Malnutrition, a global problem in search of global solutions

NEW DELHI — Sunita Devi is huddled with about 20 women in a primary health care center in Gervani village, in the central state of Chhattisgarh in India. She’s anemic and pregnant, and she has questions for the health worker: “When will my anemia go away? Will my child be born anemic too? What can I do to avoid malnutrition in my child?”

These questions apply to 1 in 3 people in the world who are malnourished in some form, and women, such as Sunita, are disproportionately affected by it. It’s not just concentrated in low- and middle-income countries; no country is spared from the many forms that malnutrition can take. More than 2 billion people suffer from other micronutrient deficiencies including anemia — which combined is called hidden hunger. About 150 million children are stunted, 50 million are wasted. According to the World Health Organization figures for 2018, 1.9 billion adults, 18 years and older, are overweight — both in high- and low-income countries — and of these, over 650 million are obese.

Malnutrition is no longer an issue for countries to tackle alone. Considering the threat to health and productivity, WHO adopted nine nutrition targets for 2025. But latest reports show most are off-track and none are making progress on the full suite of targets. Targets such as adult obesity and anemia have proven to be insurmountable for every country. Experts and practitioners are now looking for ways to turn promises into action.

A multisectoral problem

Increasingly, organizations working in the sector have recognized that malnutrition requires multisectoral solutions. It is a health issue, but it cannot be solved without collaboration from various allied sectors including agriculture, the food industry, sanitation, finance, and gender development.

A micro way to understand this would be to examine how the issue plays out in the communities with high burdens of malnutrition. Supriya Sahu, a coordinator at PRADAN — an NGO working in Sunita’s village — said that the awareness of multisectorality has to be acknowledged by the local organizations, and supported by national and international efforts to reduce malnutrition. “There is no point of policies if they are not aligned in the way they’re implemented on the ground,” Sahu said.

“If there is high prevalence of stunting in a village, and there are no toilets, that is a problem that needs to be solved along with providing people with food,” Sahu said.

Organizations such as PRADAN contribute not only toward bringing resources but also building capacity. Sahu works with community health workers to ensure that women such as Sunita are empowered to make demands from elected representatives — be it food, construction of toilets, or regular health checkups.

Recognizing the impact of malnutrition, especially stunting — a condition where children under 5 are diagnosed to be shorter than average for their age-cohort due to lack of nutrients — former World Bank President Jim Kim insisted on including it as an indicator in the human capital index introduced in 2018.

"This is about drawing their attention to a crisis that we think is real. This is connected to productivity, this is connected to economic growth,” Kim said, announcing the index at the bank’s annual meeting in Indonesia last October.

While the HCI is meant to spur competition among countries, cooperation is another key to reducing the burden of malnutrition globally, experts believe.

There is a growing awareness that countries can learn from each other, Tom Arnold, chair of the Task Force on Rural Africa at the European Commission and a member of Global Panel, told Devex. For this to be addressed, different sectors in each country need to work together.

“The three key players in each country — the government, private sector, and civil society — need to take responsibility to define what each of them need to do,” Arnold said.

Efforts such as Scaling Up Nutrition Movement and Global Panel on Agriculture and Food Systems for Nutrition are seeking to recognize successful interventions across different sectors and give them a common platform, along with serving as a community of practitioners.

Arnold, who also served as the ad interim coordinator of the SUN Movement from 2014-2016, said it is now increasingly necessary to address malnutrition through the prism of food systems that are looked at holistically.

“Reality is more complex. First we need critical insights in how the food system is affected. Hammering home the value of food systems across the value chain is critical, and each player has to take responsibility,” he said.

Funding gap

The international attention brought on by the SDGs and World Health Assembly targets has not yet translated into funding. The “2018 Global Nutrition Report” said countries are taking small steps, and in 25 countries, domestic spending on nutrition-specific programming rose by 24% from 2015 to 2018.

“Those who control resource flows — governments, multilateral organisations, philanthropic foundations and wealthy investors — need to find innovative ways to finance nutrition action and provide the institutional and human capacity necessary to do so,” the report states.

In Gervani, the importance of improving human capacity is clear. The women in the public health center have a list of complaints for Sahu, the NGO worker. The most common one is: “Nobody comes to see us regularly. How will we get our monthly nutrition package?”

This focus area, powered by DSM, is exploring innovative solutions to improve nutrition, tackle malnutrition, and influence policies and funding. Visit the Focus on: Improving Nutrition page for more.