SHAPING THE FUTURE HOW CHANGING DEMOGRAPHICS CAN POWER HUMAN DEVELOPMENT
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BOX 3.7:<br />
Malnutrition and disability: making connections<br />
Both malnutrition and disability are major global<br />
public health problems and key human rights<br />
concerns. Children with disabilities are among the<br />
most marginalized and excluded groups in society.<br />
Facing daily discrimination, and lack of adequate<br />
policies and legislation, they are effectively barred<br />
from realizing their rights to health care, education<br />
and even survival.<br />
An estimated 93 million to 150 million children<br />
worldwide live with disabilities. They are often<br />
among the poorest members of the population.<br />
They are less likely to access medical services or<br />
have their voices heard. They are more likely to drop<br />
out of school than any other vulnerable group, even<br />
in countries with high primary school enrolment<br />
rates. Their disabilities place them at a higher risk<br />
of physical abuse, and often exclude them from receiving<br />
proper nutrition or humanitarian assistance<br />
in emergencies. Too few data are collected about<br />
children with disabilities, hindering appropriate<br />
interventions.<br />
Many countries have begun including children<br />
with disabilities in mainstream education, although<br />
some still favour segregation. In practice, most<br />
countries have hybrid policies and are incrementally<br />
improving inclusive practices.<br />
Strengthening links between nutrition and disability<br />
could lead to important benefits. At numerous<br />
points throughout the life cycle, malnutrition can<br />
cause or contribute to an individual’s physical,<br />
sensory, intellectual or mental health disability. By<br />
bringing work on these two issues together, some<br />
problems can be transformed into opportunities.<br />
Nutrition programmes for children can act as<br />
entry points to address and, in some cases, avoid<br />
or mitigate disability, for instance. This requires<br />
political commitment and resources, and improved<br />
collection and use of better data on disability.<br />
Source: UNESCO 2015b, UNICEF 2015a.<br />
98<br />
Obesity is<br />
a concern especially<br />
among city-dwellers<br />
in East Asia<br />
A GROWING ISSUE OF OBESITY<br />
At the opposite end of the spectrum, rates of<br />
obesity have grown among children and adolescents.<br />
Obesity is a significant risk factor<br />
for many non-communicable diseases, which<br />
now account for a growing share, and in some<br />
countries, the largest share of overall mortality.<br />
The World Health Organization has declared<br />
childhood obesity as one of the most serious<br />
public health challenges of the 21st century,<br />
given links in later life to diabetes, hypertension,<br />
heart disease and other illnesses.<br />
Globally the number of overweight infants<br />
and young children under age five increased from<br />
32 million in 1990 to 42 million in 2013, 52 with<br />
much of the rise occurring in low- and middle-income<br />
countries. The numbers of children<br />
in Asia-Pacific edged up from 13.4 million in<br />
1990 to 14.7 million in 2013. 53 Although childhood<br />
obesity has been common in some Pacific<br />
countries, it is now increasingly being reported<br />
from countries that have recently become affluent,<br />
such as China, Indonesia, Malaysia and<br />
Thailand. The rate is alarmingly high, more than<br />
10 percent, in Indonesia, Mongolia and Thailand.<br />
In 2013, the proportion of obese girls, aged 2<br />
to 19, reached 30 percent or more in Kiribati,<br />
Micronesia and Samoa—the highest levels in<br />
the world. Similar trends were found in boys.<br />
At the same time, the rate is less than 2 percent<br />
in Bangladesh, Cambodia, Democratic People’s<br />
Republic of Korea, Lao People’s Democratic<br />
Republic and Nepal. South Asian countries with<br />
low rates still have to contend with significant<br />
numbers of children who are overweight, given<br />
their large populations. (Figure 3.6)<br />
Rapid urbanization, modernization and<br />
life styles with reduced physical activity and<br />
increasing intake of high calorie food foster the<br />
rise of obesity—levels are significantly higher in<br />
richer, more educated urban households. China,<br />
which once had the leanest of populations, is now<br />
rapidly catching up with the West in prevalence.<br />
Diabetes cases have almost quadrupled in the<br />
last 15 years. 54<br />
Both obesity and undernutrition coexist in<br />
a number of countries. In Indonesia, 36 percent<br />
of preschool and school children were stunted in<br />
2013, while 12 percent were overweight. Some