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Report of the Asian Regional Workshop, Bangkok,
Thailand,
3-7 October 1983
Edited by
JEAN E. ANDERSEN and AREE VALYASEVI
The United Nations University
Food and Nutrition Bulletin Supplement 13
This volume is a result of the interest of the United Nations University in the application of the results of its research networks conducting research on the food and nutrition problems of developing countries. It is based on a UNU co-sponsored workshop which summarized and evaluated the nutrition education programmes of Thailand and the Philippines and which also included in its proceedings the experiences with nutrition education in other Asian countries. The introductory contributions feature a critical review of existing methodologies for nutrition education in the Asian context. The experiences and lessons presented are of relevance and value to all developing countries.
It is known that good nutrition leads to good health, and vice versa. However, as long as people are ignorant of the proper ways and means to maintain good health and nutrition, the goal "Health for All by the Year 2000" will be extremely difficult to achieve. It is therefore necessary to seek the most effective and efficient ways and means to educate people, change their attitudes, and modify their practices so that they can keep themselves healthy.
Thailand has adopted the primary health-care (PHC) approach for its health-care service. The Ministry of Health and Mahidol University jointly provide training for PHC workers from Thailand and other ASEAN countries. The Institute of Nutrition has also conducted operational research using various communications techniques, including radio and video tape. Rotary International has given us financial support for the operation of the project. His Excellency Mr. Bhichai Rattakul, the former governor of District 330 of Rotary International, has assisted us in acquiring this support.
The studies in Thailand as well as in other Asian countries indicate the urgent need for innovative and effective communications. As Asian countries have many health problems in common, so they share many socio-economic, cultural, and nutritional similarities. We sincerely hope that the workshop will provide an excellent opportunity for us to share our experience and knowledge as well as to recommend future plans for nutrition and health communication programmes for this region.
There are 47 participants from 13 countries; all of them have been, and still are, actively taking leading roles in health and nutrition education in their respective countries. There are resource persons from the United States and from one Asian country, who have travelled several thousand miles to participate in this workshop. On behalf of the organizers, I should like to express our sincere appreciation for their time and efforts. The outcome of the workshop will feed in to the Fourth Asian Congress of Nutrition, to be held in Bangkok from 1 to 4 November. It is hoped that the Asian nutritionists will derive benefit from our deliberations. Finally, I hope that we will be able to achieve fruitful results and recommendations that will be applicable to each of our respective countries.
During the organization of this workshop, we had valuable advice from the principal consultant, Ms. Jean Andersen, and Professor Nevin Scrimshaw. The organizers wish to express their gratitude for financial support provided by the United Nations University (UNU), the United Nations Children's Fund (UNICEF), and the Coca-Cola Company, Atlanta, Georgia. Dr. L.J. Teply of UNICEF-New York, Mrs. Titi Memet, and Dr. Lay Maung of UNICEFEAPRO facilitated the attendance of Asian participants at the workshop; Mrs. Jane Bunnag of UNICEF-EAPRO provided advice and assistance during the initial planning; and Mrs. Suchada Sangsingkeo of UNICEF-EAPRO rendered valuable assistance in corresponding with workshop participants.
A. Valyasevi
The Asian Regional Workshop on Effective Communications for Nutrition in Primary Health Care was organized with the purpose of evaluating, expediting, and expanding the progress made with communication for health and nutritional improvement. This report on the workshop proceedings includes the papers of resource persons as we]l as the country or project reports presented during the workshop. Three case-study presentations from the Philippines, Indonesia, and Thailand give insights into some of the efforts made by Asian countries in their attempt to develop effective communication for health and nutrition in primary health care.
The main objectives of the workshop were to:
It is hoped that the proceedings will be widely distributed, not only to inform, but also to motivate various national and international agencies and institutions in other developing countries to join us in this effort to achieve health and nutritional improvements for all people.
It gives me great pleasure to preside over the opening ceremony of the Asian Regional Workshop on Effective Communications for Nutrition in Primary Health Care.
Science and technology have progressed very rapidly during the past few decades. However, many health problems still exist, especially among poor rural communities in less developed countries. Progress in medical science has, in the past, emphasized the provision of curative health care. Problems of inadequate health personnel are commonly encountered. In recent years, it has been recognized that preventive and promotive health measures are necessities in a comprehensive and effective approach to health-care service.
To enable people to contribute to their own health care, access to information regarding proper practices is crucial. Gaining information, however, does not always lead to appropriate attitudes and practices.
The process of communication we are concerned with is the transfer of messages, the creation of awareness, and the encouragement of sound practices. Communication for behavioural change is not a simple matter, as behaviours or practices may result from years of accumulated experiences from childhood on. The anthropological and sociological backgrounds of population groups are also influential. Communication with the rural poor is diffficult because illiteracy and traditional beliefs and practices further complicate the challenge of effective communication.
Despite these difficulties, I believe that various countries, governments, and institutions have been seeking ways and means to eradicate the problems. The participants in this workshop, I trust, will use their considerable abilities, knowledge, and experience to the ultimate benefit of all Asian people.
Nutrition surveys have shown that in Asian countries the prevalence of malnutrition is still as high as 50 to 75 per cent among infants and pre-school children. While it is fairly obvious that economic factors are important in uplifting the well-being and nutritional standards of the populace, studies carried out by the FAO in Thailand, Malaysia, and the Philippines clearly reveal that increased income is not always related to improved nutrition, although it does play a significant role. Moreover, an adequate national food supply is certainly not equivalent to adequate nutrition for all a nation's people.
A recent survey of rural villages in Thailand undertaken by the Institute of Nutrition at Mahidol University, under the supervision of Professor Dr. Aree Valyasevi, has shown that regular and frequent nutrition education, provided with health-care and food-producing and income-generating activities, resulted in a striking improvement in the nutritional status of infants and pre-school children in those areas.
It is clear, therefore, that providing sound nutrition information is vital. Food taboos and antiquated food beliefs and practices that have been passed on for generations have always been a great barrier to modifying eating behaviours or habits. Functional illiteracy related to malnutrition and the poor learning environment in rural settings and among disadvantaged urban groups are among the ecological factors that maintain the vicious cycle leading to malnutrition.
In order to break this cycle, an effective means of continuously transferring information on sound nutrition is imperative. This information must be communicated to people with the aim of creating an understanding of its urgency and importance so that people will be convinced that new patterns and practices related to nutrition are in their own interest.
The use of communication techniques to effect behavioural changes is by no means new. Commercial advertising is a good case in point. Those working in health or nutrition education may gain a great deal by examining such communication techniques and using any aspects that would be appropriate for their field. Health and nutrition educators must be guided by the understanding that communication is the art of giving a part of oneself to other people in such a way that they willingly accept this offering.
Advances in communication technology have enabled us to speak with people around the globe. Very often, however, we see that we cannot even bridge the ever widening communication gaps within our own families.
The challenging task is to find effective communication techniques for nutrition and health education. The questions to be answered are:
H.E. Mr. Bhichai Rattakul
Deputy Prime Minister