The global nutrition challenge
N4D is deeply concerned at the slow progress being made in reducing malnutrition. At the same time, we believe accelerated progress is possible with strong political leadership, financial investments and proven technical solutions appropriate to local contexts.
Below we outline our understanding of the global nutrition challenge, key actions that can help accelerate progress and some of the key actors at national and global levels that can make change happen. This understanding informs N4D’s priorities, approach and actions.
If you have any comments or different points of view, please share them with us. We are always keen to develop our understanding and learn from others!
Levels and trends in malnutrition
Progress in reducing malnutrition is possible. Some improvements are reported in the 2020 Global Nutrition Report, such as a decline in the number of stunted children and improvements in infant and young child feeding practices. However, malnutrition persists at unacceptably high levels throughout the world and progress for most indicators is far too slow to meet the 2025 global nutrition targets.
In the under-five population, 149 million children are stunted, 49.5 million are wasted and 20.5 million infants are born with low-birth weight. Added to this, 40.1 million under-fives are overweight and this is a growing problem everywhere. Overweight and obesity amongst adults are also at record levels with a staggering 677.6 million adults affected by obesity, particularly women. Diet related non-communicable diseases (NCDs) such as diabetes and cardio-vascular disease are high and many countries now confront a complex malnutrition picture often described as the ‘double burden’ where both undernutrition, overweight/obesity and diet related NCDs co-exist.
The number of people experiencing malnutrition whilst already at staggeringly high levels, is now likely to increase due to the COVID-19 pandemic. The ‘double burden’ is placing people at high risk in two ways; the undernourished have weaker immune systems and are likely to experience more severe illness due to the virus and those with obesity and diabetes appear to suffer worse outcomes from the virus including mortality.
Never has the realisation of good nutrition been more important than in this current crisis.
The investment case
Malnutrition is a critical contributor to ill health, disability, poverty and excess mortality. Malnutrition is responsible for more ill-health than any other cause. It is responsible for five times the death and disability burden of HIV/AIDS, tuberculosis and malaria combined. Undernutrition is a cause of 3.1 million child deaths annually which translates into just under half of all child deaths annually.
Malnutrition also has dire consequences for nations and economies. Malnutrition increases health care costs, reduces productivity and slows economic growth, which perpetuate a cycle of poverty and ill health.
Averting malnutrition will help achieve at least 12 of the 17 Sustainable Development Goals (SDGs) helping to create a healthy, prosperous, and stable world in which no one is left behind. Returns from investment in nutrition are high.
Every dollar invested in reducing stunting generates an economic return equivalent of about US$18 in high-burden countries.
In the SDGs, national governments have committed to end hunger and all forms of malnutrition by 2030. However, the World Health Assembly (WHA) and SDG targets are just 5 and 10 years away respectively but the pace of change towards realising them is slow and uneven.
Accelerating progress on nutrition
The conditions and actions for progress on nutrition are well known but are taking far too long to implement and scale up. To achieve sustainable reductions in malnutrition requires context specific actions in 7 domains, to respond to and address the causes of malnutrition, as illustrated below.
Action domains and illustrative actions for reducing malnutrition
1: People and communities
- Have sustainable access to healthy foods, natural resources water, sanitation and hygiene, health and other basic services
- Have sustainable livelihoods that enable them to meet their needs and live a prosperous and dignified life, even in the face of shocks
- Able to influence decisions and actions which affect their nutrition, diets, health, livelihoods, basic services and local environment
2: Public service delivery
- Frontline implementation capacities strengthened and resilient
- Nutrition interventions, including double duty actions, integrated into sectoral services (e.g. health, agriculture, social protection, WASH, trade, disaster management/humanitarian) and implemented at scale
- Interventions by different sectors converge at scale on same at-risk populations
3: Business practices
- Businesses, small and large, involved in food systems (i.e. food production, processing, marketing and distribution) contribute to sustainable natural environments, livelihoods and healthy diets
4: Public policies and legislation
- Nutrition integrated into sectoral and multi-sectoral policies and plans (e.g. climate change, trade, natural resources etc)
- Sectoral policies and plans (development and humanitarian) are coherent with each other and people’s priorities
- Legislation and regulations enable food systems which promote sustainable, healthy diets, livelihoods and environments
- Governments invest in quality basic services for all citizens
- Development and humanitarian partners help fill gaps in alignment with people’s priorities
- Decisions and actions are informed by information on context specific needs, causes, risks, capacities; international and local evidence of what works; and monitoring and evaluation of service provision and impacts
- People most at risk have a direct voice in political decisions at local, national, regional and global levels
- National governments are able to influence international stakeholder decision making at national, regional and global level
- Conflicts of interest are managed, i.e. objectives and interests of different actors support and do not undermine the achievement of nutrition goals
- Coordination and accountability mechanisms, at different levels, promote coherence and convergence between actors in the interests of nutrition for all
- High-level political leadership ensures coordination, coherence and convergence
Who can make change happen?
There are a multitude of actors from local to national to global levels that have roles and responsibilities in ensuring all people are well nourished.
National and sub national actors
N4D considers that the people most at risk of malnutrition need to be at the centre of decisions and actions to prevent and end malnutrition. They are not only most at risk, but also the most important agents of change and development. Organisations of small-scale food producers, workers, traders, indigenous peoples, poor consumers and other groups most at risk of malnutrition should have a priority voice in decision making spaces. National and local civil society organisations, social movements and peoples’ organisations provide support services, enable the voices of citizens to be heard in decision making and seek to hold governments, service providers and business to account.
National and local governments have primary responsibility for ensuring all citizens are well-nourished through public policies, legislation and services, as well as ensuring that the actions of their own country do not impact negatively on the well-being other countries.
Sustainable reductions in malnutrition require policies and interventions across a range of public sectors. Frontline workers and community actors are perhaps the most critical link in the chain to ensure adequate coverage of quality services yet are often understaffed, under resourced and not supported adequately.
Businesses have a key role to play in ensuring consumers have access to healthy and affordable diets as well as sustainable and dignified livelihoods. Consumer demand is essential for influencing the quality of goods, services and business practices. However, government private sector policies and legislative frameworks are also key.
International organisations, including bilateral and multilateral donors, private philanthropic foundations, UN agencies and NGOs, have roles to play in supporting (whilst avoiding undermining) the actions of domestic actors.
Global multi-actor initiatives and bodies
At the global level, there are various inter-governmental platforms and technical initiatives that have a role to play in supporting country level policies and actions for nutrition.
The Committee on World Food Security is the foremost inclusive international and intergovernmental platform for all stakeholders to work together to ensure food security and nutrition for all. Its role is one of policy coordination, convergence and coherence. During 2020, the CFS is negotiating Voluntary Guidelines on Food Systems for Nutrition to be adopted by member states at the CFS Plenary session in October 2020.
The UN Decade of Action on Nutrition 2016-2025 aims to encourage increased nutrition investments and implement policies and programmes to improve food security and nutrition within the framework agreed at the Second International Conference on Nutrition. It provides an umbrella for all relevant stakeholders and initiatives to consolidate and align actions across different sectors.
The Scaling up Nutrition (SUN) Movement, an initiative of the UN Secretary General, aims to support member countries of the SUN Movement strengthen and implement at scale multi-sectoral policies and actions for nutrition. It now has 60+ member countries and is a broad tent for all actors to converge to support country actions.
The IASC Global Nutrition Cluster supports country nutrition coordination mechanisms to achieve quality nutrition responses in emergencies by supporting strategic decision-making, planning and strategy development, capacity building on coordination and knowledge management, advocacy, monitoring and reporting, and contingency planning/preparedness. Given the multi-sectoral nature of nutrition, other humanitarian clusters also have a key role to play.
The Nutrition for Growth events aim to mobilise new policy and financial commitments for nutrition. The Government of Japan was due to host a second N4G summit in Tokyo in December 2020, but it has been postponed due to the COVID-19 pandemic.
The Global Nutrition Report first published in 2014, provides updates on the state of nutrition around the world, progress in meeting nutrition targets and makes recommendations for actions to accelerate progress. The report also provides a mechanism for tracking progress against commitments made within the N4G process. The report aims to inspire action and help hold stakeholders to account on the commitments they have made towards tackling malnutrition.