2013年-世界发展银行全球_The_Double_Burden_of_Malnutrition_in_Indonesia_82页_46mb

Summary of The Double Burden of Malnutrition in Indonesia

Core Content

This report, The Double Burden of Malnutrition in Indonesia, published by the World Bank in 2013, explores the coexistence of undernutrition and overnutrition in Indonesia across the life course. It outlines the problem, its consequences, and policy recommendations for addressing it.

Main Points

What is the Double Burden of Malnutrition (DBM)?

• DBM refers to the simultaneous presence of undernutrition and overnutrition in the same population, community, family, or individual across the life course.
• It includes both deficiencies and excesses of macronutrients and micronutrients.
• The concept was introduced over a decade ago as a "new paradigm" to recognize that both forms of malnutrition are prevalent and interconnected.

Consequences of DBM

• DBM leads to a range of non-communicable diseases (NCDs) such as Type 2 diabetes, cardiovascular disease, hypertension, and dyslipidaemia.
• These NCDs are responsible for the majority of global deaths and are disproportionately high in lower-middle-income countries (LMICs), where nearly 80% of all NCD deaths occur.
• Stunting, a form of undernutrition, is strongly linked to increased risk of NCDs later in life, making it a critical concern for Indonesia.

Indonesia's Context

• Indonesia has seen a significant decline in underweight among children and a rise in overweight and obesity, especially in urban areas.
• Stunting remains the primary nutrition concern, with 36% of children under five affected.
• Maternal undernutrition and micronutrient deficiencies also contribute to the DBM problem.

Key Information

The Magnitude of the Problem

• The Indonesian Family Life Surveys show that the proportion of thin adults has decreased, while the proportion of "gemuk" (overweight/obese) has nearly doubled over 15 years.
• Rates of "gemukness" (hidden fatness) are higher in younger children compared to older children.
• Overweight and underweight coexist in children, indicating that DBM is already a concern in Indonesia.

Causes of DBM in Indonesia

• Health/Biological Environment: Indonesia has made progress in reducing infectious diseases due to improved health infrastructure and policies, but this has shifted the burden of disease to NCDs.
• Economic/Food Environment: Increased national wealth and food availability, especially from fat, meat, and dairy, have contributed to overnutrition. Processed food imports have risen due to global trade.
• Physical/Built Environment: Urban areas lack infrastructure for physical activity and access to healthy foods, leading to reliance on ready-made foods and street vendors.
• Socio-Cultural Environment: Traditional customs and early marriage of women contribute to undernutrition, while media exposure and processed food advertising influence overnutrition.

Policy Recommendations

Nutrition Policies and Plans

• Orient nutrition programs to tackle DBM, starting with improving maternal and child nutrition to address stunting.
• Include DBM in the plan of the national nutrition council/forum, building on SUN initiatives.
• Ensure that the future National Plan for Development (RPJMN) and National Action Plan for Food and Nutrition (RANPG) address DBM.

Maternal, Infant, and Young Child Nutrition

• Strengthen enforcement of the Code of Marketing of Breastmilk Substitutes to prevent the use of substitutes for infants.
• Improve young children's diets through home-fortification, fortified complementary foods, and animal-source foods.
• Address multiple micronutrient deficiencies through fortification and supplementation, especially for iron deficiency anaemia, iodine, vitamin A, and zinc.

Food and Nutrition Security

• Promote vegetable and fruit production through small-scale local farmers to improve both food and nutrition security.
• Strengthen social welfare programs by linking cash transfers to the promotion of high-nutritional value crops.

Nutrition Education and Healthy Life Styles

• Develop extensive nutrition education for students, professionals, and the public.
• Make all schools "nutrition-friendly" with pilot initiatives in at least five provinces.
• Train nutrition professionals and health service staff to address DBM.
• Implement national regulations to restrict marketing of unhealthy foods to children.
• Ensure future urban planning includes more bike lanes, pedestrian areas, and parks to promote physical activity.

Research

• Develop models to estimate the economic and fiscal impacts of DBM across the life course.
• Explore the introduction of taxes on imported food commodities that benefit from subsidies, and on fast foods high in saturated fats, trans-fatty acids, free sugars, and salt.
• Investigate the fat content and quality of the national diet, including the amount and sources of trans fats.
• Conduct national-level nutrition surveys to assess micronutrient status.

Conclusion

• The DBM is a pressing issue in Indonesia, with both undernutrition and overnutrition contributing to a growing burden of NCDs.
• Addressing DBM requires a multi-sectoral, life-course approach that integrates nutrition into broader health and development policies.
• Strengthening nutrition governance and promoting a holistic strategy involving food security, safety, education, and urban planning is essential.

Key Figures and Data

• 25% of the world's population is overweight.
• 17% of pre-school children are underweight.
• 28.5% of pre-school children are stunted.
• 40% of women of reproductive age have anaemia.
• 36% of children under five are stunted.
• Overweight rates among adults have nearly doubled over 15 years.
• 35% of children's food comes from street vendors.
• 25% of women of reproductive age are married before age 18.
• 10% are married before age 16.
• 4 hours of daily TV exposure for children.
• NCDs account for the majority of disability and mortality in Indonesia.

Authors and Contact

• Roger Shrimpton (PhD), Nutrition Expert
• Claudia Rokx, Lead Health Specialist, ECSH1
• Leslie Elder, Senior Nutrition Specialist, HNPHE
• Darren Dorkin, Senior Operations Officer, EASHH
• Puti Marzoeki, Senior Health Specialist, EASHH
• Rebekah Pinto, Human Development Consultant, EASHD
• Eko Pambudi, Research Analyst, EASHH

For questions, contact Roger Shrimpton at feedback@worldbank.org.