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Page 1: Webb a4 nh-ispc

A Multi-Dimensional Index of Nutrition

Patrick Webb, H. Luo and U. Gentilini

A4NH/ISPC Workshop on Nutrition

Washington, D.C. September 2014

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Not another index?!!! Yes, because we need to better communicate to policymakers and donors that…: 1. No single policy suffices – it’s not just one ‘thing’

2. Multiple burdens (undernutrition, obesity, VMDs) 3. Post-2015 SDGs – ‘new’ metrics proposed

4. Which metrics can agriculture affect specifically?

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World Health Assembly’s endorsement (in 2012) Comprehensive Implementation Plan on Maternal,

Infant and Young Child Nutrition

To be achieved by 2025: 40% reduction in child stunting (against 2010 baseline) 50% reduction in anaemia in adult women 30% reduction in low birth weight (LBW) 0% increase in childhood overweight >50% target for exclusive breastfeeding (EFB 6 months) < 5% prevalence of child wasting.

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The problem…. Eradicate extreme poverty and hunger Where do we stand? 1.2 billion still live in extreme poverty, even though poverty rates have been halved between 1990 and 2010 and the MDG target has been met.

http://www.undp.org/content/undp/en/home/mdgoverview/mdg_goals/mdg1/

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4. ICN2 (2010 – 2025) “create consensus on how to achieve the global

nutrition targets by 2025 set by the World Health Assembly.”

1. MDG 1 (1990-2015) - child underweight (<2 SD of weight-for-age)

3. Draft SDGs (OPW June 2014): 2015-2030 “By 2030 end all forms of malnutrition, including targets on stunting, wasting and anemia.”

2. World Health Assembly (2010-2025): Stunting, wasting, anemia, LBW, EBF, obesity

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𝐻𝐷𝐼 = [(𝑥𝑖

3

𝑖=1

− 𝑚𝑖𝑛𝑖)/(𝑚𝑎𝑥𝑖 − 𝑚𝑖𝑛𝑖)] × 1/3

The HDI ranks countries based on 3 dimensions: a) life expectancy at birth; b) achievements in education; c) GDP per capita

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Indicator Max Min

Stunting 58 4

Anaemia 67 9

Low Birth Weight 32 3

Overweight 26 1

Exclusive Breastfeeding 85 1

Wasting 20 1

Net State of Nutrition Index (NeSNI) goalposts

Data sources: WHO and UNICEF databases

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8

Rank Country NeSNI

Stunting

(%)

Anaemia

(%)

LBW

(%)

Obesity

(%)

EBF

(%)

Wasting

(%)

1 Uruguay 4.8 15 16.9 9 9 65 2

2 Colombia 4.8 13 23.6 6 5 43 1

3 Mongolia 4.7 16 13.6 5 14 59 2

4 China 4.7 10 19.9 3 7 28 2

5 Brazil 4.7 7 23.1 8 7 41 2

6 Nicaragua 4.6 22 9.0 9 6 31 1

7 Tuvalu 4.6 10 26.3 6 6 35 3

8 Moldova 4.5 10 23.4 6 9 46 5

9 Costa Rica 4.5 6 18.9 7 8 15 1

10 Belarus 4.5 4 19.4 4 10 9 2

Net State of Nutrition Index (NeSNI)

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9 Source: Black et al. (2013) Lancet series II Source: Black et al. (2013) Lancet series II

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Rank Country NeSNI

Stunting

(%)

Anaemia

(%)

LBW

(%)

Obesity

(%)

EBF

(%)

Wasting

(%)

1 Uruguay 4.8 15 16.9 9 9 65 2

2 Colombia 4.8 13 23.6 6 5 43 1

3 Mongolia 4.7 16 13.6 5 14 59 2

4 China 4.7 10 19.9 3 7 28 2

5 Brazil 4.7 7 23.1 8 7 41 2

6 Nicaragua 4.6 22 9.0 9 6 31 1

7 Tuvalu 4.6 10 26.3 6 6 35 3

8 Moldova 4.5 10 23.4 6 9 46 5

9 Costa Rica 4.5 6 18.9 7 8 15 1

10 Belarus 4.5 4 19.4 4 10 9 2

Net State of Nutrition Index (NeSNI)

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35 Rwanda 3.9 44 59.4 7 7 85 3

36 Morocco 3.9 15 32.6 15 11 31 2

37 Burundi 3.9 58 28.0 11 3 69 6

38 Zambia 3.8 45 29.1 11 8 61 5

39 PNG 3.8 43 43.1 11 3 56 5

40 Algeria 3.7 15 31.4 6 13 7 4

41 Ghana 3.7 28 43.1 13 6 63 9

42 Sao Tome 3.7 29 26.2 8 12 51 11

Rank Country NeSNI

Stunting

(%)

Anaemia

(%)

LBW

(%)

Obesity

(%)

EBF

(%)

Wasting

(%)

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Rank Country NeSNI

Stunting

(%)

Anaemia

(%)

LBW

(%)

Obesity

(%)

EBF

(%)

Wasting

(%)

79 Haiti 2.9 29 54.4 25 4 41 10

80 Djibouti 2.8 31 46.4 10 10 1 10

81 Timor-Leste 2.8 58 31.5 12 6 52 19

82 Benin 2.7 43 63.2 15 11 43 8

83 Sierra Leone 2.6 44 62.9 11 10 32 9

84 Pakistan 2.4 44 27.9 32 6 37 15

85 Chad 2.2 39 52.4 20 3 3 16

86 Nigeria 2.1 41 62.0 12 11 13 14

87 India 2.1 48 52.0 28 2 46 20

88 Niger 2.0 51 62.2 27 4 27 12

89 Yemen 1.5 58 51.0 32 5 12 15

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Value of NeSNI

1. Helps clarify “the complexity” to policymakers: think through how policy instruments affect different aspects of nutrition

2. Allows us to track ‘net’ progress towards multiple targets simultaneously

3. Forces attention to life-course issues (not only 1,000 days)

4. Makes clear the disconnect between high GDP and nutrition.

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Where does agriculture ‘fit’ here?

Scale – markets and income versus home gardens Location – where stunting high, not always optimal for ag. Timing – impacts of ag investment on <2s mediated

through mothers’ status, empowerment, etc. Duration - ag. programs take 3-5 years to scale up. Seasonality – timing of birth/cycle of production Nutrient cycles - soil nutrient deficiencies – human VMDs Shocks – timing of droughts/floods , blight/diseases

W

S

A

LBW

EBF O

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W S

EBF

O

A

LBW

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Conclusions

1. We need new ways to communicate: a) the multifaceted nature of nutrition, and b) the multi-policy approach for solutions

3. We need to focus relatively more on ‘diet quality’ at the heart of the food environment/systems - not easily captured by NeSNI

2. NeSNI allows for more nuanced dialogue on policy-to-nutrition impacts which can be visualized in various ways.


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