In the last 12 months there have been high-level meetings coordinated and led by the UN that have drawn attention to the importance of, and critical interrelationships between, under- and overnutrition in causing the major chronic diseases that are now the leading causes of death worldwide. Many of the poorest countries in the world, while still having high rates of wasting and stunting, are showing rapidly escalating rates of overweight and obesity, diabetes and hypertension – the double burden of disease. Up to now policies aimed at addressing undernutrition have not been well coordinated with those for addressing overnutrition. Agricultural policies in low- and middle-income countries have been driven by estimates of hunger based on deficits in per capita energy supply; yet in these countries rates of obesity are rising. The models used to drive global food production have profound effects on access to water and climate change, which in turn affects local food security. The impact of dramatic increases in global food and fuel prices has been compounded since 2008 by the global economic crisis. All of these challenges are felt most acutely by the poorest in low- and middle-income countries.
There is now broad agreement that what happens to young women before and during pregnancy has profound long-term effects on the health and well-being of their offspring. The environment a fetus experiences in utero shapes its response to stressors later in life. Infants who are exposed to marginal intakes early in life, when exposed to higher intakes later on, are not able to cope well with this new situation and instead of growing ‘better’, become relatively fat and at much higher risk of diabetes. Poorly nourished children do less well at school, are economically less productive and so the cycle continues, so that at all stages of the life course they are worse off and this is perpetuated across generations.
Prevention and a public health approach that addresses the needs of the population are the best way to change the underlying social determinants of health (the causes of the causes). The challenge is how to deliver this approach, when the current driving political ideology of many governments is to focus on treatments and a more individualised informed choice model of support. Many governments encourage the transnational food and beverage industries to sit with them to shape food policy. Others argue that this represents a clear conflict of interest and that these industries should only be involved in the implementation, not the shaping, of policies.
Another key question to ask is what is the right architecture for our global institutions that are designed to promote public health?
These are complex issues. In October 2011 the seven billionth child was born. Do we have the capacity to feed the growing world population? This question has been repeatedly asked, and so far the answer has been ‘yes, we can’, if we use our resources more fairly and rationally. What is new and increasingly being asked, though, is can we feed the world in an environmentally sustainable way? Can we assume that the current dominant model of global food production is environmentally sustainable? Another challenge is how to preserve and protect the diversity of dietary behaviour found around the world from the increasingly dominant Western highly processed diet driven by transnational food and beverage industries. As more people move into mega cities, more people become dependent on others to produce and provide access to the foods they eat in exchange for cash. What is the best way to cope with these major shifts?
These are some of the big questions that participants at the World Nutrition Rio2012 Congress will be addressing in Rio de Janeiro in April this year. The theme of the congress is ‘World Nutrition: Knowledge, Policy, Action’. This affirms that different types of knowledge, including evidence derived from conventional scientific investigations and also from traditional and other sources, are needed to ensure rational policies and effective actions. Further, knowledge in itself is not enough to face the challenges that now confront public health nutrition. Policy strategies need to be implemented, evaluated and thus continually strengthened. This cyclical process explains the spiral design that is the symbol of the congress. To develop this general theme, the congress will focus on six key areas:
1. Equitable food systems with dietary diversity.
2. Food and nutrition policies.
3. Environment and food and nutrition security for all.
4. Determinants of and threats to health.
5. Successful strategies and interventions.
6. Nature and strengthening of public health nutrition.
The congress will discuss and debate the vast public health nutrition challenges and crises that now confront those in power and policy makers in multinational bodies, civil society and public interest organisations, national governments and industry, as well as relevant professional bodies, the academic community, field workers and community groups. It will go further, and will discuss, affirm and agree statements designed to be carried forward after the congress.
Rio2012 will address the basic and underlying determinants of food systems and dietary patterns, and thus of disease, health and well-being, as well as their immediate causes. It will also take into account the social, economic, political and environmental as well as the biological determinants of nutrition and health.
The congress (www.worldnutritionrio2012.com) is being held in Brazil in a partnership between the World Public Health Nutrition Association (www.wphna.org) and the Brazilian Association of Collective Health (Abrasco; www.abrasco.org.br). Why Brazil? Come and find out – apart from Rio being one of the great cities of the world, you will find a group of people who are energetic, engaged, passionate and committed to action. Brazil has led the way in improving nutrition in the past decade, so the local community know they can do amazing things and want to share their experiences with the rest of the world.
