Haan, Stef de

Truong Tuyet Mai

Unger, Fred

CGSpace

Contextualization Nutrition, Food System and Food Safety Issues in VietnamTruong Tuyet Mai, Fred Unger and Stef de Haan,Outline1. Vietnam – Background2. Nutrition situation 3. The Food System  4. Food Safety5. Take away messagesVietnam Profile Population (2018): 94 million Urban population: 33.1% Life expectancy: 73.6 No. of Doctors per 10,000 population:9 % of CHS having doctors: 78% Health Insurance coverage: 76% % of health budget in GDP: 3.5% % of Health budget in State budget expenditure: 12.9%Source: Health statistical Yearbook 2014• 24.3% stunting (2016)• 15/63 provinces have stunting rate over 30%• 5.3% overweight• Anemia: 27.8% children; 25.5% women• Huge strides forward:- Supplementation- Complementary feeding- Breast feeding promotion 2. Nutrition situation: general factsVietnam – trends in malnutrition 2000 to 2015Source: Nutrition Surveillance – National Institute of Nutrition 201620.854.526.360.325.563.6020406080Anemia Zinc deficiencyPrevalence (%)Sources: Micronutrient survey 2014 - 2015, NINPrevalence of anemia and zinc deficiency among women of reproductive age by regionUrban Rural Total22.28.249.728.413.171.627.81369.4020406080Anemia Subclinical vitamin AdeficiencyZinc deficiencyPrevalence (%)Sources: Micronutrient survey 2014 - 2015, NINPrevalence of anemia, subclinical vitamin A deficiency  (<0.7mcmol/L) and zinc deficiency among children by region Urban Rural TotalPrevalence of overweight in U5 Children (WHZ>+2Z)Source: National Institute of Nutrition 20110.90.5 0.625.51.72.85.72.23.65.84.24.86.54.25.68.24.45.50246810Urban Rural OverallPrevalence (%)Prevalence of overweight in U5 Children (WHZ>+2Z)2000 2004 2005 2008 2010 20142. Overnutrition and NCD’s5.410.815.317.122.12.33.56.612.014.91.4 3.05.39.811.205101520251993 2000 2005 2010 2015Prevalence (%)UrbanOverallRuralTrends of overweight/obesity in adults  1993-2015Source: Tuan T Nguyen and Minh V Hoang, Asia Pac J Clin Nutr 2018; 27NCD burden in VietnamCurrently the NCD prevalence is high and is increasing:Hypertension/cardio-vascular diseases12,5 million people(25% of aged 25+)COPD2 million peopleDiabetes2,5 million people(5,4% of aged 30-69)New types of cancer150,000/yearPrevalenceHigh level of risk factors of NCDsRisk factors by sex among people aged 18-69; National Risk Factors Survey 2015Percent %Data sources: STEPS Surveys 2015High level of risk factors of NCDsPercent %High levels of smoking, alcohol consumption, lack of fruit/vegetable, physical inactivity; especially in men (Risk factors survey 2015)• * Smoking: GATS survey 2015• ** 60 gram of alcohol at least once  in past 30 daysData sources: STEPS Surveys  201515.413.212.311.217.612.08.46.267.074.879.382.60% 20% 40% 60% 80% 100%2010200019901985Protein Lipid GlucidChanging Energy intake (P: L: G)2. Dietary Intake91.0 80.3 118.7188.0698.2 685.0696.6689.2020040060080010001985 1989 2000 2009Số gam LTTPNămFood consumption (gram/capital/day)Thức ăn  nguồn thực vật Thức ăn nguồn động vậtThe trend of food consumption 1985-2010(gram/capital/day)13.6518440.15259.81.710.332.3020406080100Meat Fish Egg/milk198520002010050100150200250năng lượng  protein sắt kẽm  calci vitamin A  vitamin C  vitamin B12010 Toàn quốc 2015 Lạng Sơn 2015 Hưng Yên 2015 Hà Nội% meet the RDA in <5U Children’s Dietary IntakeChallenges for Nutrition in Vietnam• In some localities, government, and community authorities have not given adequate attention to nutrition issues, or not recognized their importance• Resource investment has not met actual needs• Management and operation constraints• Capacity of the implementation network• Inactive involvement of relevant sectors and mass organisations at all levels.• Globalization, urbanization,climate change, rapid aging of the population, changes in lifestyles and unbalanced diets NATIONAL NUTRITION PLAN OF ACTION 2018-2020Objective 1: To improve the nutrition status of mothers and children2: To reduce micronutrient deficiencies among people3: To improve Vietnamese people’s height4: To improve the quantity and quality of Vietnamese diets, to control overweight/obesity and nutrition-related risk factors of some chronic non-communicable diseases in adults.5: To reinforce capacity and effectiveness of the network of nutrition services in both community and health care facilitiesPrime Minister’s Directions on Strengthening Nutrition in New Period, Dec 20171. Proper diet/nutrition2. The first 1000 days of life3. Multi-sectoral collaboration3. The Food SystemGLOPANFrameworkA = Diet qualityB = ConsumerC = Food EnvironmentD = Food Supply SystemE = Drivers of changeThere is an emerging food systems interest within a rich policy environment• Food - feed security• Food safety• Climate change• Urbanization• Trade• ‘Modernization’ of retailing• OthersFood SystemTransformationDemand & Food environ.Policies& Programs• High dietary diversity • High vegetable intake• > consumption of animal products• Pockets of micronutrient deficiency• > unhealthy diet components• Food borne diseases and contaminants Diet qualityBreakdown of urban and rural household food expenditures in 2002 and 20123A - Diet Quality Vietnamese diets are diverse and changing  Change in Food Supply per Food Group (50 years)Calories Food weightFat Proteinhttp://ciat.cgiar.org/the-changing-global-diet/3ASource: Ipsos Business Consulting. Meat Market in VietnamProduction and consumption of livestock in Vietnam from 2013 to 2019f• Quality• Trust• Tradition• Convenience• Purchasing power• Food choice under researched• Misconception: priceConsumerDiet quality3B – Consumer What types of consumer behavior are important? Food environmentConsumerDiet qualityUrban  Wet markets (upgraded to temporal Street venders and street food Urban agriculture, roof gardening Specialty “safe food shops”  Supermarkets and convenience storesPeri-urban  Hybrid Rural  Production (family farming)  Wet and village markets  Small shops / street food 3C - Food Environment Modernization and parallel pathways • Smallholder and family farming important• Self-sufficiency: rice and most vegetables• Partial self-sufficiency for fruits and fish• Feed import is substantial (soya)• Meat export (pig) and import (beef)• Smallholder supply chains predominant• Food companies with vertically integrated supplychain on the rise• Key challenges: labeling, traceability, information,access and trust. Incipient: sustainability, animalwelfare.• High levels of diversity are maintained in supplychains, including landraces and NUS3D - Food Supply Systems From production to retail Vietnam- Agricultural Imports - Exports3DAgrobiodiversity high in Retail(comparison of species and varietal diversity at wet and supermarkets in Cầu Giấy district, Hanoi)3DSource: Lama, 2017Agricultural production Food storage, transport and trade Intense agricultural production Main crops: rice (4 million ha), cassava (0.8 million ha), coffee, rubber, cashew,  6th largest producer of pig meat (30 million animals)  Rise of national milk production Food loss and waste under-researched  Rapid / direct supply  Demand for post-harvest technology  Excellent infrastructure (expanded) Import: feed, fruit, beef Export: rice, coffee, pepper, cassava, aquaculture produce Food retail and provisioning Food processing Predominance of wet markets Rapid growth of supermarkets, safe food shops and convenience stores Culture of eating out  Preference for fresh Range of ‘typical products’: noodles, fish sauce, etc. Products on the rise: milk products, instant noodles Selected Sphere of Influence: components3DFood Waste in Vietnam• National State of Environment report (2011) reports that total FW is about 5,743,056 tons per year• It accounts for 60% of the entire municipal solid waste (MSW)• FW per capita is estimated around 0.06 kg/day. • According to Olivier (2008), more than half the weight of landfill in Vietnam is FW.Source: Le Thi Thanh Huyen et al., 2015Estimation of food waste in Vietnam from 2007 to 20253D3E - Drivers of Food System TransitionBiophysical, political, economic, technological, demographicSome of the big issues for Vietnam:• > Population and urbanization• > Purchasing power and shifting demand for food• Modernization and inclusive food supply • Sustainable intensification and food safety• Climate change and food supply4. Food Safety in Vietnam• Food safety is perceived as one of the most pressing issues byVietnamese people, more important than education or health carePerception• Vietnam has a modern food safety legislation system but the use ofrisk based approach is limitedLegislation• Willing to pay 5-10% premium for safer food, not easy to decide forconsumer what is “safe”Consumers’ Behavior• Food exports relatively well managed but deficits in domesticmarketsMarket SituationFood safety risk management in Vietnam. WB 20174. Food Safety in VietnamRepeated episodes of adulterated and unsafe food• Pesticides in vegetables, mass fish intoxication, antibiotics residuesRisk perception towards chemical hazardsReported outbreaks 370 (2014-2015), 66 fatalities, high underreporting expected (>1/100)Majority of risk from biological hazards are related to cross-contamination and consumption of raw/fresh or undercooked products Information for selected hazards exists but rarely on related health impactUse of risk based approach and risk communication limitedInstitutional setup The structure of food safety management from central to local level4. Institutional setup Value chain and food safety by commodity: vegetable Consumption (Ha Noi & HCMC) Total consumption of vegetables in Ha Noi and Ho Chi Minh City is projected at 2,800 tons per day and 3,290 tons per day, respectively. Supply (Ha Noi & HCMC) 60 – 70% supplied by neighboring provinces  Market (Ha Noi & HCMC) Hanoi: 15% supermarkets, 33% whole sale markets, remaining covered by local marketsHCMC:  15% supermarkets, 85% whole sale marketsFood Safety risks Limited information on hazards:• High contamination with fecal bacteria, pathogenic bacteria, and parasites • Pesticides, 23% of vegetables exceeded the maximum levels for pesticides (MARD)Food safety risk management in Vietnam. WB 2017Value chain and food safety by commodity - Seafood Export- Seafood export value of US$ 8.32 billion in 2017, increasing- Violations notified by EU* and Japan (highest in seafood, compared to other commodities) but overall violations remain stable while volume of exports increases- “yellow card” from EU for illegal fishingDomestic market- the aquaculture sector confronts drawbacks: (1) environmental pollution issues caused by the overuse of antibiotics and chemicals, (2) instability in aquaculture output due to projected restrictions in antibiotic use (3) the unpredictability and large scale of disease occurrence.- Many chemicals are used, including lime, chlorine, iodine, saphonine, microbial enzymes, and dolomite lime. http://seafood.vasep.com.vn/657/whybuy/food-safety.htmhttps://www.tandfonline.com/doi/full/10.1080/23311932.2016.1207398*Rapid Alert System for Food and FeedValue chain & food safety by commodity: PORK Pork is an important component of the Vietnamese diet• The most widely consumed meat: 56% of total meat intake (OECD, 2016) • Annual pork consumption per capita in Vietnam:  29.1kg • 83% comes from very small or small farms• 76% of pigs are processed in small slaughtering, nearly 30,000• Preference for fresh “warm” pork supplied in retail traditional markets (>80% of all pork marketed)• affordable, address local demands• often escape effective controlPigRISK, ILRI & partner 2017ILRI’s work on Pork & Food Safety PigRISKJun 2012Sep 2017Pig competiveness2008 -2012SafePORK-Small holder pig sector is important and competitive Oct2017To assess impacts of pork-borne diseases on human health and thelivestock.  Policy engaegement* ** *NTFFS National Food Safety Taskforce** World Bank Food Safety Risk Assessment for Vietnam Capacity buildingMar 2022To develop and test market based food safety interventions Research questionsIs pork in Vietnam safe? Are the risks serious? Integrated approach Interdisciplinary team: Vets, MD, economist Risk based approach: Hazards & risksFood safety hazards: Biological and chemical From farm to forkStudy sites: Hung Yen& Nghe An PigRISK Food Safety assessment - porkPig RISK – key results  Microbial risk assessment: Salmonella contamination started at farm and increased along the pork chain (farm – slaughter – market) mainly due to poor hygienic practices             44.7% of pork at marketRisk for pork consumer:  1 – 2 person from 10 estimated to suffer Salmonella caused FBD annuallyHospitalization costs of foodborne diarrhoea per treatment episode and per day: USD 107 and USD 34, respectively.Pig RISK Key results from assessment Chemical risk assessment: Risk due to chemical hazards is low (heavy metals, grow promoters and antibiotics) low What we are concerned most is not what makes us most sick –risk from microbiological hazards far higher compared to chemicalsPigRISK, ILRI & partner 2017Pig Risk overall research question:     Is pork in Vietnam safe?   - It is not ! Are the risks serious? - Considerable!Study sites: Hung Yen& Nghe An How to reduce the risk for the consumer?Safe PORKFocus on food safety interventions & risk communicationInvolvement of private sectorFrom assessment to interventionChallenges to improve food safety • Various approaches to improving safety had been tried, largely based on systems used in developed countries e.g.:– GAP, traceability, certification, and modernising retail• However, safe meat production has not yet take a significant share of the market• The key constraints to uptake include: – high cost of adoption– lack of direct, visible benefits from changing behaviour– low consumer trust in certification• We concluded that incentive-based, light-touch interventions are needed to overcome these constraints• Focus will be on gradual improvements to the food system in place, rather than introduction of a new system Challenges to improve food safetySafePORK ILRI & partner 2017• Simple, cheap tests that detect contaminated food (“Pregnancy test” model)– Could be used directly by retailers or consumer to have direct verification of safety• Reduce contamination of carcass– Portable ozone machines to plug into water supply• Ozone is highly effective disinfectant; – Spraying of carcass (e.g. trisodium phosphate)– Avoid floor slaughter• Reduce use of antimicrobial – Replacement of antimicrobials by pro-biotics, in collaboration with private sector.• Increasing transparency and traceability in food system– 24 hour camera that shows conditions on farm, consumer visits at producer– Branding and certification, in collaboration with private sectorExamples for low cost interventions to improve pork safety SafePOR ILRI & partner 2017In a slaughterhouse pilot trial, technical evidence was provided to improve slaughter hygiene when using a set of tailored intervention (e.g. avoiding floor slaughter). The trial also demonstrated that changing the practice of workers is a key challenge for sustainability.Technical innovations vs. practice change PigRISK, ILRI & partner 2017Nutrition• Vietnam has made huge strides forward addressing malnutrition in the country with a significant drop in stunting and wasting• Elements of success:  supplementation, complementary feeding, breast feeding promotion, fortification • Yet, micronutrient deficiencies remain a critical challenge in selected pockets in the country characterized by marginal environments and poverty• Overweight and NCD’s are on the rise and a new important focus of nutrition and education programs • Dietary shifts are taking place at a rapid pace with increasingly higher of intakes of fat, energy, and protein, but the RDA of micronutrients not met in some geographies and populations.5. Take away messages5. Take away messagesFood systems• Food systems transition occurring at multiple levels in the food supply chain• Food environment and consumer behaviour are unique, but also changing• Key needs to understand food system interactions at multiple scales and to identify leverage points to improve food systems • Key outcomes should include the food system capacity to deliver and assure healthy diets, sustainability in production and food supply, and inclusiveness for smallholder producers and SME’s.   5. Take away messagesFood safety• Shift from a dominate focus on food safety for export to address deficits in the domestic market (formal and informal)• Shift from hazard-based approaches to food safety assessment to risk-based approaches that are more effective, sustainable and appropriate for LMICs• Strengthen capacity on risk assessment and communication • Prioritize good practices and behavioural change towards improved hygiene (slaughter and markets), rather than only focusing on infrastructural improvement

Contextualization nutrition food system and food safety issues in Vietnam

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Contextualization nutrition food system and food safety issues in Vietnam

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