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The burden of malnutrition in the world remains unacceptably high, and progress unacceptably slow
by 2018 Global Nutrition Report, agencies
Malnutrition is a universal issue holding back development with unacceptable human consequences. Yet the opportunity to end malnutrition has never been greater. The UN Decade of Action on Nutrition 2016–2025 and the Sustainable Development Goals (SDGs) provide global and national impetus to address malnutrition and expedite progress.
The burden of malnutrition across the world remains unacceptably high, and progress unacceptably slow. Malnutrition is responsible for more ill health than any other cause. Children under five years of age face multiple burdens: 150.8 million are stunted, 50.5 million are wasted and 38.3 million are overweight. Meanwhile 20 million babies are born of low birth weight each year. Overweight and obesity among adults are at record levels with 38.9% of adults overweight or obese, stretching from Africa to North America, and increasing among adolescents. Women have a higher burden than men when it comes to certain forms of malnutrition: one third of all women of reproductive age have anaemia and millions of women are underweight.
Yet significant steps are being made to address malnutrition. Globally, stunting among children has declined and there has been a slight decrease in underweight women. Many countries are set to achieve at least one of the targets set by the global community to track progress on nutritional status to 2025. The level of knowledge on what it takes to deliver results has never been greater. The global community and national stakeholders have never been better placed to deliver results, with more governance, policies, actions, plans and targets. Advances in data are enabling us to progress our understanding of the nature of the burden of malnutrition in all its forms and its causes – and therefore guide and inspire action and improve our ability to track progress.
It is vital we urgently seize this window of opportunity to get on track towards the SDG target of ending malnutrition in all its forms by 2030. The 2018 Global Nutrition Report provides a data update to shine a light on steps needed to do so. For if we are to end malnutrition in all its forms, we must understand the nature of the problem we are dealing with. The report collates existing data, presents new innovations in data and conducts novel data analysis, focusing on five areas: the burden of malnutrition, emerging areas in need of focus, diets as a common cause of malnutrition in all its forms, financing of nutrition action, and global commitments. Throughout the report, examples of actions being taken to address malnutrition are highlighted and explored.
Through this analysis, the 2018 Global Nutrition Report casts a light on where there has been progress and identifies where major problems still lie – and thus where actions are needed to consolidate progress and fill major gaps.
There has been some progress in reducing malnutrition, but it has been too slow and not spread across all forms of malnutrition.
Stunting in children under five years of age is declining at a global level but numbers in Africa are increasing, and there are significant disparities in progress at the subnational level. Stunting declined from 32.6% of all the world’s children under 5 years of age in 2000 to 22.2% in 2017. In numbers this is a decline from 198.4 million to 150.8 million. Stunting among children in Asia has declined from 38.1% to 23.2% since 2000 and in Latin America and the Caribbean from 16.9% to 9.6%. Stunting among children in Africa has decreased in percentage terms from 38.3% to 30.3% over the same period, yet due to population growth, the actual number of stunted children has risen. The use of geospatial data shows that trends in stunting vary significantly within countries, with some areas experiencing increases and other areas declines.
Crises around the world are increasingly protracted and significantly hamper tackling all forms of malnutrition. In situations of crises arising from conflict, fragility, violence and environmental change there is an urgent need to treat and prevent multiple burdens of malnutrition while also building nutrition resilience to what are often protracted crises. An estimated 86% of international humanitarian assistance goes to countries affected by long and medium-term crisis, yet it is mostly in the form of short-term programming. Recognition of the high burden of multiple forms of malnutrition in these protracted crises is growing and the humanitarian community is beginning to change its approaches to consider longer-term and context-specific action. Yet building lasting nutrition resilience will require the humanitarian and development communities to work together more closely to tackle the full extent of malnutrition in these most vulnerable and challenging contexts.
There has been an increase in the number and breadth of national nutrition policies and nutrition targets, with the outstanding challenge being the financing and action to deliver them. More countries are committing to nutrition by establishing national nutrition policies and action plans: 164 now have such plans, 61% of which are multisectoral. Countries also have more nutrition targets – and a greater breadth of targets to cover different forms of malnutrition: 189 countries have at least one nutrition target and 81% of countries have three or more nutrition targets. The share of countries with overweight targets has increased to 84%. There are fewer targets on micronutrient deficiencies: 41% of countries with high rates of anaemia have no anaemia target. A key outstanding challenge is ensuring that the plans to deliver on these targets are funded and implemented.
The latest data on infants’ diets shows the proportion of babies who are exclusively breastfed (up to 6 months of age) has increased but only to 41% (from 37% in 2012), and sales of infant formula are growing rapidly. Fewer than one in five children (16%) aged 6 to 23 months eat a minimally acceptable diet while only half (51%) of children aged 6 to 23 months get the recommended minimum number of meals.
A growing body of international evidence shows that addressing nutrition problems and adopting healthy dietary habits during adolescence can be important for potential ‘catch up’ growth, improved cognition and reduced risk of non-communicable diseases (NCDs) later in life.
Every year the Global Nutrition Report calls for more financing for nutrition: ultimately, without adequate and appropriate funds invested towards all forms of malnutrition, we cannot make progress. The data in this year’s report shows patchy progress. Building on this progress, domestic investments must continue to grow and international aid donors must keep investing through Overseas Development Assistance.
Funding needs to be focused on ensuring nutrition plans are delivered in practice. Yet different and innovative forms of financing will also be needed to make progress. Those who control resource flows – governments, multilateral organisations, philanthropic foundations and wealthy investors – need to find innovative ways to finance nutrition action and provide the institutional and human capacity necessary to do so.
The data presented in the 2018 Global Nutrition Report shows that poor quality diets among infants, young children, adolescents and adults is unacceptable. Suboptimal diets are a major risk factor of malnutrition, disease, disability and death globally. And they are a problem everywhere: no country or population group is immune. Governments and business need to implement a holistic package of actions to ensure food systems and food environments are delivering healthy diets that are affordable, accessible and desirable for all. The lead taken by communities, cities and city networks must be scaled up. Lessons must be learned from successes everywhere and barriers broken down.
Micronutrient deficiencies are estimated to impact a significant number of people around the world, but there remains far too little information on micronutrient status and deficiencies. More essential information and surveillance need to be gathered to make substantial progress on global targets.
The World Bank estimates that around 2 billion people live in countries affected by fragility, conflict and violence, and classifies 36 countries or territories as being in fragile situations now.
Crises take many shapes and forms, such as deteriorating governance, prolonged political crisis, post-conflict transition and fragile reform processes, often in a context of natural resource disasters and climate change. The World Bank also estimates that the share of extremely poor people living in conflict-affected areas will rise to 50% by 2030.
Crises are leading to mass population movement either within a country (internally displaced), estimated at 40 million people, or as refugees in bordering countries, estimated at 25.4 million people.
This level of movement is higher than any other time in recent history and it is estimated that around 201 million people across the world need humanitarian assistance.
Over two thirds of all refugees are from just five countries – South Sudan, Somalia, Afghanistan, Myanmar and Syria – and more than half of the refugee population is under the age of 18. Mass population disruption results in an increased risk of malnutrition, food and social insecurity and sickness, loss of livelihoods and economic opportunities, and death.
One of the key messages from the 2017 Global Nutrition Report was that peace and stability (SDG 16) is essential for good nutrition. Yet war, instability and climate-related disasters continue to affect an increasing number of countries. They are a significant factor in the estimated 124 million people in 51 countries facing significant food insecurity.
The Global Report on Food Crisis reports that this had increased by 11 million people from 2016, equivalent to an 11% rise. It also indicates that the rise is due to new or intensified conflict and insecurity in countries such as Yemen, (northern) Nigeria, the Democratic Republic of the Congo, South Sudan and Myanmar. Persistent drought also played a major role in countries including Kenya, Somalia and Uganda, and in southern Africa.
The 2017 Global Nutrition Report also highlighted that famine was declared that year in South Sudan and a high risk of famine reported for (northern) Nigeria, Somalia and Yemen. The crises in these four countries led to an estimated 10 million people being displaced, and 31.6 million people classified as in crisis.
Emerging evidence indicates fragility, conflict and violence impact all forms of malnutrition. There is a greater burden of both wasting and stunting coexisting in young children and pregnant women who are exposed to conflict give birth to children of lower weight – thus transmitting the adverse effects of conflict across generations.
While the increased risk of wasting in these crises contexts is very well known, there is now increasing evidence that high levels of stunting occur and can even increase in protracted crises.
While almost half of countries assessed are on course to meet at least one of the global targets on maternal and child nutrition, obesity and non-communicable diseases (NCDs), no country is on course to meet all and only five are on course to meet four. Nearly a quarter of children under five years of age, 150.8 million, are stunted, 50.5 million children under five are wasted and 20 million newborn babies are estimated to be of low birth weight. At the same time, 38.3 million children under the age of five are overweight. At least 124 of 141 countries struggle with overlapping burdens, while millions of children under the age of five suffer with coexisting forms of malnutrition.
Malnutrition and diet-related NCDs are still the leading causes of disability and death globally. It is clear then that while we have seen progress in some areas, it is happening far too slowly and too inconsistently. Levels of malnutrition are still unacceptably high.
However, ending global malnutrition is within our reach. In fact, we have never been better placed to do it; we have more knowledge and more data than ever before.
Ultimately we cannot make progress without adequate funds, and those who control resource flows need to prioritise nutrition. Funding needs to be focused on ensuring nutrition plans are delivered in practice. This requires scaling up and expanding existing national and international investments to address all forms of malnutrition.
* Access the full report via the link below, or see: http://globalnutritionreport.org/reports/global-nutrition-report-2018/
* Scaling Up Nutrition (SUN) Movement Annual Progress Report 2018: http://scalingupnutrition.org/progressreport2018/
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Hunger and undernutrition are still much too high in dozens of countries
by Concern Worldwide, Welthungerhilfe
The 2018 Global Hunger Index (GHI) shows that the world has made gradual, long-term progress in reducing overall hunger, but this progress has been uneven. Areas of severe hunger and undernutrition stubbornly persist, reflecting human misery for millions.
Worldwide, the level of hunger and undernutrition falls into the serious category, with a GHI score of 20.9. This is down from 29.2 in 2000, equating to a decline of 28 percent. Underlying this improvement are reductions in each of the four indicators used to assemble the GHI: (1) the prevalence of undernourishment, (2) child stunting, (3) child wasting, and (4) child mortality.
Despite these improvements, the question remains whether the world will achieve Sustainable Development Goal (SDG) 2, which aims to end hunger, achieve food security and improved nutrition, and promote sustainable agriculture, by 2030. If progress in reducing hunger and undernutrition continues on its current trajectory, an estimated 50 countries will fail to achieve low hunger according to the GHI by 2030.
Hunger varies enormously by region. The 2018 GHI scores of South Asia and Africa south of the Sahara, at 30.5 and 29.4, respectively, reflect serious levels of hunger. These scores stand in stark contrast to those of East and Southeast Asia, the Near East and North Africa, Latin America and the Caribbean, and Eastern Europe and the Commonwealth of Independent States, where scores range from 7.3 to 13.2, indicating low or moderate hunger levels.
In both South Asia and Africa south of the Sahara, the rates of undernourishment, child stunting, child wasting, and child mortality are unacceptably high. Since 2000, the rate of stunting in South Asia has fallen from approximately half of all children to over a third, but this still constitutes the highest regional child stunting rate worldwide.
Furthermore, South Asia’s child wasting rate has slightly increased since 2000. In terms of undernourishment and child mortality, Africa south of the Sahara has the highest rates. Conflict and poor climatic conditions—both separately and together—have exacerbated undernourishment there. Conflict also compromises children’s nutritional status, and the impact of conflict on child mortality is starkly evident: the 10 countries with the world’s highest under-five mortality rates are all in Africa south of the Sahara, and 7 of these are considered fragile states.
Hunger and undernutrition are still much too high in dozens of countries.
According to the 2018 GHI, one country, the Central African Republic (CAR), suffers from a level of hunger that is extremely alarming.
Six countries—Chad, Haiti, Madagascar, Sierra Leone, Yemen, and Zambia—suffer from levels that are alarming. Forty-five countries out of the 119 countries that were ranked have serious levels of hunger.
Still, there is cause for optimism. This year’s GHI includes 27 countries with moderate levels of hunger and 40 countries with low levels of hunger.
It is important to note that regional and national scores can mask substantial variation within country borders. Latin America, for example, has one of the lowest regional hunger levels, yet stunting levels in Guatemala’s departments range from 25 percent to a staggering 70 percent.
In other cases, such as Burundi, the areas with the lowest stunting levels are predominantly urban in nature (such as national capitals), and are outliers relative to other parts of the country.
Forced Migration and Hunger
In this year’s essay, Laura Hammond examines forced migration and hunger—two closely intertwined challenges that affect some of the poorest and most conflict-ridden regions of the world. Globally, there are an estimated 68.5 million displaced people, including 40.0 million internally displaced people, 25.4 million refugees, and 3.1 million asylum seekers.
For these people, hunger may be both a cause and a consequence of forced migration. Support for food-insecure displaced people needs to be improved in four key areas: recognizing and addressing hunger and displacement as political problems; adopting more holistic approaches to protracted displacement settings involving development support; providing support to food-insecure displaced people in their regions of origin; and recognizing that the resilience of displaced people is never entirely absent and should be the basis for providing support.
The 2018 Global Hunger Index presents recommendations for providing a more effective and holistic response to forced migration and hunger. These include focusing on those countries and groups of people who need the most support, providing long-term solutions for displaced people, and engaging in greater responsibility sharing at an international level.
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