target groups that often accept preventive measures to a lesser extent and make proportionately less use of them. Key decision makers and all relevant actors participate. The network is supported by professional associations, scientific organizations, by other scientific institutions, the Federal Ministry of Food and Agriculture, and by the National Breastfeeding Commission. It has developed recommendations and calls to action regarding diet and lifestyle before and during pregnancy, diet and physical exercise of infants and breastfeeding women, as well as diet and physical exercise in early childhood. Through multipliers, male and female, whom young families trust, the network seeks access to pregnant women and young families. By combining all these factors, prevention and health promotion can be sustainable and successful.
© 2020 S. Karger AG, Basel
First of all, I was very pleased to participate – for the fourth time in a row – in the Hidden Hunger Congress, which has developed into a very important international exchange among experts from a variety of disciplines. This international and interdisciplinary exchange of knowledge and experience is rewarding in every way. “Thinking outside the box” makes similarities and differences visible and creates opportunities to learn from each other. This applies particularly to the topic of the congress: “Hidden Hunger and the Transformation of Food Systems: How to Combat the Double Burden of Malnutrition?”
Where hidden hunger is concerned, and in view of the measures to combat it, we often face similar challenges across the globe. We know malnutrition exists in each and every country around the world. Its characteristics may vary, yet, where policies and strategies are concerned, the requirements to combat malnutrition are similar. Given this, we did not meet at the congress as affected states on one side and as donor states on the other. Instead, we met as parties concerned, who can learn from each other continuously.
Focusing on Prevention of Malnutrition in Mothers and Their Children
My focus is on the prevention of malnutrition in mothers and their children in the postconception period and during their first phase of life. In the sensitive phase of life surrounding childbirth, it is particularly important to ensure a balanced and sufficient diet for mother and child. It is precisely in this phase that setting the right course is vital to strengthen a child’s resilience for later life [1, 2]. That is why, in Germany, we place a special emphasis at this point with our “Healthy Start – Young Family Network.” However, it is about more than just this. As we work within the “Healthy Start” network, we become aware of how much we can learn from successful efforts in network structures. Therefore, my remarks can be taken as an example for other challenges at hand. I will begin with some introductory statements about the importance of the first 1,000 days in a person’s life, and will also try to identify the leverage points for successful prevention and health promotion.
Healthy Start – Young Family Network: Approaches towards Successful Prevention and Health Promotion
It is undisputed that the right course for a person’s health later in life is set during pregnancy, infancy, and early childhood. A healthy lifestyle at this sensitive stage of life has a significantly positive impact on the health of a mother, her child, and the entire family – not just in the short term, but in the medium and long term as well [3, 4]. Unfortunately, the reverse of this also applies. This is vividly illustrated when we look at overweight, for instance, an issue that determines the debate about nutrition in Germany, and is coming into focus in other parts of the world as well.
Obese pregnant women give birth to overweight children more frequently [5–7]. There is a high probability that these children will continue to be obese during their childhood and will carry their excess weight throughout their youth and even into adulthood [1]. Overweight and obesity challenge those affected, but also our society and our entire health and social system as much as other forms of malnutrition. In Germany, 1 in every 5 women of childbearing age is overweight, while 1 in every 7 women is obese [8]. Over 15% of all 3- to 17-year-olds in Germany are overweight or obese (5.9% are obese). At the same time, overweight and obesity are distributed unequally throughout society. Thus, at 27%, the prevalence of obesity in 3- to 17-year-old girls of low socioeconomic status is four times higher than the prevalence among those of high socioeconomic status [9]. Add to that food insecurity in social strata that are threatened or affected by poverty. This often goes along with a one-sided food supply and nutrition that are inadequate in terms of quality, which in turn quickly leads to a chronic undersupply of micronutrients such as vitamins, minerals, and trace elements [10, 11]. Food insecurity is exacerbated as people become confused by the short-lived, contradictory statements they are confronted with. It is thus vital that everyone acquires high levels of competence in matters regarding nutrition and health. People must be able to understand and assess information in order to make informed decisions on that basis.
Accordingly, empowerment is the first leverage point in any strategy to combat malnutrition. A second leverage point for successful preventive and health-promoting measures lies in correctly addressing the parties affected and concerned. It must be taken into account that the target groups we intend to address are precisely those that often accept preventive measures to a lesser extent and make proportionately less use of them [12, 13]. Also, where measures to support a health-promoting diet and sufficient physical exercise are planned and implemented, we must always take into account and use existing state structures.
Using existing structures and avoiding parallel structures represents the third leverage point. In Germany, this means, for instance, that we think in terms of our federated state structure. The fact that the state secretary of the federal state of Baden-Wuerttemberg addressed words of welcome at this congress on the occasion of its opening might show you how much importance we attach to this structure. The federal structure has indeed many advantages in terms of diversity, independence, and personal responsibility. On the other hand, complexity and lack of transparency at times represent a burden to initiatives and offers of prevention and health promotion.
All told, I would say that we have no shortage of good measures. The challenge instead is to ensure that measures work where they are needed, that they complement each other, and that we, given the diversity of opportunities, do not get lost in small details and do not strive to reinvent the wheel at various levels or locations. That is why it is so important to address issues at various existing levels – national, federal, municipality, community – and bring players together through intensive networking.
The “Healthy Start – Young Family Network”
Networking is exactly where the initiative “Healthy Start” comes in. It is located within the Federal Centre for Nutrition (“Bundeszentrum für Ernährung”), a division of the Federal Office for Agriculture and Food [14]. The go-ahead for the establishment of a nationwide network was given in 2008. The impulse did not come from the top, but from below instead. The participants of a workshop wanted to develop consistent messages regarding the first
