Gates Foundation sounds the alarm on the crisis of child malnutrition

Malnutrition is the worst health crisis that children face in the world today, with health and economic impacts that will reverberate long into the future — but countries can protect children from hunger’s worst effects by reinvesting in global health, according to the Gates Foundation. In its eighth annual Goalkeepers report, published Tuesday, the foundation urges countries to shore up global health funding, which has stagnated in recent years. The report, titled “The Race to Nourish a Warming World,” also shows how climate change is exacerbating the problem of malnutrition and making it harder to solve. “Every now and then, somebody will ask me what I would do if I had a magic wand,” the foundation’s co-chair Bill Gates wrote in the report’s introduction. “For years, I’ve given the same answer: I would solve malnutrition.” But no amount of magic can change the harsh reality that money today is tight — namely due to the complex and interlinked challenges of climate change, growing debt, conflict, and the effects of the COVID-19 pandemic — which is threatening to unravel decades of progress on poverty reduction and particularly global health. The “global health boom” of the 2000s “gave poorer nations access to life-saving vaccines, drugs, and other medical breakthroughs,” Gates wrote. But those days are now over. “When historians write about the first quarter of the 21st century, I think they may sum it up this way: Twenty years of unprecedented progress followed by five years of stagnation,” he added. But there’s good news, too. “We argue in the report that it’s absolutely possible — and indeed, I think, a call to action for the world — that we can and should be able to accelerate progress massively,” the foundation’s CEO Mark Suzman said in a call with reporters last week. “And there are multiple tools that we need to do that. A critical one is financing.” The Goalkeepers report is the foundation’s annual effort to track and accelerate progress on the 17 United Nations Sustainable Development Goals, which were set in 2015 with a target date of 2030. SDG2, ending hunger, is particularly off track. This year’s report highlights nutrition as a neglected area that has the potential to accelerate progress toward achieving the SDGs. It also highlights the urgency of the issue, pointing out that two-thirds of the world’s children — more than 400 million kids — are not getting enough nutrients to grow and thrive, according to UNICEF. The costs of malnutrition Malnutrition is the underlying cause of around half of all preventable child deaths, according to the report. When a child is malnourished, it is harder for them to recover from diseases like malaria and they are likelier to suffer from stunting and wasting — which prevents their bodies from developing and growing. The effects can be lifelong and irreversible. In 2022, 148 million children experienced stunting and 45 million experienced wasting, the most severe forms of chronic and acute malnutrition, according to the World Health Organization. And between now and 2050, climate change will mean an additional 40 million children will be stunted and an additional 28 million will be wasted, according to a projection the Gates Foundation reached with the Institute for Health Metrics and Evaluation. Those challenges will be felt particularly hard in lower-income countries in Africa and Asia that bear the brunt of climate change. The report said that economists should start thinking of malnutrition as an economic data point, as “nutritional deficits quickly translate into financial deficits.” And those financial deficits are staggering: Each year the cost of undernutrition is $3 trillion in productivity lost because people’s physical and cognitive abilities are stunted. The report listed four solutions that the world should invest in for healthier people and a more climate-resilient planet: more productive cows and safer milk, large-scale food fortification against micronutrient deficiencies, expanding access to better prenatal vitamins, and contributing to the newly launched Child Nutrition Fund. In the long run, the foundation argued, investing in these four areas would be relatively cheap, with high impact — especially compared to the costs of maintaining the status quo. “The full return on investment is a 20-year return because it’s having this generation of children, the new cohort of children born, who need to avoid stunting and wasting,” Suzman told reporters. “If they grow up healthy with a fully healthy body and brain, they are the workforce of the future. That is the most critical investment in human capital that any government can be making in the health of its own people.” 1. More productive cows and safer milk Dairy cows in lower-income countries tend to produce far less milk than those in higher-income countries. That’s now changing as various new technologies are being developed. For example, farmers might be able to use DNA and data to select cows that give birth to more productive offspring, or even more female calves, the report said. Other technologies might help produce more nutritious cow feed. As many as 109 million cases of childhood stunting could be prevented by improving dairy productivity in just five countries: Ethiopia, India, Kenya, Nigeria, and Tanzania, according to analysis from the International Food Policy Research Institute. Asked by reporters whether he was concerned about the climate impacts of dairy cattle — greenhouse gas emissions from livestock are a significant contributor to climate change — Suzman said that the low-income countries where these new technologies are being targeted contribute far less to climate change than wealthier, more industrialized nations do. “In this case, I think we would argue that the benefits of these dairy interventions for the populations affected are so disproportionately higher than any of the long-term impacts, that this should not be a factor that slows down core investments in these countries,” Suzman said. 2. Large-scale food fortification against micronutrient deficiencies Large-scale food fortification is the practice of increasing the micronutrient content in commonly eaten food to improve public health and the overall nutritional quality of the food supply. And the technology has been around for a long time: Iodized salt — which has been a critical and cheap intervention against iodine deficiency disorders — has been sold in supermarkets in the U.S. and Switzerland since the 1920s, the report said. Today, nearly 90% of households worldwide use iodized salt. Now some countries are adding other nutrients to their foods. Ethiopia, for example, is experimenting with adding folic acid to iodized salt, resulting in “double fortified” salt which would be nearly the same price for consumers. This approach has benefits such as reducing infant deaths and stillbirths by 75% due to neural tube defects and helping reduce anemia by up to 4% in the country. In Nigeria, where bouillon seasoning cubes are a staple in most households, the government is working to fortify those cubes with nutrients that vulnerable children and women need most — such as vitamin B12, iron, zinc, and folic acid. 3. Expanding access to better prenatal vitamins It’s long been known that pregnant mothers need extra nourishment during and after their pregnancies. But it’s particularly difficult for pregnant mothers in lower-income countries to get the necessary nutrients. That’s where maternal micronutrient supplements, or MMS, come in. As a scalable solution, the Gates report pointed to the world’s most complete prenatal vitamin: the United Nations international multiple micronutrient antenatal preparation multiple micronutrient supplements. It’s proven to significantly reduce the risk of adverse birth outcomes — such as stillbirths and low birth weights — and it costs only $2.60 to support one entire pregnancy. Scaling it could save nearly half a million lives and lead to 25 million babies with improved birth outcomes, the report said. “Multiple micronutrient supplements are an innovation as they replace iron folic acid, which is the cornerstone of antenatal care management of anemia, which is highly prevalent in pregnancy,” according to Rasa Izadnegahdar, who leads the Gates Foundation’s maternal, newborn, child nutrition and health portfolio. “We've been working hard to get the cost down of this, and I'm proud to say that it is now at cost parity with iron-folic acid and ready to be rolled out and integrated into health systems as part of improving the quality of antenatal care,” he added. 4. Investing in the Child Nutrition Fund The Child Nutrition Fund is a new, UNICEF-led financing mechanism that aims to scale up ways to address malnutrition in women and children. It is also meant to help improve coordination across various nutrition interventions. The fund’s inspiration is the Global Fund to Fight AIDS, Tuberculosis, and Malaria — one of the world’s fastest-scaling and most effective institutions. The Child Nutrition Fund has a goal to raise $2 billion by 2030 to support 350 million children — and has raised nearly $270 million so far. The Gates Foundation helped set it up and has been a major backer, putting in $70 million. Other founding partners are the Children's Investment Fund Foundation and the United Kingdom’s Foreign, Commonwealth & Development Office. The fund is now working in 23 countries and backs government-led initiatives aligned with the U.N. secretary-general’s Global Action Plan on Child Wasting. “We’re actually hoping to have some active discussions at the U.N. General Assembly and others with key funders,” Suzman told reporters. “That’s money that can come in right now and scale up interventions right now in real-time.”