nutrition problems coherently addressed?
Nutrition actions in countries with and without a double burden of malnutrition
Source : WHO, 2013. Global Nutrition Policy Review
Countries with stunting ≥20%
and women’s obesity ≥5%
Countries with stunting <20%
and/or women’s obesity <5%
Note: darker area indicates
implementation at national
scale, the lighter area indicates
implementation at subnational
scale, and the full bar
implementation at any scale
(national or subnational)

14. Obesity and diet-related NCDs
• Most often implemented and at
national scale:
– Promotional interventions, e.g.
• Food-based dietary guidelines
• Nutrition counselling in PHC
• Food labelling
• Media promotion of health
nutrition
• Fruit an vegetable promotion
• Less often implemented:
– control-demanding/legislative
interventions, e.g.
• Removal of TFA
• Price control
Source : WHO, 2013. Global Nutrition Policy Review

15. Food security and agriculture
• Policy goals
– Most common:
• Increase output and farm
incomes
• Improve quality of the
products
– Less common:
• Combating undernutrition
• Reducing obesity and diet-related
NCDs
• Promoting healthy diet
Source : WHO, 2013. Global Nutrition Policy Review