Questioning the Solutions: Reaching the 800 million people living with hidden hunger in South and South east Asia, with effective interventions

Keith, R. 2018. Questioning the Solutions: Reaching the 800 million people living with hidden hunger in South and South east Asia, with effective interventions. Critical Public‭ ‬ Health‭ ‬ Consequences of the Double ‭ ‬Burden ‭ ‬of ‭ ‬Malnutrition and the Changing Food Environment in South and South East Asia‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬. New Delhi, India 27 - 30 Mar 2018

TitleQuestioning the Solutions: Reaching the 800 million people living with hidden hunger in South and South east Asia, with effective interventions
AuthorsKeith, R.
TypeConference paper
Abstract

Despite one third of global nutrition aid being spent on micronutrient interventions, there are still 2 billion people in the world living with micronutrient deficiencies (hidden hunger). Over 800 million of these people live in South and South east Asia. A critical academic and political discussion is urgently needed. This dialogue needs to be based on evidence to analyse the reasons why interventions, like the present Vitamin A universal supplementation programme are continued, despite evidence illustrating continued increases in prevalence and incidence of Vitamin A deficiency. The most impactful of all micronutrients, zinc, has been added to essential drug lists in most countries, yet coverage remains under 2%.

Globally over 50% of women, of child bearing age, are anaemic. In India this figure is as high as 80%. There is emerging evidence that if more than one ferrous sulphate tablet is taken a day, the treatment can be toxic to liver cells, yet some anaemic mothers are being advised to take one iron table three times a day. Iron supplementation programmes are also marred by stock outs and failure of patients to adhere to the supplementation, for the whole pregnancy and during lactation. How do we reach the 800 million people in South Asia with effective interventions? Donors and civil society have spent millions on micronutrient supplementation and fortification programmes that do not always reach the most vulnerable. One third of global nutrition expenditure focuses on behaviour change, telling people to change without supporting them effectively. Too often solutions for one deficiency may have adverse impacts in the long term, as seen with the present normalisation of giving high calorie biscuits to children or fortified cereals laden with excessive amounts of sugar for breakfast.

There is also evidence linking such deficiencies to an increased risk of obesity and chronic illness in later life. Interventions such as exclusive breastfeeding reach just over a third of infants globally, despite its protective capacity, for improved nutrition outcomes, throughout the life cycle. Aggressive marketing of breast milk substitutes and other challenges such as lack of support to mothers have led to these low figures.

The speakers will present, the present South and South east Asian situation, including emerging research. They will critically appraise the donor preference for ‘vertically delivered, low cost solutions’, such as fortification and supplementation, to address the hidden hunger crisis, rather than addressing diet diversity challenges and food security. As present, diets contain more processed foods, which are rich in salt and sugar, they also contain fewer natural forms of micronutrients, which are essential for health and development throughout all stages of life. Challenging present food systems and questioning the involvement of the processed food industries in public health nutrition funding needs to be prioritised more by academics, NGOs and UN agencies.

Participant interaction will be invited through a panel of experts with extensive experience in addressing hidden hunger, including examples of what is working and what is not. All participants will be invited to contribute to a consensus statement calling for action to ensure interventions included in global and national nutrition programmes are the most effective in addressing hidden hunger, urging nutrition policy makers and practitioners to question ineffective solutions. Speakers will also be invited to submit their papers for publication in the World Nutrition Journal.

Workshop aim:
To explore the impact of the present priorities, policies, strategies and interventions being used to address micronutrient deficiencies (hidden hunger) in South and South east Asia.
Workshop Objectives

1. To identify interventions that are not effective in addressing hidden hunger, using examples.
2. To discuss how some solutions to malnutrition, such as high calorie flavoured biscuits, can add to the regions double burden of malnutrition.
3. To encourage discussion and debate around the present interventions and actions required to ensure South and South east Asia meet their 2025 nutrition targets, with a focus on micronutrients.
4. To develop a consensus statement calling for action to address hidden hunger issues using evidence-based interventions in the South & South-East Asia region.

Participants and format
This workshop will be convened by Regina Keith, from the World Public Health Nutrition Association and University of Westminster in the UK. The workshop will run for two hours, with two speakers giving 15-minute presentations, followed by an expert panel of speakers answering the question: How can we effectively address micronutrient deficiencies in South and South east Asia? Suggesting what actors can do at government, organization, service and practitioner level, to ensure evidenced based programmes are prioritized and implemented, in national policies, plans, interventions, priority setting and delivery. Speakers will set the scene by defining, providing examples and suggesting actions to combat specific micronutrient deficiencies. Following the expert panels answers, the discussion will be open to participants of the workshop, for the last hour. Experts will provide further insights into present evidence and will respond to participants’ questions and statements.

Chair: Dr. Prema Ramachandran

Presentations
Speaker 1: Dr. Umesh Kapil MD in Community Medicine DNB in Maternal and Child Health
Case study: Vitamin A Despite high coverage of Vitamin A supplementation widespread deficiency prevails, why do we continue to implement solutions that do not address the problem?

Speaker 2: Regina Keith RGN RM RPN MSc SfHEA WPHNA, Senior Lecturer University of Westminster, UK Reaching the 800 million: Questioning the solutions: are we implementing evidenced based approaches to address hidden hunger or simply those that donors will fund?

Each member of the Expert Panel will have one minute to answer the discussion question: How can we effectively address micronutrient deficiencies in South and South east Asia? Suggesting what actors can do at government, organization, service and practitioner level, to ensure evidenced based programmes are prioritized and implemented, in national policies, plans, interventions, priority setting and delivery.

Panel member one: Professor HPS Sachdev Senior Consultant in Paediatrics
Panel member two: Dr. Prema Ramachandran
Panel member three: Dr. Umesh Kapil
Panel member four: PHD student
Panel member five: Regina Keith WPHNA and UoW

KeywordsHidden Hunger, Micronutrient deficiencies, South east Asia, Asia
Year2018
ConferenceCritical Public‭ ‬ Health‭ ‬ Consequences of the Double ‭ ‬Burden ‭ ‬of ‭ ‬Malnutrition and the Changing Food Environment in South and South East Asia‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬
Web address (URL) of conference proceedingshttps://www.youtube.com/watch?v=iue9u_rkhi8&list=PLoHg1UZiy8oFw0VzMAwVqJIOu0rgb8Ivt
Web address (URL)https://drive.google.com/open?id=1ALYdCsCXq0J8Lhxu6YO-Y9ZMMlruAzKz

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