Phil Hay (202) 473-1796
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Olivia Elee (202) 458-7318
WASHINGTON, March 2, 2006—A new World Bank report warns that malnutrition is costing poor countries up to 3 percent of their yearly GDP, while malnourished children are at risk of losing more than 10 percent of their lifetime earnings potential. The report also says malnutrition may increase the risks of HIV infection, while reducing the numbers of children and mothers who survive malaria.
According to the new report—Repositioning Nutrition as Central to Development—malnutrition has long been known to undermine economic growth and perpetuate poverty, and yet, over previous decades, the international community and most governments in developing countries have failed to tackle malnutrition, even though well-tested approaches for doing so exist. As the report says, “the unequivocal choice now is between continuing to fail, as the global community did with HIV/AIDS for more than a decade, or to finally put nutrition at the center of development so that a wide range of economic and social improvements that depend on nutrition can be realized.”
The report says developing countries that invest in better nutrition for their children get high returns on their spending. A group of the world’s leading development economists, including three Nobel Laureates, concluded in a 2004 study known as the Copenhagen Consensus, that nutrition investments were one of the ‘best buys’ that developing countries could make in reducing poverty and improving economic growth.
“Poor nutrition is implicated in more than half of all child deaths worldwide—a proportion unmatched by any infectious disease since the Black Death,” says Jean-Louis Sarbib, Senior Vice President for Human Development at the World Bank. “It is intimately linked with poor health and environmental factors and yet, policymakers, politicians, and economists often fail to recognize these connections. For example, nearly 60% of children who die of common diseases like diarrhea and malaria could have ultimately survived had they not been malnourished in the first place.”
Malnutrition is not only the starkest manifestation of poverty—the report calls it the ‘non-income face of poverty’: it helps perpetuate poverty. Sarbib also says that malnourished children are more likely to drop out of school, are less likely to benefit from schooling, and have lower incomes as adults, while improving nutrition can add 2-3% to the GDP in poor countries and drive their economic growth. “Put this in the context that the economies of many developing countries are growing at the rate of 2-3% annually, and improving nutrition could potentially double these rates. Yet the development community has done little in this area to-date,” says Sarbib.
Why malnutrition persists
Contrary to popular perceptions, malnutrition is not simply the result of having too little food to eat: in fact, many children living in households with plenty to eat are still under-weight or stunted because of misguided infant feeding and care practices, poor access to health services, or poor sanitation. In many countries where malnutrition is widespread, food production is not the limiting factor except under famine conditions. Some of the most important factors are:
- Pregnant and nursing women eat too few calories and too little protein, have untreated infections, such as sexually transmitted diseases that lead to low birthweight, or do not get enough rest
- Mothers have too little time to take care of their young children or themselves during pregnancy
- Mothers of newborns discard their first breast milk known as ‘colostrum’ which strengthens the child’s immune system
- Mothers often feed children under the age of six months foods other than breast milk even though exclusive breastfeeding is the best source of nutrients and the best protection against many infectious and chronic diseases.
Under-nutrition’s most damaging effect occurs during pregnancy and in the first two years of life, and the effects of this early damage on health, brain development, intelligence, educability, and productivity are largely irreversible. Nutrition programs aimed at older children have little, if any effect. Initial evidence suggests that the origins of obesity and non-communicable diseases, such as cardiovascular heart disease and diabetes, may also lie in early childhood.
The Bank says that governments with limited resources are best advised to focus action on this small window of opportunity, between conception and 24 months of age, although action to control obesity may need to continue later.
“Intuitively, we all think that putting more food in the mouths of children will improve nutrition, and yet, as this report shows us, there is actually a very small "window of opportunity" to improve nutrition, between pregnancy and two years of age,” says Meera Shekar, a Senior Nutrition Specialist in the World Bank’s Human Development Network, and lead author of the new report. “The damage that happens during this period is irreparable. If we miss this window, we have missed the opportunity to address an entire generation of children.”
Africa and South Asia most affected by malnutrition
The report says nearly one-third of children under five in the developing world remain underweight or stunted, and 30 percent of the developing world’s population continues to suffer from too few vitamins and minerals. But the picture is changing: malnutrition is on the rise in Sub-Saharan Africa. Malnutrition and HIV/AIDS reinforce each other, so the success of HIV/AIDS programs in Africa depends in part on paying more attention to nutrition.
In Asia, malnutrition rates are falling, but South Asia still has both the highest rates and the largest numbers of malnourished children. Contrary to common perceptions, under-nutrition prevalence rates in the heavy-populated South Asian countries—India, Bangladesh, Afghanistan, Pakistan— are much higher (38 to 51 percent) than those in Sub-Saharan Africa (26 percent).
Even in East Asia, Latin America, and Eastern Europe, many countries have a serious problem of under-nutrition or micronutrient malnutrition. Examples include Cambodia, Indonesia, Lao PDR, the Philippines, and Vietnam; Guatemala, Haiti, and Honduras; and Uzbekistan.
“We certainly knew that large numbers of malnourished children lived in South Asia, but what this report now shows us is the shocking fact that the rates of under-nutrition in South Asia are nearly double those in Sub-Saharan Africa,” says Praful Patel, World Bank Vice President for the South Asia Region. “Nearly half of India's children are undernourished, compared with a quarter of those in Sub-Saharan Africa. This situation is unacceptable, and given its constant impact on the Indian economy, the Bank is working closely with the government to reinvigorate the campaign against malnutrition in South Asia.”
How can countries make a difference?
In spite of severe economic setbacks, many developing countries have made impressive progress. For example, more than two-thirds of the people in developing countries now eat iodized salt along with their food, combating iodine deficiency that affects about 3.5 billion people, especially women and children in more than 100 nations. About 450 million children a year now receive vitamin A capsules, tackling a deficiency that increases child mortality. The research shows clearly that, though economic growth slowly reduces malnutrition (and is key to generating the financial resources to fund nutrition programs), these kinds of direct nutrition programs have a much more direct and rapid impact than countries can get by relying only on economic growth.
Improving nutrition requires focused action by parents and communities, backed by local and national action in health and public services, especially water and sanitation. Thailand has shown that moderate and severe malnutrition can be reduced by 75 percent or more in a decade by such means. Other ways of improving nutrition include providing health and nutrition education and services (such as promoting exclusive breastfeeding, coupled with prenatal care and basic maternal and child health services), micronutrient supplements and fortified food.
“We see growing evidence that in both middle-income and poorer countries there are innovative ways to improve nutrition out there,” says Paul Gertler, Chief Economist of the World Bank’s Human Development Network, and Professor of Health Economics and Finance at the University of California, Berkeley.“Experience in Mexico shows us that conditional cash transfers, coupled with improved health and nutrition services, have allowed poor people to considerably improve their nutritional status, while other countries, such as Bangladesh, Honduras, and Madagascar, have successfully mobilized local communities to tackle malnutrition by joining forces with NGOs to use community-based approaches.”
The new report encourages countries wanting to fight malnutrition more effectively to apply the lessons of these innovative case studies to ‘scale-up’ more far-reaching national nutrition programs that would potentially help hundreds of millions of people worldwide. Much of the failure to previously ‘scale up’ action in nutrition results from a lack of sustained government commitment, leading to low demand for assistance in nutrition.
In this situation, the role of international aid donors, development agencies, and other partners, must extend beyond responding only when requested to do so by governments. They must use their combined resources of aid, analysis, and advocacy, to encourage and persuade governments to move nutrition higher on their national agenda. The global and national media could also play a valuable role in persuading governments to pay more attention to nutrition.
Lastly, donors and countries must reverse the current situation where nutrition is woefully under-funded. To help achieve this, the development community will need to co-finance a grant fund to jumpstart action in commitment-building and action research, complementing a recent Bank US $3.6 million grant to help mainstream nutrition into maternal and child health programs.
Initial estimates suggest that the costs of addressing the micronutrient agenda in Africa are approximately $235 million per year. Costs for other regions and for other aspects of the nutrition agenda have yet to be estimated. Other estimates are much larger ($750 million for global costs for two doses of Vitamin A supplementation per year; between $1 billion and $1.5 billion for global salt iodization, including $800 million to $1.2 billion leveraged from the private sector; and several billion dollars for community nutrition programs).
The World Bank says this action plan needs to be agreed to, and then acted upon by developing countries together with the development community. As the new report argues, malnutrition perpetuates poverty, and “without coordinated, focused, and increased action, no significant progress in nutrition or in poverty reduction can be expected.”