Nutrition and health impact of agriculture and food systems in Thailand Prof. Kraisid Tontisirin M.D., Ph.D Senior Advisor , Institute of Nutrition , Mahidol U. Chairman of the Planning Committee on Strategic Frame work for Food Management (SFFM) in Thailand of the National Food Committee Presentation at the WFD, Bangkok, 26 November 2013

Thailand: Current situation Has succeeded in reduced maternal and child malnutrition since the eighty by mutistakeholder efforts under the Poverty Alleviation Plan (PAP) Currently Thailand is facing with double burden of malnutrition (DBM), a coexistence of under and over nutrition, and related non-communicable diseases (NCDs) 2 Kraisid Tontisirin, Mahidol University

Nutrition well-being for all Agriculture/ Food supply/ Service Promotion Protection Treatment Food Nutrition Health Nutrition is a link between food and health, regarding the fulfillment of nutrient and non-nutrient requirements from food in human life cycle. Ultimate Goals Nutrition well-being for all Kraisid Tontisirin, Mahidol University 3

Poverty Alleviation Plan (PAP) From 1982 onward Malnutrition was considered as symptom of poverty With organization changes for management of rural development With 5 basic principles: poor area, basic services, appropriate technology, self-help and community participation PAP Fd/Nut.Prog. PHC BMN indicators Kraisid Tontisirin, Mahidol University

Community-Based Approaches Is an integrated program implemented at local level (district level and below) National commitment with sound nutrition improvement strategies and goals Community actions: basic services, mass mobilization, mutual efforts/actions to reach all people and to prevent malnutrition Kraisid Tontisirin, Mahidol University

Components of a successful community based program Minimum Basic Services (Health, Education, Agr. Extension) Supportive System Training Funding Problem Solving Supervision Menus (Activities) Antenatal Cares (ANC) Growth Monitoring and Promotion (GMP) Food production Food and nutrition education Food sanitation & safety School lunch and milk program since 1992 Other activities Facilitators Interface (service providers and community leaders) Plan/goals Implementation Monitoring/evaluation Mobilizers (1:10 households) Community Leaders Family Individual Basic Minimum Needs Goals/Indicators Kraisid Tontisirin, Mahidol University

Maternal and child nutrition and health Thailand, 1980-2006 1990 2006 ANC coverage % 35 75 95 Anemia in preg. % 50-75 18.8 10 LBW % 16 <10 PEM (Wt/Age of U 5)% 51 20 Kraisid Tontisirin, Mahidol University

Trend of nutritional status of children aged 1-5 years* % Stunting Underweight Overweight& Obesity NHES 2; Holistic Development of Thai Children; NFNS 5; NHES 4 *Courtesy from Dr. Umaporn Suthutvaravut

Roles of agriculture and food systems Food production for subsistence economy: for consumption and income Promote local healthy snacks as food supplement for pregnant mothers Promote complementary food for infants and young children: at household and community levels School gardens and school lunch program Local daily farm for school milk program: a win-win activities Kraisid Tontisirin, Mahidol University 9

National Rural Development Committee Poverty Alleviation Plan Provision of basic services with mass mobilization:1volunteer /10 households Agri.& food production for subsistence econ., suppl. food for mothers, complementary food for IYC & dairy farm for sch. Multi-stakeholder Comm. Nutrition goals and health indicators are incorporated to strategies and actions. Community based approaches Kraisid Tontisirin, Mahidol University

Thailand: Current situation Population 64.6 millions 12th largest exporter of agriculture and food products Main food exported products : e.g. Rice Processed Chicken Processed Pineapples Fishery Products 11 Kraisid Tontisirin, Mahidol University

Thailand Is A Food Exporter -- Kitchen of the World -- Thailand Export Value of Food in 2011 27,809.47 million US$ and was 34,330 millions $ in 2012 12 Kraisid Tontisirin, Mahidol University

Thailand: Current situation Kraisid Tontisirin, Mahidol University Facing with the double burden of malnutrition (DBM) and food safety issue Kraisid Tontisirin, Mahidol University

Thailand National Food Committee Act of 2008 Education Food Security Food Quality Food Safety 11 related ministries, 30 national agencies, 30 relevant Acts Ministry of Defense Ministry of Finance Ministry of Foreign Affairs Ministry of Social Development and Human Security Ministry of Industry Ministry of Public Health Ministry of Commerce Ministry of Interior Ministry of Science Ministry of Education Ministry of Agriculture The National Security Council The National Economic and Social Development board The Consumer Protection Board The national Health committee Kraisid Tontisirin, Mahidol University 14

Chairman : Prime Minister The National Food Committee Component Chairman : Prime Minister (or designated Deputy-Prime Minister) Secretary : FDA, Ministry of Public Health Co-secretary : ACFS, Ministry of Agriculture 7 Resource persons in : -Food Security (2) -Food Safety (1) -Food Quality (1) -Law (1) -Economic and Trade (1) -Food Innovation (1) Committee members 11 related ministries, 4 executive administrators Ministry of Defense Ministry of Finance Ministry of Foreign Affairs Ministry of Social development and human security Ministry of Industry Ministry of Public Health Ministry of Commerce Ministry of Interior Ministry of Science Ministry of Education Ministry of Agriculture and Commodity The National Security Council The National Economic and Social Development board The Consumer Protection board The national health committee Committee / Sub-Committee 15 Kraisid Tontisirin, Mahidol University

The Authority of the National Food Committee Setting policy, planning strategies, monitoring and assessing Food Security Food Safety Food Quality Food Education Advices and provisions of guidance to the related ministries / authorities Advices the cabinet in case of food disaster or bioterrorism for action and land uses Meeting at least 2 times a year 16 Kraisid Tontisirin, Mahidol University

W S O T SWOT Analysis Strength Weakness Threat Opportunity Fertile food production resources 2. Food contribute significantly to socio-economic and cultural development 3. Thai foods are unique and well accepted internationally 4. Continued improvement in food production and agro-industry Weakness 1. Complexity in food management 2. Inadequate inputs for small food producers 3. Degradation and deterioration of land and water in certain areas 4. Low investment in R&D 5. High logistic cost related to food 6. Weak consumer awareness W S Threat 1. Agriculture and food production sectors are not popular among young generation 2. Competition for agriculture production resources for food, feed, fuel, bioproduct and non- food crop 3. New threats from global warming , plant/ animals diseases 4. Trade competition and barriers Opportunity Increasing demand of high quality, safe and nutritious food 2. Global recognition of Thai food and food culture 3. Food is always in demand and more in crisis situations 4. Geographical Location of the country is conductive to trade 5. New innovation and technology in food O T 17 Kraisid Tontisirin, Mahidol University 17

Continuum from Agriculture to Health Food supply Food Service Promotion Protection Treatment Food Nutrition Health Food production Nutrition orientation for healthy diet Food, feed and fuel and bio-products Climate changes Food quality Food safety (Consumer and Trade) Nutrient needs Dietary intakes Nutritional wellbeing Nutrition literacy Safe from Hazards Good health F o o d S e c u r i t y F o o d a n d N u t r i t i o n E d u c a t i o n F o o d C u l t u r e 18 Kraisid Tontisirin, Mahidol University

Food Chain Approach Good Agricultural Practices Land Use OUTCOMES Safe and Nutritious Food Good Manufacturing Practices GOOD PRACTICES Good Hygienic Practices Good Agricultural Practices Plant and Animal Agro- Biodiversity (Genetics) Plant and Animal Diseases Prevention and Control BASIC ISSUES Nutrition For Plant and Animal Land Use Water Management 19 Kraisid Tontisirin, Mahidol University

for Food Security and Human Well-Being VISION Ensuring Quality and Safe Food Supply for Food Security and Human Well-Being OBJECTIVES Efficient and effective management of food production resources 2. Ensuring high quality, safe and nutritious food produced at household, community, and industrial levels 3. Promotion of R&D and utilization of knowledge along the food chain 4. Strengthening food management systems (food law, food database, etc.) 5. Ensuring food security in both normal and crisis situation at the household, community and national levels 20 Kraisid Tontisirin, Mahidol University 20

STRATEGIES & MEASURES : THEMES, STRATEGIES & MEASURES : Food Security 10 strategies 41 measures Food Quality and Safety 6 strategies 33 measures Food Education 5 strategies 17 measures Management 3 strategies 12 measures 21 Kraisid Tontisirin, Mahidol University 21

Theme 1: Food Security Supply & Access Production Principle : Ensuring a sustainable food security and effective management of food production resources by active stakeholders participation Natural & Agricultural Resources Supply & Access Production Enhancing Food Access at Household & Communities Land & Water Mgt/Reforming Food Production Zoning Innovation & Technology Balancing Food, Feed & Fuel Capacity Development & Career Logistics Improvement Establish Crisis Management Systems R & D Along the Food Chain Active Stakeholders Participation 22 Kraisid Tontisirin, Mahidol University

Theme 2 : Food Quality and Safety Community Food Production Principle : Ensuring high quality and safe food to protect consumer health and to facilitate domestic/international trade Food Standards Community Food Production Quality Safety Nutrition Food Industry Strengthening - Value Added - Enhance Production Practices Strengthening Community Food Processing (food loss reduction / value added) Establishment of harmonized standards Strengthening of food quality and safety assurance systems Trading & marketing promotion 23 Kraisid Tontisirin, Mahidol University

Knowledge Utilization Theme 3 : Food Education Principle : R&D and knowledge utilization through engaging stakeholders in sustainable and effective use of food production resources along the food chain and also strengthening desirable consumption behavior for well-being R&D Output Research and Knowledge Development Knowledge Integration Best Practice Knowledge Dissemination Knowledge Utilization & Practice Basic Knowledge Utilization 24 Kraisid Tontisirin, Mahidol University

Theme 4 : System Management Principle : Effective food management systems along the food chain to deal with current and emerging issues in food Organization Database & Management System Reorganization & Strengthening Legal system Revise and Reform 25 Kraisid Tontisirin, Mahidol University

A Cabinet Resolution on “Thailand Food Strategy” Approved The Strategic Framework of Food Management on 25 November 2010 by the Cabinet 26 Kraisid Tontisirin, Mahidol University

Implementation of the Strategic Framework of Food Management (SFFM) Integrated the SFFM in the 11th National Economic & Social Development Plan 2012-2016 2. Each sector implementing the SFFM & reports back to the National Food Committee Three thematic committees for promotion the implementation on: Food Security, Food Quality & Safety, and Linking of Food to Nutrition& Health Kraisid Tontisirin, Mahidol University

Supply Service Linking of Food, Nutrition and Health Safety Safe and Nutritious Food Surveillance Safety Supply Good Nutrition& Good Health Service Consumption ►Domestic/ Imported Food - Primary Product - OTOP - Industrial Quality / Diversity ►Restaurant ►Catering ►Mobile Food Service Facility ►School ►Household ►Market ►Access ►knowledge ►Behavior - Diet pattern/Sanitary - Life style /Exercise Production 28 Information /Standard and Knowledge based Kraisid Tontisirin, Mahidol University 28

Key Issues Linking Food, Nutrition & Health 1. Standards & indicators on nutrition & related disease 2. Food based dietary guidelines (FBDGs) 3. Food, nutrition & dietetic education 4. Promotion for more vegetable & fruit consumption 5. Reduction of sugar, fat & salt in food 6. School food & nutrition program 7. Community based nutrition program to promote nutrition & health 8. Nutrition & related disease surveillance & survey 9. Food and nutrition management during crisis Kraisid Tontisirin, Mahidol University

: Community Based Program for Food, Nutrition & Health Minimum Basic Services (Health, Education, Agricultural Extension) Supportive System Menu (Activities) Antenatal care Growth monitoring /promotion Elderly cares Cares of NCDs Food production Nutrition education Food sanitation & safety Other activities (Tobacco and alcoholic consumption control) Recreation and physical activities) Etc. Training Funding Problem Solving Supervision Facilitators Interface (service providers and community leaders) Plan/goals Implementation Monitoring/evaluation : Community Leaders Family Individual Volunteers (1:10 households) Minimum Indicators of well-being & NCDs Kraisid Tontisirin, Mahidol University 30

Kraisid Tontisirin, Mahidol University Roles of agriculture and food systems beyond the year 2015 for nutrition Ensuring nutritious and safe food supply of healthy diets through human life course Be a key partner to prevent DBM and NCDs by supplying adequate fruits & vegetables; low sugar, fat and sodium foods; healthy fats…etc Care for environment and sustainable development As a source of income Kraisid Tontisirin, Mahidol University 31

National Food Committee Str Framewk for Food Mgt (SFFM) Roles of agriculture and food systems: Ensuring nutritious and safe food supply e.g.fruits & veg; low sugar, fat & sodium foods; legume & fishes …etc Caring of environment & sustainable agriculture. Multi-stakeholder Comm. SFFM covers: Food Security, Quality & Safety, Education & Research, Management Linking of food, nutrition & health implemented at central & community levels for nutrition and p/c of NCDs . Kraisid Tontisirin, Mahidol University

Thailand’s Development Plans Policies and Strategies Nutrition Situation Thailand’s Development Plans Policies and Strategies 19601 - Anaemia in preg: 57%; - B1 deficiency: 23%; - B2 deficiency: 47%; - Low serum retinal: 38%; - Goitre in school children: 29% - PEM cases 1962 1967 1972 1977 1982 1987 1992 1997 2002 2007 2012 1st NEDP 2nd NEDP 3rd NEDP 4th NESDP 5th NESDP 6th NESDP 7th NESDP 8th NESDP 9th NESDP 10th NESDP 11th NESDP 2017 : Economic Infrastructure, Sectoral Plans : Improvement of Agriculture, Infrastructure (Started working in nutrition since 1974) : + Social Plan + Food and Nutrition Plan (FNP) + Primary Health Care (PHC) 19812 - PEM (Wt/Age of U 5): > 50% : + Poverty Alleviation Plan (PAP) + Integrated and implemented PHC + FNP and Basic Minimum Needs (BMN) Indicators in rural/urban communities 19863 - PEM (Wt/Age of U 5): 30% 19894 - Goitre in school children: 19% 19915 - Anaemia in preg: 18% 19956 - B1 deficiency: < 1%; - B2 deficiency: < 1% : 1992 + School Lunch Program (SLP) + School Milk Program (SMP) 1996 - PEM3 (Wt/Age of U 5): 15% - Anaemia in preg5: 13%; - Goiter in school children4: 4% (Worked at FAO, 2000-2006) 20034 - Goitre in school children: 1% - Anaemia in preg: 10% 20067 - PEM (Wt/Age of U 5): 9% 2007 - UI in preg8 < 150 µg/L: 61%; - Low serum retinal9: 16% : 2008 + National Food Committee Act : 2010 + Strategic Framework for Food Management (SFFM) approved by cabinet 20088 - UI in preg < 150 µg/L: 56% : Integration of the SFFM and the 11th NESDP 20108 - UI in preg < 150 µg/L: 43% : 2011 - Universal salt iodisation (USI) 201210 - PEM (Wt/Age of U 5): 7% : Promote cooperation and integration of all relevant sectors, academia, business and NGOs to strengthen national food and nutrition security : 2012 - Triferidine tablet (iron+folate+iodine) Figure Milestones of Thailand’s National Social and Economical Development Plan related to food and nutrition Kraisid Tontisirin, Mahidol University

Food Systems in Thailand Traditional Food Systems Modern Food Systems Food supply at household & community level. Include production for business in small & medium scales Use primary food preservation (e.g. smoking, sun drying, fermentation, salting) Mass production/ Large scale Apply scientific knowledge & technology in food processing Aware of food quality & safety Advance in trade information systems Food Safety Control System Procurement & distribution Center Street Food SME/OTOP How both systems could contribute for healthy agriculture, health diets &nutrition, and healthy people and prosperity Challenge

Conclusion 1 Thailand had been successful in alleviation of undernutrition under the National Rural development Committee implementing the Poverty alleviation Plan but currently is hfacing with the Double Burden of Malnutrition (DBM) Agriculture and food systems are fundamental for ensuring safe and nutritious food supply of fresh and processed foods at household, community, national and global levels. Kraisid Tontisirin, Mahidol University 35

Kraisid Tontisirin, Mahidol University Conclusion 2 Multiple strategies and actions linking between macro policy and strategies with actions at community level will lead to the success outcomes and impacts on nutrition. Under the National Food Committee, the Strategic Framework for Food Management (SFFM) had been approved by the Cabinet and has been implementing with aims for food and nutrition security, food quality and safety, and sustainable development. Kraisid Tontisirin, Mahidol University 36

Kraisid Tontisirin, Mahidol University Conclusion 3 Ultimate goals of the SFFM in Thailand are healthy agriculture and food systems, health nutrition, health people and prosperity. Kraisid Tontisirin, Mahidol University 37

Kraisid Tontisirin, Mahidol University …THANK YOU… 38 Kraisid Tontisirin, Mahidol University