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The double burden of nutrition; what will it take to end it?

Photo: Richard Bell / Unsplash.

At the beginning of the month of December, government representatives, foundations, academia, civil society members, and private sector actors gathered virtually in a summit hosted by the government of Japan. The Nutrition for Growth (N4G) Summit marked the end of a year full of public dialogues, expert consultation, online events, and actions on the ground that all had the same aim: planning and concretising multisectoral pledges to improve nutrition worldwide. Over the course of the two-days event, 500 million USD were proclaimed to be spent on nutritional programmes, tackling the growing double burden of malnutrition.

The Summit was the occasion to officially launch the Tokyo Compact on Global Nutrition for Growth, which presents the goals and commitments set by world leaders during the Summit. It paves the way for further commitments, that will be presented at the next N4G Summit in Paris in 2024. The pledge centres around five different thematic areas: health, food, resilience, accountability, and financing. Commitments all made allusions to one or more of these areas, covering most aspects of a stable food supply and intake.

The global picture of the double burden of nutrition

The State of Food and Nutrition Security in the World 2021 report published in July 2021 depicts an alarming situation: around 30% of the world population faced nutrition issues in 2020. The trends are twofold; undernutrition on the one side – which affects 10% of the worldwide population, and overnutrition on the other side – a global problem, common to all countries, also referred to as the “double burden of malnutrition”. Children and women are particularly affected by malnutrition. In contrast these population groups are the backbone of society or the “highway for development,” as Erwin Ronquillo, Technical Secretary of the Ecuadorian Child Nutrition Programme, emphasised. A strong focus laid on these vulnerable groups during the Summit.

The years 2020 and 2021 were marked by the COVID-19 pandemic, which exacerbated issues related to food provisioning and nutrition, and wiped out the progress made within the last years. But this period also come with a few learnings, as Pierre Cook Jr., Healthy Caribbean Coalition, summarised it:

“If there’s anything to learn from the COVID-19 pandemic, it’s that the only way to solve a global problem is that all countries have access to the same means and resources.”

2021 was also the year of food systems, which have intrinsic links to under- and overnutrition. The United Nations Food Systems Summit was organised to ensure that food systems deliver on all goals of the Global 2030 Agenda, whilst the N4G Summit focused entirely on human nutrition. Both Summits presented a joint statement to clarify their respective targets and to commit to achieving certain tasks, all closely interlinked and aligned with the Global 2030 Agenda.

Medical staff examine a child for signs of malnourishment in DRC

Photo: Russell Watkins (DFID, UK Department for International Development) / flickr.

Accountability: a missing compound in the nutrition equation

Whereas accountability frameworks do exist in other sectors, the nutrition area has been left aside so far. A stronger framework with clear targets, commitments, and ways of verifying promises would lead to more effective funding, which is in turn a major issue for those in charge of bettering nutrition in any country worldwide. New partners from all sectors must join the fight against malnutrition and understand the importance of healthy populations for a sustainable future, no matter in what economic system it will take place.

The role of the food industry in addressing malnutrition

Small and medium-sized enterprises, representing 95% of all enterprises, play a pivotal role in curbing malnutrition. Nonetheless, we shouldn’t forget big players.

While therapeutic foods, biofortified cereals, and supplements are seen as key to suppressing hunger, processed food can have an adverse, severe impact on entire populations; for example, in Mexico, 40% of total calorie intake comes from ultra-processed foods. The country ranks third in the list of sales of overprocessed goods, and first in the list of the one of overweight and obese population. The food industry’s role can’t be neglected anymore – processed foods provide little fibre and nutrients while containing high amounts of salt, sugar and fat. Many heads of state and NGO directors appealed the food industry to review the number of harmful substances in their recipes.

Rocco Renaldi, Secretary-General at the International Food and Beverage Alliance (IFBA), appealed for cooperation over isolation, recognising that,

“Conflicts of interest do exist, but they must be managed. When objectives are not always aligned, it is better to build bridges instead of closing doors.”

The IFBA is part of the Business Constituency Group, that promised in a pledge to reduce marketing targeting children and to support the creation of a policy framework around that topic. Another objective of the group is to reduce the amount of sodium in their recipes between 2025 and 2030.

Investment in innovation and digitisation for improved nutrition

To make changes in the food industry, resources for research and development must increase. Digital tools are seen as central to monitoring progress, mapping deficiencies, and enabling smooth programme deployments.

If accountability did exist, it’d be easier to track resources, to monitor programmes, and thus to develop skills amongst food industry members, health workers, and the population itself. But even if money would be there in quantity, it must be ensured that it is invested in the right place, where it can make the most significant impact. And that is usually on the ground, to lighten hunger on the one hand, but also to give people a chance to build up their own economies and food systems from where they are, with the best knowledge available, as Dr. Myrna Cunningham, Fund for Development of Indigenous Peoples of Latin America and the Caribbean, underpinned:

“We have to shift the way we give technical advisory; technology must be based on knowledge of local conditions besides local and Indigenous know-how and practices.”

Flexibility resonated throughout the Summit as a way to quickly adapt to political changes, climatic events, and other funding shortcomings. Looking for alternative finance sources and new donors is a necessity in a rapidly changing world, alongside leaving ideologies to the side and remembering that, “what matters in the end isnot where the budget comes from, but how things look on the ground” (Kathryn Bolles, Save the Children). If united towards the same cause, cooperation must be understood as a common battle.

Bold commitments from heads of state to end the double burden of nutrition

Numerous heads of state and ministry representatives announced their commitments to tackle the “double burden of nutrition”. All speeches had one common trait: the urgency to take action and to alleviate people from hunger but also to restrain the presence of highly transformed foods. From five to ten year plans, all commitments were bold, and the aim to end hunger could be found in most of them. Child stunting, women anaemia, and obesity were stated by multiple speakers, underlining the complex situation nutrition is facing.

Health services include nutrition targets and frameworks, while sustainable agriculture can play a pivotal role in providing sufficient nutritious food to local populations. Bigger portions of national budgets were said to be allocated to the health and the agricultural sectors, in order to make tangible progress in these areas.

A class before lunch in a primary school in Lao PDR

Photo: Stephan Bachenheimer (GPE) / flickr.

Targeted help for vulnerable groups

Poverty and health issues related to diets are strongly linked throughout the world. To reach out to the world’s poorest, more attention needs to be shifted to schools and school canteens, as they attain even the poorest households. A hungry belly doesn’t concentrate, whereas a full one absorbs much more than just nutrients, besides relieving a family, knowing that their children receive a solid meal at least once a day. School- and home gardens as well as rearing livestock around families are other solutions and can provide important sources of food.

Especially in conflict-affected areas, such as in Afghanistan, the nutritional status of children and women can rapidly weaken, as Zuhra Dadgar Shafiq, Programme Director of Action for Development Switzerland, explained:

“The social and economic empowerment of women greatly impacts on family and child welfare. As many women have been confined for the past 3 months, the nutritional status of many families has decreased rapidly”,

In the health sector, a strong emphasis must lie on breastfeeding, which has been demonised and often replaced by processed milk powder. Regaining agency over infant nutrition is regaining agency over a consequent part of life. That being said, only a healthy mother can produce enough quality milk to feed her children, hence the spotlight on pregnant and lactating women to detect and cure deficiencies.

The need for global thinking to end malnutrition locally

A holistic approach makes it easier to tackle any issue as part of a system, where all elements have a role to play. Malnutrition impacts worldwide, hence it must be tackled by all countries and sectors. Breaking the silos, cooperating amongst sectors, sharing knowledge between geographical areas and social strata is required to ensure a complete approach to malnutrition.

In this global mindset, nutrition must be included in Universal Health Coverage – the access to health services regardless of the financial situation of individuals or communities. Medicinal and nurse schools must put a more considerable emphasis on nutrition in their curricula, and health centres must provide more information related to the importance of good nutrition. In order to curb malnutrition, a disease-oriented approach is needed.

Even donors coming from the global scene must think about the importance of nutrition and local solutions. In the same vein Michael Köhler, Deputy General for European Civil Protection and Humanitarian Aid Operations, outlined:

“As a donor, you must focus on integrating nutrition services in any programme and on localising solutions while adopting innovative approaches.”

Sweden is walking the talk through the Swedish Embassy in the Democratic Republic of Congo. It is co-launching a new multi partnership and multi-funding programme, focusing on health, cash transfer, nutrition and early childhood development.

Reporting back by Magdalena Knobel, Communications Consultant at SIANI.