Time to Tackle Malnutrition and Its Massive Human Costs by Jose Graziano da Silva, Margaret Chan WHO, IDS, Food & Agricultural Organization (FAO) 4:57am 18th Nov, 2014   The scourge of malnutrition affects the most vulnerable in society, and it hurts most in the earliest stages of life. Today, more than 800 million people are chronically hungry, about 11 percent of the global population.    Undernutrition is the underlying cause of almost half of all child deaths, and a quarter of living children are stunted due to inadequate nutrition. Micronutrient deficiencies – due to diets lacking in vitamins and minerals, also known as “hidden hunger” – affects two billion people.    Another worrying form of malnutrition – obesity – is on the rise. More than 500 million adults are obese as a result of diets containing excess fat, sugars and salt.    This exposes people to a greater risk of noncommunicable diseases – like heart disease, stroke, diabetes and cancer – now the top causes of death in the world. Poor diet and physical inactivity also account for 10 percent of the global burden of disease.    Many developing countries now face multiple burdens of malnutrition, with people living in the same communities – sometimes even the same households – suffering from undernutrition, hidden hunger and obesity.    These numbers are shocking and must serve as a global call to action.    Besides the terrible human suffering, unhealthy diets also have a detrimental impact on the ability of countries to develop and prosper – the cost of malnutrition, in all its forms, is estimated between four and five percent of global GDP.    Government leaders, scientists, nutritionists, farmers, civil society and private sector representatives from around the world will gather in Rome from Nov. 19 to 21 for the Second International Conference on Nutrition (ICN2). It is an opportunity they cannot afford to miss: making peoples’ right to a healthy diet a global reality.    Creating healthy and sustainable food systems is key to overcoming malnutrition in all its forms – from hunger to obesity.    Food production has tripled since 1945, while average food availability per person has risen by only 40 percent. Our food systems have succeeded in increasing production, however, this has come at a high environmental cost and has not been enough to end hunger.    Meanwhile, food systems have continued to evolve with an even greater proportion of food being processed and traded, leading to greater availability of foods with high energy, fats, sugars and salt.    Our food systems are simply not sustainable or healthy today, let alone in 2050, when we will have to feed more than nine billion people. We need to produce more food but also nutritious food and to do so in ways that safeguard the capacity of future generations to feed themselves.    Put simply: we need healthy and sustainable food systems – that produce the right balance of foods, in sufficient quantity and quality, and that is accessible to all – if we want to lead healthy, productive and sustainable lives.    In preparation for ICN2, countries have agreed to a Political Declaration and a Framework for Action on nutrition containing concrete recommendations to develop coherent public policies in agriculture, trade, social protection, education and health that promote healthy diets and better nutrition at all stages of life.    The Framework for Action gives governments a plan for developing and implementing national policies and investments throughout the food chain to ensure healthy, diverse and balanced diets for all.    This can include strengthening local food production and processing, especially by family farmers and small-scale producers, and linking it to school meals; reducing fat, sugars and salt in processed food; having schools and other public institutions offer healthy diets; protecting children from marketing of unhealthy foods and drinks; and allowing people to make informed choices regarding what they eat.    While government health, agriculture, and education ministries should take the lead, this task includes all involved in producing, distributing and selling food.    The ICN2 Framework for Action also suggests greater investments to guarantee universal access to effective nutrition interventions, such as protection, promotion and support of breastfeeding, and increasing nutrients available to mothers.    Countries can start implementing these actions now. The first step is to establish national nutrition targets to implement already agreed-upon global targets, as set out in the Framework for Action. ICN2 is the time and place to make these commitments.    FAO and WHO are ready to assist countries in this effort. By transforming commitment into action and cooperating more effectively with one another and with other stakeholders, the world has a real chance of ending the multiple burdens of malnutrition in all its forms within a generation.    * Jose Graziano da Silva is FAO Director-General and Margaret Chan is WHO Director-General.    http://www.fao.org/about/meetings/icn2/en/ http://www.fao.org/about/meetings/icn2/news/en    * Global Nutrition Report: http://globalnutritionreport.org/    Feeding the world sustainably. (The Lancet)    Good nutrition is fundamental to human health and wellbeing, yet according to the latest estimates from the UN Food and Agriculture Organization (FAO), about 805 million people—more than a tenth of the world"s population—remain chronically undernourished. In 2013, 161 million children younger than 5 years were affected by stunting, and 51 million by wasting. Undernourishment is the main underlying cause of death in this age group, accounting for 45% of child deaths worldwide. Meanwhile, more than 2 billion people are affected by deficiencies of micronutrients such as iodine, vitamin A, zinc, and iron.    On Nov 19—21, government ministers and other participants from around the world will gather in Rome, Italy, for the Second International Conference on Nutrition (ICN2), organised by WHO and the FAO. The meeting represents a crucial opportunity to make nutrition a central part of the post-2015 sustainable development agenda, to ensure that the goals and targets set are adequate to address the many challenges of global malnutrition, and to build towards an international framework for accountability.    The publication of the first Global Nutrition Report at ICN2 should instil a sense of urgency to achieve these goals. The report is one important outcome of the Nutrition for Growth summit, held in London, UK, in 2013. Stakeholders commissioned an independent expert group to collate and synthesise diverse and fragmented international data for nutrition, with the specific aim of improving the accountability of donors, countries, and agencies with respect to commitments made to improve nutrition. The report is unique in that it includes data for all 193 UN member states, covering more than 80 indicators on nutrition outcomes, underlying determinants, interventions, resources, and political commitments.    The world has changed substantially since the first ICN meeting took place in 1992. With only slow progress in the reduction of undernutrition, the world now also faces growing epidemics of overweight, obesity, and diet-related non-communicable diseases (NCDs). This fact is reflected by the broad scope of the Global Nutrition Report, the authors noting that the coexistence of different forms of malnutrition is the “new normal”. The authors conclude that progress towards World Health Assembly 2025 targets for maternal and child nutrition is too slow, although many countries have made substantial advances on some indicators. They also summarise evidence that shows how improvements in nutritional status will contribute substantially to development goals related to poverty, health, education, gender, and employment.    The two main outcome documents from ICN2 will be the Rome Declaration on Nutrition and a Framework for Action, the texts of which have been agreed in advance. The Declaration includes commitments to eradicate hunger and all forms of malnutrition, to increase investments in effective interventions, and to develop coherent policies to enhance sustainable food systems. However, a delegation of civil society organisations described the recommendations as “weak and non-binding”, and suggested that governments have not set the bar any higher than the first ICN meeting in 1992. Others have pointed to the inadequate attention given to the issue of sustainable diets and food systems.    ICN2 should be used as an opportunity to call for more attention to be given to nutrition in the post-2015 sustainable development agenda. Currently, only one of the 169 proposed targets for the 17 provisional Sustainable Development Goals includes a specific, quantifiable target for nutrition—the reduction of stunting and wasting in children younger than 5 years. Although important, this one measure is grossly inadequate to address all the challenges of global malnutrition, including under-nutrition and micronutrient deficiencies, as well as overweight, obesity, and diet-related NCDs. More specific targets covering all of these issues are needed to galvanise funders, countries, and others to address these fundamental challenges.    Beyond these targets, the right to adequate nutrition needs to be fully integrated into the sustainable development agenda. Importantly, sustainability has to be well enough defined to make such integration meaningful. How will changing diets—with increasing consumption of meat and processed foods—affect the contribution of food production to climate change? How do we deal with overconsumption? What might a healthy, sustainable diet look like in different countries and contexts? And how do we get there? These are urgent questions, and they demand urgent answers if we are going to be able to create a lasting future of good nutrition for all.    17 Nov 2014    If governments are serious about ending hunger, this week’s international conference on nutrition must yield real results, write Lawrence Haddad and Dolf te Lintelo from the Institute of Development Studies.    This week, the eyes of the global development community will be on Rome. After a gap of two decades, the second international conference on nutrition (ICN2) is to review global progress made towards improving nutrition over the past 25 years.    The world has changed dramatically since the first meeting in 1992. Globalisation, urbanisation, information technology, population growth, concentration of the food system, the emergence of new state powers, a changing climate and outbreaks of conflict and infectious disease make for a highly dynamic and uncertain global context.    Supported by – and sometimes in spite of – this backdrop, undernutrition, as measured by the rate and pattern of child growth and by micronutrient deficiencies, has slowly edged down. Other manifestations of malnutrition such as obesity and non-communicable diseases like diabetes have become more important as drivers of the global burden of disease.    Nearly every country is now grappling with some form of malnutrition, and almost half are dealing with undernutrition and obesity at the same time. While 70% of countries are on course to meet at least one of the four targets identified by the World Health Assembly (WHA) for which data are available, 30% are not.    Against this shifting backdrop, the nutrition community has never looked more unified. Globally, the four big UN agencies – the (Food and Agriculture Organisation, the World Health Organisation, the World Food Programme and Unicef, the UN children’s agency – are on the same page. The scaling up nutrition movement (SUN) has galvanised and focused commitments for nutrition, and, through reviews in the Lancet, a consensus has been established about what works to reduce malnutrition.    The second international conference on nutrition is a major opportunity for national and global leadership to work together to meet these challenges. The costs of failing to act are tragically high for all countries: premature death, heavy morbidity burdens, stressed health systems, children and adults who never reach their potential – all causing a severe drag on economic progress.    But for leaders to convince us that they are serious about reducing malnutrition, they have to lead on accountability. Without accountability we rely only on goodwill. The most vulnerable people in society need to rely on political will, not goodwill. How can we build accountability and political will? One way is to document and assess the choices that governments and agencies can make – on spending, policies and laws.    Last week, two initiatives were launched to bring those goals closer. The first of them, the global nutrition report, brings together more than 80 nutrition indicators for each of the 193 UN member states. The data cover all forms of malnutrition, its drivers and efforts to address it.    The report concludes that nutrition needs to be embedded much more firmly in the proposed sustainable development goals (SDGs). Out of 169 targets, nutrition is mentioned in only one. The report also calls for bolder SDG nutrition targets for 2030, not mere extensions of the 2025 WHA targets. New data, funding, commitments and new understandings give cause for optimism. We need more ambition on targets, not less.    Scaling up nutrition programmes can be accelerated. A more relentless focus on programme coverage is needed. Finally, if large government budgets allocated to agriculture, education, social protection and water, sanitation and hygiene can be made more nutrition sensitive, they are likely to have a significant impact on stunting. To achieve this, accountability in nutrition needs strengthening. About 40% of all countries cannot tell if they are on or off course to meet the WHA global targets. Data on child growth is more than five years old for nearly half of all countries. Incomplete and outdated data make a mockery of accountability.    Second, the hunger and nutrition commitment index for donors (Hanci) collates and analyses 14 indicators of political commitment to hunger and malnutrition reduction by 23 donors. The index seeks to make donors accountable for their efforts to address hunger and undernutrition in developing countries. Latest findings show that coherence across donor government departments in the fight against hunger and malnutrition is wanting. The top performers, such as Canada and the UK, have good alignment across aid, agriculture and climate policies. Evidently, addressing malnutrition will require not only coherent but also sustained donor engagement, and a climate of austerity puts this to the test.    Reports such as these can support decision-makers but, above all, we need people to take bold decisions. The second international conference on nutrition is about leadership. Malnutrition reduction requires focused and united action. Those who hold the power to accelerate reductions in malnutrition need to exercise it and allow us to hold them, and ourselves, accountable for ending the worldwide tragedy of 21st-century malnutrition. http://www.hancindex.org/ Visit the related web page
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