Recent presentation given in Bangkok on updated results of the UN Standing Committee on Nutrition 2010 Report on the World Nutrition Status. My research and analysis on iodine status worldwide is included

1. 6th Report on the World Nutrition Situation Roger Shrimpton and John Mason Bangkok 10 October 2009 1 UNITED NATIONS SYSTEM Standing Committee on Nutrition http://www.unscn.org

2. Content Introduction Regional trends Maternal nutrition and the intergenerational cycle of growth failure Sustainable Food Security: an overview of some key issues Nutrition Governance Conclusions 2

3. 2. Regional trends Regional Trends in Malnutrition Results for the UN SCN 6th Report on the World Nutrition Situation SCN meeting, Bangkok, 10 October 2009 J Mason and R Shrimpton Based on the work of: Lisa Saldanha, BibiAl-Ebrahim, Emily Cercone, Linda Heron, Katie Robinette, and AmitWadhwa in the Department of International Health and Development, Tulane University School of Public Health and Tropical Medicine. 3

4. ● ▬ ● ▬ ● 2000s 1990s 1980s s 2. Regional trends Changes in regional estimates of low birth weight and underweight children,1980s to 2000s, showing that underweight tends to move with low birth weight towards zero prevalence; the length of the lines indicates extent of improvement over the approximately 20 year period. Underweight prevalences and low birth weight move together towards 0% 4

5. ● ▬ ● 2000s 1980s 2. Regional trends Change in regional estimates of low birth weight and underweight women (unweighted estimates with available data) 1980s to 2000s, showing incidence of low birth weight tends to move with prevalence of low BMI in women. Low birth weight and low BMI in women move together towards low levels of each 5

6. 2. Regional trends Summary of numbers of countries with child underweight changes improving, none, or deteriorating, from repeated national surveys with latest result >=2000. MDG rate 6

7. 2. Regional trends Figure U2. Associations between underweight and stunting, from survey results 1990-2007, by region. Stunting and underweight move together in Africa and Asia, but not in poor S. and C American countries where stunting is much higher. Africa Regression results for 3 regions together. Stunting = 20.502 + (0.894 * uwt) – 5.495 (dummy for Asia) – 14.261 (dummy for SC Amer/Caribb) + 1.036 (interaction: dummy for SC Amer/Caribb * uwt). All coefficients significant p=0.000; interaction for Asia NS when in model. N=232, adj R squ = 0.764. CS Amer Caribb Asia 7

8. 2. Regional trends Figure VA1. Trends in VAD (prevalence of serum retinol < 20 mcg/dl in children < 5yrs) Shouldn’t these rates be faster with high coverage of VAC distribution? (Do VACs affect VAD?) 8

9. 2. Regional trends Figure An1. Trends in anemia in non-pregnant women by region This seems the most intractable problem – a breakthrough is needed. (Fortify rice successfully?) 9

10. 2. Regional trends Figure I3. Predicted numbers of people (developing countries) with goitre if there were no iodized salt, compared with current estimate (with 68% iodized salt coverage). An estimated 2 billion people would have goitre if there were no iodized salt, compared with an estimated 0.7 billion with the current coverage of about 70%. 10

11. 2. Regional trends 11

12. 2. Regional trends 12

13. 2. Regional trends 13

14. 3. Maternal nutrition and the intergenerational cycle of growth failure Can this be made into a virtuous cycle? Figure 1 Intergenerational cycle of growth failure (ACC/SCN 1992) 14

16. Not just more quantity but also improved diet quality (fortification and supplementation) can help achieve this, especially if mother reached during first half of pregnancy (+100g)

17. yet maternal anaemia rates are very high and little priority given to this (except PROGRESA)

19. For each year that median age first pregnancy can be extended beyond 15y to 20y, an additional 1cm could be added to final adult woman's height.

20. Yet almost half of mothers are married before 18y in LDCs

21. Beware: Food supplementation of the still growing primiparous pregnant adolescent decreases birth weight and increases risk of maternal obesity

23. Height at two years of age largely determines adult height (Cole 2000)

24. Those born LBW are 5cm shorter at adulthood (Martorell et al 1998)

25. Half of stunting occurs in uterus and half in first two years of life (Li et al 2003)The GROWTH” WINDOW OF OPPORTUNITY” IS FROM CONCEPTION TO TWO YEARS

27. The UNICEF nutrition conceptual framework focussed on child malnutrition (not maternal malnutrition)

28. The revolution would have been even more successful if the original GOBI-FFF had been maintained (UNICEF 1982).

29. SO PUT BACK THE FFF :

30. Family planning

31. Food supplements (Micronutrients) for women during pregnancy

33. But small increase in birth weight can be magnified across the life course (e.g. 100g in birth weight is 20% reduction in stunting at two years Kusin et al 1998))

37. DC fertility down from 5 to less than 3, while LDCs fertility is still at 4.5.

38. The global population, now about 6 billion, will be close to 9 billion by 2050

42. In 2008 food stocks also recovered and climbed back over 500MT for first time since 2001 (FAO 2009)

43. Production may get over 3 billion tonnes by 2030 if sufficient R&D is applied.

45. the use of mass produced petroleum based fertilizers and chemical pesticides,

46. the use of petroleum driven machinery,

47. expanded irrigation, and

48. the introduction of genetically superior disease resistant cultivarsWhat we need now is a “technological revolution”

50. Top soil is being lost quicker than it is being replaced

51. Genetic erosion

52. Hybrid seeds mean genetic uniformity is replacing the genetic diversity of food stocks

53. Freshwater fish stocks in precipitous decline (down 30% since 1970)

54. Sea fish under threat with 75% of fish stocks fully exploited or depleted

55. Bird, bees and bats are in retreat

56. Fresh water scarcity

57. American Meaty diet needs 5000l/day vs 2000l/day for Asian diet

58. Most investment goes into withdrawal of underground water and 70-80% is used for irrigation. Extraction levels exceed replacement levels in most places.

59. Greenhouse Gas Emissions and Global warming

60. Levels of CO2, Methane and Nitrous Oxide produced on earth are increasing. These accumulate in the atmosphere and help trap the suns energy like in a greenhouseSource: (UNEP GEO4 and IAASTD 2009)

62. Are now at higher levels than ever before in the earths history

67. 1/3 of grain production feeds animals

69. In developing countries ~40% of harvest lost due to pests and pathogens

70. In UK 1/3 of food purchased is thrown away

71. In Australia ½ of landfill is food waste.

72. Globally 30 million metric tonnes of fish are discarded at sea

74. Global economic activity increased 49x times in this period, but economic growth has been highly uneven.

75. Today there is 20xgap between the USA, the richest economy, and the poorest region Africa, compared to a 4x gap a century ago.

76. And as the figure shows the gap is wideningSource: Ghosh J and Chandrasekhar CP. 2008. Global GDP growth: a longer view.

78. Global economy is expected to shrink by 1.7% in 2009.

79. On an annualized basis, global GDP growth slowed to 2 percent after averaging 5 percent over 2003-07.

81. Growth in developing countries is projected to slow to 1.6 percent in 2009, compared with 6.1 percent growth in 2008.

83. 53 million more expected in 2009

84. Despite these set backs the MDG 1a target is still likely to be met globally as well as in many regionsSource: UN 2009. The Millennium Development Report 2009. New York: United Nations 34

87. The surge in food prices since 2002 wiped out much of the global gains in hunger reduction achieved over the previous two decades.

88. About 1 billion people were undernourished in 2009, with most of these hungry people are in South Asia and sub-Saharan Africa

90. Only 20% globally have adequate social security, and 50% lack any type of protection.

91. In Sub-Saharan Africa and South Asia 90% lack any social security coverage

92. Conditional cash transfers (CCTs) programmes are increasingly seen as one of the most effective ways to spearhead the development of social protection programmes in developing countries

95. This shift may call for changing the incentive systems for all actors along the value chain to internalize as many externalities as possible, and so reduce the “socially regrettables”. The concept of food sovereignty as proposed by “La Via Campesina” may well offer the most sure way ahead. (Rosset P 2008.)

96. 39 4. Sustainable Food Security WHAT CAN BE DONE TO ENSURE SUSTAINABLE FOOD SECURITY? The Environmental Food Crisis Report (UNEP 2009) makes seven major recommendations: Regulate food prices and provide safety nets for the impoverished, Promote environmentally sustainable higher-generation biofuels that do not compete for cropland and water resources, Reallocate cereals used in animal feed to human consumption by developing alternative feeds based on new technology, waste and discards, Support small-scale farmers by a global fund for micro-finance in developing diversified and resilient eco-agriculture and intercropping systems, Increase trade and market access by improving infrastructure, reducing trade barriers, enhancing government subsidies and safety nets, as well as reducing armed conflict and corruption, Limit global warming, Raise awareness of the pressures of increasing population growth and consumption patterns on ecosystems.

98. the focus on smallholder farmers in response to the current crisis;

100. Conclusions 42 ? 

102. With family planning especially for adolescents to delay first pregnancy

103. As part of conditional cash transfer scheme

104. In LIFDCs

105. And put back the FFF

106. With food coming from local small scale farming

107. Promoting no-till, ecofriendly tree planting agriculture