Contents Executive summary: main messages of the commission report.............................................................................. 3 Acknowledgments.................................................................................................................................................... 11 1. Recent Progress .................................................................................................................................................... 13 2. Global nutrition challenges: a life-cycle approach ............................................................................................. 18 3. Societal issues underlying malnutrition: implications for progress .................................................................. 35 4. Food, agriculture and environment: future challenges ...................................................................................... 43 5. Food, nutrition and human rights ...................................................................................................................... 55 6. Vision and goals for the future ............................................................................................................................ 57 7. Establishing a new agenda for change................................................................................................................. 62 Annex 1: The establishment and membership of the Commission...................................................................... 67 Annex 2: Existing nutrition goals which should be maintained, developed or refined ....................................... 69 Annex 3: Ending undernutrition in India by 2020 ................................................................................................ 70 Annex 4: Issues to be considered by regional and national meetings ................................................................... 74 References................................................................................................................................................................. 82 “The burden of malnutrition is completely unacceptable by any standards of human decency. We must do something right now to avoid this silent holocaust.” —World Bank Vice-President, Ismail Serageldin, 1997 Richard Jolly, Chairman of the ACC/SCN played a pivotal role in sup- porting this initiative and substantial editorial help was provided by Sonya Rabeneck and her staff in the ACC/SCN Secretariat. Detailed research for the Commission was undertaken by Karen McColl, Ann Ralph and Nina Seres. Colette Backwell and Jean James provided additional help. This report is dedicated to the late Mahbub ul Haq, The findings, interpretations and views expressed in this a member of our Commission who inspired us with his vision Report are entirely those of the Commission and do not and reminded us that too often it is the lack of intellectual imply endorsement, nor necessarily reflect official policy courage rather than the lack of wisdom which holds us back or positions of the member agencies of the United Nations from reaching up to what the future could achieve. It may ACC/SCN, its Secretariat, or the International Nutrition be reproduced without prior permission of the Commission Foundation. but please attribute to the Commission. Food and Nutrition Bulletin, vol. 21, no. 3 (supplement) © The United Nations University, 2000 United Nations University Press The United Nations University 53-70 Jingumae 5-chome, Shibuya-ku, Tokyo 150-8925, Japan Tel.: (03) 3499-2811 Fax: (03) 3406-7345 E-mail: [email protected] ISSN 0379-5721 Design and Production by Desktop Publishing & Design Co., Newton, MA USA Printed by Webcom Ltd., Toronto, ON Canada Printing costs were supported by the International Obesity TaskForce. Executive summary: main messages of the commission report To live a life without malnutrition is a fundamental human right. The persistence of malnu- trition, especially among children and mothers, in this world of plenty is immoral. Nutrition improvement anywhere in the world is not a charity but a societal, household and individual right. It is the world community’s responsibility to find effective ways and means to invest for better livelihood and to avoid future unnecessary social and economic burdens. With collective efforts at international, national and community levels, ending malnutrition is both a credible and achievable goal. Vision and goals for the future national action, often mobilised by the catalytic efforts and support of one or more of the UN agen- » The Commission proposes a new paradigm of nutri- cies and its field staff. Many of the current goals tion which incorporates the double burden of under- relate to the year 2000; work is now needed to adapt nutrition and diet-related adult disease. This double and carry forward the goals into the 21st century. burden is amplified by the link between maternal » Until now the UN has considered nutritional defi- and fetal undernutrition and a population’s sus- ciencies and “excesses” as separate. This is no longer ceptibility to adult diet-related disease. This is dis- sensible. The Commission recognises that both played when food consumption and activity patterns dietary deficiency and adult chronic disease now change during economic development. affect developing countries as well as the developed » The Commission’s vision requires an acceleration world and Central and Eastern Europe. The two sets in the development and implementation of national of disorders are fundamentally linked through poor and international strategies which will allow societies maternal nutrition. and individuals to improve their life expectancy with » Just as progress against malnutrition will require minimum health handicaps from these preventable action in many sectors, supported by professionals disorders in middle and old age. from many disciplines, so most of the main UN agen- » The International Conference on Nutrition and the cies must necessarily have a role in reducing malnu- World Food Summit embodied remarkable global trition on a global scale. A strengthened mechanism plans of action with new approaches to combating is needed at UN level to ensure that its agencies can undernutrition. Why has more not been achieved? combine their best efforts. Table 1 summarises the The Commission identified several factors: recommendations of the Commission. 1. lack of a locus within many countries for highly motivated academics and NGOs to interact with political leaders and decision makers and drive Recent progress and setbacks forward the nutrition agenda; 2. frequent failure of health and agricultural sectors to » Over the last nine years, major international com- combine forces to ensure coherent plans of action; mitments have been made to reduce undernutrition. 3. within-country rivalries: these are often ampli- These were articulated at the World Summit for fied by the selective support of specific national Children in 1990, the International Conference for programmes by NGOs, bilateral agencies and UN Nutrition in 1992, and the World Food Summit in organisations; 1996. These Conferences emphasized the reduction 4. the failure of some major financial institutions to of undernutrition as part of a broader strategy to follow the World Bank initiatives which require eliminate poverty. Each Conference also emphasized intersectoral measures to improve food security the vital role of the UN family, and goals were seen and human health when developing plans for as a focus for collaboration among the agencies and economic reform and development; organisations involved in mobilizing and monitor- 5. failure of political leadership in many countries to ing implementation. realise the possibilities of making rapid improve- » Dramatic progress has been made in some areas ments by prioritizing nutrition when allocating of nutrition in recent years, especially in reducing national resources. iodine deficiency disorders and clinical vitamin » The practical value and impact of existing goals has A deficiency. Also, over the past two decades the already been shown. The main need is for strong proportion of underweight and stunted preschool Food and Nutrition Bulletin, vol. 21, no. 3, Supplement © 2000, The United Nations University. 3 Table 1: Summary of Specific Recommendations for ACC/SCN agencies 4 Recommendations For Action Action is Needed to at the International Level at the Regional Level at the National Level at the Local Level Ensure an New UN process for integrating pro- Set up regional task forces involving Establish new mechanisms, such as Creation of state or village integrated grammes and effort is needed. UN agencies, NGOs, bilateral National Nutrition Councils, for: level Boards to ensure approach UN Agencies, particularly WHO, FAO, agencies and national Governments. • developing coherent an integrated approach UNICEF and the World Bank, should Have regional meetings to reconsider nutrition policies with full community jointly consider how to strenghen the SCN. nutrition goals and set strategies. • ensuring an integrated involvement. The UNU and the IUNS should promote approach the lessons learned by previous attempts • raising nutrition as a priority. attemptsto develop National Nutrition • widening the agenda for Councils. nutrition. The SCN should promote new A new impetus for UN support National Nutrition Councils as the at the country level is required. focus for international liaison. Review and An overall