Making progress on nutrition

A new report was launched last week in the Houses of Parliament which lays out progress made in tackling nutrition in several counties, as well as the challenges still ahead. “What works for nutrition? Stories of success from Vietnam, Uganda and Kenya”, a joint publication from RESULTS UK, Concern Worldwide and the University of Westminster, discusses these countries success in the context of global nutrition targets and concludes with key recommendations for government and civil society to build on this success and learn from their experiences.

Despite considerable progress in reducing hunger and the physical signs of malnutrition (the number of hungry people has been reduced by 200 million since 1990 and stunting in children under age five by 40%), malnutrition still places a heavy burden on survival and overall development. Some two billion people, for example, are estimated to suffer from micronutrient deficiencies (about 27% of the global population), which can have wide ranging long-term and irreversible consequences for their health and livelihoods. Undernutrition can reduce GDP and an individual’s earnings by as much as 10%. Progress in tackling malnutrition has also been uneven and inequitable: children in rural areas, for example, as twice as likely to be stunted as those in urban areas. But global initiatives are improving awareness of global malnutrition, and in 2012, the World Health Association (WHA) endorsed six targets on nutrition to be achieved by 2025.

1. Achieve a 40% reduction in the number of children under-5 who are stunted;
2. Achieve a 50% reduction of anaemia in women of reproductive age;
3. Achieve a 30% reduction in low birth weight;
4. Ensure that there is no increase in childhood overweight;
5. Increase the rate of exclusive breastfeeding in the first 6 months up to at least 50%;
6. Reduce and maintain childhood wasting to less than 5%.

Financing for nutrition has been growing recently, although evidence indicates donors need to quadruple their financial pledges and governments need to at least double the amount allocated to nutrition in order to meet the WHA target on stunting in 37 high burden countries. And nutrition is a good investment: every dollar invested in nutrition yields more than 16 in return.

4 ways to reduce malnutrition

Image courtesy of [rakratchada torsap] at FreeDigitalPhotos.net

Tackling undernutrition is, as the full extent of malnutrition and micronutrient deficiencies becomes apparent, critical for human wellbeing and development. In the past we have tended to focus, with limited success, on ensuring people have enough to eat, on making the world “food secure” and on fighting hunger but now we are beginning to understand that if we are to lead healthy, productive lives, it is also about having enough to eat of the right mix of nutrients. And unlike hunger, often viewed as a more common problem in developing countries, poor nutrition, whether through famine or feasting, can be universal.

In 2008, when The Lancet published their Series on Maternal and Child Undernutrition, global policymakers began to take notice and the Scaling-Up Nutrition movement was born. Today this momentum is continuing and the new Sustainable Development Goals focus more on nutrition and non-communicable diseases than the Millennium Development Goals did. We are also learning more and more about what can be done to lessen the burden of malnutrition. Here we discuss four approaches, all of which will be needed for malnutrition to significantly decline: the scaling up of successful and cost-effective direct interventions; prioritisation of the first 1,000 day window in a child’s existence; the development of food systems that deliver enough healthy food and prioritise human health; and coordination and collaboration across government sectors to put nutrition at the heart of relevant policies and programmes.

Scale-up direct interventions where they work

Nutrition, while impacted by agricultural productivity, poverty and income, is unlikely to be improved through more general programmes aimed at bringing about economic and social development. Income growth alone will not reduce rates of malnutrition, and so we need direct interventions to tackle malnutrition. Things such as vitamin, mineral and micronutrient supplementation; delayed cord clamping after birth, kangaroo mother care, early initiation of breastfeeding, promotion of dietary diversity, fortifying staple foods, cash transfer programmes, community-based nutrition education, and school feeding programmes.

Nutrition-sensitive agriculture: a collection of case studies

A new report recently released by the United Nations Standing Committee on Nutrition, entitled, The Nutrition Sensitivity of Agriculture and Food Policies, investigates, through eight country case studies, current understanding of effective nutrition-sensitive agriculture and food policies, and the development of food-based solutions that help countries to scale up nutrition.

Recognition of the links between agriculture and nutrition is growing, and both countries and institutions are working towards making agricultural policies more nutrition sensitive. The report discusses the work of Brazil, Malawi, Mozambique, Nepal, Senegal, Sierra Leone, South Africa, and Thailand to make agriculture, a sector important for both economic development and livelihoods in many developing countries, more able to address issues of nutrition insecurity, gender inequality and resilience.

The links between agriculture and nutrition are complex, and not well understood. In particular our knowledge of how agricultural programmes or policies can impact nutritional outcomes and consumption patterns have only recently begun to be investigated. As agricultural systems become more complex and global in nature, the links to nutrition, experienced at an individual or household level, become harder to understand and manage. What is understood is that the current food systems are not well designed to provide nutrition security and, for those countries suffering a high burden of malnutrition, guidance and practical advice in making nutrition-sensitive policy decisions and measuring their impact is needed.

Addressing nutrition requires a multi-sectoral, multi-stakeholder and multi-disciplinary approach, which, through agriculture, attempts to reduce unintended consequences of agricultural policies on consumer welfare while maximising positive nutrition outcomes. The report states that food and nutrition security are a product of both dietary diversity and quality, as well as being able to access sufficient calories. As the country case studies show many countries are now thinking about the links between agriculture and food and nutrition security and are committing to achieving positive nutrition outcomes, although rarely across the whole sector or with any formal measurement of impact. Nutrition outcomes can also be seen as secondary to sector-specific objectives, particularly worrisome if this leads to negative consequences for nutrition.

Taking action on malnutrition

A lack of sufficient nutrients in the diet is responsible for around 2.6 million deaths of children per year, the largest killer of children in the world. Those children that do survive will be stunted in their physical growth and mental development, which can not only cause health problems but will detrimentally impact their education and earning potential for the rest of their lives. This is a risk faced by some 165 million children across the world.

This year, high-level decision makers will come together on 8^th June for a Hunger summit, hosted by David Cameron, ahead of this year’s G8, and nutrition will likely be on the agenda. But what action can leaders, donors and people on the ground take to tackle undernutrition?

The Montpellier Panel, in their 2011 briefing paper on Scaling Up Nutrition, outlined the urgent need for children to receive adequate nutrition in the first 1000 days of their lives (from conception to 2 years old). It also detailed the measures the United Nations Scaling Up Nutrition (SUN) movement was taking globally to combat child undernutrition. The SUN movement works with partner countries (35 to date) to integrate nutrition into development plans across sectors such as health, education and agriculture.

In particular the SUN movement supports the following interventions and policies:

Specific Nutrition Interventions

• Support for exclusive breastfeeding up to 6 months of age and continued breastfeeding, together with appropriate and nutritious food, up to 2 years of age;
• Fortification of foods;
• Micronutrient supplementation; and
• Treatment of severe malnutrition.

Nutrition-Sensitive Approaches

• Agriculture: Making nutritious food more accessible to everyone, and supporting small farms as a source of income for women and families;
• Clean Water and Sanitation: Improving access to reduce infection and disease;
• Education and Employment: Making sure children have the energy that they need to learn and earn sufficient income as adults;
• Health Care: Improving access to services to ensure that women and children stay healthy;
• Support for Resilience: Establishing a stronger, healthier population and sustained prosperity to better endure emergencies and conflicts; and
• Women’s Empowerment: At the core of all efforts, women are empowered to be leaders in their families and communities, leading the way to a healthier and stronger world.

Recent interest has focused on the contribution of agriculture to ending hunger and malnutrition. Agriculture plays a crucial role in access to nutritious and diverse crops, affordable sources of foods and as an income source but the links between agriculture and nutrition are not always clear. Several recent reports have summarised how agricultural development can have positive outcomes for household nutrition.