Dramatic changes are taking place within the nutrition community. New scientific evidence on the generational and intergenerational links between nutritional status at different stages of the life cycle is compelling. Undernourished adolescent girls and women give birth to underweight and often stunted babies. These infants are less able to learn as young children and are more likely themselves to be parents to infants with intra-uterine growth retardation and low birthweight. Moreover they are less able to generate livelihoods and are less well equipped to resist chronic disease in later life. Such life-cycle and intergenerational links demand sustained, long-term ameliorative action. In this regard, the emergence of the human rights paradigm provides powerful guidance in the formulation of appropriate policies and programmes.
Dramatic changes are also taking place in the world as we enter a new millennium. The ease with which resources - people, assets, goods, and information - can move within and across national boundaries increased dramatically in the 1990s. This globalization poses tremendous challenges for the nutrition community. It also provides tremendous opportunities for securing increased resources to reduce malnutrition.
The structure and content of the Fourth Report reflects these two sets of changes. All the subjects covered by the Third Report (1997) remain in the Fourth Report. New to this report are the life-cycle perspective on human nutrition and the challenges and opportunities presented by the global forces that are shaping all our lives.
Chapter 1 describes the state of nutrition in the developing world. This function remains the essence of the World Nutrition Situation Report. Prevalences and numbers of young child underweight, Stunting, and wasting are presented with regional and sub-regional breakdowns. What is new is the addition of data from different stages in the life cycle - not just for children under five. Descriptions of foetal, school age, adolescent, adult, and elderly nutritional status are included. The reader will, however, note the paucity of high-quality data on nutritional status for many of these groups. In general we present the available data with appropriate caveats about their overall reliability, but clearly this lack of comprehensive data is a major challenge to the nutrition community and the UN family.
Chapter 2 on micronutrients provides an update of progress in this area during 1998 and 1999. It describes advances in our understanding of the nature, causes, and consequences of various micronutrient deficiencies along with actions taken to combat them. While some new data are presented, there remains a great need for nationally representative data on the prevalence and trends in micronutrient deficiencies to inform and improve policy and programme decisions. Lessons learned, both in operational research and in the implementation of control strategies, need to continue to be documented and disseminated.
In Chapter 3, data on breastfeeding and complementary feeding are highlighted for the first time in an ACC/SCN World Nutrition Situation Report. While the nutrition community has understood the benefits of both for some time, this report - which focuses on the life cycle - highlights the importance of infant feeding practices as a predictor of human health into adulthood. Evidence suggests that both breastfeeding and appropriate complementary feeding lead to improved outcomes, but in a world plagued by HIV and increasing urbanization, new sets of challenges have risen for local, national, and international members of the nutrition community. While some of these challenges are being met, others represent growing threats.
Chapter 4 on nutrition and human development highlights the relevance of nutrition for the overall development process. The first part of the chapter focuses on the implications for development of recent findings in international nutrition. First, some recent evidence is presented on the strong links between infant undernutrition and cognitive development. Second, the policy implications of the emerging link between foetal undernutrition and adult chronic disease for nutrition policy are drawn out. Third, the importance of community empowerment to the overall development process is discussed, as is the ability of community-based nutrition initiatives to empower communities beyond immediate nutrition concerns.
The second part of Chapter 4 focuses on how some of the broad changes taking place on the global stage are affecting nutrition. First, the implications of the Asian financial crisis for the design of social safety nets are discussed in the context of an Indonesian case study. Second, the implications of the increased ease with which food can be traded are discussed, together with the need for clear and enforceable food safety standards for the protection of food producers and consumers. Third, the challenges and opportunities presented to the nutrition community by the explosion in information and communications technology are considered. Fourth, the current rapid rate of urbanization poses new challenges to the nutrition community, for urban areas will challenge the preconceived notions of many in the nutrition community about what works and what does not. The last part of this section of the chapter provides an update on the spread of HIV/AIDS and the implications for the nutrition community. It is no coincidence that the region with 89% of all cases of HIV/AIDS - Sub-Saharan Africa - is also the only region in which the rate of undernutrition is worsening.
Finally, the chapter doses with a description of how the human rights paradigm has emerged as a potentially powerful way of analyzing and practicing development, particularly in the last 15 years. The success of the human rights - based approaches in accelerating reductions in malnutrition will depend on the perceived value added they bring to communities and to the nutrition professionals working with those communities. It is clear from the Fourth Report that while progress is being made in reducing malnutrition, much remains to be done. The challenge for all readers of this document is to capitalize on the potential of the powerful rights-based paradigm and to use it, along with all the other resources at our disposal, to rapidly diminish the scourge of malnutrition.
Chapter 5 is concerned with the nutrition of refugees and displaced populations. This final chapter provides an overview of the trends and developments in the humanitarian nutritional response to displacement emergencies, drawing on recent examples to highlight the problems encountered. The first section of the chapter describes the international humanitarian structures and systems involved in nutritional emergencies and their coordination. This is followed by a consideration of recent developments in assessment and early warning methodologies. The third section describes trends in food and nutrition programmes in emergency situations, including strategies to support food security, care, and the transition to self-reliance and to prevent micronutrient deficiencies. Six case studies of current displacement emergencies are then presented to illustrate the wide range of prevalences of undernutrition in displacement emergencies and response to these crises. The case studies include Angola, the Balkans region, southern Sudan, and the United Republic of Tanzania.
The chapter concludes by identifying emerging issues (policy, operational, and research) relevant to the nutrition of refugees and displaced populations. The importance of a broad problem-solving approach to assessing and responding to nutritional problems in emergencies is emphasized.
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