An estimated 132 million babies were born worldwide in 1998. In the cycle of life, a baby's birth marks a new beginning; but unfortunately, not every baby has an equal chance for optimal growth or survival. Optimal human development is dependent on several factors, including socioeconomic status, genetics, the environment, and nutrition. Nutritional status impacts an individual's ability to grow, to learn, to work, and to fight disease.
Worldwide, improvements in national and household incomes have contributed to improved nutritional status over the past 50 years. In addition, nutrition interventions, particularly those targeted at vulnerable groups, have resulted in significant improvements in nutritional status.
However, most of these successful nutrition interventions were originally implemented with a specific focus on undernutrition and/or specific nutrient deficiencies. In the past several decades, nutrition problems worldwide have expanded to include both concerns of underconsumption and problems of imbalances and excesses. While undernutrition and food insecurity are still massive problems in many developing countries, health data also indicate soaring rates of diabetes, obesity, cancer, and cardiovascular disease. In order to respond to these new "faces of nutrition," we need a paradigm shift in our interventions. Interventions in the 21st century will differ in three key aspects.
First, interventions must now focus on strategies to promote healthful living by concentrating primarily on diet and physical activity. Interventions will need to build on past successes but go beyond a direct service model; it's not enough to provide a meal or a pill. Models of successful, sustainable interventions for healthy lifestyles will need to draw heavily on social marketing and the health communications fields to mount interventions that are effective in promoting behavior change.
Second, the new nutrition paradigms will need to focus on prevention rather than cure. Most of the earlier successes in nutrition focused on an underlying therapeutic model. Stunted children or children with low weight for age were the targets for nutrition services. We now know from vast scientific literature summarized in this report that dramatic improvements in nutritional status worldwide will occur from preventive nutrition efforts.
Third, if policymakers and implementers are truly interested in preventive nutrition, the target of interventions needs to shift to a different part of the life cycle. Investment in the preconceptional female will yield enormous nutritional benefits in other parts of the life cycle. We know unequivocally that healthier females—before pregnancy—are more likely to produce healthier babies, who develop into healthier children. This last point is critical. Most previous interventions have not effectively reached preconceptional females.
The newer paradigms of nutrition—promoting healthy lifestyles, focusing on prevention, and targeting the preconceptional female—offer enormous potential for achieving significant improvements in health and nutrition worldwide. That is why in 1999, the March of Dimes, driven by its mission to improve the health of babies, convened a 29-member international task force of nutrition scientists, administrators, and policy-makers. The report, Nutrition Today Matters Tomorrow, is the outcome of two years work by Task Force members.
For Whom Is the Report Intended?
The report will be useful for those who make or influence policies that affect nutrition and health at the community, regional or national levels and for those who provide nutrition or health services to women, infants, and young children or who supervise those who do. Examples of individuals who could make a difference include: state nutritionists, hospital administrators, nurses and physicians, public health managers and policy-makers at all levels, and managers working for government and nongovernment organizations. Working collaboratively at all levels, it will take a variety of individuals, organizations, and interventions to improve health outcomes for women and children around the world.
Nutrition is everyone's challenge, but no one's sole responsibility. To help our target audience understand their potential contributions, the Task Force identified five types of actions that can lead to optimal nutrition for women and children, including:
- Personal actions such as food choices, food safety practices, and physical activity
- Community actions such as the availability of nutritious and safe foods, outreach services and educational opportunities
- Health care provider actions such as the reinforcement of community health messages and the acquisition and use of knowledge related to the life cycle perspective and nutritional influences on health
- Regional actions such as the dissemination of this report, an action-oriented agenda and educational tools; technical assistance in developing community-specific food-based dietary guidelines and intervention strategies
- National and international actions such as the development of nutrition and food safety policies; infrastructure to provide a nutritionally adequate and safe food supply, education, supplementation and/or fortification if necessary; and the implementation of appropriate world health resolutions and codes
What Are the Goals of the Report?
The report is the blueprint to tackle the new "faces of nutrition" by providing information and implementation steps to help prevent the major nutrition problems of preconceptional, pregnant and lactating women, and of children under two years of age. Specifically, the Task Force carefully considered how to provide recommendations and implementation strategies that would incorporate food-based dietary recommendations and a life cycle perspective focused on women and very young children.
