Draft Global Nutrition Policy Review: 20 December 2010

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A Review of Nutrition Policies

Draft report 20 December 2010

The review is based on a comprehensive survey questionnaire sent to WHO Member States in July 2009 and the responses received up to November 2010 were included in the analysis. The responses were provided by the total of 119 countries and four territories, covering 81% of the world population. Peer-review was undertaken during October - November 2010 by external experts as well as by the representatives of concerned WHO Departments and Regional Offices. Thirteen detailed peer-review comments were received. When preparing this revised draft, some of these peer-review comments were taken into consideration. It should be noted, however, that many of the comments have not yet been addressed in this draft and these are currently being undertaken with a view to prepare a final draft after the open call for comments for the preparation of the 128th Session of the Executive Board in January 2011.

Draft Global Nutrition Policy Review: 20 December 2010

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Table of contents Acronyms ................................................................................................................................................. 7 Glossary .................................................................................................................................................... 9 1. Introduction....................................................................................................................................... 12 2. Current health and nutrition challenges......................................................................................... 14

2.1. Malnutrition in all its forms ...................................................................................................... 16 2.1.1. Stunting, underweight, overweight and acute malnutrition in children .............. 16 2.1.2. Overweight in adults ........................................................................................ 23 2.1.3. Vitamin and mineral nutrition .......................................................................... 24

2.2. Infant and young child feeding................................................................................................. 31 2.3. Dietary energy consumption..................................................................................................... 35

3. The evolving nature of nutrition challenges ................................................................................. 37

3.1 What are the key challenges and how to conceptualise them? ............................................. 37 3.1.1 Immediate, underlying and basic (upstream) causes........................................... 37 3.1.2 Social determinants of vulnerability ................................................................... 38 3.1.3. Lifecourse ........................................................................................................ 40

3.2 Factors affecting food and nutrition insecurity: climate change and the food price crisis42 4. Evolving global and regional macropolicy context on nutrition................................................ 44

4.1 Complexity of Global Food and Nutrition Issues.................................................................. 44 4.2 Changing global nutrition policy and strategy framework..................................................... 47 4.3 Regional plans of action ............................................................................................................. 54

4.3.1 Draft nutrition strategy and plan of action for countries of the Eastern Mediterranean region. 20102019.................................................................. 54

4.3.2 WHO European action plan for food and nutrition policy 2007-2012............... 55 4.3.3 African Regional Nutritional Strategy: 2005-2015.............................................. 56

Case Study 4.1. We are what we eat: communicating for political consensus and improved food security in the Pacific .......................................................................................59 Case study 4.2 Pan American Alliance for Nutrition and Development ............................61

5. Policy analysis .................................................................................................................................... 62 5.1. Methodology of the review........................................................................................................... 62

5.2. National policy and institutional environment....................................................................... 65

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5.3. Review of policies in topic areas .............................................................................................. 74 5.3.1. Maternal, Infant and Young Child Nutrition .................................................... 74

Case Study 5.3.1.1. Promotion of Breastfeeding and BFHI in Malaysia.............................81 Case study 5.3.1.2. Baby-friendly in New Zealand .................................................................82 Case study 5.3.1.3. The Philippines IYCF National Programme .........................................82 Case Study 5.3.1.4. Breastfeeding in a Globalized World: A Public Health Success Story.........................................................................................................................................................84 Case study 5.3.1.5. Reductions in Stunting and Inequalities in Stunting in Brazil.............85 Case study 5.3.1.6. Kuwait Nutrition Surveillance System [KNSS] .....................................86

5.3.2 International Code of Marketing of Breast-milk Substitutes .............................. 88 5.3.3. School-based programmes ............................................................................... 95 5.3.4. Vitamins and minerals ...................................................................................... 97 5.3.4. Vitamins and minerals ...................................................................................... 97

Case study 5.3.4.1. Combating iodine deficiency disorders- The success story from Nigeria......................................................................................................................................... 102 Case study 5.3.4.2. Wheat Flour Fortification in Jordan..................................................... 104 Case study 5.3.4.3. The Yen Bai story: a public health approach to reducing anaemia and improving womens health in Viet Nam ............................................................................... 105

5.3.5 Obesity and diet related chronic disease prevention......................................................... 107 Case Study 5.3.5.1. Developments in Food, Nutrition and Nutrition Status in Slovenia...................................................................................................................................................... 109 Case study 5.3.5.2. Nutrition Policy in France- effect on Obesity .................................... 111

5.3.6. Food security and agriculture ......................................................................... 112 5.4. Analysis of the nutrition policy cycle..................................................................................... 113

5.4.1 Stunting .......................................................................................................... 115 5.4.2 Maternal undernutrition and low-birth-weight................................................. 118 5.4.3 Overweight and obesity................................................................................... 121 5.4.4 Double burden of malnutrition ....................................................................... 124 5.4.5 Implementation of key maternal, infant and young child nutrition interventions

.................................................................................................................... 128 5.5. Summary of findings ................................................................................................................ 130

6. Conclusions: identifying the gaps ................................................................................................. 136 6.1. Nutrition challenges remain high .............................................................................................. 136

6.2. Nutrition policy has made progress in the last 20 years ..................................................... 136 6.3. Policies inadequate or not implemented .............................................................................. 136 6.4. A summary of policy gaps....................................................................................................... 138

References ............................................................................................................................................ 141

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List of Tables

Table 2.1.1.1. Trends1 in the prevalence of underweight by UN regions (below -2 SD weight-for-age) with 95% confidence intervals in children 0-5 years, by UN regions and sub-regions, 1990-2010 18

Table 2.1.1.2. Trends1 in the prevalence of stunting (below -2 SD height-for-age) with 95% confidence intervals in children 0-5 years, by UN regions and sub-regions, 1990-2010 19

Table 2.1.1.3. Trends1 in the prevalence of overweight (above +2 SD weight-for-heig