Editor's note: This is the second in a series reviewing the 1978 Alma Ata Declaration as we approach its 40th anniversary on September 12, 2018. In this article, Alliance's Peter Winch and Jess Fanzo join forces to examine links between food, nutrition and delivering health for all.
Then and Now: Challenges in Nutrition and Achieving Health for All
Forty years ago, over a hundred delegates from around the world convened at the International Conference on Primary Health Care held at Almaty (formerly Alma-Ata), Kazakhstan to affirm strategies towards health for all. High levels of malnutrition in low-income countries was a chief concern and promoting food and nutrition was incorporated into the Alma Alta Declaration. We have come a long way to address food and nutrition challenges since the declaration was enacted in 1978. We also have a long way to go.
At the time of the declaration, acute and chronic undernutrition were widespread among low-income and marginalized populations throughout the world. The delegates recognized that solutions to undernutrition should not only come from the offices of ministries of health or international organizations located in capital cities. Instead, the Alma Ata Declaration called for working alongside local people in the homes and communities where mortality rates were highest and undernutrition had the greatest toll. It also encouraged engaging with and learning from local community knowledge about food production and child feeding.
In the words of Carl Taylor, first Chair of the Department of International Health and a key figure in the drafting of the Alma Ata Declaration, “There are no global solutions, but there is a universal approach for finding local solutions.”
Now in 2018, community-based approaches to malnutrition are widespread, and their importance is widely recognized. In spite of these efforts, undernutrition remains a problem that severely impact the health and wellbeing of many people worldwide. While many countries are witnessing reduced undernutrition, their progress is not fast enough for them to meet the Sustainable Development Goals and other targets that address food and nutrition security.
In addition to this existing challenge, many of these countries are grappling with another form of malnutrition – overweight and obesity has compounded diet-related, chronic diseases (non-communicable diseases), such as cardiovascular disease and diabetes. These have emerged through the “nutrition transition,” driven largely by urbanization, economic globalization, and marketing of prepackaged foods and beverages. The transition over the last several decades from active lifestyles and diets high in cereal and fiber gave way to more sedentary lifestyles, together with diets high in sugars and refined carbohydrates, fat, meat, and pre-packaged foods. A comparison of the challenges at the time of the declaration and today’s challenges are outlined in the chart below.
Mapping a Successful Path Forward
Strengthening of primary health systems must integrate nutrition into existing health care prevention, treatment and services. Diet counseling and education, nutritional assessment and monitoring, as well as treating and managing diseases have been shown to help improve health outcomes. To do this, health worker professionals must have the training and capacity to use these approaches to deal with the symptoms their patients face as a result of malnutrition.
Furthermore, a new generation of primary health care (PHC) programs must also support efforts of Ministries of Agriculture and other partners to reduce the enormous greenhouse gas emissions that result from modern methods of producing food. The productivity of the food system is vulnerable in the face of climate change and ecosystem degradation. Ministries of Agriculture and other partners in food production have the responsibility to address the supply side of food systems by improving the way they produce, store and transport food to be more climate friendly, and to reduce food loss and waste. PHC and Ministries of Agriculture have the opportunity to integrate the work of community health workers and agricultural extension agents to promote climate- and nutrition-smart food systems.
PHC can play a complementary role on the demand side of sustainable food systems by educating patients to shift consumer demand towards diets that are fair and equitable. Many people in high-income countries have the option to shift to diets that use less resources and decrease their risk of diet-related NCDs. In low-income countries, many people do not get enough access to highly nourishing food, and as a result, they often do not receive enough nutrients to be healthy and resilient.
Essential Need for Integrating Work across Several Sectors
In an increasingly globalized world with interconnected health and food systems, no country or population is immune to the challenges that lay ahead for ensuring that everyone is food secure and well nourished. Potential solutions are already evident across both food systems and public health care systems; however, to adequately leverage those elements, they must be sustainable, and trans-sectoral by engaging communities, practitioners and experts across agriculture, environment, climate, and public health. Only by working this way can we transform how food is produced and allocated – and further cultivate health for all.
Take a look at other articles in this series:
Peter Winch is the Theme Leader for Healthy Environments at the Alliance for a Healthier World (AHW). As Professor in the Social and Behavioral Interventions Program at the Bloomberg School of Public Health, he teaches courses on qualitative and formative research and applied medical anthropology. His work aims to: 1) improve the health of mothers and children in areas where access to health facilities is poor or non-existent, and 2) develop and evaluate behavior change interventions and health system responses to global environmental threats.
Jessica Fanzo is the AHW Theme Leader for Food & Nutrition Security, and Bloomberg Distinguished Associate Professor of Global Food & Agricultural Policy and Ethics at the Nitze School of Advanced International Studies (SAIS), the Berman Institute of Bioethics, and the Department of International Health of the Bloomberg School of Public Health at Johns Hopkins University.