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Transforming health and food systems to end malnutrition

‌Unless urgent action is taken, UNICEF estimates that an additional 6.7 million children under 5 could suffer from wasting, the deadliest form of malnutrition, due to COVID-19 related disruptions to essential — and often life-saving — nutrition services. This is in addition to the 50.5 million children under 5 years old that were suffering from wasting prior to the COVID-19 pandemic. A group of international development experts is pushing a new plan called Nourish the Future — a bold, U.S.-led strategy looking to address these spikes in deadly malnutrition, while also building back better health and food systems in the long term.

“Every year malnutrition kills more children than AIDS, malaria, and tuberculosis combined and those who do survive a severe bout of malnutrition in their early childhood are more likely to suffer from life-long illness and impaired development,” said Blythe Thomas, initiative director at 1,000 Days, an initiative of FHI Solutions.

Proven and highly cost-effective solutions to prevent and treat malnutrition exist. Yet, these essential interventions often don’t reach the women and children who need it the most.

“Solutions to prevent, detect, and treat child malnutrition are well known, including action to ensure that children are born a healthy weight and that their health and nutrition are prioritized and protected during the critical first 1,000 days of life,” UNICEF’s Executive Director Henrietta Fore, wrote in an email to Devex.

Photo: © UNICEF / Abela Ralaivita

Bridging the funding gap

In 2016, the U.N. General Assembly declared the Decade of Action on Nutrition to help stimulate increased funding for nutrition — but a significant funding gap still exists. In 2020, less than 1% of official development assistance was spent on nutrition-specific interventions.

According to William Moore, CEO at The Eleanor Crook Foundation, many life-saving health interventions such as childhood immunization or malaria programs have been scaled up across low- and middle-income countries, but that hasn’t been the case for nutrition interventions.

“Today, these interventions are even more cost-effective in relative terms because we have picked so much of the other low-hanging fruit in global health… we’ve already got these really cost-effective interventions that we know have worked for a long time, they just haven’t been prioritized,” he said, adding that this is due to competing global health priorities, a lack of funding, and other factors.

Photo: © UNICEF / Majd Aljunaid

A ‘big bang’ for the buck

The nonprofit GiveWell — the charities that save the most lives per dollar — has listed vitamin A supplementation as among the most cost-effective interventions. And that’s just one of The Power 4 Nutrition Interventions — four essential actions that can help prevent and treat severe malnutrition:

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Supply all pregnant women with multiple-micronutrient supplementation

Support breastfeeding mothers

Continue large-scale vitamin A supplementation

Expand coverage of ready-to-use therapeutic food, or RUTF

It’s important to ensure that the scale up of any intervention within a country is fully integrated into the national nutrition strategy, explained Thomas.

“In order for The Power 4 to be successful, they must address the priorities of the local government and meet the needs of the country’s specific context,” she added.

“Interventions need to be appropriate to the local context, locally-owned, and locally-championed,” said Moore. “The four interventions can be provided by properly trained community health workers — and at least two of them [vitamin A supplementation and wasting screening to identify the need for RUTF] can be integrated into existing child immunization campaigns.”

PARTNER CONTENT FROM 1,000 DAYS

Improving both food and health systems

Health and food systems must work in harmony for impact to be sustainable. Today, health and food systems generally operate in silos, and have both failed, to date, to consistently prioritize and scale high-impact nutrition interventions. In most countries, food systems and health systems have been further weakened and strained by COVID-19.

“Although healthy food systems are part of the solution to ending malnutrition, changing the food system alone won’t get it done,” said Thomas. “To end preventable child deaths from malnutrition, we need a targeted approach focused on the world’s food and health systems working together.”

According to U.S. Ambassador Ertharin Cousin, a visiting scholar at Stanford University’s Center on Food Security and the Environment and former executive director at the World Food Programme, we need to build a food system that provides for the health of the environment, people and workers across the food system.

“We talk about building [the food system] from farm to fork — because it’s from farm to fork that drives the system, and the health system needs to be very much involved in what’s on that fork,” she said.

Photo: © UNICEF/Till Muellenmeister

Opportunity for U.S. leadership

For the past decade, the U.S. government has supported nutrition through its global health investments, including the Feed the Future initiative launched in 2010. The U.S. — along with the U.K., Canada, and Germany — has historically been among the leading donors to nutrition programs. However, U.K. funding for global malnutrition programs is now slated to be cut by 80%. While funding for U.S. international development programs has increased in recent years, nutrition programs have not been prioritized. For example, the U.S. spent $8.2 billion to combat AIDS, malaria, and tuberculosis in 2020, but the same year only directed $150 million toward supporting global malnutrition efforts.

The Global Solidarity financing scenario:
additional financing needs to achieve WHA nutrition targets

Source: Global Nutrition Report

Photo: © UNICEF / Nyan Zay Htet

Nourish the Future

Nourish the Future, a proposal for U.S. President Joe Biden’s administration — developed by over 100 experts across the global health and development community — is a five-year, U.S.-led effort seeking to improve the lives of 500 million women and children. If implemented, Nourish the Future would cut severe malnutrition in half and reduce child deaths in target countries by up to 11%, according to analysis by Johns Hopkins University and ECF. In total, the five-year plan would save 2 million child lives, improve the school performance of 18 million children, and generate a minimum of $56 billion in economic returns by saving lives and improving brain development and productivity.

Through a strong focus on sustainability, host government partnership, and multisectoral collaboration, it offers a strategy to strengthen systems and integrate existing, siloed, vertical programming. Nourish the Future builds on the successes of the USAID-led Feed the Future initiative and focuses on strengthening both health and food systems while improving food’s quality and nutritional value.

Nutrition is the foundation—the basic, fundamental foundation upon which every child’s future is built.

U.S. President Joe Biden [then vice president] during the 15th Annual Gala to End Hunger

Africa

Children and families living in poverty are in crisis. After decades of progress in reducing malnutrition, the world faces the threat of a catastrophic backslide, resulting in loss of potential for an entire generation. Yet, we know what needs to be done. Nourish the Future provides a smart, evidence-based plan, leveraging some of the most cost-effective tools in global health to deliver results. Together, we can not only reduce child deaths, but ensure that the world’s most vulnerable children grow up nourished, healthy, and strong. We must act now.

Kathy Spahn,
president and CEO,
Helen Keller International

Improving nutrition through health systems

Primary health care should be the principal means by which services to prevent and treat deadly malnutrition are streamlined and delivered at the community level, according to the 2020 Global Nutrition Report. Training and equipping community health workers to deliver essential nutrition services — particularly the Power 4 — could help them improve health outcomes for children, while also improving the impact of existing U.S. global health investments.

Based on clinical trials, vitamin A supplementation in children was shown to reduce deaths by 12-24%. Studies also show that children who are properly breastfed are up to 72% less likely to die from diarrheal disease and 57% less likely to die from respiratory infections.

“It’s not just that this is an important problem affecting millions of children. There are many important problems in the world today. The point is that the solutions have long existed, and are affordable … it’s unconscionable not to deploy them,” said Moore at the Texas Global Food Security Summit this May.

Framework for equitable integration of nutrition within health systems

Hover over infographic items to learn more

Source: Global Nutrition Report 2020

Photo: © Alice Kayibanda

Transforming food systems

“It’s time that food systems actually start delivering good nutrition,” added Moore. “The purpose of food is to keep people alive and healthy, and our food systems are failing massively on the second part.”

While global efforts have made progress on ensuring the basic caloric needs of a growing, global population, much more needs to be done for three billion people worldwide who cannot afford or access healthy diets to ensure that their food actually contributes to their health and reduces malnutrition.

“Most nutritious food is costly and out of reach for many households, while unhealthy alternatives are less expensive, readily available, and heavily marketed,” according to Fore. “Conflict, climate change, environmental degradation and humanitarian crises are also contributing to making food systems fragile for millions of children.”

Nourish the Future outlines the following critical food systems transformations to improving food security:

Need for political will and leadership

Further investments in the availability of nutritious foods — as well as the promotion of healthy diets — is crucial for reducing malnutrition, according to the World Health Organization. Leading donors are now at an important crossroads as the deadline for reaching the 2030 Sustainable Development Goals approaches.

“This year we have unique opportunities to collectively step up and tackle these issues, at the G7 Leaders’ Summit in June, the Food Systems Summit in September, and the Nutrition for Growth Summit in December,” wrote Fore. “Initiatives such as Nourish the Future provide a roadmap to scale-up proven nutrition solutions and get the world back on track to end child malnutrition for good.”

The leadership that the U.S. government provided through Feed the Future helped prioritize agriculture development funding in many LMICs, explained Cousin.

The Biden administration is now faced with a new opportunity to provide the catalytic action needed to ensure the global community comes together to provide the necessary financial resources and policy support, she said, adding that these programs have the potential to “create multisectoral action that will create a food system that not only increases economic opportunity and the health of our planet, but also the health of the entire global population.”