33rd Session of the UN Standing Committee on Nutrition
Catherine Bertini - Madame Chair,
Members of the United Nations Standing Committee on Nutrition,
Ladies and gentlemen,
Before I start, just let me say what a pleasure it is to be under the gavel of Catherine Bertini. I accompanied Catherine on a mission to the Horn of Africa at the time of the previous drought, when she was heading the United Nations World Food Programme, and before I took up this position. I know that we are in complete agreement about the close connection between nutrition and health.
So Madame Chair, good morning, and welcome to the 33rd session of the Standing Committee. WHO is delighted to be the host of this session. The initiative of this session is a vital one: to jointly discuss - and agree - how to address the growing double burden of malnutrition.
I have just come back from a week-long visit to three countries in Africa. I want to bring a little of the direct, immediate realities of the field into this meeting room. It is sometimes difficult to keep that strong sense of that reality when we are here, in comfortable Geneva, dealing with normative functions, policy harmonization and strategic frameworks.
Where I was last week, in Madagascar, Mauritius and Kenya, the everyday presence of nutritional deficiencies and disorders are painfully obvious. They dominate people's lives. They dominate their deaths. Yet often people don't see it that way. Their concerns are "my child is sick" not "my child hasn't eaten well enough to be able to fight this infection".
Malnutrition - specifically under nutrition - affects all of Madagascar, especially the rural areas. Nearly half of all children below five years of age suffer from chronic malnutrition. They are not getting off to a good start. Eighteen per cent of women of reproductive age are chronically malnourished. This is Ms Raharimalala Marie Claire, aged 32 who has four children (slide 3). Birth spacing is a problem. Diet is a problem. Alternatives to rice are too expensive, despite the fertility of the island. This is a classic multisectoral problem.
In Mauritius, chronic diseases account for more than 80% of all deaths. Chronic disease risk factors are rising in the country, and by 2015 it is estimated that more than half of all women and men will be overweight.
In Kenya, I spent some time in the Mbagathi District Hospital, in Nairobi, which diagnoses and treats people with TB and HIV. This woman came in thinking she had pneumonia (slide 4). When I met her she had already been in hospital for a month. She has both tuberculosis and HIV. In addition to the therapy she is now getting for both conditions, she desperately needs to regain weight. Nutrition has to be part of the essential package of care, treatment and support for people living with HIV/AIDS. The HIV epidemic is both driven by, and contributes to, the factors that also cause malnutrition: in particular, poverty, emergencies and inequalities. The droughts that have ravaged Niger and are now affecting the Horn of Africa are yet further setbacks to communities struggling for subsistence.
Without good nutrition, infants, children and adults alike are more vulnerable to disease and death. An HIV-positive child who is already undernourished needs more food than an infection-free child. The interactions of adequate nourishment and uptake of drugs, of having enough food and being able to fight infection, are crucial in our understanding of where our work must be directed. WHO is leading the initiative to address the linkages between HIV and nutrition.
Right now, avian influenza is sweeping through the world, wiping out entire poultry flocks within a day or so of its arrival. This brings an immediate threat to populations on the brink: a catastrophic loss of protein sources and livelihood as household flocks fall sick. The related threat, of human infection with the H5N1 virus and a change in that virus to trigger a human pandemic, is ever-present. But right now, in Asia, in Africa, in India, in the Middle East, there is an agricultural disaster building, which will inevitably have its human consequences. I invite you today, in this session, to make this part of your thinking and planning for coordination.
Next month we will launch the long-awaited Growth Standards Charts. They reflect a significant change in approach: to identification of children at risk. This preventive approach, which addresses risk factors, is at the heart of much of our work on leading causes of death - whether in the area of child survival - or in adult death from chronic diseases. It is based on the recognition that health conditions are the result of a complex interlocking set of environmental conditions and behavioural choices.
There is still a great deal to discover about the influence of each of those choices and conditions. And about what can be done to encourage and support more people to make the choices that result in better health.
We have to work on commonly agreed directions and messages. The effort to get those agreements is a tiny fraction of the effort that it takes to undo the muddle caused by confused messages. Misunderstandings, such as those caused by reporting of the conclusions of the "women's health initiative diet modification trial", can take years to clear up. And in the meantime momentum towards gathering a shared body of opinion, evidence, and action is lost.
The evolution of the growth standards is a fine example of collaboration and sharing of scientific information. This has been built up over the course of more than a decade between WHO, UNICEF, governments and many other partners. Similarly, this 33rd session is an important opportunity to rise above the boundaries that normally separate our work, and look to the greater goods of clear common interest.