Professional Documents
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Outline
What is the double burden of malnutrition? Classifying the 9 countries Consequences Policy menu Framing Priorities Evidence Gaps Implications for Australian stakeholders
Malnutrition
Under-nutrition
Interaction of low calorie, low micronutrient diets & infection Manifestations
Premature death Low height for age, weight for age, weight for height Micronutrient diseases Cognitive deficits Immune system deficits Depression
Over-nutrition
Consumption of too much fat, sugar, salt & too little exercise Manifestations
Premature death Obesity, overweight Hypertension, diabetes Heart disease Depression
Drivers
Emergence from poverty in a Westernised, increasingly urbanised , processed food context Information asymmetries Urban space that is not conducive to exercise Undernutrition at an early age in life
Drivers
Poverty Food insecurity Poor care and feeding practices Poor health environment Lack of proven interventions Lack of government commitment
Physiologically
o metabolic programming: Barker hypothesis
Financially
o within health budgets: competition between primary and tertiary spending
Politically
o Urban vs rural, middle income vs lowest income
Progress on reducing undernutrition while overnutrition not taking off: Vietnam, Cambodia
Vietnam - star performer of the set of 9 countries, showing rapid declines in undernutrition, with a low and stable overnutrition situation. Cambodia following in Vietnams footsteps, although it has not yet achieved the same pace of change in undernutrition reduction.
Consequences
15
10 5
0
Cambodia Indonesia Lao PDR Dietary Risks Childhood underweight high plasma fasting glucose high total cholesterol Myanmar Philippines Timor Leste Iron Deficiency sub-optimal breastfeeding high body mass index
Preventing undernutrition and low birth weight early in life reduces the risk of chronic disease striking decades later
Stunted women are 3 times as Preventing undernutrition will likely to give birth to children supercharge the demographic who are stunted by 2 years of age dividend
Stuckler 2008
Multi-country study: for every 10 percent increase in NCD related mortality, annual economic growth would by reduced by 0.5 percent (Stuckler 2008), an estimate that led the World Economic Forum to rank NCDs as one of the top global threats to economic development
Abegunde 2008
In the ASEAN region, a total of seven billion dollars is estimated to have been lost between 2006 and 2015 as a result of NCDs in just five ASEAN nations: Myanmar, Indonesia, the Philippines, Thailand and Vietnam.
Policy Menu
Policy menu
Overwhelming or an opportunity? Need to start somewhere Importance of prioritisation Countries need support to prioritise action Some cross learning across high, middle, low income countries
Framing
www.myworld2015.org
Priorities
Typology
Double Burden
Myanmar
Lao PDR
Priorities for further progress in reducing malnutrition Overall effectiveness of government programmes to improve Urgently need to develop an overnutrition strategy Commitment to malnutrition reduction Collect data on the nutrition situation Improve health environment Adolescents and WRA, Womens Empowerment Food security policy needs to embed disaster risk reduction within it Improve sanitation levels Increased promotion of environments that are conducive to increased physical exercise Food security policy needs to embed disaster risk reduction within it Use S UN to realise potential for a big push overnutrition on undernutrition Need to ramp up attention to Link womens empowerment to nutrition efforts Use S UN to realise increased commitment to stunting reduction Improve health environment S trengthen social protection Focus on strengthening rights basis of service provision Develop an overnutrition strategy Use S UN to realise increased commitment to stunting reduction S trengthen implementation capacity Adolescents and WRA Promote smallholder growth Build in accountability mechanisms Commitment to malnutrition reduction S trengthen implementation capacity Adolescents and WRA Monitor any growing threat of overnutrition Adolescents and women of reproductive age Improve health environment Ensure income growth continues to reduce stunting Focus more on improving infant feeding, enforce new legislation Need health system strengthening
Evidence Gaps
PNG hardly any data until very recently Myanmar, Timor Leste have more data but too little analysis Estimates of consequences of under and over nutrition from the region Little evidence on what works to combat overnutrition No tools for prioritisation and sequencing of actions
Australias Role?