Where are the Political and Social Solutions to Undernutrition?
A report in the medical journal The Lancet last week argued that undernutrition is responsible for approximately 45 percent of all under-five child deaths around the world. Some 3.1 million children die each year from undernutrition; half from wasting or severe acute undernutrition, and the other half from other causes to which undernutrition contributed. Undernutrition is, in other words, is the single-greatest threat to child survival.
In conjunction with The Lancet’s publication, the British and Brazilian governments are co-hosting a conference this weekend to address the undernutrition crisis. Dubbed “Nutrition for Growth,” the conference will “bring together business leaders, scientists, governments and civil society to make the ambitious financial and political commitments needed to reach millions more pregnant women and infants with the right nutrition at the right time, and reduce cases of stunting and deaths from severe acute malnutrition.” The conference follows on a similar summit held last summer in London.
The Nutrition for Growth conference background paper outlines the reasons why addressing undernutrition should be framed not just as a moral or normative issue, but as a pragmatic one as well. Undernutrition increases the susceptibility to infection and disease, and thus the overall cost of health care. Undernutrition in the first two years of life has a lifelong impact, slowing mental and physical development. It also undermines economic performance and depresses gross domestic product.
The background paper goes on to outline a threefold need for public action to address undernutrition. First, it argues in favor of “scaling up proven nutrition interventions.” These interventions have a median benefits to costs ratio of approximately 20:1 (compared to a BCR of 11:1 to irrigation, 3:1 for water and sanitation, and 11:1 for road infrastructure). Thus, they contend there is a real economic argument in support of addressing undernutrition. Second, they argue that any intervention strategies must address the underlying causes of undernutrition, including agricultural production, social welfare, education, women’s empowerment, and access to water and sanitation. Finally, they contend that an “enabling environment to advocate for and support these interventions and to hold various actors accountable for their quality of their nutrition relevant actions” is also necessary.
Interestingly, the Nutrition for Growth conference’s subtitle is “Beating Hunger through Business and Science.” This gives me pause. While it’s certainly important to see high level figures from the governmental and business worlds, from the Vice President of Guatemala, the Minister of Defense and former Prime Minister of Namibia to Bill Gates, drawing attention to the problem of undernutrition, it’s also problematic that the solutions being advanced focus rather narrowly on the productive side of the equation. We know that undernutrition results not from the lack of availability of food but from the inability of individuals to access the food that is produced. Intervention strategies that focus on the technical side of the question—such as biofortified foods—are unlikely to successfully address this challenge alone. While they may be a part of the equation, a long-term strategy for addressing undernutrition needs to begin by addressing the problems of poverty and inequality that are at the root of undernutrition in the first place.
To be clear, it’s not that I think that biofortification is necessarily a bad idea. But I think we are misleading ourselves if we think that just getting the technology right will do much to successfully reduce the level of undernutrition around the world. The same people who cannot afford to purchase or produce a sufficiently diverse diet now are unlikely to be able to purchase a sufficiently diverse diet of biofortified foods instead. The solution to undernutrition is economic and (especially) social development, not a magic bullet of golden rice.