11-May-2020: 2020 Global Nutrition Report: Action on equity to end malnutrition

The COVID-19 pandemic has exposed the weakness of food and health systems, disproportionately impacting already vulnerable populations. As inequalities and malnutrition continue to sweep the world, the 2020 Global Nutrition Report stresses that the need to address malnutrition in all its forms by tackling injustices in food and health systems is now more urgent than ever.

India is among 88 countries that are likely to miss global nutrition targets by 2025. It states that India will miss targets for all four nutritional indicators for which there are data available — stunting among under-five children, anaemia among women of reproductive age, childhood overweight and exclusive breastfeeding.

• Between 2000 and 2016, underweight rates have decreased from 66.0% to 58.1% for boys and 54.2% to 50.1% in girls. However, this is still high compared with the average of 35.6% for boys and 31.8% for girls in Asia.
• 37.9% of children under five are stunted and 20.8% are wasted, compared with the Asia average of 22.7% and 9.4% respectively.
• India is identified as among the three worst countries, along with Nigeria and Indonesia, for steep within-country disparities on stunting, where the levels varied four-fold across communities.
• Stunting level in Uttar Pradesh is over 40% and the rate among individuals in the lowest income group is more than double those in the highest income group at 22.0% and 50.7%, respectively.
• In addition, stunting prevalence is 10.1% higher in rural areas compared with urban areas.
• One in two women of reproductive age is anaemic, while at the same time, the rate of overweight and obesity continues to rise, affecting almost a fifth of the adults, at 21.6% of women and 17.8% of men.

Double burden: Most countries in the world must now be equipped to fight both sides of malnutrition at the same time.

Progress is too slow. One in nine people are still hungry or undernourished, while 149 million children under 5 years of age are still affected by stunting globally. Meanwhile, our world has transitioned to one in which more people of all ages are obese than underweight, with one in three people either overweight or obese.

Despite these figures, countries are often unprepared to face the global nutrition crisis. Strong government coordination on nutrition is often lacking; lower income countries tend to deprioritize overweight, obesity and diet-related chronic diseases.

Financial commitments also don’t match the scale and nature of the issue: increases in domestic resources for nutrition have been marginal at best, and obesity and overweight have been largely ignored in aid allocations.

Gerda Verburg, UN Assistant Secretary General, Scaling Up Nutrition Movement Coordinator and member of the GNR’s stakeholder group, said: “2020 must represent a turning point for nutrition. As we look to reinforce our resilience to global stresses, nutrition must become a key component of any emergency or long-term response. Investing in nutrition, renewing and expanding commitments, and strengthening accountability has now become urgent if we want to prepare our systems for future shocks, and avoid a reversal of gain.”

New perspective: redirecting resources to communities and people most affected is the right and the smartest thing to do.

Global and national patterns hide significant inequalities within countries and populations, with vulnerable groups being the most affected. The Report found clear links between levels of malnutrition and population characteristics like location, age, sex, education and wealth, while conflict and other forms of fragility compound the problem.

Differences across communities and at the sub-national level are striking: wasting in children under 5 years of age can be up to nine times higher between communities within countries, four times for stunting, and three times for overweight and obesity.

If no action is taken, the effects of the pandemic will only make it harder for vulnerable populations to protect themselves against malnutrition. Malnutrition affects our immune system, leaving us more susceptible to infection, and the socio-economic impact of the pandemic could in turn drive malnutrition globally.

Gaps in food systems: Poor diets are not simply a matter of personal food choices.

The Report calls for a change in food systems. According to the Report, existing agriculture systems still focus on staple grains like rice, wheat and maize, rather than producing a broader range of more diverse and healthier foods, such as fruits, nuts and vegetables.

Fresh or perishable foods are less accessible and affordable in many parts of the world compared to staple grains. In Burkina Faso, egg calories are 15 times more expensive than calories from staples, whereas they are 1.9 times more expensive in the United States.

Processed foods, especially ultra-processed food, are available, cheap and intensively marketed, with sales high and growing fast in many parts of the world. In sub-Saharan Africa, the growth of supermarket chains is diminishing the role of informal traders and has affected people’s food choices. These changes demand policy and planning resources to promote desirable nutrition outcomes.

Solutions have started to emerge across the world and are being implemented by a fast-growing number of countries such as India, Nigeria, Peru and Thailand, among others. These include: increased public investment for healthier food products, support for shorter supply chains for fresh-food delivery programmes, use of fiscal instruments such as taxes on sugar-sweetened beverages (now in 73 countries), limiting advertising of junk food, and food reformulation, or the use of front-of-pack labelling (FOPL) to inform consumers and influence industry behaviour adopted by Chile and the UK. However, much more remains to be done.

Venkatesh Mannar, Co-Chair of the Report and Special Adviser on Nutrition to the Tata Cornell Agriculture & Nutrition Initiative, said: “At a time when COVID-19 has further revealed the gaps in our food systems, we now have a unique opportunity to act in coordination to address them and ensure that healthy and sustainably produced food is the most accessible, affordable and desirable choice for all.”

Universal Health Coverage: an opportunity to make nutrition care universally available as a basic, live-saving and cost-effective health service.

Malnutrition in all its forms has become the leading cause of poor health and death, and the rapid rise of diet-related chronic diseases is putting an immense strain on health systems. But despite this assessment, nutrition actions only represent a minuscule portion of national health budgets although they can be highly cost-effective or even cost-saving solutions. The recent Transformation of Aspirational Districts initiative in India is one example of successful integration and delivery of equitable nutrition services as part a broader healthcare transformation effort.

In most countries, health checks do not cover diet quality and national surveys rarely comprehensively assess diets and the nutritional status of populations. The distribution of trained nutrition professionals is inequitable, and these experts are not widely accessible. Globally, the median number of nutrition professionals stands at 2.3 per 100,000 people, 0.9 per 100,000 people in Africa, and some countries have none.

Renata Micha, Co-Chair of the Report and Research Associate Professor at the Friedman School of Nutrition Science and Policy at Tufts University, said: “Good nutrition is an essential defence strategy to protect populations against epidemics, relieve the burden on our health systems and ultimately save lives. The findings of the 2020 Global Nutrition Report make clear that tackling malnutrition should be at the centre of our global health response.”

About: The Global Nutrition Report (GNR) is the world’s leading independent assessment of the state of global nutrition. We provide the best available data, in-depth analysis and expert opinion rooted in evidence to help drive action on nutrition where it is urgently needed.

A multi-stakeholder initiative comprised of global institutions, the GNR is led by experts in the field of nutrition. The GNR was established in 2014 following the first Nutrition for Growth summit, as an accountability mechanism to track progress against global nutrition targets and the commitments made to reach them.

Through a comprehensive report, interactive Country Nutrition Profiles and Nutrition for Growth Commitment Tracking, the GNR sheds light on the burden of malnutrition and highlights progress and working solutions to tackle malnutrition around the world.

In 2012, the World Health Assembly identified six nutrition targets for maternal, infant and young child nutrition to be met by 2025. These require governments to:

1. Reduce stunting by 40% in children under five
2. Reduce prevalence of anaemia by 50% among women in the age group of 19-49
3. Ensure 30% reduction in low-birth weight
4. Ensure no increase in childhood overweight
5. Increase the rate of exclusive breastfeeding in the first six months up to at least 50%
6. Reduce and maintain childhood wasting to less than 5%.

The Global Nutrition Report was conceived following the first Nutrition for Growth Initiative Summit (N4G) in 2013. The first report was published in 2014. This report is produced by the Independent Expert Group of the Global Nutrition Report, supported by the Global Nutrition Report Stakeholder Group.

The Report acts as a report card on the world’s nutrition—globally, regionally, and country by country—and on efforts to improve it.

It assesses progress in meeting Global Nutrition Targets established by the World Health Assembly. The World Health Organization (WHO) is a Global Nutrition Report Partner.

5-Dec-2018: Global Nutrition Report (GNR) 2018 released.

GNR 2018 is a peer-reviewed, independently produced annual publication on the state of the world’s nutrition.

The Global Nutrition Report was conceived following the first Nutrition for Growth Initiative Summit (N4G) in 2013. The first series was published in 2014.

Key Findings:

• Malnutrition is responsible for more ill health than any other cause.
• Children under five years of age face multiple burdens: 8 million are stunted, 50.5 million are wasted and 38.3 million are overweight.
• Meanwhile 20 million babies are born of low birth weight each year.
• Overweight and obesity among adults are at record levels with 9% of adults overweight or obese.
• One third of all women of reproductive age have anaemia and women have a higher prevalence of obesity than men. Millions of women are still underweight.

Yet significant steps are being made to address malnutrition.

• Globally, stunting among children has declined and there has been a slight decrease in underweight women.
• Many countries are set to achieve at least one of the targets set by the global community to track progress on nutritional status to 2025.
• Donors have met the funding commitment made at the Nutrition for Growth (N4G) Summit in 2013, but globally there is still a significant financing gap.

Indian Scenario:

A third of the world’s stunted children under five — an estimated 46.6 million who have low height for age — live in India. A quarter of the children display wasting (that is, low weight for height) as well.

District-level data show high and very high levels of stunting mainly in central and northern India (more than 30% and 40%, respectively), but less than 20% in almost the entire south.

Only 21% of the packaged foods available to children in India are rated as being healthy.