Addressing malnutrition in all its forms in Caribbean countries using a food systems approach


The Caribbean sub-region is facing increasing levels of overweight, obesity and diet-related noncommunicable diseases (NCDs), while at the same time coping with a persistent problem of acute and chronic undernutrition and deficiency diseases which are affecting some countries and some sectors of the population, particularly population groups under vulnerable conditions. The prevalence of obesity in adults in the Caribbean increased from 15.2% in 2000 to 24.7% in 2016, well above the global prevalence of 13.1%. In 2020, it was reported that 6.6% of children under five years of age were overweight, following an upward trend that places the Caribbean countries in danger of missing the Global Nutrition Target of no increase in childhood obesity by 2025. However, wasting is still a problem in some Caribbean countries, and many countries face coexistence of malnutrition in all its forms in different areas, communities and families. Also worrisome is the fact that the COVID-19 pandemic has contributed to increasing levels of poverty and food insecurity. In 2021, UN Agencies including the Pan American Health Organization (PAHO), the Food and Agriculture Organization (FAO), United Nations Children’s Fund (UNICEF) and World Food Programme (WFP), in a Joint Statement on Nutrition in the context of the COVID-19 pandemic in Latin America and the Caribbean, called upon all governments, civil society organizations, and the donor community to protect and prioritize the nutritional status of all individuals. The statement noted that the COVID-19 crisis threatened to impact all components of the food system: the food supply chain, food environment and consumer behaviors. However, alarmingly, the fourth round of the CARICOM Caribbean COVID-19 Food Security and Livelihoods Impact Survey conducted between January and February 2022 has revealed that the number of people who are food insecure has increased by one million since the start of the pandemic, to 2.75 million. Severe food insecurity has increased by 44% over the past year. While 57% of respondents reported job losses or reduced income for the household, food prices are increasing. The coping mechanisms employed by those affected include skipping meals and buying cheaper foods, which impact on the quality of diets and on health. As the Caribbean moves to address its nutrition problems, there must be recognition of the need for using a food systems approach. Such an approach is one which addresses all the components of the food system, namely the environment, population, resources, processes, institutions, and infrastructure, activities involved in the production, processing, distribution, preparation, as well as the consumption of food. The impact of these activities on nutrition and health, socioeconomic growth, equity, and environmental sustainability must also be taken into account. This approach must be comprehensive enough to address all forms of malnutrition – overweight, obesity, and diet-related NCDs, as well as undernutrition and micronutrient deficiencies. The joint statement by UN agencies recognized that deliberate actions must be taken to increase the resilience and sustainability of food systems so that they could support food security and nutrition. Countries must take advantage of the opportunities presented by the recent UN Food Systems Summit and the Nutrition for Growth Summit, by making commitments to transforming food systems to make them resilient, fair, healthy and sustainable. PAHO’s principles for transforming food systems are exemplified by:

• Formulation of proposals and actions that strengthen the production and availability of fresh foods
• Strengthening health and social protection systems
• Emergency actions aimed at reducing hunger
• Strengthening cultural behaviors and regulatory measures to reduce ultra-processed products
• Preventing and controlling all forms of malnutrition
• Strategies for healthy cities and food environments
• Collaborative governance
• Decisions free from conflict of interest
• Consideration of the impact of crises and climate change and
• Multisectoral coordination

The sub-region must also use cohesive, comprehensive strategies to address the regulatory environment for food and nutrition. In the last few decades there has been an increase in the availability and promotion of ultra-processed products, leading to greater consumption and contributing to a rise in intake of sodium, harmful fats and sugars, thereby increasing the risk of obesity and NCDs. Regulating the marketing and sale of foods and non-alcoholic beverages to children, and the introduction of other demand reduction policies such as the application of front-of-package warning labels, and taxation of unhealthy foods are actions that must be prioritized, relying on the incontrovertible evidence that already exists, but also building the evidence base through rigorous scientific studies. School children are at an especially vulnerable stage of life, and their health and nutrition must also be protected by robust school nutrition policies and standards to ban unhealthy food products available in and around schools. Time and effort must be spent in developing and maintaining enforcement mechanisms and monitoring systems.

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