Caballero B. (ed.) Encyclopaedia of Food Science, Food Technology and Nutrition. Ten-Volume Set

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same winery from vines grown in very different soil

types. In this polar coordinate graph, the center of the

figure represents low intensity with the distance from

the center to the intensity rating corresponding to the

relative intensity of each wine for the attribute. By

connecting the mean ratings, the profiles of wines are

shown.

0009 Wine 12 is characterized by a fruity (berry) aroma

and flavor by mouth and is high in intensity of vanilla

and butterscotch aromas. In contrast, wine 13 is low

in these notes, and high in bell pepper, soy, and vege-

tative aromas and in vegetative flavor. Soil at site 12 is

young, shallow, sandy, and nutrient-poor with a low

water-holding capacity, whereas at site 13 there is a

deep, clay-rich, older soil which is high in nutrients

with a high water-holding capacity. Using a multivari-

ate statistical method, the soil data were related to the

sensory descriptive analyses for these sites and wines,

demonstrating an association between wines with

higher intensity of vegetative aroma and flavor by

mouth and soils with higher water-holding capacity.

Conversely, fruitier wines, high in berry aroma and

flavor, were associated with older, gravelly soils with

poor water-holding capacity.

Licorice anise

Grapefruit

Citrus

Berry

(Tree)

fruit

(Tropical)

fruit

(Dried)

fruit

Other

Fresh

Canned/

cooked

Dried

Nutty

Caramel

Lemon

Blackberry

Raspberry

Strawberry

Black currant (cassis)

Cherry

Apricot

Peach

Apple

Pineapple

Melon

Banana

Strawberry jam

Raisin

Prune

Fig

Artificial fruit

Methyl anthranilate

Cut green grass

Bell pepper

Eucalyptus

Mint

Green beans

Asparagus

Green olive

Hay / straw

Tea

Tobacco

Walnut

Hazelnut

Almond

Black olive

Artichoke

Honey

Butterscotch

Diacetyl (butter)

Soy sauce

Chocolate

Molasses

Black pepper

Spicy

Cloves

Geranium

Violet

Rose

Floral

Other

Lactic

Microbiological

Yeasty

Oxidized

Pungent

Cool

Hot

Pungent

Sulfur

Chemical

Earthy

Woody

Fruity

Herbaceous

or vegetative

Nutty

Petroleum

Moldy

Earthy

Burned

Phenolic

Resinous

Orange blossom

Mousey

Horsey

Yoghurt

Sweaty

Sauerkraut

Leesy

Baker's yeast

Sherry

Menthol

Alcohol

Sulfur dioxide

Ethanol

Acetic acid

Ethyl acetate

Wet wool, wet dog

Sulfur dioxide

Burnt match

Cabbage

Skunk

Garlic

Natural gas, mercaptan

Hydrogen sulfide

Rubbery

Diesel

Kerosene

Plastic

Tar

Moldy

Moldy cork

Mushroom

Dusty

Smokey

Burnt toast

Coffee

Medicinal

Phenolic

Bacon

Oak

Cedar

Vanilla

fig0001 Figure 1 Wine aroma wheel. Standardized terminology showing most general terms (first tier) to most specific ones (inner tier).

WINES/Wine Tasting 6219

0010 As a second illustration of the application of de-

scriptive analysis, 58 Chardonnay wines spanning

three vintages were evaluated by descriptive analysis

in 1985. For clarity, mean values for only two vin-

tages are plotted in Figure 3. The younger wines from

the 1983 vintage are higher in fruity (peach, citrus,

and floral) aromas. The older wines from the 1981

vintage are lower in these fruity characteristics but

higher in vanilla and bell-pepper aromas. Previously,

it was claimed that younger wines were fruitier than

older wines, but this study was the first quantitative

evaluation to substantiate informal observations.

More recently it was demonstrated that storage

at high temperatures can decrease the fruitiness

of white wines in less than 15 days. The intensity of

citrus, floral, and green apple aromas decreased by

50% in Chardonnay wines stored at 40



C for 15

days. After 30 days, the fruity notes were almost

absent, while tea/tobacco, honey, and vanilla were

the dominant aroma characteristics (Figure 4).

0011 The 1981, 1982, and 1983 Chardonnays were also

scored for quality by expert judges using the Davis

20-point scorecard (Table 1). No significant differ-

ences in quality scores were found across the 58

wines, but quality ratings for the vintages were statis-

tically significantly different, although they were too

small to be meaningful. (The oldest vintage was

scored 14.80, and the youngest vintage the lowest,

14.08.) From examination of the aroma profiles of

these vintages in Figure 3, it can be seen that higher-

quality ratings were assigned to the older wines which

were higher in vanilla (from oak aging) and lower in

fruity notes which decreased over time because of

chemical changes, such as hydrolysis of fruity esters

to odorless or nonfruity compounds. Whether these

differences in flavor resulted in the higher-quality

ratings for the older wines, or factors such as the

Butter-

scotch

Mint

Clove

Soy

Veggie

aroma

Veggie

flavor

Bell

pepper

Berry

aroma

Berry

flavor

Vanilla

Wine

fig0002 Figure 2 Comparison of flavor profiles of two Napa Valley

Cabernet Sauvignon wines. At the origin, intensity ¼ 0; at the

perimeter, intensity ¼ 4.0. By connecting the average intensities

for each attribute, the profile for a wine is shown. Reproduced

from Spears TA (1990) Evaluation of the effects of soil and other

geographic parameters on the composition and flavor of Caber-

net Sauvignon wines from the Napa Valley. Unpublished. MSc

thesis. University of California, Davis.

Peach

Vintage

1981

1983

Vanilla

Bell pepper

Citrus

Floral

fig0003Figure 3 Comparison of mean aroma profiles for two vintages

of California Chardonnay wine. Data from Ohkubo T, Noble AC

and Ough CS (1987) Evaluation of California Chardonnay wines

by sensory and chemical analyses. Science des Aliments 7:

573–587.

Citrus

Tropical fruit

Green apple

Floral

Vanilla

Honey

Tea/tobacco

Control 15 Days 30 Days

fig0004Figure 4 Comparison of aroma profiles of Chardonnay wines

heated for 0 (control), 15, and 30 days at 40



C. Adapted from de la

Presa Owens C and Noble AC (1997) Effect of storage at elevated

temperatures on aroma of Chardonnay wine. American Journal of

Enology and Viticulture 48: 310–316, with permission.

6220 WINES/Wine Tasting

greater complexity of older wines influenced the

experts, can only be speculated upon. However, this

example illustrates the greater information provided

by wine descriptive analysis than that provided by

quality scores. (See Sensory Evaluation: Descriptive

Analysis.)

Time–Intensity Evaluation

0012 When wine is tasted, the flavor by mouth often

lingers. To measure aftertaste, the method of time–

intensity evaluation in which judges rate intensity

continuously is useful. When a wine is sweetened,

the fruitiness is perceived to increase. As shown in

Figure 5, as the concentration of sugar was increased

from 1% to 3%, the fruity flavor by mouth became

more intense and lasted longer. Time–intensity analy-

sis is useful for characterizing the temporal profiles of

bitterness and astringency. Both are very persistent

and increase in intensity upon repeated sips. For

example, astringency intensity was rated continu-

ously, while the tasters took four sips of the same

wine at 25-s intervals. The average time–intensity

curve shown in Figure 6 illustrates the build-up of

astringency when red wine is sipped rapidly.

See also: Sensory Evaluation: Practical Considerations;

Sensory Rating and Scoring Methods; Descriptive

Analysis; Appearance; Aroma; Taste; Sensory

Characteristics of Human Foods; Food Acceptability and

Sensory Evaluation

Further Reading

Amerine MA and Roessler EB (1983) Wines, Their Sensory

Evaluation. San Francisco: W.H. Freeman.

de la Presa Owens C and Noble AC (1997) Effect of storage

at elevated temperatures on aroma of Chardonnay

wines. American Journal of Enology and Viticulture

48: 310–316.

Fischer U (2001) Practical applications of sensory research:

effect of glass shape, terroir and yeast strain on wine

flavor. American Journal of Enology and Viticulture 51

(in press).

Noble AC (1988) Analysis of wine sensory properties. In:

Linskens HF and Jackson JF (eds) Wine Analysis, vol. 6.

Modern Methods of Plant Analysis, pp. 9–28. London:

Springer-Verlag.

Noble AC (1994) Application of time–intensity procedures

for the evaluation of taste and mouthfeel. American

Journal of Enology and Viticulture 46: 128–133.

Noble AC (1998) Why do wines taste bitter and feel astrin-

gent? In: Waterhouse AL and Ebeler S (eds) Chemistry of

Wine Flavor, pp. 156–165. ACS Symposium Series no.

714. Washington, DC: American Chemistry Society.

Noble AC, Arnold RA, Buechsenstein J et al. (1987) Modi-

fication of a standardized system of wine aroma termin-

ology. American Journal of Enology and Viticulture 38:

143–146.

Noble AC, Elliott-Fisk DL and Allen MS (1995) Vegetative

flavor and methoxypyrazines in Cabernet Sauvignon.

In: Rousell RL and Leahy MM (eds) Fruit Flavors:

Biogenesis, Characterization, and Authentication, pp.

226–234. ACS Symposium Series 596. Washington,

DC: American Chemical Society.

Ohkubo T, Noble AC and Ough CS (1987) Evaluation of

California Chardonnay wines by sensory and chemical

analyses. Sciences des Aliments 7: 573–587.

Rankine B (1986) Roseworthy develops new wine

scorecard. Australian Grapegrower and Winemaker

Feb: p. 16.

100

200

300

400

500

600

0 10203040

Time (s)

Fruitiness intensity

Sucrose

fig0005 Figure 5 Average curve for intensity of the fruity flavor by

mouth in white wine sweetened with 1, 2, and 3% sucrose.

From Noble and Richards, unpublished data.

0 255075100

Astringency intensity

Time (s)

fig0006 Figure 6 Average curve for intensity of astringency over time.

Four sips of the same wine were taken at 25-s intervals. Arrows at

time of sips. From Noble and LeDrean, unpublished data.

WINES/Wine Tasting 6221

WORLD HEALTH ORGANIZATION

J Akre

, World Health Organization, Geneva,

Switzerland

The Birth of the World Health Organization

0001 The World Health Organization (WHO; Figure 1)is

the culmination of efforts at international health co-

operation that began 150 years ago. Although people

have exchanged remedies and diseases for many thou-

sands of years, only recently has thought been given

to ways of working together to promote health that

could go beyond purely parochial concerns. Early

attempts at international cooperation in health were

limited to small groups of countries, which discussed

a few obviously contagious diseases such as cholera

and smallpox, and strategies such as quarantine to

keep them at bay. Although 11 international sanitary

conferences were held in Europe between 1851 and

1903, it was not until 1907 that a world-wide inter-

national institution – the Office International d’Hy-

gie

ne Publique – was founded to prepare and

administer international sanitary conventions and to

provide national health administrations an opportun-

ity for regular contact and discussion.

0002 The terrible epidemics that raged in Europe at the

end of World War I, coupled with the mass movement

of liberated prisoners of war, constituted a menace

of such magnitude as to require coordinated inter-

national effort. The League of Red Cross Societies,

created in 1919, attempted the task but quickly real-

ized that intergovernmental action was essential to

cope with a problem of such magnitude. As the char-

ter of the Office International d’Hygie

ne Publique did

not give enough power for action in individual coun-

tries, provision for necessary measures had to be

made by the League of Nations, then in the process

of creation.

0003 The Geneva-based League, during its short and un-

happy history between the two world wars, had been

the first to invoke international health cooperation to

deal with many kinds of health problems. In the same

period, the Pan American Sanitary Organization, ori-

ginally established in 1902, continued to work in its

own geographic sphere. (In 1958, it became the Pan

American Health Organization, which also serves as

WHO’s Regional Office for the Americas.)

0004 In 1945, the United Nations (UN) Conference on

International Organization, meeting in San Fran-

cisco, unanimously approved a proposal by Brazil

and China to establish an autonomous international

health organization within the UN system. The

following year, a conference held in New York set

up an interim commission and approved the Consti-

tution of the World Health Organization, which

came into force on 7 April 1948. Since then, 7 April

is celebrated every year as World Health Day, when

attention all around the globe is focused on a theme of

major international public health importance.

The Task Entrusted to WHO

0005The agreed policy of WHO is a structured effort by all

countries to bring health within the reach of every-

one. The Organization’s objective is the attainment

by all peoples of the highest possible level of health.

Health, as defined in WHO’s Constitution, is a state

of complete physical, mental, and social well-being,

and not merely the absence of disease or infirmity. It is

seen as a shared responsibility, calling for a high

degree of self-reliance from the individual, the family,

the community, and the nation as a whole. Because

the determinants of health are so broad, the efforts

of the health sector must be supported and aug-

mented by those of many other sectors, including

agriculture, water and sanitation, finance, communi-

cations, planning, and education. In carrying out its

activities, the WHO Secretariat focuses on six core

functions:

0006Articulating consistent, ethical, and evidence-based

policy and advocacy positions.

fig0001Figure 1 The WHO emblem.

6222 WORLD HEALTH ORGANIZATION

.0007 Managing information by assessing trends and

comparing performance; setting the agenda for,

and stimulating, research and development.

0008 Catalyzing change through technical and policy

support, in ways that stimulate cooperation and

action and help to build sustainable national and

intercountry capacity.

0009 Negotiating and sustaining national and global

partnerships.

0010 Setting, validating, monitoring, and promoting im-

plementation of norms and standards.

0011 Stimulating development and testing of new tech-

nologies, tools, and guidelines for disease control,

risk reduction, health care management, and ser-

vice delivery.

WHO also proposes conventions, agreements, and

regulations, and makes recommendations about

international nomenclature of diseases, causes of

death, and public health practices. It develops, estab-

lishes, and promotes international standards concern-

ing foods and biological, pharmaceutical, and similar

substances.

Structure and Management

0012 WHO is a UN specialized agency, as provided for in

the Charter of the United Nations. A goal-oriented

organization with policies, programs, and budget de-

fined through well-developed mechanisms, WHO

consists of three constituent bodies.

0013 The World Health Assembly, which is the highest

decision-making body, is held in May of each year,

and is attended by delegations from WHO’s 191

Member States and two Associate Members. Its

main function is to determine the policies of the Or-

ganization; it also appoints the Director-General and

reviews and approves the budget.

0014The Executive Board, comprising 32 members des-

ignated by Member States, meets twice a year. It

functions as the executive organ of the Assembly,

prepares the agenda for each session, and submits to

it a general program of work. The Assembly elects

countries entitled to designate members of the Ex-

ecutive Board, and one-third of the membership is

renewed annually.

0015The Secretariat is headed by the Director-General

who, as the chief technical and administrative officer

of the Organization, is appointed for a 5-year term by

the World Health Assembly on the nomination of

the Executive Board. Dr Gro Harlem Brundtland

(Norway) took office on 21 July 1998. Past Direct-

ors-General have been Dr Brock Chisholm (Canada,

1948–1953), Dr Marcolino Candau (Brazil, 1953–

1973), Dr Halfdan Mahler (Denmark, 1973–1988),

and Dr Hiroshi Nakajima (Japan, 1988–1998).

0016In general, all technical activities that are of univer-

sal applicability – such as biological standardization,

the overall assessment of the efficacy of methods

and materials, and promoting the control of diseases

– are led from headquarters in Geneva, Switzerland

(Figure 2). WHO’s decentralized structure enables it

to respond directly to the needs of its membership,

upon request, through its six regions – Africa, the

Americas, South-eastAsia, the Eastern Mediterranean,

fig0002 Figure 2 General view of the WHO headquarters in Geneva, Switzerland (photograph by J. Germain, WHO).

WORLD HEALTH ORGANIZATION 6223

Europe, and the Western Pacific – each consisting

of a regional committee and a regional office

(Figure 3). The regional offices, with their own dir-

ectors, are responsible for formulating policies of a

regional character and for monitoring regional activ-

ities. In many countries, there is a resident WHO

representative, who is the main intermediary for

WHO support, and who participates, with the gov-

ernment, in planning and managing national health

programs.

0017 Some 27% of WHO’s approximately 4300 staff

members work in countries all over the world, either

in field programs or as WHO representatives; 44%

are in the regional offices, and 29% at headquarters.

0018 The WHO’s standard-setting functions include

preparation and updating of the International Classi-

fication of Diseases, assignment of generic names for

pharmaceuticals, and development of the authorita-

tive scientific knowledge base – methodologies,

standards, norms and criteria, and guidelines and

strategies – for preventing, detecting and managing

the major forms of malnutrition. Since 1957, evalu-

ation of the safety for human consumption of selected

food additives and contaminants in food and estab-

lishment of acceptable daily intakes for these sub-

stances has been the focus of the Joint FAO (Food

and Agriculture Organization of the United Nations)/

WHO Expert Committee on Food Additives. The

committee’s reports, as well as those of a similar

FAO/WHO group responsible for evaluating the

safety of pesticide residues, are used in formulating

national food legislation intended to protect con-

sumers from hazardous additives or contaminants

and by the Codex Alimentarius Commission – an-

other joint FAO/WHO body – in establishing inter-

national food standards. Food legislation is one of the

many topics covered by WHO’s International Digest

of Health Legislation database.

0019Apart from its regular budget, WHO receives vol-

untary contributions from both governmental and

nongovernmental sources. The regular and projected

extra-budgetary figures for the biennium 2002–2003

are US$855.6 million and US$1.380 billion, respect-

ively. Voluntary contributions include subaccounts

for purposes such as developing a new international

growth reference based on an international sample

WHO African Region

WHO Region of the Americas

WHO South-East Asia Region

WHO European Region

WHO Eastern Mediterranean Region

WHO Western Pacific Region

Regional Office

WHO 00266

WASHINGTON

BRAZZAVILLE

MANILA

CAIRO

NEW

DELHI

COPENHAGEN

WHO Regional Offices and the areas they serve

fig0003 Figure 3 WHO regional offices and the areas they serve.

6224 WORLD HEALTH ORGANIZATION

of breastfed infants from healthy populations with

unconstrained growth; fostering health research; im-

proving community water supply; expanding immun-

ization; eradicating polio; preventing and controlling

HIV/AIDS, diarrheal disease and yaws; preparing a

credible emergency health response to disasters and

natural catastrophes; and responding to new and

re-emerging diseases, e.g., viral hemorrhaghic fevers

like Ebola, and tuberculosis (see below concerning

public–private partnerships).

Working Together for Better Health

0020 From its beginning, WHO set out to work not through

its small staff alone but with and through others.

Many thousands of individual researchers and scien-

tists, including Nobel laureates, have put their talents

at the Organization’s disposal – and their number

continues to grow. The same is true of the nearly

1200 leading health-related institutions around the

world that have been officially designated as WHO

collaborating centers in a wide range of disciplines.

0021 WHO was also mandated to work with other agen-

cies within the UN family of organizations. Nutrition

work, for example, quite naturally came to involve

FAO, as did work against animal diseases and, as

mentioned above, in the area of food additives, pesti-

cide residues, and contaminants. WHO cosponsored,

with FAO, the International Conference on Nutrition

(Rome, 1992) when 159 governments reached a new

global consensus on the nature of malnutrition and its

multiple causes, and on the urgent action required to

prevent, reduce, and ultimately eliminate malnutri-

tion. Programs aimed at educating teachers on how

to deal with mentally retarded children came within

the purview of the United Nations Educational,

Scientific and Cultural Organization (UNESCO). Oc-

cupational health was a shared activity with the Inter-

national Labour Organization. Drug dependence and

abuse called for collaboration with the United

Nations Division of Narcotic Drugs. WHO, together

with the United Nations Children’s Fund (UNICEF),

the United Nations Development Programme, the

United Nations Population Fund, UNESCO and the

World Bank, was a founding cosponsor of UNAIDS,

the global effort to control the spread of HIV/AIDS.

0022 One of WHO’s closest partners has been UNICEF,

with which, for example, the early yaws and malaria

campaigns were carried out, and it prepared the

International Code of Marketing of Breast-milk Sub-

stitutes (1981). In 1991, the two agencies jointly

launched the Baby-friendly Hospital Initiative to pro-

mote breastfeeding, and they continue to collaborate

in the development of a global strategy for infant and

young child feeding.

0023Collaboration was also initiated with professional,

charitable, and other nongovernmental organizations

(NGOs) pursuing aims consonant with those of

WHO. By the end of the first decade, WHO had

established official relations with 40 such bodies,

ranging from the International Council of Nurses to

the International Commission on Radiation Units

and Measurements, and from the World Federation

for Mental Health to the International Leprosy Asso-

ciation. Work of vital importance has been made

possible through the enthusiasm of these and other

valuable organizations – for example, the Bill and

Melinda Gates Foundation – which have in turn bene-

fited from the moral support and the technical infor-

mation provided by WHO.

0024Collaboration continues unabated; examples in-

clude cancer pain relief with the International Associ-

ation for the Study of Pain, efforts to insure safe blood

and plasma supplies undertaken with, among other

groups, the International Federation of Red Cross

and Red Crescent Societies, and support for polio

eradication provided through Rotary International.

The success of these joint ventures is illustrated by

the ever-lengthening list of NGOs admitted into offi-

cial relations with WHO, which now numbers 192

with the recent acceptance of Timor-Leste.

0025To further its mission and policies, WHO also

regularly interacts with commercial enterprises, in-

cluding through participation in alliances and other

relationships, exchange of information, product re-

search and development aimed at improving health,

generation of cash and in-kind donations to WHO,

and advocacy for health. While stressing the need to

be fully transparent and to avoid conflict of interest

arising in any relationship – work with the private

sector to achieve health outcomes is governed by

formal guidelines – the Executive Board has encour-

aged new forms of partnerships and other relation-

ships in order to advance WHO’s health agenda. A

number of groundbreaking public–private partner-

ships – WHO, government agencies, NGOs, and the

pharmaceutical industry – have been recently de-

veloped to tackle several particularly challenging dis-

eases, including leprosy, malaria, and trachoma.

World Health in the Twenty-first Century

0026Using pragmatic tools in pursuit of its visionary goal,

WHO strives to respond to its constitutional mandate

through its evolving program of activities. These are

based on the needs and priorities determined by

Member States themselves through the World Health

Assembly and the Executive Board. Changes in pro-

gram emphasis occur in response to altered political,

social, economic, and environmental realities.

WORLD HEALTH ORGANIZATION 6225

0027 For example, in 1977, the World Health Assembly

decided that the major social goal of governments and

WHO should be the attainment by all people of the

world by the year 2000 of a level of health that would

permit them to lead a socially and economically pro-

ductive life. This was the birth of the Health for All

movement, which was followed, in 1981, with the

adoption of the Global Strategy for Health for All.

In 1994, WHO’s Member States, while acknowledg-

ing that significant global changes had occurred since

the adoption of the goal of Health for All, called for a

renewal of the strategy to meet challenges, exploit

opportunities, and overcome obstacles at the dawn

of the twenty-first century.

0028 Respecting the new issues and priorities of the

times for WHO means grappling with the multiple

consequences for health and nutritional status of ac-

celerating social and demographic changes, including

population growth, ageing, international movements

of migrants and refugees, and complex emergencies

resulting from natural and ecological disasters, wars,

civil disturbances, and serious disease outbreaks. It

calls for dealing creatively with the impact of indebt-

edness, incurred over time, that has led many coun-

tries to reduce public spending in health services,

which are often regarded as being only an expend-

iture rather than an investment in human potential.

There continues to be a massive gap between the

resources needed to help poor communities tackle

different causes of illness – malnutrition, malaria,

tuberculosis, and HIV/AIDS being among the most

urgent examples – and the funding and human cap-

acity currently available to them.

0029 WHO must also face up to threats to human health

that respect no national boundaries, such as uncon-

trolled dumping of toxic wastes and pollution of land,

water and air, and prodigious consumption and mis-

management of natural resources. The globalization

of infectious diseases is not a new phenomenon.

However, increased population movements; growth

in international trade in food and biological products;

social and environmental developments linked with

urbanization; deforestation and climate change; and

modification of food-processing methods, distribu-

tion, and consumer habits have reaffirmed that infec-

tious disease events in one country are potentially a

concern for the entire world. The solution of these

problems hinges, to a large extent, on the degree to

which WHO is able to harness the interdependence of

nations and peoples as a positive force for conciliating

between competing present and future needs.

0030 Maintaining that health should be seen as central

for development and to the quality of human life,

WHO seeks to achieve a dynamic yet harmonious

balance between health in terms of consumption

and health as an investment in human capital with

dividends earned in the future. The Organization’s

history has been one of adaptation to evolving

circumstances, giving priority first to one health

problem, then to another, and it continues to adjust

its priorities to meet the world’s ever-changing health

requirements. At the same time, WHO is being asked

to respond to unprecedented requests for support

in addressing the problems brought about by dra-

matically declining resources, political upheaval,

war and civil strife, together with the pandemic of

AIDS, epidemics of cholera and bovine spongiform

encephalopathy (and its human form, Variant Creutz-

feldt–Jakob Disease), environmental degradation,

as well as natural disasters such as earthquakes,

floods and drought. In 2001, WHO opened an office

in Lyon (France) to help with the technical training

of specialists from all over the world who work to

control epidemics. WHO’s Tobacco Free Initiative

was created to focus international attention, re-

sources and action on the global tobacco pandemic

that kills four million people a year today. WHO is

leading the way with the Framework Convention on

Tobacco Control – the world’s first multilaterally

negotiated rules devoted entirely to a major health

issue – which will be ready for signature no later

than 2003.

0031In this light, and as a reflection of the decisions

taken during the World Health Assembly, the Execu-

tive Board, and the regional committees, WHO has

designated its priorities for the start of the twenty-

first century. These include an approach that focuses

particularly on links between health and poverty re-

duction; a greater role in establishing consensus on

health policies, strategies and standards; more effect-

ive action to improve health and decrease inequities

in health outcomes; and an organizational culture

that encourages strategic thinking, global influence,

prompt action, creative networking, and innovation.

To pursue these ends, the work of WHO has four

strategic directions:

0032reducing excess mortality, morbidity, and disabil-

ity, especially in poor and marginalized popula-

tions;

0033promoting healthy lifestyles and reducing factors

of risk to human health that arise from economic,

social, and behavioral causes;

0034developing health systems that equitably improve

health outcomes, respond to people’s legitimate

demands, and are financially fair;

0035developing an enabling policy and institutional en-

vironment in the health sector and promoting an

effective health dimension to social, economic,

environmental, and development policy.

6226 WORLD HEALTH ORGANIZATION

The Foundation of Nutritional Well-being

0036 Nutrition is a cornerstone of health and development;

it affects and defines the health of all people, rich and

poor. It is a fundamental pillar of human life, health,

and development across the entire life span and an

essential foundation for human and national develop-

ment. From the earliest stages of fetal development, at

birth, through infancy, childhood, adolescence, and

on into adulthood and old age, proper food and good

nutrition are essential for survival, physical growth,

mental development, performance and productivity,

health, and well-being. Conversely, malnutrition

spells increased vulnerability to disease and prema-

ture death.

0037 Malnutrition means ‘badly nourished,’ but it is far

more than just a reflection of what people eat, or fail

to eat. Clinically, malnutrition is the result of in-

appropriate intake and absorption of protein, energy,

and micronutrients, whether too little or too much,

and by frequent infections or disease. Nutritional

status is the result of the complex interaction between

the food we eat, our overall state of health, and the

social and physical environment in which we live –

in short, food, health and caring, the three ‘pillars

of well-being.’ Good health is as essential to nutri-

tional well-being as good nutrition is crucial for main-

taining healthy growth and development. Preventing

infection and managing infectious diseases – minim-

izing their incidence, duration, and severity – are

essential for optimizing nutrition.

0038 The fundamental WHO goal of Health for All –

that people everywhere have the opportunity to reach

and maintain the highest attainable level of health – is

impossible in the presence of hunger, starvation, and

malnutrition, which remain among the most devas-

tating problems facing the majority of the world’s

poor and needy and continue to dominate the health

of the world’s poorest nations. Indeed, poverty, in-

equality, and underdevelopment will not be truly re-

solved until both malnutrition and ill-health are

effectively addressed.

Malnutrition: Casting Long Shadows

0039 Nearly 30% of the world’s population, especially

in low-income countries, bears the triple burden

of poverty, malnutrition, and ill-health, which

stalk one another in a vicious circle. From a

human-development perspective, poverty comprom-

ises health and nutritional status, and undermines

socioeconomic development. In a world that has

both the resources and knowledge to end this catas-

trophe, the situation is a continuing travesty of justice

and an abrogation of the fundamental human right to

adequate food and nutrition, and to be free from

hunger and malnutrition. In addition to suffering

from one or more of the multiple forms of malnutri-

tion, 800 million people – many of whom depend on

food aid for their survival – are threatened by food

insecurity. Malnutrition kills, maims, cripples, and

blinds on a massive scale world-wide; and it is both

a major cause and effect – as well as a key indicator –

of poverty and underdevelopment.

0040The point here is as simple to state as it is complex

to remedy – proper nutrition is a prerequisite both

for insuring good health and for reducing poverty.

Where hunger and malnutrition prevail, unnecessar-

ily high levels of morbidity and mortality, and un-

acceptable levels of economic and social deprivation

are sure to be found. Thus, for example:

0041Poverty underlies most of the world’s malnutrition,

with attendant inadequate and insecure food

supply, inappropriate feeding practices and care,

nutritional emergencies, and widespread infection

and infestation that are compounded by lack of

health services.

0042Nutritional status, determined using nutritional in-

dices, is a reliable and easily measurable objective

indicator of poverty and progress achieved in na-

tional development.

0043Maternal malnutrition remains a major factor for

the 30 million infants born each year (23.8% of

all births) with intrauterine growth retardation

leading to retarded physical, mental, and intellec-

tual growth, and heightened risk of infectious dis-

eases and death.

0044Protein–energy malnutrition affects more than a

quarter of the world’s children – 26.7% (150 mil-

lion) underweight and almost 30% (161 million)

stunted – of which 70% are in Asia, over 25% in

Africa, and 4% in Latin America and the Carib-

bean.

0045Malnutrition contributes to 60% of the 10.9 mil-

lion deaths each year among children under five

in developing countries. Well over two-thirds of

these deaths, which are often associated with

poor feeding practices, occur during the first year

of life.

0046Some 740 million children and adults in 130 coun-

tries are affected by iodine deficiency disorders, still

the greatest single cause of preventable brain

damage to the fetus, infant, and young child.

0047Vitamin A deficiency affects more than 250 million

preschool children in 118 countries, mainly in

Africa and South-east Asia, causing blindness and

increased risk of infection and death.

0048Vast problems of iron and folate deficiency,

resulting in anemia, affect more than 60% of

WORLD HEALTH ORGANIZATION 6227

women of childbearing age in developing countries,

and millions of young children.

0049 Noncommunicable diseases contribute to approxi-

mately 60% of deaths in the world and 43% of the

global burden of disease. About half of these deaths

are attributable to cardiovascular diseases.

0050 Major natural and human-induced emergencies of

all types are increasing in number and intensity,

further compromising the care and feeding of

vulnerable populations, including refugees and

internally displaced persons who currently number

more than 40 million (including 5.5 million under-

five children).

Responding to the Challenge of the

Twenty-first Century – A Two-Pronged

Approach

0051 To promote healthy nutrition for all people, it is ne-

cessary to take simultaneous action on two different,

if overlapping, fronts. On the one hand, many less-

favored nations remain handicapped by a formidable

array of development constraints, including rapidly

increasing population, unproductive agriculture, en-

vironmental degradation, limited health service cov-

erage, and war and civil strife. Among the most visible

– and tragic – consequences are the many millions of

wasted and stunted children who do not have enough

protein and energy in their diets, who suffer from

cretinism and other permanent brain damage because

their diets and those of their parents are deficient in

iodine, or who go blind or even die for lack of vitamin

A. It is in just such environments that diarrheal dis-

ease, frequently compounded by seasonal or chronic

food shortages, take their heaviest toll in terms of

malnutrition, ill-health, and premature death.

0052 On the other hand, there has been a significant

drop in recent years in the prevalence of infectious

diseases, while food availability and the quality of

diets have improved for population groups all over

the world. The result in many countries has been a

sharp reduction in infant and child mortality and

longer adult life expectancy. These and related factors

have paved the way for a dramatic expansion of a

different type of nutrition crisis – diet-related chronic

disorders are now flourishing where, not so long ago,

infectious diseases were seen as the greatest menace to

health. Chronic disorders are fast becoming major

killers, and their prevalence is especially high in rap-

idly industrializing low- and middle-income countries

among the urban poor who pursue the unhealthy

dietary habits and lifestyles that, until recently, were

considered the province of more affluent groups.

0053 The rapidly increasing burden of noncommunic-

able diseases is a key determinant of global public

health. On the basis of current estimates, deaths

from noncommunicable diseases are expected to ac-

count for 73% of deaths and 60% of the disease

burden by the year 2020. Already 79% of deaths

attributed to noncommunicable diseases occur in de-

veloping countries, where most people affected by

these diseases are between 45 and 65 years old. In

China and India alone, the burden of cardiovascular

disease is greater than that in the industrialized coun-

tries as a whole. One of the main objectives of WHO’s

global strategy for the prevention and control of non-

communicable diseases is to reduce the level of expos-

ure to the major risk factors, namely, tobacco use,

unhealthy diet, and physical inactivity, which should

be tackled in an integrated manner.

0054WHO is committed to reducing malnutrition’s

global burden and its associated morbidity and mor-

tality. The overall aim of its work in nutrition is to

promote healthy nutrition and appropriate feeding

for all population groups based on sound scientific

evidence. WHO seeks to prevent, reduce, and elimin-

ate malnutrition world-wide, thereby promoting sus-

tainable health and well-being, accelerating poverty

reduction, and enhancing human and national devel-

opment. Within this context, WHO’s seven priority

action areas are:

0055protein–energy malnutrition – assessment, moni-

toring/management, prevention, and reduction;

0056micronutrient malnutrition:

0057Elimination of vitamin A deficiency and iodine

deficiency disorders;

0058Significant reduction of iron deficiency anemia;

0059obesity and other diet-related diseases – epidemi-

ology, prevention and management;

0060national nutrition policies and programs – develop-

ment and implementation;

0061infant and young child feeding – appropriate

breastfeeding and complementary feeding;

0062nutrition in emergencies – preparedness and re-

sponse;

0063food aid for development – guidance for food-

assisted development activities.

Against this backdrop, WHO strives to:

0064strengthen the technical capabilities of its Member

States for assessing and coping with malnutri-

tion;

0065develop authoritative standards, norms, criteria,

methodologies, guidelines and strategies for pre-

venting, detecting, and managing all major forms

of malnutrition;

0066promote the health and nutrition benefits, for food-

insecure populations, of food-assisted development

and emergency activities;

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