• ASEAN Member States should create an enabling environment and develop comprehensive strategies that focus both on vulnerable groups living in urban or periurban areas, but also in the general urban population that is experiencing increased overweight and obesity, and diet-related NCDs as a consequence.
• ASEAN Member States should promote healthy eating habits among the entire
population. It is also essential that nutritious and diverse foods be available and affordable for all populations, with special attention to the most vulnerable groups. Effective national legislation is needed on the marketing of foods and non-alcoholic beverages to children, as well as policies on sale of unhealthy products in or near schools and policies on healthy school meals.
• It is essential that ASEAN Member States mitigate the risks of lack of access to nutritious foods by the most vulnerable populations through social protection programmes (food or cash transfer), food subsidies, price controls, exports restrictions, import duty cuts and helping farmers with agricultural inputs.
• ASEAN Member States need to address climate change-related threats by using nutrition- sensitive adaptation and mitigation measures, nutrition-smart investments, increased policy coherence, and institutional and intersectoral collaboration. In order to achieve this, governance will need to be strengthened and climate-resilient policies will need to be developed.
• ASEAN Member States should focus on longer-term responses to ensure that vulnerable communities and systems are resilient to shocks. In order to achieve this, it is imperative that Member States strengthen their health, food security and nutrition systems, among others. Countries should reduce disaster-related risks through the implementation of measures that address vulnerability and build resilience.
• ASEAN Member States should consider economic tools that create incentives for certain healthy behaviours and disincentives for unhealthy ones, such as subsidies and taxes. One of the measures to ensure that the food industry supports and coordinates with the government in their endeavour to improve nutritional outcomes, is through the creation, implementation and enforcement of legal mechanisms that ensure or encourage certain actions in a compulsory or voluntary basis, respectively, depending on the importance or urgency of the matter.
• ASEAN Member States should identify different solutions to ensure equity in each country, based on the level and origin of disparities in terms of size, economic development, and health and nutritional status. All improvements achieved to ensure a more equitable environment will accelerate improvements in nutrition.
• ASEAN Member States should ensure that individuals and communities as a whole receive adequate information and are given the tools to make appropriate choices, since cultural practices with regard to healthy/non-healthy eating habits can have a lot of influence on individuals.
ethnic group of sea nomads. Their village was one of two destroyed by the 2004 tsunami.
Chapter 9:
RECOMMENDATIONS
To tackle the increasing challenges faced by ASEAN Member States in achieving the nutrition-related SDGs and global targets, a series of policy options have been proposed through several strategic documents at the global and regional levels, most of which have been endorsed by WHO Member States (see Annex 3). To advance the creation of an enabling environment for nutrition and outline main areas for action that can facilitate progress towards achieving the global targets for nutrition and nutrition-related NCDs, as set out in chapter 2, the ASEAN Member States, UNICEF and WHO recommend the following:
Strengthen national nutrition policies and legislative frameworks:
a) Strengthen national nutrition policies as well as policies for various settings (including educational institutions and the workplace) so that they comprehensively address the double burden of malnutrition, as well as nutrition in emergency preparedness and response.
b) Create an enabling environment for good nutrition through the establishment or updating of legislative and regulatory frameworks, consistent with internationally available standards (see Annex 3), and advocate for adequate mechanisms to safeguard against conflict of interest, including:
• marketing of foods and non-alcoholic beverages to children, including mechanisms for monitoring;
• marketing of breast-milk substitutes;
• maternity protection for public, and private sector workers, as well as mother- and baby- friendly workplace policies to facilitate breastfeeding;
• food and condiment fortification with micronutrients, as necessary and feasible;
• food safety and quality;
• nutrition labelling.
c) Develop guidelines, recommendations or policy measures that engage all stakeholders in the food supply chain to:
• increase availability, affordability and consumption of healthy foods;
• provide consumers with clear nutrition information;
• reduce the level of salt/sodium, saturated and trans-fats and sugars added to food.
d) Consider economic tools, such as taxes and subsidies, to create incentives for behaviours associated with improved health outcomes, encourage consumption and improve the affordability of healthier food products and discourage the consumption of less healthy options.
Promote multisectoral and multi-stakeholder commitment, policy coherence and action
a) Make nutrition explicit in the countries’ overall development policies, including economic and social development plans, poverty reduction strategies and other relevant sectoral strategies. Prioritize the nutrition indicators reflected in the global nutrition targets/SDGs, in consideration of the local setting. b) Allocate adequate funds for nutrition action, based on costing exercises for the implementation of
nutrition plans in all relevant sectors; establish budget lines and national financial targets for nutrition. c) Implement effective and active intersectoral and multi-stakeholder governance mechanisms for the
implementation of nutrition policies, as well as common results frameworks at the regional, national and local levels. Depending on the context, leadership for nutrition may be most effective at the highest level of government, or the inter-ministerial level, to ensure that nutrition is well-positioned in the development agenda and prioritized across all relevant sectors.
Implement effective nutrition-specific interventions at scale and equitably, within national plans and budgets and as part of emergency response
a) Identify and target the most vulnerable populations.
b) Implement with high coverage evidence-based nutrition-specific interventions (see detailed list in chapter 5), particularly during the first 1000 days of life.
c) Strengthen health systems and promote universal health coverage (facility and community based) and principles of primary health care, including all proven nutrition interventions relevant to the country in maternal, newborn, child and adolescent health services.
d) In relation to nutrition in emergencies, strengthen nutrition information systems, map the existing risks for disasters, build emergency nutrition capacities at all levels, and ensure that emergency nutrition preparedness plans and communication plans are in place.
Promote social and behaviour change, empowering and engaging the community
a) Implement comprehensive evidence-based communication strategies for social and behaviour change to improve nutrition.
b) Engage local governments and communities in the design of plans to expand nutrition actions and ensure their integration in existing community programmes, and provide support for the implementation of community-level nutrition actions that take into account the local context.
Strengthen institutional capacity and the workforce
a) Identify and map capacity needs in multiple relevant sectors.
b) Implement a comprehensive approach for capacity-building, including workforce, leadership and management development, community-based and civil society organizations, and academic institutions.
Ensure a coherent monitoring, evaluation and accountability framework
a) Strengthen nutrition surveillance, in accordance with international standards, to assess the nutritional status and dietary practices of the population as appropriate, and to inform nutrition policy-making. This includes harmonization of nutrition surveillance across ASEAN Member States with regard to indicators, methodologies, timing of data collection, and nationally representative surveys.
b) Develop or strengthen nutrition monitoring systems for the regular collection of information on selected process, output, and outcome indicators towards achieving the global nutrition targets/SDGs.
c) Strengthen the quality and use of evaluation in order to assess the implementation of existing
nutrition policies and plans, address bottlenecks and barriers and improve the coverage and quality of programmes.