Miliband: Why the world needs to 'wake up' to the malnutrition crisis

The global response to the food crisis and subsequent higher rates of malnutrition is “weak,” says David Miliband, the president and CEO of the International Rescue Committee and former foreign secretary of the United Kingdom, adding that the “time for excuses is over.” Malnutrition refers to undernutrition as well as being overweight and obese. As the world is currently in the midst of a rising food crisis — an estimated 828 million people are facing hunger this year — more people are at risk of being undernourished and in danger of wasting or stunting. Children are especially at risk, and around 1 in 5 deaths among children under the age of 5 are attributed to severe wasting. According to Action Against Hunger, between 2019 and 2022, the number of people who were undernourished increased by around 150 million, and in 2023 over 345 million people are expected to be food insecure, around half of which are children. Nutrition crisis Earlier this year, United Nations agencies called for urgent action to protect the most vulnerable children in the 15 hardest-hit countries, which include Afghanistan, Chad, Haiti, Kenya, and Yemen. Yet the response so far has been weak, Miliband said. “The current failure rate to treat malnutrition … is an absolute indictment of the global system,” he said. “The high-level task force [on preventing famine] that the U.N. set up 18 months ago is not yet meeting. And when it comes to malnutrition … 80% of acutely malnourished kids get no help at all.” U.N. agencies such as the World Food Programme and UNICEF have multiple programs that provide food or agricultural solutions to communities most affected, while the U.S. Agency for International Development is working to bolster Ukrainian agricultural exports amid the war and the U.K. government is expanding disaster risk finance to help guard against the impact of droughts in parts of the African continent. However, the problem, according to Miliband, is a lack of effective management of global resources and a focus on prevention at a policy level, rather than treatment at the key moment when the situation of those affected by undernourishment becomes more severe. “We’re arguing that you need to focus on treatment as well as prevention,” he said. Urgent treatment needed As part of its work to tackle malnutrition in children, IRC’s medical teams distribute a fortified peanut paste called Plumpy'nut, a ready-to-use therapeutic food, or RUTF. “Instead of waiting for malnutrition to become severe and then trying to get people to health centers, it's better to intervene early through community-based interventions that don't require doctors and medics,” Miliband said, explaining that malnutrition can be diagnosed using very basic tools and community health workers can then distribute RUTFs. “If your upper arm circumference is less than 115 mm, which is tiny, you need two sachets of Plumpy'nut. If it's 115 to 125 mm, you need one sachet,” Miliband explained. But this solution hasn’t been widely adopted; only 1 in 5 children who require the paste receive it, according to IRC. Miliband puts a lack of widespread global response to malnutrition down to inertia in the system. “Secondly, there seems to be fatalism built into the system. Thirdly, there are many other problems that people are dealing with. And fourthly, there’s the fact that the nutrition agenda often and understandably wants to focus on prevention of malnutrition.” Emergency plans for relief But, likening the current malnutrition crisis to being as critical as the HIV/AIDS pandemic, Miliband suggested the response could be inspired by that of the U.S. President's Emergency Plan for AIDS Relief, in the form of a “PEPFAR for nutrition.” PEPFAR was created in 2003, forming partnerships across 50-plus countries and accelerating the distribution of antiretrovirals as a treatment. Such a mechanism could do the same for malnutrition, allowing for the setting of concrete targets — such as UNAIDS’ 90-90-90 goals that called for at least 90% of all people diagnosed with HIV to have access to ARTs by 2020 — and the implementation of a plan to scale a solution such as RUTFs. “[Malnutrition] is a global problem with a global solution — and we call for new targets, we call for new mechanisms, we call for new funding,” Miliband said. “The U.S. has the record as well as the wherewithal to make a go of it. We would urge European leaders or Gulf leaders to be equally far-sighted.” In the meantime, it’s on those in the development sector to focus on advocating for solutions that are known to work and challenge policymakers on why they're not picking them up, Miliband said. “Wake up, wake up. There's no excuse when there's a big solution to a big problem for not implementing it.” Visit Food Secured — a series that explores how to save the food system and where experts share groundbreaking solutions for a sustainable and resilient future. This is an editorially independent piece produced as part of our Food Secured series, which is funded by partners. To learn more about this series and our partners, click here.