Final version, March 2002




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WHO. The management of nutrition in major emergencies. Geneva, 2000:236p


List of briefsExamples of “good” practice


  • Right to breastfeeding
  • Community volunteers in Thailand: a key to improving the nutritional situation through mobilisation of the community


  • Food and nutrition policy in Norway: a public nutrition approach responding to rising coronary heart disease

  • Food and nutrition policy in Europe: a reference framework for the region

  • Increasing women's involvement in community decision-making: a means to combat anaemia in Peru.

  • Mobiliszation of women by the ABESF for the improvement of diet and nutrition in Burkina Faso

  • Iron fortification of nuoc mam: a promising approach in the fight against iron deficiency in Vietnam

  • Tracking supermarket progress towards a fairer and greener food system: the Race to the Top initiative in the United Kingdom

  • A small tax on certain foods: a way to generate funds for the promotion of health

  • National awareness and information campaigns

  • Improving infant feeding in developing countries: a collaborative effort between NGOs and Research

  • The nutrition barometer: an experience in nutritional surveillance in France

The rRight to breastfeeding


Breastfeeding is recognised as the ideal way to feed and care for infants; it benefits both psychomotor development of the infant and is good for the mother. For these reasons it should be considered the mother’s right as well as the child’s.

Nevertheless this right is frequently violated: “medicalisation”tion of infant foods, promotion of breastfeeding substitutes by industry, failure on the part of society to help mothers breastfeed and work, and failure of the community to support breastfeeding.


The following table illustrates how the approach to breastfeeding as a right can be transformed into concrete commitments at different levels of society.


Breastfeeding rights: Duties and obligations at different levels of society


Duty or obligation

Household

Community

Government

Respect

To understand that breastfeeding is best for both boys and girls

To assist in the promotion of breastfeeding

To constantly promote breastfeeding

Protect

To avoid buying breast-milk substitutes

To inform people about the importance of breastfeeding

To protect people against misinformation

Establish appropriate legal measures

Facilitate

To assist in household work during lactation

To assist in reducing the workload of lactating mothers

To provide basic mother and child health care

Encourage medical and paramedical staff to support breastfeeding

Fulfil

To ensure that the lactating mother eats well and gets sufficient rest

To provide food to poor households with lactating mothers

To ensure household food security

Adapted from Nutrition throughout the life cycle. 4th report on the world nutrition situation 2000: p55.


As can be seen, even though legislation and international and national action are are extremely important, final success depends on the commitment made by individuals and communities to the right to breastfeed.


Latham MC. A mother's right to breastfeed: removing the obstacles. Food and Nutrition Bulletin, 1999;20(3):293-299

Other bibliographical references can be found in the general bibliography on the right to food and nutrition.

Community volunteers in Thailand: a key to the improvement of the nutritional situation through mobilisation of the community


In its fight against poverty, Thailand has adopted a strategy that aims to fulfil people’s basic needs and is founded on self-sufficiency. Including nutritional objectives in this strategy, and in primary health care and agricultural policies has helped achieve a significant reduction in malnutrition in children under 5 over the last two decades.


Besides political engagement and a multi-sectorial, integrated approach - both essential for programme sustainability and effectiveness – the emphasis was placed on mobilising communities and obtaining their active participation.


Community volunteers were selected and received basic professional training in nutrition, health and programme planning. The use of one volunteer (or ‘mobilizefacilitator’) for 10 households allowed the scope and impact of the action intervention to be optimisedmaximised.


The main tasks carried out by the volunteers were connected with prevention and the promotion of health. Prenatal surveillance was provided to ensure ideal bodyweight at birth, prevent micronutrient deficiencies and reduce maternal mortality. The volunteers played an essential role in locating pregnant women, distributing complementary foods, obtaining the mothers’ commitment to taking iron supplements and encouraging the women to make use of available health services.

A system was set up involving the health services, volunteers and the mothers mobilizemobilised by the volunteers to monitor child growth. Nutritional surveillance tools were developed and used at household and community levels.

Volunteer also helped set up nutrition education and communication programmes to encourage breastfeeding, the use of adequate complementary foods and satisfactory hygiene.


Active community participation allowed 95% coverage of vulnerable groups by mother and child health services.


Tontisirin K, Bhattacharjee L. Nutrition actions in Thailand - a country report. Nutrition research 2001; 21:425-433

Tontisirin K, Winichagoo P. Community-based programmes: success factors for public nutrition derived from the experience of Thailand. Food and Nutrition Bulletin 1999;20(3):315-322

Food and nutrition policy in Norway: a public nutrition approach responding to rising coronary heart disease


In the 1960s Norway suffered from very a high and rapidly increasing rising mortality rates due to coronary heart disease. In 1975 the Norwegian parliament adopted an unprecedented food and nutrition policy that aimed at adapting agricultural production to objectives for nutritional and health policy. objectives. A National Nutrition Council was created to work on the following topics:

  • Self-sufficiency in the production of healthy food;

  • Regional distribution of foods such as fruit and vegetables at constant prices;

  • Campaign to reduce intakes of fats, particularly saturated fats, and to increase intakes of poly-unsaturated fats;

  • Adaptatingon of the health service to allow surveillance of coronary heart diseases, hypertension and blood fat levels;

  • Development of a culture favouring leisure-time physical activity and sport.



This new policy was based on active participation by people at different levels of society: consumers, producers, the agri-food industry, distributors, health and education professionals, and researchers.


Community mobilization mobilisation was very high, mainly as a result of municipal services that ensured the population had access to a balanced diet.


Emphasis was placed on informing and educating the public particularly through TV programmes, the distribution of educational material to the general public and to professionals, and training. The level of knowledge about food, nutrition and the relationship between food and health increased and resulted in an improvement in diet followed by a progressive reduction in fat consumptionintakes, particularly saturated fats, and an increase in poly-unsaturated fat,s which in turn, led to a reduction in cholesterol levels.

In addition to efforts concerned with food production and access to fruit and vegetables, certain foods were fortified and careful attention was paid to labelling.


A system of surveillance was set up to provide decision-makers with information concerning the monitoring of the food and nutrition situation and to modify objectives when necessary.

This policy resulted in a significant reduction in mortality due to coronary disease, which was reduced by half over a period of 20 years.


WHO, Regional office for Europe. European food and nutrition policies in action. Eds. Milio N., Helsing E. WHO regional publications, European series 73;1998:176p

WHO, Regional office for Europe. Comparative analysis of nutrition policies in WHO European member states. EUR/ICP/LVNG 01 02 01; 1998:75p


Food and nutrition policy in Europe: a reference framework for the region


European countries are not necessarily all at the same level when it comes to defining and applying implementing food and nutrition policies. Some countries have had functioning policies for years, while others are still at the stage of drawing up policies and collecting the necessary data. Still others have instigated a number of actions in the field of nutrition, but have not yet defined a general framework. In the last few years, a desire has been expressed to define a general regional framework to support and encourage government actions in favour of nutrition.


For this reason, the WHO Regional office for Europe produced a policy document and an action plan for nutrition in the European region for the period 2000-2005. It comprises three inter-linked strategiess: one on (i) food safety, a (ii) nutritional strategy aimed at ensuring optimal health, and (iii)one concerning sustainable food supply. This action plan underlines the complementary roles played by different sectors in drawing up and applying policies to protect and promote health and reduce morbidity linked to food, while contributing to socio-economic development and a sustainable environment.


The European Union only very recently developed a policy and a specific action plan for nutrition. Despite this fact, certain European policies have already hadve an impact on nutrition via policies on: health policy, consumers policy, the internal market and industry policy, trade policy, agricultureal policy, and research policy.

A nutrition policy was defined with the following objectives:

  • To provide a safe and varied food supply, in sufficient quantities;

  • To monitor nutritional status, food intakes consumption and health status linked to nutrition;

  • To provide reliable and comprehensive nutritienton information about food;

  • To develop nutritional research and disseminateing results to all member states;

  • To train health professionals;

  • To support national nutrition policies.


Close collaboration is envisaged between WHO and the European Commission around these topics. The creation of a nutrition task-force within WHO Europe is planned that would have the following responsibilities: facilitating collaboration between international agencies and European organizationsorganisations, creating a forum for exchanges on nutrition and public health, making sure that development agencies work together to help countries, and strengthening political engagement in favour of food and nutrition.


European Commission Employement and social affairs. Priorities for public health action in the European Union. 1999:182p

OMS, Bureau Régional de l'Europe. Les incidences de la situation alimentaire et nutritionnelle sur la santé publique: les arguments en faveur d'une politique et d'un plan d'action en matière d'alimentation et de nutrition pour la région européenne de l'OMS (2000-2005), 2000:18p

OMS, Bureau Régional de l'Europe. Santé 21 : Introduction à la politique-cadre de la santé pour tous pour la région européenne de l'OMS. Série européenne de la santé pour tous n°5, 1998:35p

Société Française de Santé Publique. Santé et nutrition humaine : Eléments pour une action européenne. Collection Santé et société 2000,10:52

Increasing women's involvement in community decision-making: a means to improve iron status in Peru


This project is part of a multi-country study (Ethiopia, Kenya, Peru, Thailand, Tanzania) conducted by the International Centre for Research on Women. It is justified by the fact that, despite numerous actions interventions aimed at preventing micronutrient deficiencies, the prevalence is still high in many regions of the world. In order to increase the effectiveness of these measures, a better understanding is needed of the factors within the family that influence micronutrient status. , and rRecognition is also required of the fundamental role played by women in family nutrition, based on their earnings, the care they provide, and the production and preparation of food.


In Peru the objective was to develop and test a nutritional intervention aimed at reducing anaemia in women of childbearing age in the immediate vicinity of Lima. The goal was to provide an alternative to vitamin and mineral supplements.


The intervention took place in the framework of community kitchens where groups of women collectively prepared meals (3 three meals a day for 5 five days); the prepared food being was consumed at home.


Participatory methods were developed to actively involve women members of community kitchens in the design, application and evaluation of this nutritional intervention.

During the design stage, staff and clients of the kitchens took part in workshops to identify potential food and institutional problems, and possible solutions. A diagnosis was made of tastes and food preferences as well as of the nutritional quality of the meals.


The action intervention also had the effect of improving the service provided - the nutritive value of the meals, stock management, and hygiene during preparation. It also – and stimulated demand by improving the quality of information and the women’s knowledge through nutrition education. Quality control was the responsibility of women who had been specially trained for the task, which improved acceptance of the kitchens by others inasmuch as “cooking for the poor” no longer necessarily implied “poor quality cooking”. The participatory approach and support from planners and sponsors guaranteed the sustainability of the programme.


The convincing results of this project – an increase in the availability and consumption of iron-rich foods and a decrease in cases of anaemia – were diffused and developed throughout the country and this experiment is now being replicated in many other community kitchens.


Carrasco Sanez N. et al. Increasing women's involvement in community decision-making: a means to improve iron status. Research Report Series 1, International Center for Research on Women, 1998:28p


Site on line: http://www.icrw.org/


Mobilisation of women by the ABESF for the improvement of diet and nutrition in Burkina Faso


The Burkina Faso Association for Social and Family Economics (ABESF) has been active since 1995 in raising awareness of the role played by social and household economy in the improvement of living conditions within the family and in society as a whole. The association mobilises the entire female population to take part at different levels in the activities it organises. The members are volunteers and work for the association during their free time. One of the guiding principles of the ABESF is that its activities depend on stimulating and exploiting local resources. ABESF involvement in two major projects connected with the fight against malnutrition in Burkina Faso is entirely based on this philosophy.


In the context of the fight against vitamin A deficiency, the ABESF is taking part in a pilot project to promote consumption of red palm oil (RPO), which is a source of vitamin A, in a region where it is neither produced nor customarily consumed. The goal was thus to get the population to consume a new food because of its nutritional qualities. Red palm oil is first purchased from women producers in the southwest of Burkina Faso, and women belonging village groups at the eleven pilot sites then sell it. The ABESF functions as local coordinator and is a participating member of the steering committee; it also helps with the practical organisation of promotional activities at the pilot sites. A total of 17 seventeen facilitators are employed in the project and are responsible for contact with local populations who receive awareness raising and educational information.

This collaborative project involves the ABESF, their Canadian collaborators, the AEFQ (Quebec Association for Family Economy), a university structure in charge of the project (Department of Nutrition, University of Montreal) and researchers at the Burkina Faso Research Institute for Health Sciences and at the Institut de Recherche pour le Développement (IRD), France.

As part of the effort to improve the nutritional status of the population as a whole, a recipe book has also been published. A substantial part of the book is made up of recipes for traditional dishes that were selected from a total of 1020 collected all over the country and improved from a nutritional standpoint. In addition it contains chapters on subjects like the general principles of a balanced diet, simple procedures for processing and conserving local foods, rules for hygiene and food safety, advice on feeding infants and balanced menus for different regions of the country.


Up to now, 27 facilitators have been trained in 15 fifteen provinces of Burkina Faso, and awareness programmes have been introduced in the 144 village women’s groups that presently belong to the network; all in allaltogether a total of 6 072 women are involved.

Creating the recipe book also provided the ABESF with the opportunity to collaborate with the staff of the departments of agriculture, health, research and social welfare.


Association Burkinabé d’Économie Sociale et Familiale. Guide d’animation sur la promotion de l’huile de palme rouge (10 histoires en images). Ouagadougou, décembre 2000.

Delisle H, Zagré N, Ouedraogo V. Marketing of red palm oil for vitamin A in Burkina Faso: A pilot project involving women's groups. Food and Nutrition Bulletin 2001, 22(4): 388-394.(soumis déc. 2000)

Contact Hélène Delisle, delisleh@dsuper.net


Iron fortification of nuoc mam: a promising approach in the fight against iron deficiency in Vietnam


A national survey carried out in 1994-1995 by the Hanoi National Institute for Nutrition (NIN) showed that there was a high prevalence of anaemia throughout the Vietnamese population, particularly in women of child-bearing age, irrespective of whether they were pregnant or not, and in infants from the age of a few months. The main cause of this anaemia is nutritional, due to a problem of bioavailability of iron in the Vietnamese diet, particularly in rural areas where cereal-based diets contain high levels of food iron-absorption inhibitors like phytates. The prevalence of iron deficiency anaemia and its many consequences for health led the Vietnamese government to include control of this nutritional deficiency among the objectives of its National Action Plans for Nutrition for the periods 1995-2000 and 2001-2002.

Several complementary strategies need to be combined to fight more efficiently against iron deficiency. These strategies include iron fortification of foods that are regularly consumed by the whole population and particularly by the poorest. Nuoc mam fish sauce offered the most appropriate medium, as a condiment shown by several national surveys, including the national survey held in 2000, indicated it is to be widely consumed on a daily basis in Vietnam,. offered the most appropriate medium. The form of iron supplement selected, NaFeEDTA, has two advantages, it is organoleptically stable in nuoc mam and has satisfactory iron absorption properties, and in addition, it enables iron included in other components of the diet to be absorbed, particularly those containing high levels of food iron-absorption inhibitors.


The programme for iron fortification of nuoc mam began in 1998 with meetings attended by the Vietnamese Ministers of Health and Fisheries, representatives of two international organisations (WHO, UNICEF), representatives of a French institute for bi-lateral cooperation (IRD), representatives of the private sector, and one foundation: the International Life Sciences Institute (ILSI). A programme of this type required a series of different activities organised over a period of time:

  • Preliminary enquiries concerning the production of nuoc mam in Vietnam;

  • A study to determine the level of iron absorption in nuoc mam consumed during typical Vietnamese meals;

  • A study of the biological efficacy in Vietnamese women of childbearing age suffering from anaemia. Results of this study showed that regular consumption of nuoc mam fortified with 10 mg of iron per 10 ml of nuoc mam over a period of 6 months resulted in a significant improvement in the iron status and in the haemoglobin concentration in the subjects studied, and reduced the prevalence of anaemia and iron deficiency.

  • A study of effectiveness in real conditions when fortified nuoc mam is made available to all the households in the Red River delta. This study, which starts in 2001, will last 18 months.


In parallel with these studies, the NIN is working on proposals for regulations concerning the fortification of foods with micronutrients. This means that if the results of the effectiveness study are positive, the nuoc mam iron fortification programme can be extended to the whole country.


Contact : Professor Ha Huy Khoi, Directeur, Institut National de Nutrition, 48 Tang Bat Ho, Hanoi, VietnamIETNAM ; Jacques Berger, j.berger@fpt.vn

Tracking Supermarket Progress towards a Fairer and Greener Food System: the Race to the Top initiative in the United Kingdom


In many countries more than 80% of food products are now purchased in supermarkets and hypermarkets, which consequently play a very important role in the food system. Firstly they have a huge influence on the rural economy by setting standards for agricultural practice and by seeking ever greater efficiencies from the food chain in the name of the customer value, competition, and shareholder value. Their produce product range and geographical siting policies affect the health of our communities.


The objective of the Race to the Top initiative, which was developed by the International Institute for Environment and Development (IIED), is to benchmark and track the social, environmental and ethical performance of supermarkets in the United Kingdom, and thereby catalyse change within the agri-food sector and beyond.


A series of indicators have been identified that will allow annual assessment and monitoring of progress made by supermarkets over a period of 5 five years. These indicators are organized in 7 seven main topicsareas: biodiversity and landscape, labour standards, animal welfare standards, public health, regional sourcing and local development, sustainable management and reporting, and terms of trade with primary producers.


The Race to the Top project:

  • Offers supermarkets independent evaluation of their actions in the social, ethical and environmental domain;

  • Transforms supermarkets into an educational platform for consumers by clarifying the link between the choice of product, retail policy, health and the food system;

  • Provides indirect support for producers by supplying information about relations between supermarkets and local or foreign producers;

  • Provides investors and decision-makers with information to help them make their decisions.



Contact: Bill Vorley, International Institute for Environment and Development, 3 Endsleigh St, London WC1H 0DD, UK; bill.vorley@iied.org

A small tax on certain products:

A way to generate funds for the promotion of health


In North America, where the consequences of an unbalanced diet and unhealthy lifestyles are so obvious, both the United States (19 nineteen states and towns) and Canada have introduced a tax on certain food products like soft drinks, candysweets, and sweet confectionary and savoury snacks. This is either in the form of a flat tax as a function of the volume purchased or as a percentage of the sales price paid by either the wholesaler or the retailer.


A tax on easily identifiable foods was preferred to a tax on foods that contribute to the development of coronary diseases due to the levels of certain types of fats they contain.


However, the agri-food industry and distributors are fighting back, and, in some states, have successfully lobbied the government to cancelhave the tax rescinded, usually with promises to build factories and create jobs.


Even very small taxes can generate respectable funds. In Arkansas, a 2% tax on 12-ounce cans (360ml) of soft drinks generates 40 million dollars per year, and in California a 7.25% tax on the same products generates 218 million dollars. In the US as a whole, approximately one billion dollars per year tax is collected on the range of products listed above.


Up to now, these revenues have been included in overall tax revenues and rarely allocated for a specific use. The challenge is thus to get this money usedhave this money allocated for nutrition education programmes and the promotion of physical exercise.


Estimates made in the United States have shown that a tax of 1% on cans of soft drinks, and a tax proportional to the weight of other types of products, would generate around 1.8 billion dollars per year. Since this tax is very small, it would not have a significant effect on price or on consumption and would consequently be acceptable to both consumers and manufacturers. In addition, studies have shown that if consumers are aware that the tax is used for their health, they accept it even more easily.


Jacobson MF., Brownell KD. Small taxes on soft drinks and snack foods to promote health. American Journal of Public Health 2000 90(6):854-857

Ismail AI, Tanzer JM, Dingle JL. Current trends of sugar consumption in developing societies. Community Dent Oral Epidemiol 1997;25(6):438-43

Marshall T. Exploring a fiscal food policy: the case of diet and ischaemic heart disease. BMJ 2000;320:301-305

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