Inequality to blame for uneven nutrition progress, new report says

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Children in Senegal eat a meal made from fortified sweet potato flour. Photo by: USAID / CC BY-NC

WASHINGTON — Inequalities in food systems and health care coverage mask the true scope of poor nutrition progress within countries and populations, the “2020 Global Nutrition Report” has found.

The report, launched Tuesday, said that “striking” inequalities based on location, wealth, education level, age, and sex, as well as the presence of conflict or fragility, can determine nutritional status. Wasting in children under 5 years of age can be up to nine times higher in certain communities inside the same country, while stunting can be four times higher and overweight and obesity three times higher.

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“When we only analyze the average, or mean, we really cover differences among groups. And it’s important that we pay attention that no one is left behind,” said Camila Corvalan of the University of Chile’s Center for Research in Food Environments and Nutrition-Related Chronic Diseases. “That message is really timely because the pandemic is actually showing that: that some groups are particularly affected by, for example, COVID, and that is because we’re not starting from the same point in terms of nutrition and health.”

Globally, 1 in every 9 people in the world is hungry, while 1 in every 3 is overweight or obese. The “double burden of malnutrition” — in which undernutrition exists alongside overweight — is growing, as overweight and obesity rates increase in nearly every country in the world.

“The pandemic will be really exposing how fragile our food systems are at different points in terms of distribution of food and access to food.”

— Camila Corvalan, member, “Global Nutrition Report” independent expert group

Corvalan, who is a member of the independent expert group for the “Global Nutrition Report,” said the findings demonstrate how a compromised nutritional status, such as malnutrition or obesity, can adversely impact a person’s ability to recover from a medical condition such as COVID-19. The disease has been shown to be more fatal among people with comorbidities, including diabetes and high blood pressure.

The “Global Nutrition Report” found that even before the pandemic, the world was woefully behind in meeting the 2025 World Health Assembly nutrition targets, with no country on track to meet all 10. Corvalan said the pandemic jeopardizes further progress on the goals and could cause backsliding if programs that reach vulnerable people during this time do not include a nutrition focus.

Source: 2020 Global Nutrition Report

Securing such a focus may require advocacy from the nutrition community, she said, to ensure that the agricultural and environmental sectors, among others, are taking nutrition into account in their pandemic response.

“We need to be careful that resources that are allocated to nutrition are maintained so that we don’t have issues with programs that are already in place,” Corvalan said.

There must be a major shift in the global food system to eliminate nutrition inequalities, the report said, noting that malnourished people often do not have access to affordable, healthy food. This is because agricultural systems have been built to support an “overabundance” of staple grains such as rice, wheat, and maize. A nutritious diet must be diverse and involve more fruits, vegetables, and nuts, which becomes increasingly challenging to achieve when highly processed foods are cheap and readily available in both lower- and higher-income countries.

Preventing widespread consumption of such foods requires stronger regulatory and policy frameworks that promote healthier diets, the report said. Agricultural subsidies and supply chain transportation must be modified to boost access to proper nutrition, and the food industry should be held accountable for producing healthier and sustainable foods in both rural and urban settings.

“We know that governments need to ensure adequate food systems and health care for people for them to be able to eat proper nutritious foods,” Corvalan said. “The pandemic will be really exposing how fragile our food systems are at different points in terms of distribution of food and access to food, and it will also confront our health care system.”

The report calls for multisectoral investments in nutrition, including increased domestic financing focused on communities with particularly high malnutrition burdens and greater coordination among international finance mechanisms. It also recommends the establishment of an international system of governance and accountability to address power imbalances in the food and health systems and of a data management system to track investments.

Data will be key in the health system response to improving nutrition, the report said. Equity-sensitive nutrition data, disaggregated by demographics, is necessary to more effectively identify nutrition priorities in particular areas. Nutrition should also be integrated into country health systems via costed nutrition care plans to address all forms of malnutrition, including relevant noncommunicable diseases.

“To make progress in terms of nutrition inequalities, we really need to engage with other sectors and we really need to get on board the communities to demand healthier nutrition,” Corvalan said. “We are saying that governments have a responsibility in really ensuring adequate nutrition for all.”

About the author

  • Teresa Welsh

    Teresa Welsh has reported from more than 10 countries and is currently based in Washington, D.C. Her coverage focuses on Latin America; U.S. foreign assistance policy; fragile states; food systems and nutrition; and refugees and migration. Prior to joining Devex, Teresa worked at McClatchy's Washington Bureau and covered foreign affairs for U.S. News and World Report. She was a reporter in Colombia, where she previously lived teaching English. Teresa earned bachelor of arts degrees in journalism and Latin American studies from the University of Wisconsin.