nutrition and health impact of agriculture and food systems in thailand

Senior Advisor , Institute of Nutrition , Mahidol U.

Chairman of the Planning Committee on Strategic Frame work for Food Management (SFFM) in Thailand of the National Food Committee

Presentation at the WFD, Bangkok, 26 November 2013

Prof. Kraisid Tontisirin M.D., Ph.D

• Has succeeded in reduced maternal and child malnutrition since the eighty by mutistakeholder efforts under the Poverty Alleviation Plan (PAP)

• Currently Thailand is facing with double burden of malnutrition (DBM), a coexistence of under and over

nutrition, and related non-communicable diseases

(NCDs) 2

Kraisid Tontisirin, Mahidol University

• Promotion• Protection• Treatment

Food Nutrition Health• Agriculture/• Food supply/• Service

Nutrition is a link between food and health, regarding the fulfillment of nutrient and non-nutrient

requirements from food in human life cycle.

Nutrition well-being for all

Ultimate Goals


Poverty Alleviation Plan (PAP)• From 1982 onward• Malnutrition was considered as symptom of poverty• With organization changes for management of rural development• With 5 basic principles: poor area, basic services, appropriate technology, self-help and community participation

PAP

Fd/Nut.Prog. PHC BMN indicatorsKraisid Tontisirin, Mahidol University

Community-Based Approaches

• Is an integrated program implemented at local level (district level and below)

• National commitment with sound nutrition improvement strategies and goals

• Community actions: basic services, mass mobilization, mutual efforts/actions to reach all people and to prevent malnutrition


Minimum Basic Services(Health, Education, Agr. Extension)

Supportive System•Training•Funding

•Problem Solving•Supervision

Interface(service providers and

community leaders)•Plan/goals

•Implementation•Monitoring/evaluation

Community LeadersFamily

Individual

Basic Minimum Needs Goals/Indicators

Menus (Activities)•Antenatal Cares (ANC)Antenatal Cares (ANC)•Growth Monitoring and Growth Monitoring and Promotion (GMP)Promotion (GMP)•Food productionFood production•Food and nutrition Food and nutrition educationeducation•Food sanitation & Food sanitation & safetysafety•School lunch and milkSchool lunch and milk program since 1992 program since 1992 •Other activitiesOther activities Mobilizers

(1:10 households)

Facilitators

Components of a successful community based program Components of a successful community based program


Maternal and child nutrition andhealth Thailand, 1980-2006


1980 1990 2006ANC coverage % 35 75 95Anemia in preg. %

50-75 18.8 10

LBW % 16 10 <10PEM (Wt/Age of U 5)% 51 20 <10

Trend of nutritional status of children

aged 1-5 years*

Stunting Underweight Overweight&Obesity

NHES 2; Holistic Development of Thai Children; NFNS 5; NHES 4

%

*Courtesy from Dr. Umaporn Suthutvaravut

Roles of agriculture and food systems

• Food production for subsistence economy: for consumption and income

• Promote local healthy snacks as food supplement for pregnant mothers

• Promote complementary food for infants and young children: at household and community levels

• School gardens and school lunch program• Local daily farm for school milk program: a win-

win activities


Multi-stakeholder Comm.

Nutrition goals and healthindicators are incorporatedto strategies and actions.

Community basedapproaches

National Rural Development Committee

Poverty Alleviation Plan

Provision of basic services with mass mobilization:1volunteer /10 households Agri.& food production

for subsistence econ.,

suppl. food for mothers, complementary food for IYC & dairy farm for sch.


• Population 64.6 millions • 12th largest exporter of agriculture and food products

• Main food exported products : e.g. Rice Processed Chicken Processed Pineapples Fishery Products

11Kraisid Tontisirin, Mahidol University

Thailand

-- Kitchen of the World --

12

Export Value of Food in 2011

27,809.47 million US$and was 34,330

millions $ in 2012


Thailand: Current Thailand: Current situationsituation

Facing with the double burden of

malnutrition (DBM) and food

safety issue


Thailand National Thailand National Food Committee Act of 2008Food Committee Act of 2008

FoodSafety

FoodSecurity

11 related ministries , 30 national agencies, 30 relevant Acts

FoodQuality

Ministry of Commerce

Ministry of Interior

Ministry of Science

Ministry of Education

Ministry of Agriculture

Ministry of Finance

Ministry of Foreign Affairs

Ministry of Social Development

and Human SecurityMinistry of

IndustryMinistry of

Public HealthMinistry of

Defense

The National Security Council

The National Economic and Social Development board

The Consumer Protection Board

The national Healthcommittee


Chairman : Prime Minister (or designated Deputy-Prime Minister)

7 Resource persons in :-Food Security (2) -Food Safety (1) -Food Quality (1) -Law (1) -Economic and Trade (1) -Food Innovation (1)

Secretary: FDA, Ministry of Public HealthCo-secretary : ACFS, Ministry of Agriculture

The National Food Committee Component

Committee / Sub-Committee

Committee membersCommittee members

Ministry of Commerce

Ministry of Interior

Ministry of Science

Ministry of Education

Ministry of Agriculture and Commodity

Ministry of Finance

Ministry of Foreign Affairs

Ministry of Social development

and human securityMinistry of

IndustryMinistry of

Public HealthMinistry of Defense

The National Security Council

The National Economic and Social Development board

The Consumer Protection board

The national healthcommittee

11 related ministries, 4 executive administrators


The Authority of the National Food The Authority of the National Food CommitteeCommittee

Setting policy, planning strategies, monitoring and assessing

Advices and provisions of guidance to the related ministries / authorities

Advices the cabinet in case of food disaster or bioterrorism for action

and land uses

Meeting at least 2 times a year


SO

W

T

Strength1. Fertile food production resources 2. Food contribute significantly to

socio-economic and cultural development

3. Thai foods are unique and well accepted internationally

4. Continued improvement in food production and agro-industry

Threat1. Agriculture and food production sectors are not popular among young generation2. Competition for agriculture production resources for food, feed, fuel, bioproduct and non- food crop 3. New threats from global warming , plant/ animals diseases4. Trade competition and barriers

Weakness1. Complexity in food management 2. Inadequate inputs for small food producers 3. Degradation and deterioration of

land and water in certain areas 4. Low investment in R&D5. High l ogistic cost related to food 6. Weak consumer awareness

Opportunity1.Increasing demand of high quality,

safe and nutritious food2. Global recognition of Thai food and

food culture3. Food is always in demand and

more in crisis situations4. Geographical Location of the

country is conductive to trade5. New innovation and technology in

food17

SWOT Analysis


• Food production• Nutrition orientation for healthy diet• Food, feed and fuel and bio-products• Climate changes

• Promotion• Protection• Treatment

Food Nutrition Health• Agriculture• Food supply• Food Service

• Nutrient needs• Dietary intakes• Nutritional wellbeing• Nutrition literacy

• Food quality• Food safety(Consumer and Trade)

F o o d C u l t u r e

F o o d S e c u r i t y

F o o d a n d N u t r i t i o n E d u c a t i o n

Continuum from Agriculture to Health

• Safe from Hazards Good health


Safe and Nutritious

Food

Good Hygienic Practices

Good Manufacturing Practices

Good Agricultural Practices

Land Use Water Management

Plant and Animal Agro- Biodiversity (Genetics)

Plant and Animal Diseases Prevention and

Control

Nutrition For Plant and

Animal

OUTCOMES

GOOD PRACTICES

BASIC ISSUES

Food ChainApproach


1. Efficient and effective management of food production resources2. Ensuring high quality, safe and nutritious food produced at

household, community, and industrial levels3. Promotion of R&D and utilization of knowledge along the food chain4. Strengthening food management systems (food law, food database,

etc.)5. Ensuring food security in both normal and crisis situation at the

household, community and national levels 20


21

THEMES, THEMES, STRATEGIES & STRATEGIES & MEASURES :MEASURES :


Principle : Ensuring a sustainable food security and effective management of food production resources by active stakeholders participation

Natural & Agricultural Resources


Production Supply & Access

Establish Crisis Management Systems

• Land & Water Mgt/Reforming• Balancing Food,

Feed & Fuel

• Innovation & Technology • Food Production Zoning

• Enhancing Food Access at Household & Communities

• Logistics Improvement

Active Stakeholders Participation

R & D Along the Food Chain

• Capacity Development & Career

22

Theme 2Theme 2 : Food Quality and Safety: Food Quality and Safety

Community Food Production Food Industry

Food Standards

Principle : Ensuring high quality and safe food to protect consumer health and to facilitate domestic/international trade


• Strengthening Community Food Processing (food loss reduction / value added)

• Strengthening - Value Added - Enhance Production Practices

• Establishment of harmonized standards • Strengthening of food quality and safety assurance systems• Trading & marketing promotion

• Quality• Safety• Nutrition

23

Theme 3Theme 3 : Food Education : Food Education Principle : R&D and knowledge utilization through engaging

stakeholders in sustainable and effective use of food production resources along the food chain and also strengthening desirable consumption behavior for well-being

Knowledge Integration

R&D

Knowledge Utilization

Knowledge Utilization & Practice

Basic

Best Practice

Output Research and Knowledge Development

Knowledge Dissemination


Theme 4Theme 4 : System Management: System ManagementPrinciple : Effective food management systems along the

food chainto deal with current and emerging issues in food

Reorganization &

Strengthening

Revise and Reform

Database & Management

System

Organization

Legal system


A Cabinet Resolution on A Cabinet Resolution on ““Thailand Food Thailand Food Strategy”Strategy”

ApprovedApproved The Strategic The Strategic

Framework of Food Framework of Food Management Management

on 25 November 2010 on 25 November 2010 by the Cabinetby the Cabinet


Implementation of the Strategic Framework of Food Management

(SFFM)1. Integrated the SFFM in the 11th National

Economic & Social Development Plan 2012-2016

2. Each sector implementing the SFFM & reports back to the National Food Committee

3. Three thematic committees for promotion the implementation on: Food Security, Food Quality

& Safety, and Linking of Food to Nutrition& Health


Safe

and

Nutritio

us

Food

Good H

ygie

nic P

ractice

s

Good M

anufa

cturin

gPra

ctices

Good A

gricu

ltura

l Pra

ctices

Land U

seW

ate

r Managem

ent

Pla

nt a

nd A

nim

al

Agro

-Bio

div

ersity

(G

enetics)

Pla

nt a

nd A

nim

al

Dise

ase

s Pre

ventio

n a

nd

Contro

l

Nutritio

n F

or

Pla

nt a

nd A

nim

al

Safe

and

Nutritio

us

Food

Good H

ygie

nic P

ractice

s

Good M

anufa

cturin

gPra

ctices

Good A

gricu

ltura

l Pra

ctices

Land U

seW

ate

r Managem

ent

Pla

nt a

nd A

nim

al

Agro

-Bio

div

ersity

(G

enetics)

Pla

nt a

nd A

nim

al

Dise

ase

s Pre

ventio

n a

nd

Contro

l

Nutritio

n F

or

Pla

nt a

nd A

nim

al

Information /Standard and Knowledge based

Safety

Quality /

Diversity

Linking of Food, Nutrition and Health

28

ProductionProduction

Safe and Nutritious

Food

►Access►knowledge►Behavior - Diet pattern/Sanitary - Life style /Exercise

►Domestic/ Imported Food - Primary Product - OTOP - Industrial

►Restaurant ►Catering►Mobile Food Service Facility►School ►Household►Market

SupSupplyply

ServiServicece

Good Good NutritiNutrition&on&Good Good HealthHealth

ConsuConsumptiomptio

nn

Surveillance


1. Standards & indicators on nutrition & related disease2. Food based dietary guidelines (FBDGs)3. Food, nutrition & dietetic education4. Promotion for more vegetable & fruit consumption5. Reduction of sugar, fat & salt in food6. School food & nutrition program7. Community based nutrition program to promote nutrition & health8. Nutrition & related disease surveillance & survey 9. Food and nutrition management during crisis

Key Issues Linking Food, Nutrition & Key Issues Linking Food, Nutrition & HealthHealth


Community Based Program for Food, Nutrition & Health Community Based Program for Food, Nutrition & Health

Interface


Minimum Basic Services(Health, Education, Agricultural

Extension)

(service providers and community leaders)• Plan/goals• Implementation• Monitoring/evaluation

Supportive Supportive SystemSystem• Training

• Funding• Problem Solving• Supervision

Community LeadersFamily

Individual

Minimum Indicators of well-being & NCDs

Volunteers(1:10 households)

Facilitators

:

Menu (Activities)• Antenatal careAntenatal care• Growth monitoringGrowth monitoring /promotion/promotion•Elderly caresElderly cares•Cares of NCDsCares of NCDs• Food productionFood production• Nutrition educationNutrition education• Food sanitation Food sanitation & safety& safety• Other activitiesOther activities (Tobacco and alcoholic (Tobacco and alcoholic consumption control)consumption control)•Recreation and physical Recreation and physical activities)activities)•Etc.Etc.

Roles of agriculture and food systems beyond the year 2015 for nutrition

• Ensuring nutritious and safe food supply of healthy diets through human life course

• Be a key partner to prevent DBM and NCDs by supplying adequate fruits & vegetables; low sugar, fat and sodium foods; healthy fats…etc

• Care for environment and sustainable development

• As a source of income


Multi-stakeholder Comm.

SFFM covers: FoodSecurity, Quality & Safety,Education & Research,Management

Linking of food, nutrition &health implemented atcentral & community levelsfor nutrition and p/c of NCDs.

National Food Committee

Str Framewk for Food Mgt (SFFM)

Roles of agriculture and food systems: •Ensuring nutritious and safe food supply e.g.fruits & veg; low sugar, fat & sodium foods; legume & fishes …etc •Caring of environment & sustainable agriculture.


1962

1967

1972

1977

1982

1987

1992

1997

2002

2007

2012

1st NEDP

2nd NEDP

3rd NEDP

4th NESDP

5th NESDP

6th NESDP

7th NESDP

8th NESDP

9th NESDP

10th NESDP

11th NESDP

2017

: Economic Infrastructure, Sectoral Plans

: + Poverty Alleviation Plan (PAP) + Integrated and implemented PHC + FNP and Basic Minimum Needs (BMN) Indicators in rural/urban communities

: + Social Plan + Food and Nutrition Plan (FNP) + Primary Health Care (PHC)

: Improvement of Agriculture, Infrastructure

: 1992 + School Lunch Program (SLP) + School Milk Program (SMP)

19601 - Anaemia in preg: 57%; - B1 deficiency: 23%; - B2 deficiency: 47%; - Low serum retinal: 38%; - Goitre in school children: 29% - PEM cases

19812 - PEM (Wt/Age of U 5): > 50%

19863 - PEM (Wt/Age of U 5): 30%

19956 - B1 deficiency: < 1%; - B2 deficiency: < 1%

19894 - Goitre in school children: 19%

1996 - PEM3 (Wt/Age of U 5): 15% - Anaemia in preg5: 13%; - Goiter in school children4: 4%

20034 - Goitre in school children: 1%

20067 - PEM (Wt/Age of U 5): 9% 2007 - UI in preg8 < 150 µg/L: 61%; - Low serum retinal9: 16%20088 - UI in preg < 150 µg/L: 56% 20108 - UI in preg < 150 µg/L: 43% 201210 - PEM (Wt/Age of U 5): 7%

19915 - Anaemia in preg: 18%

: 2008 + National Food Committee Act : 2010 + Strategic Framework for Food Management (SFFM) approved by cabinet : Integration of the SFFM and the 11th NESDP

: Promote cooperation and integration of all relevant sectors, academia, business and NGOs to strengthen national food and nutrition security : 2012 - Triferidine tablet (iron+folate+iodine)

: 2011 - Universal salt iodisation (USI)

2005 - Anaemia in preg: 10%

Nutrition Situation Thailand’s Development Plans

Policies and Strategies

Figure Milestones of Thailand’s National Social and Economical Development Plan related to food and nutrition

(Started working in nutrition since 1974)

(Worked at FAO, 2000-2006)


Food Systems in ThailandTraditional Food Systems Modern Food Systems

• Food supply at household & community level.

• Include production for business in small & medium scales • Use primary food preservation (e.g. smoking, sun drying,

fermentation, salting)

•Mass production/ Large scale•Apply scientific knowledge & technology in food processing•Aware of food quality & safety•Advance in trade information systems

How both systems could contribute for healthy agriculture, health diets &nutrition, and healthy people and prosperity

Challenge

Conclusion 1• Thailand had been successful in alleviation of

undernutrition under the National Rural development Committee implementing the Poverty alleviation Plan but currently is hfacing with the Double Burden of Malnutrition (DBM)

• Agriculture and food systems are fundamental for ensuring safe and nutritious food supply of fresh and processed foods at household, community, national and global levels.


Conclusion 2• Multiple strategies and actions linking between

macro policy and strategies with actions at community level will lead to the success outcomes and impacts on nutrition.

• Under the National Food Committee, the Strategic Framework for Food Management (SFFM) had been approved by the Cabinet and has been implementing with aims for food and nutrition security, food quality and safety, and sustainable development.


Conclusion 3

Ultimate goals of the SFFM in Thailand are healthy agriculture and food systems,

health nutrition, health people and prosperity.


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nutrition and health impact of agriculture and food systems in thailand

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