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