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GOVERNING THE DIETARY TRANSITION 195


its ministry of agriculture (Juma et al. 2007). In Sri Lanka, at one point, nutrition- ists in the Ministry of Health refused to work with the Food and Nutrition Policy Planning Division (FNPPD) in the Ministry of Plan Implementation because that unit was headed by an agriculturalist rather than a nutritionist or medical doctor (Levinson 2002). Parallel disconnections driven by specialization are also manifest at the international level between, for example, the Food and Agriculture Organization of the United Nations (FAO), the World Health Organization (WHO), and UNICEF. With sufficient political leadership, however, effective cross-sector work can nonetheless proceed at Stage Two. Thailand’s National Nutrition Programme, for example, includes multiple subprograms to address healthy eating habits among children and adults, including both monitoring and control of deficiencies of nutrients such as iodine, food fortification and supple- mentation, nutrition labeling, nutrition education, immunization, environmental sanitation and deworming, and a community-based integrated approach to food security. As Thailand now moves toward Stage Three of the dietary transition, these efforts are also moving toward the prevention of degenerative chronic diseases linked to overnutrition by promoting increased fruit and vegetable consumption, moderating salt intake, and monitoring the amount and quality of fat used. One key to Thailand’s success has been high-level political commitment from the king, queen, and prime minister (WHO 2007). Political leadership from the top was also critical to Brazil’s widely credited


multisector Zero Hunger strategy (Fome Zero), launched in January 2003. This initiative has now grown to include 30 programs and activities involving more than 10 ministries plus participation by state and municipal governments and the civil society. As of 2006, according to FAO, Brazil had used this program to reduce the nation’s undernourished population from 17 million to 11.9 million (FAO 2009). Rather than trying to institutionalize cross-sector perspectives within existing ministries, the Fome Zero initiative was designed and launched by the Office of the President outside of traditional administrative channels. In some Stage Two countries at the local level, NGOs and international NGOs


are often best positioned to fill capacity deficits and help capture synergies across sectors. For example, in Bangladesh, Helen Keller International has been promoting homestead food production by providing seeds and seedlings for fruit and vegetable gardens as well as nutrition education; as of 2003, these efforts had reached more than 4.7 million individuals in Bangladesh. In this program, a strong synergy between food production and nutrition is captured directly because children in families with developed gardens consume 60 percent more vegetables than those in households without gardens (Iannotti, Cunningham, and Ruel 2009). Targeting this program toward women has been especially successful. Homestead vegetables grown by women have a higher payoff for nutrition and health because they are


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