Suchergebnisse

Vietnamese food systems are undergoing rapid transformation, with important implications for human and environmental health and economic development. Poverty has decreased, and diet quality and undernutrition have improved significantly since the end of the Doi Moi reform period (1986-1993) as a result of Viet Nam opening its economy and increasing its regional and global trade. Yet poor diet quality is still contributing the triple burden of malnutrition, with 25 percent stunting among children under age 5, 26 percent and 29 percent of women and children, respectively, anemic, and 21 percent of adults overweight. Agricultural production systems have shifted from predominantly diverse smallholder systems to larger more commercialized and specialized systems, especially for crops, while the 'meatification' of the Vietnamese diet is generating serious trade-offs between improved nutrition and sustainability of the Vietnamese food systems. The food processing industry has developed rapidly, together with food imports, resulting in new and processed food products penetrating the food retail outlets, trending towards an increase in the Westernized consumption patterns that are shifting nutrition-related problems towards overweight and obesity and, with it, an increase of non-communicable disease-related health risks. While regulatory policies exist across the food system, these are not systematically implemented, making food safety a major concern for consumers and policy makers alike. Where data exists, it is not easy to aggregate with data from across food system dimensions, making it difficult for Viet Nam to make an informed analysis of current and potential food system trade-offs. In our research, we reviewed existing literature and data, and applied a food systems framework to develop an initial food systems profile for Viet Nam and to identify a comprehensive set a of research questions to fill current data gaps identified through the review. Insights on these would provide the comprehensive evidence needed to inform policy makers on how to develop new food systems policies for Viet Nam, and further refine and improve existing policies to achieve better quality diets and more sustainable food systems in Viet Nam. Based on these, we then engaged with stakeholders to develop research priorities in the Viet Nam context and identified 25 priority research questions. This paper aims to stimulate such reflections by clearly outlining key areas for research, government policy, and development programs on priority investment to build the evidence base around inclusive food systems interventions that aim to result in healthier diets and more sustainable food systems for Viet Nam.

This 26th dossier d'Agropolis is devoted to research and partnerships in agroecology. The French Commission for International Agricultural Research (CRAI) and Agropolis International, on behalf of CIRAD, INRAE and IRD and in partnership with CGIAR, has produced this new issue in the 'Les dossiers d'Agropolis international' series devoted to agroecology. This publication has been produced within the framework of the Action Plan signed by CGIAR and the French government on February 4th 2021 to strengthen French collaboration with CGIAR, where agroecology is highlighted as one of the three key priorities (alongside climate change, nutrition and food systems).

Background: Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods: Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (>= 65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0-100 based on the 2.5th and 97.5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target-1 billion more people benefiting from UHC by 2023-we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings: Globally, performance on the UHC effective coverage index improved from 45.8 (95% uncertainty interval 44.2-47.5) in 1990 to 60.3 (58.7-61.9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2.6% [1.9-3.3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010-2019 relative to 1990-2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0.79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388.9 million (358.6-421.3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3.1 billion (3.0-3.2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968.1 million [903.5-1040.3]) residing in south Asia. Interpretation: The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people-the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close-or how far-all populations are in benefiting from UHC.