「持続的な栄養改善による人々の豊かな生き方の実現」―東京栄養サミットに向けて―
我が国はオリンピック開催国として来年１２月を目途に東京栄養サミットを開催する。
持続可能な開発目標（SDGs）の目標２は、飢餓の根絶・栄養不良の解消を掲げる。しかし、近年、6.9 億人（8.9％）が飢餓・栄養不足、1.4 億人の子どもが発育阻害に陥る一方、肥満率は増加し、本目標の達成は厳しい状況にある。新型コロナは、その進捗を更に減速。
我が国としては、本サミットを契機に、日本の戦後経験等をも踏まえ、人々の豊かな人生実
現に向けた栄養改善に関する考え方を世界に提示し、貢献を行う旨の意思表明をするべき。
１ 人の一生を通して持続的に栄養を改善することが重要「栄養」は、人生の様々な段階で人の生き方を豊かにする為、極めて重要。(幸福：Well-being)
・２歳までの栄養→その後の成長において、子どもの身体や脳の発達に影響、・成人期の女性の栄養→胎児の栄養状態に影響

・学童期の栄養（給食）→栄養知識・食習慣の定着、健康な体づくり
・成人や高齢者の栄養→生活習慣病の予防、健康寿命の延伸、活力のある老後

一方、社会的・経済的な弱者（貧困層、女性・乳幼児、疾病患者、高齢者等）は、栄養改善において、困難に直面。地域紛争、パンデミック等は、特に、弱者の栄養改善を阻害。例えば、児童が学校給食で栄養を摂取するような地域では、新型コロナウイルスの影響が甚大。
外的ショックを緩和しつつ、人生のあらゆるステージで持続的に栄養改善が可能な社会を構築できれば、人は健康状態を改善・保持し、抵抗力を蓄え、生き生きと有意義な人生を実現できる。一方、マクロ的には、パンデミック禍の下での社会・経済の強靭性向上に資する。
２ 日本の経験・知見の活用（１） 戦後の日本の経験・知見
戦後、飢餓と栄養失調に苦しんだ我が国は、ユニセフ等の支援を受けつつも 1946 年「国民栄養調査」を複数県で開始し、食料対策等のためのデータの集積を始めた。1947 年「栄養士法」が制定され、「学校給食」も再開した。1952 年には、「栄養改善法」が策定され、集団給食施設への栄養士配置と栄養知識の普及を図った。こうした中、食料事情の回復も進み、50 年代中頃には動物性食品、カルシウム、ビタミン A の摂取量が増大し、栄養状態は改善され、その後の経済・社会発展の礎を築いた。伝統食と洋食を調和した「日本型の食生活」が形成され、二重の栄養不良の問題（栄養不足、過多）の少ない模範国と称されるに至った。
昨今では、より高度な栄養課題に関して、栄養士の科学的知識の習得を推進し、他の職種との連携も強化している。さらに、食育基本法の制定により、諸外国に類をみない、食、栄養、教育分野が一体となった現場での活動（ex. 栄養教諭による食育）や政策が促進されている。
（２）日本の対外協力における経験・知見（２－１）ユニバーサル・ヘルス・カバレッジへ（UHC）の進展と栄養改善
日本は、1961 年に国民健康保険法が全面改正され、すべての国民が加入する公的医療保1

険を確立。その後も保健医療へのアクセスを改善してきた。早期の UHC 達成が、日本の世界有数の健康寿命につながった。日本は、2016 年の G7 伊勢志摩サミット、2019 年の G20
財務大臣・保健大臣合同セッション等を通じ、UHC を推進してきた。栄養改善は、予防措置として UHC と一体をなすものに位置付けられ、推進されている。
（２－２）
「食と栄養のアフリカ・イニシアチブ」（IFNA）の実施
2016 年の第 6 回アフリカ開発会議（TICAD VI）（於：ケニア）において、日本発の栄養改善を目的としたイニシアティブとして IFNA が実施されることとなった。
IFNA では、①現場における人間中心の栄養改善の実施、②保健、農業、教育、水等の複数の領域間、かつ、複数の当事者間での真の連携、③栄養改善のための科学的分析等知見の強化、④短期・中期・長期の介入を橋渡しし、栄養改善を持続的に推進する事等が目指され、JICA 理事長より、学校給食、栄養士制度等我が国の経験を踏まえた貢献についても説明された。
現在、南アに事務所を構える AU/NEPAD 内に IFNA 事務局が設置され、マダガスカル等
で人間中心の栄養改善の事業が推進されている。
３ 持続的な栄養改善に向けての４つの視点
以上の日本の経験や知見を踏まえ、東京栄養サミットにおいては、我が国の栄養改善に取り組む考え方として次の４点を強調し、それらを踏まえた政策・活動の促進、世界の人々の栄養改善に向けての積極的な貢献を行う旨、表明を行ってはどうか。
① 人の一生を通じた持続的な栄養改善の必要性（人間中心の栄養改善）② 社会科学・自然科学にわたる知見蓄積とそれらに基づいた栄養改善施策の推進③ 栄養改善に携わる技術者の育成・確保と現場への積極的な参画・関与④ 栄養改善に関わる専門分野間・関係者間の相互理解に基づく真の連携
例(①関係)…母親・学童・消費者・高齢者の栄養改善（ex. 学校給食の普及、多様な母子手帳（ex.地域に合った離乳食、電子化、難民の健康栄養状態把握等）、コメ利用嚥下食の開発、UHC 推進による予防措置の普及、IFNA 等による人道介入と中期的栄養改善との連結、感染症対応のための栄養改善・強靭性向上（ex.
貧困農村における簡易殺菌技術、簡易診断技術導入）、衛生的な水のアクセス確保と衛生習慣の確立(②関係)…IT による人道支援対象の正確な把握手法の開発、栄養食料の低コスト生産・保存・流通手法の検証（ex. 微量栄養素を含む食料生産、地産地消のサプリメント生産、減塩食品開発、太陽光発電による栄
養食料保存）、食育/表示/広告等による栄養改善効果の実証（ex. ナッジ）
、日本各地の栄養改善経験の活用(③関係)…戦後の栄養士制度確立の経験に基づく栄養技術者の育成（ex. 栄養士学校の創設、栄養士制度の創設、管理栄養士の育成）（ベトナム、カンボジア等）、栄養/診療/福祉の多職種連携手法の海外への応用(④関係)…日本企業、市民社会、学界の知見を活用した開発支援と PDCA による改善、IT 技術を活用した
安定的・衛生的水供給、食料システムの連携による栄養改善、食育を模範とした教育/栄養/食の連携支援

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“Enhancing the well-being of people through continuous nutritional improvements”-Towards the Tokyo Nutrition Summit-

1. Tokyo Nutrition for Growth Summit
Since 2012, the nutrition summits have been held in countries hosting the Olympic and Paralympic
games. Originally, the Tokyo Nutrition Summit was scheduled to be held on December 2020. However,considering the pandemic situation of COVID-19, the Tokyo Nutrition for Growth summit was
postponed and will be held on December 2021.
The Tokyo Nutrition Summit is a place where nutrition related issues can be openly raised and discuss
amongst various stakeholders from all over the world who are working towards the fight against world
malnutrition and is also the place where efforts and commitment to combat these issues are established.
Specifically, the summit is planned to cover (1) Health - Making nutrition integral to Universal Health
Coverage; (2) Food - Building food systems that promote healthy diets and nutrition; (3) Resilience Addressing malnutrition effectively in fragile and conflict-affected contexts; (4) Accountability Promoting data-driven accountability; and (5) Financing - Securing new investments and driving
innovation in nutrition financing
Currently, preparations are underway, led by the Ministry of Foreign Affairs of Japan throughdiscussions with international organizations, bilateral development organizations, international CSOs
and public and private sectors.
Since Japan is the host country for the Olympics and Paralympics this year, it is a great opportunity tohold the nutrition summit for timely and fruitful discussion. The summit should be recognized as anextremely important event that will lead to better livelihoods for the people. It is also of great
importance for Japan to take this opportunity to demonstrate leadership based on its fundamental
positions regarding this pressing global issue of malnutrition and to express its commitments toactively combat the world’s malnutrition.

2. Nutritional improvement and quality of life enhancement"Nutritional improvement" is highly relevant in enhancing people’s life quality or well-being at
various stages of their lives. Some examples can be found below:·

For children ages up to 2 years old, nutrition crucially affects the development of the children’s
body and brain, which can affect their ability to live well in the future.1·

For females of reproductive age, nutrition affects their physiologic adjustment and fetuses’ healthstatus.2
1

https://www.unicef.org/southafrica/sites/unicef.org.southafrica/files/2019-03/ZAF-First-1000-days-brief-2017.pdf
2 Meeting to Develop a Global Consensus on Preconception Care to Reduce Maternal and Childhood Mortality andMorbidity, World Health Organization Headquarters, Geneva 6–7 February 2012 Meeting report



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·

For school children, leveraging nutrition education into school life such as school meal
programmes, helps disseminate nutritional knowledge and healthy dietary habits,3 which areimportant for building and maintaining good health throughout their lives.4·

For middle aged and elderly people, a well-balanced meal with proper nutritional value helps
prevent non-communicable diseases, extends health life expectancy and can support energetic
lifestyles in their post-retirement years.5

On the other hand, socially and economically vulnerable population, such as the poor, women, infants,
the sick and wounded and the elderly, are facing difficulties in improving their nutritional intake. In
addition, regional conflicts, climate change, economic fluctuation and pandemics disrupt the efforts toenhance nutritional well-being for them.6 An example from the most current COVID-19 pandemic
resulted in the discontinuation of nutritious food supply and the suspension of school lunch programs
which created massive negative impacts in areas where people rely on school meals for their children’s
proper nutritional intake.7
Therefore, the most important thing now is to build a society that can help continuously improve
people’s nutrition while alleviating external shocks and increase people's resilience at every stage of
their lives. This will enable people to lead a lively and meaningful life. Also, from a macro perspective,
it will contribute to improving social and economic resilience against emerging external shocks suchas COVID-19 pandemic.

3. Global nutrition outlooks
In relation to the world's nutritional status, the hunger population, which was on the decline, has started
to rise again in 2014. Respectively, the percentage of the hunger population has also risen. Recently
in 2019, 690 million people (8.9%) suffer from hunger and undernourishment;8 in particular Africa(250 million people, 17.6%) and Asia (380 million people, 8.3%). If this situation continues, it will be
extremely difficult to achieve the goal of eradicating hunger by 2030.
The number of stunting of children under the age of 5 showed some improvement, which is now 140
million (21.3%). However, to achieve the target for 2025 (40% reduction), the improvement speed ismuch slower; with the number continuing to occur mainly in Africa and Asia. The wasting of children3‘Interventions to prevent global childhood overweight and obesity: a systematic review’ Lancet Diabetes
Endocrinol , 2018 Apr;6(4):332-346.
4 On the contrary, even if nutritious foods exist in the area, they may fall into a dietary habit that causes excessive
intake of carbohydrates and fat due to lack of knowledge or influence of advertisements, and abandon the traditionaland diverse diet (e.g. Traditional Kenyan leafy vegetables and millet). http://www.b4fn.org/countries/kenya/
5‘Healthy ageing: the natural consequences of good nutrition—a conference report’ European Journal of Nutrition
volume 57, pages15–34(2018)
6 FAO, ‘The State of Food Security and Nutrition in the World 2020’, page viii
7 Laborde D., Swinnen J. et al., ‘COVID-19 risks to global food security’, Science, JULY 2020 • VOL 369 ISSUE
6503, Policy Brief: The Impact of COVID-19 on Food Security and Nutrition
8
FAO, ‘The State of Food Security and Nutrition in the World 2020’under the age of 5 is at 50 million (6.9%), which is still considerably higher than the target for 2025
(5%).
In addition, the obesity rate among adults due to overnutrition has increased from 11.8% in 2012 to
13.1% in 2016, with no improvement towards the goal to stop the increase by 2025.9
In recent years, various factors such as regional conflicts, climate change and economic changes havecaused instability in sustainable nutritional improvement, but during this recent time, COVID-19
pandemic has further increased this instability.

4. Global development
4.1 Relationship with Sustainable Development Goals (SDGs)
If you look at the nutritional improvement from the viewpoint of the SDGs, it is located within thesame framework as food security in Goal 2.10 Nonetheless, it is also closely related to other SDGs as
well. In general, nutritional improvement is mutually related to items such as “poverty” (Goal 1), “foodsecurity" (Goal 2), "health" (Goal 3), "education" (Goal 4), "gender" (Goal 5) and "equality” (Goal
10), It is also closely associated with "water and sanitation" (Goal 6), "economic growth andemployment" (Goal 8), "industrialization and innovation" (Goal 9) and "sustainable production andconsumption" (Goal 12). These interrelationships mean that the nutritional improvement is important
for the achievement of other SDGs while various factors are needed to achieve the nutritional
improvement goals.

4.2 Movements of international organizations and civil society organizations
In relation to the movements of international organizations and civil society organizations, various
activities are now being carried out as follows.
(1) WHO assesses the nutritional status of each country, formulates frameworks, guidelines andstandards for the improvement of nutrition, emphasizes the role of nutrition improvement as apreventive measure for health, and incorporates nutrition improvement into the Universal Health
Coverage (UHC) which Japan has been promoting. It encourages global activities to improve
nutrition toward the achievement of the WHA 2025 target and the SDGs 2030 target.
(2) UNICEF emphasizes the first thousand days of life (roughly from conception to the second
birthday) as a unique period of opportunity which serves as the foundation for optimum health,
growth, and neurodevelopment across the entire lifespan. It promotes better nutrition intakes for
infants and mothers by training nutrition instructors, disseminating nutritional knowledge, grasping
the nutrition and health status of mothers and children and providing necessary supplies such as
9‘The 2020 Global Nutrition Report’
10 ‘End hunger, achieve food security and improved nutrition and promote sustainable agriculture’,
https://sdgs.un.org/goals/goal2water, therapeutic foods and medicines to those in need.
(3) WFP provides food and vouchers as one of its main contribution to prevent hunger andmalnutrition of the vulnerable during and after humanitarian crises. In addition, they also various
types of works such as providing micronutrients, promoting school lunch programs and the food forwork program.
(4) FAO promotes agricultural practices and food systems which are more nutrition-sensitive andresilient to shocks, with a view to eradicating hunger, chronic malnutrition and food supply
instability. It helps member countries design, implement and monitor policies including promotionof nutrition-sensitive agriculture, disseminating food composition tables and food based dietaryguidelines.
(5) CGIAR (Consultative Group on International Agricultural Research ʥ conduct numerous
researches, amongst which are the research on nutrient-enriched crops (e.g. orange sweet potatoes11)
at places such as IRRI and CIP and the analysis on the effect of nutrition-related socio-economic
interventions at IFPRI.
(6) International financial institutions such as the World Bank, African Development Bank, AsianDevelopment Bank and IFAD promote and scale up various forms of projects in preventing
malnutrition and ensuring food security and also make their investment projects more nutrition
sensitive.
(7) The Sun Movement was established in 2010 with the aim to promote collaborative work to end
malnutrition in all its forms and to facilitate the cross-cutting cooperation of the government, civilsociety, UN organizations, the private sector and so on, and now carrying out dissemination andenlightenment on nutrition improvement.
(8) Civil Society Organizations, such as Results Japan (e.g. awareness raising through GGG +forum), Save the Children (e.g. improvement of nutrition for children and women), Gates
Foundation (e.g. promotion of nutrition finance, nutritious crops) set their target and carry out
activities with the aim to end malnutrition in the world.

5. Important standpoints on nutrition improvement based on the human-centered approach
As we briefly observe at the beginning of this paper, nutrition improvement is very important toenhance people’s well-being in all stages of their lives. The importance of nutritional improvement forpeople’s well-being can also be seen in the relevancy to various goals and targets of the SDGs. The
diverse activities undertaken by different stakeholders represent and reflect the various nutrition issues
that has been occurring in people’s life.
In the following paragraphs, we will try to identify several standpoints that will be critical in advancing11This variety contains more than 50-fold more β-carotene, which is converted to vitamin A after ingestion, than theyellow or white varieties commonly eaten in African countries.

nutritional improvement initiatives by taking into account the "human-centered development
approach" which Japan has been advocating in relation to development issues.

5.1 "Nutritional improvement needs to be sustained throughout our lifespan for a better life quality"
Firstly, this is the core standpoint.
It is important to understand that people may face various nutritional challenges in their lifetime
depending on their surroundings and personal conditions. In the face of life-and-death situation due tofamine or economic crisis, emergency assistance is needed through medical treatments and availability.
In the case of malnourished children and women who are socially vulnerable, it is crucial that protein,vitamins, minerals, supplements, etc. is provided promptly. As for cases where food accessibility has
been abruptly cut off, people in that area will need food distribution and other forms of help such as
food vouchers and etc. For people living in areas suffering chronic food shortages, technical assistancefor food production and irrigation support, machinery and fertilizer will be useful in enhancing foodsecurity, developing self-reliance among people and establishing resilience of society against future
shocks.
In countries where both undernourishment and overnutrition are already occurring, it is necessary todisseminate nutritional knowledge to people of all ages while taking measures to correct the poverty
gap and ensure equitable access to healthy food. In addition, society may demand that private sectors
adopt more nutritionally friendly business practices.

Furthermore, for adults, nutritional guidance will be more important from a preventive perspective
regarding non-communicable diseases. As for the injured and the sick, it is critical to improve nutrition
to enhance the therapeutic effect. Also, nutritional support is becoming more important for the elderly
to lead a healthy life in their extended lifespan.

Currently, many specialized government agencies and international organizations and institutions havebeen working in each specialized field to address the nutritional challenges. The importance ofaccumulating the knowledge of those specialized fields, setting guidance and implementing policies
is undisputed.
However, throughout their lifetime, people can face a set of nutritional challenges, which are notlimited to a one-time problem in a specific field, but rather transforming over time and from crosssectorial factors. Thus, from the "human-centered development approach", in order to enable people
in both developing and developed countries to continuously enhance their varied nutritional well-being
throughout their lives, it is necessary to establish a consistent perspective of the society on how todynamically improve social arrangements and empower people, to identify necessary interventions
and to implement them accordingly.
5.2 Establishing a consistent perspective to enhance the nutritional well-being of people in a society
To establish a consistent perspective that enhances the nutritional well-being of people, it is necessary
to analyze relationship among external environments (social, economic and natural environments),
people’s knowledge level/unique nutritional conditions and necessary nutrition improvement
measures (in short, medium and long term).

For example, in order for a domestic family who has been receiving emergency food to try to get
nutrition in a more stable manner, they may start economic activities such as farming to earn money
for nutritious foods or to take nutrients directly from what they produce.
With this scenario, several things need to be considered, such as but not limited to the following;(1)whether there is an agricultural extension center nearby, (2)how is the access to markets for selling
produce and purchasing nutritious foods, (3)whether the nutritional knowledge and dietary culture of
the local are suitable for improving nutrition, (4)whether nutritional guidance and education are
implemented or are scientifically correct, (5)whether there is discrimination against women or children
in domestic food allocation, (6)whether there is sanitary water to cook, (7)whether there is a spread of
infectious diseases that interferes with nutrition intake, (8)whether there is access to clinics andmedicines for treating infectious diseases.

Additionally, in relation to medical settings, there needs to be consideration regarding the availabilityof nutrition experts (e.g. dietitians, registered dietitians, clinical dietitians) who can collaborate andcommunicate proper knowledge to enhance the effect of medical treatments and if a rule should be inplace to station experts at clinics.
In today’s society where the aging population is increasing, further factors need to be considered.
These factors involve the existence of nutritional guidance scheme for maintaining the health of theelderly and the distribution of commercial products that are developed with the regards of the aging
population.
Furthermore, in today’s world where the “planetary boundaries” are being discussed, it will become
more important to build a society where people of the world take in sufficient nourishment from moresustainably produced food while considering environmental constraints and properly altering a dietaryculture in the long run.

From the above examples, it is necessary to recognize that the following external environments are
intricately intertwined and plays an important role in solving nutritional issues.
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

Social environment (e.g. laws and regulations, government organizations, social conflicts,
medical system, dietitian system, agricultural extensions, health staff, infrastructure such as
hospitals, clinics, welfare facilities, schools, irrigation, waterworks and sewage systems),



Cultural environment (e.g. customs, tradition, gender bias, dietary culture),

Economy (e.g. food production, industrial development, market (prices, maturity, failure), private
sector vitality),

Natural environment (e.g. climate, land, water quality, geographical location, flood/drought,
infectious diseases)

In addition, certain personal features of people are also important such as:(1) Capacities and internal factors (e.g. reading and writing, agricultural knowledge, nutritional
knowledge, motivation, preferences, sense of value, belief)(2) Physical factors (e.g. age, infection such as parasites, metabolic state, immunological capacity,pregnancy)
Thus, adequate analysis is required not only to accurately interpret their relationship with nutrition
issues, but also to help identify and prioritize various problems, agree on a consistent perspective thatwill promote continuous nutrition improvement for the people, and formulate and implement
appropriate concrete measures.

It has been argued that the implementation of emergency food assistance would cause the market
prices of local agricultural products to plummet and reduce labor motivation inadvertently.12 It has
also been pointed out that the development of carbohydrate-based commercial crops promoted by thegovernment caused an increase stunting in the area.13
Even when nutritional improvement is encouraged in clinics and welfare facilities, the coordination
between professionals from different organization cultures (i.e. medicine, nursing, pharmaceutical,
nutrition and welfare) and the corresponding government bureaucracy still consumes a lot of time andenergy. 14

However, in order to continuously improve the nutrition of the people in a society and enhance thewell-being of the people, these seemingly complicated relationships need to be analyzed scientifically
12

FAO, ‘The State of Food Security and Nutrition in the World 2006’
World Bank, ‘LEARNING FROM WORLD BANK HISTORY, Agriculture and Food-Based Approaches for
Addressing Malnutrition’
14 ‘Report of the study group on the direction of registered dietitians in the 21st century’ (Chair: N. Hosoya),Nakamura, T., ‘Japan Nutrition unraveled by Teiji Nakamura’
13

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based on field information. It is also necessary to collaborate beyond the barriers of stakeholders anddifferent sectors to agree on priorities and establish a dynamic perspective for continuous enhancementof nutritional well-being. Making changes in a society and empowering people based on such aperspective will certainly aid the improvement of people’s health and build resilience in the society
against recurring shocks.

In light of the importance to continuously enhance people’s nutritional well-being based on consistent
perspectives, other standpoints are needed in addition to the first standpoint previously mentioned.

5.3 Accumulate and utilizing evidenceThis standpoint considers unique external environments that people face and distinctive personalfeatures that they carry. It is necessary to conduct contextual analysis based on social and naturalsciences to accumulate evidence and utilize it to reform social systems and policies, innovation,
education and the enlightenment of people. Furthermore, it is important to use such evidence in theformulation, implementation and evaluation of concrete projects in the field.
Even though interventions of several institutions are based on good intentions, but if carried out
individually, they may pose adverse effects on the continuous improvement of nutrition throughout
people’s lives. In order to prevent such a situation and to proceed with human-centered nutritional
improvement, it is important for social and natural sciences to jointly work on intervention to gather
evidence and advise stakeholders on proper implementation of the interventions.

5.4 Train and secure nutrition experts with appropriate knowledge and promote their participation anddeployment in the field
In order to solve different nutritional problems, it is necessary to train and secure technical experts onnutrition who can appropriately respond to the problems that the society is trying to overcome, andalso to let them actively participate in field work. In addition, it is necessary to reform the education
system and improve technical levels in anticipation of nutritional issues that might occur in the society
in the future.

5.5 Genuine collaboration among sectors and stakeholders based on mutual understanding
It is necessary for each sector and stakeholder involved to collaborate genuinely in addressing different
forms of nutrition issues in people’s lives, with an aim and mutual respect at producing a win-win
result for both the people who are suffering from malnutrition and stakeholders.
Generally, each organization tends to stay in a silo and gives priority to its own objective. Oftentimes,they would implement nutritional interventions separately and compete each other in securing funding.
In some cases, having everyone’s participation is mistaken for "collaboration" and in some cases, timeis spent on creating “a something for everyone type of nutrition policy plan."
In order to continuously improve people's nutrition, it is necessary to have genuine and practicalcollaboration among sectors and stakeholders.

6. Leveraging Japanese experience and knowledge
6.1 Japan's experience and knowledge after the war
After the war, Japan suffered greatly from hunger and malnutrition. Many people from different cities
lost their lives because of this. While being supported by UNICEF and other agencies, Japan started
the “National Nutrition Survey” in several prefectures in 1946 by initializing evidence collection for
national food policies and nutritional improvement. The "Dietitians Act" was enacted in 1947 and"school meals" resumed in the same year. With the enactment of the "Health Center Law" in the same
year, public dietitians were deployed to carry out nutrition works.
In addition, in 1952, the "Nutrition Improvement Law" was formulated to assign dietitians todisseminate nutritional knowledge at various places such as facilities holding group lunches.
As the food situation gradually recovered, the increase in meat consumption, calcium, and vitamin A
also improved Japan’s nutritional status during the mid-1950s, and provided the nation with thefoundation to support rapid economic and social developments. This led to the forming of the"Japanese-dietary pattern" through the harmonization between traditional Japanese food and Western
food, which helped Japan become a model country preventing the double burden of malnutrition.

During this period, people’s nutrition improvement was prompted locally by well-trained dietitians
and registered dietitians with the help and cooperation of dietary improvement volunteers.
In the present day, the acquisition of knowledge by dietitians is promoted, while systems of nutrition
support team (NST) and inter-professionals work (IPW) are strengthened to create a more advanced
nutrition management. Furthermore, the enactment of the Food Education Basic Law integrates theworks of the food, nutrition and education sectors to promote policies and field activities (e.g. Food
education by nutrition teachers, “eiyou-kyouyu”), which is unprecedented in other countries.15
As part of Japan’s nutrition improvement, securing and training technical experts on nutrition with thecollaboration between different sectors and stakeholders has made it possible for Japan to respond tovarious nutritional challenges in people’s life. This process requires the cooperation from multiple
stakeholders, and would serve as a welcoming reference for countries that are suffering frommalnutrition and are planning to build a system to improve nutrition in the society.

15

Nakamura, T., ‘Japan Nutrition unraveled by Teiji Nakamura’, Ministry of Health, Labor and Welfare ‘Nutrition
policy in Japan to leaves no one behind’ https://www.mhlw.go.jp/content/000587161.pdf

6.2 Experience and knowledge from Japan's foreign cooperation
6.2.1 Promotion of nutrition improvement through Universal Health Coverage (UHC)
The full revision of the Japanese National Health Insurance Law in 1961 had established a public
medical insurance program for all Japanese. Since then, the people’s access to healthcare has
improved accordingly. Achieving UHC at an early stage aided Japan to become the world’s leading
example of a healthy and long life expectancy. Japan has promoted UHC through at the 42nd G7
Ise-Shima summit in 2016 as well as the joint session of the G20 Finance Ministers and Health
Ministers in 2019. Nutritional improvement has been integrated with the UHC as preventive
measures and is actively promoted.

6.2.2 Implementation of the “Initiative for Food and Nutrition Security in Africa” (IFNA)
In 2016 at the 6th Tokyo International Conference on African Development (TICADVI) in Kenya,
IFNA was initiated by Japan and has been established as an initiative aiming to improve nutrition
security in African nations. In its declaration, IFNA aims to ձAccelerate people-centered (orinclusive) nutritional improvement locally, ղ Promote genuine collaboration among multiple
sectors (e.g. health, food, water, sanitation, hygiene, education, social safety net) / various
stakeholders (e.g. government, private sector, academia, civil society). ճStrengthen scientificanalytical works including M&E, մ Promote continuous nutritional improvement andenhancement of the resilience of people and communities through coordination among
Short/Mid/Long term interventions.
In addition, the president of JICA showed willingness to contribute to the initiative by using Japan’s
experience on nutrition management such as school meal program and dietitian system.16
The IFNA Secretariat was established in AU / NEPAD in South Africa and currently people-centerednutrition improvement projects are being promoted in various countries including Madagascar.

7. Human-centered nutritional improvement for the future
7.1 Contribution based on Japan's experience
We have looked at the experience of nutrition improvement in Japan. It can be said that Japan's postwar
experience cultivated the human-centered nutritional improvement processes that is known today. The
main idea of "nutrition improvement is sustained throughout people’s lives," has been established in
response to social and economic circumstances in Japan at the time. Meanwhile, IFNA's idea ofbridging short-term, medium-term, and long-term interventions to continuously promote nutritional
improvement is a reflection from this historical experience.
16https://www.jica.go.jp/activities/issues/nutrition/ku57pq00001p9zjx-att/IFNA_Declaration.pdfMoreover, the importance of "accumulating and utilizing evidence" and "creating genuine
collaborations among sectors and stakeholders” can be seen through IFNA’s main principle, theintegration of nutrition issues into UHC and also through the promotion of inter-professional work
dealing with nutrition issues.
Given the reason that Japanese postwar training and management of nutrition experts (dietitians,
registered dietitians, etc.) is the embodiment of "cultivating, securing and deploying human resources
with specialized knowledge about nutrition”, it is highly expected that Japan's experience andknowledge in nutrition management will make great contribution in promoting human-centerednutritional improvement in other countries.

7.2. Intervention examples
Below is the list of the four main points that Japan should emphasize at the Tokyo Nutrition Summitand examples of possible contributions based on Japan's experience and knowledge for each of these
key-points. (Note that the possible contributions are not limited to those listed below.)(1) Necessity for continuous nutritional improvement throughout human life
(People-centered nutritional improvement)·

To continue nutritional improvement for infants and mothers, school children, consumers
and the elderly through various types of maternal and child health handbook (“boshitecho”) (e.g. introduction of complementary feeding using local food, digitization of
MCHH, tracing refugee nutrition status and etc.), dissemination of sustainable andnutritious school meal systems (“gakkou-kyusyoku”), analyze and promote effective dietaryeducation activities on children and adults (“shokuiku”), development of food designed toaccommodate particular nutrition needs (e.g. swallowing assisting food),·

Dissemination and promotion of preventive measures through UHC,·

Linking humanitarian aid and development interventions through IFNA action plans,·

Implementation and evaluation of projects to strengthen sustainable local production ofnutritious foods and also to prevent recurrence of emergency situations (e.g. coordination
between local production and consumption (“chisan-chisyo”), linking emergency foodassistance to local food consumption, generation of jobs or building of assets)·

Better nutrition and an improved resilience against infectious diseases (e.g. tuberculosis,
COVID-19), such as introducing simple sterilization techniques and diagnostic methods inpoor rural areas, create an open access to clean water and establishing sanitary habits for
local people.

(2) Accumulation of knowledge and evidence in both social and natural sciences and thepromotion of concrete nutritional improvement measures
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

·

Accurate and timely identification of humanitarian intervention targets by ICT,·

Identification of low-cost and sustainable production/storage/distribution methods ofnutritious foods (e.g. local food containing micronutrients, bio-fortification, local
production of supplements, development of low sodium food, nutritious food stored by solar
power, empowerment of smallholders and women for better market access),·

Collecting evidence of nutritional impact of interventions in local context in collaboration
with research institutes,·

Utilizing food seasoning for nutritional improvement (ex. Salt substitution effect by“umami”)·

Verification of nutritional improvement through nutrition education and advertisement (e.g.
behavioral economics (nudges)),·

New management methods of food company for nutrition improvement (e.g. labeling,
advertisement),·

Innovative research and technological development on the relationship between nutrition
improvement and therapeutic effect and life quality,·

Utilization of nutrition improvement experience and knowledge such as reduction of sodium(“gen-en”) in Japanese local areas.

(3) Training and securing nutrition experts involved in nutritional improvement and encouraging
their active participation and deployment in field work·

Training technical experts on nutrition based on Japanese postwar experience in Vietnam
and Cambodia (e.g. establishment of a dietitian school and a dietitian system, training ofregistered dietitians, deployment of dietitians to schools, clinics, company and factory
canteens and training of researchers and government officials).

·

Promote methods of Inter-professional work (IPW) and nutrition support team (NST) withthe aim to enhance therapeutic effects and life quality.

(4) Genuine collaboration among sectors and stakeholders based on mutual understanding(Sectors: Emergency Assistance, Nutrition, Food, Medicine, Nursing, Dentistry, Welfare, Water,
Hygiene, Education, Sociology, Economics etc., Stakeholders: Local people, Governments,
International Organization, Private Sectors, Academia, CSOs etc.),·

Assistance by collaboratively utilizing experience and knowledge shared between private
sector, civil society and academia in Japan,·

Sustainable and hygienic water management using ICT through collaboration amongcommunities, academia and private sectors,·

Improvement of nutrition through coordination within the food system (production,processing, distribution, preservation, advertisement, cooking, food intake, etc.),·

Assistance for nutrition improvement through collaboration among education, nutrition andfood sectors modeled after Japanese dietary education system(“syokuiku”),·

Collaborative introduction to the experience and knowledge of NST and IPW among
dietitians, nurses, medical doctors, dentists and welfare workers.

8. Conclusion: Japan's position at the Nutrition Summit
In conclusion, considering the above experience of Japan, the following four standpoints should beemphasized in the coming Tokyo Nutrition Summit for the fight against malnutrition. Based on thesestandpoints, we should express our intention to strongly promote policies and activities and make anactive contribution for the continuous improvement of nutrition for the people around the world.

1.

Necessity for continuous nutritional improvement throughout human life (people-centerednutritional improvement).

2.

Accumulation of knowledge and evidence in both social and natural sciences and the promotionof concrete nutritional improvement measures

3.

Training and securing nutrition experts involved in nutritional improvement and encouraging
their active participation and deployment in field work.

4.

Genuine collaboration among sectors and stakeholders based on mutual understanding