Health and Nutrition Implications of Food Insecurity and Related Policies

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Health and Nutrition Implications of Food
Insecurityand Related Policies

• Marc J. Cohen
• Food Consumption and Nutrition Division, IFPRI
• Unidea Unicredit Foundation/University of
  Florence
• Summer School on Development Food Security and
  Famine Prevention
• Civita Castellana and Rome, Italy
• July 10-14, 2006

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Three Faces of Food Security

• Availability
• Adequacy of supplies
• Access
• Everyone can afford the available food or produce
  it for themselves
• Utilization
• Proper processing and storage
• Adequate knowledge of nutrition childcare
• Adequate health and sanitation services

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Causes of Child Malnutrition
Source ACC/SCN and IFPRI (2000).
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Child Malnutrition in Developing Countries

• 127 million underweight preschoolers (23)
• 148 million stunted (27)
• Consequences
• 5.6 million deaths annually
• Impaired mental and physical development for
  those who survive
• Huge losses in human potential

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Projected Change in Malnourished of Children
Under Five, 2000-05
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Asian Enigma

• Child malnutrition rising in Sub-Saharan Africa,
  declining in other developing regions
• Number (67 million) and (37) of malnourished
  children higher in South Asia than in Africa (35
  million and 25), despite better rankings on many
  indicators (economic, health, political)
• Key factor womens social status

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Nutrition Throughout the Life Cycle
Source ACC/SCN and IFPRI (2000)..
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Hidden Hunger Iron Deficiency

• Kills 100,000 mothers a year during childbirth
• Impairs mental development and learning capacity
  in childhood and adolescence
• Limits the capacity to perform physical labor

3.5 billion people in the developing world are
iron deficient
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Iodine Deficiency

• Impairs intellectual capacity at home, school,
  and work
• Causes mental retardation
• May lead to severe retardation (cretinism)

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Vitamin A Deficiency in Pre-School Children
Consequences Blindness, infections, death
Source Micronutrient Initiative and UNICEF 2005
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HIV/AIDS and Malnutrition A Vicious Circle

• Poor nutrition accelerates spread of virus
• HIV infection can lead to malnutrition, hastening
  the onset of AIDS
• Impairment of the immune system leads to
  infections, further worsening malnutrition

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A Double Burden

• A billion adults are overweight, with 300 million
  obese
• Overweight is an increasing problem among
  children in Latin America and Asia
• Undernutrition and overweight coexist in
  communities and even households
• Brazil 50 of adult men and 53 of women
  overweight
• 11 of children stunted

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Causes and Consequencesof Double Burden

• Causes
• Urbanization leads to more sedentary lifestyles
  and diets higher in fat and processed foods
• Increased consumption of energy-dense,
  nutrient-poor foods (junk food)
• Consequences
• Heart disease
• Stroke
• Cancer
• Diabetes
• Policy and public investment dilemma where to
  focus scarce public resources?

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Hunger and Crises

• Some 10 of hunger (80 million people) due to
  natural and man-made disasters
• Acute malnutrition and micronutrient deficiencies
  common among uprooted people
• Humanitarian assistance falls far short of
  amounts requested (66 in 2005)
• Darfur rations cut to 1,000 calories/person/day

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Costs of Malnutrition

• Difficult pregnancies and the illnesses that
  malnourished mothers and children experience 30
  billion per year
• Iron deficiency reduces GDP 8 a year in
  Bangladesh
• Lost productivity and income due to poor school
  performance, absenteeism, disability, early
  death hundreds of billions of U.S. dollars per
  year
• Whatever the expense of fighting malnutrition,
  doing nothing has high costs indeed

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Causes of Child Malnutrition
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Policy Responses

• Ultimate causes of malnutrition
• Poverty and inequality
• Disempowerment
• Governance failures
• Inadequate and incoherent development assistance
• Environmental degradation
• Solutions
• Poverty reduction
• Equitable and sustainable development
• Good governance
• More and better development assistance

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Constraints on Nutrition Policy in Brazil

• Inequality
• Richest 10 receive half of all earnings
• Poorest 40 receive less than 10
• Rural dwellers, urban poor, N NE Brazilians,
  indigenous people, Afro-Brazilians have less
  access to opportunity and services
• Heavy external debt burden
• 61 of foreign exchange goes to debt service
• Less than 20 of public spending benefits poor
  Brazilians

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Agricultural Growth Necessary, but not
Sufficient

• 70 of poor and hungry people live in rural
  areas and depend on agriculture for their
  livelihoods
• In Brazil
• Ag growth outstrips GDP growth
• Per capita calorie availability is
  2,800/person/day
• 21 of Brazilians lack adequate access to food
  due to poverty and unequal access to land
• 6 of preschoolers are underweight (35 in the
  northeast, and 55 of indigenous preschoolers)

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Growth Faltering by AgeThe Window of
Opportunity
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Estimated contribution of major determinants to
reductions in child malnutrition, 197095
Health environment
Food availability
19.3
26.1
Women's status
11.6
Women's education
43.0
Note Malnourished children refers to
underweight children.
Source Smith and Haddad (2000).
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An Education Gender Gap

• 55 of the 100 million unenrolled primary
  school-aged children are girls
• Adult Literacy rates
• Men Women
• Low-income
• Countries 79 73
• S.S. Africa 71 58
• S. Asia 73 44

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Tackling Hidden Hunger

• Salt iodization
• Vitamin and mineral supplements
• Integrate into maternal and child health efforts
• Food fortification
• Biofortification
• Conventional breeding
• Transgenic crops

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Breaking the HIV/AIDS-Malnutrition Link

• Better nutrition can postpone the onset of
  AIDS-related illnesses and prolong life
• Nutrition policies
• Provide incentives to improve diets
• Enhance nutrition focus of health services
• Nutritionally balanced food aid

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Policy Response toOverweight and Obesity

• WHO Global Strategy on Diet, Physical Activity
  and Health
• Voluntary codes of conduct and national
  legislation relating to marketing of
  energy-dense, nutrient-poor foods to children

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Coping with Crises

• Peacemaking and conflict resolution
• More timely response to early warning
• Climate change may increase frequency and
  intensity of natural disasters
• Need to rethink humanitarian assistance
• Replenishment of U.N. Central Emergency Response
  Fund
• Insurance approach (WFP in Ethiopia)

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Two Scenarios of Preschool Child Malnutrition in
2015
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Cost of Achieving the MDG Target

• 160 billion in additional investment in rural
  roads, education, clean water, irrigation, and
  agricultural research over 1995-2015
• Obtaining the funds is a political question
• Meeting the 0.7 of GNP aid pledge
• Low-income countries spending priorities
• 1.5 of GDP on health
• 2.3 on the military
• Challenging vested interests and concepts of
  security

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Fome Zero in Brazil

• Assuring political will
• Civil society mobilization
• Citizen Action movement
• Church food and nutrition programmes
• Food Policy Councils
• Rights-based approach
• Constitutional guarantee
• National Rapporteur
• Training of officials
• Public prosecutors intervention
• Fighting hunger is high on governments policy
  agenda

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Fome Zero, continued

• Bolsa Familiar provides income transfers to poor
  Brazilians
• 12 of government spending is on health and
  education, 3 on the military
• All schools provide meals, with priority given to
  purchases from local smallholders
• 88 of salt consumed is iodized
• All wheat and maize flour fortified with iron and
  folic acid
• Iron supplements provided to women and children
• Breastfeeding promoted