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PREFACE
Dramatic changes are taking place within the nutrition community.
New scientific evidence on the generational and intergenerational
links between nutritional status at different stages of the life
cycle is compelling. Undernourished adolescent girls and women
give birth to underweight and often stunted babies. These
infants are less able to learn as young children and are more
likely themselves to be parents to infants with intrauterine
growth retardation and low birthweight. Moreover they are less
able to generate livelihoods and are less well equipped to resist
chronic disease in later life. Such life-cycle and intergenerational
links demand sustained, long-term ameliorative action. In this
regard, the emergence of the human rights paradigm provides
powerful guidance in the formulation of appropriate policies and
programmes.
Dramatic changes are also taking place in the world as we enter
a new millenium. The ease with which resources - people, assets,
goods, and information - can move within and across national
boundaries increased dramatically in the 1990s. This globalization
poses tremendous challenges for the nutrition community. It also
provides tremendous opportunities for securing increased
resources to reduce malnutrition.
The structure and content of the Fourth Report reflects these two
sets of changes. All the subjects covered by the Third Report
(1997) remain in the Fourth Report. New to this report are the life-
cycle perspective on human nutrition and the challenges and
opportunities presented by the global forces that are shaping our
lives.
Chapter 1 describes the state of nutrition in the developing
world. This function remains the essence of the World Nutrition
Situation Report. Prevalences and number of young child
underweight, stunting, and wasting are presented with regional
and sub-regional breakdowns. What is new is the addition of
data from different stages in the life cycle - not just for children
under five. Descriptions of foetal, school age, adolescent, adult
and elderly nutritional status are included. The reader will,
however, note the paucity of high-quality data on nutritional
status for many of these groups. In general we present the
available data with appropriate caveats about their overall
reliability, but clearly this lack of comprehensive data is a major
challenge to the nutrition community and the UN family.
Chapter 2 on micronutrients provides an update of progress in
this area during 1998 and 1999. It describe advances in our
understanding of the nature, causes and consequences of
various micronutrient deficiencies along with actions taken to
combat them. While some new data are presents, there remains
a great need for nationally representative data on the prevalence
and trends in micronutrient deficiencies to inform and improve
policy and programme decisions. Lessons learned, both in
operational research and in the implementation of control
strategies, need to continue to be documented and disseminated.
In Chapter 3, data on breastfeeding and complementary feeding
are highlighted for the first time in an ACC/SCN World Nutrition
Situation Report. While the nutrition community has understood
the benefits of both for some time, this report - which focuses on
the life cycle - highlights the importance of infant feeding
practices as a predictor of human health into adulthood. Evidence
suggests that both breastfeeding and appropriate
complementary feeding lead to improved outcomes, but in a
world plagued by HIV and increasing urbanization, new sets of
challenges have risen for local, national, and international
members of the nutrition community. While some of these
challenges are being met, others represent growing threats.
Chapter 4 on nutrition and human development highlights the
relevance of nutrition for the overall developmental process. The
first part of the chapter focuses on the implications for
development of recent findings in international nutrition. First
some evidence is presented on the strong links between infant
undernutrition and cognitive development. Second, the policy
implications of the emerging link between foetal undernutrition
and adult chronic disease for nutrition policy are drawn out. Third,
the importance of community empowerment to the overall
development process is discussed, as is the ability of community-
based nutrition initiatives to empower communities beyond
immediate nutrition concerns.
The second part of Chapter 4 focuses on how some of the broad
ranges taking place on the global stage are affecting nutrition.
First, the implications of the Asian financial crisis for the design of
social safety nets are discussed in the context of an Indonesian
case study. Second, the implications of the increased ease with
which food can be traded are discussed, together with the need
for clear and enforceable food safety standards for the protection
of food producers and consumers. Third, the challenges and
opportunities presented to the nutrition community by the
explosion in information and communications technology are
considered. Fourth, the current rapid rate of urbanization poses
new challenges to the nutrition community, for urban areas will
challenge the preconceived notions of many in the nutrition
community about what works and what does not. the last part of
this section of the chapter provides an update on the spread of
HIV/AIDS and the implications for the nutrition community. It is no
coincidence that the region with 89% of all cases of HIV/AIDS -
Sub-Saharan Africa - is also the only region in which the rate of
undernutrition is worsening.
Finally, the chapter closes with a description of how the human
rights paradigm has emerged as a potentially powerful way of
analyzing and practicing development, particularly in the last 15
years. The success of the human rights-based approaches in
accelerating reductions in malnutrition will depend on the
perceived value added they bring to communities and to the
nutrition professionals working with those communities. It is clear
from the Fourth Report that while progress is being made in
reducing malnutrition, much remains to be done. The challenge
for all readers of this document is to capitalise on the potential of
the powerful rights based paradigm and to use it, along with all
the other resources at our disposal, to rapidly diminish the
scourge of malnutrition.
Chapter 5 is concerned with the nutrition of refugees and
displaced populations. This final chapter provides an overview of
the trends and developments in the humanitarian nutritional
response to displacement emergencies, drawing on recent
examples to highlight the problems encountered. The first section
of the chapter describes the international humanitarian
structures and systems involved in nutritional emergencies and
their coordination. This is followed by a consideration of recent
developments in assessment and early warning methodologies.
The third section describes trends in food and nutrition
programmes in emergency situations, including strategies to
support food, security, care, and the transition to self-reliance
and to prevent micronutrient deficiencies. Six case studies of
current displacement emergencies are then presented to
illustrate the wide range of prevalences of undernutrition in
displacement emergencies and response to these crises. The
case studies include Angola, the Balkans region, southern Sudan,
and the United Republic of Tanzania.
The chapter concludes by identifying emerging issues (policy,
operational, and research) relevant to the nutrition of refugees
and displaced populations. The importance of a broad problem-
solving approach to assessing and responding to nutritional
problems in emergencies is emphasized.