1. How can we deal with malnutrition in food assistance programs? USDA & USAID International Food Aid Conference April 14-16, 2008 Martin Bloem Chief, Nutrition Service World Food Programme

2. Rice and food through the eyes of food policy and nutrition Food Rice Food Policy Nutrition Employment Income Food availability Political stability International trade Grain/ cereals Rice Food fortification Micronutrients Malnutrition Diversified diet Plant/animal foods Intrahousehold distribution

3. Rice and food through the eyes of food policy and nutrition Food Rice Food Policy Nutrition Employment Income Food availability Political stability International trade Grain/ cereals Rice Food Staple Food fortification Micronutrients Malnutrition Balanced diet Plant/animal foods Intrahousehold distribution

10. Insufficient Health Services & Unhealthy Environment undernutrition Disease Inadequate Dietary Intake Inadequate Care for Mothers and Children Inadequate Education Resources & Control Human, Economic & Organizational Potential Resources Political and Ideological Superstructure Economic Structure Underlying Causes Immediate Causes Basic Causes Manifestation Multilateral Institutions Development Banks IMF Bilateral Institutions Private Sector Inadequate Access to Food

11. The conceptual framework for underlying causes of malnutrition Malnutrition FoodCareHealth

12. The conceptual framework for malnutrition in practice? Malnutrition Food Care Health

13. Im one of the few nutritionists who believes in the revolutionary idea that lack of food is a cause of malnutrition -Michael Golden, at the SCN meeting, 2007

14. Green Revolution What is the role of the production of staple food (energy) on malnutrition

15. Malnutrition rates and Rice prices Torlesse, Kiess and Bloem J. Nutr. 133:1320-1325, May 2003

16. Rice consumption and rice prices Torlesse, Kiess and Bloem J. Nutr. 133:1320-1325, May 2003

17. Choices and economic status Very, very poor Less poor Not poor Moderate poor Very poor Rice Rice and vegs Rice Rice and vegsRice and eggs Rice and vegsRice and eggsRice and meat RiceRice and vegsRice, vegs, and eggsRice, vegs, eggs, meat

18. Non-rice food expenditure and malnutrition Torlesse, Kiess and Bloem J. Nutr. 133:1320-1325, May 2003

20. Food Diversity and malnutrition Klotz et al. (in prep)

21. Intake of animal products and malnutrition Klotz et al. (in prep)

22. Daily cost of a diet and income (SCF UK) The research, carried out in four locations in Bangladesh, Ethiopia, Myanmar and Tanzania, showed that between 15 (in Ethiopia) and 79 (in Bangladesh) per cent of households simply couldn't afford to feed their children a healthy diet. The comparative cost of the diet compared with the equivalent average weekly earnings in the UK, –Bangladesh 2429 a week –Ethiopia 967 a week –Myanmar 834 a week –Tanzania 847 a week

23. Lessons learned Poverty is one of the key determinants of malnutrition Poor people have limited access to micronutrient rich foods (non-grain component of total food expenditure).

24. Nutrition and Emergencies Saving Lives: –Micronutrients (vitamin A, zinc, iron, etc) Prevention and Treatment of Malnutrition –Complementary Foods –Ready to use supplementary food products –Ready to use therapeutic food products

25. Micronutrient powders (sprinkles) 1996: Dr. Stanley Zlotkin begins conceptual development of Sprinkles in response to a global initiative to control childhood anemia;

26. Tsunami December 2004

28. Joint Statement WHO/UNICEF/WFP: Preventing and controlling micronutrient deficiencies in populations affected by an emergency

29. Obstacles Formulation –Malaria-endemic areas –Family, Child –Iron component Production –Packaging Family, child Shelf life Print Educational material –Formative research –acceptability

30. Development of ready to use therapeutic foods

31. Management of severe acute malnutrition in children

32. WHO/UNICEF/SCN Consultation

33. Joint Statement WHO/UNICEF/WFP: Community- based management of severe malnutrition

34. How do we make WFPs programs more effective?

35. 2007 2010 - 2012 20% WFP FOOD FORTIFIED 100%+ MICRONUTRIENT NEEDS MET FORTIFICATION COMPLEMENTARY FOODS SPRINKLES Corn Soy Blend General Food Basket Cereals, Pulses, Legumes, Vegetable Oil, Salt, CSB Nutrition Strategy FEEDING BETTER FOOD… DSM is playing a critical strategic role in enabling WFP to launch the strategy at the global level. + micronutrients

36. Role of the private sector

38. Effective programs There is need for the –Use of the right food and food products which have proven to be effective in saving lives, and preventing and reducing malnutrition –Understanding of the different cultural and ecological settings of regions, countries and communities where we work –A long-term vision behind emergency responses to make these programs part of sustainable solutions both at local and global level.

39. Paul Farmer "We've proven that people in poor settings with very complex diseases can be treated and cured," "We've had some victories," "But if I were truly influential, everyone in the world would have the right to healthcare, food, clean water, other basics. That's the goal."

40. March 2003 Source: Farmer, 2003

41. September 2003, six months later Source: Farmer, 2003