Pre-programmed sets of stimuli
The sectors of fisheries, aquaculture and forestry often are under-reported. The world governance indicators of the World Bank Institute define governance as the traditions and institutions by which authority in a country is exercised. Show more citation formats Show less citations formats. Of even greater significance is the less visible, yet pervasive, mental impairment that reduces intellectual capacity at home, in school and at work. Economic crises - impacts and lessons learned. The global hunger index is a means of monitoring whether countries are achieving the hunger-related Millennium Development Goals.
Disasters are defined as medium and large scale disasters that exceed the thresholds set for registration on the EM-DAT international disaster database. Climate variability and extremes are already negatively undermining production of major crops in tropical regions and, without adaptation, this is expected to worsen as temperatures increase and become more extreme.
In many areas, climate extremes have increased in number and intensity, particularly where average temperatures are shifting upwards: Extreme heat is associated with increased mortality, lower labour capacity, lower crop yields and other consequences that undermine food security and nutrition.
In addition to increasing temperatures and changes in rainfall, the nature of rainy seasons is also changing, specifically the timing of seasonal climate events. Within-season changes may not register as extreme climate events droughts, floods or storms but rather are aspects of climate variability that affect the growth of crops and the availability of pasture for livestock, with potentially significant implications for food security and nutrition. Several countries — notably in Africa, Central America and Southeast Asia — experienced drought, not only through abnormally low total accumulated rainfall, but also through lower rainfall intensities and fewer days of rainfall.
Food security and nutrition indicators can clearly be associated with an extreme climate event, such as a severe drought, that critically challenges agriculture and food production. Of all natural hazards, floods, droughts and tropical storms affect food production the most. Drought, in particular, causes more than 80 percent of the total damage and losses in agriculture, especially for the livestock and crop production subsectors. In relation to extreme events, the fisheries subsector is most affected by tsunamis and storms, while most of the economic impact on forestry is caused by floods and storms.
If a drought is severe and widespread enough, it can potentially affect national food availability and access, as well as nutrition, thus magnifying the prevalence of undernourishment PoU nationally.
Severe droughts are worsening global hunger and reversing progress already made. Hunger is significantly worse in countries with agricultural systems that are highly sensitive to rainfall and temperature variability and severe drought, where the livelihood of a high proportion of the population depends on agriculture and where the country does not have in place sufficient support measures to counter the fallout.
In other words, for almost 36 percent of the countries that experienced a rise in undernourishment since , this coincided with the occurrence of severe agricultural drought. Out of 27 countries with increasing change points in the prevalence of undernourishment occurring under severe drought stress conditions, most 19 countries are in Africa, with the remaining four in Asia, three in Latin America and the Caribbean, and one in Eastern Europe.
The temperature anomalies associated with El Niño show that climate variability and extremes affect agriculture. If we look at increasing change points in the PoU time series we see that many correspond to occurrences of severe drought.
For example, for almost 36 percent of the countries that experienced a rise in undernourishment since , this coincided with the occurrence of severe drought. Most striking is the significant increase in the number of change points related to severe drought conditions in — in which nearly two-thirds of the change points occurred. In these cases,the PoU increased from onwards, and this can be linked to severe droughts driven by El Niño in — A closer review reveals that many countries have witnessed periods of increased undernourishment over the past years; however, during the period of the ENSO event of — this change across so many countries contributed to a reversal of the PoU trend at the global level.
This association is further corroborated by a number of studies that show a strong link between drought and stunting in children. For example, drought events in Bangladesh are associated with a higher stunting rate around five and nine months after the beginning of the drought event. In rural Zimbabwe, one- to two-year olds exposed to drought face significantly lower growth velocity compared to children of the same age living in areas with average rainfall. In sub-Saharan Africa, warmer and drier climates are related to declining food availability and increased prevalence estimates of childhood stunting.
Climate variability and extremes are among the key drivers behind the rise in hunger. Exposure of countries to climate variability and extremes is also a rising trend. In , the average of the PoU in countries with high exposure to climate shocks was 3. Even more striking is that countries with high exposure have more than doubled the number of undernourished people as those without high exposure.
Prevalence unweighted and number of undernourished people in low- and middle-income countries with high and low exposure to climate extremes during the period of — Countries with high exposure are defined as being exposed to climate extremes heat, drought, floods and storms for more than 66 percent of the time, i. See Annex 2 for the list of countries with high exposure to climate extremes and methodology. The impact of climate variability and extremes on agriculture and food security: Rome, FAO, for classification of countries with high and low exposure to climate extremes; FAO for data on prevalence of undernourishment.
A high dependence on agriculture, as measured by the number of people employed in the sector, leaves the PoU 9. For low-income countries, the increase is equal to The finding is different for middle-income countries where the rise in PoU is less pronounced and occurs later from — This tends to indicate that middle-income countries were able to absorb the impacts of increased exposure to climate extremes, but may not have been able to cope as well in the — period, possibly due to the severity of exposure to El Niño.
While hunger is on the rise, it is equally alarming that the number of people facing crisis-level food insecurity continues to increase.
This represents an increase compared to and , when 80 and million people, respectively, faced crisis levels. In 34 of these 51 countries, more than 76 percent of the total populations facing crisis levels of acute food insecurity or worse — nearly 95 million people — were also affected by climate shocks and extremes.
Where conflict and climate shocks occur together, the impact on acute food insecurity is more severe. In , 14 out of the 34 food-crisis countries experienced the double impact of both conflict and climate shocks, which led to significant increases in the severity of acute food insecurity. Floods cause more climate-related disasters globally than any other extreme climate event, with flood-related disasters seeing the highest increase — 65 percent — in occurrence over the last 25 years.
The frequency of storms is not increasing as much as that of floods, but storms are the second most frequent driver of climate-related disasters.
Climate variability and extremes have the strongest direct impact on food availability, given the sensitivity of agriculture to climate and the primary role of the sector as a source of food and livelihoods for the rural poor. However, the overall fallout is far more complex and greater than the impacts on agricultural productivity alone.
Climate variability and extremes are undermining all dimensions of food security: Climate variability puts all aspects of food security at risk: Direct and indirect climate-driven impacts have a cumulative effect, leading to a downward spiral of increased food insecurity and malnutrition.
As mentioned, an obvious impact is that climate variability and extremes negatively affect agricultural productivity, in terms of changes in crop yields the amount of agricultural production harvested per unit of land area , cropping areas area planted or harvested , or cropping intensity number of crops grown within a year. The sectors of fisheries, aquaculture and forestry often are under-reported.
Impact of disasters on forestry is generally acknowledged in assessments, although rarely quantified in monetary terms. The impact of disasters and crises on agriculture and food security In addition, climate variability and extremes also affect food imports as countries try to compensate for domestic production losses. The impacts on production will inevitably translate into loss of income for people whose livelihoods depend on agriculture and natural resources, reducing their ability to access food.
Plant nutrition is a difficult subject to understand completely, partially because of the variation between different plants and even between different species or individuals of a given clone. Elements present at low levels may cause deficiency symptoms, and toxicity is possible at levels that are too high.
Furthermore, deficiency of one element may present as symptoms of toxicity from another element, and vice versa. Canada's Food Guide is an example of a government-run nutrition program.
Produced by Health Canada , the guide advises food quantities, provides education on balanced nutrition, and promotes physical activity in accordance with government-mandated nutrient needs. Like other nutrition programs around the world, Canada's Food Guide divides nutrition into four main food groups: Dietary and physical activity guidelines from the USDA are presented in the concept of MyPlate , which superseded the food pyramid , which replaced the Four Food Groups.
Department of Health and Human Services provides a sample week-long menu that fulfills the nutritional recommendations of the government. Governmental organisations have been working on nutrition literacy interventions in non-primary health care settings to address the nutrition information problem in the U.
The FNP has developed a series of tools to help families participating in the Food Stamp Program stretch their food dollar and form healthful eating habits including nutrition education. It is designed to assist limited-resource audiences in acquiring the knowledge, skills, attitudes, and changed behavior necessary for nutritionally sound diets, and to contribute to their personal development and the improvement of the total family diet and nutritional well-being.
Launched in , this program promotes lifelong healthful eating patterns and physically active lifestyles for children and their families. It is an interactive educational program designed to help prevent childhood obesity through classroom activities that teach children healthful eating habits and physical exercise.
Nutrition is taught in schools in many countries. In England and Wales , the Personal and Social Education and Food Technology curricula include nutrition, stressing the importance of a balanced diet and teaching how to read nutrition labels on packaging.
In many schools, a Nutrition class will fall within the Family and Consumer Science or Health departments. In some American schools, students are required to take a certain number of FCS or Health related classes. Nutrition is offered at many schools, and, if it is not a class of its own, nutrition is included in other FCS or Health classes such as: In many Nutrition classes, students learn about the food groups, the food pyramid, Daily Recommended Allowances, calories, vitamins, minerals, malnutrition, physical activity, healthful food choices, portion sizes, and how to live a healthy life.
In the US, Registered dietitian nutritionists RDs or RDNs  are health professionals qualified to provide safe, evidence-based dietary advice which includes a review of what is eaten, a thorough review of nutritional health, and a personalized nutritional treatment plan.
They also provide preventive and therapeutic programs at work places, schools and similar institutions. Certified Clinical Nutritionists or CCNs, are trained health professionals who also offer dietary advice on the role of nutrition in chronic disease, including possible prevention or remediation by addressing nutritional deficiencies before resorting to drugs.
These Board Certified Nutritionists typically specialize in obesity and chronic disease. In order to become board certified, potential CNS candidate must pass an examination, much like Registered Dieticians. This exam covers specific domains within the health sphere including; Clinical Intervention and Human Health.
The study found that health literacy increases with education and people living below the level of poverty have lower health literacy than those above it. Another study examining the health and nutrition literacy status of residents of the lower Mississippi Delta found that 52 percent of participants had a high likelihood of limited literacy skills. For example, only 12 percent of study participants identified the My Pyramid graphic two years after it had been launched by the USDA.
The study also found significant relationships between nutrition literacy and income level and nutrition literacy and educational attainment  further delineating priorities for the region. Among these problems are the lack of information about food choices, a lack of understanding of nutritional information and its application to individual circumstances, limited or difficult access to healthful foods, and a range of cultural influences and socioeconomic constraints such as low levels of education and high levels of poverty that decrease opportunities for healthful eating and living.
The links between low health literacy and poor health outcomes has been widely documented  and there is evidence that some interventions to improve health literacy have produced successful results in the primary care setting. More must be done to further our understanding of nutrition literacy specific interventions in non-primary care settings  in order to achieve better health outcomes.
Malnutrition refers to insufficient, excessive, or imbalanced consumption of nutrients by an organism. In developed countries, the diseases of malnutrition are most often associated with nutritional imbalances or excessive consumption. In developing countries, malnutrition is more likely to be caused by poor access to a range of nutritious foods or inadequate knowledge.
The aim was to boost nutrition and livelihoods by producing a product that women could make and sell, and which would be accepted by the local community because of its local heritage. Although under- and over-nutrition are often viewed as human problems, pet animals can be under- or overfed by their owners, domesticated animals can be undernourished for macro- and micro-nutrients, affecting growth and health, and wild animals can be undernourished to the point of starvation and death.
Nutritionism is the view that excessive reliance on food science and the study of nutrition can lead to poor nutrition and to ill health. It was originally credited to Gyorgy Scrinis ,  and was popularized by Michael Pollan. Since nutrients are invisible, policy makers rely on nutrition experts to advise on food choices.
Because science has an incomplete understanding of how food affects the human body, Pollan argues, nutritionism can be blamed for many of the health problems relating to diet in the Western World today.
ULs are set a safe fraction below amounts shown to cause health problems. ULs are part of Dietary Reference Intakes. When too much of one or more nutrients is present in the diet to the exclusion of the proper amount of other nutrients, the diet is said to be unbalanced. High calorie food ingredients such as vegetable oils, sugar and alcohol are referred to as "empty calories" because they displace from the diet foods that also contain protein, vitamins, minerals and fiber.
Research indicates that improving the awareness of nutritious meal choices and establishing long-term habits of healthy eating have a positive effect on cognitive and spatial memory capacity, with potential to increase a student's ability to process and retain academic information.
Some organizations have begun working with teachers, policymakers, and managed foodservice contractors to mandate improved nutritional content and increased nutritional resources in school cafeterias from primary to university level institutions.
Health and nutrition have been proven to have close links with overall educational success. There is limited research available that directly links a student's Grade Point Average G. Additional substantive data is needed to prove that overall intellectual health is closely linked to a person's diet, rather than just another correlation fallacy.
Nutritional supplement treatment may be appropriate for major depression , bipolar disorder , schizophrenia , and obsessive compulsive disorder , the four most common mental disorders in developed countries. Cancer is now common in developing countries. According to a study by the International Agency for Research on Cancer , "In the developing world, cancers of the liver, stomach and esophagus were more common, often linked to consumption of carcinogenic preserved foods, such as smoked or salted food, and parasitic infections that attack organs.
Several lines of evidence indicate lifestyle-induced hyperinsulinemia and reduced insulin function i. For example, hyperinsulinemia and insulin resistance are strongly linked to chronic inflammation, which in turn is strongly linked to a variety of adverse developments such as arterial microtrauma and clot formation i. Hyperinsulinemia and insulin resistance the so-called metabolic syndrome are characterized by a combination of abdominal obesity , elevated blood sugar , elevated blood pressure , elevated blood triglycerides , and reduced HDL cholesterol.
The state of obesity clearly contributes to insulin resistance, which in turn can cause type 2 diabetes. Virtually all obese and most type 2 diabetic individuals have marked insulin resistance. Although the association between overweight and insulin resistance is clear, the exact likely multifarious causes of insulin resistance remain less clear. It has been demonstrated that appropriate exercise, more regular food intake, and reducing glycemic load see below all can reverse insulin resistance in overweight individuals and thereby lower their blood sugar level , in those with type 2 diabetes.
In addition, reduced leptin signaling to the brain may reduce leptin's normal effect to maintain an appropriately high metabolic rate. In any case, analogous to the way modern man-made pollution may possess the potential to overwhelm the environment's ability to maintain homeostasis , the recent explosive introduction of high glycemic index and processed foods into the human diet may possess the potential to overwhelm the body's ability to maintain homeostasis and health as evidenced by the metabolic syndrome epidemic.
Antinutrients are natural or synthetic compounds that interfere with the absorption of nutrients. Nutrition studies focus on antinutrients commonly found in food sources and beverages. The relatively recent increased consumption of sugar has been linked to the rise of some afflictions such as diabetes, obesity, and more recently heart disease.
Increased consumption of sugar has been tied to these three, among others. In the same time span that obesity doubled, diabetes numbers quadrupled in America. Increased weight, especially in the form of belly fat, and high sugar intake are also high risk factors for heart disease. Elevated amounts of Low-density lipoprotein LDL cholesterol, is the primary factor in heart disease. In order to avoid all the dangers of sugar, moderate consumption is paramount.
Since the Industrial Revolution some two hundred years ago, the food processing industry has invented many technologies that both help keep foods fresh longer and alter the fresh state of food as they appear in nature. Cooling is the primary technology used to maintain freshness, whereas many more technologies have been invented to allow foods to last longer without becoming spoiled.
These latter technologies include pasteurisation , autoclavation , drying , salting , and separation of various components, all of which appearing to alter the original nutritional contents of food. Pasteurisation and autoclavation heating techniques have no doubt improved the safety of many common foods, preventing epidemics of bacterial infection.
But some of the new food processing technologies have downfalls as well. Modern separation techniques such as milling , centrifugation , and pressing have enabled concentration of particular components of food, yielding flour, oils, juices, and so on, and even separate fatty acids, amino acids, vitamins, and minerals.
Inevitably, such large-scale concentration changes the nutritional content of food, saving certain nutrients while removing others. Heating techniques may also reduce food's content of many heat-labile nutrients such as certain vitamins and phytochemicals, and possibly other yet-to-be-discovered substances.
In addition, processed foods often contain potentially harmful substances such as oxidized fats and trans fatty acids. A dramatic example of the effect of food processing on a population's health is the history of epidemics of beri-beri in people subsisting on polished rice. Removing the outer layer of rice by polishing it removes with it the essential vitamin thiamine , causing beri-beri. Another example is the development of scurvy among infants in the late 19th century in the United States.
It turned out that the vast majority of sufferers were being fed milk that had been heat-treated as suggested by Pasteur to control bacterial disease. Pasteurisation was effective against bacteria, but it destroyed the vitamin C. As mentioned, lifestyle- and obesity-related diseases are becoming increasingly prevalent all around the world. There is little doubt that the increasingly widespread application of some modern food processing technologies has contributed to this development.
The food processing industry is a major part of modern economy, and as such it is influential in political decisions e. In any known profit-driven economy, health considerations are hardly a priority; effective production of cheap foods with a long shelf-life is more the trend.
In general, whole, fresh foods have a relatively short shelf-life and are less profitable to produce and sell than are more processed foods. Thus, the consumer is left with the choice between more expensive, but nutritionally superior, whole, fresh foods, and cheap, usually nutritionally inferior, processed foods.
Because processed foods are often cheaper, more convenient in both purchasing, storage, and preparation , and more available, the consumption of nutritionally inferior foods has been increasing throughout the world along with many nutrition-related health complications.
From Wikipedia, the free encyclopedia. This article is about Nutrition in general. For Nutrition in humans, see Human nutrition. For Nutrition in animals, see Animal nutrition. For nutrition in plants, see Plant nutrition. For the medical journal, see Nutrition journal. Mineral nutrient and Composition of the human body. List of antioxidants in food. Animal nutrition and Human nutrition.
Nutrition portal Food portal. Food Balance Wheel Biology: Bioenergetics Digestion Enzyme Dangers of poor nutrition Deficiency Avitaminosis is a deficiency of vitamins. Boron deficiency medicine Chromium deficiency Iron deficiency medicine Iodine deficiency Magnesium deficiency medicine Diabetes Eating disorders Illnesses related to poor nutrition Malnutrition Obesity Childhood obesity Starvation Food: Dieting Eating Healthy eating pyramid Nutritional rating systems Lists: Diets list List of food additives List of illnesses related to poor nutrition List of life extension related topics List of publications in nutrition List of unrefined sweeteners List of antioxidants List of phytochemicals Nutrients: Dietitian Nutritionist Food Studies Tools: Human Nutrition and Food".
Retrieved 13 December Understanding Nutrition 13 ed. Deficiency, How Much, Benefits, and More. The New York Times. Archived from the original on The Profession of Dietetics.
A History of Nutrition. The Riverside Press Houghton Mifflin. Perspectives in Clinical Research. Eat, Drink, and be Healthy: The Molecular Nature of Matter and Change 5 ed. The Journal of Nutrition.
Observations on the effect of adding tryptophane to a dietary in which zein is the sole nitrogenous constituent" PDF. The Journal of Physiology. Selected Topics in the History of Biochemistry: Personal Recollections, Part 1. Retrieved March 15, Part 3 — ". Fundamental Aspects in Nutrition and Health. Part 4 — ". National Academy of Sciences.
Retrieved June 13, Retrieved December 22, Joins Hunt for Young German Chemist". Washington DC, World Bank. Millennium Development Goals indicators series metadata. Indicators for monitoring the Millennium Development Goals. New York , United Nations, Infant and young child feeding. The recommendations for feeding infants and young children 6—23 months include: The caring practice indicators for infant and young child feeding available on the NLIS country profiles include: Early initiation of breastfeeding.
This indicator is the percentage of infants who are put to the breast within 1 hour of birth. Breastfeeding contributes to saving children's lives, and there is evidence that delayed initiation of breastfeeding increases their risk for mortality. Infants under 6 months who are exclusively breastfed. This indicator is the percentage of infants aged 0—5 months who are exclusively breastfed.
It is the proportion of infants aged 0—5 months who are fed exclusively on breast milk and no other food or drink, including water. The infant is however, allowed to receive ORS and drops and syrups containing vitamins, minerals and medicine.
Exclusive breastfeeding is an unequalled way of providing the ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process, with important implications for the health of mothers.
An expert review of evidence showed that, on a population basis, exclusive breastfeeding for 6 months is the optimal way of feeding infants. Breast milk is the natural first food for infants. It provides all the energy and nutrients that the infant needs for the first months of life. Breast milk promotes sensory and cognitive development and protects the infant against infectious and chronic diseases.
Exclusive breastfeeding reduces infant mortality due to common childhood illnesses, such as diarrhoea and pneumonia, and leads to quicker recovery from illness. Breastfeeding contributes to the health and well-being of mothers, by helping to space children, reducing their risks for ovarian and breast cancers and saving family and national resources.
It is a secure way of feeding and is safe for the environment. Infants aged 6—8 months who receive solid, semisolid or soft foods. WHO recommends starting complementary feeding at 6 months of age. It is defined as the proportion of infants aged 6—8 months who receive solid, semisolid or soft foods. When breast milk alone no longer meets the nutritional needs of the infant, complementary foods should be added. This is a very vulnerable period, and it is the time when malnutrition often starts, contributing significantly to the high prevalence of malnutrition among children under 5 worldwide.
Children aged 6—23 months who receive a minimum dietary diversity. This indicator is the percentage of children aged 6—23 months who receive a minimum dietary diversity. As per revised recommendation by TEAM in June , dietary diversity is present when the diet contained five or more of the following food groups: Children aged 6—23 months who receive a minimum acceptable diet. This indicator is the percentage of children aged 6—23 months who receive a minimum acceptable diet.
Proportion of children aged months who receive a minimum acceptable diet is included as a process indicator in the core set of indicators for the Global Nutrition Monitoring Framework. The composite indicator of a minimum acceptable diet is calculated from: Dietary diversity is present when the diet contained four or more of the following food groups: The minimum daily meal frequency is defined as: A minimum acceptable diet is essential to ensure appropriate growth and development for feeding infants and children aged 6—23 months.
Without adequate diversity and meal frequency, infants and young children are vulnerable to malnutrition, especially stunting and micronutrient deficiencies, and to increased morbidity and mortality. Source of all infant and young child feeding indicators.
Infant and Young Child Feeding database. Infant and young child feeding list of publications. Global Nutrition Monitoring Framework. Children with diarrhoea receiving oral rehydration therapy and continued feeding.
This indicator is the prevalence of children with diarrhoea who received oral rehydration therapy and continued feeding. It is the proportion of children aged months who had diarrhoea and were treated with oral rehydration salts or an appropriate household solution and continued feeding.
As oral rehydration therapy is a critical component of effective management of diarrhoea, monitoring coverage with this highly cost-effective intervention indicates progress towards the child survival-related Millennium Development Goals. Health expenditure includes that for the provision of health services, family planning activities, nutrition activities and emergency aid designated for health, but excludes the provision of water and sanitation.
Health financing is a critical component of health systems. National health accounts provide a large set of indicators based on information on expenditure collected within an internationally recognized framework.
National health accounts consist of a synthesis of the financing and spending flows recorded in the operation of a health system, from funding sources and agents to the distribution of funds between providers and functions of health systems and benefits geographically, demographically, socioeconomically and epidemiologically.
General government expenditure on health as a percentage of total government expenditure is the proportion of total government expenditure on health.
General government expenditure includes consolidated direct and indirect outlays, such as subsidies and transfers, including capital, of all levels of government social security institutions, autonomous bodies and other extrabudgetary funds. It consists of recurrent and capital spending from government central and local budgets, external borrowings and grants including donations from international agencies and nongovernmental organizations and social or compulsory health insurance funds.
GDP is the value of all final goods and services produced within a nation in a given year. Public health expenditure consists of recurrent and capital spending from government central and local budgets, external borrowings and grants including donations from international agencies and nongovernmental organizations and social or compulsory health insurance funds.
Private health expenditure is the sum of outlays for health by private entities, such as commercial or mutual health insurance providers, non-profit institutions serving households, resident corporations and quasi-corporations not controlled by government involved in health services delivery or financing, and direct household out-of-pocket payments.
These indicators reflect total and public expenditure on health resources, access and services, including nutrition. Although increasing health expenditures are associated with better health outcomes, especially in low-income countries, there is no 'recommended' level of spending on health.
The larger the per capita income, the greater the expenditure on health. Some countries, however, spend appreciably more than would be expected from their income levels, and some appreciably less. When a government spends little of its GDP or attributes less of its total expenditure on health, this may indicate that health, including nutrition , are not regarded as priorities. National health accounts - World Health Statistics, http: Human development report http: Core health indicators http: Human development report indicator glossary for indicator 3.
Wealth, health and health expenditure. General government expenditure on health as a percentage of total government expenditure is defined as the level of general government expenditure on health GGHE expressed as a percentage of total government expenditure. The indicator contributes to understanding the weight of public spending on health within the total value of public sector operations.
It includes not just the resources channelled through government budgets but also the expenditure on health by parastatals, extrabudgetary entities and notably the compulsory health insurance.
The indicator refers to resources collected and pooled by public agencies including all the revenue modalities. The indicator provides information on the level of resources channelled to health relative to a country's wealth.
These indicators reflect government and total expenditure on health resources, access and services, including nutrition, in relation to government expenditure, the wealth of the country, and per capita.
When a government attributes less of its total expenditure on health, this may indicate that health, including nutrition , are not regarded as priorities. UNDAFs usually focus on three to five areas in which the country team can make the greatest difference, in addition to activities supported by other agencies in response to national demands but which fall outside the common UNDAF results matrix.
For each national priority selected for United Nations country team support, the UNDAF results matrix gives the outcome s , the outcomes and outputs of other agencies working alone or together, the role of partners, resource mobilization targets for each agency outcome and coordination mechanisms and programme modalities.
The nutrition component of the UNDAF reflects the priority attributed to nutrition by the United Nations agencies in a country and is an indication of how much the United Nations system is committed to helping governments improve their food and nutrition situation.
The indicator is "strong", "medium" or "weak", depending on the degree to which nutrition is being addressed in the expected outcomes and outputs in the UNDAF. UNDAF documents follow a predefined format, with a core narrative and a results matrix. The matrix lists the high-level expected results 'the UNDAF outcomes' , the outcomes to be reached by agencies working alone or together and agency outputs.
The results matrix the UNDAF document was used to assess commitment to nutrition , because it represents a synthesis of the strategy proposed in the document and is available in the same format in most country documents. The outcomes and outputs specifically related to nutrition were identified and counted. The outputs were compared with the evidence-based interventions to reduce maternal and child under nutrition recommended in the Lancet Nutrition Series Bhutta et al.
The method and scoring are described in detail by Engesveen et al. What are the implications? A weak nutrition component in the UNDAF document does not necessarily imply that no United Nations agency in the country is working to improve nutrition ; however, unless such efforts are mentioned in strategy documents like the UNDAF, they may receive inadequate attention from development partners to ensure the necessary sustainability or scale-up to adequately address nutrition problems in the country.
The multisectoral nature of nutrition means that it must be addressed by a wide range of actors. Basing such action in frameworks for overall development contributes to ensuring the accountability of United Nations partners. Interventions for maternal and child under nutrition and survival. The Lancet Engesveen K et al. SCN News , Nutrition component of poverty reduction strategy papers. The poverty reduction strategy approach was introduced in to empower governments to set their own priorities and to encourage donors to provide predictable, harmonized assistance aligned with country priorities.
The PRSP should state the development priorities and specify the policies, programmes and resources needed to meet the goals. It is prepared by governments in a participatory process involving civil society and development partners, including the World Bank and the International Monetary Fund, and should result in a comprehensive, country-based strategy for poverty reduction.
The indicator is "strong", "medium" or "weak", depending on the degree to which nutrition is addressed in the PRSP, in terms of recognition of under nutrition as a development problem, use of information on nutrition to analyse poverty and support for appropriate nutrition policies, strategies and programmes. The papers were systematically searched for key words to identify the parts that concerned nutrition , food security , health outcomes and interventions that would be relevant for the World Bank method.
In order to classify the commitments to nutrition in the PRSPs, a scoring system was developed, which is described in more detail by Engesveen et al. The emphasis given to nutrition in PRSPs reflects the extent to which the government considers it essential to improve nutrition for poverty reduction and national development. In other words, it can be an indication of the government's priority for improving nutrition.
A strong nutrition component in a PRSP means that the government considers nutrition a priority for poverty reduction and national development. A weak nutrition component in the document does not necessarily imply that no government department is working to improve nutrition ; however, unless such efforts are mentioned in strategy documents like PRSPs, they may not be sufficiently sustainable or be scaled-up to adequately address nutrition problems in the country.
Basing such action in frameworks for overall development contributes to ensuring the accountability of relevant government departments. Sources and further reading. Poverty reduction strategy papers. Assessing countries' commitment to accelerate nutrition action demonstrated in poverty reduction strategy paper, UNDAF and through nutrition governance.
SCN News , , Shekar M, Lee Y-K. Mainstreaming nutrition in poverty reduction strategy papers: What does it take? A review of the early experience. Health, Nutrition and Population Discussion Paper, Landscape analysis on countries' readiness to accelerate action in nutrition , This indicator is a description of the strengths and weaknesses of various aspects of nutrition governance in countries. The following 10 elements or characteristics are used to assess and describe the strength of nutrition governance: These elements were identified by countries as key elements for successful development and implementation of national nutrition policies and strategies during a review of the progress of countries in implementing the World Declaration and Plan of Action for Nutrition adopted by the International Conference on Nutrition, the first intergovernmental conference on nutrition Nishida et al.
The components of the composite indicator have been identified by countries as important for determining the completeness of national nutrition plans and policies Nishida, Mutru, Imperial Laue , For instance, a national nutrition plan and policy was considered to provide the political basis for initiating action. In many countries, official government endorsement or adoption of a national nutrition plan or policy facilitated its implementation.
The role of an intersectoral coordinating committee in implementing national nutrition plans and policies was also considered crucial, although the nature i. Another important element was considered to be regular surveys and other means of collecting data on nutrition. A periodically updated national nutrition information system and routinely collected data on food and nutrition were considered important for evaluating the effectiveness of national nutrition plans and policies and identifying subsequent actions.
Strategies for effective and sustainable national nutrition plans and policies. Modern aspects of nutrition , present knowledge and future perspective. Basel , Karger Forum for Nutrition 56 , These indicators provide information on national policies for legal entitlement to maternity protection, including leave from work during pregnancy and after birth, as well breastfeeding entitlements after return to work. Since the International Labour Organization ILO was founded in , international labour standards have been established to provide maternity protection for women workers.
Key elements of maternity protection include: The right to cash benefits during absence for maternity leave is intended to ensure that the woman can maintain herself and her child in proper conditions of health and with a suitable standard of living. The source of benefits is important due to potential discrimination in the labour market if employers have to bear the full costs. The right to continue breastfeeding a child after returning to work is important since duration of leave entitlements generally is shorter than the WHO recommended duration of exclusive and continued breastfeeding.
A composite indicator on maternity protection is included as a policy environment and capacity indicator in the core set of indicators for the Global Nutrition Monitoring Framework. It currently uses the ILO classification of compliance with Convention on three key provisions leave duration, remuneration and source of cash benefits , but an alternative method taking into account higher standards as stated in Recommendation as well as breastfeeding entitlements is under development.
The ILO periodically publishes information on the above key indicators, including the assessment of compliance with Convention No. The legislative data are collected by ILO through periodical reviews of national labour and social security legislation and secondary sources, such as the International Social Security Association and International Network on Leave Policies and Research; as well as consultations with ILO experts in regional and national ILO offices around the world.
The composite indicator on maternity protection included in the Global Nutrition Monitoring Framework is currently defined as whether the country has maternity protection laws or regulations in place compliant with the provisions for leave duration, remuneration and source of cash benefits in Convention However, an alternative method is under development which may use a scale to indicate the degree of compliance is under development.
This method will also take into account higher standards for leave duration and remuneration in Recommendation , as well as breastfeeding entitlements within both the Convention and Recommendation. Pregnancy and maternity are potentially vulnerable time for working women and their families. Expectant and nursing mothers require special protection to prevent any potential adverse effects for them and their infants.
They need adequate time to give birth, to recover from delivery process, and to nurse their children. At the same time, they also require income security and protection to ensure that they will not suffer from income loss or lose their job because of pregnancy or maternity leave.
Such protection not only ensures a woman's equal access and right to employment, it also ensures economic sustainability for the well-being of the family. Returning to work after maternity leave has been identified as a significant cause for never starting breastfeeding, early cessation of breastfeeding and lack of exclusive breastfeeding.
In most low- and middle-income countries, paid maternity leave is limited to formal sector employment or is not always provided in practice. The ILO estimates that more than million women lack economic security around childbirth with adverse effects on the health, nutrition and well-being of mothers and their children.
Maternity cash benefits for workers in the informal economy. Documentation for the maternity protection database http: Rollins et al Why invest, and what it will take to improve breastfeeding practices?
Database of national labour, social security and related human rights legislation. This indicates whether a government has adopted legislation to monitor and enforce the International Code of Marketing of Breast-milk Substitutes, which helps create an environment that enables mothers to make the best possible feeding choice, based on impartial information and free of commercial influences, and to be fully supported in doing so.
This indicator is defined on the basis of whether a government has adopted legislation for effective national implementation and monitoring of the International Code of Marketing of Breast-milk Substitutes. The Code is a set of recommendations to regulate the marketing of breast-milk substitutes, feeding bottles and teats.
The Code aims to contribute "to the provision of safe and adequate nutrition for infants, by the protection and promotion of breastfeeding, and by ensuring the proper use of breast-milk substitutes, when these are necessary, on the basis of adequate information and through appropriate marketing and distribution" Article 1.
Improper marketing and promotion of food products that compete with breastfeeding often negatively affect the choice and ability of a mother to breastfeed her infant optimally. The Code was formulated in response to the realization that such marketing resulted in poor infant feeding practices, which negatively affect the growth, health and development of children and are a major cause of mortality in infants and young children. Breastfeeding practices worldwide are not yet optimal, in both developing and developed countries, especially for exclusive breastfeeding under 6 months of age.
In addition to the risks posed by the lack of the protective qualities of breast milk, breast-milk substitutes and feeding bottles are associated with a high risk for contamination that can lead to life-threatening infections in young infants. Infant formula is not a sterile product, and it may carry germs that can cause fatal illnesses. Artificial feeding is expensive, requires clean water, the ability of the mother or caregiver to read and comply with mixing instructions and a minimum standard of overall household hygiene.
These factors are not present in many households in the world. Frequently asked questions , Degree training in nutrition exists. What does the indicator tell us?
This indicator reflects the capacity of a country to train professionals in nutrition in terms of having national higher education institutions offering training in nutrition. This indicator is defined as the existence of higher education institutions offering training in nutrition in the country.
Higher education training institutions include universities and other schools offering graduate and post-graduate degrees in nutrition or dietetics, including public health nutrition, community nutrition, food and nutrition policy, clinical nutrition, nutrition science and epidemiology.
Trained nutrition professionals work at facilities including health facilities as well as at population and community levels and may influence nutrition policies, and designing and implementation of nutrition intervention programmes at various levels. They also play an important role in training of other health and non-health cadres to plan and deliver nutrition interventions in various settings. It is recognized that availability, within a country, of sufficient workforce with appropriate training in nutrition will lead to better outcomes for country-specific nutrition and health concerns.
A competency framework for global public health nutrition workforce development: World Public Health Nutrition Association. Registering as Registered Nutritionist.
Building systemic capacity for nutrition: Nutrition is part of medical curricula. This indicator reflects the inclusion of maternal, infant and young child nutrition in pre-service training of health personnel.
This indicator is defined as the existence of pre-service training in maternal, infant and young child nutrition for health personnel. The survey investigates training in three key areas of maternal, infant and young child nutrition, namely growth monitoring and promotion, breastfeeding and complementary feeding, and management of severe or moderate acute malnutrition.
The first two of these three training topics are relevant for all forms of malnutrition, whereas the third topic only pertains to undernutrition.
Training on other topics e. Adequate training of health professionals is essential to ensure that nutrition activities are included in their regular health care activities. Nutrition counseling training changes physician behavior and improves caregiver knowledge acquisition. Nutrition Journal ; Trained nutrition professionals density. The focus of the nutrition professional indicator is on individuals trained to pursue a nutrition professional career, described in most countries as dieticians or nutritionists including nutrition scientists, nutritional epidemiologists and public health nutritionists.
These individuals are trained sufficiently in nutrition practice to demonstrate defined competencies and to meet certification or registration requirements of national or global nutrition or dietetics professional organizations. Dieticians and nutritionists may complete the same training and perform the same functions in some countries but not others.
This indicator is defined as the number of trained nutrition professionals per , population in the country in a specified year. Validation of the indicator has shown that it can predict several maternal, infant and young child nutrition outcomes.
Global nutrition monitoring framework: Density of nurses and midwi ves. Nurse and midwife density indicates whether nurses and midwifery personnel are available to address the health care needs of a given population.
It is the number of nursing and midwifery personnel and density per 10 population. These personnel include professional nurses, professional midwives, auxiliary nurses, auxiliary midwives, enrolled nurses, enrolled midwives and other personnel, such as dental nurses and primary care nurses. Traditional attendants are not counted here but as community or traditional health workers. There is no gold standard for a sufficient health workforce to address the health care needs of a given population.
It has been estimated, however, that countries with fewer than 25 health-care professionals counting only physicians, nurses and midwives per 10 population fail to achieve adequate coverage rates for selected primary health care interventions that are priorities in the Millennium Development Goals.
The World Health Report Working together for health. The World Health Report papers. G ross domestic product per capita and annual growth rate. GDP per capita purchasing power parity is the GDP divided by the midyear population, where GDP is the total value of goods and services for final use produced by resident producers in an economy, regardless of the allocation to domestic and foreign claims. It does not include deductions for depreciation of physical capital or depletion and degradation of natural resources.
Purchasing power parity indicates the rate of exchange that accounts for price differences across countries, allowing international comparisons of real output and incomes.