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Dr. Nevin S. Scrimshaw, Programme Director for Food and Nutrition, and Editor, Food and Nutrition Bulletin Ms. Edwina Murray, Assistant Editor, Food and Nutrition Bulletin* Mrs. Sarah Jeffries, Editorial Consultant, Food and Nutrition Bulletin' Ms. Rebecca Chamberlain, Fellowship Officer.
Food and Nutrition Bulletin, vol. 11, no. 2
(c) The United Nations University, 1989
The United Nations University
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WHFNB-42/WNUP-729 ISBN 92-808 0729-3 ISSN 0379-5721 Printed in Hong Kong
Abraham Horwitz
It is encouraging to report that the field of nutrition is neither dormant nor static in the world. Quite the contrary, there is a great deal of activity relating to nutrition going on within the international community of agencies and a number of the governments they serve. Regarding different actions in food and nutrition, a distinct and dynamic trend can be seen. I would like to highlight some of the major activities.
We certainly have better information about the prevalence of the undernourished population. The "First Report on the World Nutrition Situation" [1] and the recent update on 33 developing countries [2], including some of the least developed, show that even on the basis of a strict indicator-dietary-energy supply (DES) less than 1.1 times the basal metabolic rate (BMR)-the problem is simply enormous. Some believe that it is actually much larger than these reports suggest.
The "Update on the Nutrition Situation" is richer in economic and food indicators and focuses on underweight children since 1980. The update reflects the profound effects of the recession and structural adjustment policies on human welfare, including malnutrition, especially in heavily indebted countries. The need to promote and implement "development with a human face"-to use the felicitous expression of Dr. Richard Jolly of UNICEF-becomes clear. Indeed, it is urgent, because, as the report states, "Decade by decade, the trend in child nutrition seems to be of gradual improvement, if undisturbed by crisis (political, economic, or drought)." Or by epidemics, we may add.
The process of updating information by groups of countries or regions or by examining data on specific nutritional deficiencies must continue if we want to strengthen advocacy for nutrition at the highest decision-making levels of governments. This is one of the statutory responsibilities of the SCN.
Because better information is available, the Inter Agency Food and Nutrition Surveillance Programme was launched and is progressing. The focus must be on the decisions needed to implement policies and programmes leading to the information required. The number of developing countries that can either create or extend an effective surveillance system has clearly increased.
The SCN is starting to collect data on the flow of international resources for nutrition. The method employed, once validated, should be applied to all multilateral and bilateral agencies assisting developing countries, and should also include national funds. The moment will arrive, if we persevere, when we will know reasonably well the prevalence of undernutrition and malnutrition in the world, the resources being invested, and whether the nutrition policies and programmes in operation respond to priorities and to the available scientific evidence.
In emphasizing the dynamism of nutrition in the world today, we can affirm that we have better knowledge about the determinants and the consequences of malnutrition. There is stronger evidence that the most pressing problem in periurban and rural communities, particularly poverty-stricken ones in the developing world, continues to be the synergism of malnutrition and infection. This is still true 25 years after the classic monograph by Scrimshaw, Taylor, and Gordon [3]. The child-survival policy does not regularly include among its activities a nutrition programme, which is essential, particularly for an effective oral rehydration therapy. The classic study by Puffer and Serrano, sponsored by the Pan American Health Organization [4], established that in 57% of the children under five years old examined, malnutrition was an underlying or associated cause of death. We are still far from implementing a comprehensive primary health care approach, as distinguished from a targeted one, to control major infections at the community level.
Preliminary results of the Collaborative Research Support Programme [5] give us better knowledge of the functional effects of substandard levels of food energy intake in the range of mild-to-moderate deprivation. The study focuses on three key functional measures-namely, morbidity, cognitive and behavioural performance, and reproductive outcome. Once the wealth of archived data is examined, one can foresee highly significant policy implications. It is in the interest of all governments and the SCN members to have this fundamental study completed and widely disseminated so that its outcomes can be appropriately translated into policies and programmes.
The impacts of the economic adjustment policies during the 1980s on the health and nutritional status of the poor and, in general, on their living standards, incomes, and consumption are better understood. Remedial measures have been designed and are starting to be applied to the highly indebted, middle-income countries and to low-income Africa, both requiring different overtones in their strategies to protect the poor. Furthermore, the control of food insecurity in Africa, reflected in widespread hunger, is the object of a systematic approach focusing on increasing incomes of the poor, reducing fluctuations of food prices and supplies, and improving the effectiveness of food aid.
There is better evidence, determined by effective growth monitoring, on the significance of food supplementation to prevent malnutrition and promote better health in pregnant and lactating mothers and children under five. Food supplementation is no longer "just medicine" for children with severe protein-energy malnutrition. It must be used for all malnourished human beings.
No doubt we have more experience on how to prevent vitamin-A-deficiency blindness, iodine deficiency diseases, and iron-deficiency anaemia, although they all remain highly prevalent in many areas of the world. We have also advanced our knowledge on the intersectoral linkages that impair food consumption and induce malnutrition. Greater progress has been made in relation to agriculture than education. For instance, it has been documented that extra income for poor rural people is not sufficient, at least in the short-term, to induce substantial improvement in the nutritional status of children of pre-school age.
Among the "missing components" are public health, female education, and reduced energy requirements at work-all of which require further research. We need more information and effective operational approaches to institutionalize the linkages of nutrition with agriculture and with education as well as with other economic and social sectors.
Novel methodologies to change behaviours toward healthful and nutritional practices have been developed and tried with success. Well-tested "rapid assessment procedures" based on anthropological approaches are available. Perhaps more important, we count today a number of large-scale, successful, well-targeted, and well-managed nutrition programmes that can be replicated. On the other hand, there are also countries whose health and nutrition indicators approach those of some of the industrialized societies. The impact of the recession and the adjustment policies was less intense in these countries than in others of the same region.
Although long overdue, there are more studies and programmes focusing on women as essential for increasing the resources of communities and households while protecting the health and nutritional status of their families.
Yet, despite these distinct signs of progress, both conceptual and operational, and several others, the problem of insufficient intake of food, particularly energy intake, and overt malnutrition still shows a high prevalence in the developing world. Depending on the indicators used and the cut-off points, the numbers of undernourished and malnourished vary widely. Experts do not yet seem to have reached agreement. However, using the more strict and limiting indicators, it is accepted that there are at least 340 million human beings undernourished as a result of severely inadequate diets, and that more than 140 million children are stunted, with impaired potential for intellectual and social development and for access to the opportunities that society offers. Small is certainly not beautiful; normal is!
It can be safely asserted that in most developing countries there is not yet a critical mass of mothers and children who benefit from health, food consumption, and nutrition interventions. Nor do governments and the international community of agencies invest enough to reach such a critical mass, sustain its impact, and institutionalize specific processes. Rates of infant mortality, early childhood mortality, specific morbidity in children under five, malnutrition, low birth weight, food consumption, and other indicators justify this assertion. It is known that policies and programmes for better food consumption and nutrition must take into account the economic, social, and cultural characteristics of each nation. However, experience shows that the basic principles and methods to reach specific goals can be adapted to different characteristics. There is indeed a need for more research to refine knowledge and its application, but, at the same time, there is also an urgent need for greater investments to progressively reduce the numbers of underfed and malnourished. This can be done, and, ethically, it should be done.
It is a matter of great distress to note that the numbers of the poor seem to be increasing in the world. Furthermore, the prevailing political ideologies do not seem to know how to deal effectively with the poor, or how to prevent poverty. Because the pace of economic and social development appears to be too slow, the need becomes essential for specific direct interventions targeted to those at greater risk, aiming at improving their nutritional status.
We submit that available national and international resources, if better co-ordinated, could eliminate most undernourishment and malnutrition. Co ordination of plans and programmes within and among the sectors still awaits effective implementation. With the distinct trend toward larger targeted investments in food and nutrition that we witness today, better co-ordination will come to be of paramount importance.
The SCN has been observing and participating actively in this dynamic process for better nutrition in the developing world, as we hope this fifteenth session will show.
References
1. First report on the world nutrition situation. A report compiled from information available to the United Nations agencies of the ACC/SCN. Nov 1987.
2. Update on the nutrition situation: recent trends in nutrition in 33 countries. A report compiled from information available to the ACC/SCN. Jan/Feb 1989.
3. Scrimshaw NS, Taylor CE, Gordon JE. Interactions of nutrition and infection. Geneva: WHO, 1968.
4. Puffer R, Serrano P. Patterns of mortality in Latin American children. Washington, DC: Pan American Health Organization, 1975.
5. Calloway DH, Murphy SP, Beaton GH. Food intake and human function: a cross-project perspective of the collaborative research support program in Egypt, Kenya, and Mexico. Berkeley, Calif, USA: University of California, 1988.
The death of Mogens Jul of cancer on 4 February 1989, in Hillerod, Denmark, deprived the United Nations University of one of its wisest advisers and one of the most dedicated supporters of its food and nutrition research and training activities. A member of the advisory committee of the World Hunger Programme from the founding of the UNU in 1975, Professor Jul served as chairman of the committee from 1978 to 1981.
After obtaining a diploma in chemistry from the Technical University of Denmark in 1937, he joined the Technological Laboratory, Danish Ministry of Fisheries, where he was director from 1942 to 1948. Concurrently, he was Associate Professor in Fishery Industry at the Technical University, head of the Faculty of Chemistry, and comanager of the Danish Institute of Refrigeration. In 1948 he was named head of the Department of Technology, FAO Fishery Division, in Washington, D.C., and continued in this position in Rome, Italy, from 1951 to 1953.
He was then asked to return to Denmark to establish what was later known as the Danish Meat Research Institute, in Roskilde. He was director there from 1953 to 1968. During that period, he founded a chair in food preservation at the Royal Danish Veterinary and Agricultural University and became the first associate professor there from 1955 to 1985. He was also head of the Danish Meat Products Laboratory, Ministry of Agriculture, a part-time position which he held from 1955 to 1971, and was then engaged there fuII-time until his official retirement in 1984.
He was extraordinarily effective as head of the secretariat of the Protein Advisory Group of the United Nations in New York from 1968 to 1971. After returning to Denmark, he founded the Danish Research Institute for Poultry Processing, where he was director from 1971 to 1980.
Professor Jul's creative abilities were called on both nationally and internationally. Simultaneously with his position as head of literally all meat and poultry research in Denmark, he was instrumental in the founding of the Danish Meat Trade School and establishing food-science education at the Veterinary and Agricultural University. He was also a board member of the Danish Agricultural Data Processing Centre, the Planning Group of the Danish Bacon Factories Export Association, the Agricultural Consultative Group for Research, and the Technical Board of the Poultry Export Association.
For some time he was chairman of the Chemical Engineering Group in the Danish Society of Civil Engineers, and he became co-founder and first chairman of the Danish Society for Food Technology and Hygiene. The (Danish) Academy for Technical Sciences also made frequent use of his skills. From 1957 to 1964 he was vice-president and chairman of one of its sections, a board member of the Danish Technical Information Service, of the Protein Chemistry Institute, and of the Industrial Ph. D. Diploma Committee. After his official retirement, he became chairman of the Academy's Catering Committee and was one of the driving forces behind the foundation of the Danish Catering Centre.
Professor Jul was also very active in public committees, nationally and internationally. In Denmark he was chairman of a working party under the Danish International Development Agency (DANIDA) which created an FAO Veterinary Faculty at the Veterinary and Agricultural University. He was a member of the DANIDA Technical Committee on Agriculture, of the Committee on Technology Assessment of Food Industries under the Ministry of Environment, and of a joint FAO/DANIDA evaluation mission on dairy development programmes in less-developed countries. For several years he was also a board member of the Danish Technical Research Council.
From 1979 until his death, he was vice-president of the Intra-European Research Programmes COST 91 and COST 91 bis, entitled the Influence of Processing and Distribution on the Quality and Nutritive Value of Foods. He was head of the evaluation mission for the largest dairy development in the world under the World Food Programme in India in 1975-1976. Two of his reports on this project were published in the Food and Nutrition Bulletin (vol. 1, no. 3 [1979], pp. 15-19; and vol. 7, no. 2 [1985], pp. 14-20). He served as a consultant to UNIDO on food technology and nutrition research, and to the secretariat of the Nordic Council on nutrition policy in 1985, to the Danish Ministry of Agriculture on food research in 19861987, and to the International Foundation for Science on food technology and village development in 1986.
The Commission of the European Communities (CEC) made frequent use of his skills. He was a member of the CEC Programme Committee for Food Research under the Permanent Committee for Agricultural Research in 1978, and co-ordinator for Poultry Research from 1980 to 1984.
Active in management, he was a member of the planning council for the Management Centre Europe, in Brussels, and a research and development consultant for short periods in several sectors of private food and beverage industries. He was a member of the International Committee of Food Science and Technology from 1964 to 1968, became a Fellow of the Institute of Food Science and Technology, UK, in 1965 and a Fellow of the Institute of Food Technology, USA, in 1981, and was an honorary member of several Danish societies.
Within the UNU, Professor Jul was responsible for a number of significant initiatives, including a joint meeting with the UNU Human and Social Development Programme on "Goals, Processes, and Indicators for Development" in 1979, and a multidisciplinary workshop held at the Rockefeller Foundation Conference Center in Bellagio, Italy, in 1980. The report of this meeting shaped the direction of UNU food and nutrition activities for the next five-year period. He was also a tireless supporter of the fellowship programme, and he interviewed potential fellows in many different countries.
No one who has worked with the United Nations University during this period will ever forget the gentleness, tact, and good judgement with which Professor Jul presided over advisory committees, task forces, and workshops. Both his talents and his gracious personality will be greatly missed.