Hunger-Undernutrition Blog

President Obama Announces New Alliance for Food Security and Nutrition

On the heels of the G8 Summit at Camp David, President Barack Obama announced a US$3 billion initiative to fight hunger and malnutrition in Africa.

The New Alliance for Food Security and Nutrition calls on leaders from across key sectors - government, industry and civil society - to join forces and ignite sustainable, scalable and innovative initiatives to make hunger a thing of the past. USAID emphasizes that the "New Alliance supports the accelerated implementation of the African-developed and led agricultural plans (known as CAADPs)."

During the May 18 Chicago Council on Global Affairs Symposium in Washington, DC, President Obama said fighting hunger and malnutrition is a moral, economic and security imperative. And so, together with forty-nine companies, African Presidents and civil society leaders, a massive multi-sectoral commitment to invest in Africa's agricultural sector was born. The commitments were developed in collaboration with Grow Africa, a partnership led by the World Economic Forum, the African Union and the New Partnership for Africa's Development (NEPAD).

Tanzania, Ghana and Ethiopia are the first countries to be part of the New Alliance. Six more African countries, including Mozambique, Cote d’Ivoire and Burkina Faso, will join in the coming months.

But this announcement has not come without valid concerns. Among them is the need to ensure that the very communities the New Alliance is aimed to benefit, actually inform approaches and the interventions that are needed.

"The New Alliance is neither new nor a true alliance,” said Oxfam’s Lamine Ndiaye. “The rhetoric invokes small-scale producers, particularly women, but the plan must do more to bring them to the table.”

It's important to note that the majority of smallholder farmers are women and happen to make up the majority of hungry people in the developing world. Women also are catalysts for change in their communities.

In addition, civil society leaders fear that by involving the private sector, governments will drop their responsibility to fighting and investing in food and nutrition security.

“A billion people go to bed hungry every day and a challenge of this magnitude requires a new approach," said San Worthington, President and CEO of Interaction. "But any partnership with the private sector must not be a substitute for governments meeting previous obligations, such as those agreed in 2009 at the G8 summit in L’Aquila when $22 billion was pledged in agricultural and food security assistance.”

President Obama assured us that the New Alliance is not a substitute for government commitment. But how do we guarantee this?

As the New Alliance rolls out, governments will have to follow through on their promises, and private sector and civil society will need to work together better than they ever have before. In fact, for the New Alliance to be successful, it will require all three segments to share the responsibility and measure impact. It also requires all three segments to hold each other highly and unapologetically accountable to ensure the kind of progress that Africa has the potential to deliver.

If not, the New Alliance will be relegated to yet another initiative that no single entity owns, with plenty of blame to go around if it fails.

Malnutrition and Obesity: "Globesidad" Adds to our Nutrition Woes

Posted by Cara A. George, Associate at Humanitas Global Development

The world is increasingly affected by a new form of malnutrition - obesity and overweight. Last week, while researching the nutrition and health situation in Chile for a work assignment, I was impressed by the statistics showing that the South American country has “virtually eliminated hunger” – and simultaneously horrified that the country’s obesity rate is quickly growing. In fact, a new term has been created to exemplify the growing obesity epidemic that is permeating Chilean society, and globally: Globesidad ("global" +"obesity", in Spanish).

Much has been written lately on this topic. A blog post by Jennifer Clapp on the Triple Crisis Blog points to the simultaneous existence of undernutrition and overnutrition, describing possible suggestions such as raising taxes on unhealthy foods. Similarly, this topic was addressed at an event at the American Enterprise Institute for Public Policy Research a few weeks ago, in the context of US Policies such as the Supplemental Nutrition Assitance Program (SNAP). Daniel Sumner of the University of California, Davis suggested that food programs originally designed to alleviate hunger must now address spiking obesity rates among their target populations. However, in doing so through the taxation of foods heavy in saturated fats, sugar, and salt is "nonsensical due to the difficulty of determining appropriate measures and objectives for such actions" - and the complexity of balancing two seemingly opposing objectives of ensuring proper food intake for undernourished families, yet micromanaging the food they consume.

The UN Standing Committee on Nutrition has coined the phenomenon as the "double burden" and said that obesity "constitutes a new nutritional emergency" with non-communicable diseases like diabetes and other chronic illnesses associated with obesity no longer affecting affluent, developed nations, but also countries that are emerging or transitioning in development. An article by Dr. Mark Hyman, How Malnutrition Causes Obesity, explains that calorie-dense foods do NOT equal nutrient-rich, and proper food intake has little to do with the amount of food actually consumed.

As low-income societies grow, governments will have to adapt policies to ensure that health is not compromised with the increased intake of calories. We must stress the value of increased physical activity, intake of healthful foods and improved preventative health monitoring, among other items. We should ensure that policies, education, advocacy and industry efforts are part of an integral, inter-disciplinary approach to prevent the onset of obesity and related health consequences. We must balance the scales in our response to malnutrition and tackle the double burden deliberately, proactively and strategically. We'd love to hear about programs, policies or new initiatives underway to do just that, so please share!

Malnutrition and Health: The Sh!t Factor

Guest blog post by Christopher Juan Costain with Water and Sanitation Program South Asia, World Bank

 

Malnutrition is not only a direct and indirect cause of infant mortality; it also causes stunting and has life-long influences on learning and IQ which will impair future earning capacity.

The challenge of overcoming malnutrition remains one of the most intractable, particularly for those of us living in India, a country that appears year after year in the Global Hunger Index,  below countries emerging from conflict such as Liberia. Surprisingly, malnutrition shows much less correlation with income than might be expected - as much within India as between countries.

Much of what we read about malnutrition focuses on food security and the related issues of availability, access, and affordability. While these broad concepts do loosely include social and cultural themes, such as gender empowerment, which are seen to be highly relevant, the issue of absorption of  micronutrients, and particularly the important role played by safe sanitation, is frequently overlooked or underemphasized.

Many people may also be surprised to learn that India has a similarly unfavorable ranking in terms of the percentage of people practicing open defecation (for example, 51% for India versus 45% for Liberia). This is important as several studies^[1] emphasize that sanitation and hygiene are a key determinant of a child’s nutritional status. Perhaps 50% of the consequences of under-nutrition can be attributed to poor environmental health conditions as a result of diseases such as diarrhea, tropical enteropathy, and nematode infections.

A study of two year-olds showed the probability of stunting increased by 2.5% per episode of diarrhea, and 25% of all stunting was attributable to having five or more episodes of diarrhea.  Another calculation indicates that each year some 860,000 of malnutrition-related deaths of under-fives are induced by unsafe water, sanitation, and hygiene.  

Tropical enteropathy (increasingly referred to as environmental enteropathy as it is not restricted to the tropics) is receiving increasing attention in the development community as it underscores that the impact of poor sanitation is not only through diarrhea, but also that fecal bacteria, ingested in large quantities by young children living in conditions of poor sanitation, cause damage to the intestinal wall, decreasing the capacity to absorb micronutrients.

The evidence for the protective effect of sanitation against diarrhea is strong, with latrine usage potentially reducing diarrhea by an average of 36%^[2].  It is also a technology that is within the reach of every village and it is admirably cost effective. The World Bank ranks hygiene promotion as the most cost-effective public health intervention ($3 per DALY averted) followed by sanitation promotion ($11 per DALY averted).

It would be simplistic to seek to solve India or the world’s malnutrition challenge solely through improved sanitation, but given the huge health impact and the modest cost, in addition to the myriad social and economic benefits to be gained through improved sanitation for all, this has to be a worthy focus for our resources and our attention and should be part of the conversation surrounding malnutrition prevention.

 

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[1] UNICEF/WHO (2009): Diarrhoea: Why children are still dying and what can be done;

WHO (2008), Safer Water, Better Health – Costs, benefits and sustainability of interventions to protect and promote health;

Int J Epidemiol 2008, Checkley W, Buckley G, Gilman RH, et al, The Childhood Malnutrition and Infection Network. Multi-country analysis of the eff ects of diarrhoea on childhood stunting.;

 Lancet (2009); Humphrey JH. Child undernutrition, tropical enteropathy, toilets, and handwashing.

[2] Scott, (2006): Well Fact Sheet- Health Influences of Improved Household Sanitation

Intersection of Water and Food Security – When “Urgent” Replaces “Important”

By Cara A. George with Humanitas Global Development

The crisis of water is something we cannot hear enough about lately. Water shortage, water contamination, water privatization, water as a human right, water as a commodity, water and sanitation, the list goes on and on. Yet this problem has not been at the top of countries' key decision makers' list of priorities.

The Center for Strategic and International Studies recently hosted an event focused on Regional Perspectives on Water and Food Security Challenges. As populations increase and the need for increased food production grows, a simultaneous challenge grows as well, as water management on all levels is creating food security problems. This has as much to do with politics as it does with national priorities.

Governments pride themselves on being able to provide this precious resource for free, and citizens use water as if it’s an endless supply. There’s a mindset that water freedom creates good policy, but it is in fact completely the opposite. While governments have the ability to create more security around water through tighter policies, they act in a way that is more favorable to constituents and create huge instability challenges. If governments gain support from their stance on water, they are unlikely to change for fear of losing support.

Dr. Jon Alterman with the Middle East Program at CSIS presented the water and food security situation in Sana’a, Yemen, where alarmingly half of the country’s water and per capita income is spent on qat, a mildly narcotic plant that occupies more than half the country’s arable land. Other alarming statistics in his presentation pointed to Saudi Arabia, which has the largest integrated dairy production in the Middle East. To provide one gallon of milk, 23 gallons of water are required. Also in Saudi Arabia, 65% of domestic oil is used to desalinate water and create energy - a statistic that defies all logical reasoning when we think of waste in production. But when land is irrigated and farmers become constituents, the issue becomes very political and water usage is harder to control.

The examples described above are only a small portion of the situations where “urgent” replaces “important” in development – just like we see when food aid is poured into communities suffering acute malnutrition when in other areas, chronic malnutrition is barely recognized. The international community must urge the necessary actors to see the “less popular” option to avoid further perpetuating dangerous and unsustainable patterns, especially with one of our most precious resources.

Renormalizing “normal”

By Cara George, with Humanitas Global Development

Genetics influence everything about how we are created –from our eye color, to whether we can roll our tongues, even our ability to smell. But what about height? Sure, genetics play a role in that as well. But a recent entry The Global Crisis You Never Heard Of: Stunting on the 1,000 Days Blog points to stunting, or stunted growth, as a dangerous phenomenon, linked to horrifying statistics on impaired brain development and mortality resulting from diarrhea, due to chronic nutritional deficiencies.

Development work consists so heavily of creating a “new normal”. One idea we’re developing here at Humanitas Global Development is how to promote behavior change in a current nutrition project underway in Central America, where the target population does not even understand that they are stunted because everyone else around them is short too. Having served as a Peace Corps Volunteer in Guatemala, I experienced this firsthand. At 5'6" tall, I always felt at average height in the US, and once in Guatemala, it took some getting used to the feeling of towering above everyone in my town - even the men.

How do you “convince” a population of chronically malnourished individuals that genes are not solely responsible for their height, and encourage a new way of perceiving “normal”? And how does one work to establish fresh ideas around what is healthy and normal, especially when it means working in a cultural context that does not see the problem or issue in the same way?

Since our readers work in such a variety of areas and geographical/cultural contexts, we want to know your successes and challenges in working towards a “new normal”!

Working Together is Critical for Success

Guest blog post by Robert Baldwin with the Flour Fortification Initiative

In October I was in Albania on a joint mission between the Flour Fortification Initiative and UNICEF to advance flour fortification in that Balkan nation. Throughout the week, our team met in small groups with more than 35 decision and policy makers and policy shapers in the public, private and civic sectors. We were impressed with their willingness to work together to make it happen. The Ministry of Health, acknowledged by all as the entity to lead the effort, was confident that it could embrace and engage all other sectors in working together to achieve the goal.

Albanian leaders proved once before that they could work together to fortify a staple food when in 2008 they successfully undertook a salt iodization program. At week’s end our team was confident that these folks were on the right path toward fortifying flour. While there are a number of ways to decrease micronutrient deficiencies, the Albanians recognized that flour fortification is a cost efficient, technologically simple way to improve the nutrition status of a great number of people in a short timeframe.

Their commitment to work together to accomplish that goal shows that they understand micronutrient malnutrition is a multi-sector problem that demands a multi-sector response.

Oftentimes, when speaking to a group about micronutrient malnutrition, I ask the question “Do you think that micronutrient deficiencies are primarily a health sector problem?” Invariably, more than half respond with a “Yes” answer.

My response is that it is not exclusively a public health problem, but more of a societal problem. This issue of hidden hunger impacts almost all aspects of a society’s lifecycle:

• It impacts the education sector—the intellectual development of children is impaired, creativity is diminished, inventiveness is stifled.
• It affects the labor sector—nutritionally impoverished adults can’t perform at full capacity, lose time from the job, and thus are not a productive as they can be.
• It impacts the economic sector—lost productivity leads to lower wages which restrict purchasing power— these and other factors contribute to lowering a country’s GDP.
• It does affect the health sector by contributing to blindness, lowering immunity to disease, contributing to childhood morbidity and maternal mortality, increasing the incidence of debilitating birth defects, while contributing to the overall increased cost of health care.

If you buy the argument that this is a problem across society, then it is unreasonable to expect the health sector alone to deal with and solve the problem. The public health sector often provides the leadership necessary to alleviate the problem. Yet to effectively combat micronutrient malnutrition, it must muster the collaboration of other agencies within the public sector, as well as involving, from the start, the energies, experience and skills of the private and civic sectors.

This formula soon becomes apparent to those engaged in the effort to achieve national-scale flour fortification in a country. Collaboration among representatives from multiple sectors is not easy to accomplish at first and requires great effort on the part of all involved. Working together, however, they have greater strength than any one partner working alone.

 

Bread for the World Calls for Updates to US Food & Farm Policies

A guest blog by Todd Post, Bread for the World Institute

Bread for the World Institute unveiled today its 2012 edition of the Hunger Report, Rebalancing Act: Updating U.S. Food and Farm Policies. The 2012 Report picks up where the 2011 report left off, arguing for a stronger focus on U.S. food security programming on the 1,000 days window from pregnancy to age two.

The 2011 Hunger Report, Our Common Interest: Ending Hunger and Malnutrition, introduced Feed the Future, the U.S. global hunger and food security initiative, which is one of the Obama Administration's signature foreign aid programs. The 2012 report proposes ways for Feed the Future to be better coordinated with the U.S. emergency food aid program, P.L.480.

Feed the Future and P.L. 480 represent a very distinct division of labor in U.S. food security programming. The 2012 Hunger Report aims to bring both more into alignment. Feed the Future presents the U.S. government with an opportunity to test ways of coordinating agricultural development assistance and food aid, making U.S. foreign aid both more efficient and effective.

For example, Feed the Future supports improvements in agricultural infrastructure. Why not direct some of the resources for improving infrastructure to help countries build their capacity to do more local and regional purchase of food aid? Critics often say that developing countries don't have the infrastructure to mill and fortify food aid up to U.S. standards. Well, here's an opportunity to address that problem. This would achieve development objectives as well as strengthen parts of the agriculture and food production value chain.

In 2011 two impressive reports by U.S. government agencies examined the nutritional quality of food aid shipped from the United States. Nutritional quality matters most when targeting certain groups, such as young children, pregnant and lactating women, and those with compromised immune systems. A USAID/Tufts University report and a GAO report considered the feasibility of improving nutritional quality of food aid. The bottom line is it will cost more to provide more nutritious food aid.

The prospect of Congress committing new resources to improve the nutritional quality of food aid appears unlikely. In lieu of that, the 2012 Hunger Report argues for phasing out practices of monetizing food aid and using those savings to improve nutritional quality of food aid.

Monetizing food aid is a practice NGOs use to run agricultural development projects mostly. It goes back decades and became popular as agricultural development assistance fell out of favor with donors.

Monetization has always been controversial. It is widely understood to distort markets, hurting the same smallholder farmers that agricultural projects aim to help. Moreover, monetizing food aid is an extremely inefficient way to provide development assistance. Over a recent three-year period, GAO found that close to one-third of resources set aside for monetizing food aid, more than USD$200 million, was lost to development projects due to inefficiency.

Monetization may have been justified in some sense before Feed the Future, but now that the U.S. has stepped up investments in agricultural programming again, there may no longer be a compelling reason to continue this practice. NGOs may push back, but given when we know about the importance of early childhood nutrition, Bread for the World Institute thinks it makes good sense to eliminate monetization and divert those resources to improving the quality of food aid.

Fortifying Flour Where People Eat Rice

Guest Post by Scott J. Montgomery, Director of the Flour Fortification Initiative

One of the projects underway at the Flour Fortification Initiative is developing a strategy for fortifying wheat flour in Asia. When I describe this, people’s initial response is always some variation of: “Don’t they just eat rice there?”

Yes, the main cereal grain consumed in Asia is rice. But in many regions, wheat consumption is also high enough that fortifying wheat flour has the potential to deliver essential vitamins and minerals to millions of people.

Consider Malaysia, a country of 28 million people. The daily food supply quantity of rice is 314 grams per person, according to the Food and Agriculture Organization of the United Nations (FAO). That is high, as expected, but the amount of wheat in the daily food supply is also high at 181 grams per person per day.

The following table shows the rice and wheat daily food supply quantity for eight other Asian countries where the wheat in the daily food supply is more than 75 grams per person, based on FAO data.

Daily Food Supply (grams per capita per day)
Country	Rice	Wheat
Brunei Darussalam	1006	100
China	315	185
India	291	164
Japan	233	122
Maldives	178	180
Nepal	321	104
Republic of Korea	312	139
Sri Lanka	400	121
Source: Food and Agriculture Organization of the United Nations, 2007

These countries would be wise to use a multi-faceted approach to improve the nutritional status of their people. And the amount of wheat in their food supply is high enough that flour fortification should be considered in their approach. Flour can be fortified with iron, zinc, vitamin A, vitamin D, folic acid, and other B vitamins such as niacin and riboflavin. Together these vitamins and minerals increase productivity, reduce neural tube birth defects, improve maternal health, and strengthen immune systems.

Some may counter that rice fortification would be more appropriate in these countries. Currently the technology for rice fortification is evolving and is not widely practiced. Flour fortification has been practiced for decades, and modern mills already have the technology to implement the process. In countries where wheat flour is frequently consumed as a secondary cereal, flour fortification could make a health impact now while the technology to fortify rice is being developed and adopted.

Another reason we encourage flour fortification in Asian countries is that wheat consumption is increasing throughout the region. Instant noodles, made with wheat flour, are so popular that a cup noodle museum recently opened in Japan.

A study of wheat flour consumption in Indonesia shows that people are eating more flour products such as instant noodles, sweet bread and biscuits. Average national consumption of flour increased from a 15-year low of 45 grams per capita per day to 51.5 grams per capita per day in 2008. The study concluded: “This trend in increased consumption of wheat flour is accompanied by a decline in rice consumption as Indonesian’s diversify their diet as a result of economic development.”

If flour fortification becomes standard milling practice now throughout Asia, then the addition of vitamins and mineral to flour will be routine business as people diversify their traditional rice-based diets with more flour-based foods.

In Nepal, flour fortification had been voluntary, but in August this year the government made it mandatory for industrial mills to add iron, folic acid, and vitamin A to wheat flour. Now three countries in Asia – Nepal, Indonesia, and the Philippines – require fortification of wheat flour. The strategy we are developing with our partners in the public, private, and civic sectors will help provide the advocacy and technical resources needed for other countries in Asia to follow these examples.

Nutrition Takes Center Stage in the Battle Against Non-Communicable Diseases

 
Secretary-General Ban Ki-moon addresses high-level meeting on the prevention and control of non-communicable diseases.

Guest blog post by Fokko Wientjes, with DSM

Will history judge last week’s United Nations Summit on Non Communicable Diseases as a watershed moment in the battle against malnutrition?

Quite possibly, yes. The fact that the summit took place is an achievement that should not be underestimated. As this blog reported last week, this year represented only the second time in its history that the UN has discussed a health issue at its General Assembly, yet the resulting discourse between the political, non-governmental and business worlds has led to an unprecedented consensus forming around the role nutrition can play in reducing the burden of NCDs and spurring development.

This consensus is built on the understanding that a child’s diet in the first thousand days (between pregnancy and age two) is crucial. Crucial because, with the right kind of nutrition, it is possible to reduce the risk of an NCD, such as diabetes, heart disease, obesity and certain cancers, later in life. Crucial because essential nutrients early in a child's life allow the brain to develop, giving children a chance to grow to their economic and social potential.

These benefits are so acute that the Copenhagen Consensus, the think tank, has calculated that making sure a population has the right kinds of micronutrients could increase a country’s GDP by 2%.  This analysis reinforces that micronutrients are among the most cost-effective interventions a government could make in terms of generating an economic return on investment.

We have known this for some time, which is why we at DSM have been involved in a number of initiatives aimed at making sure some of the world’s most hard-pressed populations have access to adequate nutrition. We underlined this commitment in New York last week, when we launched Future Fortified, a program aimed at delivering food fortification to nutrition black spots in the Nile Delta and elsewhere, along with our partners GAIN and Herbalife.

Future Fortified is just one of a number of ambitious and worthy projects aiming to alleviate nutrition deficiency and improve food security in the developing and developed world. The UN’s Scaling Up Nutrition (SUN) program and the 1,000 days campaign, launched last year at the tenth anniversary of the Millennium Development Goals, received wide-scale backing from UN Secretary General Ban Ki-moon, U.S. Secretary of State Hillary Rodham Clinton and others last week. We continue to work with our partners in the private and public sectors on other initiatives, including Project Laser Beam, a US$50 million, five-year partnership to tackle child malnutrition.

A second, and perhaps equally critical, consensus also developed in New York last year. This was the acceptance that the private sector can and should play a role in providing the solution. Business must engage in this challenge, together with stakeholders in the public sector. We believe that only through such a cross-fertilization of know-how, innovation, experience and resources, a lasting solution can ever be achieved.

This Rubicon has now been crossed and there now pervades a real belief that, beyond providing short term remedies, the goal of long term, sustainable nutrition security for all is a genuine possibility. These are inspirational times and all of us involved in this quest are united in a commitment that we will not let this opportunity pass.

United Nations High-Level Meeting on Non-Communicable Diseases: Visible Opportunity for the Nutrition Community

World leaders are meeting today to kick off the first of a two-day United Nations General Assembly Special Session on Non-communicable Diseases (NCDs). The high-level meeting takes place in New York September 19 - 20.

NCDs, or "lifestyle" diseases, have not only taken their toll on the health and productivity of those living in rich countries, but are spreading rapidly in poor and middle-income countries. Diabetes, heart disease and stroke, cancers and chronic respiratory disease top the list. According to the World Health Organisation (WHO), NCDs are a leading cause of death worldwide with 36 million dying each year - many of these deaths are preventable.

This is the United Nations second high-level meeting on a health issue. The first was the UNGASS on HIV/AIDS in 2001. The high-level meeting will address the prevention, control and reduction of NCDs worldwide, with a special emphasis on the broad health, social and economic development challenges that have surfaced as a result.

Secretary -General of the United Nations, Ban ki-Moon is pushing for NCDs to become a global priority and expects countries to come up with workable action plans to reduce the toll of NCDs.

"The summit in September in New York is our chance to broker an international commitment that puts non communicable diseases high on the development agenda, where they belong, " said Ban Ki-moon.

Tobacco, unhealthy diets, inactive lifetsyles and alcohol abuse all increase the risk of NCDs. The NCD high-level meeting will give the important role of nutrition during the life cycle another boost, but it also reinforces the fact that countries can't look at nutrition or other interventions in a silo. We know that NCDs can be managed, and in most cases prevented, but they require collective efforts across sectors. Combating NCDs also require action plans that set specific, realistic goals to spur communities onto a path where nutrition, fitness, preventative health interventions, healthy habits and other actions all converge.

This week, governments, civil society and the private sector will be hosting side events to support the UN calls to action around NCDs and incorporate evidence-based efforts that can be deployed. The Humanitas Global Development team will be attending many of these meetings and events, and will report back.

The nutrition community needs to be demonstrate where nutrition fits in to these country action plans. The nutrition community must bring the best programs and evidence (not just clinical, but also programmatic) to the table, along with a clearly outlined path that empowers country-leaders to activate smart and effective nutrition programs within the context of their broader NCD plans.

More to come this week!