Proceedings of the Joint WHO/FAO workshop held at the 8th Asian Congress of Nutrition, Seoul, Korea
The achievement of nutrition security at the household level involves adequacy of food supply at the national level and equitable distribution of food among the population in accordance with their physiological needs. The emergence of globalization and market liberalization and the increasing power of some transnational corporations that are advocating pharmaceutical shortcuts have raised concerns in many developing countries. In order to achieve adequacy of food production, earlier mistakes (such as a reliance on unsustainable new technologies) need to be corrected and the resultant imbalances with respect to food production need to be reversed. Emerging new technologies, including genetic modifications, need to be effectively harnessed and adapted with due consideration to safety and sustainability. There is a need to collect convincing evidence of the efficacy and safety of genetically modified foods before they can gain general public acceptance. Information technology will play an important role in future programmes of food production and developing countries must strive to achieve access to this technology. There is considerable scope and need for the expansion of agro-based industries in villages and townships. This could create job opportunities and could also lead to better production and more effective utilization of local food resources by the community and reduce the present considerable loss of perishable food items. Household nutrition security means more than avoidance of chronic starvation. Policy makers of developing countries should set, as their target in the next century, the achievement of adequate nutrition rather than mere survival.
The rapid shift in the stage of nutrition towards a pattern of degenerative disease is accelerating in the developing world. Data from China, as shown by the China Health and Nutrition Survey, between 1989 and 1993, are illustrative of these shifts. For example, an increase from 22.8 to 66.6% in the proportion of adults consuming a higher-fat diet, rapid shifts in the structure of diet as income changes, and important price relationships are examples that are presented. There appears to reflect a basic shift in eating preferences, induced mainly by shifts in income, prices and food availability, but also by the modern food industry and the mass media. Furthermore, the remarkable shift in the occupations structure in lower-income countries from agricultural labour towards employment in manufacturing and services implies a reduction in energy expenditure. One consequence of the nutrition transition has been a decline in undernutrition accompanied by a rapid increase in obesity. There are marked differences between urban and rural eating patterns, particularly regarding the consumption of food prepared away from home. Other issues considered are the fetal origins hypothesis, whereby the metabolic efficiencies that served well in conditions of fetal undernutrition become maladaptive with overnutrition, leading to the development of abnormal lipid profiles, altered glucose and insulin metabolism and obesity. Furthermore, obesity and activity are closely linked with adult-onset diabetes. The shift towards a diet higher in fat and meat and lower in carbohydrates and fibre, together with the shift towards less onerous physical activity, carries unwanted nutritional and health effects. It is also clear that the causes of obesity must be viewed as environmental rather than personal or genetic.
A longitudinal survey of health and nutrition in China was undertaken in eight provinces (Liaoning, Jiangsu, Shandong, Henan, Hubei, Hunan, Guangxi, Guizhou). Data were collected in 1989, 1991, 1993 and 1997. The 1991 and 1993 data were used to investigate factors affecting intrahousehold food distribution. The discrepancy score and the ratio of food share to energy share were used to describe food distribution within households. Findings indicated that, in most cases, males had a higher proportion of nutrient intake than females, particularly in the young adult group where men presented with a higher discrepancy score than women for energy and all nutrients observed. The food and nutrient distribution tends to be more favourable to the middle-aged group, although the youngest group, while accepting relatively smaller amounts of cereals, ate much bigger amounts of meat, dairy products and fruits. Household members with higher incomes are more favoured in terms of food consumption and nutrient intake. Household leaders accepted a higher share of energy and nutrients in comparison with other members of the household across all age and sex groups. Administrators and people working in service or trade industries in rural areas are favoured in terms of food distribution relative to farmers and manual workers. Well-educated people accepted a better food allocation than others and those in employment received more nutrients than the unemployed. The 'contribution rule' (individuals who make a greater contribution to the family receive a larger share of the family's food) is discussed and deemed to be applicable in explaining the discrepancy in food distribution and nutrient intake among household members.
The food and nutrition situation in households of East Jakarta was assessed in 1993/1994 and 1998/1999 with the aim of identifying the determinants of potential problems and the dynamics of change. In 1993/1994, the nutritional status of approximately 73% of children under 5 years of age and 60% of mothers was within the normal range, although underweight and overweight were prevalent in almost all households. Between 1998 and 1999, there was a sharp increase in fathers reporting unemployment. The consumption of animal food sources decreased, whereas the consumption of food derivatives such as oils and sugar remained high. Approximately 90% of the population obtained drinking water from wells. By 1998, the public garbage collection system had almost completely collapsed in East Jakarta. Between 1993 and 1998, the prevalence of diarrhoea and acute respiratory infections in children aged under 5 years increased dramatically, from 8 and 44% to 24 and 70%, respectively. The urban environment has undergone significant changes. In Indonesia, as a whole, many achievements in the improvement of household food security and care have been lost due to the economic and political crisis. The statistical association between mothers' and fathers' education and the nutritional status of their children that was observed in 1993/94 did not appear in the 1998 survey. It seems that the education-related coping mechanisms of the parents were inadequate to deal with the rapid deterioration in the economic and political situation.
Myanmar has a policy of promoting food and nutrition security and, at the national level, food production is more than that required to meet the country's needs. Nevertheless, food and nutrition surveillance has revealed that malnutrition still exists in the country, despite economic growth and national food self-sufficiency. The National Plan of Action for Food and Nutrition, formulated in 1994 and adopted in 1995, accorded priority to household food and nutrition security. Accordingly, in 1996, in partnership with the World Health Organization (WHO), the National Nutrition Centre embarked on a study of household food and nutrition security in Myanmar. A preliminary situation analysis revealed that transitional changes in the economic, demographic and social sectors have driven dramatic changes in people's lifestyles, behaviour and practices and that these changes affect food and nutrition security. The present paper explores household and intrahousehold determinants of nutrition problems in Myanmar.
The National Nutrition Survey (NNS) in Japan has been undertaken annually since 1946. It was originally intended to provide information on the food and nutrient intake of the Japanese people, with a view to acquiring emergency food supplies from other countries when food shortages caused malnutrition in many Japanese. The food balance sheet (FBS) has been drawn up since 1949 to show the food supply available to the Japanese people. The trends and figures shown by both approaches were similar until the mid-1970s. Since then, however, the disparity between the food supply and the intake of foods and nutrients has been getting larger. National food security means that a country has enough food for everyone. This does not mean, however, that every family has enough food, because the food may not be evenly distributed. In fact, marginal deficiencies in iron and calcium are thought to still exist and there is considerable variation among households in energy intake. In Japan, nutrition and diet are now considered to play important roles in the emerging problems of obesity, diabetes mellitus, hypertension etc., because of excessive energy intake and deficiency or excessive intake of certain nutrients.
Accelerating epidemiological transition and concurrent shifts in diet, activity and body composition are universal trends, especially in middle- and lower-income countries. A unique nutrition transition has occurred in the Republic of Korea, a country that modernized earlier than most Asian countries. This analysis attempts to describe the nutrition transition in the Republic of Korea, focusing on specific features that other countries may follow to retain the healthy elements of their traditional diets. The analysis uses secondary data on economics, dietary intake, anthropometry and causes of death, including a series of comparable nationally representative dietary surveys (the National Nutrition Survey). The structure of the economy of the Republic of Korea, along with dietary and disease patterns, began an accelerated shift in the 1970s. Major dietary change included a large increase in the consumption of animal food products and a fall in total cereal intake. Uniquely, the amount and the rate of increase in fat intake have remained very low. The Republic of Korea also has a relatively low prevalence of obesity compared with other Asian countries with similar or much lower incomes. The nutrition transition in the Republic of Korea is unique. National efforts to retain elements of the traditional diet are thought to have shaped this unique transition in the Republic of Korea in the midst of rapid economic growth and introduction of western culture.
Indonesia has been afflicted by an economic crisis since July 1997. The economic crisis was preceded by a long drought associated with El Nino. The result has been a decline in food production, especially rice. In the eastern part of the country, especially in Irian Jaya, there was food insecurity during the early stages of the economic crisis. When the crisis escalated to become an economic, social and political crisis in 1998, food insecurity spread to other provinces, especially to urban areas in Java. The crisis led to increasingly high inflation, unemployment, poverty, food insecurity and malnutrition. The official figures indicate that poverty in Indonesia increased from 22.5 million (11.3%) in 1996 to 36.5 million (17.9%) in 1998. Food production decreased by 20-30% in some parts of the country. Compared with prices in January 1998, food prices had escalated 1.5- to threefold by August/ November 1998 when acute food shortages occurred, especially in urban Java. Coupled with a drop in purchasing power, the higher food prices worsened health, nutritional status and education of children of urban poor and unemployed families. Despite social and political uncertainties, the Indonesian Government has taken prompt action to prevent a worsening of the situation by massive imports of rice, instituting food price subsidies for the poor and launching social safety net programmes to cope with food shortages and malnutrition. The present paper attempts to highlight the impact of the economic crisis on food insecurity and malnutrition in Indonesia.