Malnutrition is caused not only by inadequate food availability but also the inadequacies in provision of nutrition and health services, literacy and education, especially among women. It results from poverty, poor dietary practices and the negative effects of development, such as environmental degradation, and nutritional insecurities intensify in situations of extreme stress, as during emergencies and economic crises. While accelerating food production furnishes an essential foundation for its combat, national policies also need to address contributing factors limiting nutritional improvements, such as inequity, poverty, infections, morbidity, poor education and the low status of women. The eradication of malnutrition, therefore, calls for a multifaceted approach to design of policy and programme interventions. Since nutritional security impinges on food security, a more holistic view linking these twin pillars is needed to enhance Asian prospects beyond 2000.
Providing individuals and communities with adequate and appropriate dietary intakes by first increasing the availability of food and then improving their access to food are only the initial steps towards achieving nutritional well-being to support an active, healthy life. Addressing nutrition insecurity also requires an understanding of its nature as well as the socio-cultural diversity among Asian peoples and the socio-economic conditions in Asian countries. The nature of nutritional insecurity embraces the continuum from undernutrition to overnutrition, and it evolves in response to complex interactions among socio-economic conditions and socio-cultural diversity in food preferences and practices. Interventions therefore need to be community based, and complemented by educational programmes designed with socio-cultural sensitivity to individuals, communities and nations.
Malnutrition is viewed as a sign of poverty and of ignorance and, thus, its eradication requires efforts supporting their elimination. Poverty, ignorance and disease coupled with inadequate food supplies, unhealthy environments, social stress and discrimination still persist and these factors variously combine to precipitate socio-economic conditions leading to malnutrition. Poor economic performance in recent years has led to failures to reduce poverty in many countries, in contrast to the 1980s, which, in turn, had a direct and negative effect on nutrition. One of the most dramatic aspects of malnutrition has been the extent of hunger and starvation. Malnutrition in urban areas is equally severe as in rural areas, and in urban areas the socio-economic conditions and causes of poverty and nutritional insecurity vary. The diversity in these socio-economic conditions needs to be addressed through policy interventions designed to alleviate poverty in a phased manner over a period of time.
The priority beyond 2000 is, thus, to invest more in poor people with the objective of enhancing their productivity, health and nutritional well being by increasing their access to remunerative employment and productive assets. Access to productive resources is facilitated through land reform, sound legislation on property rights and strengthened credit and savings schemes and institutions. The effective use of these resources requires provision of more effective rural labour markets and infrastructure support for small scale enterprises. Besides, there is a continued need for direct transfers, particularly for programmes offering poverty relief, food security and nutritional interventions. These activities need to be supplemented by support for lowering fertility rates and subsequent reductions in population growth increases. Investment in literacy and education among rural and poor women is essential for meeting these objectives and, in turn, for assuring food security and facilitating nutritional security.
Enhanced access to food and its equitable distribution require attention to enhance prospects beyond 2000. Targeting measures ensure that food reaches the poorest and most malnourished people. As the food distributed should be both nutritious and safe, there is a need to bring domestic production and processing into compliance with international standards for protection against unsafe food and unhygienic or fraudulent practices, adopted by the Codex Alimentarius Commission. Food aid needs to meet these standards, and its distribution needs to be viewed as the responsibility of recipient countries, and they need to develop policies ensuring that food aid reaches their poorest people as contributions to poverty reduction and to the most needy during emergencies. There also is an urgent need to reverse recent declines in foreign aid, and to remove trade restrictions as an additional contribution to enhance nutritional outcomes from food trade. The LIFDCs in Asia need special assistance to accelerate agricultural production in response to the rising food needs of their rapidly growing numbers of people.
Demographic transitions influence Asian prospects beyond 2000. Current trends show that another 1.5 billion people will be added to the population of developing Asian countries by 2025. Assuming that incomes will grow at rates closely resembling recent trends, then both direct and indirect effects of this expansion will imply an annual increase of basic staple food demands by roughly 0.5 per cent over the next 30 years. A comprehensive policy response to the challenges of demographic transition needs to include acceleration of food and agricultural production (with nutritional inputs intensified), as well as sustained expansion employment opportunities, especially for the poorer sections. While poverty in Asia is still largely observed in the rural areas, increasing urbanization will cause the poor and undernourished to move to cities. This feature must be considered, especially with regard to need for fiscal resources to finance urban and rural infrastructure and public support (such as food subsidy systems, health and education services). Meanwhile the population is ageing and this trend gives rise to prospects for increased food insecurities among older people, especially older women, in light of reduced fertility and a reduction in the number of children available to support (through food production or income) their nutrition security. This age transition poses new and dramatic challenges, especially in the socio-cultural contexts of Asian peoples.
Enhancing Asian prospects beyond 2000 requires interventions to selectively strengthen the capacity of Asian governments to maintain appropriate functions such as law and order, to establish and enforce property rights, to promote and ensure private sector competition in markets, and to maintain appropriate macroeconomic environments. Predictability, transparency and continuity in policy making and enforcement must be assured (Pinstrup and Anderson 1999). People's participation would enhance these prospects.
There is an urgent need for formulation of “food friendly” macro-economic and trade regimes supporting quality and safe foods for domestic exchange and global export. The Codex Alimentarius Commission (CAC) has come to be recognised as the inter-governmental agency for setting international standards not only for protecting the health of consumers, but also as the foundation of WTO agreements ensuring fair practices in the food trade and facilitating international trade in food. As the Codex Alimentarius Commission currently involves 165 member states and WTO 134 member states (see Table 2), extending membership in both organizations to all countries in the Asian and Pacific region is essential to improving prospects for enhanced food quality and food safety.
Further, the member governments should participate more actively in Codex work so that the CAC yields standards dealing more effectively with food safety, consumer protection and food trade issues. To do so requires ‘food friendly’ responses to the views of all interested parties when formulating the national position on Codex matters. It further requires that governments communicate and explain the decisions of Codex to those same interested parties and to the public at large. The formation and/or strengthening of National Codex Co-ordinating Committees should be given high priority to assist in this process.
As further assistance to implementation of the two WTO agreements, there is a need for governments to undertake the following activities:
As supplement to these efforts, there is also a need for governments to develop effective strategies to ensure food quality control, such as establishment and strengthening of integrated food control systems and the development of appropriate quality assurance systems for food production, processing and marketing. Responding to concerns about food contamination requires strengthening of monitoring and control programmes. Infrastructures are needed for implementation of these strategies in terms of food legislation, laboratories, inspection, training and extension services as well as improvement of food handling techniques, particularly street foods and at village and household levels.
Education and training of food scientists and other technical and administrative personnel in charge of quality and safety of food in all segments of the food chain is needed. Improving quality and safety of products requires efforts to meet regulatory and trade requirements by promoting, training and preparing reference materials to support the application of good manufacturing practices and utilization of risk analysis and quality systems. The use of hazard analysis and critical control point (HACCP), total quality management (TQM) and the International Organization for Standardization (ISO) quality control methods need to be effectively promoted in this region.
However, the success of ‘food friendly’ macro-economic policies and trade regimes supporting food quality and safety flows from the evolution of agriculture towards increased domestic marketing and export of food, and their successful implementation assumes increasing productivity of the agriculture sector regarding food. Although the population growth rate is steadily decreasing, the increase in absolute numbers of Asian people to be fed will require steadily increased gains in productivity.
Agricultural factors furnish the firm foundation for enhancing Asian prospects beyond 2000. Food supply, the availability of food, dietary intake and nutritional status are inextricably linked. The impressive gains in the food supplies achieved in the Asian region over the past few decades were the result of effective investments in agricultural research. In terms of futuristic trends, it is imperative to optimise agriculture and food production, and it is essential that these increases yield nutritional benefits for the poorest individuals and communities. To achieve this, strategies to accelerate agricultural production need to be nutritionally oriented, and particularly adapted to put more emphasis on the nutritional needs of the poor. Adjustments of agricultural price policies need to follow the same principles, since raising food prices negatively affects the poor. The tendency of developing Asian countries to produce cash crops seems to have a negative effect on the nutrition situation of the poor, and cash income to the poor favours consumption of non-food items with little regard to their nutritional needs. Ensuring responsive policies requires the active participation of the poor in design and implementation of socio-economic policies and assessment of their outcomes.
In terms of food pricing and distribution systems, social subsidies would serve the interests of Asian countries much better if more effort is devoted to designing them as efficient tools of income redistribution. Food subsidies should be targeted especially to the poor. Rationed food subsidies give a quota or ration of subsidised food to poor households while permitting unlimited sales in the open market. To achieve optimal benefits, subsidised food should also be targeted to age group, location and season specific conditions. The kind, quality and quantity of subsidised food in poor neighbourhoods also favour its distribution to the poor. Recurrent cost of targeting is substantially reduced if community groups and local volunteering agencies are engaged in the nutritional efforts. Food stamps are also efficient ways of targeting, but these programmes need to be flexible and closely monitored.
Despite the potential of Asian countries for horticulture, this capacity still remains much below that what is required to meet the micronutrient requirements. In terms of future strategies, additional attention needs to be given to revitalizing old and unproductive plantations, improving seed and planting, material and improving post harvest management. Many countries would do well by increasing their fruit and vegetable production and processing as this has marked nutritional implications especially with respect to addressing micronutrient malnutrition. By 2025, for example, strategies of developing Asian countries need to increase the average fruit and vegetables productivity by at least half a tonne/hectare/year to meet expanding requirements.
This promotion of horticultural crops should in no way be at the expense of areas under food grain crops or the inputs, which are presently being used for these crops. Biotechnology offers promising potential for optimising nutritional inputs in agriculture and it needs to be maximally exploited in the new century. The catalytic role of international agencies can be used to advantage in this respect. Along with agricultural diversification, strategies that increase the income of the poor, are most sustainable means of improving household food security and these strategies need to be maximised.
As the world enters a new millennium, Asian women are confronted with challenges both new and old. Throughout human history, Asian women formed the essential foundation for linking the twin pillars of food and nutritional security of households, communities and nations. Today, they contribute a conservative estimate of 65 per cent of household food production in Asia in a socio-economic environment characterised by unequal access to land, to inputs such as improved seeds and fertilisers, and to information and support for improving their productivity. One of the critical lessons from efforts undertaken in the past 20 years is that the actual and potential role of women in development is so large that it cannot be dealt with in isolation.
Women need to be fully integrated into all activities as decision makers, resources for sustainable development and beneficiaries, and by taking account of their diverse perspectives, albeit socio-economic or socio-cultural, or women as farmers, traders, street vendors and mothers. Wherever they are and whatever they do, Asian women need to be recognised as important contributors and beneficiaries of all activities for achieving nutritional security in households, communities and nations. Building on their centuries of experience with organising food and nutrition security enhances Asian prospects.
Examination of the current nutrition situation as the framework for designing policies and programmes to achieve nutritional security is essential to identifying priorities into the 21st century. Here-to-fore, developing Asian countries effectively invested in nutrition interventions and much was learned from these approaches, especially as regards measures for addressing malnutrition. Major approaches to enhance prospects are preventive and community based, eliciting a participatory involvement from the individuals and communities. From the point of view of enhancing Asian prospects, it is essential to target actions, especially reductions in prevalence of LBW infants.
Birth weight is the single biggest predictor of growth in the early years of life. Some of the biggest gains in improving nutritional status will come from gains in improving neonatal outcomes. Preventive strategies need to target women of reproductive age and priority needs to be given to pregnant women in order to improve birth outcomes. Interventions that target the girl child and adolescent girls prior to their first conception have a potentially high payoff for improving nutritional prospects for newborns. These targets are of particular significance, since early nutrition not only determines the growth and developmental potential of the uterus, early diet and nutrition modulates the capacity of placental vasculature to increase blood supply to the foetus during pregnancy.
Breast feeding promotion and support needs to be intensified to enhance Asian prospects, especially in view of rapid urbanisation underway in Asian countries. Specific policies to facilitate breast feeding that combine flexibility and support for working mothers need to be implemented. Nutrition education encouraging timely introduction of complementary foods needs strengthening. Linking hospital, health centre, household and community as a system for addressing problems of growth faltering and subsequent malnutrition among children is an essential feature of programming, when supplemented by efforts linking nutrition professionals and community workers with mothers.
Nutrition education encouraging the development of indigenous complementary weaning foods and also their production in the community are needed, and they can further be expanded as income generation projects. Industry partnerships enhancing these community activities need to be fostered. While its promotion is the priority, programmes also need to limit HIV/AIDS transmission from mother to child during breast-feeding by offering alternative and nutritious food sources. The development and use of community based food supplements that are micronutrient dense need to be tested in different Asian community situations and contexts.
Behaviour changes enhance Asian prospects into the 21st century and, thus, there is an immediate need for implementation of community based nutrition education programmes, called for in the ICN's Plan of Action for Nutrition. Nutrition education is essential for influencing and changing behaviour in favour of nutritional security. Such programmes promise long term impacts and effective intervention support for poverty reduction and as supplement to other nutrition-enhancing actions. Innovative ways for integrating nutrition communications components into school activities and curriculum are necessary features of community strategies, and nutrition based caring skills of parents and mothers need to be taught to women prior to the birth of their first child. All these education materials need to promote traditional foods and diets, relative to fads.
Asian prospects are enhanced by greater priority to operational research identifying key elements of successful micronutrient interventions. Nutrition screening and monitoring services are recommended as part of the package provided to communities. Further development and greater availability of more nutrition indicators promises enhanced benefits as pointers for identifying major food and nutrition concerns. As illustration, country wide nutrition indicator profiles highlight progress in eliminating micronutrient malnutrition and malnutrition using some of the more common approaches such as supplementation, food fortification, dietary diversification and control of parasitic and other infections. In the Asian context, the promotion and support for home gardens, traditional production and processing activities, and the maintenance of traditional diets, serve as sustainable examples for improving micronutrient malnutrition. The challenge beyond 2000 would be to have a better mix of approaches in local contexts.
These activities are essential for enhancing Asian prospects in vital micronutrients.
Enhancing prospects for nutritional security beyond 2000 flows from governments giving consumers protection and rights of consultation in advisory and decision-making bodies, and for governments to facilitate open and transparent access to information and participation in the establishment of food safety, quality control and labeling standards. There is also a need to establish or strengthen national mechanisms to resolve consumer problems with the food supply. Co-operation among the food sector, government and consumers needs to be promoted to ensure the food industry provides safe, wholesome, nutritious and palatable foods so that the health of consumers is protected.
Enhancing prospects for consumer protection also involves increased efforts on the part of governments to involve consumer and other interested organizations or groups in the national risk analysis process. Such groups can provide viewpoints and public perceptions that need to be considered both in making risk decisions and in communicating these decisions. At the same time, it is vitally important to encourage worldwide efforts to develop and apply appropriate safety assessment criteria for food biotechnology research and to ensure the wholesomeness and safety of the food supply.
New and renewed efforts are essential to ensure the quality and safety of food distributed through programmes, such infant formulas or food for mothers and children, or food aid as emergency relief of refugees, displaced populations or natural disasters. As recipients rely entirely on this food to meet their nutritional requirements, it is essential that appropriate fortification be practiced. Emergency relief is designed to cover the complete nutritional requirements of the target population and, thus, it is essential that food fortification be designed to meet these needs and to prevent micronutrient deficiency diseases. Increased monitoring is needed for micronutrient levels, bioavailability, stability and shelf-life of fortified food used in food aid programmes. The required nutritional information needs to be on labels for all fortified foods distributed in these programmes.
Enhancing prospects beyond 2000 flows from centuries of Asian history and Asian perspectives about the future, and focusing on the impressive foundations and gains of East and South East Asian countries in the midst of economic crisis. Asian peoples have centuries of experience with ups and downs of economic growth as individuals, families, communities and nations. Mechanisms to enhance food and nutrition security during these economic changes are not new to Asia, rather they date to the 1st century B.C. when China and India developed the first recorded food storage and distribution systems. Likewise, as the 20th century ends, accelerated economic growth among over 1.5 billion people has not only been achieved, but it is accompanied by an increasingly equitable distribution of productive assets and income. Throughout Asia, the process and content of economic growth and national development has consistently generated employment and, thereby, encouraged broad based participation and shared benefits from growth.
Prospects beyond 2000 are enhanced by food and nutritional planning, using comprehensive frameworks for translating commitments into effective actions. The availability of nutrition and related indicators, provide pointers for refining and scaling up nutrition actions in order to achieve positive nutrition and health outcomes from policy and programme intervention. Effective nutritional surveillance and monitoring nutrition actions are essential to design effective actions. Strategies and measures designed as contributions to achieving nutritional security encompass an integrated package of basic services along with the multiple components of development for agriculture, health, nutrition, education and communities. The socio-cultural context for effective intervention requires community based programming. It also requires encouraging community participation especially from women, leading to their socio-economic empowerment. These programme features evoke behavioural change in Asian communities, leading to improved and more sustainable prospects for nutrition security.
No one solution will be effective in translating the world commitments of Asian governments into effective strategies and mechanisms for achieving nutritional security beyond 2000. Instead, a collective set of policies and nutrition improvement related programme activities are necessary. Enhanced prospects for promoting nutritional status for all are ensured through a combination of improved access (enhanced production and income) to adequate levels of safe and nutritious foods, and to enhanced health and nutrition facilities and education. Serious dialogue among policy makers, researchers, practitioners and concerned groups leading to effective partnerships can optimise Asian prospects beyond 2000. Such partnerships need to be responsive to the expertise of food and nutrition professionals, planners and policy makers, as well as to the diverse perspectives and varied concerns among a wide range of organisations and communities representing food producers and consumers, women and men farmers, and people living in poverty.
More effective local and national governments are essential for other partners, such as individuals, households, communities, NGOs and the private sector, to contribute to nutritional security. Governments must be helped to relinquish those functions that are better performed by others, such as NGOs. Governments need to facilitate nutritional security for all households and individuals, by lending their support for sustaining a socio-economic environment that enables all people to assure their food security. In sum, enhancing Asian prospects beyond 2000 first flows from Asian people's participation and a partnership among Asian people in formulating strategies and designing mechanisms that effectively respond to the diversity in their socio-economic needs and their socio-cultural concerns for achieving nutritional security beyond 2000.
