Briefing Papers Number 7, October 2009 | Page 5

made nutrition a top development priFigure 2: Framework for Understanding the Causes of Malnutrition ority. The strategy was supported at the highest levels of government. The Deputy Prime Minister, given overall Manifestations Malnutrition/Death responsibility for leading the program, encouraged cooperation and coordination across many different government Immediate Disease Inadequate Dietary Intake Causes departments, including the Ministries of Public Health, Education, and AgriculInsufficient Health Insufficient Inadequate ture.26 Despite the ministries’ different Underlying Services/Unhealthy Household Food Maternal/Childcare Environment Causes ways of operating, areas of expertise, and political and legal mandates, the government managed to promote a “whole of Resources and Control: government” approach to improving nuHuman, Economic and Organizational trition. Basic Causes Second, the Thai government committed substantial financial resources Political and Ideological Superstructure to the program but welcomed contriEconomic Structures butions from other donors, including UNICEF and the United States. Outside Potential Resources contributions increased the technical capacity of the Thai government and Source: UNICEF. encouraged the integration of nutrition in programs spanning multiple government ministries.27 A recent review in the British medical journal The Lancet factors that cause malnutrition, but other important factors provides strong evidence that the nutrition interventions include overstretched, understaffed health care services; undertaken in Thailand can work in other countries with pervasive discrimination and gender inequality; and lack high rates of malnutrition as well.28 These interventions are: of education. (See figure 2.) To address these factors, nutri• Providing micronutrients, including iodine and iron tion should be integrated into the development plans of evfolate for pregnant women and iodine, zinc, and vitamin ery country, and governments should ensure that nutrition work is coordinated across ministries and sectors. A for infants and young children; Tensions between different approaches—for example, • Promoting exclusive breastfeeding for infants 0-6 whether to scale up one nutrition intervention versus anmonths of age; other, or whether to improve agriculture instead of focusing • Empowering women and caregivers to improve feeding directly on nutrition—cannot continue to get in the way of practices and working with communities to adopt these efforts to make progress. In fact, these are false choices; impractices; pr