The Role of Public Health Nutrition in Achieving the Sustainable Development Goals in

the Asia Pacific Region

Author(s): Colin Binns, Mi Kyung Lee, Wah Yun Low and Alfred Zerfas
Source: Asia Pacific Journal of Public Health , October 2017, Vol. 29, No. 7 (October
2017), pp. 617-624
Published by: Sage Publications, Inc.

Stable URL: https://www.jstor.org/stable/10.2307/26939775

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736441
editorial2017
APHXXX10.1177/1010539517736441Asia Pacific Journal of Public HealthBinns et al

Conference Report
Asia Pacific Journal of Public Health
2017, Vol. 29(7) 617­–624
The Role of Public Health Nutrition © 2017 APJPH
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DOI: 10.1177/1010539517736441
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Development Goals in the Asia journals.sagepub.com/home/aph

Pacific Region

Colin Binns, MBBS, PhD1, Mi Kyung Lee, MA, PhD2,

Wah Yun Low, PhD3, and Alfred Zerfas, MBBS, PhD4

Abstract
The Sustainable Development Goals (SDGs) replaced the Millennium Development Goals
(MDCs) in 2015, which included several goals and targets primarily related to nutrition: to
eradicate extreme poverty and hunger and to reduce child mortality and improve maternal
health. In the Asia-Pacific Academic Consortium for Public Health (APACPH) member
countries as a group, infant and child mortality were reduced by more than 65% between
1990 and 2015, achieving the MDG target of two-thirds reduction, although these goals were
not achieved by several smaller countries. The SDGs are broader in focus than the MDGs,
but include several goals that relate directly to nutrition: 2 (zero hunger—food), 3 (good
health and well-being—healthy life), and 12 (responsible consumption and production—
sustainability). Other SDGs that are closely related to nutrition are 4 and 5 (quality education
and equality in gender—education and health for girls and mothers, which is very important
for infant health) and 13 (climate action). Goal 3 is “good health and well-being,” which
includes targets for child mortality, maternal mortality, and reducing chronic disease. The
Global Burden of Disease Project has confirmed that the majority of risk for these targets
can be attributed to nutrition-related targets. Dietary Guidelines were developed to address
public health nutrition risk in the Asia Pacific region at the 48th APACPH 2016 conference
and they are relevant to the achievement of the SDGs. Iron deficiency increases the risk
of maternal death from haemorrhage, a cause of 300000 deaths world-wide each year.
Improving diets and iron supplementation are important public health interventions in the
APACPH region. Chronic disease and obesity rates in the APACPH region are now a major
challenge and healthy life course nutrition is a major public health priority in answering this
challenge. This article discusses the role of public health nutrition in achieving the SDGs. It
also examines the role of APACPH in education and advocacy and in fulfilling the educational
needs of public health students in public health nutrition.

1School of Public Health, Curtin University, Perth, Western Australia, Australia

2School of Health Professions, Murdoch University, Perth, Western Australia, Australia
3Research Management Centre, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
4Nutrition Consultant, Melbourne, Victoria, Australia

Corresponding Author:
Colin Binns, School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia,
Australia.
Email: c.binns@curtin.edu.au

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618 Asia Pacific Journal of Public Health 29(7)

Figure 1. Progress in under-5 mortality rate: 1960 to 2015 (deaths per 1000 live births).

Keywords
Sustainable Development Goals (SDGs), Millennium Development Goals (MDGs), public health
nutrition, Asia-Pacific Academic Consortium for Public Health (APACPH)

Introduction
The Sustainable Development Goals (SDGs) (2015-2030) are the successors to the Millennium
Development Goals (MDGs) that were approved in September 2000 at the United Nations
General Assembly by the 147 heads of state who had travelled to New York specifically to
approve the Millennium Declaration. The MDGs were described by Professor Jeffrey Sachs as “a
historic and effective method of global mobilisation to achieve a set of important social priorities
worldwide.”1 The MDGs included strategically important goals to halve the numbers in poverty,
eradicate hunger, achieve universal primary school completion, and among the health goals to
reduce child mortality rates by two-thirds. Specific targets were then added to the goals to assist
in the monitoring process. As described by Bill Gates, the MDGs were “a type of global report
card for the fight against poverty” for the 15 years from 2000 to 2015.1
The MDGs included several goals and targets primarily related to nutrition, including “to
eradicate extreme poverty and hunger, reduce child mortality and improve maternal health.”2 In
the Asia-Pacific Academic Consortium for Public Health (APACPH) member countries, infant
and child mortality were reduced by more than 65% between 1990 and 2015, achieving the target
of two-thirds reduction, although these goals were not achieved by several smaller countries. The
target to reduce the under-five child mortality was representative of the MDG goals and the
achievements of the APACPH member countries are shown in Figure 1.
With the completion of the MDGs, institutions of the UN system undertook a lengthy consul-
tation process to develop the SDGs. The Sustainable Development Goals (SDGs), officially

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Binns et al 619

known as “Transforming our World: The 2030 Agenda for Sustainable Development” were
approved by the General Assembly in September 2015. They comprise a set of 17 “interrelated
goals” with 169 more specific targets that are applicable to countries at all stages of economic
development.3 Speaking at the 49th APACPH Conference in Incheon, South Korea in August
2017, the former Secretary General of the United Nations, Ban Ki Moon, spoke of his role in
guiding the SDGs to final approval. He concluded by stating that “we all need to have a sense of
ownership, and recognise these are not just collectively our SDGs, but also our individual
SDGs.”4 This was a call to all the APACPH members to take up the challenge of education,
research and action to implement the SDGs. The commencement of the SDGs was followed by
the beginning of the “United Nations Decade of Action on Nutrition” (2016-2025), global joint
efforts to eradicate hunger and to prevent all forms of malnutrition in the world, an appropriate
linkage as this article argues the SDGs are dependent on improving nutrition.5,6
The objective of this article is to review the role of public health nutrition in achieving the
SDGs and the role of APACPH institutions in providing education to meet these needs.

Methods
A literature search was undertaken in the PubMed and Web of Knowledge in English. The search
words used were “Sustainable Development Goals” and “nutrition” in different combinations.
Additional documents were found on the World Health Organization (WHO), UNICEF, and
Food and Agriculture Organization (FAO) websites.
Discussions were then undertaken at the 49th APACPH conference held in Incheon, Republic
of Korea in 2017 during the Dietary Supplement Nutrition symposium. Participants reviewed the
findings of the initial review.
As the article resulted from data in existing documents, ethics committee approval was not
required.

The Sustainable Development Goals

The SDGs cover most of the areas of significance to human life and development that are broader
than the usual boundaries of public health. But, a holistic view of health reveals that most of the
goals are related to public health and require appropriate nutrition for their implementation.
Because of their breadth, the SDGs have been labeled “senseless, dreamy and garbled.”7 However,
the sheer complexity of human development while maintaining a sustainable human ecology
almost defies description. The Bill & Melinda Gates Foundation argued that any new goals
should be specific, measurable, attainable, relevant, time bound, and easy to communicate, surely
a mammoth task given the complexity of our globe. Nonetheless, they then sponsored a compre-
hensive review of the data available for all of the health-related targets, which has provided
baseline data for future evaluation and consolidated this data into a health-related SDG indica-
tor.8 They identified 33 health-related indicators which were individually scaled 0 to 100 before
incorporation into an overall index. The SDG Health Indicators did not directly assess risk fac-
tors. However, the group did discuss “nutrition” as an example of difficulties with some overall
indicators in a discussion of 2.2.2 that “proposes a measure of malnutrition that combined preva-
lence of wasting and overweight among children under age 5 years.”8 Since the distribution of
growth is a continuum, there is some reasoning behind this, but it is customary to measure preva-
lence of undernutrition and overweight separately as the cross-sectional distribution is U-shaped.
A list of the 17 SDGs and their inclusion in the SDG Index is shown in Table 1.
The MDGs have become the 17 SDGs in the context of increasing concern about climate
change and the need for sustainable development and lifestyles. Many goals and targets relate to
nutrition.

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620 Asia Pacific Journal of Public Health 29(7)

Table 1. The Sustainable Developments Goals and Targets.

Number Goal Targetsa Nutrition or Foodb SDG Health Indexc,8

1 Poverty 5 (7) 0 Yes
2 Zero hunger 5 (8) 4 Yes
3 Health 9 (13) 1 Yes
4 Learning, education 7 (10) 0
5 Gender equality 6 (9) 0 Yes
6 Clean sustainable water, sanitation 6 (8) 1
7 Energy 3 (5) 0 Yes
8 Economic growth, work 10 (12) 0 Yes
9 Industry 5 (8) 0
10 Reduce inequality 7 (10) 0
11 Sustainable communities 7 (10) 0 Yes
12 Responsible consumption and 8 (11) 1
production
13 Climate action 3 (5) 0 Yes
14 Life below water 7 (10) 1
15 Life on the land 9 (12) 0
16 Peace 10 (12) 0 Yes
17 Partnerships 19 0
aFigurein parentheses is targets plus subtargets.
bNumber of targets specifically mentioning nutrition or food.
cTargets from this goal are included in the SDG indicator.

The SDGs are broader in focus than the MDGs, but include several goals that relate directly
to nutrition: 2 (zero hunger—food), 3 (good health and well-being—healthy life), and 12 (respon-
sible consumption and production—sustainability). Other SDGs are closely related to nutrition
are 4 and 5 (quality education and equality in gender—education and health for girls and moth-
ers, which is very important for infant health) and 13 (climate action). Goal 3 “good health and
well-being” includes targets for child mortality, maternal mortality, and reducing chronic disease.
The majority of risks for these targets are nutrition related.9 For example, maternal mortality
remains a significant problem with an estimated 300 000 deaths globally in 2015.10 Hemorrhage
is the cause of most of these deaths and iron deficiency is a major risk factor, and is already
emphasized in public health programs. Chronic disease and obesity rates in the APACPH region
are now a major challenge and life course nutrition is a major public health priority in answering
this challenge.11
The United Nations has projected that during the term of the SDGs, the world population will
increase from 7.3 to 8.5 billion and life expectancy at birth from 69.1 to 70.8 years (70.3 to 71.8
years in Asia).12 The total fertility rate in Asia will continue to decline slightly from 2.20 to 2.15.
The FAO is developing a program to feed in a sustainable manner a population of around 10 bil-
lion within 50 years.13 Food production of 8.4 billion tonnes per year will need to increase to 13.5
billion tonnes per year, from an increase in productivity (50% of the required increase) and the
use of new resources. In the context of climate change and the need for sustainability, this is a
major challenge.13
For this article, each of the 17 SDGs was reviewed to ascertain their relationship to public
health nutrition as part of the chain of causality (Table 2). UNICEF has developed a conceptual
framework of malnutrition to assist in the upscaling of nutrition programs.14 In Figure 2, we have
shown how the MDGs can be integrated into the framework. The resultant tables were reviewed
by a group of APACPH experts at the APACPH conference. Each of the goals was found to have

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Binns et al 621

Table 2. The Sustainable Development Goals and Public Health Nutrition Summary Table.
1 Poverty: Poor people cannot afford food, cooking facilities, storage, hygiene
2 Zero hunger: Food, nutrition including the RDAs (recommended dietary allowance) and
dietary guidelines
3 Health: The health-nutrition cycle. Undernutrition and infection. Micronutrient deficiency (eg,
iodine, iron), chronic disease (obesity, diabetes, etc—see APACPH Dietary Guidelines).
Unwell children do not eat
4 Education: Education and nutrition. Educated mothers improve nutrition (including higher
breastfeeding rates in some countries) and have healthier children
5 Gender equality: Empowered mothers care better for the nutrition of children
6 Clean water: Quantity and quality are related to diarrhea, hepatitis, cholera, etc
7 Energy: Important for food production, transportation, processing, and storage
8 Work: Both undernourished and obese people have suboptimal work performance
9 Industry: Food science (processing, storage), nutrition of workers
10 Reduce inequality: Food and health for all. A healthy diet for everyone
11 Sustainable cities and communities: Exercise-friendly and safe urban development and
environment
12 Responsible consumption and sustainable production: reduce food waste (FAO estimates 30%
wasted with a cost per year US$680 billion). Reduce environmental contamination of food
13 Climate action: Climate change and its effect on food production (eg, rice production, fungi,
allergy)
14 Life below water: sustainable fishing, aquaculture.
15 Life on the land: Sustainable agriculture production. Land and soil degradation resulting loss of
agricultural land, loss of biodiversity, no contamination of food
16 Peace: Many wars have been fought over food and water supplies and hunger
17 Partnerships: Need to work together to keep the world fed in a healthy way

some relationship to public health nutrition, which is not unexpected because of the key role of
nutrition in human existence. The Global Burden of Diseases Study estimated that up to one-half
of the disease burden in the Asia Pacific region can be attributed to inappropriate nutrition.9,15 For
children, nutrition remains a major priority in continuing the trend of declining mortality rates.
Breastfeeding remains the best practice for all children.16,17 The 169 SDG targets are too numer-
ous to discuss in detail in a short review article.

The Role of APACPH and Schools of Public Health

Public health nutrition programs will provide an important means of achieving the SDGs related
to health. APACPH has an important role in education, advocacy, and research in the region to
achieve the SDGs.
The APACPH members have had a longstanding commitment to achieving health and devel-
opment for all with a particular interest in child health and nutrition. At the Hawaii meeting in
1987, the members passed a declaration:

Be it, therefore, declared by all participants at the Conference and by all academic institutions
represented, that universities of the region will act upon an abiding commitment to research, training,
service, and policy development in the unmitigated support of leadership development, and the
precepts and goals of Primary Health Care and Child Survival and Development in the Asia-Pacific
Region and beyond. As universities, we also re-declare our resolve and commitment to leadership
development for Primary Health Care and to Child Survival and Development in the support of the
“Health for All” movement.18

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622 Asia Pacific Journal of Public Health 29(7)

Figure 2. Relationship between UNICEF Conceptual Framework of Malnutrition (adapted) with the
Sustainable Development Goals.

Education for the SDGs represents a natural progression of the programs and special interests of
APACPH.
Schools of Public Health need to ensure that details of the SDGs are added to their education
curricula including their MPH programs. Many schools have organized continuing education and
short courses on topics that have included “Health for All” and now, these could be usefully
updated to “SDGs for All.”
Research needs to be done in targeting nutrition actions and education to the cultural, geo-
graphic and developmental level of individual countries and regions. This is an important role for
Schools of Public Health. A problem with the nutrition aspects of the targets is the complexity of
nutrition. For example, child growth is a U-shaped risk curve, with both under- and overnutrition
being at increased risk of morbidity and mortality. To reduce stunting and wasting, infants require
more nutrients; but to reduce child obesity, children need less energy and require more exercise.
This requires action to promote:

•• Target messages to small population segments rather than blanket advertising and
promotion
•• Exclusive breastfeeding of infants to around six months and then appropriate complemen-
tary foods15
•• Monitoring of growth and development by health professions
•• Changing perceptions of weight and growth by parents and grandparents

While much of the basic research for the SDGs has already been done, more research needs to
be done on application to specific countries and cultures and the cost effectiveness of different
approaches. Schools can also monitor, evaluate, and update programs where needed. These are
important roles for Schools of Public Health, many of whom work in low- and middle-income
countries. This has to be done in a climate of declining public health expenditure as governments

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Binns et al 623

spend a higher proportion of budgets on the immediate needs of hospitals, often in response to
the ageing population.19

Limitations and Threats

The threats to the SDGs include lack of funding as many of the wealthier nations become more
introspective and isolated. “Untied” international aid programs that can best be used to meet local
community needs are decreasing. Within the health and nutrition sector, funding is being diverted
to short-term needs, particularly toward hospitals in response to increasing demands as our popu-
lation ages. The SDGs contain measurable targets, but 169 is too many to monitor continuously
in a useful way. Some are too aspirational to be implemented within the timeframe allowed “in
setting goals for nutrition, there is always tension and debate over the level of ambition, between
aspiration to drive political commitment and realism to allow concrete planning and to establish
sound accountability mechanisms.”20

Conclusion
The SDGs have considerable potential to focus global actions and aid in directions that will
improve the health and well-being of all citizens. However, the goals are complex, and often
made more so by their interdependency. This will require considerable effort to optimally inter-
pret and implement them at local and region level. Schools of Public Health are based on inter-
disciplinary actions and are well placed to contribute to the implementation of the SDGs. Since
nutrition is a risk factor in many of the problems identified in the SDGs, it is important that public
health nutrition maintain a role as a core discipline within any academic public health program.

Authors’ Note
This article was originally presented at the 49th APACPH Conference held in Incheon, South Korea in
August 2017. It was prepared in consultation with the coauthors and revised versions were circulated to the
Nutrition Interest Group within APACPH for comments.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or
publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.

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