Malnutrition is often associated with developing countries and poverty. But every country across the globe is affected by some form of malnourishment – a term that encompasses anaemia, obesity, stunting, wasting and a host of other issues.
As a planet, we’re woefully off course in meeting most of our nutrition targets as laid out in the UN Decade of Action on Nutrition 2016-2025 and the Sustainable Development Goals (SDGs). However, we’re also better-equipped than ever before to end malnutrition, given strong political will, improved data and new knowledge about what works in policy.
That’s the message of the latest Global Nutrition Report (GNR), which was released on 29 November 2018. An international team of independent experts has put out a version of the report every year since 2014; and every year, they’ve found that “the global burden of malnutrition is unacceptably high,” said Corinna Hawkes, Director of the Centre for Food Policy in London, in a media statement.
In the last year, one in three adults was overweight or obese, and 18.8 percent of all adult deaths were caused by poor diet. One in five children under five years old was stunted due to undernutrition; and only one in five across the globe was eating a “minimally acceptable diet” by nutritionists’ standards. The cost of malnutrition to the global economy was estimated at USD 3.5 trillion per year.
So far, so disheartening. But the broad brushes of metadata can obscure some of the hopeful happenings at smaller scales. So let’s take a closer look at what’s changed since last year’s GNR.
More countries are making progress on childhood stunting, childhood wasting and exclusive breastfeeding. However, while stunting prevalence in Africa has gone down, the number of stunted children has increased (due to population growth). At a global level, exclusive breastfeeding is the only indicator classified as ‘making some progress’ in this year’s report: “We are edging very slowly but fortunately quite surely towards that target,” said Hawkes.
We know more about how malnutrition is distributed within countries and across genders. New geolocation data is helping to map out stunting levels in different districts, and give insight into the causes. For example, in India, new data shows that stunting rates range from 12 to 65 percent across districts, and over 70 percent of the factors explaining these variations are identifiable through geolocation data. So the information is helping to target programs more effectively at district levels.
The data is also increasingly disaggregated by gender, which is important because women are disproportionately affected by some forms of malnutrition, such as anaemia and obesity. Overall, said Hawkes, “women’s nutrition has not been getting the attention it deserves,” but countries are beginning to recognize this at national levels and are initiating new approaches that are tailored to women and girls.
And we know more about how different types of malnutrition interact with each other, too. “For too long we’ve focused on one form of malnutrition at a time; not all the forms that may exist – within households and within countries,” said Hawkes. New analysis shows that 25 million children under 5 are both stunted and overweight, or stunted and wasted at the same time. “So we need to break down silos and develop comprehensive programs that tackle all forms of malnutrition,” she concluded.
We also have a lot more detail now on exactly what people are eating. The latest report has a whole new chapter on the subject of diet. “The fact that it’s the first time we’ve done it is an indicator of the neglect, in the nutrition community and beyond, of looking closely at diet as an immediate cause of malnutrition,” said Hawkes.
“It’s obvious that what we eat is important in malnutrition. But the fine details, in which we understand exactly what people are eating, have been missing.” Once again, new tools, methodologies and data are shining light on the subject, showing for example that many countries have areas where the majority of people cannot afford a nutritious diet.
“So this data is much more than we’ve ever had before, and these insights empower policymakers to make the right interventions,” said Hawkes. For instance, Malawi has invested in improving knowledge and information among farmers to boost the production of nutritious food. Mexico has implemented a sugar tax that has reduced sugary drink sales by 10 percent. And Burkina Faso improved exclusive breastfeeding rates from 9 percent to over 50 percent between 1992 and 2014. The data on diets is set to improve, too, with a new poll on the topic being piloted in Brazil at present, ready to be rolled out in 150 countries by 2021.
Adolescent nutrition is a key area of concern. Nutrition research has always placed a lot of attention on children under 5, but new data shows adolescence is “a unique window for addressing malnutrition and its effects,” said Hawkes. “It’s a time when children can catch up on growth that they didn’t have earlier, and people can reduce their risk of obesity, too.”
But the research is clear that most adolescents are not eating good diets: for example, 59 percent of teenagers in Latin America and the Caribbean are drinking soda every day. Globally, obesity levels are rising, too. Fortunately, there is growing policy attention on this area, and a number of initiatives are in place at country levels to work with young people to address these issues.
Governments are stepping up and incorporating nutrition targets into their planning. “About a decade ago, countries didn’t really have nutrition plans,” said Hawkes. This year, 164 countries do; 189 countries have at least one nutrition target, and 81 percent have three or more. “This shows that countries are taking malnutrition seriously… and taking more of a holistic view,” said Hawkes. A number of countries are taking bold policy actions: 59 have imposed taxes on sugary drinks, and 47 are conducting analyses of local and national nutrition levels.
Globally, while progress is slower than hoped, Hawkes says there is plenty of momentum. Under the 2013 Nutrition for Growth pledge, leading international funders and donors pledged a combined total of USD 19.6 billion to the cause – and have already disbursed more than that. “I think that’s an indicator that there’s a lot of will to get things done at the international level,” said Hawkes.