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Third CARRA Inter-Agency Conference

April 14-15, 2011Almaty

Food Security and NutritionVilma Q. Tyler

UNICEF-CEE/CIS

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Global food prices are just 3% below the peak in June 2008

Perpetual Cycle of Hunger

The Cycle of Hunger

Malnourished mother has low

birth weight baby

Child does not get enough

food

Underweight female

Inadequate food intake

during pregnancy

Inadequate weight gain

during pregnancy

What are the underlying causes of undernutrition?

• Undernutrition has many inter-related causes which need to be identified in order to be effectively addressed.

• The conceptual framework, first developed by UNICEF in 1990, has been very important in helping people frame their ideas and discussions.

The conceptual framework

From: UNICEF. State of the World’s Children 1998. New York: 1998

The conceptual framework

The conceptual framework

The conceptual framework

How does it happen?The infection-undernutrition cycle

Increased incidence, severity and duration of

disease

Inadequate diet

Loss of appetiteMalabsorption

Increased nutritional requirements

Weight lossGrowth faltering

Lowered immunity

When does illness lead to undernutrition?

Bottom line….

• Illness does not lead to undernutrition among those with adequate diets.

When does illness lead to undernutrition?

But….

• Illness leads to more and more severe undernutrition if the diet is inadequate.

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What about height for age?

• HFA highlights evidence of growth failure at a given age

• HFA does not distinguish between two children of the same height and age, one who is very thin while the other is very fat.

Inapparent undernutrition

Inapparent undernutrition

103 cm7 years old

125 cm7 years old

100 cm4 years old

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Stunting

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Nutrition Status in the Central Asian Countries, 2008

Country

infants with low

birthweight

Under five

mortality rate 2008

rate of population under five (2003-2008) households

consuming iodized

salt

GNI/ capita under-

weighted suffering

from stunting

suffering from

wasting % % % % % % USD

Kazakhstan 6 30 4 17 5 92 6,140 Kyrgyzstan 5 38 3 18 3 76 740 Tajikistan 10 64 18 39 7 49 600 Turkmenistan 4 48 11 19 7 87 2,840 Uzbekistan 5 38 5 19 4 53 910

Source: UNICEF, Statistics, Nutrition; www.unicef.org

-2

-1,75

-1,5

-1,25

-1

-0,75

-0,5

-0,25

0

0,25

0,5

0,75

1

1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58

Age (months)

Z-s

core

s (W

HO

)

Weight for age (WAZ)Weight for length (WHZ)Height for age (HAZ)

Mean anthropometric z-scores by age for all 54 studies, relative to the WHO standard

Source: Victora CG, de Onis M, Hallal PC, Blössner M, Shrimpton R. Worldwide timing of growth faltering: revisiting implications for interventions using the World Health Organization growth standards. Pediatrics, 2010

Window of opportunity for intervention: pregnancy to 2 years

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More than just food prices….• Key concern is secondary impact on health and nutrition of

women and children– Increase in extreme poverty (<1.25USD/day) associated with

malnutrition

• In light of other emergencies. Price increases taking place in context of further climatic instability and natural disasters, endemic HIV/AIDS, and political crises, potentially increasing emergency response needs.

• Strategic partnership is essential to address the underlying causes. While food production and pricing are not typically in the mandate of organizations working in nutrition , nutrition groups can help mitigate short term outcomes and support addressing underlying causes

• Threat to achieving MDGs-Without collaborative efforts, there is a very real threat to achieving the MDGs and/or losing ground

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And more than just food…The goal is “nutrition security”, which entails:

• Access to appropriate micronutrients, • safe water, hygiene and sanitation, • quality health care services, • improved household and community practices on child care

and food hygiene, • environmental health.

Nutrition security is achieved when adequate food (quantity, quality, safety, socio-cultural acceptability) is available and accessible for and satisfactorily used and utilized by all individuals at all times to live a healthy and active life.

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At regional level:

Affected regions are (FAO, World Bank and UNICEF):Central and Eastern Europe is the most affected

(heavy reliance on food imports)

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At household level:• Impact at household level often linked to coping strategies (see next

slide)

• Poor households tend to employ coping strategies that undermine the well being of household members, for example – choosing to eat cheaper, less nutritious food – Reallocation of limited household budgets from education to other needs– Limited use of health services because of cost

• However, understanding of impact of coping strategies and intrahousehold distribution of food/food intake at individual level not systematically characterized within countries, nor is information systematically disaggregated along gender/age/non economic vulnerability characteristics.

2010-2011 Food Price Increase 23

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A Food Security, Livelihoods and Nutrition Assessment in Tajikistan

June/July 2008

Food insecurity was associated with more frequent use of strategies likely to have a negative impact on health and nutritional status on the short and medium term:

• up to 40% of the severely food insecure spent entire days without eating and 20% of the moderately food insecure, compared to 7% of the food secure;

• between 78% and 86% of the food insecure reduced the number of meals eaten in a day (versus 54% of the food secure);

• between 82% and 88% of the food insecure limited portion sizes at meals (versus 62% of the food secure);

• about half of the food insecure decreased their health expenditures (versus 1/4th of the food secure).

• More frequent use of strategies likely to have a negative impact on livelihoods on the medium term:

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More frequent use of strategies likely to have a negative impact on livelihoods on the medium term:

•more than half of the food insecure incurred debts for food (56-64%) compared to 1/4th of the food secure;•10-12% of the food insecure took their children out of school (compared to 4% of the food secure);•17-19% of the food insecure sold assets (versus 5% of the food secure).

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What organizations working in nutrition can do at Country level

Building on the guidance issued for the previous food price crisis, nutrition activities to mitigate effects of food prices hikes still remains relevant and should include:

• Identification of and participation in relevant food security and nutrition networks. If these are not in place, to lobby with WB, FAO, IMF, WFP to engage government to establish/strengthen linkages.

• Improve country level analysis of the impact of the increase in food price, in collaboration with FAO, WFP, the World Bank and local government.

• Advocate for broad-based introduction and expansion of social safety nets for children in the severely affected countries and provide related technical assistance.

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What organizations working in nutrition can do at Country level

(cont’d)• Scale up of Nutrition programme activities that assess,

prevent and treat undernutrition and adverse effects on children.

• Strengthen the evidence base for policy development and programmatic decision making including targeting programme interventions to mitigate impact on vulnerable populations.

• Support and advocate for policy recommendations for

Governments on how to best protect vulnerable children from the negative effects of rising food prices and aadvocate for the protection of children from the adverse effects of rising food prices.

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Thank-you