Hidden Hunger and the Transformation of Food Systems. Группа авторов
Читать онлайн книгу.
of the first 1,000 days in a person’s life, and will also try to identify the leverage points for successful prevention and health promotion.
Healthy Start – Young Family Network: Approaches towards Successful Prevention and Health Promotion
It is undisputed that the right course for a person’s health later in life is set during pregnancy, infancy, and early childhood. A healthy lifestyle at this sensitive stage of life has a significantly positive impact on the health of a mother, her child, and the entire family – not just in the short term, but in the medium and long term as well [3, 4]. Unfortunately, the reverse of this also applies. This is vividly illustrated when we look at overweight, for instance, an issue that determines the debate about nutrition in Germany, and is coming into focus in other parts of the world as well.
Obese pregnant women give birth to overweight children more frequently [5–7]. There is a high probability that these children will continue to be obese during their childhood and will carry their excess weight throughout their youth and even into adulthood [1]. Overweight and obesity challenge those affected, but also our society and our entire health and social system as much as other forms of malnutrition. In Germany, 1 in every 5 women of childbearing age is overweight, while 1 in every 7 women is obese [8]. Over 15% of all 3- to 17-year-olds in Germany are overweight or obese (5.9% are obese). At the same time, overweight and obesity are distributed unequally throughout society. Thus, at 27%, the prevalence of obesity in 3- to 17-year-old girls of low socioeconomic status is four times higher than the prevalence among those of high socioeconomic status [9]. Add to that food insecurity in social strata that are threatened or affected by poverty. This often goes along with a one-sided food supply and nutrition that are inadequate in terms of quality, which in turn quickly leads to a chronic undersupply of micronutrients such as vitamins, minerals, and trace elements [10, 11]. Food insecurity is exacerbated as people become confused by the short-lived, contradictory statements they are confronted with. It is thus vital that everyone acquires high levels of competence in matters regarding nutrition and health. People must be able to understand and assess information in order to make informed decisions on that basis.
Accordingly, empowerment is the first leverage point in any strategy to combat malnutrition. A second leverage point for successful preventive and health-promoting measures lies in correctly addressing the parties affected and concerned. It must be taken into account that the target groups we intend to address are precisely those that often accept preventive measures to a lesser extent and make proportionately less use of them [12, 13]. Also, where measures to support a health-promoting diet and sufficient physical exercise are planned and implemented, we must always take into account and use existing state structures.
Using existing structures and avoiding parallel structures represents the third leverage point. In Germany, this means, for instance, that we think in terms of our federated state structure. The fact that the state secretary of the federal state of Baden-Wuerttemberg addressed words of welcome at this congress on the occasion of its opening might show you how much importance we attach to this structure. The federal structure has indeed many advantages in terms of diversity, independence, and personal responsibility. On the other hand, complexity and lack of transparency at times represent a burden to initiatives and offers of prevention and health promotion.
All told, I would say that we have no shortage of good measures. The challenge instead is to ensure that measures work where they are needed, that they complement each other, and that we, given the diversity of opportunities, do not get lost in small details and do not strive to reinvent the wheel at various levels or locations. That is why it is so important to address issues at various existing levels – national, federal, municipality, community – and bring players together through intensive networking.
The “Healthy Start – Young Family Network”
Networking is exactly where the initiative “Healthy Start” comes in. It is located within the Federal Centre for Nutrition (“Bundeszentrum für Ernährung”), a division of the Federal Office for Agriculture and Food [14]. The go-ahead for the establishment of a nationwide network was given in 2008. The impulse did not come from the top, but from below instead. The participants of a workshop wanted to develop consistent messages regarding the first 1,000 days in a person’s life.
First, they identified the key individuals who are in close contact with young families. Then they invited relevant organizations, institutions, and professional associations to actively design the network, and the initiative attracted increasing attention. Today, the network is supported by professional associations, scientific organizations and institutions, the Federal Ministry of Food and Agriculture, and by the National Breastfeeding Commission. Through multipliers, male and female, whom young families trust, the network seeks access to pregnant women and young families.
This is where I see a fourth leverage point for successful prevention and health promotion. Multipliers, mainly doctors and midwives, but also the “early helpers,” such as family midwives, youth and health departments of local authorities with their “welcome visits,” social workers, male and female, and baby pilots – must be interconnected in a network structure [15]. The network thus uses existing structures of healthcare and counselling and places messages for health-promoting diets and sufficient physical exercise. In Germany, statutory screening and early detection examinations for pregnant women, infants, and children (“U-tests”) count among them. Here, disseminators and multipliers meet the target group face-to-face. This approach works well for families of low socioeconomic status and families with a migration background who, compared to their use of other prevention offers, can be addressed quite effectively this way. At any rate, they have been making more frequent use of these offers in recent years.
The important fifth leverage point for a successful strategy leads back to the initial impulse for the network in 2008. The participants in the workshop at that time were interested in uniform recommendations for action. Successful messages require a uniform common language. The message must be clear and it must be communicated consistently, otherwise the effect fizzles out. Translated into a successful strategy to combat malnutrition, it means we need recommendations and calls to action. The network has developed these, regarding diet and lifestyle before and during pregnancy, diet and physical exercise of infants and breastfeeding women, as well as diet and physical exercise in early childhood [16–18]. These recommendations for action are based on the current state of scientific knowledge. They are the central focus of training efforts for disseminators and multipliers in classroom events and in webinars by advisors trained to advise and support young families.
The network has also developed appropriate materials. They enable all participants to cooperate. In addition, there are low-threshold media for parents like apps, flyers, posters, and stickers, some of them available in foreign languages. They translate the recommendations into simple messages, relevant for people’s behavior in everyday life. These media support multipliers during their consultations [14].