and Agriculture Organization (FAO) of the United Nations based on the calories available from local food production, trade, and stocks; the number of calories needed by different age and gender groups; the proportion of the population represented by each age group; and a coefficient of distribution to take account of inequality in access to food (FAO 2000). From a policy and program standpoint, however, this measure has its limits. First, food insecurity exists even where food availability is not a problem because of inadequate access of poor households to food. Second, food insecurity is an individual or household phenomenon, and the average food available to each person, even corrected for possible effects of low income, is not a good predictor of food insecurity among the population. And third, nutrition security is determined not only by food security but also by the quality of care of mothers and children and the quality of the household’s health environment (Smith and Haddad 2000).
Estimates of child malnutrition, based on weight for age (underweight) and height for age (stunting), are from national survey data. The proportion of chil- dren who are underweight is the most common indi- cator of malnutrition. Being underweight, even mildly, increases the risk of death and inhibits cognitive development in children. Moreover, it perpetuates the problem from one generation to the next, as mal- nourished women are more likely to have low-birth- weight babies. Height for age reflects linear growth achieved pre- and post-natally, and a deficit indicates long-term, cumulative effects of inadequacies of health, diet, or care. It is often argued that stunting is a proxy for multifaceted deprivation and is a better indicator of long-term changes in malnutrition.
Estimates of children who are overweight are also from national survey data. Overweight in children has become a growing concern in developing countries. Researchers show an association between obesity in childhood and a high prevalence of diabetes, respira- tory disease, high blood pressure, and psychosocial and orthopedic disorders (de Onis and Blossner 2000). The survey data were analyzed in a standard- ized way by the World Health Organization (WHO) to allow comparisons across countries.
Low birthweight, which is associated with mater- nal malnutrition, raises the risk of infant mortality and stunts growth in infancy and childhood. There is also emerging evidence that low-birthweight babies are more prone to noncommunicable dis- eases such as diabetes and cardiovascular heart
diseases. Estimates of low-birthweight infants are drawn mostly from hospital records and house- hold surveys. Many births in developing countries take place at home, and these births are seldom recorded. A hospital birth may indicate higher income and therefore better nutrition, or it could indicate a higher-risk birth, possibly skewing the data on birthweights downward. The data should therefore be treated with caution.
It is estimated that improved breastfeeding prac- tice can save some 1.5 million children a year. Breast milk alone contains all the nutrients, antibodies, hormones, and antioxidants an infant needs to thrive. It protects babies from diarrhea and acute respiratory infections, stimulates their immune sys- tems and response to vaccination, and according to some studies confers cognitive benefits as well. The data on breastfeeding are derived from national surveys.
Iodine deficiency is the single most important cause of preventable mental retardation, and it contributes significantly to the risk of stillbirth and miscarriage. Iodized salt is the best source of iodine, and a global campaign to iodize edible salt is sig- nificantly reducing the risks (UNICEF, State of the World’s Children 1999).
Vitamin A is essential for the functioning of the immune system. A child deficient in vitamin A faces a 25 percent greater risk of dying from a range of childhood ailments such as measles, malaria, and diarrhea. Improving the vitamin A status of pregnant women helps reduce anemia, improves their resis- tance to infection, and may reduce their risk of dying during pregnancy and childbirth. Giving vitamin A to new mothers who are breastfeeding helps to protect their children during the first months of life. Food for- tification with vitamin A is being introduced in many developing countries.
• Prevalence of undernourishment is the percentage of the population that is undernourished. • Preva- lence of child malnutrition is the percentage of children under age five whose weight for age (under- weight) or height for age (stunting) is more than two standard deviations below the median for the inter- national reference population ages 0–59 months. For children up to two years old height is measured by recumbent length. For older children height is measured by stature while standing. The reference population, adopted by the WHO in 1983, is based on children from the United States, who are assumed to be well nourished. • Prevalence of overweight children is the percentage of children under age five whose weight for height is more than two standard deviations above the median for the international reference population of the corresponding age, established by the U.S. National Center for Health Statistics and the WHO. • Low-birthweight babies
are the percentage of newborns weighing less than 2,500 grams, with the measurement taken within the first hours of life, before significant postnatal weight loss has occurred. • Exclusive breastfeeding refers to the percentage of children less than six months old who are fed breast milk alone (no other liquids). • Consumption of iodized salt refers to the percent- age of households that use edible salt fortified with iodine. • Vitamin A supplementation refers to the percentage of children ages 6–59 months old who received at least one high-dose vitamin A capsule in the previous six months.
Data sources
Data on undernourishment are from www.fao.org/ faostat/foodsecurity/index_en.htm. Data on mal- nutrition and overweight are from WHO’s Global Database on Child Growth and Malnutrition. Data on low-birthweight babies, breastfeeding, iodized salt consumption, and vitamin A supplementation are from the WHO’s World Health Report 2004 and the United Nations Children’s Fund’s State of the World’s Children 2006.
2.18
Health risk factors and
public health challenges
Prevalence of smoking Incidence of tuberculosis Prevalence of diabetes Mortality caused by road traffic injury Prevalence of HIV % of adults Total Female per 100,000 people % of population ages 20–79 per 100,000 people % of population ages 15–49 % of population with HIV Male Female 2000–05a 2000–05a 2004 2003 1998–2003a 2001 2003 2001 2003 Afghanistan .. .. 333 8.2 .. .. .. .. .. Albania 60 18 22 3.8 11.1 .. .. .. .. Algeria 32 0b 54 4.1 .. <0.1 0.1 11.8 15.6 Angola .. .. 259 2.7 .. 3.7 3.9 55.0 59.1 Argentina 32 25 43 5.4 .. 0.7 0.7 19.2 20.0 Armenia 62 2 78 8.1 5.6 0.1 0.1 35.0 36.0 Australia 19 16 6 6.2 8.2 0.1 0.1 6.7 7.1 Austria .. .. 14 9.6 11.5 0.2 0.3 22.2 22.0 Azerbaijan .. 1 75 6.9 6.9 .. <0.1 .. .. Bangladesh 55 27 229 3.9 .. .. .. .. .. Belarus 53 7 60 6.9 14.3 .. .. .. .. Belgium 30 25 13 4.2 13.1 0.2 0.2 35.8 35.0 Benin .. .. 87 2.1 .. 1.9 1.9 57.6 56.5 Bolivia .. .. 217 4.8 .. 0.1 0.1 27.5 27.1
Bosnia and Herzegovina 49 30 53 9.6 .. .. <0.1 .. ..
Botswana .. .. 670 3.6 .. 38.0 37.3 57.6 57.6 Brazil 22 14 60 5.2 .. 0.6 0.7 37.1 36.9 Bulgaria 44 23 36 10.0 10.2 .. 0.1 .. .. Burkina Faso .. .. 191 2.7 .. 4.2 1.8c 56.0 55.6 Burundi .. .. 343 1.3 .. 6.2 6.0 54.5 59.1 Cambodia .. .. 510 2.0 .. 2.7 2.6 30.0 30.0 Cameroon .. .. 179 0.8 .. 7.0 5.5d 56.0 55.8 Canada 22 17 5 9.0 8.7 0.3 0.3 25.0 23.6
Central African Republic .. .. 322 2.3 .. 13.5 13.5 56.5 54.2
Chad .. .. 279 2.7 .. 4.9 4.8 57.1 55.6
Chile 48 37 16 5.6 10.7 0.3 0.3 32.0 33.5
China 67 4 101 2.7 19.0 0.1 0.1 20.0 22.9
Hong Kong, China 22 4 75 8.8 .. 0.1 0.1 30.8 34.6
Colombia .. .. 50 4.3 24.2 0.5 0.7 33.3 34.4
Congo, Dem. Rep. .. .. 366 2.5 .. 4.2 4.2 56.8 57.0
Congo, Rep. .. .. 377 2.6 .. 5.3 4.9 56.3 56.3 Costa Rica 29 10 14 6.9 20.1 0.6 0.6 31.8 33.3 Côte d’Ivoire .. .. 393 2.3 .. 6.7 7.0 56.3 56.6 Croatia 34 27 41 5.8 11.4 .. <0.1 .. .. Cuba .. .. 10 13.2 13.9 0.1 0.1 31.3 33.3 Czech Republic 31 20 11 9.5 14.2 <0.1 0.1 35.7 32.0 Denmark 31 25 8 6.9 8.0 0.2 0.2 17.4 18.0 Dominican Republic 16 11 91 10.0 41.1 1.8 1.0e 26.4 27.1 Ecuador .. .. 131 4.8 16.9 0.3 0.3 32.6 34.0
Egypt, Arab Rep. 40 18 27 9.8 7.5 <0.1 <0.1 10.9 13.3
El Salvador 42 15 54 6.2 41.7 0.6 0.7 32.1 34.3 Eritrea .. .. 271 1.9 .. 2.8 2.7 56.4 56.4 Estonia 45 18 46 9.7 14.8 0.7 1.1 32.0 33.8 Ethiopia 6 0b 353 1.9 .. 4.1 4.4 55.8 55.0 Finland 26 19 9 7.2 7.3 0.1 0.1 .. .. France 30 21 12 6.2 10.2 0.4 0.4 27.3 26.7 Gabon .. .. 280 2.9 .. 6.9 8.1 56.8 57.8 Gambia, The .. .. 233 2.2 .. 1.2 1.2 55.6 57.1 Georgia 53 6 82 9.0 6.2 <0.1 0.1 .. 33.3 Germany 37 28 8 10.2 8.0 0.1 0.1 19.8 22.1 Ghana 7 1 206 3.3 .. 3.1 2.2c 54.8 56.3 Greece 47 29 19 6.1 19.3 0.2 0.2 20.5 20.0 Guatemala 21 2 77 5.5 .. 1.1 1.1 41.5 41.9 Guinea .. .. 240 2.0 .. 2.8 3.2 59.0 55.4 Guinea-Bissau .. .. 199 2.0 .. .. .. .. .. Haiti 15 6 306 5.7 .. 5.5 5.6 58.3 57.7