Abstract
Severe forms of protein–energy malnutrition still occur, but they are associated most commonly with devastating natural disasters and civil unrest. With the exception of sub-Saharan Africa, progress in combating chronic undernutrition is also occurring. The prevalence of vitamin and mineral deficiencies has also declined in nearly all countries, although the pace is slow for some micronutrient deficiencies, particularly iron-deficiency anaemia.
Nevertheless, the prevalence rates of micronutrient malnutrition remain high, with devastating consequences for health, cognition, and productivity. Much remains to be done, particularly in reducing iron, zinc, and vitamin A deficiencies, which up to the present have largely been attacked by using a medical model that relies on the distribution of supplements. Supplements are effective but are expensive in terms of the support devoted to repetitive use of scarce health manpower. Fortification can work in some places. Education and awareness of the public is crucial. The public must not be considered only as the target of imposed interventions. Civil society must become engaged in the process, with the goal of their becoming demanding consumers, participating in the action to achieve micronutrient adequacy.
Sustaining the progress that has been achieved will depend on underpinning the medical model with food-based approaches that address multiple nutrient and phytochemical needs for optimal health. Agriculture, by investing in the Green Revolution, can rightly be credited for its contribution to reducing food shortages and the protein–energy malnutrition problem. A similar opportunity exists now for agriculture to invest in developing more micronutrient-dense staple crops, while not neglecting continued research on the production of livestock and small animals, fish, vegetables, and legumes.