If the ambition of the sustainable development goals, adopted in New York at the end of September, is to transform millions of lives, improving nutrition would seem a reasonable place to start. 3.5 billion people - one in every two people on the planet - is malnourished in some way, and the developmental and economic impacts of malnutrition have been well documented.
Iodine deficiency disorder (IDD) alone is a threat to 2 billion people around the world. According to the World Health Organisation (WHO), IDD “ is the leading cause of mental development disorders in young children. It is implicated in still-birth, miscarriage, physical impairment and thyroid dysfunction.” IDD can be prevented by consuming iodized table salt, and as a result, WHO calls this “one of the easiest and most cost-effective interventions for social and economic development.” The agency ranks eliminating iodine deficiency alongside some of the world’s biggest public health achievements, such as eradicating smallpox.
As poor nutrition is the result of so much more than just the absence of safe and nutritious foods, it is also a useful indicator for many of the other SDGs. The Global Panel on agriculture and food systems for nutrition writes: “Poor nutrition … derives from a host of interacting processes that link health care, education, sanitation and hygiene, access to resources, women’s empowerment and more.”
So the benefits of tackling food and nutrition insecurity - from micronutrient deficiencies to obesity - are clear. But one can argue that they have been for at least half a century (Costa Rica, for example, began to add iron to its wheat flour in 1958; the US and Switzerland have been adding iodine to salt since the 1920s) yet 805 million people are still hungry, 2 billion lack essential vitamins and nutrients and a further 1.4 billion people are overweight or obese.
Will the sustainable development goals, particularly goal 2, provide the momentum needed to establish nutrition as one of the key challenges of our time, alongside poverty, inequality and climate change?
This question, among others, was discussed in New York, at an event that preceded the SDG summit and was organised by GAIN and partners. On the importance of such a gathering, Marc van Ameringen, GAIN’s executive director said: “The theme for the last six months before the adoption of the goals has been how do we take nutrition to scale and how do we use partnerships more effectively to do that? It is important to reflect on the broad issues around nutrition and partnership and then to focus on the area where we’ve had the most traction as a community which is staple food fortification. 57 countries, 500 delegates came to take stock at a big summit in Arusha, [Tanzania]. We need a roadmap to finish the job.”
Despite all the progress that has been made (today, for example, there are salt iodization programmes in 140 countries worldwide), Shawn Baker, director of nutrition at the Bill & Melinda Gates Foundation, succinctly summarised the challenges ahead for the nutrition community. He described his area of work as invisible, [referring to the fact that chronic malnutrition often doesn’t manifest physically] orphan, (“who does the problem belong to?” Baker asked. “The ministry of health? Welfare? Agriculture?”) data poor and voiceless: “we don’t have activists scaling the walls of government,” Baker told the audience of representatives from government, civil society and the private sector.
It is the issue of voicelessness that seems a particular sticking point for the nutrition community. How do you get people to care about nutrition and respond to it as people did, for example, to the Aids epidemic in the 1980s and 90s? As Michelle Nunn, CEO of Care USA said: “The vast majority of the world don’t know and don’t understand.”
To make the point that the nutrition community often speaks in jargon that makes these central issues inaccessible - and referring to her recent appointment as head of Care USA - Nunn added: “I’m still learning my own acronyms!”
The road ahead may be long but there is no denying that developing countries have a better understanding now of the role of nutrition in building healthy, productive societies, than they did when the focus was simply on driving agricultural yields.
And it’s not just governments who are now singing from the same hymn sheet. Van Ameringen reflects on the sense of common purpose that has spread through the nutrition community - from policymakers to private sector: “When I look at the community dealing with hunger and nutrition, I don’t think there’s ever been as much unity and alignment - people coming together in new platforms to work together. That was never there before. We were highly siloed and nobody agreed on what the priorities are.”
It is this shared vision, coupled with the economic case for action, the low-cost of interventions such as food fortification, and the fact that once a programme is up and running it can be sustained by the market, that van Ameringen believes will motivate the community to keep going until the last mile is reached.
“We don’t want to be the ones who leave hunger and malnutrition to our children,” he says. “There are so many hard things to do on that list of 17 goals and 169 targets. Fortification is one of the easy ones, and it is sustainable.”
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