An integrated approach

Ultimately, success in achieving the goals outlined in this Report will depend upon political choice and public action. A blend of political choice and commitment, professional skill and community participation will be essential if every child, woman and man is to have an opportunity for a healthy and productive life. Policies which integrate various aspects of health, food production and education will be fundamental. Strategies to implement these policies are needed at local, national, regional and global levels. Appropriate institutional arrangements could clearly enhance national, regional and global capability. At every level, it is important to designate responsibility for setting priorities, developing implementation strategies and monitoring progress.

The vision of reducing malnutrition presents both a challenge and an opportunity to the United Nations today:

a challenge - the goal of rapid poverty reduction has already been adopted at the World Summit

for Social Development in 1995 and identified by

the Secretary General and by many of the UN development agencies as a central goal for UN effort;

an opportunity - because with the recent reforms agreed, the UN agencies now have the potential structure and commitment for working more closely together, globally and in support of country action. Accelerated improvements in nutrition on a world-wide basis are sufficiently fundamental to be worthy of a special place within these new efforts.

The United Nations will need to play a key role if the goal of ending undernutrition by 2020 is to be realised and new integrated goals met on a regional and national basis. Supportive action needs to be worked out on a collaborative basis in such key areas as:

Ending Malnutrition by 2020: An Agenda for Change in the Millennium

support for country-by-country action, led nationally, involving many groups within each country, supported as appropriate by the international community and donors;

a harmonization of support, analysis, monitoring and evaluation by different agencies. This will allow the resources to be used more effectively with a sharing of results and lessons learned.

Just as action against malnutrition will require action in many sectors, supported by professionals

from many disciplines, so most of the main UN agencies must necessarily have a role in reducing malnutrition on a global scale. A strengthened mechanism is needed at UN level to ensure that its agencies can combine their best efforts. This is needed to ensure a totally coherent policy by different UN agencies, bilateral and international financial institutions, to prevent the current disruption of local effort and national talent. In the next chapter the Commission sets out the stages needed for translating this vision into practical action.

Box 6.1

Nutritional, activity and dietary recommendations as public health goals

Populations should consume nutritionally adequate and varied diets based primarily on foods of plant origin.

Promote year-round consumption of a variety of non-tuber vegetables and fruits in amounts equivalent to >400 g/day to

provide at least 7% of total energy per individual.

A variety of starchy or protein-rich foods of plant origin, preferably minimally processed, to provide the majority of total energy (e.g. grains, legumes, roots, tubers). These recommendations imply a limited intake of sugars and starches with a high glycemic index. Benefit also accrues from limiting the frequency of sugar consumption in drinks, snacks and foods to improve dental health. In practice, this means free sugars should be <10% total dietary energy.

Where animal protein is in limited supply, preference should be given to pregnant women and children. Red meat should provide <10% of energy. Fish, poultry and game are preferable.

Total fats and oils to provide at least 15% of total energy. Fat intake for women of reproductive age should provide at least 20% of energy. From weaning until 2 years of age children should consume 30-40% of their energy as fat. Active individuals in energy balance should not consume more than 35% of their energy from fat. Saturated fat should provide no more than 10% of energy. A total fat intake of 20-25% should not be exceeded if fat intakes are increasing from low levels in societies becoming more sedentary. Omega-3 fatty acids from fish, and fish and vegetable oils, should be selectively targeted to pregnant women and young children when the supply is limited. The ratio of n-3 to n-6 fatty acids should be increased to at least 1:5 to 1:10.

Dairy products, where culturally appropriate, may be included if they do not exceed the fat recommendations.

Salt from all sources should not exceed 6 g/day for adults.

Alcohol consumption is not recommended. It should be restricted to <5% of energy for men, 2.5% for women.

Perishable food should be stored in ways that minimize fungal and other contamination.

Perishable food, if not consumed promptly, should be kept frozen or chilled.

Safety limits should be established and monitored for food additives, pesticides, residues, and other chemical contaminants in the food supply.

Safe, hygienic methods of food preparation and cooking should be encouraged. Production, promotion and use of tobacco in any form should be discouraged.

Ending Malnutrition by 2020: An Agenda for Change in the Millennium