Recent presentation given in Bangkok on updated results of the UN Standing Committee on Nutrition 2010 Report on the World Nutrition Status. My research and analysis on iodine status worldwide is included
6th Report on the World Nutrition Situation<br />Roger Shrimpton and John Mason<br />Bangkok<br />10 October 2009<br />1<br />UNITED NATIONS SYSTEM<br />Standing Committee on Nutrition<br />http://www.unscn.org<br />
Content<br />Introduction<br />Regional trends<br />Maternal nutrition and the intergenerational cycle of growth failure<br />Sustainable Food Security: an overview of some key issues<br />Nutrition Governance<br />Conclusions<br />2<br />
2. Regional trends<br />Regional Trends in Malnutrition<br />Results for the UN SCN <br />6th Report on the World Nutrition Situation<br />SCN meeting, Bangkok, 10 October 2009<br />J Mason and R Shrimpton<br />Based on the work of:<br />Lisa Saldanha, BibiAl-Ebrahim, Emily Cercone, Linda Heron,<br />Katie Robinette, and AmitWadhwa<br />in the Department of International Health and Development, <br />Tulane University School of Public Health and Tropical Medicine.<br />3<br />
● ▬ ● ▬ ●<br />2000s 1990s 1980s<br />s<br />2. Regional trends<br />Changes in regional estimates of low birth weight and underweight children,1980s to 2000s, <br />showing that underweight tends to move with low birth weight towards zero prevalence; <br />the length of the lines indicates extent of improvement over the approximately 20 year period. <br />Underweight prevalences and low birth weight move together towards 0%<br />4<br />
● ▬ ●<br />2000s 1980s<br />2. Regional trends<br />Change in regional estimates of low birth weight and underweight women (unweighted estimates with available data) 1980s to 2000s, showing incidence of low birth weight tends to move with prevalence of low BMI in women.<br />Low birth weight and low BMI in women move together towards low levels of each<br />5<br />
2. Regional trends<br />Summary of numbers of countries with child underweight changes improving, none, or deteriorating, from repeated national surveys with latest result >=2000.<br />MDG rate<br />6<br />
2. Regional trends<br />Figure U2. Associations between underweight and stunting, from survey results 1990-2007, by region.<br />Stunting and underweight move together in Africa and Asia, but not in poor S. and C American countries where stunting is much higher.<br />Africa<br />Regression results for 3 regions together.<br />Stunting = 20.502 + (0.894 * uwt) – 5.495 (dummy for Asia) – 14.261 (dummy for SC Amer/Caribb) + 1.036 (interaction: dummy for SC Amer/Caribb * uwt).<br />All coefficients significant p=0.000; interaction for Asia NS when in model. N=232, adj R squ = 0.764.<br />CS Amer<br />Caribb<br />Asia<br />7<br />
2. Regional trends<br />Figure VA1. Trends in VAD (prevalence of serum retinol < 20 mcg/dl in children < 5yrs)<br />Shouldn’t these rates be faster with high coverage of VAC distribution?<br />(Do VACs affect VAD?)<br />8<br />
2. Regional trends<br />Figure An1. Trends in anemia in non-pregnant women by region<br />This seems the most intractable problem – a breakthrough is needed. <br />(Fortify rice successfully?)<br />9<br />
2. Regional trends<br />Figure I3. Predicted numbers of people (developing countries) with goitre if there were no iodized salt, compared with current estimate (with 68% iodized salt coverage).<br />An estimated 2 billion people would have goitre if there were no iodized salt, compared with an estimated<br />0.7 billion with the current coverage of about 70%.<br />10<br />
3. Maternal nutrition and the intergenerational cycle of growth failure<br />Can this be made into a virtuous cycle?<br />Figure 1 Intergenerational cycle of growth failure (ACC/SCN 1992)<br />14<br />
15<br />3. Maternal nutrition<br />YES: LBW RATES CAN BE BROUGHT DOWN SHARPLY<br /><ul><li>Birth weight can be rapidly improved, even in populations of short adult women
Not just more quantity but also improved diet quality (fortification and supplementation) can help achieve this, especially if mother reached during first half of pregnancy (+100g)
yet maternal anaemia rates are very high and little priority given to this (except PROGRESA)
No risk of increased CPD even in adolescent mothers</li></li></ul><li>16<br />3. Maternal nutrition<br />BUT NOT IN YOUNG ADOLESCENTS:<br /><ul><li>improving birth weight in adolescent mothers is best achieved by delaying pregnancy until after 18y.
For each year that median age first pregnancy can be extended beyond 15y to 20y, an additional 1cm could be added to final adult woman's height.
Yet almost half of mothers are married before 18y in LDCs
Beware: Food supplementation of the still growing primiparous pregnant adolescent decreases birth weight and increases risk of maternal obesity
75% of LIFDC have more overweight than under weight women of reproductive age</li></li></ul><li>17<br />3. Maternal nutrition<br />IMPOVING BIRTH WEIGHT LEADS TO IMPROVED ADULT HEIGHT <br /><ul><li>Birth weight strongly predicts height at two years (Binkin et al 1988)
Height at two years of age largely determines adult height (Cole 2000)
Those born LBW are 5cm shorter at adulthood (Martorell et al 1998)
Half of stunting occurs in uterus and half in first two years of life (Li et al 2003)</li></ul>The GROWTH” WINDOW OF OPPORTUNITY” IS FROM CONCEPTION TO TWO YEARS <br />
18<br />3. Maternal nutrition<br />PUT BACK THE FFF<br /><ul><li>The UNICEF child survival and development revolution focussed on keeping the child growing along the “path to health” or “child survival” promoting oral rehydration, breastfeeding and immunizations (GOBI) with great success!
The UNICEF nutrition conceptual framework focussed on child malnutrition (not maternal malnutrition)
The revolution would have been even more successful if the original GOBI-FFF had been maintained (UNICEF 1982).
Food supplements (Micronutrients) for women during pregnancy
Female education</li></li></ul><li>19<br />3. Maternal nutrition<br />Improved birth weight is a public good!<br /><ul><li>The impacts of maternal nutrition interventions typically dismissed as being “small” , i.e. only 100g
But small increase in birth weight can be magnified across the life course (e.g. 100g in birth weight is 20% reduction in stunting at two years Kusin et al 1998))
Little recognition of the distribution wide effects of improved birth weight (optimal birth weight is ~2 SD above the mean) as for example with cognitive function (Richards et al 2001)</li></li></ul><li>3. Maternal nutrition<br />Why prioritise the protection of foetal and infant growth?<br />Short term<br />Long term<br />Brain <br />development<br />Cognitive and<br />educational <br />performance<br />Nutrition<br />in uterus <br />and early <br />childhood<br />Growth and muscle mass<br />Body composition<br />Immunity<br />Work Capacity<br />Diabetes, Obesity<br />Heart Disease<br />High blood pressure<br />Cancer, stroke, <br />and ageing<br />Metabolic programming of <br />glucose, lipids, protein <br />Hormone/receptor/gene<br />Death<br />Short and long term effects of early nutrition (James et al 2000)<br />
4. Sustainable Food Security: an overview of some key issues<br />21<br />What is Sustainable Development?<br /><ul><li>When governance mechanisms ensure that the use of natural capital and the creation of physical capital occurs in ways that socially regrettable effects (negative externalities) are minimal.
For this to happen socio economic development must favour human wellbeing, through the development of human and social capital, and not just favour economic growth.</li></li></ul><li>4. Sustainable Food Security<br />22<br />MOST POPULATION GROWTH IS DEVELOPING COUNTRY AND URBAN <br /><ul><li>Although there has been great progress in reducing fertility rates globally, the LDCs are still lagging behind.
DC fertility down from 5 to less than 3, while LDCs fertility is still at 4.5.
The global population, now about 6 billion, will be close to 9 billion by 2050
Most of this population growth will be in Africa and Asia</li></li></ul><li>23<br />4. Sustainable Food Security<br />MOST POPULATION GROWTH IS IN DEVELOPING COUNTRIES AND URBAN AREAS <br /><ul><li>Today about a half of the global population lives in urban areas.
By 2050 over two thirds of global population will be urban and the majority will be living in developing countries</li></li></ul><li>24<br />4. Sustainable Food Security<br />FOOD PRODUCTION IS KEEPING PACE<br />Despite global population doubling in last thirty years the per caput supply of calories for human consumption rose by over 20%.<br />FAO predictions are that Developing Countries are expected to be increasingly well fed, closing the gap on developed countries by 2050<br />
25<br />4. Sustainable Food Security<br />FOOD PRODUCTION IS KEEPING PACE<br /><ul><li>Although appearing to plateau in early nineties food production has risen again over the last six years
In 2008 food stocks also recovered and climbed back over 500MT for first time since 2001 (FAO 2009)
Production may get over 3 billion tonnes by 2030 if sufficient R&D is applied.
But areas of population growth are not areas where food production can expand</li></li></ul><li>26<br />4. Sustainable Food Security<br />FOOD PRODUCTION IS KEEPING PACE – BUT!<br />But times have changed and “peak oil” means it is no longer cheap. At over $70 a barrel and not $30 of a decade ago, the price of oil becomes one of the main drivers of high food prices<br />It has become as profitable for farmers to grow crops for biofuel as it is to grow them for food<br />The “Green Revolution” which led to the increase in food production was achieved through the : <br /><ul><li>adoption of crop rotation,
the use of mass produced petroleum based fertilizers and chemical pesticides,
the introduction of genetically superior disease resistant cultivars</li></ul>What we need now is a “technological revolution”<br />
27<br />4. Sustainable Food Security<br />FOOD PRODUCTION AND ENVIRONMENTAL SURVIVAL <br />BUT - Several environmental trends threaten the agricultural production momentum :<br /><ul><li>Soil erosion/desertification
Top soil is being lost quicker than it is being replaced
Levels of CO2, Methane and Nitrous Oxide produced on earth are increasing. These accumulate in the atmosphere and help trap the suns energy like in a greenhouse</li></ul>Source: (UNEP GEO4 and IAASTD 2009) <br />
4. Sustainable Food Security<br />FOOD PRODUCTION AND ENVIRONMENTAL SURVIVAL<br />CH4 now about 1750 ppbv<br /><ul><li>Greenhouse Gas Emissions (GGE)
Are now at higher levels than ever before in the earths history
They are increasing at rates faster than the middle case scenario used for IPCC 2007 predictions </li></ul>CO2 now about 385 ppmv<br />(Source: IAASTD) <br />Greenhouse Gas record from the Vostok Ice Core<br /><ul><li>Greenhouse Gas Emissions (GGE)
Agriculture, and meat production in particular are largest single contributors, together contributing a third of GGE (Fiala 2009) </li></li></ul><li>4. Sustainable Food Security<br />FOOD PRODUCTION AND THE ENVIRONMENTAL SURVIVAL<br />Climate Change<br />The Stern review called for global emissions to be cut by a quarter by 2050 and to be stopped from rising above the equivalent of 550ppm of CO2.<br />The current level is 430ppm, and is rising by 2ppm a year.<br />Countries needed to spend 1% of their GDP on climate change mitigation. Failure to do this would lead to damage costing much more- at least 5% and perhaps more than 20% of global GDP<br />Source: Stern Review<br />(Source: IAASTD) <br />
4. Sustainable Food Security<br />FOOD PRODUCTION AND ENVIRONMENTAL SURVIVAL <br />THE DAMAGE IS ALREADY DONE (UNEP 2009)<br /><ul><li>Even if concrete steps were taken now to reduce climate change the damage already done means that up to 25% of the worlds food production is likely to become lost due to “environmental breakdowns” by 2050, with the populations of Asia and Africa being most affected. </li></ul>Source: IAASTD<br />40C LIKELY BY 2060 (UK Meteorological Office 2009)<br />This will mean a 2m rise in sea level by 2060<br /><ul><li>Large parts of Bangladesh and Vietnam that now grow rice will likely be under the sea.
Saigon, Mumbai, New Orleans, and Venice for example, are all likely to be submerged</li></li></ul><li>31<br />4. Sustainable Food Security<br />FOOD PRODUCTION AND ENVIRONMENTAL SURVIVAL <br />Food Supply is not well used <br />“Quantity not Quality”<br /><ul><li>The large scale industrial processing of food, on the one hand allows fortification to prevent deficiency (iodized salt), but on the other hand also contributes to the escalation of chronic degenerative diseases (high energy density, cheap foods, saturated fats, etc).
Trend towards increased meat/animal fat consumption and less vegetable consumption has negative health consequences (obesity, etc).</li></ul>“Waste not want not”<br /><ul><li> Over half of food produced globally is lost
In developing countries ~40% of harvest lost due to pests and pathogens
Globally 30 million metric tonnes of fish are discarded at sea
In Africa 30% of fish landings are lost</li></li></ul><li>32<br />4. Sustainable Food Security<br /><ul><li>Economic Threats and Opportunities</li></ul>Growth of global material wealth has been enormous in the last 2 centuries - even if very uneven<br /><ul><li>While global population increased 6x since 1800, per capita income has increased 9x (Sachs 2005)
Global economic activity increased 49x times in this period, but economic growth has been highly uneven.
Today there is 20xgap between the USA, the richest economy, and the poorest region Africa, compared to a 4x gap a century ago.
And as the figure shows the gap is widening</li></ul>Source: Ghosh J and Chandrasekhar CP. 2008. Global GDP growth: a longer view. <br />
33<br />4. Sustainable Food Security<br />Economic Threats and Opportunities<br />Recession hits global economy<br /><ul><li>World economy came to a grinding halt in second half of 2008
Global economy is expected to shrink by 1.7% in 2009.
On an annualized basis, global GDP growth slowed to 2 percent after averaging 5 percent over 2003-07.
World trade flows collapsed in the last quarter of 2008, with global exports projected to decline in 2009 for the first time since 1982. </li></ul>Source: The World Bank 2009. Global Economic Prospects: Commodities at the crossroads. Washington: The World Bank<br />But developed countries are hardest hit<br /><ul><li>GDP in rich countries is projected to contract by 3.8 percent in 2009, as against 0.9 percent growth in 2008.
Growth in developing countries is projected to slow to 1.6 percent in 2009, compared with 6.1 percent growth in 2008.
Gross domestic product (GDP) growth in developing countries is expected to slow to 2.1%, and recessions are projected in Europe and Central Asia (-2.0%), and Latin America and the Caribbean (-0.6%). </li></li></ul><li>4. Sustainable Food Security<br />Economic Threats and Opportunities<br />Poverty rates in developing countries are still expected to decline<br /><ul><li>Extremely poor increased by between 130 and 155 million from 2005 to 2008 globally
Despite these set backs the MDG 1a target is still likely to be met globally as well as in many regions</li></ul>Source: UN 2009. The Millennium Development Report 2009. New York: United Nations<br />34<br />
35<br />4. Sustainable Food Security<br />Economic Threats and Opportunities<br />Source: UNEP 1990<br />Source: . FAO 2009<br />The period of cheap food that has characterized the last two decades is evidently over. <br /><ul><li>The Food Price Index (FPI) of FAO has fallen progressively since the 1974 oil crisis. But in 2007 the FPI jumped 26% followed by another 24% increase in 2008.
Although the FPI has decreased 25% since it peaked in mid 2008, the price of food as measure by the new Global Food Consumption Price Index (GFCPI) has dropped less and is still about 50% over 2006 levels</li></li></ul><li>36<br />4. Sustainable Food Security<br />Economic Threats and Opportunities<br />The number and proportion of undernourished has increased<br /><ul><li> In the period 2007-2009 the proportion of the global population that is undernourished increased for the first time in four decades.
The surge in food prices since 2002 wiped out much of the global gains in hunger reduction achieved over the previous two decades.
About 1 billion people were undernourished in 2009, with most of these hungry people are in South Asia and sub-Saharan Africa
Many more face qualitative dietary inadequacies, with serious consequences for mothers as explained in the maternal nutrition chapter. </li></li></ul><li>37<br />4. Sustainable Food Security<br />Economic Threats and Opportunities<br />Increasing global unemployment requires the strengthening of social protection programmes in developing countries<br /><ul><li>Global unemployment rate rose to 6% in 2008 with an estimated 190 million unemployed, and this will increase furthermore in 2009; in addition some 90 million people will enter the labour market worldwide in 2009-10. (ILO 2009)
Only 20% globally have adequate social security, and 50% lack any type of protection.
In Sub-Saharan Africa and South Asia 90% lack any social security coverage
Conditional cash transfers (CCTs) programmes are increasingly seen as one of the most effective ways to spearhead the development of social protection programmes in developing countries
Furthermore CCTs can accelerate the reduction of maternal and child undernutrition and contribute to fertility reduction</li></li></ul><li>38<br />4. Sustainable Food Security<br />WHAT CAN BE DONE TO ENSURE SUSTAINABLE FOOD SECURITY?<br />The Environmental Food Crisis Report (UNEP 2009) <br /><ul><li>warns that simply ratcheting up fertilizer and pesticide led food production of the past will only undermine sustainability
Recommends a revolution in food production that can boost yields by working with rather than against nature. </li></ul>The IAASTD Report concludes that:<br /><ul><li> a fundamental shift in agricultural knowledge science and technology (AKST) is required, which give increased importance to the multifunctionality of agriculture, and recognises farming communities, farm households and farmers as producers and managers of ecosystems
This shift may call for changing the incentive systems for all actors along the value chain to internalize as many externalities as possible, and so reduce the “socially regrettables”. </li></ul>The concept of food sovereignty as proposed by “La Via Campesina” may well offer the most sure way ahead. (Rosset P 2008.)<br />
39<br />4. Sustainable Food Security<br /> WHAT CAN BE DONE TO ENSURE SUSTAINABLE FOOD SECURITY?<br />The Environmental Food Crisis Report (UNEP 2009) makes seven major recommendations: <br />Regulate food prices and provide safety nets for the impoverished, <br />Promote environmentally sustainable higher-generation biofuels that do not compete for cropland and water resources, <br />Reallocate cereals used in animal feed to human consumption by developing alternative feeds based on new technology, waste and discards, <br />Support small-scale farmers by a global fund for micro-finance in developing diversified and resilient eco-agriculture and intercropping systems, <br />Increase trade and market access by improving infrastructure, reducing trade barriers, enhancing government subsidies and safety nets, as well as reducing armed conflict and corruption, <br />Limit global warming, <br />Raise awareness of the pressures of increasing population growth and consumption patterns on ecosystems. <br />
40<br />4. Sustainable Food Security<br />WHAT CAN BE DONE TO ENSURE SUSTAINABLE FOOD SECURITY?<br />The Comprehensive Framework for Action (CFA) of the High Level Task Force on the Global Food Security Crisis, <br />The CFA covers most of these recommended actions. However the mitigation of climate change dimensions should be given much more priority and eminence. The context of a “food price crisis” is changing to one of an increasingly serious “environmental food crisis” and should include family planning and special attention to adolescents <br />As noted by the Special Rapporteur on the Right to Food, the CFA could be strengthen considerably if it used as a reference the obligation of all States and the UN agencies to contribute to the realization of the human right to adequate food. <br />Such an inclusion would allow: <br /><ul><li>consideration of the relationship between their obligations under trade agreements and the human rights obligations to respect, protect and fulfil the right the food;
the focus on smallholder farmers in response to the current crisis;
the obligation of all States to contribute to establishing an international environment which enables each State to respect, protect and fulfil the right to food. </li></li></ul><li>41<br />4. Sustainable Food Security<br />WHAT CAN BE DONE TO ENSURE SUSTAINABLE FOOD SECURITY?<br />Certainly business as usual is not an option<br />