Better nutrition – better lives

José Graziano da Silva

Notwithstanding significant efforts and achievements made by many countries and the positive steps forward made by new initiatives, such as the Scaling Up Nutrition (SUN) movement, the last 20 years have seen modest and uneven progress in reducing malnutrition as measured by the targets set by the 1992 International Conference on Nutrition, the World Food Summits of 1996, 2002 and 2009 and the Millennium Development Goals.

FAO’s most recent estimate indicates 842 million people – 12 percent of the world’s population, or one in eight people – are undernourished, unable to meet their dietary energy requirements. An estimated 162 million children under five-years-old are stunted or chronically malnourished, 51 million wasted or acutely malnourished, and 2 billion people suffer one or more micronutrient deficiencies. At the same time, 500 million people are obese.

As a global community, we must collectively strive for nothing less than the end of hunger and the eradication of malnutrition and food and nutrition insecurity.

The various forms of malnutrition often overlap and can coexist within the same country and within the same household. For example, the Commonwealth countries of the Solomon Islands, South Africa, Swaziland and Vanuatu all have the three forms of malnutrition as a problem of public health significance. Significant levels of undernutrition together with multiple micronutrient deficiencies may be found in Bangladesh, Botswana, Cameroon, Ghana, Guyana, India, Kenya, Lesotho, Malawi, Maldives, Mozambique, Namibia, Nigeria, Pakistan, Rwanda, Sierra Leone, Sri Lanka, Uganda, United Republic of Tanzania and Zambia. For a number of countries, obesity levels are rising while undernutrition remains a problem (Dominica, Jamaica, Samoa, Trinidad and Tobago, and Tuvalu), and in the more developed countries of Australia, Canada, Cyprus, Malta, New Zealand and the United Kingdom, rising obesity levels are a major concern.

Exposure to food and nutritional risk factors occurs in all countries and in all socioeconomic groups. However, for those suffering undernutrition, largely due to poverty, year round availability of, and physical and economic access to food, in terms of both calories and adequate variety, nutritional content and safety, remain key determinants. In addition, for such groups, undernutrition is often aggravated, in a vicious cycle, by health related factors such as non-potable water, poor sanitation, and food borne and parasitic infections, and by social and economic factors that result in social exclusion and economic marginalization, poor education, and a lack of appropriate social welfare mechanisms, all of which need to be addressed thoroughly if malnutrition is to be eradicated.

As nutrition is an outcome of multiple factors, comprehensive solutions are needed. Thus, appropriate policy packages across sectors are needed to adequately tackle the multiple burdens of malnutrition in different situations; and food and nutrition security objectives need to be considered across all relevant sectors, with attention to gender being a critical consideration. Improving diets and raising levels of nutrition should be an explicit goal of national development policies, including policies to combat poverty.

It is clear that to promote more balanced and diverse dietary patterns, food systems not only need to make more food available, but to make more nutritious and affordable food items, such as animal sourced foods, legumes, and certain vegetables and fruits, more accessible, while avoiding excessive intakes of sugar, fat and salt. Food systems need to provide year-round access to a variety of such nutrient-rich foods that are also safe and culturally acceptable, and can be sustainably made available as part of a healthy and balanced diet.

National nutrition strategies need to involve all relevant ministries and competent authorities in complementary measures and interventions, supported by the necessary financial, human and other resources as appropriate.

Governments have the ultimate responsibility for the nutritional welfare of their citizens, but leadership on nutrition is often partial and fragmented. Government responsibility for and leadership on nutrition issues and for identifying sustainable national solutions to improve food systems needs to be supported, and coordination and monitoring mechanisms strengthened at community, national and international levels.

Governments’ investment plans should target food systems with the aim of improving the adequacy, availability, accessibility, acceptability and consumption of foods that make up a healthy diet, with research focused on identifying the most efficient local interventions for malnutrition prevention. For this, institutional capacity needs to be built, and effective coordination and monitoring across sectors implemented.

The successful eradication of malnutrition also depends on the active engagement of citizens working with committed, responsible and proactive government, civil society and the private sector through interaction among stakeholders on a common agenda. Collaborative partnerships and engagement by all relevant stakeholders in developing solutions to malnutrition, including responsible investment and research, is important to deliver sustainable improvements.

Investing in nutrition is not only a moral imperative, but it improves productivity and economic growth and reduces healthcare costs, as well as promoting education, intellectual capacity and social development. While the cost of dealing with the effects of malnutrition – whether in fiscal, economic or human terms – is high, the cost of prevention is much less.

One of the main challenges identified for improving food and nutrition security is governance, characterized by a low political commitment, weak institutional arrangements and lack of appropriate coordination/involvement of multiple stakeholders. Volatile international food prices aggravated by increased dependence on world markets and on food imports, low agricultural productivity accentuated by climate change, and post-harvest losses and food waste have also been identified as key challenges.

High-level political commitment as well as improved governance and accountability for more effective and coordinated action by various key stakeholders across sectors and better international and inter-governmental cooperation are essential to sustainably improve nutrition.

The expected outcome of the high-level event will be a political declaration endorsed by countries and a technical Framework for Action that will guide the implementation of the Declaration.

*José Graziano da Silva Director-General of the UN Food and Agriculture Organization (FAO)