Working Group on Nutrition Throughout the Life Cycle
held during the SCN's 33rd Session, 16 March 2006, Geneva
Co-Chairs: Ricardo Uauy (UNU/LSHTM, UK/INTA, Chile) and Ted Greiner (PATH)
Documentation and presentations:
Final Report
The dual nature of this session including both the biosocial aspects as well
as the human rights dimension was introduced. Participants were informed that
they would be asked to comment on two draft position papers that the Working
Group would consider submitting for consideration to the SCN as a whole.
Participants in the session exceeded 120, there were no empty seats for most of
the session.
1. Comments on the definitions proposal “Malnutrition in all its forms”.
The group endorsed the concept of developing definitions that met the twin
objectives of being effective in communications to the public as well as to
policy makers, while at the same time being supportive of a common
implementation strategy.
Discussion on the definitions paper:
Several felt that wasting should not be excluded and disagreed that it was
adequately subsumed under the term “underweight”, especially in emergency
settings. The need to include wasting and acute malnutrition, especially within
the context of emergencies and child survival was highlighted. The group
endorsed this position
A question was raised as to whether low birthweight should be mentioned.
Ricardo Uauy responded that it was equally complex as anthropometry in others
and thus should be subsumed within the “underweight” term to enhance simplicity.
The group position was that this be considered under the umbrella of
malnutrition in all its forms but as a separate category.
George Kent called for linkages to other definitions that includes the right
to food and the full functional consequences of malnutrition for example that
formula fed infants are not equally well nourished than breast fed infants even
if they have achieved similar anthropometric measures. Others reinforced that
nutritional indicators should not be based on anthropometry alone but also
include function. Limitations of unknown age were raised, especially in young
children. The option of MUAC was brought up as an effective alternative in
children less than 6 years of age.
Florence Egal asked for a breakdown of anthropometric data by livelihood.
(This was considered as a specific issue within the malnutrition but not needed
in the definition).
Food adequacy has to refer to both quality and quantity
Riboflavin deficiency is common in non-milk drinking populations
2. Comments on Malnutrition as a key component in child survival. The
presenters highlighted that
- Five out of the 11 million deaths of children under 6 are related
to Malnutrition. Severe acute malnutrition by itself leads to 1.5 million
deaths per year
- New modalities for community based and institutional based
treatment have been evaluated and proven cost effective in medium and large
scales trials. This has been recognized in the Copenhagen consensus and in the
work of the Bellagio Group on Child Survival.
- WHO has established a firm technical consensus for the
complementarity of the community and hospital based management of severe
malnutrition. A report on this topic will be released shortly SCN/WHO/UNICEF
Oct 05 Consultation on addressing severe malnutrition in community and health
services. Both models were presented based on the experience of Bangladesh and
South Africa.
- Some of the barriers in up scaling these interventions were
examined. These include the limited capacity of health professionals to apply
updated knowledge in this subject, and monitor and evaluate the results of
their actions. Additionally the brain drain is harming ability to disseminate
and maintain capacity in the field; the best human resources are drawn into
international service without contributing to their replacement.
- The establishment of an International Malnutrition Task Force was
presented, this is intended to serve a human resources development effort for
cost effective treatment and control of Malnutrition in support of enhancing
Child Survival efforts to meet the MDGs. The Task force has received initial
support of IUNS, (International Union of Nutritional Sciences); IPA
(International Pediatric Association), WHO and UNICEF. The effort is grounded
on a network of regional centers that includes (ICDDRb, Bangladesh for Asia, U
of Western Cape for Southern Africa, U of San Andres Bolivia for South
America).Other centers will be included as the program develops. The Task
force will work closely with UNICEF and WHO to upscale this effort based on
the needs of specific countries that have access to resources for this to
occur.
Several members in the group highlighted the fact that the politics of child
survival were being ignored in the Lancet series and in other fora? Human rights
was not addressed in the original Lancet series but was addressed in another
article called Beyond Bellagio in Arch Dis Child. Material on this issue was
offered and will be placed on the WG website for consideration of the members.
The Minister of Health of Bolivia Dr. Nila Heredia commented that the
Government’s decision to launch the Zero Malnutrition initiative was based on
the recognition of the ethical and moral obligation of the Government in
response to the Malnutrition problem in Bolivia. The Human Rights approach led
to a commitment for Zero Malnutrition and not a partial reduction as proposed by
some technical advisers.
The International/Economic Policy dimension was brought up by David Sanders
who underscored that Poverty Reduction Strategy Papers (PRSP) are part of the
problem, not part of the solution. To obtain resources a country has to
demonstrate to the international banks it is in good stead in paying them back
and is taking steps towards trade liberalization. To meet this requirement in
many cases, public funds for basic services in health and education are being
curtailed. This tool is obviously not exerting equal pressure on non-debtor
countries in the north to do the same in terms of lifting trade barriers to
developing countries.
In response to the need for access to local foods to meet the special needs
of young infants including the malnourished FAO indicated it is providing
seasonal food availability calendars for both wild and cultivated foods in
support of these efforts.
3. Regarding the issue of limiting advertising and marketing of energy
dense nutrient poor foods to children and adolescents, many felt there is a
need for a complete ban on advertising of all kinds directed to children too
young to understand the difference between the real world and the message used
by the advertisers. For everyone else there needs to be guidelines for what is
ethical and unethical. The following Statement was agreed by the two Working
Groups:
The human right of children and adolescents to adequate food and to be
free from obesity and related diseases.
The UN System Standing Committee on Nutrition appeals to the relevant UN
agencies, in particular WHO, UNICEF and FAO, as well as to the UN Special
Rapporteur on the Right to Food and the UN Secretary General’s Special
Representative on transnational corporations and other business enterprises, as
well as to the UN Special Rapporteur on the Right to Food as well as
governments, to urgently move towards appropriate regulation in this area,
including the (possible) adoption of a code of conduct restricting unethical
marketing.
A dialogue with the corporate food sector and related media and marketing
industries should also be initiated with a view to progressively shifting the
demand away from food and beverage products that contribute to diets that lead
to childhood and adolescent ill-health and prospects for early death and/or
disabling life years in adulthood. It is known that some corporations have
already begun to alter their products to make them less unhealthy. This is
welcome and must proceed systematically and on an accelerating scale .
The SCN requests the UN Special Rapporteur on the Right to Food and the UN
Secretary General’s Special Representative on Business and Human Rights to: Give
in-depth consideration to these issues their forthcoming reports in order to
increase the awareness of the problems faced.
The SCN urges the UN agencies concerned to:
Initiate consultations, through the SCN, with a view to develop a code of
marketing that restricts unethical marketing behavior which increases demand for
high energy, low nutrient-dense food items including fat-rich snacks and drinks
containing high level of sugar or salt, especially marketing efforts aimed at
children.
A draft letter to send the statement to the UN Secretary General’s Special
Representative on Business and Human Rights to be considered by the SCN will be
drafted by the Working Group on Nutrition, Ethics and Human Rights.
4. Possible Topics for next meeting
- Women Health and Nutrition
- Optimal Birth Weight (in conjunction with presentation of
WHO/UNICEF report)
- Nutrition of the Elderly in developing and transitional
countries.
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