Malnutrition: the new challenges are also the new opportunities…

by Lawrence Haddad | Global Alliance for Improved Nutrition (GAIN)
Thursday, 13 December 2018 10:33 GMT

Andrea Abarca, (C) leads an aerobics class in Los Guidos de Desamparados July 23, 2015. More than 300 women participated in a physical health program organized by Abarca, which aims to combat obesity and sedentary behavior in poor women living in a slum. REUTERS/Juan Carlos Ulate

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The nature of malnutrition has fundamentally changed in one generation and this new environment offers some powerful new opportunities--if we can seize them.

Lawrence Haddad is the Executive Director of the Global Alliance for Improved Nutrition (GAIN) and co-winner of 2018’s World Food Prize.

Last week, the International Atomic Energy Agency (IAEA) organised a Symposium on the double burden of malnutrition. The focus on Day 1 was on interventions and the need for more “Double Duty” interventions featured in the 2015 Global Nutrition Report – interventions around undernutrition, such as exclusive breastfeeding, that also help tackle overnutrition later.

We also learned from the 2018 Global Nutrition Report launch that 67% of 141 countries now have simultaneous serious undernutrition and serious overweight/obesity situations—up from 44% in the 2014 Global Nutrition Report. This is an astonishing rise.

Truly the double burden has become the “new normal”.

But there are several ways in which this creates a series of opportunities.

New Allies

Malnutrition affects every country. This means, for example, those regulating farmers’ markets in California and those regulating wet markets in Dhaka may well have lessons to share with each other. Or those implementing sugar taxes in Europe can learn from those in Mexico. Or those trying to promote vegetable power in the UK can learn from those trying to do the same thing in South Africa. Potential new allies are everywhere. Together we are stronger.

New Agents of Change

Compared to undernutrition, malnutrition in all its forms is more evenly spread across age groups and income groups and, crucially, geographies. No longer is malnutrition a problem “over there”. And we know that wealthier groups have more agency. And compared to under 5’s, adolescents and adults certainly do have more power. We/they need to leverage their influence and agency to defeat something that affects everyone, including those whose agency is not yet so strong. The lessons around HIV/AIDS should echo here – global action was catalysed by the fact that this terrible disease hit the gay community in western countries so hard, galvanising a truly global response to help change attitudes, and prevent and improve treatment everywhere.

New Stakeholders

Malnutrition in all its forms has one defining shared feature - inadequate food intake. Reducing undernutrition has traditionally been seen as more of a public sector duty than reducing malnutrition in all its forms. As most people buy food from markets that means businesses have to be engaged if we want more nutritious, affordable, tasty food. There are risks associated with engaging, but there are risks (I think) of not engaging. The bigger risks are in the status quo: seeing the exponential rise of overweight and obesity going unchecked, especially among children.

New Awareness of Competing Interests

With more business engagement comes more potential as well as actual conflict of interests. This is an opportunity to understand how to identify, prevent, minimise, manage and mitigate those conflicts of interest—wherever they occur. A greater understanding of conflict of interest will highlight conflicts within the public sector too. For example, when I was at the Global Nutrition Report we were funded by many of the funders we were holding accountable (notably aid agencies), but there was not a peep about this from any of the internal or external reviewers. Business rightly calls for a level playing field for all.

Becoming Global Nutrition Researchers

Are you an international researcher or a domestic researcher? Well this dichotomy no longer has much salience (if it ever did). If you do research on the UK, the chances are that it has relevance for Latin America, Asia or Africa. And vice versa. Even if there is not much direct relevance wouldn't it be great to do multi country research across the five continents to get some external validity across our work? Generally, research funding is split along “developing/developed” lines, but this is a hangover from the Millennium Development Goals and has no place in the era of Sustainable Development Goals. Wherever you do research on nutrition, you are a global researcher.

It is a truism that every crisis is an opportunity. And make no mistake the double burden is a crisis. But, true to the saying, it is also an opportunity. We need big answers to these big problems and to make this a shared global task is fundamental.

The Global Nutrition Summit of September 2020 in Tokyo is the next big chance to do this -- the best we will have before 2030. Let’s make the most of it.

Let’s bring these “opportunity perspectives” to Tokyo and make it a moment that grows the nutrition movement, rather than merely consolidates past gains, one that elevates nutrition into the consciousness of those who rarely think about it, and one that supercharges the nutrition movement, rather than simply fills up its tank.

We need to be bold and ambitious for this generation – and for future ones.