Briefs

WHAT YOU SHOULD KNOW

Malnutrition is a widespread problem. Each day, 16,000 children die from preventable causes. Undernutrition is responsible for nearly half that burden (around 3 million annually).[1] Nearly 1 in 4 children worldwide are living with stunted growth – a condition that weakens the immune system, making them more susceptible to death and disease, as well as to diminished cognitive capacity, which impacts their ability to learn in school and earn higher incomes later in life. Low-income countries increasingly are being burdened by undernutrition and obesity at the same time.

Malnutrition stymies economic development. It is a constraint to both individual earning potential and to national economic growth. Each year, malnutrition costs the global economy billions of dollars in lost productivity and health care costs, and as much as 12% of national GDPs.[2]

Malnutrition especially affects women and girls’ health and potential. Iron deficiency anemia is a major drain to human productivity and undercuts other investments made in women’s and girls’ health, education, and economic empowerment. Maternal nutrition is also key to breaking intergenerational cycles of poor health and poverty: a full 20% of maternal mortality is attributed to anemia, and babies born to malnourished mothers are often underweight and malnourished themselves.[3]

Proven, costed interventions exist that demonstrably save lives. Research shows that scaling up high-impact, high-priority nutrition interventions[4] during the critical 1,000-day window between a woman’s pregnancy and her child’s 2nd birthday can protect children from both nutritional and developmental risks, with interventions occurring before age 5 making a significant difference. Nutrition interventions are among the most cost-effective health and survival tools available.

Despite the evidence, there is a major funding gap. The U.S. and its global partners invest less than 1% of Official Development Assistance (ODA) in nutrition interventions that are essential to reaching the universally agreed upon targets to reduce stunting among children and anemia in women, increase exclusive breastfeeding rates, and mitigate the impact of severe acute malnutrition (wasting).[5]

Global nutrition efforts are aligning with national ownership. Country leadership for nutrition has been steadily rising. Under the Scaling Up Nutrition Movement, 57 countries across the world are working to end malnutrition in all its forms by building political ownership and developing costed nutrition plans. The World Bank and African Development Bank have also called on finance ministers in high-burden developing countries to invest in nutrition to reduce stunting.

17,000

children die each day from preventable causes

1 in 4

Nearly 1 in 4 children worldwide are living with stunted growth

57

countries across the world are working to end malnutrition

RECOMMENDATIONS FOR CONGRESS

Maximize the bipartisan legacy of U.S. leadership in global health, food security, and poverty reduction. U.S. government investments in global health have helped cut in half the number of child deaths over the past 2 decades. Investments in agriculture development and food security have yielded promising results in stunting reduction during the past several years.[6] Congress has an opportunity to build on that legacy to achieve transformative development through improved maternal and child nutrition. Expanded leadership and deeper engagement in supporting global nutrition efforts by Congress and the administration is essential to accelerate progress, galvanize action, and leverage investments from other donors and country governments to reach globally agreed upon targets.

Make nutrition a key U.S. global development priority. In order to unlock the transformative power of nutrition in saving lives and promoting growth, Congress must make maternal and child nutrition a central pillar of global development writ large, with improved nutrition as a key deliverable – not an add-on of agriculture development; maternal and child health; and water, sanitation, and hygiene (WASH) initiatives. Such initiatives must include ambitious targets and tracking in order to accurately measure and center the impact of U.S. investments. In doing so, Congress will elevate the vital role of nutrition in achieving long-term health and development outcomes. Continued congressional support for the U.S. commitment to help end preventable child and maternal deaths (EPCMD) and to end global hunger and poverty is crucial – nutrition is key to all development aims.

Increase funding to scale up proven nutrition interventions. Congress has provided modest but steady increases in nutrition funding[7] over the past several years, in large part due to the compelling new evidence on the most cost-effective, high-impact interventions. Additionally, Congress supported the development of the U.S. Agency for International Development’s (USAID) Multi-Sectoral Nutrition Strategy and the U.S. government’s Global Nutrition Coordination Plan and called for the U.S. government’s Global Food Security Strategy, which also prioritizes improved nutrition. Congress must provide robust resources to fully operationalize these strategies and plans, along with the U.S. roadmap to EPCMD. Because malnutrition requires a multisectoral response, the U.S. government also needs to ensure robust nutrition-related investments in food security; WASH; and maternal, newborn, and child health. Continuing the current level of funding will not allow these efforts to fully deliver on their promise.

WHY IS THIS INVESTMENT IMPORTANT?

Without specifically addressing malnutrition – the underlying cause of many health, development, and economic challenges – the U.S. will not reach the development gains it hopes to achieve. The U.S. must maximize the return on its investment in development assistance, and nutrition interventions generate returns among the highest of 17 potential development investments.[8]

The benefits of improved nutrition reach far beyond global health, and for that reason, prioritizing nutrition and increasing resources would have a multiplier effect. Investments to promote women’s health, participation, and economic well-being without due consideration to their nutritional health will not yield the maximum returns possible. Investments in child health and well-being are a cornerstone for productive adulthood and robust communities and societies. Integration of nutrition as part of an agenda to improve child lives is not only key to child survival, but it is a more holistic approach that helps the next generation reach its full potential. In an increasingly digital global economy, a greater emphasis is placed on social, emotional, and cognitive skills. According to the World Bank, investments in nutrition in the critical 1,000-day window are essential in building the human capital needed for future economic growth.[9]

Nutrition is one of the best investments the United States makes to support efforts to end extreme poverty and promote equitable economic growth. Well-nourished children earn higher wages as adults, helping to break the cycle of poverty and build national economies.

A 2016 report found that the current level of global funding for nutrition is vastly insufficient to meet four of the six global nutrition targets set forth by the World Health Assembly in 2012 and enshrined under the Sustainable Development Goals in 2015.[10] The study found that over the next 10 years, an additional $70 billion in nutrition-specific financing is needed, for a total of $109 billion from 2016-2025. Such an investment would yield tremendous returns: 3.7 million child lives saved, at least 65 million fewer stunted children, 860,000 fewer children dying from wasting, 265 million fewer women suffering from anemia, and 105 million more children exclusively breastfed as compared to the 2015 baseline.[11]

While this level of investment is ambitious, it is not unprecedented. A subset of high-impact, high-priority interventions have been identified that would serve as a “down-payment” toward reaching the targets.

With 45% of under-5 child deaths and 20% of maternal deaths attributed to malnutrition, a significant investment in urgent, scalable nutrition actions is the smart and cost-effective thing to do. The global cost of “business as usual” is too high to ignore. Not breastfeeding is associated with economic losses of more than $300 billion annually.[12] More than 800,000 children’s lives could be saved each year with increased breastfeeding rates, a nearly 13% reduction in all under-5 child deaths.[13] An additional 860,000 child lives could be saved by treating wasting.[14]

Annual GDP losses attributable to malnutrition average 12% in Africa and Asia, eclipsing the GDP losses experienced after the 2008 global financial crisis.[15] Recent estimates suggest that if a set of 15 African countries meet the 2025 WHA target for stunting, $83 billion will be added to their national economies.[16] However, despite a return of $16 for every $1 invested, the U.S. and its global partners invest less than 1% of ODA in nutrition-specific interventions.[17]

We have a compelling evidence base, global targets and goals, an investment framework to reach those targets, and growing momentum. What we urgently need is the political will and leadership to coalesce efforts and catalyze greater tangible commitment and investment by all actors to reach time-bound global targets.

A high-level U.S. government investment would uphold America’s legacy of leadership, vision, and goodwill; unlock additional resources from other donors and country governments alike; and help to ignite greater progress on nutrition at a global level.

Contributors

Samantha Chivers, 1,000 Days, sam@thousanddays.org
Mannik Sakayan, 1,000 Days, Mannik@ThousandDays.org
Saul Guerrero, Action Against Hunger, sguerrero@actionagainsthunger.org
Aaron Emmel, American Academy of Pediatrics, aemmel@aap.org
Asma Lateef, Bread for the World, alateef@bread.org
Jordan Teague, Bread for the World, JTeague@bread.org
Smita Baruah, Save the Children, SBaruah@savechildren.org
Marilyn Shapley, InterAction, mshapley@interaction.org


Citations

[1] You D, Hug L, et al. “Levels & Trends in Child Mortality: Report 2015 Estimates Developed by the UN Inter-Agency Group for Child Mortality Estimation.” UNICEF, 2015. http://bit.ly/1pYtUoX

[2] Horton, S. and R. Steckel. “Malnutrition: Global economic losses attributable to malnutrition 1900-2000 and projections to 2050.” Assessment Paper, Copenhagen Consensus on Human Challenges. 2011, Copenhagen Consensus Centre. http://bit.ly/2gTCWo3.

[3] “Repositioning Nutrition as Central to Development. A Strategy for Large-scale Action.” World Bank, 2006. http://bit.ly/2hTnm7V.

[4] This subset of interventions for urgent scale-up includes: vitamin A supplementation for children, promotion of good infant and young child nutrition and hygiene practices, antenatal micronutrient supplementation, intermittent preventive treatment of malaria for pregnant women, iron folic acid supplements for adolescent girls, staple food fortification, pro-breastfeeding social policies, national breastfeeding promotion campaigns, and treatment of severe acute malnutrition.

[5] Shekar, M., et al. “Investing In Nutrition: The Foundation for Development. An Investment Framework to Reach the Global Nutrition Targets.” The World Bank, 2016. http://bit.ly/2b8rlMa.

[6] “Feed the Future Progress Report 2016: Growing Prosperity for a Food-Secure Future.” Feed the Future: The U.S. Government’s Global Hunger & Food Security Initiative, 2016. http://bit.ly/2h9mQ5B.

[7] U.S. Government Nutrition-Specific FundingWhile not the only source of funding for U.S. global nutrition programs, the funding for nutrition in the Global Health Programs-USAID account supports vital services, such as nutrition education to improve maternal diets; enhancing nutrition during pregnancy; promoting exclusive breastfeeding; and improving infant and young child feeding practices. Resources from GHP-USAID, Global Health Programs-State, Food for Peace (FFP), Development Assistance (DA), and the Economic Support Fund (ESF) also support the promotion of diet quality and diversification (fortified staple foods, specialized food products, community gardens) and the delivery of nutrition services (micronutrient supplementation, community management of acute malnutrition).

[8] “Repositioning Nutrition as Central to Development. A Strategy for Large-scale Action.”

[9] Shekar, M., et al., “An Investment Framework for Nutrition: Reaching the Global Targets for Stunting, Anemia, Breastfeeding and Wasting.” World Bank, 2016. http://bit.ly/2gJHsAs.

[10] “Investing In Nutrition: The Foundation for Development. An Investment Framework to Reach the Global Nutrition Targets.”

[11] “Investing In Nutrition: The Foundation for Development. An Investment Framework to Reach the Global Nutrition Targets.”

[12] Rollins, N.C., et al., Why Invest, and What it Will Take to Improve Breastfeeding Practices? The Lancet. 387(10017): p. 491-504. http://bit.ly/1OYImG9.

[13] Victora, C.G., et al., Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. The Lancet. 387(10017): p. 475-490. http://bit.ly/1nZyL8P.

[14] “Investing In Nutrition: The Foundation For Development. An Investment Framework to Reach The Global Nutrition Targets.”

[15] Independent Expert Group (IEG) of the Global Nutrition Report Stakeholder Group, “Global Nutrition Report 2016- From Promise to Impact: Ending Malnutrition by 2030.” International Food Policy Research Institute (IFPRI). http://bit.ly/2b5Z1s8.

[16] “The Economic Case for Investing in Nutrition in sub-Saharan Africa: Summary of Key Findings.” Global Panel on Agriculture and Food Systems for Nutrition, 2016. http://bit.ly/2hGiML0.

[17] “Global Nutrition Report 2016- From Promise to Impact: Ending Malnutrition by 2030.”

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