Prof. Kraisid Tontisirin - MFAuswatch.mfa.go.th/IRIND/1-KraisidTontisirin_Nutrition Impact of... ·...

Senior Advisor , Institute of Nutrition ,

Mahidol U. Thailand Chairman of the Food Strategic Planning Committee, the National Food Committee

29 September 2014

Grand Millennium Sukhumvit Bangkok

Prof. Kraisid Tontisirin

Thailand: Current situation

• Population of 64.6 m.

• Success in reduced maternal and child

malnutrition since the eighty under the Poverty Alleviation Plan (PAP) • Currently facing with double burden of

malnutrition (DBM), a coexistence of under and over nutrition, and related non-communicable diseases (NCDs)

2 Kraisid Tontisirin, Mahidol University

Improvement of Maternal & Child nutrition,

Thailand

1980 1990 2006

ANC coverage % 35 75 95

Anemia in pregnancy % 50-75 18.8 10

LBW % 16 10 <10

Underweight of under 5 % 51 20 <10

9.7

12.9

5.8

8.3

6.97.9

6.3

4.8

8.5

0

2

4

6

8

10

12

14

-

* Source: NHES 2; Holistic Development of Thai Children; NFNS 5; NHES 4

Stunting Underwt Overwt & Obesity

Recent trend of

nutritional status of

under 5*

Kraisid Tontisirin, Mahidol University 3

Multi-stakeholder Comm. Nutrition goals and indicators are incorporated to strategies and actions. Community based approaches

National Rural Development Committee

Poverty Alleviation Plan

Provision of basic services with mass mobilization:1volunteer /10 households

Agri.& food production

for subsistence econ.,

suppl. food for mothers,

complementary food for IYC & dairy farm for sch.


Community-Based Approaches

• Is an integrated program implemented

at local level (district level and below)

• National commitment with sound nutrition

improvement strategies and goals

• Community actions: basic services, mass

mobilization, mutual efforts/actions to reach

all people and to prevent malnutrition


Minimum Basic Services

(Health, Education, Agr. Extension)

Supportive System

•Training

•Funding

•Problem Solving

•Supervision

Interface (service providers and

community leaders)

•Plan/goals

•Implementation

•Monitoring/evaluation

Community Leaders

Family

Individual

Basic Minimum Needs Goals/Indicators

Menus (Activities) •Antenatal Cares (ANC)

•Growth Monitoring and

Promotion (GMP)

•Food production

•Food and nutrition

education

•Food sanitation &

safety

•School lunch and milk

program since 1992

•Other activities Mobilizers

(1:10 households)

Facilitators

Components of a successful community based program


Roles of agriculture and food systems

• Food production for subsistence economy: for consumption and income

• Promote local healthy snacks as food supplement for pregnant mothers

• Promote complementary food for infants and young children: at household and community levels

• School gardens and school lunch program

• Local daily farm for school milk program: a win-win activities


1962

1967

1972

1977

1982

1987

1992

1997

2002

2007

2012

1st NEDP

2nd NEDP

3rd NEDP

4th NESDP

5th NESDP

6th NESDP

7th NESDP

8th NESDP

9th NESDP

10th NESDP

11th NESDP

2017

: Economic Infrastructure, Sectoral Plans

: + Poverty Alleviation Plan (PAP) + Integrated and implemented

PHC

+ FNP and Basic Minimum Needs (BMN) Indicators in rural/urban communities

: + Social Plan + Food and Nutrition Plan (FNP) + Primary Health Care (PHC)

: Improvement of Agriculture, Infrastructure

: 1992 + School Lunch Program (SLP) + School Milk Program (SMP)

19601 - Anaemia in pregnant women: 57%;

- B1 deficiency: 23%;

- B2 deficiency: 47%;

- Low serum retinal: 38%;

- Goitre in school children: 29%

- PEM cases

19812 - PEM (Wt/Age of U 5): > 50%

19863 - PEM (Wt/Age of U 5): 30%

19956 - B1 deficiency: < 1%;

- B2 deficiency: < 1%

19894 - Goitre in school children: 19%

1996 - PEM3 (Wt/Age of U 5): 15%

- Anaemia in preg5: 13%; - Goiter in school children4: 4%

20034 - Goitre in school children: 1%

20067 - PEM (Wt/Age of U 5): 9% 2007 - UI in preg8 < 150 µg/L: 61%; - Low serum retinal9: 16% 20088 - UI in preg < 150 µg/L: 56% 20108 - UI in preg < 150 µg/L: 43% 201210 - PEM (Wt/Age of U 5): 7%

19915 - Anaemia in preg: 18%

: 2008 + National Food Committee Act

: 2010 + Strategic Framework for Food Management (SFFM) approved by cabinet : Integration of the SFFM and the 11th NESDP

: Promote cooperation and integration of all relevant sectors,

academia, business and NGOs to strengthen national food and nutrition security : 2012 - Triferidine tablet (iron+folate+iodine)

: 2011 - Universal salt iodisation (USI)

2005 - Anaemia in preg: 10%

Nutrition Situation Thailand’s Development Plans

Policies and Strategies

Figure Milestones of Thailand’s National Social and Economical Development Plan related to food and nutrition

Kraisid Tontisirin, Mahidol University

8

Multi-stakeholder Comm.

SFFM covers: Food Security, Quality & Safety, Education & Research, Management

Linking of food, nutrition &health implemented at central & community levels for nutrition and p/c of NCDs

National Food Committee

Str Framewk for Food Mgt

(SFFM)

Roles of agriculture and

food systems:

• Ensuring nutritious and

safe food supply e.g. fruits

& veg; low sugar, fat &

sodium foods; legume &

fishes …etc

• Caring of environment &

sustainable agriculture.


SWOT Analysis Related Food Strategies of Thai Gov. Agencies:

Thailand Food Strategy

Related Food Strategies of:

• ASEAN • Japan • England

• Australia • Canada • EU • Etc.

• NESDB • Min. of Public Health • Min. of Agriculture and Commodity • Min. of Industry • Min. of Commerce • Etc.

Theme 1 Food security

Theme 2 Food quality and safety

Theme 3 Food education

Theme 4 Management System

Food Management Strategic Framework

Food Chain Approach / Global Reach /

Local Links to the community and household

Vision Objectives Outcomes

Principles

• Evidence based plan

• Participation/ Partnership • Guided plan • Integration

• Risk based analysis • Sustainability

Continued Research and Knowledge Based Inputs

REVIEW REVIEW


• Food production,

processing & supply

• Nutrition orientation

for healthy diet

• Food, feed and fuel

and bio-products

• Climate changes

Food Nutrition Health

• Nutrient needs

• Dietary intakes

• Nutritional wellbeing

• Nutrition literacy

• Food quality

• Food safety

• Food service

(For consumer and trade)

Food Culture

Food Security

Food, Nutrition & Dietetic Education

Continuum from agriculture, food, nutrition to health

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Agri

culture


• Promotion

• Protection

• Treatment

• Safe from Hazards

Good health

Safe and Nutritious

Food

Good Hygienic Practices

Good Manufacturing

Practices

Good Agricultural Practices

Land Use Water Management

Plant and Animal Agro- Biodiversity

(Genetics)

Plant and Animal Diseases

Prevention and Control

Nutrition For Plant and Animal

OUTCOMES

GOOD PRACTICES

BASIC ISSUES

Food Chain Approach


Principle : Ensuring a sustainable food security and effective management of food production resources by active stakeholders participation

Natural & Agricultural Resources


Production Supply

& Access

Establish Crisis Management Systems

• Land & Water Mgt/Reforming

• Balancing Food,

Feed & Fuel

• Innovation & Technology

• Food Production Zoning • Enhancing Food Access at Household & Communities

• Logistics Improvement

Active Stakeholders Participation

R & D Along the Food Chain

• Capacity Development & Career

13

Food Quality and Safety

Community Food

Production Food Industry

Food Standards

Principle : Ensuring high quality and safe food to protect consumer

health and to facilitate domestic/international trade

• Ensuring Quality & Safety of Fresh Food

(Smart Farmers, GAP, R&D)

• Strengthening Community Food Processing

(Food Loss Reduction / Value Added)

• Strengthening

- Value Added

- Enhance Production Practices

• Establishment of Harmonized Standards

• Strengthening of Food Quality and Safety Assurance Systems

• Trading & Marketing Promotion

• Quality

• Safety

• Nutrition


Theme 3 : Food Education Principle : R&D and knowledge utilization through engaging stakeholders in

sustainable and effective use of food production resources along

the food chain and also strengthening desirable consumption

behavior for well-being

Knowledge Integration

R&D

Knowledge Utilization

Knowledge Utilization & Practice

Basic

Best Practice

Output Research and Knowledge Development

Knowledge Dissemination


Theme 4 : System Management

Principle : Effective food management systems along the food chain

to deal with current and emerging issues in food

Reorganization

& Strengthening

Revise and

Reform

Database &

Management

System

Organization

Legal system


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Information / Standard and Knowledge based

Safety

Quality / Diversity

Linking of Food, Nutrition and Health

17

Production

Safe and Nutritious Food

►Access ►knowledge ►Behavior - Diet pattern/Sanitary - Life style /Exercise

►Domestic/ Imported Food - Primary Product - OTOP - Industrial

►Restaurant ►Catering ►Mobile Food Service Facility ►School ►Household ►Market

Supply Service Good Nutrition & Good Health

Consumption

Surveillance


1. Standards & indicators on nutrition & related disease

2. Food based dietary guidelines (FBDGs)

3. Food, nutrition & dietetic education

4. Promotion for more vegetable & fruit consumption

5. Reduction of sugar, fat & salt in food

6. School food & nutrition program

7. Community based nutrition program

to promote nutrition & health

8. Nutrition & related disease surveillance & survey

9. Food and nutrition management during crisis

Key Issues Linking Food, Nutrition & Health


Roles of agriculture and food systems beyond

the year 2015 for nutrition

• Ensuring nutritious and safe food supply of healthy

diets through human life course

• Be a key partner to prevent DBM and NCDs by

supplying adequate fruits & vegetables; low sugar,

fat and sodium foods; healthy fats…etc

• Care for environment and sustainable development

• As a source of income


Food Systems in Thailand

Traditional Food Systems Modern Food Systems

• Food production & supply at

household & community level.

• Food production for business

in small & medium scales

• Use simple food preservation and

processing techniques (e.g. smoking,

sun drying, fermentation, salting)

• Mass production/ Large scale

• Apply science & technology in

food production & processing

• Strengthen in food quality & safety

• Strengthen and use of food and

trade information systems

Contributions of both food systems to healthy agriculture, health diets & nutrition, healthy people and prosperity

Challenge


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Thailand: Agriculture & Food Systems for…

Kraisid Tontisirin, Mahidol University Source: the National Food Committee 2014

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