1. How to work multisectorally at country level : nutrition
WHO – Lausanne University
Seminar on Non Communicable Diseases
Geneve, 9 May 2012
How to work multisectorally at country level : nutrition
Early nutrition can determine the risk to develop chronic diseases later in life.
Protection of optimal health and promotion of optimal function has therefore to be initiated since conception.
F.Branca
Director, Department of Nutrition
for Health and Development
WHO
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2. The multifaceted challenge of malnutrition

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3. 171 million children under 5
are stunted (in 2010)
Prevalence of Stunting
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4. 500 million obese individuals aged 20+ years (2008)
Source: Global status report on noncommunicable diseases World Health Organization 2011
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5. Stunting prevalence and number affected in developing countries50
48.6 50
100
150
200
190
40.3
39.3 40
38.2
37.7
138 30
Number of stunted (millions)
27.6
Stunting (%)
23.7
100 20
18.1 60
13.5 45 51 10
In developing countries, stunting remains the biggest problem (29%) with relative decrease of 20% per ten-year period, followed by wasting which shows a persistent rate around 10% for the last 20 years
In Africa, stunting stagnated at ~ 40% which translates into increasing numbers of stunted children (from 45 million in 1990 to 60 million in 2010)
Asia, in contrast, with a prevalence of 28%, nearly halved the number of stunted children over the last 20 years from 190 million (1990) to 100 million (2010) 13 10 7
1990
2000
2010
1990
2000
2010
AFRICA
ASIA
LATIN AMERICA
Source: Department of Nutrition, World Health Organization
WHO – Lausanne University
Seminar on NCD Geneva,

6. Overweight prevalence and number affected in developing countries2 4 6 8 10 5 10 15 20
8.5 18
6.8
6.9
6.8 14 13 13
5.7
Number of overweight (millions)
Overweight (%)
4.9 4
3.7 7
3.2 4 4 4 4
43 million children worldwide
Globally, overweight increased from 4% to 7%, with highest rates in developed countries (12%) followed by Africa (9%) and Latin America (7%)
1990
2000
2010
1990
2000
2010
AFRICA
ASIA
LATIN AMERICA
Source: Department of Nutrition, World Health Organization
WHO – Lausanne University
Seminar on NCD Geneva,

7. Children's overweight increasing more rapidly in LMI countries
We are aware of the global epidemic of obesity, but we are now witnessing a much more rapid increase in countries of Low and Middle Income.
This slide shows the change in the prevalence of overweight in children under 5. Countries have been grouped by income, according to the World Bank classification.
IN LMIC countries the prevalence has doubled between 1990 and 2010 and is further increasing at the level of UMIC, that include many countries in the Middle East
The prevalence is now higher in LMI countries than in High Income countries
Source : WHO
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8. The double burden of malnutrition
Source: WHO Global Database on Child Growth and Malnutrition
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9. 293 million children under 5
are anemic
Category of public health significance
(anaemia prevalence)
Normal (<5.0%)
Mild ( %)
Moderate ( %)
Severe (≥40.0%)
No Data
Source: WHO Global database on Anaemia, 2006
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10. WHO – Lausanne University
A LBW baby is also likely to be exposed to further environmental stressors after birth, trapping him in a cycle of malnutrition that spills over into the next generation.
United Nations Subcommittee on Nutrition Fourth Report on the World Nutrition Situation, 2000
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11. Changes in food systems
Source : FAO, 2004
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12. Interventions and strategies

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13. Infant and Young Child Feeding
Protection, promotion and support of appropriate IYCF
Exclusive breast feeding for 6 months
Complementary feeding (need strengthening and support for use of local foods, food fortification, micronutrient supplementation)
Feeding of IYC in difficult circumstances (HIV, malnutrition, emergencies, LBW)
Health services
Baby Friendly Hospital Initiative
Pre-service education and in-service training
Maternity protection
Code of marketing of breastmilk substitutes
Monitoring and evaluation
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14. Global Strategy on Diet, Physical Activity and Health (2004)
Reducing trans fatty acids and salt
Restricting availability of energy dense foods and high calorie non-alcoholic beverages
Increasing availability of healthier foods including fruits and vegetables
Practice of responsible marketing to reduce impact of unhealthy foods to children
Making healthy options available and affordable
Providing simple, clear and consistent food labels that are consumer friendly
Reshaping industry to introduce new products with better nutritional value
Making physical activity accessible in all settings
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15. WHO – Lausanne University
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16. Global nutrition targets
40% reduction of childhood stunting by 2025
50% reduction of anemia in women of reproductive age by 2025
30% reduction of Low Birth Weight by 2025
0% increase in childhood overweight by 2025
Increase exclusive breastfeeding rates in the first 6 months up to 50% by 2025
Reducing and maintaining childhood wasting to less than 5% by 2025
World Nutrition Rio2012

17. Outline of comprehensive implementation plan
ACTION 1 : To create a supportive environment for the implementation of comprehensive food and nutrition policies
ACTION 2 : To adopt efficient strategies and include all required effective health interventions with an impact on nutrition in plans for scaling up
ACTION 3: To stimulate the implementation of non health interventions with an impact on nutrition
ACTION 4 : To provide adequate human and financial resources for the implementation of health interventions with an impact on nutrition
ACTION 5 : To monitor and evaluate the implementation of policies and programmes
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18. Non-health interventions with an impact on nutrition
Agriculture and food production
Micronutrient fortification of staple foods
Micronutrient fortification of complementary foods
Salt iodization
Water fluoridation
Interventions to improve food security at household level
Interventions to improve the nutritional quality of foods (reduction of salt, fat and sugar content,elimination of trans-fatty acids)
Trade
Taxation and application of  price policies
Enacting legislation on marketing of foods and non-alcoholic beverages to children
Provision of food in public institutions
Nutritional labelling of food
Social protection
Conditional and unconditional cash transfers
Food aid
Education
Women's primary and secondary education
Improvement of diet and physical activity in schools
Labour
Support to lactating working women (through adopting and enforcing the ILO Maternity Protection Convention, 2000 (No. 183) and Recommendation (No. 191)
Information
Conducting social marketing campaigns
Labelling of food products
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19. The European Food And Nutrition Action Plan
ACTION AREAS
Supporting a healthy start
Ensuring safe, healthy and
sustainable food supply
Providing comprehensive
information and education
to consumers
Implementing integrated actions
Strengthening nutrition and
food safety in the health sector
Monitoring and evaluation
HEALTH CHALLENGES
Diet related noncommunicable diseases
Obesity in children
and adolescents
Micronutrient deficiencies
Foodborne diseases
The Action Plan aims to tackle four main health challenges :
Diet related noncommunicable diseases
Obesity in children and adolescents
Micronutrient deficiencies
Foodborne diseases
And recommends to do it through a series of priority actions
6 action areas are envisaged
1) Supporting a healthy start – dealing with infant and young child nutrition
2) Ensuring safe, healthy and sustainable food supply
3) Providing comprehensive information and education to consumers
4) Implementing integrated actions – promotion of physical activity, control alcohol, ensure safe water supply
5) Strengthening nutrition and food safety in the health sector
6) Monitoring and evaluation
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20. Country strategies and plans

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21. Global Review of food and nutrition policies
Questionnaire circulated to 193 WHO Member States
117 respondents (Ministry of Health)
Additional sources for data validation and integration
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22. Components of food and nutrition policies
EMR
SEAR 50 52 5 62 46 35 79 55 66 51 57 18 65 67 47 43 3 31 22 24 1 32 28 75 10 20 30 40 60 70 80 90
AFR
AMR
EUR
WPR %
Underweight
Overweight
IYCN
Vitamins and Minerals
All four areas
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23. WHO – Lausanne University
Nutrition governance 7 17 4 15 66 45 73 92 55 63 14 9 8 25 2 10 20 30 40 50 60 70 80 90
100
AFR
AMR
EMR
EUR
SEAR
WPR %
President or Prime Ministers Office
Ministry of Health
Ministry of Agriculture
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24. What is limiting progress?
Choice of interventions
Comprehensiveness
Coverage and quality
Policy coherence
Population awareness
Targeting
Level of investments
Coordination for delivering interventions
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25. What is there for each actor ? (1) Government
Agricultural sector : primary production, food processing, distribution and retail is mindful of health objectives
Consumer protection : adequate information is provided to consumers.
Education : schools orient food preferences and consumption towards healthy goals
Urban planning : enhance access to healthy and safe food
Labour : adequate parental leave, breastfeeding breaks and flexibility to support working women during lactation
Social policy : social benefits to improve the food security of vulnerable population groups
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26. What is there for each actor ? (2) non government
Advocacy NGOs and consumers’ organizations : monitor the implementation of commitments from the public sector and the private sector
Food operators : improve the availability of healthy foods including fruits and vegetables, products with lower levels of saturated fats, added sugars and salt
Media : support awareness raising campaigns about nutrition and food safety
Advertisers and marketers : comply with recommendations about the marketing of food and non-alcoholic beverages to children.
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27. Slovenia : health in all policies (FNAP 2005-10)
CAP Fruit School Scheme (2009/10) : 75 % participating primary schools, involving agriculture, education and health sector.
Education sector : School nutrition programs. In all children 1-18 eat up to four cooked meals per day in the public education institutions. Up to one third of meals are distributed for free and the rest of them are subsidized by the state budget.
Finance : differentiation in taxation of different types of foods
Culture : reducing marketing pressure to children
Social affairs : nutrition for undeprivileged population groups.
Activities with private sector (with public health leadership) : reformulation of food products,
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28. Western Pacific – legislative action
Taxation on beverages (American Samoa, Fiji)
Taxation on foods (Fiji. PNG, Samoa, Solomon Islands)
Taxation on foods and drinks for the establishment of a prevention fund (French Polinesia)
Import laws (Cook Islands, Micronesia, Fiji)
Restrictions on the use of ingredients with little nutritonal value (Fiji)
Controls on advertising (Fiji)
Source : Clarke & Mc Kenzie, WHO, 2007
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29. WHO – Lausanne University
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