Good nutrition is the lifeblood of sustainable development and drives the changes needed for a more sustainable and prosperous future
New evidence continues to signal that the number of hungry people in the world is growing, reaching 821 million in 2017 or one in every nine people, according to “The State of Food Security and Nutrition in the World 2018” released on 11 Sept.2018. Limited progress is also being made in addressing the multiple forms of malnutrition, ranging from child stunting to adult obesity, putting the health of hundreds of millions of people at risk.
Last year, The State of Food Security and Nutrition in the World marked the start of a new era in monitoring progress towards achieving a world without hunger and malnutrition in all its forms – an aim set out in the 2030 Agenda for Sustainable Development (2030 Agenda). Addressing the challenges of hunger, food insecurity and malnutrition in all its forms features prominently in the second Sustainable Development Goal (SDG) of the 2030 Agenda:
Ensuring access to safe, nutritious and sufficient food for all (Target 2.1) and eliminating all forms of malnutrition (Target 2.2). It is also understood that attainment of SDG2 depends largely on – and also contributes to – the achievement of the other goals of the 2030 Agenda: ending poverty; improving health, education, gender equality and access to clean water and sanitation; decent work; reduced inequality; and peace and justice, to name only a few.
This transformational vision embedded in the 2030 Agenda provides an imperative for new ways of thinking, acting and measuring. For example, the growing global epidemic of obesity, which is increasingly affecting lower income countries and rapidly adding to the multiple burden of malnutrition and non-communicable diseases, also points to the need to re-examine how we think about and measure hunger and food insecurity as well as their linkages with nutrition and health. Fortunately, data gathering and measurement tools are rapidly evolving to meet the monitoring challenges presented by the new agenda.
Last year, this report included several innovations aimed at promoting new ways of thinking about food security and nutrition in the context of the 2030 Agenda and responding to the challenges of the Second International Conference on Nutrition (ICN2) Framework for Action and the UN Decade of Action on Nutrition 2016–2025. The scope of the report was expanded to include a set of six nutrition indicators used to monitor World Health Assembly global targets for nutrition and diet-related non-communicable diseases, three of which are also indicators of the SDG2 targets. The report also introduced for the first time a new indicator of food security, the prevalence of severe food insecurity based on the Food Insecurity Experience Scale (FIES), which is an estimate of the proportion of the population facing serious constraints on their ability to obtain sufficient food.
Evidence continues to signal a rise in world hunger. According to available data, the number of people who suffer from hunger has been growing over the past three years, returning to levels from a decade ago. The absolute number of people in the world affected by undernourishment, or chronic food deprivation, is now estimated to have increased from around 804 million in 2016 to nearly 821 million in 2017. The situation is worsening in South America and most regions of Africa; likewise, the decreasing trend in undernourishment that characterized Asia until recently seems to be slowing down significantly.
Without increased efforts, there is a risk of falling far short of achieving the SDG target of hunger eradication by 2030.
Good nutrition is the lifeblood of sustainable development and drives the changes needed for a more sustainable and prosperous future.
Progress, although limited in magnitude and pace, has been made in reducing child stunting and increasing exclusive breastfeeding for the first six months of life. Nonetheless, while the prevalence of overweight in children under five years may not have changed significantly in recent years, adult obesity continues to rise and one in three women of reproductive age in the world is anaemic.
Multiple forms of malnutrition are evident in many countries. Poor access to food and particularly healthy food contributes to under-nutrition as well as overweight and obesity. It increases the risk of low birth-weight, childhood stunting and anaemia in women of reproductive age, and it is linked to overweight in school-age girls and obesity among women, particularly in upper-middle- and high-income countries. The higher cost of nutritious foods, the stress of living with food insecurity and physiological adaptations to food restriction help explain why food insecure families have a higher risk of overweight and obesity. Additionally, maternal and infant/child food deprivation can result in foetal and early childhood “metabolic imprinting”, which increases the risk of obesity and diet-related non-communicable diseases later in life.
Having thoroughly investigated the role of conflict last year, the focus in 2018 is on the role of climate – more specifically, climate variability and extremes forms of malnutrition are evident in many countries. Poor access to food and particularly healthy food contributes to undernutrition as well as overweight and obesity. It increases the risk of low birthweight, childhood stunting and anaemia in women of reproductive age, and it is linked to overweight in school-age girls and obesity among women, particularly in upper-middle- and high-income countries. The higher cost of nutritious foods, the stress of living with food insecurity and physiological adaptations to food restriction help explain why food insecure families have a higher risk of overweight and obesity. Additionally, maternal and infant/child food deprivation can result in foetal and early childhood “metabolic imprinting”, which increases the risk of obesity and diet-related non-communicable diseases later in life.
Climate variability and extremes are a key driver behind the recent rises in global hunger and one of the leading causes of severe food crises. The changing nature of climate variability and extremes is negatively affecting all dimensions of food security (food availability, access, utilization and stability), as well as reinforcing other underlying causes of malnutrition related to child care and feeding, health services and environmental health. The risk of food insecurity and malnutrition is greater nowadays because livelihoods and livelihood assets – especially of the poor – are more exposed and vulnerable to changing climate variability and extremes. What can be done to prevent this threat from eroding the gains made in ending hunger and malnutrition in recent years?
This report launches an urgent appeal to accelerate and scale up actions to strengthen resilience and adaptive capacity in the face of changing climate variability and increasing extremes. National and local governments are facing challenges in trying to determine measures to prevent risk and address the effects of these stressors. They can be guided by existing global policy platforms and processes whereby climate resilience is an important element: climate change (governed by the UNFCCC and the 2015 Paris Agreement); disaster risk reduction (the Sendai Framework on Disaster Risk Reduction); humanitarian emergency response (the 2016 World Humanitarian Summit and the Grand Bargain); improved nutrition and healthy diets (the Second International Conference on Nutrition
[ICN2] and the UN Decade of Action on Nutrition 2016–2025); and development (as part of the overarching 2030 Agenda for Sustainable Development).
However, it is important to ensure better integration of these global policy platforms and processes to ensure that actions across and within sectors such as environment, food, agriculture and health pursue coherent objectives. The success of policies, programmes and practices that national and local governments implement to address these challenges will also depend on cross-cutting factors, as well as specific tools and mechanisms that are adaptable to specific contexts.
Call for action
The report calls for implementing and scaling up interventions aimed at guaranteeing access to nutritious foods and breaking the intergenerational cycle of malnutrition. Policies must pay special attention to groups who are the most vulnerable to the harmful consequences of poor food access: infants, children aged under five, school-aged children, adolescent girls, and women.
At the same time, a sustainable shift must be made towards nutrition-sensitive agriculture and food systems that can provide safe and high-quality food for all.
The report also calls for greater efforts to build climate resilience through policies that promote climate change adaptation and mitigation, and disaster risk reduction.
“By 2030, end all forms of malnutrition, including achieving, by 2025, the internationally agreed targets on stunting and wasting in children under five years of age, and address the nutritional needs of adolescent girls, pregnant and lactating women and older persons.”
Nutrition is central to the 2030 Agenda. Target 2.2 calls for an end to all forms of malnutrition, and good nutrition also lays the foundation for achieving many of the SDGs (Figure 5). Improvements in nutrition directly support the achievement of ensuring healthy lives (SDG3), while also playing a role in ending poverty (SDG1), ensuring quality education (SDG4), achieving gender equality (SDG5), promoting economic growth (SDG8), and reducing inequalities (SDG 10). In this way, good nutrition is the lifeblood of sustainable development, and drives the changes needed for a more sustainable and prosperous future.
In the 2012 World Health Assembly (WHA), Member States approved six global targets for improving maternal, infant and young child nutrition to be met by 2025. These WHA targets call for measures to: i) reduce anaemia in women of reproductive age; ii) reduce low birthweight in newborns; iii) increase rates of exclusive breastfeeding in infants; iv) reduce stunting; v) reduce wasting; and vi) halt the rise of overweight among children under five years of age. The latter three are also part of the SDG monitoring framework. To align with the 2030 deadline of the SDGs, this set of 2025 targets has been extended to 2030 to establish global targets for nutrition. In addition, the WHA plan of action for the prevention and control of non-communicable diseases also called for a reduction in adult obesity by 2025.
Extending the World Health Assembly Nutrition Targets to 2030
In 2012, the World Health Assembly (WHA) agreed on six global targets for improving maternal, infant and young child nutrition to be achieved by 2025. Subsequently, in 2015, the Sustainable Development Goals established a global agenda for substantial improvement in nutrition by the year 2030, setting a specific objective of ending all forms of malnutrition by 2030, including achieving the 2025 targets and addressing the nutritional needs of adolescent girls, pregnant and lactating women, and older persons.
To align with the deadline year of 2030 for all SDG targets, UNICEF and WHO then extended the WHA nutrition targets up to the same year – in the process making some of them more ambitious – keeping in mind the original methodology used, the ambition declared in the SDGs to “end all forms of malnutrition”, and the feasibility of achieving the new targets.12
The 2030 nutrition targets have been calculated based on a similar approach to that used for the 2025 targets. The rates of improvement between 1999 and 2017 were calculated for each indicator for all countries with trend data. After excluding countries that had already achieved a low level of malnutrition, the 20th percentile among all the rates of improvement was selected as an ambitious rate of improvement, but also one that has proven to be feasible in a large number of countries. This 20th percentile of the annual rate of improvement was then applied to the baseline prevalence globally to calculate a new 2030 target.
Final numbers were rounded. For two of the indicators (low birthweight and anaemia in women of reproductive age), the past rate of improvement has been too slow to achieve the WHA target, even by 2030. Thus, for these indicators, the revised 2030 target is the same as the 2025 target, since the level of ambition for 2030 should not be less than that agreed upon for 2025.
For the other indicators, more ambitious targets for 2030 are proposed.