Malnutrition in all its forms: a double burden & a double duty for food policyProf Corinna Hawkes, Director, Centre for Food PolicyCo-Chair, Global Nutrition Report

2.1 By2030endhungerandensureaccessbyallpeople,in

particularthepoorandpeopleinvulnerablesituationsincludinginfants,tosafe,nutritiousandsufficientfoodallyearround.

2.2 By2030endallformsofmalnutrition,includingachieving

by2025theinternationallyagreedtargetsonstuntingand

wastinginchildren.

GlobaltargetsinWHA65/6Comprehensiveimplementationplanonmaternal,infant&youngchildnutritionadoptedbyMemberStatesofWHO(2013)

3.4By2030,reducebyonethirdprematuremortalityfromnon-communicable

diseasesthroughpreventionandtreatmentandpromotementalhealthandwell-being

GlobaltargetsinComprehensiveglobalmonitoringframeworkfortheprevention&controlofNCDsadoptedbyWHOMemberStates(2013)

Source:NCDAlliance

Nutrition feeds into 12 of the 17 SDGs — and dozens of the indicators used to track the SDGs

1

1

2

2

3

3

3

3

7

7

12

12

Goal 12: Sustainable cons & prodn

Goal 17: Global Partnerships

Goal 8: Growth & Employment

Goal 16: Peace and Justice

Goal 4: Education

Goal 6: WASH

Goal 10: Reduce Inequality

Goal 11: Cities

Goal 1: Poverty

Goal 2: Hunger and Nutrition

Goal 3: Healthy Lives

Goal 5: Gender Equality

Number of indicators highly relevant to nutritionNumber of indicators not highly relelvant to nutrition

Source: GNR authors

www.globalnutritionreport.org

www.globalnutritionreport.org#NutritionReport

Global Nutrition Targets: where are we now?

Malnutritioninallitsformsispervasive

• Malnutritionaffectsall193 countries

• Malnutritionaffects1in3people- willriseto1in2peopleifcurrenttrendscontinue

• 800millionarehungry,2billionhavemicronutrientdeficiency,1.9billionareoverweightorobese

• Overweight/obesityratesarerisingineverycountry• Undernutritionratesdecreasingtooslowly

Malnutrition in Nordic countries

55 55 56 58 59

19 21 21 23 23

5 7 6 7 7

Denmark Finland Sweden Iceland Norway

Adult overweight, obesity and diabetes, 2014 (%)

Adult overweight

Adult obesity

Adult diabetes

All Nordic countries are OFF COURSE for overweight and obesity and only Iceland is ON COURSE for diabetes

Women’s Anemia rates ≥ 20% (2011)

Adult Overweight

(BMI ≥ 25) rates≥ 35% (2014)Antigua and Barbuda,

Bahamas, Bahrain, Barbados, Brunei Darussalam, Croatia, Cyprus, Czech Republic, Estonia, Greece, Hungary, Kuwait, Latvia, Lithuania, Oman, Poland, Qatar, Seychelles, Slovakia, Slovenia, United Arab Emirates

Double burden in high-income countries

Andorra, Australia, Austria, Belgium, Canada, Chile, Denmark, Finland, France, Germany, Iceland, Ireland, Israel, Italy, Luxembourg, Malta, Netherlands, New Zealand, Norway, Portugal, Spain, Sweden, Switzerland, UK, USA, Uruguay

Japan, Singapore

Republic of Korea

Under 5 Stunting

Women’s Anemia

Adult OverweightEthiopia, Rwanda

Ghana, Japan, Senegal, Sri Lanka, Thailand

Argentina, Australia, Brazil, Chile, Colombia, Costa Rica, Germany, Mexico, Paraguay, Peru, FYR Macedonia, Tonga, USA, Uruguay

Afghanistan, Angola, Bangladesh, Benin, Bhutan, Burkina Faso, Burundi, Cambodia, Cameroon, Central African Republic, Chad, Comoros, Congo, Côte d’Ivoire, Democratic People’s Republic of Korea, Democratic Republic of the Con-go, Djibouti, Eritrea, Gambia, Guinea, Guinea-Bissau, India, Indonesia, Kenya, Lao People’s Democratic Republic, Liberia, Madagascar, Malawi, Maldives, Mali, Mauritania, Mozambique, Myanmar, Nepal, Niger, Nigeria, Pakistan, Philippines, Sao Tome and Principe, Sierra Leone, Somalia, Sudan, Timor-Leste, Togo, Uganda, Tanzania, Zambia, Zimbabwe

Honduras, Nicaragua

Algeria, Azerbaijan, Barbados, Belarus, Belize, Bolivia, Bosnia and Herzegovina, Brunei Darussalam, Dominican republic, El Salvador, Gabon, Georgia, Guyana, Iran, Jamaica, Jordan, Kazakhstan, Kuwait, Kyrgyzstan, Malaysia, Mongolia, Montenegro, Morocco, Oman, Panama, Republic of Moldova, Saint Lucia, Saudi Arabia, Serbia, Seychelles, Suriname, Tunisia, Turkey, Uzbekistan, Venezuela

Albania, Armenia, Botswana, Ecuador, Egypt, Equatorial Guinea, Guatemala, Haiti, Iraq, Lesotho, Libya, Namibia, Papua New Guinea, Solomon Islands, South Africa, Swaziland, Syria, Tajikistan, Vanuatu, Yemen

China, Republic of Korea, Vietnam

Multiple burdens globally

Double burden: the new normal

2.Foodanddietasadriverofthedoubleburden

Most global burden of disease risk factors are linked to diet

Akeyfactorincommonbetweenpeopleatriskofundernutrition &obesity:poordietquality

Risingconsumptionofsugars,fats,ultra-processedfoodsinmostplacesandamongmostpeople,includinginfants

15% Anaverageofonly15%ofunder-2’sconsumeaminimallyacceptablediet.

50% Morethanhalfofallwomeninterviewedin6sub-Saharancountriesdonotconsumelegumes,nuts,vitaminA-richfruitsandvegetables,dairyoreggsinanygivenday

Proportion of daily food intake among infants aged 6-23 months, Egypt

Source:Kavle,JustineA.,etal."Exploringwhyjunkfoodsare‘essential’foodsandhowculturallytailoredrecommendationsimprovedfeedinginEgyptianchildren."Maternal&childnutrition11.3(2015):346-370.

Proportionofinfantsaged6-23monthsconsumingsweet/savorysnacks,Nepal

Source:PriesA,HuffmanS,Champeny M.AssessmentofPromotionofFoodsConsumedbyInfantsandYoungChildreninNepal:AssessmentandResearchonChildFeeding(ARCH)– NepalCountryReport.HKI,2015

3.Whatapproacheshavebeentakentotodatetoaddressobesityandundernutrition?

1.Obesity

CROSS-SECTOR INITIATIVES OF THE UN AGENCIES

Source:WCRFInternational

2. Undernutrition

§ Folicacidsupplementationorfortification§Universalsaltiodization§Balancedenergy-proteinsupplementation§Calciumsupplementation§Multiplemicronutrientsupplementation§Promotionofbreastfeeding(counselling)§Promotionofcomplementaryfeeding(education)§ Feedingforchildrenwithmoderateacutemalnutrition§Therapeuticfeedingforseverelywastedchildren§VitaminAsupplementation§Zinctreatmentfordiarrhea§Preventivezincsupplementation

Directnutritioninterventions

Evidenceinpracticealsoshowscrucialroleofaddressingthe“causesofthecauses”

“In short, the causes of the impressive decline in childmalnutrition in Brazil appear to lie in the improvements incoverage of essential public services and increases infamily income, both particularly favoring the poor”(Monteiro, 2009)

2016 GNR success stories show key elements ofsuccess are: political commitment; economicgrowth/poverty reduction, education; female education;water, sanitation and health; health systems; socialprotection, supplementation as success factors in thereduction of undernutrition (food and diets not mentioned)

1960s/70s:assumptioninagriculturecommunitythatfoodavailabilitywastheanswerto“hunger”

“Itwasassumedthattheoverallincreaseintheaggregatefood

supplyandhigherincomethroughagriculture(thedominant

occupationofthepoor)werethemainroutestobetternutrition”

(WorldBank,2014)

Food environments

Food production

People’s purchasing power

People’snutrientintake

People’s diets

Food production,storage,distribution,trade,

transformation,processing,retailing,provision

The

food

sys

tem

The“dietdisconnect”

Example: school food policies

Healthyschoolmeals?

SchoolfoodprogrammeinSyria(Source:WorldFoodProgramme)

4.Whatcanfood policydo?

A.Unifythefood-relatedcausesofmalnutritionaroundpoliciestoimprovedietquality

WHOdefinitionofahealthydietemphasizestheimportanceofstarting

healthyeatinghabitsinearlylife(notablythroughbreastfeeding)andlimitingtheintakeoffreesugarsandsalt.Itadvises

peopletoeatplentyoffruitsandvegetables,wholegrains,bre,nutsandseeds,whilelimitingfreesugars,sugarysnacksandbeverages,processedmeatsandsalt,andreplacingsaturatedandindustrialtransfatswithunsaturated

fats.(p.17)

“Researchers who work on all forms of malnutrition should come together with the international agencies to identify

‘double-duty actions’ that can address undernutrition as well as overweight, obesity and nutrition-related non-communicable

diseases simultaneously.”

B.Shiftpolicymakersmindsetsto“doingdoubledutyforthedoubleburden”

Examples of application to infants and young childrenN Restrict misleadingclaims/labelsofmilks,complementaryfoods,foods>2

O Offeronlyhealthyfoodsinpre-schoolsettingsU Useconditional cashtransferstoprovidehealthyeatingincentives

R Restrictinappropriate marketingofBMS,complementaryfoods,foods>2

I Improvethenutritionalquality(e.g. sugars)ofcomplementaryfoods,foods>2

S Setzones forhealthyfoodretailinplaceswhereyoungchildrengather

H Harnessagriculturalinterventionstopromotedbackyardgardenswithfruit-trees

I Informpeoplethroughpublicawarenessaboutinappropriatenessof“junk”foodasfoodsforinfants/youngchildren

N NutritioncounsellingforpregnantwomenG Give nutritioneducation(foodliteracy,skills)tofamilieswithyoungchildren

C.Introduceevidence-informedpoliciestoencourage“healthydietsforhealthygrowth”

D. Identify opportunities to lever food environments & systems for double dietary benefits

City, University of LondonNorthampton SquareLondonEC1V 0HBUnited Kingdom

T: +44 (0)20 7040 5060E: department@city.ac.ukwww.city.ac.uk/department

Corinna HawkesProfessor of Food Policy

Director, Centre for Food PolicyCo-Chair, Global Nutrition Report

corinna.hawkes@city.ac.uk@corinnahawkes@FoodPolicyCity

@GNReport