One of the welcome and surprising headline findings from the 2015 global nutrition report is that 39 out of 114 countries with data are on course to meet the World Health Assembly goals for under-five stunting.
This represents a real achievement. One year ago, the number of countries set to meet the goals was only 24. The increase to 39 is enormous. And even countries that are not on course are accelerating the pace at which stunting reduction is happening, among them India, Bangladesh and Ethiopia.
The speed of the reduction is particularly impressive, given that the accepted view has always been that stunting is an indicator of long-term deprivation, and would take a long time to turn around. Experience from the state of Maharashtra in India, as well as from Kenya, Vietnam and Brazil, has shown us that rapid declines can take place in less than a generation.
How has this happened? We do not have definitive proof, but we believe it is because of concerted efforts to address the problem. Changes have occurred: countries have made it a priority; donors have stepped up; energy levels are high; and knowledge about what to do is unprecedented.
The challenge for countries now is to expand the commitment to tackle malnutrition in all its forms, and to do so without diluting the progress made against stunting. We also need to remember that 75 of the 114 countries with data on stunting progress are not on course for the goals.
How can we meet that hydra-headed challenge? We believe three things have to happen.
First, we have to reframe malnutrition. It is not just about stunting or anaemia or obesity – it is all of these things. All forms of malnutrition come back to interactions between poor diets and unhealthy environments, such as open defecation or food systems that serve profit over health. We quickly need to unify the different disciplines within nutrition. We need to bring malnutrition into the 21st-century vision of sustainable development – and give it coherence.
Second, we need to apply what is working for stunting to other areas. We know that we need the following to address stunting: strong government commitment; policies that make environments around people healthy, reduce poverty and educate and empower women; and interventions delivered through the health and care systems to ensure nutrient needs are met and malnutrition is prevented and treated.
Yet too often the political commitment to this approach to reducing all forms of malnutrition is lacking. Overweight and obesity are not taken seriously enough as threats to health, and rates of anaemia among women are often invisible.
We ask governments to have the courage to commit to reducing malnutrition in all its forms. Nutrition champions need to create the political environment to enable that to happen – or at least make it uncomfortable for politicians and bureaucrats if nothing is done.
Third, we need to identify “double duty” actions that work to prevent or reduce multiple forms of malnutrition. For example, exclusive breastfeeding and complementary feeding help protect people throughout their lives from multiple forms of malnutrition.
Schools play an important part in this, in both providing nutritious food and teaching how to make healthy food choices. Food systems need attention and can be geared towards promoting nutrition, for example through a greater emphasis on productivity and resilience of pulses, fruits and vegetables. Businesses should stop partitioning their work into things they do to improve undernutrition and things they do that affect obesity and diet-related non-communicable diseases – they are connected.
The three authors of this paper come from different nutrition disciplines. Working together over the past five months on the global nutrition report, we have been struck by the similarities of approach in each of our specialist areas, as well as by the different language used to describe the same things.
Bringing these wings of the nutrition family together will create a more powerful force for change.
Of course, it will require changes in institutional organisation, in developing solutions, and in capacity, training and research. But as the global nutrition reports of the last two years found, nearly half of all countries have both of these variants of malnutrition (stunting or anaemia, plus adult obesity). The data has already made our old divisions obsolete. It is time to bring malnutrition into the 21st century – and end it.
- Lawrence Haddad, Corinna Hawkes and Emorn Udomkesmalee are co-chairs of the Independent Expert Group of the global nutrition report