Nutrition and Health in Thailand: Trends and Action (UNSSCN, 1992, 124 P.)

Nutrition and Health in Thailand: Trends and action (UNSSCN, 1992, 124 p.) INSTITUTE OF NUTRITION MAHIDOL UNIVERSITY by Yongyout Kachondham Pattanee Winichagoon Kraisid Tontisirin Institute of Nutrition Mahidol University 1992 December UN ACC/SCN country case study supported by UNICEF United Nations Children's Fund. A case study for the XV Congress of the International Union of Nutrition Sciences, September 26 to October 1, 1993 Adelaide FOREWORD Viewing improved nutrition as an outcome of development processes expands the area of concern for policy-makers and practitioners who seek to combat malnutrition. These processes operate at different levels in society, from the individual through to the whole arena of governmental policy and indeed international relationships. The SCN, in deciding on initiating a series of country-wide reviews of nutrition-relevant actions in 1990, aimed to provide a rich base of documented experiences of why and how such actions were undertaken and what was their effect on nutrition. This country-wide approach built on the progress made at the 1989 workshop on "Managing Successful Nutrition Programmes" held at the 14th IUNS Congress in Seoul. The focus here had been on nutrition programmes, and the essential factors determining their success, and the synthesis of findings and individual case studies were later published as ACC/SCN Nutrition Policy Discussion Paper No. 8. Two other influential documents were the SCN's "Nutrition-Relevant Actions" that emerged from the 1990 workshop on nutrition policy held in London, and UNICEF's 1991 Nutrition Strategy document. Together these provided both a common analytical framework for organising the reviews and a common language for discussing the various actions that impinge on nutrition. The value of such a framework has been demonstrated by the ease with which it lends itself to analyses of both the nutrition problem and its potential solutions. The food - health - care triad of underlying causes of malnutrition, in particular, proved to be a very useful framework for orienting the inputs and subsequent discussions at the 1992 International Conference on Nutrition, co-sponsored by FAO and WHO. Communication and thus advocacy are facilitated when people share such a conceptual understanding. UNICEF had originally proposed that a series of country-wide reviews be undertaken and the results presented at the 15th IUNS Congress in September 1993. At the time of writing, preparations for the workshop are well underway - in fact, the richness of documented material has necessitated the organisation of an additional two-day satellite meeting in Adelaide. We are extremely grateful to UNICEF for their financial support throughout this exercise. The series editor for these country reviews was Stuart Gillespie, and the SCN Advisory Group on Nutrition (AGN) also technically examined the drafts as these emerged. In addition, I would like to express gratitude to the external technical reviewers, selected for their in-depth knowledge of particular countries, who provided the authors with comments and suggestions on initial drafts. The essential value of these country case studies lies in their ability to describe the dynamics involved when a national government attempts to combat malnutrition. Questions such as the role of the political economy in determining policy options, obstacles met in implementation, how programmes are modified or expanded, and how they are targeted, are all addressed. The need for actions to be sustainable to achieve results over the long-term, and the importance of both measurable objectives and a system of surveillance to monitor progress, are examples of important conclusions. These reviews thus provide valuable insights into the questions of "how", as well as "what", in terms of nutrition policy. The country reviews are intended for a wide audience including those directly concerned with nutrition in developing countries, development economists, and planners and policy makers. Along with the output of the Adelaide meeting, they will be valuable for advocacy in underscoring that effective actions will improve nutrition. It is hoped that these reviews and the proceeding of Adelaide will provide guidance for a strengthening and expansion of future actions for reducing nutritional deprivation. Dr. A. Horwitz Chairman, ACC/SCN PREFACE AND ACKNOWLEDGEMENTS As a result of the ACC/SCN-organized workshop on "Managing Successful Nutrition Programmes" at the 14th IUNS Congress in Seoul in 1989, it was decided, following a proposal by UNICEF, to conduct a series of studies on country-wide actions aimed at improving nutrition. These case studies could then be presented at the 1993 IUNS Congress in Australia. In keeping with this recommendation, this document provides a country review as to Thailand's food and nutrition situation, its trends, and the policies and programs which have been formulated and implemented in the 1980s. Thailand's achievements in health and social development, since its First National Economic Development Plan (1961) and those of its National Food and Nutrition Plans beginning in the Fourth National Economic and Social Development Plan (1977), have received worldwide acclaim. During the last decade, the nation has dramatically reduced protein-energy malnutrition (PEM), including the virtual eradication of severe PEM. Children and adults, alike, have better access to health care services, preventive and curative, during the past decade as Thailand's poverty alleviation, primary health care and quality of life approaches have reached out into even the remotest of rural villages. The nation is also self-reliant in terms of food and is a major exporter of food. Nonetheless, Thailand's food and nutrition picture is not totally bright. As in other nations, the major micronutrient deficiencies persist, though these are being tackled through innovative technologies, communication techniques, and the hard work of government officials, non-government organizations, academics and community members as partners in development. New food and nutrition challenges are also emerging as Thailand enters the industrialized world and transitions into the final phase of the epidemiological transition. The objective of this case study is to draw important conclusions as to which programs are effective in combatting and preventing malnutrition, why, and how they are best managed. The scope goes beyond "nutrition" programs per se, however. In addition to the analysis of changes in nutritional status, the study investigates the scope of indirect actions and trends in socio-economic factors (agriculture, food, industry, education and health) that have a bearing on the nutritional status of the Thai population. This review also intends to draw out important policy conclusions on what actions have worked or not worked in the context of Thailand and the principles underlying successful efforts which may be transferable for other situations. In preparing this review, we are indebted to many persons and organizations. Most significantly, we extend our deepest gratitutde to Drs. Marito Garcia and Stuart Gillespie of the ACC/SCN Secretariat who assisted in initiating this work and editing the report. Sincerest appreciation also goes to UNICEF New York and the ACC/SCN for their support for the preparation of the reviews, and UNICEF Thailand for their generous agreement to support for publication. Yongyout Kachondham, MD, MPH Pattanee Winichagoon, PhD Kraisid Tontisirin, MD, PhD Institute of Nutrition, Mahidol University, Thailand LIST OF ACRONYMS ACC/SCN Sub-Committee on Nutrition ANP Applied Nutrition Programme BMN Basic Minimum Needs DHS Thailand Demographic and Health Survey EPI Expanded Programme for Immunization FAO United Nations Food and Agriculture Organization GDP Gross Domestic Products GNP Gross National Products H/A Height for Age HFA Health For All by the Year 2000 IDD Iodine Deficiency Disorders IFPRD Institute of Food Research and Product Development IMR Infant Mortality Rate INMU The Institute of Nutrition, Mahidol University IUNS International Unions of Nutritional Sciences LBW Low Birth Weight MOPH The Ministry of Public Health, Thailand MCH Maternal and Child Health NCHS National Center for Health Statistics NESDB The National Economic and Social Development Board NESDP The National Economic and Social Development Plan NFNP National Food and Nutrition Policy NGO Non Government Organization PAP Poverty Alleviation Policy PEM Protein-Energy Malnutrition PHC Primary Health Care RDA Recommended Daily Allowance SD Standard Deviation TFR Total Fertility Rate UNICEF United Nations Children's Fund UNDP United Nations Development Program VHC Village Health Communicator VHV Village Health Volunteer W/A Weight for Age W/H Weight for Height WHO World Health Organization I. INTRODUCTION Among the most difficult problems confronting the world community throughout the history of mankind has been the problem of food shortage and diet deficits. However, there seems to be little dispute that remarkable increases in food production have been achieved in providing for the nutritional needs of all human beings over the past decades by both developing and developed countries. Yet the number of hungry people has increased due to rapid population growth and more importantly, the lack of effective food distribution and political will to solve the problem. Never before have food chains and food webs been more vulnerable to disruption. Human beings have unrelentingly manipulated

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