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Category: Global

The importance of food systems and the environment for nutrition

Published: 24 November 2020

Publication: The American Journal of Clinical Nutrition

Authors: Jessica Fanzo, Alexandra L Bellows, Marie L Spiker, Andrew L Thorne-Lyman, and Martin W Bloem

Read the original paper here.

Summary 

  • Food systems contribute to and are vulnerable to ongoing climate and environmental changes that threaten their sustainability
  • We’re going to need more research to tell us what food policy changes we should make to ensure everyone has access to nutritious food despite the impacts of climate change.
  • We need to think about this key question: how can both human and planetary health thrive while meeting the demands of a growing human population, and if we can’t have it all, what trade-offs are we willing to live with?

Background

  • Food systems involve the production, processing, packaging, distribution, marketing, purchasing, consumption, and waste of food.
  • By “transforming” (improving) food systems, we could make healthy food more accessible and reduce environmental impact 
  • We need a lot more research to figure out how best to structure this transformation
  • Silos within the field make this research harder

Research Gaps

The impact of climate change on food systems

  • The link between climate and food systems is getting more and more attention, but there are still a lot of gaps in our knowledge. Specifically, we need more research on:
    •  The “missing middle” of the food supply chain (aka anything other than people’s diets and agricultural production) 
    • How climate change will affect non-staple crops (most research to date has only looked at staple crops).
    • How to create context-specific policies (eg. financial incentives, targeted messaging campaigns etc.) that encourage/allow people to eat sustainable diets and how to measure whether these policies are working:

Food systems 

  • Diets. We need more information on:  
    • The best way to measure how sustainable someone’s diet is
    • How people’s diets are changing as incomes rise
    • Healthy, locally appropriate, and sustainable diets are sometimes at odds with one another. How should we prioritize?
      • “One of the shortcomings of the EAT–Lancet Commission report was that it provided a single healthy reference diet for the world, and did not take into account that healthy and sustainable diets may differ in their availability, accessibility, and cost at the global, regional, and individual levels. Even more so, what is considered healthy is not always sustainable, and what is considered a sustainable diet is not always a healthy one.”
  • Food safety. We need more information on:
    • The danger of using pesticides and chemicals, and whether these dangers affect consumer purchases.
    • The danger of plastics (in food packaging, production etc.).
  • Food loss and waste.  We need more information on:
    • How to measure and reduce food waste/loss.

Interesting Stats

  • “Some models suggest that changes in food availability due to climate change, specifically reduced availability of fruit and vegetables, are estimated to result in an additional 529,000 deaths by 2050.”
  • “Globally, agriculture and livestock production utilize ∼40% of arable land account for ∼70% of fresh water withdrawn for human purposes, and are responsible for ∼11% of GHG emissions (although some estimates range from 11% to 24% depending on what is counted).”
  • “​​Food wasted at the retail and consumer levels alone averages 1217 calories, 33 g protein, 6 g fiber, and 286 g Ca per person per day.”

Figure: Link between food systems and the environment

The COVID-19 crisis will exacerbate maternal and child undernutrition and child mortality in low- and middle-income countries

Published: July 2021

Publication: Nature Food

Authors: Saskia Osendarp, Jonathan Kweku Akuoku , Robert E. Black , Derek Headey, Marie Ruel , Nick Scott , Meera Shekar, Neff Walker, Augustin Flory , Lawrence Haddad, David Laborde , Angela Stegmuller , Milan Thomas  and Rebecca Heidkamp

Read the original paper here.

Summary:

  • COVID-related disruptions to food and health systems mean cases of malnutrition around the world are likely to get worse.
    • People also have less money and therefor are turning to less expensive sources of calories such as starchy staples and eating fewer nutrient-dense foods.
  • The study authors used statistical models to predict what these disruptions would do to malnutrition rates.
  • They calculated “optimistic”, “moderate” and “pessimistic” outcomes.
  • After the paper’s publication, the authors stated the pessimistic outcomes are the most likely.
  • Using the pessimistic model as the authors recommend, they predict that by the end of 2022, COVID-19-related disruptions could result in an additional:
    • 13.6  million wasted children 
    • 3.6 million stunted children 
    • 283,000 additional child deaths
    • 4.8 million maternal anaemia cases
    • 3 million children born to women with a low BMI 
    • US$44.3 billion in future productivity losses due to excess stunting and child mortality.
  • To make up for the demands of the projected undernutrition increases, the authors predict we will need an additional $1.7 billion per year.
  • The report also predicts that ODA for nutrition will be 19% less through 2030 than it would have been without COVID, accompanied by a similar decrease in domestic health budgets.
  • We could save a lot of babies from being born small, preterm or stillbirth by a) switching the prenatal vitamins we give out from iron folic acid (IFA) to multiple micronutrient supplements (MMS) and b) Give balanced energy and protein supplements to malnourished pregnant women.
  • The report argues1 that fewer children would be impacted if we move funding away from providing complementary foods and instead allocate resources toward:
    • Balanced energy protein supplementation
    • Breastfeeding promotion
    • IYCF counseling at 6–23 months of age in food-secure households
    • Wasting treatment
    • Vitamin A supplementation

  • These numbers should make it clear to decision makers that the pandemic is causing levels of undernutrition to rise in LMICs and that we need to urgently increase ODA and domestic funding to address this crisis.

Key Quotes:

  • “The COVID-19 pandemic has created a nutritional crisis in LMICs. Without swift and strategic responses by subnational, national, regional and international actors, COVID-19 will not only reverse years of progress and exacerbate disparities in disease, malnutrition and mortality, but will also jeopardize human capital development and economic growth for the next generation.”
  • “While women of reproductive age and young children are largely spared COVID-19’s direct effects (that is, serious disease and death), our projections demonstrate that, regardless of the scenario, the COVID-19 crisis is expected to have dramatic indirect effects on maternal and child undernutrition and child mortality in the current generation.”
  • “The nutritional impacts of the COVID-19 crisis could have massive, long-term productivity consequences that could extend to future generations. Poor nutrition during early life stunts both physical and cognitive development, affects schooling performance and adult productivity, increases the risks of overweight/obesity and diet-related non-communicable diseases later in life, and triggers the intergenerational transmission of malnutrition.”

1 The article notes that “The optimal results and allocative efficiency gains will vary across countries, depending on demographics, epidemiological factors and baseline intervention coverages, as well as context-specific costs, priority targets, delivery platforms and other constraints.”

Scaling Up Impact on Nutrition: What Will It Take?

Published: 07 July 2015

Publication: Advances in Nutrition

Authors: Stuart Gillespie, Purnima Menon, and Andrew L Kennedy

Read the original paper here.

Summary:

  • Even though scaling is important to the nutrition community, people have different ideas about what the term means. 
  • If we’re going to successfully scale nutrition interventions, we need a clear and consistent definition of what the word means.
  • This paper analyses 36 scaling frameworks (from multiple sectors), and distills these frameworks into nine “critical elements” for successfully scaling nutrition projects:
  1. Have a vision/goal:  From the beginning, it is important that everyone agrees on what the project is trying to achieve and how you will measure success. 
  2. Focus on evidence-based interventions: only scale interventions that have already been tested and that are effective at a smaller scale.  
  3. Context matters.  Make sure that any programs you try to scale take into account all the challenges and opportunities of the surrounding environment (policies, institutions, culture etc.). If there are big barriers, make sure your intervention can work around them or don’t scale it there. 
  4. Drivers for scale up include high-level political support, an engaged nutrition champion to spark support, national and local ownership of the intervention, and performance incentives for individual frontline workers or  whole organizations.
  5. Identify scaling-up strategy, processes, and pathways: Be clear about exactly what you’re trying to scale and how you’re going to do it. These measures can be quantitative (expansion in geographical coverage, budget, or size), functional (increase in types of activities and integration with other programs), political (increases in political power and engagement), and organizational (strengthened organization capacity)
  6. Make sure there is strategic and operational capacity to scale up.  Capacity can be improved through nutrition leadership and training.
  7. Governance:  Recognize that successful scaling means managing trade-offs (for example between demonstrating short-term success and building sustainable systems) and make sure governments at different levels have a coherent way of working together.
  8. Financing:  Not only do you need to have enough money, but that money needs to be reliable and flexible. Interventions also cost different amounts depending where you are, so wherever possible make sure your budget is based on local data and prices.
  9. Monitoring, evaluation, learning, and accountability:  We need a lot more evidence on the impact of and lessons learned from scaling. Make sure to collect and disseminate data as you go.

Ensuring Women Have Access to Proper Nutrition Grows Their Power

Image Source: Jonathan Torgovnik, Getty Images, Images of Empowerment

By: Megan Deitchler, Initiative Director, Intake; Sandy Remancus, Initiative Director, Alive & Thrive; Blythe Thomas, Initiative Director, 1,000 Days

Every person has the fundamental human right to access safe, affordable, and nutritious foods, but women and girls are twice as likely to suffer from malnutrition as men and boys due to a combination of biological, social, and cultural factors. We must do better to change this reality. Ahead of this year’s International Women’s Day, 1,000 Days and our sister Initiatives at FHI Solutions, Alive & Thrive and Intake, are calling for greater action to improve the nutrition of women and girls worldwide.

We know that well-nourished women and girls are healthier, more productive, and more likely to finish school. Malnutrition is a barrier that keeps women from accessing their full potential, which reinforces women’s oppression in all aspects of their lives. Good nutrition and women’s empowerment go hand in hand. A more intentional focus that targets improving women’s’ and girls’ nutrition is critical to making concrete, cost-effective, and sustainable improvements to the status of girls around the world. Simply put – ensuring women have access to proper nutrition can help them grow their power. Consequently, gender equality and increasing women’s decision-making powers are crucial to overcome nutritional vulnerabilities and break the inter-generational cycle of malnutrition.

Good nutrition is an essential building block in our fight for gender equality, but our approaches thus far have been siloed. Considering the interlinks between a woman’s health and her ability to claim her agency, actors and service providers across health, social protection, agriculture, and women’s empowerment sectors must prioritize optimal nutrition for women in their own right. Failure to harness a nuanced approach to these interlinked issues, from the community level to the global, will continue to leave women behind.

Over the next two years, FHI Solutions will work hand in hand with our diverse and multi-sectoral allies, ranging from community organizations to government leaders, to galvanize global- and country-level momentum for a compelling Women’s Nutrition Action Agenda. Through this Action Agenda, we aim to:

  1. Advance women’s nutrition as a global development priority of major donors and in target priority low- and middle-income countries (LMICs)
  2. Inform and inspire more and better use of new and existing financing for nutrition on priority World Health Assembly nutrition targets (anemia, low birthweight, and exclusive breastfeeding) from target LMICs and donors
  3. Influence delivery platform gatekeepers in health, including primary health care / Universal Health Coverage platforms, as well as other sectors to integrate preventive nutrition interventions in target LMICs
  4. Advocate for the use of reliable, validated metrics, such as the Global Diet Quality Score, to track progress in achieving healthy diets for all, especially women and girls

Nutrition programming is an underleveraged tool in the fight to advance girls’ rights and empowerment. By leveraging targeted nutrition interventions as a key part of gender equality programming, women’s empowerment actors can give a cost-effective boost to their investments and move the world back closer to reaching Sustainable Development Goal 5 – SDG 5. We are committed to working together with critical partners, both inside the global nutrition community and beyond, as we build a multi-sectoral policy, advocacy, and communications effort to inspire national and international commitment to, and scaled-up investment for, women’s nutrition. We must ensure the nutrition and health of girls and women to fully support their ability to build vibrant lives of their own making.

Kicking Off #March4Nutrition – Join Us All Month Long

In honor of National Nutrition Month, 1,000 Days is kicking off our annual #March4Nutrition campaign to amplify the importance of nutrition for moms and babies around the world. We invite you to follow #March4Nutrition on Facebook, Instagram, and Twitter all month long and join the conversation. 

This #March4Nutrition, we’ll get back to basics and focus on good nutrition in the 1,000-day window. Throughout pregnancy, infancy and beyond, families need good nutrition, breastfeeding support, and nurturing care in order to thrive. 

Every week in March, we’ll dive deep into a new theme and explore how nutrition lays the foundation for brighter, healthier futures. Find more information below and check out our social media toolkit full of graphics and messages to share with your online communities!  

Week 1 March 1-8: Women’s nutrition – Access to proper nutrition can help women grow their power. 

Week 2 March 9-16: Benefits of breastfeeding – Breastfeeding has critical benefits for both moms and babies.  

Week 3 March 17-24: Healthy foods and drinks for babies and toddlers – Growing babies need good nutrition to flourish. 

Week 4 March 25-31: Raise your voice – Help us spark action to change the world for moms, babies and families, 1,000 days at a time.  

At 1,000 Days, we believe that every family, everywhere deserves the opportunity to have a healthy 1,000-day window and beyond – and that starts with access to good nutrition. 

Join us this month as we #March4Nutrition for moms and babies! 

Why Nutrition Matters

Nutrition in the First 1,000 Days – Why It Matters

Good nutrition during pregnancy and the first years of a child’s life provides the essential building blocks for brain development, healthy growth and a strong immune system. In addition, a growing body of scientific research indicates that the foundations for lifelong health—including predispositions to obesity and certain chronic diseases—are largely set during this 1,000 day period.

There are three crucial stages in the first 1,000 days: pregnancy, infancy and early childhood. During pregnancy, a mother’s health and eating habits have a significant impact on the development and future well-being of a child. If a mother’s diet is not giving her the nutrients she needs to support a healthy pregnancy and her baby’s development or if it is contributing to excessive weight gain—or both—it can have serious, long-term consequences.

From birth through the first year, breastfeeding provides unparalleled brain-building benefits and gives babies the healthiest start to life. Because of the unsurpassed benefits of breastfeeding, the world’s leading health agencies including the World Health Organization (WHO) and the American Academy of Pediatrics (AAP) recommend that babies are fed only breastmilk for their first 6 months, but many mothers lack the support they need to meet this recommendation.

And, finally, beginning at 6 months of age, children should eat a diverse diet of nutrient-rich foods to help fuel their growth and development and shape their taste preferences for healthy foods. Throughout early childhood, parents and other caregivers should also teach healthy eating habits and make sure that water and other non-sugar-sweetened beverages become a consistent part of a child’s diet. Deficiencies in key nutrients, poor eating habits and unhealthy weight gain during the early years of a child’s life can set the stage for numerous developmental and health problems down the road.

From India to Indiana, Kenya to Kentucky, mothers and children everywhere need good nutrition and nurturing care in the first 1,000 days to thrive. Yet too many families in the U.S. and throughout the world do not get the food, healthcare or support they need. Whether your organization works to end the crisis of malnutrition in low- and middle-income countries, or you’re focused on the urgent needs of families especially in the United States, thank you for working with us to create a healthier and more equitable future for all pregnant and birthing people, parents, and their children.

The Nutrition Year of Action in Review: 5 Things that Give Us Hope

It’s easy to be pessimistic about the current state of global nutrition. Malnutrition still kills more kids in an average year than the population of Chicago, and leaves millions more with permanently stunted brain development and life-long health problems. COVID-related disruptions to food and health systems have exacerbated these numbers, with experts predicting that by the end of 2022 we’ll see an additional 13.6 million cases of wasting, the most deadly type of malnutrition. To top it all off, experts are now saying that we’ve been underestimating how much it will cost to reach our global nutrition targets, and that with the additional demand from the pandemic we now need to mobilize at least $10.8 billion every year just to stay on track.

On December 8, the 3rd Nutrition for Growth Summit wrapped up the 2021 Nutrition Year of Action, a pledging event that could not have come at a more urgent time. And despite all the challenges ahead, we want to take a moment to celebrate some of the things that give us hope as we conclude the Nutrition Year of Action and move into 2022. Here are our top five:

  1. Breadth and depth of high-burden country commitments

As N4G hosts, the Government of Japan created an inclusive environment that helped encourage and support governments to prepare bold commitments to accelerate progress on the nutritional issues in their countries. This support helped facilitate new commitments from 70 countries with a high burden of malnutrition. Commitments ranged from financial, policy, programmatic, and impact to cut across the five themes of the Summit: Health, Food, Resiliency, Financing, Data/Accountability. This is great news, in part because steadily increasing domestic resource mobilization is a key component of nutrition financing models toward the WHA targets. We are hopeful that the large number of new commitments from high-burden countries will help offset the rising cost of these interventions.

  1. New vehicles for innovative financing

Donors are increasingly turning to innovative financing mechanisms to fill funding gaps and leverage new funding streams. One great example is the Nutrition Match Fund launched this year by the Children’s Investment Fund Foundation (CIFF), UNICEF, and the Bill & Melinda Gates Foundation. The fund helps to mobilize domestic resources for nutrition by providing a 1-to-1 match for any money governments spend on essential tools to combat undernutrition such as purchasing ready-to-use therapeutic foods to treat wasting. The fund has unlocked nearly $4 million of incremental domestic resources, and is already attracting additional donor investment. We are hopeful that advancements like this one in nutrition supply financing will help prevent supply chain disruptions and offer one solution for the low coverage rates of many nutrition interventions.

  1. Progress on UN wasting treatment reform

An update to the UN’s wasting management protocols has been a long time coming. The reform process began in 2020 with the launch of the Global Action Plan (GAP) on Child Wasting. Though the GAP fell short of expectations in many ways, we are heartened by the steps the UN has taken to advance this work in 2021, including releasing operational country roadmaps for the GAP. Another step forward is the WHO and UNICEF’s ongoing evidence review to update global and national guidelines on wasting treatment. This review will reflect the growing evidence that there are simpler, cheaper, and more efficient ways to detect and treat wasting to open the door for reaching more children.

  1. Nutrition accountability at the forefront

One of the major outcomes from the 2021 Nutrition Year of Action is the launch of the Global Nutrition Report’s (GNR) Nutrition Accountability Framework (NAF). The NAF is the world’s first comprehensive accountability platform for nutrition, helping to ensure all commitment-makers put their promises into tangible action. Commitments must be SMART and align with national nutrition plans. The platform inspires bold and measurable commitments that drive progress on nutrition. At 1,000 Days, we believe holding ourselves and our leaders accountable is a crucial component of scaling evidence-based nutrition interventions.

  1. Renewed US leadership in the global nutrition space

In 2019 – the lead-up to the original 2020 N4G dates – the US was pulling back from international obligations and seemed unlikely to make any sort of substantial commitment at N4G. By December 2021, the US has not only publicly committed up to $11 billion over three years to combat global malnutrition, but sent USAID Administrator Power to make the announcement. The commitment builds on the Biden Administration’s repeated nods to the importance of good nutrition, especially in the wake of the pandemic. Though it is still unclear how the US will fulfill its financial commitment and how much (if any) of the $11 billion is new money, US commitments throughout the Nutrition Year of Action signal its plans to remain at the forefront of the fight against global malnutrition. As the sector’s largest donor, and in the face of a notable lack of commitment from the UK, US leadership will be a key component of any successful nutrition effort. As advocates continue to socialize the Nourish the Future proposal in 2022, the Administration’s demonstrated commitment to global nutrition is a welcome signal for more to come.

On top of these successes, we saw a host of other positive developments for nutrition, such as the addition of multiple micronutrients to the WHO Essential Medicines List, a growing adoption of the new OECD DAC nutrition policy marker, and the recent release of the Global Financing Facility’s Nutrition Roadmap. Ultimately, Summit participants from around the world pledged over $27 billion toward global nutrition at a time when donor fatigue is high and every country in the world is facing outsized domestic challenges. 2021 was a year of setbacks in our fight against malnutrition, but the new tools and resources coming out of the Nutrition Year of Action give us hope that the state of global nutrition will look better in 2022 and beyond.

The Looming Threat of Malnutrition in the COVID-19 Pandemic

Co-hosted by 1,000 Days, Bread for the World and InterAction, The Looming Threat of Malnutrition in the COVID-19 Pandemic, brought together five speakers from different fields including government, the nutrition community and documentary film, to share their perspectives on how COVID-19 has impacted health and nutrition for women, children, and families globally. The overwhelming consensus: the time to act on addressing dramatically increasing rates of severe malnutrition around the world is now.

The picture is staggering. In many parts of the world, malnutrition related to the pandemic is projected to kill more people, especially children, than the pandemic itself because of COVID-19-related disruptions to food and health systems. Recent estimates show that by 2022, these disruptions could leave an additional 12 million children severely malnourished.

Investing in nutrition can’t wait.

Highlights from the virtual briefing moderated by Jenny Marron, Director of Public Policy and Government Relations at InterAction:

Congressman Jim McGovern, co-chair of the House Hunger Caucus, spoke to the importance of investing in nutrition now not later so that we do not lose progress. A strong nutrition advocate, McGovern laid out in urgent terms what is at stake: “We know that each day we fail to focus on the threat of malnutrition, that means another child will grow up stunted, a mother will give birth to a malnourished baby…and a family and a community will have a diminished future.” He followed by explaining we know what needs to be done to combat malnutrition and food security and that investments in the health of women and children are in the best interest of us all. View his remarks here.

Skye Fitzgerald, Emmy and Oscar nominated documentary filmmaker, discussed his film Hunger Ward which chronicles the famine in Yemen. He provided a view of what severe malnutrition looks like in the world right now. Watch a clip from his film here.

Karin Lapping, Nutrition Technical Director at FHI Solutions, outlined the causes of malnutrition and the proven solutions we have to save women and children. She explained that poor nutrition affects every aspect of a person’s life, especially in three main areas: education, health, and economics. But we have the solutions, like the protection and promotion of breastfeeding, which is an extremely successful intervention that saves lives, and is easily scalable. Her concluding remarks were straight to the point: “Bottom line, we have to act now. Children are dying and this will continue to happen. It is an ethical, economic, and human remit. We must reinvigorate efforts towards nutrition. The cost is too high not to.”

Asma Lateef, Director at Bread for the World Institute, highlighted the history of U.S. leadership on nutrition and the need for that to continue by saying: “We know that when the U.S. leads, other donors and partners follow. That is crucial.”

Shawn K Baker, Chief Nutritionist at USAID, provided closing remarks, emphasizing that, while malnutrition is a major threat to the health and wellbeing of many children around the world, it is a problem for which there are numerous, cost-effective solutions. Additionally, if mothers, infants and young children have access to quality nutrition in the 1,000-day window, he emphasized, “we have locked in their ability to survive and to thrive, and that is irreversible.” The United States has demonstrated consistent commitment to ending the crisis of maternal and child malnutrition, even amidst the challenges posed by the coronavirus pandemic, and this leadership is crucial in ensuring the U.S., other partner governments, civil society and the private sector can work together and mobilize resources to have the greatest possible impact. Continued U.S. leadership is critical in improving the nutrition of mothers, infants, and young children— “we know it’s possible, we know it saves lives, and we know it ensures their future.”

Urgent investment in proven, cost-effective, and scalable nutrition solutions is necessary to address the crisis of maternal and child malnutrition and end preventable child deaths. The time to act is now.

Find a recording of the full event here. And for more, read our brief on severe malnutrition and COVID here.